Intervention for Justice-Involved Homeless Veterans With Co-Occurring Substance Use and Mental Health Disorders: Protocol for a Randomized Controlled Hybrid Effectiveness-Implementation Trial.

Background: The US Veterans Affairs mental health residential rehabilitation treatment programs (MH RRTPs) provide residential care for veterans experiencing homelessness. However, those with co-occurring mental health and substance use disorders and criminal legal involvement require additional interventions to address risk factors for recidivism.

Objective: We aimed to (1.

Clinical Characteristics of Patients With and Without Chronic Pain Seeking Behavioral Health Treatment for Co-Occurring Opioid Use and Mental Health Disorders.

Background: Among patients with chronic pain (CP; pain persisting for 3+ months) and opioid use disorder (OUD), ~3 in 4 report co-occurring mental health conditions, which may exacerbate difficulties accessing and engaging in behavioral health treatment. Beyond rates of co-occurring diagnoses, little is known about the differences in specific behavioral health needs of individuals with CP versus those without CP when they seek behavioral health treatment for OUD and co-occurring mental health disorders.

Methods: These secondary analyses utilized data from a randomized controlled trial.

Receipt of medications for opioid use disorders among veterans by race/ethnicity and legal involvement: an observational study of electronic health records.

Background: The Veterans Health Administration has made strides to improve access to medications for opioid use disorder overall. However, quality improvement methods to assess treatment gaps may not sufficiently detect differences in medication access by intersecting patient factors, which may have multiplicative rather than additive effects. This study aimed to determine whether race/ethnicity and legal involvement interact in receipt of medications for opioid use disorder among Veterans Health Administration patients.

Artificial intelligence conversational agents in mental health: Patients see potential, but prefer humans in the loop.

Background: Digital mental health interventions, such as artificial intelligence (AI) conversational agents, hold promise for improving access to care by innovating therapy and supporting delivery. However, little research exists on patient perspectives regarding AI conversational agents, which is crucial for their successful implementation. This study aimed to fill the gap by exploring patients' perceptions and acceptability of AI conversational agents in mental healthcare.

Developing a Wearable Sensor-Based Digital Biomarker of Opioid Dependence.

Background: Repeated opioid exposure leads to a variety of physiologic adaptations that develop at different rates and may foreshadow risk of opioid-use disorder (OUD), including dependence and withdrawal. Digital pharmacovigilance strategies that use noninvasive sensors to identify physiologic adaptations to opioid use represent a novel strategy to facilitate safer opioid prescribing. This study aims to identify wearable sensor-derived features associated with opioid dependence by comparing opioid-naïve individuals to chronic opioid users with acute pain and developing a machine-learning model to distinguish between the 2 groups.

Protocol of a randomized controlled trial examining psychosocial enhancement and standard medication treatment for co-occurring opioid use and mental health disorders: A half fractional factorial randomized controlled trial.

Background: The opioid epidemic disproportionately affects individuals with co-occurring opioid use and mental health disorders (COD), who often have poor treatment engagement. Multicomponent treatment models are popular solutions to increase treatment access and engagement for those with COD. Maintaining Independence and Sobriety through Systems Integration, Outreach and Networking (MISSION) is a hybrid multicomponent linkage and treatment approach that provides assertive community outreach combined with psychosocial treatment.

Evaluation of a digital tool for detecting stress and craving in SUD recovery: An observational trial of accuracy and engagement.

Background: Digital health interventions offer opportunities to expand access to substance use disorder (SUD) treatment, collect objective real-time data, and deliver just-in-time interventions: however implementation has been limited. RAE (Realize, Analyze, Engage) Health is a digital tool which uses continuous physiologic data to detect high risk behavioral states (stress and craving) during SUD recovery.

Methods: This was an observational study to evaluate the digital stress and craving detection during outpatient SUD treatment.

The feasibility of wildlife immersion experiences for Veterans with PTSD.

Introduction: Animal-assisted interventions (AAI) offer potential physical and psychological health benefits that may assist Veterans with post-traumatic stress disorder. However, more feasibility studies are needed regarding intervention details, adverse events, reasons for study withdrawal, and animal welfare.

Methods: This mixed methods feasibility trial involved a modified crossover study in which Veterans with PTSD/PTSD symptoms were provided a series of 8 nature and wildlife immersion experiences to evaluate feasibility and preliminary efficacy.

Multicomponent Co-Occurring Disorders Treatment and Wraparound Services for Individuals Experiencing Chronic Homelessness.

Individuals experiencing chronic homelessness have high rates of persistent co-occurring mental health and substance use disorders (COD), and they often have difficulty with service engagement and retention, resulting in symptom exacerbation and housing loss. This study pilot tested Maintaining Independence and Sobriety Through Systems Integration, Outreach and Networking (MISSION), a multicomponent wraparound treatment approach to improve COD symptoms and housing stability among individuals experiencing chronic homelessness and persistent COD. This open pilot study enrolled and assessed 109 individuals with a COD experiencing chronic homelessness and offered one year of MISSION.

For whom are treatments for criminal recidivism effective? Moderator effects from a randomized controlled trial of justice-involved veterans.

Objective: In a recent trial, moral reconation therapy (MRT)-a cognitive-behavioral intervention for criminal recidivism-was not more effective than usual care (UC) for veterans in behavioral health treatment. To determine for whom treatments of recidivism are most effective, we tested if recency of criminal history or psychopathic traits moderated MRT's effects on outcomes.

Method: In a multisite trial, 341 veterans (95.

Criminogenic Needs and Legal Problem Severity Among Legal System Involved Veterans.

Background: Many veterans seeking behavioral health services have history of criminal-legal involvement. Research on criminogenic needs of legal system involved veterans is burgeoning. However, most research has relied on cross-sectional examinations and the vast majority of prior work has focused assessment on just one criminogenic need per study.

The effectiveness of a telephone smoking cessation program in mental health clinic patients by level of mental well-being and functioning: a secondary data analysis of a randomized clinical trial.

Background: Few studies have examined the effectiveness of telephone smoking cessation interventions by severity of behavioral health symptoms. Using data from a telephone counseling study, we examined whether abstinence rates varied by level of behavioral health symptoms.

Methods: The parent study recruited adults who smoke cigarettes (N = 577) referred by mental health providers at six Veterans Health Administration facilities.

Disentangling the relationship between posttraumatic stress disorder, criminogenic risk, and criminal history among veterans.

Objective: Posttraumatic stress disorder (PTSD) is positively associated with involvement in the criminal justice system among veterans. Research that examines whether this association is confounded by risk factors ("criminogenic needs") from the risk-need-responsivity model of correctional rehabilitation can inform risk management with this population.

Hypotheses: We hypothesized that (a) veterans with probable PTSD would score higher on all criminogenic needs than veterans without PTSD and (b) probable PTSD would be associated with criminal history but not after accounting for criminogenic needs.

A Peer Recovery Coach Intervention for Hospitalized Patients with Opioid Use Disorder: A Pilot Randomized Controlled Trial.

Objectives: Patients with opioid use disorder (OUD) are increasingly being hospitalized for acute medical illnesses. Despite initiation of medications for OUD (MOUDs), many discontinue treatment after discharge. To evaluate whether a psychosocial intervention can improve MOUD retention after hospitalization, we conducted a pilot randomized controlled trial of a peer recovery coach intervention.

Community reentry: Racial/ethnic differences in unmet needs among adults with co-occurring opioid use and mental health disorder.

Background: Adults with co-occurring opioid use and mental health disorder (COD) recently released from incarceration have many social and health needs that place them at the most significant risk for overdose and poor reentry outcomes. Little is known about racial/ethnic differences in this population.

Methods: To examine racial/ethnic differences in social and health needs, data were analyzed for 293 adults with COD within two weeks of release, a high-risk period for overdose, from six Massachusetts jails.

The Effectiveness of a Telephone Smoking Cessation Program in Mental Health Clinic Patients by Level of Mental Well-Being and Functioning: A Secondary Data Analysis of a Randomized Clinical Trial.

Background: Few studies have examined the effectiveness of telephone smoking cessation interventions by severity of behavioral health symptoms. Using data from a telephone counseling study, we examined whether abstinence rates varied by level of behavioral health symptoms.

Methods: The parent study recruited adults who smoke cigarettes (N = 577) referred by mental health providers at six Veterans Health Administration facilities.

Digital Biomarker Applications Across the Spectrum of Opioid Use Disorder.

Opioid use disorder (OUD) is one of the most pressing public health problems of the past decade, with over eighty thousand overdose related deaths in 2021 alone. Digital technologies to measure and respond to disease states encompass both on- and off-body sensors. Such devices can be used to detect and monitor end-user physiologic or behavioral measurements () that correlate with events of interest, health, or pathology.

Identifying strategies to advance equitable implementation of co-occurring mental health and substance use disorder treatment in drug treatment courts: A study protocol.

Introduction: Behavioral health treatment disparities by race and ethnicity are well documented across the criminal legal system. Despite criminal legal settings such as drug treatment courts (DTCs) increasingly adopting evidence-based programs (EBPs) to improve care, there is a dearth of research identifying strategies to advance equitable implementation of EBPs and reduce racial/ethnic treatment disparities. This paper describes an innovative approach to identify community- and provider-generated strategies to support equitable implementation of an evidence-based co-occurring mental health and substance use disorder intervention, called Maintaining Independence and Sobriety through Systems Integration, Outreach and Networking-Criminal Justice (MISSION-CJ), in DTCs.

Facilitators and barriers to collaboration between drug courts and community-based medication for opioid use disorder providers.

Introduction: Access to medications for opioid use disorder (MOUD) is limited for individuals in drug courts - programs that leverage sanctions for mandatory substance use treatment. Drug courts rely on community agencies to provide MOUD. However, relationships with MOUD agencies, which impact access to treatment, are understudied.

Integrating data analytics, peer support, and whole health coaching to improve the health outcomes of homeless veterans: Study protocol for an effectiveness-implementation trial.

Background: Homelessness is a strong determinant of acute care service utilization (inpatient hospitalization, emergency department visits) among US adults. Data analytics, peer support, and patient-centered approaches can collectively offer high-quality care for homeless patients who frequently utilize acute care ("super utilizers"). However, few outpatient programs have integrated these components and tested their effectiveness for this patient population.

Peer support and whole health coaching to address the healthcare needs of homeless veterans: a pilot study.

Background: Homelessness is a robust social determinant of acute care service utilization among veterans. Although intensive outpatient programs have been developed for homeless veterans who are high utilizers of acute care ("super utilizers"), few scalable programs have been implemented to address their needs.

Objective: Describe the development and pilot testing of a novel intervention that integrates the roles of a peer and whole health coach ("Peer-WHC") in coordination with primary care teams to reduce homeless veterans' frequent use of acute care.

Perceptions on wearable sensor-based interventions for monitoring of opioid therapy: A qualitative study.

Prescription opioid use is a risk factor for the development of opioid use disorder. Digital solutions, including wearable sensors, represent a promising opportunity for health monitoring, risk stratification and harm reduction in this treatment space. However, data on their usability and acceptability in individuals using opioids is limited.

Staff and Veteran Perspectives on Residential Treatment Programs' Responses to COVID-19: A Qualitative Study Guided by the WHO's After Action Review Framework.

Healthcare must rapidly and systematically learn from earlier COVID-19 responses to prepare for future crises. This is critical for VA's Mental Health Residential Rehabilitation and Treatment Programs (RRTPs), offering 24/7 care to Veterans for behavioral health and/or homelessness. We adapted the World Health Organization's After Action Review (AAR) to conduct semi-structured small-group discussions with staff from two RRTPs and Veterans who received RRTP care during COVID-19, to examine COVID-19's impact on these programs.