Programs Addressing Psychological Health and Resilience in the U.S. Department of Homeland Security

Short abstract

This study reviews the evidence base for common approaches used in workplace psychological health programs and profiles U.S. Department of Homeland Security programs that address psychological health, peer support, and resilience.

Abstract

The U.S. Department of Homeland Security (DHS) was created in the aftermath of the September 11, 2001, terrorist attacks from all or part of 22 existing federal departments and agencies to oversee and coordinate a national strategy to protect the country from terrorism and to prevent future attacks. The unique organizational structure of DHS and differences in the number and type of employees in each of its components have resulted in a support system that includes both DHS-wide programs and component-specific programs to promote resilience and prevent psychological health problems that can result from long-term stress and exposure to trauma. However, little is known about the nature and effectiveness of these programs. This study provides an overview of the evidence base for common approaches used in workplace psychological health programs and identifies the extent to which programs across DHS that address psychological health, peer support, and resilience align with evidence-based practices. To ensure employees' psychological well-being, DHS must respond to their specific psychological health needs and concerns, as well as measure the effectiveness of existing programs that address psychological health. The study outlines a path forward for DHS to determine whether its investments in these programs are achieving their desired outcomes for the department, its employees, and their families.

The U.S. Department of Homeland Security (DHS) was created in the aftermath of the September 11, 2001, terrorist attacks from all or part of 22 existing federal departments and agencies to oversee and coordinate a national strategy to protect the country from terrorism and to prevent future attacks. DHS currently employs more than 230,000 people who serve in different capacities across the department's operational components to prevent terrorism, secure and manage U.S. borders, enforce and administer immigration laws, safeguard and secure cyberspace, and ensure resilience to disasters. In carrying out these responsibilities, many DHS employees face considerable work-related stressors or are exposed to potentially traumatic events. The consequences could include job dissatisfaction, burnout, or psychological health problems, such as anxiety, depression, posttraumatic stress disorder, or substance use disorders. In 2012, the U.S. Government Accountability Office found evidence for increased stress among DHS employees and reported lower job satisfaction and lower engagement among DHS than the average of all other federal agencies based on data from the 2011 Federal Employee Viewpoint Survey.

The unique organizational structure of DHS and differences in the number and type of employees in each of its components have resulted in a support system that includes both DHS-wide programs and component-specific programs to help promote resilience and engagement among employees and prevent psychological health problems that can result from long-term stress and exposure to trauma. However, little is known about the nature and effectiveness of these programs. The DHS Office of Health Affairs (OHA), which has shared responsibility with the Office of the Chief Human Capital Officer (OCHCO) for the overall well-being of the DHS workforce, asked the RAND Corporation to identify and inventory existing DHS programs that address psychological health, peer support, and resilience; to highlight gaps in existing programs relative to recommended practice; and to develop recommendations for new initiatives or for expanding or replicating existing evidence-based programs to support other DHS components.¹

To support this effort, we conducted a series of interviews with subject-matter experts and DHS program managers to identify the psychological health risks faced by DHS employees, approaches to mitigating those risks, and existing programs across DHS that address psychological health. We also reviewed the research literature on key approaches to addressing psychological health that have been adopted by workforces similar to those of DHS components, including law enforcement, emergency medical services, and military personnel. We evaluated the evidence base for each approach to assess the level of certainty that a given intervention will have a net benefit for the population receiving it, with the goal of identifying the most appropriate interventions to meet the needs of DHS component employees.

Evaluation of Workplace Approaches to Increasing Resilience and Reducing Psychological Health Problems Among Employees

Overall, the evidence supporting commonly adopted workplace interventions to increase resilience and support psychological health was sparse, perhaps as a result of the newness of this field or the relative infrequency of traumatic events and ethical concerns related to conducting research on those exposed to such events. We adapted a metric developed by the U.S. Preventive Services Task Force (2013) to classify the quality of the available evidence for each program type and the certainty of a net benefit as high, moderate, or low based on this evidence.

None of the interventions examined met the criteria for high certainty of a net benefit. Only five rose to the level of moderate certainty: (1) employee assistance programs (EAPs), (2) short-term counseling (for civilian populations only), (3) commercial resilience training programs (for civilian populations only), (4) psychological first aid, and (5) mental health first aid. All others had a low certainty of net benefit; however, in some cases, these approaches were either quite new or had shown promise for a subset of individuals (e.g., demonstrated effectiveness in civilian but not military populations). Table 1 summarizes the interventions and the results of our evaluation.

Table 1.

Summary of Findings on Workplace Approaches to Promoting Resilience and Preventing Psychological Health Problems

Intervention	Purpose	Certainty of Positive Net Impact Based on Available Evidence
EAPs	Strategic guidance, support, and consultation offered internally to an organization or through an external provider to assist with personal or family issues	Moderate
Short-term counseling	Brief, solution-focused counseling to address general conditions of living and issues specific to the individual, such as stress management, adjustment challenges (e.g., reassignment, geographical moves), interpersonal problems, financial or employment issues, and grief and loss	Low-moderate
Self-care	Activities to nurture the self and promote well-being, such as meditation, mindfulness practice, moderate exercise, journaling, taking deliberate breaks from work or home tasks, participating in meaningful activities, or limiting unnecessary exposure to trauma	Low
Resilience training	Intervention before a problem appears, including educational programming or training on risk, strategies to manage stress and other risk factors, and recognizing warning signs of a developing problem	Low overall but moderate for commercial training programs for civilian populations
Peer support	Peer-based intervention to help individuals respond to stress, including training for peer supporters to connect affected individual with resources or to provide case management support, education, or counseling	Low
Critical incident stress management	Acute crisis response, sometimes including pre-crisis and post-crisis components	Low
Critical incident stress debriefing	Structured, small-group acute crisis debriefing, either formal or informal, within 72 hours of event	Low; contraindicated
Psychological first aid	Response to individual psychological needs resulting from a disaster or traumatic event	Moderate
Stress first aid	Response to individual psychological needs resulting from job-related stress or traumatic events	Low
Mental health first aid	Response to individual needs of a person developing a mental health condition or having a mental health crisis	Moderate

Overview of DHS Programs to Address Employee Psychological Health

Through our interviews, we identified psychological health programs as of February 2017 in OHA and seven DHS operational components: U.S. Customs and Border Protection, the Federal Emergency Management Agency, U.S. Immigration and Customs Enforcement, Federal Law Enforcement Training Centers, the Transportation Security Administration, U.S. Citizenship and Immigration Services, and the U.S. Secret Service. Our study focused specifically on programs for preventing nonclinical psychological health issues (e.g., coping with stress, building resilience) and providing care (e.g., access to on-site mental health care providers, peer support, response to traumatic incidents). We did not include programs specifically targeting suicide, substance use, work-life balance, workplace violence, or health and wellness, which are informed by different sets of research. We also did not include programs in the U.S. Coast Guard. Finally, we note that it was not possible to conduct interviews with personnel at every location housing a given program, employees who participated in the programs described in this study, or DHS or component leadership. As a result, our findings do not represent a comprehensive account of perceptions regarding the function, purpose, and future of psychological health programs in individual components or across DHS.

DHS-Wide Programs

The Behavioral Health Branch (BHB) of OHA was established to address behavioral health matters, including resilience and suicidality. BHB uses an operational framework based on a health and wellness continuum, with an emphasis on evidence-based practices to advance health and well-being at individual and systemic levels. BHB focuses on both primary and secondary prevention, with initiatives aimed at reducing occupational stress and increasing resilience. It also supports component agencies in addressing the psychological health of their workforces.

Each DHS component agency offers an EAP that provides short-term counseling, access to 24-hour phone support, and some form of financial advice, general health and wellness information, support for life challenges, and other services. In some components, EAP providers play a prominent role in critical incident response. In others, these providers play a supportive role in responding to critical or traumatic incidents, if requested.

Component-Specific Programs

Individual DHS components provide a variety of services to their employees to address psychological health and promote resilience. Through our interviews, we identified existing component-level programs and categorized them according to the type of service they provided: peer support, critical or traumatic incident response, or resilience training. We also identified programs in development and related initiatives that components are pursuing to support the psychological health of their employees.

We found that most components had peer-support programs in place or in development—the Federal Emergency Management Agency was the exception—and these programs varied in terms of size, the amount and type training provided to peer supporters, and reporting requirements. A few components also provided short-term counseling and guidance on self-care as part of their EAPs. Finally, most offered some type of resilience training, but the focus of these programs varied.

Four of the DHS-wide or component-specific program types had a moderate or low-moderate certainty of having a positive net impact on participants: EAPs, short-term counseling, resilience training, and psychological first aid. As noted earlier, the level of certainty was determined from a review of the available literature, which is limited or lacks rigor for many types of interventions. It is unclear whether DHS programs using interventions with a low level of certainty of positive net impact have a positive impact in the context of DHS.

Recommendations

DHS employees are the front line for ensuring the safety and security of the United States. These jobs are inherently stressful, and some DHS employees risk exposure to emotional or traumatic events. To improve employees' psychological well-being, DHS must respond to their specific psychological health needs and concerns, as well as measure the effectiveness of existing programs that address psychological health. Our study suggests that the evidence base for most workplace psychological health interventions is limited due to a paucity of high-quality studies. While a peer-support program and other resilience initiatives may add nominal value and improve employee well-being overall, ensuring that these programs are both effective and beneficial to employees is paramount. The following recommendations provide a way forward for building on the current momentum with a focus on helping DHS determine whether its investments in these programs are achieving their desired outcomes for the department, its employees, and their families.

Recommendation 1. Ensure That All DHS Employees Have Access to Psychological Health Support

Given consistent findings of low morale among DHS employees and the work-related stressors they face, DHS should ensure that all employees have access to psychological health support when needed. It should also consider providing access to a DHS-trained licensed mental health care provider in each operational component.

Recommendation 2. Ensure That There Are Clear Policies for Peer-Support Programs in All Operational Components

Formal policies should outline all duties that peer supporters can and cannot perform, what training is required for performing those duties, what peer supporters can and cannot be held accountable for in their role, the resources in place to assist peer supporters, and the management plan and chain of command for peer supporters within the component. DHS should also ensure that peer supporters receive effective training, including refresher training at regular intervals.

Recommendation 3. Replace Formal Debriefing with a First-Aid Model

Although debriefing is sometimes used in law enforcement and other workplace contexts, the evidence does not support its continued use. Either stress first aid or psychological first aid would be an appropriate alternative that is supported by evidence.

Recommendation 4. Optimize Management of Psychological Health Programs Across DHS

DHS is a large, complex organization, and, as we discuss in this study, there have been numerous efforts across the department to address the psychological health of employees. To ensure that these efforts are coordinated and to optimize the management of its portfolio of programs, DHS should develop mechanisms for ensuring consistency across psychological health programs and components. Improved communication and regular collaboration among program managers and leadership would help streamline and unify these efforts. Such an approach could also help components learn from one another and increase ownership and responsibility for employee well-being, psychological health, and job satisfaction. In addition, DHS should conduct a psychological health needs assessment prior to developing new programs. Finally, this study provides a “snapshot” of programs identified in selected DHS components as of February 2017. Inevitably, these programs will change over time as funding, priorities, and staffing changes in components. DHS should develop a mechanism for sustaining a list of all psychological health programs across the department.

Recommendation 5. Build Evaluation into Psychological Health Programs

Without a systematic process for evaluation, untested programs could be a poor investment of resources or inadvertently result in harm to those who participate in them. None of the programs identified in this study had been formally evaluated by an external organization, and DHS had evaluated only six programs in two components. To address this gap, DHS should develop criteria to assess program effectiveness and encourage components to collect consistent data on their programs and implement quality improvement processes to address programs that are not meeting their goals. The data collected should not include any personally identifiable information to ensure the confidentiality of the employees who use the program's services. For large or critical programs, it may be appropriate for DHS to contract with an independent external evaluator.