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Improving Linkage to Health and Other Services for Veterans Leaving Incarceration (PIE)

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ClinicalTrials.gov Identifier: NCT02964897
Recruitment Status : Recruiting
First Posted : November 16, 2016
Last Update Posted : July 4, 2018
Sponsor:
Collaborator:
US Department of Veterans Affairs
Information provided by (Responsible Party):
VA Office of Research and Development

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.

Condition or disease Intervention/treatment Phase
Linkage to Care Homelessness Substance Use Disorder Mental Health Behavioral: Peer-support plus usual care from the Health Care for Reentry Veterans program Behavioral: Usual care from the Health Care for Reentry Veterans program Not Applicable

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.

Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 180 participants
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Supportive Care
Official Title: Veterans Justice Reentry (Post-Incarceration) (QUE 15-284)
Actual Study Start Date : November 27, 2017
Estimated Primary Completion Date : September 30, 2019
Estimated Study Completion Date : September 30, 2020

Arm Intervention/treatment
Experimental: Intervention Arm with Peer Support
Veterans in this arm will receive the peer-support intervention, in addition to the usual care from the Health Care for Reentry Veterans Program.
Behavioral: Peer-support plus usual care from the Health Care for Reentry Veterans program
a peer mentor who is also a veteran will establish a relationship with each subject and provide instrumental and emotional support to the subject during the first 6 months of the subject's release from incarceration. This is in addition to the usual reentry support provided by the Health Care for Reentry Veterans program.
Other Name: peer mentoring; forensic peer support

Comparison Arm with Usual Care
Veterans in this arm will be receiving usual care from the Health Care for Reentry Veterans program (but they will not receive the peer-support intervention). They will be selected to be frequency-matched to veterans in the intervention arm by date of release from incarceration.
Behavioral: Usual care from the Health Care for Reentry Veterans program
Health Care for Reentry Veterans program provides reentry planning while the veteran is incarcerated. An outreach worker visits the veteran in the incarceration facility to conduct a needs assessment and help create a reentry plan to cover issues such as where they will be housed, what health care appointments they will need in the first 30 days, whether they need legal assistance, etc.
Other Name: HCRV reentry support




Primary Outcome Measures :
  1. Linkage to healthcare services [ Time Frame: 6 months after release from incarceration ]
    Participant will have made and kept one or more primary or specialty health care appointments.


Secondary Outcome Measures :
  1. Living in transitional or permanent housing [ Time Frame: 6 months after release from incarceration ]
    Subject is residing in transitional or permanent housing. Transitional housing is housing that provides appropriate supportive services (e.g. MH or SUD group therapy) to recently homeless persons to help them achieve independent living. Transitional and permanent housing do not include emergency shelters, living on the streets, or living in a structure unfit for human habitation.



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Ages Eligible for Study:   Child, Adult, Older Adult
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

Phase 1

  • Veteran released from a Massachusetts state prison
  • (for intervention subjects: interested in receiving reentry services) Phase 2
  • Veteran released from a Pennsylvania state prison
  • (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.


Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02964897


Contacts
Contact: Donald K McInnes, ScD MS BA (781) 687-3507 Keith.McInnes@va.gov
Contact: Beth A Petrakis, MPA BA (781) 687-2975 BethAnn.Petrakis@va.gov

Locations
United States, Massachusetts
Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA Recruiting
Bedford, Massachusetts, United States, 01730
Contact: Donald K McInnes, ScD MS BA    781-687-3507    Keith.McInnes@va.gov   
Contact: Justeen K Hyde, PhD    (781) 687-2028    Justeen.Hyde@va.gov   
Principal Investigator: Allen L. Gifford, MD         
Principal Investigator: Donald K McInnes, ScD MS BA         
Sponsors and Collaborators
VA Office of Research and Development
US Department of Veterans Affairs
Investigators
Principal Investigator: Donald K McInnes, ScD MS BA Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA
Principal Investigator: Allen L. Gifford, MD Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: VA Office of Research and Development
ClinicalTrials.gov Identifier: NCT02964897     History of Changes
Other Study ID Numbers: QUX 16-012
QUE 15-284 ( Other Grant/Funding Number: HSR&D QUERI )
First Posted: November 16, 2016    Key Record Dates
Last Update Posted: July 4, 2018
Last Verified: July 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: No

Keywords provided by VA Office of Research and Development:
justice involvement
Homeless
Vulnerable Populations
Linkage to care
Veterans

Additional relevant MeSH terms:
Substance-Related Disorders
Chemically-Induced Disorders
Mental Disorders