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

(MISSION-CJ Trial)

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

134 Participants Needed

Trial Summary

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 data supports the idea that MISSION-CJ Program for Substance Abuse and Mental Health Issues in Homeless Veterans is an effective treatment?

The available research shows that the MISSION-CJ program can enhance success among participants in drug treatment courts by addressing both mental health and substance use issues. It has been implemented in various courts and has shown preliminary effectiveness in helping individuals with co-occurring disorders, which means having both mental health and substance use problems. The program is designed to integrate different support systems, which helps participants maintain independence and sobriety. While the research highlights some challenges in implementation, it suggests that MISSION-CJ can be a valuable tool in improving outcomes for those involved in the criminal justice system. ^{1 2 3 4 5}

What data supports the effectiveness of the MISSION-CJ treatment for substance abuse and mental health issues in homeless veterans?

Research suggests that the MISSION-CJ treatment can enhance success among participants in drug treatment courts by addressing both mental health and criminal justice needs, particularly for those with co-occurring disorders (having both mental health and substance use issues). Additionally, a pilot study showed that MISSION-CJ improved treatment access and engagement when used alongside housing support for homeless individuals. ^{1 2 3 4 5}

What safety data is available for the MISSION-CJ treatment?

The provided research does not explicitly mention safety data for the MISSION-CJ treatment. However, it discusses the implementation and effectiveness of the program in drug treatment courts and mental health courts, focusing on co-occurring disorders and criminal justice risk factors. The studies highlight the importance of flexible implementation and equitable treatment but do not provide specific safety data. ^{1 2 3 5 6}

Is the MISSION-CJ program safe for humans?

The available research does not provide specific safety data for the MISSION-CJ program, but it is an evidence-based intervention used in drug treatment courts, suggesting it is generally considered safe for participants in these settings. ^{1 2 3 5 6}

Is the MISSION-CJ treatment for substance abuse and mental health issues in homeless veterans promising?

Yes, the MISSION-CJ treatment is promising. It has shown positive outcomes, such as reducing jail time, alcohol, and drug use, and increasing employment among participants. It helps veterans and others with mental health and substance use disorders by integrating support within court systems, making it easier for them to access and engage in treatment. ^{2 4 5 7 8}

How is the MISSION-CJ treatment different from other treatments for substance abuse and mental health issues in homeless veterans?

MISSION-CJ is unique because it integrates mental health and substance use disorder treatment with criminal justice support, specifically targeting veterans involved in the justice system. It combines case management, peer support, and wraparound services to address both mental health and legal challenges, which is not typically offered in standard treatments. ^{2 4 5 7 8}

What is the purpose of this trial?

The purpose of this study is to determine whether Maintaining Independence and Sobriety through Systems Integration, Outreach and Networking - Criminal Justice version (MISSION-CJ) is effective for reducing criminal recidivism and improving other health-related outcomes (substance use, mental health, housing, employment, community integration) among justice-involved, homeless Veterans with a co-occurring substance use and mental health disorder.

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

Eligibility Criteria

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

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

Treatment Details

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.

Participant Groups

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+

Findings from Research

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]

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]

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]

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]

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]

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]

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]

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]

References

1. England 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. [2023]

2. United States pubmed.ncbi.nlm.nih.gov

Implementation of MISSION-Criminal Justice in a Treatment Court: Preliminary Outcomes Among Individuals With Co-occurring Disorders. [2020]

3. Ireland pubmed.ncbi.nlm.nih.gov

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

4. United States pubmed.ncbi.nlm.nih.gov

Permanent Supportive Housing and Specialized Co-Occurring Disorders Wraparound Services for Homeless Individuals. [2022]

5. United States pubmed.ncbi.nlm.nih.gov

Challenges and Lessons Learned in the Regional Implementation of MISSION-CJ in Drug Treatment Courts. [2022]

6. England 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). [2021]

7. United States 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. [2021]

8. United States pubmed.ncbi.nlm.nih.gov

Integrating a Co-occurring Disorders Intervention in Drug Courts: An Open Pilot Trial. [2020]