An Alternative to Incarceration: Co-Occurring Disorders Treatment Intervention for Justice-Involved Veterans

Abstract

This article reports on the implementation, evaluation, and policy implications of MISSION‐Criminal Justice (CJ), an innovative intervention used to treat justice‐involved veterans with co‐occurring mental health and substance use disorders (CODs). In this pilot feasibility study, MISSION‐CJ was embedded into four Massachusetts courts and their probation services as an alternative to incarceration. Seventy‐six veterans were diverted from jail to MISSION‐CJ and completed intake and six‐month follow‐up assessments. The MISSION‐CJ participants were primarily white, had at least two prior arrests, served in a war combat zone, had a trauma before age 18, and had previously received mental health and substance use treatments. Preliminary six‐month follow‐up data suggested that the MISSION‐CJ participants showed improvements in COD problems, trauma symptoms, and a nonsignificant reduction in hospitalization/ER visits. MISSION‐CJ was feasible to implement and seemed to show some preliminary program success. A randomized controlled trial of MISSION‐CJ is a necessary next step in determining program efficacy. Policy implications for tailoring interventions for justice‐involved veterans such as MISSION‐CJ and their delivery alongside the court and probation are discussed.

Integrating a Co-occurring Disorders Intervention in Drug Courts: An Open Pilot Trial

“…In its overarching framework, MISSION-CJ is unique in that it takes a deliberate and systematized approach to addressing criminogenic risk and needs to reduce recidivism as a recovery goal for participants. In a previous study, we integrated MISSION-CJ alongside probation but separate from a specialized treatment court docket, and found it to be effective for increasing communication between the court, probation, and providers (Smelson et al 2015).…”

“…MISSION-CJ was adapted from our wraparound approach called MISSION, originally developed to help clients with a co-occurring mental health and substance abuse problem engage in community supports while simultaneously addressing some of their clinical needs, and has recently been included in the Substance Use and Mental Health Services National Registry for Evidence Based Practices (Smelson et al 2007;MISSION 2016). Our previous research has shown MISSION to improve mental health, substance use, housing, and employment outcomes for homeless clients as well as veterans (Smelson et al 2012(Smelson et al , 2013(Smelson et al , 2015. MISSION was recently adapted and pilot tested with criminal-justice involved veterans who were diverted from jail, but not seen in a specialty court session (Smelson et al 2015).…”

“…Our previous research has shown MISSION to improve mental health, substance use, housing, and employment outcomes for homeless clients as well as veterans (Smelson et al 2012(Smelson et al , 2013(Smelson et al , 2015. MISSION was recently adapted and pilot tested with criminal-justice involved veterans who were diverted from jail, but not seen in a specialty court session (Smelson et al 2015). The adaptations of MISSION for homeless clients, to MISSION-CJ for justice-involved clients included the integration of a criminogenic risk and need assessment, and was incorporated into a new MISSION-CJ Treatment Manual (Pinals et al 2014) and Participant Workbook (Smelson et al 2014).…”

“…"Dosing" of MISSION-CJ programming and treatment referrals can be titrated depending on the risk level of the client with regard to recidivism. Modeled after the original MISSION intervention for homeless clients, the same core treatment components were used in the MISSION-CJ approach (Smelson et al 2015).…”

Perceptions of voluntary consent among jail diverted veterans with co‐occurring disorders

“…These programs aim to address the unique issues that veterans face upon returning from service, including PTSD, depression, and suicidal ideation, the incidences of which may be increasing due to various changing physical, political, and cultural forces (Hartsfield, ; Nidiffer & Leach, ). Jail diversion for veterans is executed through varying models, including participation in specialized veteran treatment courts (VTCs), which number over 250 nationally, or through dockets of drug, mental health, or traditional criminal courts, in which linkage, support, and referral services are provided as a condition of probation (Department of Veterans Affairs, ; Smelson et al, ). Combined, these efforts highlight the beginning of a paradigm shift towards rehabilitative and, to some extent, restorative jurisprudence for criminally involved service members with underlying mental health and substance use issues (Baldwin & Rukus, ; Seamone et al, ).…”