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Intro -- Cover -- Titile Page -- Copyright -- Contents -- Preface -- Tables -- Summary -- Acknowledgments -- Abbreviations -- Chapter One: Introduction -- The Purpose of This Report -- How the Report Is Organized -- Chapter Two: Overview of 2013 WWP Alumni Survey, Respondents, and Analysis -- Survey Content -- Survey Administration -- Sample Characteristics -- Selection of Analyses -- Statistical Techniques -- Chapter Three: Mental Health Outcomes -- At Least Half of Alumni Report Mental Health Symptoms and Problems -- Alumni Report Challenges Accessing Mental Health Care and Seeking Help -- Alumni Reporting Mental Health Conditions: Female Alumni and Younger Alumni Report More Difficulties and Delays in Getting Care or Not Getting Care -- Summary -- Chapter Four: Physical Health Outcomes -- Achieving a Healthy BMI Is a Challenge for Over 80 Percent of Alumni -- BMI Is Related to Other Physical Health Outcomes and Perceptions -- Mental and Physical Injuries Are Both Related to Perceptions of Health -- Alcohol Use Is Related to General Self-Reported Health in an Unexpected Way -- Summary -- Chapter Five: Economic Outcomes -- Half of Alumni Are Employed -- Few Alumni Access Employment and Education Benefits -- Type of Injury Is Related to Participation in Employment and Education Benefit Programs -- High VA Disability Ratings and Many Injury Types Are Associated with Unemployment -- Summary -- Chapter Six: Discussion -- Empowering Wounded Warriors in Mind and Spirit -- Empowering Wounded Warriors in Body -- Empowering Wounded Warriors Economically -- Technical Appendix A: Interpretation of Regression Analyses -- Multiple Regression -- Logistic Regression -- Explanatory Variables -- Statistical Significance -- Weighting -- Technical Appendix B: Analyses for Chapter 3 -- Technical Appendix C Analyses for Chapter 4.

Wounded Warrior Project® (WWP) provides support and raises public awareness for service members and veterans who incurred physical or mental injury, illness, or wound coincident to their military service on or after September 11, 2001, as well as their families and caregivers. Through WWP, members (Alumni) have access to programs that support four main areas of recovery—engagement, mind, body, and economic empowerment.

The authors use the Wounded Warrior Project's 2013 survey of its members to understand the physical, mental, and economic challenges that they face.

This article describes RAND Corporation researchers' assessment of SimCoach, a computer program featuring a virtual human that speaks and gestures in a video game–like interface, designed to encourage service members, especially those with signs or symptoms of posttraumatic stress disorder (PTSD) or depression, to seek help to improve their psychological health. The assessment included a formative component assessing SimCoach's design, development, and implementation approaches and a summative component assessing outcomes among participants in a user experience survey and a randomized controlled trial (RCT). Results of the formative evaluation identified both strengths and opportunities for improvement. For example, although SimCoach development processes were well-aligned with best practices for software engineering, SimCoach content development and evaluation processes could have been more tightly coupled to best practices in psychological health. The summative evaluation RCT did not show any SimCoach-related benefit in intent to seek help compared with that of control users not exposed to any intervention. However, secondary outcomes indicated that SimCoach users had satisfying experiences without distress. If SimCoach development is continued, greater attention to clinical processes and outcomes is needed so that the program can have its intended impact on help-seeking for PTSD and depression.

Patient narratives have emerged as promising vehicles for making health care more responsive by helping clinicians to better understand their patients' expectations, perceptions, or concerns and encouraging consumers to engage with information about quality. A growing number of websites incorporate patients' comments. But existing comments have fragmentary content, fail to represent less vocal patients, and can be manipulated to "manage" providers' reputations. In this article, we offer the first empirical test of the proposition that patient narratives can be elicited rigorously and reliably using a five-question protocol that can be incorporated into large-scale patient experience surveys. We tested whether elicited narratives about outpatient care are complete (report all facets of patient experience), balanced (convey an accurate mix of positive and negative events), meaningful (have a coherent storyline), and representative (draw fulsome narratives from all relevant subsets of patients). The tested protocol is strong on balance and representativeness, more mixed on completeness and meaningfulness.

We conducted a simulated clinician-choice experiment, comparing choices and decision-making processes of participants ( N = 688) randomized among four experimental arms: a conventional website reporting only quantitative performance information, a website reporting both qualitative (patient comments) and quantitative information, the second website augmented by a decision aid (labeling of patient comments), and the decision-aided website further augmented by the presence of a trained navigator. Introducing patient comments enhanced engagement with the quality information but led to a decline in decision quality, particularly the consistency of choices with consumers' stated preferences. Labeling comments helped erase the decline in decision quality, although the highest percentage of preference-congruent choices was seen in the navigator arm. Engagement with the quality information and satisfaction with choices available were likewise highest in the navigator arm. Findings held for high- and low-skilled decision makers. Thus, navigator assistance may be a promising strategy for equitably promoting higher quality choices in information-rich contexts.

CHAPTER ONE: Introduction and Purpose -- CHAPTER TWO: Conceptual Model of Influences on a Service Member's Decision to Seek Mental Health Care -- CHAPTER THREE: How Barriers to and Facilitators of Mental Health Care Have Been Measured -- CHAPTER FOUR: Factor Analyses, Item Analyses, and Preliminary Validity of RAND Barriers and Facilitators Banks -- CHAPTER FIVE: How DoD Can Use the RAND Barriers to and Facilitators of Mental Health Care -- APPENDIXES: A. Methods Used to Identify Existing Measures and Develop a Conceptual -- B. Methods Used to Narrow Down the Measures to a Manageable List for -- C. Methods Used to Field-Test the Preliminary Item Pool -- D. Methods Used to Analyze Field-Test Data to Create the Final Item Bank -- E. Methods Used to Develop Options for Utilizing the Item Banks.