The descriptions of projects below represent collaborative efforts of the Clearinghouse with various military and civilian partners. These projects span from revising behavioral health prevention program focused on target prevention of alcohol use, to creating dynamic online-trainings for child and youth professions, to conducting rapid literature reviews, to developing trainings for mental health clinic staff, to developing evaluations plans and implementing them. The common elements of these projects involve practical science brought to bear on addressing challenges that our military partners identify. We are committed to translating science into action. Let’s have a conversation to see how we can assist you in strengthening service member and family health and well-being.
Better Kid Care On-Demand Learning System: Development and Testing of a Randomized Controlled Trial Protocol for Online Curriculum Evaluation
The Clearinghouse devised a Randomized Control Trial for a set of three learning modules to assess participant knowledge and retention of new information presented within specific learning modules in the Better Kid Care on-demand system.
Child and Youth Development Evaluation Plan Project
CYDEPP’s goal was to develop a system-wide theory of change for the DoD Child and Youth Development System that accounted for individual system components and their potential synergistic impacts. The project outlines a common understanding of how each program impacts the development and health of military families, establishes specific, measurable, attainable, relevant, and time-bound (SMART) outcomes, and engages extensively with component program staff to assess program evaluability or readiness for evaluation.
Family Readiness Program Evaluation Development Project
The goal of this project was to create detailed evaluation plans to assess the effectiveness of selected family readiness programs within each of the four services.
Intimate Partner Physical Injury Risk Assessment
The Clearinghouse developed online training and test modules for over 900 clinicians across the services to support them in quantifying the level of risk for victims and potential victims across 15 risk domains.
Suicide Literature Reviews
The Clearinghouse completed two suicide-related literature reviews. One that focused on Lesbian, Gay, Bisexual, and Transgender (LGBT) individuals’ psychological health with an emphasis on suicide (i.e., suicidal ideation, attempts, and completion), and another that involved conducting a comprehensive review of the suicide literature that focused on the costs of suicide.
A web-based family advocacy and consultation program to assist military families stationed overseas who have children diagnosed with Autism Spectrum Disorder (ASD).
The collaboration between the U.S. Air Force and the Clearinghouse began in 2012, with a USDA cooperative agreement to conduct two research evaluations. Since then, the Clearinghouse has completed various projects with the Air Force in the areas of mental health, father engagement, drug and alcohol misuse, and suicide prevention. The projects have included the development of online trainings, evaluating the effectiveness of the Community Assessment Survey (CAS), an implementation evaluation of evidence-based PTSD treatments, and the development of an updated manual for Level 1 treatment within ADAPT.
4C Career Field Education and Technical Training Plan (CFETP) Manual
The goal of this project was to create a manual to provide information necessary for the Air Force Career Field Manager (AFCFM), Functional Manager (MFM), commanders, training managers, supervisors, and trainers to plan, develop, manage, and conduct an effective career field training program. This manual outlined the training that individuals in the Air Force Specialty (AFS) should receive in order to develop and progress throughout their career. It included information on initial skills, upgrade training, qualification training, advanced training, and proficiency training.
ADAPT Aftercare Toolkit
This evidence informed ADAPT Aftercare toolkit was created to facilitate the standardization of Aftercare among Air Force ADAPT clinics. It is supported by current scientific research on treating patients with a substance use disorder (SUD). The goal of this product is to enable ADAPT staff to present evidence-based and evidence-informed relapse prevention strategies in group and/or individual settings as well as personalize treatment options based on each patient’s diagnosis and/or follow-on drinking plan (e.g., abstaining from alcohol or responsible drinking).
As outlined in the plan of work, the Clearinghouse began this project by conducting a literature review aimed at examining all available research on: (1) evidence-based relapse prevention strategies; (2) aftercare treatment options based on diagnosis; and (3) aftercare treatment options based on follow-on drinking plan. Results relevant to the Air Force’s Aftercare program were limited. However, over 57,102 articles were initially located utilizing various search terms. Exclusions were made to limit articles to those being published in the last 10 years (i.e., since 2010). After weeding through the literature in more detail, articles were examined thoroughly for use within the Aftercare Toolkit project. More information the literature review process can be obtained by the Clearinghouse upon request.
Through the examination of all relevant research articles, key evidence-informed components of alcohol and/or substance use treatment were identified for inclusion in this toolkit. Each component included in this toolkit focuses on a different topic that your patient may benefit from during ADAPT Aftercare. Each ADAPT patient is different. Each patient has different needs, different goals, and different levels of success with treatment and sobriety. This toolkit is intended to be used by ADAPT staff in a manner that allows ADAPT staff to pick and choose the tools that are needed for each individual patient or group of patients.
To meet the project goals, the ADAPTability tool was created to assist patients in keeping track of their goals and monitoring their progress during their time in the ADAPT program. Reminders can be utilized motivate patients and help keep them on track. In addition, the ADAPTability tool provides opportunities for accountability as patients record things that are important to them, as it relates to their treatment progress. In addition, the tool provides patient’s the option to download all goals, notes, and progress. These downloadable PDFs can then be shared with ADAPT staff at the patient’s discretion. This was done to assure patient privacy and compliance with the Health Insurance Portability and Accountability Act.
Air Force Medical Operations Agency - Mental Health and Alcohol/Drug Misuse Projects
Although different in scope, each of the mental health related projects the Clearinghouse collaborates on with the U.S. Air Force Medical Operations Agency (AFMOA) assists the U.S. Air Force in: (1) development, application, and implementation of medical policy; (2) research and evaluation to address healthcare resourcing and operations; and (3) providing medical resources, coordinating best practices, analyzing data, and providing clinical expertise for efficient patient-centered healthcare.
Air Force Mental Health Provider Online Ethics Trainings
Mental health professionals providing services must adhere to a professional code of ethics (e.g. American Psychological Association, American Counseling Association). Mental health professionals serving in a branch of the armed forces may face situations in which their duties may be in direct conflict with some aspects of ethical codes. The United States Air Force (AF) partnered with researchers at the Clearinghouse for Military Family Readiness at the Penn State (Clearinghouse) to produce six one-hour mental health ethics webinars to address ethics in both a broad context, and in the military context. In these trainings, mental health professionals receive an overview of ethical codes of counseling and discuss how these guidelines may cause some boundary issues.The Clearinghouse team monitored successful completion of the webinar post-tests and awards Continuing Medical Education (CME) credits, and continuing education units (CEUs) on behalf of the American Psychological Association (APA), and the National Association of Social Workers (NASW).
Beta Implementation of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP)
The Clearinghouse provided a program evaluation of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP; Barlow et al., 2011) in military service members and their family members. The UP is a cognitive-behavioral therapy (CBT) that can be applied to a range of different disorders and problems including; panic attacks, worry, social anxiety, obsessive thoughts, compulsive behaviors, depressed mood, PTSD, and impulsive behaviors. The aim of this beta test/evaluation was to assess the effectiveness of the UP program as offered within the Air Force mental health clinic setting. Given the small N of this evaluation, the focus was on feasibility and overall program effectiveness.
Beta Test of Brief Cognitive Behavioral Therapy (BCBT) for Suicide Prevention
Deaths by suicide remain high in the military, with rates now surpassing that of the civilian population. Congress has mandated that the Armed Forces work to reduce suicide rates, encouraging clinicians and researchers to collaborate and focus efforts on improving the use of evidence-based treatments which target this population. In order to bring change, the Air Force Medical Operations Agency (AFMOA) partnered with the researchers at the Clearinghouse for Military Family Readiness (Clearinghouse) at the Pennsylvania State University to conduct an implementation evaluation of the feasibility and utility of Brief Cognitive Behavioral Therapy (BCBT). BCBT is a promising intervention given the empirical support for its effectiveness in reducing suicide attempts for those at risk. Ultimately, there was not enough data from this beta test to determine whether or not BCBT is an appropriate treatment to be used in reducing suicide in suicidal patients within the Air Force.
BHOP Awareness Campaign
To continue building upon the success of BHOP, the Clearinghouse for Military Family Readiness at Penn State (Clearinghouse) was tasked with the development of a BHOP awareness campaign. The Clearinghouse worked with the Air Force to develop a targeted awareness campaign that could be utilized to further promote the use of BHOP services in meeting the behavioral health needs of Air Force service members and their families. The final campaign delivered included the use of various marketing platforms for optimal visibility to targeted audiences.
Development of ADAPT Level 1 Menu of Programs, Manual Refinement, and Beta-Testing
The main purpose of this collaboration between AFMOA personnel and researchers at the Clearinghouse was to evaluate Level 1 practices and generate evidence-based programs from Level 1 that were contextualized for Air Force. First, the Clearinghouse team conducted a review and initial assessment of the Level 1 treatment approach used by the Air Force. Then, the Clearinghouse team evaluated a total of 48 alcohol treatment programs. A Level 1 menu was generated through collaboration between the AFMOA ADAPT staff and the Clearinghouse teams. The programs on this menu were either evidence-based or evidence-informed, had been manualized, and aligned with the Institute of Medicine and/or Clearinghouse’s recommendations for evidence-based practices. Through this collaboration, three manuals were adapted for use by the Air Force’s ADAPT Level 1 treatment. Adaptations were deemed necessary in order to reflect an orientation toward Air Force personnel and Air Force regulations and included an exclusive emphasis on alcohol use disorder. Then webinar trainings were conducted followed by feedback webinars that lead to the development of enhancement process.
Development of Air Force Alcohol and Drug Abuse Prevention and Treatment Program Outcome Measures for Substance Abuse
This project included a comprehensive review of literature to identify standardized substance abuse outcome measures for ADAPT. This included strengths and limitations of each measure, guidelines for use, a review of psychometric properties, the revision of identified measure(s) as required from Phase I, and the development of computer-based training.
Development of Alcohol Brief Counseling Comprehensive Implementation Manual
Development of CBT Modules for ADAPT MH Techs
This project aims to prepare ADAPT MH technicians to take and pass the Alcohol and Drug Counselor (ADC) exam through the creation of 18 online training modules. These interactive modules include information on the ASAM treatment levels, DSM-5 diagnostic criteria, counseling patients, patient screening and assessment, the therapeutic relationship, and legal and ethical considerations for treatment.
Early Mental Health Help-Seeking Campaign
Evaluation of ADAPT Level 1 Treatment
The evaluation of ADAPT Level 1 Treatment was funded by the Air Force Research Laboratory with the goal of providing a robust outcome evaluation of Level 1 treatment programs from the newly created menu. The Level 1 evaluation project provided information regarding the quality of delivery of Level 1 EBTs, as well as the relation between implementation quality and patient outcomes. The evaluation assisted ADAPT leadership in: determining effectiveness of its Level 1 treatment programs; examining continuous quality improvement; and providing professional development and technical assistance to clinic staff.
This examination represented the most comprehensive evaluation of the Air Force’s ADAPT Level 1 Program to date. Results indicated that a standardized Level 1 Program has not been implemented across the USAF. Specifically, there was a lack of systemic staff training and consistency in implementing evidence-based treatments. Overall results of this evaluation suggested that program implementation factors do not impact patient completion rates.
Evidence-Based Course of Care Repository
This project was designed to assist Air Force mental health and behavioral health providers to efficiently apply the proper courses of care for a wide variety of diagnoses. For this project, the Clearinghouse designed an evidence-based course of care repository. This was done for the top 10 most frequently diagnosed mental health issues in the Air Force.
Group Unified Protocol Pilot Test
The United States Air Force partnered with researchers at the Clearinghouse for Military Family Readiness at the Penn State (Clearinghouse) to conduct a pilot test of a brief version of the Group Unified Protocol (Group UP) within Military Treatment Facilities (MTF) across the Air Force. This pilot test focused on the feasibility, acceptability, and utility of this brief Group UP within Air Force mental health. In addition, this pilot test examines patient outcomes.
Mission: Dad is an interactive online program intended to support fathers’ engagement with their young children. It includes information on child development, ideas on fun activities and games for fathers to play with their children, resources to track child development, and a platform for multimedia engagement among caregivers. The Clearinghouse worked with partners to develop the web-based application for the program, and is currently conducting a study to determine usability and user satisfaction. The goal is to understand how fathers engage with the program, which individual components are most used, and fathers’ sentiments on the program as a whole.
Moving Forward Beta Test
The United States Air Force partnered with researchers at the Clearinghouse for Military Family Readiness at the Penn State (Clearinghouse) to conduct a beta test of Moving Forward within Military Treatment Facilities (MTF) across the Air Force. This beta test focused on the feasibility, acceptability, and utility of implementing Moving Forward treatment within Air Force mental health.
New Alcohol and Drug Abuse Prevention and Treatment (ADAPT) Program Manager’s Manual
This project involved the design and development of a training manual to help officers as they begin leading ADAPT programs. Generally, these officers may or may not have experience in substance abuse or ADAPT. The training manual was designed to provide an orientation of ADAPT and substance abuse treatment. In addition, the training manual would provided officers specific guidance on their responsibilities as supervisors supporting CADCs.
New Provider Training (NPT)
This project involved development of modules in order to train Mental Health providers that were new to the Air Force – specific protocols and policies that would be needed to be successful at their job. This project included the development of seven modules: Mental Health Operations; Suicide Prevention; Command Consultation; Profiles and Duty Limiting Conditions; Termination and Transfer; EFMP-M; and Special Duty Evaluations.
Prolonged Exposure in Primary Care (PE-PC)
The United States Air Force (AF) partnered with researchers at the Clearinghouse for Military Family Readiness at the Penn State (Clearinghouse) to conduct a beta test of Prolonged Exposure in Primary Care (PE-PC). PE-PC is a standardized and manualized intervention that is designed for primary care settings and utilizes components from Prolonged Exposure (PE). Treatment involves the use of a workbook to process the traumatic event in the form of a narrative. Providers assist in processing emotions and problematic beliefs associated with patient trauma, provide support for in vivo exposure homework, and offer education and strategies for relapse prevention. Appointments are scheduled at 1- to 2-week intervals. In comparison to other, longer PTSD interventions, PE-PC consists of an intake session and only four individual 30-minute sessions. The beta test focused on examining the feasibility and utility of utilizing PE-PC treatment with patients in the AF’s Behavioral Optimization Program (BHOP); a service that integrates behavioral health care into the AF’s primary care clinic. In terms of feasibility and utility, all results indicate that PE-PC is an intervention well-suited for use within BHOP. This is evidenced in (1) the fit of PE-PC within the BHOP model; (2) provider satisfaction and feedback; and (3) beta test patient outcomes, although these are limited in quantity. The Clearinghouse recommended an AF-wide phased implementation of PE-PC because of the relative low cost of training providers in PE-PC and the need to be able to treat PSTD within the primary care setting. This phased unveiling should be linked with a rigorous outcome evaluation.
Technical Assistance and Support for Community Action Planning in conjunction with RAND Needs Assessment
In 2017, the Air Force released the Community Feedback Tool (CFT). This survey, a heavily revised version of the previous Air Force Community Assessment Survey (AFCAS), provided an opportunity for Active, Guard and Reserve Airmen, spouses of Airmen, and Air Force civilian employees to influence change in the Air Force. The CFT process is completed in conjunction with Air Force Instruction 90-501 (AFI 90-501); which calls for the Community Action Information Board (CAIB) to use the CFT to assess the health of the community and to enact positive programs and services that foster resiliency. The Clearinghouse was tasked with providing proactive technical assistance and data interpretation to installation CAIB staff. An overview of the work completed for this project is below.
Testing a Sustainable Implementation Process within the Air Force for the Broad Use of the Social Norms Intervention (Social Norms) – Phase II
This project explores modifications to the implementation design executed in Phase I that yielded successful results as measured by a reduction in Alcohol Related Misconduct (ARM) incidents from 2012-2013 at eight participating Air Force Bases. In Phase II, from May to September of 2015, actual and misperceived norms regarding alcohol use and misuse were documented via an anonymous survey of young Airmen age 18-24 at fourteen participating Air Force installations. A 40% response was set as the minimal percentage of an installation’s 18-24 year old population required to be able to receive installation specific messages. Six installations achieved a response rate of 40% or more, and received messages using data collected at their respective bases. Eight bases did not achieve a 40% response rate; however, they received messages created with their respective aggregate data. Data was used to create targeted media that intensively exposed young Airmen to actual and corrective, normative messages around alcohol use with a goal of reducing harmful and risky behavior caused by alcohol misuse. In early 2016, an additional seven installations were selected for participation in a third treatment option that offers exposure to messages containing aggregate data from all Phase II surveyed bases, with no base specific data collection.
Wilford-Hall PTSD Treatment Study
The Wilford-Hall Post Traumatic Stress Disorder (PTSD) treatment outcome study was conducted to evaluate the effectiveness of evidence-based treatments (EBT’s) currently administered to patients who present in the Air Force Mental Health clinic with PTSD symptoms. The data for this study are from case reviews of 166 patients seen in the Wilford-Hall PTSD clinic between August 5, 2004, and April 7, 2014. Cases were coded using a coding system developed by the Wilford-Hall Air Force research team with input from staff at the Penn State Clearinghouse for Military Family Readiness (Clearinghouse). De-identified data were computer entered, cleaned, and analyzed at the Clearinghouse. A major focus of the study examined whether treatment sessions received by patients were on protocol or off protocol, according to the EBT utilized, and whether EBT adherence was associated with symptom reduction over time. Clinicians indicated whether their sessions were on protocol. Further information regarding the content of each session, including the quality of EBT delivery, was not available. Therefore, we were unable to evaluate why sessions were off protocol, or what activities actually occurred during the treatment sessions. A total of nine recommendations were made based on the results of this study.
Zero Suicide Systems Approach (ZSSA)
The Clearinghouse partnered with the U.S. Air Force to pilot test the Zero Suicide Systems Approach (ZSSA); making the Air Force the first service to pilot test a Zero Suicide Framework. The ZSSA is a pilot test of the Zero Suicide Framework across Military Treatment Facilities (MTF) at five Air Combat Command (ACC) Air Force Bases. The ZSSA aimed to improve care and outcomes for individuals at risk for suicide in a healthcare system. Project evaluation data showed that over the course of this project (2015 – 2019), participation in the pilot program was associated with a statistically significant decrease of suicide death rates. These results were achieved during a time when Air Force suicides, in general, were increasing. Thus, there was preliminary evidence that ZSSA may be having a positive impact on suicide-related outcomes. In comparison, no other recent efforts, noted to date, used to reduce military suicides have made a difference.
The collaboration between the U.S. Army and the Clearinghouse began in 2011, with a USDA cooperative agreement to conduct a single program evaluation. Since then, the Clearinghouse has completed various projects with the Army in the areas of family advocacy, community service, and healthy parenting.
Army Community Services (ACS): Cost Benefit/Cost Effectiveness Analysis and Program Evaluations
In partnership with the Office of Army Chief of Staff of Installation Management (OACSIM), the Clearinghouse has two primary aims. The first aim includes: (1) carrying out evaluability assessments for 11 selected Army Community Service (ACS) programs; (2) conducting Cost Benefit/Cost Effectiveness analysis for the ACS Survivor Outreach Services (SOS) program and the Army Volunteer Corp Coordinator (AVCC) program; and (3) completing an economic assessment for the Family Advocacy Program (FAP). The second aim involves conducting evaluations for the FAP and the Employment Readiness Program (ERP).
Army Volunteer Corps Program – Cost Benefit/Cost Effectiveness Analysis
Volunteering is instrumental to many efforts to support successful functioning of local communities. Strategic community interventions to augment volunteerism can bring substantial resources into local communities. The Army Community Services’ Army Volunteer Corps (AVC) represents the largest such program for military populations in the world. This work presents findings from an evaluation of the fiscal and societal contributions of over 30,000 volunteers participating in the AVC. The AVC produced over 3 million volunteer hours annually (over 1,300 FTEs) with a positive return-on-investment.
Employment Readiness Program – Outcome Evaluation
Family Advocacy Program – Economic Assessment
Family Advocacy Program – Process Evaluation
Survivor Outreach Services Program – Cost Benefit/Cost Effectiveness Analysis
Army Family Advocacy Program Quality Assurance Project
The primary objective of this study was to investigate how well the Army FAP was performing in four aspects of implementation quality: (1) Adherence (Is the program being delivered as it was designed to be delivered?); (2) Quality of program delivery (How well is the program being delivered?); (3) Participant exposure/dosage (How much help is offered to participants?); and (4)Participant responsiveness (To what degree do participants engage with and use the help offered?).
Army Family Advocacy Program Support Study Phase II
Army New Parent Support Program (NPSP) Engagement: Phase III
Department of Defense Education Activity (DoDEA)
Since our partnership began in 2014, the Clearinghouse has worked diligently to support DoDEA in fulfilling their commitment to ensuring all school-aged children of military families are provided a world-class education and to educate, engage, and empower each student to succeed in a dynamic world. Our work includes creation and delivery of professional development training for teachers and school psychologists that assists DoDEA professionals in supporting the unique needs of military families.
Parental Absence Support Research Project
Schools Empowering At-Risk Students (SEAS)
Penn State Faculty (Dr. Cristin Hall) and Clearinghouse staff are working with DoDEA partners to develop six online learning modules for school psychologists, school counselors, and school nurses related to warning signs and risk assessment, prevention, intervention, postvention, ethical and legal issues, and self-care and care coordination for at-risk students. In addition, the Clearinghouse team is working to develop supplemental materials and lesson plans for school personnel to deliver to students.
Department of Defense Family Advocacy Program
Located within the Office of the Under Secretary (of Defense) for Personnel and Readiness, Military Community and Family Policy (MCF&P), Family Advocacy Program is the congressionally-designated program responsible for preventing and responding to child abuse and neglect and domestic abuse in military families. The program works with key military and civilian departments, including medical, law enforcement, legal, chaplains, child and youth, and social agencies to promote a coordinated community response.
Commanders and Leaders FAP Training
This DoD FAP project focuses on web-based learning materials to support training commanders and senior enlisted leaders on understanding, preventing, and responding to child abuse, neglect, and domestic abuse.
Domestic Abuse Victim Advocate (DAVA)
This project involves using previously collected data to explore data-driven caseload recommendations for Domestic Abuse Victim Advocates (DAVAs). Using data from across the services (collected by the Marine Corps), the Clearinghouse is assessing complexity indicators that were hypothesized to affect the amount of time a DAVA spends on an individual case. Analyzing the data will inform recommendations about how to determine caseload sizes for DAVAs.
New Parent Support Program (NPSP): Continuous Quality Improvement Pilot Implementation
The New Parent Support Program is a secondary prevention program delivered through home visitation services for expectant and new parents and their very young children (prenatal to age 5). This pilot implementation of the Clearinghouse resulted in a DoD-wide logic model and corresponding evaluation plan that will accomplish two tasks: (1) test the feasibility of the research design of the evaluation plan, and (2) test four measures that examine how well each contributes to specified outcomes of the NPSP, and how useful each measure is for tailoring service delivery.
Impact of Active Duty Marine Suicides on the Family Survivors
A research study partnership between the United States Marine Corps and the Clearinghouse, that examined the gaps in service professionals understanding certain aspects of military family survivors of those who committed suicide.
Navy Youth Sports and Fitness (YSF) Research Project
Developed to provide consistency in youth sports and fitness programming across all naval installations (OCONUS and CONUS).
Virtual Youth Program Project
Office of Military Community and Family Policy
Located within the Office of the Under Secretary (of Defense) for Personnel and Readiness, Military Community and Family Policy (MCF&P) provides direction and oversight of quality of life programs for the military community to ensure these programs are designed and executed to support the needs of the Total Force. Our partnership with MCF&P began in 2010 and includes work in the areas of military and family readiness, child and youth services, recreation and education opportunities, and career and transition support.
Child Development Center Evaluation
The Clearinghouse, at the request of Military Community and Family Policy in the Office of the Secretary of Defense, is conducting an evaluation of the effectiveness of the Child Development Centers (CDC) across all four military services (Army, Navy, Air Force, and Marines). This evaluation will compare military-connected children in CDC care with military children in civilian care. Observations will assess the quality of care that is received in each child care facility, and questionnaires completed by parents and teachers will assess child development, family-work conflict, parent stress, and parental absenteeism from work.
Our collaboration with Reserve Affairs began in 2011. Our work is focused on providing a broad array of services to a DoD-wide initiative that promotes the well-being of National Guard and Reserve members, their families and communities, by connecting them with resources throughout the deployment cycle.
Yellow Ribbon Reintegration Program
The focus of this partnership is to provide the Yellow Ribbon Reintegration Program with program evaluation and improvement support. Examples of these efforts include: developed a logic model; reviewed standardized curriculum to ensure alignment with research; standardized a post-event survey; automated data cleaning and analyses for ongoing data collection efforts; evaluated the program specialist position and how it was utilized in support of program implementation tasks by the respective services; and developed a template for web-based content delivery.