Unit Needs Assessment - Adobe Connect · PDF file“Medically Ready Force . . . . Ready...

“Medically Ready Force . . . . Ready Medical Force” 1 1

Deanna Beech, Ph.D.

Dwight D. Eisenhower Army

Medical Center

Child, Adolescent &Family Behavioral

Health Service

Unit Needs Assessment

“Medically Ready Force . . . . Ready Medical Force” 2

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“Medically Ready Force . . . . Ready Medical Force”

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Learning Objectives

∎ At the conclusion of this session participants will be able to …

Identify informal and formal methods of obtaining information on unit needs.

Identify the differences and benefits between the various formal needs assessment tools.

Understand the process for administering and scoring the tools.

Be able to discuss the results with command and help them align available resources to address identified concerns.

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∎ Dr. Deanna Beech is a Clinical Psychologist with more than 20 years of experience working with

children, adolescents, and adults.

∎ Dr. Beech is currently working with the soldiers and families stationed at Ft. Gordon, GA. Prior to

this she had the privilege to work with the 25th Infantry Division at Schofield Barracks, Hawaii, as an

Embedded Psychologist with the 8th TSC. Before that she was Chief of Child Psychology at the US

Army Health Center in Vicenza, Italy, and developed regional initiatives for the Army's

Comprehensive Soldier Fitness program.

∎ Dr. Beech also served as an active duty Military Psychologist, worked for international aid

organizations in Bosnia and Kosovo, and organized several international conferences on the effects

of trauma

∎ Additionally, she has written and presented on a variety of topics such as Emotional Wellness,

Military Psychology, and Ethics in international aid.

∎ Presently, she aspires to put concrete tools for facilitating r resiliency in hands of parents and

teachers, because all of our children deserve this.

Deanna Beech, Ph.D.

11


Deanna Beech, Ph.D.

Dwight D. Eisenhower Army

Medical Center

Child, Adolescent &Family Behavioral Health Service

Unit Needs

Assessment

12


• The views expressed in this presentation are those of Dr. Beech and

do not reflect the official policy of the Department of Defense or the

U.S. Government.

• The description of programs in this presentation is for descriptive

purposes only and not intended to promote any individual program.

• The following lecture is for educational purposes.

• The speaker you are about to hear from, and the treatment, approach,

therapy technique, etc., you are about to learn about is not endorsed

above or beyond other speakers and treatments, approaches,

therapies, and techniques.

Disclosure

13


But all of these are still focused on only one aspect of the distribution

∎ Reading the players – SM, 1SG, Commander

Through phone conversations

Meeting in person – face to face builds “street cred”

Walk abouts

∎ Noticing Trends

Such as a surge of SM’s from one company or platoon

∎ High risk meetings

Larger view to check for trends

Use of group dynamics to further understanding the players

Informal UNA


∎ By default we see the portion of the group with the

greatest mental health difficulties.

∎ We expect that any where between 9 and 31% of

our total population needs MH care (Thomas et al, 2010).

∎ But - it is estimated that we see only about 30 to 40

% of those

that need us

the most (Brown et.al, 2011).

Informal UNA pt.2


Informal UNA pt.3

∎ It has been thought that the other 60 to 70% of those that

should be coming to see us have been turned off by

stigma and barriers to care (Hoge et al., 2004).

∎ But recent evidence suggests that the SM’s own “negative

attitude towards treatment” and the belief that their

problems are “not severe enough” are more predictive of

not seeking treatment (Kim et al., 2011; Britt et al., 2011).

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∎ And, what about the

other 69 to 91 % of the

population?

∎ If they aren’t walking into

our offices should we

assume that all is fine?

Informal UNA pt.4


Formal UNA’s

∎ The Unit Behavioral Health Needs Assessment – UBHNA

Takes 20 to 30 min’s to administer

Covers Risk and Unit functioning, minimal Resiliency

∎ The “Checking In” Survey

Takes less than 5 min’s to administer

Covers Risk, Resiliency, and Unit functioning

∎ The Unit Risk Assessment – URA

Takes about 10 min’s to administer

Covers Risk, minimal Unit Functioning & no Resiliency

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From WRAIR

UBHNA


UBHNA - methodology

∎ Developed by a panel of experts as a short form of the

much larger Land Combat Study

∎ Anonymous with voluntary participation

∎ Data is presented in aggregate

∎ Has comparison statistics for setting the “context” for

interpretation

∎ Takes 20 to 30 minutes to complete

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UBHNA – areas covered

∎ Demographics

∎ Recent Deployments

∎ PTSD (PCL)

∎ Unit Cohesion

∎ Depression (PHQ9)

∎ Alcohol / Drug use

∎ Use of existing MH

resources

∎ Questions about stigma

and barriers

• Marital Satisfaction

– Separating/divorcing

– Spouse abuse

– Satisfaction

• Unit support to family

• Three things (good or

bad) that contribute to

your current state of well-

being.

21


∎ cac controlled database

UBHNA – inputting data


UBHNA - output


UBHNA – Checking In

From the need to know


PHQ 4 Lowe et al., 2010

Grit / Hardiness Duckworth & Quinn, 2009

MacDermott, 2010

Socially Referenced Drinking

Optimistic

Disposition

Buffer Thomas et al., 2011

Sleep Physical Health

Financial Stress

The questions reflect the core DSM V features PTSD Intrusions

Avoidance

Hyperstartle

Negative Mood

General Mental Health


Family status Avril & Magnini, 2007 Chaplains like to know

Social Supports Procidano & Heller, 1983

Hatch, 2013

Smith et al., 2013

Signficant

Relationship Hendrick, 1988

Rowe et al., 2013

Supports


Parenting


Perceived Combat Readiness Shamir et al., 2000

Work


“Checking In” - methodology

∎ Developed by a team of clinician’s focused on providing actionable data to command and garrison to improve readiness and prevent bad outcomes

∎ Anonymous with voluntary participation

∎ Data is presented in aggregate

∎ A face valid measure with items from standard measure that showed the greatest correlation with the construct, where possible.

∎ Includes reverse scoring items to ensure that SM’s have read the questions.

∎ Takes less than 5 minutes to complete

29


Command Climate*

Ready to fight

Confidence in leadership

Evasion of duties

Being part of a team

PHQ-4

Risk Factors Depression

Anxiety

PTSD

Alcohol

Anger

Finances

Resiliency Factors

Subjective Happiness*

Marital Satisfaction (also a risk)

Parent Satisfaction*

Social Supports

Health

Sleep

Grit*

Faith

“Checking In” – areas covered


“Checking In” – inputting data

∎ The good news…

It’s easy to administer so it’s easy to get buy in from

command groups.

∎ The bad news…

It requires comfort with Excel and/or SPSS

so it’s cumbersome to interpret.

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BH and Fusion Cell had been shut out. These results were the first step back into the 307th. Subsequent to briefing we were invited to give a training to the commanders on “What BH can do to support the mission.”

“Checking In” - output


Unit Risk Inventory

From ASAP


A Program of the… Risk Reduction Program Coordinator Army Substance Abuse Program (ASAP)

∎ Anonymous, but no statement of voluntary

∎ In reality it takes about 30 mins

∎ Local ASAP can do it on demand.

Command just has to ask - which means they have to

know it exists or someone has to offer.

URI - methodology


Army Approved Command Climate Survey

Designed for use at the

Company level

Screens for high-risk behaviors

and attitudes that compromise unit readiness

No cost to Installation or Units

URI – areas covered


∎ The person in charge at ASAP sends the surveys to the

mother ship and they get back a beautiful collated report

∎ No number crunching

∎ But, it really don’t get at

resiliency and has limited

command information

URI – inputting data


∎ Find out more at

http://acsap.army.mil/sso/

pages/public/resources

/rr-uri1.jsp

URI - output


UNA – 173rd ABCT OEF ‘10

∎What can you do with data?

An example of how UNA’s can have a huge impact on readiness

38


O’Leary’s prediction

∎ OEF ’07-’08 was a 15 mt deployment with extensive

losses, a mass casualty event at the end of the tour

(Wanat-27 WIA, 9 KIA), and many companies spent that tour

in what CNN called “the deadliest place on earth” – the

Korengal Valley (total loss 42 KIA).

∎ OEF ‘10 about 1/3rd of the soldiers where heading back

for their 2nd round with the 173rd

∎ The rules of engagement had changed.

10 seconds on context


UNA – to get visibility of the gp

We developed the “Checking In” with the intent of get a group level Mental Status.

6 months prior to deployment we gathered data from 554 soldiers

Results were presented to the 173rd HHC, the combat BTTNs (1st & 2nd of the 503rd), to each company commander, and garrison leadership .

1 mt prior to deployment we gathered a second round of data from 525 soldiers.

The results were again presented to the 173rd command.

40


What we found:

Risk Factors – 6 months out

Combat Stress

∎ 20% of those with prior deployments (PD)

reported increased intrusive ideation about

previous deployments

Reported greater hyper-startle response and

irritability than ND

Were significantly more likely to report they don’t get

along with others,

and a significant correlation was found with

number of deployments

41


Risk Factors - 6 months out

General Risk

∎ 5% report their physical health as not at all good,

PD reported significantly decreased physical health

∎ 41% reported that they drink excessively,

and 8% reported that this was very true for them

∎ 41% reported they do not get 7/8 hours of sleep per night,

those with no deployments (ND) were getting significantly less sleep than the PD group

∎ ND group was significantly more likely to report financial problems

42


Resiliency Factors – 6 months

out

∎ 59% reported feeling strongly that they work well under pressure (Grit),

and those with PD were significantly more likely to feel this was true about themselves.

∎ 59% describe themselves to be very happy,

4.4% report this is not at all true for them,

and there is a significant difference with PD showing less happiness than ND

∎ 52% report being in a committed relationship and,

of these, 66% describe the relationship as very satisfying

7% report their relationships to be not satisfying at all with no significant difference between PD and ND

43


Resiliency Factors – 6 months

out pt.2

∎ 67% report their faith to be a source of support,

and, of these, 25% report it to be a very important

support,

33% report it to be not at all supportive,

PD were significantly less likely to find their faith

supportive

∎ 90% report their friendships to be supportive,

and, of these, 50% report that these relationships are

very supportive

PD were significantly less likely to describe their

relationships as supportive

44


Family Supports – 6 months out

∎ Number of Children

70% do not have children

Of the 30% with kids

60% are in the 0-4 age range

∎ 93% describe themselves as good parents

and describe their kids as well behaved,

only 2.1% report they feel they are

not at all good at parenting

and a significant difference was found with

PD reporting their parenting is ‘not as good’

45


Why? Because they are all new recruits fresh from home.

∎ 80% report having some concerns about the effects of deployment on children,

and of these, 61% were very concerned

INTERESTINGLY – a significant difference was found between those with one or more deployments and those with no deployments

Those with PD were less worried

Why? - our hypothesis was “I know this beast.”

∎ 63% report concerns with extended family,

and, of these, 25% report being very concerned, those who have never deployed showed greater concern

Family Supports - 6 months out


Command’s response - they know what it’s

like - we need to show

them they have more skills than they feel

∎ 71% felt that their supervisors responded in a calm and fair

manner

and of these, 34% felt that was very true

20% felt this was not at all true

∎ 55% felt they were being well trained and mentored to

succeed at their mission

and 19% felt this was not true at all

there was a significant difference with PD feeling more

strongly that they were not being sufficiently well trained

Command Climate – 6 months

out


Command Climate – 6 months

out pt.2

∎ 80% felt that they were an important part of the team

50% felt that was very true

12 % felt that was not true at all (In gp – Out gp)

∎ 66% felt that they were able to trust their chain of

command

32% felt this was very true

23% felt strongly that they could not

those with PD were significantly less likely to trust

48


Putting It All Together:

Who needed to know what?

∎ Our “suck rate” could be estimated to be

between 4 - 8%

Command, TMC, Health Center & BH

Tasked to determine deployability

∎ We needed to get our Soldiers sleeping and

drinking less

Command, BH & ASAP

∎ We needed to reach out to single spouses (married without

children) and CONUS families

FRG & ACS

49


Putting It All Together:

Who needed to know what? Pt.2

∎ We needed to get information and support to families who

were in their 1st deployment

ACS & Behavioral Health

∎ Needed to develop leadership in junior NCO’s

Command and BH

Field training and Leadership course

∎ Those with prior deployments were feeling rode hard and

hardened from it

Everyone needed to know

50


Yes

For the most part

Did it work?


Combat Stress

Intrusive ideation about previous deployments had

slightly but significantly gone down

Hyperstartle and Irritability

significantly reduced (?training as exposure tx)

PD still show significantly more difficulty getting along

with others,

and a significant correlation was still found with number of

deployments

Risk Factors - 1 month out


Risk Factors - 1 month out pt.2

General Risk

Improved perception of physical health was found with 96%

feeling good, only 4 reporting that they feel they are in poor

health

No longer a significant difference between PD and ND

A slight increase in excessive drinking was found,

but not statistically significant and no adverse actions.

Still the young ND group over indulging

A significant increase in amount of sleep per night was found

No longer a difference between PD and ND

53


81% reported feeling that they work well under pressure

(Grit),

and of these, 60% report feeling they work very well

under pressure

Significant improvement from the 59% 6 mts ago

Again, it was found that Soldiers with combat

experience who were redeploying reported a

significantly higher perceived level of Grit than those

who had not deployed.

∎ No significant change in Subjective Happiness, being in

a committed relationship, Faith, or Friendship support.

Resiliency Factors - 1 month out


So 50% have Family of Origin

as their main support

∎ 47% report being in a committed relationship and,

of these, 75% describe the relationship

as very satisfying

8% report their relationships to be not satisfying at all

INTERESTING – when you look at the two separate

samples neither individually shows a significant

difference between PD and ND,

BUT when considered at a BDE level they separate

out with PD reporting less satisfaction in their

relationships than ND.


pt.2



pt.3

∎ 94% report their friendships to be supportive, up from

90%

and of these, 57% report that these relationships are

very supportive – up from 50%

This shows a significant increase in reliance on social

support as the deployment approached

BUT those with PD were still significantly less likely

to find their relationships as supportive

56


Family Supports - 1 month out

∎ Number of Children

68% do not have children

Of the 32% with kids most are in the 0-4 age range

These final numbers are consistent with the initial

sample

∎ 96% of the parents describe themselves as good

parents and describe their kids as well behaved

Only 4 % report they feel that they are not at all good

at this

The difference between PD and ND resolved

57


Family Supports - 1 month out

pt.2

∎ 78% report having some concerns about the effects of deployment on

children,

And of these, 50% were very concerned

22% report that they are not worried at all

No difference at this point between the PD and ND groups

∎ Why was PD group less worried?

Hypothesis:

“My family has already been through this before, and

I feel we have good strategies for coping with the separation.”

Survey says – 68% feel this is true and 29% feel it is very true

32% feel that they do not have good strategies in place

PD families felt significantly more prepared

58


Command Climate - 1 month out

∎ 94% felt that their supervisors responded

in a calm and fair manner (prior 71%)

Of these, 56% felt that was very true (prior 34%)

Only 6.3% felt this was not at all true

Shows significant improvement

No difference was found between the PD & ND

59



pt.2

∎ 91% felt they were being well trained and mentored to

succeed at their mission (prior 55% )

And 57% felt this was very true

Only 8.6% felt that this was not true at all (prior 19%)

While this shows significant improvement from the first

data set (t=-7.55, p>.001),

There was still a significant difference with PD feeling

more strongly that they were not being sufficiently well

trained (t=-4.87, p=.004)

60



pt.3

∎ 94% felt that they were an important part of the team,

compared to 80% prior

68% felt that this was very true (prior 50%)

6.4% felt that was not true at all (prior 12%)

Shows a significant increase in group cohesion (t=-

6.66, p>.001).

And, no difference was found between the PD and

ND perceptions

61



pt.4

∎ 92% felt that they were able to trust their chain of

command (prior 60%)

64% felt this was very true (prior 33%)

8% felt strongly that they could not (prior 23%)

Shows significant improvement (t=-11.35, p>.001)

But, those with PD continued to be significantly less

likely to trust (t=-5.22, p=.001).

62


In Summary

∎ By providing information to command and garrison direct

action was taken to increase resiliency pre-deployment.

∎ The data clarified differences between our community’s

needs and what would have been expected based on

the literature.

∎ Understanding these needs allowed our system to

respond more effectively and efficiently.

63


Deanna Beech, Ph.D.

Clinical Psychologist

DDEAMC, CAFBHS

[email protected]

Thanks for your time

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