Improving Treatment Engagement and Outcomes among Justice-involved Veterans

 描述（由申请人提供）： 每年大约有146，000名退伍军人从惩教机构获释;然而，三分之二的人可能会再次犯罪并返回司法系统。反社会认知和行为是再次犯罪的最强预测因子，在涉及司法的退伍军人（JIV）中非常普遍。然而，在缺乏与JIV证明有效的治疗，没有系统的方法来解决反社会的认知和行为已实施VA。道德重建疗法（Moral Reconation Therapy，MRT）是一种认知行为干预，旨在减少反社会认知和行为。MRT在降低平民罪犯的刑事累犯风险方面有最好的经验支持，其相关机制（人际功能和冲动控制的改善）与健康相关结果的改善有关，这些结果也是累犯的风险因素（物质使用，心理健康，住房和就业问题）。然而，没有对联合投资车辆进行过试验。联合调查组与涉及司法的平民之间的区别（例如，创伤性脑损伤的患病率;人际关系问题）表明，先前对平民进行MRT的研究可能无法推广，并促使VA的退伍军人司法计划（VJP）和MRT的开发人员开发了一个针对退伍军人的干预课程。测试这个新的捷运退伍军人手册是VJP的首要任务。使用新的退伍军人专用手册，当前提案的总体目标是实施和评估MRT作为一种干预措施，以降低犯罪累犯的风险，并改善VA心理健康住宅康复治疗计划（MH RRT）中JIV的健康相关结果。使用混合1型设计，该项目将在多地点随机对照试验中测试MRT的有效性（帕洛阿尔托、小石城和贝德福德），并进行形成性评估，以促进未来在弗吉尼亚州实施MRT：目标1：在过去12个月里，共有365名退伍军人被收容到MH RRTP，并被逮捕、指控和/或从监禁中释放，将完成基线评估，随机分配至MRT或常规治疗（UC），并在基线后6个月和12个月进行随访。假设：那些在捷运（与UC相比）条件，将（1a）具有较低的刑事再犯的总体风险;（1b）具有更好的健康相关结果（物质使用、心理健康、住房和就业）;及（1c）捷运对降低再犯风险和改善健康的影响-相关结果将部分通过完成MH RRTP和利用物质使用障碍和精神健康持续护理服务的更大可能性来介导。目标二：使用覆盖、有效性、采用、实施和维护（RE-AIM）框架，我们将对每个研究中心的6名提供者和12名患者进行定性访谈，以确定（2a）在VA的MH RRT中实施MRT的障碍和促进因素，以及（2b）是否和/或如何调整MRT，使其对不同的退伍军人亚群（例如，OEF/OIF退伍军人;妇女;种族/少数民族;患有创伤后应激障碍的人）。鉴于弗吉尼亚州还没有系统地实施干预措施，解决反社会的认知和行为，该项目填补了在弗吉尼亚州的JIV护理的巨大差距，因此有显着的潜力，以改善这一弱势群体的长期健康。因此，它得到了VACO运营合作伙伴（VJP和心理健康服务）和三个HSR&D创新中心的大力支持。

 DESCRIPTION (provided by applicant): Approximately 146,000 Veterans are released each year from correctional settings; however, two thirds will likely reoffend and return to the justice system. Antisocial cognitions and behaviors are the strongest predictors of reoffending and are highly prevalent among justice-involved Veterans (JIVs). However, in the absence of treatments with demonstrated effectiveness with JIVs, no systematic approach to address antisocial cognitions and behaviors has been implemented in VA. Moral Reconation Therapy (MRT) is a cognitive-behavioral intervention that aims to reduce antisocial cognitions and behaviors. MRT has the best empirical support for reducing risk for criminal recidivism among civilian offenders, and its associated mechanisms (improvements in interpersonal functioning and impulse control) have been linked to improvements in health-related outcomes that are also risk factors for recidivism (substance use, mental health, housing, and employment problems). However, no trials have been conducted with JIVs. Differences between JIVs and justice-involved civilians (e.g., prevalence of traumatic brain injuries; interpersonal problems) suggests prior research on MRT with civilians may not be generalizable, and prompted the VA's Veterans Justice Programs (VJP) and the developers of MRT to develop a Veteran-specific curriculum of this intervention. Testing this new MRT Veteran manual is a top priority of VJP. Using the new Veteran-specific manual, the overarching objective of the current proposal is to implement and evaluate MRT as an intervention to reduce risk for criminal recidivism and improve health-related outcomes among JIVs in VA Mental Health Residential Rehabilitation Treatment Programs (MH RRTPs). Using a Hybrid Type 1 design, this project will test the effectiveness of MRT in a multisite RCT (Palo Alto, Little Rock, and Bedford) and conduct a formative evaluation to facilitate future implementation of MRT in VA: Aim 1: A total of 365 Veterans who are being admitted to an MH RRTP, and had been arrested and charged and/or released from incarceration in the past 12 months, will complete a baseline assessment, be randomized to MRT or usual care (UC), and followed at 6 and 12 months post-baseline. Hypotheses: Those in the MRT (vs. the UC) condition, will (1a) have a lower overall risk for criminal recidivism; (1b) have better health-related outcomes (substance use, mental health, housing, and employment); and (1c) the effects of MRT on reduced risk for recidivism and better health-related outcomes will be mediated in part by greater likelihood of completing the MH RRTP and utilizing substance use disorder and mental health continuing care services. Aim 2: Using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, we will conduct qualitative interviews with 6 providers and 12 patients at each study site to identify (2a) barriers and facilitators to implementation of MRT in MH RRTPs across VA, and (2b) whether and/or how to adapt MRT to be most effective with diverse subpopulations of Veterans (e.g., OEF/OIF Veterans; women; racial/ethnic minorities; those with PTSD). Given that VA has not systematically implemented interventions that address antisocial cognitions and behaviors, this project fills a substantial gap in care for JIVs in VA, and therefore has significant potential to improve the long-term health of this vulnerable population. Accordingly, it has strong support from VACO operational partners (VJP and Mental Health Services) and three HSR&D Centers of Innovation.