Operational Stress Control: Conserving the Force by f3j9He

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									Operational Stress Control:
  Conserving the Force
        Presented by:
 Bureau of Medicine & Surgery
 Deployment Health Directorate

       Unclassified       080328
Healthy
 Force
                   Mission
                   Focused
                                                  Issue
          • There is a concern that Sailors and Marines are not meeting their own mental
            health needs or using existing mental health resources before serious
            consequences occur to self, others, or career (DMSS, PDHRA referrals)

          • 06FEB08 CJCS, ADM Mullen: "I am extremely concerned about the toll the
            current pace of operations is taking on them and on their families, on our
            equipment and on our ability to respond to crises and contingencies beyond
            ongoing operations in Iraq and Afghanistan," he said.

          • Naval leaders and the mental health system do not have the resources to
            wait for the 20% to 25% of sailors who need mental health services to
            develop impaired functioning before they get help (Hoge, Koffman, et al.
            NEJM, vol 351, no. 1, 2004)

          • The Navy needs to move beyond responding to mental illness to promoting
            psychological health (CNO Blue-Gold Guidance)

          • CNO Navy Objectives for FY 2008 and Beyond: 2.h. Emphasize Combat
            Stress Control Programs, reduce stigma of using behavioral health services,
            and develop resilient Sailors and families.

          Unclassified                                                     080328
Healthy
 Force
                   Mission
                   Focused
                               Background
          • Operational and occupational demands have
            steadily increased since 2001
          • Cumulative stress negatively impacts mission
            readiness, productivity, physical health, and
            quality of life.
          • The cornerstone of operational psychological
            health is the Combat and Operational Stress
            Control (COSC) program
          • Maritime doctrine for operational stress control
            for Sailors and Marines is in development


          Unclassified                                080328
Healthy
 Force
                   Mission
                   Focused
                                       Historical Perspective
                             Ready                                Ill
                    Fit for Full Duty                    Not Fit for Full Duty
                    Mission Focused                          Depression
                   100% Productive                             Anxiety
             Fully engaged in training                          PTSD
                                           Temporarily
                                              Non-         Medical Boards
                                             Mission        Appointments
                                             Ready

                             Leaders                         Caregivers



          Unclassified                                                  080328
Healthy
 Force
                   Mission
                   Focused
                             Stress Continuum Model

            READY             REACTING             INJURED                  ILL
     •     Good to go         • Distress or      • More severe       • Stress
     •     Well trained         impairment         or persistent       injuries that
     •     Prepared           • Mild and           distress or         don’t heal
                                transient          impairment        • Types:
     •     Fit and tough
                              • Anxious or       • Four types:         • PTSD
     •     In cohesive
                                irritable           • Trauma           • Depression
           units &
                                                    • Fatigue          • Anxiety
           families           • Behavior
                                                    • Grief            • Substance
                                change                                   abuse
                                                    • Moral injury

      Unit Leader                   Individual Responsibility        Chaplain & Medical
      Responsibility                                                     Responsibility
          Unclassified                                                   080328
Healthy
 Force
                   Mission
                   Focused
                             Stress Injury Mechanisms
                               Intense or Prolonged
                                      Stress


                                                                      MORAL
             TRAUMA             FATIGUE          GRIEF
                                                                      INJURY

  An impact injury     A wear-and-tear       A loss injury        A loss injury
  Due to events           injury             Due to the loss of   Due to a disruption
     provoking terror, Due to the                people who are       in trust in moral
     horror, or           accumulation of        cared about          values
     helplessness         stress over time

          Unclassified                                               080328
Healthy
 Force
                   Mission
                   Focused
                                  Core Leader Functions
          • Strengthen
             – Create confidence/ forewarn
             – Inoculate to extreme stress
             – Foster unit cohesion
          • Identify
             – Know crew stress load
             – Recognize reactions, injuries, illnesses
          • Mitigate
              – Remove unnecessary stressors
              – Ensure adequate sleep and rest
              – After-Action Reviews (AARs) in small groups
          • Treat
              – Rest and Restoration (24-72 hours)
              – Chaplain
              – Medical
          • Reintegrate
              –   Keep with unit if at all possible
              –   Expect return to full duty
              –   Don’t allow retribution or harassment
              –   Continuously assess fitness
              –   Communicate with treating professionals (both ways)

          Unclassified                                                  080328
Healthy               Mission
                                      Operational Stress Control
 Force                Focused

                                          Decision Matrix
                                                  Sailor or Marine Under Stress
            Green Zone (Ready):
            • Continue to monitor for signs                 Are there signs of
            of distress or loss of function in      NO        DISTRESS or
            the future                                          LOSS OF              Distress or Loss of Function:
                                                              FUNCTION?              •   Difficulty relaxing and sleeping
                                                                                     •   Loss of interest in social or recreational activities
                                                                        YES          •
                                                                                     •
                                                                                         Unusual and excessive fear, worry, or anger
                                                                                         Recurrent nightmares or troubling memories
                                                                                     •   Hyperactive startle responses to noises
           Yellow Zone (Reacting):                                                   •   Difficulty performing normal duties
           • Ensure adequate sleep & rest                                            •   Any change from normal personality
           • Manage home-front stressors            NO      Is the distress or
           • Discussions in small groups                     loss of function    SEVERE Distress or Loss of Function:
           • Refer to chaplain or medical if                    SEVERE?
                                                                                 •   Inability to fall asleep or stay asleep
           problems worsen                                                       •   Withdrawal from social or recreational activities
                                                                        YES      •
                                                                                 •
                                                                                     Uncharacteristic outbursts of rage or panic
                                                                                     Nightmares or memories that increase heart rate
                                                                                 •   Inability to control emotions
            Orange Zone (Injured):
                                                                                 •   Serious suicidal or homicidal thoughts
            • Keep safe and calm                            Has the distress
            • Rest & recuperation 24-72 hrs.        NO         or loss of        •   Loss of usual concern for moral values
            • Refer to medical or chaplain                     function
            • Mentor back to full duty and                   PERSISTED?
            function                                                             PERSISTENT Distress or Loss of Function:
                                                                                 • Stress problems that last for more than 60 days
                                                                        YES      post-deployment
            Red Zone (Ill):                                                      • Stress problems that don’t get better over time
            •   Refer to medical                                                 • Stress problems that get worse over time
            •   Ensure treatment compliance
            •   Mentor back to duty if possible
            •   Transition to VA if necessary



          Unclassified                                                                                             080328
Healthy            Mission
                                  Operational Stress Control
 Force             Focused

                                   Assessment & Response
          Observe:
             Actively observe behaviors; look for patterns.
          State Observations:
             All attention to the behaviors; just the facts without interpretations or
             judgments.
          Clarify Role:
             State why you are concerned about the behavior. Validates why you
             are addressing the issue.
          Ask Why:
             Seek clarification; try to understand the other person's perception of
             the behaviors.
          Respond:
             Clarify concern if indicated. Discuss desired behaviors. State
             options in behavioral terms.

          Unclassified                                                     080328
Healthy
 Force
                   Mission
                   Focused
                             USN/USMC Operational
                             Stress Control Training
          • There is one core Operational Stress Control concept
             – The approach to Psychological Health and Traumatic Brain Injury
               must meet the needs of diverse military cultures that include deep
               ocean ships, littoral forces, Marine and Special Warfare land
               forces, Naval aviation, and Navy healthcare
             – Effective operational stress control must be responsive to small
               groups, support peer and unit leader responsibility, be evidenced-
               based and culturally informed while promoting readiness, wellness
               & retention
          • Implementation
             – Develop cohesive resources for Sailors, leaders, families,
               caregivers
             – Leverage existing curriculum that already addresses optimal
               performance, stress management, situational awareness skills, or
               first-aid
             – Develop focused training that includes problem solving and skill
               building at critical leadership transition points

          Unclassified                                               080328
Healthy
 Force
                   Mission
                   Focused
                                     Operational Stress Control
                                          Training Scope
                                                    Small Groups & Crew
                                                    Stress Continuum                      Care-Givers:
                             Sailors & Marines:     Peer and Unit Leader          •   Assessment &
                                                     Responsibility                    Intervention
                         •   Resiliency building
                                                                                   •   Psychological First Aid
                         •   Stress monitoring
                                                                                   •   Diagnosis & Treatment
                         •   Shipmate care
                                                                                   •   Buddy-Care
                         •   Self care
                                                                                   •   Self care

                                                            Core Content:
                                                   •   Stress continuum model
                                                   •   Prevention strategies
                                                   •   Early intervention
                                                       strategies
                                                   •   Treatment and
                                                       rehabilitation strategies

                                                                                            Families:
                                 Leaders:
                                                                                   •   Resiliency building
                     •       Resiliency training
                                                                                   •   Stress monitoring
                     •       Stress mitigation
                                                    Evidence based                •   Self care
                     •       Stress surveillance
                                                    Culturally informed           •   Child care
                     •       Stress management
                                                    Promoting readiness,          •   Spouse care
                                                     wellness & retention



          Unclassified                                                                              080328
Healthy
 Force
                   Mission
                   Focused
                                    Way Ahead
              – Senior Line leaders to clearly articulate that
                psychological health is a mission relevant issue and
                set the tone for use of psychological health services
              – Effective services require a core concept of stress
                adaptation and response that is consistent from
                bootcamp through war college promoting shipmate-
                care with “one-up” support
              – Use of a population-based public health model
                promotes a psychologically healthy force and family
                that is mission focused
              – Effective non-stigmatizing services require a
                comprehensive and coordinated line and medical
                process that conserves service members who are
                temporarily non-mission ready

          Unclassified                                        080328
Healthy
 Force
                   Mission
                   Focused
                             Operational Stress Control


                                 Questions
                                    or
                                 Comments
                                 POC: CAPT Robert Koffman, MC
                                  Director, Deployment Health
                                 Bureau of Medicine and Surgery
                                 Robert.Koffman@med.navy.mil




          Unclassified                                            080328

								
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