Military Health Provider Training and Evaluation of a Problem-Solving Intervention to Reduce Distress and Enhance Readiness Among Service Members.

Abstract

Department of Defense (DoD) has identified problem-solving training (PST) as a promising prevention/early intervention for mental health disorders. PST is a four-session group intervention that emphasizes building problem-solving and coping skills to mitigate emotional dysregulation and the adverse effects of stressful events. It was adapted from problem-solving therapy, which is an evidence-based, cognitive-behavioral approach that has shown effectiveness with treating depression and managing suicide risk. The current evaluation examined a pilot program that: (1) trained DoD providers in the delivery of PST, (2) conducted PST intervention groups with active duty personnel, and (3) developed PST master trainers to train other providers. Clinical (e.g., psychologists) and non-clinical (e.g., chaplains) providers attended a 2.5-day workshop of didactic coursework and experiential training on conducting PST, with a subset of providers selected to attend an additional workshop to become master trainers in PST. Providers (n = 82) who attended a PST Facilitator Workshop completed pre- and post-workshop assessments of self-efficacy in PST skills. Eight providers evaluated a Master Trainer Workshop. After completing workshop training, providers conducted PST intervention groups with service members (n = 435), who were experiencing distress, with or without a mental health diagnosis, and whose needs were appropriate for a prevention/resiliency-based skills group. Service members completed the following pre- and post-PST group outcome measures: (a) Outcome Questionnaire-30 (OQ-30) and Patient Health Questionnaire-9 (PHQ-9) as measures of distress; and (b) Brief Resilience Scale (BRS) to assess resilience, which contributes to readiness. They also completed the Social Problem Solving Inventory-Revised: Short Form (SPSI-R:S), as a process measure for the intervention. The SPSI-R:S, which assesses how individuals cope when faced with problems, includes the following subscales: (1) positive problem orientation, (2) negative problem orientation, (3) rational problem-solving, (4) impulsivity/carelessness style, and (5) avoidance style. Service members also completed a post-group evaluation of PST. Data were analyzed with descriptive statistics, paired sample t-tests, and correlational analyses. Providers showed pre- to post-facilitator workshop increases in self-efficacy of PST skills (all p < 0.001) and those selected as master trainers evaluated their workshop training favorably, particularly the role-playing exercises. Analyses of pre- vs. post-PST group intervention measures among service members indicated that OQ-30 and PHQ-9 scores declined, while BRS and SPSI-R:S total scores increased (all p < 0.001). In addition, correlational analyses of change scores showed that the SPSI-R:S subscales negative problem orientation and avoidance style were negatively correlated with BRS and positively correlated with OQ-30 and PHQ-9 (all p < 0.001). Service members gave positive post-group evaluations of PST effectiveness and program materials. DoD providers reported increased self-efficacy in skills required for the delivery of a four-session PST group intervention after participating in a pilot program of training workshops. The pilot of the PST group intervention showed an association with improvements on service members' self-reported measures related to distress, readiness, and coping. In addition, changes in problem-solving measures were associated with changes in outcome measures. Follow-on research is needed to further investigate if PST is effective in preventing more severe forms of distress.