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Operational Stress Control: Train the Trainer
 

Operational Stress Control: Train the Trainer

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OSC "Train the Trainer" from aboard the USS BOXER

OSC "Train the Trainer" from aboard the USS BOXER

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  • Slide 3 – NCCOSC MISSION In line with the SECNAV direction the COSC program was established He incorporated OSC into OPNAV N135, the behavioral health programs.*NCCOSC works for and supports the OSC Program and N135.NCCOSC is now a directorate coded M95 under BUMED M9 / Admiral Neimeyer – Wounded Ill and Injured. A line led program with a great deal of involvement and support from Navy Medicine and Chaplain Corps.NCCOSC was designed to build and preserve the psychological health of our Sailors & Marines.The Naval Center for Combat and Operational Stress Control (NCCOSC) helps to lead Navy Medicine’s efforts to promote and preserve the psychological health of Sailor and Marines.The Center:-Develops comprehensive programs that educate service members on psychological health-Aid Research -Promote best practices in the treatment of combat and operational stress injuries.NCCOSC programs support the entire naval community and require close working relationships with partners and stakeholders in the Navy and Marine Corps.* With that, I would like to begin today’s training with some words from our MCPON Rick West on Operational Stress Control. 
  • A. Operational Stress Control (OSC) is leader-focusedactions and responsibilities to reduce stigma andpromote resilience and psychological health in Sailors,Marines, units and families exposed to stress of routineor wartime military operations.B. OSC Goals are to:1. Prevent or minimize stress injuries - 2. Facilitate healing to minimize warfighting gaps3. Promote resilience4. Reduce stigma5. Maintain a ready fighting forceOverarching GOALS are three: PITPrevention, Identification and TreatmentThis training is not intended to be clinical in nature; rather, it focuses on the leadership responsibilities involved with preserving psychological health in Service members. It provides a foundation so leaders can understand the value of recognizing and addressing combat and operational stress issues andwhy this skill is so important to the well-being of Marines and Sailors.This is not another training, it is an extention of who we are…Sailors taking care of Sailors, Shipmates taking care of shipmates*The value of this brief is three fold: self aid / buddy aid and it is about you as a leader, providing you with the tools to assist those that are assigned under your instruction.It provides a foundation so leaders can understand the value of recognizing and addressing combat and operational stress issues and why this skill is so important to the well-being of Sailors.
  •  SLIDE 5Core Components Stress Continuum – Teaching us how to recognize stress responses.A simple tool in common language to id stress reactions and intervene as appropriate.  Combat and Operational Stress First Aid (COSFA)-Assessing the psychological health of your team and taking action to mitigate further injury.Flexible multi-step process for the timely assessment and pre-clinical care of stress reactions or injuries in individuals or units with the goals to preserve life, prevent further harm, and promote recovery.  Five Core Leader Functions-Leader driven actions to preserve force readiness.An important component for both leadership and our junior members in managing stress within our units. Importance to define stress.
  • SLIDE 9 – Does a Stressed member Mean a Stressed Home? Discussion/ Poll/ Story Rhetorical Q - You are professionals, your doing your job and doing it to the best of your ability, but I need you to ask yourself, when we go home, does a portion of the daily stress go home with us?Is this true? FOTM is the current Optempo is affecting our military lives. Programs: Families OverComing Under Stress (FOCUS) and Chaplin Religious Enrichment Program (CREDO)  
  • SLIDE 10This is not about combat/ PTSD it is about the challenges you face in your individual assignments on a daily basis.With that being said it is important to recognize stress within yourself and those around/assigned to you.What is stressDefine Stress The stressor is the challenge/ threat and the stress is the way individuals perceive their ability to control and adapt to the stressor. Stress reactions are normal reactions by normal people to severely challenging experiences.Different categories of stress – Combat, Operational, OccupationalCombat StressOperational StressOccupational Stress – Harmful physical/emotional responses that occur when job requirements do not match workers capabilities, resources or needs.THE LARGEST Spectrum of influencing factors. What are some of the influencing factors of stress in your line of work? With a show of hands, how many believe stress is Neutral? Not everyone perceives a stressor the same. Are we willing to talk about it? A person’s perception of an event that determines his/her response.(STRESS is RELATIVE)How many believe stress is positive? Stress is positive when a person feels stimulated and able to manage a situation. The positive response prepares the body for action and activates the higher thinking centers of the brain, provides the body for the energy to handle emergencies, to meet challenges and excel.As human being, you need stress to thrive, excel and enjoy life. This is called positive stress. However, positive stress can become negative if it is not balanced and managed efficiently.
  • ACTION: Review with NEURONS throughout slide.Define stressa. Process by which we respond to challenges orperceived threats to the body or mind. Stressrepresents our perception of our own ability to handlethe stressor or situation. It presents both a danger and,if the stress is recognized and handled properly, anopportunity for growth.b. Stress is a necessary component of your life and duty;it can promote growth and push you to be your best.However, if there is too much stress for too long, it canbe harmful.c. When you are deployed in a war zone, it is probablethat you will experience combat stress. The stress youfeel helps you prepare for challenges and brace fordanger.Operational Stress is defined as changes in physicaland mental functioning or behavior due to operating ina combat zone, experiencing direct combat or itsaftermath, or from the consequences of militaryoperations.e. These changes can be positive and adaptive (e.g.,increased confidence in oneself or peers) or negative,including distress or loss of normal functioning.f. All service members and their families experienceoperational stress. Sources include:Deployment cycles – length and frequencyWork-ups, Long hours, Duty sections frequency, Separations, Flight ops, Humanitarian missions, Relocations, Homecomings, Short times at homeSudden changes in schedulePhysiological effects on the brain - How many of you have heard of the fight or flight response? Physiological Effects of Stressa. The "fight or flight" stress reaction refers to thephysical response to handling perceived or realthreats or stressors.Through a hormonal change, our bodies decide tocontest (fight) or remove (flight) ourselves from aperceived or real threat.Besides “fight” or “flight,” people may also “freeze” inplace for reasons other than fear/fright, such as beingoverwhelmed by surrounding stimuli.b. When faced with danger, the body releases hormonessuch as adrenaline and cortisol which:Dilate pupilsRaise metabolismIncrease blood pressure and heart rateCause breathing to become more rapidStimulate metabolismIncrease blood flow to musclesThe long-term consequences of constant stress isdamaging to mental and physical health. The body haslittle time to relax and recover.Chronic over-secretion of stress hormones adverselyaffects:Brain functionCognitive abilityConcentrationMood regulationMemoryd. Symptoms of Stress1) Physical - Fatigue, sleep difficulties, somaticcomplaints2) Emotional - Irritability, anxiety, sadness, guilt,helplessness, feeling overwhelmed, uptight3) Behavioral - Aggression, callousness,pessimism, cynicism, substance use/abuse (food,alcohol, caffeine, power drinks)4) Work-related - “Presenteesim,” tardiness,increased errors, staff conflicts, nonresponsiveness,decreased productivity,absenteeism5) Interpersonal - Thoughtless communication, poorconcentration, social withdrawal,dehumanization of clients, doubting oneself orone’s abilities, engaging in conflict, lackingconfidence, feeling incompetent, decreased trust Physiological Effect Stress is negative when a person feels threatened and not in control of the situation. These feelings instigate a powerful reaction – affecting both the brain and body in ways that can be destructive to physical and mental health.The Stress Reaction: Fight-or-FlightRegardless of the cause, our perception of a challenge or threat triggers the fight-or-flight reaction, a potent mind-body phenomenon designed to save our lives. The fight-flight reaction is now expanded by some to include "freeze.”The stress reaction begins with the amygdala, an almond shaped structure deep in the brain's emotional center – the limbic system. The amygdala scans incoming signals from the senses for anything that could cause distress. If a threat of any kind is perceived, the amygdala acts like an alarm system, instantaneously sending a message of crisis to all parts of the brain. The sympathetic nervous system releases general stimulants such as noradrenalin (also known as norepinephrine) into the brain and adrenalin (also known as epinephrine) into the body. This release of chemicals does the following:Increases muscle tension, blood pressure, heart rate, breathing rate and blood flow to our muscles. Raises our metabolism so our body works at the highest levels of efficiency. Slows our digestive process to direct our energy to the emergency at hand. Dilates the pupils of the eyes for maximum light; directs the eyes peripherally to see danger or locks eyes into tunnel vision. Turns up our hormonal temperature. This is why long after a stressful experience has ended your heart is still pounding and you still feel upset.  Cortisol, a stress hormone, is secreted to do the following: Releases glucose (from liver) and breaks down tissues to release fat into the blood stream to supply muscles with nutrients Inhibits protein uptake by 70% while breaking down protein (reduced muscle mass) to supply energy to muscles.  The long-term consequences of constant stress are damaging to our mental and physical health. If stress is constant and unrelieved, the body has little time to relax and recover. The stress button keeps getting pushed, continually releasing stress hormones when we don't need them, putting the body into overdrive. High levels of the major stress hormone, cortisol, depress cognitive function and the immune system. Because of the stigma associated with reacting to stress or stress injury behaviors, we often try to hide them from our supervisors and avoid medical attention. We cannot, however, hide these behaviors from our family members, shipmates and friends. This is why we are teaching all service members to recognize when a shipmate is in trouble, to break the code of silence and get them connected with the next level of help.  
  •  Slide 12 – Stress Continuum - First GlanceAt first glance…What are some of the first things you notice?The significance of this slide is what you see at first glance and until you are trained we may miss the subtleties of stress reaction.Would you agree that our military members are well trained?Holt “…….”
  • Slide 15 – Stress Continuum Stress Continuum – Teaching us how to recognize stress responses.A simple tool in common language to id stress reactions allowing us to intervene as appropriate. Q-How can we expect our juniors to be that extension or bridge that the SECNAV is asking for if we are not trained or at a minimal aware of what stress reaction and outcomes to surveillance and where to intervene?Stress Continuum How many of you have seen this before? What is your understanding of the Stress Continuum?The COSC series starts off with the Stress Continuum Model and since become the foundation for all Combat and Operational Stress Control training, surveillance, and interventions in both the Marine Corps and Navy.  Evidenced based development of a simple tool in common language for you to identify stress reactions, allowing you to intervene early and take action when necessary. The Continuum has four vertical zones: Ready, Reacting, Injured and Ill. These zones identify the entire spectrum of stress responses and outcomes and are placed in the four vertical zones. Maybe alil corny or elementary but easy to remember – easy to teach.  We need stress to thrive, and we use stress to challenge our service members body and mind with the intent of making them grow and become stronger. But we as good leaders know how to manage this making our service members more resilient in the face of challenges.The long-term consequences of constant stress is damaging to mental and physical health. The Continuum Model is a paradigm, providing a common language, which delineates the entire spectrum of stress responses, features, & outcomes including (from left to right)• adaptive coping and wellness (color coded Green as the “Ready” Zone); The GREEN ZONE does not mean we are without stress or stress free – it means that we are adapting and functioning like we are suppose to. This is the zone when we can challenge and train our service members the hardest…building resilience.Readiness is a leadership responsibility to keep us Fit & Focused, well trained, positive command climate, high morale, unit cohesion, balanced health (physical, emotional, spiritual) Ready families.Q – What does a member or unit look like that is in the Green?Q - What are we doing to keep ourselves in the Green?Q – What are your commands doing to keep you in the Green? • mild and reversible distress or loss of function (the Yellow “Reacting” Zone); Everyone faced with stressful stimuli reacts – 100%. How people reacts depends on are how well trained they are for the stressors and how they interpret them. The inability to recognize the features of this zone can push yourself, or members of your department into the orange injured zone.Q- How many of you have taken the time to evaluate your thoughts after an stressful event/time or a challenging time? How had it impacted your feelings and behaviors? Q – evidence of a unit in the Yellow Zone?Q – evidence of a member in the Yellow Zone?Q – Has anyone observed this in the past? Willing to share?*What changes about you? Do we have any jokesters in the class? When you are stressed…do you keep playing or does you r fun joking personality digress?Reacting Units and IndividualsUnits and Sailors whose resiliency is compromised fall into the yellow “Reacting” zone. 2) Combat or operational stress that impacts readiness may result in mild, temporary stress symptoms. *Normally, the symptoms resolve quickly and can be helped by prompt, low-level intervention.3) It is important to note that all Sailors and families face stressful situations. How you react depends on your preparation and resilience and how you interpret the stressor. 4) Most Sailors use stress reactions to build their life experiences and increase the resources in their coping toolbox.*HAND SLAP DEMONSTRATION – can you feel how quickly your recover?Ok, now how many personnel have knives on them? Are you willing to pull it out? The person to the left or right of you…may I ask you to role up your sleeve closest to your brother with the knife? For demonstration purposes May I ask you to stab your brother in the leg? It doesn’t matter which one.If we were to precede what would be the result? More severe and persistent pain…loss of fluids, greater reaction…greater time to heal/ recover, would this take some intervention? Now we know when we receive appropriate care we heal, grow and most cases are stronger, but say we do not attend to this flesh wound and he endures another wound…at some point the tools that you have will not heal these wounds and we need to refer to a higher echelon of care in order to achieve a full recovery.***Or speak of a real flesh wound or spider bit that progressed without care… • more severe and persistent distress or loss of function (the Orange “Injured” Zone); Signaling the presence of some kind of damage to the mind (thought process), brain, spirit.Most are temporarily non-mission ready and usually benefit from appropriate involvement by leaders or other caregivers to augment social support and coping resources.The orange “Injured” zone indicates Sailors and families who are affected by intense or persistentstress. They may experience severe and lasting distress and/or an inability to be productive, but arelikely to fully recover if they receive early intervention.If a Sailor or family member exhibits these signs, it istime to seek assistance from: COC, Chaps, Medical or other external resources. *FOUR SOURCES OF INJURY • Diagnosable mental disorders arising from stress and unhealed stress injuries (the Red “Ill” Zone). Contrary to belief..a small number of people develop stress-related illness that require 6-12 months to be mission ready or transition out. Dx may include PTSD, Major depression, anxiety disorders or substance abuse. RED indicates danger! The red “Ill” zone is the most serious of all four zones. The symptoms are severeindicators of psychological distress that require professional help for returning to a healthy condition. Across the bottom, the continuum highlight the shared responsibilities that all personnel have. *What is important to take away from the horizontal presentation of responsibility is that the leaderships never takes his hands off the Sailor. The fundamental idea behind the Stress Continuum model is that since stress tends to push individuals toward the yellow, orange, or even red zones, the goal of COSC is to keep service members, units, and families in the Green “Ready” Zone as much as possible, and to return them to that zone as quickly as possible after leaving it.The question then is…if we have this knowledge…Do we engage? Do our juniors engage? BreakQ- As instructors managing the daily lives of your students…what kind of changes have you observed of your students? Q- What is your expectations of their reactions to the stressors you have embedded/ or inherent of being a student within this curriculum?Q – Do you have a protocol in place that addresses these behaviors in order to keep them in the program? Q –What are some of the stressors or challenges that may be faced as a student internal and external of the class room?The COSC series starts off with the Stress Continuum Model and since become the foundation for all Combat and Operational Stress Control training, surveillance, and interventions in both the Marine Corps and Navy. Stress Continuum Model is a spectrum of stressresponses categorized in four zones identifying stressresponses: Green “Ready” zone, Yellow “Reacting”zone, Orange “Injury” zone and Red “Illness” zone. It isa common language that allows us to identify andengage stress responses.Introduction of Stress Continuum Model1. The Operational Stress Continuum Model is thefoundation for all stress control interventions in the Navyand Marine Corps.2. The continuum model has four vertical zones:a. Green “Ready” Zone: Wellness and adaptive copingb. Yellow “Reacting” Zone: Mild and reversible distress orloss of functionc. Orange “Injured” Zone: More severe and persistentdistress or loss of functiond. Red “Ill” Zone: Medical disorders arising from stressand unhealed stress injuries3. Across the bottom, the Stress Continuum modelhighlights the shared responsibility that all navy personnelhave for force protection and for conservation. Evidence based development of a simple tool in common language for you to identify stress reactions, allowing you to intervene early and take action when a member….has a stress reaction. The Continuum has four vertical zones: Ready, Reacting, Injured and Ill. These zones identify the entire spectrum of stress responses and outcomes.  Maybe alil corny or elementary but easy to remember – easy to teach.  The Continuum Model is a paradigm, providing a common language, which delineates the entire spectrum of stress responses, features, & outcomes including (from left to right)• adaptive coping and wellness (color coded Green as the “Ready” Zone); The GREEN ZONE does not mean we are without stress or stress free – it means that we are adapting and functioning like we are suppose to. Readiness is a leadership responsibility to keep us Fit & Focused, well trained, positive command climate, high morale, unit cohesion, balanced health (physical, emotional, spiritual) Ready families.Q – What does a member or unit look like that is in the Green?Q - What are we doing to keep ourselves in the Green?Q – What are your commands doing to keep you in the Green? • mild and reversible distress or loss of function (the Yellow “Reacting” Zone); Everyone faced with stressful stimuli reacts – 100%. How people reacts depends on are how well trained they are for the stressors and how they interpret them. The inability to recognize the features of this zone can push yourself, or members of your department into the orange injured zone.Q – evidence of a unit in the Yellow Zone?Q – evidence of a member in the Yellow Zone?Q – Has anyone observed this in the past? Willing to share? • more severe and persistent distress or loss of function (the Orange “Injured” Zone); Signaling the presence of some kind of damage to the mind (thought process), brain, spirit.Most are temporarily non-mission ready and usually benefit from appropriate involvement by leaders or other caregivers to augment social support and coping resources. • Diagnosable mental disorders arising from stress and unhealed stress injuries (the Red “Ill” Zone). Contrary to belief..a small number of people develop stress-related illness that require 6-12 months to be mission ready or transition out. Dx may include PTSD, Major depression, anxiety disorders or substance abuse.  Across the bottom, the continuum highlight the shared responsibilities that all personnel have. *What is important to take away from the horizontal presentation of responsibility is that the leaderships never takes his hands off the Sailor. The fundamental idea behind the Stress Continuum model is that since stress tends to push individuals toward the yellow, orange, or even red zones, the goal of COSC is to keep service members, units, and families in the Green “Ready” Zone as much as possible, and to return them to that zone as quickly as possible after leaving it.The question then is…if we have this knowledge…Do we engage? Do our juniors engage? The old way was a “Go” or “No Go” model whereby the “ready” Sailor was fit for the mission and the “ill” Sailor was not.As opposed the Go/No Go model, the Stress Continuum model provides a user-friendly framework -- and a common language -- for the identification of stress concerns as well as for training, tracking and interventions. It emphasizes early intervention to lessen the impact of stress so that injuries and illnesses don’t develop. With this approach, service members, leaders and families take a greater role in fostering and maintaining psychological health,The value of recognizing stress responses and addressing early will save you time and decrease the impact on your division or unit.
  • Four Sources of Stress Injury are Life Threat, Wearand Tear, Loss, and Inner Conflict/Injury:1) Life ThreatSeeing someone dieFelling helplessTraumatic life event2) Wear and TearFatigue or prolonged stressCan be non-operational because of insufficientsleep/rest/restoration3) LossGrief due to loss of a relationshipDeath of close comrades, leaders, friends tofamily members4) Inner Conflict/Moral InjuryBeliefs injury – conflict between personalethics/moralsUnable to prevent harm to a buddySurvivor’s guilt
  •  
  • Combat and Operational Stress First Aid (COSFA)- Lowest form of Psychological First AidAssessing the psychological health of your team and taking action to mitigate further injury.Flexible multi-step process for the timely assessment and pre-clinical care of stress reactions or injuries in individuals or units with the goals to preserve life, prevent further harm, and promote recovery. Introduction to Combat Operational Stress First Aid(COSFA) – The “Seven Cs” of COSFA outlines practicalthings you can do to help yourself, service members andother caregivers move toward Green after a particularlystressful or traumatic event. Its goals are to preserve life,prevent further harm and promote recovery.1. Componentsa. Continuous Aid – Check and Coordinateb. Primary Aid – Cover and Calmc. Secondary Aid – Connect, Competence andConfidence2. The Seven “Cs” are designed to:a. Reduce the initial distress caused by traumatic eventsb. Foster short - and long - term resiliencec. Augment and promote repair of support structuresdamaged by trauma or lossd. Reduce excessive, uncontrollable distresse. Correct negative self-thoughtsf. Facilitate social connectednessg. Provide self-help resourcesh. Identify when normal healing and recovery doesn’toccurFacilitate help for individuals and the unitThe 7 C’s of COSFA Q - Ask who is BLS certified. How many of you have responded or observed a Man down drill - Ok, this is a reaction to a man down.  “COSFA is a flexible multi-step process for the timely assessment and pre-clinical care of stress reactions or injuries in individuals or units with the goals to preserve life, prevent further harm, and promote recovery.  Refer to CPR Continuous – Check and Coordinate – Observe/Listen - you may be that help. Primary(rescue response) - Cover(safety ASAP) and Calm(get to relax and refocus) Secondary– Connect(talk with chaplain, friends, family) Competence – restore effectiveness Confidence – restore self esteem  COSFA is designed to fill the care gap between the leader-based resilience-building and stress mitigation tactics at the left end of the Stress Continuum and the clinical treatments that are on the right. As a set of indicated prevention interventions, COSFA critically depends on the two continuous-aid processes of checking (assessment and reassessment) and coordination (referral and collaboration) at all levels of the enterprise. *Story – Big kid falls off their bike and skins his knee, what do we do? The first thing we know how…checking him – look /listen to make sure he is ok. You may be all the help he needs.. Next you ensure he is safe from any additional danger and calm him down, next you dust him off and provide him a band-aid or connect him with his parents, Lastly, get him back on his bike and make sure he is riding it correctly and once he shows his competence to ride, let him go around the block to restore his confidence to play with the rest of the kids.Or Fighting a Fire.COSFA ScenarioSTP delivery of two Marines to the STP. The Doc was working on him for the last 45 minutes coming from the an IED explosion that hit them up the road in…..It was Doc Hendersons Marines, so we he wasn’t leaving. He dove right it with the STP Doc…Doc came out and reported that he lost LCpl Johnston, Doc lost his mind, dumping cans and throwing everything out of the ambulance in, STP Dr. grabbed him looked at him in the eye and walked him down the road…away from the bedside of his dead Marine. This allowed the Marine to be appropriately removed to another care area. Walking him around the camp they returned back to another tent where he was able to join his other Marine and render some final care and see him well because of his sound emergency interventions. In understanding the physiology of stress on our body and how one event can injure us, what was the best thing the STP Dr. did?Interupted the flow of Cortisol to his brain reducing the long term damage that was taking place, ultimate mitigating the long term damage to that corpsmans brain.The Science is all there and what we do know today is if we can interrupt the flow of adrenaline and cortisol to the body and brain we can decrease the chance of injury.
  •  SLIDE 21Five Core Leader Functions – The Navy-Marine Corps stress continuum model provides a framework for understanding and recognizing the spectrum of stress experiences and sx. This model by itself cannot improve psychological health. This component is key not just as a tool for leadership, but also to the junior member understanding how he/she can better support the bigger picture of what their leadership is trying to achieve in managing the stress within their unit or shop.
  •  SLIDE 22Strengthen –Strength is important in our military. It is our job to strengthen our military members to meet the mission. This is why it is the first of our five core leader functions. Physical strengthening is important, but so is mental and emotional strength.And It takes Good Leadership to enhance the resilience of our members -firm but fair, a source of courage, communicates plan and listens. Additionally it important to Expose our members to tough realistic training – not only physically, but mentally and train like we fight, so we may fight like we train. Foster unit cohesion – through trust of you and those on either side of them. *Most important – to the success is their revovery. Q – What do you do at your command to strengthen – what could we do? Q – How do you define Strength in you, your unit, command?Q – What do you do / have experienced w/in a command that fosters unit cohesion? Mitigate – No member is immune from stress. The key is to mitigate or lesson negative effects of stress. You can do this by removing unnecessary stressors. Mitigating stress is about balance between strengthening and reducing stressors as we train and operate. On one side it is about intentionally adding stress through realistic training and on the other side it is about reducing unnecessary stressors that are not essential to training or mission.Q – What can we do within our units to maintain the balance between strengthening and reducing stressors as we train and operate? Identify – not just about identifying reactions in the member, but knowing the environment and the individuals life intrusively… FOTM Leadership is task saturated and that it is challenging to hold good observation of your members daily. What can we do as leaders and as junior enlisted? We train our juniors and ourselves to identify these stress reactions and behavior changes. They and the members family will notice it before you and I anyway, unless you are fortunate enough to have a small close group. We say people are the most important asset but on the other hand “Mission often takes precedence and those items that support the mission are often placed in front of them…machinery, equipment, weapons  Treat – Rest or resources – communicate, listen, and making it ok. Not necessarily medical – making it ok to talk about and pursue access – to have trust in the COC. *Story - 1st Sgt who presented sx and did not seek help in time - 3 successful tours, 2 bronze stars, 25 yrs ---divorced, lost kids, successful suicide –  This is not just our juniors…the greatest number effected are E7-E9. Do we remember the Go No Go mentality – the change of culture Is to continue to build resilience in those that are well and to take care of those across the spectrum of the continuum from green to red and back.Q-Why are we afraid…or why do we hesitate to engage when a junior or a peer is having problems or presenting stress reactions? Did you know that there is a Policy Change: SF86, Q21? Q- If one of your peers is being treated by Mental Health…should he/she be ranked differently? Reintegrate – “Reintegration requires Consideration.” Keep Sailors with their unit – , Expect a rtn to full duty, continue communicating with treating professionals  *Sgt Hopper Story - a success story of a Marine who served two tours in three years…while in formation to receive is his N/MC accommodation medal with a V for valor, the MC had read the citation that restated the events that merited the V for valor triggering the same emotions and reaction he had felt when engaged in the fight. SgtMaj approached him later to ask how he was doing…this simple action made Sgt Hopper feel safe enough to open up and then seek care.  Before OSC was in vogue - *most who reintegrated – event forgotten.  Q - Who has felt the affects or seen the affects of a gapped billet?  Increased watches, increased stigma, decreased trust in you and the ship or unit leadership. BUPERS will not reduce Stigma nor will it provide you another body when you lose one of your members to an incident.  
  • Define Resilience Resilience; ability to bounce back after a challenging event.Resilience: The value of stressing our members, more importantly being the hands on leader that can balance the stressor, allowing them to grow and become more resilient. KEY TAKEAWAYS: Repeated, controlled exposure to stress + recovery + motivation builds strength and resilience.  By repeatedly moving Marines from green into yellow and back down to green, we stretch their green and yellow zones. The Marine is now resilient.
  • Returning Home from Deployment Don't Forget To Take Time for YourselfBe patientTake care of yourselfMake time to restLimit your use of alcoholGo slowly in getting back into the swing of things.Watch your spendingKnow when to seek help Reconnecting with your Spouse/Significant OtherUnderstand that it's normal to feel out of sync with your spouse at firstSpend time talking with each otherEase back into intimacyListen to your partner's experienceRebuild a routineCelebrateWork to resolve conflictGet help if you need it Reconnecting with your ChildrenLearn all you can about your children's lives while you were goneBe patient with your children and yourselfExpect your children to test the rules now that both parents are homeMake time in your schedule for family activitiesNegotiate your role as a parentRemember this is your child, not a member of the military: Accept guidance from your spouse or your child's guardian. Reconnecting with Your ParentsBe patient with your parentsNegotiate new roles/responsibilitiesShare with them what is appropriateIf you have younger siblings, be respectful of your parents' rules for them and be aware that you are a role model for your siblingsCelebrate!
  •  Stigma Campaign – all of these labels fall under the …of stigma…encompassing all of the listed labels.ADD UNDERSTANDING (Limited understanding of PH and the responsibilities of the providers and how the MH system works.)Limited understanding of operational command requirements, commitments and demands.Lack of effective communication between commands and provider and the need for better comm.Review how to best build this slideCommon Barriers to Manage Stress(What is keeping you from getting the help you need?)StigmaFearAccess to careCommunication in both directions of the leadership and the MH provider.Barriers to Managing Stress1. A common barrier to managing stress is a Sailor’s inabilityto recognize and mitigate normal adaptive responses tostress, even severe stress.B. Two major barriers are stigma and fear. Leaders need to takean active role in reducing stigma.1. Stigma - The most common barrier to seeking treatment isthe perceived stigma of asking for professional help.Sailors often struggle to move beyond thoughts, such as:I would be seen as weak.Members of my unit might have less confidence inme.Leaders would blame me for the problem.It would be too embarrassing for my family.2. Fear - Many Sailors are afraid to take the critical steps toget help because they believe it might reflect badly on theircharacter. FOTM is that the common barriers of stigma and fear still lay deep within our Warriors to come ask for help.By doing exactly what we are doing – talking about it. The more we talk about it, the less the stigma and fear of our Marines will be in seeking assistance. (This injury is just like any flesh wound that requires assistance from someone other than yourself) Q- How easy is the concept ?– when you have a cold or sprain you treat it with what you know and because our bodies are resilient we recover, but when have greater flu sx or show signs of a broken bone after an event what do we do for ourselves? What do we expect as an action from our leadership or peers alongside you? A large percentage are smart enough to seek greater assistance for ourselves or push our brother/sister to head over to Medical. It is no different, for a stress reaction can easily effect the member or the unit and or the mission. More importantly as any illness or injury it can and will get worse before it gets better without proper guidance or assistance.  **It’s not so much about know the signs and symptoms, BUT about creating a safe environment for our Shipmates.
  • NCCOSCa. Is a BUMED directorate dedicated to addressingpsychological health of Sailors and Marines andsupporting operational stress and resilience initiatives.b. The NCCOSC website is a warehouse of relevant andpractical information for active-duty Sailors and Marines,leaders, military health providers and families.The information is presented in a succinct and easy-toreadformat.
  • CloserWe have come to the end of the training. You have learned about actions and tools that build resilience through strengthening the individual and the organization. We have discussed how to mitigate the impact of stressors while strengthening our members, we have learned about the value of a simple tool in a common language allowing us identify when one or many of our members are responding to stress allowing us to intervene as necessary and when you intervene how you yourself can treat the member or deliver them to a greater echelon of care and then lastly the importance of the continued effort in breaking the barriers..especially stigma in making it ok to seek and accept care in order to get our members the care they need and bring them back as a contributing member of your team. The conversation that happened here today is as important as the tools that you have learned. The true value is going to be those conversations that take place outside of these four walls.

Operational Stress Control: Train the Trainer Operational Stress Control: Train the Trainer Presentation Transcript

  • www.nccosc.navy.milPatrick NardulliHMC, USN (Ret.)OPERATIONAL STRESS CONTROLTrain the TrainerUSS Boxer (LHD 4)Monique BeauchampMA, MFT
  • www.nccosc.navy.milUSS BOXER (LHD 4)Mission:Embark, transport and landelements of a landing forcefor a variety of expeditionarywarfare missions.
  • OverviewOperational Stress Control (OSC)is leader-focused actions and responsibilities topromote resilience and psychological health in Sailors,Marines and families exposed to the stress of routineor wartime military operations.Goals:• Prevent or minimize stress injuries• Facilitate healing to minimize war-fighting gaps• Build and maintain resilience• Reduce stigma• Maintain a ready fighting force
  • StressContinuumModelwww.nccosc.navy.milComponents of OSCCombat andOperational StressFirst Aid (COSFA)Five CoreLeaderFunctions
  • www.nccosc.navy.milA Stressed Sailor Means a Stressed Home
  • www.nccosc.navy.milDefine StressThe process by which werespond to challenges to ourminds and bodies.Stress is good, stress isnormal, stress keeps us sharp,stress keeps us focused.
  • The PhysiologicalEffects of Stresson the Body
  • www.nccosc.navy.mil
  • ReactingReady Injured IllAdaptive copingOptimal functioningWellnessFeaturesWell trained and preparedFit and focusedIn controlOptimally effectiveBehaving ethicallyMild and transient distressor loss of optimalfunctioningTemporary & reversibleLow risk for illnessFeaturesIrritable, angryAnxious or depressedPhysically too pumped upor tiredReduced self-controlPoor focusPoor sleepPersistent and disablingdistress or loss of functionUnhealed stress injuriesMental disorderTypesPTSDMajor DepressionAnxietySubstance abuseFeaturesSymptoms and disabilitypersist over many weeksSymptoms and disability getworse over timeMore severe and persistentdistress or lossHigher risk for illnessCausesLife threat, Loss,Inner conflict, Wear and tearFeaturesPanic or rageLoss of control of body/mindCan’t sleepRecurrent nightmares/ badmemoriesPersistent shame, guiltor blameLoss of moral valuesand beliefsUnit LeaderResponsibilityCaregiverResponsibilityIndividual, Shipmate, FamilyResponsibilityThe Operational Stress Continuum
  • www.nccosc.navy.milLife ThreatA traumainjuryDue to eventsprovoking terror,helplessness,horror, shockLossWear and TearA fatigueinjuryDue to theaccumulation ofstress over timeInner ConflictA beliefsinjuryDue to conflictbetweenmoral/ethicalbeliefs andcurrentexperiencesA griefinjuryDue to loss ofpeople who arecared aboutFour Sources of Injury
  • What is an Orange Zone Indicator?Recent Stressor Events: Recent exposure toevents with high potential to causetrauma, grief or moral injuryVerbalized Distress: Significant and persistentdistress, such asfear, anger, anxiety, sadness, guilt or shameChanges in Function: Significant andpersistent changes in physical, mental, socialor spiritual responsesHow to Recognize Who Needs Help:Orange Zone Indicatorswww.nccosc.navy.mil
  • www.nccosc.navy.milScenarioA Sailor, who until recently has truly enjoyed his joband the Navy, is feeling extremely worn out. Withcrew sizes decreasing there is a lot more work,more maintenance, more watches, less time off. Itadds up to many stressful days. The recent increasein Sailors going on limited duty has exacerbated theproblem. The Sailor, who regarded himself as“squared away,” has started smoking and hasdecreased his exercising. He is frustrated to beworking so hard with no reprieve in sight. He hasnot been sleeping well, is irritable, not feeling goodabout himself or his job, and is now spending moretime out drinking to ease his frustrations.
  • Combat and Operational Stress First Aid
  • www.nccosc.navy.milSeven Cs ofStress First AidContinuous Aid1. CheckAssess, Observe and Listen2. CoordinateGet Help, Refer as NeededPrimary Aid3. CoverGet to Safety ASAP4. CalmRelax, Slow Down, RefocusSecondary Aid5. ConnectGet Support from Others6. CompetenceRestore Effectiveness7. ConfidenceRestore Self-Esteem and HopeCombat and Operational Stress First AidCOSFA
  • Reacting Injuredwww.nccosc.navy.milCOSFA on the Stress ContinuumPromotes a sense of safetyPromotes calmingPromotes connectedness
  • www.nccosc.navy.milFive Core Leader Functions
  • www.nccosc.navy.milFive Core Leader FunctionsStrengthenLeadership that is Firm, Fair, a Source ofCourage, Communicates Plans and ListensExpose to Tough, Realistic TrainingFoster Unit CohesionMitigateRemove Unnecessary StressorsEnsure Adequate Sleep and RestConduct After-Action Review (AAR) in SmallGroupsIdentifyKnow Crew Stress LoadRecognize Reactions, Injuries and IllnessTreatIndividualBuddy-Aid (Peers)Chain of CommandChaplainMedicalReintegrateKeep with Unit if at all PossibleExpect Return to Full DutyDon’t Allow Retribution or HarassmentCommunicate with Treating Professionals (BothWays)
  • Building ResilienceREADYREACTINGINJUREDILL
  • Factors That Contribute To ResilienceBehavior ControlControl and ConfidenceOptimismPositive CopingFlexible ThinkingValuesResilience
  • Post-Deployment Reunion andReintegration• Reunion can be a building block• Common post-deployment challenges• Post-deployment reintegration strategies• Post-deployment self-assessment check lists
  • Relationships Thinking/Feeling Environment SpiritualitySpouse/Children Guilt Traffic UnderstandingWhyFriends Thrill Seeking Crowds Loss of Trust inOthersIrritability Hatred Money Loss of Trust inSelfConflict/Anger Boredom Alcohol Loss of Trust inHigher PowerDetachment Routine Security/Control Moral ConflictWithdrawal Disillusionment Aggressive Driving Loss of BeliefControl Shame Hypervigilence AngerCommon Post-Deployment Challenges
  • Self Spouse Children Family/FriendsTake care of yourself It’s normal to feelout of sync withyour wife orhusbandLearn all you canabout your children’slives while you weregoneBe patient with yourparentsBe patient Spend time talkingwith each otherBe patient with yourchildren and yourselfNegotiate newroles/responsibilitiesMake time to rest Ease back intointimacyNegotiate your roleas a parentShare with themwhat is appropriateGo slowly in gettingback into the swingof thingsRebuild routine Remember: This isyour child, not amember of themilitaryBe a role model foryounger siblings ifyou have themWatch yourspendingWork to resolveconflictChildren will testrules of the homeCelebratePost-Deployment Reintegration Strategies
  • 23Self-Assessment Okay Needs Work Needs HelpRelationshipsOpenCommunicationTension Coldness or FightingWork function Effective Indifferent Hostile environmentPublic behavior Patient, calm Aggressive, irritable Risky, hostileSubstance abuse Not an issue Could be an issue Is an issueMoney and finances Under control Financial worries Financial troublePhysical and mentalhealthHealthy and fit IndifferentDisturbing thoughts,feelingsRoles in lifeBalanced,comfortableOut of balance Pulled apartSpirituality Connected, peaceful Something’s missingEmpty, lack of “moralcompass”
  • www.nccosc.navy.milCommon Barriers Associated withPsychological HealthSTIGMAFEARUNDERSTANDINGCOMMUNICATIONACCESS
  • www.nccosc.navy.milWeb address:www.nccosc.navy.milFollow us onFacebook, Twitter,YouTube andSlideShareWebsite andSocial Media
  • Questions, Answers and SurveysThank you!Patrick Nardulli, USN, Ret.Monique Beauchamp, MFT