Integrating Psychological Counseling into National Guard Youth ChalleNGe Programs: Insights and Recommendations from Current Practices

The National Guard Youth Challenge (ChalleNGe) Program is a residential, quasi-military program for youth ages 16 to 18 who are experiencing academic difficulties and exhibiting problem behaviors inside and outside traditional high school. The program has 39 sites across the United States, including in the District of Columbia and Puerto Rico. Mental health issues are an increasing concern among adolescents, and the youth served by ChalleNGe may be particularly at risk for mental health problems. To better understand how ChalleNGe can support cadets experiencing mental health concerns, RAND researchers examined the mental health services provided to cadets while enrolled in the ChalleNGe program. To do so, we reviewed the relevant literature, examined survey data collected from the 39 ChalleNGe sites in 2019, and conducted in-depth discussions with counselors from six ChalleNGe sites.

The survey included information about cadets, mental health needs and sites, and counseling services. The results indicated that the majority (65 percent) of the sites considered cadets’ mental health during the application process. In addition, a significant proportion of cadets were taking medication for mental health disorders while attending ChalleNGe. The percentage of cadets taking medication ranged from 1 percent to 68 percent, with a majority of sites (22 of 39) reporting at least 20 percent. Also, only three of the 39 sites that responded to the survey met the counselor-to-cadet ratio (1:30) set forth by the National ChalleNGe Cooperative Agreement. The other 36 sites had a ratio that was as high as one counselor to 100+ cadets.

From the interviews, we learned that there is substantial variation in counseling services offered across sites. These differences span many aspects of counseling services, including staffing models, ways of accessing services, and methods of providing services. Staffing models ranged from using all licensed counselors to using a combination of counselors and interns. The ways through which counselors provide services also vary. Some counselors are integrated into the day-to-day operations at their sites, working collaboratively with cadre and teachers to provide consultation on mental health issues among cadets, versus counselors whose work is a siloed activity. Some counselors also provide training to staff on such topics as building a healthy relationship with cadets and how to recognize and handle cadet mental health issues. Several counselors noted that additional staff training and support are needed. The variety of services provided by counselors also differs. Many counselors indicated that the main purpose of these services is retention—to keep the cadet enrolled at ChalleNGe. Because counselors have very little time with cadets (e.g., between classes) and counselors often serve 50 or more cadets per class, counselors do not have the resources to provide long-term psychological counseling. Some discuss providing psychosocial support and evidence-based interventions, such as cognitive behavioral therapy, but the evidence base for other techniques is unclear. In addition, some sites have developed partnerships with community-based agencies to provide more-intensive mental health care to cadets. Finally, counselors gave suggestions on how to improve counseling services to better serve cadets.

Based on the findings, we make four recommendations concerning different aspects of ChalleNGe's mental health services: (1) implement flexible staffing models that include at least one licensed counselor to meet the needs of the cadets and the sites, (2) establish an integrated counseling department in which counselors and other staff (e.g., teachers, cadre) work hand-in-hand to support cadets’ mental health, (3) partner with community mental health providers to train and support staff, and (4) use evidence-based counseling practices to ensure high-quality and effective mental health services. Counselors share that sites select a staffing model depending on the resources available and the needs of cadets. Regardless of the staffing model selected, we recommend the inclusion of licensed counselors. Interviewees shared the different levels of collaboration at their sites. When the counseling department is more integrated and counselors are working side by side with other ChalleNGe staff (e.g., teachers, cadre), counselors are able to provide more-comprehensive and -effective services to cadets. Because most counselors do not have the capacity to provide longer-term and more-intensive psychological services, partnerships with nearby community-based mental health providers would allow ChalleNGe counselors to make referrals and ensure that cadets who are in need receive the appropriate level of care. Furthermore, community-based mental health providers can provide mental health training to counselors and other ChalleNGe staff. Finally, counselors shared with us that they use a variety of skills and practices with cadets, including curriculum-based cognitive behavioral therapy and group classes on stress management. We recommend using evidence-based practices whenever possible. It is important to evaluate both the implementation and the outcome of evidence-based practices. Building a continuous quality improvement process is key to ensuring that evidence-based practices are being delivered correctly and have the intended outcomes (Weist, 2005). Finally, counselors will require ongoing training, supervision, and support to deliver evidence-based practices.