Clinical trial NCT02964897: Improving Linkage to Health and Other Services for Veterans Leaving Incarceration
Official title: Veterans Justice Reentry (Post-Incarceration) (QUE 15-284)
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Linkage to Care
Homelessness
Substance Use Disorder
Mental Health
Keywords: justice involvement
Homeless
Vulnerable Populations
Linkage to care
Veterans
Lead sponsor: VA Office of Research and Development
Sponsor class: FED
Collaborators: name: US Department of Veterans Affairs
First posted: 2016-11-16
Enrollment: 79
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NON_RANDOMIZED
Intervention model: PARALLEL
Primary purpose: SUPPORTIVE_CARE

Brief summary: Veterans leaving incarceration and re-entering their communities (often described as "reentry" Veterans) face a number of challenges, including uncertainty about housing, vulnerability to substance use and relapse, on-going mental health concerns, and often multiple health conditions require timely continuity of care. The purpose of the project is to increase support for Veterans post-incarceration through the addition of trained peers with lived experience of being a Veteran and a history of incarceration. Emphasis will be on peers who will help link Veterans to Veterans Health Administration (VHA) services, including housing and healthcare. Peers will provide linkage with Health Care Reentry Veterans program specialists, transportation to appointments, and support in community reintegration. Peers will assist reentry veterans to make a successful transition and get and stay engaged in their care.

Detailed description: Veterans leaving incarceration (henceforth, "reentry Veterans") are among the most underserved by the VA and thus are an increasingly high priority population. The Bureau of Justice Statistics estimates that 140,000 Veterans are incarcerated in the U.S. at a given time, approximately 80% of whom are eligible for VA benefits. Many of these Veterans had problems with substance use disorders (SUD)(including alcohol) and/or mental health (MH) issues prior to being incarcerated.

The VA's national Health Care for Reentry Veterans (HCRV) program identifies 10,000-15,000 incarcerated Veterans annually preparing to transition back to the community. A HCRV outreach specialist works with incarcerated VHA-eligible Veterans to establish a post-release plan for linkage to VHA services. This program, with 1-2 outreach specialists per state, has improved the connection between reentry Veterans and the VHA. However, the investigators' analyses of homeless program data linked to VHA administrative data indicate that 43% of eligible HCRV Veterans do not have a VHA outpatient contact in the first 4 months post incarceration. Reducing this number is critical given the elevated rates of chronic health conditions, as well as MH or SUDs in this population.

To address this gap, the investigators will work with the national HCRV office to implement an evidence-based peer support intervention to extend the reach and effectiveness of the HCRV program in linking Veterans to VHA. Peers with incarceration experience are likely to better understand and connect with Veterans on a personal level than the outreach specialist, and thus are more likely to maintain contact and link to VHA during the first months post-release. Peers are gaining popularity in forensic settings (called "forensic peer specialists") with civilian populations and would likely be beneficial for a Veteran population .

The aims of this project are:

1. Conduct contextual analysis to identify VHA and community reentry resources, and to describe how reentry Veterans use them.
2. Implement peer-support, in one state, to link reentry veterans to VHA primary, mental health, and SUD services. The investigators will use external and internal facilitation as the implementation strategy.
3. Spread the peer-support intervention to another, geographically, and contextually different state.

Eligibility criteria: Inclusion Criteria:

Phase 1

* Veteran released from a Massachusetts state prison or county jail.
* (for intervention subjects: interested in receiving reentry services) Phase 2
* Veteran released from a Connecticut state prison or jail.
* (for intervention subjects: interested in receiving reentry services)

Exclusion Criteria:

- No history of dementia or other serious cognitive condition that would prevent them from being interviewed or completing a survey questionnaire.

Primary outcomes:
measure: Substance Use Care
timeFrame: 3 months after release from incarceration
measure: Mental Health
timeFrame: 3 months after release from incarceration
measure: Primary Care
timeFrame: 3 months after release from incarceration
Secondary outcomes:
Other outcomes:
Locations:
city: West Haven
country: United States
facility: VA Connecticut Healthcare System West Haven Campus, West Haven, CT
state: Connecticut
city: Bedford
country: United States
facility: VA Bedford HealthCare System, Bedford, MA
state: Massachusetts
Study officials:
affiliation: VA Bedford HealthCare System, Bedford, MA
name: Donald K McInnes, ScD MS BA
role: PRINCIPAL_INVESTIGATOR
affiliation: VA Bedford HealthCare System, Bedford, MA
name: Allen L. Gifford, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Kim B, McCullough MB, Simmons MM, Bolton RE, Hyde J, Drainoni ML, Fincke BG, McInnes DK. A novel application of process mapping in a criminal justice setting to examine implementation of peer support for veterans leaving incarceration. Health Justice. 2019 Mar 26;7(1):3. doi: 10.1186/s40352-019-0085-x.
citation: Simmons MM, Fincke BG, Drainoni ML, Kim B, Byrne T, Smelson D, Casey K, Ellison ML, Visher C, Blue-Howells J, McInnes DK. A two-state comparative implementation of peer-support intervention to link veterans to health-related services after incarceration: a study protocol. BMC Health Serv Res. 2017 Sep 12;17(1):647. doi: 10.1186/s12913-017-2572-x.