MISSION-Vet HUD-VASH Implementation Study
David A. Smelson PSYD
Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA
Bedford, MA
Funding Period: April 2011 - December 2015

BACKGROUND/RATIONALE:
The inclusion of an evidence-based substance abuse/mental illness treatment model in the HUD-VASH Supportive Housing program is particularly important given that approximately 80% of individuals enrolled in HUD-VASH meet criteria for either a substance abuse problem or a co-occurring mental health issue. This project will compare implementation of the Maintaining Independence and Sobriety through Systems Integration, Outreach, and Networking co-occurring disorders treatment model for Veterans (MISSION-Vet) in the HUD-VASH program currently planned through VA Office of Patient Care Services to a well-established, manual guided, enhanced implementation approach called Getting to Outcomes (GTO) via a multisite, cluster randomized, hybrid implementation-effectiveness trial.

OBJECTIVE(S):
1. Compare the effect on fidelity to the MISSION-Vet intervention between HUD-VASH case managers implementing MISSION-Vet augmented with GTO and HUD-VASH case managers using implementation as usual (IU) strategies.
2. Compare the effect on the proportion of time the Veteran is housed between HUD-VASH case managers implementing MISSION-Vet augmented with GTO and HUD-VASH case managers using implementation as usual (IU) strategies.
3. Compare the effect of the MISSION-Vet intervention on mental health, substance use, and functional outcomes among veterans served by HUD-VASH case managers implementing MISSION-Vet augmented with GTO and HUD-VASH case managers using implementation as usual (IU) strategies.
4. Conduct an analysis of MISSION-Vet implementation by tracking factors key to the successful deployment of a new treatment as specified by the Reach, Effectiveness, Adoption, Implementation, & Maintenance (RE-AIM) model.

METHODS:
This project is a multisite, cluster-randomized,hybrid implementation-effectiveness trial in which 50 HUD-VASH case managers at three of the largest HUD-VASH programs in the country: VA Boston Healthcare System (Boston, MA), VA Capitol Health Care Network (Washington, D.C.), and VA Eastern Colorado Health Care System (Denver, CO), will be randomized to one of two conditions: (1) MISSION-Vet Implemented as Usual (IU) -OR- (2) IU augmented by GTO.


FINDINGS/RESULTS:
Thus far, emphasis has been placed on the pre-implementation planning and coordination efforts necessary to implement MISSION-Vet and GTO at each of the study sites. Meetings were held with key staff and leadership from each site to obtain buy-in and support for both MISSION-Vet and GTO. Training modules and electronic study note templates have been developed with input from HUD-VASH case managers to concisely capture key study data in a timely manner, and staffing adjustments have been made to the overall concept model to account for program changes since this project started. Washington D.C. has started enrolling participants and implementing MISSION-Vet along with the intervention group meeting regularly with the Technical Analyst. The Boston VAMC site was replaced with the Northampton VAMC which is starting to enroll participants.

IMPACT:
Findings from this study have the potential to guide policy and practice actions to achieve maximum treatment outcomes among homeless Veterans by examining the implementation of a treatment model within HUD-VASH, contributing to President Obama's goal of ending Veteran homelessness by 2015.

PUBLICATIONS:
None at this time.

DRA: Mental, Cognitive and Behavioral Disorders, Substance Abuse and Addiction
DRE: none
Keywords: QUERI Implementation
MeSH Terms: none