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：涉及司法的退伍军人（即被刑事司法系统拘留或监督的退伍军人）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）。对于经常有复杂的精神健康和身体健康需求的伊拉克和阿富汗退伍军人来说尤其如此。此外，伊拉克和阿富汗退伍军人在人口结构上与退伍军人健康管理局 (VHA) 服务的其他战争群体有所不同：许多人更年轻，而且许多是女性。在伊拉克和阿富汗服役的参与正义的退伍军人（以下称为 OJIV）将有可能成为明天的长期 VHA 患者。迫切需要制定干预措施，改善他们对 MH/SUD 服务的进入和参与，以满足他们的 MH 护理需求，并打破无家可归和犯罪累犯的循环。目标：本研究旨在通过以下方式提高 VHA 护理的利用率：(1) 确定需要此类护理的 OJIV 进入和参与 VHA MH/SUD 护理的预测因素，(2) 评估 OJIV 与 VHA MH/SUD 护理相关的经验，以及 (3) 制定并试点测试干预措施，以增加 OJIV 中 VHA MH/SUD 护理的进入/参与度。方法：基于安徒生的行为模型和生命历程理论，当前提案将使用定量和定性方法来制定干预措施，以改善 OJIV 中 VHA MH/SUD 护理的进入/参与度。第一项研究将利用 VHA 管理数据库和现有调查数据来确定进入/参与 VHA MH/SUD 护理的交付系统（目标 1.1）和患者层面（目标 1.2）预测因素。定量结果将为目标 2 提供信息，目标 2 将评估 OJIV 与司法系统的 VHA MH/SUD 护理相关的经验。对关键知情人（包括 VHA 领导层、VHA 提供者、司法系统代表和社区团体）的半结构化访谈将有助于描述 OJIV 所经历的进入/参与障碍（目标 2.1）。将挑选关键知情人组成咨询委员会，以验证结果并指导干预措施的制定。此外，对 OJIV 的叙述性和半结构化访谈将用于确定进入和参与 VHA MH/SUD 护理的障碍/促进因素（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测试目标 3 中的干预措施，以支持 OJIV 改善其进入/参与 VHA MH/SUD 护理。在使用 OJIV 进行试点测试（目标 3.2）之前，将通过焦点小组（目标 3.1）征求以患者为中心的反馈。职业发展：研究活动以及与运营合作伙伴的合作以及利用导师专业知识的培训活动将为 PI 的长期研究和职业目标提供坚实的基础。 （1）内容：参与正义的退伍军人（导师：Smelson；顾问：Binswanger）；心理健康服务（导师：Frayne、Timko、Smelson）；女性健康（导师：Frayne）。 （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 发展成为一名独立资助的 VA 卫生服务研究人员，拥有进行定量和定性评估的专业知识，以及为 VHA 服务的退伍军人和其他弱势群体（例如无家可归的退伍军人）制定和实施干预措施。