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Delivery of high-quality behavioral health (BH) care is essential to supporting the readiness of the U.S. armed forces and their families. The coronavirus disease 2019 (COVID-19) pandemic led to a dramatic expansion of virtual behavioral health (VBH) care: remote patient access to BH care using technology such as a computer or cellular phone. The U.S. Army asked RAND Arroyo Center to examine the use of VBH to inform recommendations on the role of VBH care in the future of BH care in the Military Health System. The authors analyzed administrative data on VBH and in-person BH care from prior to the pandemic through March 2022 and surveyed soldiers who received BH care to assess their perceptions of VBH care. Administrative data analyses showed that direct care providers were less likely to deliver VBH care than private-sector providers and relied heavily on audio rather than video VBH. In addition, soldiers who received VBH care typically received a mix of VBH and in-person visits. Survey respondents who used VBH care had similar perceptions of the quality of their care and more-positive views of VBH than respondents who did not use VBH care. Few respondents had declined VBH care in favor of in-person care. Using these findings, the authors make recommendations on the role of VBH care in overall BH delivered by the military.

Acute and chronic pain are common among service members, with musculoskeletal pain and injuries being the leading cause of nondeployability among active-duty service members. Given the significant implications for individual health and force readiness, providing high-quality pain care to service members is a priority of the Military Health System (MHS). Prior RAND research used administrative data to assess the quality and safety of pain care and opioid prescribing in the MHS, generated a set of quality measures that the MHS could adopt going forward, and identified strengths and opportunities for improvement in care provided to service members with pain conditions. In this study, authors document findings from interviews with MHS administrators, providers, and patients, providing valuable detail and context for those findings, along with on-the-ground perspectives on MHS pain care policies and guidance in practice. Staff and patients recommended prioritizing increases in treatment access and availability to improve pain care, and patients emphasized effective treatment and patient-centered care as the most important facilitators of high-quality pain care.

California leads the nation with its relatively low rate of maternal deaths during pregnancy and the postpartum period. However, individuals insured via Medi-Cal suffer a disproportionate share of maternal deaths and severe complications at birth; within this group of publicly insured individuals, certain racial and/or ethnic groups have even higher rates of poor outcomes. The state can attribute part of its success in lowering rates of maternal mortality (MM) to the implementation of a data-driven statewide portfolio of quality improvement activities focused on the leading causes of maternal death. This quality improvement infrastructure has not previously been leveraged to respond in a focused way to the relatively large shares of MM and morbidity still seen in the Medi-Cal-insured population. B-CORE aimed to expand on existing statewide quality improvement efforts to effectively mitigate these adverse outcomes in Medi-Cal births by engaging Medi-Cal stakeholders.

The U.S. Army has a long history of preventing, detecting, and treating infectious diseases. Like other organizations and agencies involved in public health, the Army is increasingly interested in syndromic surveillance strategies-those designed to identify outbreaks before clinical data are available. Researchers use various methods to identify surveillance strategies across the globe, investigate these strategies' benefits and limitations, and recommend actions to aid the Army in their efforts to detect emerging epidemics and pandemics.

Women make up an increasingly large share of the U.S. veteran population, and their numbers continue to grow while the overall number of veterans is on the decline. Yet programs designed to support veterans' health and well-being have largely focused on men. Women's military experiences and postservice needs often differ from those of men, and women veterans also differ in significant ways from their nonveteran counterparts. Few studies have explored these variations, and this has translated to potentially missed opportunities to improve support for women during and after their transition from military to civilian life. Adagio Health, a provider of health, wellness, and nutrition services based in Western Pennsylvania, has taken steps to improve care for women veterans in its service area. To identify opportunities to further expand and enhance Adagio Health's efforts to support women veterans' health and wellness, the authors quantitatively and qualitatively assessed the needs of women veterans in the Adagio Health service area. The assessment provides a clearer picture of this often-underserved population, available services and resources, gaps in support, barriers to access, and areas to prioritize to provide the best support possible for the health and well-being of women who served. With the approaches recommended in this assessment, Adagio Health can continue increasing its capacities and capabilities for supporting its women veteran patients and making progress toward its goal of advancing their health and well-being.

Following a suicide attempt, components of aftercare can include efforts to reduce suicidal behavior (i.e., suicide, attempt, or ideation) of a person who has attempted suicide and facilitate the psychosocial adjustment of the patient and their family members. The purpose of this systematic review and meta-analysis of key outcomes was to synthesize the existing evidence on interventions for people who have attempted suicide and their family members. The authors found that aftercare interventions show a statistically significant reduction in further suicide attempts for intervention participants. Studies also reported a reduction in suicide deaths, depression, and hopelessness, but the results are based on limited quality of evidence. The uptake of interventions and treatment retention varied widely by aftercare intervention. The authors could not explore the effects of the intervention target (e.g., participants who attempted suicide versus family members or both) or populations because of the homogeneity of the sample and the lack of studies measuring family member responses. The identified studies did not meaningfully address the effects of interventions on family members because these were rarely included in existing research studies.

The topic of the tenth U.S. Department of Defense International State-of-the-Science Meeting on Blast Injury Research was "Toward a Unified Multiscale Computational Model of the Human Body's Immediate Responses to Blast-Related Trauma." The meeting was held August 16-17, 2022, at the RAND Corporation office in Arlington, Virginia, and more than 60 scientists, clinicians, and military leaders provided scientific overviews, presentations, and posters describing new and emerging science in the field. Before the meeting, a conference planning committee consulted on the literature review and research questions and served as a peer review panel for submitted abstracts. Five leading scientists and clinicians in related fields were invited to serve on an expert panel, lead working groups, and develop overall recommendations. These conference proceedings summarize the meeting and present key findings.

National security organizations need highly skilled and intellectually creative individuals who are eager to apply their talents to address the nation's most pressing challenges. In public and private discussions, officials and experts addressed the need for neurodiversity in the national security community. They described missions that are too important and too difficult to be left to those who use their brains only in typical ways. Neurodivergent is an umbrella term that covers a variety of cognitive diagnoses, including (but not exclusive to) autism spectrum disorder, attention deficit disorder (ADD) and attention-deficit/hyperactivity disorder (ADHD), dyslexia, dyscalculia, and Tourette's syndrome. Neurodivergent individuals are already part of the national security workforce. The purpose of this study is to understand the benefits that people with neurodivergence bring to national security; the challenges in recruiting, working with, and managing a neurodiverse workforce; and the barriers in national security workplaces that prevent agencies from realizing the full benefits of neurodiversity. To carry out this research, the authors conducted a review of primary, secondary, and commercial literature; they conducted semistructured interviews and held discussions with government officials, researchers and advocates for the interests of neurodivergent populations, and representatives from large organizations that have neurodiversity employment programs; and they synthesized findings from across these tasks to describe the complex landscape for neurodiversity in large organizations in general and in national security specifically.

Victims of sexual assault and sexual harassment often experience a variety of psychological outcomes and mental health symptoms related to posttraumatic stress disorder (PTSD), depression, anxiety, substance abuse, suicidal ideation, and self-harm. Sexual trauma also might affect careers. Despite a need to address these harms, some service members have reported that connecting to health care or mental health services following sexual assault or sexual harassment can be difficult-in part because of a lack of leadership support. Given these persistent challenges, the Psychological Health Center of Excellence identified an urgent need to better understand research that is pertinent to sexual assault and sexual harassment during military service so that the U.S. Department of Defense and the military services can improve the health care response for service members. RAND researchers investigated and synthesized relevant research in three topic areas: (1) the effectiveness of psychotherapy treatments designed for adult victims of sexual assault or sexual harassment in military settings; (2) barriers faced by U.S. military members to accessing and remaining in mental health care settings; and (3) associations between sexual assault or sexual harassment and mental health conditions.