CAPT Scott Johnston, MSC, USN Director, Naval Center for Combat & Operational Stress Control

Mental Health in the Military

Treatment Wellness

Total Force Fitness (TFF)

www.nccosc.navy.mil

MIND•Psychological •Behavioral •Spiritual •Social

BODY•Physical •Medical and Dental •Nutritional•Environmental

An initiative from the Chairman of the Joint Chiefs of Staff

TFF Addresses Multiple Needs

www.nccosc.navy.mil

Achieving multi-dimensional wholeness and balance to meet the challenges of changing environments

• Engaging senior leaders

• Providing key terms and definitions for DoD

• Providing framework for cataloging programs and integrating resilience-focused policy and doctrine

• Starting point for developing standardized metrics

DCoE Resource and Efforts

www.nccosc.navy.mil

RAND studies • On web: Resilience and Suicide Prevention

• New studies: Stigma Reduction, Sleep Issues, Family Resilience

White papers reviews • Integrate three areas: scientific evidence, current programming,

stakeholder inputs

• DCoE Integrative Health and Wellness website

• Topics: Mind-body skills, peer support, worksite health promotion/wellness programs, leveraging technology, well-being, reintegration programs

Comprehensive Soldier Fitness

Overview Five Dimensions Five Pillars

$140 Million mandatory program for all Soldiers

PhysicalGlobal Assessment Tool

(GAT)

Five dimensionsFive pillars

SocialComprehensive Resilience

Modules

CSF is not a treatment program Emotional Master Resilience Trainers

Train specific mental and physical resilience techniques

through a program of continuous self - development.

SpiritualInstitutional Military Resilience Training

Designed to improve physical & psychological health and

resilienceFamily Enhanced Performance

www.nccosc.navy.mil

Air Force Resilience Initiatives

IMPLEMENTED ONGOINGAROUND THE CORNER

(Jul 12 & forward)

Deployment Transition Center (DTC)

Senior Review Group Joint use of DTC (Navy)

Leadership Toolkit on Portal Resilience Mobile Training Teams (RMTT)

Master Resilience Trainers (MRT) training

Support and Resilience Inventory (SRI) on Portal and at A&FRCs

Developing learning goals for AF Learning

Resilience integrated into accessions and PME training

Wingman Day resources on Portal

Leadership Pathways Metrics:- MRT- Resilience impact: Airmen, civilians, and families

Resilience incorporated in family programs

Community Support Coordinator positions (71) for wings

Lessons Learned Report to CSAF

Deployment Transition Center ImplementationRamstein AB, Germany

• Decompression and Re-integration Training

• Strength-based approach to assist Airmen regularly exposed to significant risk of death in direct combat

• Headcount—total 3,444

• AF/A1 and USAFE/CC working way ahead on DTC of the future

• Research on effectiveness

• Showed significantly reduced symptoms of Post Traumatic Stress, problematic alcohol use/abuse, and serious conflict with family/others

As of: 29 Feb 12

Marine Total Fitness

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Social Mind Body Spirit

Marines and families that engage in socially healthy behaviors

Marines and families that engage in psychologically healthy behaviors

Mission-capable units whose Marines are physically able to perform current and future missions

Marines and families living out their spirituality in a way that enables them to successfully meet their duties

E-Marine Integrate Behavioral Health

Physical Fitness Policy Review & Overhaul

Spiritual Fitness Guide

Single Marine Program Representative

Operational Stress Control and Readiness Program (OSCAR)

Enhanced nutrition, fatigue mgt, combat conditioning instruction

Chaplain Referral Tool

Pilot Operation Adrenaline Rush (O.A.R.)

MCFIT- web-based tool to inform and equip Marines IRT “Marine Total Fitness

Sports Medicine and Injury Prevention

Standardized CREDO Programming

Pre/Post-Deployment Unit Cohesion

Behavioral Health Information Network

Physical Fitness Website Chaplain Billet Structure Review

MCFTB Curriculum Refresh

DSTRESS Line Post PT Nutritional Enhancements

Revision CREST-chaplain training.

Navy Operational Stress Control (OSC)

www.nccosc.navy.mil

Functional Areas Programs Unit Resilience

Policy- Develop/update Doctrine & CONOPS and Fleet guidance

Returning Warrior Workshops(RWWs)

OSC Awareness GMT

Training- Deliver annually and all career milestones (pre- and post-deployment; and complemented by regular Unit-level training.

FOCUS (Families Over Coming Under Stress)

Navy OSC Leaders Course

Strategic Communications- Focuses on informing leadership, changing behavior, and developing partnerships

Caregiver OSC (CgOSC) Command Stress Assessment/DEOCS

Assessment and Analysis Measure program effectiveness

Psychological Health Outreach Programs (Mobile Care Teams, OSCAR Embedded Provider)

Organizational Resilience Assessment Pilot

The Operational Stress Continuum

Ready Reacting Injured Ill

Good to Go

Well-Trained

Fit and Focused

Cohesive Units

Ready Families

Distress or Impaired

Mild and Temporarily Anxious,

Irritable or Sad

Physical or Behavioral Changes

More Severe or Persistent Stress or

Impairment

May Leave Lasting Memories, Reactions

and Impressions

Stress Injuries That Don’t Heal Without

Help

Symptoms Persist Get Worse or Initially Get

Better Then Return Worse

Unit LeaderResponsibility

CaregiverResponsibility

Individual, Shipmate, FamilyResponsibility

Five Core Leader Functions

StrengthenLeadership that is Firm, Fair, a Source of Courage, Communicates Plans and Listens

Expose to Tough, Realistic Training

Foster Unit Cohesion

MitigateRemove Unnecessary Stressors

Ensure Adequate Sleep and Rest

Conduct After-Action Review (AAR) in Small Groups

IdentifyKnow Crew Stress Load

Recognize Reactions, Injuries and Illness

TreatRest and Restoration (24-72 Hours)

“Buddy Help”

Chaplain

Medical

ReintegrateKeep with Unit if at all Possible

Expect Return to Full Duty

Don’t Allow Retribution or Harassment

Communicate with Treating Professionals (Both Ways)

Proposed Navy Resilience ProgramFour pillars of the program1. Assessment tools

2. Resilience training modules

3. Train-the-trainer training

4. Institutional resilience training

Resilience program will include:1. Evidence-supported tools and methods that

support skill development

2. Research-supported program evaluation and outcome measures

www.nccosc.navy.mil

www.nccosc.navy.mil

Initiatives in Wellness and Optimal Performance

• Evaluate and compare effectiveness of stress regulation skills• Coherence Training (emWave) Vs. PMR

• N = 106 IDC students

• Classes assigned to Coherence Training or PMR

• Assessments at baseline, 3 mo, 6 mo, 1 year• Stress, anxiety, sleep, PTSD, unit support, performance & attrition

www.nccosc.navy.mil

Coherence Training Study

• Evaluate the effectiveness of stress regulation skills• SRTS Vs. PMR (both iPad based systems)

• N = 200 service members in training environments

• Random assignment: SRTS, PMR or waitlist control

• All participants receive an iPad for 2 months

• Assessments at baseline, 2 and 4months

• Stress, resilience, coping, anxiety, sleep, PTSD, unit support, performance & attrition

www.nccosc.navy.mil

Stress Resilience Training System

Questions and Comments