Military Behavioral Health Research Articles

Suicide prevention safety planning in the US Department of defense: Qualitative assessment of training.

Suicide rates in the military are a significant public health concern. The suicide prevention safety planning intervention is a brief and effective intervention in which a provider and patient work collaboratively to recognize warning signs of a suicidal crisis and create a defined list of coping strategies and supports for use during future crises (Stanley & Brown, 2012). Implementation of safety planning has been supported by the Department of Defense (DoD), yet readily available training and continuing education for healthcare providers in this intervention is limited and passive in nature. Existing safety planning training experiences and needs of DoD behavioral health providers are unknown. The present study is an exploratory qualitative assessment of current safety planning in DoD to inform the design and development of an interactive virtual standardized training patient. Ten military behavioral health providers completed semi-structured interviews. Thematic content analysis was conducted, and three themes are described in this paper: variety of training received, barriers to receiving suicide safety planning training, and desires for future training. Lack of protected time for training and a lack of access to training resources were identified as key barriers. Rich data obtained can help inform the key design features and relevance of new safety planning intervention training approaches.

Practice-Based Implementation Network: Behavioral Health Technician Optimization Pilot Lessons Learned.

Between June 2021 and December 2022, the Practice-Based Implementation (PBI) Network conducted a pilot to study the optimization of behavioral health technicians (BHTs) within military behavioral health (BH) care system specialty BH clinics. Behavioral health technicians are paraprofessionals found in all branches of the military, and with training across a variety of clinic functions. Behavioral health technicians support BH specialty providers in many clinic functions (i.e., administrative, case management, clinical, and outreach). The primary aim of the BHT optimization pilot was to increase BHTs' involvement in clinical care. Four military BH outpatient clinics participated in the BHT optimization pilot. Participants from the 4 clinics included 12 BHTs, 3 providers, 3 internal facilitators, and 3 dual-role providers/internal facilitators. The pilot asked each clinic to assess their BHT utilization needs, and then barriers and facilitators to BHT optimization were addressed by creating site-specific BHT optimization plans. The degree to which clinic optimization of BHTs impacts provider workload, clinic capability or capacity, and patient access to evidence-based care could not be determined during the BHT optimization pilot. However, individualized clinic BHT optimization plans and strategies appeared to be feasible and acceptable methods for military health system BH clinics to optimize BHTs' clinical skills. Lessons learned from this pilot included that: (1) clinics should consider establishing and maintaining action plans with specific, actionable goals for use of BHTs, and (2) BHT supervision, training, and clinic processes supporting optimization should be prioritized despite time constraints. Overall, individualized clinic BHT optimization plans and strategies appear to be feasible and acceptable methods for military health system BH clinics to optimize BHTs' clinical skills.

Unlocking What Makes Military Behavioral Health Interventions Work, Stumble, or Fade Away.

The Office of the Secretary of Defense and each of the services have made an unprecedented commitment to the prevention of sexual assault and related behavioral health phenomena. Indeed, the Department of Air Force has selected, in some cases tailored, and disseminated a wide array of evidence-based preventative programs, policies, and practices (EBPs) over the last few decades. However, many of these efforts seem to follow a predictable life course. EBPs are initially implemented with great enthusiasm, supported for a few years, then fall out of favor, and are replaced by a different effort. This research effort aims to build on the existing civilian implementation science research to (1) offer a military-specific model of sustained, high-quality implementation and (2) test this model in a series of interconnected studies. New York University's Institutional Review Board approved the study protocols, and the Army's Human Research Protection Office provided permission to collect data. We conducted interviews first with prevention leaders in the services and at the Office of the Secretary of Defense level regarding factors that they thought helped or hurt the sustainment of EBPs. We used these interviews to identify EBPs currently implemented in Department of Air Force and selected four EBPs out of the 25 identified for intensive study. We then interviewed implementers of those four EBPs regarding what they thought helped or hurt the sustainment of that EBP. We also gathered information about the 25 currently implemented EBPs themselves and gathered policy and guidance, as well as leadership communication about those EBPs and the target problems they focus on. We coded this information to allow us to test EBP parameters and policy and leader communication that predict sustained high-quality implementation. We conducted over 100 observations of the 4 EBPs we are studying intensively and have collected quantitative data from implementers and participants to help us test factors related to sustained high-quality implementation within each of those 4 EBPs and across the EBPs. Several military-specific factors were nominated for inclusion in the military-specific model of implementation sustainment. The implementation of even highly standardized EBPs varies greatly. Implementers and participants are generally highly engaged, but implementers vary in the extent to which they understand the mechanisms of action for the EBP they are implementing. We recommend training implementers in the mechanisms of action in the EBPs they are expected to implement and including quality assurance as a component of prevention efforts in a manner more similar to how the military addresses aspects of the operational mission. By moving beyond counting classes and attendance, and specifying how to engage participants in the EBPs in the manner that produces the key outcomes, it is likely that EBPs will have more robust implementations that can be better sustained over time.

Implementation and Adaptations of Written Exposure Therapy: Lessons Learned Across Settings

Written Exposure Therapy (WET) is a promising evidence-based psychotherapy (EBP) for posttraumatic stress disorder (PTSD), in part because it is less time-intensive (i.e., five sessions with no between-session assignments) and has lower dropout than other first-line PTSD psychotherapies. As such, WET has the potential to improve access to quality care and reduce attrition, particularly among difficult-to-reach populations (e.g., veterans, military service members, and minoritized groups). The process of effectively translating WET to diverse practice settings is likely to require the development of customized treatment-congruent adaptations to facilitate access to care and the uptake of the intervention.This article outlines several recent efforts to implement WET in novel ways, while maintaining an emphasis on fidelity to the core mechanisms of the treatment. Implementation efforts include a cultural center with Spanish-speaking immigrants, active-duty military behavioral health, technology-based approaches, and group format in residential and outpatient Veterans Affairs (VA) settings. We will review lessons learned and program evaluation data from the included sites and will offer suggestions for clinic administrators and providers hoping to implement WET.

Behavioral Health Integrated Support Network (BHISN).

This article reviews process and performance of an innovative effort leveraging virtual health to manage unmet demand for behavioral health and substance use disorder services across a large military region. This effort began in June 2022 and included nearly all of the Defense Health Agency Region-Europe's military behavioral health and substance abuse clinics participating. The two goals of improving access to behavioral health and substance use services for active duty service members and improving utilization of the military clinics were employed. Operational and remote locations with known care gaps could access services as well. Connecting services to the point of need is an established strength of virtual health delivery systems of care. A team consisting of clinical leaders and Virtual Medical Center-Europe staff developed a centralized screening process and simple business rules. When a clinic was unable to meet its access-to-care standard of 28 days, the patient requesting or referral from a remote location, was offered a virtual video option with a provider from another clinic with availability. Centralized screening was created and staffed by three technicians. The Behavioral Health Integrated Support Network (BHISN) screening clinic assessed appropriateness of virtual care using established exclusion criteria. Once screened, the patient was scheduled for an appointment with one of the 31 therapists in 14 participating clinics in a 3- to 5-day window. The military health system's video connect platform was used. Between June 2022 and November 2023, 131 patients who were unable to find routine care in their home clinic were screened, scheduled, and completed a virtual visit with one of the 31 participating therapists from 14 behavioral health and substance use clinics. Seventy-eight (59%) participants were active duty empaneled to military treatment facilities in Europe and 53 (39%) were active duty enrolled in Tricare Prime Remote and deployed to remote locations with limited care. Forty-four percent of patients were recommended for continued virtual therapy or counseling kept their first follow-up demonstrating good follow-up care using a virtual option. The overall no-show rate was low at 7%. Care and consultation were successfully delivered using video visits to location in 18 countries in three geographic Europe, the Middle East and, Africa. The Virtual Medical Center-Europe, Army Europe Behavioral Health, and Substance Use leadership work collaboratively to plan and optimize program performance. For BHISN to function as intended requires key dedicated support staff, such as mental health and social services assistants to screen and coordinate virtual care. Scheduling can be performed by a central cell requiring clinics to relinquish some local control in the interest of meeting patient demand in large and diverse area that covers three continents. BHISN shows promising initial success by providing a process of managing demand and connecting requests for behavioral health and substance use care leveraging capacity from all clinics using a virtual video service in a diverse operating environment.

Military behavioral health technicians: Multiple relationship dilemmas and recommendations for supervision.

Enlisted behavioral health technicians (BHTs) in the military provide behavioral health care to service members worldwide under the supervision of licensed providers. Given their paraprofessional role, BHTs serve in close social and personal proximity to their patient population and may be at risk for engaging in multiple relationships. In order to guide supervision of BHTs, a framework should be leveraged that examines power differentials, the duration of treatment, the nature of termination, the compatibility of multiple roles, supervisor consultation, and informed consent. Several illustrative scenarios are provided to demonstrate the utilization of this model in a manner that is sensitive to the unique nature of BHTs serving in the military cultural setting. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Identifying and mitigating moral injury risks in military behavioral health providers

ABSTRACT The term “moral injury” was initially used to describe the multifaceted pain that service members feel after perpetrating, witnessing, or failing to prevent acts that conflict with their moral codes. More recently the term has been used to describe healthcare providers’ pain stemming from their experiences serving on the frontlines of the healthcare system when: a medical error causes serious harm to patients, systems continuously impede their abilities to provide proper care, or providers assess that they have acted in ways that conflict with their professional ethics or oaths to “do no harm.” This article explores moral injury risk at the intersection of military service and healthcare by examining challenges that military behavioral healthcare providers face. Leveraging moral injury definitions previously applied to service members (personal or witnessed transgressions) and in two healthcare contexts (“second victim” to adverse client outcomes and system-driven moral distress), as well as literature on ethical challenges in military behavioral health, this paper uncovers situations that may amplify military behavioral health providers’ risks for moral injury. It concludes by offering policy and practice recommendations germane to military medicine aimed at alleviating pressures military behavioral healthcare providers face and mitigating moral injuries’ potential ripple effects on provider wellness, retention and care quality.

Effectiveness of the DROP training for military behavioral health providers targeting therapeutic alliance and premature dropout

Premature discontinuation from behavioral health treatment is a major problem reducing effectiveness of care in military populations. A training was developed and delivered to 622 behavioral health providers across 15 sites within the Army behavioral healthcare system. The training taught two techniques to foster treatment engagement: (1) Progress Informed Treatment, consisting of reviewing symptom assessments and outcome measures, and (2) assessment and discussion of the treatment alliance via a paper survey given near the end of each session. Eighty-five percent of providers indicated the training was useful and 89% of providers incorporated a technique into their practice. Dropout before the fourth session was significantly reduced in the six months following training, from 72.5% to 67.1% in Service Members (SM; X 2(1, N=9127) = 39.58, p < .001). In both the pre and post-training periods, providers working at the Master’s level, SM aged 17 or 46 or older, and clients receiving a mood, PTSD, anxiety, adjustment, substance or childhood/adolescent psychiatric diagnosis experienced significantly less dropout, while SM aged 18–21 had significantly more dropout. This training is a feasible and available option to increase treatment engagement and improve treatment outcomes for service members.

Clinical Skills in Military Behavioral Health Education: Efficacy of Role Play vs Standardized Actor Patient Training

The use of Role Play (RP) and Standardized Actor Patients (SAP) have significantly impacted the behavioral health field’s ability to train clinicians in clinical practice and the development of clinical skills. The purpose of this study was to test and compare the effects of RP and SAP in training graduate social work students in the development of military specific clinical skills. Masters of social work students (n = 156) at a university were enrolled in a quasi-experimental study and provided clinical training with the use of either RP or SAP. Participants were measured on their ability to clinically engage with clients and their ability to recognize and responds to symptoms of PTSD and suicide ideation. Participants in both groups demonstrated increases in self-efficacy, clinical engagement, recognizing, and responding to PTSD and suicidal symptoms, and overall performance. Overall significant differences were not found in the development of clinical skills between RP and SAP groups with an exception related to developing a collaborative relationship, with participants in the RP group scoring higher than those in the SAP group. These findings suggest that though SAP and RP appear to be equally effective training modalities, RP may provide advantages in the development of the therapeutic relationship.

Understanding Post-Traumatic Stress Responses among Military Chaplains: Implications for Military Behavioral Health

Introduction: Military chaplains play a vital role in helping the military accomplish their missions. These chaplains can be exposed to traumatic experiences during their deployments with some of them developing posttraumatic stress disorder (PTSD). Method: Using in-depth interviews with 17 former and active-duty chaplains who have been diagnosed with PTSD, this study employs classical grounded theory to formulate a conceptual model explaining key factors that contribute to their trauma resiliency. Results: The conceptual model derived from grounded theory analysis of the interviews theorizes that chaplains with PTSD who have a greater number of overall and religious/spiritual protective factors and fewer overall and religious/spiritual risk factors are more resilient to military-related trauma experiences. Alternatively, chaplains who have more overall and religious/spiritual risk factors and fewer of these protective factors demonstrate decreased resiliency. Key risk factors included high levels of guilt, perceived weakness and stigma associated with symptoms, heavy work demands during deployments, competitive work environments, isolation, and unhelpful leadership responses. Discussion: Implications for military behavioral health to support military chaplains are highlighted. They include recommendations for increased and targeted psychoeducation efforts, expanded use of camaraderie-based approaches/fostering informal support, incorporation of chaplain’s faith/spirituality, increased use of narrative and cognitive interventions, and advocating for chaplains.

Targeted Assessment and Context-Tailored Implementation of Change Strategies (TACTICS) to increase evidence based psychotherapy in military behavioral health clinics: Design of a cluster-randomized stepped-wedge implementation study

BackgroundDespite efforts by the U.S. Department of Defense to train behavioral health (BH) providers in evidence-based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD), numerous barriers limit EBP implementation. A context-tailored implementation approach called TACTICS (Targeted Assessment and Context-Tailored Implementation of Change Strategies) holds promise for increasing the use of EBPs such as prolonged exposure therapy (PE) in military treatment facilities. TACTICS combines a needs assessment, a rubric for selecting implementation strategies based on local barriers, an implementation toolkit, and external facilitation to support local champions and their implementation teams in enacting changes. This paper describes the rationale for and design of a study that will evaluate whether TACTICS can increase implementation of PE for PTSD and improve patient outcomes in military BH clinics relative to provider training in PE alone. MethodsThe study is a multi-site, cluster randomized, stepped-wedge trial, with the military treatment facility as the unit of analysis. Eight facilities undergo a provider-training phase, followed by 5 months of TACTICS implementation. The timing of TACTICS at each facility is randomly assigned to begin 9, 14, or 19 months after beginning the provider-training phase. Primary analyses will compare the proportion of PTSD patients receiving PE and patients' mean improvement in PTSD symptoms before and after the onset of TACTICS. DiscussionTACTICS endeavors to balance standardization of empirically-supported implementation strategies with the flexibility of application necessary for success across varied clinical settings. If successful, TACTICS may represent a systematic and scalable method of promoting and supporting EBP implementation. Trial registrationClinicaltrials.gov Identifier: NCT03663452

A Nonrandomized Trial of Prolonged Exposure and Cognitive Processing Therapy for Combat-Related Posttraumatic Stress Disorder in a Deployed Setting

For many decades, the U.S. military’s general operational guideline has been to limit the use of trauma-focused treatments for combat and operational stress reactions in military service members until they have returned from deployment. Recently, published clinical trials have documented that active-duty military personnel with combat-related posttraumatic stress disorder (PTSD) can be treated effectively in garrison. However, there are limited data on the treatment of combat and operational stress reactions or combat-related PTSD during military deployments. This prospective, nonrandomized trial evaluated the treatment of active-duty service members (N = 12) with combat and operational stress reactions or combat-related PTSD while deployed to Afghanistan or Iraq. Service members were treated by deployed military behavioral health providers using modified Prolonged Exposure (PE; n = 6) or modified Cognitive Processing Therapy (CPT; n = 6), with protocol modifications tailored to individual mission requirements. The PTSD Checklist–Military Version (PCL-M) total score was the primary outcome measure. Results indicated that both groups demonstrated clinically significant change in PTSD symptoms as indicated by a reduction of 10 points or greater on the PCL-M. Participants treated with modified PE had significant reductions in PTSD symptoms, t = -3.83, p = .01; g = -1.32, with a mean reduction of 18.17 points on the PCL-M. Participants treated with modified CPT had a mean PCL-M reduction of 10.00 points, but these reductions were not statistically significant, t = -1.49, p = .12; g = -0.51. These findings provide preliminary evidence that modified forms of PE and CPT can be implemented in deployed settings for the treatment of combat and operational stress reactions and combat-related PTSD.

Accelerated Resolution Therapy-Based Intervention in the Treatment of Acute Stress Reactions During Deployed Military Operations.

The treatment and resolution of psychological traumas during military deployments directly supports medical readiness and the military mission and potentially prevents symptom progression to post-traumatic stress disorder (PTSD). However, current evidence-based trauma-focused psychotherapies can be difficult to employ during military contingency operations due to various barriers. Deployed military behavioral health providers need an effective, trauma-focused intervention that is suitable for the operational environment. In this retrospective case series, we describe how a therapeutic intervention based on accelerated resolution therapy (ART), an emerging trauma-focused psychotherapy, was pivotal in the treatment of acute stress reactions in eight deployed U.S. Army soldiers. ART can be conceptualized as a hybrid of several evidence-based psychotherapy techniques. In brief, ART is a manualized, procedural adaptation of eye movement desensitization and reprocessing (EMDR) that incorporates mindful awareness of emotions and sensations, bilateral eye movements, imaginal exposure, desensitization, visual and cognitive rescripting, and gestalt-style interventions for the processing of traumatic experiences. The eight deployed U.S. soldiers in this case series received a single 45 to 60minute session of an ART-based intervention within 96hours of a traumatic death. All of the treated soldiers had rapid improvement in both depressive and acute stress symptoms after treatment. Furthermore, the therapeutic benefits were sustained at 1year postincident despite continued exposure to the stress of deployed military operations for up to 6months after treatment. Based on these encouraging preliminary findings, the authors recommend that behavioral health providers who are preparing to deploy become familiar with ART or related interventions in order to develop the confidence and the skills that are needed to provide timely and effective trauma-focused care for deployed soldiers.

Psychiatric Aeromedical Evacuations of Deployed Active Duty U.S. Military Personnel During Operations Enduring Freedom, Iraqi Freedom, and New Dawn.

The primary objective of this study was to describe the demographic, clinical, and attrition characteristics of active duty U.S. military service members who were aeromedically evacuated from Iraq and Afghanistan theaters with a psychiatric condition as the primary diagnosis. The study links the U.S. Transportation Command Regulating and Command and Control Evacuation System (TRAC2ES) data with the Defense Manpower Data Center (DMDC) to conduct an examination of the long-term occupational impact of psychiatric aeromedical evacuations on military separations and discharges. Retrospective analyses were conducted on the demographic, clinical, and attrition information of active duty service members (N = 7,023) who received a psychiatric aeromedical evacuation from Iraq or Afghanistan between 2001 and 2013 using TRAC2ES data. Additionally, TRAC2ES database was compared with DMDC data to analyze personal and service demographics, aeromedical evacuation information, and reasons for military separation with the entire 2013 active duty force. Chi-square tests of independence and standardized residuals were used to identify cells with observed frequencies or proportions significantly different than expected by chance. Additionally, OR were calculated to provide context about the nature of any significant relationships. Compared with the active duty comparison sample, those with a psychiatric aeromedical evacuation tended to be younger, female, white, divorced or widowed, and less educated. They were also more likely to be junior enlisted service members in the Army serving in a Combat Arms military occupational specialty. The primary psychiatric conditions related to the aeromedical evacuation were depressive disorders (25%), adjustment disorders (18%), post-traumatic stress disorder (9%), bipolar disorders (6%), and anxiety disorders (6%). Approximately, 3% were evacuated for suicidal ideation and associated behaviors. Individuals who received a psychiatric aeromedical evacuation were almost four times as likely (53%) to have been subsequently separated from active duty at the time of the data analysis compared with other active duty service members (14%). The current study also found that peaks in the number of aeromedical evacuations coincided with significant combat operational events. These peaks almost always preceded or followed a significant operational event. An unexpected finding of the present study was that movement classification code was not predictive of subsequent reasons for separation from the military. Thus, the degree of clinical supervision and restraint of a service member during psychiatric aeromedical evacuation from deployment proved to be unrelated to subsequent service outcome. Psychiatric conditions are one of the leading reasons for the aeromedical evacuation of active duty military personnel from the military combat theater. For many active duty military personnel, a psychiatric aeromedical evacuation from a combat theater is the start of a military career-ending event that results in separation from active duty. This finding has important clinical and operational implications for the evaluation and treatment of psychiatric conditions during military deployments. Whenever possible, deployed military behavioral health providers should attempt to treat psychiatric patients in theater to help them remain in theater to complete their operational deployments. Improved understanding of the factors related to psychiatric aeromedical evacuations will provide important clinical and policy implications for future conflicts.

Burnout Among US Military Behavioral Health Providers.

The present study investigated the prevalence of burnout among US military behavioral health providers (BHPs) and tested a mechanism of developing burnout in a job demands-resources model. Surveys were sent to BHPs working with US military populations globally (T1). Six months after, surveys were collected again at T2. In total, 271 providers completed T1, and 116 completed T2. The job demands-resources model showed that T1 burnout self-efficacy and support predicted T2 burnout and work engagement. T1 job demands predicted T2 burnout. To provide a deeper comparison of our findings, we included a meta-analysis, which indicated burnout among BHPs working on a military installation was equivalent with other professions. Providers working with military clients within the community reported lower burnout than other professionals. Findings suggest BHPs working on a military installation might be at greater risk of developing burnout. Burnout might be preventable by increasing job resources and decreasing job demands.

Videoconferenced Telebehavioral Health Referral Process Adherence.

In 2015, the Army mandated 100% digital storage of telehealth consent forms (DA4700) in the Health Artifact and Image Management Solution (HAIMS) system, and a telebehavioral health (TBH) hub clinic set an aim to accomplish this by improving adherence to referral procedures essential to expanding patient access to videoconferenced (VC) behavioral health care. The Knowledge-to-Action (KTA) planned action framework underpinned development of a two-phase, PDSA (Plan-Do-Study-Act) quality improvement project to increase the rates of TBH new intake consent form completeness and upload adherence. First, a provider education initiative addressed form uploads. Second, TBH consultants prepared (signed and sent) intake forms to referring sites for their patients to finalize during the initial VC encounter. A chart review of consecutive new intake encounters compared data extracted from CY2015 Q1 baseline records (n = 65) with data from CY2016 Q1 improvement period records (n = 40). A total of 352 forms were reviewed. Referrals (N = 118) that resulted in kept new VC TBH intake visits (n = 105), originated from three military behavioral health clinic referral sites. In CY2016 Q1, all DA4700 consent forms were uploaded to HAIMS. Telehealth treatment and medication consent form upload adherence increased from 94% and 68%, respectively, to 100% (p > 0.05). Form completeness increased from 36% to 95% (p < 0.001), and multiple linear regression analysis predicted an average 59% increase across the three referral sites (sr2 = 0.54). Consultant preparation of telehealth new intake consent forms effectively improved form completeness and increased adherence to new intake referral processes essential to this hub clinic expanding patient access to TBH care.

Understanding Post-Deployment Reintegration Concerns Among En Route Care Nurses: A Mixed-Methods Approach

The objective of this study was to better understand the post-deployment behavior health symptoms and readjustment/reintegration experienced by military nurses who provided en route care while serving in Operation Enduring Freedom/Operation Iraqi Freedom. Employing an exploratory, concurrent, mixed-methods design with an electronic survey consisting of several valid instruments and single, face-to-face interviews; data were gathered from 119 surveys and 22 interviews. Four qualitative themes aligned with the Post-Deployment Readjustment Inventory items. Findings from interviews support and illuminate the outcomes of the Post-Deployment Readjustment Inventory. Behavioral health usage was high in the quantitative sample. Nearly 74% (n = 88) of respondents indicating they had used Military Behavioral Health services following deployment. Statistically significant differences were noted among all subscales except Intimate Relationship Problems. Combined results indicated en route care nurses encountered difficulties when attempting to return to predeployment roles; behavioral health problems mirrored those of combat warriors. Interventions to assist post-deployment reintegration of en route care nurses should be conducted at the peer, leader, and health care provider levels. Embedding military mental health providers into en route care units is needed. It is imperative to gather lessons learned and identify ways to improve preparation for future conflicts and behavioral health of en route care nurses.

Staff Attitudes Regarding the Impact of a Therapy Dog Program on Military Behavioral Health Patients.

Human-animal interactions in the form of animal-assisted therapy (AAT) have become common in both civilian and military health care facilities. Evidence supports AAT as a beneficial therapeutic alternative for patients with physical disabilities and psychological disorders. Few studies have been conducted in the civilian health care setting to evaluate staff attitudes regarding the impact of an AAT program on behavioral health (BH) patients. To our knowledge, no research has examined staff attitudes on the impact and effectiveness of AAT on active-duty Servicemembers in a BH program at a military facility. At the completion of a year-long AAT dog program and after institutional review board exemption, an anonymous, six-question survey was used to examine staff attitudes (n = 29) regarding the impact and continuation of the program with military BH patients. Most staff members (86%) believed the AAT dog program had a positive impact on the BH patients, including improved patient mood, greater patient relaxation, improved patient attitude toward therapy, and increased social interactions among patients. All the staff reported a desire to continue the program at the military facility. Most BH staff thought the year-long AAT dog program had a positive impact on patients. All staff supported continuation of the program.

An Analysis of Personal Technology Use by Service Members and Military Behavioral Health Providers.

Personal technology use is ubiquitous in the United States today and technology, in general, continues to change the face of health care. However, little is known about the personal technology use of military service members and the behavioral health care providers that treat them. This study reports the technology use of 1,101 active duty service members and 45 behavioral health care providers at a large military installation. Participants reported Internet usage; ownership of smartphones, tablets, and e-readers; usage of mobile applications (apps); and basic demographic information. Compared with providers, service members reported higher rates of smartphone ownership, were more likely to own Android smartphones than iPhones, and spent more time gaming. Both groups spent a comparable amount of time using social media. With the exception of gaming, however, differences between service members and providers were not statistically significant when demographics were matched and controlled. Among service members, younger respondents (18-34) were statistically more likely than older respondents (35-58) to own smartphones, spend time gaming, and engage in social media. Our findings can help inform provider's technology-based education and intervention of their patients and guide the development of new technologies to support the psychological health of service members.

U.S. Army Psychiatry in the Vietnam War: New Challenges in Extended Counterinsurgency Warfare

Back to table of contents Previous article Next article Communications and UpdatesFull AccessU.S. Army Psychiatry in the Vietnam War: New Challenges in Extended Counterinsurgency WarfareJason I. Dailey, M.D.Jason I. DaileySearch for more papers by this author, M.D.Published Online:1 Sep 2015https://doi.org/10.1176/appi.ajp.2015.15040469AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail by Norman M. Camp, M.D. Fort Sam Houston, Tex., Office of the Surgeon General, Borden Institute, U.S. Army Medical Department Center & School, 2015, 596 pp., $101.00 (hardcover).In U.S. Army Psychiatry in the Vietnam War: New Challenges in Extended Counterinsurgency Warfare, Col. Norman Camp, M.C., U.S. Army (Ret.) argues that the Vietnam War should really be viewed as two separate conflicts temporally demarcated by the 1968 Tet Offensive. Prior to this series of battles, American involvement in Vietnam involved purposeful combat missions with relatively high support for the war back in the United States, leading to fairly high morale and low rates of behavioral health casualties in spite of high combat exposure. Following the Tet Offensive, however, American support for the war both in the United States and in Vietnam decreased dramatically. The shift in combat focus from directly engaging the enemy to instead training the Vietnamese to fight for themselves also meant that the average soldier was often not meaningfully involved in any productive activity. As the war dragged on, psychiatrists were increasingly responsible for trying to control rampant heroin use, racial tension, and general unwillingness to fight. In addition, the psychiatrists themselves struggled with a lack of training in military psychiatry in the deployed setting and ambivalence about serving in Vietnam at all.The civilian psychiatrist will find U.S. Army Psychiatry in the Vietnam War an interesting historical account of the war from a relatable perspective. One may be shocked by the seeming nonchalance some soldiers had around routine “fragging,” which involves soldiers murdering a member of their leadership who is perceived as overly rigid by throwing a fragmentary grenade into the individual’s office or sleeping quarters. Yet just as provocative may be the empathy the reader develops for early-career psychiatrists sent to Vietnam who had only five weeks of military training but were expected to manage the morale of tens of thousands of troops with little more than chlorpromazine and a typewriter.For the modern military psychiatrist, Camp’s work should be mandatory reading. Lengthy accounts of the precise experiences of several individual psychiatrists in Vietnam may be too much detail for the average reader, but military psychiatrists who have deployed to Afghanistan in recent years will likely find that many of the same difficulties surrounding the support of stability operations in a counterinsurgency environment are identical between wars separated by more than 50 years and 3,000 miles. Dual-agency struggles, including an expectation to manage subclinical issues of morale and misconduct for a unit in spite of residency training predominantly focused on more severe mental illness, will be all too familiar. In fact, most modern military psychiatrists will be surprised by how little the overall structure of psychiatric care in the deployed setting has changed over half a century and may be left with a lingering desire for a similar volume about Operation Enduring Freedom, even if little more than the names and places will have changed from Camp’s work.Where U.S. Army Psychiatry in the Vietnam War does struggle is in overall editing. While the occasional typo may be mildly distracting, in at least two places in the text a psychiatrist who is meant to be anonymized as “Dr. A” is overtly identified by name. Moreover, a more critical editing process could have easily shortened the volume by removing unnecessary repetition both within and between chapters. Yet aside from these errors, the work is overall well researched and brought to life by engaging photographs predominantly taken by Maj. Gen. Richard D. Cameron (Ret.).History buffs looking for a unique exploration of the Vietnam War supported by impressive data and a multitude of firsthand accounts will find U.S. Army Psychiatry in the Vietnam War a fascinating view of a war they thought they knew. Meanwhile, military behavioral health professionals will find the education they wish they had received in residency—ironically the same education combat psychiatrists in the Vietnam War wished they had received as well.Maj. Jason I. Dailey is the Commander of the 212th Medical Detachment (Combat and Operational Stress Control) at Fort Campbell, Ky.The opinions or assertions contained herein are the private views of the author and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.The author reports no financial relationships with commercial interests. FiguresReferencesCited byDetailsCited ByNone Volume 172Issue 9 September 01, 2015Pages 914-915 Metrics PDF download History Accepted 1 April 2015 Published online 1 September 2015 Published in print 1 September 2015