Comparing High- and Low-Intensity Strategies to Implement the Honest, Open, Proud Peer Program for Justice-Involved Veterans with Mental Health and Substance Use Disorders

What this Trial Is About

Justice-involved Veterans JIVs often face co-occurring substance use disorders SUD and mental health MH conditions, yet many do not receive appropriate treatment. This trial focuses on evaluating different strategies to implement Honest, Open, Proud HOP, a peer-led stigma reduction program, which aims to help Veterans reduce self-stigma and improve engagement in care. The study compares high-intensity versus low-intensity approaches to delivering this intervention and assesses their impacts and costs across multiple VA medical centers. The intervention, Veterans Affairs-Honest, Open, Proud VA-HOP, is a peer-delivered group program consisting of three lessons designed to guide participants through decisions about disclosing behavioral health conditions. Sessions are held weekly for nine weeks, either as 45-minute meetings or three longer sessions. The study uses two implementation strategies a low-intensity audit and feedback approach with monthly data reports and optional discussions, and a high-intensity implementation facilitation involving biweekly virtual meetings focused on problem-solving and planning. These strategies are tested sequentially over six months each, followed by a nine-month sustainment period without active support. Participants are Veterans enrolled in specific VA Justice Programs who meet criteria for mental health or substance use disorders and are willing to engage in VA-HOP. Throughout the study, researchers track the number of sessions delivered, adherence to the HOP model, and patient outcomes like outpatient care usage, emergency visits, and suicide risk. Data collection spans pre-implementation, active implementation, and sustainment phases, with qualitative interviews to explore long-term maintenance. The total study period covers up to 21 months of intervention and follow-up.

Honest, Open, Proud (HOP): A Peer Delivered, Co-occurring Disorders Intervention for Justice-involved Veterans