US Veterans' Court Programs: An Inventory and Analysis of National Survey Data.

This study used data from a phone survey inventory of US veterans' courts to provide descriptive information on the current status of their various elements. To identify which items were most predictive of a court's percentage of subjects terminated from their program, a linear regression was performed. The following were associated with higher rates of termination from the veterans' court (VC) program: (a) programs that offered phase progression based on measurable goals, (b) programs that conduct frequent drug and alcohol testing, and (c) programs for which sanctions are more severe for failing immediate goals (sobriety) versus long-term ones (completion of training). The following were associated with lower rates of termination from the VC program: (a) programs in which later phases permit less stringent testing, (b) programs utilizing behavioral contracts, (c) programs utilizing brief incarcerations. This inventory provides nationwide empirical data that may be used in the development of veterans' courts.

Homelessness in a national sample of incarcerated veterans in state and federal prisons.

The Veterans Health Administration (VHA) has been increasing efforts to reach out to assist incarcerated veterans. While previous studies have shown strong associations between incarceration and homelessness, few studies have examined distinctive characteristics of incarcerated homeless and non-homeless veterans. National administrative data on 30,348 incarcerated veterans served by the Health Care for Re-entry Veterans (HCRV) program were analyzed. Incarcerated veterans were classified into four groups based on their history of past homelessness: not homeless, transiently homeless, episodically homeless, and chronically homeless. Multinomial logistic regression was used to compare groups on sociodemographic characteristics, criminal justice status, clinical status, and their interest in using VHA services. Of the sample, 70 % were classified as not homeless, 8 % as transiently homeless, 11 % as episodically homeless, and 11 % as chronically homeless. Thus, 30 % of the sample had a homeless history, which is five times the 6 % rate of past homelessness among adult men in the general population. Compared to non-homeless incarcerated veterans, all three homeless groups reported significantly more mental health problems, more substance abuse, more times arrested in their lifetime, more likely to be incarcerated for a non-violent offense, and were more interested in receiving VHA services after release from prison. Together, these findings suggest re-entry programs, like HCRV, can address relevant mental health-related service needs, especially among formerly homeless veterans and veterans in need of services are receptive to the offer of assistance.

Risk of incarceration and clinical characteristics of incarcerated veterans by race/ethnicity.

PURPOSE: Unprecedented growth in the US prison population has highlighted the overrepresentation of racial/ethnic minorities in prisons. This study examined the hypothesis that veteran status is protective against incarceration for veterans of different racial/ethnic minorities and compared the clinical characteristics of incarcerated veterans by race/ethnicity. METHODS: Using national data from a prisoner re-entry program and data from the 2010 National Survey of Veterans, this study examined the risk of incarceration among veterans who were racial/ethnic minorities and compared sociodemographic and clinical characteristics to White incarcerated veterans. RESULTS: Of a sample of 30,834 incarcerated veterans, 52 % were White, 39 % African American, 7 % Hispanic, and 2 % were categorized as "Other." African American veterans were 5.6 times and Hispanic veterans 4.3 times more likely to be incarcerated than White veterans across age groups. However, the published odds of being incarcerated as an African American in the general population compared to Whites (6.7 times) is higher, suggesting that veteran status may be somewhat protective against incarceration for African Americans, particularly among certain age groups. Among incarcerated veterans, multivariate analyses found that African American veterans were significantly more likely to have a drug/abuse dependency diagnosis and be currently incarcerated for a drug offense than Whites. Hispanic veterans were significantly more likely to be chronically homeless and also more likely to be incarcerated for a drug offense. CONCLUSIONS: Racial/ethnic differences in incarceration persist among veterans, although are slightly attenuated. Efforts to connect incarcerated veterans with mental health services post-release should be supported, especially in connecting veterans to substance abuse treatment.

Comparison of outcomes of homeless female and male veterans in transitional housing.

Homelessness among female veterans is of national concern, but there have been few studies of how they differ from male veterans or whether they have different outcomes. This study compared 59 female and 1,181 male participants in a multi-site study of three VA-funded transitional housing programs over a 1-year period following completion of an episode of treatment. At baseline, female participants were younger, reported more psychiatric symptoms, had shorter histories of homelessness,were less likely to have substance use disorders, and were less likely to be working than males. After controlling for these baseline differences, there were no overall gender differences in outcomes measures of housing, employment,substance use, physical and mental health, or quality of life. These results suggest homeless female veterans have different characteristics than male veterans, but benefit equally from transitional housing.

Do faith-based residential care services affect the religious faith and clinical outcomes of homeless veterans?

Data on 1,271 clients in three residential care services funded by the Department of Veterans Affairs was used to examine: (1) how religious-oriented programs differ in their social environment from secular programs, (2) how religious-oriented programs affect the religiosity of clients, and (3) how client religiosity is associated with outcomes. Programs were categorized as: secular, secular now but religious in the past, and currently religiously oriented. Results showed (1) participants in programs that were currently religious reported the greatest program clarity, but secular services reported the most supportive environments; (2) participants in programs that were currently religious did not report increases in religious faith or religious participation over time; nevertheless (3) greater religious participation was associated with greater improvement in housing, mental health, substance abuse, and quality of life. These findings suggest religious-oriented programs have little influence on clients' religious faith, but more religiously oriented clients have somewhat superior outcomes.

Cognitive-behavioral treatments for criminogenic thinking: Barriers and facilitators to implementation within the Veterans Health Administration.

Cognitive-behavioral treatments for criminogenic thinking (i.e., antisocial cognitions, attitudes, and traits) are regarded as best practices for reducing criminal recidivism among justice-involved adults. However, the barriers and facilitators to implementation of these treatments within large health care systems such as the Veterans Health Administration (VHA) are largely unknown. To address this gap, we conducted qualitative interviews with 22 Specialists from the VHA's Veterans Justice Programs who had been trained in a cognitive-behavioral treatment for criminogenic thinking (i.e., Moral Reconation Therapy [MRT], Thinking for a Change [T4C]). The time-intensiveness of these treatments emerged as a barrier to implementation. Potential solutions identified were patient incentives for treatment engagement, streamlining the curriculum, and implementing the treatments within long-term/residential programs. At the program level, providers' stigma/bias toward patients with antisocial tendencies was seen as a barrier to implementation, as were time/resource constraints on providers. To address the latter, use of peer providers to deliver the treatments and partnerships between justice programs and behavioral health services were suggested. At the system level, lack of recognition of criminogenic treatments as evidence based, and uncertainty of sustained funds to support ongoing costs of these treatments emerged as implementation barriers. To address the latter, a train-the-trainers model was suggested. Our findings serve as a guide for implementation of criminogenic treatments for providers and policymakers in VHA and other large health care systems, which are increasingly called upon to provide care to justice-involved adults in the community. (PsycINFO Database Record

Predictors of Incarceration of Veterans Participating in U.S. Veterans' Courts.

OBJECTIVE: Significant variability exists regarding the criteria and procedures used by different veterans' courts (VCs) across the country. Limited guidance is available regarding which VC model has the most successful outcomes. The purpose of this study was to examine factors associated with incarceration during VC participation. METHODS: This study used data for 1,224 veterans collected from the HOMES (Homeless Operations Management and Evaluation System) database of the Department of Veterans Affairs, as well as data from a national phone survey inventory of all U.S. VCs. To identify variables associated with incarceration during VC participation, four backward conditional logistic regressions were performed. RESULTS: The following variables were associated with higher rates of incarceration because of a veteran's noncompletion of the VC program: charges of probation or parole violations, longer stays in the VC program, end of VC participation because of incarceration for a new arrest or case transfer by the legal system, and requiring mental health follow-up but not undergoing treatment. The following variables were associated with lower rates of incarceration: stable housing and participating in a VC program that referred veterans for substance abuse treatment. CONCLUSIONS: This study offers VCs a thorough review of an extensive set of recidivism data. Further investigation is necessary to understand the impact of VCs.

Criminal history as a prognostic indicator in the treatment of homeless people with severe mental illness.

OBJECTIVE: This study examined the clinical problems and treatment outcomes of homeless people with severe mental illness and a history of incarceration. METHODS: Between May 1994 and June 1998, a total of 5,774 people entered assertive community treatment case management services in the Access to Community Care and Effective Services and Supports (ACCESS) demonstration program at 18 sites in nine states. This study used data from reassessments at 12 months after program entry. Analysis of variance was used to compare baseline status and 12-month outcomes for clients with a lifetime incarceration history of less than six months, of six months or more, and no incarceration history. The outcomes assessed were housing status, employment status, psychiatric problems, alcohol problems, drug problems, and criminal justice involvement. RESULTS: Two-thirds of the ACCESS clients had a history of incarceration, with about one-third having less than six months of incarceration and about one-third having six months or more of incarceration. Clients with a long-term incarceration history had higher psychiatric symptom scores, higher drug use and alcohol use scores, and higher levels of dual diagnosis than those with a short-term incarceration history or those with no history of incarceration. The same order of differences was found on measures of childhood abuse, family-of-origin stability, and childhood conduct disorder. Clients with an incarceration history of six months or more reported higher levels of long-term homelessness than the group without an incarceration history. The group with an incarceration history of less than six months showed less improvement at the 12-month follow-up evaluation than the group with no incarceration history on only one outcome measure, psychiatric problems. The group with an incarceration history of six months or more had poorer outcomes than the group with no incarceration history on only two of six outcomes, psychiatric problems and number of days in jail. CONCLUSIONS: This study found that among homeless clients with severe mental illness, clients with a history of incarceration have more serious problems and show somewhat less improvement in some community adjustment domains.

The U.S. Department of Veterans Affairs Veterans Justice programs and the sequential intercept model: case examples in national dissemination of intervention for justice-involved veterans.

Veterans are a significant subpopulation in criminal justice populations, comprising between 9% and 10% of arrestee, jail, prison, and community-supervision populations. In order to address the needs of justice-involved veterans, the U.S. Department of Veterans Affairs (VA) Veterans Justice Programs (VJP) offer services to veterans at multiple points in their involvement in the criminal justice system. Within the context of the VA's national mandate to develop VJP, this article presents best practice case examples using the Sequential Intercept Model as the intervention frame, and discusses each in context of a community psychology framework for innovation dissemination. The case examples demonstrate how central program guidance is adapted locally to meet the national mandate using strategies that fit the local environment, illustrating the innovations in action orientation, boundary spanning, and flexibility of organizations. This review provides examples of creative reinvention that expand on the mandate and work to meet local needs. To optimize services to veterans released from custody or supervised in the community, future study of the implementation of this national mandate should examine all VJP sites to identify the full range of best practices in local program implementation.

Risk of incarceration and other characteristics of Iraq and Afghanistan era veterans in state and federal prisons.

OBJECTIVE: The Health Care for Reentry Veterans (HCRV) program provides Veterans Health Administration outreach services to veterans incarcerated in state and federal prisons. This study used HCRV data to compare risk of incarceration of veterans of Operations Enduring Freedom (OEF), Iraqi Freedom (OIF), and New Dawn (OND) and other veterans and to identify sociodemographic and clinical characteristics of incarcerated veterans of OEF/OIF/OND. METHODS: Administrative national data were analyzed for 30,968 incarcerated veterans, including 1,201 OEF/OIF/OND veterans, contacted from October 2007 to April 2011. Odds ratios were calculated comparing the risk of incarceration among OEF/OIF/OND and other veterans in the HCRV sample and in a weighted sample of nonincarcerated veterans from the 2010 National Survey of Veterans. Stepwise logistic regressions of HCRV data examined characteristics of incarcerated veterans independently associated with OEF/OIF/OND service. RESULTS: Regardless of ethnicity or age, OEF/OIF/OND veterans were less than half as likely as other veterans to be incarcerated and constituted only 3.9% of the incarcerated veterans. Compared with other incarcerated veterans, OEF/OIF/OND veterans were younger, were more likely to be married, were more likely to report combat exposure, expected a shorter incarceration, were 26% less likely to have a diagnosis of drug abuse or dependence, and were three times more likely to have combat-related posttraumatic stress disorder (PTSD). CONCLUSIONS: OEF/OIF/OND veterans appeared to be at lower risk of incarceration than veterans of other service eras, but those who were incarcerated had higher rates of PTSD. Efforts to link these veterans to mental health services upon their release are warranted.

Sobriety as an admission criterion for transitional housing: a multi-site comparison of programs with a sobriety requirement to programs with no sobriety requirement.

BACKGROUND: This study examined whether homeless clients enrolled in transitional housing programs that required sobriety (SR) as an admission criterion have outcomes comparable to clients enrolled in programs that did not require sobriety (NSR) as an admission criterion. METHODS: A total of 1062 military veterans in 40 transitional housing programs funded by the United States Department of Veterans Affairs were grouped based on whether they were in SR or NSR programs and followed over a one-year period after program discharge. Participants in SR and NSR programs were compared on their ratings of the social climate of the program, and housing and psychosocial outcomes. RESULTS: Participants in SR programs reported more days housed and better psychosocial outcomes than participants in NSR programs, although the differences were small and there were no differences in ratings of their social climate. Both participants in SR and NSR programs showed improvements on most outcomes after discharge from transitional housing. There were no significant differences in outcomes between participants actively abusing substances at program entry compared to those who were not. CONCLUSIONS: Requiring sobriety as an admission criterion in transitional housing made only a small difference in housing outcomes post-discharge. Further study is needed to determine whether requiring sobriety at admission in transitional housing is necessary for successful client outcomes.

Caveolin-1 and altered neuregulin signaling contribute to the pathophysiological progression of diabetic peripheral neuropathy.

OBJECTIVE: Evaluate if Erb B2 activation and the loss of caveolin-1 (Cav1) contribute to the pathophysiological progression of diabetic peripheral neuropathy (DPN). RESEARCH DESIGN AND METHODS: Cav1 knockout and wild-type C57BL/6 mice were rendered diabetic with streptozotocin, and changes in motor nerve conduction velocity (MNCV), mechanical and thermal hypoalgesia, Erb B2 phosphorylation (pErb B2), and epidermal nerve fiber density were assessed. The contribution of Erb B2 to DPN was assessed using the Erb B2 inhibitors PKI 166 and erlotinib and a conditional bitransgenic mouse that expressed a constitutively active form of Erb B2 in myelinated Schwann cells (SCs). RESULTS: Diabetic mice exhibited decreased MNCV and mechanical and thermal sensitivity, but the extent of these deficits was more severe in diabetic Cav1 knockout mice. Diabetes increased pErb B2 levels in both genotypes, but the absence of Cav1 correlated with a greater increase in pErb B2. Erb B2 activation contributed to the mechanical hypoalgesia and MNCV deficits in both diabetic genotypes because treatment with erlotinib or PKI 166 improved these indexes of DPN. Similarly, induction of a constitutively active Erb B2 in myelinated SCs was sufficient to decrease MNCV and induce a mechanical hypoalgesia in the absence of diabetes. CONCLUSIONS: Increased Erb B2 activity contributes to specific indexes of DPN, and Cav1 may be an endogenous regulator of Erb B2 signaling. Altered Erb B2 signaling is a novel mechanism that contributes to SC dysfunction in diabetes, and inhibiting Erb B2 may ameliorate deficits of tactile sensitivity in DPN.

Residential environment and quality of life among seriously mentally ill residents of board and care homes.

This study examined the relationship between residential environment of seriously mentally ill patients living in board and care homes and quality of life. Participants included 162 seriously mentally ill veteran patients living in 26 board and care homes in Los Angeles. Data from structured interviews were used to assess subjective quality of life (satisfaction with living situation and general well-being) and objective quality of life (social functioning and daily activities). Independent variables examined in multivariate analyses included individual socio-demographic and clinical characteristics, objective characteristics of the home, and subjective resident assessments of social climate within the home. Adjusting for individual characteristics, social climate was significantly and positively associated with both satisfaction with current living situation and with general well-being. Interpersonal conflict was negatively associated with general well-being. Number of beds within the home and median income in the neighborhood were significantly associated (positively and negatively, respectively) with social functioning outside the home. Living environment characteristics explained between 3 and 9% of the total variation in three of four quality of life measures, and 27% of the variation in the fourth, satisfaction with living situation. Satisfaction with living situation among seriously mentally ill residents of board and care homes may be enhanced by making the social climate more positive, and reducing conflict within the home. Social functioning outside of the home may be enhanced by placing patients into a home with more beds, and/or a home located in a lower income neighborhood.