BEHAVIORAL HEALTH: INCREASING RESILIENCY AND ENDURANCE October – December 2014 Perspective 1 MG Steve Jones Developing Effective Leadership Competencies in Military Social Workers 3 COL Jennifer L. Humphries; COL (Ret) Reginald W. Howard Evolution of the Combat and Operational Stress Control Detachment 8 MAJ Jason I. Dailey; CPT Victoria L. Ijames The Psychosocial Challenges of Conducting Counterinsurgency Operations 14 COL Derrick Arincorayan; Larry Applewhite, PhD; et al Sleep and the Use of Energy Products in a Combat Environment 22 LTC Wendi M. Waits; Michael B. Ganz, PhD; Theresa Schillreff, OTR/L; CPT Peter J. Dell Telebehavioral Health: Practical Application in Deployed and Garrison Settings 29 CPT Michelle M. Garcia; Kristin J. Lindstrom, PsyD Effectiveness of Telebehavioral Health Program Nurse Case Managers (NCM): 36 Data Collection Tools and the Process for NCM-Sensitive Outcome Measures Judy Carlson, EdD, APRN; Roslyn Cohen, MSN; Wynona Bice-Stephens, EdD, RN Military Service Member and Veteran Self Reports of Efficacy of Cranial Electrotherapy 46 Stimulation for Anxiety, Posttraumatic Stress Disorder, Insomnia, and Depression Daniel L. Kirsch, PhD; et al Raising the Clinical Standard of Care for Suicidal Soldiers: 55 An Army Process Improvement Initiative Debra Archuleta, PhD; David A. Jobes, PhD; Lynette Pujol, PhD; et al Mild Traumatic Brain Injury in the Military: Improving the Referral/Consultation Process 67 MAJ Charles Watson Directorate of Treatment Programs: Providing Behavioral Health Services 73 at the US Disciplinary Barracks LTC Nathan Keller; et al The Effects of Military Deployment on Early Child Development 81 Dana R. Nguyen, MD; Juliana Ee, PhD; Cristobal S. Berry-Caban, PhD; Kyle Hoedebecke, MD The Effect of Deployment, Distress, and Perceived Social Support on 87 Army Spouses’ Weight Status LTC Tammy L. Fish; Donna Harrington, PhD; Melissa H. Bellin, PhD; Terry V. Shaw, PhD Applying the Korem Profiling System to Domestic Violence 96 CPT Victor Johnson; Chandra Brown, LMSW Understanding the Student Veterans’ College Experience: An Exploratory Study 101 2LT Timothy Olsen; Karen Badger, PhD, MSW; Michael D. McCuddy, MSW Mental Health Outreach and Screening Among Returning Veterans: 109 Are We Asking the Right Questions? Karen Bloeser, MSW; Kelly K. McCarron, PsyD; et al Skilled and Resolute A New Offering from the Borden Institute History Series 118 COL Betsy Vane, Army Nurse Corps Historian A Professional Publication of the AMEDD Community Online issues of the AMEDD Journal are available at http://www.cs.amedd.army.mil/amedd_journal.aspx October – December 2014 The Army Medical Department Center & School PB 8-14-10/11/12 LTG Patricia D. 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Perspective COMMANDER’S INTRODUCTION MG Steve Jones THE HUMAN DIMENSION OF COMBAT Soldiering during the past 13 years of war has been increase the risk for PTSD. A dysfunctional home and tough, as tough as during any other time in our history. poor upbringing may produce a recruit without a strong Soldiers endured deployments that were too frequent value system and with poor life decision-making skills. and too long, and their time at home was too short. They may produce a recruit with poor self-control, one While at home, the pace was often so fast that they prone to impulsive behavior who now faces high risk looked forward to the next deployment as a break. As a operational and personal environments. Deployments result, Soldiers never fully mentally reset or reintegrated provide an environment where taking life threatening into their families.1 risks is an everyday occurrence. Every time Soldiers leave the wire, they face the threat of death from an IED Whether Soldiers see combat or not, every day on a or an ambush. Their risk taking is rewarded, a Soldier deployment is “Groundhog Day.” The monotony, long who attacks an enemy position across open terrain, or hours, and lack of time off take their toll. For some, bore- the combat medic who treats a casualty while under fire dom is interspersed with brief periods of high emotion are recognized for their courage. With frequent expo- and excitement.2 The loss of a buddy can be particularly sure they adapt. Their sense of danger erodes and they traumatic because it strips away the Soldier’s feeling of no longer worry about the risk. They lose their natural invincibility. Continuous combat causes physical as well inhibition towards engaging in high risk behaviors, and as psychological stress including sleep deprivation and they acquire the ability to commit violence on them- both physical and mental fatigue. Many Soldiers live on selves and others energy drinks, some recover from operations by playing video games for hours into the night, others use alcohol One of the classic studies on human behavior in com- and drugs. bat is The Anatomy of Courage. It was written by Lord Moran, Winston Churchill’s physician, based on his ex- Redeployment brings new challenges. The unremitting perience as medical officer of the First Battalion of the pace upon return coupled with reintegration issues cause Royal Fusiliers in the First World War. He noted that additional stress. Soldiers return to a life that lacks the courage is will power, it’s like money in the bank and no excitement and meaning they experienced in combat. one has an unlimited supply. You can make deposits, but They relinquish positions of authority—such as serving are always spending, and when your courage is used up, as mayor of a town—and in fact some of our Reserve you’re finished.5 Component Soldiers may find they have even lost their job. These issues occur in the face of normal post com- The most effective way to destroy psychological strength bat reactions which can lead to anger, violent behavior, is through poor leadership. There is an unwritten moral and self-medication. contract between leaders and their Soldiers. Leaders are expected to take care of their Soldiers, treat them fair- Genetic factors may increase the likelihood of develop- ly, and share their hardships. In return, Soldiers follow ing PTSD in some individuals.3 A shared genetic dia- orders—even though it may mean their death.6 When thesis also leads to the association of PTSD and other leaders break that contract and fail to care for their Sol- behavioral health disorders. Genetic factors may also diers, when they mistreat them or cause unnecessary increase the exposure to trauma. Most of our Soldiers casualties, then they will find it impossible to maintain enlisted after September 11, 2001, and they joined our morale, respect, or discipline. Army to fight. Some may have the high risk taking, high sensation seeking personality type known as the Type Lt-Col Sir John Baynes, a British military historian, “T” personality. studied how the British infantry in the First World War was able to retain its morale in the face of the terrible Environmental factors also play a role in the development slaughter. He noted the value of training,