UMMS Affiliation

Department of Psychiatry

Publication Date


Document Type



Criminology and Criminal Justice | Health Policy | Mental and Social Health | Military and Veterans Studies | Psychiatry and Psychology


Moral Reconation Therapy (MRT), an evidence-based intervention to reduce risk for criminal recidivism among justice-involved adults, was developed and primarily tested in correctional settings. Therefore, a better understanding of the implementation potential of MRT within non-correctional settings is needed. To address this gap in the literature, we evaluated the adoption and sustainment of MRT in the US Veterans Health Administration (VHA) following a national training initiative in fiscal years 2016 and 2017. In February 2019, surveys with 66 of the 78 VHA facilities that participated in the training were used to estimate the prevalence of MRT adoption and sustainment, and qualitative interviews with key informants from 20 facilities were used to identify factors associated with sustainment of MRT groups. Of the 66 facilities surveyed, the majority reported adopting (n = 52; 79%) and sustaining their MRT group until the time of the survey (n = 38; 58%). MRT sustainment was facilitated by strong intra-facility (e.g., between veterans justice and behavioral health services) and inter-agency collaborations (e.g., between VHA and criminal justice system stakeholders), which provided a reliable referral source to MRT groups, external incentives for patient engagement, and sufficient staffing to maintain groups. Additional facilitators of MRT sustainment were adaptations to the content and delivery of MRT for patients and screening of referrals to the groups. The findings provide guidance to clinics and healthcare systems that are seeking to implement MRT with justice-involved patient populations, and inform development of implementation strategies to be formally tested in future trials.


Adoption, Criminal recidivism, Justice-involved veterans, Moral reconation therapy, Sustainment, Veterans health administration

Rights and Permissions

© This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply 2021

DOI of Published Version



Blonigen DM, Shaffer PM, Smith JS, Cucciare MA, Timko C, Smelson D, Blue-Howells J, Clark S, Rosenthal J. Recidivism Treatment for Justice-Involved Veterans: Evaluating Adoption and Sustainment of Moral Reconation Therapy in the US Veterans Health Administration. Adm Policy Ment Health. 2021 Jan 30:1–14. doi: 10.1007/s10488-021-01113-x. Epub ahead of print. PMID: 33515346; PMCID: PMC7847225. Link to article on publisher's site

Journal/Book/Conference Title

Administration and policy in mental health

Related Resources

Link to Article in PubMed

PubMed ID