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

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人）是一个高度脆弱的群体，有多种健康需求（例如，精神健康[MH]，物质使用障碍[SUD]），以及刑事司法累犯和无家可归的风险）。这可能是特别真实的伊拉克和阿富汗退伍军人谁往往有复杂的MH和身体健康的需求。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健康管理局（VHA）服务的其他战争群体不同：许多人更年轻，许多人是女性。在伊拉克和阿富汗服役的正义退伍军人（以下简称OJIV）将可能成为明天的长期VHA患者。迫切需要制定干预措施，改善他们进入和参与MH/SUD服务，以满足他们的MH护理需求，打破无家可归和犯罪累犯的循环。目的：本研究旨在通过以下方式提高VHA护理的利用率：（1）确定有此类护理需求的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）开发和试点测试干预措施，以增加OJIV进入/参与VHA MH/SUD护理。研究方法：根据Andersen的行为模型和生命过程理论，目前的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。第一项研究将利用VHA管理数据库和现有调查数据，以确定进入/参与VHA MH/SUD护理的输送系统（目标1.1）和患者水平（目标1.2）预测因素。量化结果将为目标2提供信息，该目标将评估OJIV与司法系统的VHA MH/SUD护理相关的经验。对关键信息提供者（包括VHA领导层、VHA提供者、司法系统代表和社区团体）进行半结构化访谈，将有助于描述OJIV遇到的进入/参与障碍（目标2.1）。将挑选一些关键的信息提供者组成一个咨询委员会，以验证结果并指导干预措施的制定。此外，将使用对OJIV的叙述性和半结构化访谈来确定进入和参与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：研究活动伴随着与业务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)内容有：参与司法的退伍军人（导师：Smelson;顾问：Binswanger）;心理健康服务（导师：Frayne、Timko、Smelson）;妇女健康（导师：Frayne）。(2)研究方法：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作为独立资助的VA卫生服务研究员的发展，该研究员具有进行定量和定性评估以及为涉及司法的退伍军人和其他弱势群体（如无家可归的退伍军人）制定和实施干预措施的专业知识，由VHA服务。

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.