275

Resetting the Force: Reentry and Redeployment

Chapter 18

RESETTING THE FORCE: REENTRY AND 

REDEPLOYMENT

KRIS A. PETERSON, MD*; and MICHAEL E. DOYLE, MD†

INTRODUCTION

BACKGROUND

REENTRY CHALLENGES BY POPULATION

Regular Army

National Guard and Army Reserve

Family Members of Regular Army, Reservists, and National Guard Members

REDEPLOYMENT PROGRAMS

SUMMARY

ATTACHMENT: HEALTH ASSESSMENT FORMS

*Colonel, Medical Corps, US Army; Chief, Department of Psychiatry, Madigan Army Medical Center, Tacoma, Washington 98431; formerly, Child and 

Adolescent Psychiatry Consultant to The Surgeon General, US Army 

†

Lieutenant Colonel, Medical Corps, US Army; Deputy Commander for Clinical Services, USAMEDDAC West Point, 900 Washington Road, West 

Point, New York 10996

This chapter was previously published as: Doyle ME, Peterson KA. Re-entry and reintegration: returning home after combat. Psychiatric 

Quarterly. 2005;76:361–370. Adapted with permission of Springer. 
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Combat and Operational Behavioral Health

The capacity of Soldiers for absorbing punishment and enduring privations is almost inexhaustible so long as they believe 

they are getting a square deal, that their commanders are looking out for them, and that their own accomplishments are 

understood and appreciated.

—General Dwight D Eisenhower, 1944

INTRODUCTION

Soldier life in the US Army is structured by the 

cycles of predeployment, deployment, and postdeployment. Management of behavioral health in each 

phase is a continuous process, with features unique to 

each phase. Soldiers redeploying from combat to their 

home units face a number of stressors that may affect 

postdeployment adjustment. Among the factors that 

influence stress levels are the nature of the conflict, 

level of national support, family support and family 

stability, and the soldier’s component (regular Army, 

National Guard, or US Army Reserve). 

“Resetting the force”—reentry, reintegration, recovery, and reconstitution—has become an essential 

operation of the postdeployment phase of the cycle. 

Resetting the force can be thought of as personal or 

soldier maintenance. Just as equipment needs to be 

repaired or refurbished after deployment, and maintained throughout its use to prevent breakdown, so, 

too, do soldiers need ”maintenance” in the form of support before, during, and after deployment. This chapter will look at processes developed by the military 

over the course of the global war on terror (GWOT) 

to reset the force by assisting soldiers in reentry and 

reintegration. 

Resetting the force includes many concepts; for 

example, implicit in maintaining a ready deployable 

force is making soldiers available for contingency 

operations while simultaneously sustaining garrison operations. Early inclusion of families and 

communities into the planning for reentry and 

reintegration, normalization (nonmedicalization 

of distress), destigmatization of behavioral health 

problems, and assistance for behavioral health 

needs, including easy access to a behavioral health 

professional and education of soldiers and families 

on resources and benefits, are other essential elements in this process. 

The military recognizes resetting the force as a vital 

part of the return to readiness, as important as preparing soldiers for deployment. This concept acknowledges that recovery after a deployment maintains 

the soldier and is part of the preparation process for 

future deployments. Soldiers recover and return to 

combat readiness as the next round of deployments 

approaches. The effectiveness of the reintegration 

process strongly affects the state of individual and unit 

readiness. Thus, stakeholders include the soldier; the 

soldier’s family, unit, and local community; the Army; 

and all of US society. These identified stakeholders 

provide context to resetting the force and shape its 

outcome. 

 Recognizing this, Army leadership (under G1), 

in concert with behavioral health professionals, developed an intensive program to reach all returning 

soldiers—active duty, reserve, and National Guard—

who were mobilized and deployed to combat zones. 

The Deployment Cycle Support Program (DCSP) directs as much attention to the postdeployment phase as 

the Army historically has to the actual deployment and 

run-up to it. The DCSP brings balance to the varying 

soldier, unit, and family needs within the deployment 

cycles or continuum. 

Background

Accounts of wars throughout recorded history 

frequently include descriptions of the physical and 

emotional suffering of the combatants. The GWOT, 

Operation Iraqi Freedom (OIF), and Operation Enduring Freedom (OEF) will likely continue this trend. Scientific study of the emotional and psychiatric impact 

of combat operations is extensive up to and including 

the Persian Gulf War. Publications since then include 

numerous reports on peacekeeping operations1,2 and 

a recent article on symptoms of posttraumatic stress 

disorder in OIF/OEF soldiers and marines.3

For OIF/OEF, reentry—or returning home after 

combat—and reintegration have received attention 

in the media, but rigorous scientific study has not 

yet occurred. Moreover, the media attention has been 

primarily negative: individual incidents of criminal 

behavior with deployment experience implicated as 

the cause, an anticipated epidemic of posttraumatic 

stress disorder as thousands of service members demobilize following the war, and problems with soldiers’ 

follow-up medical care, infrastructure at major medical 

centers, and the physical disability system. 

In the 1995 textbook War Psychiatry,

4

 Faris Kirkland 

discusses at length the impact on soldiers primarily, 

and on society to a lesser extent, of troops returning 

home after conflict. Kirkland divides US involvement 
277

Resetting the Force: Reentry and Redeployment

in numerous conflicts and armed interventions into 

three categories: major wars, limited actions, and 

rapid-deployment operations. Major wars are those 

defined by large-scale mobilizations against a defined, 

“evil” and dehumanized enemy, fought by “champions 

of the people” for the greater good, in which reentry 

of the combatant into civilian life is accomplished by 

demobilization. Demobilization places responsibility 

for reentry and reintegration squarely on society at 

large, making it “a societal, not military problem.” 

In major wars the soldier and family impact involves 

less conflict. The societal embrace of soldiers doing 

their duty in the face of a dehumanized enemy, fighting for a greater good, validates the soldier’s actions 

and modifies the negative psychological sequelae of 

combat. Resetting via acknowledgment of meaningful actions and sacrifices “not in vain” is more readily 

accomplished.4

Limited wars are those requiring only a fractional 

commitment of national resources; they are conducted 

in a different psychopolitical climate than major wars.4

National interests frequently serve as the pretext for 

action, civilian inconvenience and involvement are 

modest, and ambivalence about the cause pervasive. 

Numerous factors complicate reentry of service members, significantly, the absence of national consensus, 

lack of validation of soldiers’ efforts, and the return of 

soldiers individually from theater. “Soldiers were not 

able to process their experiences with the comrades 

with whom they had trained and fought.”4(p293) Reentry 

management in modern limited wars has been shouldered by society. Following the Korean War, soldiers 

met indifference; following Vietnam, hostility.4 Thus 

far public ambivalence has greeted returning OIF and 

OEF troops: praise for heroism, countered by belief in 

the moral injustice of the war, coupled with the portrayal of soldiers as pawns trapped in a commitment 

to serve. 

In limited wars, wherein society does not identify 

with the soldier and is neutral or even negative toward 

a soldier’s sacrifice, the psychological impacts land 

more heavily upon both soldier and society. “Psychiatric casualties increase greatly when the soldier feels 

isolated, and psychological and social isolation from 

home and society was one of the results of the growing 

antiwar sentiment in the United States,” such as during the Vietnam War.5

 Furthermore, in Vietnam, one 

consequence of soldiers’ alienation was an increase 

in “Dear John” letters.5 OIF and OEF reflect similar 

dynamics; the divorce rate for soldiers, and the officer 

corps in particular, rose rapidly in the first 3 years of 

the conflict, leveled off, and then rose again.

Psychiatric casualty rates in Vietnam “were similar 

to home-front approval ratings for the war, and an 

argument can be made that psychiatric casualties can 

be impacted by public disapproval.”5(p278) In multiple 

studies two factors show up again and again as critical 

to the magnitude of the posttraumatic response. First 

and most obvious is the intensity of the initial trauma. 

The second, and less obvious but absolutely vital, factor is the nature of the social support structure available to the traumatized individual.5

 Society accepting 

as necessary soldiers’ behavior in combat—killing, 

managing violence—vitalizes resetting the force and 

mitigates the psychological impact of combat. In contrast, the decline in public support for the war in Iraq 

as well as negative media attention may contribute to 

difficulties in reentry and reintegration for redeploying 

and demobilizing service members. Leaders and citizens, locally and nationally, who comment that a war 

is unjust, based on a lie, or in vane, make the soldier’s 

task to refit and reset more difficult. It is consequently 

important for leaders to speak up about the justness of 

the fight, identify what the country is fighting for, and 

outline the strategic successes. Reset must encompass 

not just an acceptance of but accolades for soldiers’ 

accomplishments.

The third form of combat, the rapid-deployment 

operation, is enacted for national interest by a professional military cohort that has trained together but 

must rapidly transition from training to combat mode 

and back again to prepare for the next deployment scenario.4

 Soldiers involved in these actions seldom have 

time to consider or internalize virtues of the cause, but 

instead must rely on horizontal and vertical cohesion 

Major War

• Large scale

• Moral superiority

• Fought by champions

• National will validates 

 soldiers’ efforts

• Society manages reentry

OIF/

Limited War OEF

• Fractional commitment

 of national will

• National interest

• Modest inconvenience

• Individualized reentry

• Societal indifference

RapidDeployment 

Operation

• National interest

• Professional military

• Cohort reentry

• Unit-level validation

• Repeated deployments

Figure 18-1. The characteristics of major wars, limited wars, 

and rapid deployment operations overlap in Operation Iraqi 

Freedom (OIF) and Operation Enduring Freedom (OEF).
278

Combat and Operational Behavioral Health

within their units for validation.4 Responsibility for 

reentry and reintegration rests primarily on the unit 

and military. The ability of these soldiers to rely on unit 

cohesiveness and esprit de corps significantly impacts 

deployment readiness.4

Special forces operations employed in GWOT as 

well as during the Cold War fall under this construct. 

The resetting of these combat teams is made easier 

through the unit cohesion and esprit de corps developed during their specialized training. Conversely, frequent deployments, toxic environments, and combat 

losses take a toll. The stigma of having a behavioral 

health problem is amplified because these soldiers 

may feel they cannot rely upon distressed members. 

Consequently, seeing behavioral health practitioners 

for assistance in a reset is made even more difficult in 

this group. Typically, special forces soldiers reach out 

to chaplains and leaders for these needs. Increasingly, 

however, regular forces follow the same behavior pattern, and the factors that mitigate distress in the special 

operations population may not exist as robustly in the 

regular forces community. 

History may determine where GWOT, OIF, and OEF 

fall among the models discussed. These related conflicts have been framed as a major war against a great 

evil but executed as a limited war by an increasingly 

professional and full-time military that must prepare 

for return-to-combat while planning its return home. 

OIF and OEF also entail the largest call-up of reserve 

forces since World War II, with 18-month mobilization orders for the National Guard, and 2- to 3-year 

mobilizations for reservists. These groups also face the 

increasing pressures of the deployment cycle. Figure 

18-1 depicts this overlap between major, limited, and 

rapid deployment operations, with elements of each 

apparent in OIF and OEF. 

REENTRY CHALLENGES BY POPULATION

The unusual spectrum of the GWOT, OIF, and OEF 

conflicts presents multiple challenges to reentry and 

reintegration for the three separate populations of 

regular Army soldiers, National Guard and reserve 

soldiers, and family members. 

Regular Army

The DCSP, resulting from the peacekeeping operations of the 1990s and the development of concepts 

based on expeditionary force practices among Army 

leadership, reflects recognition that in the post-Cold 

War era, soldiers are in predeployment, deployed, 

or postdeployment states at any given time. And so 

are family members. The DCSP plan, dated May 2, 

2004, disseminated and operationalized Army-wide, 

includes a return-to-readiness—termed “recovery” 

or “reconstitution”—period (Figure 18-2). The plan 

is intended to assist soldiers in reentry and reintegration and restore them and their units to combat 

readiness:

Reintegration training for both the Soldier and his/

her family is an essential task for all units’ return to 

readiness plans. It is as important as any other training or personnel action the Soldier undertakes. Reintegration entails three components; the single Soldier 

and his/her assimilation back into a garrison environment; the married Soldier and his/her assimilation with his family; and the family of the deployed 

Soldier.6

Reintegration training is not a single session but a 

continuous and, at times, parallel process: 

	 •	 Reintegration training occurs in advance of

soldiers’ return to home station, often intheater or at the location to which soldiers 

have been deployed. 

	 •	 Rear detachment leaders coordinate with the

installation to provide reintegration training to families of deployed soldiers as well. 

Although the training is voluntary for family 

members, units encourage participation. Units 

publicize training sessions and conduct them 

at times that allow maximum family member 

participation. The training also includes takehome information about what families might 

expect during the homecoming of their combat veteran.6

	 •	 The reconstitution phase starts upon a soldier’s arrival at home station after deployment. Commanders establish a half-day 

schedule to “facilitate family reintegration and 

to commence administrative tasks required 

upon return.”6 Half-days occur through the 

first 10 days, and during this time the soldier’s 

duties entail “administrative functions, Soldier and leader professional education, and 

family reintegration.”6

Rear detachment commanders and personnel 

provide support and training resources for reintegration in advance of the unit’s return. They ensure that 

“suitable time is allocated for family reintegration 

activities both for the married and single Soldier.”6

Leaders will “execute family reintegration counseling for all redeploying Soldiers. To the greatest extent 
279

Resetting the Force: Reentry and Redeployment

PDHRA

Reintegration Tasks

Day 0 Pass Pass Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7 Day 8 Day 9 Day 10

Day180

Day -60 Day -30 Day -3 Day -2 Day -1

{

RecepFlight 

{

tion

Pass

{{

Days 1–10 Do Not Include Weekend Days (Protected)

Redeployment Tasks

{

In Transit

{

Key Components

• Commander’s program

• Structured decompression/reintegration

• Mental health risk stratification program prior to departure from theater

• Active tracking and monitoring, which involves cordination between

 BCT/division and the local AMEDD resources

• Tailored to both active and reserve components

possible, this counseling will occur in theater, prior 

to the Soldiers redeploying.”6 Units are expected to 

sustain needed family reintegration training following soldiers’ return, based on unit sensing sessions, 

command climate surveys, and feedback to the unit 

leadership from installation support agencies and 

healthcare providers. 

At-risk soldiers are identified by commanders prior 

to returning home to “ensure that they receive tailored 

training and/or assistance based on their particular 

circumstances.”6

 The Army identifies soldiers-at-risk 

by marital difficulties or difficulties with fiancés, 

financial difficulties, problems with alcohol or substance abuse, medical problems, and problems such as 

depression or anxiety reported by the soldier during 

pre- and postdeployment screening. This list is not 

all-inclusive and other issues might identify a soldier 

as at risk as well.6

Lastly, as directed March 26, 2007,7 all redeploying 

soldiers undergo a health reassessment 3 to 6 months 

after redeployment. This reassessment includes general health questions, seeking to address medical issues 

Figure 18-2. Key components in decompression and reintegration. 

BCT: brigade combat team

AMEDD: Army Medical Department

PDHRA: Post-Deployment Health Re-Assessment

not identified at the initial screening, but also presents 

soldiers with the opportunity to seek treatment for any 

behavioral health concerns that may have arisen since 

the initial screening.

National Guard and Army Reserve

As advocated by the “One Army” concept of 

seamlessness among components, requirements of 

the DCSP apply equally across active duty, National 

Guard, and reserve units. Reserve and National Guard 

soldiers are demobilized, like soldiers from World War 

II or Korea; their reentry and reintegration is largely 

shouldered by their communities; and medical care is 

provided by the Department of Veterans Affairs (VA) 

hospital nearest their home.

Reentry anxieties abound among these soldiers. 

Many have lost their jobs or fear the possibility of job 

loss, despite legislative protections. Sole proprietors 

and small-business owners are particularly at risk. A 

frequently noted concern is that soldiers feel different 

than they did before deployment. Other issues faced by 
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Combat and Operational Behavioral Health

demobilizing reservists and Guard members include 

a sense of isolation from peers, estrangement from 

family and friends, and a loss of common purpose. 

The bonds forged in combat and other operations may 

remain if the Guard unit has a localized base; however, 

this is often not the case. 

Case Study 18-1: Specialist A presented for care shortly 

after being notified of his imminent release from active duty. 

The soldier expressed fears that he would respond negatively 

or even violently in his work environment when confronted 

with inevitable conflicts. “I’m not ready to go home. Most of 

the guys where I work are Middle Eastern; I’m afraid I will 

go off on them.” 

Demobilizing reservists and National Guard personnel often return to their home unit stations as soon as 

4 days after arriving at the demobilization site. This 

facilitates a quick reunion for them and their families; 

however, follow-up care and monitoring may be scarce 

in the home communities. Thus, these soldiers may find 

themselves in a difficult situation: either remain on active 

duty, separated from family and loved ones, to address 

medical questions, or ignore the medical issues and return 

home. Washington state sought to redress these issues in 

November 2004 when it established a memorandum of 

agreement with multiple federal agencies to 

augment the ongoing, comprehensive effort to ensure military service members and their families are 

honored for their valuable and honorable service to 

our country. It is recognized that the Department of 

Defense and the U.S. Department of Veterans Affairs 

are providing world-class transition service . . . to 

deal with the multitude of medical and mental conditions associated with war. This agreement will focus 

primarily on “after active-duty” and deal with problems and issues military members often face several 

months or years following military service.8

This agreement and its accompanying programs aim 

to shore up local reintegration and reentry of returning 

service members. Features include

	 •	 ensuring that each returning veteran receives

a letter from the governor, the adjutant general, and the director of the Washington State 

Department of Veterans Affairs thanking 

them for their service and encouraging them 

to seek their various veteran benefits and 

entitlements;

	 •	 follow-up letters at 3 and 6 months;

	 •	 a family activity day, held within 3 to 6 months

following return, conducted by teams consisting of representatives from the VA, Veterans 

Benefits Administration, Veterans Health Administration, and Washington Employment 

Security Department; accredited veteran services officers; and mental health professionals 

for the purpose of providing information to 

assist veterans and their family members with 

reintegration; and

	 •	 a family support program providing education about VA services and benefits in classes 

for family members of deployed service members, conducted by accredited veteran services 

officers at local armories and sponsored by the 

command.8

Like those on active duty, reserve component soldiers receive the health reassessment screening at 3 to 

6 months postdeployment. Specific questions on the 

screening aim to measure the presence and impact 

of posttraumatic stress disorder. If the reassessment 

identifies healthcare needs, soldiers are offered care 

through military medical treatment facilities, VA medical centers or veterans’ centers, TRICARE providers, 

or community-based healthcare organizations established by the Army. Part of this intervention plan are 

behavioral healthcare providers, who further assess 

soldiers’ needs and ensure that care is offered. 

Family Members of Regular Army, Reservists, and 

National Guard Members

The Deployment Health Clinic at Madigan Army 

Medical Center, Tacoma, Washington, like similar 

clinics at other military treatment facilities, recognizes 

that family preparedness for deployment is essential to 

ensuring soldier readiness for deployment. With this 

in mind, the Deployment Health Clinic developed the 

Army Family Readiness Course, which is an online 

resource for soldiers and family members. This has 

evolved over time into additional resources for soldiers 

and family members now embodied in the efforts of 

the Technology and Telehealth Initiative from the Department of Defense. 

 Case Study 18-2: Ms B is a 32-year-old spouse of an 

infantryman. The couple arrived at Fort Lewis, Washington, 

3 months prior to his deployment to Iraq. His previous assignment was in Korea, where his 12-month tour had been 

extended to 15 months. Ms B presented feeling overwhelmed 

at being separated from her spouse so soon and for yet 

another year. The couple had four children, ages 3 to 13. 

Ms B had significant back pain, anxiety, and a history of 

depression. Following her spouse’s return from Iraq, where 

he had served as a squad leader for an infantry squad with 

numerous combat encounters, she reported, “He tells me 

everything. I thought he’d keep it inside. I thought I’d be better 

when he came home, but I still can’t sleep.”
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Resetting the Force: Reentry and Redeployment

During deployment, family members of regular 

Army soldiers usually have the benefit of support from 

the on-post community, support that is often not available for National Guard members or reservists. However, 

family members of National Guard and reserve soldiers 

may have greater access to family and long-standing 

community relationships that regular Army families 

do not. Regardless of component, home-front stability 

is key to soldier readiness. Family instability, which 

generally increases at deployment, distracts the service 

member, and absence of a family care plan often results 

in administrative separation of deploying soldiers. 

Often, however, the greatest challenge to families is 

the return of the deployed soldier. When the returning 

soldier reclaims prior responsibilities, the spouse may 

be left feeling that his or her efforts during deployment 

are invalidated. Months of adaptation and coping are 

upended, giving rise to such questions as:

	 •	 Who now pays the bills, takes out the trash,

mows the lawn?

	 •	 Who disciplines the children? How?

	 •	 Who gets the remote?

	 •	 Are there problems with intimacy?9 

Redeployment Programs

Commanders’ plans for resetting the force have 

varied, but they generally intend to provide a broadbased and inclusive assessment of the mental wellbeing of soldiers deploying to and returning from 

combat. In the Army’s first resetting iteration, the 

Walter Reed Army Institute of Research developed a 

postdeployment questionnaire that was filled out by 

soldiers upon or near redeployment and often in theater. This questionnaire became known as the Health 

Risk Appraisal questionnaire (HRA I). Subsequently, 

many local institutions and commands broadened the 

questionnaire and, through consensus, standardized 

its contents to create the HRA II. Soldiers completed 

the HRA II prior to deployment and upon return 

from a combat theater. Based on these assessments, 

interventions could be carried out to assist resetting 

soldiers in need. For example, a soldier who started 

smoking in the combat theater might express interest 

in smoking cessation. The request would be identified 

on the HRA II, and follow-up contact and treatment 

interventions arranged. 

Further evolution of the resetting efforts occurred 

over time, with different programs being implemented 

on different military posts. Ultimately, Army leadership adopted a standardized schedule and format for 

the predeployment and postdeployment assessments 

and the postdeployment health reassessment (see 

Attachment). In addition to the health assessments 

administered upon deployment, redeployment, and 

3 to 6 months postdeployment, the DCSP supports 

behavioral health by surveillance for trends and compliance, treatment referrals when indicated, and, most 

importantly, making it mandatory that soldiers have 

the opportunity to complete all assessments (although 

completion is voluntary).

The Army initially delegated treatment decisions to 

local medical treatment facilities. Arguably the most 

comprehensive of these efforts is a program called the 

Soldier Wellness Assessment Pilot Program (SWAPP), 

deployed initially at Fort Lewis, Washington (Exhibit 

18-1).

In general, military treatment facility reintegration 

programs operate as follows: Returning soldiers are 

assigned a care manager (usually a social worker) if 

medical or behavioral health issues are identified on 

the postdeployment health screening. The care manager assists the soldier in scheduling needed follow-up 

and then in keeping those appointments. This often 

requires coordination with the soldier’s command 

to ensure that the needed time is given. Those who 

need ongoing care are assigned case managers, who 

monitor the progress of the soldier’s therapy with a 

goal of full return to duty. Soldiers with identified 

behavioral health concerns that may limit duty are 

assisted by case managers in concert with behavioral 

health professionals. 

However, soldiers may also present with behavioral 

health concerns to the local behavioral health clinic, 

where those recently deployed are offered a wide 

variety of therapeutic modalities. These may include 

one-to-one supportive, insight-oriented, or cognitive/ 

behavioral therapy, as well as group therapies such 

as postdeployment adjustment groups, interpersonal 

process groups, depression groups, groups focused 

on adjustment to military life, or groups focused on 

life skills or anger management. Marital and family 

therapies are also offered in a variety of modalities. 

Medication management is also available when appropriate. Treatment for posttraumatic stress disorder, 

consistent with treatment guidelines based on the 

literature, is also offered.10

The expectation of wellness and recovery remains 

an integral part of any treatment program. For many, 

use of reassurance is efficacious. Practitioners should 

use language such as: “What you are experiencing now 

is an expected consequence of your combat tour. It will 

get better with time. However, the following may be 

helpful in this process. . . .”
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Combat and Operational Behavioral Health

EXHIBIT 18-1

SOLDIER WELLNESS ASSESSMENT PILOT PROGRAM 

Interventions to reset the force have been in development since soldiers began redeploying to combat operations in 

Afghanistan and Iraq. A program that has gained significant acceptance and captured the commander’s intent is the 

Soldier Wellness and Assessment Pilot Program (SWAPP) at Fort Lewis, Washington. SWAPP is a useful model built 

on the Deployment Cycle Support Program’s intents to 

	 •	 standardize predeployment and postdeployment health risk assessments, with an identical process before

and after deployment;

	 •	 encompass a broad definition of health and wellness, including physical, emotional, spiritual, financial, and

legal needs; 

	 •	 make data transparent to commanders and medical staff; and

	 •	 ensure a face-to-face encounter with a licensed provider for each soldier assessed.

Participation in SWAPP is voluntary. Many commanders and soldiers view the program as an opportunity to establish a broad-based overview of physical, emotional, and spiritual wellness. The assessment is scheduled for completion between 90 and 180 days after return, and 45 to 125 days prior to departure. As seen in Figure 18-3, soldiers 

check in and begin with a face-to-face encounter that introduces aspects of the program and attempts to destigmatize the resetting process. It is made clear that the process is voluntary. 

Soldier 

Feedback 

Questionnaire

Health Risk 

Appraisal

(HRA II) Psychologist

Social Worker

Chaplain

Substance

Abuse

Counselor 

Medical

Chaplain

Tobacco

Cessation 

Injury

Prevention 

Occupational

Health 

I CORPS

Units

Mental 

Wellness 

Nurse

Practitioner

(Exit Interview) 

Clinic

Appointment(s) 

Med/

Prevention Battlemind II 

Blood

Pressure 

Check-in 

Figure 18-3. Soldier Wellness and Assessment Pilot Program flow chart.

 (Exhibit 18-1 continues)
283

Resetting the Force: Reentry and Redeployment

Exhibit 18-1 continued

Soldiers complete the health risk appraisal (HRA II) questionnaire in several venues, administered on computer 

kiosks, and results are forwarded to providers. The questions encompass the postdeployment health reassessment 

questions in form DD 2900 (see Attachment). HRA II has 76 questions used to identify risk in soldiers, who are 

categorized as being at high, moderate, and low risk for disease or mental health conditions. If soldiers are high 

risk, 60 minutes is allotted for a face-to-face meeting with a credentialed provider, and a soldier at moderate risk is 

allotted 30 minutes. Credentialed providers include psychologists, psychiatrists, social workers, psychiatric nurse 

practitioners, and chaplains. Licensed practical nurses and occupational and preventive medicine professionals are 

also on site to assess needs unrelated to mental health, such as tobacco cessation and medical referrals. 

As the program matures, its data will be accessible, comparable, and transparent, allowing for longitudinal followup. Currently data pertaining to form DD 2900 are sent to the Army Medial Surveillance Activity to be entered 

into the Defense Medical Surveillance System. Feedback from this system is sent to commanders via a Web-based 

report that is compliant with the Health Insurance Portability and Accountability Act of 1996. The data provided 

to commanders include diagnoses by type and prevalence, deployment-related conditions, safety issues, legal and 

financial problems, and the overall state of morale. 

As Figure 18-3 demonstrates, SWAPP is resource intensive. Though it is not used Army-wide, its elements are 

encompassed in return processing at other duty stations, and it serves as a model for many other programs in the 

military. Initial feedback and response from commanders and soldiers alike has been positive. Efforts to expand the 

SWAPP program to other Army posts are underway. 

Case Study18-3: Staff Sergeant C had recently been 

evacuated from Iraq following an improvised explosive device explosion in which he sustained an injury to his leg. His 

physical recovery was progressing well and he was hopeful 

for a full recovery. However, he complained of increasing 

awareness of disrupted sleep due to nightmares. He stated 

that he’d had them start before being injured and leaving Iraq 

and thought they’d go away once he was home. But now, 

some 2 months later, the nightmares persisted. Typically they 

involved combat operations and often centered on having 

to make a choice such as kill or be killed, killing, and then 

discovering the victim was a child.

Other soldiers often complain of hypervigilance 

while driving—fearing every piece of trash is an 

improvised explosive device or other drivers are potential suicide bombers. For many, the lack of sleep 

alone, without nightmares, represents a problem; often 

soldiers’ spouses report these concerns. Recognizing a more pervasive need to normalize experiences 

and assist redeploying soldiers in adapting what is 

a normal and acceptable behavior and response in 

the combat zone to what is normal and acceptable at 

home, the Army developed and introduced Battlemind 

training.

The Battlemind program (Exhibit 18-2) is another 

intervention with a renewed emphasis on normalizing anticipated feelings and reactions during the 

deployment cycle. “Battlemind” is the soldier’s inner strength and ability to face fear and adversity in 

combat with courage. Components are designed to 

build self-confidence and mental toughness. However, 

although Battlemind skills are helpful in combat, they 

Buddies (cohesion) 

Accountability 

Targeted aggression 

Tactical awareness 

Lethally armed 

Emotional control 

Mission operational security 

Individual responsibility 

Nondefensive (combat) driving 

Discipline and ordering 

Adapted from: US Army. Battlemind Web site. 

http://www.Battlemind.army.mil. Accessed March 

31, 2010.

EXHIBIT 18-2

Battlemind

may cause problems on returning home; for example, 

tactical awareness in a combat zone might become hypervigilance at home. Battlemind training is a method 

of aiding soldiers in transitioning to home-front living. 

Battlemind training emphasizes that
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	 •	 Battlemind “injuries” (ie, a maladaptive

response to a formerly dangerous situation) 

can occur in any soldier when combat skills 

are not adapted to the home;

	 •	 getting help for a Battlemind injury is NOT a

sign of weakness; and

	 •	 it takes courage to ask for help and it takes

leadership to help a fellow soldier get help. 

The training, conducted upon redeployment, initially consists of an educational brief that emphasizes 

Battlemind concepts. Retraining after 3 to 6 months 

includes scenario-driven vignettes and videos that recreate typical situations experienced by redeployed soldiers and suggested ways of handling these issues. 

The programs and procedures outlined above work 

towards improving communication between soldiers 

and family members in an effort to resolve crises and 

mitigate distress. The inclusion of these programs in 

command-sponsored and command-driven operations plans and memoranda of understanding highlights a number of important considerations:

	 •	 Planners must integrate families and communities early into the planning for reentry 

and reintegration.

	 •	 Distress during this time is expected and

should not be medicalized.

	 •	 Behavioral health professionals should be

available to soldiers and families following 

return from combat.

	 •	 Education of families about available resources and benefits is as important as training 

soldiers.

Services for family members need to be easily accessible, perhaps even more so when the soldiers are 

deployed. Families with preexisting mental health 

needs frequently have increased demands, and those 

who did not demonstrate preexisting problems might 

also need services. Often sources in the community are 

not readily available or sufficient, even in more populated areas. With active duty mental health professionals deployed, the increased demand for services from 

family members at home may tax behavioral health 

resources beyond capabilities. For example, at the 

Madigan Army Medical Center outpatient psychiatry 

clinic, patient contacts for fiscal year 2001 numbered 

approximately 8,000; the same number was logged 

during just the first 6 months of 2005. 

Summary

In current and projected future operations, the 

burden of soldier reentry and reintegration will be 

borne equally by the Army and society, who must 

collaborate to ensure that maximal benefits to the 

soldier, family members, and society are realized. 

Since the beginning of GWOT, OEF, and OIF, the US 

Army has developed and refined its efforts to reset 

the force, reaching out to all returning and redeploying service members with a variety of mental and 

behavioral health initiatives. How well these efforts 

are working must be tracked and analyzed, so that 

the programs may continue to evolve to serve the 

changing needs of soldiers, families, the Army, and 

US society.

REFERENCES

1. Adler AB, Castro CS. US Soldiers and Peacekeeping Deployments. Heidelberg, Germany: US Army Medical Research 

Unit-Europe; 2001. Research Report.

2. Schumm WR, Bell DB, Knott B. Characteristics of families of soldiers who return prematurely from overseas deployments: an assessment from Operation Restore Hope (Somalia). Psychol Rep. 2000;86(3 Pt 2):1267–1272.

3. Hoge CW, Castro CA, Messer SC, et al. Combat duty in Iraq and Afghanistan, mental health problems, and barriers 

to care. N Engl J Med. 2004;351(10):13–22.

4. Kirkland FR. Postcombat reentry. In: Jones FD, Sparacino LR, Wilcox VL, Rothberg JM, Stokes JW, eds. War Psychiatry. 

In: Zajtchuk R, Bellamy RF, eds. Textbooks of Military Medicine. Washington, DC: Department of the Army, Office of 

The Surgeon General, Borden Institute; 1995: 291–317.

5. Grossman D. On Killing: The Psychological Cost of Learning to Kill in War and Society. New York, NY: Little Brown and 

Company; 1995.

6. I (US) Corps OPLAN 04-10 (Return to Readiness). Unclassified. Fort Lewis, Wash. April 2004.
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7. Peter Geren, Acting Secretary of the Army. Deployment Cycle Support (DCS) Directive. Washington, DC: US Department 

of the Army. Memorandum, March 26, 2007. Available at: http://www.armyg1.army.mil/dcs/docs/DCS%20Directive.

pdf. Accessed September 15, 2009.

8. Memorandum of Understanding Between Washington State Military Department, Washington State Department of 

Veterans Affairs, Washington State Employment Security Department, US Department of Veterans Affairs, Benefits 

Administration, US Department of Veterans Affairs, Health Administration, US Department of Labor, Association of 

Washington Business, Governor’s Veterans Affairs Advisory Committee, November 2004.

9. Robertson M, Humphreys L, Ray R. Psychological treatments for posttraumatic stress disorder: recommendations for 

the clinician based on review of the literature. J Psychiatr Pract. 2004;10:106–118. 

10. Getting Back Together (Homecoming/Reunion) [videotape]. Washington, DC: US Army; 1994. US Army training video 

TVT20-1048. 
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