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Opportunities to Enhance the Health and Well-Being of the Department of Homeland Security Law Enforcement Workforce: Proceedings of a Workshop—in Brief (2018)

Chapter:Opportunities to Enhance the Health and Well-Being of the Department of Homeland Security Law Enforcement Workforce: Proceedings of a Workshop - in Brief

Suggested Citation:"Opportunities to Enhance the Health and Well-Being of the Department of Homeland Security Law Enforcement Workforce: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2018. Opportunities to Enhance the Health and Well-Being of the Department of Homeland Security Law Enforcement Workforce: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press. doi: 10.17226/25225.
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Proceedings of a Workshop


IN BRIEF

August 2018

Opportunities to Enhance the Health and Well-Being of the Department of Homeland Security Law Enforcement Workforce

Proceedings of a Workshop—in Brief

On January 17 and 18, 2018, the National Academies of Sciences, Engineering, and Medicine hosted a workshop focused on enhancing the health and well-being of the Department of Homeland Security’s (DHS) law enforcement workforce. The workshop featured presentations in two main topic areas: (1) the operational stressors and environments faced by the DHS law enforcement workforce, and (2) strategies that can be used to address these stressors and promote overall health and well-being. The workshop was opened by Larry Fluty, DHS’s principal deputy assistant secretary for countering weapons of mass destruction and acting chief medical officer.

In his opening remarks, Fluty acknowledged the growing mental health and suicide problem among law enforcement personnel across the country, highlighting the need for DHS to actively address the issue. He noted that DHS was interested in establishing a holistic approach to supporting the workforce that could create a “culture of wellness” in the everyday life of DHS employees. Fluty explained that the goals of the workshop were to explore opportunities to improve wellness, learn from best practices implemented by other law enforcement agencies and institutions, and consider how to implement similar approaches within DHS. The workshop was organized into three sessions around these goals. Several topics that emerged throughout the workshop from the presentations and discussions are noted below and attributed to individual workshop participants.

Several speakers, including Edrick Dorian of the Los Angeles Police Department, commented that law enforcement should be humanized in order to build more empathy and break down the stigma surrounding the occupational stress and mental health issues stemming from current perceptions of the profession. William Nash of the U.S. Marine Corps (USMC) and others said that stress mitigation—finding ways to address stress before it occurs—is more important than stress management. Nash also suggested that institutions could be held more accountable for this process. Several participants—including Judith Andersen from the University of Toronto-Mississauga, Rajeev Ramchand and Terri Tanielian of RAND, and Curt West of the Uniformed Services University of the Health Sciences (USUHS)—said that the definition of resilience and related terms should be clarified and that there should be a greater focus on assessing the evidence base for strategies already in place to prevent high-risk behavior and stress: What are the science and data that back up the use of employee assistance programs (EAPs)? Of suicide prevention programs? Of other common resources? Addressing these concerns would make mental health and wellness easier to tackle, they said.

OVERVIEW OF THE DHS LAW ENFORCEMENT OPERATIONAL ENVIRONMENT

Perspectives from the Front Line

The workshop began with a panel of frontline officers who serve in various components and agencies across DHS. Addressing common stressors faced by law enforcement officers, Ralph Corbin from the Border Patrol, Customs and Border Protection (CBP), cited low morale as a major issue at CBP and other panelists agreed that morale is a concern


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Suggested Citation:"Opportunities to Enhance the Health and Well-Being of the Department of Homeland Security Law Enforcement Workforce: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2018. Opportunities to Enhance the Health and Well-Being of the Department of Homeland Security Law Enforcement Workforce: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press. doi: 10.17226/25225.
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across DHS. Faron Paramore from the U.S. Secret Service (USSS) mentioned a lack of work–life balance as a primary stress- or for USSS agents and described the average agent’s concerns about unpredictable scheduling. Agents’ lives are dictated by their protectees’ schedules, he said, and weekend obligations, holiday obligations, or other unplanned trips can lead to extreme overextension for agents. The travel schedule affects not only agents, Paramore said, but also their families. Lastly, Catrina Bonus of the USSS Uniformed Division said that the typical “No Failed Mission” mentality common among USSS Uniformed Division agents and other law enforcement officers may add stress to everyday work. Agents are expected to remain constantly vigilant and alert, she said, but are also deeply affected by long hours, lack of sleep, and the lack of work–life balance as described by Paramore.

In addition to stressors, panelists discussed high-risk behaviors common among their peers. Each panelist mentioned alcohol abuse as a critical problem that affects colleagues across DHS, and Corbin and Bonus both described it as a form of self-medication. Paramore and Patrick Culver from the U.S. Coast Guard (USCG) also mentioned sleep deprivation as a high-risk behavior, which they attributed to inconsistent shift schedules; Culver noted that sleep deprivation can make it difficult for USCG officers to concentrate while on duty. Bonus said that domestic violence and family unrest are issues in some law enforcement families.

Paramore, Bonus, Culver, and Steve Collins of Homeland Security Investigations (HSI), Immigration and Customs Enforcement (ICE) all cited physical fitness as being important for law enforcement in dealing with high levels of stress. Collins said that agents at ICE are allotted up to 3 hours during the work week to participate in physical activities, which is helpful when balancing busy schedules, and Bonus said that many USSS Uniformed Service officers exercise in their free time. Both Collins and Bonus also emphasized support from their respective agency’s EAPs and social gatherings with colleagues, friends, and families as important outlets.

Addressing resources that frontline law enforcement personnel would like to see implemented at their respective agencies, Bonus said that she would like USSS to do more to recognize the spillover of occupational stress that affects families and spouses of agents, and she cited an example of a successful program addressing this issue at the National Defense University (NDU): A spouses club that hosted monthly meetings, offered classes, and held social events for the spouses of NDU students to ensure that they felt included and accounted for in the law enforcement community. Culver said that USCG’s policies are more reactive than proactive, and noted that improving policies around resilience and wellness before exposure to stress would be useful. Jason Liebe of the Border Patrol, CBP, who moderated the first session, said that wellness activities such as yoga are already being implemented at his post in San Diego and could help address some of the issues described by Culver. Paramore said that the resource environment at the USSS recently became more accessible as the system shifted from being headquarters-centric to one focused on agents’ needs across the country. Despite the stressful work environment, several panelists described the rewarding nature of their work. Collins said that law enforcement was a calling, and noted that he is attracted to the moral responsibility he feels fulfilling the mission of DHS during particularly horrific cases such as the pursuit of child traffickers.

During the discussion that followed, Scott Salvatore of DHS asked about the possibility of mandatory mental health and wellness checks, noting that legislation was being considered around that topic. Several panelists agreed that mandatory checks would not be well received among DHS employees. Culver said that resources are already available for those who seek mental health support, and Collins said that careful encouragement rather than a requirement would likely be more accepted by employees. Paramore expressed concern about the effect of mandatory checks on job security, suggesting that a negative review could affect security clearance for agents.

Supporting the Front Line

The second panel of the workshop featured agency-support representatives discussing programs and interventions being used across DHS. Collins emphasized the importance of one-on-one interventions in the ICE peer-support program. Ken Middleton of the employee resilience unit at ICE described the partnership between the ICE peer-support program and its EAP. Kier Maxwell from the USSS EAP also discussed the critical role of the EAP in supporting personnel, especially in a resource-constrained environment, but emphasized points of entry. She said that at USSS, employees initiate contact when seeking out services, and she and her staff emphasized the importance of the EAP reaching out to field agents and offices across the country.

Scott Bryan of the Resiliency Programs at CBP emphasized the need for more accountability and empathy among agency leadership to promote issues of mental health and wellness. Continuing on the role of leadership, several speakers said that agency leaders’ most important role in promoting wellness is acknowledging stress and high-risk behaviors, and referring employees to the proper resources for support. The panelists also considered measurements of success in promoting wellness and curtailing high-risk behaviors. Collins and Maxwell both noted that personal stories, including those

Suggested Citation:"Opportunities to Enhance the Health and Well-Being of the Department of Homeland Security Law Enforcement Workforce: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2018. Opportunities to Enhance the Health and Well-Being of the Department of Homeland Security Law Enforcement Workforce: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press. doi: 10.17226/25225.
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that are often kept private, help support staff gauge success in this area. Maxwell also referred to a work–life survey she conducted at USSS to better understand feelings around wellness resources among employees. However, Middleton noted that the qualitative and quantitative evidence base in this area is lacking and needed.

During the discussion following the panel, Patricia Deuster of USUHS asked about support programs’ fit in the culture of law enforcement. Maxwell said that she and her colleagues at the USSS EAP view themselves as being embedded in the everyday work life of USSS agents and make a conscious effort to understand the culture of the agency; she said that visiting field offices across the country and hosting activities for employees has been an important way to express interest and remain involved on a day-to-day basis. Middleton said that at ICE, EAP clinicians are encouraged to ride along with frontline officers, and several clinicians are former officers themselves. Bryan echoed Middleton’s comments, noting that it is important to leverage individuals who have an understanding of both the operational environment and the support sector. He said that peer-support personnel and chaplains are useful for this reason because they play multiple roles at CBP. Collins also said that HSI makes a concentrated effort to connect EAP and employees regularly during particularly difficult cases and during training.

Daren Brabham of the University of Southern California asked who participates in the peer-support programs across DHS, and wondered how peer supporters make themselves visible to other employees. Collins said there are announcements at ICE to recruit peer-support members. To become a member of the peer-support network, employees must interview, take a class, and pass a written exam, which is a relatively competitive process. Collins said there are no visible cues to identify peer supporters, but employees are generally aware of the resource.

Lastly, Salvatore asked about support for chronic conditions such as depression and post-traumatic stress disorder (PTSD). Noting that employee assistance programs are often geared towards short-term support, he asked whether there is a continuum of care for individuals with long-term mental health problems. Maxwell said that USSS EAP clinicians receive evidence-based training and are expected to be able to identify certain mental health conditions before referring employees to community clinicians. Middleton said that legally, ICE employees—including chaplains and peer support—must refer other employees to EAP, noting that there is a gap in the continuum of care regarding chronic conditions.

EXPLORING OPPORTUNITIES FOR HEALTH PROMOTION AND HIGH-RISK BEHAVIOR PREVENTION AT LAW ENFORCEMENT AGENCIES

Lessons in Resilience and Mindfulness

Amy Adler of the Walter Reed Army Institute of Research presented on resilience in the Department of Defense and U.S. Army. She said that her research considers possible effects of resilience on three levels—among individuals, teams, and leaders. Adler said that when considering positive behavior adaptations as a baseline, it is important to weigh participants’ stage of change, referring to the transtheoretical model developed by James Prochaska and Carlo DiClemente that outlines five stages of change: precontemplation, contemplation, preparation, action, and maintenance (and/or relapse) (Prochaska and DiClemente, 1983). Adler noted that the model is typically used for the rejection of negative behaviors such as smoking, but the Army adapted it for the adoption of positive behaviors. Individuals in the precontemplation stage may require a stronger push, while individuals in the contemplative or preparation stages may be more willing to act, Adler said. She encouraged DHS to consider this as a factor when implementing new resilience programs.

Adler discussed behavioral nudging as a method to build resilience, referring to her recent research on sleep cycles (Adler et al., 2017). Using ActiGraph watches, she said, study participants were provided detailed reports on their sleep patterns. The results of the study showed that compared to the control group, those who received the intervention reported more hours slept and recorded fewer sleep problems. Moving to team-level interventions, Adler emphasized the importance of a team’s emotional culture as a catalyst for resilience. She said that Army units that report high levels of hope and optimism experience better emotional culture during periods of negative feedback. She also described a developing program based on an Israeli Defense Forces parallel called iCOVER, which teaches real-time resilience during a high-stress event, such as a soldier freezing up on the field of battle. iCOVER stands for: Identify a buddy in need; Connect; Offer commitment; Verify facts; Establish order of events; and Request action.

Adler ended her presentation by discussing resilience among leaders. She said that the key to developing resilient leaders is teaching specific, refined skills that are associated with good outcomes in their own units. Adler referred to a study of Army leaders during a mandatory quarantine following the 2014 West Africa Ebola outbreak (Adler et al., 2018); the outcome of the study demonstrated that leaders who emphasized soldiers’ physical well-being and the importance of the humanitarian mission reported better attitudes toward the quarantine among their ranks. Ultimately, Adler said, resiliency training can be successful with buy-in from leadership and implementation at the small team level.

Suggested Citation:"Opportunities to Enhance the Health and Well-Being of the Department of Homeland Security Law Enforcement Workforce: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2018. Opportunities to Enhance the Health and Well-Being of the Department of Homeland Security Law Enforcement Workforce: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press. doi: 10.17226/25225.
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Amishi Jha of the University of Miami presented on mindfulness training in high-stress cohorts. Mindfulness, she said, is the mental mode characterized by attention to the experience of the present moment without conceptual elaboration or emotional reactivity, and formal training (including breathing methods) is required to maintain that state. She explained that periods of high stress—even the predeployment phase for military service members—can compromise attention and working memory. Jha said her work focuses on the possible protection that mindfulness training affords against these declines through the development of cognitive resilience, which Jha defined as the ability to maintain or regain cognitive capacities that are at risk of degradation.

Jha described the state of research on mindfulness, as well as her own recent research in the field. According to a 2015 meta-analysis of mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT) studies, mindfulness training is effective at reducing depression, anxiety, and perceived stress compared to other mindfulness programs (Gotink et al., 2015). However, Jha admitted that the field is undergoing significant changes and self-scrutiny, and more research is required to understand the full extent of the benefits of mindfulness training.

Turning to her own recent research, Jha described two recent studies conducted with military service members based on MBSR. The first study, which limited training time to 24 hours total (down from 40 in typical MBSR training), indicated that total practice time was linked directly to training benefits (Jha et al., 2017a). The second study limited training time to 8 hours, but split participants into two groups: One that received mindfulness training and another that only received didactic information about it (Jha et al., 2017b). The training group saw core functions remain stable, while the other group saw a decline, Jha said, indicating that the practice of training is crucial to mindfulness. Currently, Jha said she is developing a new training curriculum called mindfulness-based attention training (MBAT) that will scale down to 4 weeks of training and include trainers who are familiar with the military context. She said scalability and relatability are important for adapting these programs to the military and other organizations that have training infrastructure and leaders who can influence buy-in down to the unit level.

Mike MacKrell of the Texas Army National Guard presented on the Master Resilience Training (MRT) program. Acknowledging that military service members can become burdened and overwhelmed by the demands of duty, MacKrell referred to the U.S. Army Ready and Resilient (R2) strategy for strengthening individual and unit-level readiness (U.S. Army, 2016). Within that context, MRT was developed by the Army in collaboration with the University of Pennsylvania’s Penn Resilience Program and is now directed by the Army Resiliency Directorate. MacKrell said that Master Resilience Trainers are able to provide formal and informal counseling to service members and are expected to refer soldiers to professional counseling as needed. Ultimately, MacKrell, said, the goal of MRT is to teach service members that the personal challenges facing them are not insurmountable. MacKrell ended by advocating for investment in resilience training, and he described the resilience skills MRT is designed to teach, including “hunting the good stuff,” which entails creating and focusing on positive emotions; avoiding thinking traps; performing real-time resilience; and practicing assertive communication.

Nash presented on the downside of promoting mindfulness as a tool to mitigate and manage stress. Nash stated that USMC and similarly situated organizations are obligated to help their employees manage stress, because the military exposes personnel to the stress with which they must cope. He said institutions should attempt to do more to mitigate stress and noted that researchers should do more to understand how mindfulness training may or may not be beneficial in managing stress. According to recent research, Nash said, evidence-based (according to a framework developed by the Substance Abuse and Mental Health Services Administration) stress management is central to organizational approaches to psychological health. Nash acknowledged that mindfulness may play a role in promoting recovery following normal or traumatic stress, but emphasized that more could be done organizationally before individuals experience traumatic stress. Nash said that organizations should do more to explore methods to monitor stress levels in real time, and ultimately be more explicit and transparent about support for each individual to put the onus of recovery on the organization. He also said that USMC has not done enough to address stigma around mental health, and putting more responsibility on the institution could help shift that perspective.

Lastly, Deuster and Garth Spendiff of CBP presented on the connection between physical fitness and resilience among law enforcement. Spendiff explained that informal physical activity and structured exercise both contribute to overall physical fitness. Deuster went on to explain the connection between physical fitness and resilience. She said that physical fitness confers physiological and psychological benefits in that it blunts stress reactivity and serves as a buffer against stress; in doing so, she said physical fitness protects against stress-related disorders (e.g., PTSD) over the long term and other chronic conditions, including depression. Deuster also mentioned research that demonstrated that individuals with little or no fitness training have much higher responses to exercise stress, and broadly, lack of physical fitness across law enforcement is a threat to success in the occupation. Ultimately, she said aerobic fitness is a good indicator of long-term health, and being physically unfit leaves individuals more vulnerable to occupational and health risks.

Suggested Citation:"Opportunities to Enhance the Health and Well-Being of the Department of Homeland Security Law Enforcement Workforce: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2018. Opportunities to Enhance the Health and Well-Being of the Department of Homeland Security Law Enforcement Workforce: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press. doi: 10.17226/25225.
×

Following the presentations, Salvatore asked Jha about potential barriers to implementing mindfulness training. Jha said that aside from program effectiveness, accessibility for users and trainers is an important feature. She said creating a program that is engaging for users and scalable for skilled trainers is critical to success. A workshop participant asked Adler about addressing stress and the culture of military and law enforcement. Adler said that a cultural shift could occur through two steps: Stress should be addressed during the earliest stages of recruitment and training and “grandfathered” into institutional programming during periods of calm.

Experiences and Best Practices from State and Local Agencies

During the final panel of day 1, state and local law enforcement personnel discussed approaches being used to support officers in their jurisdictions. Michael Finegan of the Maryland State Police said that Maryland’s large police agency employs many different mental health professionals, including psychologists like himself. He said the agency’s mental health services focus largely around critical incident response—such as following up with officers after a shooting—as well as teaching tactical skills, leadership skills, and emphasizing “commitment,” which Finegan described as the linking of police values to behavior during the course of duty. In that context, Finegan also mentioned that he teaches officers to work through “moral injury” when they commit a perceived mistake and attempt to recover from the psychological trauma of the events that cause said injury.

Jocelyn Roland, an independent police psychologist based in California, described her experience supporting police agencies in a much different environment compared to Maryland. Referring to herself as an “out-of-house psychologist,” Roland said that she externally supports small local police agencies without the significant staff support described by Finegan. She noted that as a result of the staffing deficit, she often uses creative models such as peer support and interdepartmental arrangements to share the burden of support services. Under interdepartmental arrangements, localities within close proximity of each other agree to share support resources.

Last, Jennifer Tejada of the Emeryville Police Department in California presented on recently implemented mindfulness practices in her jurisdiction. While not a mental health professional, Tejada explained that she was involved in the rollout of wellness and mindfulness services in the Emeryville Police Department. She said that her department does not offer mental health services like those described by Finegan and Roland, but it does prioritize the implementation of a culture of mindfulness within the police force. Describing the mindfulness training offered in Emeryville, she said that the humanization of trauma and the incorporation of mindfulness into everyday police training activities have been the most important steps for establishing a culture that is conscious of mindfulness and well-being.

Lessons Learned from Recent Research

Astrid Schütz of the University of Bamberg, Germany, opened the session by presenting on health-oriented leadership. She emphasized the importance of organizational leaders, highlighting their common role as ambassadors for organizations and influencers to subordinates. Referring to two important studies on the topic, she described the trickle-down effect of leadership behavior. First, she described the crossover effects of leader stress: Recent research has shown that leaders’ stress affects followers’ stress and leads to less satisfaction among employees. Highlighting leadership health on its own, Schütz said that leaders who score higher on self-evaluations experience less exhaustion and provide more effective leadership. Salvatore, noting that the connection is more complex, asked about the possibility of followers affecting leaders’ health. He said that high levels of employee self-confidence likely play a role in that connection, and observed that bad leadership can lead to a need for further employee support.

Kerry Kuehl of the Oregon Health & Science University presented on disease risk factors among law enforcement. He said that law enforcement personnel are at higher risk of cardiovascular disease because of occupational risk, physical exertion, sleep deprivation, stress, and other factors. Kuehl discussed the results of a recent study he led, titled Safety & Health Improvement: Enhancing Law Enforcement Departments (SHIELD), which approached health from a total worker wellness concept. The study demonstrated that team-based behavioral change approaches can be useful and effective when supervised, and Kuehl said that other studies to investigate the concept are currently under development, including a study funded by the National Institute of Justice investigating novel biomarkers for stress. The study will survey 60 law enforcement officers with mixed levels of high and low stress and complete brain imaging and biomarker identification for each participant.

Andersen presented on the biological effects of occupational stress and ways to build physical resilience. She said that while stress, resilience, and wellness are often discussed from a mental health perspective, biological functionality must be considered and measured as well. She used heart rate as an example of a biological function that changes in high-stress situations. She explained that there is an optimal range (around 140–160 beats per minute) during the

Suggested Citation:"Opportunities to Enhance the Health and Well-Being of the Department of Homeland Security Law Enforcement Workforce: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2018. Opportunities to Enhance the Health and Well-Being of the Department of Homeland Security Law Enforcement Workforce: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press. doi: 10.17226/25225.
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“build up” phase of verbal and social interaction that can often precede a physical confrontation for a law enforcement officer: If heart rate is too high, an officer is likely experiencing panic, and if it is too low, an officer is not physically primed for the event.

Ultimately, she said, internal processes and the physical signs of stress can affect both short-term performance and long-term health trajectory. Describing a model developed through recent research (LeDoux and Pine, 2016), Andersen said that a threat can activate both a biological fear response and a behavioral-emotional fear response. Addressing the brain–body activation that occurs during and after a threat, Andersen said understanding the roles of both the sympathetic and parasympathetic nervous systems is crucial. The activation of the sympathetic nervous system typically emerges in a “fight or flight” type of response, Andersen said, while the parasympathetic nervous system plays a role in understanding the bigger picture and stepping back from high-stress situations. She emphasized that both systems should theoretically work together in a successful internal response to a stressful situation.

Building on the scientific concepts described above, Andersen described a training program she and colleagues developed called the International Performance, Resilience, and Efficiency Program (iPREP). The program teaches acute skills to regain control of physical functions during stressful situations in law enforcement; cognitive information, including information about the brain and physiology; understanding of self-awareness, including the use of HRV biofeedback; and physical self-regulation through iPREP skills developed by the program. Andersen also described the importance of program delivery, including facilitator interactions and scenario-based examples. In assessing the success of iPREP, Andersen described a randomized clinical trial among law enforcement officers that demonstrated that resilience training lessened the arousal level of participants and decreased the number of force errors (Andersen and Gustafsberg, 2016). In closing, she said that resilience is a suite of physical competency skills that should be measured objectively; people can practice resilience and override stress responses by practicing the acute skills that lead to physical resilience.

Ramchand presented on suicide among law enforcement and military personnel, noting that there is conflicting evidence about an elevated risk of suicide among law enforcement personnel. More broadly, Ramchand was skeptical and questioned the effectiveness of suicide screening programs and other previously discussed programs used widely at law enforcement agencies such as EAPs and peer-support programs. He said that in general, the evidence base for law enforcement mental health intervention programs must be further developed. Ramchand encouraged the implementation of integrated health (including mental health) and wellness services at law enforcement agencies in order for them to become a part of everyday operations in the law enforcement community.

Lastly, Richard Goerling of the Hillsboro, Oregon, Police Department and the Mindful Badge Initiative discussed mindfulness-based resilience training (MBRT). According to one MBRT study, Goerling said, an 8-week course of mindfulness led to a reduction in anger, aggression, and alcohol consumption, as well as improved sleep patterns (Christopher et al., 2018). Goerling described what he viewed as the central ethos issue in policing today: There is an ecosystem of resilience in place with a focus on individual intervention, but community outcomes should be a larger focus. He said there is an epidemic of trauma in the law enforcement community that requires more research and improved interventions that can be implemented at an operational level.

IMPLEMENTING STRATEGIES FOR HEALTH PROMOTION AND HIGH-RISK BEHAVIOR PREVENTION: THE LAST-MILE CHALLENGES AND STRATEGIES FOR IMPLEMENTATION

The workshop’s final panel focused on the implementation of strategies discussed earlier in the meeting, and featured several implementation and employee engagement experts. The panelists discussed areas of focus for future training to promote wellness. Charles Brewer of the Federal Law Enforcement Training Center said that the current training environment is too reactive, and taking a more proactive approach could pay dividends. Alisa Green from DHS’s Office of the Chief Human Capital Officer agreed, and emphasized that the fundamentals of wellness are not addressed at the front end of training across DHS components. She also noted that based on her interactions with employees, she knows that the work–life balance is important to them and should be prioritized. Deuster and Spendiff mentioned fitness and ability to perform a job as important features for baseline wellness; establishing a baseline will allow DHS leadership to focus on how to create a more proactive environment of wellness.

Next, the panelists addressed barriers to the implementation of wellness programs. Green pointed to the organizational structure of DHS and its “loose confederation” of several distinct agencies as major barriers to the implementation of programs across the department. She also said there is not a satisfactory central communication system at DHS, and noted that as a result of the sprawling organizational makeup, it is nearly impossible for central offices such as that of the chief human capital officer to address different employees’ specific needs across agencies. Deuster also noted that bottom up buy-in is crucial to successful program implementation at large organizations, and DHS may consider paying closer attention to employee buy-in in the future.

Suggested Citation:"Opportunities to Enhance the Health and Well-Being of the Department of Homeland Security Law Enforcement Workforce: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2018. Opportunities to Enhance the Health and Well-Being of the Department of Homeland Security Law Enforcement Workforce: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press. doi: 10.17226/25225.
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Lastly, the panel addressed gaps in knowledge around the implementation of wellness and resilience programs. Green said that more emphasis should be placed on understanding the nuances between the distinct jobs across DHS, and she suggested paying closer attention to leadership styles and abilities across the agencies. Echoing speakers from previous sessions, Deuster commented that the lack of inclusion of science across wellness programs is a gap in the current system. She also said that setting up an effective evaluation mechanism should become a priority.

Following the panel discussion, Ramchand commented on the confusion around terminology in this field, suggesting that it contributes to employees’ reluctance to engage in wellness programs because “building resilience” and other terms assume the negative state. He and West said that the definition of resilience requires further refinement. Salvatore wondered whether there are examples of successful wellness programs that DHS can attempt to mimic, even on a smaller scale.

WORKSHOP WRAP-UP AND FINAL REMARKS

Workshop participants shared final thoughts as the meeting concluded. Brabham and Middleton discussed learning from other organizations. Brabham suggested that DHS consider expanding the types of partners it engages with on a regular basis to better understand stigma and wellness. He mentioned faith-based groups as a potential partner for fostering work–life balance and lesbian, gay, bisexual, transgender, and queer (LGBTQ) advocacy groups to help foster “safe spaces” for those who feel stigmatized. He also said that outside organizations, including businesses and corporations that have proven successful in employee engagement, could be consulted to help understand how to build innovative employee engagement and wellness programs. Middleton noted that the takeaways from the workshop reinforced for him the work currently being done at ICE, but also demonstrated that law enforcement institutions, including DHS, must embrace a paradigm shift by becoming more open to learning from outside organizations.

Addressing stigma, Dorian said that in order to successfully promote health and prevent high-risk behavior among law enforcement personnel, leadership and the agencies themselves must work to humanize law enforcement and build institutional support around that cause. Finegan also emphasized the need to destigmatize the common conditions and experiences faced by law enforcement personnel, noting that a conscious recognition of this commonality will support officers in their recovery. He also recognized the “moral courage” of implementing programs at DHS and other law enforcement agencies to combat high-risk behaviors.

Addressing the future direction of research in this area, several participants mentioned the need to better understand the science behind certain interventions. West said that in the field at large, law enforcement could do a better job of emphasizing and using scientific evidence when implementing intervention programs. Green also emphasized the importance of outcome-centric work, and reiterated the importance of considering the intentions of new directions and programs before implementation. Echoing Nash from earlier in the workshop, West also acknowledged that bad behavior by leaders, managers, institutions, and other responsible parties can contribute to problems around health promotion, and said they need to address stress among personnel at the front end of the intervention process. Andersen reiterated that research in the field—embedded in law enforcement agencies themselves—is extremely important and worthwhile, and she said there are researchers available who are interested and willing to conduct that type of work.

Ramchand spoke from an epidemiological perspective and said that in conducting research on law enforcement agencies and interventions aimed at preventing high-risk behavior, more should be done to explicitly define the problem of interest to directly address that problem. He noted that EAPs and other common resources may not be as effective as some believe owing to a lack of supportive scientific evidence. Scott Lillibridge of Texas A&M University encouraged DHS to further consider the use of biomarkers, testing, and wearables as presented by Kuehl. He said that other organizations with many employees, including major companies, are investing more in that area, and he said it makes sense as a potential solution for DHS as well.

Tanielian lamented over the cyclical nature of lessons learned in the broad arena of workforce resilience. She referenced a National Academies report (IOM, 2014) on a similar topic and noted that despite repeated attempts to reform federal agencies and their workplace cultures, the lessons learned from that report and others produced by other organizations are similar but are implemented only in a piecemeal fashion. Referring to earlier discussions around the choice of terminology and language used in promoting wellness, she said that DHS should consider the policies that directly affect the well-being of the workforce and the burden that is placed on individuals who deal with wellness issues and high-risk behavior every day either through personal experience or by supporting others. Additionally, she said that society as a whole should do more to promote wellness—including proper practices around sleep, nutrition, and exercise—and address stigma by doing more to contextualize people’s environments and needs.

Salvatore, referring to the use of science to inform best practices, said the current environment suffers from “paralysis by analysis,” in that overanalysis of a big system like DHS can often lead to less than satisfactory solutions. He said

Suggested Citation:"Opportunities to Enhance the Health and Well-Being of the Department of Homeland Security Law Enforcement Workforce: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2018. Opportunities to Enhance the Health and Well-Being of the Department of Homeland Security Law Enforcement Workforce: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press. doi: 10.17226/25225.
×

DHS must find the best starting point to understand the best practices for supporting its employees, and offered the HHS Healthy People 2020 Initiative as a possible model for DHS’s own approach to employee health.1

Others considered fitness and leadership. Liebe emphasized that broadly, the introduction or reintroduction of fitness as a mechanism to promote wellness is important. Addressing the topic of sound leadership, Spendiff said that DHS should require further oversight for wellness programs and should make a stronger effort to engage and promote good leadership in this area.

Leslie Holland from DHS ended the workshop by providing some reflective remarks on behalf of the sponsor. Holland acknowledged that service in law enforcement is a difficult occupation right now, given the political environment, the pressure on the job, the resource constraints, and the complexity of the DHS organizational structure. She emphasized that from a public health perspective, DHS is beginning to approach wellness through the lens of primary, secondary, and tertiary prevention—a framework reintroduction she attributed to Salvatore. She said that sleep, nutrition, and exercise are well-established areas of concern in regard to wellness, and they should remain as focus areas for prevention activities. She closed by saying that these activities not only address human health and wellness, but also lessen costs for the government: Fewer employee wellness issues can lead to fewer worker compensation bills, which would ultimately save funds that could be redirected elsewhere to support crucial aspects of the execution of the DHS mission. ♦♦♦

REFERENCES

Adler, A. B., B. C. Gunia, P. D. Bliese, P. Y. Kim, and M. L. LoPresti. 2017. Using actigraphy feedback to improve sleep in soldiers: An exploratory trial. Sleep Health 3(2):126-131.

Adler, A. B., P. Y. Kim, S. J. Thomas, and M. L. Sipos. 2018. Quarantine and the U.S. military response to the Ebola crisis: Soldier health and attitudes. Public Health 155:95-98.

Andersen, J. P., and H. Gustafsberg. 2016. A training method to improve police use of force decision making: A randomized controlled trial. SAGE Open 6(2):2158244016638708.

Christopher, M. S., M. Hunsinger, R. J. Goerling, S. Bowen, B. S. Rogers, C. R. Gross, E. Dapolonia, and J. C. Pruessner. 2018. Mindfulness-based resilience training to reduce health risk, stress reactivity, and aggression among law enforcement officers: A feasibility and preliminary efficacy trial. Psychiatry Research 264:104-115.

Gotink, R. A., P. Chu, J. J. V. Busschbach, H. Benson, G. L. Fricchione, and M. G. M. Hunink. 2015. Standardised mindfulness-based interventions in healthcare: An overview of systematic reviews and meta-analyses of RCTs. PLoS ONE 10(4):e0124344.

IOM (Institute of Medicine). 2014. Advancing workforce health at the department of homeland security: Protecting those who protect us. Washington, DC: The National Academies Press.

Jha, A. P., A. B. Morrison, S. C. Parker, and E. A. Stanley. 2017a. Practice is protective: Mindfulness training promotes cognitive resilience in high-stress cohorts. Mindfulness 8(1):46-58.

Jha, A. P., J. E. Witkin, A. B. Morrison, N. Rostrup, and E. Stanley. 2017b. Short-form mindfulness training protects against working memory degradation over high-demand intervals. Journal of Cognitive Enhancement 1(2):154-171.

LeDoux, J. E., D. S. Pine. 2016. Using neuroscience to help understand fear and anxiety: A two-system framework. American Journal of Psychiatry 173(11):1083-1093.

Prochaska, J. O., and C. C. DiClemente. 1983. Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology 51(3):390-395.

U.S. Army. 2016. U.S. Army Ready and Resilient: Overview. http://readyandresilient.army.mil/overview.html (accessed June 11, 2018).

___________________

1 Read more about the initiative here: https://www.healthypeople.gov (accessed June 11, 2018).

Suggested Citation:"Opportunities to Enhance the Health and Well-Being of the Department of Homeland Security Law Enforcement Workforce: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2018. Opportunities to Enhance the Health and Well-Being of the Department of Homeland Security Law Enforcement Workforce: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press. doi: 10.17226/25225.
×

DISCLAIMER: This Proceedings of a Workshop—in Brief was prepared by Ben Kahn and Scott Wollek as a factual summary of what occurred at the workshop. The statements made are those of the rapporteur or individual workshop participants and do not necessarily represent the views of all workshop participants; the planning committee; or the National Academies of Sciences, Engineering, and Medicine.

REVIEWERS: To ensure that it meets institutional standards for quality and objectivity, this Proceedings of a Workshop—in Brief was reviewed by Edrick Dorian, Los Angeles Police Department, and Terri Tanielian, RAND Corporation. Lauren Shern, National Academies of Sciences, Engineering, and Medicine, served as the review coordinator.

SPONSOR: This workshop was partially supported by the Department of Homeland Security.

For additional information regarding the meeting, visit http://nationalacademies.org/hmd/activities/publichealth/medicalreadiness/2018-jan-17.aspx.

Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2018. Opportunities to enhance the health and well-being of the Department of Homeland Security law enforcement workforce: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/25225.

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Copyright 2018 by the National Academy of Sciences. All rights reserved.

Suggested Citation:"Opportunities to Enhance the Health and Well-Being of the Department of Homeland Security Law Enforcement Workforce: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2018. Opportunities to Enhance the Health and Well-Being of the Department of Homeland Security Law Enforcement Workforce: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press. doi: 10.17226/25225.
×
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Suggested Citation:"Opportunities to Enhance the Health and Well-Being of the Department of Homeland Security Law Enforcement Workforce: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2018. Opportunities to Enhance the Health and Well-Being of the Department of Homeland Security Law Enforcement Workforce: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press. doi: 10.17226/25225.
×
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Suggested Citation:"Opportunities to Enhance the Health and Well-Being of the Department of Homeland Security Law Enforcement Workforce: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2018. Opportunities to Enhance the Health and Well-Being of the Department of Homeland Security Law Enforcement Workforce: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press. doi: 10.17226/25225.
×
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Suggested Citation:"Opportunities to Enhance the Health and Well-Being of the Department of Homeland Security Law Enforcement Workforce: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2018. Opportunities to Enhance the Health and Well-Being of the Department of Homeland Security Law Enforcement Workforce: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press. doi: 10.17226/25225.
×
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Suggested Citation:"Opportunities to Enhance the Health and Well-Being of the Department of Homeland Security Law Enforcement Workforce: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2018. Opportunities to Enhance the Health and Well-Being of the Department of Homeland Security Law Enforcement Workforce: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press. doi: 10.17226/25225.
×
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Suggested Citation:"Opportunities to Enhance the Health and Well-Being of the Department of Homeland Security Law Enforcement Workforce: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2018. Opportunities to Enhance the Health and Well-Being of the Department of Homeland Security Law Enforcement Workforce: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press. doi: 10.17226/25225.
×
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Suggested Citation:"Opportunities to Enhance the Health and Well-Being of the Department of Homeland Security Law Enforcement Workforce: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2018. Opportunities to Enhance the Health and Well-Being of the Department of Homeland Security Law Enforcement Workforce: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press. doi: 10.17226/25225.
×
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Suggested Citation:"Opportunities to Enhance the Health and Well-Being of the Department of Homeland Security Law Enforcement Workforce: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2018. Opportunities to Enhance the Health and Well-Being of the Department of Homeland Security Law Enforcement Workforce: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press. doi: 10.17226/25225.
×
Page8
Suggested Citation:"Opportunities to Enhance the Health and Well-Being of the Department of Homeland Security Law Enforcement Workforce: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2018. Opportunities to Enhance the Health and Well-Being of the Department of Homeland Security Law Enforcement Workforce: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press. doi: 10.17226/25225.
×
Page9
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On January 17 and 18, 2018, the National Academies of Sciences, Engineering, and Medicine hosted a workshop focused on enhancing the health and well-being of the Department of Homeland Security’s (DHS) law enforcement workforce. The workshop featured presentations in two main topic areas: (1) the operational stressors and environments faced by the DHS law enforcement workforce, and (2) strategies that can be used to address these stressors and promote overall health and well-being. This publication summarizes the presentations and discussions from the workshop.

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