Medical-legal partnerships to prevent evictions and homelessness among veterans

医疗法律合作防止退伍军人被驱逐和无家可归

• 批准号: 10709560
• 负责人: Marc I Rosen
• 金额: --
• 依托单位: VA CONNECTICUT HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-11-01 至 2025-10-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10709560
• 关键词: Address; Attention; Caring; Communities; Community Integration; Complement; Complex; Connecticut; Control Groups; Country; Criminal Justice; Data; Disputes; Enrollment; Face; Fostering; Foundations; Funding; Goals; Health; Healthcare; Healthcare Systems; Homelessness; Housing; Impairment; Income; Intervention; Interview; Investments; Leadership; Legal; Legal Intervention; Legal Status; Legal system; Low income; Measures; Mediation; Mediator; Medical; Medical Assistance; Medical Care Team; Medical center; Mental Health; Mental Health Services; Mental disorders; Methods; Modeling; Movement; Observational Study; Outcome; Participant; Patient-Centered Care; Positioning Attribute; Provider; Quality of life; Randomized; Randomized, Controlled Trials; Recovery; Rehabilitation therapy; Reporting; Research; Research Design; Risk; Services; Severities; Site; Surveys; Symptoms; Testing; Time; Uncontrolled Study; Veterans; Work; court; effective intervention; effectiveness evaluation; empowerment; experience; follow-up; health care delivery; health service use; improved; innovation; integrated care; interest; multidisciplinary; patient population; payment; prevent; primary outcome; psychosocial; psychotic symptoms; randomized trial; response; secondary analysis; secondary outcome; social health determinants; social integration; symptomatology; treatment group; treatment response

Background: Medical-legal partnerships (MLPs) represent an innovative intervention that integrates legal providers into healthcare teams to address complex problems and support the rehabilitation of vulnerable patient populations. In the MLP intervention, community legal providers partner with VA facilities to provide legal assistance to homeless and at-risk veterans. MLP staff can help veterans by negotiating with landlords, setting up alternative payment plans, and representing them in eviction court which may ultimately improve Veterans’ social integration and quality of life. Our group completed a 2-year uncontrolled study of VA MLPs and found that veterans showed significant improvements in housing, income, and mental health after receiving MLP services. A more rigorous research design is proposed as a next step in evaluating VA MLPs and their effect on the rehabilitation of veterans. Objectives: This project has two major aims: 1) evaluate the impact of MLP on housing outcomes (primary) and mental health outcomes (secondary); and 2) examine the veteran experience with seeking and receiving assistance from MLP and outside legal providers. Methods: For Aim 1, a randomized controlled trial of the MLP intervention for Veterans with housing-related issues (i.e., rent-based evictions, rule violations, landlord-tenant disputes) will be conducted. The study site will be the VA Connecticut Healthcare System, where the MLP intervention will be provided in partnership with the Connecticut Veterans Legal Center. A total of 300 homeless and at-risk veterans will be randomly assigned to either the MLP intervention or referral to an outside legal provider. Veterans in both groups will be assessed at baseline, 3, 6, and 12 months on housing, mental health, and various psychosocial measures. The primary outcome will be housing status and a secondary outcome will be mental health. Exploratory analyses will be conducted on outcomes such as financial status, legal status, social integration and citizenship, and quality of life. For Aim 2, a total of 30 veterans participating in the randomized controlled trial (15 participants each from the treatment and control groups) will be interviewed to collect qualitative data on their experiences receiving the MLP intervention or outside legal services. Significance: The VA is committed to preventing and ending veteran homelessness. While considerable efforts have been made to house veterans, services are needed to help them sustain housing and community integration. Numerous reports and surveys indicate that legal assistance for civil legal problems is a major unmet need among homeless and at-risk veterans. VA MLPs offer an opportunity to help veterans address housing-related issues, which could prevent homelessness and assist their rehabilitation. The MLP intervention is consistent with the VA’s comprehensive continuum of rehabilitative services for veterans and the movement towards multidisciplinary, integrated care to address social determinants of health. This project will provide needed data on VA MLPs and help inform decisions about the expansion of MLPs across the country for homeless and at-risk veterans.

背景：医疗法律合作伙伴关系（MLP）代表一种创新的干预措施，该干预措施整合法律 提供者进入医疗团队，以解决复杂的问题并支持脆弱的康复 患者人群。在MLP干预中，社区法律提供者与VA设施合作 对无家可归者和高危退伍军人的法律援助。 MLP员工可以通过与房东进行谈判来帮助退伍军人 制定替代付款计划，并在驱逐法院代表他们，这可能最终改善 退伍军人的社会融合和生活质量。我们的小组完成了一项为期2年的VA MLP研究 并发现退伍军人在住房，收入和心理健康方面表现出显着改善 接收MLP服务。提出了更严格的研究设计，作为评估VA MLP的下一步 以及它们对退伍军人康复的影响。 目标：该项目有两个主要目的：1）评估MLP对住房结果的影响（主要） 和心理健康成果（次要）； 2）检查寻求和接受的老将经验 MLP和外部法律提供者的协助。 方法：对于AIM 1，是与住房相关的退伍军人的MLP干预的随机对照试验 将提出问题（即，基于租金的驱逐，违反规则，房东租户纠纷）。研究地点将 成为VA康涅狄格州的医疗保健系统，将与MLP干预与 康涅狄格州退伍军人法律中心。共有300名无家可归者和处于危险的退伍军人将被随机分配给 MLP干预或转介到外部法律提供者。两组的退伍军人将在 基线，3、6和12个月的住房，心理健康和各种社会心理措施。主要 结果将是住房状况，次要结果将是心理健康。探索性分析将是 在财务状况，法律地位，社会融合和公民身份以及质量等成果上进行 生活。对于AIM 2，共有30名退伍军人参加了随机对照试验（每个参与者来自 将采访治疗和对照组），以收集有关其经验的定性数据 MLP干预或外部法律服务。 意义：VA致力于预防和结束退伍军人无家可归。虽然很大 已经努力为退伍军人付出，需要服务来帮助他们维持住房和社区 一体化。大量报告和调查表明，针对民事法律问题的法律援助是主要的 无家可归者和高危的退伍军人之间的需求未满足。 VA MLP提供了帮助退伍军人地址的机会 与住房有关的问题，可以防止无家可归并协助他们的康复。 MLP干预 与VA对退伍军人和运动的综合康复服务的全面持续相符 迈向多学科的综合护理，以解决健康的社会决定者。这个项目将提供 有关VA MLP的需要数据，并帮助告知有关MLP在全国范围内扩展的决定 无家可归和高危的退伍军人。