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Health Services Research & Development

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Blonigen DM, Rodriguez A, Nevedal A, Smelson D, Finlay A, Rosenthal J, Timko C. A Qualitative Analysis to Identify Provider Perceptions of Gaps in the Implementation of Best Care Practices to Reduce Recidivism among Justice-Involved Veterans. Presented at: VA HSR&D / QUERI National Meeting; 2015 Jul 10; Philadelphia, PA.
Abstract: Objectives: Justice-involved Veterans (JIVs) are a vulnerable population at risk for poor health outcomes and criminal recidivism. The Veterans Health Administration's (VHA) Justice Programs (VJP) promote community reintegration of JIVs by linking them to health services. To date, there have been no efforts to document gaps in the implementation of best practices to reduce recidivism among JIVs (e.g., treat substance abuse, homelessness, unemployment, and "criminogenic" thinking; assess recidivism risk level), which is critical to improving the long-term health of this population. To address this gap, we examined provider perceptions regarding assessment and treatment of recidivism risk among JIVs. Methods: Qualitative semi-structured interviews were conducted with 63 VJP Specialists (3 randomly selected from each VISN in VHA). VJP Specialists are providers who conduct outreach and engagement efforts with JIVs. To guide the interview, we utilized the Risk-Need-Responsivity (RNR) model, which outlines evidence-based principles that have been shown to reduce risk for poor health outcomes and recidivism among justice-involved individuals. Thematic coding and pile-sorting were used to identify major themes related to treatment access and practices for recidivism risk. Results: Specialists reported that JIVs generally have access to treatment for RNR-based risk factors of recidivism (e.g., substance abuse, homelessness, unemployment), but have less access to treatment in VHA that directly targets "criminogenic" thinking. In addition, few Specialists reported using structured assessments to measure risk level for recidivism, but the vast majority indicated that such assessments would be highly valuable for triage and case management and wanted training on use and interpretation of these assessments. Constraints on time and resources, provider stigma regarding "high-risk" patients, and lack of Veteran-specific tools were noted as potential barriers to integration of these assessments in VHA. Implications: Treatment of criminogenic thinking and integration of structured risk assessments may be significant gaps in the implementation of best practices to reduce recidivism among JIVs. Impacts: Criminal recidivism and poor health outcomes are highly intertwined; thus, greater efforts to reduce the former will help reduce the latter. The findings call for more systematic efforts in VHA to implement interventions for criminogenic thinking, and structured risk assessments to support case management and triage.

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