As an Army, we check our teeth annually, but we do not check our heads with the same emphasis. With all due respect to our dental professionals, you never see anyone make the news for having a cavity. The consequences for lapses in intervention and prevention in mental health are obviously far different—and carry varying levels of sensitivity and complexity. This lends itself to novel approaches that make diagnosis and treatment less challenging.
Over the past several years, the case for a preventative framework toward harmful behaviors has been made clear, and wellness is front and center. The proliferation of Army programs is a welcome advancement, but initiatives can be short-lived, sunset by leader tenure or an unrelenting appetite for measures of effectiveness. After all, how might one prove why an event, such as a suicide, did not happen?
Moreover, when it comes to evaluating medical readiness, our primary, universal tool remains ill-suited as a meaningful preventative measure. The annual Periodic Health Assessment has a reputation as a compliance exercise that soldiers rarely take seriously, many either fearing the stigma associated with asking for help or dismissing the assessment as just another survey. Resultingly, this keystone process requires reformation by instituting an annual, face-to-face wellness check with provider-driven follow-through, combined with continued familiarization with soldier and family-related resources (e.g., access to childcare, spousal employment, financial services). Such a novel approach builds readiness and combat power, and is ripe for further experimentation.
Over the past two years, 3rd Brigade, 82nd Airborne Division instituted its own Panther Annual Wellness (PAW) program. The PAW was an organizational necessity after conducting a longitudinal analysis of the past several years of Defense Organizational Climate Surveys (DEOCS). This data is available to any current or incoming commander, and looking over time affords insight into a unit’s culture. Not to be taken lightly, DEOCS results can provide unit leaders with a powerful understanding of organizational deficits.
Concurrently, we conducted a time series analysis of suicidal ideations—decisions not to take one’s life—or zeroes in a binary construct. This effort was a stark departure from more common analyses of fatalities. Indeed, there is power in studying these events with similar weight as tragic, completed events, and asking key questions: What were the proximate causes to the ideations? When did they occur relative to a unit’s training cycle? Importantly, how did we learn about the ideation? When a supervisor is called first, for example, might this counterintuitively be considered a proxy for trust in the chain of command? In our case, the data further lent itself to intervention. And, while we do not suggest that our annual assessment is the sole reason for a turnaround, we argue that how we did it provides a viable, exportable model to get ahead of a range of issues, beyond suicide and suicidal ideations, before they metastasize.
Our wellness checks were designed to reinforce the pillars of the Army’s Holistic Health and Fitness (H2F) program. In 2020, the H2F pilot expanded to address a range of health conditions that were impacting our force, going beyond traditional emphasis on gym equipment to include key staff, from occupational therapists to cognitive performance specialists. In mental health, it is common to treat soldiers who are impacted by these conditions (e.g., physical injury, poor diet, inadequate sleep, performance anxiety, attenuated mental readiness or spiritual dimension). The PAW’s design enabled us to identify common occurrences among our soldiers and intervene with appropriate referrals and treatment. Some might draw parallels to the Defense Health Agency’s Targeted Care Pilot Program, also known as vectoring. However, what set our wellness checks apart from this program was that they were strategically conducted considering fluctuations in the unit’s operational tempo and with all personnel. Our soldier touchpoint was normalized by command encouragement and socialization.
In 2023, senior Army leaders considered mandating annual wellness checks. There was already success in programs such as Victory Wellness at Fort Riley. A recurring issue, however, was the availability of providers, which impacted the sustainability of similar efforts across the Army. There is a spectrum of providers in most units ranging from behavioral health officers to line medics. Behavioral health officers are often inundated with patient workload—frequently on the response side of the equation. However, not every issue requires clinical treatment. Military family life counselors are also in high demand, but it is difficult to surge them to assist a specific unit without an opportunity cost to an installation. Brigades also do not always have their full complement of chaplains. So, how might one source the manpower to build a viable wellness check program with trusted providers?
Our solution was through leveraging a public-private partnership with a local university—a model that can be replicated easily, at no cost, and with a range of benefits to stakeholders.
Endorsed by Womack Army Medical Center, our brigade entered into an agreement with Fayetteville State University to create a Warrior Wellness Scholar practicum, onboarding master of social work candidates, one per battalion, who served under the watchful eye of our behavioral health officers. These scholars underwent an intensive training period, gaining practical counseling experience and an understanding of available resources to prepare them for nonclinical care during the PAW and subsequent service within their respective battalions. The Warrior Wellness Scholar program also addressed the manpower shortage needed to conduct our annual assessment, and importantly, at zero cost to the Army. Apart from being fiscally responsible, it is worth noting that changes in Army structure required the brigade to provide care to units that were in various stages of transition and often limited in their internal resources. We activated or inactivated around two dozen units over two years; put another way, we had people in a fragile, transitory status.
As part of their training, members of the Warrior Wellness Scholar program were familiarized with the range of soldier and family resources to accommodate appropriate referrals. A general script was provided to ease the PAW conversations and accommodate soldiers’ needs for additional resources. Post-PAW, scholars had a regular presence in their assigned units, gaining further real-world experience that enhanced their academic coursework. The relationships they built with their battalion command teams and across their formations were critical. Scholars routinely taught classes and were present during a host of events including Ask, Care, Escort training, iCOVER, and field visits. Wellness checks were maintained with newly in-processing soldiers throughout the year; although these touchpoints were less frequent, they facilitated ongoing engagement and awareness of available resources. Scholars also checked in with discrete populations (e.g., promotion board failures, former special operations candidates). Their routine presence in unit areas built trust.
The routinized wellness check provided face-to-face interaction for everyone, and from the sustained presence of additional counselors, it was much different from the legacy Periodic Health Assessment. Because everyone participated, it inherently reduced the stigma associated with asking for help. Moreover, the framework provided continuous exposure to resources and ensured a warm handoff with providers, as needed. We did this by building a resource fair around the PAW, inviting soldier and family services from across post. In the event installation-level representatives were unavailable, we created videos so soldiers could get information from the sanctity of their barracks rooms by scanning a QR code. Importantly, we collected no data on soldiers other than PAW attendance (~3,700 soldiers). We did, however, offer an optional five-question exit survey to improve future iterations that was widely utilized (2,014 soldiers) and had an overwhelmingly positive response, with an average 9.23 rating of the program (1 being the least satisfied, 10 the most satisfied). The last question on the survey provided an opportunity for soldiers to provide open feedback. Over 1,600 soldiers responded to this question with consistent comments to implement PAW twice a year and with longer sessions, which is significant in its own right for a population ever skeptical of being surveyed.
Over two years, the organizational change was palpable both quantitatively and qualitatively. Quantitatively, descriptive statistics that were previously trending negatively reversed course (e.g., serious incident reports, retention). We remained imperfect, but there was progress, and we learned between the first- and second-year PAW iterations, making changes mainly driven by soldiers’ survey feedback. Qualitatively, countless soldiers provided testimonials about the program’s profound personal impact—particularly among our more senior-grade population, who are less likely to seek help for a variety of reasons. Part of their skepticism was related to potential negative career impact, such as the pre-2016 language on the security clearance request form that mandated disclosure of counseling. We have evolved over the years yet still have work to do here. Certainly, care must be taken with our senior population as they will become veterans shortly.
Data on propensity to serve highlights the multitude of reasons why people join the military. Distilled to its simplest form, people join for one of two reasons: They are either running to something, or they are running from something. We must meet them where they are. It is our responsibility to guide our youth to become the best versions of themselves, and this may be leading them through their hardest day of ground combat or their hardest day altogether. The latter can be anything from working through a delicate family situation to a career transition. The reasons we stay in the Army may change over time, but we are all in transition at some point and need assistance. As a senior leader once remarked, we spend a great deal of time standing at attention—we need to spend more time paying attention. Wellness checks routinize paying attention and complement other critical efforts from reception and integration to developmental counseling.
Ultimately, we did not write this article to highlight the relative success of a brigade’s boutique program. Instead, we argue that we did not go far enough. There is power in the public-private model that can be expanded to other brigades, universities, and domains. We can evolve our nonclinical counselors to become clinical counselors. We can establish a framework to more easily onboard other graduate students, from physical therapists to strength and conditioning coaches, through a well-monitored practicum endorsed by our military treatment facilities. The positive externalities will far outweigh any negative, and importantly, help fulfill our moral obligations to our soldiers and their families.
Colonel Jaron S. Wharton, PhD, is a former brigade commander and lead editor of Bend but Do Not Break: Shaping the Future of the All-Volunteer Force.
Lieutenant Colonel Rick Hawkins, MD, is a former division surgeon and presently the command surgeon for 1st Special Forces Command (Airborne).
Captain Kayla Moen, LCSW, is a former brigade behavioral health officer in the 82nd Airborne Division and presently a social work child and family fellow at Walter Reed National Military Medical Center.
Zarah Bunny-Dean is a master of social work candidate and presently a member of the Warrior Wellness Scholar program.
Captain Ashley Johnston, BSN, RN, is a brigade nurse in the 82nd Airborne Division.
The views expressed are those of the authors and do not reflect the official position of the United States Military Academy, Department of the Army, or Department of Defense.
Image credit: Sgt. 1st Class Daniel Wallace, US Army
