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#BrainCareSavesLives

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#BrainCareSavesLives

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Content #BRAINCARESAVESLIVES 1
#BrainCareSavesLives
Mitchell K. Page, MSW
Capstone Proposal
Presented to the Faculty of the
Suzanne Dworak-Peck School of Social Work
in Partial Fulfillment for the Degree
Doctor of Social Work
University of Southern California
SOWK 722 Implementing Your Capstone & Re-envisioning Your Career
Devon Brooks, PhD, MSW
October 29, 2020
December 2020
#BRAINCARESAVESLIVES 2
#BrainCareSavesLives
Executive Summary
Link Between Brain Care and Progress on Eradicate Social Isolation
This capstone project addresses the Grand Challenge of Eradicating Social Isolation
(Fong et al., 2018). There are clear correlations between social isolation and medical conditions
as minor as the common cold and as serious as suicide (Hammig, 2019). Both active duty
military and veteran service members (MSM) of the United States armed forces suffer from the
same effects of social isolation as civilians. However, when MSM do not meet the high
expectations placed upon them, they suffer unique and increased risks (Abrams, 2018). Due to
greater stigma for mental health help-seeking in the military than in civilian life, the majority
of MSM deny psychiatric symptoms they experience, they socially isolate and avoid mental
health treatment (Porcari et al., 2017). This contributes to higher rates of post-traumatic stress
and suicide in the DoD compared to the civilian population ( 2019 National Veteran Suicide
Prevention Annual Report , 2019).
Purpose of Project Innovation Represented Within Larger Conceptual Framework
The purpose of my #BrainCareSavesLives (BCSL) project is to increase the number of
MSM engaging effectively in brain hygiene as close to the time they experience a
psychologically stressful event as possible. By moving MSM mental health treatment out into the
field where MSM can engage in self-administered brain hygiene in real time, post-traumatic
stress disorder (PTSD) symptoms will be reduced, help-seeking stigma will become less
relevant, and the negative effects (social isolation, exacerbation of symptoms, self-medication
with substances, suicide) of untreated psychological trauma will be minimized (Page, 2019).
The Problem Project Addresses Within Field of Policy or Practice
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The Department of Defense (DoD) has used resilience theory as a basis for the
Comprehensive Soldier Fitness (CSF) policies and practices based primarily on studies with
children and families going back to the 1970's (Masten, 2018). This theoretical model relies on
systems theory to understand the strengths and capacities developed by a child in the context of
their caregivers and siblings. The theory speaks about personality characteristics and family traits
consistent with resilience such as attachment, nurturance, collaboration, optimism, and positive
thinking. The problem with this theory as a basis for any DoD mental health program is that it
does not incorporate a brain-based, trauma-informed construct from which to design effective,
objectively measured policies and practices and their outcomes. BCSL does incorporate
these essential elements and will therefore be more effective in reducing MSM PTSD and
suicidality.
How Overarching Methodology and Methodological Tools Address Project’s Aims
The methodology BCSL utilizes to increase MSM engagement in daily brain hygiene
includes a strategy and rationale based on social norms theory, the latest brain-based
understanding of psychological trauma, and modern computer technology to design and
implement the program. By working with these disciplines, BCSL will partner with the DoD and
Department of Veterans Affairs (VA) to engage in ongoing research, treatment, and
education/advocacy.
The BCSL methodological tools are a brain hygiene training curriculum, wearable
technology, the Brain Care smartphone app, the PTSD Checklist for DSM-5 (PCL-5), and the
Self-Stigma of Seeking Help Scale SSOSH ( PCL-5 What is It? , 2017)(Vogel et al., 2006). Prior
to the training sessions and the actual implementation of Brain Care, all MSM will be
administered the PCL-5 and SSOSH to gather baseline data on MSM symptoms of PTSD and
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subjective experiences of stigma related to mental health help-seeking (Page, 2019). During
classroom training, MSM will be monitored for engagement and understanding of the brain care
curriculum. At the end of each training session they will be required to complete an exit ticket
where they will answer ten questions about the material taught in that session and MSM will be
asked to write a brief narrative describing what was unclear from the session. Based on MSM
responses, trainers will re-teach unclear material identified during the first portion of the
following training session.
Aims for Project Implementation and Future Action Steps
The aims for project implementation are three-fold. BCSL aims to provide preventive and
ongoing mental health treatment for MSM. BCSL will utilize the latest science and
understandings of how psychological trauma affects the brain and how current
mindfulness-based Cognitive Behavioral Treatment (CBT) works to repair damage done on a
neuronal level Second, BCSL aims to engage in ongoing research with partners from the VA and
DoD to better understand how MSM can more effectively self-monitor and manage stress-related
illnesses. Third, BCSL will work to provide education to and advocacy for all MSM at risk for
stress-related illnesses so that early and often brain hygiene becomes the new norm for all MSM
within the DoD.
Future steps include presenting components of the proposed BCSL solution to leadership
within the DoD and VA systems in Connecticut to build partnerships in research, treatment, and
public education and advocacy (Page, 2019).
How Project Represents an Innovative Step Forward with Potential to Scale Up
BCSL represents an innovative step forward and has potential implications beyond a
narrow context because to date no one within the DoD has used norms theory combined with the
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utilization of end user real time, stress-related, neuro and bio data to deliberately design policy
and implement practices altering, in an objectively measurable way, MSM utilization of mental
health treatment and its outcomes (Page, 2019). Given the ubiquitousness of smartphones, this
innovative approach can be scaled up at US Army bases across the United States to train MSM
during Advanced Individual Training (AIT). The wearable neuro and biotechnology are small,
lightweight, easy to use, and will link seamlessly with the Brain Care app. Over the course of
three to five years, BCSL will work to have all new US Army recruits trained in brain hygiene.
Conceptual Framework
The Problem Within the Context of at Least One Grand Challenge for Social Work
The problem of loneliness and social isolation among military service members has
unique aspects that require special attention from medical and mental health professionals. A
comprehensive review of the literature reveals that it was noted loneliness and social isolation
are related to mental health problems and as MSM age they are particularly vulnerable.
MSM experiencing the stresses of combat or military service in general who do not talk about
their problems are inclined to withdraw (Wilson et al., 2018). This withdrawal puts them at
greater risk for their condition worsening.
MSM are reluctant to talk about their mental health problems as a result of traditional
masculine roles and associated norms. Most MSM are men who have been trained and oriented
to demonstrate self-reliance, hyper-masculinity, and selfless sacrifice for the reference
group (Selig et al., 2019). As a result of these social norms, it feels emasculating for many
MSM to express their feelings, their vulnerabilities, and their weaknesses (Shields, 2017). By
encouraging MSM to use their own words to describe their experience, social
workers start where the client is and join with them to best understand their needs.
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In addition to traditional gender roles and expectations of hypermasculinity, MSM are
trained and oriented to “suck it up” and deny their emotional and psychological needs. This Stoic
approach to difficult thoughts and feelings has driven much of the culture and norms within the
United States Army since it was founded. In fact, this philosophical and behavioral approach to
psychic and physical pain has been the standard since before the armies of the Roman-Persian
wars (Sherman, 2005). These norms are deeply ingrained and do not change easily. In order to
change these norms, it will require an effective deviant that can sustain over time and eventually
be adopted in its place (Bicchieri, 2017).
What is Known and How Project Connects with Current Context
In one interview with Army officer Cliff Bauman, he reported experiencing bad
memories and thoughts from rescuing people in New York City on 9/11 when the terrorists
struck the Twin Towers. He was anxious and his sleep was being disrupted. He would not ask for
help. He self-medicated with alcohol and his condition worsened. Like Mr. Bauman, over 60%
of MSM report they would not ask for help for mental health problems because it would interfere
with or potentially end their careers (Dastagir, 2019). These perceived and real negative
sanctions for receiving mental health treatment need to change within the DoD or the suicide rate
of MSM will likely continue unchanged.
What makes this situation even more difficult for MSM is the nature of post-traumatic
stress symptoms. For men and women trained to ignore or deny their own emotional or physical
pain and discomfort, it is even easier to ignore trauma symptoms because they are “invisible
wounds” and up to now they have been difficult to observe and measure ( Preventing Military
Suicides , 2010) (Kieran, 2019). Psychological difficulties are particularly challenging for trained
military professionals to acknowledge and accept. When individuals do not seek help as their
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symptoms worsen it is possible, they will experience social isolation and increased vulnerability
for suicidality.
A review of the literature by Hom et al., (2017) found that MSM at greatest risk for
suicide are single white males of E7 rank or higher. This high-risk group had little or no family
encouragement to seek treatment, little or no peer support, and a lack of leadership support (Hom
et al., 2017). Those MSM who had received psychoeducation regarding the value of counseling
or psychotherapy were more inclined to seek help when they felt it was needed. To date, the
work done within the DoD to change, in any real and lasting way, the effects of stigma on mental
health utilization by MSM has not been effective in changing the behavior of the majority of
MSM. This is demonstrated by the low percentage of MSM engaging in mental health treatment,
the rising numbers of those MSM meeting the diagnostic criteria of PTSD, and the steady rise in
the incidence and prevalence of MSM suicide.
The BCSL capstone project capitalizes on what is currently being done in the DoD from
the theoretical, policy, and practice standpoint. BCSL moves beyond using resilience theory by
acknowledging and leveraging social norms as barriers and facilitators to the reduction of MSM
social isolation. BCSL builds on the existing public health policies employed by the DoD to
educate MSM about the importance of utilizing available mental health resources. BCSL literally
places tools in the hands of every MSM by establishing a new policy of training and equipping
MSM in the use of Brain Care built into their phone. Finally, BCSL shifts away from a practice
of identification and referral of MSM for mental health treatment to a new practice of having
MSM directly link to and manage their own neuro and bio data.
Problem is Socially Significant, Important to Real People, Has Applied Implications
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Prior to the onset of the wars in Afghanistan and Iraq at the turn of this century,
the MSM suicide rate was commensurate with that of the civilian population. From 2001 to 2014
the number of MSM meeting the diagnostic criteria for PTSD increased 160% while the
incidence and prevalence of MSM suicide went from 18.5 in 2005 to 27.7 per 100,000 in
2017 and these numbers continue to climb ( 2019 National Veteran Suicide Prevention Annual
Report , 2019). Much of research regarding MSM suicide focuses on one thing: military culture.
The problem, according to retired Army Colonel Allen Haring at the Service Women’s Action
Network is that the culture of the military is to “suck it up” and if you do not then you are weak
and you will be rejected (Dastagir, 2019). This attitude is what contributes significantly to the
steady increases in MSM social isolation and suicidality.
As a result of stigma, many MSM suffer in isolation with depression, anxiety, and
crippling symptoms of post-traumatic stress, which makes it more likely for them to withdraw
further, experience a worsening of their symptoms, and become vulnerable for suicide (Cacioppo
et al., 2016). In one study researchers looked at MSM utilization of mental health services over
the course of nine years from 2002 to 2011 (Quartana et al., 2014). They found there was an
overall increase in utilization but that a large percentage of MSM still do not seek mental health
care and, in fact, though utilization was up overall, the trend since 2007 is downward. In this
study, the authors found two thirds of those MSM screening positive for psychological problems
did not ask for help from available mental health services. In another, more recent study,
self-stigma and not public stigma of seeking psychological help correlated with significantly low
mental health utilization among active duty MSM (Seidman, 2019). These are critical findings
as they support the idea that norms exist within the military that discourage MSM from seeking
mental health treatment.
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A Coherent Conceptual Framework and Logic Model Clarifying Theory of Change
My proposed BCSL project is guided by a conceptual framework incorporating the latest
scientific understanding of the neurophysiology of psychological trauma and its treatment,
combined with the theory of social norms change. The specific behavior change sought is that
MSM and their leaders will demonstrate increased engagement of mental health treatment for
trauma symptoms above the current rate of approximately 33%. In order to achieve this goal I
will need to decrease the stigma of engaging in mental health treatment within the DoD (Page,
2019). Simultaneously, I will need to help DoD leadership understand the value of building into
their mental health policies and practices a brain-based, trauma-informed approach to MSM
mental health treatment protocols.
In order to improve treatment outcomes for MSM, the DoD, and eventually the VA, I will
need to change the way leadership in these organizations think about and respond to the mental
health needs of MSM from the moment MSM enter service. I plan to initiate this process of
change at the local level, within the leadership of the Connecticut Army National Guard. I will
also work to collaborate with experienced clinicians and researchers within the VA Connecticut
Healthcare System. By engaging leadership within these local organizations as well as
stakeholder groups and elected leaders within Connecticut, I will be well positioned to scale up
the work of the BCSL project to Army bases throughout the United States (See Logic Model -
Appendix A).
Problems of Practice and Innovative Solution
Proposed Innovative Solution
MSM will be trained in brain hygiene during AIT. This will include an overview of the
parts of the brain, their function, and how the brain is affected by trauma. Training will also
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teach MSM why and how to use the second part of the proposed solution, a smartphone app
named Brain Care, paired with wearable neuro and biofeedback devices. MSM will learn how
their own high arousal measures displayed as bio/neuro metric data from those devices can be
used to guide the MSM selection of mindfulness and cognitive behavioral treatment modules
stored and continuously updated within the Brain Care app.
In the appendices to this paper I have attached the logic model to provide a graphic
representation of the resources, inputs, activities, outputs, and outcomes of the proposed
innovation. The goal of BCSL is to double the percentage of MSM engaging in mental health
treatment from 33% to 66% by 2023. In addition, and as a result of increased treatment
engagement I expect the incidence and prevalence of suicide per 100,000 to begin to decline.
More MSM and leaders will behave as if trauma and brain hygiene is a standard way of doing
business, no different from foot care, skin care, or proper hydration. It will be an embedded
policy and practice to take care of one’s brain hygiene in the service of competent and effective
mission completion.
How Proposed Innovation Will Help Eradicate Social Isolation
The BCSL proposed innovative solution will contribute to improvements in the Grand
Challenge: Eradicating Social Isolation (ESI) within the DoD (Fong et al., 2018). By training and
equipping MSM in brain hygiene, the stigma of mental health treatment will be reduced among
MSM in the DoD. More MSM will engage in brain hygiene and fewer MSM will experience
debilitating symptoms of PTSD. Over time, MSM will demonstrate decreased usage of
substances to self-medicate, and suicide rates will decrease. The key to the success of the BCSL
proposed innovation is to help DoD leadership understand that MSM need to think about mental
health treatment as different from any other physical or medical intervention.
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The Problem from Multiple Stakeholder Perspectives
Since the United States entered the wars in the Middle East in 2001, multiple
stakeholders have offered their perspectives on how best to understand and solve the complex
problems of MSM brain based conditions. These stakeholders include but are not limited to
concerned significant others (CSO), military and Veterans Affairs (VA) researchers,
politicians, military leaders, and clinicians who provide MSM with care (Kieran, 2019). Each of
these groups has unique needs and expectations, sometimes agreeing, often at odds with each
other.
CSO most affected by MSM traumatic stress are MSM friends and loved ones. Other
than the MSM themselves, no one has suffered more than CSO as a result of loss and impairment
secondary to the demands of war (Cozza et al., 2017). The challenges for those closest to
affected MSM has been tremendous as they deal with the shock and uncertainty of war and its
effects (Lucero et al., 2018). The innovative solution brought by BCSL will have a direct
positive effect on MSM CSO as MSM experience a reduction in stress-related illnesses.
DoD and VA researchers, in cooperation with numerous university and National
Institutes of Health scientists and academicians, have worked tirelessly to better understand and
treat the effects of war on MSM. With advances in science and technology, researchers now have
a greater understanding of how the brain responds to trauma, as well as which treatments work
best (Butt et al., 2019). The challenge remains to bring this new knowledge into practice within
the DoD in real time, as close to the time MSM experience stress and psychological trauma. By
intervening early and often with all MSM, researchers will have vast amounts of data with which
to continuously improve treatments.
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Political leadership from Presidents George W. Bush to Barack Obama and the respective
congresses were not prepared for the devastating effects of engaging in a protracted war where
MSM took part in multiple deployments over the course of years. As the DoD and VA struggled
to respond, politicians played catch up to lay blame, provide resources, and hold people
accountable to offer effective treatments and reduce the rate of suicide. While some problems
with the VA were remedied with increased resources and political pressure to improve response
times to MSM, the number of people suffering from traumatic stress and suicide continues to
climb.
How Proposed Innovation Builds on Existing Evidence
The scientific understanding of trauma and advances in diagnosis and treatment have
paralleled technical advances in brain imaging technology. For example, with advances in
magnetic resonance imaging (MRI) technology, scientists and medical professionals have a
much more sophisticated understanding of how psychological trauma causes material changes in
the brain (Bremner, 2007) (Butt et al., 2019) (Feder et al., 2019). This medical and physiological
understanding of trauma has great potential, when explained in the context of the stresses of war,
to change social norms related to mental health treatment utilization by MSM. By shifting MSM
and their leadership's thinking away from trauma-induced emotional and behavioral
dysregulation, as being tied to strength of character and instead as directly related to brain
physiology, stigma and its effects on mental health treatment utilization can be altered
significantly.
PTSD was a mystery up until the early part of the 20 th Century. It was only after World
War One that researchers termed the phrase “shell shock” and began to investigate the effects of
combat stress on a person (Gradus, 2019). Over the years, the DoD worked to actively deny,
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minimize, or punish MSM mental health issues (Russell, M., Schaubel, S., & Figley, C., 2018).
There are many reasons for this including stigma, avoidance of having to provide costly care,
and the threat to recruitment efforts. Most recently the policy and practice of the DoD has been
to acknowledge and encourage mental health utilization but these efforts have fallen short as a
result of social norms and negative sanctions for MSM mental health utilization as described in
this paper.
The work of BCSL builds on this history, policy, practice, public knowledge and
discourse by shifting the paradigm from help-seeking to self-administered brain hygiene paired
with existing routine self-care practices. This has the promise of reducing stigma, increasing
MSM mental health utilization, improving mission readiness, and saving lives. In an age when
the large majority of people have their own sophisticated mobile device, it only makes sense to
change how the DOD engages MSM in the business of mental health treatment. It is especially
fitting during this Covid-19 pandemic that MSM are empowered to self-direct their care.
How Proposed Project Considers Existing Opportunities for Innovation
My proposed project considers existing opportunities for innovation within the DoD by
examining where there is the greatest opportunity to effect change and apply sustainable
solutions. I find Peter F. Drucker's work on the seven sources of innovative opportunity to be a
useful way to frame this examination (Drucker, 2007). One of these sources is referred to as
incongruity. This refers to gaps that exist between what the organization provides and what
end-users need.
Since it was rolled out in 2009 the Master Resilience Training program (MRT) developed
by the US Army and the University of Pennsylvania has not met the needs of their service
members. While self-report measures used by the MRT are suggestive of a successful program,
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empirical evidence of rising rates of trauma and suicide counter those claims (Reivich et al.,
2011). Anecdotal evidence from MSM interviews and peer-reviewed studies also points to a gap
between what MRT provides and what MSM want and need in order to manage their
stress (Lester et al., 2011).
Another area for consideration to justify existing opportunities for innovation has to do
with examining the existing ways the company (DoD) does business and how that might be
improved. Drucker refers to this as process need (Drucker, 2007). For decades, the DoD has
utilized an identification and referral process when intervening with MSM suffering from trauma
symptoms. While this model may work well in other settings, in the DoD where MSM are
reluctant to follow through with mental health treatment, this process often fails to connect the
MSM with necessary services. By empowering MSM with training and wearable technology to
monitor and manage their psychological stress responses, MSM will engage in the care they need
early and often, thus reducing symptoms and saving lives.
How Proposed Innovative Solution Aligns with Logic Model and Theory-of-Change
I propose an innovation consisting of several interrelated phases informed by social
norms theory and the science of neurophysiology. The first phase has to do with data gathering,
design, and delivery of a brain care curriculum. I will meet with MSM to hear directly from them
in order to develop empathy and understanding of their experiences. From these in-depth
conversations I am better informed to design the brain care curriculum that accurately meets
MSM needs.
The second phase involves equipping MSM with EEG and biometric wellness devices to
monitor, measure, and record their heart rate, respiration, galvanic skin response (GSR), and
brain wave activity indicative of the sympathetic nervous system’s varying states of arousal
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(Fajardo, & Guzmán, 2016). This will allow MSM to observe their brain’s and body’s own
arousal data. By having concrete data points created by MSM during a firefight or some other
high arousal situation they would then be able to engage with the topic of PTSD in an entirely
new way.
MSM will be able to select any one of the sensory data points to display on their
smartphone screen and engage themselves or another MSM to move their sensory data to a lower
level of stress (more calm) through gamification. Young MSM grew up on video games. By
gamifying their own sensory data and encouraging friendly competitions during downtime, the
MSM would be creating new norms around brain hygiene while simultaneously gaining greater
control over their symptoms and treatment.
Finally, within the Brain Care app MSM use to access their sensory data includes
information about and treatment tips and reminders for proper foot care, proper hydration,
frostbite, and brain hygiene. This early intervention would also have the positive effect of
improving MSM prognosis as we know from the most recent literature on PTSD that early
intervention is most effective (Bray et al., 2016).
The Proposed Project’s Overall Likelihood of Success
BCSL has a moderate to high likelihood of success over the next five years. I have
received favorable feedback during interviews with leaders within the DOD, including in 2019, a
phone conversation with the now retired commandant of the United States Marine Corp, General
Robert Blake Neller (R. B. Neller, personal communication, June 19, 2019). I have also obtained
encouraging as well as critical feedback from MSM during a Brain Care app focus group in
September 2020. I have been encouraged by authors Nancy Sherman and David Kieran to push
forward with this work as they both acknowledge the barrier mental health stigma presents to all
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MSM (N. Sherman, personal communication, June 21, 2019) (D. Kieran, personal
communication, October 29, 2019).
#BrainCareSavesLives is now established as 501c3 in the State of Connecticut and our
officers are actively recruiting qualified people who are invested in reducing MSM social
isolation, PTSD, and suicide to serve on our board of directors. I am currently in conversations
with staff at United States Senator Richard Blumenthal’s office to assist me in meeting with
clinical and administrative leadership at the VA Hospitals in West Haven and Newington,
Connecticut as well as with leadership at the Connecticut Army National Guard. Finally, I am
working with lobbyists in Hartford, Connecticut to create opportunities to meet with state
legislators to educate them on the urgency of our project. I have reached out specifically to State
Representative Gary Turco, and we will sit down to discuss the work of BCSL after the election
November 3, 2020. And you’re publishing : )
Project Structure, Methodology, and Action Components
Presentation of Prototype
The Brain Care smartphone app consists of four areas based on a review of the most
modern, most effective health and educationally-related smartphone apps on the market (Bush,
2019). The first is a video game where end-users navigate mindfulness stations and earn points
for both participation and for achieving lower arousal scores as measured on their wearable tech
devices while using the mindfulness-based cognitive behavioral treatment modalities within the
game. The purpose of the video game modality is to pair the existing norm of video game
utilization by young men and women with a new norm of brain care. The second area consists
of daily tips and reminders that can be toggled on or off at any time. These tips and reminders
provide relevant, constantly updated information on foot care, skin care, brain hygiene, and
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proper hydration. The third area is an information resource library on the four self-care activities
referenced above. Finally, there is a help link available 24 hours a day for both technical and
clinical support (See Prototype Wireframe - Appendix B).
This prototype is designed to increase mental health treatment engagement within the
United States Department of Defense (DoD) while decreasing the incidence and prevalence of
military service members (MSM) meeting the diagnostic criteria of PTSD. Based on my review
of the current literature, by pairing brain hygiene with existing self-care routines I am confident
the new norm of brain hygiene will be more readily adopted and sustained over time (Bicchieri,
2017). The long-term goal of this app is to decrease the number of active duty and veteran or
retired MSM taking their own lives as a result of untreated post-traumatic stress.
This prototype was developed as a result of extensive review of the current research into
the reasons driving the social problem of MSM not engaging in mental health treatment (Morgan
et al., 2016). Also, I reviewed the history of the practice problem of the Department of
Defense not responding effectively to long-standing barriers to MSM mental health treatment
utilization such as stigma and negative sanctions. I developed the Brain Care app informed
by social norms theory and the latest neurophysiological understandings of how psychological
trauma affects the brain. MSM are reluctant to engage in mental health treatment for fear of
negative sanctions from peers and supervisors when their amygdala enters a state of hyperarousal
in response to environmental cues or stimuli similar to their initial psychological trauma
(Bicchieri, 2017; Yabuki & Fukunaga, 2019). Finally, I have engaged with existing wearable
neurotechnology, game theory, and smartphone app technology as a delivery system of
brain-based, evidence-based clinical interventions to create a user-friendly, scalable
intervention.
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The result of this prototype is that MSM will no longer have to risk stigma and negative
sanctions for mental health treatment engagement but instead, they are empowered to monitor
and manage their own brain hygiene needs, no different from other routine bodily self-care.
Because MSM no longer have to ask for help, they can avoid ridicule, or threats of demotion.
Instead, they can take care of their mental health needs independently and, when needed, connect
directly with a licensed mental health professional via the Brain Care app.
This prototype will impact the success of my capstone project by providing ongoing
mental health education and support to hundreds of thousands of MSM, thereby creating a
paradigm shift in the DoD by changing the way both MSM and the DoD think about and respond
effectively to stress-related illness (Kuhn, 1996). As leadership within the DoD and VA work to
modify existing mental health care policies within their respective organizations, MSM will
benefit from this vital Brain Care training. The existing Brain Care app is ready for
implementation pending further review by a team of software and hardware engineers, mental
health professionals, and military experts as it relates to practical application of Brain Care in a
variety of real-world MSM environments. Old theories that are incompatible with existing
outcomes will be replaced with new theories, policies, and practices to dramatically improve
outcomes, and save lives.
The Brain Care app prototype is currently accessible in iOS for demonstration purposes
only. As BCSL collaborates with the DoD and VA we hope to move from a demonstration
model to a working app, able to provide educational and, eventually, treatment modalities to
MSM as they experience high stress events in real time.
Market Analysis for the Proposed Innovation Relative to Alternatives
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MSM currently have several options available to them for self-help, education, and
support. On the National Center for PTSD website published by the VA there are listed 18
smartphone apps, educational videos, research publications, and myriad other mental health
resources for MSM and their families ( Va.gov | Veterans Affairs , 2020). The apps listed contain
the latest evidence-based practices from mindfulness to cognitive processing techniques. None of
these apps or resources appear to be designed to change social norms around mental health
utilization. While norms change is not the only way behavior change can happen, public
education and public health interventions based on resilience theory within the DoD have not
proven effective.
In order to distinguish the Brain Care app from all of the others, and to ensure sustained
adoption by the DoD in this crowded marketplace, I will need to engage stakeholders within both
the inner and outer context of the DoD. This means I will need to establish relationships with
technical and medical professionals in the private sector and within the DoD to move forward
with research, clinical trials, and education regarding the utility of doing business differently
with MSM psychological trauma. This new type of smartphone app that incorporates routine
self-care modalities such as foot care, skin care, and proper hydration paired with existing
self-care routines may not be initially understood or accepted by DoD leadership. BCSL will
need to gain credibility by running clinical trials and gathering data to support the contention of
its efficacy.
I will have to articulate clearly the complementarity between existing options
promulgated by the DoD and VA and my proposed prototype. The DoD is a large organization
with a culture (basic assumptions and values) that influences outcomes of its activities, or
missions (Hartnell et al., 2019). The strongly held value of the DoD is that all MSM must be
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resilient, effective, and reliable. As a result, the stigma of a service member displaying symptoms
of psychological trauma has historically been a barrier to them seeking and receiving mental
health treatment, including utilization of their own smartphone apps. I plan to overcome this
barrier by changing the focus from mental illness to brain hygiene using physiology, science, and
biometrics.
The Project’s Methods for Project Implementation
There are four main strategies I intend to use for the prototype implementation. The first
of these has to do with the use of ongoing feedback from end users as well as professionals
delivering the intervention (Kirchner et al., 2017). This allows ongoing evaluation and iteration
of program design, outcome measures, and the development and delivery of Brain Care to ensure
it meets end user and institutional needs. I will meet with leadership from the Connecticut Army
National Guard (CNG) and DoD to ensure this process is adhered to by developing
the monitoring and data gathering systems of Brain Care. In an initial focus group with MSM
conducted in September 2020, BCSL was able to obtain valuable feedback regarding all aspects
of the Brain Care app.
The second relevant strategy category is to have the clinical innovation remain adaptable
and yet flexible while remaining clear about the innovation’s most essential elements in order to
maintain fidelity of implementation (Kirchner et al., 2017). One example of this has to do with
feedback I received in 2019 from the then Commandant of the United States Marines. General
Robert Blake Neller told me that the wearable neurotechnology requires stealth technology to
prevent it from giving off an electronic signature which might indicate to others the location of
US forces. I will work with the BCSL and DoD teams to build in these and any other
#BRAINCARESAVESLIVES 21
necessary modifications to ensure the wearable neurotechnology meets all requirements for use
in the field.
The third category has to do with building and maintaining positive and effective
partnerships, and identifying and encouraging champions and early adopters (Kirchner et al.,
2017). This is critical for several reasons. I am not a veteran. In order to have sufficient
credibility with the leadership in the DoD, CNG, and Connecticut Department of Veterans
Affairs, I will need to collaborate with Adjutant General Frank Evon of the CNG.
General Evon lives in my town and has been gracious enough to discuss this project. Moving
forward, I intend to build on this relationship with the general in order to meet other potential
champions within the CNG.
Education and training is at the heart of my proposed innovation (Kirchner et al., 2017).
Both DoD and Va leadership need to understand how Brain Care can effectively change social
norms around mental health utilization. MSM need ongoing training and support from trained
leadership and peers to encourage norm change and early adoption of Brain Care. I will rely on
the power of this fourth strategy to reframe mental illness and mental health treatment in the
context of the DoD to help MSM and leadership adopt a new norm of brain hygiene. Teaching
and training all the various stakeholder groups early on will help them understand how the
proposed capstone will meet their needs. This will be accomplished by training and equipping
MSM during advanced individual training (AIT) after basic training and prior to deployment. By
teaching MSM about the parts and functions of the brain and how the brain is affected by trauma
as well as how self-administered Brain Care can help the MSM to heal from trauma, MSM will
be more prepared to utilize Brain Care effectively in the field.
The Project’s Financial Plans and Implementation Strategy
#BRAINCARESAVESLIVES 22
In the first full year of operation (FFYO) BCSL will increase brain hygiene engagement
by 100% for the 5,000 Connecticut Army National Guard (CNG) MSM and reduce the number
of MSM reporting symptoms of post-traumatic stress disorder as measured by the PCL-5
checklist by 10% year over year ( PCL-5 What is It? , 2017). These outcomes will be
accomplished with the solid financial plan I developed as outlined below.
This project’s plan for the startup year (SU) requires $2.2M and for the FFYO requires
$1.1M. More specifically, the plan’s 12-month SU and then FFYO looks like the following:
Start-Up FFYO
Revenue $2.2M $1.1M
Expenses
Personnel $546K $828K
Other Exp’s $1.608M $180K
Total Exp’s $2.154M $1.008M
Surplus $46K $92K
The majority of expenses, approximately $1.5 million, for the project’s SU activities
cover the acquisition of wearable neurotechnology devices from companies such as Muse and
Fitbit ( Muse - How It Works , n.d.) ( Fitbit Products Technology Motivation , n.d.). During its
FFYO, expenses will go primarily towards responding to requests from MSM for brain care
coaching as well as technical assistance in using wearable technology and Brain Care. See
Budget Details - Appendix C). BCSL has decided to align their fiscal year with that of the
DoD and VA which run from October 1 through September 30.
The Prototype’s Methods for Assessment of Impact
#BRAINCARESAVESLIVES 23
The staff at BCSL will utilize established, standardized instruments pre and post
intervention with each MSM to measure two variables. The first measured variable is the degree
to which a MSM experiences stigma as a barrier to seeking treatment for their mental health
problems using the Self-Stigma of Seeking Help (SSOSH) Scale (Vogel et al., 2006) (See
SSOSH Scale - Appendix D). The second measured variable will be the degree to which each
MSM is experiencing symptoms consistent with the diagnosis of PTSD as measured by the
PTSD Checklist-5 (Wortmann et al., 2016) (See PCL-5 - Appendix E). These measures are
optimal given the documented effects of stigma on help-seeking behavior within the military
(O'Donnell et al., 2017). By gathering these two data points before and after MSM are provided
training in brain hygiene for psychological trauma, BCSL will demonstrate the efficacy of their
proposed intervention.
My goal in implementation of the Brain Care smartphone app within the DoD is to
answer the following research question: Will MSM with PTSD symptoms using mindfulness and
cognitive behavioral interventions to reduce arousal states in real time via mobile technology
experience a reduction in trauma symptoms while simultaneously changing mental health
treatment utilization social norms? In order to answer this question I will use a variety of mixed
methods measures before and after MSM engage with the Brain Care app including interviews
and focus groups, in addition to the quantitative data.
Relevant Stakeholder Involvement
Engaging stakeholders is an essential part of the overall Brain Care project in order to
ensure success. I have contacted General Frank Evon, Connecticut Army National Guard (F.
Evon, personal communication, June 14, 2019). He referred me to Lt. Col. Alyssa Kelleher to
arrange a meeting with 10 to 15 soldiers to discuss their understanding of MSM stress and the
#BRAINCARESAVESLIVES 24
potential of Brain Care to provide relief (A. Kelleher, personal communication, June 14,
2019). In the meantime, I convened a Zoom focus group on September 2, 2020 with active duty
and veteran MSM to get feedback from them on the pros and cons of Brain Care (Focus Group,
personal communication, September 2, 2020).
General Robert B. Neller, the Commander of the United States Marine Corp has offered
helpful advice to me on the utilization of Brain Care in the field of battle and to be particularly
careful to not create an “electronic signature” where bad guys could use the electronic
signature to target friendly forces. I explained my project to the General and asked for his
support to run a pilot program with marines to determine if they think the Brain Care app would
be practical and effective. While my capstone is directed primarily at MSM in the US Army, I
believe I may gain leverage with the leadership of the US Marines to run a prototype given the
expressed concern by General Neller. General Neller has since retired, but I am working to
establish a partnership with the new leadership there.
I have reached out to Dr Bill Byrom at Signant Health in Nottingham Trent University in
the United Kingdom (B. Byrom, personal communication, June 15, 2019). Dr. Byrom works on
wearable and connected devices to monitor brain and body systems. Dr. Byrom explained his
wearable devices are not directly relevant to my purpose, and he directed me to four other
organizations that develop neuro and biofeedback devices. Those businesses
are Emotiv, MC10, Muse, and Shimmer. I am in conversations currently with people and Fitbit
to pair my Brain Care prototype for beta testing. I am also working with Mr. Benjamin C. Page
in Somerville, Massachusetts to continue to develop the prototype of the Brain Care app.
Finally, I had a fruitful conversation with Dr. Susan Borja, Program Chief at the
Dimensional Traumatic Stress Research Program at the National Institute of Mental Health
#BRAINCARESAVESLIVES 25
(NIMH) to discuss the recent work she and her staff have done on the relationship between
biomarkers and PTSD (S. Borja, personal communication, June 20, 2019). Dr. Borja explained
contributing factors to the development of PTSD such as hormones and neural pathway changes
in the brain early after they experience a traumatic situation. Dr. Borja referred me to Dr. Amit
Etkin and his work on the neural basis of emotions. I left voicemail and emails for Dr. Etkin on
June 21, 2019 but did not hear back from him.
The Project’s Communications Products and Strategies
BCSL is developing a comprehensive package of communications products and strategies
to increase our audience, communicate the urgency of the problem we are addressing, and
engage relevant stakeholders as partners in working towards viable solutions. The three main
audiences BCSL is working to reach include MSM and their families, clinicians,
researchers, leadership at the DoD and VA, and finally policymakers at the state and federal
level, those individuals responsible for allocating resources in the area of MSM and veteran
healthcare research. In order to reach these three audiences BCSL will utilize popular social
media, professional, trade, and academic journals, newspapers and magazines, and live
presentations at academic and professional conferences.
Social media includes but is not limited to Facebook, Instagram, LinkedIn, TikTok,
Twitter, and YouTube. We will work to have coordinated, unified messaging on all platforms to
ensure consistency and potency of the BCSL brand. The strategy with LinkedIn is to reach
colleagues and potential partners from all disciplines to learn about BCSL work and to
share links to our videos, educational presentations, the latest research, and next steps to reduce
PTSD and suicide in the DoD. Facebook, Instagram, TikTok, and Twitter can provide a variety
of consistent messaging to young and older audiences, professional, and lay persons, end-users,
#BRAINCARESAVESLIVES 26
and providers. These platforms will be useful for short, easily digestible ideas about the
importance and relevance of our work with regular calls to action. YouTube will be utilized for
more sustained, more in-depth presentations lasting 5 to 6 minutes and these videos will be
transcribed and uploaded to the BCSL blog for those interested in taking in the information
through the written record.
Capstone Components Address the Stated Problem of Practice
The United States Army has attempted to turn back the rate of suicide by training their
MSM to build capacity for dealing with the inevitable stresses of military life. For
example, University of Pennsylvania academicians and clinicians partnered with the DoD in
2009 to create the Master Resilience Training (MRT) program to help soldiers increase skill
sets for dealing with the stress of serving in the military (Reivich, Seligman, & McBride, 2011).
While this program was well researched and well-intentioned in its aims, it failed to change the
incidence and prevalence of suicide because it failed to address the underlying causes of suicide,
the military’s normative expectations regarding mental health treatment utilization. Until social
norms are properly diagnosed and an innovation is designed to disrupt those norms, it is likely
the suicide rate will continue as it has for the last fifteen years.
The Study to Assess Risk and Resiliency of SM (STARRS) was begun in 2008 by the
National Institute of Mental Health (NIMH) and the DoD (Bernecker et al., 2018). Seven years
after that in 2015 a larger, a more extensive iteration (Longitudinal Study) of STARRS was
rolled out as an attempt to collect data on tens of thousands of SM having to do with behavioral
and emotional well-being (Naifeh et al., 2019). While this study was the largest of its kind at the
time, it concluded that the cause of the rise in Army suicide remained unclear. Other studies on
the cause of MSM suicide focus on social determinants of health including employment/financial
#BRAINCARESAVESLIVES 27
problems, legal issues, unstable housing, family/social conflict, or exposure to violence
(Blosnich, 2020).
Ethical Concerns and Possible Negative Consequences
The profession of social work and conducting social work research is guided by the
National Association of Social Work Code of Ethics ( National Association of Social Workers
(Nasw) , 2017). This document details, among other topics, the social worker’s ethical
responsibilities to their client and their colleagues when conducting research (Barsky, 2017). In
general, the guidelines state that social workers need to consider ethical implications for their
research and always strive to ensure the respect and dignity of all people involved. This includes
obtaining informed consent so that the participants understand the full scope and nature of the
research. Also, participants need to understand they can withdraw from the research without
penalty. The researcher needs to pay close attention to how they protect the rights of vulnerable
populations such as children, incarcerated individuals or those committed to psychiatric
institutions involuntarily. Of course, BCSL will work closely with the institutional review board
at the VA hospital to make sure the research projects and pilot studies meet all ethical guidelines.
When working with people suffering from PTSD, clinicians always need to be careful to
not re-traumatize their clients (Holliday et al., 2019). BCSL will always put their clients’ health
and welfare first when providing training during AIT and when intervening clinically via the
brain care smartphone app. Any person suffering from PTSD symptoms needs to determine, with
help from the clinician, the frequency, intensity, and duration of each step of the process. By
remaining in control of their mental health care, MSM are less likely to be re-traumatized and
more likely to invest in ongoing treatment all the way to successful completion.
Conclusions, Actions, and Implications
#BRAINCARESAVESLIVES 28
How the Project Aims to Inform Potential Future Decisions and Actions
As a result of the challenges the DoD has faced in their efforts to reduce the number of
MSM experiencing PTSD and suicide, there continues to be a shared sense of urgency among all
stakeholders within the DoD. State and federal political leadership, the VA, and family and
friends of those MSM suffering needlessly are all working on solutions to this problem affecting
thousands of MSM annually. My vision is for the BCSL project to leverage this collective sense
of urgency to drive change within the DoD so that leadership understands they are facing a
people problem and not a scientific or technological one.
Hundreds of millions of dollars have been spent over the last 20 years on developing
programs, services, and technological supports for MSM suffering from stress-related illnesses.
BCSL has great potential to inform and educate decision-makers about the powerful
undercurrents of social norms as those norms have worked to effectively undercut the DoD’s
best efforts. BCSL can help explain why only one in three MSM who need mental health
treatment take advantage of the DoD's services. We can help explain to policymakers why MSM
prefer to socially isolate and suffer in silence rather than make use of the DoD’s programs.
Eventually, leadership in the inner and outer context of the DoD will begin to fully appreciate the
social norms of stoicism and hypermasculinity that hold into place negative sanctions for MSM
accessing mental health treatment.
Contextualize Project Conclusions Within a Field of Practice
The Brain Care app development team consisting of myself, Benjamin Page (software
coding), and Erica Lyons (game design specialist) have taken feedback from stakeholders over
the past year to bring our Brain Care app to its current iteration. Originally we were going to
include information about weapon care in the app as I thought that was a regular routine
#BRAINCARESAVESLIVES 29
maintenance activity that would pair well with the new norm of brain hygiene. Active duty and
veteran MSM interviewed individually and during a focus group consistently said that it does not
make sense to them as the other self-care routines have to do with personal health and
well-being. So BCSL removed weapon care from the app (Focus Group, personal
communication, September 2, 2020).
BCSL also received feedback from Navy submariners that the technology required in the
neuro and biofeedback devices may not be allowed on submarines as it may put MSM at risk if
the technology was hacked by opposing forces attempting to gather operations intelligence.
Similarly, the feedback from General Neller referenced earlier in this paper points to potential
security concerns as the devices emit an electronic signature that needs to be shielded from
detection. This would need to be addressed in the partnership between BCSL and the DoD.
The Brain Care app in its current state addresses the client problem of the majority of
MSM preferring not to engage in mental health treatment by bringing effective brain hygiene
practices directly to them. Brain Care also addresses the practice problem of identification and
referral by making brain hygiene a universal practice. It would seem quite odd and impractical
for service members to require a referral for routine care of their feet or hydration needs. The
Brain Care app will work to move brain hygiene to the point where the practice is no longer the
exception, but the rule.
To address the Grand Challenge: Eradicate Social Isolation, the Brain Care app includes a
feature within the gaming mode that will allow MSM to share neuro and biometric data as they
work to achieve lower scores by using the mindfulness gaming stations. By normalizing brain
hygiene through this process and by encouraging sharing of progress between MSM, the Brain
Care app will promote greater social interaction, reduce the stigma of mental health treatment
#BRAINCARESAVESLIVES 30
utilization, and reinforce brain hygiene as a preferred activity, consistent with optimal
functioning of all MSM.
Describe the Implications of the Project Innovation for Practice and Further Action
The implications of the BCSL project innovation for practice and further action have to
do specifically with how the DoD views mental health treatment. There exists a
significant stigma associated with mental illness in the United States. Given the emphasis on
stoicism and strength running throughout the United States military there are even
greater burdens on military service members in deciding to access mental health care. The
existing theory of risk and resilience employed by the DoD is insufficient in addressing what is
now known about the effects of psychological trauma on a person’s brain. No longer can the
DoD rely primarily upon the public health policy of education and dissemination of research.
The DoD can not continue to employ primarily a practice of identification and referral of at risk
MSM for assessment and treatment.
The BCSL project innovation will move existing DoD theory, policy and practice to a
new, more relevant, more impactful level. By pushing military, clinical, and political leadership
to think about brain hygiene as an essential, non-negotiable, universal self-care practice, the DoD
and their charges will effectively significantly reduce issues of stigma and negative sanctions as
brain hygiene becomes a new norm, no different from foot care, skin care, or hydration.
Limitations and Risks and Recommendations for Future Work
Treating individuals suffering from psychological trauma contains some risk of
re-traumatizing them. Clinicians need to be trained in brain-based, trauma-informed care in order
to take steps necessary to prevent re-traumatizing the client (Gerber, 2019). To ensure this will
happen, BCSL will train clinicians Utilizing the most current evidence-based practices. The
#BRAINCARESAVESLIVES 31
application of best practices begins in the first contact with the client where they are educated by
the clinician about the need for the client to move at their pace and to only divulge what they feel
they are ready to discuss at the time. By empowering the client to set the pace in their trauma
work from the start, the clinician is demonstrating respect for the client and helping the client
remain in control and maintain healthy boundaries throughout treatment.
Legal liability is always a concern when providing medical care to clients. In order to
limit my liability and that of BCSL, and to expedite the development of the Brain Care app I
have researched how to define the purposes of the app when promoting its uses to potential
funders. The majority of smartphone apps used by the DoD and VA are described as educational,
support, or self-help, but not for the purposes of treatment. There are a few apps listed by the VA
that are described as “treatment companion apps” (TCA) and they require a healthcare
professional be involved ( Va.gov | Veterans Affairs , 2020). It is my intention to classify my
Brain Care app as a TCA because one of its features is to allow the end-user to connect at any
time day or night with a licensed mental health professional for support.
How Capstone Project (Prototype) Can be Immediately Shared With Relevant
Practitioners and/or External Constituencies
The Brain Care app is currently operational as a prototype. It is currently loaded onto the
iPhone operating system (iOS) and is functional internally for demonstration purposes. The end
user is able to log in using a random username and password. Once logged in the end user is able
to experience the game mode and visit the self-care informational library detailing how best to
engage in foot care, skin care, hydration, and brain hygiene. At any time, the end user needs
clinical or support they simply click the red help button. For 24 hour a day technical support the
#BRAINCARESAVESLIVES 32
end user clicks the “settings” switch and is able to summon technical support, and turn on or off
sounds, notifications, and helpful tips and reminders for all four self-care practices.
I have been working closely with a licensing associate at the University of Southern
California (USC) Stevens Center for Innovation since February 2020. Our work together has
progressed and the staff at Stevens have helped me connect with potential incubators and
accelerators. I continue this effort and at the time of this writing I am planning another Zoom
meeting with an active duty service member and MBA student at USC who has expressed an
interest in potentially collaborating on furthering the project.
On September 29, 2020, I met virtually with staff from United States Senator Richard
Blumenthal's office to pitch my prototype (M. Szarkowicz, personal communication, September
29, 2020). The purpose of this meeting was to solicit the Senator’s assistance to build
relationships between BCSL and leadership within the Departments of Veterans Affairs and
Defense At the end of my presentation they asked me to send them a one-page summary of my
work and my ask of the senator’s office. On October 8, 2020, I received confirmation from the
senator’s office that they are working on helping me make connections with leadership within
the DoD and VA. I will follow up with them at the end of this week.
A Concrete Plan for Advancing Next Steps
Future action steps involve meeting with staff from the offices of state and federal
political leaders who can help me open doors to decision makers at the DoD and VA. It is then
up to me to make effective presentations to a variety of stakeholders there regarding the urgency
of this problem and how it can be solved. I am also working actively to secure funding by
applying for grants related to military veteran health ( Fisher House Foundation - Helping
Military Families , n.d.) ( Evergreen Foundation Grant Application , n.d.) ( Honoring Those Who
#BRAINCARESAVESLIVES 33
Serve , n.d.) ( Tackle Big Challenges with Google's Technology , n.d.). In addition, I will soon
enter discussions with makers of Fitbit, Muse, and Emotiv to negotiate in-kind donations for
purposes of running pilot studies with the Brain Care app.
I will continue the work of seeking feedback in the form of focus groups with MSM as
the BCSL team creates future iterations of the Brain Care app. In the spring of 2021, I am
moving forward with educational presentations in person, through YouTube, on my BCSL
website, and on social media. Through ongoing collaborative research, clinical trials, and
educational programs, BCSL will be well positioned to effect positive change within the DoD
and VA long term. We will continue the important work of empowering military service
members (and eventually first responders) with neurotechnology for brain care, healing, and
hope.

#BRAINCARESAVESLIVES 34

#BRAINCARESAVESLIVES 35
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#BRAINCARESAVESLIVES 46

#BRAINCARESAVESLIVES 47
Appendix A

#BRAINCARESAVESLIVES 48

#BRAINCARESAVESLIVES 49
Appendix B - Wireframe

#BRAINCARESAVESLIVES 50
Appendix C - Budget Narrative
BCSL will require significant funding during its SU phase and then annual costs will
decrease significantly and level off moving forward. Projected revenues to support the short-term
SU period ($2.2M) will include requests to the Ashner Family Evergreen Foundation for
$500K ("Evergreen Grants," 2020), Fisher House Foundation Inc. for $100K ("Fisher House
Grants," 2020), and the remaining $1.437M from Google ("Google Grants," 2020), Newman’s
Own ("Newman's Own Foundation," 2020) , and the Wounded Warrior Project ("Wounded
Warrior Grants," 2020).
The long-term revenue plan for this program is to have funds supplied through a large
number of individual donors who believe in and support the mission and vision of BCSL. And
in its FFYO, the BCSL goal is for the majority of the $1.1M in projected revenues to be provided
by a combination of individual donors, and funds from the DoD and VA. Details for all of the
revenue plans are also contained in the attached budgets and narrative.
The leadership of BCSL has a combined sixty years of clinical, research, teaching, and
administrative experience. Our team is committed to seeing the DoD and VA help military SMs
manage their brain care effectively and efficiently to improve health and mission effectiveness.
To that end, we will be utilizing the latest technology to monitor BCSL interventions for fidelity
and integrity using ongoing formative data. The BCSL financial plan detailed below
demonstrates that BCSL will indeed save military SMs’ lives and in a scalable, sustainable, and
cost-effective manner.
Program Expenses
Personnel/Staffing Costs
#BRAINCARESAVESLIVES 51
BCSL is dedicated to hiring clinicians with expertise in trauma-informed and brain-based
treatments in order to ensure the most effective, high quality care is delivered to our CNG SMs.
During the startup operation (SU), BCSL will be hiring four dynamic, engaging, experienced
(five years or more) licensed clinical social workers to be trained as brain care trainers. These
dedicated professionals will be required to have certification in Eye Movement Desensitization
Reprocessing (EMDR), and experience in Cognitive Behavioral Therapy (CBT), and
Mindfulness-Based treatments.
Once trained by the clinical director, Mr. Mitch Page, LCSW, BCD, these clinicians will
teach, over the course of one year, the 5,000 Connecticut National Guard SMs about how
psychological trauma affects the brain on a neuronal level. They will also teach SM about how to
use wearable neurotechnology in conjunction with the paired smartphone app to engage in brain
care. Once this training of SMs is complete, then BCSL will enter the FFYO.
Based on current national salary data, these four licensed clinical social workers will
initially be paid $90K annually with potential to earn up to a 3.3% raise in pay at the end of the
start up phase based on performance. Clinicians will be provided benefits (adding 30% to salary
expenses) including paid time off (PTO), health, life, dental, and vision insurance. They will also
enjoy a generous matching 401K plan of 50 cents on the dollar up to 6% of the employee’s pay,
and an HSA and FSA account option. Benefits will also include long and short term disability
coverage, tuition reimbursement up to $5250 annually, childcare subsidies up to $350 per child
annually, a gym membership, wellness and EAP plans, relocation reimbursement, and monthly
employee recognition for those who have met quantitative and qualitative training expectations.
Once the training is completed during the SU phase, these same four individuals will work as
brain care coaches for the SM in the FFYO.
#BRAINCARESAVESLIVES 52
Other (Non-Personnel) Operating Costs
During the SU phase of implementation, BCSL will work to rent offices and training space
from the Hartford Armory. The Hartford Armory is located in central Connecticut. This military
facility will provide relatively equal easy access to CNG SMs living throughout the state of
Connecticut. The fixed cost of the daily rental fees for the Hartford Armory for civilians is $750.
BCSL is confident they can reduce the rental fee for this facility to $400 per week (or less) and
decrease overall projected costs during the startup phase. This is because the BCSL project is
designed to have direct benefit to the DoD and its SMs. In the FFYO rental costs will decrease to
1,000 per month as the clinicians, IT staff, and BCSL director will work out of smaller office
space providing on call and in person support, as well as conducting research on
trauma-informed best practices.
In the SU phase of this important endeavor the largest expense will be the acquisition of the
wearable neurotechnology projected to be $1.5M in order to equip 5,000 CNG SMs at $300
(retail price) per SM ("Muse - How it works," 2020).
This is a variable cost as the final expenditure depends on the number of devices required
combined with the final negotiated cost per unit. In addition, BCSL has contracted with a
smartphone app developer, Benjamin C. Page, to create their brain care app which empowers the
SM to engage in real time brain care while they are in the field.
The app features eye movement desensitization reprocessing and mindfulness-based
cognitive behavioral therapy treatment modules. These will allow the SM to process
psychologically traumatic, high arousal events on a brain-based level. The goal is to reduce
arousal states by calming the amygdala, and to train the brain to reframe the traumatic experience
so that it no longer grips the SM in a fight/flight/freeze response from their activated amygdala,
#BRAINCARESAVESLIVES 53
but instead is becomes a benign stored memory associated with little or no anxiety (Santarnecchi
et al., 2019) . SM will be able to link, through the brain care smartphone app, with a brain care
coach as needed for clinical and/or technical support in using either the app or the wearable
neurotechnology.
The development of the initial app from the prototype to completion of the first working
version will cost $11K and this variable cost will reduce to app maintenance fees from the FFYO
and moving forward. BCSL will also purchase 6 laptop computers for $4K so the staff have the
tools needed to provide live, real time brain care coaching as well as technical questions about
using the app and/or neurotechnology as SM monitor and manage their arousal states.
During the startup phase of operation, BCSL will spend $50K to create 5,000 curriculum
packets at $10 per packet that compliment and support the PowerPoint slides and oral
presentations during the weekly training of the CNG SM at 100 SM per week. In both the startup
and first full year of operation BCSL will spend $4K combined property and liability insurance.
Program Revenues
Revenue Strategies/Models and Funding Types
During the SU phase of this vital project, BCSL will be working closely with several
foundations and corporations to fund the initial purchase of the Muse wearable
electroencephalography (EEG) device. With these essential mobile neurofeedback devices,
BCSL staff and clinicians will be enabled to train up to 5,000 SM in Connecticut to monitor how
their brain responds to threats to their safety.
BCSL is establishing an online presence to communicate to people across the country and
around the world about this potentially life-saving work. By telling the BCSL story of changing
#BRAINCARESAVESLIVES 54
the way SMs and families understand and respond to psychological trauma, we intend to inspire
and raise funds from like-minded individual donors.
BCSL has the steepest financial hill to climb during the SU phase of this project. In order
to train and equip 5,000 CNG SMs, BCSL will need to purchase 5,000 wearable
neurotechnology devices. These 5,000 devices will cost approximately $300 each for a total of
$1.5M. Because this is a large initial investment, BCSL has decided to seek funding from large
corporations and foundations with the ability to support an investment this size.
In preparation for moving into the FFYO, BCSL is committed to building relationships
with individuals interested in our mission. In this process of “friend-raising” we will identify
individuals who share our ideals and see the project as a wonderful opportunity to get involved in
serving those who serve our country. One way we do this is through our board of directors. With
guidance from our board, we plan to build relationships with members in the community locally
and beyond who have our shared vision.
Once potential donors understand and demonstrate an interest, BCSL leadership will solicit
an investment from them to help grow our programs. Once a new investor is committed, BCSL
will keep that individual or organization updated on a regular basis with quantitative and
qualitative da ta describing our progress as well as our challenges. Through continuous and
transparent communication with all our partners, BCSL will demonstrate good faith and honest
stewardship of every dollar invested (Jutze, 2015).
Revenue Plans (the “Numbers”)
In the SU phase of the program, in the short-term, BCSL expects to raise a total of $2.2M
from corporate grants, in-kind donations, and four foundations aligned with the mission and
vision of BCSL. Google will be asked for $700K, Muse will be requested to donate 1,667
#BRAINCARESAVESLIVES 55
wearable EEG devices or the equivalent of $500K. Newman's Own, Wounded Warrior Project,
Fisher House, Ashner Family Evergreen Foundations will be invited to invest a total of $1M to
support the work of BCSL.
In the FFYO and in the long-term beyond, BCSL will work with individual donors and
monies from the DoD and the VA to fund the ongoing work of SM training, equipping, and
engaging in brain care. More specifically, in the FFYO, local and national donors will be asked
to contribute $600K, with the DoD and VA contributing $200K each. To close the remaining gap
in necessary revenue the Wounded Warrior Project will be asked to donate $100K.
Operational/Performance Measures
Outputs and Operational Efficiency
BCSL takes seriously their responsibility for providing funders the data they require to make the
most informed decisions about their investment. To that end, BCSL will use ongoing formative
metric data on brain care utilization rates to drive decisions throughout the implementation and
sustainment phases of this project. BCSL has defined the social problem as SMs reluctance to
engage in mental health treatment as a result of perceived and real stigma (Sherman, 2007).
BCSL will survey SMs prior to entering brain care training to determine how many of
them have sought mental health treatment in the service previously. Then another survey will be
administered at three-month intervals for twelve months to determine how many SMs utilize
their wearable bio/neuro technology and paired brain care app.

#BRAINCARESAVESLIVES 56

#BRAINCARESAVESLIVES 57
Appendix D - SSOSH (Vogel et al., 2006)
INSTRUCTIONS: People at times find that they face problems that they consider seeking help
for. This can bring up reactions about what seeking help would mean.
Please use the 5-point scale to rate the degree to which each item describes how you might react
in this situation.
1 = Strongly Disagree 2 = Disagree 3 = Agree & Disagree Equally 4 = Agree 5 = Strongly Agree
1. I would feel inadequate if I went to a therapist for psychological help.
2. My self-confidence would NOT be threatened if I sought professional help.
3. Seeking psychological help would make me feel less intelligent.
4. My self-esteem would increase if I talked to a therapist.
5. My view of myself would not change just because I made the choice to see a therapist.
6. It would make me feel inferior to ask a therapist for help.
7. I would feel okay about myself if I made the choice to seek professional help.
8. If I went to a therapist, I would be less satisfied with myself.
9. My self-confidence would remain the same if I sought professional help for a problem I could
not solve.
10. I would feel worse about myself if I could not solve my own problems.
Items 2, 4, 5, 7, and 9 are reverse scored.

#BRAINCARESAVESLIVES 58
Appendix E - PCL - 5 ( PCL-5 What is It? , 2017)
Instructions: Below is a list of problems that people sometimes have in response to a very
stressful experience. Please read each problem and then select one of the options to indicate how
much you have been bothered by that problem in the past week. The options include not at all, a
little bit, moderately, quite a bit, and extremely.
In the past week, how much were you bothered by: Not at all A little bit Moderately Quite a bit
Extremely
1. Repeated, disturbing, and unwanted memories of the stressful experience? 0 1 2 3 4
2. Repeated, disturbing dreams of the stressful experience? 0 1 2 3 4
3. Suddenly feeling or acting as if the stressful experience were actually happening again
(as if you were actually back there reliving it)? 0 1 2 3 4
4. Feeling very upset when something reminded you of the stressful experience? 0 1 2 3 4
5. Having strong physical reactions when something reminded you of the stressful
experience (for example, heart pounding, trouble breathing, sweating)? 0 1 2 3 4
6. Avoiding memories, thoughts, or feelings related to the stressful experience? 0 1 2 3 4
7. Avoiding external reminders of the stressful experience (for example, people, places,
conversations, activities, objects, or situations)? 0 1 2 3 4
8. Trouble remembering important parts of the stressful experience? 0 1 2 3 4
9. Having strong negative beliefs about yourself, other people, or the world (for example,
having thoughts such as: I am bad, there is something seriously wrong with me, no one
can be trusted, the world is completely dangerous)? 0 1 2 3 4
10. Blaming yourself or someone else for the stressful experience or what happened after
it? 0 1 2 3 4
#BRAINCARESAVESLIVES 59
11. Having strong negative feelings such as fear, horror, anger, guilt, or shame? 0 1 2 3 4
12. Loss of interest in activities that you used to enjoy? 0 1 2 3 4
13. Feeling distant or cut off from other people? 0 1 2 3 4
14. Trouble experiencing positive feelings (for example, being unable to feel happiness or
have loving feelings for people close to you)? 0 1 2 3 4
15. Irritable behavior, angry outbursts, or acting aggressively? 0 1 2 3 4
16. Taking too many risks or doing things that could cause you harm? 0 1 2 3 4
17. Being “superalert” or watchful or on guard? 0 1 2 3 4
18. Feeling jumpy or easily startled? 0 1 2 3 4
19. Having difficulty concentrating? 0 1 2 3 4
20. Trouble falling or staying asleep? 0 1 2 3 4

Abstract (if available)

Abstract This capstone project addresses the Grand Challenge of Eradicating Social Isolation (Fong et al., 2018). There are clear correlations between social isolation and medical conditions as minor as the common cold and as serious as suicide (Hammig, 2019). Both active duty military and veteran service members (MSM) of the United States armed forces suffer from the same effects of social isolation as civilians. However, when MSM do not meet the high expectations placed upon them, they suffer unique and increased risks (Abrams, 2018). Due to greater stigma for mental health help-seeking in the military than in civilian life, the majority of MSM deny psychiatric symptoms they experience, they socially isolate and avoid mental health treatment (Porcari et al., 2017). This contributes to higher rates of post-traumatic stress and suicide in the DoD compared to the civilian population (2019 National Veteran Suicide Prevention Annual Report, 2019).

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The Senior Social Isolation Project (SSIP): a comprehensive response to a growing aging population

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Reducing the prevalence of missed primary care appointments in community health centers

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Increasing access to mental health counseling for homeless youth: Peer2Peer Counseling Supports

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Behavioral Health for All Kids

Asset Metadata

Creator Page, Mitchell Kenneth (author)

Core Title #BrainCareSavesLives

School Suzanne Dworak-Peck School of Social Work

Degree Doctor of Social Work

Degree Program Social Work

Publication Date 03/24/2021

Defense Date 11/19/2020

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag first responders,heteronormative hypermasculinity,mental illness,military service members,OAI-PMH Harvest,post traumatic stress disorder,social isolation,stigma,Stoicism,Suicide

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Brooks, Devon (committee chair)

Creator Email mitchpage@yahoo.com

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c89-432042

Unique identifier UC11667842

Identifier etd-PageMitche-9350.pdf (filename),usctheses-c89-432042 (legacy record id)

Legacy Identifier etd-PageMitche-9350.pdf

Dmrecord 432042

Document Type Capstone project

Rights Page, Mitchell Kenneth

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA