# A Randomized Controlled Trial of MISSION-CJ for Justice-Involved Homeless Veterans with Co-Occurring Substance Use and Mental Health

> **NIH VA I01** · EDITH NOURSE  ROGERS MEMORIAL VETERANS HOSPITAL · 2020 · —

## Abstract

Background: Among the 146,000 Veterans released from correctional settings annually, approximately 60%
have a co-occurring mental health and substance use disorder (COD). These individuals often access
treatment inconsistently, resulting in increased antisocial activities and acceleration into unemployment and
homelessness – strong predictors of reoffending. VHA Mental Health Residential Rehabilitation Treatment
Programs (MH RRTPs) commonly serve justice-involved Veterans (JIVs) with an estimated 50% annually. JIVs
receive assistance with their addiction and behavioral health needs, but MH RRTP programs do not directly
address their antisocial behaviors and cognitions. Furthermore, MH RRTP discharge is a vulnerable transition
and no national transitional approach facilitates Veteran engagement in prosocial community behaviors that
maintain MH RRTP gains, and ultimately reducing revolving door service use. Maintaining Independence and
Sobriety through Systems Integration, Outreach, and Networking-Criminal Justice version (MISSION-CJ) is a
new case manager and peer delivered team-based treatment for JIVs with a COD. Three recent open pilots of
MISSION-CJ showed reduced criminal recidivism, improved behavioral health outcomes and increased access
and engagement in care. A randomized controlled trial (RCT) is a critical next step prior to dissemination.
Significance/Impact: This application is responsive to the VHA MISSION Act, Veteran Care Priorities of
Access to Care, Mental Health, and Health Equity. The project aims to (a) increase access and engagement in
VHA and community-based care, (b) offer timely Veteran-centered care, and (c) improve the health and well-
being of JIVs while reducing disparities. It also includes an implementation aim to support VHA learning.
Innovation: While MISSION-CJ derives in part from an evidence-based treatment for homeless individuals
(MISSION), it includes a new conceptual framework and numerous new and differentiating features for a CJ
population including: (1) a treatment planning tool focused on criminogenic needs that monitors progress and
tunes service delivery elements, (2) a prosocial treatment curriculum, and (3) tools/resources to address
Veteran legal issues. With MISSION-CJ, this study attempts to change the practice paradigm and transform
care for JIVs by moving beyond the current model of linking Veterans to VA care and tracking behavioral
health outcomes, to a hybrid treatment/linkage approach that addresses criminogenic needs, supports
engagement in VA and non-VA care, and targets recidivism as an outcome–the gold standard for CJ research.
Specific Aims: Aim 1: An RCT will compare MISSION-CJ to EUC. We predict that those in MISSION-CJ will
have (1a) lower criminal recidivism; (1b) lower overall risk for criminal recidivism; (1c) better health-related
outcomes (substance use, mental health, housing, employment); and (1d) the effects of MISSION-CJ on 1a,
1b and 1c, will be mediated by (i) reductions a...

## Key facts

- **NIH application ID:** 9940962
- **Project number:** 1I01HX002701-01A2
- **Recipient organization:** EDITH NOURSE  ROGERS MEMORIAL VETERANS HOSPITAL
- **Principal Investigator:** Daniel Michael Blonigen
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2020-09-01 → 2025-02-28

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9940962

## Citation

> US National Institutes of Health, RePORTER application 9940962, A Randomized Controlled Trial of MISSION-CJ for Justice-Involved Homeless Veterans with Co-Occurring Substance Use and Mental Health (1I01HX002701-01A2). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9940962. Licensed CC0.

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