Readiness of Soldiers and Adult Family Members Who Receive Behavioral Health Care

Identifying Promising Outcome Metrics

by Kimberly A. Hepner, Carol P. Roth, Heather Krull, Lea Xenakis, Harold Alan Pincus

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Research Questions

  1. What outcome metrics could be used to assess readiness among soldiers and adult family members who receive behavioral health care?
  2. How do BH providers assess soldier readiness, and how could the readiness assessment be improved?

Behavioral health (BH) conditions—such as posttraumatic stress disorder, depression, and anxiety—are the second most common medical reasons for nondeployability in the U.S. Army. The authors of this report aimed to identify promising metrics to assess readiness among soldiers and adult family members who receive BH care. These metrics would expand the Army's outcome monitoring, which currently includes symptom improvement metrics, for patients who received BH care.

The authors developed rigorous criteria to evaluate candidate readiness metrics, conducted interviews with stakeholders (Army subject-matter experts and BH providers), reviewed existing sources of data that could support the development of a readiness metric, and conducted a literature review to identify instruments that have been used to measure readiness-related domains in both military and civilian populations.

The authors found that no existing data source or patient self-report instrument met criteria for implementation of a readiness metric for soldiers, but one instrument, the Walter Reed Functional Impairment Scale (WRFIS), is promising. No existing data source or patient self-report instrument met criteria for Army-wide implementation of a readiness metric for adult family members. Stakeholders reported that psychiatric symptoms, diagnosis, treatment, and impaired functioning are important indicators of lack of readiness among soldiers and adult family members. BH providers reported variability in assessing readiness and applying profiles, but behavioral experts provided suggestions for improving readiness assessment.

The authors recommend that the Army conduct a pilot evaluation of a soldier readiness metric based on the WRFIS and increase standardization in applying profiles by continuing provider training.

Key Findings

Stakeholders reported that psychiatric symptoms, diagnoses, treatment, and impaired functioning are important indicators of lack of readiness among soldiers and adult family members

  • BH expert and provider responses were consistent with the Army's current policies regarding BH conditions and their potential negative impact on readiness.
  • Stakeholder interviews highlighted the importance of the Army's ongoing symptom monitoring as a key component of monitoring readiness.
  • Stakeholders also highlighted the significant role of multiple aspects of functioning related to readiness.

No existing data source or patient self-report instrument met criteria for Army-wide implementation of a readiness metric for soldiers, but one instrument is promising

  • The Walter Reed Functional Impairment Scale assesses important components of soldier readiness, is feasible to use, and appears valid and reliable, but further pilot testing is needed.
  • No existing data source or patient self-report instrument met criteria for Army-wide implementation of a readiness metric for adult family members.

BH providers reported some variability in assessing readiness, but BH experts and providers offered suggestions for improving readiness assessment

  • BH providers reported using a variety of information sources to assess readiness; patient self-report measures and clinical interviews were used most commonly.
  • BH experts and BH providers suggested that the Army's Behavioral Health Data Portal should be improved for better performance and expanded to include additional measures.
  • These stakeholders also suggested that more information should be collected about family members, including whether they are ready for their soldier to deploy.

Recommendations

  • The Army should conduct a pilot evaluation of a soldier readiness metric based on the WRFIS.
  • The Army should increase standardization in applying profiles, including continuing provider training.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Methods

  • Chapter Three

    Measuring the Readiness of Soldiers and Families

  • Chapter Four

    Evaluation of Existing Data Sources and Potential Instruments to Support a Readiness Metric

  • Chapter Five

    Improving Readiness Assessment

  • Chapter Six

    Summary and Recommendations

  • Appendix A

    Readiness Policies

  • Appendix B

    Interview Protocols

  • Appendix C

    Existing Data Sources

  • Appendix D

    Terms Used for Instrument Search

  • Appendix E

    Instruments Identified in the Instrument Search

  • Appendix F

    Instruments from Supplemental Search

Research conducted by

The research described in this report was sponsored by the United States Army and conducted by the Personnel, Training, and Health Program within RAND Arroyo Center.

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