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2019 HSR&D/QUERI National Conference Abstract

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1137 — Improving post-incarceration reentry support for Veterans with mental health and substance use disorders: Application of the Collaborative Care Model

Lead/Presenter: Bo Kim,  COIN - Bedford/Boston
All Authors: Kim B (VA Center for Healthcare Organization and Implementation Research, Bedford/Boston, MA; Harvard Medical School, Boston, MA), *Bolton RE (VA Center for Healthcare Organization and Implementation Research, Bedford/Boston, MA; Brandeis University The Heller School for Social Policy and Management, Waltham, MA), *Hyde J (VA Center for Healthcare Organization and Implementation Research, Bedford/Boston, MA; Boston University School of Medicine, Boston, MA) Fincke BG (VA Center for Healthcare Organization and Implementation Research, Bedford/Boston, MA; Boston University School of Public Health, Boston, MA) Drainoni M (VA Center for Healthcare Organization and Implementation Research, Bedford/Boston, MA; Boston University Schools of Public Health and Medicine, Boston, MA) Petrakis B (VA Center for Healthcare Organization and Implementation Research, Bedford/Boston, MA) Simmons MM (RAND Corporation, Boston, MA) McInnes DK (VA Center for Healthcare Organization and Implementation Research, Bedford/Boston, MA; Boston University School of Public Health, Boston, MA) *co-second authors

Objectives:
12,000-16,000 Veterans leave incarceration annually. Veterans with mental health (MH) and substance use disorders (SUDs) are at increased risk for deteriorating health, drug overdose, homelessness, and recidivism. Gaps in services are common and coordination of care is often lacking for this highly vulnerable population. Our objective was to identify opportunities to provide improved reentry support to Veterans with MH and SUDs leaving incarceration, by organizing care and services according to the evidence-based Collaborative Care Model (CCM).

Methods:
We conducted semi-structured interviews with 16 Veterans post-incarceration, and 22 stakeholders from Massachusetts organizations involved in the reentry process, representing federal, state, and community organizations. We performed a grounded thematic analysis, then recognizing consistencies between the emergent themes and the CCM, mapped findings to the CCM's elements - work-role redesign, patient self-management support, provider decision support, clinical information systems, linkages to community resources, and organizational/leadership support.

Results:
Themes organized by the CCM elements included the need for coordinated roles and responsibilities across reentry services; support for Veterans to manage anxiety associated with community reintegration; better needs-based matching of Veterans to providers with the relevant expertise; information systems to track medication and treatment records between prison and civilian healthcare systems, especially for MH and SUDs, to avoid gaps in medication taking; more widely shared knowledge with and among post-incarceration Veterans regarding community resources; and dedicated organizational resources toward longer-term peer support and case management for Veterans with MH and SUDs following release.

Implications:
The CCM constituted a useful organizing framework for our findings. The CCM may help comprehensively support the reentry needs of Veterans with MH conditions and SUDs, by delivering resources/expertise to Veterans in an efficient and coordinated manner, based on individual needs. Such strong anchoring of services to Veteran needs is an essential component of VA's continued progress towards fostering a learning health care community.

Impacts:
The CCM can bring rigorous coordination and implementation approaches to the growing field of reentry planning, particularly for Veterans with MH and SUD needs. Its application may contribute to reductions in mental health crises, overdoses, and recidivism in the precarious first weeks of the reentry period.