1 State Coordinator TrainingNovember 1 – 4, 2016

2 Session 1: Welcome Talking Points:

3 Session # Welcome The Building Healthy Military Communities (BHMC) pilot aims to better understand unique challenges faced by geographically dispersed Service members and their families that may impact their readiness, resiliency, and well-being. Talking Points: CAPT Elenberg Introduction and welcome

4 Session # Lay of the Land There are index cards on each table for questions. We will be sure to address questions at the end of each day. We will have a “parking lot” for ideas that may be off topic but we want to keep in mind or return to during a later session. The third day is intended for state coordinators and state representatives, though all are invited to intend if desired.

5 Session # Why We Are Here “Our fundamental responsibility to the nation is to be a ready force.” Gen. Joseph F. Dunford Jr., Chairman of the Joint Chiefs of Staff1 Talking Points: DoD News, Defense Media Activity.

6 Session # Why We Are Here Today Where We Are Despite heavy investments in programs supporting the health and well-being of Service members and their families, data suggest the need for increased support and information across well-being domains. Senate Report calls for the execution of a pilot to “ensure enhancement of recruitment, retention, readiness and resilience”.1 There were 121 accident-related injuries per 100 military personnel in FY15. 2 The percent of veterans that believe they are ill-prepared for a financial emergency. 4 1 During today’s training, 1 Service member will take his/her own life. 5 16 During today’s training, the DoD will receive 16 reports of sexual assault. 3 55 121 Talking Points: Despite a multitude of resources, we still see staggering statistics on health and well-being of service members and their families. Our goal is to do something about this. The first statistic comes from the Office of P&R, In FY 2015 we had 1,762,117 accident-related military injuries, 41,965 of these were hospital/quarters lost time related injuries (military members weren't able to work), and 512,337 duty limitations. Looking at the same data by rate, there are 121 injuries per 100 military personnel per year. Transition: While this is a new approach, it is not a new concept. We have looked at this before in the Healthy Based Initiative. What We Can Do We must come together to eliminate inefficiencies, reduce redundancies, and provide the necessary and highest quality of resources to Service members and their families to promote readiness, well-being, and resiliency. Senate Report DoD Suicide Event Report, 2014. DoD Office of Personnel and Readiness. FY 2014 DoD Annual Report on Sexual Assault in the Military. The Importance of Financial Literacy for Veterans.

7 HBI focused on six main areas:Session # History As a predecessor to BHMC, the Healthy Base Initiative (HBI) was a limited demonstration pilot launched in 2013 to promote healthy lifestyles among Service members and their families living on installations. The focus of HBI was on the installation across pilot sites. A major conclusion of HBI was that most military families live off the installation and further coordination and leveraging of resources with adjacent communities is an important component of success when considering the well- being. HBI demonstrated a need to coordinate the DoD’s efforts to move from a system that treats disease to one that promotes well-being. The TFF Capabilities Based Assessment (CBA) was chartered to inform the DoD’s long- term strategy for TFF optimization. The CBA is the initial analysis process designed to identify and validate capability gaps. The CBA aims to identify what current efforts exist in the eight TFF domain areas, what gaps exist, and how the DoD can address those gaps. HBI focused on six main areas:

8 Current State of the ForceData indicates that force readiness is not optimized across many well-being domains Component Physical Financial Psychological Reserve 62.7% are classified as overweight or obese1 13.7% report problems with money constituted the most significant source of stress1 9.9% met screening criteria for Post-Traumatic Stress Disorder1 Active 51.2% are classified as overweight2 17% of spouses report experiencing at least one financial problem in the past 12 months2 9.6% report high depression symptoms2 Component Social Medical/Dental Behavioral Reserve 52 Reserve Members committed suicide in Q1 FY163 Only 47% of personnel were fully medically ready in first quarter, FY104 25% are current smokers1 41% reported being heavy/episodic binge drinkers1 Active 7.9% reported suicidal ideation since joining the military2 23.4% of individuals cited for non-deployment due to illness or medical problems2 11% are current smokers5 33.1% report binge drinking2 Talking Points: Failure to optimize TFF results in sub-optimal force readiness. Data captured on this slide is just a sampling of TFF domain data, additional information will be considered in the CBA. The data captured on this slide is still not a comprehensive review of the challenges faced by service members and their families across TFF domains. There is a lack of data. Transition: For the sake of the pilot, we are looking at readiness through at the individual and community level through the TFF framework. Note: Data above represent a sample of TFF domains; additional information will be considered as the TFF CBA continues. Department of Defense Health Related Behaviors Reserve Component Survey. DoD Quarterly Suicide Report Q RAND Corporation 2011 Department of Defense Health Related Behaviors Survey of Active Duty Military Personnel. 2015 Health Care Survey of DoD Beneficiaries.

9 Public Health in the Military“The science and art of preventing disease, prolonging life, and promoting health through the organized efforts and informed choices of society, organizations, public and private communities, and individuals.” 1 - CEA Winslow Photo: IF Fisher and EL Fisk “As leaders, we must have the knowledge and resources to influence cultural change that best facilitates personal health readiness and creates environments where the healthy choice is the easy choice.” 2 – Patricia Horoho, Lt. Gen., Ret. Former Surgeon General of the U.S. Army, 2015 Adapted from Center for Disease Control, Introduction to Public Health, Public Health 101 Series, Winslow CEA. The untilled field of public health. Mod Med 1920;2:183–91. Army Medical “Health of Force”.

10 Core Functions of Public HealthAssessment Systematically collect, analyze, and make available information on healthy communities Policy Development Promote the use of a scientific knowledge base in policy and decision making Assurance Ensure provision of services to those in need Institute of Medicine. The future of public health. Washington, DC: National Academies Press; 1988. Adapted from Center for Disease Control, Introduction to Public Health, Public Health 101 Series.

11 Partners in Public HealthVehicle for public discourse Health education and promotion Health communication Social media as catalyst Media Employer-sponsored health insurance programs Wellness initiatives and benefits Healthy workplaces and communities Employers and Businesses Government Agencies City planning Education Health in all policies Education Training Research Public Service Academia Adapted from Center for Disease Control, Introduction to Public Health, Public Health 101 Series.

12 Total Force Fitness OverviewTotal Force Fitness (TFF) is a DoD framework for well-being that views “health, wellness, and resilience and as holistic concept”, requiring “a connection among mind, body, spirt, and social relationships”. 1 Main Points2: *TFF was created by the Joint Chiefs of Staff and became policy in 2011. TFF is the DoD’s 21st Century paradigm for improving Population Health, and includes eight domains of fitness. TFF is a state in which the individual, family and organization can sustain well-being and performance under all conditions. The Services are responsible for implementing TFF Programs. TFF requires the collaboration of the partners in public health. Service Members & Families *The 8 domains in blue were the original domains recommended by the Joint Chiefs of Staff. Additional measures, highlighted in gray, are under consideration. 1. Senate Report 2. Chairman of the Joint Chiefs of Staff Instruction (CJCSI)

13 Public Health in the CommunityOptimize Individual Well-Being The ability to physically accomplish all aspects of the mission while remaining healthy and uninjured. Physical Fitness The ability to perform mission-specific duties in any environment. The ability to meet stablished standards for medical readiness. Medical and Dental Fitness The ability to recognize and select the requisite nutrition to sustain and optimize physical and cognitive performance and health. Nutritional Fitness The ability to adhere to beliefs, principles, or values needed to persevere and prevail in accomplishing missions. Spiritual Fitness The ability to effectively cope with the unique mental stressors and challenges associated with mission readiness. The relationship between one's behaviors and health. Behavioral fitness is not simply about avoiding negative behavior; it is also about supporting and affirming positive behavior. Behavioral Fitness The ability to engage in healthy social networks that promote overall well-being and optimal performance - intertwines the individual, unit, family, and community. Social Fitness Environmental Fitness Psychological Fitness Body Mind Enhance Community Well-Being The National Prevention Strategy (NPS) was established in 2011 under Executive Order and the Patient Protection and Affordable Care Act (Public Law ). The NPS works to “…improve the health and quality of life for individuals, families, and communities by moving the nation from a focus on sickness and disease to one based on prevention and wellness.” NPS Strategic Directions The NPS includes four strategic directions that form the foundation for the nation’s preventative health efforts. OLW coordinates community well-being policies and initiatives that support all four directions: Healthy and safe community environments: Health and wellness are influenced by the places in which people live, learn, work, and play Clinical and community preventative services: Evidence- based preventative services are effective in reducing death and disability Empowered people: When people are empowered, they are able to take an active role in improving their health, supporting their families and friends in making healthy choices, and leading community change Elimination of health disparities: Reducing disparities in health will give everyone a chance to live a healthy life and improve the quality of life for all TFF is a methodology for understanding, assessing, and maintaining Service members' well-being and sustaining their ability to carry out missions. TFF was created by the Joint Chiefs of Staff in 2011 (CJCSI ), and expresses that optimal performance requires fitness of the mind and body; OLW coordinates policies and initiatives to support the eight domains of TFF: U.S. Surgeon General. "National Prevention Strategy.“ SurgeonGeneral.gov. U.S. Department of Health and Human Services (HHS), available at:

14 Session 2: Why this Pilot?

15 Problem Statement & BackgroundThe Department of Defense (DoD) lacks a comprehensive plan to improve policies and programs that support the well-being of Service members and their families. There is a limited understanding of differences in well-being outcomes between Active Component (AC) and the Reserve Component (RC), particularly for those that are geographically dispersed. Despite investment in programs supporting Service members, existing data suggest the need for increased support across TFF domains for the geographically dispersed Uniformed Services population.1 To identify and understand any challenges that exist for the geographically dispersed population, S.R calls for the execution of a pilot to “ensure enhancement of recruitment, retention, readiness and resilience”.2 DoD increasingly relies on the RC, consisting of the Guard and the Reserves, due to factors such as decreasing budgets and personnel and funding reductions.3,4 Chairman of the Joint Chiefs of Staff Instruction (CJCSI) Senate Report RAND Corporation, 2008 U.S. Senate Committee on Armed Services

16 Session # Proposed Solution The pilot aims to design a strategic plan to coordinate and integrate existing DoD, federal, state, regional, and local efforts in support of Service members and their families. Intervention 1: Implement a State Coordinator Intervention 2: Promote an Information Campaign Intervention 3: Utilize Mobile Health Technologies to reduce barriers in accessing information and connecting with resources to communicate initiatives and resources to Service members and their families to serve as a lynchpin and develop a data-informed, tactical plan to build strategic relationships and leverage DoD, national, state, and local resources NM Evaluate Baseline: Conduct a Rapid Needs Assessment (RNA) to determine a baseline understanding of available resources and inform the following interventions: The three key interventions aim to coordinate and align a network of resources to support geographically dispersed Service members and their families

17 Reserve Component Breakdown1BHMC Pilot Scope Target Population and Timeframe Target Population Reserve Component Breakdown1 All Service members and their families – both AC and RC – will be invited to leverage the key interventions to connect to available resources in their area. Target sub-populations include: AC and RC living 0-30 miles off installation AC and RC living miles off installation AC and RC living 50+ miles off installation Timeframe The pilot will take place over multiple years to allow sufficient time for meaningful recommendations and measurements. A phased roll-out approach will validate adequate resources and guidance are available for each site. Military OneSource 2014 Demographics Report.

18 Pilot Population BreakdownMilitary OneSource 2014 Demographics Report.

19 Intended Impact Research Objectives Pilot EvaluationSession # Intended Impact The pilot will assess if and how any of the following issues impact well-being, readiness, and resilience: Research Objectives Awareness of resources Access to resources Utilization of resources Priority that Service members place on using resources Motivation of Service members to use resources Saturation due to potential resource redundancies Pilot Evaluation Evaluation of the pilot will be based on the following: Evaluation of the three interventions to assess if they are associated with improvements of identified challenges and gaps. Health Related Quality of Life (HRQoL), a multidimensional concept that “goes beyond the direct measures of health and focuses on the quality-of-life consequences of health status”. 1 Readiness, measured by percent ready to deploy. Healthy People 2020

20 Session 3: Who is Involved?

21 Major Players Session #This organizational chart is tailored and solely for the purpose of training for the BHMC pilot. This chart is not intended to be a comprehensive overview of the DoD structure.

22 Personnel Risk and Resiliency (PRR)Session # Who Are We? Personnel Risk and Resiliency (PRR) Why are we involved in the BHMC pilot? What is our role? PRR oversees, plans, and socializes the BHMC pilot. PRR convenes key stakeholders to gain buy-in and align business processes, initiatives, and plans that inform the TFF framework across the many BHMC pilot workstreams. Who are the principal POCs involved from this organization? Mr. Leonard Litton, Director, PRR CAPT Kimberly Elenberg, Deputy Director, PRR

23 Reserve Component (RC)Session # Who Are We? Reserve Component (RC) Why are we involved in the BHMC pilot? What is our role? The RC includes the Reserves and the Guard across the Services and serves as the target population for the BHMC pilot. Leaders within the RC provide guidance and feedback on the BHMC pilot’s direction. Who are the principal POCs involved from this organization?

24 National Guard Bureau (NGB)Session # Who Are We? National Guard Bureau (NGB) Why are we involved in the BHMC pilot? What is our role? NGB manages the contract for state coordinators and developed the content for this training. NGB also coordinates with state leadership at pilot sites to communicate BHMC pilot updates. Who are the principal POCs involved from this organization? Mr. Anthony Wickham, Chief, J1 Ms. Darla Siegel, Family Programs, J1 LTC Larry Dismore, Chief, Wellness Programs, J1

25 Dr. Patty Deuster, Professor and Scientific Director, CHAMPSession # Who Are We? Uniformed Services University of the Health Sciences (USUHS), Consortium for Health and Military Performance (CHAMP) Why are we involved in the BHMC pilot? What is our role? USUHS/CHAMP is responsible for selecting and implementing the health tracking technology for the BHMC pilot as well as measuring and evaluating BHMC pilot outcomes. Who are the principal POCs involved from this organization? Dr. Patty Deuster, Professor and Scientific Director, CHAMP

26 Military Community & Family Policy (MC&FP)Session # Who Are We? Military Community & Family Policy (MC&FP) Why are we involved in the BHMC pilot? What is our role? Military OneSource (MOS) provides confidential, non-medical counseling for Service members and their families. Each state coordinator will work hand-in-hand with the MOS Consultants in the state to integrate existing resources in support of geographically dispersed Service members and their families. In Minnesota, the MOS consultant will also serve as the state coordinator. Who are the principal POCs involved from this organization? Mr. Ed Brown, Director, Non-medical Counseling Program, MC&FP Ms. Erika Slaton, Program Analyst, Non-medical Counseling, MC&FP

27 Collaborators in Our CommunitySession # Who Are We? Collaborators in Our Community Why are we involved in the BHMC pilot? What is our role? The BHMC pilot has DoD, federal, national, regional, state, and local collaborators across communities that are integral for its success. Examples include: State and Local Public Health Departments Research & Land Grant Universities WIC Locations Community Based Organizations Job Assistance Centers

28 State Coordinator RoleSession # Who Are We? State Coordinator Role Why are we involved in the BHMC pilot? What is our role? The state coordinator role will assist with the RNA, develop key partnerships, and integrate resource networks across their states. The state coordinator role will also help to develop a data-informed strategic plan for their state to address any resource gaps and challenges identified through the RNA. Who are the principal POCs involved from this organization? Mr. Michael Meier (MOS-MN) Ms. Lynn Brannon (FL) Ms. Joy Ashcraft (MD) Mr. Kyle Wood (IN) Ms. Susie Galea (NM) Mr. Tim Hawley (National Project Supervisor) Mr. Rick Tyler (MS) Mr. Lonnie Bacon (OK) Mr. Jason Mathewson (National Multi-media Specialist)

29 Session 4: When & Where is it Happening?

30 Session # Pilot Site Selection State Accreditation Status Reason for Selection FL A Good representation with AC/RC/NG and Services, potential to work with Special Operations Command (SOCOM) community, ethnically diverse population, high density IN High RC (tri-Service), high obesity, low economic status, moderate density, leadership support (MG Wilmot [Deputy Surgeon General, Army National Guard]) MD Local (NCR, close to USU), political support (Senator Mikulski [D-MD]), has diverse demographics and well represented with AC/RC/NG and all Services, supportive leadership in state, high density MN Most mature JCF program with a seasoned coordinator in place, can gain lessons learned, supportive leadership and forward leaning, support of Governor, leadership request from former Chief NGB GEN Grass MS Good representation with AC/RC/NG and Services, high obesity, health disparities, low SES, rural, low availability to internet NM Strong program (one of first to embrace JCF), potential to work with tribal populations, high ethnic diversity, low population density, low SES, high Air Force backing for support and participation OK Oklahoma has a history of strong support and forward-leaning initiatives to support Service members and their families The selected states meet the pre-determined site selection criteria, including strong leadership commitment and representation of multiple Services from both the AC and the RC. The sites also vary in terms of demographic data and geographic location. Talking Points: Awaiting accreditation blurb *Indicates whether or not state has completed Family Assistance Center (FAC) accreditation process, run by NGB.

31 Pilot Timeline Begin RNA Visits (1/09) Evaluate 11/1- 11/4 DevelopContinuous evaluation of key interventions 11/1- 11/4 State Coordinator Training Develop Key Interventions based on findings from the RNA Review Ongoing review of Quarterly Reports from State Coordinators and adjustment of interventions as needed November2 016 2017 June Plan Select Pilot States Plan RNA Assess Outcome Measures Execute Tailored interventions based on the findings from the RNA Complete RNA Visits (4/28) RNA Timeline: Feb 27 – Mar 3, Oklahoma Jan 09 – 13, Maryland Mar 13 – 17, Florida Jan 23 – 27, New Mexico Mar 27 – 31, Indiana Feb 6 – 10, Mississippi Apr 24 – 28, Minnesota

32 Session 5: How is it being done?

33 How Are We Doing it? Outcomes Execute RNA Tailor Interventions MeasureSession # How Are We Doing it? Pilot Process Execute RNA The RNA will be conducted in each pilot site to determine a baseline assessment of available resources. Results of the RNA will inform and tailor the three interventions through the development of a data-informed strategic plan designed to coordinate resources and address gaps in existing resources within each pilot site. Tailor Interventions Based on the gaps found in the RNA, the interventions will be tailored to fit the needs of Service members and their families in each pilot site. The interventions will be periodically assessed and revised, depending on results and outcomes. The pilot will be evaluated by process and outcome measures. Process measures will assess if the pilot increased efficiencies in resource access and navigation. Outcome measures will assess Health Related Quality of Life (HRQoL) and % ready to deploy. Outcomes Measure & Review Outcomes

34 Tampa/St. Petersburg, FL AreaWhere Are We Going? Using the DoD’s Defense Installations Spatial Data Infrastructure (DISDI) Atlas tool, the BHMC pilot team identified regions of interest in each pilot site by mapping population density of Service members and their families and relevant DoD assets. The graphics below highlight one of the selected areas from each pilot site. Duluth, MN Area Terre Haute, IN Area Annapolis, MD Area Oklahoma City, OK Area Las Cruces, NM Area Gulfport, MS Area Tampa/St. Petersburg, FL Area

35 Travel Schedule and LocationsSession # Travel Schedule and Locations Pilot Site Dates Locations Maryland Monday, January 9 – Friday, January 13 Baltimore, Annapolis, Patuxent River, Cumberland New Mexico Monday, January 23 – Friday, January 27 Albuquerque, Santa Fe, Clovis, Las Cruces Mississippi Monday, February 6 – Friday, February 10 Memphis, TN outskirts, Jackson, Hattiesburg, Biloxi/Gulfport Oklahoma Monday, February 27 – Friday, March 3 Oklahoma City, Fort Sill, Tulsa Florida Monday, March 13 – Friday, March 17 Jacksonville/St. Augustine, Pensacola, Tampa, Orlando* Indiana Monday, March 27 – Friday, March 31 Indianapolis, Terre Haute, Gary, Fort Wayne Minnesota Monday, April 24 – Friday, April 28 Minneapolis/St. Paul, Rochester*, Mankato*, Little Falls, Duluth *Locations are tentative depending on travel schedules. All dates were selected based on federal holidays.

36 Session # Who Are We Meeting With? As a starting point, the BHMC pilot team used the DISDI tool to provide a regional map of DoD assets and military population density. Below is an example from Duluth, MN. Legend The DISDI tool provided an extensive list of DoD assets, but the pilot team recognizes that true community capacity building relies on a blend of varying types of resources.

37 Map and Identify Key PartnersSession # Engaging Community Partners To conduct a thorough environmental scan of existing resources in each pilot area, the BHMC pilot team aims to meet with local community partners and organizations in addition to DoD assets. The pilot team is leaning on existing relationships and targeted outreach to leverage points of contact within each pilot site. Map and Identify Key Partners Services 1 Map installations across the Services in each pilot site, with a focus on the Reserve and Guard. DoD State Liaisons & Community Partners C Leverage existing and new partnerships with state policymakers, local organizations, business leaders, and other influential partners. Adjutant Generals(TAGs) B Identify state partnerships to engage key leaders across the pilot site. A Prioritize Partnerships For each pilot site, prioritize the key partnerships to pursue first based on stakeholder influence and impact on the RNA. 2 Create an asset map for each pilot site to visually capture partners and existing resources Engage Stakeholders Set up meetings and facilitate discussions with identified stakeholders to gather information on existing resources, challenges and gaps, and understanding of readiness. 3

38 Session # What Are We Asking? Goal: The interviews will seek to find common information from three groups of primary sources, which will lead to a saturation point of information regarding readiness and the availability of resources that impact the TFF domains. For Unit Leadership What are your challenges? What does an optimally “ready” SM in your unit look like? What factors are preventing those SM from being optimally ready? What key factors are affecting readiness in your unit? What do you use to monitor readiness? Resource/Program Managers What is the name, description, and purpose of program? Who was your program designed to help? Who do you actually serve? How do participants find your program? Are there specific eligibility criteria required to enter the program? For Recruiters/Retention Officers Which recruits are successful? Which don’t make it? What are those reasons? What can be done about it? What incentives work for recruiting? For the BHMC pilot, saturation is the stage at which no new information is able to gathered, regardless of the source.

39 Session 6: Resource Eligibility

40 Resource Eligibility by TitleService members and their families are eligible for different benefits and resources (ex: education assistance, TRICARE, employment assistance, etc.) depending upon their title status. What is a Title? The United States Code is a classification system that, among other things, describes benefits available to Service members and their families. Generally, Service members fall under the following titles: Title 10 references those falling within Active Duty, including those that are called up to Active Duty. Title 32 refers to National Guard members. Title 5 provides definitions of all government entities and employees, including the status of veterans, reservists, and active duty members of Uniformed Services, which include the Armed Services, the Commissioned Corps of the United States Public Health Service (USPHS), and the Commissioned Corps of the National Oceanic and Atmospheric Association (NOAA). Title 42 deals with public health, social welfare, and civil rights. It references the USPHS. Each member falling under a particular title (10, 32, 5, 42) is eligible for varying services that promote health and well-being. There are resources, some of which are outlined below, that are available to determine eligibility for each Service member. Military OneSource and Benefits.gov outline national, federal, state, and/or local resources for which Service members and their families may qualify. 1. United States Code 2. NGAUS Fact Sheet.

41 Eligibility Example: National GuardSession # Eligibility Example: National Guard A National Guard member is seeking resources on tax assistance. He works a 9-5 job, and lives in a suburban area. NEED Title 10 - Active Duty Military Member and Families Title 32 - National Guard/Reserve Member and Families Title 42 - United States Public Health Service Member and Families Title 5 Federal Employee and Families GROUPS Is the Service member eligible for resources at Military OneSource, a local installation, or other federal resources? Are the resources on the local installation accessible? (For this scenario, is the resource open on the weekends? Is it near public transportation?) Is the resource affordable? Is the resource easy to use? Is there a reason the Service member may choose to not use a resource on the installation? (i.e., is there a stigma?) ELIGIBILITY & CONSIDERATIONS RESOURCE SUPPORT Community Resources Military One Source May refer to one another Local Installation MOS and/or local installation may refer member to community resource. MEETING THE NEED Though eligible for MOS services and resources on a nearby installation1, MOS referred this Service member to a community resource, due to accessibility during the weekend and proximity to this Service member’s location. Military OneSource. Eligibility.

42 Eligibility Example: USPHSSession # Eligibility Example: USPHS A USPHS member is seeking resources on tax assistance. He works a 9-5 job, and lives in a suburban area. NEED Title 10 - Active Duty Military Member and Families Title 32 - National Guard/Reserve Member and Families Title 42 - United States Public Health Service Member and Families Title 5 - Federal Employee and Families GROUPS Is the Service member eligible for resources through Military One Source or other federal resources? Are national and/or local resources accessible? (For this scenario, is the resource open on the weekends? Is it near public transportation?) Is the resource affordable? Is the resource easy to use? Is there a reason the Service member may choose to not use a resource on the installation? (i.e., is there a stigma?) ELIGIBILITY & CONSIDERATIONS RESOURCE SUPPORT Federal Occupational Health May refer to outside resource Community Resource USPHS members do not qualify for MOS services1. However, USPHS can utilize the FOH program which contains free financial services if provided in-house. FOH may refer members to a community resource at a cost to the member if they are not able to address the issue2. MEETING THE NEED Military OneSource. Eligibility Federal Occupational Health (FOH)

43 Eligibility Example: Federal EmployeeSession # Eligibility Example: Federal Employee A Department of Commerce employee is seeking resources on tax assistance. He works a 9-5 job, and lives in a suburban area. NEED Title 10 - Active Duty Military Member and Families Title 32 - National Guard/Reserve Member and Families Title 42 - United States Public Health Service Member and Families Title 5 - Federal Employee and Families GROUPS Is the federal employee eligible for resources through Military One Source or other federal resources? Are national and/or local resources accessible? (For this scenario, is the resource open on the weekends? Is it near public transportation?) Is the resource affordable? Is the resource easy to use? Is there a reason the Service member may choose to not use a resource on the installation? (i.e., is there a stigma?) ELIGIBILITY & CONSIDERATIONS RESOURCE SUPPORT Department of Commerce Employee Assistance Program (EAP) Vendor Contracting with Department of Commerce MEETING THE NEED Department of Commerce employees do not qualify for military resources, but can receive free financial assistance through a vendor that contracts with the Department of Commerce to address the need. The vendor may also provide referrals in the local community, which may come at a cost to employees1. U.S. Department of Commerce

44 What Can You Do? Session #Although a plethora of resources exist to support Service members and their families with a variety of issues impacting well-being, readiness, and resilience, there is no single person that is examining the needs of a particular state population and comparing it the resources available to meet those needs. The State Coordinator will fill this role by assessing the needs of the population, looking across resources and programs supporting Service members and their families, and identifying gaps and/or redundancies. This information will inform a comprehensive, data-driven, strategic plan for targeted community capacity building. Military OneSource. Eligibility.

45 Session 10: What is Success for the State Coordinator?

46 BHMC Pilot State Coordinator RoleTo be successful, the BHMC Pilot State Coordinator will identify and address gaps in resources in order to support well-being, readiness, and resilience of Service members and their families. Key Responsibilities Assist with conducting a rapid needs assessment (RNA) in partnership with the BHMC pilot team to assess the current resources available within a state or territory and identify existing gaps Coordinate the needs assessments, metrics, and best practices Gather/analyze information regarding the issues affecting Service members and their families Integrate networks by connecting Service members to federal, state, and local resources Coordinate with state leadership to develop an outreach strategy model that addresses gaps and integrates capacity building assets Develop key partnerships to improve coordination on the state and local level Support strategic initiatives through the integration of community, state, and federal resources Recommend program improvements and submit an annual report on State programs Implement strategic communication initiatives and projects to increase understanding and access to resources Inform the strategic plan for the pilot way ahead, including supporting the development and implementation of a strategic communications plan to market programs and initiatives that support Service members and their families

47 Intended Impact Session #The pilot will assess if and how any of the following issues impact well-being, readiness, and resilience: Research Objectives Awareness of resources Access to resources Utilization of resources Priority that Service members place on using resources Motivation of Service members to use resources Saturation due to potential resource redundancies Evaluation of the pilot will be based on the following: Pilot Evaluation Evaluation of the three interventions to assess if they are associated with improvements of identified challenges and gaps. Health Related Quality of Life (HRQoL), a multidimensional concept that “goes beyond the direct measures of health and focuses on the quality-of-life consequences of health status”. 1 Readiness, measured by percent ready to deploy. Healthy People 2020

48 Session 16: State Overviews & Breakouts48

49 RNA Planning Process Overview30 Minutes The BHMC pilot team has gone through an extensive planning process to prepare for the RNA in each pilot site. State Coordinator involvement is requested in the areas highlighted in red.

50 Comprehensive ecosystem ofRNA Planning – Research Resources After using the DISDI tool to select the pilot sites by population density and DoD assets, the pilot team researched community resources in the area to provide a comprehensive ecosystem of well-being offerings available to Service members and their families. Comprehensive ecosystem of well-being resources + = The map on the left shows the population density of Service members and DoD resources in Jackson, Mississippi. The map on the right provides a comprehensive overview of all well-being resources available, based on the pilot team’s research.

51 RNA Planning – Prioritize ResourcesThe pilot team prioritized the resources to visit based on resource type, TFF domain coverage, location, and feedback from key stakeholders.

52 RNA Planning – State SnapshotsState snapshot (printed) walkthrough The pilot team created state snapshots to provide an overview of each state, including information regarding the population, culture, and current events for the interview teams to prepare for travel.

53 Feedback Breakout SessionRNA Planning – Feedback Breakout Session In small groups, please review the resource list for your state and provide feedback: Are there any resources missing from the list? Are there any groups or types of resources missing? Are there people missing from the list? Do you know of any POCs for the listed resources? Are there any resources on the list that should be removed or replaced? 30 Minutes

54 Break (15 minutes)

55 RNA Interview Questions (Dr. Libretto)30 minutes presentation, 30 minutes review/answering of questions

56 Appendix

57 Pilot Way Ahead Major Milestones Finalize pilot plan:Mid - Aug Conduct survey and analysis of available data Aug - Dec 2016 – Coordinate planning for rapid “needs assessment” visits. Jan Apr Conduct rapid needs assessment May Deliver a final report on the pilot June Formulate a cohesive strategic plan informed by the RNA final report Summer Begin execution with DoD, cross-agency, and regional/state/local stakeholders

58 Total FAC Quick Tracker ContactsNational Guard Family Assistance Centers Quick Tracker visits form a network of approximately 500 points of access across 54 States and Territories.1 FAC Quick Tracker Use by Branch FY11 FY12 FY13 FY14 AIR FORCE (Total) 18,524 23,746 29,296 35,815 Active 2,889 1,734 8,603 15,070 Reserve 1,984 3,810 1,731 1,187 National Guard 13,651 18,202 18,962 19,558 ARMY (Total) 2,257,042 2,665,099 2,694,198 3,638,059 10,546 5,099 24,904 56,626 16,364 19,796 69,209 86,321 2,230,132 2,640,204 2,600,085 3,495,112 COAST GUARD (Total) 771 3,142 3,573 5,635 736 3,108 2,969 5,274 35 34 604 361 MARINE CORPS (Total) 6,398 13,612 23,994 23,623 2,758 1,292 14,091 12,221 3,640 12,320 9,903 11,402 NAVY (Total) 12,883 9,994 19,930 32,800 2,951 2,376 9,043 22,326 9,932 7,618 10,887 10,474 NOAA 286 51 1,388 77 USPHS 21 1. National Guard Bureau. NGB FAC Data Set

59 Maryland Session # 1 2 Baltimore, MD 2 Jan 10 – 12 1 Cumberland, MD3 4 Annapolis, MD Jan 12 3 Pax River, MD Jan 13 4

60 State Profile: MarylandRepresentation of the AC Population: Army, Navy, Air Force Representation of the RC Population: Army, Navy, Marine Corps Population size: 5,976,4074 Geographic size: 9, square miles4 Mean travel time to work: 32.2 minutes4 Population Density: persons per square mile (5th overall)5 Urban: 96%5 Rural: 4%5 Lives in household with high-speed internet use: 83.4%6 Geographic Dispersion TRICARE Region: North Total DEERS population: 96,7923 28,100 Active Duty (2.4% total US AD)1 18,136 Select Reserve (2.3% of total US SR)1 50.3% Female4 Per capita income: $36,3544 Obesity Rate: 29.6%4 White: 52.6%4 Hispanic or Latino: 9.3%4 Black or African American: 30.3%4 American Indian: 0.6%4 Asian: 6.4%4 Native Hawaiian: 0.1%4 Two or more Races: 2.6%4 Demographic Data Key State Initiatives: Partners in Care 6 cities with Family Assistance Centers: Townson, Havre de Grace, Hagerstown, Baltimore, Annapolis, Salisbury 99 JCF Family Support Contacts listed online 203 JCF Family Support Resources offered online Has Service Members and dependents from all services Ranks 11th in total DEERS population Congressional support Military installations include:1,2 Fort Meade Fort Detrick Andrews AFB NAS Patuxent River Maturity of the JCF Model Military Community & Family Policy Military Authority National Guard Bureau, 2015. U.S. Census Bureau. Quick Facts 2014 U.S. Census Bureau. State and Local Census Geography File, Thom and Camille Ryan

61 New Mexico Session # 1 3 Santa Fe, NM Clovis, NM Jan 23 Jan 26 1 2 3 2Albuquerque, NM Jan 24 – 25 2 4 Las Cruces, NM Jan 27 4

62 State Profile: New MexicoSession # State Profile: New Mexico Representation of the AC Population: Air Force, Army Representation of the RC Population: Air Force, Army Population : 2,085,5724 Geographic: 121, square miles4 Mean travel time to work: 21.7 minutes4 Population Density: 17 persons per square mile (45th overall)5 Urban: 75%5 Rural: 25%5 Lives in household with high-speed internet use: 68.1%6 Geographic Dispersion TRICARE Region: West Total DEERS population: 46,5773 12,111 Active Duty (1.1% total US AD)1 5,126 Select Reserve (0.6% of total US SR)1 50.3% Female4 Per capita income: $23,7634 Obesity Rate: 28.4%4 White: 38.9%4 Hispanic or Latino: 47.7%4 Black or African American: 2.5%4 American Indian: 10.4%4 Asian: 1.7%4 Native Hawaiian: 0.2%4 Two or more Races: 2.5%4 Two or more Races: 2.6%4 Demographic Data Key State Initiatives: New Mexico Veteran and Family Support Services National Guard Family Readiness Program 6 cities with Family Assistance Centers: Albuquerque, Las Cruces , Roswell, Las Vegas, Santa Fe, Rio Rancho Highest number of Air NG and dependents, ranks 6th in total DEERS population 89 JCF Family Support Contacts listed online 151 JCF Family Support Resources offered online Military installations include:1,2 White Sands Missile Range Cannon AFB Holloman AFB Kirtland AFB Maturity of the JCF Model Military Community & Family Policy Military Authority National Guard Bureau, 2015. U.S. Census Bureau. Quick Facts 2014 U.S. Census Bureau. State and Local Census Geography File, Thom and Camille Ryan

63 Mississippi Session # 1 1 Memphis (Metro Area), TN Feb 6 3Hattiesburg, MS Feb 9 2 2 3 Jackson, MS Feb 7 – 8 4 Biloxi, MS Feb 10 4

64 State Profile: MississippiSession # State Profile: Mississippi Representation of the AC Population: Air Force, Army, Navy Representation of the RC Population: Air Force, Army Population size: 2,994,0794 Geographic size: 46, square miles4 Mean travel time to work: 24 minutes4 Population Density: 63.2 persons per square mile (32nd overall)5 Urban: 46%5 Rural: 54%5 Lives in household with high-speed internet use: 62.3%6 Geographic Dispersion TRICARE Region: South Total DEERS population: 49,3263 11,322 Active Duty (1% total US AD)1 16,833 Select Reserve (2.1% of total US SR)1 51.4% Female4 Per capita income: $20,6184 Obesity Rate: 35.5%4 White: 57.3%4 Hispanic or Latino: 3%4 Black or African American: 37.5%4 American Indian: 0.6%4 Asian: 1%4 Native Hawaiian: 0.1%4 Two or more races: 1.2%4 Demographic Data Key State Initiatives: Mississippi Veterans Affairs Board 3 cities with Family Assistance Centers: Jackson, Starkville, Camp Shelby 109 JCF Family Support Contacts listed online 119 JCF Family Support Resources offered online Military installations include:1,2 Camp Shelby Columbus AFB Gulfport NCBC Keesler AFB NAS Meridian NAVSTA Pascagoula Maturity of the JCF Model Military Community & Family Policy Military Authority National Guard Bureau, 2015. U.S. Census Bureau. Quick Facts 2014 U.S. Census Bureau. State and Local Census Geography File, Thom and Camille Ryan

65 Oklahoma Session # 3 Tulsa, OK Mar 2 – 3 3 1 2 1 Oklahoma City, OK 2Feb 27 – 28 1 2 Fort Sill, OK Mar 1

66 State Profile: OklahomaRepresentation of the AC Population: Air Force, Army Representation of the RC Population: Air Force, Army Population : 3,911,3384 Geographic size: 68, square miles4 Mean travel time to work: 21.2 minutes4 Population Density: 54.7 persons per square mile (35th overall)5 Urban: 59%5 Rural: 41%5 Lives in household with high-speed internet use: 85.8%6 Geographic Dispersion TRICARE Region: South Total DEERS population: 67,2853 19,643 Active Duty, 1.7% total US AD)1 13,914 Select Reserve (1.7% of total US SR)1 50.5% Female4 Per capita money income: $24,6954 Obesity Rate: 33%4 White: 75.1%4 Hispanic or Latino: 9.8%4 Black or African American: 7.7%4 American Indian: 9.0%4 Asian: 2.1%4 Native Hawaiian: 0.2%4 Two or more Races: 5.9%4 Demographic Data Key State Initiatives: Honoring America’s Warriors Horseback Heroes 9 cities with Family Assistance Centers: Oklahoma City, Norman, McAlester, Enid, Stillwater, Mustang, Broken Arrow, Tulsa, Fort Sill 96 JCF Family Support Contacts listed online 143 JCF Family Support Resources offered online Military installations include:1,2 Altus AFB Fort Sill Tinker AFB Vance AFB CG Institute Maturity of the JCF Model Talking Military Community & Family Policy Military Authority National Guard Bureau, 2015. U.S. Census Bureau. Quick Facts 2014 U.S. Census Bureau. State and Local Census Geography File, Thom and Camille Ryan

67 Florida Session # 2 Jacksonville, FL Mar 13 – 14 5 2 1 5 Pensacola, FLSt. Augustine, FL Mar 13 4 3 Tampa, FL Mar 15 – 16 3 Orlando, FL Mar 16 4

68 State Profile: FloridaRepresentation of the AC Population: Air Force, Army, Marine Corps, Navy Representation of the RC Population: Air Force, Army, Marine Corps, Navy Population: 19,893,2974 Geographic size: 53, square miles4 Mean travel time to work: 26.1 minutes4 Population Density: persons per square mile (8th overall)5 Urban: 96%5 Rural: 4%5 Lives in household with high-speed internet use: 78.3%6 Geographic Dispersion TRICARE Region: South Total DEERS population: 179,6953 60,095 Active Duty (5.2% total US AD)1 36,488 Select Reserve (4.5% of total US SR)1 51.1% Female4 Per capita money income: $26,2364 Obesity Rate: 26.2%4 White: 55.8%4 Hispanic or Latino: 24.1%4 Black or African American: 16.8%4 American Indian: 0.5%4 Asian: 2.8%4 Native Hawaiian: 0.1%4 Two or more Races: 2.0%4 Demographic Data Key State Initiatives: Florida Military Family and Community Covenant Florida Guard Family Career Connections 10 cities with Family Assistance Centers: Plant City, Starke, Camp Blanding, Orlando, Eustis, Pinellas Park, Bradenton, Miami, Panama City, West Palm Beach 97 JCF Family Support Contacts listed online 259 JCF Family Support Resources offered online Military installations include:1,2: Camp Blanding NG Eglin AFB Hurlburt Field Macdill AFB NAS Jacksonville Maturity of the JCF Model Military Community & Family Policy Military Authority National Guard Bureau, 2015. U.S. Census Bureau. Quick Facts 2014 U.S. Census Bureau. State and Local Census Geography File, Thom and Camille Ryan

69 Indiana Session # 4 Indianapolis, IN Mar 27 – 28 1 Gary, IN Mar 31 4 3Fort Wayne, IN Mar 30 3 Terre Haute, IN Mar 29 2

70 State Profile: IndianaRepresentation of the AC Population: Army, Air Force, Navy Representation of the RC Population: Army, Marine Corps, Navy Population: 6,596,8554 Geographic Size: 35, square miles4 Mean travel time to work: 23.3 minutes4 Population Density: 181 persons per square mile (16th overall)5 Urban: 74%5 Rural: 26%5 Lives in household with high-speed internet use: 75.3%6 Geographic Dispersion TRICARE Region: West Total DEERS population: 32,6553 815 Active Duty (0.1% of total US AD)1 19,885 Select Reserve (2.5% of total US SR)1 50.7% female4 Per capita income: $24,6354 Obesity Rate: 32.7%4 White: 80.3%4 Hispanic or Latino: 6.6%4 Black or African American: 9.6%4 American Indian: 0.4%4 Asian: 2%4 Native Hawaiian: 0.1%4 Two or more races: 1.9%4 Demographic Data Key State Initiatives: The Military Family Research Institute at Purdue University (funded by the DoD) Joining Community Forces-Indiana (NG, MFRI) 13 cities with Family Assistance Centers: Indianapolis, Muncie, Linton, Evansville, Fort Wayne, Columbus, Indianapolis, Kokomo, Lafayette, New Albany, Edinburgh, Gary, Crawfordsville 105 JCF Family Support Contacts listed online 175 JCF Family Support Resources offered Military installations include:1,2 Grissom ARB DFAS Indianapolis Center Fort Benjamin Harrison NSWC Crane Division Maturity of the JCF Model Military Community & Family Policy Military Authority National Guard Bureau, 2015. U.S. Census Bureau. Quick Facts 2014 U.S. Census Bureau. State and Local Census Geography File, Thom and Camille Ryan

71 Minnesota Session # 4 Duluth, MN Apr 28 1 Minneapolis / St. Paul, MN 43 Little Falls, MN Apr 27 3 1 Rochester / Mankato, MN Apr 26 2 2

72 State Profile: MinnesotaRepresentation of the AC Population: Air Force, Army, Navy Representation of the RC Population: Air Force, Army, Navy Population size: 5,457,1734 Geographic size: 79, square miles4 Mean travel time to work: 23 minutes4 Population Density: 66.6 persons per square mile (31st overall)5 Urban: 74%5 Rural: 26%5 Lives in household with high-speed internet use: 82.6%6 Geographic Dispersion TRICARE Region: West Total DEERS population: 30,3873 466 Active Duty (less than 0.1% total US AD)1 18,852 Select Reserve (2.3% of total US SR)1 50.3% Female4 Per capita income: $27,5234 Obesity Rate: 27.6%4 White: 81.4%4 Hispanic or Latino: 5.1%4 Black or African American: 5.9%4 American Indian: 1.3%4 Asian: 4.7%4 Native Hawaiian: 0.1%4 Two or more Races: 2.3%4 Demographic Data Key State Initiatives: Beyond the Yellow Ribbon 10 cities with Family Assistance Centers: Saint Paul, Mankato, Marshall, Little Falls, Rosemont, Detroit Lakes, Bemidji, Rosemount, Duluth, Brooklyn Park 104 JCF Family Support Contacts listed online 171 JCF Family Support Resources offered online No active duty installations Developed program to certify JCF communities – serves as model program with strong state support Military installations include:1,2 Fort Snelling Maturity of the JCF Model Military Community & Family Policy Military Authority National Guard Bureau, 2015. U.S. Census Bureau. Quick Facts 2014 U.S. Census Bureau. State and Local Census Geography File, Thom and Camille Ryan

73 Pertinent Layers on DoD DISDI ToolThe BHMC Pilot Team selected relevant resources available in the DISDI mapping tool that would strategically inform the RNA in the pilot sites. World Wide DoD Sites Personnel and Communities Data USAF (Guard and Reserve) 2014 DoD Demographics USA (Guard and Reserve) Total Personnel by State USMC (Reserve) Veteran’s Affairs Facilities USN (Reserve) Benefits Admin Regional Offices US Coast Guard Sites Community Based Outpatient Clinics Joint Bases and Operation Centers Independent Outpatient Clinics Emergency Services Residential Rehab Treatment Program Locations Fire Stations Hospitals VA Hospitals Urgent Care Centers Veterans Centers Police Stations Vocational Rehab and Employment Locations Emergency Medical Services Military Family Member Population and Population Density Hurricane Evacuation Routes American Red Cross Headquarters and Chapters Commissaries Federal Lands and Indian Reservations Contract Services US County and State Boundaries DoD Childcare Centers ESRI USA Unemployment Rate Family Assistance Centers Medical Facilities Tricare Facilities Public Schools on Installations

74 BHMC Pilot Population Breakdown Size & Demographic by RankMilitary OneSource 2014 Demographics Report.

75 BHMC Pilot Population Breakdown Martial StatusThe majority of the Reserve Component is unmarried, either never married or divorced. *Includes annulled, widowed, and unknown cases. Note: Percentages may not total to 100 due to rounding. Military OneSource 2014 Demographics Report.

76 BHMC Pilot Population Breakdown Family SizeThe total DoD ratio of Selected Reserve Member to family members is 1 to 1.3. *Selected Reserve members include both married and single members. ** Family members include spouses, children, adult dependents under age 21 who are not spouses or children. Note: Percentages may not total to 100 due to rounding. Military OneSource 2014 Demographics Report.

77 Sources Army Medical Releases ‘Health of Force’ Report Card https://www.army.mil/article/160206 A National Veterans Strategy: The Economic, Social and Security Imperative. Prepared by: Institute for Veterans and Military Families, Syracuse University and Institute for National Security and Counterterrorism, Syracuse University Benefits.gov Benefits Finder. Benefits.gov/benefits/benefit-finder#benefits&qc=cat_1. Center for Disease Control, Introduction to Public Health, Public Health 101 Series. Chairman of the Joint Chiefs of Staff Instruction (CJCSI) “Chairman’s Total Force Fitness Framework.” 01 September 2011. Department of Defense Health Related Behaviors Reserve Component Survey – Defense Lifestyle Assessment Program (DLAP). July Prepared by RTI International. Department of Defense Health Related Behaviors Survey of Active Duty Military Personnel, Feb Prepared by RTI International. Department of Defense Overview: Fiscal Year 2014 Department of Defense Annual Report on Sexual Assault in the Military. Department of Defense Quarterly Suicide Report. Calendar Year 2016, 1st Quarter. Defense Suicide Prevention Office (DSPO). Department of Defense Suicide Event Report (DoDSER), 2014 Annual Report. National Center for Telehealth & Technology (T2), Defense Centers for Excellence for Psychological Healthy & Traumatic Brain Injury. Department of Veterans Affairs “Free tax return preparation for Veterans, military members and their families.” Official Blog of the U.S. Department of Veterans Affairs. DoD News, Defense Media Activity. Dunford Sends Message to Joint Force, Stresses Readiness, Warfighting, Education. File, Thom and Camille Ryan. Computer and Internet Use in the United States: 2013, American Community Survey Reports. U.S. Census Bureau https://www.census.gov/history/pdf/2013computeruse.pdf Healthy People Foundation Health Measure Report, Health-Related Quality of Life and Well-Being. November. Health Care Survey of DoD Beneficiaries 2010. https:/www.healthypeople.gov/sites/default/files/HRQoLWBFullReport.pdf The Henry J. Kaiser Family Foundation. Population Distribution by Metropolitan Status The Importance of Financial Literacy for Veterans, Joining Community Forces (JCF). Our Mission. https://www.jointservicessupport.org/communityforces/ National Guard Bureau. FAC Visits Data Set National Guard Fact Sheet. Memorandum: Public-Private Partnerships Supporting the DoD Mission. 25 April

78 Sources Military Authority. Military Bases by State. Military OneSource. http.militaryonesource.mil Military OneSource Demographics Report, September 2014. Military OneSource Eligibility. National Guard Bureau. Data Compiled by LTC Larry Dismore.18 Dec 2015 Military Community & Family Policy. Demographics Profile of the Military Community Httm://download.militaryonesource.mil/12038/MOS/Reports/2014-Demographics-Report.pdf Military Medicine. Program Evaluation of Total Force Fitness Programs in the Military. 175, 8:103. (2010). RAND Corporation. National Defense Research Institute. Deployment Experiences of Guard and Reserve Families: Implications for Support and Retention RAND Corporation. Improving Medical and Dental Readiness in the Reserve Components Senate Report – Department of Defense Appropriations Bill, th Congress ( ) https://www.congress.gov/congressional-report/114/senate-report/63 U. S. Census Bureau. Quick Facts U.S. Census Bureau. State and Local Census Geography https://www.census.gov/geo/reference/geoguide.html U.S. Code. U.S. Publishing Office. https://www.gpo.gov/fdsys/browse/collectionUScode.action?collectionCode=USCODE U.S. Code Title 10 Subtitle A – General Military Law. https://www.law.cornell.edu/uscode/text/10/subtitle-A U.S. Department of Commerce. Employee Assistance Program (EAP). U.S. Department of Defense. Defense Health Agency. TRICARE Eligibility. U.S. Department of Health and Human Services. Federal Occupational Health. Financial & Legal Services. United States Senate Committee on Armed Services. “Senate Armed Services Committee Completes Markup of National Defense Authorization Act for Fiscal Year 2016.” U.S. Surgeon General. "National Prevention Strategy.“ SurgeonGeneral.gov. U.S. Department of Health and Human Services (HHS), available at: