1. COSC Program Update
September 2011
Patricia Powell
Program Manager

2. Combat and Operational Stress Control (COSC)
COSC assists Commanders and Marine leaders in maintaining their warfighting capabilities.
COSC implements activities focusing on:
Force preservation and readiness
Long-term health and well-being of the Marine and their family
Leaders are key to COSC
Leaders influence prevention, mitigation, early identification and referral for treatment
Leaders set a command climate to reduce the stigma of seeking and receiving treatment
COSC utilizes five Core Leader Functions (SMITR)
Supported by Regional Training Coordinators
RTC – COSC/SP/SA
G7, MCCS

3. IOM Prevention Model USMC Treatment Providers and Resources USMC and
TX Providers and Resources
USMC
OSCAR
COSC as per IOM
INJURED
ILL
READY
REACTING
STRESS CONTINUUM

4. Individual Responsibility
Where Are You On The Stress Continuum?
READY
REACTING
INJURED
ILL
Good to go
Well trained
Prepared
Fit and tough
Cohesive units, ready families
Distress or impairment
Mild, transient
Anxious or irritable
Behavior change
More severe or persistent distress or impairment
Leaves lasting evidence (personality change)
Stress injuries that don’t heal without intervention
Diagnosable
PTSD
Depression
Anxiety
Addictive Disorder
Chaplain & Medical
Responsibility
Individual Responsibility
Unit Leader
Responsibility

5. Factors that affect your decision to receive mental health services
J-MHAT 7 Assessment
Factors that affect your decision to receive mental health services
Army % agree or strongly agree: Screen positive
USMC % agree or strongly agree: Screen positive
Army % agree or strongly agree: Did not screen positive
USMC % agree or strongly agree: Did not screen positive
Mental health services aren't available
28.2%
7.9 %
11.2 %
7.0%
I don't know where to get help
17.0 %
5.8 %
4.7%
6.8 %*
It is difficult to get an appointment
31.3 %
11.9 %
11.8 %
6.6%
There would be difficulty getting time off work for treatment
49.3%
24.5 %
19.6 %
18.3 %
It's too difficult to get to the location where the mental health specialist is
32.7%
14.2 %
15.7 %
12.5 %
My leaders discourage the use of mental health services.
15.1 %
9.6%
4.0%
5.2%*
Recent findings regarding barriers to mental health care
Note: * = USMC numbers in bold higher than comparative US Army sample.

6. Key Initiatives COSC training OSCAR Team Training Resources and tools
Deployment Cycle Training, known as
Marine Operational Stress Training (MOST)
OSCAR Team Training
MARADMIN requires Bn-sized units to train & maintain OSCAR teams
Outlines certifications & authorized training
Provides guidance to complete reporting
Resources and tools
Behavioral Health Information Network (BHIN)
Resource map

7. Behavioral Health Integration
BHIN is integrated outreach resource
Combat & operational stress is a risk factor for behavioral health issues
Family violence, assault, substance abuse, suicide
Assist with Subject Matter Expertise
Set the tone to reduce stigma
Strategic partnerships
Target the right audience
IOM prevention model utilized to ensure programs are in the right area of concern, eliminate program overlaps & potential gaps
Early identification and referral
Strategic partnerships includes working together with non-Marine Corps agencies to more efficiently partner. For examples join effort at WRC.
Target right audience: tailor message to what Marines understand, include family, speak differently to officers, SNCOs, NCOs, junior Marines.
IOM model shows distribution of programs and how the support; helps identify overlaps and potential gaps
“An ounce of prevention is worth a pound of cure” is basis for teaching continuum. Others have found useful and adopted (SAPR, chaplains).

8. Operational Stress Control and Readiness
OSCAR Teams:
Team Members / Mentors (Selected Marines)
Extenders (Corpsmen, Medical Officers, Religious Ministry Team)
Providers (Mental Health Professionals)
OSCAR Team Members/Mentors:
Identify small changes in behavior
Quickly intervene when Marines show signs of negative stress reactions
Refer for assistance when appropriate
Reduce stigma concerning behavioral health
Over 3000 Marines are OSCAR trained
Mental Health Professionals
Embedded at the Division/Regimental level
OSCAR training:
Builds teams to assist commanders in prevention, early identification, referral and support
Incorporates mental health providers embedded in the operating forces, where they are needed most
Develops OSCAR teams across the Marine Air Ground Task Force

9. OSCAR Team Structure (Infantry)XX
DIVISION
OSCAR Mental Health Providers (3, full time)
OSCAR Psych Techs (4, full time)
III
INFANTRY REGIMENTS
OSCAR Mental Health Providers
(2, full time)
OSCAR Psych Techs (2, full time) II
INFANTRY BATTALIONS
OSCAR Mentors
(XO, SgtMaj, and selected Marines)
OSCAR Extenders (Medical Providers, Chaplain, RP and Corpsmen) I
INFANTRY COMPANIES
OSCAR Mentors
(XO, 1stSgt, and selected Marines)
OSCAR Extenders (Corpsmen)

10. (56 hour course plus experience training)
OSCAR Training Structure
MEF MASTER TRAINERS
(56 hour course plus experience training)
100
Certified to train trainers
OSCAR TEAM TRAINERS
(40 hour course) 200
Certified to train team members
ADVANCED TEAM MEMBERS
(32 hour course) ~50
Mentors able to provide
informal briefings and assist trainers in conducting Team Training
MENTORS (6 hour course)
50–75 per Battalion
Mentors able to provide informal briefings

11. OSCAR Training Value for Leaders
SgtMaj Barrett, Sergeant Major of the Marine Corps
3 min

12. OSCAR Way Ahead MARADMIN Sustainment Preparing for Generation 2
Certifying Master Trainers in all MEFs & MFR
Preparing for Generation 2
Lessons learned from 18 months of OSCAR Team Training
Conducting focus groups
Integrating emergent priorities
Developing trainer skills
Developing specialized training
OSCAR Providers
OSCAR Executive Course
If it’s not broken, don’t fix it
Increase practical tools and promote positive case studies

13. Supporting Families
Developing strategies with Marine Corps Family Team Building (MCFTB) to:
Raise awareness and provide tools to help identify stress reactions and refer using a common frame of reference
Conducted working groups with active duty spouses to review concepts and tools – Instructor Battalion &1/6
Foundational COSC training
Leveraging OSCAR format
Piloting with I MEF NOV 2011

14. Deployment Cycle Training Way Ahead
Currently (2005): Marine Operational Stress Training (MOST)
Generic COSC information with a medical bias
Targets Warriors (Marines), Leaders & family members
Planned
Interactive, small unit discussion; practical use of concepts
Lessons learned from OSCAR Training & Third Location Decompression
Emerging priorities such as TBI protocols
Content tailored to each specific point on the deployment cycle
Unit leadership & OSCAR Team Members lead discussions
Retain audience focus: Warriors (Marines), Leaders & family members

15. COSC Way Ahead Finalizing Marine Corps Order Developing AIRS Checklist
Preparing for Third Location Decompression for PRP & EOD
Updating Deployment Cycle Training (MOST)
FY 2012 Strategy:
Developing a strategic plan
Institutionalizing COSC fundamentals
Supporting the Commandant’s resiliency efforts
Developing specific tool kits
Building a scientific base
Gathering best-evidence
Developing communication plan
Collaboration
Staff development
AIRS – Automated Inspection Reporting System

16. How You Can Help Let the Marines own it Support when asked
Partner with the RTCs
Institutionalize key concepts
Promote seeking leadership tools
Leadership principle: know yourself and seek self-improvement. It is part of every Marines job to be aware of any deficiencies and address them. Seeking timely help keeps the Marine functional and contributing to the unit mission. Not addressing emerging stress (or other) issues will most likely lead to greater impairment and further impact to the unit.

17. Points of Contact
Questions? Ms. Patricia Powell, Program Manager, COSC LtCol Curt Strader, OSCAR Lead, COSC