VA Research: Justice Involved Veterans & Employment – A Structured Evidence Review

Justice Involved Veterans & Employment – A Structured Evidence Review

Editor’s Note:  Thanks to Lily Casura for providing this ‘hot-off-the-press’ report.


In January 2012, after a one and one-half year strategic planning process and four years into the operation of VA’s national effort to provide outreach to incarcerated Veterans, the National Steering Committee of the Veterans Health Administration (VHA) Veterans Justice Outreach Program (VJO) set as one of five strategic goals the matching of justice-involved Veterans with the medical, mental health/psychiatric, vocational, and social services that would improve health and optimize successful community integration and safety for these Veterans.

Justice Involved Veterans and Employment: A Systematic Review of Barriers and Promising Strategies and Interventions was completed in support of that goal.

Undertaken by investigators from the Center for Innovation to Implementation (Ci2i) at the VA Palo Alto Health Care System in Menlo Park, California, the structured evidence review is a comprehensive and critical examination of the employment needs and interventions which either are, or are thought to be, relevant to this population of Veterans.

A wealth of careful, thoughtful, and clear assessment of the evidence awaits the reader of the structured evidence review. Examination and feedback from research and other leaders with significant experience in this domain provided critical input to the structured evidence review’s final draft.

Intended audiences of the structured evidence review include VA and non-VA practitioners and service providers, criminal justice professionals, researchers and program evaluators, and leadership across all of these domains.

The intended objectives of the structured evidence review are to: understand the current knowledge base regarding employment for this population of Veterans, describe the evidence base for intervention to aid in selection of interventions for this population, and highlight the many areas where further work is needed.

In providing information on the state of what is available, this document provides the beginning elements of an agenda for evaluating developmental work through pilot and demonstration projects in order that policy questions such as effectiveness, staffing, and costs can begin to be informed.

It is important to acknowledge that evaluating work in this field is enormously challenging. Research usually requires specialized prisoner representation on Institutional Review Boards (IRBs), which is not common practice. IRBs and funding agencies may not support the randomized designs necessary to provide the rigorous evidence needed to evaluate interventions, although a compelling rationale has been put forth to do just this with justice populations (Gueron, 2000).

Finally, the complexity of needs of this population strongly suggests the need for interventions complementary to adjunctive treatment/services, which newly developed effectiveness-implementation hybrid designs may be suited to examine.

Limitations of the structured evidence review include feasibility decisions on limits of depth of coverage across the potentially wide range of domains, and on not highlighting in depth critical overlapping dimensions such as housing and other psychosocial factors, mental health and substance dependence related issues, and impact of environment and stigma. In addition, VA’s benefits, medical services, and mental health (broadly), and homeless services were taken as a given for this review.

Structured Evidence Review 2 Veterans Justice Programs (VJP) and Homeless Veteran Community Employment Services (HVCES) acknowledge and appreciate the high quality of the structured evidence review by Ci2i. VJP and HVCES outlined the general structure and made the decisions regarding domain coverage, and Ci2i had license to assess the literature scientifically.

We believe the structured evidence review makes a highly significant contribution to VA’s mission with justice-involved Veterans: To partner with the criminal justice system to identify Veterans who would benefit from treatment as an alternative to incarceration.

VJP [and HVCES] will ensure access to exceptional services, tailored to individual needs, for justice-involved Veterans by linking each Veteran to VA and community services that will prevent homelessness, improve social and clinical outcomes, facilitate recovery and end Veterans’ cyclical contact with the criminal justice system (Clark, Blue-Howells, Rosenthal, & McGuire, 2010).

Carma Heitzmann, Ph.D. Director, Homeless Veteran Community Employment Services

Joel Rosenthal, Ph.D. National Training Director, Veterans Justice Programs

Link to online copy: