Evaluating Health Services for Justice-Involved Veterans to Improve Policy and Practice

评估参与司法的退伍军人的健康服务，以改进政策和实践

• 批准号: 10595495
• 负责人: Andrea K Finlay
• 金额: --
• 依托单位: VETERANS ADMIN PALO ALTO HEALTH CARE SYS
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-01 至 2025-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10595495
• 关键词: Address; Behavioral Model; Caring; Case Management; Characteristics; Communities; Complex; Criminal Justice; Crisis Intervention; Data; Disease; Effectiveness; Goals; Health; Health Services; Health Services Administration; Healthcare; Homelessness; Housing; Imprisonment; Intervention; Interview; Jail; Justice; Knowledge; Link; Measures; Medical; Mental Health; Mental disorders; Methodology; Methods; Modeling; Monitor; Outcome; Personal Satisfaction; Police; Policies; Population; Predictive Factor; Prisons; Process; Program Evaluation; Research; Research Personnel; Residential Treatment; Resource Allocation; Resources; Risk; Sampling; Services; Specialist; Statutes and Laws; Structure; System; United States Health Resources Administration; Veterans; Veterans Health Administration; Visit; Vulnerable Populations; court; dashboard; health equity; housing instability; improved; improved outcome; innovation; mortality; mortality risk; operation; outreach; parole; pilot test; probation; programs; recruit; research and development; residence; service gap; service programs; stakeholder perspectives; suicidal risk; tool

Background: An estimated 181,500 veterans are incarcerated in prison or jail with thousands more arrested, involved in courts, or on probation or parole each year. These “justice-involved Veterans” have extensive medical and mental health disorders, housing instability, and an elevated risk for suicide and other mortality. Since 2007, the Veterans Health Administration (VHA) has operated the Veterans Justice Programs (VJP) to provide outreach, assessment, and case management for justice-involved Veterans in local courts, jails, and prisons, and to liaise with criminal justice partners. In fiscal year 2018, VJP provided services to 80,653 Veterans. Research on the link between VJP services and Veteran outcomes is hindered by a lack of systematic methods to assess VJP structures, processes and outcomes. VJP and Veteran-focused criminal justice initiatives continue to implement new features without the tools needed to measure, describe, and evaluate their components. To inform program planning and resource allocation, it is essential to know which structures and processes are linked to better outcomes for justice-involved Veterans. This explanatory sequential mixed methods study will develop a VJP program evaluation dashboard to determine gaps in VJP and VHA services for justice-involved Veterans. By using this dashboard, VJP leaders can develop policies and practices to improve healthcare, housing and mortality outcomes among justice-involved Veterans. Significance/Impact: Given the elevated risk mental health disorders, homelessness, and mortality for justice- involved Veterans, it is imperative that VHA provides services to address the needs of this population. This study responds to VA priorities to deliver effective and efficient care to Veterans, Veterans Treatment Court legislation, the Office of Research & Development priority to increase real-world impact of research, HSR&D priorities of mental health treatment and health equity, and the VJP priority to maximize successful outcomes among justice-involved Veterans. Innovation: VJP is at the forefront of partnering with non-VHA criminal justice and community agencies to serve justice-involved Veterans. This project breaks new ground by examining the full continuum of VJP/non- VHA partnerships and drawing lessons that can be applied to Veterans who receive services outside VHA. Specific Aims: The three aims are scientifically important and reflect extensive input from justice-involved Veterans and VJP leaders and staff: (1) Identify Veteran, VJP, VHA facility, and criminal justice factors that predict healthcare, housing and homeless services, and mortality outcomes for justice-involved Veterans; (2) Qualitatively evaluate Veterans’ and other key stakeholders’ perspectives of factors that explain successful healthcare, housing, and mortality outcomes among justice-involved Veterans; and (3) Develop a program evaluation dashboard of VJP services, VHA resources, and criminal justice factors that impact justice-involved Veteran outcomes. Methodology: The current study is guided by Behavioral Model for Vulnerable Populations. In Aim 1, we will conduct multi-level regression models with a random effect for facility, to examine Veterans, VJP, VHA facility, and criminal justice factors associated with successful outcomes among justice-involved Veterans (n=80,653 in FY18). For Aim 2, we will conduct qualitative interview with 32 justice-involved Veterans and 48 VHA and criminal justice staff at 8 VHA facilities and partner agencies (n=80). Aim 3 will be to develop and pilot-test (n=14) a program evaluation dashboard to identify service gaps and inform policy and practice. Implementation/Next Steps: Results will be of immediate value to VJP, the National Center on Homelessness Among Veterans, and VHA to prioritize and tailor health services to justice-involved Veterans to maximize benefit and used to develop interventions to improve the health and healthcare of justice-involved Veterans that will be evaluated in a subsequent IIR.

背景：估计有 181,500 名退伍军人被关押在监狱或监狱中，另有数千人被捕， 每年都涉及法庭、缓刑或假释。这些“参与正义的退伍军人”拥有广泛的 医疗和精神健康障碍、住房不稳定以及自杀和其他死亡风险升高。 自 2007 年以来，退伍军人健康管理局 (VHA) 实施了退伍军人司法计划 (VJP)，以 为地方法院、监狱和监狱中参与司法的退伍军人提供外展、评估和案件管理 监狱，并与刑事司法合作伙伴联络。 2018 财年，VJP 为 80,653 人提供了服务 退伍军人。对 VJP 服务与退伍军人结果之间联系的研究因缺乏 评估 VJP 结构、流程和结果的系统方法。 VJP 和退伍军人犯罪分子 司法举措继续实施新功能，但没有衡量、描述和评估所需的工具 评估它们的组成部分。为了为计划规划和资源分配提供信息，必须了解哪些 结构和流程与参与正义的退伍军人获得更好的结果息息相关。这个解释 序贯混合方法研究将开发 VJP 计划评估仪表板，以确定 VJP 的差距 为参与正义的退伍军人提供 VHA 服务。通过使用此仪表板，VJP 领导人可以制定政策 改善参与司法的退伍军人的医疗保健、住房和死亡率结果的实践。 意义/影响：鉴于精神健康障碍、无家可归和正义死亡率的风险升高—— 由于涉及退伍军人，VHA 必须提供服务来满足该人群的需求。这 研究响应退伍军人管理局的优先事项，为退伍军人、退伍军人治疗法庭提供有效和高效的护理 立法、研究与发展办公室优先考虑增加研究、HSR&D 的现实世界影响 心理健康治疗和健康公平的优先事项，以及 VJP 最大限度地提高成功结果的优先事项 在参与正义的退伍军人中。 创新：VJP 处于与非 VHA 刑事司法和社区机构合作的最前沿， 为参与正义的退伍军人服务。该项目通过检查 VJP/non-的完整连续体开辟了新天地 VHA 合作并汲取经验教训，适用于在 VHA 之外接受服务的退伍军人。 具体目标：这三个目标具有重要的科学意义，反映了司法相关领域的广泛投入 退伍军人和 VJP 领导人和工作人员：(1) 确定退伍军人、VJP、VHA 设施和刑事司法因素 预测参与司法的退伍军人的医疗保健、住房和无家可归者服务以及死亡率结果； (2) 定性评估退伍军人和其他主要利益相关者对成功因素的看法 参与司法的退伍军人的医疗保健、住房和死亡率结果； (3) 制定计划 VJP 服务、VHA 资源以及影响司法参与的刑事司法因素的评估仪表板 老兵的成果。 方法：当前的研究以弱势群体行为模型为指导。在目标 1 中，我们将 对设施进行具有随机效应的多级回归模型，以检查退伍军人、VJP、VHA 设施、 与参与司法的退伍军人的成功结果相关的刑事司法因素（n = 80,653 2018 财年）。对于目标 2，我们将对 32 名参与正义的退伍军人和 48 名 VHA 和 8 个 VHA 设施和合作机构的刑事司法工作人员 (n=80)。目标 3 将是开发和试点测试 (n=14) 一个项目评估仪表板，用于识别服务差距并为政策和实践提供信息。 实施/后续步骤：结果将对 VJP（国家中心）具有直接价值 退伍军人无家可归问题和 VHA 优先考虑并为参与司法的退伍军人量身定制医疗服务， 利益最大化并用于制定干预措施以改善司法相关人员的健康和医疗保健 将在随后的 IIR 中评估的退伍军人。