Surveillance of Modifiable Social Determinants of Health for Prioritizing Wraparound Supports

Surveillance of Modifiable Social Determinants of Health for Prioritizing Wraparound Supports 60% of Veterans in Veterans Treatment Courts (VTCs) have a co-occurring mental health and opioid use disorder (OUD), thereafter called COD. Those Veterans are at risk for opioid overdose (OOD) but have less engagement of medications for OUD (MOUD) and other OUD

treatments than other Veterans, resulting in unemployment and homelessness - predictors of reoffending. Many Veterans in VTCs, particularly those with an OUD have multiple social determinants of health (SDOH) issues that need to be addressed simultaneously. Adverse SDOH have been identified as key barriers to MOUD engagement and increasing risk of OOD.

We have identified 8 modifiable SDOH (mSDOH)¾job insecurity, housing insecurity, financial insecurity, food insecurity, legal problems, social/familial problems, transportation problems, and violence¾that could be used to identify Veterans at highest risk of MOUD disengagement and other suboptimal treatment engagement and OOD.

Maintaining Independence and Sobriety through Systems Integration, Outreach and Networking-Criminal Justice (MISSION-CJ), is a cross disciplinary, team-based multicomponent intervention that is being tested in a large implementation study by Dr. Smelson (MPI) in collaboration with the Veteran Justice Outreach Program (VJP). However, MISSION-CJ goes

beyond traditional linkage support provided through VJP. It offers Veterans 6 months of psychosocial treatment combined with assertive outreach, empowering clients to access and engage in care and community services to address addiction, mental health and other mSDOH needs while promoting recovery. Because of large caseload sizes among providers in VJP, it is

important that “Surveillance of mSDOH for MISSION” (SoS-MISSION) prioritizes Veterans in VJP at high risk of MOUD suboptimal engagement and OOD (non-fatal and fatal) with mSDOH to offer MISSION-CJ. This is critical as our implementation study demonstrated that VJP providers have capacity to offer SoS-MISSION to fewer than 30% their clients.

In this application, we will develop and test SoS-MISSION, a dashboard which flags unmet social needs of JIV at high risk of MOUD discontinuation and OOD. We will develop innovative natural language processing (NLP) approaches, and then incorporate these mSDOH to improve prediction of vulnerable Veterans in VJP with poor MOUD engagement and OOD. SoS-

MISSION addresses untreated addiction as listed as one focus in the National Drug Control Strategy recently released by the White House. While efforts have identified single mSDOH (e.g., homelessness) from EHR notes, little research examined concurrent mSDOH and their attributes from structured and unstructured EHR and how they improve prediction of MOUD

engagement and OOD, and then integrated into MISSION-CJ.