https://armypubs.army.mil/epubs/DR_pubs/DR_a/ARN45919-ALARACT_0092026-000-WEB-1.pdf
ALARACT 009/2026
DTG: 261415Z FEB 26
UNCLAS
SUBJ/ALARACT 009/2026 - MEDICAL PLANNING AND EXECUTION
CONSIDERATIONS FOR COMBAT AND OPERATIONAL STRESS CONTROL
THIS ALARACT MESSAGE HAS BEEN TRANSMITTED BY JSP ON BEHALF OF
HQDA, OFFICE OF THE SURGEON GENERAL
1. (U) REFERENCES:
1.A. (U) DODI 6490.05, MAINTENANCE OF PSYCHOLOGICAL HEALTH IN MILITARY
OPERATIONS (AVAILABLE AT HTTPS://WWW.ESD.WHS.MIL/
1.B. (U) DODI 6490.09, DOD DIRECTORS OF PSYCHOLOGICAL HEALTH
1.C. (U) AR 600-63, ARMY HEALTH PROMOTION
1.D. (U) FM 4-02, ARMY HEALTH SYSTEM
1.E. (U) ATP 4-02.5, CASUALTY CARE
1.F. (U) ATP 4-02.6, THE MEDICAL COMPANY (ROLE 2)
1.G. (U) ATP 4-02.8, FORCE HEALTH PROTECTION
1.H. (U) ATP 4-02.46, ARMY HEALTH SYSTEM SUPPORT TO DETAINEE
OPERATIONS
1.I. (U) ATP 4-02.55, ARMY HEALTH SYSTEM SUPPORT PLANNING
2. (U) PURPOSE: TO CLARIFY THAT COMBAT AND OPERATIONAL STRESS
CONTROL (COSC) IS A COMMAND RESPONSIBILITY EXECUTED BY LEADERS AT
ALL ECHELONS, WITH SUPPORT FROM MEDICAL, MINISTRY, AND SPECIALIZED
COSC PERSONNEL.
2.A. (U) THIS ALARACT CLOSES A DOCTRINAL GAP PENDING PUBLICATION OF
ATP 4-02.16. IT COMMUNICATES INFORMATION TO HELP ARMY COMMANDERS
TASK ORGANIZE COSC PERSONNEL AND DIRECT, COORDINATE, AND
SYNCHRONIZE COSC ACTIONS IN GARRISON AND DURING OPERATIONS.
2.B. (U) MEDICAL COMMANDERS, COMMAND SURGEONS, AND COMMANDERS
SHOULD REFERENCE THIS ALARACT WHEN EMPLOYING COSC PERSONNEL
AND DEVELOPING COSC PLANS IN GARRISON AND DEPLOYED
ENVIRONMENTS. APPROPRIATE UTILIZATION OF COSC PERSONNEL AND
PRINCIPLES IMPROVES FORCE HEALTH PROTECTION AND HEALTH OF THE
FORCE.
2.C. (U) COSC PRINCIPLES ENHANCE ADAPTIVE STRESS REACTIONS, PREVENT
MALADAPTIVE STRESS REACTIONS, BUILD RESILIENCY SKILLS, AND HELP
SOLDIERS ADDRESS COMBAT AND OPERATIONAL STRESS REACTIONS
(COSRS) AND BEHAVIORIAL DISORDERS.
2.D. (U) COSC PERSONNEL ARE SPECIALISTS IN COSR PREVENTION AND
INCLUDE CLINICAL SOCIAL WORKERS, CLINICAL PSYCHOLOGISTS,
PSYCHIATRISTS, OCCUPATIONAL THERAPISTS, PSYCHIATRIC NURSE
PRACTITIONERS, PSYCHIATRIC NURSES, ENLISTED BEHAVIORAL HEALTH
SPECIALISTS, AND ENLISTED OCCUPATIONAL THERAPY SPECIALISTS.
BEHAVIORAL HEALTH OFFICERS (BHOS) SPECIFICALLY CONSIST OF CLINICAL
SOCIAL WORKERS, CLINICAL PSYCHOLOGISTS, PSYCHIATRISTS, PSYCHIATRIC
NURSE PRACTITIONERS, AND PHYSICIAN ASSISTANTS WITH PSYCHIATRIC
TRAINING.
2.E. (U) LINE AND UNIT MINISTRY PERSONNEL SUPPORT PSYCHOLOGICAL
HEALTH DURING OPERATIONS.
3. (U) ATTACHMENTS 1 THROUGH 4 DESCRIBE PRINCIPLES, ROLES, AND
RESPONSIBILITIES FOR COSC PERSONNEL.
4. (U) THE HQDA-OTSG POINT OF CONTACT IS LTC(P) PETER ARMANAS, MC,
CHIEF, BEHAVIORAL HEALTH DIVISION, READINESS AND HEALTH INTEGRATION,
HEADQUARTERS, U.S. ARMY MEDICAL COMMAND, COMMERCIAL: 703-681-4598,
EMAIL: PETER.S.ARMANAS.MIL@ARMY.MIL.
5. (U) THIS ALARACT MESSAGE EXPIRES ON 26 FEBRUARY 2027.
ATTACHMENTS:
1. (U) COSC IN GARRISON
2. (U) COSC IN ARMY OPERATIONS
3. (U) MEASURES AND TOOLS TO SUPPORT COMMANDER’S DECISION MAKING
WITH REGARD TO UTILIZATION OF BHOS
4. (U) BEHAVIORAL HEALTH UTILIZATION DATA
ATTACHMENT 1: COMBAT AND OPERATIONAL STRESS CONTROL (COSC) IN
GARRISON
1. (U) REF/A INCLUDES NON-CLINICAL FORCE HEALTH PROTECTION (FHP) AND
CLINICAL HEALTH SERVICE SUPPORT (HSS) AS COSC SPANS THE PROTECTION
AND SUSTAINMENT WARFIGHTING FUNCTIONS.
1.A. (U) NON-CLINICAL FHP TASKS INCLUDE PREVENTION, IDENTIFICATION, AND
MANAGEMENT OF COSR IN ADDITION TO PSYCHOLOGICAL FIRST AID,
SURVEILLANCE OF BEHAVIORAL HEALTH (BH) PROBLEMS, UNIT RISK FACTOR
ASSESSMENT, OPERATIONAL RISK MANAGEMENT, AND COMMAND
CONSULTATION.
1.B. (U) CLINICAL HSS TASKS INCLUDE TRIAGE, ASSESSMENT, AND TREATMENT
OF BH AND NEUROPSYCHIATRIC DISORDERS, REFERRAL FOR OTHER HSS
SERVICES, AND DUTY DISPOSITION.
1.C. (U) SPIRITUAL RESILIENCE IS A CRITICAL ELEMENT OF PSYCHOLOGICAL
RESILIENCE, AND PASTORAL COUNSELING HELPS PREVENT AND TREAT COSR.
1.D. (U) NON-BH MEDICAL PERSONNEL AND UNIT MINISTRY TEAMS EXTEND BH
CARE BY PROVIDING MEDICATION MANAGEMENT, COUNSELING, IDENTIFYING
COSRS, PERFORMING PSYCHOLOGICAL FIRST AID, AND BUILDING RESILIENCE.
1.E. (U) MEDICAL LEADERS AND BHOS PROVIDE THEIR COMMANDERS WITH A
STAFF ESTIMATE INCLUDING MEASURES OF HEALTH AND READINESS OF THE
FORCE. SEE ATTACHMENT 3 FOR EXAMPLES OF MEASURES. MEASURING
EFFICACY MAY BE CHALLENGING AS COUNTLESS FACTORS INFLUENCE
HUMAN BEHAVIOR.
1.F. (U) PERSONNEL ASSIGNED TO THE OPERATING FORCE AT ECHELONS
BELOW DIVISION SHOULD SPEND 50% OF THEIR TIME PERFORMING CLINICAL
HSS ACTIVITIES AND 50% CONDUCTING NON-CLINICAL FHP ACTIVITIES.
1.F.1. (U) CLINICAL HSS ACTIVITIES SHOULD BE INFORMED BY MISSION NEEDS,
CREDENTIALING AND LICENSING REQUIREMENTS, CLINICAL EXPERIENCE, AND
OTHER FACTORS. PERSONNEL ASSESS AND TREAT COMPLEX PATIENTS
SUFFERING FROM SEVERE MENTAL ILLNESS AND NEUROPSYCHIATRIC
EFFECTS OF COMBAT OPERATIONS.
1.F.2. (U) NON-CLINICAL FHP ACTIVITIES SHOULD ALIGN WITH ROLES AND
RESPONSIBILITIES IN SECTION 2.
2. (U) ROLES AND RESPONSIBILITIES OF COSC PERSONNEL.
2.A. (U) UTILIZE PREVENTIVE STRESS MANAGEMENT TECHNIQUES, UNIT RISK
FACTOR ASSESSMENT, OPERATIONAL RISK MANAGEMENT, COMMAND
CONSULTATION, AND APPLICATION OF PRINCIPLES TO ENHANCE COMBAT
EFFECTIVENESS.
2.B. (U) IDENTIFY AND MANAGE COSRS AND BEHAVIORAL HEALTH CONDITIONS,
INCLUDING SEVERE PSYCHIATRIC DISORDERS.
2.C. (U) PERFORM COMMAND CONSULTATION FOCUSING ON PREVENTION,
ASSESSMENT, AND TREATMENT. ASSIST COMMANDERS WITH EMBEDDING
PSYCHOLOGICAL READINESS INTO THE COMMAND'S ETHOS AND TRAINING,
BUILDING A CULTURE OF TRUST, PREPARING UNITS FOR EXTREME STRESS,
CONDUCTING MORALE ASSESSMENTS, AND EDUCATING ON SELF-AID
SUPPORTIVE RESOURCES.
2.D. (U) PARTICIPATE IN PRE- AND POST-DEPLOYMENT SUPPORT ACTIVITIES
AND ADVISE THE COMMANDER ON BH READINESS (E.G., DISABILITY
EVALUATION STATUS, PROFILE STATUS, MINIMAL NECESSARY INFORMATION
TO MITIGATE RISK TO SELF/OTHERS/MISSION).
2.E. (U) TRAIN AND SUPERVISE TECHNICIANS AND/OR PROVIDERS IN CLINICAL
CARE, PSYCHOLOGICAL FIRST AID, PREVENTION, INDIVIDUAL CRITICAL TASKS
AND PROFESSIONAL CONTINUING EDUCATION.
2.F. (U) CONDUCT INFORMAL (E.G., WALKABOUTS) AND FORMAL (E.G., BH
PULSE) ASSESSMENTS OF UNIT FUNCTIONING.
2.G. (U) INTEGRATE WITH SUPPORTING MILITARY TREATMENT FACILITY (MTF)
TO PROVIDE DIRECT CLINICAL CARE INCLUDING PERCENTAGE FULL TIME
EQUIVALENT (FTE) TEMPLATED APPOINTMENTS, TRIAGE, GROUP THERAPY,
COMMAND DIRECTED BEHAVIORAL HEALTH EVALUATIONS, ADMINISTRATIVE
SEPARATION EVALUATIONS, AND SPECIAL DUTY EVALUATIONS.
2.H. (U) EXECUTE TRAUMATIC EVENT MANAGEMENT.
2.I. (U) SUPPORT HIGH/AT-RISK SERVICEMEMBERS IN THE UNIT FOOTPRINT.
2.J. (U) PERFORM POPULATION HEALTH ASSESSMENT.
2.K. (U) FACILITATE COORDINATION OF CARE.
2.L. (U) PARTICIPATE IN OPERATIONAL FIELD TRAINING ACTIVITIES.
2.M. (U) COORDINATE WITH INSTALLATION RESOURCES INCLUDING BUT NOT
LIMITED TO UNIT AND GARRISON CHAPLAINS, MILITARY FAMILY LIFE
CONSULTANTS (MFLC), INTEGRATED PREVENTION ADVISORY GROUPS (IPAG),
COMMUNITY READY AND RESILIENT INTEGRATORS (CR2I), SUICIDE
PREVENTION PROGRAM MANAGERS (SPPM), H2F COORDINATORS,
INSTALLATION DIRECTORS OF PSYCHOLOGICAL HEALTH (IDPH), ARMY
SUBSTANCE ABUSE PROGRAM (ASAP), ARMY COMMUNITY SERVICES (ACS),
AND SOLDIER FAMILY READINESS GROUP (SFRG) COORDINATORS.
2.N. (U) RESERVE COMPONENTS (RC). RC PERSONNEL MAY HAVE DIFFERENT
GARRISON ROLES AND RESPONSIBILITIES DURING ANNUAL TRAINING AND
INACTIVE DUTY FOR TRAINING PERIODS. PERSONNEL SHOULD BE FAMILIAR
WITH ROLES AND RESPONSIBILITIES IN THIS ALARACT AND UTILIZE WHAT IS
MOST APPROPRIATE BASED ON LOCAL ORGANIZATIONAL PROCEDURES AND
RESOURCES.
2.O. (U) ADDITIONAL ROLES AND RESPONSIBILITIES.
2.O.1. (U) DIVISION PSYCHIATRIST. OVERSEE BH OPERATIONS FOR THE
DIVISION, PROVIDING GUIDANCE, LEADERSHIP, COORDINATION, AND TRAINING
FOR DOWNTRACE BHOS. COMMANDERS SHOULD CONSIDER INCLUDING
DIVISION PSYCHIATRISTS IN THE RATING CHAIN OF ORGANIC BHOS AS AN
INTERMEDIATE RATER. DIVISION PSYCHIATRISTS COORDINATE WITH THE
DIVISION SURGEON ON MEDICAL SUPPORT OF THE DIVISION, INCLUDING
READINESS, TRAINING, AND OPERATIONAL PLANNING. PROVIDE CLINICAL
SUPPORT AND ADVICE ON PRESCRIBING PRACTICES, COORDINATION OF
CARE, AND TRAINING OF OTHER BHOS AND MEDICAL STAFF. MAY SERVE AS
SIGNATURE AUTHORITIES ON PERMANENT BH PROFILES AND PERFORM RULE
OF COURTS MARTIAL EVALUATIONS.
2.O.2. (U) BDE PSYCHOLOGISTS AND SOCIAL WORKERS. SERVE AS BDE STAFF
TO PLAN COSC/BH/NEUROPSYCHIATRIC HEALTH SUPPORT TO THE BDE. THEY
SHOULD BE RATED BY THE BDE SURGEON, INTERMEDIATE RATED BY THE
DIVISION PSYCHIATRIST, AND SENIOR RATED BY BDE COMMANDER. AT
INSTALLATIONS WITHOUT A DIVISION PSYCHIATRIST, CONSIDER INCLUDING
IDPH AS INTERMEDIATE RATER.
2.O.3. (U) PSYCHOLOGISTS MAY ALSO PERFORM PSYCHOLOGICAL
ASSESSMENTS AND RULE OF COURTS MARTIAL EVALUATIONS.
2.O.4. (U) 68X BEHAVIORAL HEALTH SPECIALIST. EXTEND AND AMPLIFY BHO
EFFICACY, INCREASE ACCESS TO BH CARE, AND IMPROVE UNIT READINESS.
THEY SHOULD BE UTILIZED AT THEIR HIGHEST CREDENTIALS TO PERFORM
MOS-SPECIFIC ACTIVITIES. THEY ARE TRAINED ON BEHAVIORAL HEALTH
CONDITIONS AND ARE NOT QUALIFIED TO DIAGNOSE OR TREAT THEM.
2.O.5. (U) DETACHMENT AND BDE OCCUPATIONAL THERAPISTS. PERFORM
ASSESSMENTS AND EXECUTE SERVICE DELIVERY IAW THE BH CONCEPT OF
SUPPORT ESTABLISHED BY THE AREA SUPPORTED OR ASSIGNED. THEY
SUPPORT BHOS WITH EARLY PROBLEM IDENTIFICATION, TRIAGE, AND SLEEP
EDUCATION. THEY DIRECTLY SUPPORT SOLDIERS BY BUILDING RESILIENCY
SKILLS TO ADDRESS COSRS AND BH DISORDERS.
2.O.6. (U) BDE OCCUPATIONAL THERAPY TECHNICIANS. IMPROVE THE
PSYCHOLOGICAL HEALTH AND HUMAN PERFORMANCE OF THE FORCE IN
GARRISON. COMMANDERS SHOULD UTILIZE 68L OCCUPATIONAL THERAPY
TECHNICIANS TO PERFORM MOS-SPECIFIC ACTIVITIES BECAUSE THEY
EXTEND AND AMPLIFY THE EFFICACY OF BHOS IN THE GARRISON FUNCTION.
2.O.7. (U) PSYCHIATRIC/BEHAVIORAL HEALTH NURSES. PERFORM ESSENTIAL
TASKS INCLUDING STABILIZATION, UNIT NEEDS ASSESSMENTS,
PSYCHOLOGICAL FIRST AID, PSYCHOLOGICAL DEBRIEFINGS, AND GROUP
PSYCHOEDUCATION FACILITATION.
2.O.8. (U) IDPH. SERVES AS THE INSTALLATION'S PRINCIPAL CONSULTANT FOR
PSYCHOLOGICAL HEALTH. ADVISES THE SENIOR COMMANDER ON THE STATUS
OF CARE AND THE ADEQUACY OF RESOURCES. RESPONSIBLE FOR
COORDINATING ALL MILITARY AND NON-MILITARY SUPPORT PROGRAMS ON
THE INSTALLATION WITH THE DIVISION SURGEON, DIVISION PSYCHIATRIST,
AND/OR SENIOR MEDICAL PERSONNEL TO ENSURE THAT SOLDIER AND THEIR
FAMILIES HAVE ACCESS TO COMPREHENSIVE SYSTEM OF BH CARE.
2.O.9. (U) ALLIED PROFESSIONS. MEDICAL LEADERS, AND BHOS SHOULD
INCLUDE THESE ADJACENT ROLES THAT SUPPORT COSC PRINCIPLES DURING
PLANNING.
2.O.10. (U) FIRST RESPONDERS, INCLUDING BATTALION SURGEONS,
PHYSICIAN ASSISTANTS, NURSES, AND MEDICS. FIRST RESPONDERS SHOULD
ENSURE THEY RECEIVE TRAINING ON OSR, TRIAGING PSYCHIATRIC
CASUALTIES, AND MANAGING MENTAL ILLNESS. ROLE 1 PROVIDERS AND
MEDICS SHOULD BE FAMILIAR WITH BEHAVIORAL HEALTH SCREENING AND
DEVELOP RELATIONSHIPS WITH FELLOW SOLDIERS TO INFORM BHOS AND
UNIT LEADERSHIP INSIGHT INTO RESILIENCE OF THE FORCE.
2.O.11. (U) REGISTERED DIETITIANS (RDS/RDNS). MANAGE SOLDIER NUTRITION
TO SUPPORT READINESS. THEY ADDRESS THE PHYSICAL AND MENTAL
FATIGUE CAUSED BY STRESS-RELATED EATING HABITS BY CREATING AND
SUPERVISING NUTRITION PLANS FOR INDIVIDUALS AND UNITS, ENSURING
THEY MEET PERFORMANCE AND BODY COMPOSITION GOALS FOR MISSION
COMPLETION.
2.O.12. (U) NUTRITION CARE SPECIALISTS. IMPROVE THE NUTRITION
ENVIRONMENT AND STATUS OF SOLDIERS AND UNITS. COMMANDERS SHOULD
UTILIZE 68M NUTRITION-CARE SPECIALISTS TO PERFORM MOS SPECIFIC
ACTIVITIES BECAUSE THEY EXTEND AND AMPLIFY THE WORK OF RDS/RDNS.
2.O.13. (U) CLINICAL PHARMACIST. PROVIDE CONSULTATIONS TO REVIEW
PATIENT POLYPHARMACY RISKS, IDENTIFY POTENTIAL DRUG-DRUG
INTERACTIONS, DEVELOP IMPROVED MEDICATION COMPLIANCE STRATEGIES,
IDENTIFY POTENTIAL THERAPEUTIC ALTERNATIVES, REVIEW THEATER ENTRY
REQUIREMENTS, AND ASSIST IN CARE PLAN DEVELOPMENT TO PREVENT
UNNECESSARY DISRUPTIONS IN MEDICATION TREATMENT WHILE DEPLOYED.
ATTACHMENT 2: COSC IN ARMY OPERATIONS
1. (U) PRINCIPLES, ROLES, AND RESPONSIBILITIES ARE SIMILAR TO GARRISON,
WITH THE ADDITIONS IN SECTIONS 2-5.
2. (U) PLANNING REQUIRES SURVEILLING BEHAVORIAL HEALTH (BH),
ANTICIPATING CASUALTY RATES, AND IMPLEMENTING A BH CARE SYSTEM
COORDINATED WITH MEDICAL ROLES OF CARE. USE AVAILABLE DATA TO
DEFINE MINIMAL BH FORCE REQUIREMENTS. SEE ATTACHMENT 4 FOR
GARRISON UTILIZATION DATA.
2.A. (U) THE CURRENT MTOE FOR ARMORED AND INFANTRY BCTS (TWO BHOS
AND TWO BH TECHS PER ~4000 SOLDIERS). USE THESE NUMBERS ONLY WHEN
SURVEILLANCE AND WORKLOAD DATA ARE UNAVAILABLE, AND CONTINUALLY
ADJUST THE BH SUPPORT CONCEPT BASED ON THE OPERATIONAL
ENVIRONMENT. DETACHMENTS PROVIDE AREA COVERAGE TO UNITS WITHOUT
ORGANIC BH PERSONNEL AND MAY ALSO SUPPORT BCTS AS NEEDED.
3. (U) VIRTUAL BEHAVIORAL HEALTH (VBH) ENHANCES PREVENTION AND
TREATMENT IN DISPERSED ENVIRONMENTS. PLANNERS SHOULD OPTIMIZE BH
SUPPORT BY EMPLOYING VBH WHENEVER THE MISSION PERMITS. VBH IS AS
EFFECTIVE AS FACE-TO-FACE CARE.
4. (U) ALIGN AND COORDINATE THE BH CARE SYSTEM WITH OTHER MEDICAL
SERVICES TO INTEGRATE TRIAGE, ASSESSMENT, DIAGNOSIS, AND TREATMENT.
CARE DELIVERY PRINCIPLES ARE BREVITY, IMMEDIACY, CONTACT,
EXPECTANCY, PROXIMITY, AND SIMPLICITY (BICEPS). CONSIDER COMBINING
RESTORATION CAPABILITIES FOR COSRS AND NEUROPSYCHIATRIC/MILD
TRAUMATIC BRAIN INJURIES (MTBIS), AS THEIR TREATMENT APPROACHES ARE
SIMILAR (E.G., REST, REHABILITATION, EDUCATION, MONITORING).
5. (U) PLANNING FOR LARGE SCALE COMBAT OPERATIONS (LSCO). EFFECTIVE
LSCO SUPPORT MIRRORS ACTIVITIES FROM OTHER OPERATIONS. PLANNERS
MUST ADAPT TO PREVENT, DIAGNOSE, AND TREAT PSYCHIATRIC CASUALTIES
IN A CONTESTED BATTLESPACE. EXPECT DELAYED EVACUATIONS AND
CONSTANT SURVEILLANCE OF MEDICAL CAPABILITIES. ANTICIPATE INCREASED
DEMAND FOR INTERVENTIONS TO MANAGE STRESS AND IMPROVE
RESILIENCE. PERSONNEL WILL SUPPORT UNITS EXPERIENCING INTENSE
COMBAT, RESULTING IN A HIGH PREVALENCE OF COMBAT STRESS, ACUTE
STRESS DISORDER, AND MILD TBIS FROM BLASTS OR OTHER NOVEL WEAPON
SYSTEMS.
5.A. (U) DATA IS INADEQUATE TO PROJECT BHO REQUIREMENTS FOR LSCO OR
TO VALIDATE THE CURRENT ALLOCATION OF TWO BHOS PER BCT. LESSONS
FROM RECENT CONFLICTS SUGGEST A GREATER RELIANCE ON BUDDY-AID,
MEDICS, PRIMARY CARE, HOLISTIC HEALTH AND FITNESS (H2F), AND VBH. ALL
MEDICS, PRIMARY CARE, AND H2F PERSONNEL REQUIRE FOUNDATIONAL
KNOWLEDGE IN BUDDY-AID TOOLS (E.G., ICT 081-COM-3000, "REACT TO
BATTLEFIELD STRESS"). THIS INCLUDES MANAGING OSRS, UNDERSTANDING
THE STRESS CONTINUUM, AND CONDUCTING MTBI SCREENING (E.G., MACE).
BHOS MUST BE PROFICIENT IN IDENTIFYING AND MANAGING SERIOUS
BEHAVIORAL HEALTH CONDITIONS (E.G., PSYCHOSIS, BIPOLAR DISORDER) IN
FORWARD ENVIRONMENTS BY COLLABORATING WITH A PSYCHIATRIST OR
UNIT SURGEON.
5.B. (U) PLANNERS MAY NEED TO CURTAIL OR MODIFY BHO BATTLEFIELD
CIRCULATION TO RETAIN SERVICES FOR THE MAJORITY OF THE FORCE. MOST
BHO ACTIVITIES WILL OCCUR IN THE SUPPORT AREA, SERVICING UNITS
ROTATING FROM THE CLOSE AREA. THIS DIFFERS FROM GLOBAL WAR ON
TERROR PRACTICES.
ATTACHMENT 3: MEASURES AND TOOLS TO SUPPORT COMMANDER’S
DECISION-MAKING WITH REGARD TO UTILIZATION OF BHOS
1. (U) MEASURES. THE FOLLOWING LIST IS NOT ALL-INCLUSIVE AND MAY NOT
BE APPLICABLE IN ALL ENVIRONMENTS. MEDICAL PLANNERS SHOULD ADVISE
LEADERS WHICH MEASURES BEST INFORM SPECIFIC UNIT DECISION MAKING
REGARDING THE UTILIZATION OF BEHAVIORAL HEALTH OFFICERS (BHOS).
1.A. (U) ACCESS TO CARE FOR BEHAVIORAL HEALTH (BH) CLINICS.
1.B. (U) SHORT-TERM/LONG-RANGE TRAINING SCHEDULE FOR UNITS.
1.C. (U) UTILIZATION RATES OF BH CARE AT THE MILITARY TREATMENT
FACILITY.
1.D. (U) SOLDIER REFERRALS TO PRIVATE SECTOR BH CARE.
1.E. (U) RATES OF DUTY LIMITING BH PROFILES IN THE UNIT.
1.F. (U) PROJECTED RATE AND QUANTITY OF SOLDIERS WHO WILL REQUIRE BH
RELATED THEATER MEDICAL WAIVERS FOR DEPLOYMENTS.
1.G. (U) RATES OF PSYCHIATRIC HOSPITALIZATIONS.
1.H. (U) PREVALENCE OF ALCOHOL RELATED INCIDENTS IN THE UNIT.
1.I. (U) CHAPLAIN ANALYSIS OF FREQUENTLY REPORTED STRESSORS.
1.J. (U) RESULTS OF MORALE AND WELL-BEING SURVEYS AS INDICATED.
2. (U) LEADERS SHOULD ASSESS BHO TRAINING COMPLETION OF COMBAT AND
OPERATIONAL STRESS CONTROL (COSC) AND TRAUMATIC EVENT
MANAGEMENT COURSE, BHO CLINICAL EXPERIENCE, BHO MILITARY
EXPERIENCE, UNIT SUICIDE PREVENTION TRAINING, PARTICIPATION IN BHO-
LED BH TRAINING BY NON-BH MEDICAL PERSONNEL, AND CURRENT BHO
UTILIZATION TO INCLUDE CLINICAL, PREVENTIVE, AND STAFF OFFICER DUTIES.
3. (U) TOOLS. CURRENT TOOLS FOR INFORMING BHO UTILIZATION INCLUDE
DEFENSE HEALTH AGENCY DASHBOARDS, BH PULSE RESULTS, UNIT RISK
INVENTORY (URI)/DEFENSE ORGANIZATIONAL CLIMATE SURVEY (DEOCS)
RESULTS, ARMY MEDICAL OPERATIONAL DATA SYSTEM (MODS), THE
COMMANDER’S RISK REDUCTION TOOLKIT (CRRT), AND INTEGRATED
PERSONNEL AND PAY SYSTEM-ARMY (IPPS-A).
ATTACHMENT 4: BH PATIENT UTILIZATION DATA
1. (U) THIS OUTLINES A PLANNING FORMAT TO DETERMINE APPROPRIATE
BEHAVIORAL HEALTH OFFICER (BHO) SUPPORT REQUIRED FOR MILITARY
OPERATIONS OTHER THAN WAR AND COMBAT OPERATIONS. MISSION, ENEMY,
TERRAIN AND WEATHER, TROOPS AND SUPPORT AVAILABLE, TIME AVAILABLE,
AND CIVIL CONSIDERATIONS (METT-TC) MAY INFLUENCE ACCURACY OF THE
ESTIMATES IN 2-3 BELOW.
2. (U) GARRISON BEHAVIORAL HEALTH (BH) UTILIZATION RATES (2023 DATA)
SHOW APPROXIMATELY 15% OF AC SOLDIERS ACROSS THE ARMY ACCESS
OUTPATIENT BH SPECIALTY CARE PER YEAR AND AVERAGE 4 VISITS FOR
CARE. ANOTHER 7-8% RECEIVE TREATMENT FOR A BH DIAGNOSIS ONLY
THROUGH PRIMARY CARE. APPROXIMATELY 1% OF SOLDIERS HAVE
PSYCHIATRIC HOSPITALIZATIONS PER YEAR.
3. (U) TO PREDICT A WORKLOAD FOR BH UTILIZATION IN A DEPLOYED SETTING,
PLAN FOR 15% OF THE UNIT TO UTILIZE BH CARE. FIGURE 4 VISITS PER
SOLDIER UTILIZING BH. AN APPROXIMATE PLANNING FACTOR OF 1 HOUR PER
VISIT WILL PROVIDE AN ESTIMATE FOR THE NUMBER OF HOURS A BHO MAY
SPEND IN CLINIC. (UNIT STRENGTH * .15 * 4= NUMBER OF HOURS A BHO
SHOULD PLAN TO SPEND DOING TREATMENT ACTIVITIES.)
4. (U) MEDICAL PLANNERS SHOULD CONSIDER PREVENTION ACTIVITY TIME
REQUIREMENTS WHEN ASSESSING IF ORGANIC BH ASSETS ARE SUFFICIENT
FOR THE MISSION.