Supporting the Mental Health Needs of Community College Students

The United States faces an unprecedented mental health crisis, with youth and young adults at the center. Even before the COVID-19 pandemic, nearly 50 percent of college students reported at least one mental health concern. The COVID-19 pandemic notably exacerbated these issues and underscored the urgent need to identify and implement ways to ameliorate the youth mental health crisis. In 2021, the National Academies of Sciences, Engineering, and Medicine called on the field of higher education to address growing concerns about student mental health by identifying and elevating emerging and promising approaches that offer a more holistic way to support students' mental health. Serving as the main entry point for more than 40 percent of students seeking a postsecondary degree, community colleges represent a tremendous and untapped opportunity to better address mental health in the United States, particularly for students who have been traditionally underserved (e.g., students of color, first-generation students, and low-income students). However, community colleges have limited evidence and guidance to inform the implementation of multilevel, holistic approaches to support students with varying mental health needs. To address this knowledge gap, this article shares a descriptive study of eight community colleges at the forefront of implementing multilevel approaches (a combination of prevention, early intervention, and treatment services) to support student mental health, as well as key facilitators for and barriers to their success.

Integrating Psychological Counseling into National Guard Youth ChalleNGe Programs: Insights and Recommendations from Current Practices

The National Guard Youth ChalleNGe program is a residential, quasi-military program for youth ages 16 to 18 who are experiencing academic or behavioral difficulties in traditional high school. Mental health disorders are an increasing concern among adolescents, and the youth served by ChalleNGe may be particularly at risk for mental health disorders. To better understand how ChalleNGe can support cadets with mental health disorders, RAND researchers conducted interviews with counselors from six ChalleNGe sites and surveyed 39 ChalleNGe sites about their counseling services and cadets' mental health needs in 2019. The survey found that the majority (65 percent) of the sites considered cadets' mental health disorders (e.g., depression, anxiety) during the application process. In addition, a significant proportion of cadets are taking medication for mental health disorders while completing ChalleNGe. Counselor interviews indicated that there are substantial variations in counseling services across sites, including different staffing models, different ways for cadets to access counseling services, and different ways in which counseling services are integrated into a site's day-to-day operations. Based on the findings, the authors made four recommendations: (1) implement flexible staffing models that include at least one licensed counselor to meet the needs of the cadets and the sites, (2) establish an integrated counseling department in which counselors and other staff (e.g., teachers, cadre) work hand-in-hand to support cadets' mental health, (3) partner with community mental health providers to train and support staff, and (4) use evidence-based counseling practices to ensure high-quality and effective mental health services.

Incentives and Physical Activity: An Assessment of the Association Between Vitality's Active Rewards with Apple Watch Benefit and Sustained Physical Activity Improvements

The benefits of physical activity include a lowered risk of some major non-communicable diseases and improving wellbeing and mental health. However, roughly about one third of the global adult population is not meeting the minimum weekly level of physical activity recommended by the World Health Organisation. Discovery, a South African multi-national insurance group, offers two types of incentives to its members: Vitality Active Rewards and Vitality Active Rewards with Apple Watch. The Vitality Active Rewards scheme, a gain-framed incentive, rewards individuals for tracking and reaching different thresholds of physical activity, whereas the Vitality Active Rewards with Apple Watch benefit makes monthly repayments for an Apple Watch in amounts linked to different levels of physical activity thresholds that the individual reaches per month. Discovery commissioned RAND Europe to conduct an independent assessment on whether the Vitality Active Rewards with Apple Watch benefit is associated with increased physical activity levels for Vitality members that take up the benefit, compared to those individuals that only participate in the Vitality Active Rewards programme. The study also examined whether these associations persist over time. The findings of this study suggest that incentivising physical activity to tackle inactivity and a sedentary lifestyle can lead to better activity levels. When more unhealthy individuals take up an incentive of this kind, the results can lead on average to a more pronounced behaviour change than we see in already relatively more active and healthy individuals. This is important when designing health promotion programmes.

Assessing the Needs of Soldiers and Their Families at the Garrison Level

The RAND Arroyo Center conducted a 2014 formal needs assessment survey of active component soldiers at 40 installations. The original study described a broad landscape of needs in such areas as quality of life support services provided to help families cope with a variety of challenges. In this study, new analysis of those survey data explores differences at the garrison level and includes additional focus group data. The analysis suggests that resources providing one-on-one, personalized help should be given priority and it is possible that emphasizing trust between soldiers and their leaders could help fulfill this need. Providing easily accessible information online and staffing services that provide information to soldiers and their families should also be continuing priorities. In intergovernmental support agreements and other community partnership activities, Army garrisons should consider focusing more on partnerships that help meet the needs of soldiers and their families. The Army might consider a series of solutions to achieve the right balance between fostering resilience and helping its soldiers solve problems early. One solution is to expose noncommissioned officers and other soldiers earlier and more frequently in their careers to information regarding what resources are available. Another solution is to set priorities at the aggregate Army level, rather than leaving lower levels to determine how to prioritize the many requirements that are passed down. Finally, the Army should consider strengthening the "no wrong door" policy at Army Community Service and broadening the policy to help soldiers and families navigate resources.

2015 Department of Defense Health Related Behaviors Survey (HRBS)

The Health Related Behaviors Survey (HRBS) is the U.S. Department of Defense's flagship survey for understanding the health, health-related behaviors, and well-being of service members. In 2014, the Defense Health Agency asked the RAND Corporation to review previous iterations of the HRBS, update survey content, administer a revised version of the survey, and analyze data from the resulting 2015 HRBS of active-duty personnel, including those in the U.S. Air Force, Army, Marine Corps, Navy, and Coast Guard. This study details the methodology, sample demographics, and results from that survey in the following domains: health promotion and disease prevention; substance use; mental and emotional health; physical health and functional limitations; sexual behavior and health; sexual orientation, transgender identity, and health; and deployment experiences and health. The results presented here are intended to supplement data already collected by the Department of Defense and to inform policy initiatives to help improve the readiness, health, and well-being of the force.

How Cultural Alignment and the Use of Incentives Can Promote a Culture of Health: Stakeholder Perspectives

In 2013, the Robert Wood Johnson Foundation embarked on a pioneering effort to advance a Culture of Health. This report focuses on two questions that are central to understanding how individuals and sectors think about health and are motivated to promote it: How can the commonly understood concepts of cultural identity (e.g., ethnic or religious; lesbian, gay, bisexual, transgender plus; military) and organizational culture be harnessed to develop a Culture of Health? How can incentives be used to promote individual health and engage investors and leaders within organizations or governments to promote health and well-being broadly? This study draws on 43 one-hour semistructured interviews that RAND researchers conducted with stakeholders whose work focused on cultural alignment, incentives, or both to learn how organizations are addressing and leveraging culture and incentives to promote health and well-being, as well as to identify facilitators, barriers, potential best practices, and lessons learned. Key findings include the following: Equity is often addressed in silos, which impedes progress toward a unified goal of health equity for all; members of specific cultural groups need to be given a voice in health-related activities; systems are built around prevailing cultural norms, making it challenging for those working with specific cultures to make cultural adaptations; and not all incentives are monetary. Recommendations include institutionalizing practices that ensure ongoing input from marginalized populations, identifying ways to help smaller organizations overcome structural inequalities, and institutionalizing health promotion efforts in sectors other than public health or health care to sustain collaborative efforts.

Nurse-Designed Care Models and Culture of Health: Review of Three Case Studies

The Robert Wood Johnson Foundation (RWJF) recently made a commitment to advancing a national culture of health (COH)-an action framework developed by RWJF that focuses on well-being and equity with the goal of empowering and supporting people to lead healthier lives where they live, learn, work, and play, now and in generations to come. Nurses are well positioned to provide care that is consistent with, and contributes to, a COH in their communities. RWJF contracted with the American Academy of Nursing (the Academy) with a subcontract to the RAND Corporation to explore the ways that innovative nurse-designed models of care are currently advancing a COH. This article presents findings from case studies of three nurse-designed care models that have been recognized as innovative by the Academy's Edge Runner program, which identifies nurses who have designed innovations to remedy challenges in the delivery of health care or address an unmet health need of a population, and who can demonstrate positive clinical and financial outcomes. Findings indicate that nurse-designed models of care focus extensively on activities in the four different "action areas" set forth in RWJF's COH framework: making health a shared value; fostering cross-section collaboration to improve well-being; creating healthier, more equitable communities; and strengthening integration of health services and systems. Strong leadership and broad community support were key to the success of each of these models. A persistent challenge was identifying a sustainable funding mechanism for community-level efforts aimed at addressing social determinants of health-most of these efforts are currently grant-funded.

An Agenda to Advance Integrative Resilience Research and Practice: Key Themes From a Resilience Roundtable

People are facing an increasing variety and number of stressors, ranging from interpersonal difficulties to environmental hazards and societal forces. Resilience is the process of, capacity for, or outcome of adapting well in the face of adversity, trauma, tragedy, threats, or significant sources of stress. The science of resilience has advanced greatly since 2000, but there is an increasing recognition of the need for researchers and practitioners from different disciplines and sectors to work better together on this topic and for a shared agenda for promoting transdisciplinary resilience research. The study provides a path forward, primarily built on proceedings from a Resilience Roundtable, held in June 2016, and supplemented with relevant literature review. The Resilience Roundtable brought together researchers, practitioners, and policymakers, across disciplines and sectors for a daylong discussion of where and how we can move to a more integrated and cohesive resilience agenda, with attention to critical factors that would motivate more collaborative work. The roundtable identified priorities for advancing a shared resilience agenda and made ten recommendations for implementing it.

Building a National Culture of Health: Background, Action Framework, Measures, and Next Steps

Because health is a function of more than medical care, solutions to U.S. health problems must encompass more than reforms to health care systems. But those working to improve health, well-being, and equity still too often find themselves traveling on parallel paths that rarely intersect. In 2013, the Robert Wood Johnson Foundation (RWJF) embarked on a pioneering effort to advance a Culture of Health initiative. A Culture of Health places well-being at the center of every aspect of life, with the goal of enabling everyone in our diverse society to lead healthier lives, now and for generations to come. To put this vision into action, RWJF worked with RAND to develop an action framework that identifies how the nation will work toward achieving these outcomes. This article provides background on the development of this action framework. The Culture of Health action framework is designed around four action areas and one outcome area. Action areas are the core areas in which investment and activity are needed: (1) making health a shared value; (2) fostering cross-sector collaboration to improve well-being; (3) creating healthier, more equitable communities; and (4) strengthening integration of health services and systems. Each action area contains a set of drivers indicating where the United States needs to accelerate change and a set of measures illustrating places for progress. Within the primary Culture of Health outcome---improved population health, well-being, and equity---the authors identified three outcome areas: enhanced individual and community well-being, managed chronic disease and reduced toxic stress, and reduced health care costs.

Financial incentives: only one piece of the workplace wellness puzzle comment on "corporate wellness programs: implementation challenges in the modern american workplace"

In this commentary, we argue that financial incentives are only one of many key components that employers should consider when designing and implementing a workplace wellness program. Strategies such as social encouragement and providing token rewards may also be effective in improving awareness and engagement. Should employers choose to utilize financial incentives, they should tailor them to the goals for the program as well as the targeted behaviors and health outcomes.