MOBILE CARE TEAM

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COSC Doctrine

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NCCOSC Mission:To build and preserve the psychological health of Sailors, Marines and their families

Components of CGOSC

Combat and Operational Stress First Aid (COSFA)

Five Core Leader Function

Stress Continuum Model

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What is Stress?The process by which we respond to challenges to our minds and bodies.

Stress is good, stress is normal, stress keeps us sharp, stress keeps us focused.BUT…

Operational Stress Control Program Core Objectives

Early Recognition

Breaking the Code of Silence

Engage Caregivers in Early Help

Course ObjectivesDescribe 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).

Definitions

Combat Stress

Operational Stress

Occupational Stress

Compassion Stress

Vicarious Trauma

Compassion Fatigue

Burnout

Compassion Satisfaction

Caregiver Resilience

Symptoms of Stress

Physical

Emotional

Behavioral

Work-Related

Interpersonal

Components of OSC

Combat and Operational Stress First Aid (COSFA)

Five Core Leader Function

Stress Continuum Model

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 > 60 Days, Get Worse or Initially Get Better Then Return Worse

The Operational Stress Continuum

Unit LeaderResponsibility

CaregiverResponsibility

Individual, Shipmate, FamilyResponsibility

READYGreen Zone“Fit and Focused”

Well-Trained and Qualified

Positive Command Climate

High Morale

Unit Cohesion

Balanced HealthPhysicalEmotionalSpiritual

Yellow Zone - REACTING

REACTINGYellow ZoneAnxious, Irritable, Sad

Poor Concentration

Sleep Difficulties

Appetite Changes

Apathy

Negative, Pessimistic

Interpersonal Conflict

Poor Decision Making

INJUREDOrange ZonePoor Emotional Control

Major Sleep Difficulties

Guilt, Shame, Fear

Loss of Interest

Challenge to Moral Values

Substance Abuse

Decreased Confidence

Poor Morale

Family Disruptions

ILLRed ZoneChronic 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

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What is Stress?The process by which we respond to challenges to our minds and bodies.

Stress is good, stress is normal, stress keeps us sharp, stress keeps us focused.BUT…

Physiological Effects of Stress

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

How to Recognize Who Needs Help:Orange Zone Indicators

Many Causes vs. Only FourYellow Zone Reactions vs. Orange Zone Reactions

Lack of Sleep

Family Separation

Loss of Possessions

Boredom

Peer Conflicts

Hard Work

Relationship Problems

Money Problems

Physical Injury

Life Threat

Wear and Tear

Loss

Inner Conflict

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Combat and Operational Stress First AidCOSFA

Reacting Injured Ill

Where COSFA Falls on the Stress Continuum

Promotes a Sense of Safety Promotes Calming Promotes Connectedness

Check

Coordinate Coordinate

Coordinate

Check Check

Continuous Aid

Check

Check

DangerousNeeds Stress Zone

1-to-1 InteractionsCollateral Information

Response to InterventionsChange in Functioning

Distress Stressors

Decide Observe

Keep TrackExamine

Check

LookListen

Coordinate

Coordinate

Collaborate Get Help

ReferInform

CoordinateTo Manage CrisisTo Get Information

To Promote Recovery

Direct Hand-OffRecommended ResourcesConsultation

Chain of CommandFamilyPeers

To Ensure SafetyTo Promote RecoveryTo Follow Up

Primary Aid

Primary Aid (Cover and Calm) is a rescue response to a dangerous situation.

Cover

Stand By Make Safe

Make Others

Safe

EncourageFeelings of

Safety

Cover

Authoritative PresenceWarn

ProtectAssist

Disarm

ProtectWarn

Calm PresenceReduce DangerReduce Chaos

Ready to AssistHold AttentionWatch and Listen

Cover

Calm

Calm

Calm

Rest Quiet

SootheCompose

Calm

Stop Physical ExertionSlow Down Heart Rate

Reduce HyperalertnessRelax

Reduce Emotional IntensityListen Empathically

Draw Attention OutwardDistractRefocus

Time OutSleepRecuperate

Secondary AidRestore Function, Reduce Distress:

Connect

Competence

Confidence

Restore Function, Reduce Distress:

Connect

Competence

Confidence

Secondary Aid

ConnectProvide Support

Promote Social Interactions

Facilitate Rituals

Remove Problem-Solving Obstacles

Connect

Be With Comfort

ReduceIsolation

ReduceAlienation

Connect

AcceptEncourage

Soothe

InvitePlayTalk

Include

UnderstandingCorrect MisconceptionsRestore Trust

Eye ContactPresenceListenEmpathize

CompetenceMentor to Full Function

Problem-Solving Strategies

Manage Stress Reactions

Competence

Competence

OccupationalSkills

SocialSkills

Well-BeingSkills

Problem-Solving SkillsHygieneFitness

Managing Trauma and Loss Reminders

Develop Family RelationshipsDevelop Peer Relationships

Brief Operational PauseMentor Back to Duty

RetrainReassign

ConfidenceTaking the Previously Mentioned Steps Will Help You:

Get Back Into a Routine

Rebuild Confidence and Trust in Yourself and Others

Confidence

Hope Self-Worth

MeaningTrust

Confidence

Belief in SelfAccurate Self-Concept

Self-Respect

FaithMaking Sense

HonorPurpose

Trust in PeersTrust in EquipmentTrust in LeadersTrust in Mission

Forgiveness of SelfImagining the FutureForgiveness of Others

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Combat and Operational Stress First AidCOSFA

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)

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)

SummaryStress is a Continuum

Four Sources of Stress

Caregivers Use COSFA

One Size Does Not Fit All

Good Leaders are the Best Medicine