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

Mental Health in the Military Treatment Wellness

Total Force Fitness (TFF) 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 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 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 OverviewFive DimensionsFive Pillars $140 Million mandatory program for all Soldiers PhysicalGlobal Assessment Tool (GAT) Five dimensions Five pillars Social Comprehensive Resilience Modules CSF is not a treatment programEmotionalMaster Resilience Trainers Train specific mental and physical resilience techniques through a program of continuous self - development. Spiritual Institutional Military Resilience Training Designed to improve physical & psychological health and resilience FamilyEnhanced Performance

Air Force Resilience Initiatives IMPLEMENTEDONGOING AROUND THE CORNER (Jul 12 & forward) Deployment Transition Center (DTC) Senior Review GroupJoint use of DTC (Navy) Leadership Toolkit on PortalResilience 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 PathwaysMetrics: - 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 Implementation Ramstein 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 SocialMindBodySpirit 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-MarineIntegrate 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 LinePost PT Nutritional Enhancements Revision CREST-chaplain training.

Navy Operational Stress Control (OSC) Functional AreasProgramsUnit 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 ReadyReactingInjuredIll 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 Leader Responsibility Caregiver Responsibility Individual, Shipmate, Family Responsibility

Five Core Leader Functions Strengthen Leadership that is Firm, Fair, a Source of Courage, Communicates Plans and Listens Expose to Tough, Realistic Training Foster Unit Cohesion Mitigate Remove Unnecessary Stressors Ensure Adequate Sleep and Rest Conduct After-Action Review (AAR) in Small Groups Identify Know Crew Stress Load Recognize Reactions, Injuries and Illness Treat Rest and Restoration (24-72 Hours) “Buddy Help” 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)

Proposed Navy Resilience Program Four pillars of the program 1.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

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 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 Stress Resilience Training System

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