Caregiver Occupational Stress Control (CgOSC)

CDR Jean Fisak, NC, USNPMHCNS-BC

Deputy Director, NCCOSC

DisclaimerThe opinions expressed in this article are the author's own and do not necessarily reflect the view of the United States Government, the United States Department of Defense, The United States Navy, or The United States Navy Bureau of Medicine and Surgery. 

The study protocol was approved by the Naval Medical Center San Diego Institutional Review Board in compliance with all applicable Federal regulations governing the protection of human subjects.

I am an employee of the U.S. Government. This work was prepared as part of my official duties. Title 17 U.S.C. §105 provides that ‘copyright protection under this title is not available for any work of the United States Government.’ Title 17 U.S.C §101 defines U.S. Government work as a work prepared by a military service member or employee of the U.S. Government as part of that person’s official duties.

Objectives• Understand the roles of CgOSC trainers and

team members

• Describe the tools available and capabilities of CgOSC teams

• Identify key roles of mental health and pastoral care professionals within CgOSC teams

Introduction• Standardized primary prevention and recognition

program• Targets improved patient care and safety• 3 Core Objectives

• Early recognition of caregivers in distress

• Breaking the code of silence r/t occupational stress reactions

• Engaging caregivers in early help as needed to maintain mission and personal readiness

Navy and Marine Corps Combat and Operational Stress Control Doctrine

OSC N170D

Navy Medicine CgOSC Program

InstructorTrainers

Local CgOSC Teams

Program Evaluation

and ReportingSustainment

OSC N170D

CgOSC Instructor Trainer

CgOSC Team

Development

Trainer Refresher

Program Effectiveness

Reporting Requirements

CgOSCInstructor

Trainer

CgOSC Trainer Tools• Stress Continuum Model

• Core Leader Functions

• Caregiver Occupational Stress First Aid (BLS for Stress)

• Resilience Building

• Self-Care

• Work Environment or Unit Assessment Skills

• Buddy-Aid or Peer-to-Peer Training Assessment

Three Key Components of CgOSC

Combat and Operational Stress First Aid (COSFA)

Five Core Leader Functions

Stress Continuum Model

Relationship:Resilience, CgOSC, COSC

CgOSC

COSCResilience

Relationship

CgOSC

COSCResilience

Promotion

Universal

Selective

Indicated

Cas

e Id

entif

icat

ion

Stan

dard

Tre

atm

ent f

or

Know

n D

isor

ders

After-care

(including Rehabilitation)

Promotion

Prevention

Treatment

Maintenan

ce

Compliance

with

Long-term

Treatment

(Goal: R

eduction in

Relapse

and

Recurre

nce)

Resilience Adaptation of cognitive-behavioral principles designed to address values, attitudes/beliefs and behaviors

Targets six evidence-informed factors:• Values• Flexible Thinking• Acceptance & Strength• Optimism• Behavioral Control• Positive Coping

Emphasizes multimodal learning skills acquisition and application strategies

Seven Cs of Stress First Aid

Primary Aid 3. Cover Get to Safety ASAP 4. Calm Relax, Slow Down, Refocus

Secondary Aid 5. Connect Get Support from Others 6. Competence Restore Effectiveness 7. Confidence Restore Self-Esteem and Hope

Continuous Aid 1. Check Assess, Observe and Listen 2. Coordinate Get Help, Refer as Needed

Combat and Operational Stress First Aid(COSFA)

Three Levels of Prevention Interventions

Universal Selective IndicatedEveryone in a

population (before or after exposure)

Subgroups of the population at

heightened risk (e.g., deployed units)

Individuals identified to be suffering subclinical distress or impairment

Prevention Interventions:

Target populations with no or subclinical

symptoms

Treatment Interventions:

Target populations with

diagnosable mental

disorders

Best bang

for the

buck*

*Feldner, Monson, &

Friedman, 2007

Self-Care• Burnout• Compassion Fatigue• Compassion Satisfaction

Work Environment/Unit Assessment• Leader Request• Stress Assessment• Assessment Scales• Focus Groups• Findings and Recommendations to Leaders

Buddy Aid (Peer-to-Peer)• Recognize the array of interventions methods for stress reactions

and promote early intervention for individuals

AssessmentsScales• Individual

• Work Center • Environment

or Unit

OSC N170D

Navy Medicine CgOSC Program

InstructorTrainers

Program Evaluation

and ReportingSustainment

Local CgOSC Teams

OSC N170D

CgOSC Team Development

CgOSC Team

Development

Trainer Refresher

Program Effectiveness

Reporting Requirements

CgOSC Instructor

Trainer

CgOSC Team Development Team Composition

• Officer, Enlisted, Civilian• Chaplains and RPs• Mental Health

Activities as Outlined in Instructor Trainers Tools

Command Orientation Briefs, Command Training and Assessments

Mental Health and Spiritual Wellness ProfessionalsKey roles within CgOSC Teams• Lead work environment or unit assessment

• Assist with peer-to-peer assessment and training

• Mentor team members

• Facilitate further care

OSC N170D

Navy Medicine CgOSC Program

InstructorTrainers

Local CgOSC Teams

Sustainment

Program Evaluation and

Reporting

OSC N170D

CgOSC Program Effectiveness

CgOSC Team

Development

Trainer Refresher

Program Effectiveness

Reporting Requirements

CgOSC Trainer

Program EffectivenessAssessment and Program Evaluation• Various Assessment Tools

• Stress-O-Meter

• Individual Assessments

• Program Assessments

OSC N170D

CgOSC Reporting Requirements

CgOSC Team

Development

Trainer Refresher

Program Effectiveness

Reporting Requirements

CgOSC Trainer

Reporting RequirementsLocal CgOSC

• Provide monthly reports/status to Executive Officer

Commands• Quarterly reporting to Regional Commander

Regions

• Quarterly status to BUMED M9 via M95

OSC N170D

CgOSC Trainer:Training Refresher

CgOSC Team

Development

Training Refresher

Program Effectiveness

Reporting Requirements

CgOSC Trainer

Master Trainers

Local CgOSC Teams

Assessment, Program

Evaluation, and ReportingSustainment

SustainmentIngrained within Commands

Instruction

Training Evaluation

Program Evaluation

Training Refresher for Instructor Trainers

NCCOSC SME Guidance and Assistance

Key Points• Stress as a continuum

• Core Leader Functions

• COSFA

• Sustainment

• Good leaders are the best medicine

Caregiver Occupational Stress Control (CgOSC)CDR Jean Fisak, NC, USN

PMHCNS-BCDeputy Director, NCCOSC

Questions?

Caregiver Occupational Stress Control (CgOSC)CDR Jean Fisak, NC, USN

PMHCNS-BCDeputy Director, NCCOSC

Thank You