Barriers and Potential Solutions to Implementing Evidence-Based PTSD Treatment in Military Treatment Facilities.

INTRODUCTION: Prolonged exposure therapy is an effective treatment for posttraumatic stress disorder that is underutilized in health systems, including the military health system. Organizational barriers to prolonged exposure implementation have been hypothesized but not systematically examined. This multisite project sought to identify barriers to increasing the use of prolonged exposure across eight military treatment facilities and describe potential solutions to addressing these barriers. MATERIALS AND METHODS: As part of a larger project to increase the use of prolonged exposure therapy in the military health system, we conducted a needs assessment at eight military treatment facilities. The needs assessment included analysis of clinic administrative data and a series of stakeholder interviews with behavioral health clinic providers, leadership, and support staff. Key barriers were matched with potential solutions using a rubric developed for this project. Identified facilitators, barriers, and potential solutions were summarized in a collaboratively developed implementation plan for increasing prolonged exposure therapy tailored to each site. RESULTS: There was a greater than anticipated consistency in the barriers reported by the sites, despite variation in the size and type of facility. The identified barriers were grouped into four categories: time-related barriers, provider-related barriers, barriers related to patient education and matching patients to providers, and scheduling-related barriers. Potential solutions to each barrier are described. CONCLUSIONS: The findings highlight the numerous organizational-level barriers to implementing evidence-based psychotherapy in the military health system and offer potential solutions that may be helpful in addressing the barriers.

Identifying Policy Implications and Future Research Directions Regarding Military Community Support and Child Psychosocial Adjustment.

INTRODUCTION: As former U.S. Army Surgeon General Horoho points out, a large fraction of what determines the health and readiness of our military families does not occur during appointments with professionals, but rather within the "Lifespace-where health really happens...." Indeed, when children of military families experience psychosocial difficulties, such stress impacts the service members' personal well-being and ability to focus at work, impairing their capacity to attend to the mission. As such, the Department of Defense (DoD) has instituted a family readiness system to bolster resiliency within military families, including children, e.g., by linking families with support networks. Bolstering military family resiliency, including the prevention of and effective intervention for child psychosocial problems, is an important issue at all levels of the DoD. Service members, leaders, and policy makers have a vested interest in promoting mission readiness and a healthy force. Research can play an important role in shaping decision-making by consolidating what is currently known and not known about a particular expertise area. To date, there has been no consolidation of research regarding outcomes associated with military community support and the programs that currently exist to bolster child and family resiliency. Given the importance of military families to mission readiness, a review of the relevant research is warranted. METHODS: This commentary article reviews the literature on community support for military children, provides an overview of currently available resources, discusses concerns with the current provision of support services to military families, and offers recommendations for future research, policy, and implementation of military community support programs. CONCLUSION: Although there is a dearth of research on available support programs, there appears to be no lack of services available to military families. However, several steps could be taken to make these resources into a more supportive system. Family members must be able to identify what support services exist, distinguish which service is most suitable for their needs, and be able to readily access these services in a resource-conserving manner. Considerable overlap in support services seems to suggest limited coordination between organizations and service providers, particularly in regard to the government/civilian interface, which inherently lies outside of DoD control. This overlap suggests a redundancy, which may not be efficient economically or in regard to accessing support. There also may be some confusion over which support service is most suitable for the consumer's need. Although some overlap is useful, such as the provision of different services to different populations (e.g., having separate programs for the Army, Navy, Air Force, and Marine subcultures), limited organization and parsimonious provision of services makes it particularly difficult for spouses and family members to navigate resources. Initial attempts are being made to organize and consolidate resources in both the government and civilian sectors. However, it is clear that these initiatives have not completely solved problems related to resource access, redundancy, and lack of research-supported efficacy.

Assessing Military Community Support: Relations Among Perceived Military Community Support, Child Psychosocial Adjustment, and Parent Psychosocial Adjustment.

INTRODUCTION: The emotional, cognitive, and behavioral health of the nearly two million children of military service members in the United States is important as these children play an integral role in the operational readiness of the armed forces. For example, when a service member's child experiences psychosocial difficulties, these difficulties often impact the service member's personal well-being and ability to focus at work, impairing the service member's ability to focus on the mission. Although military service members and their families (e.g., children and spouses) face many of the same stressors as their civilian counterparts, they also experience additional stressors related to being a military family, including frequent relocation, unpredictable schedule changes, short- and long-term family separation, and threats to service members' safety. Psychosocial functioning and resilience to stress may be influenced by a variety of factors. One important factor that influences parent and child functioning is community support. Community support may be especially important for military families because of the increased significance of social support during stress such as deployment and geographic relocation. Research is promising regarding the protective effects of community support in civilian populations. However, there is a comparable dearth in the literature regarding military families and no validated measures designed specifically to assess the construct of community support in military families. We therefore aimed to develop and examine a new measure, the Community Assessment of Military Perceived Support (CAMPS) and examine its potential relationship with the psychosocial functioning of military parents and their children. MATERIALS AND METHODS: The CAMPS was developed and initially tested with both quantitative and qualitative methods. The CAMPS was then used to examine the relationships among perceived community support and child/parent psychosocial symptoms. This cross-sectional correlational study was conducted in a sample of military parents with children between the ages of 2 and 18 years of age who completed an online, anonymous survey. RESULTS: One hundred and fifty-seven military parents completed the CAMPS. Internal consistency was excellent (α = 0.94). More community support as measured by the CAMPS was associated with fewer child and parent psychosocial symptoms (p < 0.01) and the relationship between perceived military community support and child well-being was mediated by parent well-being (95% confidence interval [-0.19, -0.04]). Together, parent psychosocial functioning and perceived military community support explained 24% of the variance in child psychosocial functioning. CONCLUSION: The CAMPS is an internally consistent measure that appears to be associated with military parent and child psychosocial functioning. Given the importance of military community support, the CAMPS may have potential as a tool for outcome research and program evaluation. Future research is required to validate the CAMPS in a larger, more diverse military sample. Moreover, longitudinal studies are needed to determine the directionality of the relationship between community military support and psychosocial functioning.