Justice-Involved Veterans: Mental Health and Substance Use Care of Young Adults

参与正义的退伍军人：年轻人的心理健康和药物使用护理

• 批准号: 8782116
• 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: 2014
• 资助国家: 美国
• 起止时间: 2014-08-01 至 2019-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8782116
• 关键词: Address; Address; Afghanistan; Afghanistan; Alcohol or Other Drugs use; Alcohol or Other Drugs use; Behavioral Model; Behavioral Model; Caring; Caring; Characteristics; Characteristics; Collaborations; Collaborations; Communities; Communities; Complex; Complex; Criminal Justice; Criminal Justice; Data; Data; Databases; Databases; Development; Development; Diagnosis; Diagnosis; Disease; Disease; Early Intervention; Early Intervention; Effectiveness of Interventions; Effectiveness of Interventions; Evaluation; Evaluation; Feedback; Feedback; Focus Groups; Focus Groups; Fostering; Fostering; Foundations; Foundations; Funding; Funding; Future; Future; Gender; Gender; Goals; Goals; Health; Health; Health Services; Health Services; Health Services Administration; Health Services Administration; Healthcare; Healthcare; Homelessness; Homelessness; Impairment; Impairment; Imprisonment; Imprisonment; Individual; Individual; Intervention; Intervention; Interview; Interview; Iraq; Iraq; Jail; Jail; Justice; Justice; Leadership; Leadership; Life; Life Cycle Stages; Life Cycle Stages; Mental Health; Mental Health; Mental Health Services; Mental Health Services; Mentors; Mentors; Mentorship; Mentorship; Methods; Methods; Outcome; Outcome; Patients; Patients; Population; Population; Prisons; Prisons; Provider; Provider; Qualitative Evaluations; Qualitative Evaluations; Qualitative Methods; Qualitative Methods; Qualitative Research; Qualitative Research; Quantitative Evaluations; Quantitative Evaluations; Randomized Controlled Trials; Randomized Controlled Trials; Research; Research; Research Activity; Research Activity; Research Personnel; Research Personnel; Research Training; Research Training; Resources; Resources; Risk; Risk; Sampling; Sampling; Services; Services; Site; Site; Solid; Solid; Structure; Structure; Substance Use Disorder; Substance Use Disorder; Supervision; Supervision; Surveys; Surveys; Symptoms; Symptoms; System; System; Testing; Testing; Training; Training; Training Activity; Training Activity; Trauma; Trauma; Unemployment; Unemployment; Veterans; Veterans; Visit; Visit; Vulnerable Populations; Vulnerable Populations; War; War; Woman; Woman; Women' s Health; Women' s Health; Women' s Health Services; Women' s Health Services; Work; Work; administrative database; administrative database; adverse outcome; adverse outcome; base; base; care delivery; care delivery; career; career; career development; career development; cohort; cohort; design; design; disorder risk; disorder risk; experience; experience; health administration; health administration; high risk; high risk; high risk population; improved; improved; informant; informant; men; men; operation; operation; patient oriented; patient oriented; physical conditioning; physical conditioning; programs; programs; recidivism; recidivism; research and development; severe mental illness; severe mental illness; skills; skills; social; social; theories; theories; therapy development; therapy development; treatment services; young adult; young adult

DESCRIPTION (provided by applicant): Background: Justice-involved Veterans (i.e., those detained by or under the supervision of the criminal justice system) are a highly vulnerable population with multiple health needs (e.g., mental health [MH], substance use disorders [SUD]), and risk for criminal justice recidivism and homelessness). This may be especially true for Iraq and Afghanistan Veterans who often have complex MH and physical health needs. Moreover, Iraq and Afghanistan Veterans demographically differ from other war cohorts served at the Veterans Health Administration (VHA): many are younger, and many are women. Justice-involved Veterans who served in Iraq and Afghanistan (hereafter called OJIVs) will potentially be tomorrow's long-term VHA patients. There is an urgent need to develop interventions that improve their entry to and engagement in MH/SUD services, so as to address their MH care needs and to break the cycle of homelessness and criminal recidivism. Objectives: This research aims to improve utilization of VHA care by: (1) Identifying predictors of entry to and engagement in VHA MH/SUD care among OJIVs with a need for such care, (2) Evaluate OJIVs' experiences connecting to VHA MH/SUD care, and (3) Develop and pilot-test an intervention to increase entry to/engagement in VHA MH/SUD care among OJIVs. Methods: Based on Andersen's Behavioral Model and Life Course Theory, the current proposal will use quantitative and qualitative methods to inform the development of an intervention to improve entry to/engagement in VHA MH/SUD care among OJIVs. The first study will utilize VHA administrative databases and existing survey data to identify delivery system (Objective 1.1) and patient-level (Objective 1.2) predictors of entry to/engagement in VHA MH/SUD care. The quantitative findings will inform Objective 2 which will evaluate OJIVs experiences connecting to VHA MH/SUD care from the justice system. Semi-structured interviews with key informants, including VHA leadership, VHA providers, justice system representatives, and community groups will help characterize entry/engagement barriers experienced by OJIVs (Objective 2.1). Select key informants will be tapped to form an Advisory Board to validate results and guide intervention development. Additionally, narrative and semi-structured interviews with OJIVs will be used to identify barriers to/facilitators of entry to and engagement in VHA MH/SUD care (Objective 2.2). Results from the quantitative (Objective 1) and qualitative (Objective 2) studies will be used to develop and pilot-test an intervention in Objective 3 to support OJIVs in improving their entry to/engagement in VHA MH/SUD care. Patient-centered feedback will be solicited through focus groups (Objective 3.1) before pilot-testing with OJIVs (Objective 3.2). Career Development: Research activities accompanied by collaborations with operational partners and training activities that capitalize on mentors' expertise will provide a solid foundation for the PI's long-term research and career goals. (1) Content: Justice-involved Veterans (Mentor: Smelson; Consultant: Binswanger); Mental Health Services (Mentors: Frayne, Timko, Smelson); Women's Health (Mentor: Frayne). (2) Methods: VHA Databases (Mentors: Frayne, Asch); Quantitative Methods (Consultant: Sox-Harris); Qualitative Research (Consultant: Koenig); Intervention/Implementation (Mentors: Timko, Asch). The outlined research and training plan will promote the PI's development as an independently-funded VA health services researcher with expertise in conducting quantitative and qualitative evaluations and developing and implementing interventions for justice-involved Veterans and other vulnerable populations, such as homeless Veterans, served by VHA.

描述（由申请人提供）： 背景：涉及正义的退伍军人（即，由刑事司法系统的监督或在刑事司法系统的监督下拘留的人）是一个高度脆弱的人群，具有多种健康需求（例如，心理健康[MH]，药物使用障碍[SUD]），以及刑事司法累犯和无家可归的风险）。对于经常有复杂的MH和身体健康需求的伊拉克和阿富汗退伍军人而言，这尤其如此。此外，伊拉克和阿富汗退伍军人在人口统计学上与退伍军人卫生管理局（VHA）服务的其他战争队列不同：许多年轻，许多是妇女。在伊拉克和阿富汗服役的司法老兵（以下称为Ojivs）可能是明天的长期VHA患者。迫切需要制定干预措施，以改善其参与和参与MH/SUD服务，以满足他们的MH护理需求，并打破无家可归和犯罪犯罪行为的循环。目的：这项研究旨在通过以下方式提高对VHA护理的利用：（1）确定需要这种护理的OJIV的进入和参与VHA MH/SUD护理的预测因素，（2）评估OJIVS与VHA MH/SUD CARE连接的经验，以及（3）在/（3）中，（3）在/（3）增加和驾驶员在/参与vha MH中/参与vha MH中/参与/参与。方法：基于安德森的行为模型和生命课程理论，当前的提案将使用定量和定性方法来告知干预措施的开发，以改善/参与OJIV中的VHA MH/SUD CARE。第一项研究将利用VHA管理数据库和现有的调查数据来识别输送系统（目标1.1）和患者级别（目标1.2）进入/参与VHA MH/SUD CARE的预测指标。定量发现将为目标2提供信息，该目标将评估与司法系统与VHA MH/SUD护理相关的Ojivs体验。与关键线人的半结构化访谈，包括VHA领导力，VHA提供者，司法系统代表和社区团体，将有助于表征Ojivs经历的进入/参与障碍（目标2.1）。选择关键的线人将被轻拍以组成咨询委员会，以验证结果并指导干预开发。此外，对OJIVS的叙事和半结构化访谈将用于确定进入/促进进入和参与VHA MH/SUD CARE的障碍（目标2.2）。定量（目标1）和定性（目标2）研究的结果将用于开发和试点目标3的干预措施，以支持OJIV改善其参与/参与VHA MH/SUD CARE。以焦点小组（目标3.1）进行试点测试（目标3.2），将通过焦点组（目标3.1）征求患者的反馈（目标3.2）。职业发展：研究活动伴随着与运营伙伴和培训活动的合作，以利用导师的专业知识，将为PI的长期研究和职业目标提供坚实的基础。 （1）内容：涉及正义的退伍军人（导师：Smelson；顾问：Binswanger）；心理卫生服务（导师：弗雷恩，蒂姆科，斯梅尔森）；妇女健康（导师：弗雷恩）。 （2）方法：VHA数据库（导师：Frayne，Asch）；定量方法（顾问：Sox-Harris）；定性研究（顾问：Koenig）；干预/实施（导师：Timko，Asch）。概述的研究和培训计划将促进PI的发展发展，作为一名由独立资助的VA卫生服务研究人员，在进行定量和定性评估方面具有专业知识，并为官方涉及的退伍军人和其他易受伤害人群（例如无家可归的退伍军人）提供了干预措施。