Justice-involved Veterans Research Articles

American Legion Participation Among Incarcerated Veterans

ABSTRACT In the social sciences, belongingness is among the individual core social needs. Institutionalization is a powerful mediator in the individual search for belongingness, as it establishes agency among group members. Using a conceptual framework that borrows from theories of institutionalization and group membership, we examine the lives of incarcerated military veterans and their choices in group affiliation during incarceration, especially in the context of American Legion posts behind bars. We use interview data from 43 incarcerated veterans to interpret patterns of belongingness, group trust, and group affiliation as developed within and across institutions. Five themes related to American Legion involvement emerged: (1) brotherhood and camaraderie; (2) serving others and the community; (3) creating a routine and improving quality of life; (4) creating community; and (5) leadership and conflict. Research on belongingness, group membership, and participation in peer-led prison programs is critical for improving knowledge on prison adaptation. It also provides a foundation for innovative approaches to post-release integration and desistance from crime among justice-involved veterans.

‘Spice’ Use Motivations, Experiences, and Repercussions among Veterans of the United States Armed Forces

Background and Objectives The potential for synthetic cannabinoids (SCs) to function as an alternative to marijuana without the same risk of a positive urinalyses led to claims of pervasive military SC use. Case studies confirm use among veterans, but no study has adequately explored SC use in the military using detailed interview data. Methods Interviews (1-2 h) were conducted with 318 justice-involved veterans. Recruitment was attempted with all participants in eight veterans treatment courts in three U.S. states (54.9% of 579 eligible veterans). Interviews were transcribed and thematic analyses completed. Results SC use was reported by 65 participants (21.3%). Major emergent themes indicated SCs were perceived as unpleasant, overly powerful, and a poor substitute for marijuana. Further, habitual use was rare as many chose not to reuse after initial negative experiences. Few indicated that the perception that SCs would not appear on routine military urinalyses enabled their use. Veterans were aware of the changing drug composition and feared “bad batches.” Conclusions SCs were explicitly disliked both independently and relative to marijuana. Nine discussed avoiding positive military drug screens as a consideration, but negative initial experiences generally prevented progression to habitual use. Veterans did not view SCs as a suitable marijuana replacement. Fears that SCs are being used as a marijuana alternative among veterans subject to frequent drug testing appear unfounded. These interviews suggest that routine military drug testing did not motivate individuals to use SCs habitually as a marijuana replacement; however, veterans’ negative interpretation of SC effects contributed to this outcome.

Patterns of Psychiatric Medication Prescriptions for Veterans in Treatment Courts and Other Specialty Courts.

Psychiatric medications can serve as important tools for addressing behavioral health issues among criminal justice-involved (CJI) veterans. This study used national data on 12,790 CJI veterans in the U.S. Department of Veterans Affairs (VA) Veterans Justice Outreach program from 2019 to 2020 to compare patterns of psychiatric medication prescriptions among veterans who entered a veterans treatment court (n = 6975), another specialty court (SC; n = 414), or no-SC (n = 5401). Different classes of medications were examined, including antidepressants, stimulants, antipsychotics, benzodiazepines, and medications for substance use disorders. The results showed that 60.2% of the total sample was prescribed a psychiatric medication within 1 year of entering the Veterans Justice Outreach program. There was no significant difference in overall psychiatric prescribing among veterans treatment court, other SC, and no-SC groups, but there were a few differences in certain classes of psychiatric medications. Moreover, about 7.8% of veterans who were in the no-SC group and were prescribed psychiatric medications did not have a psychiatric diagnosis. Veterans who were younger, non-Hispanic white, married, with a VA service-connected disability rating, had a diagnosis of mental and/or substance use disorder, and used more VA health care services were more likely to have been prescribed psychiatric medication. Together, these findings illustrate the essential role of psychiatric medications in courts and programs that serve CJI veterans, as well as the important link between VA service engagement and psychiatric prescriptions.

New Research on Veterans Treatment Courts: An Overview of the Community Participatory Research on Veterans in Specialized Programming Project

ABSTRACT Justice-involved veterans return to civilian life with a variety of mental and physical health challenges that often go untreated and increase their risk for self-harm and involvement in the criminal-legal system. Veterans Treatment Courts (VTC) were created to respond to the unique problems of justice-involved veterans by attempting to coordinate services and support with the U.S. Department of Veterans Affairs (VA), local treatment providers, and the VTC. Our research has two distinct phases. In Phase 1, we conducted qualitative interviews with VTC team members in twenty (20) VTCs from each USA region; in each VTC, we gained the perspectives of team members – judges, prosecutors, defense attorneys, VJOs, VTC program coordinators, mentors, probation officers, and treatment providers – on the operation of VTCs, with a focus on how to improve service provision for justice-involved veterans. A total of 145 interviews were conducted. We begin by describing the unique problems and treatment needs of justice-involved veterans, and briefly summarize the findings from previous research on the implementation and impact of VTCs. We then present our research study protocol and highlight findings from our phase 1 qualitative interviews with VTC team members. In addition, we describe phase 2 of our project, which will include focus groups with VTC graduates, and quantitative analyses of the service provision networks of three VTCs.

A Qualitative Measure of Veterans Treatment Courts Efficacy

A lack of empirical evidence lending to the development of best practices for Veterans Treatment Courts (VTC) programs has stifled potential efficacy towards reducing recidivism rates amongst justice-involved veterans. The use of a qualitative, semistructured interview served to identify what programmatic factors of VTC lend to the success of the participants in preventing recidivism. Conversely, the interview design further evaluated what factors might be perceived as preventing success in and through the program. The resulting findings led to the realization of several programmatic factors identified by participants as contributing to success in the VTC program, as well as those that were noted as likely being detrimental to success. Recommendations for the role of these factors in the court are addressed, and the methods of this study as a viable research design to be promulgated through further research to that same end are presented.

Supplemental Material for For Whom Are Treatments for Criminal Recidivism Effective? Moderator Effects From a Randomized Controlled Trial of Justice-Involved Veterans

Supplemental Material for For Whom Are Treatments for Criminal Recidivism Effective? Moderator Effects From a Randomized Controlled Trial of Justice-Involved Veterans

At Risk and Underserved: Veterans Treatment Court Team Member Perspectives on Service Delivery Challenges

ABSTRACT As Veterans Treatment Courts (VTC) proliferate across the United States, questions have been raised about their capacity to provide critical services and support for justice-involved veterans. The current study examines the key decisions made by core VTC team members as justice-involved veterans move through each stage in the VTC process. This study presents in-depth interviews with 145 VTC team members from 20 court jurisdictions across the United States. Interviews revealed common challenges in meeting the service needs of VTC participants coalescing around five intercepts addressing challenges related to pre-entry, eligibility, service coordination and access, and veteran engagement. VTC team members’ views about how best to provide services and support to justice-involved veterans are also highlighted. This study provides the unique perspectives of VTC team members on how to address these challenges in ways that will enhance their ability to offer services and provide support for justice-involved veterans.

No Veteran Left Behind? Perspectives on VTC Eligibility Criteria for Justice-Involved Veterans in Multiple Jurisdictions Across the United States

ABSTRACT The explosive growth of veterans treatment courts (VTCs) in the United States has raised questions concerning which justice-involved veterans (JIV) are eligible and ultimately selected for participation. For instance, should VTCs be more inclusive in their selection processes, and is it possible to do so within existing court parameters? Using data from 145 interviews of team members working in 20 VTCs across the country, this study explores the perceptions of those personnel on a range of factors impacting eligibility determinations of JIV. These include the decision-making processes of VTC teams, determinations of the nexus between a veteran’s military service and their offending behavior, and the capacity of jurisdictions to provide treatment and services to all JIV, either through Veterans Affairs programs or community providers. Findings illustrate the variability of VTCs nationwide and suggest that specific midcourse alterations are necessary to fulfill stated court missions.

“God, I Hope It Doesn’t Fade Out”: Team Member Perspectives on the Future of Veterans Treatment Courts

ABSTRACT Despite their rapid spread over the last 15 years, little research has explored the perceptions of Veterans Treatment Courts (VTCs) team members regarding the viability and longevity of VTCs. The present qualitative study explores the perceptions of 145 VTC team members from 20 VTCs around the United States regarding the future of their own VTC and VTCs in general. Our analysis revealed four overarching themes about team members’ expectations and hopes for VTCs in the future: the need for continued funding and increased resources; desires to expand participation in VTCs; hope and uncertainty about the future of VTCs; and depending on specific people to ensure the future of VTCs. While interviewees in general felt quite hopeful and optimistic that VTCs would continue to exist and may even expand, there was unease about exactly how this would occur. These concerns included securing stable funding sources, maintaining “buy in” from key individuals, and resource needs for expanding the participation and eligibility criteria of VTCs. Given the important role that VTCs can play in effectively supporting justice-involved veterans, and offering more benefits compared to a traditional justice-system response, it seems vital to ensure that VTCs are able to continue operating in the future.

Measuring moral injury and treatment response in justice-involved veterans: Development and validation of a new Moral Injury Scale.

Measuring moral injury and treatment response in justice-involved veterans: Development and validation of a new Moral Injury Scale.

A Research Agenda forCriminal Justice Involvement Among U.S. Veterans.

A substantial proportion of adults in the U.S. criminal justice system are military veterans. Justice-involved veterans are of particular public concern given their service to the country and the high rates of health and social problems in the general veteran population. This article describes the development of a national research agenda for justice-involved veterans. In the summer of 2022, the VA National Center on Homelessness among Veterans in partnership with the VA Veterans Justice Programs Office convened a national group of subject matter experts and stakeholders across three listening sessions that included 40-63 attendees per session. These sessions were recorded, and transcriptions of all sessions and chats were synthesized to generate a preliminary list of 41 agenda items. The Delphi method involving two rounds of ratings from subject matter experts was used to develop consensus. The final research agenda consists of 22 items covering five domains: Epidemiology and knowledge of the population, treatment and services, systems and systems interface, methodology and research resources, and policies. The intent of sharing this research agenda is to spur stakeholders to conduct, collaborate, and support further study in these areas.

Personality Disorder Diagnosis Among Justice-Involved Veterans: An Investigation of VA Using Veterans.

Justice-involved veterans are more likely to experience myriad mental health sequelae. Nonetheless, examination of personality psychopathology among justice-involved veterans remains limited, with studies focused on males within correctional settings. We examined Department of Veterans Affairs (VA) electronic medical records for 1,534,108 (12.28% justice-involved) male and 127,230 (8.79% justice-involved) female veterans. Male and female veterans accessing VA justice-related services were both approximately three times more likely to have a personality disorder diagnosis relative to those with no history of using justice-related services. This effect persisted after accounting for VA use (both overall and mental health), age, race, and ethnicity. Augmenting and tailoring VA justice-related services to facilitate access to evidence-based psychotherapy for personality psychopathology may promote optimal recovery and rehabilitation among these veterans.

Suicide risk among veterans using VHA justice-involved services: a latent class analysis

BackgroundJustice-involved Veterans experience notable risk for psychosocial stressors (e.g., homelessness) and psychiatric multimorbidity, which can result in complex clinical presentations. However, research examining how such factors coalesce to impact risk for suicide remains limited.MethodsWe conducted a latent class analysis of 180,454 Veterans accessing Veterans Health Administration (VHA) justice-related services from 2005 to 2018.ResultsA four-model class membership solution was identified. Among these classes, risk for suicide was highest among Veterans with greater psychiatric burden, with risk most notable among those with high VA service use. Veterans seeking healthcare primarily focused on substance use disorders or with low psychiatric burden and service use had a lower risk for suicide.ConclusionsPsychiatric multimorbidity is salient as it relates to suicide among Veterans accessing VHA justice-related services. Further evaluation of existing VHA services for this population and methods of augmenting and enhancing care for justice-involved Veterans with histories of co-occurring psychiatric conditions may be beneficial in facilitating suicide prevention efforts.

Understanding Criminogenic Risk Factors Among United States Military Veterans: An Updated Literature Review

Justice-involved veterans (JIVs) are a high-priority subgroup within the U.S. judicial system. In recent years, empirical research into the characteristics, needs, and outcomes of this veteran subgroup has developed rapidly. To allow research to better inform efforts to support JIVs, a systematic review was completed to organize existing literature on criminogenic risk within this population through the lens of the Risk-Need-Responsivity Model. Of the eight risk factors theorized by the Risk-Need-Responsivity Model, history of antisocial behavior and substance use had the most robust evidence as criminogenic risk factors for veteran justice involvement. Modest evidence was identified for antisocial personality, educational and occupational difficulties, and disruptions to family and marital relationships as risk factors. However, only limited evidence was identified for antisocial thinking, affiliation with antisocial peers, and lack of prosocial activities as risk factors due to these factors being relatively underassessed in research. Such patterns provide insight into potential interventions and supports for JIVs while also highlighting areas for continued research.

Social Determinants of Health and Traumatic Brain Injury: Implications for Rehabilitation Service Delivery and Outcomes.

Social Determinants of Health and Traumatic Brain Injury: Implications for Rehabilitation Service Delivery and Outcomes.

Racial, ethnic, and sex differences in psychiatric diagnosis, mental health sequelae, and VHA service utilization among justice-involved veterans.

Intervening in the cycle of symptom exacerbation and recidivism among justice-involved veterans is critical given elevated rates of psychiatric diagnoses and mental health sequelae. To responsively and effectively address justice-involved veterans' needs, it is essential to examine distinct groups who are at heightened risk (e.g., marginalized communities). Although racial and ethnic disparities within the justice system are well established, veteran-focused research remains limited. We hypothesized that significant differences exist in service utilization, psychiatric diagnoses, and mental health sequelae among Black, Indigenous, and people of color (BIPOC) and White/non-Hispanic justice-involved veterans, for both male and female cohorts. We examined a national data set of veterans accessing U.S. Department of Veterans Affairs (VA) justice-related services (i.e., justice-involved veterans) between 2005 and 2018 (N = 183,880; nBIPOC = 73,863, nWhite = 110,017) to elucidate racial and ethnic differences across clinical characteristics documented in the VA electronic medical record. Using linear and logistic analyses, we analyzed male (n = 173,487) and female (n = 10,393) justice-involved veterans separately to capture intersectionality. In general, BIPOC justice-involved veterans were more likely than White/non-Hispanic justice-involved veterans to be diagnosed with schizophrenia and other psychotic disorders and to use homeless services, p < .001. They were less likely to be diagnosed with mood, anxiety, personality, and opioid use disorders, p < .01. Separate examinations of Black and Hispanic justice-involved veterans, compared with their White/non-Hispanic counterparts, demonstrated some divergent trends (e.g., frequency of use of Veterans Health Administration [VHA] services). Our findings also revealed nuanced sex-related differences in terms of service use and diagnoses. Descriptive characteristics for each racial and ethnic category are reported. These findings provide support for race and ethnicity as a key social factor of health associated with distinct psychiatric diagnoses and mental health sequelae among justice-involved veterans. We discuss practice and policy implications, including how to adapt existing VHA programming and practices to meet the needs of BIPOC justice-involved veterans. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Dialectical behavior therapy for justice-involved veterans (DBT-J): Feasibility and acceptability.

Justice-involved veterans are a high-risk, high-need subgroup serviced by behavioral health services within the Veterans Health Administration (VHA) system. Justice-involved veterans often have complex mental health and substance use difficulties, a myriad of case management needs, and a range of criminogenic needs that are difficult to treat with traditional outpatient VHA services. The present study represents an initial evaluation of dialectical behavior therapy for justice-involved veterans (DBT-J), a novel psychotherapy program providing 16 weeks of skills-based group therapy and individualized case management services to veterans with current or recent involvement with the criminal justice system. A total of 13 veterans were successfully enrolled into this initial acceptability and feasibility trial. Results broadly suggested DBT-J to be characterized by high ease of implementation, successful recruitment efforts, strong participant attendance and retention, high treatment fidelity, and high acceptability by veteran participants, DBT-J providers, and adjunctive care providers alike. Although continued research using comparison conditions is necessary, veterans who completed participation in DBT-J tended to show reductions in criminogenic risk across the course of treatment. Cumulatively, these findings suggest DBT-J holds potential as a VHA-based intervention to address the various needs of justice-involved veterans. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Dialectical behavior therapy for justice-involved veterans: Changes in treatment targets in a small, pre-post design clinical trial.

[Correction Notice: An Erratum for this article was reported online in Psychological Services on Jul 13 2023 (see record 2023-89801-001). In the article, the title was incorrect and should have been "Dialectical Behavior Therapy for Justice-Involved Veterans: Changes in Treatment Targets in a Small, Pre-Post Design Clinical Trial." This error did not impact the results or conclusions. All versions of this article have been corrected.] Dialectical Behavior Therapy for Justice-Involved Veterans (DBT-J; Edwards, Dichiara, Epshteyn, et al., 2022) was recently developed as an integrative psychotherapy + case management intervention to address the range of complex criminogenic, mental health, substance use, and case management needs commonly faced by justice-involved veterans. Research to date suggests delivery of DBT-J to be both acceptable and feasible (Edwards, Dichiara, Epshteyn, et al., 2022). However, data on therapeutic change experienced by DBT-J participants has been limited. The present study represents an initial investigation into longitudinal changes in criminogenic risk, psychological distress, substance use, case management needs, and quality of life experienced by 20 justice-involved veterans across their course of DBT-J participation. Results reflected notable improvements across treatment targets from pre- to posttreatment; these gains were largely maintained at 1-month follow-up. Such findings attest to the potential utility of DBT-J and to the need for continued research into the efficacy of this intervention. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Supplemental Material for Racial, Ethnic, and Sex Differences in Psychiatric Diagnosis, Mental Health Sequelae, and VHA Service Utilization Among Justice-Involved Veterans

Supplemental Material for Racial, Ethnic, and Sex Differences in Psychiatric Diagnosis, Mental Health Sequelae, and VHA Service Utilization Among Justice-Involved Veterans

Supplemental Material for Dialectical Behavior Therapy for Justice-Involved Veterans: Changes in Treatment Targets in a Small, Pre-Post Design Clinical Trial

Supplemental Material for Dialectical Behavior Therapy for Justice-Involved Veterans: Changes in Treatment Targets in a Small, Pre-Post Design Clinical Trial