U.S. Department of Veterans Affairs Veterans Justice Outreach Program

• Author: Janet C. Blodgett,Jim McGuire,Sean C. Clark,Leon Sawh,Jessica Blue-Howells,Andrea K. Finlay,Christine Timko,Ingrid Binswanger,Alex H. S. Harris,Joel Rosenthal,Tom Bowe,Susan M. Frayne,David Smelson
• Published date: 01 March 2016
• Date: 01 March 2016
• DOI: http://doi.org/10.1177/0887403414562601

562601CJPXXX10.1177/0887403414562601Criminal Justice Policy ReviewFinlay et al.
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Criminal Justice Policy Review
2016, Vol. 27(2) 203 –222
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DOI: 10.1177/0887403414562601
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Justice Outreach Program:
Connecting Justice-Involved
Veterans With Mental
Health and Substance Use
Disorder Treatment
Andrea K. Finlay1,2,3, David Smelson4,5, Leon Sawh4,5,6,
Jim McGuire7, Joel Rosenthal7, Jessica Blue-Howells7,
Christine Timko2,3, Ingrid Binswanger8,
Susan M. Frayne2,9, Janet C. Blodgett2, Tom Bowe1,
Sean C. Clark7, and Alex H. S. Harris1,2
Abstract
The Veterans Justice Outreach (VJO) program of the U.S. Veterans Health Administration
has a primary mission of linking military veterans in jails, courts, or in contact with law
enforcement to mental health and substance use disorder treatment. National data of
veterans with VJO contact were used to describe demographic characteristics, and
mental health and substance use disorder diagnoses and treatment use and test correlates
1 Substance Use Disorder Quality Enhancement Research Initiative, VA Palo Alto Health Care System,
Menlo Park, CA, USA
2Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA
3Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, CA, USA
4 National Center on Homelessness Among Veterans, Edith Nourse Rogers Memorial Veterans Hospital,
Bedford, MA, USA
5Department of Psychiatry, University of Massachusetts Medical School, Worcester, USA
6School of Criminology and Justice Studies, University of Massachusetts Lowell, USA
7Veterans Justice Programs, Department of Veterans Affairs, USA
8University of Colorado School of Medicine, Denver, CO, USA
9Division of General Medical Disciplines, Stanford University School of Medicine, Palo Alto, CA, USA
Corresponding Author:
Andrea K. Finlay, VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA
94025, USA.
Email: Andrea.Finlay@va.gov

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Criminal Justice Policy Review 27(2)
of treatment entry and engagement using multi-level logistic regression models. Of the
37,542 VJO veterans, treatment entry was associated with being homeless and having
a mental health disorder or both a mental health and a substance use disorder versus
a substance use disorder only. Being American Indian/Alaskan Native was associated
with lower odds of treatment entry. Engagement was associated with female gender,
older age, Asian race, urban residence, and homeless status. Increased utilization of
substance use disorder treatment, especially pharmacotherapy, is an important quality
improvement target.
Keywords
veterans health, criminal justice, mental disorders, substance use disorders, mental
health services, U.S. Department of Veterans Affairs
Introduction
Incarceration rates in the United States have been on the rise since the 1980s (Western
& Pettit, 2010) and many incarcerated adults have a mental health and/or substance use
disorder (Mumola & Karberg, 2006). In response to its costs, many states have intro-
duced a number of alternatives to incarceration (Piquero, 2010). Alternatives to incar-
ceration include jail diversion programs that divert individuals with mental health and
substance use disorders to treatment upon contact with the criminal justice system (i.e.,
law enforcement, courts, and jails). These programs screen individuals involved in the
legal system for an active mental health or substance use disorder, arrange for clinical
staff to evaluate those who screen positive, negotiate with legal staff for a mental health
disposition to reduce charges or in lieu of prosecution, and link them with community-
based treatment (Steadman, Morris, & Dennis, 1995). Pre-booking diversion includes
individuals who are arrested and directly transported to mental health treatment by law
enforcement, whereas post-booking diversion includes individuals in jail or court who
screen positive for mental illness and are ordered into treatment as an alternative to
prosecution or jail (Sirotich, 2009). Specialty courts, such as mental health courts, drug
courts, and veterans treatment courts, are post-booking diversion programs; that is, the
court mandates participants to treatment and monitors for treatment adherence.
Evidence is mixed that jail diversion programs, including treatment courts and
court-based diversion, successfully reduce criminal recidivism (Scott, McGilloway,
Dempster, Browne, & Donnelly, 2013; Skeem, Manchak, & Peterson, 2011). A review
of prebooking, jail-based, and court-based diversion programs found reductions in
time spent in jail but no reductions in recidivism for individuals with mental health
disorders (Sirotich, 2009). However, individuals with mental health disorders who
participated in court-based jail diversion programs (programs that did not use a mental
health or drug treatment court model) had fewer arrests and spent fewer days in jail in
the following 12-month period compared with the 12 months prior to program enroll-
ment (Case, Steadman, Dupuis, & Morris, 2009). A recent randomized trial of a case

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Finlay et al.
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management jail diversion program in California found that program participants had
more outpatient visits, but fewer days of psychiatric hospitalization, fewer jail book-
ings, and lower odds of being jailed again in the 12 months after program enrollment
compared with participants in the treatment-as-usual group (Cusack, Morrissey,
Cuddeback, Prins, & Williams, 2010).
Studies of specialty treatment courts find more positive evidence of their effective-
ness. Meta-analyses and reviews indicate that mental health and drug courts are effec-
tive at reducing recidivism (Huddleston, Marlowe, & Casebolt, 2008; Marlowe, 2010;
Sarteschi, Vaughn, & Kim, 2011). For example, individuals participating in mental
health courts also have fewer arrests and fewer days of incarceration compared with a
control group (Steadman, Redlich, Callahan, Robbins, & Vesselinov, 2011). However,
studies of drug courts that used random assignment found no effects and programs
shorter than 1 year were not effective (Latimer, Morton-Bourgon, & Chretien, 2006).
In general, the methodologies of the reviewed studies are weak (Sarteschi et al., 2011;
Wilson, Mitchell, & MacKenzie, 2006), suggesting that more rigorous work in this
area should be done.
Roughly 10% of people incarcerated in the United States are military veterans
(Noonan & Mumola, 2007). These numbers were significant enough to justify specialty
courts that would improve access to Veterans Affairs (VA) benefits and services. Veterans
treatment courts, modeled after mental health and drug treatment courts, are dedicated
courts where veterans who have criminal charges are connected to needed mental health
and/or substance use disorder treatment. Veterans are also supervised to adhere to treat-
ment with sentences or charges potentially reduced, dismissed, or expunged upon pro-
gram completion (Cavanaugh, 2010; Clark, McGuire, & Blue-Howells, 2010). Research
on veterans treatment courts is in the early stages, but preliminary evidence suggests that
recidivism in the 1-year period after program graduation is less than 10% (Holbrook &
Anderson, 2011; Russell, 2009). The number of veterans treatment courts is increasing
throughout the country and some courts are using electronic or telephone technology to
expand access to veterans in rural areas (Smee et al., 2013).
In 2004, at least half of veterans incarcerated in jails or prisons self-reported mental
health or substance use disorders. Furthermore, justice involvement and homelessness
are strongly correlated with one another (Greenberg & Rosenheck, 2008; Tsai,
Rosenheck, Kasprow, & McGuire, 2014). Services that link justice-involved individu-
als to mental and medical treatment and support their engagement in treatment, are
critical for reducing homelessness and recidivism, and improving other outcomes
(Mallik-Kane & Visher, 2008). To address their needs, the Veterans Health
Administration (VHA) has developed two programs for veterans involved in the crim-
inal justice system (Blue-Howells, Clark, van den Berk-Clark, & McGuire, 2013). The
national Health Care for Reentry Veterans (HCRV) program was launched in 2007 and
provides outreach to veterans in prison who are reentering the community and links
them with appropriate VHA treatments. In 2009, the national Veterans Justice Outreach
(VJO) program was created with the core mission of connecting veterans entering the
criminal justice system with VHA treatment for mental health or substance use disor-
ders as well as other needed medical services (Clark, Blue-Howells, Rosenthal, &

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Criminal Justice Policy Review 27(2)
McGuire, 2010). The VJO program is under the auspices of the VHA national home-
less program office and shares the overarching goal of reducing and preventing home-
lessness and criminal justice recidivism among veterans. The VJO program is the
focus of this article.
Although service delivery format and program settings vary, generally VJO
Specialists are licensed social workers or psychologists who provide outreach to vet-
erans in criminal justice settings, and includes active collaborations with law enforce-
ment, defense counsel, prosecutors, jails, and courts (Blue-Howells et al.,...