MISSION-CJ Intervention Targets Recidivism Among Justice-Involved US Veterans
A federally funded clinical trial is underway to evaluate whether a structured intervention, MISSION-CJ (Maintaining Independence and Sobriety through Systems Integration, Outreach, and Networking-Criminal Justice), can reduce criminal recidivism and improve mental health and recovery outcomes for justice-involved veterans in US Department of Veterans Affairs (VA) mental health residential rehabilitation treatment programs (MH RRTPs).
The intervention is designed for veterans experiencing homelessness who also face the complex challenges of co-occurring substance use and mental health disorders—conditions often compounded by recent criminal legal involvement.
This hybrid type 1 randomized controlled trial includes 226 veterans, evenly randomized into two groups: MISSION-CJ and Enhanced Usual Care (EUC). Veterans are enrolled at the time of MH RRTP admission and receive 6 months of services—3 months while in residence and 3 months post-discharge in the community.
Veterans in the EUC group receive standard peer support services, which focus on outreach and facilitating connections to community resources. In contrast, those assigned to the MISSION-CJ group participate in a comprehensive, team-based intervention that pairs a case manager with a peer support specialist. This team delivers a suite of enhanced services designed to address the complex needs of veterans with co-occurring disorders and criminal legal involvement. Core components of the intervention include case management grounded in the Critical Time Intervention (CTI) model to strengthen community-based referrals and support continuity of care. Veterans also engage in dual recovery therapy specifically tailored for individuals with co-occurring mental health and substance use disorders. Additionally, the intervention provides structured peer support sessions and emphasizes collaborative treatment planning to promote long-term recovery and reintegration.
Assessments are conducted at three time points: baseline, 6 months, and 15 months. They encompass substance use, psychiatric symptoms, recidivism risk, medication adherence, housing and employment status, and community involvement.
As of March 2025, 118 veterans have been enrolled across two VA sites. Site 1 enrolled 52 participants (44.1%), and Site 2 enrolled 66 (55.9%). Among them, 58 veterans have been randomized to MISSION-CJ and 60 to EUC.
Researchers are employing generalized linear mixed effects models to assess outcomes and mediation analyses to understand underlying mechanisms of change. The qualitative component uses thematic analysis to explore how the intervention is received and implemented.
Should MISSION-CJ prove effective, the integration of this structured, team-based intervention into MH RRTPs may significantly improve outcomes for veterans at high risk of reoffending. Importantly, the intervention targets modifiable risk factors that traditional MH RRTPs may not adequately address, such as antisocial cognition, limited community support, and lack of coordinated care post-discharge.
For clinicians working with this population, MISSION-CJ may provide a replicable model that augments standard peer-based support with structured care transitions and therapy aligned with justice-involved veterans’ needs.
Veteran treatment and follow-up assessments are ongoing. The final outcomes of both the clinical and qualitative analyses are expected in 2026. The investigators anticipate that results will inform broader VA policy regarding rehabilitation and reintegration strategies for veterans with complex, intersecting needs.
Reference
Bruzios K, Shaffer P, Blonigen DM, et al. Intervention for justice-involved homeless veterans with co-occurring substance use and mental health disorders: protocol for a randomized controlled hybrid effectiveness-implementation trial. JMIR Res Protoc. 2025;18:14:e70750. doi:10.2196/70750
