Examining implementation and preliminary performance indicators of veterans treatment courts: The Kentucky experience

Veterans’ Treatment Courts (VTCs) are posited as a solution to offer rehabilitation for veterans involved in the criminal justice system. Despite the pervasive implementation of VTCs, there is little research focused specifically on VTC implementation and outcomes, which are based on other problem-solving court models such as drug court. The current study presents qualitative process evaluation data from key stakeholders (n = 21) and veteran participants (n = 4) to show accomplishments, challenges, and lessons learned during first-year implementation at two VTC sites. Quantitative performance data is also presented on veteran participants (n = 19) served during the first year to show: types of services, monitoring, judicial interaction, sanctions/therapeutic responses, and rewards, as well as preliminary data on recidivism. Qualitative data, from both key stakeholders and veteran participants, suggests that offering rehabilitation via various program components, services/referrals, and accountability are critical to the success of the VTC. Data also provides valuable lessons learned for VTC implementation including communication, collaboration, information/protocols, and resources. Performance data shows that a variety of services are utilized and that frequent judicial interaction, drug testing, and sanctions are cornerstones of the VTC. Implications and future directions for research are discussed.     

Considering child care and parenting needs in Veterans Affairs mental health services

Child care and parenting needs of adults with mental illness are of growing concern, especially among those seeking Department of Veterans Affairs (VA) mental health services. One area of interest concerns the possible benefits that on-site child care could have for improving veterans’ access to VA mental health care. Child care programs are currently being piloted at the VA for the first time, although the need for them has not been evaluated. We conducted a brief survey of a convenience sample of 147 veterans (132 men, 15 women) seeking mental health care at outpatient clinics and/or at a psychiatric rehabilitation center at one VA. Participants were asked about their attitudes and experiences regarding child care and parenting support at the VA. Of the 52 (35.4%) participants who responded and had children under 18, the majority of both men and women surveyed agreed that the VA should offer child care services and that they would use child care services at the VA if it were available. These results are based on a small sample of participants, but they may contribute to ongoing discussion and efforts to develop “family-friendly” mental health services.     

Applying the Housing First approach to single-site permanent supportive housing

This study explored how the U.S. Departments of Housing and Urban Development-Veterans Affairs Supportive Housing (HUD-VASH) program applies Housing First principles in the context of ten single-site programs. Focus group discussions with 64 HUD-VASH staff and community partners explored how the programs were influenced by Housing First principles and specific strategies to implement these principles in a single-site setting. Focus group respondents described resourceful ways that the principles of Housing First were implemented in their programs specifically related to (1) housing choice and structure, (2) separation of housing and services, (3) service philosophy, and (4) service array. Several of the Housing First domains cite the importance of integrated housing and the provision of services off-site; it was of particular interest to learn how single-site programs address these issues logistically. Lessons learned from this study include the importance of leveraging the independent yet overlapping tasks of case management and property management to ensure functional – if not geographic – separation of housing and services; maintaining staff on-site to address Veterans’ needs; working with community service organizations to complement the array of service available to residents; and housing single-site programs in mixed-use buildings.     

Military Veterans Sharing First‐Person Stories of War and Homecoming: A Pathway to Social Engagement,Personal Healing,and Public Understanding of Veterans' Issues

What power, meaning and value may exist within a soldier's first‐person war story? Former Marine captain Tyler Boudreau, quoted below, suggests that constructing a personal narrative of the traumas of war and homecoming, then “asking questions” of the story, can provide a veteran with a “chart.” If this is so, can that chart help one along the road to healing from those traumas, especially when that story is shared with others? Could there be dangerous turns or pitfalls on the journey? How can a public sharing of narratives of wartime experiences help audiences to better respond to those veterans and families who must cope with a difficult transition from the battlefield to home? What guidelines can be used effectively to train and prepare storytellers for their role? In this collaborative article, strengthened by the clinical wisdom of various consulting clinicians, we examine these questions through the lenses of two programs that provide veterans opportunities to share their war stories publicly. They include the Veterans Education Project (VEP) and the “100 Faces of War Experience” project (100 Faces).     

The Legacy of War: An Intergenerational Perspective

Children of combat veterans are affected to varying extents by the physical and psychological aftermath of war as experienced by the parent. Traumatic experiences exist on a continuum; trauma related messages can be communicated by a parent who does not have Post Traumatic Stress Disorder. An intergenerational perspective explores the complex family processes by which those who did not experience the actual events come to exhibit varying degress of emotional, psychological and behavioral manifestations of their parents' traumatic experiences.     

Military service and STEM employment: Do veterans have an advantage?

We use five years of American Community Survey data to examine how military service provides a non-degree-based pathway into STEM occupations. Military service is associated with STEM occupations in positive and surprising ways. Veterans are more likely than their civilian counterparts to work in STEM, an effect particularly strong for women and among workers without a STEM bachelor's degree. Among workers lacking STEM BAs, veterans were more likely to hold STEM occupations. Indeed, veterans lacking a college degree at all are more likely than their nonveteran counterparts to hold STEM employment. We conclude that military service in itself provides a rarely-discussed route to diversifying STEM and consider the policy implications.     

Altering the life course: Military service and contact with the criminal justice system

Using data taken from the 1997 National Longitudinal Survey of Youth, we examine the relationship between military service and contact with the criminal justice system. Drawing on the life course concept of a turning point, we show that military service does little to affect the risk of being arrested or being convicted of crimes involving violence or destructive behavior, while at the same time significantly reducing the risk of being arrested or being convicted of non-violent crimes. We find no evidence that service in a combat zone alters these relationships. Our results demonstrate how participation in a large-scale institution can serve as a turning point, altering the life course trajectories of young persons.     

Personal and Professional Knowledge of and Experience With Suicide and Suicide Prevention Among Stakeholders in Clinical and Community Practice

Community-dwelling veterans at risk for suicide may be in contact with a variety of providers in agency-based settings that offer health and human services. The study aim is to describe the perspective of agency-based clinical and community providers who may come into contact with veterans in need of suicide prevention services and to examine the nature of their personal and professional relationships to individuals at risk for suicide among this sample.

This study reports on qualitative data from a sample of Veterans’ Affairs (VA) and community providers serving veterans and military families in one Midwestern state (N = 70). Providers completed a survey assessing exposure to suicide, including contact with and relationship to someone suicidal, and organizational characteristics of the providers’ employing agencies. Semi-structured interview questions probed for the nature of how they would react with suicidal individuals. Most providers (94%) had some prior contact with someone who was suicidal, and nearly three quarters (77%) knew someone who had died by suicide. Providers reported powerful emotional responses of sadness and remorse to suicidal experiences. While these providers interact with veterans and military families as part of their jobs, they may have their own history of being exposed to suicide, both professionally and personally.     

Mental Health of Non-gamblers Versus “Normal” Gamblers Among American Indian Veterans: A Community Survey

Goal This analysis was undertaken to assess the demographic and mental health characteristics of “normal” or non-problem gamblers versus non-gamblers in a representative community sample. Sample Study participants consisted of 557 North Central American Indian veterans. Data collection included a demographic and trauma questionnaire, a computer-based Diagnostic Interview Schedule for DSM-III-R, and a treatment history algorithm. Findings Univariate analyses revealed that gamblers had greater social competence (i.e., higher education, living with a spouse) and higher lifetime psychiatric morbidity. Binary regression analysis revealed that, compared to non-gamblers, gamblers were older, more highly educated, and more apt to be married. More gamblers showed evidence for lifetime risk-taking as evidenced by Antisocial Personality Disorder and Tobacco Dependence. Conclusions Social achievement and disposable income function as prerequisites for “normal” gambling in this population, although “externalizing” or “risk-taking” disorders also serve as independent contributors to at least some gambling. The increased rate of “internalizing” or emotional disorders are only indirectly related to gambling, perhaps through increasing age or through the “externalizing” disorders.     

Prevalence and correlates of diabetes mellitus among homeless veterans nationally in the Veterans Health Administration

Abstract

Background: Homeless people are at high risk for many chronic medical conditions although their risk of diabetes has not been well studied. Current epidemiological studies of diabetes prevalence among homeless adults have been based mostly on self-report data not supported by clinical assessments.

Objectives: To determine the prevalence and risk factors for diabetes mellitus (DM) among homeless veterans in the Veteran Health Administration (VHA).

Methods: The sample included 3?464?364 veterans with documented body mass indexes (BMI), 137?720 (4%) of whom had been homeless. Logistic regression models were used to determine the odds of having DM among homeless veterans compared to non-homeless veterans. Bivariate and multi-variate analyses were then used to identify potential risk factors for DM among homeless veterans.

Results: The prevalence of DM in homeless veterans was 19%. Homeless veterans with DM, compared to those without it were older, more likely to have a BMI?>?40 and more likely to have DM-related co-morbidities.

Conclusions: There is a high prevalence of DM among homeless veterans in the VHA compared to previous reports for homeless adults (8%). Tailored approaches to improve access to DM screening, prevention, and treatment could benefit homeless veterans.