Completed Projects

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.

The purpose of the ADAPTability Tool was to Develop a drinking assessment and motivation tool to be utilized by the Air Force’s Alcohol and Drug Abuse Prevention and Treatment (ADAPT) staff. This tool will be utilized to measure drinking behavior as serve as a transition into Level 1 treatment. This tool is being created to support all ADAPT programming, with specific attention paid to compatibility with the Level 1 toolkit being developed by NYU’s Family Translational Research Group (FTRG). Although there are existing tools and resources available in the public domain, these resources are cost prohibitive to the Air Force and/or Airmen seeking help. This tool was developed with the aim of being stand alone and not requiring long-term cost to AFMRA.

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.

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.

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).

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.

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.

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.

Through collaboration between the Clearinghouse and AFMOA, a working group was established to develop a training to identify and promote best practices in providing high-quality care and ensuring empathic responding to victims of sexual assault. This work resulted in the creation of the Compassionate Care Training. This Compassionate Care training was comprised of three components. First, the learner completed two, asynchronous Computer Based Training (CBT) modules including knowledge check quiz items and video vignettes. The first module, Sexual Assault Trauma, Re-victimization, and Providing Compassionate Care, outlined core knowledge required when working with victims of sexual assault within a military context. Learning objectives included: integrating basic knowledge of sexual assault trauma; identifying reporting requirements and definitions according to the Uniform Code of Military Justice (UCMJ); identifying basic processes occurring before, during, and after trauma; and recognizing re-victimization and other types of trauma that can occur in the treatment of victims of sexual assault. The second module, Dispelling Myths, Self-Care, and Compassionate Care for Sexual Assault Victims, identified common misinformation regarding sexual assault, encouraged the learner to examine their own biases, and promoted self-care when providing care to victims of sexual assault. Notably, in module 2, branching occurred at the mid-point of the training allowing for the presentation of tailored training information targeted toward either mental health care providers and technicians or administrative staff. The final and third component of the training was a group discussion activity facilitated by the clinic leadership at each respective base. The primary aim of the group discussion was to allow staff to process their reactions to the training content and discuss how the identified best practices might inform day-to-day practice in the clinic. In addition, a script was developed to aid the discussion facilitator. Moreover, thought activities and video vignettes were generated to enhance the group discussion activity.

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.

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.

This project involved the evaluation of ABC practices in order to generate new materials and training modules for the updated version of ABC, ABC 2.0. Materials included an updated manual, interview materials and forms, and implementation measurement materials. Eleven ABC 2.0 training modules were generated. Modules contained information about the Substance Use Assessment Tool (SUAT), the criteria for Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition and Fifth Edition, Text Revision (DSM-IV-TR or DSM-5), diagnoses for substance- and alcohol-use disorders, an overview of the principles needed to use Motivational Interviewing successfully, and guidelines on how to use the ABC 2.0 materials, such as the Alcohol Education Module and the Value Exploration Module.

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.

The Early Action Campaign was developed in order to improve mental health service utilization by reducing stigma associated with mental health help-seeking. It involved a lengthy and iterative process to develop and field-test appropriate messaging and poster images, a series of 3 posters that were widely disseminated across Air Force installations, and a facebook messaging component that was utilized on a small scale for the first few months of the campaign. A third component involving radio PSA messaging was not utilized.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Evaluation Report