review the following: The Mississippi law around participation in veterans' courts: https://law.justia.com/codes/mississippi/2014/title-9/chapter-25/section-9-25-1The announcement for such a court fro

Studies of VTC effectiveness reported mixed findings. Future rigorous research should expand on VTC outcomes, variability in VTC jurisdictions, and the role of peer mentors. KEYWORDSVeterans Treatment Court; mental illness; offender rehabilitation; community- based rehabilitation; substance abuse There is national concern in the U.S. Department of Veterans Affairs (VA) and outside the VA about veterans being involved in the criminal justice system after their military service. Many veterans have had problems read- justing to civilian life and have been found to have extensive healthcare and psychosocial needs (RAND Corporation,2008). Following the develop- ment of drug and mental health courts in the past three decades, specialized Veterans Treatment Courts (VTCs) have emerged for criminal justice-involved veterans in the past decade (Frederick,2014). As early as 2004, a diversion program in Anchorage, Alaska began for military veterans with behavioral health problems allowing its participants to enter a VA treatment program rather than serving jail time (Smith,2012). However, it was in January 2008 when wide recognition as the first VTC model was CONTACTJanice D. McCall [email protected] Department of Social Work, Carlow University, 3333 Fifth Ave., Pittsburgh, PA 15213, USA. 2018 Taylor & Francis Group, LLC JOURNAL OF OFFENDER REHABILITATION 2018, VOL. 57, NO. 6, 384–401 https://doi.org/10.1080/10509674.2018.1510864 attributed to the VTC presided by Judge Robert Russell in Buffalo, New York (Russell,2009; Cartwright,2011; Cavanaugh,2010). VTCs are led by a judge and involve an interdisciplinary team to advance the sobriety, recovery, and stability of criminal justice-involved veterans (Edelman, 2016). Having representatives from the VA healthcare system is an import- ant and unique component of the interdisciplinary teams working with VTCs and interfacing between courts and VA medical facilities. For veter- ans in a VTC, participation may entail frequent appearances in court for status review hearings, requirements to undergo frequent drug and alcohol testing or other surveillance procedures, and the receipt of incentives for accomplishments and sanctions for infractions; successful graduates may avoid a criminal record or receive a substantially reduced sentence (Johnson et al.,2016).

Today, there are more than 461 VTCs nationally, and they are continu- ing to be developed (Edelman,2016; Flatley, Clark, Blue-Howells, & Rosenthal,2016; McGuire, Clark, Blue-Howells, & Coe,2013). Though VTCs have proliferated across judicial systems in the U.S., the growing body of studies on VTCs suggests wide variability in eligibility, court oper- ations, geographic placement of VTC sites, and potential impact on the recovery and recidivism of VTC participants. However, no systematic reviews could be found to summarize the key concepts and gaps underpin- ning this research area, specifically in regards to the profile of participants, services provided, and impact on recidivism within the current knowledge base. Therefore, we mapped relevant literature related to VTCs using a scoping study methodology. A scoping study methodology was selected as it provides a way to examine emerging evidence (Levac, Colquhoun, & O’Brien,2010) and to rapidly map key concepts underpinning a research area (Mays, Roberts, & Popay,2002).

Methods Our choice of a scoping study was informed by two reasons as articulated by Arksey and O’Malley (2016). First, a systematic review typically requires an established knowledge base from which appropriate study designs can be identified in advance; second, systematic reviews aim to examine a rela- tively narrow range of quality assessed studies. A scoping study method- ology was used to address the broader topical area of VTCs where many different study designs might be applicable. Scoping studies are used to col- lect and evaluate a new knowledge base that is not mature or dense enough for systematic, meta-analytic, or other structured reviews. The following describes our stage-based approach, which is similar to a previously pub- lished scoping study (Broyles, Conley, Harding, & Gordon,2013). JOURNAL OF OFFENDER REHABILITATION 385 Stage 1: Identifying the research question This study asked,“What are the primary topical areas of interest among scholars of VTCs since 2008, the year when the VTC concept was modeled by Buffalo, New York?”Specifically, we sought to examine what is known about VTC participants, the operational aspects of the VTC treatment model, its effectiveness to reduce recidivism, and important gaps in the lit- erature regarding VTCs.

Stage 2: Identifying relevant studies Relevant studies were identified among seven key Internet databases (e.g., Criminal Justice Abstracts, PsycINFO, PubMed, Academic Lexis-Nexis, HeinOnline, JSTOR, and SSRN-Social Science Research Network), manual searches of two representative Veterans Health Administration Veterans Integrated Service Network (VISN) web-based resources, and manual searches from two major VTC web-based resources. All searches were lim- ited to the English language and dates between January 2008 and December 2016. Search criteria included broad key words“veteran ”and “court”, and were augmented to“specialized courts”and“veteran ”or "vet- erans treatment court" for searches in JSTOR, HeinOnline, and Academic Lexis-Nexis due to a return of articles in excess of 300,000. Selection crite- ria were narrowed to titles or abstracts demonstrating direct relevance to VTC practices or VTC participants.

Stage 3: Study selection The first exclusion of publications occurred due to duplicate returns from web-based sources (Figure 1). Among the initial 1,207 sources, 150 were removed. Next, titles and abstracts were reviewed for their use of the term “veterans treatment court”or the use of a specific“veterans”context in a treatment court setting. Then, 791 studies were removed due to titles and abstracts not focused or having any mention of VTC. Finally, 266 publica- tions underwent a full-text review and 60 studies were excluded because they did not contain content related to VTCs.

Stage 4: Charting the data The lead author reviewed all articles and worked closely with senior authors to refine topical areas of interest and the inclusion of appropriate source material. In summary, the scoping study began in November 2016 with all review of the literature concluding in February 2017. Final selec- tions of studies occurred in March 2017 with manuscript preparation 386 J. D. MCCALL ET AL. completed through May and June 2017. A total of 1,207 sources were ini- tially collected and a total of 1,001 publications were removed due to dupli- cation and for content deemed unrelated to VTCs (e.g., Medicare fraud, nonveteran related, military court, workers’compensation cases).

Stage 5: Collating, summarizing, and reporting results The remaining 206 studies were organized based on the source type and subject matter, and a subgroup of scholarly sources (n¼48; e.g., journals, books, other research materials such as policy reports and white papers) was more closely examined for content pertaining to VTC participants, court characteristics, and other key topical areas. Nonscholarly sources Figure 1.Flow of scoping study source selection. JOURNAL OF OFFENDER REHABILITATION 387 included newspapers, magazines, press releases, and manuals and opera- tions sources.

Results We found two distinct source categories: scholarly sources (n¼48, 23%), and nonscholarly sources (n¼158), which included newspapers, magazines, and press releases (n¼59) and manuals and operations sources (n¼97).

Among the 48 scholarly sources, herein referred to as the final literature sample, we found a majority of articles discussing the operations and struc- ture of VTC (n¼26), single-state case studies (n¼11), historical summa- ries (n¼7), legislative or policy histories pertaining to VTCs (n¼6), and one theoretical application to VTCs (n¼1). There were 15 articles that characterized study participants, and these articles were also evaluated for sample size, study period, and available demographics. Eleven sources were also identified as outcome studies. Four studies utilized a qualitative method component (Table 1).

Descriptive components of VTCs Seven studies chronicled the historical origins of the VTC model and its operational structure (Cavanaugh,2010; Frederick,2014; Hawkins,2010; Huskey,2015; Jacobs, McFarland, & Ledeen,2012; Pratt,2010; Russell, 2009). In addition, Clark, McGuire, and Blue-Howells (2010), Jones (2013), Shah (2014), and National Center for State Courts (2009) included a chron- ology of pertinent legislative initiatives informing the establishment of VTC, while two other studies provided state-level legislation in the context of a VTC case example (Adams, Hobart, & Rosenberg,2016; Caron,2013).

A number of sources focused on personnel: for example, the role of the prosecutor-as-gatekeeper was suggested in Erickson (2016); Baldwin (2016) surveyed 114 VTCs and reported on key VTC structural components such as funding, jurisdiction, stages within the VTC, and VTC procedures; Baldwin and Rukus (2015) incorporated qualitative observations of VTC sessions and team meetings in their study; Smee et al. (2013) called for more forensic clinicians as VTC stakeholders; and the Honorable Eileen Moore penned her observations on the role of mentors within a VTC (Moore,2012). A“promising practices”discussion paper funded by the National Institute of Corrections provided a range of interviews from key stakeholders and advocates of the VTC model (Edelman,2016).

Among the final literature sample, a number of state-specific sources described specific VTC planning and implementation activities in Illinois (Adams et al.,2016), Alabama (Glassford,2013), Connecticut 388 J. D. MCCALL ET AL. Table 1.Characteristics of VTC participant studies (n¼15) and outcome studies (n¼11) within the final literature sample. Author(s) QualitativeStudy period Study location Study subjects Key points Tsai et al. (2016) a,b No July 2010–November 2015 National, varied rural/urban N=8,083 (VTC participants)Purpose: To compare characteristics and outcomes between veterans who participated in VTCs and veterans involved in criminal justice who participated in other TCs or who participated in neither VTCs or TCs.

Among VTC participants: mean age: 44 years; females 5%; White 69%, Black 27%.

Major findings: No sociodemographic disparities in access to VTCs. VTC participants were more likely than non-TC participants to have drug or public-order offenses, and they were more likely than other-TC participants to have DUI offenses. VTC and other-TC participants were more likely to have jail sanctions and new incarcerations compared with non-TC participants. Housing and employment outcomes also reported.

Ahlin and Douds (2016) a Yes April 2014–March 2015 Local, rural suggested, “central Pennsylvania” N¼10 VTC team interviews, N¼12 VTC participants interviews, N¼7 (focus group)VTC participants; females 0%; White 67%, Black 33% Baldwin (2016) a 2012 National, rural/urban N¼114 VTCsAdditional demographics of: VTC personnel respondents, VTC region within U.S., VTC goal types, target population, eligibility requirements, graduation requirements, funding, jurisdiction, mentor program, stage-based, treatment, procedures Erickson (2016) b Unknown Local, urban Broward County, FL (264 participant cases), Colorado Springs, CO (289 cases), Anchorage, AK (147 cases)Case study to examine whether 3 VTCs were meeting their intended goals Major findings: Average enrollment time¼1 year or more recidivism rates not significantly different or lower than similar traditional courts. Colorado Springs VTC required a guilty plea before participation and conviction entered, Broward County VTC and dismissed all criminal charges after successful completion of VTC.

Hartley and Baldwin (2016) a,b Late 2010–May 2014 Local, urban n¼144 VTC participants; n¼157 comparison groupPurpose: Impact evaluation of rearrest in a treatment group and a comparison group of veteran probationers in a large urban VTC.

Among VTC participants: Mean age: 35 years; females 12%; and White 32%, Black, 15%, Hispanic: 52%; legal history, risk/needs scores, supervision level also reported. (continued) JOURNAL OF OFFENDER REHABILITATION 389 Table 1. Continued. Author(s) QualitativeStudy period Study location Study subjects Key points Major findings: At 12-month mark, recidivism rates were 8.7% for VTC graduates, 14.2% VTC general participants, and 21.1% for the comparison group. At the 24-month mark, recidivism rates increase to 11.4% for VTC graduates, 20.2% for VTC general participants, and 34.1% for the comparison group. At 36 months, recidivism rates were 20% for VTC graduates, 31.7% for VTC general participants, and 50.0% for the control group.

Johnson et al. (2016) b October 2011–September 2013 National, rural/urban N¼302 VTCsPurpose: To identify which court components were most predictive of a court’s percentage of terminations from their program.

Major findings: Higher rates of termination based on programs conducting frequent drug and alcohol testing, and programs for which sanctions are more severe for failing immediate goals. Lower rates of termination associated with later phases permitting less stringent testing, behavioral contracts, and brief incarcerations.

Knudsen and Wingenfeld (2016) a,b Unknown Local, urban N¼86 VTC participants referred from single-site quality of life, sleep quality also reported pretrial centerPurpose: Examined efficacy of VTC on trauma-affected veterans.

Mean age: 41; females 5%; White 50%, Black 47%; service era, combat experience, mental health and behavior improvement, Major findings: Participants improved in mental health, substance use, emotional, well-being, sleep, and relationship with others/family.

Baldwin (2015) a June 2012–December 2012 National, rural/urban N¼3,649 veterans who have ever partici- pated in any of 79 VTCsAge: 26–30 (21%), 31–40 (23%), 41–50 (23%), females 6%; White 62%, Black 30%, Hispanic 12%; reserves status, service era, branch of armed forces, trauma experience, legal issues, social determinants, reasons why participants opted in or opted out of VTC, reasons for termination also included.

Baldwin and Rukus (2015) a Yes Phase I: September 2011–December 2011 Phase II: May 2012–September 2012 Local, rural/urban in one “VTC in Southern United States”(Baldwin & Rukus,2015, p. 187) N¼123 veteransFemales 5%; White 56%; age groups, preliminary diagnoses, discharge status, branch of armed forces, conflict era, observations of team meetings, court sessions, and veterans interviews also included.

Canada et al. (2015) a Yes Unknown Local, rural/urban unknown, “this particular Midwest county”(Canada et al.,2015, p. 119) N¼7 VTC participants, andN¼6 VTC staffVTC participants: Mean age¼46 years; females 0%; White 86% 390 J. D. MCCALL ET AL. Johnson, Graham, et al. (2015) b June 2010–April 2012 Local, urban N¼53 participants sanctioned by presiding judgePurpose: Does veteran’s mental health diagnosis or the initial criminal charge committed before enrollment relate to a greater propensity for sanctions, relapse, or overall compliance.

Major findings: Infractions most associated with jail sanctions were unex- cused absence, failure to complete a task, substance use relapse, and miss- ing a hearing. Substance-related relapses placed veterans at greatest risk of noncompletion of the program.

Johnson, Stolar, et al. (2015) b 2009–2014 Local, urban N¼100 VTC participantsPurpose: Examined veteran’s propensity for arrest following separation from VTC and if it was associated with veteran’s length of stay in VTC, type of discharge, or judicial sanctions issued.

Major findings: Arrests following separation from the VTC was inversely associated with length of stay in the program, a history of TBI was not associated with rearrest and a prior diagnosis of opiate misuse was predict- ive of arrest following separation.

Larsen (2015) a,b Yes Part I: 2001–2011 Part II: November 2011–April 2013 (O) Local, rural/urban “central California”(Larsen,2015, p. 41) Part I:N¼70 matched pairs of veterans and civilians in drug court Part II (O):N¼41 VTC participantsPurpose: The second aim of this dissertation evaluated participants’mental health, alcohol/drug abuse severity, employment problems, and program satisfaction.

Part I: Among 35 veterans from matched pairs: females 3%; European American 71%, Latino/a 20%, Black 6%, Asian 3%; Part II: females: 2%; White non-Hispanic 58%, Hispanic-Mexican 24%, Other Hispanic 9%, American Indian 6%, Black non-Hispanic 3%; age, marital status, educational attainment, service status, branch of armed forces, years of service, dis- charge status, deployment experience, combat exposure, behavioral health interviewed indicators, and traumatic stressors also included. Qualitatively examined barriers and access to mental health treatment.

Major findings: At three months into treatment compared to baseline, VTC participants reported: fewer symptoms of PTSD, reduction in depression, reduced alcohol use, reductions in drug abuse severity, reduction in employment. problems.

Baldwin (2014) a 2012 National, rural/urban N¼3,649 participants across 79 VTCAge: 26–30 (21%), 31–40 (22%), 41–50 (23%); females 6%; White 62%, Black 30%, Hispanic 12%; military vs. reserves, service era, branch of armed forces, legal issues, behavioral and social determinants, stage within justice system at which veteran participant were identified, supervision, perspectives of respondents regarding VTC operation, among others.

Clark, McGuire, and Blue-Howells (2010) a September 2008–February 2013 National, rural/urban N¼3,166 (n¼1,168 with minor children, n¼1,998 without)Family circumstance of veterans.

Mean age with minor children¼38 years, without¼47 years; females 4%; overall: White 64%, Black 31%; marital status, military service era, branch of service, homelessness, employment, medical/psychiatric history, and health care use also included.

Caron (2013) a,b (continued) JOURNAL OF OFFENDER REHABILITATION 391 Table 1. Continued. Author(s) QualitativeStudy period Study location Study subjects Key points July 2010–June 2012 Local, urban N¼131 participantsPurpose: Two-year review of VTC in Hennepin County, MN whether VTC was meeting program goals.

Mean age¼44 years; females 3%; White 63%; gross misdemeanor 43%, common misdemeanor (32%), felony (25%); employment, marital status, housing, educational attainment, branch of service, VTC satisfaction also included, among others.

Major findings: During the first six months of VTC, 83% committed fewer offenses than during the 6 months prior. Graduates tested positive for drug/alcohol related issues at a lower rate than terminated; more than half of graduates completed inpatient treatment, maintained/increased their level of employment from entry to graduation; housing was maintained in private residence for nearly three fourths of graduates.

Slattery et al. (2013) a,b Unknown, “over a period of three years” (Slattery et al., 2016, p. 924) Local, urban N¼83 participantsPurpose: Evaluation of VTC in Colorado Springs for reductions of stress in post- traumatic disorder diagnoses and improvements in symptoms.

Age:“Just under 30 years”; females 5%; White 76%; substance use, social functioning, employment and housing stability, PTSD and TBI screening scores also included.

Major findings: Participants did not significantly improve unstable housing or unemployment, but mental health did improve. Improvements in were significant from baseline to 6-month interview and sustained from 6- to 12-month.

Smith (2012) a,b July 1994–December 2010 Local, urban N¼147 participants in VTC (38 graduates)Purpose: Examine recidivism of VTC participants in AK.

Age: 41% were born between 1950 and 1959; females 7%; White 53%, Black 30%, Native American 2%, Hispanic 2%, Asian 1%; financial ability (appointment of counsel), classification of offenses among graduates also included.

Major findings: 17 of 38 graduates reoffended within three years at a recid- ivism rate of 45% (AK rate¼50%).

Holbrook and Anderson (2011) a 2009–2010 National, rural/urbanN¼14 VTCsCharacterization of surveyed VTCs include: enrollment criteria, when partici- pant is identified, referral source, and various participant factors: treatable health condition, eligibility for VA benefits, types of eligible offenses, among others.

Note.VTC: Veterans Treatment Courts; PTSD: posttraumatic stress disorder; TBI: traumatic brain injury; VA: Veterans Affairs. Scholarly sources in the final literature sample include jour- nals, books, other research materials such as policy reports and white papers, and a thesis. aArticle focusing on VTC participant characteristics.bOutcome study. 392 J. D. MCCALL ET AL. (Garza,2013), Maryland (Totman,2013), Minnesota (Caron,2013), South Carolina (Wall IV,2013), Pennsylvania (McCormick-Goodhart,2012), Tennessee (Tennessee Administrative Office of the Courts,2012), Michigan (Ingham County Veterans Treatment Court,2010), and Wisconsin (Bjerke,2009).

VTC participant characteristics Among the final literature sample, there were 15 studies where veterans’ demographics, psychological diagnoses, and other characteristics among par- ticipants were reported. In these studies, sample sizes ranged from seven to 144 participants at a single site (Ahlin & Douds,2016; Baldwin & Rukus, 2015; Knudsen & Wingenfeld,2016) to national samples with 3,649–22,708 study participants across over 100 sites (Tsai, Flatley, Kasprow, Clark, & Finlay,2016; Baldwin,2014,2015,2016; Holbrook & Anderson,2011).

There were a few studies using qualitative methods that illuminated partic- ipants’perceptions of the VTC experience (Ahlin & Douds,2016; Canada, Brinkley, Peters, & Albright,2015; Larsen,2015; Baldwin & Rukus,2015).

For example, Ahlin and Douds (2016) semi-structured interviews and focus group data revealed an“almost universal response”that prior military experience“distinguishes veterans as members of a subculture”(p. 87). In Baldwin and Rukus (2015), 92% of their study participants also commented on the camaraderie of the military community in the VTC. For example, one participant shared,“They respect you. Everyone has respect for you in the veteran court because they are soldiers and I’m a soldier. They under- stand me”(Baldwin & Rukus,2015, p. 193). Baldwin and Rukus (2015) also reported on the“comfort”felt by VTC participants in such statements as “Just the atmosphere there. You could tell they’re there to help you. They’re not there to crucify you. I recommend [VTC] highly. I think all courts should work like that”(p. 196).

VTC treatments and services Examination of scholarly sources revealed that very little known about the treatment veterans receive through their participation in a VTC. For example, we found only one study that provided a table listing the frequen- cies of 13 types of intervention or service received (Knudsen & Wingenfeld,2016). Knudsen and Wingenfeld (2016) reported that most of their 86 VTC study participants received case management (87%) and received outpatient mental health (79%); these researchers also reported use of other services such as inpatient mental health services (22%), vocational services (36%), and emergency room services (36%). In this study, the JOURNAL OF OFFENDER REHABILITATION 393 remaining service types included outpatient substance abuse treatment, physical therapy, psychiatric medication, peer mentor services, transporta- tion services, housing services, trauma-specific treatment, and residential substance abuse treatment (Knudsen & Wingenfeld,2016). Other sources in the final literature sample of our scoping study mentioned therapeutic journaling (Canada et al.,2015) and another source offered clinical recom- mendations for the use of motivational interviewing and adaptive treatment strategies to encourage engagement among participants (Borsari, Conrad, Mastroleo, & Tolou-Shams,2014).

VTC outcome studies Among the final literature sample, we identified 11 evaluation studies that examined a range of topics including behavioral health improvement (Knudsen & Wingenfeld,2016; Slattery, Dugger, Lamb, & Williams,2013) and recidivism in terms of new arrests (Hartley & Baldwin,2016; Tsai et al.,2016), new incarcerations (Tsai et al.,2016), and court characteristics that were associated with VTC participant termination (Johnson, Graham, Sikes, Nelsen, & Stolar,2015; Johnson et al.,2016). One publication exam- ined the VTC model in a theory-driven restorative justice context (Baldwin & Rukus,2015) and another publication presented Pennsylvania’s adopted performance measures for its VTCs (Cheesman,2015).

Studies included in our review reported recidivism, broadly defined, in the range of 2.5–56% (Tsai et al.,2016; Erickson,2016; Hartley & Baldwin, 2016; Smith,2012). Effectiveness of VTCs to reduce recidivism remain mixed. In Alaska’s VTC, 17 of the 38 graduates reoffended within three years at a recidivism rate of 45%–an improvement from the 50.4% recid- ivism rate of the state (Smith,2012). However, in Tsai et al. (2016) national study, VTC participants when compared with nontreatment court partici- pants were more likely to have jail sanctions (19.7% vs. 10.4%), more likely to have new arrests (10.1% vs. 7.2%), and more likely to have new incarcer- ations (4.0% vs. 1.5%). Despite these differences, it is important to note that recidivism may not be reported consistently as some sites may not col- lect recidivism or re-arrest data and may be anecdotally reported (Erickson, 2016). Definitions of recidivism also vary by study and by participant sta- tus. For example, Hartley and Baldwin (2016) provided recidivism rates of VTC graduates (8.7%) alongside VTC participants who were terminated from their VTC program (56.3%).

Various sampling was used in these 11 outcome studies. Some studies were based on one VTC at a single site (Caron,2013; Johnson, Stolar, Wu, Coonan, & Graham,2015; Knudsen & Wingenfeld,2016; Slattery et al., 2013; Smith,2012), some utilized sample sizes of less than 200 veterans 394 J. D. MCCALL ET AL. (Caron,2013; Hartley & Baldwin,2016; Johnson, Graham, et al.,2015; Johnson, Stolar, et al.,2015; Knudsen & Wingenfeld,2016; Larsen,2015; Slattery et al.,2013; Smith,2012), and others used much larger samples and included multiple VTCs across various states (Johnson et al.,2016; Tsai et al.,2016). Lastly, no efficacy studies were identified.

Gaps in the VTC knowledge base The majority of articles among the final literature sample acknowledged the primacy of participant needs and characteristics, the importance of the multidisciplinary team, and the urgency for more formative evaluations. A minority of articles examined the implementation of component parts of the VTC model such as the role of mentors (Moore,2012; Ahlin & Douds 2016) or geographical considerations where VTCs are sited in urban, sub- urban, and rural contexts (Smee et al.,2013). These semi-implementation studies reflect important examinations of facets of the VTC model.

Additionally, mixed findings regarding VTC outcomes suggest this is an area that needs much greater study and examination. Outcome studies with more rigorous designs with larger sample sizes are needed. Furthermore, data on the type and intensity of treatment mandated by VTCs is lacking and would be important to analyze.

Discussion Presently, the VTC knowledge base includes scholarship that addresses the descriptive histories of the VTC emergence as a specialty court, a descrip- tion of VTC participant characteristics, and a few outcome-oriented studies.

Our final literature sample reported that most VTC participants were White males with mean ages ranging between 30 and 50 years of age, with alcohol and drug use disorders as well as mental illness. There was broad multidisciplinary interest in VTC and its juncture at the intersection of law, behavioral health, and psychosocial spheres of practice and research.

However, few sources provided information about the types of treatments received by VTC participants or geographic variation.

VTCs have been broad and swift in their adoption across the country in a variety of jurisdictions. However, one of the underdeveloped areas within our scoping study sources was the largely unexplored geographical contexts of where VTC operate (Smee et al.,2013; Ahlin & Douds,2016; Larsen, 2015). Health care needs of veterans in rural areas are not adequately met, their access to care may be lacking, and there may be higher personnel costs to the VA to operate primary care practices (Smee et al.,2013; Wallace et al.,2010; Weeks, Wallace, West, Heady, & Hawthorne,2008). JOURNAL OF OFFENDER REHABILITATION 395 Rural recruits are overrepresented in current conflicts (Wallace et al.,2010) and 39% of returning veterans who served in Iraq or Afghanistan and are receiving VA services reside in rural areas (Smee et al.,2013). In Smee et al. (2013), the practice of Web-Cam Court in rural Oregon was summar- ized as a possible method for those courts seeking a rural adaption. In this court, veterans are able to comply with court sessions through web-cam appearances to inform the court about treatment status, goals, and plans (Smee et al.,2013). Future research is encouraged to examine rurality as this model proliferates.

A truly unique court typology is nurtured within VTCs that is not uni- formly present among other specialty court settings. One characteristic of this court is the peer-mentoring program which is a“particularly unique and vital component”(Russell,2009, p. 369) that operates in partnership with the VTC and the VA. The benefits from peer mentors have been described to“[increase] the likelihood that a veteran will remain in treat- ment and improves the chances for sobriety and law-abiding behavior in the future”(Russell,2009, p. 366). However, a mentor’s role, designation, and operationalization remain varied. For example, in one study peer men- tors were a service type and grouped with other treatments received by vet- erans (Knudsen & Wingenfeld,2016). Other studies noted that mentors were not an official member of the VTC team (Canada et al.,2015), or were unpaid volunteers (Holbrook & Anderson,2011), and were also varied in whether VTCs required mentors to be a veteran themselves (Holbrook & Anderson,2011). In Knudsen and Wingenfeld (2016), only 57% of veter- ans were assigned a veteran peer mentor, but peer mentoring positively predicted improvements in social connectedness (p<.05) and emotional limitations (p<.05). In Knudsen and Wingenfeld (2016), VTC treatment improvements were notable when participants were provided a combin- ation of trauma-specific treatment, peer mentor services, and medication.

In Slattery and colleagues’(2013) study, the average time to graduate their VTC program was approximately 17 months, however, they also reported the mean number of total treatment appointments related to VTC partici- pation (16 per month) which included court appearances, meetings with probation officers, treatment appointments, substance use monitoring, as well as“meetings with peer mentors and service providers”(p. 928). When asked about the impact of peer mentors on their success in the program, 87% of these VTC participants attributed“some”or“all”of their success to the help of their peer mentors (Slattery et al.,2013, p. 928). While the inclusion of mentors appear to support the overall veteran culture within the context of a VTC, future inquiry is encouraged to expand upon the uses, influences, and impact of mentors as a component of VTC.

396 J. D. MCCALL ET AL. It is important to note that 11 sources discussed a range of criticisms of the VTC concept. It has been purported by some as special treatment and has also been criticized for diagnostic misuse, veteran malingering, and possible avoidance of the penalty of law (Berenson,2010; Borsari et al., 2014; Frederick,2014; Hawkins,2010; Jones,2013; Perlin,2012; Russell, 2009). One law journal article discussed the potential need for VTCs’own legislative mandate to maintain democratic legitimacy to also ensure that the“judiciary respects the separation of powers doctrine”(Shah,2014).

This seeming contradiction to the popularity of the VTC model promotes future research that may satisfy supporters and opponents alike.

In summary, there continues to be tremendous support and adoption of the VTC model across the United States. VTCs target the underlying psy- chological and behavioral needs to try and eliminate recurrence of their undesirable behaviors (Frederick,2014). Supporters of the VTC model challenge the perception of preferential treatment by noting that VTCs are an effort to better target the needs of participants by reconceptualizing crime (Huskey,2015) and taking into account the circumstances due to exposure to military experience (Hawkins,2010). Limitations of our study include the potential exclusion of studies published before 2008, studies indexed under different key words, and journals not indexed among our list of online databases. Acknowledgements Dr. McCall was supported with use of facilities at the Pittsburgh, VA and the Office of Academic Affiliations Advanced Fellowship in Women’s Health. The contents of this manuscript do not represent the views of the U.S. Department of Veterans Affairs or the United States Government.

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