Use of Veterans Health Administration Mental Health and Substance Use Disorder Treatment After Exiting Prison: The Health Care for Reentry Veterans Program

Finlay, Andrea K.; Stimmel, Matthew; Blue‐Howells, Jessica; Rosenthal, Joel; McGuire, Jim; Binswanger, Ingrid A.; Smelson, David A.; Harris, Alex H. S.; Frayne, Susan M.; Bowe, Tom; Timko, Christine

doi:10.1007/s10488-015-0708-z

Cited by 46 publications

(47 citation statements)

References 32 publications

(41 reference statements)

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“…VHA data thus offer a unique opportunity to examine place of intensive community-based mental health services in a 21 st century system of care and the veterans it serves. This study uses national VHA data on 1.3 million veterans who received specialized mental health services from VHA in FY 2012, 240,000 (18%) of whom received often intensive community-based services that can be classi ed in four types: 1) ACT-like intensive case management and recovery-oriented day program services for veterans disabled by serious mental illness (SMI) [31,32] [33]; 2) outreach service to veterans involved in the criminal justice system [34][35][36][37]; 3) outreach and housing services for homeless veterans [38][39][40][41][42], and 4) rehabilitation and community-based employment services [43][44][45]. The primary goal of the criminal justice programs was outreach and linkage to standard VHA outpatient services.…”

Section: Introductionmentioning

confidence: 99%

Social Determinants of Mental Health Care Systems: Intensive Community Based Care in The Veterans Health Administration

Bhalla

Stefanovics

Rosenheck

2020

Preprint

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Background: Since deinstitutionalization in the 1950s-1970s, public mental health care has changed its focus from asylums to general hospitals, outpatient clinics and specialized community-based programs addressing both clinical and social determinants of mental health. Analysis of the place of community-based programs within a comprehensive health system such as the Veterans Health Administration (VHA) may illuminate the role of social forces in shaping contemporary public mental health systems. Methods: National VHA administrative data were used to compare veterans who exclusively received outpatient clinic care to those receiving four types of specialized community-based services, addressing: 1) functional disabilities from severe mental illness (SMI), 2) justice system involvement, 3) homelessness, and 4) vocational rehabilitation. Bivariate comparisons and multinomial logistic regression analyses compared groups on demographics, diagnoses, service use, and psychiatric prescription fills. Results: An hierarchical classification of 1,386,487 Veterans who received specialty mental health services from VHA in Fiscal Year 2012, showed 1,134,977 (81.8%) were seen exclusively in outpatient clinics; 27,931 (2.0 %) received intensive SMI-related services; 42,985 (3.1%) criminal justice services; 160,273 (11.6%) specialized homelessness services; and 20,921 (1.5%) vocational services. Compared to those seen only in clinics, veterans in the four community treatment groups were more likely to be black, diagnosed with HIV and hepatitis, had more numerous substance use diagnoses and made far more extensive use of mental health outpatient and inpatient care. Conclusions: Almost one-fifth of VHA mental health patients receive community-based services prominently addressing major social determinants of health and multimorbid substance use disorders.

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Section: Introductionmentioning

confidence: 99%

Social Determinants of Mental Health Care Systems: Intensive Community Based Care in The Veterans Health Administration

Bhalla

Stefanovics

Rosenheck

2020

Preprint

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“…However, there is a lack of data on the effectiveness and implementation potential of MRT within mental health treatment programs. To fill this gap in the literature, the study described in this protocol paper aims to evaluate the effectiveness and implementation potential of MRT for veterans in mental health residential treatment programs within the US Veterans Health Administration (VHA) – a large, integrated healthcare system which provides mental health and psychosocial services to a substantial number of justice-involved veterans [ 41 – 43 ].…”

Section: Introductionmentioning

confidence: 99%

Study protocol: a hybrid effectiveness-implementation trial of Moral Reconation Therapy in the US Veterans Health Administration

Blonigen

Cucciare

Timko

et al. 2018

BMC Health Serv Res

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BackgroundMoral Reconation Therapy (MRT) is a cognitive-behavioral intervention aimed at reducing risk for criminal recidivism by restructuring antisocial attitudes and cognitions (i.e., “criminogenic thinking”). MRT has empirical support for reducing risk for criminal recidivism among civilian offenders. Recently, a version of MRT was developed for military veterans; however, no randomized controlled trials (RCT) have been conducted with the veteran-specific protocol, and the effectiveness and implementation potential of MRT outside of correctional settings has not been established.MethodsUsing a Hybrid Type 1 RCT design, this study will test the effectiveness of MRT to reduce risk for criminal recidivism and improve health-related outcomes among justice-involved veterans entering mental health residential treatment at three US Veterans Health Administration (VHA) Medical Centers. Upon admission to the treatment program, justice-involved veterans will complete a baseline assessment, be randomized to usual care (UC) or UC + MRT, and be followed 6 and 12 months post-baseline. A process evaluation will also be conducted to identify barriers and facilitators to implementation of MRT in residential treatment.DiscussionThe primary aim of this study is to evaluate the effectiveness of MRT with justice-involved veterans. If MRT proves effective in this trial, the findings can provide large healthcare systems that serve veterans with an evidence-based intervention for addressing criminogenic thinking among justice-involved adults, as well as guidance on how to facilitate future implementation of MRT in non-correctional settings.Trial registrationThis trial is funded by the VA Health Services Research & Development Program (IIR 14–081) and is registered with ClinicalTrials.gov (ID: NCT02524171).

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“…In fiscal year 2009, there were 331,623 veterans diagnosed with alcohol use disorder (Harris et al, 2012), representing 6% of those served in VA facilities. AUD is even more prevalent among subgroups of VA patients: 57% of justice-involved veterans who received VA outreach services in jails or courts (Finlay, Smelson, et al, 2016), 33% of those who received VA outreach in prison (Finlay et al, 2015), and 49% of veterans who received VA homeless services had AUD (Tsai, Kasprow, & Rosenheck, 2014). …”

Section: Introductionmentioning

confidence: 99%

Barriers to and facilitators of pharmacotherapy for alcohol use disorder in VA residential treatment programs

Finlay

Ellerbe

Wong

et al. 2017

Journal of Substance Abuse Treatment

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Among US military veterans, alcohol use disorder (AUD) is prevalent and in severe cases patients need intensive AUD treatment beyond outpatient care. The Department of Veterans Affairs (VA) delivers intensive, highly structured addiction and psychosocial treatment through residential programs. Despite the evidence supporting pharmacotherapy among the effective treatments for AUD, receipt of these medications (e.g., naltrexone, acamprosate) among patients in residential treatment programs varies widely. In order to better understand this variation, the current study examined barriers and facilitators to use of pharmacotherapy for AUD among patients in VA residential treatment programs. Semi-structured qualitative interviews with residential program management and staff were conducted and the Consolidated Framework for Implementation Research was used to guide coding and analysis of interview transcripts. Barriers to use of pharmacotherapy for AUD included cultural norms or philosophy against prescribing, lack of access to willing prescribers, lack of interest from leadership, and perceived lack of patient interest or need. Facilitators included cultural norms of openness or active promotion of pharmacotherapy; education for patients, program staff and prescribers; having prescribers on staff, and care coordination within residential treatment and with other clinic settings in and outside VA. Developing and testing improvement strategies to increase care coordination and consistent support from leadership may also yield increases in the use of pharmacotherapy for AUD among residential patients.

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Use of Veterans Health Administration Mental Health and Substance Use Disorder Treatment After Exiting Prison: The Health Care for Reentry Veterans Program

Cited by 46 publications

References 32 publications

Social Determinants of Mental Health Care Systems: Intensive Community Based Care in The Veterans Health Administration

Social Determinants of Mental Health Care Systems: Intensive Community Based Care in The Veterans Health Administration

Study protocol: a hybrid effectiveness-implementation trial of Moral Reconation Therapy in the US Veterans Health Administration

Barriers to and facilitators of pharmacotherapy for alcohol use disorder in VA residential treatment programs

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