Maintaining Independence and Sobriety Through Systems Integration, Outreach, and Networking

Background: Homeless Veterans often have multiple health care and psychosocial needs,
including assistance with access to housing and health care, as well as support for ongoing
treatment engagement. The Department of Veterans Affairs (VA) developed specialized Homeless
Patient Alignment Care Teams (HPACT) with the goal of offering an integrated, "one-stop
program" to address the Housing and Healthcare needs of Homeless Veterans. However, while 70%
of HPACT's Veteran enrollees have co-occurring mental health and substance use disorders
(COD), HPACT does not have a uniform, embedded treatment protocol for this subpopulation. One
wraparound intervention designed to address the needs of homeless Veterans with COD which is
suitable to be integrated into HPACT clinic sites is the evidence-based practice called
Maintaining Independence and Sobriety through Systems Integration, Outreach, and
Networking-Veterans Edition, or MISSION-Vet. Despite the promise of MISSION-Vet within HPACT
clinics, implementation of an evidence based intervention within a busy program like HPACT
can be difficult. The current study is being undertaken to identify an appropriate
implementation strategy for MISSION-Vet within HPACT. The study will test the implementation
platform called Facilitation and compared to implementation as usual (IU).

Aims: (1) Compare the extent to which IU or Facilitation strategies achieve fidelity to the
MISSION-Vet intervention as delivered by HPACT homeless provider staff. (2) Compare the
effects of Facilitation and IU strategies on the National HPACT Performance Measures. (3)
Compare the effects of IU and Facilitation on the permanent housing status. (4) Identify and
describe key stakeholders' (patients, providers, staff) experiences with, and perspectives
on, the barriers to, and facilitators of implementing MISSION.

Design: Type III Hybrid modified stepped wedge implementation comparing IU to Facilitation
across 7 HPACT teams in 3 sites in the greater Los Angeles VA system.

Discussion: Integrating MISSION-Vet within HPACT has the potential to improve the health of
thousands of Veterans but, it is crucial to implement the intervention appropriately in order
for it to succeed. The lessons learned in this protocol could assist with a larger roll-out
of MISSION within HPACT.

Inclusion Criteria:

- meets Diagnostic and Statistical Manual of Mental Disorders, 5th Edition diagnostic
criteria of International Classification of Diseases, 10th Revision for a current
substance abuse or dependence disorder, e.g.:

- alcohol

- marijuana

- cocaine

- or poly substance use and a co-occurring mental illness that includes anxiety, mood,
or a psychotic spectrum disorder

- is willing to participate in the service

- is empaneled in HPACT at one of the study sites

Exclusion Criteria:

- Does not meet inclusion criteria