Upload
others
View
3
Download
0
Embed Size (px)
Citation preview
Behavioral Health Leadership in a High-Risk Occupation
Occupational Health Psychology Summer InstituteOregon Healthy Workforce Center
Portland State UniversityJuly 2016
Amy B. Adler, Ph.D.Center for Military Psychiatry and Neuroscience
Walter Reed Army Institute of Research
Disclaimer: The views expressed in this presentation are those of the authors and do not necessarily represent the official policy or position of the U.S. Army Medical Command or the Department of Defense
Walter Reed Army Institute of Research 22
PTSD
Source: Castro & Adler (2011) “Re-Conceptualizing PTSD” in Deployment Psychology
• Unexpected• Discrete• Unwanted
TraumaticEvent
• Freezing• Intensefear• Shutting
down
Reaction
• Maladaptive• Spread
acrossdifferentdimensions
Symptoms
• Social• Work• Family
Impairment
VictimModelofPTSD
Walter Reed Army Institute of Research 33
OccupationalHealthModelofPTSD
Source: Adapted from Castro & Adler (2011) “Re-Conceptualizing PTSD” in Deployment Psychology
• Adaptive• Maladaptive
Symptoms
• Expected• Consistent
withidentity• Multiple
Events
TraumaticEvent
• TrainingKicksIn
• “Autopilot”
Reaction
• Grief• Second
guessing• Anger• Risk-Taking• Moralinjury
Symptoms
• Functioningwithsymptoms
• Unmaskedpost-transition
Impairment
TrainingandPreparation Context MilitaryCulture
&Structure
Walter Reed Army Institute of Research 44
Leadership• Leadership correlated with better mental health
– Civilian contexts (Kelloway & Barling, 2010) – Peacekeeping (Bliese & Halverson, 1998)– Combat (Jones et al., 2012)
• General leadership skills– Relevant in many situations (Bliese & Britt, 2001)– Span transactional and transformational behaviors (Bass, 1990).
• Limitations– Relatively “blunt instrument” for addressing specific challenges– Harder to teach (Barker, 1997; Gunia et al., 2015)
Walter Reed Army Institute of Research 55
WRAIRGeneralLeadership
WRAIRItemsExhibitsclearthinkingandreasonableactionunderstress
Tellssoldierswhentheyhavedoneagoodjob
Triestolookgoodtohigher-upsbyassigningextramissionsordetailstosoldiers
Embarrasses soldiersinfrontofothers
Source:WRAIRitems:Bliese &Britt,2001;Castro&McGurk,2007
Walter Reed Army Institute of Research 66
Domain-SpecificLeadership
• Previous Research– Safety-specific leadership1
– Health-specific leadership2
– Family-supportive leadership3
• Measures– Behaviors that can be observed– Referent varies depending on context
GeneralLeadership Domain-SpecificLeadership
MentalHealth&Well-Being
1Source:Barling,Loughlin,&Kelloway (2002);2Source:Gurt,Schwennen,&Elke(2011);3Hammeretal.(2011)
Walter Reed Army Institute of Research 77
BehavioralHealthLeadershipDomains
• Sleep leadership• Combat Operational Stress
Control (COSC) leadership• Health-promoting leadership• Resilience training leadership• Emotion regulation leadership• Post-traumatic growth
leadership
Walter Reed Army Institute of Research 88
SleepLeadership
Walter Reed Army Institute of Research 99
61%
8%
25%21%
10%
31%
4%
41%
0%
10%
20%
30%
40%
50%
60%
70%
Soldiers Civilians
%ofP
opulation
HoursofSleepPerNight
ReportedHoursofSleepAmongSoldiersandCivilians
≤5 6 7 ≥8
SleepHours
Walter Reed Army Institute of Research 1010
Sleep:Background• High-risk occupations and sleep problems
– 20-30% (Seelig et al., 2010)– 28.7-32.2% (J-MHAT-7)
• Sleep problems linked to – Performance problems (Wesensten et al., 2006)– Mistakes (LoPresti et al., in press; MHAT-9)– Affect dysregulation (van der Helm & Walker, 2012)– Mental health problems (Seelig et al., 2010; Wright et al., 2011)– Moral decision-making (Barnes et al., 2012)– Health risk behaviors (Luxton et al., 2011)
Walter Reed Army Institute of Research 1111
SleepLeadershipImmediateLeaders
Often/AlwaysConsidersleep asanimportantplanningfactor 34.7%
EncourageServiceMemberstogetextrasleepbeforemissionsthatrequirelonghours
34.6%
EncourageServiceMemberstotrytogotosleepontime 29.8%
EncouragesServiceMemberstogetadequatesleep 25.6%
WorktoensureServiceMembershaveagoodsleepenvironment(quiet,dark,nottoohotorcold)
23.6%
Supporttheappropriateuseofprescriptionsleepmedication 16.5%
Discouragetheuseofcaffeineornicotinewithinseveralhoursbeforetryingtogotosleep
14.1%
EncourageSoldierstoreducesleepdistractionsbyusingearplugs,eye-masksorotherstrategies
10.8%
EncourageServiceMemberstonapwhenpossible* 8.5%
AsksServiceMembersabouttheirsleepinghabits 5.8%
Walter Reed Army Institute of Research 1212
SleepLeadership:Peacekeeping• Survey of 623 US Soldiers deployed to Horn of Africa
(alpha = .90)
Rank GeneralLeadership
SleepLeadership
SleepQualityMoraleCohesion
Source:Gunia,Sipos,LoPresti &Adler,2015,MilitaryPsychology
Walter Reed Army Institute of Research 1313
SleepLeadership:Combat• Survey of 619 US Soldiers deployed to Afghanistan (alpha
= .93)
Rank GeneralLeadership
SleepLeadership
SleepQuantityMoraleCohesion
Source:Gunia,Sipos,LoPresti &Adler,2015,MilPsych
Walter Reed Army Institute of Research 1414
SleepLeadership:IndirectEffects• In both studies, indirect effect of sleep leadership
• Longitudinal study finding similar effects (Gunia et al., in prep)
(-.52***)
(.07+)
Sleep quality.10* -.51***
.02 DepressionSleep leadership
Bootstrap, CI = -.87 to -.27 (5000 iterations; Preacher & Hayes, 2004)
Source:Gunia,Sipos,LoPresti &Adler,2015,MilPsych
Walter Reed Army Institute of Research 1515
BehavioralHealthLeadershipDomains
• Sleep leadership• Combat Operational Stress
Control (COSC) leadership• Health-promoting leadership• Resilience training leadership• Emotion regulation leadership• Post-traumatic growth
leadership
Walter Reed Army Institute of Research 1616
COSCLeadership• Combat Operational
Stress Control (COSC) Leadership– COSC manual identifies a set
of leader behaviors designed to reduce or ameliorate combat stress reactions of subordinates
Walter Reed Army Institute of Research 1717
COSCLeadership
Source: Adler, Saboe, Anderson, Sipos & Thomas (2014) Current Psychiatry Reports
Often/Always
PlatoonSergeant
PlatoonLeader
Does notjudgesoldierswhoseekbehavioralhealthhelp 53.4% 50.8%
Encouragessoldierstoseekhelpforstress-relatedproblems 47.7% 47.2%
Demonstratesconcernforhowfamiliesaredealingwithstress
48.0% 46.8%
Interveneswhenasoldierdisplaysstressreactionssuchasanxiety, depressionorotherbehavioralhealthproblem
45.2% 43.8%
Encouragessoldierstoexpressemotionsfollowinglossesandsetbacksduringdeployment
42.3% 42.3%
Remindssoldiersafterintenseexperiences thatweareheretoservewithhonor,mission,greaterpurpose
49.4% 49.4%
Walter Reed Army Institute of Research 1818
COSCLeadership&MentalHealth
• 2,072 US Soldiers in Afghanistan (alpha = .91-.94)
Rank&Combat
Experiences
GeneralLeadership(NCO&PL)
COSC-SpecificLeadership
PCLAnxiety
DepressionComfort
talkingtoBHProvider
Source: Adler, Saboe, Anderson, Sipos & Thomas (2014) Current Psychiatry Reports
Walter Reed Army Institute of Research 1919
COSCLeadership&Combat
17
27
37
47
Low High
PTSD
Sym
ptom
s(PC
L)
CombatExposure
COSCLeadershipBehaviors,CombatExposure,andPTSDSymptoms
LowCOSCLeadership HighCOSCLeadership
Note: Analysis controlled for rank and general leadership.Source: Adler, Saboe, Anderson, Sipos & Thomas (2014) Curr Psych Rep
Walter Reed Army Institute of Research 2020
BehavioralHealthLeadershipDomains
• Sleep leadership• Combat Operational Stress
Control (COSC) leadership• Health-promoting
leadership• Resilience training leadership• Emotion regulation leadership• Post-traumatic growth
leadership
Walter Reed Army Institute of Research 2121
Health-PromotingLeadershipThinkingaboutyourcurrentteam/unit,ratehowoftendoesyourleadership Often/AlwaysEmphasizemaintainingprofessionalstandards 74%
Emphasizetakingcareofyourselfphysically 63%
Emphasizetheimportanceofthemedicalmission 61%
Emphasizetakingcareofyourselfmentally 52%
Giveyoupositivefeedbackaboutyouraccomplishments 44%
Emphasizemaintainingcompassion 41%
Remindyoutotakeabreak/recharge 41%
Encourageyoutogetenoughsleep 37%
Giveyouspecificguidanceonhowtoimprove 35%
Reducetension intheteam/unitwhenemotionsrunhigh 34%
Source: Adler, Adrian, Hemphill, Scaro, Sipos, & Thomas, under review
Walter Reed Army Institute of Research 2222
Health-PromotingLeadership&Burnout
• 344 medical staff deployed to Afghanistan (alpha = .95)
RankPTSD
SymptomsProfessionalStresssors
GeneralLeadership
Health-PromotingLeadership
Burnout(EmotionalExhaustion+Deperson-alization)
Source: Adler, Adrian, Hemphill, Scaro, Sipos, & Thomas, under review
Walter Reed Army Institute of Research 2323
OperationUnitedAssistance• 498 Soldiers in Controlled Monitoring Areas (CMAs) • 21-Day CMA (quarantine)• 4 cohorts (MAR-MAY 2015)• Following 6-month deployment to Liberia in response to
Ebola outbreak
Walter Reed Army Institute of Research 2424
CMA:Attitudes
Agree or Strongly Agree
19.7%
43.9%
30.0%
42.7%
52.5%
54.0%
63.5%
71.8%
0% 20% 40% 60% 80% 100%
Shouldbeapartofeverydeployment
Willhelpmetransitionhomemoreeasily
Isawasteoftime
Isagoodidea
Willhelpkeepourcommunitiessafe
Willhelpkeepourfamiliessafe
Isunderstandable
Willreduceanxietyinourcommunities
Walter Reed Army Institute of Research 2525
% Often or Always
53.0%
58.4%
58.6%
62.5%
65.0%
65.4%
73.9%
74.1%
0% 20% 40% 60% 80% 100%
Giveyouspecificguidanceonhowtoimprove
Encourageyoutogetenoughsleep
Emphasizetheimportanceofthehumanitarianmission
Placecommandemphasisonimportanceofhealthmonitoringmeasures
Leadbyexamplebyusinghealthmonitoringmeasuresthemselves
Emphasizetakingcareofyourselfmentally
Emphasizemaintainingprofessionalstandards
Emphasizetakingcareofyourselfphysically
*
CMAVersionofHealth-PromotingLeadership
Walter Reed Army Institute of Research 2626
Health-PromotingLeadershipinCMA
Rank General Leadership
Health-Promoting Leadership
DepressionAnxiety
Attitudes toward CMA
Source: Adler, Kim, Thomas & Sipos, in prep --Alpha = .97
Walter Reed Army Institute of Research 2727
BehavioralHealthLeadershipDomains
• Sleep leadership• Combat Operational Stress
Control (COSC) leadership• Health-promoting leadership• Resilience training
leadership• Emotion regulation leadership• Post-traumatic growth
leadership
Walter Reed Army Institute of Research 2828
ResilienceTrainingLeadership
ImmediateLeadersModerately/Quitea
Bit/A lotAttendresiliencetrainingactivities 64%
Emphasizetheimportanceofresilience trainingskills 62%
Refertoskillswhen talkingwithsoldiers 56%
Encouragesoldierstousetheskills 66%
Walter Reed Army Institute of Research 2929
ValidationofResilienceTrainingLeadership
9%21%
35%
62%
0%
20%
40%
60%
80%
100%
Negative Justgoingthroughthemotions
Opentotheideaitmightbeuseful
Enthusiastic
%SoldiersA
gree
ingL
eade
rs
Attend
edResilien
ceTraining
SoldierPerceptionofLeaderAttitudetowardResilienceTraining
Figure1.SoldierPerceptionofLeaderAttitudesTowardResilienceTrainingandTraining
Attendance
Walter Reed Army Institute of Research 3030
ResilienceTrainingLeadership&UnitClimate
• 2,181 Soldiers deployed to Afghanistan
Rank&Combat
Experiences
GeneralLeadership
ResilienceTraining
Leadership
PerceptionofTraining
UnitClimate
Source: Sims & Adler (in press) Parameters
Walter Reed Army Institute of Research 3131
AdditionalBehavioralHealthLeadershipDomains
• Sleep leadership• Combat Operational Stress
Control (COSC) leadership• Health-promoting leadership• Resilience training leadership• Emotion regulation
leadership• Post-traumatic growth
leadership
Walter Reed Army Institute of Research 3232
EmotionRegulationLeadership• 3,030 Soldiers surveyed in Afghanistan and Germany
(alpha = .86)
Often/Always
PlatoonSergeant
PlatoonLeader
Canpausewithoutimmediately reactinginemotionallychargedsituations.
36.3% 36.8%
Cancalmdownquicklyifhe/shegetsupset. 48.0% 46.3%
IsgoodatcalmingSoldiersdownwhentheygetangry.
41.7% 54.8%
IsgoodatacknowledgingwhenSoldiersaregoingthroughatoughtime.
46.7% 43.0%
Walter Reed Army Institute of Research 3333
Leadershipvs.BHLeadership• Are domain-specific leadership behaviors all the same?
– Similar pattern for Platoon Leaders & Immediate Supervisors
SleepLeadership
COSCLeadership
ResilienceTrainingLeadership
EmotionRegulationLeadership
GeneralLeadership .35 .55 .28 .61
SleepLeadership .52 .40 .44COSCLeadership .43 .72ResilienceTrainingLeadership
.35
Walter Reed Army Institute of Research 3434
Implications• Validates doctrine
– Sleep – COSC
• Training– Examine degree to which these skills are trainable– Assess efficacy of training in context
• Alternatives to Training– Over reliance of training as “The Answer”– Integrate into the culture– Consider role of “bystanders”– Train indirectly
• Work with Stakeholders
Walter Reed Army Institute of Research 3535
ImplementationDirectTraining
TrainEmbeddedProvidersin“ConversationStarters”
IntegratedintoMasterResilience Training–Medicalcourse
Integrateinpre-commandcourse
TrainEmbeddedProvidersin“ConversationStarters”
GeneralLeadership
SleepLeadership
OperationalStressControl
Leadership
FamilySupportiveLeadership
ResilienceTraining
Leadership
HealthPromotingLeadership
Emotion
Regulation
Walter Reed Army Institute of Research 3636
SleepLeadershipTraining
Walter Reed Army Institute of Research 3737
FutureDirections• Complete analysis of behavioral health leadership scales
– Emotion regulation– Post-traumatic growth leadership (Wood et al.)
• Sleep leadership training studies– Army study with Behavioral Health Officers– Hammer study with National Guard– Navy study of sleep leadership – International interest (5-nation program)
• Explore emotion regulation leadership – Mindfulness leadership– Self-distancing techniques
• Consider small-team culture & other occupational groups
Walter Reed Army Institute of Research 3838
ThankYou!
AmyAdler,PhDClinicalResearchPsychologistandSeniorConsultantCenterforMilitaryPsychiatryandNeuroscience