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Operational Stress Control


OSC Agenda

• Stress Defined

• The Stress Continuum Model

• Taking Action

• Leadership Functions

• Principles of Resilience

• Resources

UNCLAS

Presenter

Presentation Notes

Agenda – Talking Points: 1. Give overview of way-ahead.


What Is "Stress”?

“The process by which we respond to challenges to the body, mind or spirit.”

UNCLAS

Relevant Training, Expectation Management, and Leadership Support are foundations for effective Operational Stress Control

Presenter

Presentation Notes

Stress Defined - Talking Points: Define Stress Differentiate between “good stress” and “bad stress.” Stress is inevitable. In operational and combat settings it is expected. However, people can mean many things when they say “stress”. Sometimes it refers to the stressful event itself. Other people use the term to mean how people respond physically to a stressor. 4. Our definition is more inclusive. <<Read definition as it presents>> “Stress is the process by which we respond to challenges to the body, mind or spirit.” Stress presents both a danger and, if the stress is recognized and handled properly, it can be an opportunity for growth. Research has shown us that stress is a necessary component of our lives. It can promote growth and push us to be our very best. However, if there is too much stress for too long, it can beat us down. 6. Navy leaders can help strengthen their Sailors so they adapt to stress more successfully. By providing tough, realistic training and providing Sailors with knowledge, skills, and attitudes to help them build resilience to stress problems, Sailors can better cope with the enviable stressful events they will encounter throughout their military service and after.


Stress Continuum Model


Getting Back to Green

READY (Green) REACTING (Yellow) INJURED (Orange)

ILL (Red)

Caregiver Responsibility

Unit Leader Responsibility

Individual, Shipmate, Family Responsibility

The Goal of Navy OSC is to move towards GREEN

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4/4/2017 16:30:24

Presenter

Presentation Notes

Getting Back To Green - Talking Points: The goal of the entire OSC program is to move Sailors, families, and commands towards the ready Green zone. Moving towards Green is a shared responsibility of Sailors, family members, and command leaders, as well as Medical and other caregivers.


In Other Words… Check the Oil? (Prevention)

Check the Oil? Repair the Motor?

(Intervention) OR


Green Zone – Ready and Healthy

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Sailors: Calm and steady; Confident Well-trained and qualified Healthy rest and diet Regularly working out, staying fit Physically/socially/spiritually active Commands: Positive command climate High morale; strong cohesion Good order and discipline Families: Active parenting Engaged in family routines/activities Children functioning well at home and in school

READY

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Green Zone - Talking Points: 1. This chart lists signs and symptoms that would be present in the first zone (Green or “Ready”). Ready Sailors are: Calm and steady; they are confident and competent. They get the job done. They have a sense of humor. They get enough sleep, eat the right amount, work out and stay fit. Healthy Sailors play well and often and are active socially; they are at peace within themselves and have a healthy spiritual life. 2. Ready Green Zone commands: Have a positive command climate and morale is high. There is strong command or unit cohesion. All equipment is maintained properly and there is good order and discipline. Alcohol use is deglamorized and alternatives are offered at command functions. Command members have a clear sense of mission. 3. In the same way, ready Green Zone families are those where there is: Active parenting; all family members are engaged in family routines and activities. Children are functioning well at home and in school. All family members feel secure. Regular family routines are maintained and the home is clean and organized. There is good communication between all family members and the couple are communicating and resolving conflict effectively. 4. Being “Ready” is a leadership responsibility. Good leaders know when their unit’s are ready and they know how to motivate and reward them to keep them at that state of readiness. In the family, you as parents are the leaders. It is your responsibility to ensure your family has everything it needs to be safe and comfortable. 5. Most of these are readily identifiable. They are listed here to provide a baseline for comparison as we move through the continuum. You will see how stress can play a role in each of these areas. The goal is to always work to move to the ready Green zone.


Yellow Zone - Recognizing Stress

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Sailors: Feeling anxious, irritable, worrying Cutting corners on the job Poor diet or trouble sleeping Apathy, loss of interest Commands: Deferred maintenance Minor discipline problems Families: Children having trouble in school Couple not communicating well Family time compromised Reduced intimacy

REACTING

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Presentation Notes

Yellow Zone - Talking Points: This chart lists signs and symptoms that could be present in the Yellow zone. Symptoms here are normal stress reactions that can happen in situations that are challenging or new to us. They do not necessarily warrant further action, unless they get worse or don’t go away over time. The goal is to identify them and take steps to reduce the stress and return to the Green zone, where one is “good to go” and “in control.”


Stress Injuries Stress Reactions – Very common – Always temporary – Mild distress or loss

of function – Usually self-correcting

– Uncommon – May leave lasting

changes – More severe distress or

loss of function – May heal faster with help

Stress Reactions and Stress Injuries

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YELLOW ORANGE

Presenter

Presentation Notes

Stress Reactions and Stress Injuries - Talking Points: Review some of the color zone dynamics previously discussed. Address color differentiation. Lead a discussion to explain illustration of bending vice snapping. 3. Facilitate discussion.


What Are “Stress Injuries”?

• Wounds to the mind or brain caused by intense or prolonged stress:

Impact Wear and Tear

Loss Inner Conflict

Trauma Fatigue

Grief Injury to Core

Beliefs

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Presentation Notes

Stress Injuries - Talking Points: Define Stress Injuries. Stress Injuries are defined as: “Wounds to the mind or brain caused by intense or prolonged stress.” Research has shown that Operational Stress Injuries have four different possible causes and associated results: Impact which can lead to Trauma — due to life-threatening situations or feelings of terror, horror, or helplessness. Wear and Tear from prolonged or repeated stress, including from non-operational sources, without sufficient sleep, rest, and restoration the can lead to Fatigue. Loss of close Shipmates, family members, friends, or relationship that cause Grief Inner Conflict due to actions that go against one’s belief system which can lead to feeling of Moral Injury — (give Non-combat examples…) 2. As you can see, there are many causes for stress injuries – but the really stunning fact is that no matter what the cause, the symptoms can look the same. Now let us look at what signs and symptoms indicate a Sailor, command or family might be approaching the more severe level of “Stress Injured.”


Orange Zone: Recognizing Stress Injuries

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Sailors: Loss of control; panic or rage Can’t fall or stay asleep Intense guilt; Disruption of moral

values Suicidal or homicidal thoughts Commands: Low morale, divided camps Equipment out of service Significant discipline problems Families: Loss of closeness/intimacy Verbal or physical abuse

INJURED

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Presentation Notes

Orange Zone - Talking Points: 1. Although stress injuries may be caused by a variety of experiences, many of the reactions are the same. They may include: Losing control of one’s body, emotions, or thinking. Being frequently unable to fall or stay asleep or waking up from recurrent, vivid nightmares. Feeling persistent, intense guilt or shame or feeling a lack of remorse. Experiencing attacks of panic or rage. Losing one’s memory or the ability to think rationally. Not being able to enjoy normal activities. Losing grounding in previously held moral values or displaying significant and persistent change in behavior or appearance. 2. A Command or Unit might also be injured. You might see: Low morale, divided camps. Equipment out of service. Significant discipline or alcohol incidents. Maybe even vigilante missions. 3. Injured families might have: children with failing grades or discipline problems at school and/or home. The couple may experience a loss of closeness or intimacy. There is often a feeling of chaos. There might be constant fighting or periods of silence/no communication. Verbal or physical abuse are very real possibilities. 4. Signs and symptoms in this zone are indicators that combat or operational stress problems are persistent and may be serious. If you or another Sailor exhibits these signs, it is definitely time to seek assistance from your chain of command, chaplain, medical officer, or a Fleet and Family Service Center counselor.


Red Zone: Stress Illnesses

Stress injury symptoms that persist

Symptoms that get worse over time instead of better

Symptoms that get better

for awhile but then come back worse

All stress Illnesses MUST be referred to Medical for evaluation

ILL

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4/4/2017 16:30:26

Presenter

Presentation Notes

Talking Points: 1. Address bullets 2. The Red Zone (Illness Zone) is the most serious of all four zones. These signs and symptoms are severe indicators of psychological stress that require professional help for returning to a healthy condition. 3. This slide indicates that the signs and symptoms that persist in the Orange Zone for more than 60 days, get worst, and come back after temporary relief, would be present at the fourth level, the Red zone. 4. Symptoms in the Red zone indicate potentially serious illnesses that require prompt medical evaluation and treatment. Post Traumatic Stress Disorder, Anxiety and Panic Disorders, and severe depression fall into this ill Red Zone. Symptoms may include more severe versions of those seen in the Orange Zone but also may include severe uncontrollable rage, persistent uncontrollable shaking, panic, loss of emotional control (“hysterical”), and even temporary blindness or deafness. 5. Many different illnesses and injuries can look like red zone. They include stress impact but also Traumatic Brain Injuries (TBI), infections, or even severe dehydration. It is just important to know that medical evaluation to determine appropriate treatment is essential when red zone indicators are seen. 6. However, these are usually not career-enders when treated early by appropriate medical personnel. Statistics show that most Sailors treated for these disorders return to full duty within a few months. Leaders must ensure that when Sailors are referred for treatment, they are allowed access to care, keep all medical appointments, and don’t receive harassment from other unit members. The goal is to fully reintegrate the Sailor back into the command.


DISTRESS or LOSS OF FUNCTION?

Distress

Ready: •Maintain •Monitor

SEVERE Distress

PERSISTENT Distress

Reacting: •Rest •Manage •Discuss

Injured: • Safe / Calm • Rest (24-72 hrs) • Refer • Mentor

Ill: • Refer • Comply • Mentor • Reintegrate

Is it SEVERE?

YES

YES

YES

Has it PERSISTED?

NO

NO

NO

OSC Decision Matrix Sailor Under Stress

Presenter

Presentation Notes

KEY MESSAGES: The Stress Decision Matrix can help leaders decide what zone a Sailor is in and what to do about it If you believe a Sailor is in the Orange Zone or may be in the Red Zone, get them to a Chaplain or Medical professional as soon as possible Only Medical personnel can determine if a Sailor is in the Red Zone SCRIPT: <Instructor to students: “Get out your OSC Leader pocket guide and flip to the “Decision Matrix” tab and follow along.”> This is going to look complicated, but it’s not. All you’re really doing is deciding ‘What zone do I think this Sailor is in?’ and ‘What do I need to do about it?’ We’re not trying to turn you into a doctor; you’re not diagnosing, you’re just taking care of a shipmate. The first thing you need to decide is if they are in the yellow zone by looking at these indicators. If so, look at the Yellow zone box and see what you should do. If the distress or loss of function is severe, check to see if they are in the orange zone. If they are in the orange zone, you need to refer to them a Leader, Chaplain, or medical personnel. The red zone is for medical staff to determine, but if you think that they are in the red zone, help them get the help they need, immediately.


Assessing the Psychological Health of Your Unit

Observe - Actively observe Sailors.

State Observations – Share observations with member in behavioral terms, relate to mission and interpersonal issues.

Clarify Role - State why you are concerned about the behavior; validate why you’re addressing the issue.

Ask - Seek clarification; try to understand the other person’s perception of the behaviors.

Respond - Clarify concern if indicated; discuss desired outcomes in behavioral terms; identify options/resources.

Operational Stress Control Assessment and Response (OSCAR)


Take Action

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WHAT DO I DO?

1. Sleep and Rest 2. Eat right, stay hydrated 3. PT 4. Spend time with people you

like and trust 5. Attend Spiritual needs 6. Take your mind off worries

you can’t fix 7. Encourage self and others 8. Leaders:

- Do positive after-action reviews

- Recognize and reward accomplishments

1. Administer Stress First Aid (COSFA Model)

2. Talk with Leadership 3. Seek guidance from chaplains,

counselors, or medical staff 4. Leaders:

- Take immediate action to address command problems

Presenter

Presentation Notes

Stress Reaction Requirements - Talking Points: Emphasize that boundaries between the color stages overlap. They are not distinct and rigid. Explain positive actions that leaders can take to alleviate yellow zone stressors. Explain positive actions that leaders can take to address orange zone stressors. Discuss points for leaders: Study and understand various leadership models. Consider group dynamics in after-action reviews Understand the power of rewards and their use. Knowing your limits for hurting troops.


Combat Operational Stress First Aid (COSFA)

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Presentation Notes

KEY MESSAGES: COSFA is an easy tool to use; you don’t need to be a mental health professional Follow the steps of COSFA when a Sailor is in distress and may be putting himself or others at risk (i.e. a panic attack, loss of focus, anxiety) COSFA Primary Aid Check to see what stress zone a Sailor is in and if you need to take action Coordinate the next steps and make other people aware of the situation Cover and get to safety Calm – reduce the intensity of the physical and emotional response and regain mental focus and control COSFA Secondary Aid Connect with the Sailor Restore Competence and ability Restore Confidence SCRIPT: -Using two instructors, role-play a COSFA event -Now here are some more tools. The first tool is Combat Operational Stress First Aid (COSFA). -Again, this looks complicated, but it is easy to follow. -This is a tool that will help you know what action to take when a fellow Sailor is not handling stress well and is putting themselves or others at risk. -Question: How many of you are parents? How many of you have been trained in first aid? (These questions asked up front to equate COSFA to combat life saver and first aid) -Question: How many of you have seen a Sailor freeze up or freak out at a critical moment? Tell me what you saw. -Question: What were the risks? What did you do? -What you did intuitively is COSFA. It is a series of steps developed to help Sailors know what to do when one of their buddies has a severe stress reaction. It’s like your EMAT or Combat Lifesavers: it’s meant to keep your buddy safe and alive until the corpsman can get there. -Demonstration: Have two instructors come up and role play on how to utilize COSFA. Sailor exhibits a stress symptom (i.e. zoning out, freezing up in battle, shaking, startled, etc.). Instructor will walk through COSFA. -First four steps: -Check -Coordinate -Cover and get safe -Calm him down -After you get them to safety, you apply the other three steps. -Connect -Competence -Confidence -Discussion: How did they do? -Question: After you’ve completed the first two steps (Check, Coordinate), what are some actions that might be necessary to “Cover” or make the Sailor safe? -Possible Answers: Take cover from gunfire, help Sailor don gas-mask, move to an unaffected location, etc. -Once you’ve made them safe, then you can focus on calming. -Discussion: Why is calming important?�-If a Sailor is having a stress crisis, it is because the body is dumping a lot of stress hormones into the bloodstream. The longer the hormones are there, the more damage it does to their brain. And it really is damage. The sooner you can get them to calm down, the less damage will be done and the lower this risk for a long term stress injury. So calm them down as quickly as you can. -You may need to restore focus before you get them to calm down. You need to do whatever is necessary to get their attention (like calling their name, giving a command, shaking, shouting, slapping them on the back, restraining, etc.). Even though covering and calming is common sense, we now have science that backs it up. -Lead the Sailors through tactical breathing: Use a calm voice, have them use tactical breathing (demonstrate, 4 seconds in-hold for 4-exhale). -If that doesn’t work, have them take a deep breath and clench their muscles for about five seconds as hard as they can and then let go. Do this 4-5 times until they calm down. -Tactical breathing is a very active technique to calm and not to zone out but to re-focus. This technique is used by snipers, Seals, detainee ops personnel etc. Practicing tactical breathing is the same as a firefighter practicing picking up a firehouse and spraying water. You have to practice to be able to perform under pressure. Competence and Confidence: What is reintegration? About helping that individual Sailor feel that they have the competence and confidence in their ability to do the job and that their peers have confidence in them. So the last two steps of COSFA apply. You probably have times that you feel that you didn’t do something as well as you could have. Did your buddies tell you that? No. We do that to ourselves. So competence and confidence are intertwined. Building competence and confidence may take weeks. It may take a mentor helping them. Does anyone remember a time when they worked with a Sailor to restore competence and confidence? As good leaders you’ve been doing this every day. It makes sense from a gut level. Hopefully we’ve been able to share with you some of the background information as to the long term psychological protective factor. <Note: COSFA is meant to keep you in the fight, not take priority over the fight. If the situation dictates the application of COSFA, use common sense. The idea is to keep your Sailors and others from getting hurt.>


Core Leadership Functions

• 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 – Communicate with treating

professionals (both ways)

Treat: (“Use your resources”)

• Rest and Restoration (24-72 hours) • Chaplain • Medical • FFSP Programs

Reintegrate: (“Expect success”)

• Keep with unit if at all possible • Expect return to full duty • Don’t allow retribution or harassment • Communicate with treating professionals (both ways)

Strengthen: (“Train like you’re going to fight”)

• Create Confidence • Forewarn • Expose to stress in training • Foster Unit Cohesion

Identify: (“Know your people”)

• Know crew stress load • Recognize reactions, injury

Mitigate: (“Work smarter, not harder”)

• Remove unnecessary stressors • Ensure adequate sleep/rest • After-Action Reviews (AARs)

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Successfully handling a stressful event builds resiliency!

Presenter

Presentation Notes

Core Leadership Functions - Talking Points: 1. Facilitate discussion as each subset of functions present itself on the slide. 2. Effective implementation of Combat and Operational Stress Control occurs through several core functions performed by unit leaders. These are traits of good leaders and consistent with mission accomplishment. 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)


Principles of Resilience

• Predictability -Adverse effects less likely when event is predictable • Controllability -Sense of control leads to positive results • Relationships- Strong relationships increase resilience

to stress • Trust -Sets positive expectations, decreases stress

• Meaning -Provides greater sense of purpose

Confidence Boosters


Additional Resources and Support

• Shipmates

• Chain of Command

• Chaplains/RP’s

• Providers (MDs, PAs, NPs)

• Corpsmen

• USO / MWR

• MST / MCT

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Presentation Notes

Resources in the Field - Talking Points: Discuss the value of partnerships within a command or community. 2. Ask participants to identify organizational locations and/or organizational personalities. 3. Ask participants to address the value of care provided by each organization

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operational stress control - united states navy stress... · operational stress control . 3. . what...

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