Abstract
Introduction:
The Deployment Cycle Resilience Training (DCRT) is a rebranded and revised version of the initial deployment resilience training called Battlemind, that was in effect from 2014 to 2018.
Methods:
To maintain the relevance and utility of resilience training centred on the deployment cycle, the current version of DCRT was formally evaluated using mixed methodologies by the Walter Reed Army Institute of Research.
Results:
The evaluation team found that both soldiers and their spouses reported predominantly positive ratings for the pre-deployment and reintegration modules of the training. In addition to reporting the training to be satisfactory and relevant and reporting an intention to apply the skills beyond the deployment cycle, soldiers and spouses also identified areas for improvement related to addressing the training’s relevancy and relatability.
Discussion:
To continue improving the training, the evaluation team recommends that the training include more examples from the army reserve and the National Guard, and that the support network (i.e., circle of support) be widened beyond spouses. These, and additional recommendations, are further discussed.
Key words: Battlemind, deployment, military, resilience training, U.S. Army
Lay Summary
The objective of the Deployment Cycle Resilience Training is to prepare U.S. Army soldiers and their spouses for stressors and challenges that are commonly experienced by military personnel and their families prior to, during, and after deployment. This training is re-evaluated on a routine basis to ensure that the content remains current. In the most recent evaluation of the training, the evaluation team found strengths of the curriculum to sustain as well as areas for improvement. The authors describe the evaluation process and present recommendations for creating a more relevant and relatable training through revisions to facilitate engagement for all service components (i.e., active duty, army reserves and the National Guard) and broaden the soldiers’ support network to include partners, parents, and friends.
Abstract
Introduction :
La Deployment Cycle Resilience Training (formation de résilience au cycle de déploiement; DCRT) est une version revue et révisée de la formation initiale sur la résilience au déploiement du nom de Battlemind, qui était utilisée de 2014 à 2018.
Méthodologie :
Pour que la pertinence et l’utilité de la formation sur la résilience demeurent axées sur le cycle de déploiement, la version actuelle de la DCRT a fait l’objet d’une évaluation formelle par le Walter Reed Army Institute of Research (WRAIR; institut militaire de recherche Walter Reed) à l’aide de méthodologies mixtes.
Résultats :
L’équipe d’évaluation a établi que tant les militaires que leurs conjoint(e)s ont attribué surtout des classements positifs aux modules de la formation portant sur la période précédant le déploiement ainsi que sur la période de réintégration. En plus de trouver la formation satisfaisante et pertinente et de déclarer une intention de mettre en œuvre les compétences au-delà du cycle de déploiement, les militaires et leur conjoint(e)s ont également nommé les secteurs à améliorer à l’égard de la pertinence et de l’accessibilité de la formation.
Discussion :
Pour continuer d’améliorer la formation, l’équipe d’évaluation recommande d’inclure d’autres exemples tirés des réserves de l’armée et de la Garde nationale dans la formation, et d’élargir le réseau de soutien (le cercle de soutien) au-delà des conjoint(e)s. Ces mesures et d’autres recommandations sont exposées plus en détail.
Mots-clés : Battlemind, déploiement, formation à la résilience, Forces armées américaines, militaire
Introduction
The great number of combat deployments within the U.S. Army in the early 2000s led to a high exposure to combat deployment-related stressors.1 Research documents the mental health problems1 and functional impairments2 associated with this type of exposure, as well as when post-deployment soldiers are most at risk for these impairments to present themselves.3 Given this risk, U.S. Army leaders and researchers sought to develop a systematic training that could fit within the military’s occupational mental health model4 to successfully mitigate the potential consequences of combat deployment and its unique stressors.
With the military-specific framework in mind, researchers at the Walter Reed Army Institute of Research (WRAIR) initiated Battlemind as the U.S. Army’s tailored training for early intervention to address potential deployment-related challenges and stressors.5 This training was the first systematic attempt to create a research-based mental health initiative that could teach skills to increase resilience, which the U.S. Army defines as “the ability to face and cope with adversity; adapt to change; and recover, learn, and grow from setbacks,”6 as a preventative measure before and upon return from deployment.5 The initial training highlighted safety and relationship building while also increasing awareness around common responses (e.g., physical, social, psychological) to combat.5 Results found that Battlemind effectively decreased mental health problems for those returning from a combat deployment5,7 and was well liked.8
Revising and rebranding the training
Since implementing the initial training, Battlemind has undergone several revisions to increase the training’s relevancy and scope. More specifically, a spouse-specific training was created to target the spouse’s experience of stressors and challenges during a deployment. The spouse training was prevention-oriented9 and provided the basic concepts of resilience (e.g., flexibility, connectedness, communication). Subsequent trainings then built on these foundational resilience concepts.10
In 2009, the revised Battlemind training was rebranded as the Deployment Cycle Resilience Training (DCRT). In this revision, the scope of the training was widened to include different deployment types such as humanitarian and peace-keeping missions, as these types of deployments have their own unique stressors and challenges.11 The training’s implementation was also revised. Originally, chaplains taught Battlemind, but, with the rebranding and revisions, DCRT was to be delivered by command-selected, in-unit leaders who were qualified Master Resilience Trainers (MRTs) who received DCRT-specific supplemental training.12,13 Additionally, the format of the training was updated to be discussion-based with pre-set examples covering a wider variety of scenarios and circumstances rather than the previously used lecture-based format.
DCRT version two built on the first set of revisions and relied on the expertise of curriculum developers and anecdotal feedback from soldiers to update the curriculum. The version two revisions transformed the training into six separate modules that focused on the stressors and challenges that three target audiences (i.e., soldiers, leaders, spouses) were likely to experience throughout the three main phases of the deployment cycle (i.e., pre-deployment, immediate reintegration, and three to six months post reintegration). Restructuring the modules allowed DCRT version two to cover specific skills to address different stressors and challenges that accompany each phase of the deployment. For example, the soldiers’ pre-deployment module taught skills such as deliberate breathing and grounding, whereas the soldiers’ reintegration module taught acceptance. While some skills may be taught in both modules (i.e., Hunt the Good Stuff13) the application varies to teach end-users how the skill applies under different circumstances. See Knust et al.14 and Kirk et al.15 for additional history of Battlemind and DCRT revisions.
Deployment training content must be regularly evaluated to understand whether the material is effective and relevant for end-users. Therefore, program evaluators began their evaluation process of DCRT version two using a similar methodology used to evaluate the MRT course.16 The present evaluation, a subset of a larger data collection,14 aimed to assess the participants’ perceptions of the training and use that feedback to inform curricula revisions for DCRT version three.
Methods
The WRAIR Human Subjects Protection Branch approved the evaluation protocol based on an explanatory framework.17 The evaluation team invited soldiers and spouses to complete a quantitative survey upon completion of the training. Participants were then invited to a qualitative semi-structured interview. Data collection took place at a total of 15 U.S. Army active duty, army reserve, and National Guard locations.
Participants
The DCRT evaluation team invited active duty, army reserve, and National Guard soldiers who completed the DCRT training to participate in the evaluation. The team surveyed participants following nine iterations of the pre-deployment module and five iterations of the reintegration modules. Following the pre-deployment and reintegration modules, 276 soldiers (90%) and 50 soldiers (96%), respectively, consented to participate in the survey. Spouses were also invited to participate in the survey. While those modules were designed for military spouses, the participants’ relationship to their soldier was confirmed. Participants may have included additional members of the soldiers’ circle of support, including extended family members, close friends, and any other source of support. Of the 314 who participated in the pre-deployment module training, 97% consented to the survey, and of the 18 who participated in the reintegration module training, 94% consented to the survey. Following the surveys, the evaluation team invited soldiers and spouses to participate in focus group interviews. See Table 1 for additional demographic and focus group interview information.
Table 1.
Class and focus group information and demographic information for survey completers
| Pre-deployment module | Reintegration module | |
|---|---|---|
| Soldiers |
n = 248 |
n = 48 |
| Classes | 7 | 2 |
| Component | ||
| Active duty | 0 | 0 |
| Reserve | 5 | 0 |
| National Guard | 2 | 2 |
| Focus groups | 8 | 6 |
| Component | ||
| Active duty | 0 | 3 |
| Reserve | 4 | 0 |
| National Guard | 4* | 3 |
| Rank, no. (%) | ||
| E1-E4 | 93 (37.5) | 7 (14.6) |
| E5-E9 | 93 (37.5) | 23 (47.9) |
| Officer/warrant officer | 62 (25.0) | 18 (37.5) |
| Deployment experience | ||
| First-time deployers | 161 (67.7) | 3 (6.5) |
| Experienced deployers |
77 (32.4) |
43 (93.5) |
| Spouses |
n = 304 |
n = 17 |
| Classes | 3 | 2 |
| Component | ||
| Active duty | 0 | 0 |
| Reserve | 0 | 0 |
| National Guard | 3 | 2 |
| Focus groups | 1 | 3 |
| Component | ||
| Active duty | 0 | 0 |
| Reserve | 0 | 0 |
| National Guard | 1† | 3 |
* One National Guard focus group was with leaders following the pre-deployment module for leaders.
† The focus group with spouses following the pre-deployment module was held together with soldiers.
Survey measures
Soldier DCRT
For the pre-deployment module, soldiers used four possible response options (1 = not at all to 4 = very much) to rate their satisfaction with the module, how useful they thought the module was, and how relevant they thought the module was for soldiers. Soldiers then used five possible response options (1 = strongly disagree to 5 = strongly agree) to rate how much they agreed or disagreed with statements about the module, such as, “this training was a good use of my time.” Soldiers then evaluated the usefulness of each skill (i.e., Big Chill, Activating Event, Thought, Consequences (ATC)/Controlling Your Thoughts, Hunt the Good Stuff, Grounding, and Deliberate Breathing) using six response options (1 = not at all useful, 5 = extremely useful, and 6 = don’t recall the skill). Next, soldiers rated how much they agreed or disagreed that the module could make them better at a list of 12 items, such as “focusing on the task at hand.” The final section of the survey asked soldiers to provide what they would sustain or improve about the module.
For the post-deployment reintegration module, soldiers responded as to whether they agreed or disagreed that they could identify ways in which they grew through their recent deployment. Soldiers then evaluated the usefulness of each skill (i.e., Acceptance and Hunt the Good Stuff) using the same response options as above. Next, using the same 12 items asked in the pre-deployment surveys, soldiers rated if they agreed or disagreed that the training would help them in different situations. Finally, soldiers could provide their suggestions for what to sustain or improve within the module.
Spouse DCRT
For the pre-deployment module, spouses rated their satisfaction with the overall training, how useful the training was, and how relevant the training was using four response options (1 = not at all to 4 = very much). Spouses then rated how much they agreed or disagreed that the module was a good use of time and whether the skills taught during the module could help them personally. Next, spouses evaluated the usefulness of the skills (i.e., Negativity Bias, Big Chill, Hunt the Good Stuff, and Deliberate Breathing) using the same six response options as above.
Next, spouses rated how much they agreed or disagreed that the module could help with various tasks (e.g., managing my energy, managing my stress levels). As with the soldiers’ surveys, spouses could provide suggestions for aspects of the modules to sustain or improve.
For the reintegration module, spouses rated their levels of agreement or disagreement with whether they could identify ways in which first, they, and then second, their soldier, grew through this deployment. Next, spouses evaluated the usefulness of the skills (i.e., Active Constructive Responding and Acceptance) using the same six response options as above. Spouses then rated how much they agreed or disagreed that the training could help them be better at the same 12 items as asked in the pre-deployment module. Finally, spouses provided their recommendations for what to sustain or improve within the module.
Focus group interviews
Focus group interviews were led by WRAIR researchers and support staff along with personnel from the Army Resilience Directorate (Headquarters of the Army; now Directorate of Prevention, Resilience and Readiness), using a semi-structured interview guide. During the focus group sessions, participants were prompted to discuss their perceptions, knowledge, and opinions regarding the module training they received.
Data analysis
The research team at WRAIR collected and processed the quantitative survey data. The researchers calculated frequencies of demographic variables then calculated mean scores for the items to assess the overall module. Next, soldier response differences were analyzed by module type (i.e., pre-deployment and reintegration) using t-tests. To assess the perception of each skill taught, the team calculated frequencies of the participants’ responses. All statistical analyses were computed using R 4.1.0.18
For the qualitative data analyses, the research team combined and evaluated information from the focus groups and the write-in portion of the surveys. Three researchers present for the focus groups read the transcripts. Two researchers reviewed the write-in portions of the survey to develop an initial codebook using Excel.19 Throughout the coding process, the two researchers established intercoder reliability through discussion, building consensus, and continual communication. If the intercoder reliability coefficient fell below 0.70, the third researcher from the team reviewed. Next, once the intercoder reliability coefficients exceeded 0.70, the team analyzed the frequency of codes, representative quotes, and evaluation notes throughout the analysis using a grounded theory.20 This process helped the team to inductively determine key themes from the qualitative data. Furthermore, the raters engaged in a reflexive process21 throughout analysis to mitigate potential bias that could impact the process and development of valid interpretations. The identified themes were based on the codes and organized in the sustain and improve categories to prepare for revising the DCRT curriculum.
Results
Quantitative analyses
Soldiers DCRT (pre-deployment)
Overall, soldier satisfaction and perception of training reported high relevancy for the pre-deployment training (Table 2). Most soldiers agreed or strongly agreed that the training was a good use of their time and that the skills learned during the module would help them professionally and personally (Table 3). Most soldiers found the pre-deployment skills to be at least very useful (Table 4). Most soldiers agreed that the pre-deployment training would help them in various ways such as “focusing on the task at hand” (Appendix 1).
Table 2.
Soldier and spouse responses to pre-deployment and reintegration DCRT
| Training, mean (SD) |
t-test (p value) |
||
|---|---|---|---|
| Pre-deployment | Reintegration | ||
| Soldiers |
n = 248; classes = 7 |
n = 48; classes = 2* |
|
| How satisfied are you with the training? | 3.58 (0.63) | 3.23 (0.86) | 74.53 (< 0.001) |
| How useful do you find the training? | 3.60 (0.63) | 3.02 (0.89) | 71.97 (< 0.001) |
| How relevant is the training for soldiers? |
3.67 (0.57) |
3.17 (0.72) |
81.19 (< 0.001) |
| Spouses |
n = 297–304; classes = 3 |
n = 17; classes = 2 |
|
| How satisfied are you with the training? | 3.67 (0.52) | 3.94 (0.24) | |
| How useful do you find the training? | 3.69 (0.52) | 3.88 (0.33) | |
| How relevant is the training for soldiers? | 3.75 (0.46) | 3.88 (0.33) | |
While both soldier classes received the reintegration training, one class received the training prior to redeployment and the other class received it between 3 and 6 months after redeployment. Because of the small sample size in the spouse reintegration group, comparisons were not made based on training class. Response options ranged from 1 = not at all to 4 = very much.
Table 3.
Soldiers and spouses who agree or disagree with each statement regarding the DCRT received
| Training, mean (SD) |
t-test (p value) |
||
|---|---|---|---|
| Pre-deployment | Reintegration | ||
| Soldiers |
n = 248 |
n = 48 |
|
| This training was a good use of my time. | 4.23 (0.89) | 3.65 (0.98) | 68.40 (< 0.001) |
| I learned skills that will help me professionally. | 4.20 (0.88) | 3.35 (1.08) | 64.86 (< 0.001) |
| I learned skills that will help me personally. | 4.23 (0.86) | 3.60 (1.03) | 69.17 (< 0.001) |
| I can identify ways that I grew through this deployment.* |
— |
3.98 (1.00) |
|
| Spouses |
n = 302–303 |
n = 17 |
|
| This training was a good use of my time. | 4.34 (0.69) | 4.53 (0.51) | |
| I learned skills that will help me personally. | 4.28 (0.70) | 4.53 (0.51) | |
| I can identify ways that I grew through this deployment. | — | 4.41 (0.62) | |
| I can identify ways that my soldier grew through this deployment. | — | 4.18 (0.81) | |
This item was only asked following the reintegration training; because of the small sample size in the spouse reintegration group, comparisons were not made based on training class. Response options ranged from 1 = strongly disagree to 5 = strongly agree.
Table 4.
Frequency of soldier and spouse responses to how useful each DCRT skill or concept was for pre-deployment or reintegration training received
| No. (%) of responses |
||||||
|---|---|---|---|---|---|---|
| Not at all useful | Slightly useful | Somewhat useful | Very useful | Extremely useful | Don’t recall the skill | |
| Soldier pre-deployment training; n = 243–244 |
|
|
|
|
|
|
| Big Chill | 7 (2.9) | 15 (6.1) | 65 (26.6) | 78 (32.0) | 63 (25.8) | 16 (6.6) |
| ATC/Controlling your thoughts | 4 (1.6) | 15 (6.2) | 45 (18.5) | 91 (37.4) | 76 (31.3) | 12 (4.9) |
| Hunt the Good Stuff | 5 (2.1) | 10 (4.1) | 43 (17.7) | 79 (32.5) | 84 (34.6) | 22 (9.1) |
| Grounding | 1 (0.4) | 8 (3.3) | 42 (17.3) | 85 (35.0) | 74 (30.5) | 33 (13.6) |
| Deliberate Breathing |
4 (1.6) |
11 (4.5) |
46 (18.9) |
74 (30.5) |
79 (32.5) |
29 (11.9) |
| Soldier reintegration training; n = 46–47 |
|
|
|
|
|
|
| Acceptance | 5 (10.6) | 5 (10.6) | 15 (31.9) | 12 (25.5) | 8 (17.0) | 2 (4.3) |
| Hunt the Good Stuff |
6 (13.0) |
6 (13.0) |
12 (26.1) |
14 (30.4) |
7 (15.2) |
1 (2.2) |
| Spouses pre-deployment training; n = 279–282; classes = 3 |
|
|
|
|
|
|
| Negativity Bias | 3 (1.1) | 15 (5.4) | 52 (18.6) | 117 (41.8) | 89 (31.8) | 4 (1.4) |
| Big Chill | 3 (1.1) | 8 (2.9) | 33 (11.8) | 122 (43.6) | 113 (40.4) | 1 (0.4) |
| Hunt the Good Stuff | 2 (0.7) | 9 (3.2) | 29 (10.4) | 113 (40.5) | 125 (44.8) | 1 (0.4) |
| Deliberate Breathing |
9 (3.2) |
24 (8.6) |
59 (21.1) |
97 (34.8) |
89 (31.9) |
1 (0.4) |
| Spouse reintegration training; n = 17; classes = 2 |
|
|
|
|
|
|
| Active Constructive Responding | 0 (0.0) | 0 (0.0) | 0 (0.0) | 10 (58.8) | 7 (41.2) | 0 (0.0) |
| Acceptance | 0 (0.0) | 0 (0.0) | 1 (5.9) | 11 (64.7) | 5 (29.4) | 0 (0.0) |
ATC = Activating Event, Thought, Consequences.
Soldiers DCRT (reintegration)
Soldiers were satisfied with the reintegration module (Table 2) though the ratings were significantly lower compared to the ratings following the pre-deployment module, χ2312.50, p < .05 (Table 2). Soldiers reported the module was a good use of their time and that the skills will help them professionally and personally (Table 3). Most soldiers found the reintegration skills to be at least somewhat useful (Table 4). When asked how well the reintegration module could help with various tasks, soldiers responded that they thought the training helped them with various activities such as “managing my energy” (Appendix 1).
Spouses DCRT (pre-deployment)
Spouses reported being satisfied with the pre-deployment module, and they thought the module was relevant for them (Table 2). Most spouses agreed that the training was a good use of their time and that the modules taught skills that will help them personally (Table 3). Most spouses found the pre-deployment skills to be at least somewhat useful (Table 4). Moreover, spouses responded that they agreed that the module helped them focus on the task at hand and manage their energy (Appendix 1).
Spouses DCRT (reintegration)
Spouses reported being satisfied with the reintegration module and that the module was relevant for them (Table 2). As with the pre-deployment module, most spouses agreed that the reintegration module was a good use of their time and that the skills would help them personally (Table 3). Most spouses found the specific reintegration skills to be at least somewhat useful (Table 4). Finally, spouses responded that they agreed that the module helped them manage their energy and focus on the task at hand (Appendix 1).
Qualitative analyses
The qualitative analyses assessed participants’ responses to the survey prompts for three sustains and three improves for the module they recently completed, along with the transcripts from the focus group interviews. Codes were thematized and themes were organized in terms of overall training sustains and improvements because the intent was to revise the DCRT curriculum. The research team reached consensus on three areas of sustainment and five areas of improvement that include quotes from the surveys and focus groups.
Sustain one: Discussion-based training
Soldiers and spouses enjoyed the interactive format of the training and recommended maintaining it:
Keep the training at the small group or platoon level for increased effectiveness. This allows members to share their experiences and their ideas with the group that they have spent time with. This also allows junior soldiers an opportunity to hear from the seniors as well and the experiences that they have in common and how they will handle situations was a transition back home.
– Soldier, Kuwait (Reintegration)
Sustain two: Content
Both soldiers and spouses wanted the in-the-moment skills and communications discussions to remain in the training:
The communication was good, planning, what to talk/not talk about, what to expect. Also the blackout, where I can’t talk or call back home for weeks/months.
– Soldier, Honolulu, HI (Pre-deployment)
Sustain three: Engaged presenters
Participants suggested using a facilitator with deployment experience. If that is not an option, then the facilitator should lean on Et al. deployers in the training to assist with the discussions:
Huge credibility when a Master Sergeant comes in here, the difference of just the guy with a college degree vs. a Master Sergeant saying everything that they’ve said is right.
– Soldier, Fort Sill (Pre-deployment)
Improve one: Content
Participants suggested making the training more practical and applicable, more component-specific, and more deployment-type specific:
This seems to be … focused on the active duty component and the return to Garrison. We should have a national guard version that focuses on the transition back to civilian life, work, and school. Our versions focus on the stresses that we encounter in terms of resilience.
– Soldier, Kuwait (Reintegration)
Improve two: Relatability
The next recommendation was to increase the relatability of the training by providing more varied and diverse examples in the soldier module and by replacing “spouse” with “circle of support” to include more of a soldier’s support network:
Single soldiers are coming home to the barracks, and they don’t have their support system there. They live alone in their little room and not everyone is there. There are challenges to living alone.
– Soldier, Fort Sill (Reintegration)
Improve three: Timing of training delivery
For both the pre-deployment and reintegration modules, soldiers and spouses preferred that the training take place about three months prior to the event:
This should have been at the beginning. Three months ago not three weeks before we go out the door. If it’s six months ago, you’d forget it so that’s why we try to do it at the last minute. That makes sense, but this is stressful to have when everything is going wrong. Might be nice to have it on a drill weekend. It’s hard when it’s during the week and people have to take off work. Required pre-deployment stuff should be focused on drill weekends.
– Soldier, Fort Belvoir (Pre-deployment for leaders)
Improve four: Ensure enough time for the presentation and discussions
Soldiers and spouses, more specifically those in the reserve and guard units, reported wanting additional time for the modules and their discussions:
Allow for more time to discuss or to expound on topics.
– Spouse, Baltimore (Reintegration)
Improve five: Sharing and promoting resources
Participants requested a handout with key notes from the module to be a reference following the training:
It will be better if there will be hand-outs of the slides that were used in the training.
– Spouse, Kapolei (Pre-deployment)
Discussion
The current evaluation assessed the perceptions of soldiers and spouses who had recently completed the pre-deployment or reintegration module of DCRT. The evaluation team used an explanatory framework, leveraging quantitative and qualitative methods, to understand the effectiveness of the content and implementation of DCRT version two and to inform module improvements.
Overall, deploying soldiers from U.S. Army active duty units, the reserves, and the National Guard, along with their spouses, found the trainings to be relevant, useful, and applicable to multiple aspects of their lives, though soldiers who completed the pre-deployment module did rate that module as more useful than soldiers who completed the reintegration module. Interestingly, while the ratings were significantly higher for the pre-deployment module, the ratings for the reintegration module remained favourable. In fact, when asked about their current situation and future challenges, both soldiers and spouses predicted incorporating the newly learned resilience skills into their everyday life following both modules. Across the board, the interactive material, engaged instructors, and discussion-based facilitation of the material was enjoyed by the end-users. This positive feedback helped inform what to sustain in future iterations of DCRT.
More specifically, end-users responded well to having engaged presenters leading the discussions. The facilitated discussions allowed the presenters to relate the material to real-life examples more easily, which, in turn, allowed participants to feel comfortable sharing their experiences. These examples could be positive experiences of how a skill helped to successfully mitigate a stressor or how a skill could have improved a situation. In both scenarios, end-users benefit from the examples and discussion.
The evaluation also highlighted training issues that must be improved. Curriculum developers must make the training more inclusive of component and of soldiers’ support members. If end-users struggle to see how the examples relate to their upcoming experience, they may struggle to put the skills into practice. Equally important to the content improvements are the guidelines for implementation. Leaders must understand that the details regarding implementation are critical for success. In the present evaluation, the research team found inconsistencies with the timing of the reintegration modules. More specifically, only two reintegration classes were evaluated, and one was taught well outside the window of optimal delivery. The incorrect timing meant soldiers learned skills that could have been helpful months prior to the training. This poor implementation likely impacted buy-in and overall training satisfaction. Training effectiveness may suffer if implementation guidelines are not followed.
Given the number of required trainings soldiers must complete before deploying, curriculum developers must ensure that the required resilience training is worthy of soldiers’ and spouses’ time. The goal and intent of quality improvement evaluations are to inform curriculum developers on the current perceptions of the training. This information along with current literature, regular assessments, and incorporating instructional design methodologies work together to keep military resilience training effective.22,23
Limitations
As with any evaluation, this study had limitations. First, the cross-sectional nature of the evaluation limited comparisons and analyses. Further, the small sample size for the spouse reintegration module limited module comparisons. Next, the research team surveyed only two soldier reintegration classes, and the timing of those trainings within the deployment cycle varied greatly, as only one occurred within the intended timeline. Third, only one pre-deployment course for leaders was observed, and no three-to-six month post-deployment courses were observed. Limitations such as time, lack of volunteers for the focus group interviews, and last-minute changes meant that some data collections consisted only of focus group interviews or surveys, but not both. This challenge can be seen in the limited information from the active duty component. Next, the surveys assessed self-reported perceived utility of the training using scales developed for this evaluation and did not capture whether end-users used the skills post-training. Finally, the evaluation team focused on the end-user’s (i.e., soldier’s or spouse’s) perception of the training and did not ask demographic questions in the survey, which limited the reporting of additional details about the participants.
Future directions
Findings from this evaluation demonstrated that while the trainings were well-liked, there were aspects that could be improved. Updates to the training aim to make the material more relevant and relatable. As stated above, revising the content is only the first step. Implementation of the training must be emphasized to leaders at echelon. Without protected time, instructors will be unable to cover each skill or may have to sacrifice the facilitated discussions. Without buy-in from leaders, soldiers and spouses may doubt the significance of the training. Finally, stakeholders must work as a team with the curriculum developers and instructors to ensure the intent of the training is met to best prepare end-users for their upcoming deployments.
To further emphasize the relatability of the content, future evaluations should consider additional demographic questions. Knowing this information will help curriculum developers provide examples for the training that will target a wider audience. Moreover, to maintain current, relevant, and effective training, curriculum developers should conduct frequency evaluations, regularly review relevant literature, and consult effective curriculum development strategies. Conducting frequent evaluations along with thorough assessments of the current literature and relying upon effective training development strategies15,22,23 can work together to maintain current, relevant, and effective training. Current DCRT modules are available on the WRAIR website.24
Acknowledgements
The authors would like to thank the following people for their contributions to this evaluation effort: Jason Nolet, MAJ Carl Smith, Pam Kumparatana, and Kourtney Sappenfield.
Data Availability Statement
The data and material for this study are not publicly available because of institutional regulations related to human participant protection requirements but can be made available from the corresponding author upon reasonable request (may require data use agreements to be developed).
Competing Interests
The authors have nothing to disclose.
Ethics Approval
This study was approved by the Human Subjects Protection Board at the Walter Reed Army Institute of Research, Silver Spring, Maryland, United States, on January 12, 2018. The opinions or assertions contained herein are the private views of the authors and are not to be construed as official, or as reflecting true views of the Department of the Army or the Department of Defense. The investigators have adhered to the policies for protection of human subjects as prescribed in AR 70–25.
Informed Consent
N/A
Registry and Registration no. of the Study/Trial
N/A
Animal Studies
N/A
Peer Review
This manuscript has been peer reviewed.
Biographies
Susannah K. Knust, PhD, is a research psychologist at the Walter Reed Army Institute of Research. She is the director of the Research Transition Office at the Walter Reed Army Institute of Research and is also a Principal Investigator. Prior to becoming director, she was the liaison officer to the current Directorate of Prevention, Readiness and Resilience for six years. She has degrees in sport psychology and motor behaviour, coach education, and Spanish education.
Laurel C. Booth, MPH, was a research associate with TechWerks, LLC and consults with the Walter Reed Army Institute of Research.
Kelly A. Toner, MS, is research associate with TechWerks, LLC, and consults with the Walter Reed Army Institute of Research. She is currently pursuing her PhD in clinical psychology at Drexel University.
John Eric M. Novosel-Lingat, PhD, is a research psychologist in the Medical Services Corps, United States Army. He is currently serving as a principal investigator and the deputy director of the Research Transition Office in the Center for Military Psychiatry and Neuroscience at the Walter Reed Army Institute of Research.
Amanda L. Adrian, PhD, is a research psychologist with TechWerks, LLC. She currently consults with the Walter Reed Army Institute of Research.
Appendix 1. Soldiers and spouses who think DCRT will help them be better at the following tasks
| Soldiers, mean (SD) |
t-test (p value) |
Spouses, mean (SD) |
|||
|---|---|---|---|---|---|
| Pre-deployment; n = 245–246 | Reintegration; n = 46–47 | Pre-deployment; n = 302–303 | Reintegration; n = 17 | ||
| Focusing on the task at hand | 4.15 (0.75) | 3.28 (1.07) | 69.75 (< 0.001) | 4.09 (0.67) | 4.18 (0.53) |
| Managing my energy | 4.07 (0.78) | 3.23 (1.03) | 67.77 (< 0.001) | 3.96 (0.72) | 4.00 (0.79) |
| Letting go of things I cannot change | 4.13 (0.81) | 3.47 (1.06) | 68.71 (< 0.001) | 4.04 (0.73) | 4.18 (0.73) |
| Managing my stress levels | 4.15 (0.76) | 3.38 (1.09) | 70.22 (< 0.001) | 4.00 (0.72) | 3.94 (0.56) |
| Performing at my best during stressful situations | 4.11 (0.78) | 3.36 (1.05) | 69.05 (< 0.001) | 4.01 (0.72) | 4.24 (0.44) |
| Feeling confident | 4.11 (0.83) | 3.32 (1.06) | 65.88 (< 0.001) | 3.96 (0.75) | 4.12 (0.70) |
| Supporting my family and friends* | 4.11 (0.70) | 4.18 (0.64) | |||
| Putting things in perspective | 4.24 (0.74) | 3.66 (0.96) | 77.12 (< 0.001) | 4.17 (0.71) | 4.29 (0.59) |
| Managing expectations | 4.17 (0.78) | 3.49 (1.04) | 71.32 (< 0.001) | 4.12 (0.70) | 4.35 (0.49) |
| Communicating with family | 4.19 (0.79) | 3.53 (1.04) | 70.98 (< 0.001) | 4.15 (0.71) | 4.12 (0.60) |
| Communicating with battle buddies/friends | 4.20 (0.76) | 3.40 (1.04) | 71.85 (< 0.001) | 4.05 (0.76) | 4.00 (0.61) |
| Transitioning through different phases of the deployment cycle | 4.11 (0.81) | 3.45 (1.06) | 68.52 (< 0.001) | 4.08 (0.75) | 4.29 (0.69) |
Only asked of spouses; because of the small sample size in the reintegration group, comparisons were not made based on training class. Response options ranged from 1 = strongly disagree to 5 = strongly agree.
Funding Statement
This study received funding from the Walter Reed Army Institute of Research, the Army Study Program, TechWerks LLC, and the Army Resilience Directorate of Prevention, Resilience, and Readiness under interagency agreement #14009575.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data and material for this study are not publicly available because of institutional regulations related to human participant protection requirements but can be made available from the corresponding author upon reasonable request (may require data use agreements to be developed).