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Combat and Operational Stress Control (COSC) training with a focus on the …

Combat and Operational Stress Control (COSC) training with a focus on the
care giver in support of deploying Mobile Care Team (MCT) members.

The MCT are Directed by Vice Chief of Naval Operations and Deputy Surgeon
General to emphasize preventive mental health, surveillance, and command
consultation by engaging in routine site visits outside traditional medical
settings in an effort to reduce mental health stigma and remove barriers to

MCT members visit Navy IAs and administer a Behavior Health Needs Assessment
Survey (BHNAS) which evaluates the psychological health and readiness of
"Boots on ground" IA sailors. They focus on mental health challenges (PTSD,
anxiety and depression), mental health care stigma, combat exposure;
deployment related stressors, attitudes toward leadership, sleep problems,
positive effects of deployment, unit cohesion, and morale.

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  • 2. COSC Doctrine www.nccosc.navy.mil
  • 3. NCCOSC Mission:To build and preserve thepsychological health of Sailors,Marines and their families www.nccosc.navy.mil
  • 4. Components of CGOSCStress Continuum Combat and Five Core Leader Model Operational Stress Function First Aid (COSFA)
  • 5. What is Stress?The process by which we respond tochallenges to our minds and bodies.Stress is good, stress is normal, stresskeeps us sharp, stress keeps us focused.BUT… www.nccosc.navy.mil
  • 6. Operational Stress ControlProgram Core Objectives Early Recognition Breaking the Code of Silence Engage Caregivers in Early Help
  • 7. Course Objectives Describe the Caregiver Occupational Stress (CGOSC) concepts used by the Navy and Marine Corps. Recognize stress reactions and injury sources using the Stress Continuum Model. Describe Combat and Operational Stress Control Five Core Leader Functions. Describe assessment and intervention methods using Combat/Operational Stress First Aid (COSFA).
  • 8. Definitions Combat Stress Operational Stress Occupational Stress Compassion Stress Vicarious Trauma Compassion Fatigue Burnout Compassion Satisfaction Caregiver Resilience
  • 9. Symptoms of Stress Physical Emotional Behavioral Work-Related Interpersonal
  • 10. Components of OSCStress Continuum Combat and Five Core Leader Model Operational Stress Function First Aid (COSFA)
  • 11. The Operational Stress Continuum Good to Go Distress or Impaired More Severe or Stress Injuries Persistent Stress or That Don’t Heal Well-Trained Mild and Impairment Without Help TemporarilyFit and Focused Anxious, Irritable or May Leave Lasting Symptoms Persist Sad Memories, Reactions > 60 Days, Get WorseCohesive Units and Impressions or Initially Get Better Physical or Then Return WorseReady Families Behavioral Changes
  • 12. Green Zone READY “Fit and Focused” Well-Trained and Qualified Positive Command Climate High Morale Unit Cohesion Balanced Health Physical Emotional Spiritual
  • 13. Yellow Zone - REACTING
  • 14. Yellow Zone REACTING Anxious, Irritable, Sad Poor Concentration Sleep Difficulties Appetite Changes Apathy Negative, Pessimistic Interpersonal Conflict Poor Decision Making
  • 15. Orange Zone INJURED Poor Emotional Control Major Sleep Difficulties Guilt, Shame, Fear Loss of Interest Challenge to Moral Values Substance Abuse Decreased Confidence Poor Morale Family Disruptions
  • 16. Red Zone ILL Chronic and severe distress Substance dependence Major disruptions of sleep, appetite, mood Significant problems at work Panic, anger, rage or shame Injuries that don’t heal without help Family/relationship violence or abuse
  • 17. What is Stress?The process by which we respond tochallenges to our minds and bodies.Stress is good, stress is normal, stresskeeps us sharp, stress keeps us focused.BUT… www.nccosc.navy.mil
  • 18. Physiological Effects of Stress
  • 19. How to Recognize Who Needs Help:Orange Zone Indicators What is an Orange Zone Indicator? Recent Stressor Events: Recent exposure to events with high potential to cause trauma, grief or moral injury Verbalized Distress: significant and persistent distress, such as fear, anger, anxiety, sadness, guilt or shame Changes in Function: significant and persistent changes in physical, mental, social or spiritual responses
  • 20. Many Causes vs. Only FourYellow Zone Reactions vs. Orange Zone Reactions Lack of Sleep Life Threat Family Separation Wear and Tear Loss of Possessions Loss Boredom Inner Conflict Peer Conflicts Hard Work Relationship Problems Money Problems Physical Injury
  • 21. Combat and Operational Stress First AidCOSFA www.nccosc.navy.mil
  • 22. Where COSFA Falls on the Stress ContinuumPromotes a Sense of Safety Promotes Calming Promotes Connectedness
  • 23. Continuous Aid Check Coordinate Coordinate Check Check Coordinate
  • 24. Check
  • 25. Check Decide Observe LookDangerous ListenNeeds Stress Zone Check Response to Interventions Change in Functioning Distress Stressors Examine Keep Track1-to-1 InteractionsCollateral Information
  • 26. Coordinate
  • 27. Coordinate Collaborate Get Help To Ensure Safety To Promote Recovery To Follow Up To Manage Crisis To Get Information Coordinate To Promote Recovery Chain of Command Family Peers Inform Refer Direct Hand-Off Recommended Resources Consultation
  • 28. Primary Aid Primary Aid (Cover and Calm) is a rescue response to a dangerous situation.
  • 29. Cover
  • 30. Cover Authoritative Presence Warn Protect Assist Disarm Ready to Assist Stand By Make Safe Hold Attention Watch and Listen Cover Protect Warn Calm Presence Encourage Make Reduce Danger Feelings of Others Reduce Chaos Safety Safe
  • 31. Calm
  • 32. Calm
  • 33. Stop Physical ExertionCalm Slow Down Heart Rate Reduce Hyperalertness Relax Rest Quiet Time Out Sleep Recuperate Calm Draw Attention Outward Reduce Emotional Intensity Distract Listen Empathically Refocus Compose Soothe
  • 34. Secondary Aid Restore Function, Reduce Distress: Connect Competence Confidence
  • 35. Secondary AidRestore Function,Reduce Distress: Connect Competence Confidence
  • 36. Connect Provide Support Promote Social Interactions Facilitate Rituals Remove Problem-Solving Obstacles
  • 37. Connect Accept Encourage Soothe Eye Contact Presence Listen Be With Comfort Empathize Connect Understanding Correct Misconceptions Restore Trust Reduce Reduce Invite Isolation Play Alienation Talk Include
  • 38. Competence Mentor to Full Function Problem-Solving Strategies Manage Stress Reactions
  • 39. Competence Brief Operational Pause Mentor Back to Duty Retrain Reassign Social Occupational Skills Skills Develop Family Relationships Develop Peer Relationships Competence Problem-Solving Skills Hygiene Well-Being Fitness Skills Managing Trauma and Loss Reminders
  • 40. Confidence Taking the Previously Mentioned Steps Will Help You: Get Back Into a Routine Rebuild Confidence and Trust in Yourself and Others
  • 41. Confidence Belief in Self Accurate Self-Concept Self-RespectForgiveness of Self Hope Self-WorthImagining the FutureForgiveness of Others Confidence Trust in Peers Faith Trust in Equipment Making Sense Trust in Leaders Honor Trust in Mission Purpose Trust Meaning
  • 42. Combat and Operational Stress First AidCOSFA www.nccosc.navy.mil
  • 43. Five Core Leader Functions Strengthen Leadership that is Firm, Fair, a Source of Courage, Communicates Plans and Listens Treat Expose to Tough, Realistic Training Rest and Restoration Foster Unit Cohesion (24-72 Hours) Mitigate Chaplain Remove Unnecessary Stressors Medical Ensure Adequate Sleep and Rest Reintegrate Conduct After-Action Review (AAR) in Small Keep with Unit if at all Possible Groups Expect Return to Full Duty Identify Don’t Allow Retribution or Harassment Know Crew Stress Load Communicate with Treating Professionals Recognize Reactions, Injuries and Illness (Both Ways)
  • 44. Summary Stress is a Continuum Four Sources of Stress Caregivers Use COSFA One Size Does Not Fit All Good Leaders are the Best Medicine