Heroes in Mind Advocacy and Research Consortium (HiMARC) / Consortium de recherche sur le suport et defense des heros (CRSDH)

Projects

  • Veteran-Friendly Campuses in Alberta: Supporting Veteran Military to Civilian Transition

    Upon release from the Canadian Armed Forces (CAF), many military members pursue post-secondary training. In an effort to support military to civilian transition, the Government of Canada announced a Veterans Education and Training Benefit for Canadian Armed Forces veterans that will go toward the cost of college, university or technical education. This benefit aims to enhance transferable skills and position veterans to be competitive in the civilian workforce. This first exploratory phase of a five-year evidence-based practice implementation research project will build upon efforts to support veterans in their academic pursuits and co-create a strategy for fostering Veteran Friendly Campuses (VFC) and cultures across post-secondary institutions in Alberta (polytechnics, colleges and universities). The overall aim is to enable veterans to successfully navigate into and through post secondary institutions and post-secondary institutions in Alberta to implement and facilitate VFCs.

    This project, guided by the National Implementation Research Network’s four-stage implementation model, employs an exploratory mixed-methods, multiple case study design. The project will lay the foundation for collaboration across key stakeholders and the co-creation of a vision, principles and strategies for establishing VFCs across post-secondary institutions in Alberta.

    Based on preliminary interviews and environmental scan and literature review findings, it is anticipated that post-secondary institutions will need to initiate ways to identify veterans upon admission, make recruitment and career counsellors available, enhance mental health services for veterans, offer residential and financial supports, establish a veteran support hub and train faculty and students in VFC culture. Further, veterans will benefit from flexible admission options, access to an education and training inventory, and support from a veteran-on-campus liaison, student navigator and transition modules. Findings will inform post-secondary institutions of tangible steps needed to serve the educational needs of veteran students.

    HiMARC is proud to be engaging with Campus Alberta and other universities, such as the University of British Columbia, on this exciting and necessary initiative to help Canada’s veterans in their transition from military life and into new educational and vocational pursuits.

  • Brain Bootcamp: An integrated behavioral health intervention for military members with reduced executive cognitive functioning

    Canadian Armed Forces (CAF) Service Members (SMs) experience higher rates of mild traumatic brain injuries (mTBIs) and psychosocial risk factors such as mental health diagnoses, sleep disturbances, alcohol consumption, and post-concussion symptoms than Canadian civilians. Associated challenges with executive cognitive functioning (ECF) can significantly compromise their performance, engagement, and deployability. Occupational Therapists provide rehabilitation services to CAF-SMs, including those with reduced ECF. To address challenges with ECF, an Occupational Therapist created and delivered Brain Bootcamp; an integrated behavioral health intervention for CAF-SMs who sustained mTBI or more serious traumatic brain injuries (TBI). While qualitative program evaluation of the program are favourable, its impact on ECF in individuals with mTBI/TBI and/or mental health diagnoses, is yet to be determined.

    Purpose: This study aimed to determine if Brain Bootcamp improves cognitive performance, reduces mTBI/TBI-related symptoms, and increases external aid utilization in CAF-SMs who have reduced ECF.

    Methods: A secondary analysis was conducted of clinical outcomes collected from 55 participants who participated in the Brain Bootcamp program. Measures used to determine change prior to and following engaging in the program included the Montreal Cognitive Assessment (MoCA), Rivermead Post-Concussion Symptom Questionnaire (RPQ), and External Aids Utilization Survey (EAUS).

    Results: Statistically significant changes pre- and post-intervention were observed, including improved cognitive performance, reduced self-reported mTBI/TBI symptoms, and increased external aid utilization. Improved ECF enables CAF-SMs to be operationally ready for military service and contribute to well-being in life. Brain Bootcamp appears to be a promising ECF-enhancing intervention. 

  • CAF 3rd Division Growth and Resilience Integrated Training (GRIT) Initiative
    3 Canadian Division (3 Cdn Div) Total Wellness Leader and Soldier Commitment to Readiness, Resilience, and Growth (RRG) outlines 3 Cdn Div’s commitment to the Canadian Armed Forces Total Health and Wellness strategy. GRIT (Growth and Resilience Integrated Training), a strengths-based, total wellness (mind, body, spirit) training program nested within RRG, is being developed to tactically operationalize the RRG way of life. Born from a commitment to reinvigorate the warrior spirit, GRIT is designed to provide participants with the knowledge, skills and attributes required to inculcate the belief that life’s successes and challenges can be opportunities for learning and growth. GRIT is comprised of core and elective components; practical applications that integrate physical, psychosocial and spiritual elements; and a specific delivery sequence (GRIT application, reflection, and dialogic teaching). Various configurations of the GRIT program are under development and are being piloted by 3 Cdn Div in collaboration with the University of Alberta.
  • Clinical workload overview of the physiotherapy services provided by deployed Canadian Armed Forces (CAF) Physiotherapy Officers (PTO) during the initial rotations of Operation REASSURANCE
  • Cognitive Assessment in Canadian Armed Forces Members with mTBI
    Military personnel in the Canadian Armed Forces (CAF) have high-risk occupations that may put them at greater chance of sustaining traumatic brain injuries (TBIs), mental health disorders, such as post-traumatic stress disorder (PTSD), sleep disturbances, substance abuse and other biopsychosocial issues than the civilian population (Department of National Defense, 2016). This is also similar in the Canadian Veteran population (VAC, 2016). In addition, post-concussive symptoms may present at a higher rate in military members who have experienced a mild traumatic brain injury in comparison with the civilian population, due to the presence of comorbid psychosocial risk factors affecting military members (Department of National Defense, 2016; Garber, Rusu, & Zamorski, 2014). These conditions, especially when combined with psychosocial variables, can negatively affect one’s cognitive functioning. Our cognition includes domains such as attention, memory and planning to name a few (AOTA, 2013). Reduced cognitive functioning can lead to additional barriers to participation in everyday occupations of military personnel and veterans from military service. Cognitive assessment and treatment of CAF members and veterans are topics of interest where evidence-based research is lacking and required to address gaps in healthcare services for these populations. Assessing cognitive functioning and performance can be difficult and presents a number of challenges and shortcomings regarding ceiling effects, reliability, feasibility, validity, engagement, etc. Further, completing multiple assessments to address various cognitive domains of functioning is quite time-consuming for both the clinician and the client. As allied health professionals within Canadian Forces Health Services (CFHS) have engaged in training to become Certified Brain FX 360 administrators, questions regarding acceptance, usability, model/framework appropriateness, and feasibility of the technologically based cognitive assessment in the CAF context has been raised. Using the Unified Theory of Technology Acceptance and Use of Technology (UTAUT) model, this pilot project will analyze the acceptance and usability of the Brain FX 360 Assessment with the first cohort of CAF clinicians and CAF members, whom are their patients, to begin utilizing this assessment in clinical practice. This pilot project will be one component of an evidence-based evaluation and implementation science project appraising the use of the Brain FX 360 assessment in the CAF context as well as future adoption of technological assessment and treatment methods.
     
  • Edmonton Fire Road to Mental Readiness (R2MR) Evaluation

    The demands and stressful nature of firefighting, unpredictability of the calls to which they respond, and exposure to traumatic events in the line of duty such as critical incidents can contribute to operational stress injuries (OSIs) (Carlton et al.2016). A recent study with the Hamilton, Ontario Fire Department found that 85%of the firefighters indicated exposure to some type of critical incident in the past two months (MacDermid et al., 2019). The 5 most commonly reported critical incidents included: 1) “Responded to incident involving one or two Deaths”(64%); 2) “Direct exposure to blood and body fluids” (53%); 3) “Responded to incident involving multiple serious injuries” (33%); 4) “Incident requiring police protection while on duty” (24%); 5) Threat of serious line of duty injury or threat of death to fellow emergency worker (that did not result in actual serious injury or death)” (24%) (MacDermid et al., 2019). A 2018 study found that 34.1% of surveyed Canadian firefighters screened positive for a mental health condition(Carlton et al. 2018b). Of these, 13.5% scored positive on screens for Post-Traumatic Stress Disorder (PTSD) (Carlton et al. 2018b). Such mental health injuries can leave firefighters unable to return to work, compromise their quality of life and well-being, and negatively impact their livelihood and relationships. 

    The Road to Mental Readiness (R2MR) program was originally developed by the Canadian Department of National Defense to “improve short term performance and long term mental health outcomes” through building a “solid foundation in the concept of resilience” (National Defence, the Canadian Armed Forces, 2017).R2MR is a peer-delivered program which provides evidence-based psychoeducation on mental health and stress, as well as providing a series ofevidence-based cognitive behavioral therapy style skills designed to help participants to manage stress; for example, goal setting, mental rehearsal/visualization, adapted cognitive monitoring (i.e. awareness of self-talk),and arousal management through adapted breathing (i.e. tactical breathing)(Carlton et al., 2018a). R2MR has since been adopted by multiple PSP organizations including the Edmonton Fire Rescue Services (EFRS), Royal Canadian Mounted Police, and multiple municipal policing organizations. Despite the evidence-based foundations for the psychoeducation and skills provided by the R2MR training programs offered by the Canadian Armed Forces and the Mental Health Commission of Canada (MHCC), a lack of research exists specifically assessing the impact of the program on PSP (Carlton et al., 2018a).In 2019, the Edmonton Fire Rescue Services (EFRS) will be rolling out the updated version of R2MR to their population.

    The purpose of this project is to answer the call from the Blue Paper and assess for changes in self-reported mental health symptoms, resilience, mental health awareness, work engagement, and mental health stigma attitudes of Edmonton Firefighters who have participated in the updated R2MR training program over a one-year time frame. (Carlton et al. 2016).

     
  • Edmonton Police Services Reintegration Program Project: Train the Trainer

    A 2016 study found that 36.7% of surveyed Canadian police officers screened positive for a mental health condition - primarily PTSD (Carlton et al. 2016). Such injuries can leave police officers unable to return to work in their required capacity; some are unable to return to work at all (University of Regina, 2018). Studies related to return to work initiatives for public safety personnel (PSP) remain scarce. Higher quality reintegration program effectiveness studies that incorporate stronger study designs, rigor, validity, and reliability, are required.

    The goal of the Edmonton Police Services (EPS) Reintegration Program is to assist PSP to get back to full duties in their workplace as soon as possible after an OSI, while diminishing the potential for long-term psychological injury (Edmonton Police Services, 2018). To prepare PSP peers to deliver the program to colleagues who seek to return to duty following an OSI, a 5-day Reintegration Program Trainer Training course is offered to PSP agencies in Alberta. The aim of this pre/post mixed-methods cohort pilot study is to:
    1. Evaluate if the EPS Reintegration Program Trainer Training meets the learning goals set out by the instructors,
    2. Explore changes in knowledge, skills, attitudes and learning within individual sub-groups of PSPs attending the training course, and
    3. Identify areas of strengths and improvement within the training course.
     
    Data was collected during the 5-day training from April 8 to 12, 2019. Participant (n=59) data included pre/post competency surveys, daily evaluation surveys, Mental Health Knowledge Questionnaires (MAKS; Evans-Lacko et al., 2010), Open-Minds Survey of Workplace Attitudes questionnsires (OMSWA; Szeto, Luong, & Dobson, 2013), and a World Cafe.
     
    This study is the first in Canada to systematically evaluate the impact of a Workplace Reintegration Trainer Training Program to answer the call for, "research studies and ongoing evaluations examining the effectiveness of peer support or crisis-focused psychological intervention programs with appropriate sample sizes, empirically supported outcome measures, and using methodologically rigorous designs" (University of Regina, 2016). Future research into return to work/duty initiatives that involve longitudinal observation amongst PSP is warranted.

     
  • Evaluating Prognostic Factors for Return to Work in Public Safety Personnel Undergoing Treatment for Work-Related Post-Traumatic Stress Injuries
  • Experiences of 3MDR Clinicians and CAREN Operators with a Virtual Reality Intervention for PTSD

    Motion-Assisted Multi-Modal Memory Desentization and Reconsolidation (3MDR) has recently emerged as a promising intervention for post-traumatic stress disorder (PTSD). 3MDR was developed for use with the Computer Assisted Rehabilitation ENvironment (CAREN) two of which is located in Edmonton, AB and Ottawa, ON. 3MDR requires a clinician and a CAREN Operator to engage with the patient and system during therapy. Although the clinicians generally have experience with a military, veteran, and/or trauma-exposed population, CAREN operators, who generally have information technology or engineering education, are more familiar with patients with musculoskeletal dysfunction. Working with a trauma exposed population, which necessitates exposure of the CAREN operators to potentially graphic imagery and theraputic engagement, is a new, and unique occupational demand.

    Secondary stress is the emotional duress that results when an individual hears about the firsthand trauma experiences of another. This is not uncommon amongst clinicians working with trauma affected populations. To date, there has yet to be a study of the effect of 3MDR on the 3MDR therapists or the CAREN operators. This international mixed-methods pilot project will analyze secondary stress and professional quality of life in clinician and CAREN Operators pre/post engagement with 3MDR. Although promising new avenues for treatment of mental health are emerging, it is imperative that there is investigation and awareness of the impact of these interventions on the patient/participant and the staff involved in the process. Care must be taken to assure the health of all who are exposed to imagery and interactions that could cause occupational or secondary stress for clinicians and CAREN operators.

     
  • Forgiveness as a key intervention of healing from Moral Injury
    Military personnel are routinely exposed to experiences that can affect them physically, mentally, emotionally, socially, and spiritually. Of the more difficult to navigate are morally injurious experiences (MIEs) which can result in Moral Injury (MI). MI has been noted to shatter one’s being at the deepest level, leaving military members and veterans interiorly conflicted and struggling with cognitive dissonance, negative self-attributions, guilt, shame, and fractured relationships with self, others, the world, and the sacred/Transcendent. To effectively address MI a holistic biopsychosocial-spiritual approach is needed. As part of a program evaluation of services and interventions delivered by the Royal Canadian Chaplain Service, a current state analysis and literature review of key interventions used to treat MI - including forgiveness - was conducted.
  • Multi-Modal Virtual-Reality Based Treatment for Canadian Armed Forces Members with Combat-Related Post-Traumatic Stress Disorder: A Computer Assisted Rehabilitation Environment (CAREN) Study

    Military members, veterans, and public safety personnel face numerous stressors and experience potentially traumatic events in the line of duty. As a result, they are at greater risk of developing operational stress injuries (OSIs) including post-traumatic stress disorder (PTSD). Multi-modular Motion-assisted Memory Desensitization and Reconsolidation (3MDR) therapy is a promising intervention for the treatment of combat-related PTSD (cr-PTSD) that utilizes virtual reality in the form of a Computer-Assisted Rehabilitation Environment (CAREN). The ojectives of this project are to (1) examine the effect of 3MDR therapy on PTSD symptoms of Canadian Armed Forces (CAF) service members (SMs) with chronic cr-PTSD who do not benefit from other therapies, (2) study clinicians' and CAREN operators' perceived acceptance and usability of the CAREN system with 3MDR, (3) examine the impact of delivering 3MDR on clinicians and CAREN operators, and (4) contribute to an international dataset for analysis of 3MDR utilizing the CAREN.Outcome measures will include: The Clinically Administered PTSD Scale (CAPS), Brain FX, PTSD symptoms (PCL-5), Posttraumatic avoidance behaviour questionnaire (PABQ), Generalized anxiety disorder scale (GAD-7), Patient health questionnaire (PHQ-9), Health Questionnaire (EQ-5D-5L), Alcohol use disorder identification test (AUDIT), moral injury (MISS-M), Unified Theory of Acceptance and Use of Technology (UTAUT) model Questionnaire for Participants, Outcome Questionnaire 45 (OQ-45), 3MDR Questionnaire, Client Satisfaction Questionnaire (CSQ-8), Dissociative Experiences Questionnaire (PDEQ), and Subjective Units of Distress scale (SUDS). Biomarkers will also be collected, including cortisol levels in blood and saliva, and specific protein biomarkers, inflammatory markers, and microRNA in blood samples. Physiological data will include gait analysis, heart rate monitoring, force plate analysis, brain activity, and eye-tracking. As well, questionnaires will be administered to, and focus groups conducted with, clinicians and CAREN Operators to examine the impact of delivering 3DMR (Perceived Stress Scale, Professional Quality of Life Scale, and Secondary Traumatic Stress Scale, Subjective Units of Distress scale (SUDS)), and use of the Brain FX assessment (UTAUT questionnaire regarding usability of the Brain FX assessment). Acceptance and usability of the CAREN for 3MDR by participants, clinicians and CAREN operators will also be explored.

    More info

    Videos: 

    3MDR - Cardiff, UK

    3MDR - Virtual Reality PTSD Therapy Demonstrated at the Glenrose Rehabilitation Hospital, Edmonton, Alberta, February, 2019

    News articles: 

    1. Virtual reality used to help treat PTSD (February 13, 2019). CTV Edmonton; https://edmonton.ctvnews.ca/virtual-reality-used-to-help-treat-ptsd-1.4296124#_gus&_gucid=&_gup=twitter&_gsc=0e6UW7V
    2. CAF members treat PTSD with virtual reality (February 13, 2019). CTV Edmonton; https://edmonton.ctvnews.ca/video?clipId=1611436
    3. 'Mind-blowing': Virtual reality PTSD treatment central to launch of consortium (February 13, 2019). Edmonton Journal; https://edmontonjournal.com/news/local-news/mind-blowing-virtual-reality-ptsd-treatment-central-to-launch-of-consortium?utm_term=Autofeed&utm_medium=Social&utm_source=Twitter#Echobox=1550092363
    4. Virtual reality to cure post-traumatic stress in military (February 13, 2019). Radio-Canada; https://ici.radio-canada.ca/nouvelle/1152884/realite-virtuelle-vr-3mdr-himarc-armee-canadienne-post-traumatique-traitement-militaires
    5. Group offers virtual-reality PTSD treatment for military members (February 13, 2019). Toronto Sun; https://torontosun.com/news/local-news/mind-blowing-virtual-reality-ptsd-treatment-central-to-launch-of-consortium/wcm/49ef31d1-d029-4af1-bcdf-b2f03fc6da3c
    6. Virtual therapy for soldiers suffering from PTSD (February 13, 2019). CityNews, Edmonton; https://edmonton.citynews.ca/video/2019/02/13/virtual-therapy-for-soldiers-suffering-from-ptsd/
    7. New Edmonton research project aims to tackle PTSD among military members (February 13, 2019). Global Edmonton; https://globalnews.ca/video/4959400/new-edmonton-research-project-aims-to-tackle-ptsd-among-military-members/  
    8. Virtual reality PTSD therapy demonstrated at Glenrose Hospital (February 14, 2019). Edmonton Journal; https://edmontonjournal.com/news/local-news/watch-virtual-reality-ptsd-therapy-demonstrated-at-glenrose-hospital
  • Pre/Post Analysis of an Occupational Therapy Tinnitus Management Intervention for CAF Members

    Tinnitus is defined as auditory perceptions of sound in the absence of external acoustic stimulation. Canadian Armed Forces (CAF) members experience tinnitus at an elevated prevalence when compared to the general Canadian population (Department of National Defence, 2016). In a study of CAF Army, Navy, and Air Force, of 1057 members surveyed, 52% reported experiencing some tinnitus; 11% reported moderate to much interference in their ability to hear (Abel, 2004). This increased occurrence of tinnitus is possibly attributed to the increased exposure to often unpredictable and repeat high decibel noise during military duties (Humes, Jollenbeck, & Durch, 2006). Tinnitus may be caused, or exacerbated, by mental health conditions, noise-related trauma, stress, and other conditions which are experienced by CAF members at a higher rate than their civilian counterparts (Department of National Defence, 2016). Tinnitus can have a profound effect on a person's functioning, sleep, cognition, and affect. The objective of this research was to determine if a 60 minute psychoeducational CAF occupational therapist led intervention improved CAF member's tinnitus severity, mental health, and dysfunction attributed to tinnitus.

     

    A secondary analysis was conducted of medical records from occupational therapy case files from June, 2016 to July, 2018. 23 CAF members were referred to occupational therapy for tinnitus management strategies and education by a primary care clinician and 6 completed pre and post intervention outcome measures. Outcome measures included the Tinnitus Function Index (TFI, Fackrell, Hill, Berry, & Hoare, 2016), Tinnitus Handicap Inventory (Newman, Jacobson, & Spitzer, 1996), and Tinnitus Reaction Questionnaire (Wilson, Henry, Bowen, & Haralambous, 1991). Included participants had endured their tinnitus for longer than 6 months and scored greater than a "moderate" score on the baseline outcome measures.  Future research on the effectiveness, frequency, intensity, and length of tinnitus management interventions amongst CAF members with larger sample sizes would be beneficial.


  • Project Trauma Support: Addressing Post-traumatic Stress Disorder and Moral Injury in Military Members and Veterans
    Project Trauma Support (PTS), a Canadian not-for-profit organization in Ontario, offers a 6-day residential program aimed at addressing Post-Traumatic Stress and Operational Stress Injuries sustained by military personnel, veterans, and public safety personnel. This physician-led program integrates group and individual psychotherapeutic, psychoeducational and activity-based interventions. The primary goals are to provide timely access to help for those suffering from service-related trauma, minimize distress, and support maintenance of healthy lives and relationships. This study aims to evaluate the impact of PTS on Veterans who have experienced PTSD and MI. 

    This mixed-method, randomized waitlist-control trial will include veterans and military members with a diagnosis of an operational stress injury, PTSD and/or Moral Injury (MI). Standardized questionnaires assess stress (IES-R), PTSD (PCL-S), MI (MISS-M), emotional well-being (MHC–SF), adverse childhood experiences (ACEs), post-traumatic growth (PTGI short), and resilience (CD-RISC-10 and Global Resilience Question). Demographic and health information is also collected. Phone interviews post-intervention capture participant reports of the impact and effectiveness of the program, and their perspectives regarding how the program might be improved. Interviews are audio-recorded, transcribed, and thematically analyzed.

    Preliminary thematic analysis of post-intervention phone interviews indicate that the most helpful aspects of the program include: (1) the environment (i.e., feeling at "home" in nature with good food); (2) loving support and connection from the PTS team; (3) engagement in spiritual practices, rituals, ceremonies; and (4) receiving letters from loved ones. Least helpful aspects of PTS: (1) lack of follow-up care and isolation upon program completion; (2) logistical challenges of travel, funding, etc.; and (3) lack of daily schedule. Influence/changes themes include: (1) more connection and better communication with loved ones and peers once home; (2) more open, calm, and self-efficacious with their ability to handle their OSI; and (3) a sense of PTG and hope.
  • Resilient Parents...Resilient Communities (RPRC): Interventions to enhance resilience among military personnel, veterans and their families
    The Defense Policy - Strong, Secure and Engaged (2017) - has put an extraordinary focus on ensuring that military personnel, veterans, and their families are well-supported and resilient. It is well-recognized that military personnel face uniquely challenging situations which may place them at increased risk of Operational Stress Injuries and a heavy allostatic load across all of the domains of health. Military families experience a multitude of stressful events not experienced by civilian families including the frequent moves, separation of family members, and deployment of parent/spouse to hostile environments and war zones. While most research has focused on the impact of military life on children (i.e., deployment and relocation), emerging evidence indicates that children’s adjustment is more closely linked to the mental health of their parents, and parenting has a mediating effect on the impact of stressful events on children. Enhancing the resilience (i.e., the ability to bounce back in the face of life’s challenges) of both parents and children is therefore essential. The aim of this project was to enhance resilience and mental health outcomes of parents and service providers of military and veteran families. And to examine the effectiveness of the two resiliency skills-training programs: “Bounce Back & Thrive!” (BBT) which focuses on military and veteran parents, and “Reaching IN...Reaching OUT” (RIRO) for service providers of military and veteran families. This study utilized a mixed methods approach.  Preliminary findings will be presented, including differences on standardized measures pre-post intervention and on follow up, and an initial thematic analysis of post-intervention focus groups and interviews. Providing a resiliency-training program to military and veteran parents and service providers potentially offers a unique way to enhance the mental health and wellbeing of the community, and means by which adults can better model resilience to children. Helping to build resilient parents might result in a more resilient community, and as a result, resilient Force.
  • Royal Canadian Chaplaincy Service (RCChS) initiatives

    The RCChS mission is to enable a mission ready Defense Community that is morally and spiritually healthy and resilient to serve Canada with honour, at home and abroad. The RCChS is responsible for providing the full spectrum of spiritual and religious (S/R) care and support to the Defense Community, respecting the freedom of conscience and religion of each person, promoting the moral development, mission readiness and well-being of all.

    One of the ways in which the RCChS meets this mandate commitment is through the administration of spiritual programming for service members and their families. The RCChS is committed to reviewing its existing programming to ensure that it continues to meet the S/R needs of service members and their families and that it is keeping pace with emerging trends. 

    The desired outcome is a current state analysis of the RCChS capabilities and services. a report summarizing a current state analysis including (a) key stakeholder engagement, (b) comprehensive needs assessment, and (c) review of existing RCChS programming based on RCChS spiritual indicators. This may include:   

    Phase 1 – Current state analysis including (a) key stakeholder engagement, (b) comprehensive needs assessment, and (c) review of existing RCChS programming based on RCChS spiritual indicators 
    Phase 2 – Validation and further development of the spiritual indicators, as well as associated assessments and interventions
    Phase 3 – Development and delivery of educational materials in collaboration with the Chaplaincy school to train RCChS Chaplains in the spiritual fitness continuum 
    Phase 4 – Development and delivery of educational materials in collaboration with the Chaplaincy school to train CAF members in the spiritual fitness continuum
    Phase 5 – Validation, spread and sustainability