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Implementation of Maintaining Independence and Sobriety through Systems Integration, Outreach, and Networking-Criminal Justice (MISSION-CJ) in Veterans Treatment Courts

HSS Investigator: David Smelson
Funding Agency: VA Quality Enhancement Research Institute (QUERI) 
Status: Ongoing

Project Overview: Veterans Treatment Courts (VTCs) are alternative to incarceration programs to help address behavioral health needs of veterans with criminal legal involvement. Veterans enrolled in VTCs have high rates of co-occurring mental health and substance use disorders (COD) and social determinants of health needs, which often results in poor treatment engagement and retention. The VA Veterans Justice Outreach (VJO) Program serves VTCs and delegates a VJO Specialist to the court, who has the responsibility of linking eligible veterans to VA addiction and other behavioral health services. While the VJO Program has shown great success, high risk veterans in VTCs, particularly those with COD could benefit from comprehensive wraparound services to help the veteran remain engaged in VA and non-VA care. Maintaining Independence and Sobriety through Systems Integration, Outreach and Networking-Criminal Justice (MISSION-CJ) is an evidenced-based, multicomponent, interdisciplinary, wraparound treatment intervention delivered by case manager and peer specialists, who offer justice-involved veterans with COD group psychoeducational therapy sessions, outreach, and linkage support for 6-months. While MISSION-CJ has been found to increase engagement in care and improve behavioral health and criminal legal outcomes for both veterans and non-veterans with a COD, implementation of multicomponent interventions in complex healthcare systems with high fidelity to the model remains challenging. This study uses a hybrid type III randomized implementation-effectiveness adaptative design to test implementation facilitation approaches in VA and VTC nationwide. We will accomplish this via three specific aims: (1) assess the effectiveness and intensity of the implementation facilitation approach using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework, (2) conduct moderation analyses using identified pre-implementation barriers and facilitators related to the MISSION-CJ intervention, VTC practice settings, and the wider ecological context of the VA and the criminal legal system and (3) evaluate MISSION-CJ effectiveness via treatment engagement as well as mental health and substance use outcomes among veterans with COD in VTCs.

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