Combat Stress Conference 2003

California’s MobilizationStress Prevention Program

Sheila Dominguez PhD COL, AN, CAARNG

Guy C. Lamunyon MSN MAJ, AN, CAARNG

California Army National Guard

Task Force MercyCombat Stress Control

STEPHEN M. WYMAN Brigadier General (Ret)

Special Assistant to the Adjutant General for Medical Readiness

California Army National Guard

Research Design

Sheila Dominguez PhD COL, AN, CAARNG Deputy State Surgeon

DETACHMENT 8 STATE AREA RESERVE COMMAND

MEDICAL DETACHMENT

OIC - Los Alamitos Physical Examination Station California Army National Guard

Research Design

GOALS:

1. Prevention of acute combat stress 2. Prevent dysfunctional combat stress behaviors (homicide, fratricide, torture, brutality, mutilations, rape, looting, desertion, abuse sick call) 2. Prevention of long term consequences (PTSD)

3. Development of a soldier oriented stress scale 4. Contribute to the body of knowledge

Research Design ASSUMPTIONS:

1. Available instruments to measure stress do not consider unique needs of soldiers.

2. AMC Screening does not consider psychosocial stressors.

3. A unique soldier oriented stress scale is necessary. 4. Frequent mobilizations provide adequate subjects for

development of a soldier oriented instrument. 5. Human subjects committee review is necessary.

Research Design

METHODS:

1. Literature Review 2. Study available stress instruments 3. Development of a soldier oriented stress scale.

4. Field testing (pilot)

Research Design

STRESS SCALES:

1. PreDeployment - 23 Questions

2. PostDeployment - 24 Questions

MOBILIZATION STATIONCamp Roberts SPR

Central Coast

Mobilization Site

Camp Roberts

Research Design

MOBILIZATION TOTALS:

Calguard 3,800 All California Reserve 13,500 All citizen-soldiers 223,000

(17 APR 03 – Press Democrat, Santa Rosa, CA)

Research Design

RESULTS: First Group

Total N = 439 Referred for further assessment = 9% NO GO = 1 (one)

Research Design

RESULTS: Second Group

Total N = 270 Referred for further assessment = 34% NO GO = 16%

(More media exposure – less restrictive consent form)

Clinical Application Guy C. Lamunyon MSN

Psych/Mental Health Nurse 66C MAJ, AN, CAARNG

Personnel Officer (S-1) DETACHMENT 8

STATE AREA RESERVE COMMAND MEDICAL DETACHMENT

Clinic Manager Los Alamitos Physical Examination Station

California Army National Guard

Background

Vietnam War:

* Jungle to living room in 3 days.

* Debriefing = none!

Clinical Application

THREE LEVELS (similar to AMC)

1. Stress Scale Only 2. Mid-Level Review 3. Psychiatrist Consultation

AMC Screening

Annual Medical Certification (unique to National Guard)

Level 1 - Medic/Corpsman Level 2 - Mid-Level (PA, AN, NP) Level 3 - MC (MD) (AR 40-501)

Stress Scale

Used as screening tool during Soldier Readiness Processing (SRP)

Soldiers with high stress scores referred for mid-level assesment by PhD, MSW, AN66C

Likert Type Scale (1 highly agree – 5 highly disagree) and Yes-No responses

Referrals for Mid- Level

Assessment

Review by medical NCO

Pattern of high response scores (3’s and 4’s)

Yes responses on Stress factors

Referral by Physical Examination Team

Mid-Level Assessment

Determine normal stress reactions (Faking Good - False Negatives)

Exclude malingerers (Faking Bad - False Positives)

Problem solving for psychosocial stressors

Refer soldiers with true pathology

Family Section (1-5)

1. I am satisfied with my/our current living situation.

2. I have a good network to get emotional support.

3. My family will cope well with 6-9 months of activation.

4. My family will be able to meet their needs for food, clothing, shelter, etc.

5. My family knows where to go for help for family support, medical care, ID cards, PX, etc.

6. I am satisfied with childcare arrangements.

Army/Training Section (1-5)

7. I like my Army job.8. I feel competent in my MOS.9. I feel my skills are being utilized.10. I enjoy being a member of the National

Guard.11. I feel I will cope well with 6-9 months

activation.12. I have been trained well enough to survive in

the field.

Economic Section (1-5)

13. I am satisfied that my employer will be fair with me upon my return from mobilization.

14. I am satisfied my income will be adequate upon mobilization.

15. I have adequate emergency savings.

16. My dependents will be able to access bank accounts and do other financial transactions during my mobilization.

Stress Section (Y-N)17. I have had severe marital difficulties, or

separation, divorce or relationship breakup.18. I have experienced serious injury or death in

my family or close relatives/friends.19. I have legal actions pending.20. I have been fired, laid off or have a recent job

change.21. I have married.22. I have moved.23. There is a pregnancy or birth in my family.

Referrals for Psychiatric Evaluation

Determine Mobilization Status – (MOB)

Review/Revise Profile on S (Psychiatric)

Refer for Medical Board (MEB)

(AR 40-501)

Psychiatric Evaluation - MOBDetermines fitness for mobilization

according to Standards of Medical Fitness (AR 40-501).

NO GO = Profile code V (Deployment). This code identifies a soldier with restrictions on deployment. Specific restrictions are noted in the medical record.

NO GO = Profile of 3 or 4 on S (Psychiatric)

Psychiatric Evaluation – Profile on S 1 No psychiatric pathology. May have history of

transient personality disorder.2 May have history of recovery from an acute

psychotic reaction due to external or toxic causes unrelated to alcohol or drug addiction.

3 Satisfactory remission from an acute psychotic or neurotic episode that permits utilization under specific conditions (assignment when outpatient psychiatric treatment is available or certain duties can be avoided).

4 Does not meet the above. (AR 40-501)

Psychiatric Evaluation - MEB3-31 Disorders with psychotic features

3-32 Mood disorders requiring extended or recurrent hospitalizations, limitations of duty/performance

3-33 Anxiety, somatoform, or dissociative disorders requiring extended or recurrent hospitalizations, limitations of duty/performance

3-34 Dementia and other cognitive disorders

3-35 Personality, sexual and gender identity, or factitious disorders; disorders of impulse control; substance- related disorders

3-36 Adjustment disorders – may be the basis for administrative separation if recurrent and interfering with military duty

3-37 Eating disorders – unresponsive to treatment/interfering with military duty. (AR 40-501)

Questions ? ? ?

Remember - everything rolls downhill (don’t kill the messenger)

This PowerPoint and the Stress Scales may be downloaded from:

http://tservcsc.bizhosting.com