Veterans Health Administration Deflection Programming: A Qualitative Study of Providers and Police Officers

Lance Washington; Andrea Finlay; Kreeti Singh; Katie Stewart; Matthew Stimmel; Antonio  Harris

doi:10.5281/zenodo.15227648

Autores/as

Lance Washington United States Department of Veteran Affairs
Andrea Finlay
Kreeti Singh
Katie Stewart
Matthew Stimmel
Antonio Harris

DOI:

https://doi.org/10.5281/zenodo.15227648

Palabras clave:

Veteranos, Justicia penal, Sanidad, Departamento de Asuntos de Veteranos de los Estados Unidos, ODS, ODS 1, ODS 3, ODS 5, ODS 10, ODS 15

Resumen

Objetivo: El personal de los programas de deflexión interviene con una persona antes o durante una crisis o un encuentro en la comunidad para ponerla en contacto con los servicios sanitarios o psicosociales necesarios y evitar su detención o una mayor interacción con el sistema jurídico penal. A medida que los programas de deflexión se desarrollan y amplían, surgen oportunidades para conectar a los veteranos en crisis o con otras necesidades de servicios con la asistencia sanitaria. La Administración de Salud de los Veteranos (VHA, por sus siglas en inglés) apoyó y formó al personal para crear y ampliar las asociaciones de deflexión para atender a los veteranos que corren el riesgo de resultados legales o clínicos adversos. Este estudio examinó las experiencias de los profesionales de la VHA y sus recomendaciones para las asociaciones de deflexión.

Métodos: Se realizaron entrevistas semiestructuradas virtuales con 13 miembros del personal de la VHA entre mayo y junio de 2024. El objetivo principal de las entrevistas era examinar los socios clave, los recursos basados en la comunidad, las barreras para el éxito de las asociaciones de deflexión, el seguimiento de datos y la futura mejora de la calidad. Las transcripciones se codificaron utilizando códigos a priori y emergentes y se analizaron utilizando el método del marco.

Resultados: La mayoría de los participantes eran mujeres (56%), caucasicos (87%), con un máster (94%) y 10 o más años de empleo en la VHA (69%). Se identificaron cuatro temas: (1) características de la asociación de deflexión, (2) necesidad de Especialistas Pares, (3) recursos y barreras de la VHA y de la comunidad, y (4) seguimiento de datos.

Conclusión: Los resultados indicaron que el personal de la VHA es muy colaborador, pero las lagunas en los recursos de la VHA y de la comunidad, el escaso número de especialistas dedicados a los servicios jurídicos para veteranos y la falta de seguimiento de los datos limitaron el éxito de las asociaciones de deflexión. Las recomendaciones para garantizar la continuidad y la expansión del programa incluyen proporcionar más recursos y formación, contratar a Especialistas Pares dedicados a los servicios para veteranos con implicación legal y mejorar la recopilación y el seguimiento de datos para facilitar asociaciones de deflexión eficaces para los veteranos.

Citas

Anderson, E., Shefner, R., Koppel, R., Megerian, C., & Frasso, R. (2022). Experiences with the Philadelphia police assisted diversion program: A qualitative study. International Journal of Drug Policy, 100, 103521. https://doi.org/10.1016/j.drugpo.2021.103521

Armstrong, N., McDonough, J., & Savage, D. (2015). Driving Community Impact: A Case for Local Evidence-Based Coordination in Veteran and Military Family Services and the AmericaServes Initiative. Institute for Veterans and Military Families. https://surface.syr.edu/ivmf/118

Blue-Howells, J. H., Clark, S. C., van den Berk-Clark, C., & McGuire, J. F. (2013). The U.S. Department of Veterans Affairs Veterans Justice Programs and the sequential intercept model: Case examples in national dissemination of intervention for justice-involved veterans. Psychological Services, 10(1), 48–53. https://doi.org/10.1037/a0029652

Britton, P. C., Karras, E., Stecker, T., Klein, J., Crasta, D., Brenner, L. A., & Pigeon, W. R. (2023). Veterans Crisis Line Call Outcomes: Treatment Contact and Utilization. American Journal of Preventive Medicine, 64(5), 658–665. https://doi.org/10.1016/j.amepre.2023.01.024

Chalker, S. A., Serafez, J., Imai, Y., Stinchcomb, J., Mendez, E., Depp, C. A., Twamley, E. W., Fortuna, K. L., Goodman, M., & Chinman, M. (2024). Suicide prevention by Peers Offering Recovery Tactics (SUPPORT) for US veterans with serious mental illness: Community engagement approach. Journal of Participatory Medicine, 16, e56204. https://doi.org/10.2196/56204

Chinman, M., Salzer, M., & O’Brien-Mazza, D. (2012). National survey on implementation of Peer Specialists in the VA: Implications for training and facilitation. Psychiatric Rehabilitation Journal, 35(6), 470–473. https://doi.org/10.1037/h0094582

Claver, M., Friedman, D., Dobalian, A., Ricci, K., & Horn Mallers, M. (2012). The role of Veterans Affairs in emergency management: A systematic literature review. PLoS Currents, 4, e198d344bc40a75f927c9bc5024279815. https://doi.org/10.1371/198d344bc40a75f927c9bc5024279815

Department of Veterans Affairs. (2024, April). VHA directive 1162.06. Under Secretary for Health.

Finlay, A. K., Owens, M. D., Taylor, E., Nash, A., Capdarest-Arest, N., Rosenthal, J., Blue-Howells, J., Clark, S., & Timko, C. (2019). A scoping review of military veterans involved in the criminal justice system and their health and healthcare. Health & Justice, 7(1), 6. https://doi.org/10.1186/s40352-019-0086-9

Furber, C. (2010). Framework analysis: A method for analysing qualitative data. African Journal of Midwifery and Women’s Health, 4(2), 97–100. https://doi.org/10.12968/ajmw.2010.4.2.47612

Hester, R. D. (2017). Lack of access to mental health services contributing to the high suicide rates among veterans. International Journal of Mental Health Systems, 11(1), 47. https://doi.org/10.1186/s13033-017-0154-2

Hoffman, K., & Titus, D. (2017). Data sharing and the transformation of veterans’ healthcare: opportunities and challenges in interoperability. Health Lawyer, 30, 30.

Johnson, R. (2013). Biopsychosociocultural perspective on ‘Operation Enduring Freedom/Operation Iraqi Freedom’ women veterans as civilian police officers: Mild traumatic brain injury and post-traumatic stress disorder challenges. International Journal of Police Science & Management, 15(1), 45–50. https://doi.org/10.1350/ijps.2013.15.1.300

Karway, G., Ivanova, J., Bhowmik, A., Murcko, A., Saks, M., McCarty, D., Campbell, A., & Grando, M. A. (2022). Recommendations to inform substance use disorder data sharing research: Scoping review and thematic analysis. Journal of Addiction Medicine, 16(3), 261. https://doi.org/10.1097/ADM.0000000000000893

Kumar, A., Azevedo, K. J., Factor, A., Hailu, E., Ramirez, J., Lindley, S. E., & Jain, S. (2019). Peer support in an outpatient program for veterans with posttraumatic stress disorder: Translating participant experiences into a recovery model. Psychological Services, 16(3), 415–424. https://doi.org/10.1037/ser0000269

Leung, L. B., Rubenstein, L. V., Yoon, J., Post, E. P., Jaske, E., Wells, K. B., & Trivedi, R. B. (2019). Veterans Health Administration investments in primary care and mental health integration improved care access. Health Affairs, 38(8), 1281–1288. https://doi.org/10.1377/hlthaff.2019.00270

McCarthy, S., Chinman, M., Mitchell-Miland, C., Schutt, R. K., Zickmund, S., & Ellison, M. L. (2019). Peer specialists: Exploring the influence of program structure on their emerging role. Psychological Services, 16(3), 445–455. https://doi.org/10.1037/ser0000250

Mok, C., Weaver, C., Rosenthal, J., Pettis, T., & Wickham, R. (2018). Augmenting Veterans Affairs police mental health response: Piloting diversion to health care as risk reduction. Journal of Threat Assessment and Management, 5(4), 227–237. https://doi.org/10.1037/tam0000112

Neuman, M., Morrell, S., Cooper, S., & Vasquez, K. (2024). Veterans Justice Programs Peer Specialist resource guide. Veterans Justice Program.

Pinals, D. A. (2017). Jail diversion, specialty court, and reentry services: Partnerships between behavioral health and justice systems. In Principles and Practice of Forensic Psychiatry (3rd ed.). CRC Press.

Savage, J., & Morabito, M. S. (2020). Police response to people with mental illnesses in a major US city: The Boston experience with the co-responder model and mental health innovation. In Policing and Mental Health. Routledge.

Schmutte, T., Krishnamurti, L. S., Davidson, L., Klee, A., Bullock, J., Panas, R. M., Pfeiffer, P. N., & Chinman, M. (2023). Implementing Peer Specialists in suicide prevention efforts in the Veterans Health Administration. Psychiatric Quarterly, 94(2), 311–319. https://doi.org/10.1007/s11126-023-10034-x

Shia, S. S., Miller, M. J., Swensen, A. B., & Matthieu, M. M. (2013). Veterans Justice Outreach and Crisis Intervention Teams: A collaborative strategy for early intervention and continuity of care for justice-involved veterans. Military Behavioral Health, 1(2), 136–145. https://doi.org/10.1080/21635781.2013.829387

Singh, K., Timko, C., Yu, M., Taylor, E., Blue-Howells, J., & Finlay, A. K. (2024). 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. Health & Justice, 12(1), 18. https://doi.org/10.1186/s40352-024-00274-9

Soratto, J., Pires, D. E. P. D., & Friese, S. (2020). Thematic content analysis using ATLAS.ti software: Potentialities for research in health. Revista Brasileira de Enfermagem, 73(3), e20190250. https://doi.org/10.1590/0034-7167-2019-0250

Tsai, J., Gonzalez, C., Szymkowiak, D., Stewart, K., Dillard, D., Whittle, T., & Woodland, P. (2023). Evaluating Veterans Response Teams and police interventions on veterans’ health care utilization. Journal of Public Health Management and Practice, 29(3), 387–391. https://doi.org/10.1097/PHH.0000000000001718

Tsai, J., Kelton, K., Blonigen, D. M., Keith Mcinnes, D., Sean Clark, Blue-Howells, J., & Hooshyar, D. (2024). A research agenda for criminal justice involvement among U.S. veterans. Military Medicine, 189(3–4), e481–e485. https://doi.org/10.1093/milmed/usad201

Washington, L., Singh, K., Stewart, K., Firesheets, K., Charlier, J., & Finlay, A. K. (2024). Veterans deflection: Not waiting for military veterans to be arrested or in crisis before we act. Routledge.

Wood, J. D., Watson, A. C., & Barber, C. (2021). What can we expect of police in the face of deficient mental health systems? Qualitative insights from Chicago police officers. Journal of Psychiatric and Mental Health Nursing, 28(1), 28–42. https://doi.org/10.1111/jpm.12691