MISSION-CJ for Justice-Involved Homeless Veterans

VA Office of Research and Development

Status: Enrolling

Conditions: Homelessness; Mental Health Disorder; Substance Use Disorder

Treatments: Behavioral: Maintaining Maintaining Independence and Sobriety through Systems Integration Outreach and Networking- Criminal Justice; Behavioral: Maintaining Maintaining Independence and Sobriety through Systems Integration Outreach and Networking Peer Support

Study type: Interventional

Funder types: Other U.S. Federal agency

Identifiers

NCT04523337

IIR 18-040

Details and patient eligibility

About

The purpose of this study is to determine whether Maintaining Independence and Sobriety through Systems Integration, Outreach and Networking - Criminal Justice version (MISSION-CJ) is effective for reducing criminal recidivism and improving other health-related outcomes (substance use, mental health, housing, employment, community integration) among justice-involved, homeless Veterans with a co-occurring substance use and mental health disorder.

Full description

VHA Mental Health Residential Rehabilitation Treatment Programs (MH RRTPs) serve Veterans with an estimated 50% having criminal justice involvement annually. Justice-involved Veterans (JIVs) receive assistance with their addiction and behavioral health needs, but MH RRTP programs do not directly address their antisocial behaviors and cognitions. Furthermore, MH RRTP discharge is a vulnerable transition and no national transitional approach facilitates Veteran's engagement in prosocial community behaviors that sustain MH RRTP gains, ultimately reducing revolving door service use.

Maintaining Independence and Sobriety through Systems Integration, Outreach, and Networking-Criminal Justice version (MISSION-CJ) is a new case manager and peer delivered team-based treatment for JIVs with a co-occurring substance use and mental health disorder (COD). While MISSION-CJ derives in part from an evidence-based treatment for homeless individuals (MISSION), it includes a new conceptual framework and numerous new and differentiating features for a CJ population including: (1) a treatment planning tool focused on criminogenic needs that monitors progress and tunes service delivery elements; (2) a prosocial treatment curriculum; and (3) tools/resources to address JIVs' legal issues. With MISSION-CJ, this study attempts to change the practice paradigm and transform care for JIVs by moving beyond the current model of linking Veterans to VA care and tracking behavioral health outcomes, to a hybrid treatment/linkage approach that addresses criminogenic needs, supports engagement in VA and non-VA care, and targets recidivism as an outcome-the gold standard for CJ research.

Using a Hybrid Type 1 design, this project will test the effectiveness of MISSION-CJ in a three-site RCT (Bedford, Palo Alto, and Little Rock VAs) with JIVs with a COD, admitted to an MH RRTP, and previously arrested and charged and/or released from incarceration in the past 5-years.

Enrollment: 150 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• (a) are entering a Mental Health Residential Rehabilitation Treatment Program (MH RRTP)
• (b) were arrested and charged and/or released from incarceration in the past 5 years
• (c) have a co-occurring substance use and mental health disorder (COD)

Exclusion criteria

• The only exclusion criterion is being too cognitively impaired to understand the informed-consent process and other study procedures.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

---

150 participants in 2 patient groups

MISSION-CJ

Experimental group

Description:

Maintaining Independence and Sobriety through Systems Integration Outreach and Networking- Criminal Justice version (MISSION-CJ) programming targets co-occurring substance use and mental health disorders and other related health outcomes faced by justice-involved homeless Veterans through assertive outreach, psychoeducation, and linkages to community-based services.

Treatment:

Behavioral: Maintaining Maintaining Independence and Sobriety through Systems Integration Outreach and Networking- Criminal Justice

Enhanced Usual Care

Experimental group

Description:

Usual care provided by the mental health residential rehabilitation treatment programs, with patients in both groups are enrolled in, in addition to peer support and community outreach case management. Patients receive 2 Peer Support Curriculum sessions per week (24 sessions total). Patients will receive unstructured community outreach and linkage support while enrolled in the mental health residential rehabilitation program. After discharge, patients will continue to receive 1 hour of weekly linkage support per week.

Treatment:

Behavioral: Maintaining Maintaining Independence and Sobriety through Systems Integration Outreach and Networking Peer Support