MISSION-CJ Program for Substance Abuse and Mental Health Issues in Homeless Veterans

(MISSION-CJ Trial)

Not currently recruiting at 3 trial locations

Overseen By Michael A Andre, MPH

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: VA Office of Research and Development

Disqualifiers: Cognitive impairment

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: 12 months

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests a program designed to assist homeless veterans involved with the justice system who face both substance use and mental health challenges. The goal is to determine if the program can reduce re-arrest rates and improve mental health, housing stability, and community involvement. The trial includes two main groups: one receives usual care with added peer support and community help, while the other participates in a specialized program called MISSION-CJ (Maintaining Independence and Sobriety through Systems Integration, Outreach, and Networking-Criminal Justice), which focuses on recovery and community connections. Veterans who may be suitable have participated in a mental health rehab program, encountered legal troubles in the past five years, and deal with both substance and mental health issues. As an unphased trial, this study offers veterans a unique opportunity to contribute to innovative solutions for enhancing their well-being and community reintegration.

Do I have to stop taking my current medications for the trial?

The trial protocol does not specify whether you need to stop taking your current medications.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It is best to discuss this with the trial coordinators or your healthcare provider.

What prior data suggests that the MISSION-CJ program is safe for homeless veterans with substance abuse and mental health issues?

Research has shown that the MISSION-CJ program has been tested in several recent small studies. These studies found that the program can help reduce repeat offenses and improve health for homeless Veterans involved with the justice system who have substance use and mental health issues.

Regarding safety, these studies did not report any major negative effects, indicating that participants generally tolerate the program well. Since the program focuses on support and connecting participants to community services, rather than using medication, the risk of physical side effects is likely low. This makes the MISSION-CJ program a generally safe option for those considering participation. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the MISSION-CJ program because it takes a unique, holistic approach to addressing substance abuse and mental health issues among homeless veterans involved with the criminal justice system. Unlike traditional treatments that might focus solely on medical interventions or counseling, MISSION-CJ combines assertive community outreach, psychoeducation, and robust linkages to community-based services, providing a comprehensive support network. This integrated method not only targets the veterans' immediate health needs but also works on their long-term independence and sobriety through peer support and systems integration, which is a fresh departure from standard care options like standalone therapy or medication.

What evidence suggests that the MISSION-CJ program is effective for reducing criminal recidivism and improving health-related outcomes in homeless veterans?

Research has shown that the MISSION-CJ program, a treatment option in this trial, holds promise for assisting homeless Veterans involved with the justice system. Recent small studies found that MISSION-CJ reduced the number of participants returning to jail or prison. Participants also reported improved mental health and reduced substance use. They were more likely to engage in and maintain treatment, enhancing their overall health. This program emphasizes active outreach and community support, addressing the needs of Veterans facing both substance use and mental health challenges. Another treatment arm in this trial, Enhanced Usual Care, offers usual care with added peer support and community outreach case management. ^{1 2 4 5 6}

Who Is on the Research Team?

David A. Smelson, PsyD

Principal Investigator

VA Bedford HealthCare System, Bedford, MA

Daniel M. Blonigen, PhD MA

Principal Investigator

VA Palo Alto Health Care System, Palo Alto, CA

Are You a Good Fit for This Trial?

This trial is for homeless veterans who have recently been in legal trouble, are about to enter a mental health program, and struggle with both substance use and mental health disorders. Veterans must be able to understand the study's consent process.

Inclusion Criteria

People who are struggling with their mental health are often entering residential rehabilitation treatment programs.

In the past 12 months, people who were arrested and charged or released from incarceration were mostly (a) men.

You have both a substance use disorder and a mental health disorder at the same time.

Exclusion Criteria

I understand the consent process and study procedures.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive MISSION-CJ programming targeting co-occurring substance use and mental health disorders, with assertive outreach, psychoeducation, and linkages to community-based services

12 months

Weekly sessions

Follow-up

Participants are monitored for changes in criminal recidivism, mental health, substance use, and community integration

3 months

What Are the Treatments Tested in This Trial?

Interventions

• Maintaining Independence and Sobriety through Systems Integration Outreach and Networking- Criminal Justice
• Maintaining Independence and Sobriety through Systems Integration Outreach and Networking Peer Support

Trial Overview The MISSION-CJ program aims to help these veterans by reducing criminal behavior and improving their overall well-being, including substance use, mental health status, housing stability, employment opportunities, and community involvement.

How Is the Trial Designed?

Group I: MISSION-CJ Experimental Treatment 1 Intervention

Maintaining Independence and Sobriety through Systems Integration Outreach and Networking- Criminal Justice version (MISSION-CJ) programming targets co-occurring substance use and mental health disorders and other related health outcomes faced by justice-involved homeless Veterans through assertive outreach, psychoeducation, and linkages to community-based services.

Group II: Enhanced Usual Care Experimental Treatment 1 Intervention

Usual care provided by the mental health residential rehabilitation treatment programs, with patients in both groups are enrolled in, in addition to peer support and community outreach case management. Patients receive 2 Peer Support Curriculum sessions per week (24 sessions total). Patients will receive unstructured community outreach and linkage support while enrolled in the mental health residential rehabilitation program. After discharge, patients will continue to receive 1 hour of weekly linkage support per week.

Maintaining Independence and Sobriety through Systems Integration Outreach and Networking- Criminal Justice is already approved in United States for the following indications:

Approved in United States as MISSION-CJ for:

• Co-occurring substance use and mental health disorders in justice-involved individuals

Who Is Running the Clinical Trial?

VA Office of Research and Development

Lead Sponsor

Trials

1,691

Recruited

3,759,000+

Published Research Related to This Trial

Among 37,542 veterans involved in the Veterans Justice Outreach program, those who were homeless and had both mental health and substance use disorders were more likely to enter treatment compared to those with only substance use disorders.

Factors such as being female, older, Asian, living in urban areas, and experiencing homelessness were linked to better engagement in treatment, highlighting the need for targeted strategies to improve access and utilization of substance use disorder treatments, especially pharmacotherapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

U.S. Department of Veterans Affairs Veterans Justice Outreach Program: Connecting Justice-Involved Veterans with Mental Health and Substance Use Disorder Treatment. Finlay, AK., Smelson, D., Sawh, L., et al.[2021]

The 'Engager' program highlighted the importance of building trust and rapport between professionals and clients in the criminal justice system, which is crucial for engaging individuals with mental health issues during their transition from prison to community.

Effective interagency collaboration, characterized by shared practices and strong supervision, is essential for improving client engagement and mental health outcomes, as identified through a multiple case study design involving four sites.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Using multiple case studies of health and justice services to inform the development of a new complex intervention for prison-leavers with common mental health problems (Engager). Lennox, C., Stevenson, R., Owens, C., et al.[2021]

The MISSION-CJ intervention, targeting co-occurring mental health and substance use disorders, showed promising preliminary effectiveness in a pilot study with 97 participants enrolled in a mental health court.

After 6 months, participants experienced significant reductions in nights incarcerated, illegal drug use, trauma symptoms, and behavioral health symptoms, indicating that MISSION-CJ may effectively address the needs of individuals in the criminal justice system.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Implementation of MISSION-Criminal Justice in a Treatment Court: Preliminary Outcomes Among Individuals With Co-occurring Disorders. Pinals, DA., Gaba, A., Clary, KM., et al.[2020]

In a pilot study involving 136 chronically homeless individuals, the MISSION program combined with Permanent Supportive Housing (PSH) resulted in 82.4% of participants being housed after one year, highlighting the effectiveness of this integrated approach for improving housing stability.

Participants who were housed showed significant improvements in mental health outcomes, including reduced emergency room visits for mental health issues and decreased illegal drug use, indicating that stable housing is crucial for better clinical results.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Permanent Supportive Housing and Specialized Co-Occurring Disorders Wraparound Services for Homeless Individuals. Smelson, DA., Perez, CK., Farquhar, I., et al.[2022]

Integrating the MISSION-Criminal Justice (MISSION-CJ) intervention into drug court procedures led to significant improvements in participants' lives, including reduced nights spent in jail and decreased alcohol and drug use over a 6-month period.

Participants also experienced an increase in full-time employment, highlighting the potential effectiveness of combining mental health and substance use treatment within the criminal justice system.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Integrating a Co-occurring Disorders Intervention in Drug Courts: An Open Pilot Trial. Smelson, D., Farquhar, I., Fisher, W., et al.[2020]

The CJ-DATS initiative focuses on testing and promoting effective addiction treatment interventions within the criminal justice system, using data from the National Criminal Justice Treatment Practice Survey to assess treatment access and service types.

The program aims to enhance the delivery and quality of drug abuse treatment services by applying systems change thinking, which could lead to more sustainable and research-supported treatment practices in correctional settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Understanding the importance of organizational and system variables on addiction treatment services within criminal justice settings. McCarty, D., Chandler, RK.[2009]

The MISSION-CJ case management program has been shown to enhance success rates among drug court participants, indicating its efficacy in supporting individuals in recovery.

Implementation of the program faced challenges that required flexibility in adherence to the model and clear communication of roles within the court system, suggesting that adaptability is crucial for successful integration.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Challenges and Lessons Learned in the Regional Implementation of MISSION-CJ in Drug Treatment Courts. Berdine, DE., Thomas, MC., Kahn, LS., et al.[2022]

This study aims to address racial and ethnic disparities in behavioral health treatment within drug treatment courts by implementing the MISSION-CJ intervention, which focuses on co-occurring mental health and substance use disorders.

Using qualitative interviews and community input, the research will identify barriers to equitable implementation and develop strategies to improve access and effectiveness of treatment for Black/African American and Hispanic/Latino individuals.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Identifying strategies to advance equitable implementation of co-occurring mental health and substance use disorder treatment in drug treatment courts: A study protocol. Gaba, A., LoVette, A., Pridgen, B., et al.[2023]

Citations

1. clinicaltrials.gov clinicaltrials.gov/study/NCT04523337

MISSION-CJ for Justice-Involved Homeless Veterans The purpose of this study is to determine whether Maintaining Independence and Sobriety through Systems Integration, Outreach and Networking - Criminal ...

2. reporter.nih.gov reporter.nih.gov/project-details/11371593

Project Details - NIH RePORTER Three recent open pilots of MISSION-CJ showed reduced criminal recidivism, improved behavioral health outcomes and increased access and engagement in care. A ...

3. researchprotocols.org researchprotocols.org/2025/1/e70750/PDF

Intervention for Justice-Involved Homeless Veterans With Objective: We aimed to (1.1) evaluate whether the Maintaining Independence and Sobriety through Systems Integration,. Outreach, and Networking ...

4. missionmodel.org missionmodel.org/mission-model

About Mission Model MISSION is an evidence-based intervention developed in 2001 to specifically meet mental health, substance misuse and other psychosocial needs of individuals.

5. researchgate.net researchgate.net/publication/390319087_Intervention_for_Justice-Involved_Homeless_Veterans_with_Co-Occurring_Substance_Use_and_Mental_Health_Disorders_Protocol_for_a_Randomized_Control_Hybrid_Effectiveness-Implementation_Trial_Preprint

Intervention for Justice-Involved Homeless Veterans with ... Supplemental workbook for the Maintaining Independence and Sobriety through Systems Integration, Outreach, and Networking (MISSION) treatment ...

6. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/40680272/

Intervention for Justice-Involved Homeless Veterans With ... A hybrid type 1 randomized controlled trial to test the effectiveness and implementation of MISSION-CJ, a multicomponent intervention for co-occurring disorder.