Readiness & Early Intervention

Prevention interventions in the Military Health System (MHS) have an ultimate goal of creating good psychological health among service members and their families. Good psychological health is not just an absence of mental health problems and symptoms, but rather a “state of well-being in which persons can realize their abilities, cope [effectively] with life’s stresses, and work regularly and productively [for the purpose of enhancing readiness and contributing to combat effectiveness]” (Institute of Medicine, 2004).

Prevention interventions focus both on reducing risk for mental health problems as well as promoting positive psychological health. Risk reduction interventions target specific risk factors associated with mental health problems, while health promotion strategies focus on increasing overall levels of psychological health. These strategies are part of a continuum of care that includes treatment and maintenance of psychological disorders. [ Reference 1 ]

Modified IOM Intervention Spectrum for Psychological Disorders

Chart: On the nonclinical strategies side of the spectrum is prevention with indicated, selective, and universal. In the middle is treatment with case identification and standard treatment for known disorders. On the clinical side of the spectrum is Maintenance with compliance with long-term treatment (goal: reduction in relapse and recurrence) and after-care (including rehabilitation).

Prevention interventions can be organized into three categories: universal, selective and indicated. These classifications are based on the populations being targeted by the intervention.[ Reference 2 ]

  • Universal prevention interventions target broad populations without consideration of their risk for developing a mental health problem (e.g., all service members)

  • Selected prevention interventions target specific sub-groups of individuals with a higher-risk of developing a mental health problem (e.g., service members exposed to a combat environment)

  • Indicated prevention interventions target high-risk individuals identified as having minimal but detectable signs or symptoms for a mental health problem (e.g., service members who report elevated symptoms and/or impairment)

Department of Defense (DoD) Prevention Mission

DoD Instruction (DoDI) 1010.10, Health Promotion and Disease Prevention,   (April 28, 2014), indicates that it is DoD policy to “provide effective, integrated, and comprehensive health promotion and disease prevention programs throughout the DoD that are based on scientific evidence” and more specifically the assistant secretary of defense for health affairs in consultation with the surgeons general of the military departments “recommends and prioritizes evidence-based health promotion and disease prevention initiatives in accordance with the MHS mission, strategies and objectives.”

Thus, DoD implements many different prevention strategies to support the psychological health of service members and their families across the continuum of care. The strategies include policies, programs, practices and other resources. These strategies range from universal prevention programs aimed at raising community awareness of mental health issues that encourage help-seeking behaviors to indicated programs that provide support to service member’s families. These programs focus on many different biological, psychological and social influences on health such as substance abuse, domestic abuse, child abuse and neglect, mental health conditions such as depression and PTSD, and family support. Some examples of DoD prevention programs include: Real Warriors Campaign, Comprehensive Soldier Fitness, Families OverComing Under Stress (FOCUS), and Military OneSource which is a central hub for information and resources about programs available for service members and their families. An example of a DoD prevention strategy is Screening Brief Intervention and Referral to Treatment (SBIRT) to address alcohol misuse in Military MHS Health System primary care.

Deployment Health Clinical Center (DHCC) and Prevention

DHCC advances the psychological health of service members and their families through identifying evidence-based prevention strategies and psychological health advocacy practices for the MHS, non-clinical providers, leaders, agencies, and beneficiaries. These strategies include policies, programs, practices, and other resources.  More specifically, DHCC focuses on:

  • Reducing barriers to care

  • Evaluating and disseminating effective evidence-based prevention strategies

  • Using research to inform policy

  • Bridging the gap between clinical and nonclinical providers through training and education

  • Translating evidence-based strategies into programs and policy

  • Informing prevention related research gaps and priorities

Our partners in this work include:

  • DoD organizations including Military Operational Medicine Research Program (MOMRP), Walter Reed Army Institute of Research (WRAIR), and Congressionally Directed Medical Research Program Office (CDMRP)

  • Department of Veterans Affairs (VA)

  • Other federal agencies including the Substance Abuse and Mental Health Services Administration (SAMHSA), Centers for Disease Control and Prevention (CDC), Agency for Healthcare Research and Quality (AHRQ), National Institute of Mental Health (NIMH), and National Institute of Alcohol Abuse and Alcoholism (NIAA)

  • DoD-funded centers including the Clearinghouse for Military Family Readiness

References

  1. Institute of Medicine (2014). Preventing Psychological Disorder in Service Members and Their Families: An Assessment of Programs. Washington, D.C: The National Academies Press.

  2. Institute of Medicine (1994). Reducing Risks for Mental Disorders: Frontiers for Preventive Intervention Research. Washington, DC: The National Academies Press