Testing implementation support strategies to facilitate an evidence-based substance use and mental health care intervention in veterans treatment courts: A hybrid type III trial protocol

Veterans Treatment Courts (VTCs) are alternative to incarceration programs for veterans involved in the criminal legal system. VTC participants have high rates of co-occurring mental health and substance use disorders (COD). Maintaining Independence and Sobriety Through Systems Integration, Outreach and Networking – Criminal Justice (MISSIONCJ) is an evidence-based, multicomponent intervention offered alongside VTCs to support veterans’ complex needs. Multicomponent interventions are often difficult to implement nationally, let alone when care is offered and coordinated across multiple systems. This protocol offers an overview of an implementation-effectiveness trial of MISSIONCJ in VTCs. This quality improvement (QI) project will involve an adaptive, randomized design, in which VA staff in four geographically-dispersed regions across the U.S. will be invited to participate and receive varying implementation facilitation (IF) support (i.e., low/passive and high/active) for implementing MISSIONCJ. Sites will have a 9-month run-in period (e.g., orientation) followed by 9-months of low/passive IF. Sites that meet an implementation benchmark will then be randomized to continue low/passive IF or discontinue; and sites that do not meet the benchmark will be randomized to continue low/passive IF, or receive high/active IF for 12-months. Implementation outcomes are based on the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework (e.g., reaching eligible veterans, adoption rates, fidelity to MISSIONCJ, and maintenance/sustainment). MISSIONCJ effectiveness outcomes include treatment engagement and COD improvements. This QI project aims to determine the most effective type and intensity of IF to increase MISSIONCJ, while improving outcomes among VTC participants. As the first national trial to implement MISSIONCJ in VTCs, it has important implications for the criminal legal and implementation science fields. ISRCTN registry, ISRCTN13576289, Registered 21 December 2022, https://www.isrctn.com/ISRCTN13576289