Showing posts with label Justice-Involved Veterans. Show all posts
Showing posts with label Justice-Involved Veterans. Show all posts

Monday, February 29, 2016

The Availability and Utility of Services to Address Risk Factors for Recidivism among Justice-Involved Veterans

The availability and utility of services to address recidivism risk factors among justice-involved veterans is unknown. We explored these issues through qualitative interviews with 63 Specialists from the Department of Veterans Affairs’ (VA) Veterans Justice Programs. To guide the interviews, we utilized the Risk-Need-Responsivity (RNR) model of offender rehabilitation. Specialists reported that justice-involved veterans generally have access to services to address most RNR-based risk factors (substance abuse; lack of positive school/work involvement; family/marital dysfunction; lack of prosocial activities/interests), but have less access to services targeting risk factors of antisocial tendencies and associates and empirically-based treatments for recidivism in VA. Peer-based services, motivational interviewing/cognitive-behavioral therapy, and Veterans Treatment Courts were perceived as useful to address multiple risk factors. 

These findings highlight potential gaps in provision of evidence-based care to address recidivism among justice-involved veterans, as well as promising policy-based solutions that may have widespread impact on reducing recidivism in this population.

...The objectives of the current study were to determine the availability of services for justice-involved veterans that address empirically-supported risk factors for recidivism that are targeted by the RNR model, the types of treatment options and resources that are perceived as being most helpful in addressing these risk factors, and whether justice-involved veterans have access to empirically-based treatments for recidivism risk. For most risk factors (substance abuse, lack of positive school or work involvement, family/marital dysfunction, and lack of prosocial activities/interests), responses from the majority of Veterans Justice Program Specialists in our sample included description of some type of treatment option or resource that was available to address these issues among justice-involved veterans. By comparison, only a little more than half of the Specialists’ responses included description of any treatment options or resources to address antisocial tendencies and antisocial associates. This is noteworthy, given that risk factors related to antisociality (i.e., the Big Four) have been identified as the strongest predictors of criminal recidivism (, ).

The current findings are largely consistent with research on availability of services for offenders in general. For example, a recent review highlighted the range of offender reentry programs and services that target vocational training, substance abuse prevention, and other psychosocial needs of offenders (e.g., housing; James, 2015). By contrast, others have noted that extant programming for offenders tend not target antisocial tendencies, despite the centrality of these issues in the prediction of recidivism risk (;). This potential gap may be greater among justice-involved veterans, given that in the current study the availability of interventions that directly target antisocial cognitions and attitudes (e.g., MRT, T4C) were reported to be less prevalent in VA (vs. non-VA settings)...

Full article at:   http://goo.gl/ty4VwX

1 HSR&D Center for Innovation to Implementation, VA Palo Alto Health Care System
2 Palo Alto University, Palo Alto, CA
3 National Center for PTSD, VA Palo Alto Health Care System
4 Veterans Justice Programs, Veterans Health Administration
5 HSR&D Center for Health Care Organization and Implementation Research, Bedford VA Medical Center
6 University of Massachusetts Medical School, Worcester, MA
7 Stanford University School of Medicine, Palo Alto, CA
Correspondence to: Daniel M. Blonigen, Ph.D., HSR&D Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, 795 Willow Road (152), Menlo Park, CA 94025. Phone: 650-493-5000, ext. 27828, Fax: 650-617-2736.  vog.av@neginolB.leinaD




Wednesday, January 27, 2016

US Veterans' Court Programs: An Inventory and Analysis of National Survey Data

This study used data from a phone survey inventory of US veterans' courts to provide descriptive information on the current status of their various elements. To identify which items were most predictive of a court's percentage of subjects terminated from their program, a linear regression was performed. 

The following were associated with higher rates of termination from the veterans' court (VC) program: 
  1. programs that offered phase progression based on measurable goals, 
  2. programs that conduct frequent drug and alcohol testing, and 
  3. programs for which sanctions are more severe for failing immediate goals (sobriety) versus long-term ones (completion of training). 
The following were associated with lower rates of termination from the VC program: 
  1. programs in which later phases permit less stringent testing, 
  2. programs utilizing behavioral contracts, 
  3. programs utilizing brief incarcerations. 
This inventory provides nationwide empirical data that may be used in the development of veterans' courts.

Purchase full article at:   http://goo.gl/j6VJ1h

  • 1Massachusetts General Hospital/Harvard Medical School, Boston, MA, 02114, USA. rscottjohnson3@gmail.com.
  • 2Mental Health Care Line, Michael E. DeBakey Veterans Affairs (VA) Medical Center, Houston, TX, USA.
  • 3Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.
  • 4Veterans' Court Treatment Program, Houston, TX, USA.
  • 5, Houston, TX, USA.
  • 6Neurorehabilitation: Neurons to Networks Traumatic Brain Injury Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
  • 7Department of Veterans Affairs, South Central Mental Illness, Research, Education and Clinical Center (MIRECC), Houston, TX, USA. 
  •  2016 Jan 21.




Friday, January 15, 2016

The Epidemiology of Substance Use Disorders in US Veterans: A Systematic Review & Analysis of Assessment Methods

BACKGROUND:
Substance use disorders (SUDs), which encompass alcohol and drug use disorders (AUDs, DUDs), constitute a major public health challenge among US veterans. SUDs are among the most common and costly of all health conditions among veterans.

OBJECTIVES:
This study sought to examine the epidemiology of SUDs among US veterans, compare the prevalence of SUDs in studies using diagnostic and administrative criteria assessment methods, and summarize trends in the prevalence of SUDs reported in studies sampling USveterans over time.

METHODS:
Comprehensive electronic database searches were conducted. A total of 3,490 studies were identified. We analyzed studies samplingUS veterans and reporting prevalence, distribution, and examining AUDs and DUDs.

RESULTS:
Of the studies identified, 72 met inclusion criteria. The studies were published between 1995 and 2013. Studies using diagnostic criteria reported higher prevalence of AUDs (32% vs. 10%) and DUDs (20% vs. 5%) than administrative criteria, respectively. Regardless of assessmentmethod, both the lifetime and past year prevalence of AUDs in studies sampling US veterans has declined gradually over time.

CONCLUSION:
The prevalence of SUDs reported in studies sampling US veterans are affected by assessment method. Given the significant public health problems of SUDs among US veterans, improved guidelines for clinical screening using validated diagnostic criteria to assess AUDs and DUDs in US veteran populations are needed.

SCIENTIFIC SIGNIFICANCE:
These findings may inform VA and other healthcare systems in prevention, diagnosis, and intervention for SUDs among US veterans.

Below:  Prevalence of lifetime alcohol use disorders (AUDs) among US veterans reported by studies using diagnostic (ie, DSM) criteria (Panel A) and administrative (ie, ICD-9) criteria (Panel B), by publication year. Note: black solid lines represent trend lines, calculated using weighted least squares regression. Note: Some of the data points overlap with each other since they had the same or very similar data point. DSM, Diagnostic and Statistical Manual of Mental Disorders; DUD, drug use disorder; ICD-9, international classification of diseases.



Below:  Prevalence of past year alcohol use disorders (AUDs) among US veterans reported by studies using diagnostic (ie, DSM) criteria (Panel A) and administrative (ie, ICD-9) criteria (Panel B), by publication year. Note: black solid lines represent trend lines, calculated using weighted least squares regression. Note: Some of the data points overlap with each other since they had the same or very similar data point. AUD, alcohol use disorder; DSM, Diagnostic and Statistical Manual of Mental Disorders; ICD-9, international classification of diseases.



Below:  Prevalence of lifetime drug use disorders (DUDs) among US veterans reported by studies using diagnostic (ie, DSM) criteria (Panel A) and administrative (ie, ICD-9) criteria (Panel B), by publication year. Note: black solid lines represent trend lines, calculated using weighted least squares regression. Note: Some of the data points overlap with each other since they had the same or very similar data point. AUD, alcohol use disorder; DSM, Diagnostic and Statistical Manual of Mental Disorders; ICD-9, international classification of diseases.



Full article at:   http://goo.gl/H6dSHm

  • 1Department of Community Health Sciences, University of California, Los Angeles, Fielding School of Public Health, Los Angeles, California.
  • 2Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
  • 3Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.
  • 4Pain Treatment Services, APT Foundation, Inc., New Haven, Connecticut.
  • 5National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland.
  • 6Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.
  • 7Mental Health Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.
  • 8Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pennsylvania.
  • 9Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut.
  • 10Department of Psychology, Syracuse University, Syracuse, New York.
  • 11Department of Epidemiology, Brown University, School of Public Health, Providence, Rhode Island. 




Wednesday, January 6, 2016

Patient Perspectives on an Opioid Overdose Education and Naloxone Distribution Program in the US Department of Veterans Affairs

BACKGROUND:
In an effort to prevent opioid overdose mortality among Veterans, Department of Veterans Affairs (VA) facilities began implementing Opioid Overdose Education and Naloxone Distribution (OEND) in 2013 and a national program began in 2014. VA is the first national health care system to implement OEND. The goal of this study is to examine patient perceptions of OEND training and naloxone kits.

METHODS:
Four focus groups were conducted between December 2014 and February 2015 with 21 patients trained in OEND. Participants were recruited from a VA residential facility in California with a substance use disorder treatment program (mandatory OEND training) and a homeless program (optional OEND training). Data were analyzed using matrices and open and closed coding approaches to identify what participants liked and did not like, group discussion disagreements, and suggestions for improvement.

RESULTS:
Veterans thought OEND training was interesting, novel, and empowering, and that naloxone kits will save lives. Some veterans expressed concern about using syringes in the kits. A few patients who never used opioids were not interested in receiving kits. Veterans had differing opinions about legal and liability issues, whether naloxone kits might contribute to relapse, and whether and how to involve family in training. Some veterans expressed uncertainty about the effects of naloxone. Suggested improvements included active learning approaches, enhanced training materials, and increased advertisement.

CONCLUSIONS:
OEND training was generally well-received among study participants, including those with no indication for a naloxone kit. Patients described a need for OEND and believed it could save lives. Patient feedback on OEND training benefits, concerns, opinions, and suggestions provides important insights to inform future OEND training programs both within VA and in other health care settings. Training is critical to maximizing the potential for OEND to save lives and this study includes specific suggestions for improving the effectiveness and acceptability of training.

Purchase full article at:   http://goo.gl/JfkPlb

  • 1 VA Palo Alto Health Care System - Center for Innovation to Implementation , Menlo Park , CA , USA.
  • 2 VA Office of Mental Health Operations - Program Evaluation and Resource Center , Menlo Park , CA , USA.
  • 3 Stanford University School of Medicine - Department of Psychiatry and Behavioral Sciences , Stanford , CA , USA.
  • 4 Louis Stokes Cleveland VA Medical Center , Cleveland , OH , USA.
  • 5 Case Western Reserve University School of Medicine - Department of Psychiatry , Cleveland , OH , USA.
  • 6National Health Law Program , Los Angeles , CA , USA.
  • 7 Cincinnati VA Medical Center , Cincinnati , OH , USA.
  • 8 University of Cincinnati College of Medicine - Department of Psychiatry and Behavioral Neuroscience , Cincinnati , OH , USA.
  •  2015 Dec 16:0. 





Monday, November 16, 2015

Sex Differences in Mental Health and Substance Use Disorders and Treatment Entry among Justice-involved Veterans in the Veterans Health Administration

Over half of veterans in the criminal justice system have mental health or substance use disorders. However, there is a critical lack of information about female veterans in the criminal justice system and how diagnosis prevalence and treatment entry differ by sex.

Objectives:  To document prevalence of mental health and substance use disorder diagnoses and treatment entry rates among female veterans compared with male veterans in the justice system.

Research Design: Retrospective cohort study using national Veterans Health Administration clinical/administrative data from veterans seen by Veterans Justice Outreach Specialists in fiscal years 2010-2012.

Subjects:  A total of 1535 females and 30,478 male veterans were included.

Measures: Demographic characteristics (eg, sex, age, residence, homeless status), mental health disorders (eg, depression, post-traumatic stress disorder), substance use disorders (eg, alcohol and opioid use disorders), and treatment entry (eg, outpatient, residential, pharmacotherapy).

Results: Among female veterans, prevalence of mental health and substance use disorders was 88% and 58%, respectively, compared with 76% and 72% among male veterans. Women had higher odds of being diagnosed with a mental health disorder and lower odds of being diagnosed with a substance use disorder compared with men. Women had lower odds of entering mental health residential treatment.

Conclusions: Female veterans involved in the justice system have a high burden of mental health disorders (88%) and more than half have substance use disorders (58%). Entry to mental health residential treatment for women is an important quality improvement target.

Full article at:  http://goo.gl/NulCvY

  • 1*Center for Innovation to Implementation (Ci2i), Substance Use Disorder Quality Research Enhancement Initiative, VA Palo Alto Health Care System, Menlo Park, CA †Division of General Internal Medicine University of Colorado School of Medicine, Community Health Services, Denver Health Medical Center, Denver, CO ‡National Center on Homelessness Among Veterans, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA §Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA ∥School of Criminology and Justice Studies, University of Massachusetts, Lowell, Bedford, MA ¶Department of Veterans Affairs, Veterans Justice Programs #Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA **Department of Psychiatry and Behavioral Sciences ††Division of General Medical Disciplines, Stanford University School of Medicine, Menlo Park, CA. 

Sunday, November 15, 2015

Prevalence of Mental Health Disorders among Justice-Involved Veterans

Justice-involved veterans are a special population with unique mental health needs compared with other veterans or justice-involved adults. Prevalence estimates of mental health concerns of justice-involved veterans across 18 samples of these veterans (1987-2013), including both incarcerated and community samples, were identified through a systematic literature search of published studies supplemented by Department of Veterans Affairs Veterans Justice Programs data. 

Despite heterogeneity across samples and measures used, the review highlights several prominent mental health concerns among veterans. Many justice-involved veterans have likely experienced at least one traumatic event, and many have post-traumatic stress disorder (prevalence from 4% to 39% across samples). At least half of justice-involved veterans have an alcohol and/or drug use disorder (estimates as high as 71% and 65%, respectively), and other psychiatric disorders, such as depression (14%-51%) and psychotic disorders (4%-14%), are common. 

Justice-involved veterans with comorbid substance use and psychiatric disorders are at increased risk of negative outcomes, including homelessness and violent behavior. Overall, comparisons of justice-involved veterans with other justice-involved adults found a slightly higher rate of mental health concerns among justice-involved veterans, with some indication that intravenous drug use is more prevalent. 

Compared with other veterans, justice-involved veterans have consistently higher rates of mental health concerns, particularly substance use disorders.

Purchase full article at:  http://goo.gl/CBpQcw

By:  Blodgett JC, Avoundjian T, Finlay AK, Rosenthal J, Asch SM, Maisel NC, Midboe AM.
Center for Innovation to Implementation, VA Palo Alto Health Care System (152MPD), 795 Willow Road, Menlo Park, CA 94025 (e-mail:janet.blodgett@gmail.com).