UlmerT DMFT 7202-11 NIH Grant this one (1)_HansonBradleyFeedback

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Northcentral University - Arizona *

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Jan 9, 2024

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Running head: NIH GRANT SUBMISSION ULMER T DMFT7202-11 NORTHCENTRAL UNIVERSITY ASSIGNMENT COVER SHEET Student: Tamara Ulmer THIS FORM MUST BE COMPLETELY FILLED IN Follow these procedures: If requested by your instructor, please include an assignment cover sheet. This will become the first page of your assignment. In addition, your assignment header should include your last name, first initial, course code, dash, and assignment number. This should be left justified, with the page number right justified. For example: UlmerT DMFT7202-11 Save a copy of your assignments: You may need to re-submit an assignment at your instructor’s request. Make sure you save your files in accessible location. Academic integrity: All work submitted in each course must be your own original work. This includes all assignments, exams, term papers, and other projects required by your instructor . Knowingly submitting another person’s work as your own, without properly citing the source of the work, is considered plagiarism. This will result in an unsatisfactory grade for the work submitted or for the entire course. It may also result in academic dismissal from the University. Ulmer T DMFT7202-10 Carrie Hanson-Bradley Understanding Various Grant Types CHE Grant Submission This definite challenges me as I struggled with reducing the information to meet the required characters. Faculty Use Only Hi Tamara, I wrote comments via track changes as I read your grant. Some of the questions I asked via track changes were answered later in your grant. I want to draw your attention to these comments because if a funder were to review your grant they would have the same questions I had. Your grant contains most of the information that is requested in the NIH grant guide (except for your Specific Aims section which is missing most of what was requested). However, the organization of your grant was confusing and while the pieces of the project were presented, funders would be confused about the aim of the project (e.g. what is it that you hope to accomplish, what is the research component and how will it advance the literature, what is the project timeline). When you write a grant you want to be very clear about what it is you are doing and how you will go about doing it. You are presenting multiple arguments to funders. First, you need to convince them that the problem you are addressing is in fact a problem and needs to be addressed. You start to do this in your introduction. You need to strengthen this section and make it

NIH GRANT SUBMISSION ULMER T DMFT7202-11 1 clear that PTSD is a problem that impacts families and communities, especially the community you are proposing to work in. Second, you must convince funders that what is currently being done to address the problem is insufficient and that your idea is the most logical, innovative, and most-likely-to-succeed solution there is. You need to provide evidence that what you are doing will work with this population, that the population you are proposing to work with will respond to what you are providing. You also need to illustrate that in the end the individuals you are working with, as well as the community, will benefit. Third, you want to paint a clear picture of what is it you are proposing to do. Take the funders step-by-step through your project. I would suggest you organize the research strategy section like this: 1. Briefly reiterate the problem and the need for a solution, include citations and current research. 2. State why your project is significant. 3. State how your project is innovative. 4. Clearly state your approach. Organize it so funders know exactly who you will recruit into the program, how you will recruit them, how they will be chosen to participate, what will exclude them from participating. Then state what you will do first, second, third, ect. You can take all of the information you have at the end of the grant and reorganize it so funders know as they read it what it will look like for each participant to go through this study. 5. Discuss feasibility of your project. 6. Discuss potential problems and how you will solve them. By reorganizing, and adding to, what you have written here you will have a stronger applications. NIH grants are hard to write, but you have a good start with what you have provided below. Please let me know if you have any questions. Based on the NCU grading guidelines you: Completed all required parts of the assignment, demonstrated some good understanding of the readings, used clear writing, and have a few errors in grammar, mechanics and APA formatting. Your grade for this assignment is: 90% Please let me know if you have any questions about my feedback or this assignment. Sincerely, Dr. Hanson-Bradley <Faculty Name> <Grade Earned> <Date Graded>

NIH GRANT SUBMISSION ULMER T DMFT7202-11 1 Tamara Ulmer NIH Grant Northcentral University Project Name: Helping families impact by Combat PTSD using a Wellness Recovery Action Plan Project Summary Since the year 2001, over 2 million individual service members have been deployed to Afghanistan and Iraq and research indicates that upwards of 19%, or approximately 380,000, of

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NIH GRANT SUBMISSION ULMER T DMFT7202-11 2 these military personnel suffer from clinical anxiety, depression or posttraumatic stress disorder (PTSD) (Courtney, 2012). A study exploring the impact to 227 South Dakota National Guard members who experienced combat and displayed CPTSD symptoms also had strain in the marriage as their spouses displayed traumatic stress symptoms as well. Symptoms include irritability, hypervigilance, depression, marriage dissolution and domestic violence (Bjornestad, 2010). According to the Center for Disease Control (2016) the national average for suicide per 100,000 is 12.97% the state South Dakota is 17.06%, well above the national average. The South Dakota National Guard is not immune to suicide, in 2016 a unit returning from Afghanistan, consisting of approximately 130 members lost 3 soldiers to suicide with-in a 9- month time frame. Northcentral University , in conjunction with Lutheran Social Services (LSS) , will be offering a Wellness Recovery Action Group to families impacted by CPTSD. Participants will learn be able to identify the warning signs and triggers and as such develop healthy coping skills. This will be done by The proposed program will : 1) teach participants how to implement the key concepts of recovery (hope, personal responsibility, education, self-advocacy and support) in their day -to- day lives . 2) help participants organize a list of their wellness tools i.e., activities they can use to help themselves feel better when they are experiencing difficulties as a result of their combat, and to prevent these difficulties from arriving. 3) assist each participant in creating an advance directive that guides involvement of family, friends, or supporters in their natural environment when they feel they can no longer take appropriate actions on his or her behalf. 4) H h elp each participant to develop an individualized post crisis plan for use as the difficulty subsides, to promote a return to enhanced overall wellness and self-determination According to Wilson, Hutson, and Holston (2013) the use of a Wellness Recovery Action Plan (WRAP) can contribute to increased self-awareness and increased ability to cope with personal, social and societal relationships. “WRAP can be used by anyone to deal with any kind of physical or emotional illness or issue” (Copeland, 2001, p.127). WRAP is a program in which participants identify internal and external resources for gaining and maintaining recovery. Project Narrative North Central University (NCU) DMFT is requesting funding for developing a family group program to reduce violence, suicide, and marital discourse in families impacted by combat PTSD. This is a pilot program that will assist at risk families in gaining skills needed to address symptoms of CPTSD on a systemic level. We are requesting $68,223 over a three-year period. Biographical Sketch Tamara Ulmer LPC-MH, QMHP MSW PIP and a 1Lt in the United States Army National Guard is using is the foundational statement that all United State Army members follow, particularly one section of the Soldiers creed which states: I am disciplined, physically and mentally tough, trained and proficient in my warrior tasks and drills. I always maintain my arms, my equipment and myself. Tamara will be conducting the research and facilitation of the Combat Wellness Recovery Action Plan group, she has obtained two graduate degrees, and is dually licensed in the state of South Dakota as a Licensed Professional Counselor in Mental Health, and a Clinical Social Worker. Over the last ten years Tamara has worked with the military and civilian population addressing PTSD and pervasive mental illness in both a military and clinical setting, offering individual and group counseling. As an officer in the South Dakota Army National Guard as a Behavioral Health Officer (BHO) and a combat veteran, she offers a deeper and personal connection with the participants in regards to combat and the impact that combat has to families and military members. As a BHO she is tasked with offering prevention strategies for

NIH GRANT SUBMISSION ULMER T DMFT7202-11 3 suicide, assault, as well as, increasing self-determination and reduction of behaviors that are harmful to members, families and communities. Educational Background Northcentral University: March 2016 to Present 10000 E University Dr Prescott Arizona 86314 Currently attending the Doctorate of Marriage and Family Program with emphasis of Military families. Start date March 2016 projected graduation date March 2020 University of South Dakota: August 2010 to August 2012 414 E Clark Street Vermillion SD 57069 Graduated in August 2012, with a Masters Degree in Social Work, with a GPA of 4.0 for the MSW Program and cumulative GPA of 3.97 for both graduate programs. The University of South Dakota's Master of Social Work program is a 2-year program that prepares professionals to provide social work services in diverse communities in South Dakota and the surrounding region. The Master of Social Work program seeks to educate a workforce of social workers who are able to deliver professional services such as clinical and therapeutic services, administrative and staff supervision, policy analysis, and community planning and organization, which will effectively meet the social services needs of the citizens of our state and region (60 credit hours). Participated in the AmeriCorps program. Current member of Phi Alpha IGMA THETA Social Work National Honor Society. South Dakota Stated University, West River Program: May 2006 to August 2009 2201 University Station Brookings SD 57007 Graduated in August 2009 with a Master Degree in Agency Counseling and Human Resource Track with a Grade point average of 3.87. I am a member of the Golden Key International Honor Society. Courses included Counseling the Family, Career Counseling, Group Counseling, Multicultural Counseling, Intro to Alcoholism, Play therapy, Narrative Therapy, Theories, Clinical Diagnosis, Assessment and Research Methods. Completed internship with Behavior Management Systems supervised by Robert Holmes, MSW LCSW-PIP. Internship responsibilities include: Outpatient counseling to the public, both individual, family and children. Determine eligibility for SPMI, SEDC, addiction and counseling services. Conduct intake interviews to establish history, assess needs and diagnosis formulation. Provide supportive counseling to clients and/or Family members as outlined in treatment plan to assist client in developing increased self- awareness, identify and overcome personal roadblocks to promote optimal emotional and interpersonal functioning. Black Hills State University: September 2000 to May 2006 1200 University Street Spearfish, South Dakota 57799 Graduated in May 2006 with a double major in psychology and sociology with a grade point average of 3.3 I am a member of the National Honor Society of Psychology PSI CHI. Courses included all general requirements: computer applications in word, power point excel,

NIH GRANT SUBMISSION ULMER T DMFT7202-11 4 and spread sheets. Also, classes in contemporary human behavior, industrial psychology, adolescent psychology, cognitive psychology, and psychology of women. Also, completed an internship at Wellspring which is a residential facility that deals with youths that have been abused and may have a chemical dependency problem. Taken classes in social thought, social problems, life cycles and stages. Areas also included classical and contemporary social theory, gender roles, and sociology of aging. Budget Agency Name: Northcentral DMFT Project Name: Combat Wellness Recovery Action Plan Stage 2 Budget SUPPORT/ REVENUE Total Support/Revenue Amount requested from CHE $68,223 Cash Committed from Other Sources (Identify source(s) on separate lines below) $0 $0 $0 Cash Anticipated from Other Sources (Identify source(s) on separate lines below) $0 $0 $0 Project-Related Income/Revenue (Identify source(s) on separate lines below) $0 $0 $0 Project-Related In-Kind Support (Identify source(s) on separate lines below) Support Staff Income Provided by Lutheran Social Services of Rapid City $7,764 Conference room rental Provided by Lutheran Social Services of Rapid City $7,200 $0 Other Support (Identify source(s) on separate lines below)

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NIH GRANT SUBMISSION ULMER T DMFT7202-11 5 $0 $0 $0 Total Support/Revenue $83,187 Click on Expenses Tab to complete your proposed budget. Agency Name: Northcentral University DMFT - Project Name: Helping families impacted by Combat PTSD using a Wellness Recovery Action Plan - Stage I Year One Budget EXPENSES FTE Total Requested from CHE Expenses Personnel Salaries (list positions and FTE) Group Facilitators holds Unrestricted License in Counseling or Clinical Social Work (2 clinicians) 20 hrs./wk. $17,920 $17,920 Support Staff 15 hrs./ wk. $2,588 $0 $0 $0 $0 $0 $0 $0 Payroll Taxes/Benefits (specify) Wage Tax $4,101 $0 Clinicians are required to fill out a T-1099 as they are contracted out $0 $0 $0 $0 $0 $0 $0 $0 Subtotal Personnel $24,609 $17,920 Operating (Telephone, postage, office supplies/equipment, printing, mileage) Office Operations $0 $0 Marketing-Flyers, posters, wellness bags $1,500 $1,500 Training & Education $0 $0 Facilitator Training manual: Mental Health Recovery Including Wellness Recovery Action Plan Curriculum QTY2 Required $258 $258 Facilitator Correspondence Training for WRAP QTY 2 Required $600 $600 Assorted Books and videos for facilitators and participants (one time purchase ) QTY 12 Required $720 $720 WRAP and Peer support guide Qty 48 Required $1,197 $1,197 Workbook of Action Plans for recurring health and emotional problems Qty 48 Required $815 $815 Depression Workbook Qty 24 Required $598 $598 Equipment (Equipment, technology) $0 $0 projector/screen, laptop with programs $3,000 $3,000

NIH GRANT SUBMISSION ULMER T DMFT7202-11 6 Facility (Rent/Utilities) $0 $0 conference room rental $2,400 $0 Facility Improvement Facility-Related Equipment $0 $0 $0 $0 $0 $0 Other (Identify) $0 $0 $0 $0 $0 $0 $0 $0 Subtotal Operating $720 $720 Indirect Costs Indirect ( Not to exceed 10% of the total requested from CHE) $0 $0 Total Expenses $25,329 $18,640 DIFFERENCE TOTAL SUPPORT/REVENUE $23,628 $18,640 (TOTAL EXPENSES) $23,628 $18,640 Agency Name: Northcentral University DMFT - Project Name: Helping families impacted by Combat PTSD using a Wellness Recovery Action Pla n - Year Two Budget EXPENSES FTE Total Requested from CHE Expenses Personnel Salaries (list positions and FTE) Group Facilitators holds Unrestricted License in Counseling or Clinical Social Work ( 1 clinician) 20 hrs/week $17,920 $35,840 Support Staff 15 hrs/week $2,588 $0 $0 $0 $0 $0 $0 $0 Payroll Taxes/Benefits (specify) Wage Tax $4,101 $8,202 Clinicians are contracted out and required to use a T-1099 for Tax purposes $0 $0

NIH GRANT SUBMISSION ULMER T DMFT7202-11 7 $0 $0 $0 $0 $0 $0 Subtotal Personnel $24,609 $44,042 Operating (Telephone, postage, office supplies/equipment, printing, mileage) Office Operations $0 $0 Marketing-Flyers, posters, wellness bags $1,500 $3,000 Training & Education $0 $0 Facilitator Training manual:Mental Health Recovery Including Wellness Recovery Action Plan Curriculum QTY2 Required $258 $516 Facilitator Correspondence Training for WRAP QTY 2 Required $600 $1,200 Assorted Books and videos for facilitators and participants (one time purchase )QTY 12 Required $720 $1,440 WRAP and Peer support guide Qty 48 Required $1,197 $2,394 Workbook of Action Plans for recurring health and emotional problems Qty 48 Required $815 $1,630 Depression Workbook Qty 24 Required $598 $1,196 Equipment (Equipment, technology) $0 $0 Facility (Rent/Utilities) $0 $0 conference room rental $2,400 $4,800 Facility Improvement Facility-Related Equipment $0 $0 $0 $0 $0 $0 Other (Identify) $0 $0 $0 $0 $0 $0 $0 $0 Subtotal Operating $700 $1,440 Indirect Costs Indirect ( Not to exceed 10% of the total requested from CHE) $0 $0 Total Expenses $25,309 $45,482 DIFFERENCE TOTAL SUPPORT/REVENUE $23,628 $18,640 (TOTAL EXPENSES) $23,628 $45,482

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NIH GRANT SUBMISSION ULMER T DMFT7202-11 8 DIFFERENCE $0 -$26,842 Agency Name: Northcentral University DMFT - Project Name: Helping families impacted by Combat PTSD using a Wellness Recovery Action Plan - Year Three Budget EXPENSES FTE Total Requested from CHE Expenses Personnel Salaries (list positions and FTE) Group Facilitators holds Unrestricted License in Counseling or Clinical Social Work (2 clinicans) 20 hrs/week $17,920 $53,760 Support Staff 15 hrs/week $2,588 $0 $0 $0 $0 $0 $0 $0 Payroll Taxes/Benefits (specify) Wage Tax $4,101 $12,303 Clinicians are contracted out and required to use a T-1099 for Tax purposes $0 $0 $0 $0 $0 $0 $0 $0 Subtotal Personnel $24,609 $66,063 Operating (Telephone, postage, officesupplies/equipment, printing, mileage) Office Operations $0 $0 Marketing-Flyers, posters, wellness bags $1,500 $4,500 Training & Education $0 $0 $0 $0 $0 $0 Assorted Books and videos for facilitators and participants QTY 12 Required $720 $2,160 WRAP and Peer support guide Qty 48 Required $1,197 $3,591 Workbook of Action Plans for recurring health and emotional problems Qty 48 Required $815 $2,445 Depression Workbook Qty 24 Required $598 $1,794 Equipment (Equipment, technology) $0 $0 Facility (Rent/Utilities) $0 $0

NIH GRANT SUBMISSION ULMER T DMFT7202-11 9 conference room rental $2,400 $7,200 Facility Improvement Facility-Related Equipment $0 $0 $0 $0 $0 $0 Other (Identify) $0 $0 $0 $0 $0 $0 $0 $0 Subtotal Operating $700 $2,160 Indirect Costs Indirect ( Not to exceed 10% of the total requested from CHE) $0 $0 Total Expenses $25,309 $68,223 DIFFERENCE TOTAL SUPPORT/REVENUE $23,628 $68,223 (TOTAL EXPENSES) $23,628 $68,223 DIFFERENCE $0 $0 Budget Justification Salaries are provided to clinicians who hold an unrestricted license in clinical counseling and social work. The salary covers psychosocial assessment on all participants, survey assessments and analysis, post follow-up at the 6, 12 and 18-month period, group facilitation, and referral to outside resources. The average salary for fully licensed clinicians in the Rapid City SD area is $43,000 annually. Training for the facilitators is required by LSS as part of their accreditation process to ensure fidelity and best practices are followed by implementing the WRAP group. This training is done by correspondence as it is more cost effective. Due to the limited income and rural setting of South Dakota funding is requested to purchase materials needed for group participants. Additional rationale is that absorbing the cost of materials will reduce financial strain, increase the number of referrals and by-in to participants. (see table below for specific materials and item description). The Wellness Recovery Action Plan has been recognized by the Federal Substance Abuse and Mental Health Service Administration as an evidence based practice (Advocates for Human Potential, 2016). The Cognitive Depression Workbook provides evidence based tools that participants can identify tools will assist them in feeling better, communicating better, and reduce depressive symptoms that they may experience from CPTSD (Knaus, 2006). Item Description Cost Required by Program

NIH GRANT SUBMISSION ULMER T DMFT7202-11 10 Facilitator Training Manual: Mental Health Recovery Including Wellness Recovery Action Plan Curriculum $129 each Yes, one source of implementation guidance is required Correspondence Training For WRAP $299 per facilitator Yes Wellness Recovery Action Plan [book] $10 each Yes, one source of implementation guidance is required Assorted books and videos for facilitators and participants $2-$60 each Yes, one source of implementation guidance is required Online participant materials Free No Wellness Recovery Action Plan and Peer Support: Personal, Group, and Program Development $24.95 each No Winning Against Relapse: A Workbook of Action Plans for Recurring Health and Emotional Problems $16.95 each No The Depression Workbook: A Guide for Living with Depression and Manic Depression $24.95 each YES Participant cost to attend WRAP $70 each couple per group session: payment options- self pay, insurance (Funding available through Victim of Crimes/ Military One source) YES Facilities No cost Group room and location donated by Lutheran Social Services of Rapid City Yes Staff Facilitator Support Staff Facilitators: LPC MH/ MSW PIP $8960.00 annually Support Staff $2588.00 annually Yes Marketing / Recruitment $ 1000- Flyers, posters, wellness bags Yes Specific Aims A major obstacle in treating military members is the unspoken belief that a military member must be strong and manage their life regardless of the events that the solider is exposed to during the term of service. Knowing the unspoken mindset of military left a possible treatment modality that would honor the concept of self-determination and resiliency. According to Wilson, Hutson, and Holston (2013) the use of WRAP can contribute to increased self-awareness and increased ability to cope with personal, social and societal relationships. There are four main goals for the WRAP facilitators in the group as a whole: 1) teach participants how to implement the key concepts of recovery (hope, personal responsibility, education, self-advocacy and support) in their day -to- day lives. 2) help participants organize a list of their wellness tools i.e., activities they can use to help themselves feel better when they are experiencing difficulties as a result of their combat, and to prevent these difficulties from arriving. 3) assist each participant in creating an advance directive that guides involvement of family, friends, or supporters in their

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NIH GRANT SUBMISSION ULMER T DMFT7202-11 11 natural environment when they feel they can no longer take appropriate actions on his or her behalf. 4) help each participant to develop an individualized post crisis plan for use as the difficulty subsides, to promote a return to enhanced overall wellness and self-determination (Cook et al., 2010). Research Strategy We are proposing using the concepts of a Wellness Recovery Action Plan to assist individuals and their spouses/significant others by who have been impacted by Combat PTSD. The participant s will be interviewed prior to group to ensure safety of group participants, group fit, and inform the participants of group requirements, expectations, and potential risks. Participants are expected to attend each week, if a participant misses three weeks they will be asked to leave the group, with an opportunity to join at another group at a later time, or given a referral to another provider. If at any time a participant behaves in a manner that is threating to others, they will be terminated from the group. The implementation of a WRAP group occurs in six stages. Wellness Tool Box, Daily Maintenance Plan, Triggers, Early Warning Signs, When Things are Breaking Down, Crisis and Post crisis (Copeland, 2002; Scott and Wilson, 2011). Each stage involves practices of making written plans, self-monitoring and taking action in response to environmental and emotional changes in one’s mental health.  Stage 1: weeks 1-3, for the group individual is to develop a wellness tool box. The tool box focuses on what the group member does that help them stay well. It includes a description of a person, in thought and behavior. This is done to help the client and those that are involved in the individual’s life monitors the clients well-being, helping them to identify when decomposition has begun or is occurring (Copeland 2002).  Stage 2: weeks 4-6, Creation of a Daily Maintenance Plan. The daily maintenance plan helps to remind group members what the activities that they need to do in order to maintain wellness (Copeland 2002). Copeland (1997), recommends a mixture of activities that promote stress reduction, for example eating right, getting enough sleep and exercise, meditating, and spending time in a fun or creative exercise.  Stage 3: weeks 7-9, is for the group members to list both internal and external events or situations that may trigger group members to decompensate. Naturally, these triggers will be different for each group member, but might include some stressors like receiving traumatic news, economic difficulties. The mental health aspect might include: increased anxiety, forgetfulness, lack of motivation and increased isolation. The plan would be to respond to these triggers with healthy coping skills that they currently use and ones that they will learn in the future (Copeland 2002).  Stage 4: week 10, a plan is constructed for times when the mental illness is progressing and placing the client at risk for decomposition which could lead to hospitalization. Here the plan will become directive, with clear instructions and very few choices. This stringent phase is designed to intervene strongly at the onset of a crisis situation. Copeland (1997), indicates that the plan would use language such as: things I must do, or things I could do if they feel right to me (Copeland 2002).  Stage 5: weeks 11-12, is the crisis plan development. This is for periods when others involved with the individual decide that the group member is no longer able to care for themselves. It gives criteria for others to use in recognizing a crisis situation, list of key supporters, and instructions to supporters, social workers, and mental health

NIH GRANT SUBMISSION ULMER T DMFT7202-11 12 professionals. this is because the underlying assumption is that others are making decisions for the group member due to their inability to do so in a healthy manner, while following the wishes of the individual promoting self-determination (Copeland 2002).  Stage 6: weeks 13-16 for planning is the for the period after crisis. This is arguably the most important stage as it involves the group member to resume and take responsibility for their wellbeing on day to day basis. The planning stage therefore, is open to change as the individual lives change and adjustments to their wellness are needed in order to ensure stability in their personal and professional relationships (Copeland 2002). WRAP groups range in size from 8 to 12 participants and are led by a trained facilitator. Information is imparted through lectures, discussions, and individual and group exercises, and key WRAP concepts are illustrated through examples from the lives of the facilitators and participants. The intervention is delivered over twelve weekly two hour sessions, but it can be adapted for shorter or longer times to more effectively meet the needs of participants. Participants often choose to continue meeting after the formal eight-week period to support each other in using and continually revising their WRAP plans (Cook et al., 2010). Evaluation The evaluation of the program will utilize a variety of scales and surveys to ascertain the fidelity and value of the WRAP program. The self-report survey is based on a Likert scale with one being extremely not satisfied and ten being extremely satisfied. The participants will rate their inter/intra personal relationships, social network, occupational environment and finally overall well-being. The facilitators will also administer a five question open ended survey that consist of the following questions: 1. What about the WRAP group do you find useful? 2. What about WRAP does not work for you? 3. What would you like to see done differently? 4. What would you like to see more or less of? 5. Is there anything that was not asked that you would like to tell us? The last question will ask them to rate their overall experience: Please rate your experience in the group from: extremely helpful, somewhat helpful, not helpful, it made things worse. Variables/ tool(s) and measures use to evaluate each objective: Outcomes  Symptoms of Combat PTSD Symptoms of mental illness will be assessed using the Brief Symptom Inventory (BSI), a 53-item self-report instrument. The BSI yields scores on the Global Severity Index (an overall measure of psychological distress), the Positive Symptom Total (a measure of the number of symptoms), and nine symptom subscales: somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism. Using a 5-point scale ranging from "not at all" to "extremely," participants will rate each item for how much the symptom bothered them in the past week ( Derogatis, 1993 ).  Hopefulness Hopefulness will be assessed using the Hope Scale (HS), a 12-item self-report instrument with two subscales: one that measures belief in one's capacity to initiate and sustain actions and another that measures ability to generate routes by which goals may be reached. Participants will rate each item on a 4-point scale ranging from "definitely

NIH GRANT SUBMISSION ULMER T DMFT7202-11 13 false" to "definitely true," and scores for each item are summed to produce a total score (Farran, Herth, & Popovich, 1995).  Recovery from mental illness Recovery from mental illness will be assessed using the Recovery Assessment Scale (RAS), a 41-item self-report instrument with five subscales: personal confidence, willingness to ask for help, goal orientation, reliance on others, and freedom from symptom domination. Participants rate each item on a 5-point scale ranging from "strongly agree" to "strongly disagree," and scores for each item are summed to produce a score for overall recovery (Jorge-Monteiro, M., & Ornelas, J. H. (2016).  Self-advocacy Self-advocacy will be assessed using the Patient Self-Advocacy Scale (PSAS), a 12-item self-report instrument that measures three dimensions: patient knowledge, assertiveness, and potential for nonadherence to treatment. Participants rate each item on a 5-point scale ranging from "strongly agree" to "strongly disagree” Jansson et al., 2015).  Physical and mental health Physical and mental health will be assessed using the Medical Outcomes Study 12-Item Short Form Survey (SF-12), a self-report instrument that evaluates health indicators, allowing for examination of the presence and seriousness of physical and mental conditions, acute symptoms, age and aging, changes in health, and recovery from depression. Timeframe(s) data be collected (pre/post-test, retrospective posttest, pre/mid/posttest)?  Symptoms of Combat PTSD Participants will be randomly assigned to an intervention group that will receive WRAP or to a wait-list control group that will receive services as usual. The BSI will be administered to participants 6 weeks before (baseline) and six weeks after (posttest) they received the intervention and at a six month and twelve-month follow-up. The BSI will ascertain whether participants will have a significantly greater reduction in the severity and number of symptoms across time (from baseline to posttest to six and twelve-month follow-up) relative to control group participants ( Derogatis, 1993 ).  Hopefulness Participants will be randomly assigned to an intervention group that will receive WRAP or to a wait-list control group that received services as usual. The HS will be administered to participants 6 weeks before (baseline) and 6 weeks after (posttest) they received the intervention and at a 6 and 12-month follow-up. received WRAP The HS scale will indicate whether or not the participants had a significant increase in feelings of hopefulness (Farran, Herth, & Popovich, 1995).  Recovery from mental illness The RAS will be administered to participants before (pretest) and 1 month after (posttest) they received the intervention in hopes that WRAP participants will report a significant improvement in RAS scores for overall recovery and in the five subscales: personal confidence, willingness to ask for help, goal orientation, reliance on others, and freedom from combat PTSD symptom domination (Jorge-Monteiro, & Ornelas 2016).  Self-advocacy

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NIH GRANT SUBMISSION ULMER T DMFT7202-11 14 The PSAS will be administered to participants before (pretest) and 1 month after (posttest) they received the intervention in hopes that the WRAP participants will report a significant improvement in self-advocacy (Jansson, et al., 2015).  Physical and mental health The SF-12 was administered to participants before (pretest) and 1 month after (posttest) they received the intervention. From pre- to posttest the SF-12 will indicate whether or not the WRAP participants had a significant improvement in physical and mental health (Tabolli et al.,2011). Reference Army Field Manual 22-51, Leader's Manual for Combat Stress Control . (September, 1994). Government Printing Office Card-Mina, M. E. (2011). Leadership and post traumatic stress symptoms. Military Review, 91 (1), 47-53. Retrieved from http://search.proquest.com.proxy1.ncu.edu/docview/851691141?accountid=28180 Caruth, G. D. (2013). Demystifying mixed methods research design: A review of the literature. Mevlana International Journal of Education, 3 (2), 112. Retrieved from http://proxy1.ncu.edu/login?url=http://search.ebscohost.com.proxy1.ncu.edu/login.aspx? direct=true&db=edb&AN=89641952&site=eds-live Castillo, D. T., Chee, C. L., Nason, E., Keller, J., C’de Baca, J., Qualls, C., . . . Keane, T. M. (2016). Group-delivered cognitive/exposure therapy for PTSD in women veterans: A randomized controlled trial. Psychological Trauma: Theory, Research, Practice, and Policy, 8 (3), 404-412. doi:10.1037/tra0000111; 10.1037/tra0000111.supp (Supplemental) Cook, J.A., Copeland, M.E., Corey, L., Buffington, E., Jonikas, J.A., Curtis, L. C., Grey, D.D., & Nicholas, W. H. (2010). Developing the evidence base for peer-led services: Changes among participants following wellness recovery action planning (WRAP) education in two statewide initiatives. Psychiatric Rehabilitation Journal, 34: 113-120. Copeland, M. E. (2002). Mental health recovery: Facilitator training manual. West Dummerston, VT: Peach Press Copeland, M. E., & Mead, S. (2004). Wellness Recovery Action Plan and peer support: Personal, group, and program development. Dummerston, VT: Peach Press . http://search.proquest.com.proxy1.ncu.edu/docview/1032525374?accountid=28180 Courtney, J. M. (2012). The posttraumatic stress disorder (PTSD) family workshop: A pilot study of preliminary outcomes and effect sizes of an attachment-based intervention for family members of veterans with combat-related PTSD (Ph.D.). Retrieved from http://search.proquest.com.proxy1.ncu.edu/docview/1032525374?accountid=28180

NIH GRANT SUBMISSION ULMER T DMFT7202-11 15 Derogatis, L. (1993 ). Brief Symptom Inventory (BSI): Administration, scoring and procedures. Manual (3rd ed.) National Computer Systems. Minneapolis, MN Dekel, R., Levinstein, Y., Siegel, A., Fridkin, S., & Svetlitzky, V. (2016). Secondary traumatization of partners of war veterans: The role of boundary ambiguity. Journal of Family Psychology, 30 (1), 63-71. doi:10.1037/fam0000163 Farran, C.J., Herth, K.A, & Popovich, J,M. (1995). Hope and hopelessness: Critical clinical constructs. Thousand Oaks, CA: Sage Publications Galovski, T., & Lyons, J. A. (2004). Psychological sequelae of combat violence: A review of the impact of PTSD on the veteran's family and possible interventions. Aggression and Violent Behavior, 9 (5), 477-501. doi: http://dx.doi.org/10.1016/S1359-1789(03)00045-4 Gambrel, L. E., & Butler, J. L. VI (2013). Mixed methods research in marriage and family therapy: A content analysis. Journal of Marital and Family Therapy, 39 (2), 163-181. Retrieved from http://proxy1.ncu.edu/login?url=http://search.ebscohost.com/login.aspx? direct=true&db=ofs&AN=86745621&site=eds-live Greenwood, M. D., & Terry, K. J. (2012). Demystifying mixed methods research: Participation in a reading group 'sign posts' the way. International Journal of Multiple Research Approaches, 6 (2), 98-108. Retrieved from http://proxy1.ncu.edu/login?url=http://search.ebscohost.com/login.aspx? direct=true&db=ehh&AN=85171751&site=eds-live Harkness, L. (1993). Transgenerational transmission of war-related trauma. In J. P. Wilson & B. Raphael (Eds.), International handbook of traumatic stress syndromes (pp. 635-643). New York: Plenum Press. Hoe, M., & Brekke, J. S. (2008). Cross-ethnic measurement invariance of the brief symptom inventory for individuals with severe and persistent mental illness. Social Work Research, 32 (2), 71-78. Retrieved from http://proxy1.ncu.edu/login?url=http://search.ebscohost.com/login.aspx? direct=true&db=c8h&AN=105775757&site=eds-live Herron, S s . (2004). Twice the Citizen: The New Challenges of Serving in the Army Reserve and National Guard Twice the Citizen . Bloomington , US: Author H h ouse Publications . Jansson, B. S., Nyamathi, A., Duan, L., Kaplan, C., Heidemann, G., & Ananias, D. (2015). Validation of the patient advocacy engagement scale for health professionals. Research in Nursing & Health, 38 (2), 162-172. doi:10.1002/nur.21638 Jorge-Monteiro, M., & Ornelas, J. H. (2016). Recovery assessment scale--portuguese version. Psyctests, doi:10.1037/t49214-000; Full; Full text; 999949214_full_001.pdf Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M. & Nelson, C. B. (1995). Posttraumatic stress disorder in the national comorbidity survey. Arch Gen Psychiatry, 52,1048-1060. Knaus, W. J. (2006). Cognitive behavioral workbook for depression : A step-by-step guide to overcoming depression . Oakland, US: New Harbinger Publications.

NIH GRANT SUBMISSION ULMER T DMFT7202-11 16 McLean, C. P. (2015). Prolonged exposure therapy. Evidence based treatments for trauma-related psychological disorders (pp. 143; 143-159; 159). Cham: Papazoglou, K. (2012). Combat-related posttraumatic stress disorder. In C. R. Figley (Ed.), Encyclopedia of trauma: An interdisciplinary guide (pp. 121-123). Thousand Oaks, CA: SAGE Publications Ltd. doi: 10.4135/9781452218595.n41- Roberts, G. & Wolfson, P. (2004). The rediscovery of recovery. Advances in Psychiatric Treatment, 10, 37-49. Rogers, S., & Silver, S. (2002). Is EMDR an exposure therapy? A review of trauma protocols. Journal of Clinical Psychology, 58, 43-59 Scott, A. & Wilson, L. (2010). Valued identities and deficit identities: Wellness recovery action planning and self-management in mental health. Nursing Inquiry, 18:40-49 Tabolli, S., Spagnoli, A., di Pietro, C., Pagliarello, C., Paradisi, A., Sampogna, F., & Abeni, D. (2011). Assessment of the health status of 2,499 dermatological outpatients using the 12- item medical outcomes study short form (SF-12) questionnaire. The British Journal of Dermatology, 165 (6), 1190-1196. doi:10.1111/j.1365-2133.2011.10532 . Taylor, S., Thordarson, D. S., Maxfield, L., Fedoroff, I. C., Lovell, K., & Ogrodniczuk, J. (2003). Comparative efficacy, speed, and adverse effects of three PTSD treatments: Exposure therapy, EMDR, and relaxation training. Journal of Consulting and Clinical Psychology, 71 (2), 330-338. doi:10.1037/0022-006X.71.2.330 Ulmer, T. (2016). Literature Review. Unpublished manuscript, Department of Marriage and Family Therapy, Northcentral University, Alexandria, Virginia. Venkatesh, V., Brown, S. A., & Bala, H. (2013). Bridging the qualitative-quantitative divide: Guidelines for conducting mixed methods research in information systems. MIS Quarterly, 37 (1), 21-54. Retrieved from http://proxy1.ncu.edu/login?url=http://search.ebscohost.com/login.aspx? direct=true&db=bth&AN=85634550&site=eds-live

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