Medical-legal partnerships to prevent evictions and homelessness among veterans

医疗法律合作防止退伍军人被驱逐和无家可归

• 批准号: 10709560
• 负责人: Marc I Rosen
• 金额: --
• 依托单位: VA CONNECTICUT HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-11-01 至 2025-10-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10709560
• 关键词: Address; Attention; Caring; Communities; Community Integration; Complement; Complex; Connecticut; Control Groups; Country; Criminal Justice; Data; Disputes; Enrollment; Face; Fostering; Foundations; Funding; Goals; Health; Healthcare; Healthcare Systems; Homelessness; Housing; Impairment; Income; Intervention; Interview; Investments; Leadership; Legal; Legal Intervention; Legal Status; Legal system; Low income; Measures; Mediation; Mediator; Medical; Medical Assistance; Medical Care Team; Medical center; Mental Health; Mental Health Services; Mental disorders; Methods; Modeling; Movement; Observational Study; Outcome; Participant; Patient-Centered Care; Positioning Attribute; Provider; Quality of life; Randomized; Randomized, Controlled Trials; Recovery; Rehabilitation therapy; Reporting; Research; Research Design; Risk; Services; Severities; Site; Surveys; Symptoms; Testing; Time; Uncontrolled Study; Veterans; Work; court; effective intervention; effectiveness evaluation; empowerment; experience; follow-up; health care delivery; health service use; improved; innovation; integrated care; interest; multidisciplinary; patient population; payment; prevent; primary outcome; psychosocial; psychotic symptoms; randomized trial; response; secondary analysis; secondary outcome; social health determinants; social integration; symptomatology; treatment group; treatment response

Background: Medical-legal partnerships (MLPs) represent an innovative intervention that integrates legal providers into healthcare teams to address complex problems and support the rehabilitation of vulnerable patient populations. In the MLP intervention, community legal providers partner with VA facilities to provide legal assistance to homeless and at-risk veterans. MLP staff can help veterans by negotiating with landlords, setting up alternative payment plans, and representing them in eviction court which may ultimately improve Veterans’ social integration and quality of life. Our group completed a 2-year uncontrolled study of VA MLPs and found that veterans showed significant improvements in housing, income, and mental health after receiving MLP services. A more rigorous research design is proposed as a next step in evaluating VA MLPs and their effect on the rehabilitation of veterans. Objectives: This project has two major aims: 1) evaluate the impact of MLP on housing outcomes (primary) and mental health outcomes (secondary); and 2) examine the veteran experience with seeking and receiving assistance from MLP and outside legal providers. Methods: For Aim 1, a randomized controlled trial of the MLP intervention for Veterans with housing-related issues (i.e., rent-based evictions, rule violations, landlord-tenant disputes) will be conducted. The study site will be the VA Connecticut Healthcare System, where the MLP intervention will be provided in partnership with the Connecticut Veterans Legal Center. A total of 300 homeless and at-risk veterans will be randomly assigned to either the MLP intervention or referral to an outside legal provider. Veterans in both groups will be assessed at baseline, 3, 6, and 12 months on housing, mental health, and various psychosocial measures. The primary outcome will be housing status and a secondary outcome will be mental health. Exploratory analyses will be conducted on outcomes such as financial status, legal status, social integration and citizenship, and quality of life. For Aim 2, a total of 30 veterans participating in the randomized controlled trial (15 participants each from the treatment and control groups) will be interviewed to collect qualitative data on their experiences receiving the MLP intervention or outside legal services. Significance: The VA is committed to preventing and ending veteran homelessness. While considerable efforts have been made to house veterans, services are needed to help them sustain housing and community integration. Numerous reports and surveys indicate that legal assistance for civil legal problems is a major unmet need among homeless and at-risk veterans. VA MLPs offer an opportunity to help veterans address housing-related issues, which could prevent homelessness and assist their rehabilitation. The MLP intervention is consistent with the VA’s comprehensive continuum of rehabilitative services for veterans and the movement towards multidisciplinary, integrated care to address social determinants of health. This project will provide needed data on VA MLPs and help inform decisions about the expansion of MLPs across the country for homeless and at-risk veterans.

背景：医疗-法律伙伴关系(MLP)代表了一种创新的干预措施，它整合了法律 将医疗服务提供者纳入医疗团队，以解决复杂问题并支持弱势群体的康复 患者群体。在MLP干预中，社区法律提供者与退伍军人管理局合作提供 为无家可归和面临风险的退伍军人提供法律援助。MLP工作人员可以通过与房东谈判来帮助退伍军人， 制定替代付款计划，并在驱逐法庭上代表他们，最终可能会有所改善 退伍军人的社会融合和生活质量。我们小组完成了一项为期两年的VA MLP的非对照研究 研究发现，退伍军人在退伍军人的住房、收入和心理健康方面都有显著的改善 正在接收MLP服务。作为评估退伍军人事务部MLP的下一步，建议进行更严格的研究设计 以及它们对退伍军人康复的影响。 目标：本项目有两个主要目标：1)评估MLP对住房结果的影响(主要) 和心理健康结果(次要)；以及2)检查退伍军人在寻求和接受方面的经验 来自MLP和外部法律提供者的帮助。 方法：对于AIM 1，MLP干预退伍军人住房相关的随机对照试验 将处理各种问题(即，基于租金的驱逐、违反规则、房东与租户之间的纠纷)。研究地点将 是退伍军人事务部康涅狄格州医疗保健系统，其中MLP干预将与 康涅狄格州退伍军人法律中心。总共300名无家可归和面临风险的退伍军人将被随机分配到 要么是MLP介入，要么是转介给外部法律提供者。两组的退伍军人都将在 基线、3个月、6个月和12个月的住房、心理健康和各种心理社会措施。初级阶段 结果将是住房状况，次要结果将是精神健康。探索性分析将是 对财务状况、法律地位、社会融合和公民身份以及 生活。对于目标2，共有30名退伍军人参加随机对照试验(来自 治疗组和对照组)将接受采访，以收集他们接受治疗的经验的定性数据 MLP的干预或外部法律服务。 意义：退伍军人管理局致力于防止和结束退伍军人无家可归现象。虽然相当可观 已经努力为退伍军人提供住房，需要提供服务来帮助他们维持住房和社区 整合。许多报告和调查表明，为民事法律问题提供法律援助是一项重要的 无家可归和面临风险的退伍军人中未得到满足的需求。退伍军人管理局MLP提供了一个机会来帮助退伍军人解决 与住房有关的问题，这可以防止无家可归者，并帮助他们康复。MLP干预 符合退伍军人管理局为退伍军人和运动提供的全面康复服务 走向多学科、综合护理，以解决健康的社会决定因素。该项目将提供 需要关于退伍军人管理局MLP的数据，并帮助为在全国范围内扩大MLP的决策提供信息 无家可归和处于危险之中的退伍军人。