<![CDATA[PsychCoalition - Community]]>Sat, 13 Aug 2016 11:45:13 -0400Weebly<![CDATA[Benefits of Embedded Operational Psychology]]>Sat, 10 Oct 2015 21:21:47 GMThttp://psychcoalition.org/community/october-10th-2015By Mark Staal, Ph.D., ABPP 

*The views expressed in this article are those of the author and do not necessarily reflect the official policy of the Department of Defense or other departments of the U.S. Government.  

In the following brief article I discuss the unique contributions of embedded operational psychology. In doing so, the article attempts to highlight the diversity of applied psychological specialties and the demonstrable benefits of embedded psychology in general. The article focuses on a case example of one critically manned special operations community and their use of embedded operational psychologists to enhance the resiliency of their force and the mission performance of their personnel. 

Introduction to Applied Psychology

 Psychology is a diverse field of study. As the study of human behavior, the human mind, and much more, it contains many sub-disciplines or specialty areas of application. While each specialty leverages common elements associated with principles within behavioral science, each applies these elements in different ways and to different aspects of human experience. According to the American Psychological Association (APA), “psychologists work independently and also team up with other professionals - for example, with other scientists, physicians, lawyers, school personnel, computer experts, engineers, policymakers and managers - to contribute to every area of society. Thus, we find them in laboratories, hospitals, courtrooms, schools and universities, community health centers, prisons and corporate offices.” (APA, 2015). On their “careers in psychology” webpage, the APA’s provides descriptions of 19 different sub-disciplines. Far from an exhaustive list, one finds a description of engineering psychologists, industrial/organizational psychologists, forensic, and social psychologists. In each case, these applied practitioners often operate with third-party clients and from within organizational or corporate settings. Their work is contrasted with psychologists in traditional healthcare roles whose primary activity is focused on health promotion and combating disease processes. The juxtaposition of these two disparate communities of American psychologists highlights the diversity of experience and perspective when considering the practice of applied psychology. 

The Embedded Psychology Model

Traditionally, clinical psychology falls under the umbrella of healthcare provision. The model most often employed is one of specialty care - set aside from other healthcare practitioners - contained in a clinic, group practice, or individual office. However, over the last two decades, embedded behavioral health models have emerged and established themselves as very useful and effective platforms for the prevention of disease and promotion of health. Kurt Strosahl has pioneered the embedding of psychologists into primary care clinics and, along with others (Hunter, Goodie, Oordt, & Dobmeyer, 2009), has demonstrated the effectiveness of this model over traditional mental healthcare systems. For example, clients referred to an embedded behavioral health provider are much more likely to attend their appointment (and therefore receive care) as compared to clients referred to an offsite specialty mental health provider. According to Strosahl (1998), the magnitude of this difference is 90% in the embedded consultation model as opposed to 15% using the traditional platform. Collins, Hewson, Munger, & Wade (2010) and Cwikel, Zilber, Feinson, & Lerner (2008) found that only 10% of patients followed up with their referrals when the provider was not embedded.  

Embedded psychologists have been employed throughout the military and the results appear to strongly support an integrated model (Johnson, Ralph, & Johnson, 2005). Data coming out of this analysis indicates that embedded support providers enhance service provision across a number of domains. For example, when it comes to cost and utilization of services, the military reports a reduction in inpatient admissions (4%), in emergency room visits (7%), specialty care appointments (2%), pharmacy costs (13%), and overall primary care medical costs (9%) when embedded psychologists are used as opposed to traditional psychological services. Moreover, the Department of Defense has found improvements across eight preventative service measures, an increase in access to support (21%), improvements in logistics to care, and greater client satisfaction when compared to facilities that do not employ embedded behavioral health providers (USAF, 2014). 

The evolution of this model for traditional clinical psychologists has taken time, effort, and education. There were concerns initially about standards of care, informed consent, competence, and other ethical issues. For example, when it comes to informed consent, professionals in the field of embedded behavioral healthcare state that, “a formal, written, informed consent document is neither required nor recommended”. Similarly, experts in the field assert, “…the ‘standard of care’ for specialty mental health clinics does not apply” to embedded behavioral health care services (USAF, 2014, pg 46).

As an analog to embedded clinical psychology, the following section of this article will examine the benefits of embedded operational psychology. Although applying behavioral science principles to non-healthcare related challenges, operational psychologists are often operating in similar embedded environments and their work often benefits from integration with their third party client organization.

Operational Psychology

Most military psychologists are doctoral-level human behavior experts who provide mental health consultation on topics such as depression, stress, and anxiety. However, a small portion of these, have received specialized training in the areas of human performance, personnel selection, survival training, human intelligence, information operations, etc. These individuals often identify themselves as operational psychologists to help differentiate what they do from traditional healthcare practitioners. Operational psychology as an applied specialty is diverse and challenging. It typically includes consultation with operational decision makers regarding a number of operational and organizational activities. One of those activities concerns personnel selection and training (S&T) for selectively manned operational units. In the following portion of the article we examine the value of embedded operational psychology to special duty S&T.

Selection and Training: A SOF Case Study

Special operations personnel constitute a community within the military that is often critically manned. In other words, they are a low density asset to military operational capability that often doesn’t have enough qualified personnel to adequately support the mission. The demand for these individuals has never been greater since the events of 9/11. However, with historically small numbers and challenging training pipelines, it has been difficult to keep up with the demand. Selection, training, and retention remain significant challenges. Attrition during training is a major contributing factor. Therefore, reducing attrition rates can assist special operations forces (SOF) in meeting its operational manning requirements. 

Operational psychologists have been used to assist in the selection and training of SOF personnel for many years. For example, Special Forces (SF) candidates must complete the SF Assessment and Selection course, a month-long test of their mental toughness and suitability. This includes an extensive battery of testing and interviews by operational psychologists. However, their role does not end with selection. The Army employs embedded operational psychologists within each of its SF Groups to assist with training and human performance issues. Similarly, Navy SEAL candidates complete a six-month Basic Underwater Demolition/SEAL (BUD/S) course. Here too, operational psychologists play a key role in selection and training of NAVSOF personnel as embedded assets. An analog exists within the Air Force SOF community and among its Special Tactics (ST) personnel as well. 

ST Combat Control (CCT) 

CCT is critically manned and there just are not enough qualified CCT operators. This is largely the result of two factors: 1) insufficient numbers of capable candidates and 2) high rates of attrition during training. For example, 30% of CCT candidates drop out during the first year. Pre-scuba indoctrination is one of the most challenging phases of CCT training. It is a prerequisite for all ST personnel prior to attending Navy dive school. A significant portion of each class fails this phase, forcing them to be recycled. In some cases, students are recycled several times before they successfully graduate or are dropped from the program. The loss of resources associated with recycling is not insignificant nor is the cost associated with each student that fails to complete the program. 

Most students that struggle with this phase do so because they lack effective technique and water confidence - two human performance problems that can be remedied with proper intervention. Many of the technique-related issues can be resolved by the dive instructor cadre; however, water confidence problems are more complex. Students become anxious and experience stress (even panic) when “drowned-proofing” or engaged in one of the many underwater training exercises. As the student’s anxiety increases, so does their respiration, leading to a decrease in breath control. Moreover, students become preoccupied with their physiological and psychological reactions which further distract them from concentrating on their underwater tasks. Ultimately, they become frustrated and feel incapable of performing adequately which only worsens their condition. In order to reduce this risk for attrition while maintaining training rigor, an operational psychologist is often invaluable. As an embedded member of the unit, he or she is not viewed as an outsider and therefore is perceived more favorably. Furthermore, as an embedded asset, the psychologist is present at the site of intervention (in the context of training). Instead of the individual being pulled from training in order to find the needed support, this resource is available where and when it is needed (a consequence of being embedded). Lastly, while there remains stigma in seeking a healthcare provider for what may be perceived as “a disease process”, this barrier is largely removed when receiving support from an operational psychologist whose focus is performance enhancement from a sports medicine perspective. 

Since the employment of embedded operational psychologists within AFSOF units, there have been numerous instances when potential training losses were recouped and poorly performing operators were brought back to pace with their peers as a result of operational psychology interventions. Such examples, and others like it outside of S&T, provide ample evidence for the value of embedded operational psychologists within operational units.

References 

  1. Collins, C., Hewson, D. L., Munger, R., & Wade, T. (2010). Evolving Models of Behavioral Health Integration in Primary Care. New York: Milbank Memorial Fund.
  2. Cwikel, J., Zilber, N., Feinson, M., & Lerner, Y. (2008). Prevalence and risk factors of threshold and sub-threshold psychiatric disorders in primary care. Social Psychiatry and Psychiatric Epidemiology, 43, 184–191. doi:10.1007/s00127-007-0286-9 
  3. Hunter, C. L., Goodie, J. L., Oordt, M. S., & Dobmeyer, A. C. (2009). Behavioral health in primary care: A practitioner’s handbook. Washington, DC: American Psychological Association. 
  4. Johnson, W.B., Ralph, J., Johnson, S.J. (2005). Managing multiple roles in embedded environments: The case of aircraft carrier psychology. Professional Psychology Research and Practice, 36(1), 73-81. 
  5. Strosahl, K. (1998). The dissemination of manual-based psychotherapies in managed care: Promises, problems, and prospects. Clinical Psychology: Science and Practice, 5, 382-386.
  6. United Stated Air Force (2014). Primary care behavioral health services: Behavioral health optimization program (BHOP). Practice Manual. San Antonio, TX: Air Force Medical Operations Agency.

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<![CDATA[DOD Documents Related to Detention & Interrogations]]>Sun, 27 Sep 2015 13:27:37 GMThttp://psychcoalition.org/community/dod-docs-on-interrogationsThese are official DoD documents that cover the area of interrogation and detention operations for the military. They include regulations, policy, specific guidance, and a number of important investigations. Many have specific mentions of the use of psychologists who consult to the military in these areas. Where possible, they are labeled with the date that they were issued, followed by the name of the document. Click on the document title to download the document.

1992 09 28 Field Manual 34-52:  This is the Army Field Manual that gave US doctrine (how to conduct interrogation operations) from 1992 until it was superseded by the new Field Manual in 2006.

1997 10 01 AR 190-8 Enemy Prisons of War:  This is the Army Regulation (which applied to all of DoD) on how to treat Prisoners of War, Retained Persons, Civilian Internees, and any other detainees under US military control.  It was recently updated, in 2015, but was the official regulation from 1997 until 2015.

2004 06 Jacoby Report:  A review of interrogation and detention operations in Afghanistan.

2004 07 21 Detainee Operations Inspection Report:  This was a detailed inspection of DoD detainee and interrogation operations.  It included a psychologist on the team of investigators.

2005 04 01 AR 15-6 Investigation into FBI Allegations at GTMO:  This was a formal investigations into abuse at GTMO based on allegations from the FBI.

2005 05 24 Interim Guidance on Detainee Care:  This was medical guidance that was provided to all Army medical personnel on the treatment of detainees in US custody.  It included initial guidance for psychologists who provide “any form of assistance with the interrogation process.”

2005 05 24 Martinez Lopez Report:  This was a report of a detailed assessment into the medical support to detainee operations.  It included a review of the use of psychologists supporting interrogation and detention operations.

2005 06 03 Medical Program Principles and Procedures for the Protection and Treatment of Detainees in the Custody of the Armed Forces of the United States:  This was a memorandum from the Assistance Secretary of Defense for Health Affairs articulating the Principles and Procedures for all DoD Health Care Personnel (including psychologists supporting interrogation and detention operations) for working with detainees in US custody.

2008 11 20 SASC Report: The Senate Armed Services Committee Report is the most detailed and accurate rendition of the US’s involvement and actions concerning interrogation from 2001 until 2008.

2009 02 Walsh Report:  This is the report commissioned by President Obama to review the conditions of confinement at Guantanamo Bay, Cuba.  It specially found that the mission of psychologists supporting interrogation operations should be continued.

2006 09 Field Manual 2-22.3:  This is the Army manual (it applies to all uniformed services) that give the doctrine on interrogation operations.  Because of the Detainee Treatment Act, it is also US Law.  It clearly outlines the prohibition of any abuse of detainees.

2006 10 20 MEDCOM Policy:  This is the detailed guidance on how psychologists may support interrogation operations.  It clearly outlines the prohibition of any abuse of detainees.

2008 05 30 Joint Publication 3-63:  This is the joint publication that provides guidelines for planning and executing military detainee operations.  It clearly outlines the prohibition of any abuse of detainees.

2008 10 09 DODD 3115.09 DOD Intelligence Interrogations (2008):  Updated version of the DoD Directive on conducting Intelligence Interrogations.

2005 11 03 DODD 3115.09 DOD Intelligence Interrogations (2005):  This is the DoD Directive that covers Intelligence Interrogations, specifically addressing humane treatment and the use of psychologists who support interrogations.

2005 09 ST 4-02 46 Medical Support to Detainee Operations: This provides the details of the techniques and procedures that govern medical support to detainee operations, including the requirements to report abuse, and the overall function of psychologists who support interrogation operations.

2005 12 30 SECDEF Memorandum - Interrogation & Treatment of Detainees by the Department of Defense:  This implements the Detainee Treatment Act, requiring that only techniques in the Army Field Manual are used in intelligence interrogations, and that all persons held by the Armed Forces shall be treated humanely.

2006 06 06 DODI 231008E Medical Program Support for Detainee Operations: This provides medical policy for the treatment of detainees.   Enclosure 2 gives specific guidance on the use of psychologists who support interrogations.

2006 08 25 DOD IG Investigations of Detainee Abuse:  This is the formal review of the various DoD-Directed Investigations into Detainee Abuse.

2006 09 05 DODD 2310.01E DOD Detainee Program:  The is the Directive that outlines responsibilities and policy for the Department of Defense on Detainee Operations.

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<![CDATA[Executive Order: Using Behavioral Science Insights to Better Serve the American People]]>Tue, 15 Sep 2015 15:22:44 GMThttp://psychcoalition.org/community/executive-orderThe White House
Office of the Press Secretary
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For Immediate Release, September 15, 2015
 
EXECUTIVE ORDER:
USING BEHAVIORAL SCIENCE INSIGHTS
TO BETTER SERVE THE AMERICAN PEOPLE

A growing body of evidence demonstrates that behavioral science insights -- research findings from fields such as behavioral economics and psychology about how people make decisions and act on them -- can be used to design government policies to better serve the American people.

Where Federal policies have been designed to reflect behavioral science insights, they have substantially improved outcomes for the individuals, families, communities, and businesses those policies serve. For example, automatic enrollment and automatic escalation in retirement savings plans have made it easier to save for the future, and have helped Americans accumulate billions of dollars in additional retirement savings. Similarly, streamlining the application process for Federal financial aid has made college more financially accessible for millions of students.

To more fully realize the benefits of behavioral insights and deliver better results at a lower cost for the American people, the Federal Government should design its policies and programs to reflect our best understanding of how people engage with, participate in, use, and respond to those policies and programs. By improving the effectiveness and efficiency of Government, behavioral science insights can support a range of national priorities, including helping workers to find better jobs; enabling Americans to lead longer, healthier lives; improving access to educational opportunities and support for success in school; and accelerating the transition to a low-carbon economy.

NOW, THEREFORE, by the authority vested in me as President by the Constitution and the laws of the United States, I hereby direct the following:

Section 1. Behavioral Science Insights Policy Directive.

(a) Executive departments and agencies (agencies) are encouraged to:

(i) identify policies, programs, and operations where applying behavioral science insights may yield substantial improvements in public welfare, program outcomes, and program cost effectiveness;

(ii) develop strategies for applying behavioral science insights to programs and, where possible, rigorously test and evaluate the impact of these insights;

(iii) recruit behavioral science experts to join the Federal Government as necessary to achieve the goals of this directive; and

(iv) strengthen agency relationships with the research community to better use empirical findings from the behavioral sciences.

(b) In implementing the policy directives in section (a), agencies shall:

(i) identify opportunities to help qualifying individuals, families, communities, and businesses access public programs and benefits by, as appropriate, streamlining processes that may otherwise limit or delay participation -- for example, removing administrative hurdles, shortening wait times, and simplifying forms;

(ii) improve how information is presented to consumers, borrowers, program beneficiaries, and other individuals, whether as directly conveyed by the agency, or in setting standards for the presentation of information, by considering how the content, format, timing, and medium by which information is conveyed affects comprehension and action by individuals, as appropriate;

(iii) identify programs that offer choices and carefully consider how the presentation and structure of those choices, including the order, number, and arrangement of options, can most effectively promote public welfare, as appropriate, giving particular consideration to the selection and setting of default options; and

(iv) review elements of their policies and programs that are designed to encourage or make it easier for Americans to take specific actions, such as saving for retirement or completing education programs. In doing so, agencies shall consider how the timing, frequency, presentation, and labeling of benefits, taxes, subsidies, and other incentives can more effectively and efficiently promote those actions, as appropriate. Particular attention should be paid to opportunities to use nonfinancial incentives.

(c) For policies with a regulatory component, agencies are encouraged to combine this behavioral science insights policy directive with their ongoing review of existing significant regulations to identify and reduce regulatory burdens, as appropriate and consistent with Executive Order 13563 of January 18, 2011 (Improving Regulation and Regulatory Review), and Executive Order 13610 of May 10, 2012 (Identifying and Reducing Regulatory Burdens).

Section 2. Implementation of the Behavioral Science Insights Policy Directive. (a) The Social and Behavioral Sciences Team (SBST), under the National Science and Technology Council (NSTC) and chaired by the Assistant to the President for Science and Technology, shall provide agencies with advice and policy guidance to help them execute the policy objectives outlined in section 1 of this order, as appropriate.

(b) The NSTC shall release a yearly report summarizing agency implementation of section 1 of this order each year until 2019. Member agencies of the SBST are expected to contribute to this report.

(c) To help execute the policy directive set forth in section 1 of this order, the Chair of the SBST shall, within 45 days of the date of this order and thereafter as necessary, issue guidance to assist agencies in implementing this order.

Section 3. General Provisions. (a) Nothing in this order shall be construed to impair or otherwise affect:

(i) the authority granted by law to a department or agency, or the head thereof; or

(ii) the functions of the Director of the Office of Management and Budget relating to budgetary, administrative, or legislative proposals.

(b) This order shall be implemented consistent with applicable law and subject to the availability of appropriations.

(c) Independent agencies are strongly encouraged to comply with the requirements of this order.

(d) This order is not intended to, and does not, create any right or benefit, substantive or procedural, enforceable at law or in equity by any party against the United States, its departments, agencies, or entities, its officers, employees, or agents, or any other person.

BARACK OBAMA

THE WHITE HOUSE
September 15, 2015

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<![CDATA[Supporting Heroes in Mental Health Foundational Training (SHIFT)]]>Tue, 01 Sep 2015 16:15:46 GMThttp://psychcoalition.org/community/shiftSince the advent of the Internet, child pornography crimes have exploded, causing irrevocable harm not only to the child victims, but also to the law enforcement officers, forensic analysts, prosecutors, judges, and other professionals who must view their violation in order to rescue them. Exposure to child sexual abuse materials can have widespread and serious negative effects on professionals. Psycho-educational programs are crucial to helping exposed individuals learn how to recognize and cope with problems, before they become severe or permanent.

The Innocent Justice Foundation has partnered with the Department of Justice’s Office of Juvenile Justice and Delinquency Prevention (OJJDP), five Internet Crimes Against Children (ICAC) task force Commanders, and a leading global mental health expert in the child sexual abuse material field to develop one of the first comprehensive, foundational training programs in the United States to address this exploding problem.  The program, including several basic and advanced level trainings, is called the Supporting Heroes in Mental Health Foundational Training (SHIFT). Below are direct links to selected resources posted on their website.

  • Video: Impacts of Investigating Child Sexual Abuse Images - This video outlines the impacts of viewing and investigating child sexual abuse images and the strong need for mental health wellness programs for exposed individuals.
  • Judicial Guide - Judicial personnel’s guide to understanding the needs of individuals exposed to child pornography in the workplace.
  • Upper-Level Management (Administrator’s) Guide - A high-level administrator’s guide to understanding the needs of individuals exposed to child pornography in the workplace.
  • Friends and Family of Exposed Individuals Guide - The support of friends and family is essential in assisting exposed individuals deal with trauma. In fact, 90% of the Internet Crimes Against Children (ICAC) task forces surveyed reported that a strong family and friend base contributed to staying healthy. This guide provides advice and support to family and friends of exposed individuals.
  • Unit Commander Guide - The Purpose of this Guide is to (1) Provide best practice recommendations for those managing or supporting individuals exposed to child pornography images through their work; (2) Provide suggestions for practical guidelines that can be implemented within the workplace; and (3) Provide advice on finding an appropriate mental health professional to work with your unit or to work with employees individually.
  • The Confidentiality Guide - This guide explains how confidentiality and data protection is applied in counseling.
  • Finding a Mental Health Professional Guide - The Purpose of this Guide is to (1) Provide best practice recommendations for choosing a mental health professional for your organization to work with those individuals exposed to child sexual abuse images; (2) Provide suggestions for practical guidelines ranging from identifying possible candidates to initiating a formal contract; and (3) Provide suggested questions to ask during the interview process.
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<![CDATA[Interrogation in the 21st Century: Merging Science and Human Rights]]>Thu, 29 Jan 2015 22:07:33 GMThttp://psychcoalition.org/community/new-americaModerated by Peter Bergen, Director, International Security Program, New America
Participants: Mark Fallon, Steven Kleinman, Christian Meissner & Melissa Russano

Ever since reports of abusive tactics surfaced in the early 2000s, the efficacy of interrogation methods used by the U.S. military and intelligence services has been an issue of contention. Over the past 15 years, the debate has focused largely on whether or not abusive tactics were necessary to elicit intelligence. The discussion has been largely among politicians, with little input from scientists who have relevant data, or from practitioners who can speak to the efficacy of ethical, science-based methods that treat detainees with respect.

New America is pleased to welcome Col. (Ret.) Steven Kleinman, a career military intelligence officer with expertise in human intelligence and strategic interrogations; Mark Fallon, a national security consultant and former deputy assistant director of the Naval Criminal Investigative Service; Christian Meissner, a professor at Iowa State University who has coordinated a five-year research program for the High-Value Detainee Interrogation Group; and Melissa Russano, associate professor of criminal justice at Roger Williams University who has interviewed interrogators with experience of questioning high-value targets, for a discussion about the methods that are really used in these kinds of interrogations, and the value of the intelligence that they elicit.

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