Running Head: MILITARY YOUTH & YOUNG ADULT RESILIENCY 1

Military Youth & Young Adult Resiliency

Kaylee B. Grant, Kami N. Kramer, Amber L. Michael, Claire E. Palmatier, Leanne R. Pizzi, Molly C.

Quinlan, Amber L. Reichardt, Julia L. Riopelle, and Maureen F. Rose

University of Anchorage Alaska

MILITARY YOUTH & YOUNG ADULT RESILIENCY

Abstract

Nursing students formulated the Military Youth and Young Adult Resiliency program to promote

resiliency in an emerging adult military associated population. This population exhibits high-risk

behaviors leading to poor health outcomes. Assessment included a literature review, key informant

presentations, and a questionnaire. Results documented need for resiliency training focused on coping

skills. Training was given to 28 JROTC members using discussion, interactive activities, and distribution

of community resource cards. Evaluation questionnaire showed improvement in identification of positive

coping skills and community resources, as well as self-promotion of resiliency. Intervention had a

positive impact on participants and improved self-perception of resiliency.

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Military Youth & Young Adult Resiliency

During the spring of 2015, students of the University of Anchorage, Alaska (UAA) School of

Nursing (SON) partnered with the Alaska Army National Guard (ANG) and Colony High School Junior

Reserve Officers' Training Corps (JROTC) for their Community Health Promotion Project. Both federal

and state governments fund the ANG, while JROTC is funded by the Department of Defense and local

school districts (State of Alaska, 2013; Establishing a JROTC program, n.d.). To help military service

members and their families deal with the challenges of military life, the United States (US) Military

developed numerous support trainings and resources focused on resilience, domestic violence, bystander

awareness and much more (Ready and Resilient, n.d.). As explained by Sergeant 1st Class Diane Singh

of the ANG, what is missing from these offerings is a training focused on the normalization of adversity

in daily life combined with identification of coping skills (personal communication, January 21, 2015).

To meet this need, we developed the Military Youth & Young Adult Resiliency Program (MYYARP).

The following paper will describe this project, beginning with the assessment of our target population, the

analysis of the gathered data, and the planning of our intervention. The intervention will be detailed along

with the evaluation of its effect, project impact and suggestions for future work.

Assessment, Analysis, & Planning

Our target population was emerging adults associated with the military, ages 16-24. According to

the Centers for Disease Control (CDC) Youth Risk Behavior Surveillance Report (2014c), 70% of all

deaths among youths and young adults aged 10–24 years resulted from motor vehicle crashes,

unintentional injuries, homicide, and suicide. Other risk behaviors that contributed to death and disability

were tobacco, alcohol, and drug use, as well as unsafe sexual practices. Coupled with the stresses of

military life, the presence of these high-risk behaviors put this population at risk for negative health

outcomes.

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Assessment Process

Our assessment began with a briefing from a panel of key informants from the Alaskan ANG

regarding the culture and recent challenges faced by this organization. The panel included the following

active duty and civilian members: Chaplain Richard Koch, Chaplain Ted McGovern, Lyn Tashea,

Director of Psychological Health; Octavia Thomson, Joint Forces Headquarters Sexual Assault Response

Coordinator; Sergeant Monique Andrews, Victim Advocate Coordinator; and Captain Troy Townsend,

Behavioral Health Officer.

On subsequent meetings, we received resiliency training from Sergeant 1st Class Diane Singh,

Coordinator for the Comprehensive Family Fitness Program. Kim Conkling, Prevention Educator at

Alaska National Guard, spoke to us regarding risk behavior reduction. Ruby Batchelor discussed suicide

awareness and prevention in the military. Sergeant Andrews returned to provide bystander awareness

training. Finally, we directly observed the JROTC program at Colony High School and discussed student

challenges with teachers Lieutenant Colonel Butch Diotte and First Sergeant Derek Heavener.

Specific assessment of our target population was conducted with a structured written

questionnaire, given to ANG soldiers during a drill weekend on January 24, 2015 and JROTC students

during class on January 23, 2015. We received ninety completed questionnaires from our target

population. The questionnaire asked the following closed-ended, multiple-choice questions: their age,

stressful life events experienced, coping methods used during these times, likelihood to reach out to

others, and how well they bounced back from stressful situations. In order to provide feedback for the

ANG, we also asked if military trainings helped individuals deal with stressful life events and increased

their awareness of community resources.

Assessment Rationale

We relied on Diem and Moyer’s (2005) Community Health Nursing Projects to guide our

assessment process. Key informants from the ANG and JROTC were our first primary sources of

information. Their input helped us identify the present health situation of our target population, strengths

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and barriers to health, and available resources. We learned that a variety of trainings and community

resources are available to military associated emerging youth. However, missing from these offerings are

the normalization of adversity in daily life and an overarching training to tie these programs together (D.

Singh, personal communication, January 21, 2015).

Our specific assessment consisted of a questionnaire to collect data in our target population at

different times and locations. Questionnaires were self-administered and anonymous, consisting of

closed-ended questions that could be answered quickly to encourage the maximum return rate, with prizes

of food to encourage participation. Several of the questions were formulated to provide our key

informants with requested feedback on the perceived efficacy of their existing training programs and

participant’s knowledge of community resources.

Review of Literature

The purpose of our literature review was to better understand our target population of military

associated emerging adults, ages 16 to 24. We also sought to better understand resiliency and the best

educational methods to convey this concept.

We started our literature review by researching emerging adults. We determined that emerging

adulthood is a developmental state from the late teens through the twenties, with a focus on ages 18 – 25

(Arnett, 2000). Risk behaviors for emerging adults are sensation seeking and peer influences. Both are

correlated with drug use, promiscuous sexual behavior, reckless driving and theft (Bradly & Wildman,

2001). Emerging adults in the military are at high risk for sexual misconduct, suicide and risky behaviors

(Department of Defense, 2015; Department of Defense, 2014; National Institute on Drug Abuse, 2011).

In order to better understand the relationship between adversity in our population and future health

outcomes, we reviewed the Adverse Childhood Experiences study conducted by the Kaiser Permanente’s

Health Appraisal Clinic in 1995. The study demonstrated a strong relationship between higher levels of

traumatic stress encountered during childhood and poor physical, mental, and behavioral outcomes later

in life (CDC, 2014a).

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Resiliency can enable individuals to overcome adverse life experiences, as the American

Psychological Association (2015) defines it as “the process of adapting well in the face of adversity,

trauma, tragedy, threats or significant sources of stress.” We learned about the connection between

resiliency and coping skills from the American Psychological Association (2015).

We found Foundations of Nursing to be a good resource for educational theories to guide our

intervention, such as learning domains (Berman & Snyder, 2012). Our intervention incorporated

cognitive, affective and psychomotor learning domains. The teaching techniques of discovery,

demonstration and group discussion were used. We also incorporated audiovisual materials.

Development of Goals & Objectives

From assessment data, we learned all participants had experienced stressful life events. The three

most common were school (72%, n=56), loss (47%, n=37), and relationships (45%, n=35). Positive (51%,

n=148) and negative (49%, n=140) coping skills were used almost equally to deal with these stressors.

Participants were more likely to always (23%, n=18) or sometimes (46%, n=36) reach out to others

during times of stress, compared to those who never did (31%, n=24). Most respondents rated themselves

as always or nearly always bouncing back after adverse experiences (70%, n=53). Additionally, most

respondents knew of community resources to use in times of stress or if they felt overwhelmed (79%,

n=61) compared to those who did not (21%, n=16).

Based on the assessment, our target population exhibited numerous strengths. Most were likely to

reach out to others during difficult times. The majority of the target population was aware of community

resources they could turn to when feeling overwhelmed and perceived themselves as resilient. However,

the assessment also identified potential weaknesses. In particular, all participants reported experiencing

adversity in their lives. In dealing with adversity, they used both positive and negative coping skills

equally and nearly a quarter were unaware of community resources.

We developed the following action statements to address the issues found in our assessment: the

military associated emerging adults (a) are at risk for ineffective coping based on their use of negative

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coping skills, (b) are at risk for ineffective coping based on their lack of information regarding

community resources, and (c) have readiness for improved health based on their self-perception of being

resilient. Our goal in this project was to promote resiliency in the military associated emerging adult. In

order to achieve this goal, we formulated the following objectives: (a) 95% of the military associated

emerging adults will name one positive coping method, (b) 95% of the military associated emerging

adults will identify one community resource, and (c) 75% of the military associated emerging adults will

plan to apply one method to promote self-perception of resiliency at the end of the intervention on

February 9, 2015.

The social ecological model guided our intervention (CDC, 2014b). This model focuses on the

complex relationship between individual, relationship, community, and societal factors. According to

Stanhope and Lancaster (2008), resiliency is “a function of individual, interpersonal, organizational,

community, and population factors” (p. 384). While our focus was on individual interventions, resilient

behavior is a product of all four factors.

Description of Intervention

The MYYARP intervention took place on February 9, 2015 with the third period JROTC class at

Colony High School in Palmer, Alaska. The training lasted 46 minutes and consisted of 28 students. We

presented educational activities in a formal course that consisted of lectures, a group game, and group

discussions that were delivered in person and included audiovisual materials.

We used the learning theories of behaviorism, cognitivism, and humanism to develop different

teaching techniques and address the three learning domains. The game that was created achieved

cognitive learning, the class discussion achieved affective learning, and our activity with the tree helped

with psychomotor learning, which will be described in more detail below.

The presentation began with students describing resiliency, followed by a short introduction on its

meaning and importance. We discussed the survey results, for the purpose of showing that all students

experienced some sort of stressful event, thus normalizing adversity. Next, students participated in a

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version of the Family Feud game show (Appendix B), taking turns guessing the top four positive and

negative coping skills students identified in the questionnaire. Students actively participated in this game

and received prizes.

Next, participants received green and brown leaves, on which they wrote coping methods. A short

explanation accompanied this activity, explaining how positive coping skills promote resilience. Most

students taped multiple green, or positive, coping skills to the branches of the Tree of Resilience

(Appendix C), while brown, or negative coping skills, were taped at the base of the tree to represent fallen

leaves. A class discussion on coping methods followed the activity. The discussion provided an

opportunity to discuss other ways to promote resiliency, including the importance of positive

relationships.

We then showed a short video that told the story of Bob Shumaker, a prisoner during the Vietnam

War (Sweet, Streeter & Bloom, 2010). He explained how using a tap code to communicate with other

prisoners helped him develop resilience during his time in prison. We used this video to illustrate the

centrality of relationships in resiliency promotion. Following the video, we distributed cards with

community resources that were specific to Colony High School JROTC. The cards included names and

contact information for school counselors, the Military Family Life Counselor, and the Alaska Careline

Crisis Intervention Line.

Our presentation concluded with a summary focused on positive coping skills and how these

important life skills can be used to promote healthy relationships, goal achievement and ultimately

resiliency. We further discussed ways that negative coping skills can result in outcomes such as domestic

violence, sexual assault, drug and alcohol abuse, and suicide. We stressed the importance of making good

choices in life, and how individual choices can affect other individuals and the community. We

incorporated the topic of bystander awareness into our conclusion by discussing the fact that individuals

can set a positive example for others regarding their coping choices, and those who set a positive example

are leaders among their peers.

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Evaluation

Following the intervention, we evaluated effectiveness by having students fill out a self-

administered, structured, written, open-ended questionnaire. Our outcome evaluation focused on

evaluating participant’s learning in the three areas identified as issues in our assessment: (a) naming

positive coping skills, (b) identifying community resources to use when feeling overwhelmed, and (c)

promoting resiliency in daily life.

After analyzing the results of the twenty-four evaluations, we determined that we met two of our

three objectives. Our first objective was achieved, as 96% (n=23) of the military associated emerging

adults were able to name one positive coping method. We did not achieve our second objective, as at the

end of our presentation, only 88% (n=21) of the respondents could name a community resource to turn to

when they felt overwhelmed, rather than the 95% that was our goal. Our third objective was achieved, as

88% (n=21) of the military associated emerging adults could describe at least one method to promote self-

perception of resiliency at the end of the intervention presentation on February 9, 2015. We received good

feedback, with most participants writing on the questionnaire that they understood and enjoyed the

presentation.

Impact & Future Anticipated Impact

The immediate impact of the MYYARP was to normalize adversity, by emphasizing that

everyone experiences adversity and by communicating the survey results regarding the most common

adverse experiences for this population. The presentation, the game, the Tree of Resiliency, and class

discussion all served to increase understanding of positive versus negative coping skills. Focusing on

positive coping skills provided participants with additional tools to promote resiliency. The negative

coping skills were associated with negative outcomes. Finally, participants have increased awareness of

community resources to help deal with stressful events.

The future anticipated impact of the MYYARP is to promote resilient behavior in participants. By

modeling resilient behavior, participants promote resiliency in their peers, leading to sustainable cultural

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change. In the long term, greater reliance on positive coping skills can lead to decreased adverse

outcomes, like substance abuse, interpersonal violence, and suicide. Additionally, Sergeant Andrews, who

watched the training, said that she was very happy with the intervention and would incorporate elements

into her trainings with similar populations, which could also be easily adapted for an older audience as

well (personal communication, February 9, 2015).

Recommendations for Future Work

Central to future work on this subject is continued discussions on the importance of resilience.

We have specific recommendations for future work in this area. First, military associated emerging adults

in JROTC would benefit from continued resiliency trainings, such as the Comprehensive Soldier Fitness

Resiliency Training, with a focus on mental fitness promotion. Secondly, the training should be provided

to additional JROTC populations in the Anchorage area. Third, as our intervention took place with the

JROTC population only, it would be beneficial to conduct the MYYARP intervention with the ANG

population as well. This program provides a different perspective than current military resiliency trainings

as it focuses on the normalization of adversity and connects coping skills to both positive and negative

outcomes. Finally, and perhaps most importantly, continued partnerships with the UAA SON, the Alaska

ANG, and JROTC programs would bring the unique nursing perspective to help create interesting

programs to meet the challenges faced by youths associated with the military, providing them with the

tools necessary to succeed in life.

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References

American Psychological Association. (2009). Publication manual of the American

Psychological Association (6th ed.). Washington, DC: Author.

American Psychological Association. (2015). The road to resilience. Retrieved from:

http://www.apa.org/helpcenter/road-resilience.aspx

Arnett, J. J. (2000). Emerging adulthood: A theory of development from the late teens through

the twenties. American Psychologist, 55(5), 469-480. doi:10.1037/0003-066X.55.5.469

Berman, A., & Snyder, S. (2012). Kozier & Erb’s Fundamentals of Nursing (9
th
ed.). Upper Saddle River,

New Jersey: Pearson Education, Inc.

Bradley, G & Wildman, K. (2001). Psychosocial predictors of emerging adults’ risk and reckless

behaviors. Journal of Youth and Adolescence, 31(4): 253-265.

Centers for Disease Control and Prevention. (2014a). Injury prevention & control: division of violence

prevention. Retrieved from http://www.cdc.gov/violenceprevention/acestudy/

Centers for Disease Control and Prevention. (2014b). The socio-ecological model: A framework for

prevention. Retrieved from: http://www.cdc.gov/violenceprevention/overview/social-

ecologicalmodel.html

Centers for Disease Control and Prevention. (2014c). Youth risk behavior surveillance-United states 2013

(Surveillance Summaries Vol. 63 No. 4). Retrieved from:

http://www.cdc.gov/mmwr/pdf/ss/ss6304.pdf

Diem, E., & Moyer, A. (2005) Community health nursing projects: Making a difference. Philadelphia,

PA: Lippincott Williams & Wilkins.

Establishing a JROTC program. (n.d.). Retrieved from: http://www.usarmyjrotc.com

/jrotc-program/establish-jrotc-program

National Institute on Drug Abuse. (2011). Substance abuse among the military, veterans and their

families. Retrieved from: http://www.drugabuse.gov/sites/default/files/veterans.pdf

Ready and Resilient. (n.d.). Retrieved from: http://www.army.mil/readyandresilient

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Stanhope, M., & Lancaster, J. (2008). Public health nursing: Population-centered health care in the

community. Maryland Heights, MO: Elsevier Mosby.

State of Alaska FY2015 Governor’s Operating Budget. (2013). Retrieved from:

https://www.omb.alaska.gov//ombfiles/15_budget/DMVA/Proposed/comp2135.pdf

Sweet, J., Streeter, S., & Bloom, A. (Producers). (2010). This emotional life: The tap-code. [Television

series]. United States of America: Public Broadcasting Service.

Retrieved from: http://www.pbs.org/thisemotionallife/video/tap-code

United States Department of Defense. (2014). Department of defense quarterly suicide report calendar

year 2014. Retrieved from: http://www.suicideoutreach.org

/Docs/Reports/DoD%20Quarterly%20Suicide%20Report%20CY2014%20Q1.pdf

United States Department of Defense. (2015). Report on sexual harassment and violence at military

service academies. Retrieved from: http://sapr.mil/public/docs/reports/MSA

/APY_1314_MSA_Report_Executive_Summary.pdf

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Appendix A

Copy of questionnaire

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Appendix B

Version of the Family Feud game show

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Appendix C

Tree of Resiliency

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Appendix D

Evaluation Survey

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Appendix E

Resource Card

Undergraduate Journal of Service Learning and Community-Based Research, Volume 4, Fall 2015

Military Youth and Young Adult Resiliency

Amber L. Michael

University of Alaska Anchorage

The UAA College of Nursing capstone project has become well known for the

contributions that students make to the community. It is a project that I had been looking

forward to even before I began nursing school, and I couldn’t wait to be a part of it. What I

didn’t expect was the intense coordination and strain that a project of this magnitude would have

on my nine-person team. Grasping the concepts of resiliency and who our population was took

time and effort, and a lot of communication.

We were handed a blank slate with a lot of information and were then asked to produce

positive teaching tools to help young enlisted military members become more resilient in their

everyday lives. The fundamental idea of resiliency was initially much larger in scope than we

could grasp. It appeared as though each of us understand resiliency differently, and finding a

common ground as to what and how we could employ teaching tools proved to be a complex

challenge. I was grateful to have a talent for grasping and communicating concepts. As the leader

of our group, I spent most of our meetings reflecting and rephrasing concepts between members

of our group, the professor, and our key informants. I relied heavily on my teammates to make

sure our ideas and information was organized, while they relied on me to keep everyone on

point, making sure the work we were doing would lead us all in the right direction.

The key informants from the Alaska National Guard do exceptional work, and we were

humbled by the time they took to teach us about the struggles they face with their young enlisted

soldiers. We spoke with social workers, chaplains, educators, and members of the sexual assault

response team. Lowering rates of sexual assault, domestic violence, and drug and alcohol abuse

encompasses their jobs, and yet they were asking us for help, for a different perspective. The

viewpoint of the public health nurse was missing from their approach, so they welcomed our

input and were eager to learn.

After our literature review, meeting with key informants, and surveying soldiers, we

began to form a picture that was more tangible. Due to scheduling conflicts, we knew we would

be teaching these concepts to high school NJROTC students instead of soldiers, but these

students still fell into the category of young adult. Knowing our audience gave us a sense of

direction and an understanding of how to grab their attention and to teach concepts that they

could use in their daily lives. We reached this understanding very late into our project, and were

then able to quickly grasp the need to teach these students how to cope.

We were both equally frustrated and motivated by this realization – motivated by the

epiphany and direction, but dismayed because teaching coping skills alone seemed to leave out

so many concepts that resiliency comprises. We also realized that these young adults were more

than likely overwhelmed with the amount of information and stress that they deal with on a daily

basis.

Nine people can make quite a large presentation, but nine overachievers who work well

together can make a fantastic presentation. We expanded our teaching strategy to include coping

skills, bystander awareness, and discussion about what stressors and coping strategies these

young adults have on a daily basis. Our multimedia and interactive approaches were well

received by the students and teachers. The interactions we had were incredibly positive and our

challenges during the learning process helped us become more familiar with our own resiliency

Michael 2

Undergraduate Journal of Service Learning and Community-Based Research, Volume 4, Fall 2015

as well as the resiliency of our own families. Most of us found ourselves teaching our children

how to be more resilient, and altering some of our coping skills to be more positive and effective

in our own lives. As a group, we founded new friendships that the previous year of study

together had not forged.

I am incredibly proud of my team and how well we supported each other. These women

saw their strengths and acknowledged their weaknesses, and we stepped in to fill those gaps

where we could, so that no one was overburdened. When I felt as though I was not handling the

agendas and documentation well as leader, another teammate stepped in, because her talent was

in the details. This relieved me of stressful work I am normally challenged by and allowed me to

utilize my talent motivating and communicating. This project will always be a proud moment for

me as a student, as a nurse, and as a friend and teammate.

I would like to give my sincere thanks to Professor Angelia Trujillo, DNP of the University of

Alaska Anchorage for sharing her love of community health and learning, and for her

unwavering support for my professional future.

Amber L. Michael, University of Alaska Anchorage Research
Amber L. Michael, University of Alaska Anchorage Reflection