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Lebenbaum M, Kouyoumdjian F, Huang A, Kurdyak P. The Association Between Prior Mental Health Service Utilization and Risk of Recidivism among Incarcerated Ontario Residents. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2024; 69:21-32. [PMID: 36518095 PMCID: PMC10867412 DOI: 10.1177/07067437221140385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND There is mixed evidence on the link between mental health and addiction (MHA) history and recidivism. Few studies have examined post-release MHA care. Our objective was to examine the association between prior (pre-incarceration) MHA service use and post-release recidivism and service use. METHODS We conducted a population-based cohort study linking individuals held in provincial correctional institutions in 2010 to health administrative databases. Prior MHA service use was assigned hierarchically in order of hospitalization, emergency department visit and outpatient visit. We followed up individuals post-release for up to 5 years for the first occurrence of recidivism and MHA hospitalization, emergency department visit and outpatient visit. We use Cox-proportional hazards models to examine the association between prior MHA service use and each outcome adjusting for prior correctional involvement and demographic characteristics. RESULTS Among a sample consisting of 45,890 individuals, we found that prior MHA service use was moderately associated with recidivism (hazard ratio (HR): 1.20-1.50, all P < 0.001), with secondary analyses finding larger associations for addiction service use (HR range: 1.34-1.54, all P < 0.001) than for mental health service use (HR range: 1.09-1.18, all P < 0.001). We found high levels of post-release MHA hospitalization and low levels of outpatient MHA care relative to need even among individuals with prior MHA hospitalization. DISCUSSION Despite a high risk of recidivism and acute MHA utilization post-release, we found low access to MHA outpatient care, highlighting the necessity for greater efforts to facilitate access to care and care integration for individuals with mental health needs in correctional facilities.
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Affiliation(s)
- Michael Lebenbaum
- ICES, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
| | - Fiona Kouyoumdjian
- ICES, Toronto, ON, Canada
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | | | - Paul Kurdyak
- ICES, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Marotta P, Hass A, Viera A, Doernberg M, Barbour R, Grau LE, Heimer R. Technical violations and infractions are drivers of disengagement from methadone treatment among people with opioid use disorder discharged from Connecticut jails 2014-2018. Subst Abuse Treat Prev Policy 2023; 18:43. [PMID: 37420271 PMCID: PMC10329353 DOI: 10.1186/s13011-023-00541-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/25/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND We investigated the interaction between arrests for technical violations vs. receiving new charges with receiving community-based methadone treatment on time-to reincarceration (TTR) in a cohort of men with opioid use disorder (OUD) released from custody from two Connecticut jails from 2014 to 2018. METHODS Hazard ratios (HR) were estimated for time to reincarceration for technical violations/infractions, misdemeanors only, felonies only, and both misdemeanors and felonies after adjusting for age, race/ethnicity, and receiving methadone treatment during incarceration or in the community following release. Moderation analyses tested the hypotheses that the benefits of receiving methadone in jail or the community on TTR were significantly different for people with only technical violations and infractions compared to misdemeanor and felony charges. RESULTS In the sample of 788 men who were reincarcerated, 29.4% received technical violations with no new charges (n = 232) with the remainder of the sample receiving new charges consisting of 26.9% new misdemeanor charges, 6.5% felony charges, and 37.2% both felony and misdemeanor charges. Compared to men who received new misdemeanor charges, TTR was significantly shorter among those who received technical violations and infractions with no new charges amounting to a 50% increase in TTR (334.5 days, SD = 321.3 vs. 228.1 days, SD = 308.0, p < 0.001; aHR = 1.5, 95% CI = 1.3, 1.8, p < 0.001). TTR of men who resumed methadone and were charged with a new crime was 50% longer than those who resumed methadone and received technical violations/infractions with no new charges. (230.2 days, SD = 340.2 vs. 402.3 days, SD = 231.3; aHR = 1.5, 95%CI = 1.0, 2.2, p = 0.038). CONCLUSIONS Reducing technical violations may enhance the benefits of providing community-based methadone following release from incarceration on extending the time between incarcerations during the vulnerable time post-incarceration and reduce the burden on correctional systems.
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Affiliation(s)
- Phillip Marotta
- Brown School, Washington University in St. Louis, 1 Brookings Dr., St. Louis, MO USA
| | - Alissa Hass
- Indiana University School of Medicine, Bloomington, USA
| | - Adam Viera
- Yale School of Public Health, New Haven, USA
- Yale University, New Haven, USA
| | - Molly Doernberg
- Yale School of Public Health, New Haven, USA
- Yale University, New Haven, USA
| | - Russell Barbour
- Yale School of Public Health, New Haven, USA
- Yale University, New Haven, USA
| | - Lauretta E. Grau
- Yale School of Public Health, New Haven, USA
- Yale University, New Haven, USA
| | - Robert Heimer
- Yale School of Public Health, New Haven, USA
- Yale University, New Haven, USA
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3
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Villalobos-Gallegos L, Medina-Mora ME, Marín-Navarrete R, Magis-Rodriguez C, Ruiz-Velasco Acosta S. Testing the Synergistic Effects of Depression, Anxiety, and Substance Use in Unsafe Sex: a Cross-sectional Study. Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-020-00291-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Yangyuen S, Kanato M, Mahaweerawat C, Mahaweerawat U. The Perceived Stigma of Addiction and Treatment Utilization among Cannabis Addicts in Thailand. Indian J Community Med 2020; 45:492-496. [PMID: 33623208 PMCID: PMC7877418 DOI: 10.4103/ijcm.ijcm_532_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 07/06/2020] [Indexed: 11/10/2022] Open
Abstract
Context: A major social problem among clients with substance use disorders is stigmatization related to health conditions, which contributes to poor mental and physical health circumstances and becomes hazardous to substance abuse treatment. Meanwhile, decreased stigmatization among cannabis users might occur because some people use cannabis without experiencing harm or believe it to be a harmless substance and might not be receiving treatment. Several studies have investigated stigma toward substance use disorder and treatment. However, less is known about how stigmatization influences treatment. Aims: To investigate the association between the perceived stigma of addiction and treatment utilization among cannabis addicts. Materials and Methods: A cross-sectional design was conducted with consecutive sampling techniques among 977 cannabis users recruited from all 7 compulsory drug detention centers in Thailand. The data were collected by standardized interviewers with a structured interviewing questionnaire. Binary logistic regression was applied to determine the effect of perceived stigma of treatment utilization. Results: Most clients were male (84.5%), had a family history of drug problems (54.5%), and had a history of mental health problems (5.1%). Most of them reported moderate-to-high levels of perceived stigma (87.2%) and received treatment (28.9%). Greater perceived stigma was associated with decreased treatment for cannabis abuse. Conclusions: The perceived stigma of addiction is a barrier to cannabis abuse treatment utilization. Thus, a better understanding of stigma could reduce its negative impact on seeking and engaging in treatment.
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Affiliation(s)
- Suneerat Yangyuen
- Department of Occupational Health and Safety, Faculty of Public Health, Mahasarakham University, Mahasarakham, Thailand
| | - Manop Kanato
- Department of Community Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Udomsak Mahaweerawat
- Department of Occupational Health and Safety, Faculty of Public Health, Mahasarakham University, Mahasarakham, Thailand
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Kim B, Bolton RE, Hyde J, Fincke BG, Drainoni ML, Petrakis BA, Simmons MM, McInnes DK. Coordinating across correctional, community, and VA systems: applying the Collaborative Chronic Care Model to post-incarceration healthcare and reentry support for veterans with mental health and substance use disorders. HEALTH & JUSTICE 2019; 7:18. [PMID: 31832790 PMCID: PMC6909453 DOI: 10.1186/s40352-019-0099-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 11/20/2019] [Indexed: 05/05/2023]
Abstract
BACKGROUND Between 12,000 and 16,000 veterans leave incarceration annually. As is known to be the case for justice-involved populations in general, mental health disorders (MHDs) and substance use disorders (SUDs) are highly prevalent among incarcerated veterans, and individuals with MHDs and SUDs reentering the community are at increased risk of deteriorating health and recidivism. We sought to identify opportunities to better coordinate care/services across correctional, community, and VA systems for reentry veterans with MHDs and SUDs. METHODS We interviewed 16 veterans post-incarceration and 22 stakeholders from reentry-involved federal/state/community organizations. We performed a grounded thematic analysis, and recognizing consistencies between the emergent themes and the evidence-based Collaborative Chronic Care Model (CCM), we mapped findings to the CCM's elements - work role redesign (WRR), patient self-management support (PSS), provider decision support (PDS), clinical information systems (CIS), linkages to community resources (LCR), and organizational/leadership support (OLS). RESULTS Emergent themes included (i) WRR - coordination challenges among organizations involved in veterans' reentry; (ii) PSS - veterans' fear of reentering society; (iii) PDS - uneven knowledge by reentry support providers regarding available services when deciding which services to connect a reentry veteran to and whether he/she is ready and/or willing to receive services; (iv) CIS - lapses in MHD/SUD medications between release and a first scheduled health care appointment, as well as challenges in transfer of medical records; (v) LCR - inconsistent awareness of existing services and resources available across a disparate reentry system; and (vi) OLS - reentry plans designed to address only immediate transitional needs upon release, which do not always prioritize MHD/SUD needs. CONCLUSIONS Applying the CCM to coordinating cross-system health care and reentry support may contribute to reductions in mental health crises and overdoses in the precarious first weeks of the reentry period.
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Affiliation(s)
- Bo Kim
- VA Center for Healthcare Organization and Implementation Research, Bedford/Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - Rendelle E. Bolton
- VA Center for Healthcare Organization and Implementation Research, Bedford/Boston, MA USA
- Brandeis University The Heller School for Social Policy and Management, Waltham, MA USA
| | - Justeen Hyde
- VA Center for Healthcare Organization and Implementation Research, Bedford/Boston, MA USA
- Boston University School of Medicine, Boston, MA USA
| | - B. Graeme Fincke
- VA Center for Healthcare Organization and Implementation Research, Bedford/Boston, MA USA
- Boston University School of Public Health, Boston, MA USA
| | - Mari-Lynn Drainoni
- VA Center for Healthcare Organization and Implementation Research, Bedford/Boston, MA USA
- Boston University School of Medicine, Boston, MA USA
- Boston University School of Public Health, Boston, MA USA
| | - Beth Ann Petrakis
- VA Center for Healthcare Organization and Implementation Research, Bedford/Boston, MA USA
| | | | - D. Keith McInnes
- VA Center for Healthcare Organization and Implementation Research, Bedford/Boston, MA USA
- Boston University School of Public Health, Boston, MA USA
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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; 7:3. [PMID: 30915620 PMCID: PMC6718000 DOI: 10.1186/s40352-019-0085-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 03/12/2019] [Indexed: 05/22/2023]
Abstract
BACKGROUND Between 12,000 and 16,000 veterans leave incarceration every year, yet resources are limited for reentry support that helps veterans remain connected to VA and community health care and services after leaving incarceration. Homelessness and criminal justice recidivism may result when such follow-up and support are lacking. In order to determine where gaps exist in current reentry support efforts, we developed a novel methodological adaptation of process mapping (a visualization technique being increasingly used in health care to identify gaps in services and linkages) in the context of a larger implementation study of a peer-support intervention to link veterans to health-related services after incarceration ( https://clinicaltrials.gov/ , NCT02964897, registered November 4, 2016) to support their reentry into the community. METHODS We employed process mapping to analyze qualitative interviews with staff from organizations providing reentry support. Interview data were used to generate process maps specifying the sequence of events and the multiple parties that connect veterans to post-incarceration services. Process maps were then analyzed for uncertainties, gaps, and bottlenecks. RESULTS We found that reentry programs lack systematic means of identifying soon-to-be released veterans who may become their clients; veterans in prisons/jails, and recently released, lack information about reentry supports and how to access them; and veterans' whereabouts between their release and their health care appointments are often unknown to reentry and health care teams. These system-level shortcomings informed our intervention development and implementation planning of peer-support services for veterans' reentry. CONCLUSIONS Systematic information sharing that is inherent to process mapping makes more transparent the research needed, helping to engage participants and operational partners who are critical for successful implementation of interventions to improve reentry support for veterans leaving incarceration. Even beyond our immediate study, process mapping based on qualitative interview data enables visualization of data that is useful for 1) verifying the research team's interpretation of interviewee's accounts, 2) specifying the events that occur within processes that the implementation is targeting (identifying knowledge gaps and inefficiencies), and 3) articulating and tracking the pre- to post-implementation changes clearly to support dissemination of evidence-based health care practices for justice-involved populations.
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Affiliation(s)
- Bo Kim
- VA Center for Healthcare Organization and Implementation Research, Bedford/Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - Megan B. McCullough
- VA Center for Healthcare Organization and Implementation Research, Bedford/Boston, MA USA
- Boston University School of Public Health, Boston, MA USA
| | | | - Rendelle E. Bolton
- VA Center for Healthcare Organization and Implementation Research, Bedford/Boston, MA USA
- Brandeis University Heller School for Social Policy and Management, Waltham, MA USA
| | - Justeen Hyde
- VA Center for Healthcare Organization and Implementation Research, Bedford/Boston, MA USA
- Boston University School of Medicine, Boston, MA USA
| | - Mari-Lynn Drainoni
- VA Center for Healthcare Organization and Implementation Research, Bedford/Boston, MA USA
- Boston University School of Public Health, Boston, MA USA
- Boston University School of Medicine, Boston, MA USA
| | - B. Graeme Fincke
- VA Center for Healthcare Organization and Implementation Research, Bedford/Boston, MA USA
- Boston University School of Public Health, Boston, MA USA
| | - D. Keith McInnes
- VA Center for Healthcare Organization and Implementation Research, Bedford/Boston, MA USA
- Boston University School of Public Health, Boston, MA USA
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7
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Taylor E, Timko C, Harris AHS, Yu M, Finlay AK. Receipt of pharmacotherapy for alcohol use disorder by justice-involved women in the Veterans Health Administration. Addict Sci Clin Pract 2019; 14:1. [PMID: 30602392 PMCID: PMC6317204 DOI: 10.1186/s13722-018-0129-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 12/18/2018] [Indexed: 01/30/2023] Open
Abstract
Background Alcohol use disorder (AUD) and unhealthy drinking are prevalent among women involved in the criminal justice system and women military veterans. Pharmacotherapy—including naltrexone, topiramate, acamprosate, and disulfiram—for AUD is one form of effective treatment that is associated with better health and criminal justice outcomes. The current study examined the association of justice involvement with receipt of pharmacotherapy for AUD, as well as other patient factors that may explain variation in receipt of pharmacotherapy for AUD among women veterans who receive care at Veterans Health Administration (VHA) facilities.
Methods Using national VHA clinical records, we examined all women VHA patients who received an AUD diagnosis during an outpatient or inpatient visit in fiscal years (FY) 2014–2017. We compared patient characteristics by justice status, defined as contact with one of the VHA’s justice outreach programs, and used a mixed-effects logistic regression model to test whether justice involvement was independently associated with odds of receiving pharmacotherapy for AUD. Results Of 10,511 women veterans diagnosed with AUD in FY2017, 852 (8%) met our definition of justice-involved. Since FY2014, the percentage of women veterans who received pharmacotherapy for AUD increased (14–21%). Women justice-involved veterans and those who were homeless had higher odds of receiving pharmacotherapy for AUD (OR 1.29, CI 1.15–1.45; OR 1.35, CI 1.25–1.47). Women veterans age 55 or older or who were African-American had lower odds of receiving pharmacotherapy (OR 0.74, CI 0.67–0.82; OR 0.73, CI 0.68–0.79). Conclusions While women involved in the criminal justice system face many barriers to accessing health and social services, women justice-involved veterans had higher odds of receiving pharmacotherapy for AUD at VHA facilities compared to women veterans with no justice involvement. Legal mandates and supportive programming directed towards veterans in the criminal justice system may explain the higher rate of receipt of pharmacotherapy observed among justice-involved women veterans. Women veterans who are homeless may also have more opportunities to access and use pharmacotherapy for AUD compared to their housed counterparts.
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Affiliation(s)
- Emmeline Taylor
- Department of Veterans Affairs Health Care System, Center for Innovation to Implementation, Palo Alto, CA, 94304, USA. .,, 795 Willow Road (MPD-152), Menlo Park, CA, 94025, USA.
| | - Christine Timko
- Department of Veterans Affairs Health Care System, Center for Innovation to Implementation, Palo Alto, CA, 94304, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Alex H S Harris
- Department of Veterans Affairs Health Care System, Center for Innovation to Implementation, Palo Alto, CA, 94304, USA.,Department of Surgery, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Mengfei Yu
- Department of Veterans Affairs Health Care System, Center for Innovation to Implementation, Palo Alto, CA, 94304, USA
| | - Andrea K Finlay
- Department of Veterans Affairs Health Care System, Center for Innovation to Implementation, Palo Alto, CA, 94304, USA.,Department of Veterans Affairs, National Center on Homelessness Among Veterans, Menlo Park, CA, 94025, USA
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Finlay AK, Binswanger I, Timko C, Rosenthal J, Clark S, Blue-Howells J, McGuire J, Hagedorn H, Wong J, Van Campen J, Harris AHS. Receipt of Pharmacotherapy for Alcohol Use Disorder by Male Justice-Involved U.S. Veterans Health Administration Patients. CRIMINAL JUSTICE POLICY REVIEW 2018; 29:875-890. [PMID: 30393426 PMCID: PMC4852381 DOI: 10.1177/0887403416644011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examined whether, among Veterans Health Administration (VHA) patients, veterans with recent or current justice involvement have equal receipt of pharmacotherapy for alcohol use disorder compared to veterans with no justice involvement. Using national VHA records, we calculated the overall and facility rates of receipt as the number of patients who received pharmacotherapy for alcohol use disorder divided by the number of patients diagnosed with an alcohol use disorder. Using a mixed-effects logistic regression model, we tested whether justice involvement was associated with pharmacotherapy receipt. Male veterans with jail/court involvement had significantly higher odds of receiving pharmacotherapy for alcohol use disorder compared to other male veterans. Justice-involved veterans had equal or better receipt of pharmacotherapy for alcohol use disorder compared to veterans with no justice involvement. Pharmacotherapy rates are low overall, suggesting that more work can be done to connect veterans to these medications.
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Affiliation(s)
- Andrea K Finlay
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA 94025
- Department of Medicine and Division of General Medical Disciplines, Stanford University School of Medicine, 300 Pasteur Drive, S-102, Stanford, CA 94305-5110
| | - Ingrid Binswanger
- Kaiser Permanente Institute for Health Research, 10065 E Harvard Ave., Suite 300, Denver, CO 80231
- Division of General Internal Medicine, University of Colorado School of Medicine, E. 17 Ave., Aurora, CO 80204, USA
| | - Christine Timko
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA 94025
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305
| | - Joel Rosenthal
- Veterans Justice Programs, Department of Veterans Affairs, 795 Willow Road (152-MPD), Menlo Park, CA 94025
| | - Sean Clark
- Veterans Justice Programs, Department of Veterans Affairs, 2250 Leestown Road, Lexington, KY 40511
| | - Jessica Blue-Howells
- Veterans Justice Programs, Department of Veterans Affairs, Greater Los Angeles Health Care System - West LA Campus, Los Angeles, CA 90073
| | - Jim McGuire
- Veterans Justice Programs, Department of Veterans Affairs, Greater Los Angeles Health Care System - West LA Campus, Los Angeles, CA 90073
| | - Hildi Hagedorn
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, One Veterans Drive, Minneapolis, MN 55417
| | - Jessie Wong
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA 94025
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305
| | - James Van Campen
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA 94025
| | - Alex H S Harris
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA 94025
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Finlay AK, Stimmel M, Blue-Howells J, Rosenthal J, McGuire J, Binswanger I, Smelson D, Harris AHS, Frayne SM, Bowe T, Timko C. Use of Veterans Health Administration Mental Health and Substance Use Disorder Treatment After Exiting Prison: The Health Care for Reentry Veterans Program. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 44:177-187. [PMID: 26687114 DOI: 10.1007/s10488-015-0708-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The Veterans Health Administration (VA) Health Care for Reentry Veterans (HCRV) program links veterans exiting prison with treatment. Among veterans served by HCRV, national VA clinical data were used to describe contact with VA health care, and mental health and substance use disorder diagnoses and treatment use. Of veterans seen for an HCRV outreach visit, 56 % had contact with VA health care. Prevalence of mental health disorders was 57 %; of whom 77 % entered mental health treatment within a month of diagnosis. Prevalence of substance use disorders was 49 %; of whom 37 % entered substance use disorder treatment within a month of diagnosis. For veterans exiting prison, increasing access to VA health care, especially for rural veterans, and for substance use disorder treatment, are important quality improvement targets.
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Affiliation(s)
- Andrea K Finlay
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA, 94025, USA.
| | - Matthew Stimmel
- Veterans Justice Programs, Department of Veterans Affairs, 795 Willow Road, Menlo Park, CA, 94025, USA
| | - Jessica Blue-Howells
- Veterans Justice Programs, Department of Veterans Affairs, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA, 90073, USA
| | - Joel Rosenthal
- Veterans Justice Programs, Department of Veterans Affairs, 795 Willow Road, Menlo Park, CA, 94025, USA
| | - Jim McGuire
- Veterans Justice Programs, Department of Veterans Affairs, 795 Willow Road, Menlo Park, CA, 94025, USA
| | - Ingrid Binswanger
- Kaiser Permanente Institute for Health Research, 10065 E. Harvard Avenue, Suite 300, Denver, CO, 80231, USA
- Division of General Internal Medicine, University of Colorado School of Medicine, 12631 E. 17th Avenue, Aurora, CO, 80045, USA
| | - David Smelson
- National Center on Homelessness Among Veterans, Edith Nourse Rogers Memorial Veterans Hospital, 200 Springs Road, Bedford, MA, 01730, USA
- Department of Psychiatry, University of Massachusetts Medical School, 55 N Lake Avenue, Worcester, MA, 01655, USA
| | - Alex H S Harris
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA, 94025, USA
| | - Susan M Frayne
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA, 94025, USA
- Women's Health Service, Medical Service, VA Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA, 94304, USA
- Division of General Medical Disciplines, Stanford University School of Medicine, 1265 Welch Road, Stanford, CA, 94305, USA
| | - Tom Bowe
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA, 94025, USA
| | - Christine Timko
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA, 94025, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA, 94305, USA
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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; 17:647. [PMID: 28899394 PMCID: PMC5596492 DOI: 10.1186/s12913-017-2572-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 08/25/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Approximately 600,000 persons are released from prison annually in the United States. Relatively few receive sufficient re-entry services and are at risk for unemployment, homelessness, poverty, substance abuse relapse and recidivism. Persons leaving prison who have a mental illness and/or a substance use disorder are particularly challenged. This project aims to create a peer mentor program to extend the reach and effectiveness of reentry services provided by the Department of Veterans' Affairs (VA). We will implement a peer support for reentry veterans sequentially in two states. Our outcome measures are 1) fidelity of the intervention, 2) linkage to VA health care and, 3) continued engagement in health care. The aims for this project are as follows: (1) Conduct contextual analysis to identify VA and community reentry resources, and describe how reentry veterans use them. (2) Implement peer-support, in one state, to link reentry veterans to Veterans' Health Administration (VHA) primary care, mental health, and SUD services. (3) Port the peer-support intervention to another, geographically, and contextually different state. DESIGN This intervention involves a 2-state sequential implementation study (Massachusetts, followed by Pennsylvania) using a Facilitation Implementation strategy. We will conduct formative and summative analyses, including assessment of fidelity, and a matched comparison group to evaluate the intervention's outcomes of veteran linkage and engagement in VHA health care (using health care utilization measures). The study proceeds in 3 phases. DISCUSSION We anticipate that a peer support program will be effective at improving the reentry process for veterans, particularly in linking them to health, mental health, and SUD services and helping them to stay engaged in those services. It will fill a gap by providing veterans with access to a trusted individual, who understands their experience as a veteran and who has experienced justice involvement. The outputs from this project, including training materials, peer guidebooks, and implementation strategies can be adapted by other states and regions that wish to enhance services for veterans (or other populations) leaving incarceration. A larger cluster-randomized implementation-effectiveness study is planned. TRIAL REGISTRATION This protocol is registered with clinicaltrials.gov on November 4, 2016 and was assigned the number NCT02964897 .
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Affiliation(s)
- Molly M Simmons
- VA Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, USA. .,Boston University School of Public Health, Boston, USA.
| | - Benjamin G Fincke
- VA Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, USA.,Boston University School of Public Health, Boston, USA
| | - Mari-Lynn Drainoni
- VA Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, USA.,Boston University School of Public Health, Boston, USA.,Boston University School of Medicine, Boston, USA
| | - Bo Kim
- VA Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, USA.,Harvard Medical School, Boston, USA
| | - Tom Byrne
- VA Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, USA.,Boston University School of Social Work, Boston, USA
| | - David Smelson
- VA Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, USA.,VA National Center on Homelessness among Veterans, Bedford, USA.,University of Massachusetts Medical School, Worcester, USA
| | - Kevin Casey
- VA New England Healthcare System, Bedford, USA
| | - Marsha L Ellison
- VA Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, USA.,University of Massachusetts Medical School, Worcester, USA
| | | | | | - D Keith McInnes
- VA Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, USA.,Boston University School of Public Health, Boston, USA
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11
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Motta-Ochoa R, Bertrand K, Flores-Aranda J, Patenaude C, Brunelle N, Landry M, Brochu S. A Qualitative Study of Addiction Help-Seeking in People with Different Co-occurring Mental Disorders and Substance Use Problems. Int J Ment Health Addict 2017. [DOI: 10.1007/s11469-017-9762-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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12
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Priester MA, Browne T, Iachini A, Clone S, DeHart D, Seay KD. Treatment Access Barriers and Disparities Among Individuals with Co-Occurring Mental Health and Substance Use Disorders: An Integrative Literature Review. J Subst Abuse Treat 2015; 61:47-59. [PMID: 26531892 DOI: 10.1016/j.jsat.2015.09.006] [Citation(s) in RCA: 284] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 09/08/2015] [Accepted: 09/29/2015] [Indexed: 10/22/2022]
Abstract
The purpose of this integrative review is to examine and synthesize extant literature pertaining to barriers to substance abuse and mental health treatment for persons with co-occurring substance use and mental health disorders (COD). Electronic searches were conducted using ten scholarly databases. Thirty-six articles met inclusion criteria and were examined for this review. Narrative review of these articles resulted in the identification of two primary barriers to treatment access for individuals with COD: personal characteristics barriers and structural barriers. Clinical implications and directions for future research are discussed. In particular, additional studies on marginalized sub-populations are needed, specifically those that examine barriers to treatment access among older, non-White, non-heterosexual populations.
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Affiliation(s)
- Mary Ann Priester
- College of Social Work, DeSaussure College, University of South Carolina, Columbia, SC, 29208.
| | - Teri Browne
- College of Social Work, DeSaussure College, University of South Carolina, Columbia, SC, 29208
| | - Aidyn Iachini
- College of Social Work, DeSaussure College, University of South Carolina, Columbia, SC, 29208
| | - Stephanie Clone
- College of Social Work, DeSaussure College, University of South Carolina, Columbia, SC, 29208
| | - Dana DeHart
- College of Social Work, DeSaussure College, University of South Carolina, Columbia, SC, 29208
| | - Kristen D Seay
- College of Social Work, DeSaussure College, University of South Carolina, Columbia, SC, 29208
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13
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Pre- and post-sentence mental health service use by a population cohort of older offenders (≥45 years) in Western Australia. Soc Psychiatry Psychiatr Epidemiol 2015; 50:1097-110. [PMID: 25608707 DOI: 10.1007/s00127-015-1008-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 01/08/2015] [Indexed: 10/24/2022]
Abstract
PURPOSE Information on older offenders' mental health service (MHS) used before and after sentence is sparse. We therefore aimed to determine the 1-year prevalence of MHS use before sentence, and the likelihood and predictors of MHS use in the 5-year post-sentence period by first-time older adult offenders (≥45 years). METHODS Pre- and post-sentence MHS use by a cohort of 1,853 first-time offenders over 45 years in Western Australia was determined through whole-population linked administrative data. Logistic regression models compared the 1-year pre-sentence MHS contacts between offenders and matched non-offenders. Cox proportional hazards regression models identified the socio-demographic, offending and pre-sentence health service variables that determined post-sentence MHS use. RESULTS Older offenders were six times more likely to have used MHSs than non-offenders before sentence. Substance use was the most commonly treated disorder. Non-custodial offenders were twice more likely than prisoners to have been treated for any mental disorder and substance use disorders, and violent offenders were four times more likely to have attempted self-harm than non-violent offenders before being sentenced. The strongest predictors of post-sentence MHS contact were past psychiatric diagnosis in offenders with a pre-sentence MHS contact, and pre-sentence hospitalisation for attempted self-harm or physical illness, or being a male in those without. Discontinuity in MHS use after sentence by over half of the offenders with a prior contact was prominent. CONCLUSION Better detection and treatment of mental disorders in older offenders to ensure continuity of care at all transition points through age-sensitive correctional and community-based MHSs is needed.
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14
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Finlay AK, Binswanger IA, Smelson D, Sawh L, McGuire J, Rosenthal J, Blue-Howells J, Timko C, Blodgett JC, Harris AHS, Asch SM, Frayne S. Sex differences in mental health and substance use disorders and treatment entry among justice-involved Veterans in the Veterans Health Administration. Med Care 2015; 53:S105-11. [PMID: 25767963 PMCID: PMC5764085 DOI: 10.1097/mlr.0000000000000271] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND 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 [adjusted odds ratio (AOR)=1.98; 95% confidence interval (CI), 1.68-2.34] and lower odds of being diagnosed with a substance use disorder (AOR=0.50; 95% CI, 0.45-0.56) compared with men. Women had lower odds of entering mental health residential treatment (AOR=0.69; 95% CI, 0.57-0.83). 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.
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Affiliation(s)
- Andrea K. Finlay
- Center for Innovation to Implementation (Ci2i), Substance Use Disorder Quality Research Enhancement Initiative, VA Palo Alto Health Care System, Menlo Park, CA
| | - Ingrid A. Binswanger
- Division of General Internal Medicine University of Colorado School of Medicine, Community Health Services, Denver Health Medical Center, Denver, CO
| | - David Smelson
- National Center on Homelessness Among Veterans, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA
| | - Leon Sawh
- 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
| | - Jim McGuire
- Department of Veterans Affairs, Veterans Justice Programs
| | - Joel Rosenthal
- Department of Veterans Affairs, Veterans Justice Programs
| | | | - Christine Timko
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA
- Department of Psychiatry and Behavioral Sciences
| | - Janet C. Blodgett
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA
| | - Alex H. S. Harris
- Center for Innovation to Implementation (Ci2i), Substance Use Disorder Quality Research Enhancement Initiative, VA Palo Alto Health Care System, Menlo Park, CA
| | - Steven M. Asch
- Division of General Medical Disciplines, Stanford University School of Medicine, Menlo Park, CA
| | - Susan Frayne
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA
- Division of General Medical Disciplines, Stanford University School of Medicine, Menlo Park, CA
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15
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Finlay AK, Smelson D, Sawh L, McGuire J, Rosenthal J, Blue-Howells J, Timko C, Binswanger I, Frayne SM, Blodgett JC, Bowe T, Clark SC, Harris AHS. U.S. Department of Veterans Affairs Veterans Justice Outreach Program: Connecting Justice-Involved Veterans with Mental Health and Substance Use Disorder Treatment. ACTA ACUST UNITED AC 2013; 27. [PMID: 32180665 DOI: 10.1177/0887403414562601] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Veterans Justice Outreach (VJO) program of the U.S. Veterans Health Administration has a primary mission of linking military veterans in jails, courts, or in contact with law enforcement to mental health and substance use disorder treatment. National data of veterans with VJO contact were used to describe demographic characteristics, and mental health and substance use disorder diagnoses and treatment use and test correlates of treatment entry and engagement using multi-level logistic regression models. Of the 37,542 VJO veterans, treatment entry was associated with being homeless and having a mental health disorder or both a mental health and a substance use disorder versus a substance use disorder only. Being American Indian/Alaskan Native was associated with lower odds of treatment entry. Engagement was associated with female gender, older age, Asian race, urban residence, and homeless status. Increased utilization of substance use disorder treatment, especially pharmacotherapy, is an important quality improvement target.
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Affiliation(s)
- Andrea K Finlay
- Veteran Affairs Substance Use Disorder Quality Enhancement Research Initiative, Department of Veterans Affairs.,Center for Innovation to Implementation, VA Palo Alto Health Care System.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| | - David Smelson
- National Center on Homelessness Among Veterans, Edith Nourse Rogers Memorial Veterans Hospital.,Department of Psychiatry, University of Massachusetts Medical School
| | - Leon Sawh
- National Center on Homelessness Among Veterans, Edith Nourse Rogers Memorial Veterans Hospital.,Department of Psychiatry, University of Massachusetts Medical School.,School of Criminology and Justice Studies, University of Massachusetts Lowell
| | - Jim McGuire
- Veterans Justice Programs, Department of Veterans Affairs
| | - Joel Rosenthal
- Veterans Justice Programs, Department of Veterans Affairs
| | | | - Christine Timko
- Center for Innovation to Implementation, VA Palo Alto Health Care System.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| | | | - Susan M Frayne
- Center for Innovation to Implementation, VA Palo Alto Health Care System.,Women's Health Service, Medical Service, VA Palo Alto Health Care System.,Division of General Medical Disciplines, Stanford University School of Medicine
| | - Janet C Blodgett
- Center for Innovation to Implementation, VA Palo Alto Health Care System
| | - Tom Bowe
- Veteran Affairs Substance Use Disorder Quality Enhancement Research Initiative, Department of Veterans Affairs
| | - Sean C Clark
- Veterans Justice Programs, Department of Veterans Affairs
| | - Alex H S Harris
- Veteran Affairs Substance Use Disorder Quality Enhancement Research Initiative, Department of Veterans Affairs.,Center for Innovation to Implementation, VA Palo Alto Health Care System
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