Wednesday, March 20, 2013

List of Resilience Programs Reviewed by RAND

Today has been one more eye opener while researching my book, The Warrior SAW, Suicide After War and I am sick to my stomach over what I discovered today. The following cannot wait until the book is done.

Rand has a fascinating report that must have just missed every reporter in the country because it addresses the problems with the military approach of reducing military suicides by making them "resilient" and actually showed the results from this huge study.

If you want to know why hundreds of millions of dollars have been spent over all these years producing the record high suicide rates across the military branches, this is it.

Table 3.2 List of Resilience Programs Reviewed
Assessment of the Army Center for enhanced Performance (ACeP)
Operational Stress Control and Readiness (OSCAR)
Employee engagement Program (nSA)/Corporate Athlete
Energy Project
Gallup Consulting
Joint Speakers Bureau (JSB)
Landing Gear
Marine Resiliency Study (MRS)
Mindfulness-Based Mind Fitness training (MMFt)
National Guard Resiliency Program
Operational Stress Injury Social Support (OSISS)
Passport toward Success
Penn Resiliency Project (PRP)
Preventive Psychological health Demonstration Project (PPhDP)
Promoting Alternative thinking Strategies (PAthS)
School Mental health team (SMht)
Senior Leader wellness enhancement Seminar (SLweS)
Soldier evaluation for Life Fitness (SeLF)
Spiritual warrior training Program (SwtP)
Warrior Resiliency Program (wRP)
Warrior Resilience and thriving (wRt)
Most programs have been implemented before evidence of their effectiveness has been established. Programs often are modified for each client or context, making it difficult to design studies that will provide evidence of effectiveness for all military populations and situations. New scientific studies have recently been funded and are in the planning or initial data collection stages, but, as with most quasi-experimental or controlled studies, it will be a number of years before evidence of their effectiveness is fully established. As these studies with evaluative data progress, they should be encouraged to publish their results.
Conduct More Rigorous Program Evaluation
Although there are many programs available to the military and civilian communities, there is very little empirical evidence that these programs effectively build resilience.

Similarly, there are a number of factors related to resilience, but there is almost no evidence that resilience can be taught or produced. Results from both the literature review and the program review echo the need for more program evaluation, as identified as one of the missions of the DCoE. As noted, only 11 documents in the literature review are based on RCT evaluation design, and only five of the programs reviewed have formally evaluated program success, yet programs are often rolled out before evidence of their effectiveness has been established and are modified for each client or context, making it difficult to provide evidence for effectiveness across populations and situations.

In general, studies of resilience in the military should enhance scientific rigor by conducting more RCTs and longitudinal studies that span the phases of deployment. This is particularly true for military families, since little research has been published in this area (MacDermid et al., 2008). In addition, studies with existing evaluative data need to be encouraged to publish their results.

Promoting resilience in the military is an increasingly important objective of DoD.
Effective programs that improve service members and their families’ resilience directly assist the military in keeping its personnel better prepared for combat. Our study reached the following conclusions:
• There is evidence in the literature supporting many factors that can help to promote resilience at the individual, family, unit, and community levels.
– Scientific evidence is especially strong for positive thinking, positive affect, positive coping, realism, and behavioral control, as well as for positive command climate and belongingness.
• Many of the programs that were reviewed as part of this study incorporate these evidence-based factors into their core missions.
• However, interviews with program representatives identified five types of challenges to program implementation, which suggest opportunities to improve program capabilities:
– lack of leadership support by the military
– problems with logistics
– limited funding to sustain programs
– poor fit within the military culture
– mental health stigma.
Building resilience in the military can be strengthened in several ways. Clear policy to define roles, responsibilities, and broad guidance for implementation would be extremely helpful. Using evidence-based resilience factors in a flexible, culturally sensitive context is also important. Resilience policies should also direct more rigorous program evaluation, using standardized measures and comparing across different programs.

Such evaluations could help guide military members and their families to make informed decisions about program selection. Ultimately, strong command leadership will enable the success of resilience programming and will enhance the overall strength and resilience of service members and their families.
I knew this was bad but I didn't know how much proof there was the DOD has pushing something they didn't even know would work and then refused to end it when it was proven to leave more dead by suicide, 43% still refusing to get care and 57% committing suicide even after they got it.
Findings from 2011 also by RAND RAND Study Promoting Psychological Resilience in the U.S. Military 2011 Summary of Reported Barriers to Program Implementation
Lack of leadership support
13 “Supportive leadership . . . can model change in their own behavior and also serve as a ‘strong internal champion’ for the program.” “when communication from the top down is not as clear, families may not get relevant information or feel particularly encouraged to attend. there is higher participation when commanders’ families participate in the program.”
Problems with logistics
12 “Identifying appropriate periods of measurement within the military is an ongoing challenge.” “there are many demands on training time . . . sometimes training time is cut short in order to continue the mission.”
Limited funding to sustain program
8 “the business process [of] traditional systems works against efforts to provide a prevention oriented system. Currently, they are tied to a system that rewards for patient encounters.” “we started with some seed money to develop the program and got additional support from local representatives. It will be important to get ongoing support to further develop and expand the program.”
Poor fit within the military
8 “It is a challenge to figure out how to present the material in an effective way, e.g., self-care and self regulation can be presented as part of self-sustainment.”
Mental health stigma
5 “Soldier’s reaction is ‘why do we need this touchy-feely course?’ It is sometimes hard to get through to senior leadership the importance of addressing these issues prior to deployment.”