Debra A. Pinals, M.D. Principal Investigator David Smelson, Psy.D. Co-Principal Investigator David Goldstein, Peer Specialist Charles Delaney, MLA,

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1 Debra A. Pinals, M.D. Principal Investigator David Smelson, Psy.D. Co-Principal Investigator David Goldstein, Peer Specialist Charles Delaney, MLA, Peer Specialist

2 Overview of MISSION DIRECT-VET Overview of MISSION Model of Care Peer Specialist Experiences Delivering

3

4 Funding: SAMHSA-CMHS $2,126,000 awarded to Massachusetts DMH Grant Components: Court identification and linkage Service Delivery/Agency Collaboration/Training Program Evaluation Trauma-informed care Project Length: 5 Years Target Population: returning OIF/OEF Dually Diagnosed Veterans with a Trauma History

5 Met with senior MA Department of Mental Health, District Court and Veterans Administration leaders to identify and engage other key stakeholders Formed Statewide Advisory Committee First meeting November 2008 Project Introduction and Training Focus on signing of Memorandum of Agreement Currently meets annually in each Grant Year Provides a forum for discussion of sustainability and program expansion

6 MA Department of Mental Health UMass Medical School US Department of Veterans Affairs MA Department of Veterans Services US Department of Labor-VETS MA Department of Public Health MA District Court Department of the Trial Court MA Parole Board MA Department of Probation MA Committee for Public Counsel Services Office of the District Attorney for the Middle District (Worcester County) Massachusetts Rehabilitation Commission National Alliance for the Mentally Ill (NAMI-MASS) Office of the District Attorney for Essex County

7 Established local advisory committees at each site: Worcester, Lawrence, and Brockton Developed out of State Advisory Committee During high priority planning phase, meet as often as monthly Worcester and Lawrence currently meet approx. quarterly Provides critical oversight and input on program structure

8 State Advisory Committee Local Advisory Committees

9 Active Recruitment Persons with history of military service Status of military discharge does not disqualify for clinical eligibility Co-Occurring mental lllness and substance Use disorders Trauma history Competent to enter plea agreement to probationary term with augmented treatment

10 MISSION DIRECT VET (MDV) FLOW CHART Defendant Identified Arrest/Probation Surrender Arraignment & Court Appearances Individual identified as potentially eligible for MDV program. Identified via Family Member, Peer or Defense Attorney Consult with Attorney MDV Eligibility Screening and Assessment Scheduling Defendant/Attorney contacts Clinical Screener or MDV Informational line If appropriate Clinical Screener schedules Assessment MDV Clinical Assessment and Recommendations (Conducted by Clinical Screener*) Event Tracking Form 1 (Initial Screening Form Referral to Clinical Evaluation) Consult with Attorney Sentencing Court Decision Tracking Form 2 (Judge s Decision to Divert) (completed by Peer Support*) Probation Plea/Probation Consent Document Probation Officer passes along Defendant s information to MDV Case Manager MDV Services MDV Case Manager/Peer Support mentions evaluation component and asks to pass along information to evaluation team Initial Evaluation Contact Consent to Evaluation Person Tracking (Tracking Database) Baseline Assessment (Only for those consenting to the evaluation component) MDV Services 6 th Month Follow Up (Only for those consenting to Evaluation) Services Use Data Collection Form Arrest Data Collection Form 6 th Month Assessment MDV Services 12 Month Follow Up (Only for those consenting to Evaluation) 12 Month Assessment *-Clinical Screener =MDV Case Manager or VA MSW Student Intern or Veterans Justice Outreach (VJO) Specialist

11 Recruitment Numbers as of June 24 th, 2011 Number Screened 61 Number Screened as Eligible 54 Number Diverted to MISSION (by Judge) 34 Number Consented to Receive Services 32 Number Consented to Enroll in Evaluation 31 Referrals: Courts 18 - Worcester; 10 Lawrence; 6 E. Brookfield and Dudley, 5 - Westborough; 3 Fitchburg; 2 Uxbridge and Boston, 2- Ayer, Springfield, Northampton, Roxbury, Gardner, Gloucester, Peabody, Billerica, Quincy, and Wakefield Referral Source (not exclusive categories): 23 Probation Officers; 18 Attorneys; 13 - Self-Referral; 4 Bedford VA and Family Members; 3 CBOC; 1 Judge, ADA, and DVS

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13 Goal: Engage Individuals with Co- Occurring Disorders in Treatment Engagement Strategies: Assertive Community Outreach (peer and case manager) Skills Development (increase self efficacy) Service Linkage (community supports) Flexible delivery platform

14 Combines Evidenced Base Practices 1. Dual Recovery Therapy (Ziedonis, 1997, 2005) 2. Critical Time Intervention (Susser et al, 1997) 3. Peer Support Services 4. Employment Support 5. Trauma Informed Care (VET Edition) Studied with Several Populations/lengths

15 Najavits (2010) Not Specialized PTSD and Addiction Treatment Rather Determine if Specialized Trauma Care is Needed Coordinating Trauma Specialty Care Deliver Trauma Informed Support Services Develop Plan for Increased Safety Provide Psychoeducation on Trauma and Substance Abuse Teach Coping Skills to Control Trauma Symptoms

16 Harm Reduction Do NOT punish for relapse Coordination and buy in from probation Probation still makes supervision determinations Prevent Incarceration (Reduce Jail Days)

17 MISSION Treatment Teams Case Manager + Peer Caseloads of 15 clients per 1 team 2, 6 and 12 month Service Delivery Clear Treatment Plan/Responsibilities Good Collaboration Promote Hope

18 MISSION Resource Materials MISSION Treatment Manual Guide for implementation MISSION Consumer Workbook Peer facilitated guided exercises Fidelity Measure Tracks Model Adherence Supported by Grants from SAMHSA

19 Supported by Grants from VA ORD

20 2 Month Intervention ( ) (Completed) Supported by VA HSR&D/VISN 3 MIRECC Previous & Current MISSION Studies Components: Critical Time Intervention (CTI), Dual Recovery Therapy (DRT), and Peer Support. Setting: Acute psychiatry/inpatient treatment program MISSION NJ ( ) (Completed) Supported by SAMHSA Treatment Length: 12 months Components: CTI, DRT, Peer Support, and Vocational Support. Setting: Residential treatment program MISSION-VET (2010) (Completed) Supported by VA ORD/HSR&D/National Center for Homeless Veterans MISSION Jail Diversion Project (2008-Present) Supported by SAMHSA-CMHS Treatment Length: 2 months, 6 months, or 12 months Components: CTI, DRT, Peer Support, Vocational/Educational Supports, and Trauma-Informed Care Considerations Setting: Inpatient treatment program, residential treatment program, or once placed in housing Treatment Length: 12 months (treatment begins after adjudication) Target Population: returning OIF/OEF Dually Diagnosed Veterans with a Trauma History who have been diverted from jail and selected by judge to receive treatment rather than serve jail time HUD-VASH Randomized Controlled Trial (2011-Present) Supported by VA National Center for Homeless Veterans Treatment Length: 6 months Setting: Formerly homeless, dually diagnosed Veterans who have received housing placements through HUD-VA Supportive Housing Program Study Design: In addition to standard HUD-VASH Case Management, for 6 months, participating Veterans will receive either MISSION-VET care coordination, Telephone Counseling or symptom monitoring via telephone-based monitoring system MISSION-Vet Getting to Outcomes Service Deliver Project (October 2011) Supported by VA ORD/HSR&D/National Center for Homeless Veterans Components: Hybrid implementation and effectiveness trial to determine the most effective implementation strategy for MISSION-Vet Intervention within VA Homeless Services

21 David Goldstein Charles Delaney, MLA Veteran Peer Support Specialists MISSION DIRECT VET

22 State: Massachusetts Program Name: MISSION DIRECT VET Court Systems: Worcester County, Essex County and Plymouth County Intercept Point: Post Adjudication Innovations: Created Veterans Guide Book Edited Probation Intake Form MISSION Service Model

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24 MDV is a 12 month program We see or have contact with vets 3 or more times a week Large part is reaching out to keep vets involved in meetings and VA services Extensive amount of time getting clients plugged into VA Services Significant presence in the courts

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