Talk to the Veterans Crisis Line now
U.S. flag
An official website of the United States government

Health Services Research & Development

Veterans Crisis Line Badge
Go to the ORD website
Go to the QUERI website
HSRD Conference Logo



2019 HSR&D/QUERI National Conference Abstract

Printable View

1067 — Implementing a peer-support intervention to enhance housing, health care, and community reintegration for Veterans with criminal justice involvement

Lead/Presenter: D. Keith McInnes,  COIN - Bedford/Boston
All Authors: McInnes DK (Center for Healthcare Organization and Implementation Research, Bedford/Boston, and Boston University School of Public Health), Hyde J (Center for Healthcare Organization and Implementation Research, Bedford/Boston; and Boston University School of Medicine), Petrakis BA (Center for Healthcare Organization and Implementation Research, Bedford/Boston) Drainoni ML (Center for Healthcare Organization and Implementation Research, Bedford/Boston; and Boston University Schools of Medicine and of Public Health) Fincke BG (Center for Healthcare Organization and Implementation Research, Bedford/Boston; and Boston University School of Public Health) Byrne T (Center for Healthcare Organization and Implementation Research, Bedford/Boston; and Boston University School of Social Work) Yakovchenko V (Center for Healthcare Organization and Implementation Research, Bedford/Boston; and University of Massachusetts, Lowell, MA) Bolton R (Center for Healthcare Organization and Implementation Research, Bedford/Boston; and Brandeis University Heller School for Social Policy and Management, Waltham MA) Kim B (Center for Healthcare Organization and Implementation Research, Bedford/Boston; and Harvard Medical School, Boston MA) Wilson CK (VA New England Healthcare System, Bedford, MA) Blue-Howells J (VACO Health Care for Reentry Veterans and Project CHALENG) Casey K (VISN1 Network Homelessness Program, Bedford, MA) Simmons M (Rand Corporation, Boston, MA) Visher CA (Center for Drug and Health Studies, University of Delaware)

Objectives:
Persons released from incarceration face a risk of death 13 times that of the general population, with overdose being the primary cause. Veterans released from incarceration ("reentry veterans") have significant substance use and mental health treatment needs, and face barriers to healthcare, housing, and other social services. We developed and implemented the VA's first peer-support initiative for reentry Veterans, called the Post-Incarceration Engagement (PIE) program, to help reduce their risks of morbidity, mortality, homelessness and recidivism.

Methods:
We used internal and external Facilitation to implement PIE in Massachusetts. Pre-implementation work included developing an intervention manual and a curriculum to train peers. External facilitation involved stakeholder engagement and network development with state departments such as Corrections and Mental Health, and with community-based services; and marketing to VHA regional homelessness programs. Internal facilitation involved educating service line chiefs at Massachusetts' VHA medical centers. Peers met weekly with Veterans to address life priorities, and support community reintegration in 3 areas: linkage to services, skill building, and social support. Survey data (baseline and 3-months) and VA administrative data were analyzed. Three-month access outcomes were assessed, comparing PIE reentry Veterans to a cohort of reentry Veterans without peer support.

Results:
Planning and pre-implementation work overcame initial skepticism among state and community organizations, leading to PIE becoming a partner in state-wide criminal-justice initiatives. Over a 12-month period, PIE worked with 31 reentry Veterans released from 6 prisons. Peers had over 200 encounters with these Veterans, and co-facilitated weekly reentry Veteran groups at a VA medical center. PIE reentry veterans had a higher likelihood than comparison Veterans of linkage to substance use treatment (80% versus 19%, respectively, P < 0.001) and mental health care (87% versus 64%, respectively, borderline significant). They were more likely than comparison Veterans to access VHA's domiciliary program (53.3% versus 2.7%, respectively, P < 0.001) and short-term housing (26.7% versus 5.4%, respectively, P = 0.05). Trends (non-significant) suggested reentry Veterans, more than comparison Veterans, accessed transitional housing (26.7% versus 25.4%, respectively) and housing vouchers (6.7% versus 3.7%, respectively).

Implications:
A peer support program developed significant partnerships with state and community agencies resulting in a collaborative and coordinated approach to serving reentry Veterans, and enhanced Veterans' linkage to substance use, mental health, and housing services.

Impacts:
In a novel peer program, reentry Veterans, at elevated risk for overdose, are gaining greater access to services that can reduce their risk, and are being supported in their path to successful community reintegration.