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Local Connections Strengthen Prevention Programming for New Jersey Military Families
Strong connections with partners across the state help the New Jersey Prevention Network develop and deliver culturally appropriate programming to military personnel and their families.
For nearly a decade, New Jersey’s Division of Mental Health and Addiction Services (DMHAS) has dedicated resources and funding to improving the health and positive coping skills of military families living or stationed in the state. In June of 2008, nearly 3,000 troops from the New Jersey Army National Guard were deployed to Iraq, representing the largest deployment of NJ National Guard soldiers to a combat zone since World War II.
Today, the state continues to be home to some of the most active military bases in the country, with large segments of the population deeply affected by the stressors of military life, including frequent moves, deployments, and reunions.1 Substance use has been identified as a self-medicating behavior to “cope” with deployment stress. In the absence of healthy coping skills, this self-medication can lead to substance misuse, with the highest rates found among military members ages 18-24 years.2 Children in military families are also vulnerable to the effects of these difficult life transitions, including increased risk for emotional distress, substance use, and other risky behaviors.1
“The military is a population that everyone would like to focus on,” says Dr. Donald Hallcom, Director of Prevention and Early Intervention for DMHAS. “There is a lot of need there. The question is how to do so effectively.”
To answer this question, in 2008 DMHAS awarded a Military Initiative Grant (MIG) to the New Jersey Prevention Network (NJPN), a public health agency with a successful track record of collaborating with the NJ National Guard and local Army bases. The MIG is designed to bring prevention programming to the state’s military community. Under the grant—now in its second cycle—NJPN developed and continues to deliver two evidence-based programs aimed at helping military personnel and their families navigate the challenges of deployment:
The two programs were specifically selected to boost protective factors that safeguard individuals, families, and communities against substance misuse and related behaviors. The targeted factors include problem-solving skills, parenting skills, communication skills, anger management, and positive community involvement.2
NJPN worked directly with the programs’ creators and authorized trainers to tailor the materials—adding nuances and case examples that would resonate with military audiences without compromising the effectiveness of the original curricula. To reduce any potential self-consciousness associated with attending a workshop focused on coping, communicating, or managing stress, they also changed the programs’ names to the less threatening “Achieving Personal Balance” and “Military Family Nights.”
To deliver the programs, NJPN collaborates with a wide range of community partners, including ten partner agencies certified to facilitate the APB and MFN programs state-wide; fourteen military representatives who serve as cultural advisors on the NJPN Community/Military Prevention Collaborative; and hundreds of other individuals and organizations who support the Network’s recruitment efforts. “Creating these local connections has helped NJPN reach the military where they live and work,” says Diane Litterer, CEO and Executive Director of NJPN. “It has also helped us sustain ongoing referral sources and ensure that program materials reflect the needs and culture of the state’s military population.”
The success of NJPN’s collaborative approach is reflected in their evaluation data. Over the past six years, 1456 individuals (representing 524 families) have graduated MFN and 212 individuals have graduated APB. Evaluation findings are consistently positive: participants report increases in positive coping skills, reductions in use of avoidance coping strategies (e.g., substance use/misuse), and increases in social support.2
The NJPN leadership team understood that choosing the right community partners to deliver their programming was critical. These agencies would be on the “front lines,” interfacing regularly with military service members and their families. So rather than relying on established relationships, NJPN issued an RFP to identify and guide the selection of their 10 statewide partner agencies. Their criteria were clear: partner agencies needed to have experience delivering programs based on evidence-based practices, demonstrated success delivering programs similar to MFN and APB, and be located near a military base or Military Family Assistance Center (FAC). Moreover, all of the selected agencies needed to be skilled connectors, equipped to help participants navigate their local resources and link people with the substance misuse and related services they need.
When NJPN first launched their prevention programs, they relied on their military partners at bases and family support centers to serve as their primary recruiters. They soon discovered, however, that many potential participants—particularly service members—were reluctant to seek help at the military base, fearful that any type of help-seeking would reflect negatively on perceptions of their job performance.
NJPN knew they would need to find other channels for recruitment (see Don’t be afraid to expand your network, below) but were also eager to maintain their relationship with their military partners. So they embraced the idea of transitioning their partners to the role of “cultural competence advisors.” Since this transition, the advisors have played a key role in helping to ensure that the two MIG programs resonate with the needs and experiences of military staff and their families. They have been instrumental in shaping training content for facilitators and developing invaluable tools such as Military Acronyms, Abbreviations, and Terms for Family Team Building. “For children to hear the language that their parents speak fluently [that is, the military acronyms they speak in their homes] reflected in this program—it’s a great way to make the children feel safe and comfortable,” says Lisa Daly, NJPN’s Associate Director.
As military partners transitioned away from recruitment, NJPN invited other new and existing partners—operating at both the local and state levels—to fill the gap. At the local level, the Network relies heavily on community partner agencies to connect with area schools, particularly those with student assistance counselors. Many of these schools are already working with military families, so referring to MFN represents a natural extension of their work.
At the state level, NJPN regularly attends Yellow Ribbon Events hosted by the Military FACs to connect National Guard and Reserve members, their families, and communities with resources and services. NJPN also collaborates with the New Jersey Broadcasters Association to air public service announcements about their programs, and has created the NJPN Community/Military Prevention Collaborative. This broad support network not only helps NJPN recruit new partners and program participants, but also helps to build program credibility.
NJPN relies strongly on program graduates to spread the word and recruit new families to participate. “Military families trust other military families,” says Daly. “Word of mouth has been our most effective referral source.” Program graduates are invited back for Booster Sessions—single-session events that reinforce learned skills and combine celebration, family-fun, and cultural appreciation. Families are reconnected to reinforce the support network created during the program; they are also encouraged to invite other military family and friends to meet program facilitators and promote the program. These sessions have become a strong referral source for both MFN and APB, and help to strengthen ties among the provider agencies, regional substance abuse prevention coalitions, and military community. Attendees are encouraged to join coalition efforts and become a voice for military families.
NJPN facilitates regular opportunities for program staff across partner agencies to communicate and network. Throughout the year, NJPN shares links to current data, curriculum enhancements, and relevant online trainings. They also host an annual statewide meeting where certified program facilitators can share lessons learned, successes, and opportunities of improvement. Meeting attendees also help identify training and technical assistance needs for the upcoming year. “Our partner agencies consistently tell us that cultural competency is a primary need,” says Daly, “Every deployment creates a new grouping of military personnel, and our facilitators need to understand how personnel needs have changed over the past 15 years of conflict.”
NJPN made a deliberate decision to engage multiple partners in the design and execution of the MIG evaluation. This strategy not only enhanced the quality of the evaluation design, but also created a sense of ownership for the program and an investment in delivering program modules with fidelity. They worked closely with the curriculum developers from Strengthening Families to oversee the evaluation design and to develop tools and measures tailored to the needs and concerns of military populations. They also enlisted local program facilitators to capture key data and lessons learned using a customized web-based reporting system, and to report short-term outcomes like attitudes and behaviors using pre- and post-test survey results. Moreover, by engaging partners in program evaluation, NJPN has initiated important conversations among collaborators related to program customization, improvement, and training needs. These evaluation discussions play a significant role in strengthening both the program and NJPN’s relationships with its partners.
With more than 1600 individuals trained through the MIG (which was refunded in 2014 for another five years), the project continues to broaden its impact. NJPN gathers data on an annual basis and consistently sees positive effects. During 2013-2014 grant year, participants in MFN reported a 23% increase in positive family communication and interaction, and a 58% decrease in negative discipline and negative reaction towards children’s behaviors. Similarly, participants in APB demonstrated an increase in positive coping skills, with a 57% increase in the number of participants who set achievable personalized stress-reduction goals and strategies.
Evaluators have also seen a significant reduction in the use of avoidance coping strategies, including the reliance on alcohol or drugs to alleviate tension. For example, they saw a 33% decrease in participants who associated drinking alcoholic beverages daily with no risk, and a 33% increase in those who perceived smoking marijuana regularly as a great risk.
In addition to their evaluation measures, NJPN enthusiastically shares the anecdotal achievements of which they are very proud. “We are finding that participants are developing lasting friendships and support networks,” says Daly. “For example, participants are getting together and creating carpools for their children. That is a wonderful and unexpected outcome.”
Looking toward the future, NJPN plans to further extend its partner network. The grant’s early challenge with recruitment has been replaced by the challenge of continuing to build statewide capacity to meet the needs of all service members and families who wish to seek help through their programs. This increase in program acceptance and interest is a direct result of NJPN’s focus on building a program based on cultural sensitivity and trust. “Establishing those relationships and building that trust-- those are the major accomplishments of the project” says Dr. Hallcom.