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Weinick NATIONAL DEFENSE RESEARCH INSTITUTE An Evaluation of the Implementation and Perceived Utility of the Airman Resilience Training Program Gabriella C. Gonzalez, Reema Singh, Terry L. Schell, Robin M. Weinick Prepared for the Office of the Secretary of Defense Approved for public release; distribution unlimited The research described in this report was prepared for the Office of the Secretary of Defense (OSD). The research was conducted within the RAND National Defense Research Institute, a federally funded research and development center sponsored by OSD, the Joint Staff, the Unified Combatant Commands, the Navy, the Marine Corps, the defense agencies, and the defense Intelligence Community under Contract W74V8H-06-C-0002. Library of Congress Cataloging-in-Publication Data is available for this publication. ISBN: 978-0-8330-8628-0 The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. 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RAND OFFICES SANTA MONICA, CA • WASHINGTON, DC PITTSBURGH, PA • NEW ORLEANS, LA • JACKSON, MS • BOSTON, MA CAMBRIDGE, UK • BRUSSELS, BE www.rand.org Preface Since 2001, the U.S. military has been functioning at an operational tempo that is historically high for the all-volunteer force in which servicemembers are deploying for extended periods on a repeated basis. Even with the drawdown of troops from Iraq in 2011, some servicemem- bers are returning from deployment experiencing difficulties handling stress, mental health problems, or deficits caused by a traumatic brain injury (TBI). In response to these challenges, the U.S. Department of Defense (DoD) has implemented numerous programs to support ser- vicemembers and their families in these areas. In 2009, the Assistant Secretary of Defense for Health Affairs asked the RAND National Defense Research Institute (NDRI) to develop a comprehensive catalog of existing programs sponsored or funded by DoD to support psycho- logical health and care for TBI, to create tools to support ongoing assessment and evaluation of the DoD portfolio of programs, and to conduct evaluations of a subset of these programs. This report describes RAND’s assessment of an Air Force program, Airman Resilience Training (ART), which is a psychoeducational program designed to improve airmen’s reac- tions to stress during and after deployment and to increase the use of mental health services when needed. ART was initiated in November 2010, replacing a previous program named Landing Gear, which had been in place since April 2008. Our study took place from August 2011 through November 2011. This report will be of particular interest to officials within the Air Force who are respon- sible for the psychological health and well-being of airmen, as well as to others within the mili- tary who are developing programs for servicemembers to help them cope with stress while in combat situations and after returning from deployment. This research was sponsored by the Assistant Secretary of Defense for Health Affairs and the Defense Centers for Excellence for Psychological Health and Traumatic Brain Injury and was conducted jointly by RAND Health’s Center for Military Health Policy Research and the Forces and Resources Policy Center of the RAND NDRI. The Center for Military Health Policy Research taps RAND expertise in both defense and health policy to conduct research for the Department of Defense, the Veterans Health Administration, and nonprofit organiza- tions. RAND Health aims to transform the well-being of all people by solving complex prob- lems in health and health care. NDRI is a federally funded research and development center sponsored by the Office of the Secretary of Defense, the Joint Staff, the Unified Combatant Commands, the Navy, the Marine Corps, the defense agencies, and the defense Intelligence Community. For more information on the Center for Military Health Policy Research, see http://www. rand.org/multi/military.html or contact the director (contact information is provided on the web page). For more information on the Forces and Resources Policy Center, see http://www. iii iv An Evaluation of the Implementation and Perceived Utility of the Airman Resilience Training Program rand.org/nsrd/ndri/centers/frp.html or contact the director (contact information is on the web page). Contents Preface ........................................................................................................... iii Figure and Tables ..............................................................................................vii Summary ........................................................................................................ ix Acknowledgments ........................................................................................... xvii Abbreviations .................................................................................................. xix ChAPTer One Introduction ..................................................................................................... 1 Background ....................................................................................................... 1 Air Force Deployment Process and Deployment-Related Psychological Health Concerns ............. 1 Overview of Airman Resilience Training ..................................................................... 2 Underway Efforts to Build Resilience in the Air Force ...................................................... 4 Psychoeducational Resilience Programs ....................................................................... 5 Purpose of This Study and Research Questions .............................................................. 6 Organization of This Report .................................................................................... 7 ChAPTer TwO Methodological Approach .................................................................................... 9 Rationale for Site Selection ..................................................................................... 9 Data Collection Activities ......................................................................................10 Structured Observations ....................................................................................10 Discussion Sessions and Interviews .........................................................................11 Analytic Approach ..............................................................................................12 ChAPTer Three Findings from the Site Visits: Delivery of ArT ..........................................................15 Instructions for Delivery of ART .............................................................................15 Variations in the Delivery of ART ............................................................................16 Factors Affecting the Variation in Delivery of ART ........................................................18 Institutional Setting ..........................................................................................18 Briefers’ Style of Delivery ................................................................................... 20 Airmen’s Level of Engagement with the ART Briefings ....................................................21 Briefers’ Style of Delivery ....................................................................................21 Briefing Fatigue ............................................................................................. 22 Timing of Delivery .......................................................................................... 23 Conclusions ..................................................................................................... 24 v vi An Evaluation of the Implementation and Perceived Utility of the Airman Resilience Training Program ChAPTer FOur Findings from the Site Visits: Perceived usefulness of ArT’s Content ..............................25 Perceived Redundancy of ART Content with Other Programs ..........................................25 PowerPoint Format of ART .................................................................................. 26 Opinion of Design and Graphics of ART ................................................................ 26 Mnemonic Device Used to Structure Briefing Seen As Not Memorable ............................. 27 Perceived Effectiveness of PowerPoint Format ........................................................... 27 Lack of Tailoring to Differences Within Each Audience .................................................. 28 Deployment Locations ...................................................................................... 28 Occupational Specialty .......................................................................................29 Deploying as an Individual .................................................................................29 Previous Deployment Experience ...........................................................................29 Content Could Be Improved ................................................................................. 30 ART Content Reported to Be Vague and Ambiguous .................................................. 30 Gaps in Skills Covered ...................................................................................... 30 Gaps in Topics Covered ......................................................................................31 Anecdotes and Relevant Examples Made Material More Memorable ..................................32 Briefing Instructions and Training Reported to Be Less Than Satisfactory ...........................33 Conclusions ......................................................................................................33 ChAPTer FIVe Key Findings and Suggestions for Improvement ........................................................35 Summary of Findings...........................................................................................35 ART Is Implemented in a Variety of Ways ................................................................35 Perceived Usefulness of ART Was Generally Low ........................................................35 Suggestions for Improvement ..................................................................................37 Conduct an Assessment to Identify the Best Goals for ART ............................................37 Implement Strategies for Ongoing Quality-Improvement of ART ................................... 38 Conclusion .......................................................................................................41 APPenDIxeS A. Airmen resilience Training PowerPoint Slides and Manual ..................................... 43 B. Structured Observation Tool ............................................................................69 C. Protocol for Discussion Sessions with Deploying and reintegrating Airmen .................73 D. Protocol for Interviews with Chief Mental health Officers and Their Staff ....................79 Bibliography ....................................................................................................81 Figure and Tables Figure 5.1. Summary of Key Findings, Implications, and Suggestions for Improvement ............. 36 Tables 2.1. Data Collection Efforts and the Number of Participants for Each Site .....................12 3.1. Summary of Variation of Delivery of ART in Four Sites and Briefers’ Characteristics ...19 vii