Clients of VA-Housed Legal Clinics: Legal and Psychosocial Needs When Seeking Services and Two Months Later

Timko, Christine; Tsai, Jack; Taylor, Emmeline; Smelson, David A.; Blonigen, Daniel M.; Nash, Amia; Finlay, Andrea K.

doi:10.21061/jvs.v6i1.167

Cited by 3 publications

(1 citation statement)

References 18 publications

(24 reference statements)

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“…Veterans not yet connected with VA, those residing in rural areas [6,7], or those requiring more intensive and longer-duration legal assistance [8] are especially at risk for unmet need.…”

Section: Introductionmentioning

confidence: 99%

Legal Services for Veterans (LSV): Protocol for evaluating the grant-based LSV initiative supporting community organizations’ delivery of legal services to veterans

Kim,

Petrakis,

Griesemer

et al. 2024

PLoS ONE

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Background 1.8 million Veterans are estimated to need legal services, such as for housing eviction prevention, discharge upgrades, and state and federal Veterans benefits. While having one’s legal needs met is known to improve one’s health and its social determinants, many Veterans’ legal needs remain unmet. Public Law 116–315 enacted in 2021 authorizes VA to fund legal services for Veterans (LSV) by awarding grants to legal service providers including nonprofit organizations and law schools’ legal assistance programs. This congressionally mandated LSV initiative will award grants to about 75 competitively selected entities providing legal services. This paper describes the protocol for evaluating the initiative. The evaluation will fulfill congressional reporting requirements, and inform continued implementation and sustainment of LSV over time. Methods Our protocol calls for a prospective, mixed-methods observational study with a repeated measures design, aligning to the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) and Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) frameworks. In 2023, competitively selected legal services-providing organizations will be awarded grants to implement LSV. The primary outcome will be the number of Veterans served by LSV in the 12 months after the awarding of the grant. The evaluation has three Aims. Aim 1 will focus on measuring primary and secondary LSV implementation outcomes aligned to RE-AIM. Aim 2 will apply the mixed quantitative-qualitative Matrixed Multiple Case Study method to identify patterns in implementation barriers, enablers, and other i-PARIHS-aligned factors that relate to observed outcomes. Aim 3 involves a mixed-methods economic evaluation to understand the costs and benefits of LSV implementation. Discussion The LSV initiative is a new program that VA is implementing to help Veterans who need legal assistance. To optimize ongoing and future implementation of this program, it is important to rigorously evaluate LSV’s outcomes, barriers and enablers, and costs and benefits. We have outlined the protocol for such an evaluation, which will lead to recommending strategies and resource allocation for VA’s LSV implementation.

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“…Veterans not yet connected with VA, those residing in rural areas [6,7], or those requiring more intensive and longer-duration legal assistance [8] are especially at risk for unmet need.…”

Section: Introductionmentioning

confidence: 99%

Legal Services for Veterans (LSV): Protocol for evaluating the grant-based LSV initiative supporting community organizations’ delivery of legal services to veterans

Kim,

Petrakis,

Griesemer

et al. 2024

PLoS ONE

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Relationship Between Unmet Social Needs and Care Access in a Veteran Cohort

et al. 2023

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Background The association between unmet social needs (e.g., food insecurity) and adverse health outcomes is well-established, especially for patients with and at risk for cardiovascular disease (CVD). This has motivated healthcare systems to focus on unmet social needs. Yet, little is known about the mechanisms by which unmet social needs impact health, which limits healthcare-based intervention design and evaluation. One conceptual framework posits that unmet social needs may impact health by limiting care access, but this remains understudied. Objective Examine the relationship between unmet social needs and care access. Design Cross-sectional study design using survey data on unmet needs merged with administrative data from the Veterans Health Administration (VA) Corporate Data Warehouse (September 2019–March 2021) and multivariable models to predict care access outcomes. Pooled and separate rural and urban logistic regression models were utilized with adjustments from sociodemographics, region, and comorbidity. Subjects A national stratified random sample of VA-enrolled Veterans with and at risk for CVD who responded to the survey. Main Measures No-show appointments were defined dichotomously as patients with one or more missed outpatient visits. Medication non-adherence was measured as proportion of days covered and defined dichotomously as adherence less than 80%. Key Results Greater burden of unmet social needs was associated with significantly higher odds of no-show appointments (OR = 3.27, 95% CI = 2.43, 4.39) and medication non-adherence (OR = 1.59, 95% CI = 1.19, 2.13), with similar associations observed for rural and urban Veterans. Social disconnection and legal needs were especially strong predictors of care access measures. Conclusions Findings suggest that unmet social needs may adversely impact care access. Findings also point to specific unmet social needs that may be especially impactful and thus might be prioritized for interventions, in particular social disconnection and legal needs.

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Scoping review of military veterans involved in the criminal legal system and their health and healthcare: 5-year update and map to the Veterans-Sequential Intercept Model

Singh,

Timko,

et al. 2024

Health Justice

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Background A previous scoping review of legal-involved veterans’ health and healthcare (1947–2017) identified studies and their limitations. Given the influx of literature published recently, this study aimed to update the previous review and map articles to the Veterans-Sequential Intercept Model (V-SIM) – a conceptual model used by key partners, including Veterans Health Administration, veteran advocates, criminal justice practitioners, and local governments to identify intercept points in the criminal legal system where resources and programming can be provided. Developing an updated resource of literature is essential to inform current research, discover gaps, and highlight areas for future research. Methods A systematic search of 5 databases identified articles related to legal-involved veterans’ health and healthcare published between December 2017 through December 2022. The first and senior authors conducted abstract reviews, full-text reviews, and data extraction of study characteristics. Finally, each article was sorted by the various intercept points from the V-SIM. Results Of 903 potentially relevant articles, 107 peer-reviewed publications were included in this review, most related to mental health (66/107, 62%) and used an observational quantitative study design (95/107, 89%). Although most articles did not explicitly use the V-SIM to guide data collection, analyses, or interpretation, all could be mapped to this conceptual model. Half of the articles (54/107, 50%) collected data from intercept 5 (Community Corrections and Support Intercept) of the V-SIM. No articles gathered data from intercepts 0 (Community and Emergency Services Intercept), 1 (Law Enforcement Intercept), or 2 (Initial Detention and Court Hearings Intercept). Conclusions There were 107 articles published in the last five years compared to 190 articles published in 70 years covered in the last review, illustrating the growing interest in legal-involved veterans. The V-SIM is widely used by front-line providers and clinical leadership, but not by researchers to guide their work. By clearly tying their research to the V-SIM, researchers could generate results to help guide policy and practice at specific intercept points. Despite the large number of publications, research on prevention and early intervention for legal-involved veterans is lacking, indicating areas of great need for future studies.

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Clients of VA-Housed Legal Clinics: Legal and Psychosocial Needs When Seeking Services and Two Months Later

Cited by 3 publications

References 18 publications

Legal Services for Veterans (LSV): Protocol for evaluating the grant-based LSV initiative supporting community organizations’ delivery of legal services to veterans

Legal Services for Veterans (LSV): Protocol for evaluating the grant-based LSV initiative supporting community organizations’ delivery of legal services to veterans

Relationship Between Unmet Social Needs and Care Access in a Veteran Cohort

Scoping review of military veterans involved in the criminal legal system and their health and healthcare: 5-year update and map to the Veterans-Sequential Intercept Model

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