The Army represents a discrete cultural group with unique features of language, manners, norms of behavior, and belief systems. Cultural competence, traditionally applied to the treatment of ethnic and racial minorities, is also essential for the ethical treatment of Army personnel. We describe some of the challenges and opportunities that non-veteran civilian psychologists may experience when conducting psychological assessments, treatment, and command consultations in an Army medical treatment facility. In addition, training procedures, including Army cultural exposure experiences, training on relevant regulations, observation of experienced Army psychologists, and mentoring, are recommended to assist civilian psychologists in obtaining the knowledge and skills required for ethical practice.

This article describes a training program for primary behavioral health care (PBHC) for clinical psychology interns. The authors discuss the rationale for integrating mental health into primary care and the need for additional training programs at the predoctoral internship level. A review of relevant literature suggests that effective functioning in primary care requires competence in (a) generalist psychology, (b) health psychology, (c) interdisciplinary team functioning, and (d) skills specific to primary care. The authors advocate for a relatively intensive training program to address these areas. Common intern training difficulties observed during 3 years of program implementation are discussed. Practical, lessons-learned recommendations that address these problem areas provide guidance for others seeking to develop a PBHC training program.A growing body of literature recognizes the potential value of integrating behavioral health services into the primary care arena. Researchers have found that approximately 60% of primary care visits involve some behavioral health need (Cummings, Cummings, & Johnson, 1997). Furthermore, epidemiological research suggests that although 28% of Americans in any given year meet diagnostic criteria for a mental disorder, half of these individuals do not receive any form of treatment. Of those who are treated, approximately half receive specialized mental health treatment, whereas the remaining half receive services solely through their general medical providers (Narrow, Regier, Rae, Manderscheid, & Locke, 1993;Regier et al., 1993). Thus, the existing mental health system provides specialized, intensive services to a minority of individuals with behavioral health problems. The rest receive treatment solely from their physician or receive no behavioral health services whatsoever.Traditional models of mental health care cannot adequately provide services to the large numbers of individuals presenting to primary care clinics with a host of biopsychosocial problems. Consequently, innovative service delivery models capable of providing more comprehensive behavioral health interventions to primary care populations have been developed (

Telehealth has been touted as one solution to the shortage of mental health providers within the military. Despite developing evidence for the equivalence of telehealth mental health care, there is no research that covers the use of telehealth for population mental health screening, a standard component of postdeployment medical screening. This paper summarizes soldier perceptions of three separate screening events in which telehealth was used and the cost-effectiveness of telehealth versus in-person implementations of the same screening. Soldiers who have not been through telehealth screening report a strong preference for in-person screening. Soldiers who have been through telehealth screening still report preference for in-person screening, but they express more ambivalence about the screening method. Using telehealth-only mental health screening for large numbers of soldiers within a compressed time frame is more expensive than in-person screening. Telehealth resulted in higher referral rates than in-person screening. Government and military leaders should use care when making decisions about telehealth implementation. Although telehealth for small numbers may be sufficiently equivalent and economical, there is no evidence of cost savings or improved acceptability for telehealth mental health post-deployment screening.

The Global War on Terrorism and its corresponding frequent and long deployments have resulted in an increase in mental health concerns among active duty troops. To mitigate these impacts, the Department of Defense has implemented postdeployment screening initiatives designed to identify symptomatic soldiers and refer them for mental health care. Although the primary purpose of these screenings is to identify and provide assistance to individuals, macrolevel reporting of screening results for groups can assist Commanders, who are charged with ensuring the wellbeing of their soldiers, to make unit-level interventions. This study assesses the utility of a metatheory of occupational stress, the Soldier Adaptation Model, in organizing feedback information provided to Army Commanders on their units' postdeployment screening results. The results of a combat brigade of 2319 soldiers who completed post-deployment screening following return from Iraq were analyzed using Structural Equation Modeling to assess the Soldier Adaptation Model's use for macrolevel reporting. Results indicate the Soldier Adaptation Model did not strengthen the macrolevel reporting; however, alcohol use and reckless driving were found to mediate the relationship between combat exposure and numerous mental health symptoms and disorders (e.g., post-traumatic stress disorder, anger, depression, anxiety, etc.). Research and practice implications are discussed.