Operational Stress Control: Conserving the Force

1
Operational Stress ControlConserving the Force

• Presented by
• Bureau of Medicine Surgery
• Deployment Health Directorate

2
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.

3
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

4
Historical Perspective
Temporarily Non-Mission Ready
5
Stress Continuum Model

• Distress or impairment
• Mild and transient
• Anxious or irritable
• Behavior change

• More severe or persistent distress or impairment
• Four types
• Trauma
• Fatigue
• Grief
• Moral injury

• Stress injuries that dont heal
• Types
• PTSD
• Depression
• Anxiety
• Substance abuse

• Good to go
• Well trained
• Prepared
• Fit and tough
• In cohesive units families

6
Stress Injury Mechanisms
Intense or Prolonged Stress
7
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
• Dont allow retribution or harassment

8
Operational Stress Control Decision Matrix

• Green Zone (Ready)
• Continue to monitor for signs of distress or
  loss of function in the future

Are there signs of DISTRESS or LOSS OF FUNCTION?
NO

• Distress or Loss of Function
• Difficulty relaxing and sleeping
• Loss of interest in social or recreational
  activities
• Unusual and excessive fear, worry, or anger
• Recurrent nightmares or troubling memories
• Hyperactive startle responses to noises
• Difficulty performing normal duties
• Any change from normal personality

YES

• Yellow Zone (Reacting)
• Ensure adequate sleep rest
• Manage home-front stressors
• Discussions in small groups
• Refer to chaplain or medical if problems worsen

Is the distress or loss of function SEVERE?
NO

• SEVERE Distress or Loss of Function
• Inability to fall asleep or stay asleep
• Withdrawal from social or recreational
  activities
• Uncharacteristic outbursts of rage or panic
• Nightmares or memories that increase heart rate
• Inability to control emotions
• Serious suicidal or homicidal thoughts
• Loss of usual concern for moral values

YES

• Orange Zone (Injured)
• Keep safe and calm
• Rest recuperation 24-72 hrs.
• Refer to medical or chaplain
• Mentor back to full duty and function

Has the distress or loss of function PERSISTED?
NO

• PERSISTENT Distress or Loss of Function
• Stress problems that last for more than 60 days
  post-deployment
• Stress problems that dont get better over time
• Stress problems that get worse over time

YES

• Red Zone (Ill)
• Refer to medical
• Ensure treatment compliance
• Mentor back to duty if possible
• Transition to VA if necessary

9
Operational Stress Control 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.

10
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

11
Operational Stress Control Training Scope

• Small Groups Crew
• Stress Continuum
• Peer and Unit Leader Responsibility

• Care-Givers
• Assessment Intervention
• Psychological First Aid
• Diagnosis Treatment
• Buddy-Care
• Self care

• Sailors Marines
• Resiliency building
• Stress monitoring
• Shipmate care
• Self care

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

• Families
• Resiliency building
• Stress monitoring
• Self care
• Child care
• Spouse care

• Evidence based
• Culturally informed
• Promoting readiness, wellness retention

12
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

13
Operational Stress Control

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