Innovations: Accommodations: Efforts to Support Special-Needs Soldiers Serving in the Israeli Defense Forces

Before induction, IDF recruits undergo screening procedures that include medical evaluation, psychometric evaluation, and a basic assessment for psychopathology. The psychometric evaluation includes cognitive testing of scholastic ability and personality measures (a structured personality interview and questionnaires) aimed at assessing combat suitability and future military performance. More detailed information about the evaluation has been published elsewhere ( 6 ).

Recruits who are identified as having difficulties may receive special assistance. The IDF has defined categories of special-needs recruits who may be assigned to less stressful service environments and occupations, receive different initial training, or receive enhanced support during their service. Recruits are categorized into these groups during induction but may be recategorized later during their service.

Three common categories for soldiers who may need special assistance are MHP (Mental Health Profile) ( 6, 8 ), ADS (Adaptation Difficulties Score) ( 6, 9, 10 ), and MACAM (the acronym for the title in Hebrew of the Center for the Advancement of Special Populations) ( 1, 10 ). The main distinction between these groups is that soldiers in the MACAM group receive special consideration and support both at the time of recruitment and during their entire service, whereas the two other groups receive consideration only during initial assignment.

Mental Health Profile group. A profile is determined during the recruitment period and represents the level of mental health of a recruit ( 6 ). Scores vary and indicate that the soldier cannot be recruited, that the soldier should be assigned to limited service options, or that the soldier's mental health makes him or her suitable for all positions. MHP is based on a psychiatric examination to which draftees are referred by paraprofessional interviewers or by civilian professionals who screen the entire population of recruits ( 8 ). When an interviewer's impression is that a draftee may have a psychiatric disorder, the interviewer refers the draftee to a psychiatrist. The MHP reflects an individual's functional level in the military rather than a precise clinical diagnosis.

Adaptation Difficulties Score group. The ADS indicates the adjustment skills and mental strength of recruits. Evaluation is performed only when the paraprofessional interviewers suspect problems. ADS status is based on the Mental Health Assessment, a semistructured interview conducted by a clinical social worker ( 6 ). Possible scores range from 0, no indication of disturbance, to 60, severely disturbed. The score has been found to predict functioning in the military and is validated annually ( 9 ). Recruits with scores above the mild range receive special consideration in their assignments, and draftees who receive high scores are not recruited ( 9 ).

MACAM group. Soldiers in the MACAM group are identified during the induction phase. MACAM recruits are males only and are the most problematic. They have educational, social, and psychological problems ( 10 ), and most have difficult backgrounds. Their psychosocial profile is characterized by emotional, behavioral, and cognitive problems ( 1 ). Emotional problems include an intense need for attention, difficulty delaying gratification, impulsiveness, a low threshold for frustration, difficulty establishing trust and accepting responsibility, fear of being away from home, and low self-esteem. Cognitive problems include poor education, concrete thinking, and difficulty distinguishing between essential and secondary issues, solving problems, and planning ahead. Behavioral problems include difficulty functioning under stress and accepting authority, lack of perseverance, difficulty taking initiative and responsibility, childishness, a tendency toward aggression, and lack of disciplined habits.

Because MACAM is ranked as the most problematic group, this classification overrides any other classification. Soldiers in the other two groups—those with MHP or ADS levels above the mild range—are assigned to regular noncombat units with less stressful duties. After this assignment, these soldiers are expected to cope without enhanced support systems other than supports available to the general military population. In contrast, MACAM soldiers are recruited through a specific mechanism and assigned to long and gradual basic training in the MACAM center. The center offers an enhanced educational and rehabilitation framework tailored to help the new recruits overcome their deficits ( 1 ). They are then assigned to units according to their current abilities, where they are accompanied by officers and commanders from MACAM who have received special training and education. In addition, MACAM soldiers' mandatory service is shorter than that of other soldiers—two years instead of three ( 1 ). Commanders work to increase the MACAM soldiers' self-efficacy and self-discipline, provide an organized daily schedule, and accompany the soldiers in periods of stress and in other situations where they can demonstrate success and competence.