Veterans involved in the legal system have more extensive mental health (MH) and substance use (SU) disorders than other Veterans. Veterans frequently report legal difficulties related to obtaining and using VA health care benefits. In community samples, 54%-60% with civil legal problems have SU and MH disorders, and an estimated 56% of community samples with MH and SU disorders have civil legal problems, most often in the health care domain. The prevalence of legal, MH, and SU problems is likely higher in Veteran than in community populations. Resolution of patients' civil legal problems is associated with lower health care costs. A new model, VA-hosted legal clinics, has developed, with an emphasis on helping Veterans to gain access to VA health care (e.g., obtain needed military discharge upgrades and VA benefits), and to address civil legal issues that are barriers to utilizing treatment even when Veterans have access to care (e.g., driver's license reinstatement to enable transportation to health appointments). By addressing legal needs, VA-based legal clinics help Veterans receive health care services and improve their health and quality of life. However, even with access, Veterans with SU and MH disorders are likely to need intensive (or facilitated) referral to initiate and engage with treatment. Despite their rapidly increasing number, there has been no systemwide study of VA-legal clinics in terms of population served, function, or organization, or empirically-based suggestions on how to further improve their usefulness to VA and Veterans, such as their potential as a setting in which Veterans with MH and SU problems may receive assistance with linking to VA health services to improve their well-being. This project will conduct a survey (developed and pretested prior to funding, in a currently-funded Locally Initiated Project) of all VA legal clinics nationwide. The survey (N=120) will determine the extent to which VA-located legal clinics: (a) assess and identify Veteran clients' SU and MH problems, and facilitate and monitor use of VA SU and MH services by clients; (b) view legal clinics as a feasible point of intervention by intensive referral to facilitate transition to and engagement with the VA health care system by Veterans in need of SU and MH care; and (c) are characterized by additional transition barriers and facilitators identified in our conceptual model. This project will also collaborate with the VA Palo Alto legal clinic to assess and follow its Veteran clients. The purpose will be to collect data on clients' acceptance of participating in a longitudinal research project that tracks their SU and MH problems and VA treatment and outcomes (via self-reports and health records), and to publish findings on changes in these Veterans' legal and health status. The survey and client data will be used in a subsequent IIR proposal to intervene with VA legal clinic clients using an intensive referral approach to facilitate their transition to needed VA health care services and improve outcomes. This project meets priorities of the VA Blueprint for Excellence, HSR&D, the Center for Innovation to Implementation (the research team's HSR&D Center of Innovation), our VA operations partner, the Veterans Justice Programs, and the White House Legal Aid Interagency Roundtable. This research program has the potential to improve access to care by a sizable but underserved and vulnerable Veteran population. The pilot project will fill a critical gap by gathering information about functions of the rapidly expanding number of VA- located legal clinics, and about health services needs of Veterans they serve. We will use the pilot's findings in an IIR project to develop and test an intervention to facilitate transition to treatment and thus enable better outcomes among Veterans using VA-based legal clinics. Our ultimate goal is to improve practices across VA facilities by which Veterans using legal clinics are referred to, initiate, and engage in treatment, in order to improve their health outcomes and reduce their use of expensive health services. This research program will contribute to better coordination between VA and community systems working to improve Veterans' well-being.

Public Health Relevance

Veterans with legal problems have more mental health and substance use disorders than Veterans without legal problems. However, Veterans with dual legal-health problems may not have access to VA health care, or may not use treatment even when they do have access. VA-located legal clinics help Veterans access and overcome barriers to using VA health care. This project will study VA-based legal clinics as a potential setting in which to better connect Veterans who need treatment with VA care. It will conduct a survey of all VA-based legal clinics in the US, to describe characteristics of clinics and of Veteran clients, and the extent to which clinics facilitate and monitor clients' access to and use of VA mental health and substance use services. It will also study Veterans at one VA legal clinic to examine changes in health and legal status, and help determine the extent to which Veterans seeking legal help will participate in research. This research program will contribute to better coordination between VA and community systems working to improve Veterans' well-being.

National Institute of Health (NIH)
Veterans Affairs (VA)
Veterans Administration (I21)
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HSR-4 Mental and Behavioral Health (HSR4)
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Veterans Admin Palo Alto Health Care Sys
Palo Alto
United States
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