An interventional study of Peer-support plus usual care from the Health Care for Reentry Veterans program and Usual care from the Health Care for Reentry Veterans program in Linkage to Care, Homelessness and Substance Use Disorder, sponsored by VA Office of Research and Development. Completed at 2 sites in United States. Per ClinicalTrials.gov, last updated 2023-07-21.
Sponsored by VA Office of Research and Development · Not applicable, Interventional, and Supportive care
Veterans leaving incarceration and re-entering their communities (often described as "reentry" Veterans) face a number of challenges, including uncertainty about housing, vulnerability to substance use and relapse, on-going mental health concerns, and often multiple health conditions require timely continuity of care. The purpose of the project is to increase support for Veterans post-incarceration through the addition of trained peers with lived experience of being a Veteran and a history of incarceration. Emphasis will be on peers who will help link Veterans to Veterans Health Administration (VHA) services, including housing and healthcare. Peers will provide linkage with Health Care Reentry Veterans program specialists, transportation to appointments, and support in community reintegration. Peers will assist reentry veterans to make a successful transition and get and stay engaged in their care.
Veterans leaving incarceration (henceforth, "reentry Veterans") are among the most underserved by the VA and thus are an increasingly high priority population. The Bureau of Justice Statistics estimates that 140,000 Veterans are incarcerated in the U.S. at a given time, approximately 80% of whom are eligible for VA benefits. Many of these Veterans had problems with substance use disorders (SUD)(including alcohol) and/or mental health (MH) issues prior to being incarcerated.
The VA's national Health Care for Reentry Veterans (HCRV) program identifies 10,000-15,000 incarcerated Veterans annually preparing to transition back to the community. A HCRV outreach specialist works with incarcerated VHA-eligible Veterans to establish a post-release plan for linkage to VHA services. This program, with 1-2 outreach specialists per state, has improved the connection between reentry Veterans and the VHA. However, the investigators' analyses of homeless program data linked to VHA administrative data indicate that 43% of eligible HCRV Veterans do not have a VHA outpatient contact in the first 4 months post incarceration. Reducing this number is critical given the elevated rates of chronic health conditions, as well as MH or SUDs in this population.
To address this gap, the investigators will work with the national HCRV office to implement an evidence-based peer support intervention to extend the reach and effectiveness of the HCRV program in linking Veterans to VHA. Peers with incarceration experience are likely to better understand and connect with Veterans on a personal level than the outreach specialist, and thus are more likely to maintain contact and link to VHA during the first months post-release. Peers are gaining popularity in forensic settings (called "forensic peer specialists") with civilian populations and would likely be beneficial for a Veteran population .
The aims of this project are:
2,181 studies on the registry are indexed under Substance-Related Disorders; 399 are open to participants now.
This study's enrollment of 79 is below the median of 108 across 1,770 interventional studies indexed under Substance-Related Disorders.
Browse Substance-Related Disorders studies →VA Office of Research and Development is the lead sponsor of 1,767 studies on the registry; 394 are open to participants now.
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Phase 1
Exclusion Criteria:
- No history of dementia or other serious cognitive condition that would prevent them from being interviewed or completing a survey questionnaire.
Veterans in this arm will receive the peer-support intervention, in addition to the usual care from the Health Care for Reentry Veterans Program.
Behavioral: Peer-support plus usual care from the Health Care for Reentry Veterans program
Veterans in this arm will be receiving usual care from the Health Care for Reentry Veterans program (but they will not receive the peer-support intervention). They will be selected to be frequency-matched to veterans in the intervention arm by date of release from incarceration.
Behavioral: Usual care from the Health Care for Reentry Veterans program
a peer mentor who is also a veteran will establish a relationship with each subject and provide instrumental and emotional support to the subject during the first 6 months of the subject's release from incarceration. This is in addition to the usual reentry support provided by the Health Care for Reentry Veterans program.
Also known as: peer mentoring; forensic peer support
Health Care for Reentry Veterans program provides reentry planning while the veteran is incarcerated. An outreach worker visits the veteran in the incarceration facility to conduct a needs assessment and help create a reentry plan to cover issues such as where they will be housed, what health care appointments they will need in the first 30 days, whether they need legal assistance, etc.
Also known as: HCRV reentry support
Substance Use Care
Participant will have made and kept one or more substance use disorder care visits
Time frame: 3 months after release from incarceration
Mental Health
Participant will have made and kept one or more outpatient mental health care visits
Time frame: 3 months after release from incarceration
Primary Care
Participant will have made and kept one or more primary care visits
Time frame: 3 months after release from incarceration
| Milestone | Intervention Arm With Peer Support | Comparison Arm With Usual Care |
|---|---|---|
| Started | 43 | 36 |
| Completed | 43 | 36 |
| Not completed | 0 | 0 |
Participant will have made and kept one or more substance use disorder care visits
| Participants | Intervention Arm With Peer Support | Comparison Arm With Usual Care |
|---|---|---|
| Substance Use Care | 37 | 7 |
Participant will have made and kept one or more outpatient mental health care visits
| Participants | Intervention Arm With Peer Support | Comparison Arm With Usual Care |
|---|---|---|
| Mental Health | 42 | 23 |
Participant will have made and kept one or more primary care visits
| Participants | Intervention Arm With Peer Support | Comparison Arm With Usual Care |
|---|---|---|
| Primary Care | 25 | 24 |
Collected over 1 Year. Non-serious events are listed at a 0% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Intervention Arm With Peer Support | 1/43 (2.3%) | 1/43 (2.3%) | 0/43 (0%) |
| Comparison Arm With Usual Care | 0/36 (0%) | 0/36 (0%) | 0/36 (0%) |
| Event | Intervention Arm With Peer Support | Comparison Arm With Usual Care |
|---|---|---|
| DeathGeneral disorders | 1/43 | 0/36 |
| Age, Continuous(years) | Intervention Arm With Peer Support | Comparison Arm With Usual Care | Total |
|---|---|---|---|
| Mean | 49.3 ± 13 | 53.8 ± 14 | 51.4 ± 14 |
| Sex: Female, Male(Participants) | Intervention Arm With Peer Support | Comparison Arm With Usual Care | Total |
|---|---|---|---|
| Female | 0 | 0 | 0 |
| Male | 43 | 36 | 79 |
| Race/Ethnicity, Customized(Participants) | Intervention Arm With Peer Support | Comparison Arm With Usual Care | Total |
|---|---|---|---|
| Race — African American or Black | 10 | 6 | 16 |
| Race — White | 31 | 30 | 61 |
| Race — Multiple/other/declined | 2 | 0 | 2 |
| Region of Enrollment(Participants) | Intervention Arm With Peer Support | Comparison Arm With Usual Care | Total |
|---|---|---|---|
| United States | 43 | 36 | 79 |
| Marital status(Participants) | Intervention Arm With Peer Support | Comparison Arm With Usual Care | Total |
|---|---|---|---|
| Not partnered (single, divorced, separated, widowed) | 37 | 34 | 71 |
| Married or other partner relationship | 6 | 2 | 8 |
| Self-rated health(Participants) | Intervention Arm With Peer Support | Comparison Arm With Usual Care | Total |
|---|---|---|---|
| Excellent | 6 | 8 | 14 |
| Very good | 9 | 3 | 12 |
| Good | 17 | 12 | 29 |
| Fair | 8 | 5 | 13 |
| Poor | 3 | 4 | 7 |
| Missing | 0 | 4 | 4 |
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