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Singh K, Timko C, Yu M, Taylor E, Blue-Howells J, Finlay AK. Scoping review of military veterans involved in the criminal legal system and their health and healthcare: 5-year update and map to the Veterans-Sequential Intercept Model. HEALTH & JUSTICE 2024; 12:18. [PMID: 38639813 PMCID: PMC11027330 DOI: 10.1186/s40352-024-00274-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 04/07/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND A previous scoping review of legal-involved veterans' health and healthcare (1947-2017) identified studies and their limitations. Given the influx of literature published recently, this study aimed to update the previous review and map articles to the Veterans-Sequential Intercept Model (V-SIM) - a conceptual model used by key partners, including Veterans Health Administration, veteran advocates, criminal justice practitioners, and local governments to identify intercept points in the criminal legal system where resources and programming can be provided. Developing an updated resource of literature is essential to inform current research, discover gaps, and highlight areas for future research. METHODS A systematic search of 5 databases identified articles related to legal-involved veterans' health and healthcare published between December 2017 through December 2022. The first and senior authors conducted abstract reviews, full-text reviews, and data extraction of study characteristics. Finally, each article was sorted by the various intercept points from the V-SIM. RESULTS Of 903 potentially relevant articles, 107 peer-reviewed publications were included in this review, most related to mental health (66/107, 62%) and used an observational quantitative study design (95/107, 89%). Although most articles did not explicitly use the V-SIM to guide data collection, analyses, or interpretation, all could be mapped to this conceptual model. Half of the articles (54/107, 50%) collected data from intercept 5 (Community Corrections and Support Intercept) of the V-SIM. No articles gathered data from intercepts 0 (Community and Emergency Services Intercept), 1 (Law Enforcement Intercept), or 2 (Initial Detention and Court Hearings Intercept). CONCLUSIONS There were 107 articles published in the last five years compared to 190 articles published in 70 years covered in the last review, illustrating the growing interest in legal-involved veterans. The V-SIM is widely used by front-line providers and clinical leadership, but not by researchers to guide their work. By clearly tying their research to the V-SIM, researchers could generate results to help guide policy and practice at specific intercept points. Despite the large number of publications, research on prevention and early intervention for legal-involved veterans is lacking, indicating areas of great need for future studies.
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Affiliation(s)
- Kreeti Singh
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA, 94025, USA.
| | - Christine Timko
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA, 94025, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 291 Campus Drive, Li Ka Shing Building, Stanford, CA, 94305, USA
| | - Mengfei Yu
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA, 94025, USA
| | - Emmeline Taylor
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA, 94025, USA
- Department of Psychology, University of Colorado, Columbine Hall 4th Floor, 1420 Austin Bluffs Pkwy, Colorado Springs, CO, 80918, USA
| | - Jessica Blue-Howells
- Department of Veterans Affairs, Veterans Justice Programs, 810 Vermont Avenue, Washington DC, NW, 20420, USA
| | - Andrea K Finlay
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA, 94025, USA
- Department of Veterans Affairs, National Center on Homelessness Among Veterans, 795 Willow Road, Menlo Park, CA, 94025, USA
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Blonigen DM, Smith JS, Javier S, Cucciare MA, Timko C, Nevedal AL, Filice N, Rosenthal J, Smelson D. Implementation Potential of Moral Reconation Therapy for Criminal Recidivism in Mental Health Residential Programs. Psychiatr Serv 2022; 73:856-863. [PMID: 35080418 DOI: 10.1176/appi.ps.202100089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Criminal recidivism is common among patients in mental health residential treatment programs. Moral reconation therapy (MRT) has empirical support for reducing criminal recidivism by modifying antisocial cognitions and behaviors; however, its implementation potential in noncorrectional settings has been rarely studied. This potential was examined in a three-site effectiveness-implementation trial of MRT for justice-involved veterans receiving residential mental health treatment in the U.S. Veterans Health Administration. METHODS Semistructured interviews were conducted with 36 veterans who received MRT and 13 residential program staff who were involved in its implementation during the trial. Interviews were guided by the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework and a focus on patient engagement and context. Content analysis was used to identify facilitators of and barriers to MRT implementation in residential mental health treatment. RESULTS Participants viewed MRT as unique and complementary to usual residential care, with benefits beyond recidivism reduction. However, time intensity of the MRT curriculum, challenges in adapting its content and format, and long-term costs of maintaining MRT were viewed as barriers to implementation. To facilitate implementation, participants suggested streamlining the MRT curriculum, adding motivational components, and establishing partnerships in- and outside the health care system. CONCLUSIONS The findings suggest strategies and modifications to MRT, which, if shown to be effective, may facilitate its wider implementation in mental health residential treatment programs.
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Affiliation(s)
- Daniel M Blonigen
- Health Services Research and Development, Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California (Blonigen, Smith, Javier, Timko, Nevedal); Department of Psychiatry and Behavioral Sciences (Blonigen, Timko) and Center for Primary Care and Outcomes Research (Javier), Stanford University School of Medicine, Stanford, California; Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Cucciare); Clinical Psychology Program, Palo Alto University, Palo Alto, California (Filice); Veterans Justice Programs, Veterans Health Administration (VHA), Washington, D.C. (Rosenthal); Health Services Research and Development, Center for Health Care Organization and Implementation Research, Bedford VA Medical Center, Bedford, Massachusetts, and University of Massachusetts Chan Medical School, Worcester (Smelson)
| | - Jennifer S Smith
- Health Services Research and Development, Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California (Blonigen, Smith, Javier, Timko, Nevedal); Department of Psychiatry and Behavioral Sciences (Blonigen, Timko) and Center for Primary Care and Outcomes Research (Javier), Stanford University School of Medicine, Stanford, California; Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Cucciare); Clinical Psychology Program, Palo Alto University, Palo Alto, California (Filice); Veterans Justice Programs, Veterans Health Administration (VHA), Washington, D.C. (Rosenthal); Health Services Research and Development, Center for Health Care Organization and Implementation Research, Bedford VA Medical Center, Bedford, Massachusetts, and University of Massachusetts Chan Medical School, Worcester (Smelson)
| | - Sarah Javier
- Health Services Research and Development, Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California (Blonigen, Smith, Javier, Timko, Nevedal); Department of Psychiatry and Behavioral Sciences (Blonigen, Timko) and Center for Primary Care and Outcomes Research (Javier), Stanford University School of Medicine, Stanford, California; Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Cucciare); Clinical Psychology Program, Palo Alto University, Palo Alto, California (Filice); Veterans Justice Programs, Veterans Health Administration (VHA), Washington, D.C. (Rosenthal); Health Services Research and Development, Center for Health Care Organization and Implementation Research, Bedford VA Medical Center, Bedford, Massachusetts, and University of Massachusetts Chan Medical School, Worcester (Smelson)
| | - Michael A Cucciare
- Health Services Research and Development, Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California (Blonigen, Smith, Javier, Timko, Nevedal); Department of Psychiatry and Behavioral Sciences (Blonigen, Timko) and Center for Primary Care and Outcomes Research (Javier), Stanford University School of Medicine, Stanford, California; Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Cucciare); Clinical Psychology Program, Palo Alto University, Palo Alto, California (Filice); Veterans Justice Programs, Veterans Health Administration (VHA), Washington, D.C. (Rosenthal); Health Services Research and Development, Center for Health Care Organization and Implementation Research, Bedford VA Medical Center, Bedford, Massachusetts, and University of Massachusetts Chan Medical School, Worcester (Smelson)
| | - Christine Timko
- Health Services Research and Development, Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California (Blonigen, Smith, Javier, Timko, Nevedal); Department of Psychiatry and Behavioral Sciences (Blonigen, Timko) and Center for Primary Care and Outcomes Research (Javier), Stanford University School of Medicine, Stanford, California; Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Cucciare); Clinical Psychology Program, Palo Alto University, Palo Alto, California (Filice); Veterans Justice Programs, Veterans Health Administration (VHA), Washington, D.C. (Rosenthal); Health Services Research and Development, Center for Health Care Organization and Implementation Research, Bedford VA Medical Center, Bedford, Massachusetts, and University of Massachusetts Chan Medical School, Worcester (Smelson)
| | - Andrea L Nevedal
- Health Services Research and Development, Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California (Blonigen, Smith, Javier, Timko, Nevedal); Department of Psychiatry and Behavioral Sciences (Blonigen, Timko) and Center for Primary Care and Outcomes Research (Javier), Stanford University School of Medicine, Stanford, California; Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Cucciare); Clinical Psychology Program, Palo Alto University, Palo Alto, California (Filice); Veterans Justice Programs, Veterans Health Administration (VHA), Washington, D.C. (Rosenthal); Health Services Research and Development, Center for Health Care Organization and Implementation Research, Bedford VA Medical Center, Bedford, Massachusetts, and University of Massachusetts Chan Medical School, Worcester (Smelson)
| | - Nicholas Filice
- Health Services Research and Development, Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California (Blonigen, Smith, Javier, Timko, Nevedal); Department of Psychiatry and Behavioral Sciences (Blonigen, Timko) and Center for Primary Care and Outcomes Research (Javier), Stanford University School of Medicine, Stanford, California; Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Cucciare); Clinical Psychology Program, Palo Alto University, Palo Alto, California (Filice); Veterans Justice Programs, Veterans Health Administration (VHA), Washington, D.C. (Rosenthal); Health Services Research and Development, Center for Health Care Organization and Implementation Research, Bedford VA Medical Center, Bedford, Massachusetts, and University of Massachusetts Chan Medical School, Worcester (Smelson)
| | - Joel Rosenthal
- Health Services Research and Development, Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California (Blonigen, Smith, Javier, Timko, Nevedal); Department of Psychiatry and Behavioral Sciences (Blonigen, Timko) and Center for Primary Care and Outcomes Research (Javier), Stanford University School of Medicine, Stanford, California; Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Cucciare); Clinical Psychology Program, Palo Alto University, Palo Alto, California (Filice); Veterans Justice Programs, Veterans Health Administration (VHA), Washington, D.C. (Rosenthal); Health Services Research and Development, Center for Health Care Organization and Implementation Research, Bedford VA Medical Center, Bedford, Massachusetts, and University of Massachusetts Chan Medical School, Worcester (Smelson)
| | - David Smelson
- Health Services Research and Development, Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California (Blonigen, Smith, Javier, Timko, Nevedal); Department of Psychiatry and Behavioral Sciences (Blonigen, Timko) and Center for Primary Care and Outcomes Research (Javier), Stanford University School of Medicine, Stanford, California; Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Cucciare); Clinical Psychology Program, Palo Alto University, Palo Alto, California (Filice); Veterans Justice Programs, Veterans Health Administration (VHA), Washington, D.C. (Rosenthal); Health Services Research and Development, Center for Health Care Organization and Implementation Research, Bedford VA Medical Center, Bedford, Massachusetts, and University of Massachusetts Chan Medical School, Worcester (Smelson)
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Blonigen DM, Cucciare MA, Byrne T, Shaffer PM, Giordano B, Smith JS, Timko C, Rosenthal J, Smelson D. A randomized controlled trial of moral reconation therapy to reduce risk for criminal recidivism among justice-involved adults in mental health residential treatment. J Consult Clin Psychol 2022; 90:413-426. [PMID: 35404638 PMCID: PMC9426716 DOI: 10.1037/ccp0000721] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Moral reconation therapy (MRT) is a cognitive-behavioral intervention to reduce risk for criminal recidivism. Despite being implemented widely in correctional settings, there are no randomized controlled trials of MRT, and its effectiveness for reducing recidivism among justice-involved adults in noncorrectional settings is unknown. METHOD In a pragmatic trial, 341 justice-involved patients (95.3% male; 57.8% White/non-Hispanic) admitted to one of three mental health residential treatment programs were randomly assigned to usual care (UC) or UC plus two MRT groups per week for 12 weeks. Follow-ups were conducted at 6- and 12-month postbaseline (71.3% and 74.8% retention, respectively). Primary outcomes were criminal thinking and criminal associates. Secondary outcomes were legal problem severity, days incarcerated in the past 30, rearrested/charged (per official records), substance use, and employment and family/social problems. The study design, analysis, and outcomes were preregistered (ClinicalTrials.gov; ID: NCT02524171). RESULTS Patients in both conditions improved over time on most outcomes. In intent-to-treat analyses, the rate of change in outcomes over time did not differ by condition, nor did the prevalence of being rearrested and charged within 1 year of baseline (UC = 20.2%, MRT = 24.9%; OR = 1.14; 95% CI [0.67, 1.94], p = .63). MRT engagement was low; 37% of those randomized to MRT received a minimum dose-that is, completed at least Step 3. In per-protocol analyses, this subgroup, relative to UC, improved more on criminal associates, days incarcerated, legal problem severity, and alcohol use severity. CONCLUSIONS In this study, MRT was not more effective than UC at reducing recidivism risk for patients in mental health residential treatment. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Daniel M. Blonigen
- HSR&D Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA USA
| | - Michael A. Cucciare
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR 72205, USA
- Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR 72205, USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Thomas Byrne
- HSR&D Center for Health Care Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA USA
- University of Massachusetts Medical School, Worcester, MA USA
| | - Paige M. Shaffer
- HSR&D Center for Health Care Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA USA
- University of Massachusetts Medical School, Worcester, MA USA
| | - Brenna Giordano
- Clinical Psychology PhD Program, Palo Alto University, Palo Alto, CA USA
| | - Jennifer S. Smith
- HSR&D Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA USA
| | - Christine Timko
- HSR&D Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA USA
| | - Joel Rosenthal
- Veterans Justice Programs, Veterans Health Administration, Washington DC USA
| | - David Smelson
- HSR&D Center for Health Care Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA USA
- University of Massachusetts Medical School, Worcester, MA USA
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