Integration of the ATTOC 12-Steps into the UMass Tobacco-Free Initiative

On May 27, 2008, UMass Memorial Health Care and The University of Massachusetts Medical School implemented a complete tobacco- free policy, both indoors and outdoors-- for all properties, including parking facilities and in vehicles parked there. This ban is for all tobacco products, including chewing tobacco, and extends to everyone who smokes--patients, visitors, employees, students and vendors

Case Management

This chapter describes the roles and responsibilities of the MISSION-VET Case Manager and how it relates to MISSION-VET service delivery. The chapter begins with an overview of the MISSION-VET Case Manager’s responsibilities. Settings in which MISSION-VET can be delivered and implications for case management are then reviewed. The importance of teamwork with the Peer Support Specialist is stressed, and the Case Manager’s role is distinguished from that of the Peer Support Specialist. The Chapter then reviews each of the Case Manager’s primary responsibilities. Because case management is seen as the foundation of the MISSION-VET model, this chapter refers to a number of appendices that will be useful tools for the Case Manager to use as MISSION-VET is implemented

A cluster randomized Hybrid Type III trial testing an implementation support strategy to facilitate the use of an evidence-based practice in VA homeless programs

BACKGROUND: The Housing and Urban Development-Veterans Affairs Supportive Housing (HUD-VASH) program is one of the largest initiatives to end Veteran homelessness. However, mental health and substance use disorders continue to reduce client stability and impede program success. HUD-VASH programs do not consistently employ evidence-based practices that address co-occurring mental health and substance use disorders. This paper presents a study protocol to evaluate the implementation of an evidence-based, co-occurring disorder treatment called Maintaining Independence and Sobriety Through Systems Integration, Outreach, and Networking-Veterans Edition (MISSION-Vet) in HUD-VASH using an implementation strategy called Getting To Outcomes (GTO). METHODS/DESIGN: In three large VA Medical Centers, this Hybrid Type III trial will randomize case managers and their clients by HUD-VASH sub-teams to receive either MISSION-Vet Implementation as Usual (IU-standard training and access to the MISSION-Vet treatment manuals) or MISSION-Vet implementation augmented by GTO. In addition to testing GTO, effectiveness of the treatment (MISSION-Vet) will be assessed using existing Veteran-level data from the HUD-VASH data monitoring system. This project will compare GTO and IU case managers and their clients on the following variables: (1) fidelity to the MISSION-Vet intervention; (2) proportion of time the Veteran is housed; (3) mental health, substance use, and functional outcomes among Veterans; and (4) factors key to the successful deployment of a new treatment as specified by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) model. DISCUSSION: This project is an important step for developing an implementation strategy to increase adoption of evidence-based practice use in VA homeless programs, and to further examine efficacy of MISSION-Vet in HUD-VASH. This project has important implications for program managers, policy makers, and researchers within the homelessness field. VA Central IRB approval for this study was granted in October 2011. The three sites were trained on MISSION-Vet and GTO in the first half of 2013. The first GTO planning meetings began after training occurred, between January 2013 and November 2013, across the three sites. The data collection-via a fidelity measure embedded into the VA Computerized Patient Record System-began as each site initiated MISSION-Vet, between April 2013 and January 2014. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01430741

Preliminary needs assessment of mobile technology use for healthcare among homeless veterans

Background. Homeless veterans have complex healthcare needs, but experience many barriers to treatment engagement. While information technologies (IT), especially mobile phones, are used to engage patients in care, little is known about homeless veterans\u27 IT use. This study examines homeless veterans\u27 access to and use of IT, attitudes toward health-related IT use, and barriers to IT in the context of homelessness. Methods. Qualitative interviews were conducted with 30 homeless veterans in different housing programs in Boston, MA, ranging from emergency shelters to supportive transitional housing that allow stays of up to 2 years. Interviews were conducted in person, audio recorded and then transcribed. Three researchers coded transcripts. Inductive thematic analysis was used. Results. Most participants (90%) had a mobile phone and were receptive to IT use for health-related communications. A common difficulty communicating with providers was the lack of a stable mailing address. Some participants were using mobile phones to stay in touch with providers. Participants felt mobile-phone calls or text messages could be used to remind patients of appointments, prescription refills, medication taking, and returning for laboratory results. Mobile phone text messaging was seen as convenient, and helped participants stay organized because necessary information was saved in text messages. Some reported concerns about the costs associated with mobile phone use (calls and texting), the potential to be annoyed by too many text messages, and not knowing how to use text messaging. Conclusion. Homeless veterans use IT and welcome its use for health-related purposes. Technology-assisted outreach among this population may lead to improved engagement in care

The MISSION-VET Consumer Workbook

Summary: Supplemental workbook for the Maintaining Independence and Sobriety through Systems Integration, Outreach, and Networking (MISSION) treatment approach, which was adapted specifically for Veterans (MISSION-VET). MISSION-VET, a flexible, integrated, time-limited, yet assertive service delivery platform was designed specifically to provide direct treatment, ongoing support, and care coordination to homeless Veterans suffering from co-occurring disorders and transitioning and/or adjusting to independent living in the community. The Consumer Workbook is a supplemental workbook to engage homeless Veterans by providing exercises and resources to aid in their recovery from a co-occurring disorder and homelessness. Peer Support Specialists and Case Managers should work with the Veteran to complete the items in the workbook that correspond with specific Dual-Recovery Therapy sessions and use the workbook as a talking point in helping clients with co-occurring mental illness and substance abuse, homelessness and related issues that arise in the various stages of their recovery

HUD-VASH Resource Guide for Permanent Housing and Clinical Care

The Department of Housing and Urban Development – VA Supportive Housing (HUD-VASH) Program is a joint effort between HUD and VA to move Veterans and their families out of homelessness and into permanent housing. The HUD-VASH Resource Guide for Permanent Housing and Clinical Care was designed to provide case managers, and other who work with homeless Veterans in the HUD-VASH program, with a comprehensive set of resources to assist in addressing the multifaceted needs of homeless Veterans. The Resource Guide is a product of the National Center on Homelessness Among Veterans and was developed by a dynamic team of researchers, policy analysts, public health experts, psychologists, physicians and social workers located throughout the country

Validation of time-resolved, automated peak trans-mitral velocity tracking: Two center four-dimensional flow cardiovascular magnetic resonance study

Objective: We aim to validate four-dimensional flow cardiovascular magnetic resonance (4D flow CMR) peak velocity tracking methods for measuring the peak velocity of mitral inflow against Doppler echocardiography.  Method: Fifty patients were recruited who had 4D flow CMR and Doppler Echocardiography. After transvalvular flow segmentation using established valve tracking methods, peak velocity was automatically derived using three-dimensional streamlines of transvalvular flow. In addition, a static planar method was used at the tip of mitral valve to mimic Doppler technique.  Results: Peak E-wave mitral inflow velocity was comparable between TTE and the novel 4D flow automated dynamic method (1.02±0.41 m/s vs 1.02±0.36 m/s; P=0.77) however there was a statistically significant difference when compared with the static planar method (0.93±0.37 m/s; P=0.04). Mean A-wave peak velocity was also comparable across TTE and the automated dynamic streamline (0.87±0.39 m/s vs 0.87±0.36 m/s; P=0.99). A significant difference was seen with the static planar method (0.78±0.36 m/s; P=0.04). E/A ratio was comparable between TTE and both the automated dynamic and static planar method (1.22±0.52 vs 1.20±0.34; p=0.76 and 1.36±0.81; p=0.25 respectively). Both novel 4D flow methods showed good correlation with TTE for E-wave (dynamic method; r=0.70; P<0.001 and static planar method; r=0.67; P<0.001) and A-wave velocity measurements (dynamic method; r=0.83; P<0.001 and static method; r=0.71; P<0.001). The automated dynamic method demonstrated excellent intra/inter-observer reproducibility for all parameters.  Conclusion: Automated dynamic peak velocity tracing method using 4D flow CMR is comparable to Doppler echocardiography for mitral inflow assessment and has excellent reproducibility for clinical use

MISSION-VET Treatment Manual

Summary: Treatment manual for the Maintaining Independence and Sobriety through Systems Integration, Outreach, and Networking (MISSION) treatment approach, which was adapted specifically for Veterans (MISSION-VET). MISSION-VET, a flexible, integrated, time-limited, yet assertive service delivery platform was designed specifically to provide direct treatment, ongoing support, and care coordination to homeless Veterans suffering from co-occurring disorders transitioning and/or adjusting to independent living in the community. This audience for this manual is case managers and peer support specialists

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

Little research has focused on systematically integrating clinical treatment within existing drug court procedures. This could be particularly useful for clients with substance use disorders, who comprise those on court dockets and often have co-existing mental health issues. This article reports on the preliminary outcomes of integrating MISSION-Criminal Justice (MISSION-CJ), a co-occurring mental health and substance use wraparound intervention, within two Massachusetts drug courts. In this open pilot, clients completed intake and 6-month follow-up assessments. The participants were primarily Caucasian (86%), male (82%), had at least 2 prior arrests, and received outpatient treatment for mental health (54%), alcohol use (51%), or drug use (88%) prior to enrolling in MISSION-CJ. Six-month follow-up data suggested that participants showed statistically significant reductions in average number of nights spent in jail, alcohol use, and drug use, as well as an increase in full time employment

Integrating Permanent Supportive Housing and Co-Occurring Disorders Treatment for Individuals Who Are Homeless

OBJECTIVES: While permanent housing, addictions, and mental health treatment are often critical needs to achieve housing stability and community reintegration, few studies have systematically integrated them into a single comprehensive approach for people experiencing chronic homelessness. This pilot study examined the feasibility and preliminary outcomes of systematically integrating permanent supportive housing and an evidence-based co-occurring disorders intervention called Maintaining Independence and Sobriety Through Systems Integration, Outreach, and Networking (MISSION). METHODS: This single-group open pilot enrolled 107 people with co-occurring disorders experiencing chronic homelessness from two Massachusetts inner-city and rural areas. Enrolled subjects were interested in receiving permanent supportive housing along with 1 year of MISSION services. Data were collected through baseline and 6- and 12-month follow-up assessments. RESULTS: Participants (Mage = 49.52 years, SD = 10.61) were mostly male (76.6%), Caucasian (52.3%), and unemployed (86.0%), with an average of 8.34 years (SD = 8.01) of homelessness. Self-reported lifetime problems with anxiety (75.7%) and depression (76.6%) were common, as was use of alcohol (30.8%), cannabis (31.8%), and cocaine (15.9%). Almost all participants (95.3%) were placed into permanent housing, which took on average 42.6 days from enrollment (SD = 50.09). Among those placed, nearly 80% of the clients were able to retain housing through the end of the study. Overall retention was high, with 86.0% remaining in MISSION treatment until the end of the study. While there were no significant changes in rehospitalization, service utilization, or substance use, there were modest significant mental health symptom improvements from baseline to program completion. CONCLUSIONS: This pilot study suggests that co-occurring disorder interventions like MISSION are feasible to integrate with permanent supportive housing despite the somewhat differing philosophies, and preliminary data suggested substantial improvements in housing and modest improvements in mental health symptoms. While caution is warranted given the lack of a comparison group, these findings are consistent with other rigorous studies using MISSION among homeless individuals who did not receive permanent supportive housing