Wellness Check Interventions for Soldiers

Psychological Services | 2024, Vol. 21, No. 2, p. 337-346

Wellness Checks: Piloting a Universal Intervention for Soldiers

Amy B. Adler; Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States

Paul D. Bliese; Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States; Department of Management, Darla Moore School of Business, University of South Carolina

Yvonne S. Allar; Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States

As part of an Army pilot program, mandatory annual wellness checks were initiated to introduce individuals to counseling and to support psychological resilience and thriving. The program was evaluated using a cross-sectional survey completed by 7,831 soldiers. Findings revealed that about half of soldiers who reported a wellness check rated the check at least moderately helpful in their professional and personal lives. Participants receiving a wellness check reported being more likely to report willingness to seek help if they were to have mental health problems and to report higher levels of resilience and thriving even after controlling for rank, age, education, months in the unit, and trait negative affect. Participants were also less likely to report stigma-related concerns compared to those who had not received a wellness check. Consistent with theory on the common factors in counseling and the contextual model of psychotherapy (Laska et al., 2014), feeling listened to and learning new skills partially mediated the association between perceived wellness check usefulness and study outcomes, although acquiring a new perspective about problems did not. While not a randomized trial, this evaluation suggests that wellness checks are associated with programmatic goals: improved attitudes toward care-seeking, resilience, and thriving. Future work should consider ways to ensure counselors address therapeutic common factors and should use a randomized, longitudinal design. Study findings have implications for implementing programs like wellness checks for military personnel and others working in high-stress occupations like first responders.

Resilience; thriving; help seeking; common factors; Army

“The present study reports on wellness checks, a new initiative piloted on one large Army installation. Wellness checks are a one-on-one annual counseling session with a mental health professional (e.g., counselor, marriage and family therapist, social worker)... There are several unique components to this intervention. First, these sessions are mandatory. Everyone—from the most junior soldier to the commanding general—must participate. Second, the counselors are outside of the DoD’s medical context, and no medical records are kept other than tracking which individuals completed their wellness check appointment. Sessions are confidential except for the usual limits to confidentiality regarding threats to safety. Third, the topics are at the discretion of the individual. Thus, these sessions are not mental health screenings, are not designed to identify high-risk individuals, and there is no set script. Overall, wellness checks are designed to target three primary outcomes: willingness to seek help, resilience, and thriving” (p. 337-338).

“The present study reports on a survey conducted after the wellness check program had been in place for more than a year, ensuring that the assessment would reflect a more mature program that had stabilized into a routine for the organization. This cross-sectional survey study assessed how participants perceived the wellness checks, and whether wellness checks were associated with study outcomes… Participants were U.S. Army soldiers assigned to the same installation… Informed consent was provided by 7,831 participants” (p. 339). 

“In this pilot study, soldiers who received a brief wellness check were more likely to report willingness to seek help from a mental health professional and reported higher levels of resilience and thriving. They also were less likely to report stigma-related career concerns than soldiers who had not received a wellness check. Overall, results suggest that wellness checks may successfully address the program’s goals: introducing soldiers to counseling, promoting resilience, and encouraging thriving” (p. 343). 

“First, wellness checks were associated with positive attitudes toward seeking mental healthcare. Not only were soldiers more likely to report they would seek care, but wellness checks were also associated with lower levels of concern about career worry associated with counseling… Second, wellness checks were associated with resilience and thriving. Previous research has shown that self-reported resilience is predictive of coping successfully with stress in the military” (p. 343).

“The link between perceived usefulness and positive outcomes appears largely driven by soldiers feeling listened to and learning new skills during the wellness check. Both of these variables represent pathways in the contextual model of psychotherapy. In contrast, thinking about things they had not considered before was not a significant mediator, suggesting this pathway, what Wampold (2015) called“expectation,” maybe relatively less critical in the context of a brief, nonclinical wellness check. Unlike clients in therapy, who approach the counselor with a clinical difficulty of some sort, soldiers interacting with MFLCs during a wellness check may not have had a concern that reached clinical levels, and so did not benefit from this particular pathway… Still, results suggest that the two common factors (listening and skills) may offer helpful insight into understanding wellness check effectiveness” (p. 343).

“There are limitations to the study. First, this study was not a randomized controlled trial, and thus results need to be interpreted with caution because unmeasured confounding variables could potentially explain observed group differences. With this limitation in mind, our use of mixed-effects models with random intercepts for unit membership helped provide an unbiased estimate of the individual-level impact of receiving a wellness check. That is, the individual-level estimate of the slope we obtained in our models removed any potential unit-level effects such as whether peers support the initiative and differences in how units choose to implement the program (Bliese et al., 2020). At the individual level, we examined a broad range of potential covariates and ultimately controlled for a wide range of factors (rank, age, education, tenure within a unit, and NA) that differed by wellness check status and were also potentially related to our outcomes of interest. Moreover, even with these controls, the observed power for the key effects was relatively strong, often well above .80, suggesting results are likely to be robust to variants of the reported models. Likewise, while use of multiple models suggests results be interpreted with caution, the high observed power for likelihood of seeking help, thriving, and concern about seeking informal help harming one’s career suggests these findings are particularly likely to be replicated in future work. Our use of mixed-effects models and careful selection of individual-level controls helps reduce the possibility that other unmeasured factors are responsible for the significant wellness check effects we observed. Nonetheless, the only way to completely eliminate the possibility that other variables may account for differences between those who received a wellness check and those who did not would be to randomly assign individuals to condition. Moreover, it was not feasible to specifically track individual MFLCs in our study design. Consequently, we could not control for difference in MFLC skills and ability to adapt to the wellness check process. Relatedly, there is no way to know the specific details of how each MFLC conducted the wellness check although most of the MFLCs had been in place for about a year by the time the survey was conducted, ensuring at least some shared understanding of this process. Finally, the study relied on self-report, although the percent of individuals completing wellness checks was consistent with records held by the installation.

Study findings have implications for preparing MFLCstomanage wellness checks optimally. By encouraging MFLCs to focus on the first (relationship) and third (skills) pathway in the contextual model of psychotherapy (Wampold, 2015), these counselors can be better prepared to adapt their skills for nonclinical encounters. For example, MFLCs could be trained to deliver a diversity of health promoting techniques to provide even more individualized support. They can also offer to provide personal skill prescriptions to support use of these techniques after the session is over. Furthermore, findings can be used to inform the adaptation of a wellness check program for other military services and for organizations that support first responders such as police, firefighters, and emergency medical technicians. These other organizations can leverage study results to establish appropriate expectations regarding wellness checks and to strengthen counselor skills” (p. 344).