Army Policy and Secretariat
Army Headquarters
IDL 24 Blenheim Building
Marlborough Lines
Andover
Hampshire, SP11 8HJ
United Kingdom
Ref: Army/Sec/FOI05462/W/M
E-mail:
xxxxxxxxxxxxx@xxx.xxx.xx
Website:
www.army.mod.uk
9 June 2021
Cdr Alexandros Pantzopoulos
xxxxxxxxxxxxxxxxxxxxxxx@xxxxxxxxxxxxxx.xxx
Dear Cdr Pantzopoulos
Thank you for your email of 22 May 2021 in which you requested the following information:
LFSO 3217 AND LFSO 3218
I am treating your correspondence as a request for information under the Freedom of Information
Act (FOIA) 2000. A search for the information has now been completed within the Ministry of
Defence, and I can confirm that the information in scope of your request, Land Forces Standing
Order 3217 and 3218 are held and are attached below. Some of the information falls entirely within
the scope of the absolute exemption provided for at section 40 (Personal Data) of the FOIA and
this information has been redacted from the requested documents. Section 40(2) has been applied
to the requested information in order to protect personal information as governed by the Data
Protection Act. Section 40 is an absolute exemption and there is therefore no requirement to
consider the public interest in making a decision to withhold the information.
Under Section 16 of the Act (Advice and Assistance) you may find it helpful to note that if you wish
to find out anything further, you may use the normal military channels. Your chain of command
should advise you further.
If you have any queries regarding the content of this letter, please contact this office in the first
instance. Following this, if you wish to complain about the handling of your request, or the content
of this response, you can request an independent internal review by contacting the Information
Rights Compliance team, Ground Floor, MOD Main Building, Whitehall, SW1A 2HB (e-mail
CIO-
xxxxxx@xxx.xx). Please note that any request for an internal review should be made within 40
working days of the date of this response.
If you remain dissatisfied following an internal review, you may raise your complaint directly to the
Information Commissioner under the provisions of Section 50 of the Freedom of Information Act.
Please note that the Information Commissioner will not normally investigate your case until the
MOD internal review process has been completed. The Information Commissioner can be
contacted at: Information Commissioner’s Office, Wycliffe House, Water Lane, Wilmslow,
Cheshire, SK9 5AF. Further details of the role and powers of the Information Commissioner can be
found on the Commissioner's website at
https://ico.org.uk/. Yours sincerely,
Army Policy and Secretariat
RESTRICTED
L F S O
Not to be communicated to
anyone outside HM Service
3217
without authority
(FIRST REVISE)
LAND FORCES
STANDING ORDER NO 3217
by
General Sir Nick Parker
KCB CBE ADC Gen
Commander in Chief Land Forces
TRAUMA RISK MANAGEMENT (TRiM)
POC SO2 PS4(A)
ANDOVER
XXXXXXXXXXXXX
AUGUST 2011
Ext XXXXXXXXXX
RESTRICTED
RESTRICTED
LAND FORCES STANDING ORDER NO 3217
(FIRST REVISE)
TRAUMA RISK MANAGEMENT (TRiM) ARMY POLICY
References:
A.
Trauma Risk Management Training Manual Revised 2008.
B.
LFSO 3209, dated Jun 2011, Post Operational Stress Management Policy.
BACKGROUND
1.
For organisations, such as the Army, that routinely expose their personnel to traumatic events,
there are moral, legal and economic reasons to look after individuals1. Following a traumatic event,
those individuals who have been adversely affected are likely to be less effective at work and in some
instances are less likely to remain within the service unless supported appropriately. The numbers of
personnel who develop chronic psychological problems having been involved in a traumatic incident
are relatively small in the context of the numbers deployed on operations. For this reason the problem
should not be overstated, however an awareness of symptoms and the identification of the small
minority who may require support is very important.
2.
In 2007 the Army formally adopted Trauma Risk Management (TRiM), an initiative that aims
to capitalize on the social cohesion available within units by training personnel in the early recognition
of symptoms associated with post traumatic stress2. The TRiM Training Cell (Army) (TTC(A) was
established on 1 April 2008 and is responsible for the delivery of all TRiM training to Regular and
Reserve Army units.
AIM
3.
This LFSO explains the rationale behind TRiM, and directs organisations on how best
to implement the strategy in operational and non-operational environments.
RATIONALE
4.
TRiM is a peer delivered, evidence informed psychological support strategy3. TRiM is not a
treatment in itself; preferably it endeavours to foster peer and organisational support in the short
term and, where appropriate, direct individuals towards formal sources of help if they do not appear
to be following what is considered to be a normal recovery pattern.
5.
After a traumatic event, TRiM trained personnel will advise commanders about best practice in
relation to traumatic stress. They will carry out structured risk assessments of those exposed to the
event identifying whether individuals might benefit from additional support. A further risk assessment is
carried out after a month and personnel who continue to exhibit significant symptoms are assisted in
seeking help from a formal4 source of support. If the second risk assessment is inconclusive a third
risk assessment can be carried out at the 3 month point. In addition to this, and particularly
1 Management of Health & Safety at Work Regulations 1999 requires employers to assess risks to health and safety from hazards at work.
2 Whilst Operational Stress is recognised as a component of Military Occupational Stress, TRiM is essentially concerned with the
management of post traumatic stress.
3 The Academic Centre for Defence Mental Health (ACDMH) has conducted a series of randomised control trials which has led to
the delivery of TRiM in its current form.
4 RMO, Padre, Welfare Officer.
1
V.01 AUG 2011
RESTRICTED
RESTRICTED
noteworthy, is the way in which the culturally informed delivery of TRiM can reduce the stigma
associated with mental health issues, which will ultimately encourage those who need help to seek it.
CHAIN OF COMMAND ENGAGEMENT
6.
The initial management of personnel involved in incidents of a traumatic nature is likely to be
carried out by individuals other than TRiM trained personnel (often the local commander). It is
therefore vital that commanders at all levels have some knowledge of the procedures involved in
TRiM and recognise the benefits associated with an early intervention strategy. For a TRiM strategy to
be credible it must be actively promoted by the chain of command. Commanders must issue a policy
statement giving clear direction on how TRiM should be implemented within their Formation/unit. An
example of a TRiM Policy Statement is at Annex A. Further to this, a TRiM Plan must be developed
describing in detail action to be taken before, during and specifically after an incident, the plan must
also include the post operational normalisation period outlined in Reference B. An example of a TRiM
Plan is at Annex B.
RESPONSIBILITIES
7.
Although TRiM is currently and arguably necessarily directed at the operational environment it
is not confined to it. Indeed the operational TRiM model is equally effective when adapted to meet the
challenges associated with a non-operational incident. Nevertheless, regardless of circumstance a
TRiM response must be logical, consistent and coordinated across all levels of command:
a.
Brigade Headquarters’. Ideally Bde HQs should appoint a TRiM liaison officer, who is
responsible for the following:
(1)
Liaison between Bde units and TTC (A) in order to coordinate TRiM training.
(2)
Monitor in theatre TRiM activity during operations.
(3)
Liaison between Bde unit TRiM Coordinators and Jt F Sp TRiM Coordinator (in
Afghanistan).
(4)
Close liaison with the Rear Ops Group (ROG) TRiM Coordinator.
b.
In addition to this Bde HQs are to appoint a ROG TRiM Coordinator who is responsible
for liaison between Bde Fwd and Bde rear. This is particularly important when dealing with
individuals who leave theatre early and who need to be TRiM risk assessed. This level of
coordination must also include:
(1)
Royal Centre for Defence Medicine (RCDM) Clinical Unit. This is especially
important for those subject to AEROMED:
(a)
AEROMED to Role 4. In almost all circumstances support is provided
by on-site agencies. However, some personnel will remain at Role 4 for a short
period and may well be sent on Hospital Sick Leave. This must be monitored
closely by ROGs who are to ensure that where necessary personnel are given
the opportunity to undergo or complete the TRiM risk assessment process.
(b)
AEROMED other than to Role 4. It is the responsibility of the ROG to
ensure that those personnel who do not proceed to role 4 are monitored and
2
V.01 AUG 2011
RESTRICTED
RESTRICTED
where necessary given the opportunity to undergo or complete the TRiM risk
assessment process.
(2)
Regional Brigade Headquarters. Regional Brigade Headquarters are to
ensure that those Regular Reserves who return from theatre early and who are
subsequently demobilised undergo or complete the TRiM risk assessment process.
(3)
TA Units. TA Units are responsible for those personnel who return from
theatre and who subsequently return to their parent TA Unit. As such they are to
ensure, where necessary, individuals undergo or complete the TRiM risk assessment
process.
c.
Formed Units. Experience has shown that the number of TRiM trained personnel
required by a unit is dependant on its size and role, nevertheless, where possible major
units should adhere to the following:
(1)
Major units should have at least 5 TRiM Coordinators, of whom 1 should have
overall responsibility for the units TRiM strategy, and 20 Practitioners shared between
sub-units. In addition to this non-deployable units and training establishments must
ensure that they have a sufficient number of TRiM trained personnel to support those
assigned to their establishments who have just returned from operations.
(2)
During periods of operational deployment units are to nominate at least one rear
party TRiM Coordinator and two TRiM Practitioners to support those who return from
theatre early.
(3)
It is recommended that Unit Welfare Officers (UWO) and Padres undergo
TRiM training in order to assist in their provision of second line support to those who
have been assessed and to those TRiM trained personnel carrying out the
assessments. UWOs and Padres should not conduct risk assessments as this may
compromise their second line support role.
(4)
TRiM trained personnel must not act as Casualty Notification Officers (CNOs) or
Casualty Visiting Officers (CVOs) for incidents they have risk assessed.
(5)
The Medical Officer (MO) must be included in the unit TRiM strategy. Moreover,
the MO must be regularly updated on TRiM risk assessments and most importantly the
assessment outcomes. Those individuals requiring additional support must be directed
to the MO at the earliest opportunity.
d.
TA Units. In most circumstances TA Units are to adopt the same TRiM strategy as a
Formed Regular Unit. However, best practice shows that PSAOs and ROSOs are best placed
to provide a consistent TRiM strategy and as such should be trained as TRiM Coordinators.
e.
Reserves Training and Mobilisation Centre (RTMC). RTMC are to have a sufficient
number of TRiM trained personnel capable of dealing with those individuals undergoing
demobilisation and who require a TRiM risk assessment. RTMC are to liaise with TA Units and
Regional Brigades to ensure that those who require additional TRiM interventions are
supported appropriately.
3
V.01 AUG 2011
RESTRICTED
RESTRICTED
TRAINING
8.
The emphasis of TRiM training is not about the medical management of stress or Critical
Incident Stress Debriefing (CISD)5. It is a system of common sense post incident procedures carried
out by individuals tasked to provide a peer support strategy to manage those exposed to traumatic
events.
9.
Qualities required in the TRiM Trained Personnel. TRiM trained personnel are volunteer
nonmedical personnel who are selected by the chain of command for their individual qualities and not
necessarily by rank or appointment. They should be conscientious, discreet, credible, and empathic,
have good communication skills and must not have unresolved welfare or psychological issues of their
own. Those individuals selected will be trained in psychological risk assessment and provided with a
basic understanding of the principles of trauma psychology.
10.
TTC(A). The training is delivered by suitably experienced service personnel who have been
trained by mental health professionals and assessed as competent to deliver this type of training.
Training takes place over 2 or 3 days depending on the level of training provided.
11.
TTC(A) delivers TRiM training on 3 levels:
a.
Awareness. TRiM awareness is delivered through progressive training at 3 levels:
(1)
All Ranks. All Army personnel are required to understand the rationale,
training and application of TRiM.
(2)
HQ Staff. All staff officers require a basic awareness of TRiM, especially the
management of auditable documents.
(3)
Commanders. Commanders are defined as SNCOs and officers who require
an increased awareness of TRiM due to their appointment and the need to
understand how best to support personnel following a traumatic incident.
b.
Practitioner (foundation) Course. This is a two and a half day course which trains
personnel to identify existing and potential psychological problems following a traumatic
event and assist in the planning and management of the unit TRiM strategy. The course is
rank ranged; OR3 to OF36 and those who successfully complete the course remain qualified
for three years whereupon they must be revalidated by the unit TRiM Coordinator7.
c.
Coordinator (advanced) Course. This is a three day course rank ranged OR88 to
OF3. Those who successfully complete the course remain qualified for 3 years after which
they must attend a refresher course delivered by TTC(A). The course trains personnel to meet
the following TRiM responsibilities:
(1)
Identify existing and potential psychological problems following
a traumatic event.
(2)
Planning and managing the unit TRiM strategy. To include:
5 Critical Stress Debriefing was the forerunner to TRiM. Its use vetoed by the Surgeon General in 2000.
6 Corporal & Major.
7 Revalidation of practitioners must not be carried out during a live incident.
8 WO2.
4
V.01 AUG 2011
RESTRICTED
RESTRICTED
(a)
Management of TRiM Log Books.
(b)
Management of unit TRiM Diary.
(c)
Selection of TRiM trained personnel for specific TRiM tasks.
(d)
Form and manage a cadre of TRiM trained personnel.
(3)
Revalidating unit TRiM Practitioners after three years.
(4)
Provide support and mentoring to unit TRiM Practitioners as necessary.
(5)
Ensuring that TRiM Practitioners remain current and competent by delivering
refresher training where required.
d.
Unit administrative staff are to ensure that those who successfully complete the
course are recorded on JPA as ‘TRiM Trained’, whereas those who complete the course but
do not achieve a requisite understanding of TRiM are to be recorded on JPA as ‘TRiM Aware’
Reference A covers TRiM training in detail.
TRiM RESPONSE
12.
The period immediately after an incident, particularly when there are casualties, is often
difficult. Whilst it is important to provide support to those involved, TRiM risk assessments must not
be conducted until 72 hours after the incident. This allows time for those involved to make some
sense of what took place. However, detailed planning can take place before initial risk assessments
are undertaken and the unit TRiM teams should engage with the chain of command as early as
possible. If traumatic stress is to be managed effectively it is vital that any intervention is carefully
planned in advance:
a.
The Planning Meeting. Ideally a meeting should take place within 24 hours of the
incident occurring. The purpose of the Planning Meeting is to allow all those involved in the
management process to formulate a plan based on careful analysis of the situation. Those
attending the meeting must be selected for their ability to contribute to the successful
management of those involved in the incident. Any decisions taken by the planning meeting
team must reflect the requirements arising from a balance of, the nature of the traumatic
incident, who was traumatised and the unit’s current mission. Where possible the following
personnel should attend the planning meeting:
(1)
Medical Officer (MO). The MO will not divulge confidential information but may
be able to give some guidance on how to support those who may be at risk of
developing psychological issues.
(2)
Padre. The Padre has a very important role providing both pastoral and welfare
support.
(3)
Sub-Unit Commanders. It is extremely important that Commanders are fully
involved in the decision making process regarding the management of their personnel.
(4)
TRiM Trained Personnel. A TRiM Coordinator or alternatively a TRiM
Practitioner must attend to allocate TRiM resources and to ensure that the
TRiM documentation is completed properly.
5
V.01 AUG 2011
RESTRICTED
RESTRICTED
b.
Filtering. When it has been decided that a TRiM intervention should take place the
planning team must identify those involved in the incident and categorize them in relation
to their involvement in, and proximity to, the incident.
c.
TRiM Risk Assessment. Having considered the incident the planning team must
decide whether the risk assessments should be carried out individually or within a group9.
Ideally, group TRiM risk assessments should be carried out by a TRiM Coordinator and a
Practitioner or in extremis two Practitioners.
(1)
Initial Risk Assessment. The initial TRiM risk assessment, which is conducted
at least 72 hrs after the incident, has two major functions. First, it allows for simple
needs assessment which, depending on the circumstances may result in the individual
being directed to seek help from the MO. Second, it sets a baseline by which the
second risk assessment can be judged. It should be noted that TRiM is not compulsory
as this would be counter productive.
(2)
Second Risk Assessment. This will be conducted one month after the initial
risk assessment. The importance of the one month follow up assessment is threefold:
(a)
Individuals may not suffer stress immediately after the incident, but may
develop psychological problems after a delay. This will not be detected if only
one risk assessment is conducted following an incident.
(b)
Some individuals will continue to experience psychological distress
following the initial risk assessment. If this happens then they should be
considered at risk of developing long term psychological problems which a
stand-alone risk assessment would not detect.
(c)
The progress of an individual coming to terms with a traumatic event
can be gauged by comparing their psychological and behavioural state during
the initial risk assessment with that at the one month risk assessment.
(3)
Third Risk Assessment. In most cases a third risk assessment (at the 3
month point) is unnecessary. However, an individual may present with problems
during ongoing monitoring and support which justifies a third risk assessment being
carried out.
d.
Briefing Meeting. This should be delivered to personnel who have been exposed to a
traumatic incident and who are currently not considered to be at risk of developing
psychological problems. The purpose of the briefing meeting is to dispel rumour and to ensure
that all those involved are aware of the support available if the need arises.
13.
Where incidents are ongoing it is important to manage the scene in order to reduce
unnecessary exposure to trauma. Where human remains are to be recovered, TRiM trained
personnel can provide advice on the psychological management of those involved in the recovery
process. A summary of the TRiM process carried out after an incident is at Annex C.
CONFIDENTIALITY
9 If an individual is undergoing TRiM then they do not necessarily need to be placed on the SVRM register.
6
V.01 AUG 2011
RESTRICTED
RESTRICTED
14.
The peer delivered approach to TRiM is based on trust and it is critical that confidentiality is
maintained. This is made clear to TRiM trained personnel, but it is essential that the principle of
confidentiality is maintained throughout. During TRiM risk assessments and interviews, TRiM trained
personnel must explain the principle of confidentiality; and outline the circumstances in which it may
be breached. Confidentiality has to be broken only to prevent: the risk of self harm, a danger to
others, a serious crime (civil or military), a breach of security or the effectiveness of a soldier being
compromised in the course of their duty.
DOCUMENTATION
15.
It is a requirement that records are maintained for all TRiM interventions10. TRiM activity must
be recorded in both the TRiM Log Book and on JPA.
a.
TRiM Log Book. The TRiM Incident Log Book is an auditable document in which the
following must be recorded:
(1)
Details of the incident.
(2)
Details of those directly and indirectly involved.
(3)
Details of decisions made at the planning meeting and those in attendance.
(4)
Details of those invited to be risk assessed (and those who decline assistance).
(5)
Risk assessment scores and action taken.
b.
The unit TRiM Coordinator must maintain each Log Book, updating it after each risk
assessment. Once the Incident Log Book is closed by the TRiM Coordinator it must be
securely stored and retained for 24 months from the date of the last entry, it must then be
forwarded to TTC(A) where it will be archived. Incident Log Books are to be accounted for in a
suitable register in accordance with MOD guidance; they are not to be considered as medical
documents and are classified as ‘Sensitive Personal Data’. Under no circumstances should
they be accessed for career management purposes. It should be noted that information can
only be entered into the TRiM Incident Log Book with the consent of the individual concerned.
All TRiM documentation is personally confidential and must be managed in accordance with
DPA98.
c.
The following procedures are to be implemented when dealing with those personnel
who are temporarily attached to or who augment a Formed Unit:
(1)
Attached Personnel and Individual Reinforcements (IR). TRiM
documentation relating to personnel who are temporarily attached to a unit, who have
been involved in an incident and subsequently undergone an initial risk assessment
must be copied as a matter of priority to the individual’s permanent duty station by the
losing unit’s senior TRiM Coordinator (this may be via the ROG if the individual is
leaving theatre early); this will ensure follow up risk assessments are carried out. TRiM
Log Books are retained for 24 months after which they are to be forwarded to the TRiM
Training Cell.
10 For assurance purposes, TRiM is part of a unit’s SPS inspection.
7
V.01 AUG 2011
RESTRICTED
RESTRICTED
(2)
Regular Reserves (RR). TRiM documentation relating to RR personnel who
are temporarily attached to a unit, who have been involved in an incident and who have
undergone an initial risk assessment, must be copied to RTMC (this may be via the
ROG if the individual is leaving theatre early) where, and if within the prescribed time
frame (one month from initial risk assessment), a second risk assessment can be
carried out. If the individual’s time at RTMC does not correspond with receiving a
second risk assessment then all TRiM documentation must copied to the individual’s
Regional Brigade who will be responsible for any subsequent TRiM interventions.
Regional Brigades are to manage TRiM Log Books for a period of 24 months after
which they are to be sent to TTC(A).
(3)
Territorial Army (TA). TRiM documentation relating to TA personnel who are
temporarily attached to a unit, who have been involved in an incident and who have
undergone an initial risk assessment, must be copied to the individuals permanent TA
Unit (this may be via the ROG if the individual is leaving theatre early). This will ensure
follow-up risk assessments are carried out. TRiM Log Books are retained for 24
months after which they are to be forwarded to TTC(A).
(4)
Personnel Newly Assigned to a Unit. Newly assigned personnel must have
their TRiM status checked by the receiving unit. Where necessary receiving units are
to ensure that any outstanding Trim risk assessments are completed.
d.
Recording on JPA. Recording TRiM activity on JPA is now mandatory and auditable.
Unit HR staffs are responsible for data input (see Annex D for details) onto JPA. This record is
a management tool showing which stages of the TRiM process have been completed. This
can be referred to during arrivals checks and as part of the Stress Management process.
TRiM IN RELATION TO POSM
16.
TRiM trained personnel may play a key role in the POSM process including helping to ensure
that the decompression process is as psychologically beneficial as possible, presenting POSM briefs,
advising the chain of command about healthy routines for normalising troops and providing informal
support to those identified during the POSM process as being at increased risk of mental ill health.
Whilst POSM and TRiM are distinct processes they work synergistically to support psychological well
being of LF personnel.
WELFARE OF TRiM TRAINED PERSONNEL
17.
The welfare of TRiM trained personnel is an important consideration which must be addressed
by units. The Padre and UWO should be encouraged to engage with unit TRiM trained personnel and
to be watchful for the signs of excessive stress. TRiM Coordinators are initially responsible for
monitoring the welfare of TRiM Practitioners; although by the very nature of their training TRiM trained
personnel are well placed to seek assistance. TRiM trained personnel must not carry out TRiM risk
assessments if they are experiencing personal traumas of their own.
SUMMARY
18.
TRiM is regarded as an essential strategy which is there to support personnel on operations,
exercises and in their unit lines. It is not directed towards forced emotional expression or the relief of
strong suppressed emotions, but rather it identifies and assesses those who might be at risk of
8
V.01 AUG 2011
RESTRICTED
RESTRICTED
developing problems as a result of being involved in an incident and ensuring that those who need
help are assisted in seeking it.
19.
The point of contact for this LFSO is SO1 Personnel Support (94331 3888) LF-DPS(A)-PS4A-
PS-SO1 to whom any comments or suggested amendments should sent.
M W Poffley OBE
Maj Gen
for CinC
Annexes:
A.
TRiM Policy Statement (example).
B.
Unit TRiM Plan (example).
C.
Summary of TRiM Process.
D.
Guidance on using JPA for the Recording of TRiM Activity.
9
V.01 AUG 2011
RESTRICTED
ANNEX A TO
LFSO 3217
DATED AUG 11
COMMANDING OFFICER’S POLICY LETTER
TRAUMA RISK MANAGEMENT IN THE (Unit title)
INTRODUCTION
1.
Trauma Risk Management (TRiM) is a proactive, peer group delivered activity that aims to
support individuals following exposure to a traumatic event. Its purpose is the early identification of
the signs and symptoms of stress and where necessary assist those who require help and support
to seek it. It is a management initiative and is not medical in nature, although the Medical Officer will
be required to support the strategy by providing a medical referral service for individuals identified as
being at increased risk.
CONCEPT OF EMPLOYMENT
2.
For many of us exposure to traumatic events is an occupational hazard, although, contrary to
many media claims, estimates of psychological injury as a result of service are low. Nevertheless, it is
inevitable that some of those who are exposed to traumatic events will become psychologically unwell
as a consequence. The management of traumatic stress is primarily a command responsibility; it is
essentially good leadership.
3.
I have appointed
(********) as the unit TRiM Coordinator.
He/she is to ensure the unit
maintains sufficient numbers of TRiM trained personnel and that they are current and competent.
He/she is to coordinate all matters relating to TRiM, which includes the production and management
of the Unit TRiM Plan. Furthermore,
he/she is to liaise closely with the Medical Officer, who is
responsible for ensuring that those requiring treatment for stress related problems receive it. In
addition to this, the Padre and Unit Welfare Officer are also to be TRiM aware as it is likely that they
will be called upon to provide support following an incident.
4.
Sub-units are to nominate an officer or Warrant Officer to act as the sub-unit TRiM
Coordinator. This individual is to liaise with the unit TRiM Coordinator to ensure that TRiM is delivered
coherently and consistently across the unit. Furthermore, sub-units are to have a minimum of 5 TRiM
trained Practitioners who are to be suitably experienced and have the acumen to undertake the TRiM
Practitioner role. TRiM affords commanders a number of options when dealing with a traumatic event;
however commanders at all levels are to fully understand and comply with the Unit TRiM Plan.
TRiM AWARENESS
5.
Before deployment on operations all ranks are to attend a pre deployment TRiM brief which is
designed to increase awareness of stress related issues and demonstrate how the unit will respond to
traumatic incidents. On return from operations further awareness training is to be carried out during
the normalisation process which will include a Post Operational Stress Management (POSM) brief.
Some symptoms of post traumatic stress can be slow to develop or can be delayed; for this reason
those who are deemed to be most at risk should be monitored for a minimum of three months after a
traumatic incident. If these individuals or groups show signs of difficulty, they should be encouraged to
seek help from the MO at the earliest opportunity. Particular care is to be taken over the management
of those individuals who are to leave the unit after incidents or operational tours.
A - 1
SUMMARY
6.
The numbers of soldiers who develop chronic psychological problems following a traumatic
incident are very small compared to the numbers deployed on operations. For this reason the problem
should not be overstated, but an awareness of the symptoms and the identification of the small
minority who may need support is extremely important. Others may experience adjustment difficulties
and these soldiers too may need our assistance. TRiM should be regarded as an essential welfare tool
available to support our soldiers on operations, exercises and in barracks. It should be noted that
although TRiM is directed at the operational environment it is not confined to it. The management of
stress is the responsibility of commanders at all levels and not just those in the medical chain.
A N Example
Lt Col
Commanding Officer
A - 2
ANNEX B TO
LFSO 3217
DATED AUG 11
TRiM Training Cell (A) - Example Only
TRAUMA RISK MANAGEMENT PLAN
Pre-Deployment Trainin
Serial
Event
Deadline
Action
Personnel Involved
Responsibility
Date Completed
Remarks
Liaise with Regt Ops team and discuss unit
Regt TRiM
Purpose will dictate concentration of TRiM effort in specific quarters -
1 Identify scope of TRiM commitment in theatre of operation.
purpose across the spectrum of operations
Ops Offr/Asst Ops Offr/Regt TRiM Coordinator
Coordinator
higher risk of trauma & frequency of occurrence = greater concentration.
in theatre.
Examine the OET. Identify largest
concentration of troop effort, identify the threat
level in each location, identify troop role in
each location and balance risk against
There must be sufficient TRiM Practitioner flex in each location to
Identify specific TRiM requirement at each location. (Threat
numbers likely to be affected. Assign sufficient
Regt TRiM
2
Ops Offr/Regt TRiM Coordinator
deal with all situations likely to occur. Calculate a ratio of at least 1
potential v Quantity of troops likely to be affected).
practitioner (and coordinator) posts in each
Coordinator
(practitioner):14 (troops) (worse case scenario).
location to afford manpower flex and address
a TRiM related incident within 48 hours
(including periods of R&R) without burnout of
tasked Practitioners.
Use the OET to compile a list of various
ranks (Cpl to Capt) in accordance with the
assessment carried out at serial 2.
Liaise with each sub-unit (either OC/2IC or
WO) and confirm first glance selection of
Regt TRiM
3 Selection of unit personnel for Practitioner training.
OC, 2IC or WO & Regt TRiM Coordinator
individuals is suitable for the role of
Coordinator
practitioner/coordinator.
Individuals selected as potential practitioners
undergo a selection questionnaire to determine
suitability for role.
Sub-unit CoC any changes to first glance selection. Specific reasons
for change are not to be disclosed as these form part of the personal
Compile nominal roll of confirmed suitable
Regt TRiM
4 Ratify list of those selected for Practitioner training.
Regt TRiM Coordinator
information resulting from the selection questionnaire - which was
candidates.
Coordinator
completed in confidence. OC's/2IC's/WOs are only to be told that an
individual was 'unsuitable at the selection stage'.
TTC (A) courses load a total of 12. Practitioner courses are in high
demand with a booking profile exceeding 5 months. The solution is to
Regt TRiM
5 Book Practitioner Courses for selected personnel.
Liaise with TTC (A) for course programme.
Regt TRiM Coordinator
host the TTC (A) at the Regt, thereby controlling the loading list,
Coordinator
reducing T&S from the operational budget and ensuring the unit TRiM
commitment is met.
Coordinator courses are run infrequently and there are few of them.
Regt TRiM
This is due to insufficient demand. Most units follow the generic Op
6 Book Coordinator Courses for selected personnel.
Liaise with TTC (A) for course programme.
Regt TRiM Coordinator
Coordinator
requirement for TRiM thus bidding for vacancies on these courses is
not an issue.
Pre-deployment requirement consists of recording the names of all
7 OSM recording requirement.
Prepare unit HR staff for JPA OSM recording.
Unit Administators
RAOWO
personnel who have received a briefing covering TRiM and
associated operational stress.
B - 1
Inform them of their involvement in the TRiM
Regt TRiM
8 Liaise with unit Padre and UWO.
process and the necessity to understand the
Padre/Medical Centre/Regt TRiM Coordinator
Coordinator
TRiM model.
Regt TRiM
9 Create TRiM Unit Action Plan.
Promulgate to CoC
Regt TRiM Coordinator
Plan should be mostly generic but must incorporate the nuances
Coordinator
particular to the unit role in theatre.
Compile abridged version of Operational
Regt TRiM
General overview of TRiM function to inform all personnel of the
10 Presentation - Introduction to TRiM (purpose and function of unit
All unit personnel deploying
unit requirement and rationale for peer support following
Stress presentation provided by TTC (A).
Coordinator
roles).
exposure to a traumatic incident.
Presentation provided by TTC (A) shows graphic content of mutilated
bodies. Having discussed the extent of body handling by troops in
Afghanistan with both the medical services and the SIB, the likelihood of
Compile abridged version of handling human
Regt TRiM
11 Introduction to handling human remains briefing.
All unit personnel deploying
soldiers from this unit being involved in a pre planned body parts
remains presentation provided by TTC(A).
Coordinator
recovery operation is highly unlikely. Presentation in current form is thus
deemed inappropriate. Adumbrative guidance only at this stage, with
follow up practical procedure at a later date.
FOB practitioners to report directly to the Regt TRiM Coordinator for
notification only of an incident involving ----- troops at that location. As
Regt TRiM
12 Compile TRiM organisational schematic.
Promulgate to CoC
Regt TRiM Coordinator
the FOB personnel will be embedded with another unit it is deemed
Coordinator
pragmatic that incidents at that location will be swept up by the TRiM
plan created by that unit.
Delivered as a stand on forthcoming
Regimental exercise (TBC). To include
reference to Op BARMA, correct application of
PPE, photographing/sketch plan of area, GR,
Trg Wing & Regt
Regt 2IC to confirm date required. Trg Wing to provide body parts
13 Practical training regarding the handling of human remains.
Medical Centre, Trg Wing & All unit personnel deploying
packaging drill, location report, (Place, date,
TRiM Coordinator
scene, Regt TRiM coordinator to explain recovery process.
time, who found, what was found, who was the
body part handed to on return to base). Outline
the purpose of Op ELEKTRA.
5 x packs (1 per Team Leader) each consisting of 10 x disposable masks,
50 x disposable masks, 24 paper suits and
Medical Centre
14 Prepare Body Parts Handling (BPH) PPE.
TRiM Teams
6 x paper suits and 1 box of rubber gloves. Further supplies can be
5 boxes of rubber gloves required.
Practice Manager
obtained from the medical centre and RMP in theatre if required.
Starter packs consisting of all relevant TRiM
Regt TRiM
Documentation will need to be photocopied in theatre prior to use.
15 Prepare TRiM documentation packs for each Coordinator.
documentation, current TRiM policy, unit
Regt TRiM Coordinator
Coordinator
Packs intended to be lightweight for transit purposes.
TRiM Org schematic, and unit action plan.
This exercise is intended to gain as much information as possible
Conduct Stressors -v -Resources analysis of
TRiM Coordinators
about each soldier for the purpose of team cohesion and appropriate
16 Troop familiarisation.
soldiers under command to gain appreciation
TRiM Teams
planning following a traumatic incident. Consult Regt TRiM Coord if
of vulnerability potential.
further guidance required.
Provide copy of TRiM org schematic to
Regt TRiM
17 Brief TRiM team on reporting chain and extent of responsibilities.
all qualified personnel and specifically
TRiM Teams
state individual responsibility.
Coordinator
All officers and WOs in station (less those TRiM qualified) to attend
18 Commanders (TRiM) briefing.
Deliver TTC presentation.
All officers not TRiM trained
TTC
J1 Study Day.
Check quantity and notify Team Leaders
Regt TRiM
Distribute amongst Practitioners for packing in personal kit and recover as
19 Disseminate BPH PPE.
TRiM Teams
of supply source in theatre.
Coordinator
a whole on arrival in theatre. Store as a crash out kit.
Team Leaders to outline TRiM unit action
TRiM Coordinators
Multiple Commanders to be aware of all TRiM trained personnel at
20 Multiple Commanders’ discussion period.
plan to Multiple Commanders and reinforce
All troops conducting patrolling duties in theatre
peer support system.
their location.
B - 2
TRiM Deployed
Serial
Event
Deadline
Action
Personnel Involved
Responsibility
Date Completed
Remarks
TRiM Coordinators
TRiM Coordinators
21 Sub units to confirm that TRiM documentation is held at their location. Arrival + 1day Each location to notify Regt TRiM Coord
Opportunity to photocopy will be available during the RIP, if required.
If location TRiM Coordinator is uncontactable or unavailable to control
Location
Incident
Implement Stage 1 Regt TRiM Reaction
TRiM Practitioners, TRiM Coordinator
and oversee the TRS then the most senior TRiM Practitioner present
22 Incident Occurs.
TRiM Coordinator
+ 30 mins
Strategy (TRS).
& Ground Comd
is to commence Stage 1 in his absence. There is to be no delay of
action due to the absence of a TRiM Coordinator.
Location
Incident
23 Within first 24 hours.
Implement Stage 2 of the Regt TRS.
TRiM Practitioners
TRiM Coordinator
TRiM Coordinator to have assumed full control by this stage.
+24 hrs
Incident
Complete Annex E to LANDSO 3209 and
TRiM Coordinators
TRiM Coordinators
Regt TRiM Coordinator to liaise with Adjt (rear) and notify for TRiM
24 AEROMED & POSM.
+ 48 hrs
send to UWO.
UWO
and POSM follow up at rear.
TRiM Practitioners, TRiM Coordinator, Other
Location
Incident
25 Within first 72 hours.
Complete Stage 2 of Regt TRS.
relevant personnel at the scene.
TRiM Coordinator
Must be in a position to commence Stage 3 at the 72 hour point.
+72 hrs
Location
Incident
Early identification of those with problems and signposting to
26 72 hours +
Implement Stage 3 Regt TRS.
TRiM Practitioners
TRiM Coordinator
+96 hrs
medical chain where appropriate.
Location
Those risk assessed must be followed up at the 1 month point and scores
Incident +
27 28 days.
Follow up risk assessments where required.
TRiM Practitioners
TRiM Coordinator
compared to initial RA. Details entered in incident log and forwarded to
6 weeks
TRiM coordinator.
Monitoring will continue on return to the UK at EOT, however, the plan
28 28 days +
Until EOT
Continued support and monitoring by CoC.
TRiM Practitioners
TRiM Practitioners
in theatre will be more stringent due to the tempo and type of activity.
Decided by Letter of thanks to soldier who is not returning
29 AEROMED correspondence.
Adjt (fwd)
CO
Template in LANDSO 3209
CO
to theatre.
Flown out +
30 Decompression activity for short toured personnel.
24 hrs Contact NSE.
Adjt (fwd)/Adjt (rear)
CO
Unit may need to appoint a Decompression Adviser to assist NSE.
On arrival Rolling programme to be devised
31 Normalisation activity for short toured personnel.
Adjt/UWO/RAO
Adjt (rear)
Programme should mirror Normalisation procedure for unit
back in UK and implemented.
personnel returning after a full tour.
6 - 4 weeks
32 Decompression activity (Bde decision).
before EOT Establish contact with NSE.
Adjt (fwd)
CO
Decompression activity may require input from unit personnel
Intended to raise awareness of potential increase of stress related injuries
4 weeks Contact APHCS Regional Clinical Director
Medical Centre Practice Manager & Regt TRiM
Medical Centre
33 APHCS - population surge.
Population surge on local civilian healthcare system may require forward
before EOT and notify of unit return.
Coordinator
Practice Manager
planning by APHCS.
2-4 weeks Deliver presentation(s) for families of returning
Must be delivered as close as possible to EOT date. UWO must
34 Operational Stress brief - Families.
Welfare Office
UWO
be familiar with LANDSO 3209. TRiM leaflets to be distributed
before EOT troops.
during families brief.
Return From Deployment
Serial
Event
Deadline
Action
Personnel Involved
Responsibility
Date Completed
Remarks
Identify those most vulnerable to stress
related conditions.
Link in with Decompression Team
delivering Stress presentation and
provide input if required.
Record on POSM Annex E for each
Majority of this should be done prior to departure from theatre. Meeting
On arrival
TRiM Coordinators
Regt TRiM
35 Decompression.
of all Coordinators to confirm vulnerability list to take place during
in Cyprus soldier. Pass to Med Chain via FMed 965.
Coordinator
decompression.
Copy of Annex E held on Quad 9.
Consider SVRM.
Compile nominal roll of those present
at decompression.
B - 3
4 weeks prior to EOT, Adjt (rear) is to compile a list of all deployed
soldiers/officers who are due assignment change within the first 4 weeks
On return to Complete LANDSO 3209 Annex E and
TRiM Coordinators
36 Assignments out on return from theatre.
Adjt (rear)
after EOT. This list is to be sent to the Regt TRiM Coordinator (Adjt (fwd)).
home unit forward with Q9 to new unit.
& Rear Party RAO
The POSM Annex E will be completed in theatre prior to departure and
processed on arrival back in the UK during Normalisation.
CO to decree duration.
Consider:
On return to
Adjt (rear)/RAO/Sqn OC's
37 Normalisation.
Completion of post op admin (reverse MCCP)
CO
home unit
TRiM Coordinators/UWO
Sufficient time to allow reintegration of
deployed personnel with rear party personnel
and families.
On return to Secure all TRiM documentation in unit
Regt TRiM
All TRiM documentation to be held for 2 years at unit level, after which
38 Security of TRiM documents.
Regt TRiM Coordinator/UWO
home unit Welfare Office.
Coordinator
it is forwarded to the TTC (A) at Camberley for archiving.
On return to Padre to deliver pastoral presentation
39 Home coming brief by Padre.
Adjt (fwd)/Adjt (rear)/Padre
Padre
home unit and invoke discussion.
Present the system in place through the medical
Linkage with the Padre home coming brief is essential as one should
On return to
40 Medical input from the CMP as required.
chain to deal with psychological trauma,
Adjt (rear)/CMP
CMP
naturally flow into the other. Adjt (rear) is to liaise with the CMP TRiM
home unit outlining the different levels of support.
poc and confirm his availability to talk to all on the day.
The aim is to increase awareness of stress/trauma induced
psychological indicators and promote a buddy buddy culture across the
regiment. Creating awareness at this stage facilitates problem
identification early on. Emphasis must be placed on the support
Overview/reminder delivered by
Regt TRiM
agencies available both internally and externally and to provide points of
41 Effects of operational stress.
Prior to POL
TRiM Practitioners/UWO
TRiM Practitioners at sub-unit level.
Coordinator
contact within the unit for assistance if needed. Those to be assigned to
other units need to be notified of the POSM Annex E form that
accompanies their Quad 9 and of the requirement to notify the UWO at
the new unit of the POSM procedure that needs to be conducted. Regt
TRiM Coordinator to organise - Practitioners and UWO to deliver.
Record all personnel having undergone
Recorded iaw HQLF/PersOps/2905 dated 29 Oct 06. SSM's to
42 OSM recording on JPA.
During POL
home coming brief and other operational
Unit Administators/SSMs
RAWO
provide nominal rolls of all those having attended briefings and hand
stress management presentations.
them to Sqn administrators for input.
TRiM Practitioners in conjunction with unit Welfare are responsible for
43 Support and monitoring.
POL + 1 day Implement support and monitoring programme.
UWO/Regt TRiM Coordinator
UWO
the programme. The Regt TRiM Coordinator is to provide guidance if
required.
Only to be implemented if heavy combat has been experienced and
Establish a welfare committee to manage
a large number of TRiM assessments have been conducted. If
44 Consider welfare review at regimental level.
POL + 5 days
2IC/Adjt/UWO/Regt TRiM Coordinator
CO
the TRiM issues within the regiment.
implemented, meetings to take place monthly and minutes recorded
with accountable actions assigned to individuals.
12 weeks after
45 Stress Briefing.
Standard POSM Stage 3 presentation.
All unit personnel that deployed
UWO
LANDSO 3209 Annex E (POSM record) for all personnel to be
return
updated with attendance at briefing.
6 months
after return
Entry on Pt 1 Orders in accordance with
46 Reminder of common reactions to traumatic events.
Adjt/Pt 1 Order Administrator
Adjt
Standardised suggested entry is published at Annex C to LANDSO 3209.
& quarterly POSM Stage 3 LANDSO 3209.
thereafter
B - 4
TRiM Training Cell (A) - Example Only
TRiM Reaction Strategy
Incident Ongoing and/or Task Incomplete
Serial
Stage 1
Personnel Involved
Responsibility
Completed (Y/N)
Remarks
TRiM Practitioners/TRiM Coordinator
TRiM Coordinator
1 Stage 1 Planning meeting
20 - 30 minutes max. Initial thoughts to alleviate the overall
/Ground Comd
potential psychological impact.
Commander's call based on the significance of the mission
Consider continuance of task with same troops based on extent of
2
TRiM Coordinator & Ground Comd
Ground Comd
outcome - this decision may need to be justified in a legal
psychological impact anticipated.
forum or elsewhere at a later date.
Careful selection - do not choose those who are known to be
pschologically vulnerable, or those who are good friends of
3 Appoint casualty treatment and evacuation teams (if applicable).
TRiM Coordinator & Ground Comd
Ground Comd
the injured or dead. Ask for volunteers if there is little choice of
personnel.
Approx Duration:
Commander's evaluation - rough estimate. Required to
TRiM Coordinator &
4 Estimate duration of task completion.
TRiM Coordinator & Ground Comd
approximate likelihood and extent of further TRiM related
Ground Comd
issues relevant to the activity taking place.
If achievable, troops exposed to a traumatic incident should
5 Identify replacements and/or reinforcements.
TRiM Coordinator & Ground Comd
Ground Comd
be replaced as quickly as possible to facilitate a reduction in
potential psychological impact.
Remove those most affected and deploy only those troops essential
Streamlining of manpower necessary to achieve the mission
6
TRiM Practitioners & TRiM Coordinator
Ground Comd
to complete the mission.
objective will reduce the overall psychological effect.
Careful selection is necessary - empathic, good interpersonal
TRiM Coordinator
7 Appoint a Liaison Officer for civilian interface if required.
TRiM Coordinator
skills and an understanding of the civilian culture, coupled with
suitable age and experience are necessary to fulfil this role.
Compile a list of all involved including (list is not inexhaustive):
1. Troops on the ground.
Other categories not listed must be accounted for. The extent
TRiM Coordinator
8 2. Rescuers.
TRiM Practitioners
of who is involved will depend on the scale of the operation
3. Medical personnel.
that has taken place.
4. Comms staff.
5. Support and logistics staff.
9 Consider adequate rest periods.
Ground Comd/Ground 2IC
Ground Comd
Create a shift system and inform all those affected of the hours
they will be working.
Rotation of personnel may fall out of sync with planned shift
system if individuals show signs of psychological trauma
Rotate personnel appropriately to minimise increase of
TRiM Practitioners/TRiM Coordinator
TRiM Coordinator
10
during their period of activity. Any plan must be flexible to
psychological trauma.
/Ground Comd
contend with this situation if possible given the environment
and geography of task.
Consider food options - curries, BBQ and meat dishes are
Ensure sufficient quantities of food and drink are freely available during rest
TRiM Coordinator
11
TRiM Practitioners
inappropriate where severe injury and mutilated bodies have
periods.
been witnessed. If a chef is available - liaise.
TRiM Coordinator
12 Implement high stress, low stress, rest initiative (cycle).
TRiM Practitioners & TRiM Coordinator
Necessary to allow psychosomatic recuperation between
tasks.
13 If decision is made to continue the task, ensure that it is completed.
Ground Comd
Ground Comd
Psychological impact could be exacerbated if continued effort
achieved nothing.
Intended to maintain self esteem. First glance at possible
psychological impact. Off going team member only, must brief
Obtain tactical brief from incoming team during rotation and praise
Multiple 2IC/Multiple Comd/TRiM Coordinator/Ground
the oncoming team commander of the tactical situation that
14
Ground Comd
effort/achievements.
Comd
awaits them (essential that they are not removed from the
usual briefing process as this can contribute to a feeling of
guilt if someone has been injured or killed).
Utilise skill set wherever possible to fulfil another post
TRiM Practitioners/TRiM Coordinator
TRiM Coordinator
elsewhere - intended for maintenance of self esteem and to
15 Re-assign those overtly demonstrating psychological trauma.
/Ground Comd
reduce further exposure. Ensure all those re-assigned are
tracked and monitored prior to TRiM intervention at Stage 3.
Maintains momentum of team involvement. Knowledge
facilitates mental preparation and provides structure to
16 Keep teams informed of events at frequent intervals.
Ground 2IC/Multiple Comd/Ground Comd
Ground Comd
thought process. Regular updates also provide commanders
with the opportunity to review psychological impact.
Sense of achievement is key to alleviating frustration. The
debrief should focus on the positive aspects of the operation
conducted particularly in the face of adversity. It should
17 Tactical debrief to all on completion.
TRiM Practitioners
Ground Comd
conclude with a reminder of the stress indicators associated
with such events, the buddy buddy system and the support
structure available through TRiM and the CoC.
Incident Concluded and/or Task Complete
Serial
Stage 2
Personnel Involved
Responsibility
Completed (Y/N)
Remarks
Establish the information that they have recorded concerning
the incident. Ensure that the information correlates with the
TRiM Practitioners and
TRiM Coordinator
facts known. Inform them that they are to delay the release of
18 Liaise with Media Ops & Media reporting on the incident.
TRiM Coordinator.
information until after regt brief has taken place. Names of
deceased and seriously injured are not to be included in
media publication until NOK informed.
Considerations:
1. Extent of recovery operation (number of body parts).
2. Smell.
3. Individuals who display no psychological trauma or are
detached from those involved should form the team(s).
4. Ensure team(s) are briefed on what to expect at the scene.
Mention avoidance of eye contact and not to conduct a search
of personal effects recovered.
TRiM Practitioners and
TRiM Coordinator
5. Appropriate PPE issued.
19 Appoint body part handling team(s) if required.
TRiM Coordinator.
6. Removal of body parts from scene - separate transport
from recovery team if possible.
7. Identify area for team to change and wash on return -
do not have team disposing of their own PPE.
8. Liaise with chef to ensure appropriate menu for
body handling team(s) when they return.
9. Transport team to be made aware of location for body part
processing.
10. Organise area for TRiM assessments on return of body
handling team(s).
Agree and organise suitable times and locations for those
directly involved to be interviewed as witnesses by the SIB
TRiM Practitioners and
where death or serious injury has occurred. Note: The SIB
20 Liaise with OC SIB
Ground Comd
TRiM Coordinator.
may have already visited and spoken to individuals but sub
unit commanders will be aware prior to them doing so. Ground
Comd to notify Adjt (fwd) of any SIB activity.
If there is a likelihood of psychological trauma affecting
TRiM Coordinator
TRiM Coordinator
21 Liaise with RAMC/Medical Centre
several individuals, it would be prudent to involve the
local RMO in the planning meeting if available.
TRiM Practitioners or
TRiM Coordinator
22 Complete TRiM log with as much information as available at this stage.
Complete nominal roll and stress incident record in detail.
TRiM Coordinator.
Instead of a full blown TRiM intervention with all concerned,
TRiM Practitioners, TRiM Coordinator, Other relevant
consider at this stage whether a Briefing Meeting iaw
TRiM Coordinator
23 Stage 2 Planning Meeting
personnel at the scene
Management Strategy 6, TRiM Training Manual, is more
appropriate. Do not however, use this format as an easy
option if full TRiM intervention is required.
Sufficient information is required at this stage to apprise all
Overview brief of what has occurred, including extent of exposure to specific
TRiM Coordinator
TRiM Coordinator
concerned of all of the facts known. There must be an
24 individuals or groups, to all in attendance.
opportunity for feedback from all present to ensure that detail
has not been omitted.
Filter exercise:
A. Those who were there at the time it occurred and witnessed it first hand.
B. Rescuers/helpers/medics.
TRiM Practitioners, TRiM Coordinator, Other relevant
TRiM Coordinator
25 C. Those involved at distance (Ops room etc.)
personnel at the scene
Conducted iaw TTC training.
D. Those who could or should have been there but were not.
E. Vulnerable people (those not involved but linked through
similar experience).
F. Those who attend through morbid curiosity.
Scale is dependent on volume of personnel, time required,
Determine scale of TRiM intervention at individual level and assess
TRiM Coordinator
TRiM Coordinator
complexity of incident and current mission objectives (what
26 the requirement for additional TRiM Practitioners to expedite the
needs to be achieved outside the wire whilst the TRiM
interview process.
process is taking place!)
TRiM Coordinator
TRiM Coordinator
Ensure practitioners are selected carefully, a JNCO/SNCO
27 Assign TRiM Practitioners to individual and/or group interviews.
should not be TRiM assessing an officer for example.
This must be done at the same time across the theatre of
operations and as quickly as possible after the event. The
appointed individuals to deliver the brief are to be of
sufficient rank and experience (suggested ranks are
Appoint individuals to deliver pre-prepared incident brief to all regt
TRiM Coordinator
Regt TRiM
WO2/WO1 and Capt to Lt Col). Where death or serious injury
28 personnel not undergoing group or individual TRiM assessment.
Coordinator
resulting in AEROMED has occurred, the briefing is to
include the requirement for the security of information until
the NOK have been informed. All personnel are to be
reminded of entries on social networking sites and the
content of telephone calls back to the UK.
Access to phones should also be made available to other
personnel involved, depending on proximity and
Establish priority access to telephones for troops directly involved in the
TRiM Coordinator
TRiM Coordinator
psychological impact. The purpose of this is to ensure that
29 incident.
(Team Leader)
(Team Leader)
families at home in the UK are informed of their well being
before the media publishes the occurrence. Again, security of
information is paramount until NOK informed.
Location may be devoid of suitable facilities to interview
individuals e.g. FOB. If facilities exist e.g. KAF, BSN, KBL,
TRiM Practitioners and
TRiM Coordinator
30 Arrange locations for TRiM interviews to take place (if necessary).
then use them wherever possible. Interviews are not to take
TRiM Coordinator (Team Leader)
(Team Leader)
place in close proximity to the incident scene or whilst the
noise of combat is still audible.
31 Produce schedule of interview activity.
TRiM Practitioners
TRiM Practitioners
Interviewing activity to commence no earlier than incident +72
hours.
Ensure all practitioners have sufficient quantities of TRiM
TRiM Coordinator
TRiM Coordinator
32 Issue copies of relevant TRiM documentation.
documentation or have access to a photocopier. To include
standardised TRiM advice leaflet.
TRiM Coordinator
TRiM Coordinator
33 Update the TRiM Incident Log.
Complete as far as possible.
TRiM Intervention
Serial
Stage 3
Personnel Involved
Responsibility
Completed (Y/N)
Remarks
TRiM Coordinator
TRiM Coordinator
34 Prepare RMO for availability at the conclusion of TRiM interviews.
To provide timely advice and assistance if required. The RMO
must be familiar with the TRiM model.
Temperature specific i.e. cold drinks - hot weather. If
35 Ensure refreshments are available throughout.
TRiM Practitioners/available troops
TRiM Practitioners
cookhouse located close by then use it.
Ensure practitioners have copies of documentation that can be referred
Geo Branch/Ops Offr/TRiM Practitioners/Assigned
TRiM Coordinator
36 to during the interview if they are available. E.g. maps, reports and items
Intended for clarity and ease of explanation.
Administrator
of media.
37 TRiM Interviews.
TRiM Practitioners/Sub unit Commanders
TRiM Practitioners
To commence NLT incident + 96 hours.
38 Issue standard TRiM advice leaflet.
TRiM Practitioners
TRiM Practitioner
To each person interviewed.
TRiM Coordinator
To be held centrally in a secure lockable container by the
39 Collate all completed TRiM documentation.
TRiM Practitioners
Coordinator and controlled by him. The contents are the
sole responsibility of the Coordinator.
1 month after TRiM assessment. If the review date falls within
R&R then the review is to take place immediately before the
soldier departs theatre (provided more than 3 weeks have
elapsed since the incident). If less than 3 weeks have elapsed
40 Organise review dates for all interviewees.
TRiM Practitioners/Sub unit Commanders
TRiM Practitioners
then conduct the review immediately upon the soldier's return
to theatre. If the incident occurs during the last 4 weeks of the
deployment then the soldier is to be reviewed during
Normalisation back in the UK and prior to POL.
Interviewees to be informed of the requirement to be flexible
41 Inform all interviewees of review dates.
TRiM Practitioners
TRiM Practitioners
as operational tempo may override the ability for the interview
to take place at the agreed time.
Ensure practitioners and sub unit commanders have adopted
a recordable monitoring strategy e.g. a log of interspersed
monitoring activity with comments relating to the demeanour,
behaviour, interaction with others and performance of those
TRiM Coordinator
subjected to a TRiM interview. Note - the sub unit commander
42 Create monitoring programme and implement.
TRiM Practitioners/Sub unit Commanders
role here is merely to observe and record specific
stress/trauma indicators in his men. They are not to be given
specific information regarding the account provided by the
interviewee during a TRiM assessment (unless the
interviewee has agreed for the information to be divulged).
Practitioners to approach coordinator and obtain a
controlled copy of previous TRiM interview record within 24
43 1 month TRiM review for all personnel TRiM assessed.
TRiM Practitioners
TRiM Practitioner
hrs prior to the review taking place. Note any variations in
scores and report to TRiM Coordinator.
Controlled copy to be returned to the Coordinator together
TRiM Coordinator
with all newly completed documentation. The Coordinator is
44 Collate all completed TRiM review documentation.
TRiM Practitioners
(Team Leader)
responsible for destroying the controlled copy by shredding or
incineration.
Brief bespoke management plans need to be compiled for
each individual having undergone the TRiM process. For
those who are likely to display signs of increased
TRiM Practitioners and
TRiM Coordinator
45 TRiM Strategic Vista (TSV).
psychological trauma, the plan must cater for avoidance of
TRiM Coordinator (Team Leader)
associated trauma triggers where possible. A third
assessment may be necessary and this should be articulated
in the plan if decided as a course of action.
The content of any management plan is restricted to those who
are TRiM qualified unless the individual who has been
TRiM Coordinator
assessed has agreed for the information to be divulged to their
46 TSV information release to sub-unit commanders.
TRiM Interviewees/TRiM Practitioners
line manager or immediate CoC. Authority to release
information must be obtained in writing and a copy held with
the TRiM Incident Log.
All documentation relating to an incident is to be placed into a
TRiM Coordinator
TRiM Coordinator
suitable envelope marked with the TRiM incident number,
47 Complete the TRiM Incident Log and secure all information.
(Team Leader)
(Team Leader)
date stamped and signature sealed. It is only to be opened by
the Team Leader (Coordinator) or Regt TRiM Coordinator.
Monitoring log to be maintained. Sub unit commanders only
TRiM Coordinator
48 Continue monitoring programme.
TRiM Practitioners/Sub unit Commanders
involved if agreement is obtained in writing for the release of
information from the TRiM assessed individual.
TRiM Coordinator
Regt TRiM
All requests for copies of TRiM documentation by the SIB are
49 SIB Assistance (Request for information)
to be directed to the Regt TRiM Coordinator. No information is
Coordinator
to be released without this authority.
ANNEX C TO
LFSO 3217
DATED AUG 11
SUMMARY OF THE TRiM PROCESS
Pre Incident Strategies
Produce Unit TRiM Plan
Produce Commanders TRiM Directive
The designated Unit TRiM
Ensure the organisation has sufficient TRiM trained
Coordinator is responsible for
personnel
these tasks
Ensure that that TRiM trained personnel are current &
competent
Incident(s) Occurs
Post Incident Support
Carry out effective Site Management Strategies
Conduct a Planning Meeting
Filter those involved in the Incident
o
Individual TRiM Risk Assessment
o
Small Group TRiM Risk Assessment
Briefing Meeting
First Line Support
(Chain of Command)
First TRiM Risk Assessment (not before 72 hrs)
Monitor Closely
Use internal Support
Systems
Remove from source of
Second TRiM Risk Assessment (mandatory one month)
stress if possible
Ensure that the second
risk assessment is
carried out
No problems or problems
Problems Continue
resolved.
Liaison
The TRiM Coordinator may
choose to conduct a further
If during the 3
risk assessment at the 3
month risk
month point or alternatively
assessment the
Liaison
the
individual
TRiM Coordinator can close
presents with
the Log Book and annotate
trauma related
Second Line Support
the Unit TRiM Diary
issues
‘Sign Post’
accordingly
Medical Officer
Padre
Unit Welfare Officer
Mental Health Services
Problems Continue
ANNEX D TO
LFSO 3217
DATED AUG 11
GUIDANCE ON USING JPA FOR THE RECORDING OF TRIM ACTIVITY
1.
TRiM activity is to be captured on the JPA OSM record as soon after the event as
possible. The following table illustrates TRiM activities that are to be recorded.
2.
The right of the table shows existing OSM headings on JPA which TRiM activity is to
be recorded against.
TRiM
JPA – Operational Stress Management (OSM)
Stage 1 – Pre-Deployment – Briefing
Risk Assessment 1*
Stage 1 – Pre – Deployment RAF Interview
Risk Assessment 2*
Stage 2 – Deployment – Coming Home Brief
Stage 2 – Deployment – Decompression
Stage 3 – Post Deployment – Dismounting Course
Risk Assessment 3*
Stage 3 – Post Deployment – Interview
Stage 3 – Post Deployment – RAF station Recall
Stage 3 – Post Deployment – Subsequent Interview
*You are to annotate the date the Risk Assessment was completed and date for next assessment
where relevant. No other information is to be recorded.
3.
Once the TRiM process is complete the JPA record is to be closed by HR staff.
4.
A guide to inputting data onto the OSM record is at:
http://www.ipublish.dii.r.mil.uk/nlapps/data/folders/JPA Do cs/IN908007.htm
5.
Handy tips on how to raise the OSM report are at:
http://defenceintranet.diiweb.r.mil.uk/DefenceIntranet/Library/Army/BrowseDocumentCategories/Infor
mationPolicyAndServices/InformationManagement/InformationManagementPolicyAndGuidance/
SmicHandyTips.htm
RESTRICTED
Not to be communicated to
L F S O
anyone outside HM Service
3218
without authority
LAND FORCES
STANDING ORDER NO 3218
by
GENERAL SIR PETER WALL
KCB CBE ADC Gen
Commander in Chief Land Forces
ARMY STRESS MANAGEMENT TRAINING POLICY
UPAVON
POC SO2 Aftercare
JANUARY 2010
XXXXXExt XXXX
TYP/JAN 10
RESTRICTED
LAND FORCES STANDING ORDER NO 3218
ARMY STRESS MANAGEMENT TRAINING POLICY
References:
A.
JSP 898 Part 3 – Chapter 13 Defence Stress Management Policy.
B.
JSP 375, Leaflet 25: Stress Management.
C.
AGAI Volume 3 Chapter 110 – SVRM Policy.
D.
2009DIN01-097 Tri Service TRiM Policy.
E.
LFSO 3217 TRiM Policy.
F.
LFSO 3209 Post Operational Stress Management Policy.
Background
1.
Reference A recognises that all personnel require some degree of pressure or
stimulation to achieve best performance, but when the pressure becomes excessive, work
performance and the health of the individual can be adversely affected. Stress has been
defined as, “The adverse reaction an individual has to excessive pressure or demands
placed upon them”1. It is also recognises that it is natural for individuals to feel stressed at
times: particularly when they feel that they cannot cope. There is no simple way of
predicting what will cause harmful levels of pressure and who will be affected. Personality,
experience, training, motivational factors and the support available from work colleagues,
families and friends will have an impact on an individual’s ability to deal with stressful
situations. Moreover, stress can manifest itself in physical, behavioural, mental or emotional
effects, or as a combination of these. These effects are normally short-lived and they cause
no lasting harm (ie when pressures recede there is a quick return to normal). Stress is not,
therefore, the same as ill-health. It is only when pressures are intense and prolonged that
the effects of stress can become more sustained and damaging, leading to psychological
problems and physical ill-health.
2.
The Army has a moral imperative and legal duty to protect the health, safety and
welfare of its personnel, including the risks arising from stress. Although some factors are
beyond the Army’s responsibilities or control, it is incumbent on individuals commanders at
all levels to be aware of them because these factors can make individuals more vulnerable
to stress at work, as will as affecting performance and judgement. External pressures
involved with family life, occupational stress2, operational stress3 and traumatic stress4 can,
at times, contribute to the risk faced by individuals. The basis of managing stress is to
assess the risk and introduce appropriate control and mitigation measures. Consequently,
Commanding Officers, Directors and Heads of Establishments are responsible for managing
the organisational implications to ensure the maintenance of operational/business
effectiveness. Commanders are required to identify and manage stress on operations and in
the workplace, look for the signs and symptoms of stress amongst personnel and then take
action to help alleviate them. Individuals are to be educated in recognising the signs of stress
in themselves and others and to know from where to seek help.
3.
In order to be able to carry out these responsibilities, Stress Management Training
(SMT) is to be provided to educate Army personnel in the ways that stress can be managed,
to prepare individuals for the rigours of operations and promote self-awareness and effective
working practices. Certain training is mandatory for all personnel and some is targeted at
1 Definition by the Health & Safety Executive.
2 Generally accepted as referring to stress in the workplace.
3 Defined as “an individual of group reaction to stressors relating to the operational context which, if not managed, may result in
impaired performance and possible effects on health”. JSP 375 Vol 2 Leaflet 25.
4 Usually as a result of a traumatic incident, defined as “any event which leads to an individual experiencing significant
helplessness, horror or fear and, as a result, has the potential to cause emotional of psychological harm”.
TYP/JAN 10
1
commander or carefully selected peers in the case of TRiM5, especially to support those at a
higher risk (eg personnel who have recently joined the Army, those about to deploy on,
currently deployed on or recently returned from operations). The intention is to equip
personnel to be resilient in stressful situations and remove the perception of stigma6.
Aim
4.
The aim of this policy is to set out the responsibilities for the management and
delivery of SMT across the Army.
Principles
5.
The principles are that:
a.
SMT is to be progressive, relevant to individual and command or supervisory
responsibilities and appropriate to the level of risk. It must emphasise the vital role of
the Chain of Command. Thus, SMT features in initial training and builds, at regular
intervals, through incorporation in key career courses that are supplemented with
specifically focused training when necessary.
b.
SMT is to be responsive to both general HSE guidance and specific
mission factors as defined in Commanders’ risk assessments, where this is
appropriate. Training is also to be responsive to changes in requirement, feedback
from operational lessons identified, Service Inquiry findings, direction received from
relevant committees/stress related committees and the findings of the Army
Wellbeing Survey7.
c.
SMT is to be integrated into the operational cycle as it contributes to
operational capability by preparing personnel for the realities of war and assisting
personnel to manage the potential consequences of occupational, operational
and traumatic stress.
d.
SMT is to be integrated across the Army to promote a common understanding
of nomenclature and avoid duplication in terms of design and development effort.
Scope
6.
This policy is applicable to all Army personnel, including Reserve
Forces.
Governance
7.
Responsibility for the formulation and promulgation of Army Policy on Stress
Management rests with DPS(A). DPS(A) is responsible for setting the SMT objectives and
is the Training Requirements Authority (TRA). DG AMS is the Competent Army Authority
(CAA).
8.
Army Mental Wellbeing Steering Group (AMWSG). The AMWSG assures that the
overall provision of SMT accords with the policy laid down by the Armed Forces Mental
Wellbeing Steering Group (AFMWSG). The AMWSG meets biannually. Training and
education are standing agenda items.
5 Trauma Risk Management.
6 Research evidence has shown that delays in the treatment of stress often arise as a direct result of the perceived stigma
which individuals suffering from stress associate with acceptance of the need to seek help and that, indeed, such stigma is
experienced more by those who are distressed; the result is that those who most need help are the least likely to ask for it.
7 Army Wellbeing Survey is being conducted by DSTL, with the survey being conducted in Sep/Oct 09 and the final report due
in Jan 10.
TYP/JAN 10
2
9.
Training responsibilities. DTrg are responsible for ensuring that the requirement is
included in generic training:
a.
Stress Management Training during Phase 1 and subsequent career military
training.
b.
Implementing the training objectives in compliance with both the policy and
Defence Systems Approach to Training (Quality Standard) processes.
c.
Reporting on issues concerning delivery and training policy
compliance.
Performance statements
10.
Training levels. SMT training has been categorised into 4 levels appropriate to the
seniority and specific responsibilities of the individual. In addition, deployment training may
be required at any level subject to employment in an operational environment.
a.
Level 1. Initial training for all personnel new to the Army aimed to ensure that
they recognise stress in themselves and others, and understand how to seek appropriate
sources of help should the need arise.
b.
Level 2. Aimed at those who manage others to ensure that they are
able to recognise signs of pressure and stress in themselves and their subordinates.
Included in this is an understanding of how to seek appropriate sources of help
should the need arise.
c.
Level 3. Aimed at those with responsibility for managing stress at an
organisational level in order to maintain operational and/or business effectiveness.
Included in this is an understanding of how to seek appropriate sources of help should the
need arise.
d.
Level 4. Aimed at non-medical personnel in posts with specific stress
management responsibilities who require additional training to enable them to carry out
their duties in key posts or to address specific risks. Included in this is an understanding
of how to seek appropriate sources of help should the need arise. Trauma Risk
Management (TRiM) falls within this category.
11.
SMT objectives. SMT objectives describing Performance, Conditions and
Standards are set out at Annex A. The Training Objectives have been approved by the 2
Star Service Personnel Executive Group (SPEG), and are incorporated into Formal
Training Statements and the Operation Performance Statement. Tolerable variations in
Army implementation may result in this training being delivered using a range of methods
and media.
Timing of training
12.
Initial/Induction Training (Level 1). All newly-joined personnel are to taught how to
recognise stress in themselves and others and to understand how to seek appropriate
sources of help should the need arise. Level 1 SMT is to be delivered in initial training to
enable trainees to recognise that certain feelings, thoughts and behaviours are normal from
the pressures inherent in initial training and that there are a number of ways that this can be
managed. Additionally training in self-help and “buddy” help techniques are to be delivered
to assist trainees to deal with pressure during Phase 1 training. Therefore:
a.
Level 1 for OR is to be complete the end of Phase 2 training.
TYP/JAN 10
3
b.
Level 1 for Officer Cadets is to be complete by the end of RMAS. In addition,
due to the junior command roles to be filled by Officer Cadets on commissioning,
SMT at Level 2 must also be completed whilst at RMAS.
13.
Continuation training. Stress awareness training in the form of MATT 6 is an
annual requirement.
14.
Career development. Personnel are to receive SMT at specific career points.
There are 2 SMT levels that reflect the distinction between commanding others (perhaps as
a reporting officer) and those with a wider duty of care throughout an organisation (as a
function of unit/formation command responsibility). This is summarised as follows:
a.
Commanding others (Level 2). Level 2 SMT is to ensure that those who
command others are able to recognise signs of pressure and stress in themselves
and their subordinates. Measures to mitigate stress as an individual are to be
included, including traumatic stress and supervision of those at risk of deliberate
self-harm (DSH) and suicide8. The training is also to include non-medical procedures
to alleviate stress and how to access specialist medical assistance when that is
required.
b.
Command/senior management (Level 3). Level 3 SMT is aimed at those
with responsibility for managing stress at an organisational level in order to maintain
operational or business effectiveness. It covers the management of the “pressure”
needed to maintain operational and occupational performance, organisational
strategies to alleviate stress which include interventions away from the workplace,
duty of care responsibilities for the management of post-operational and traumatic
stress, and procedures for those at risk of DSH and suicide.
15.
Specialist SMT (Level 4). Additional training to enable certain personnel to carry out
their duties in key posts or address specific risks; eg TRiM is included as an option for the
Chain of Command to use selected non-medical personnel in order for them to support
individuals following exposure to traumatic events. Reference E highlights the requirement.
16.
Operational SMT. Prior to undertaking an operational deployment, personnel are to
undertake continuation SMT. This is to be delivered as follows:
a.
Mission specific training. Mission Specific SMT will focus on how to
recognise occupational, operational and traumatic stress, and on making personnel
aware of the resources and facilities available to those identified as needing support.
The aim is to prepare personnel at all levels to carry out their duties under all
circumstances. The specific content of pre-deployment training will be tailored to
meet the nature of operations faced by then deploying force as identified in
commanders’ estimates and risk assessments. Commanders should take account of
prior training and experience when determining training content. The following
documents must be considered by commanders to tailor the appropriate pre-
deployment training: the Mounting Instruction and LFSO TRiM.
b.
Through-deployment training. Formal training is not continued during
operations and, therefore, only takes place in extremis. Mission-specific briefings or
aide-memoirs are to be produced locally if the Commander deems them necessary.
c.
Post-deployment. The specific stresses related to homecoming need to be
addressed post deployment. The use of appropriate leaflets, DVDs and briefings
should be considered as part of the Post Operational Stress Management (POSM)
package. This must also address the information that is given to families. Following
8 AGAI Volume 3 Chapter 110 covers the Suicide Vulnerability Risk Management Policy.
TYP/JAN 10
4
recovery to the home base, intervention strategies may be deemed to be appropriate
as part of force recovery mechanisms and readjustment/normalisation processes.
Commanders are to have sufficient trained personnel in place, as detailed in
Reference F, to identify and assist those individuals or groups that are at risk form
suffering a post-traumatic reaction.
17.
Transition to civilian life. Prior to leaving the Army, personnel should be given the
necessary briefings to equip them to cope with any problems connected with operational or
other forms of stress which might arise once they have returned to the civilian community. A
mental wellbeing assessment should be conducted as part of the final medical. This is not a
formal training event as part of the resettlement process but personnel should know where
to turn if problems arise post Service9. Commanders must also refer to D/DPS(A)/33 PS4(A)
dated 6 Aug 09 “Co-ordinating welfare and resettlement support needs identified during lead
up to discharge and beyond” as this covers identifying and assisting vulnerable service
leavers.
Training records
18.
Training records. Where SMT is delivered as a stand-alone course, recording of
the level of training achieved and date of that training is to be made on existing HR reporting
systems. Where SMT is delivered as part of a broader career course, separate recording is
not required.
Evaluation of training
19.
In accordance with DSAT (QS) the Army Mental Wellbeing Steering Group (AMWSG)
will review the effectiveness of the SMT policy based on some of the following: feedback
from the Chain of Command, survey and focus groups and research directed by DASA and
DAPS(Sci). Amendments to the training tasks and objectives are to be coordinated by the
AMWSG. Training effectiveness can only be assessed by noting trends of behaviour and
perceptions of personnel assessed through attitude surveys10 and monitoring the numbers of
stress-related complaints over time. The AMWSG monitors such trends and will propose
changes where necessary.
Instructional staff
20.
The delivery of military SMT instruction at Levels 1 to 3 should be undertaken by
suitably experienced members of the unit chain of command or, on command/career
courses, by appropriately qualified directing staff. In order to reinforce the message that it is
a commander’s responsibility to manage stress, junior commanders should deliver
continuation SMT at unit level for their own subordinates11.
Training facilities
21.
There are no specific training facilities required other than classrooms/lecture
theatres with IT support and e-learning facilities.
……………..
M W Poffley
Maj Gen
for CinC
9 The Royal British Legion and Combat Stress are two examples of voluntary organisations that may provide assistance to
veterans. The SPVA Veterans Helpline should be used in the first instance. For Mental Health issues post Service the first
point of contact is the local GP.
10 The Army Wellbeing Survey is due to report in Jan 10.
11 MATT/WIP 6 covers stress.
TYP/JAN 10
5
Annex:
A.
Stress management: training objectives to support tasks.
TYP/JAN 10
6
Annex A to
LFSO 3218
STRESS MANAGEMENT TRAINING (SMT): TRAINING OBJECTIVES
Requirement
TO No
Performance
Condition
Standard
Notes
C
L
A
1
Initial Training (Level 11)
1.1
Define pressure, stress,
√
stressors, strain, depression,
1.
On entry to Military
trauma and other forms of
Service.
mental unease or distress.
In accordance with JSP 375
1.2
Identify the different types of
2.
As an individual and as
Leaflet 25 and single-Service
√
stress.
a member of a team.
procedures:
1.3
Describe the causes of stress
√
(and depression)
3.
Supervised and
Unsupervised.
AC 64204
1.4
Identify the signs and symptoms
√
of stress (and depression).
4.
In and out of working
1.5
Recognise the effects of
hours.
√
traumatic stress.
1.6
Describe methods of stress
0. On and off duty.
√
management (primarily
buddy/buddy).
1. In all environments.
1.7
State the sources of support that
√
are locally available.
1Levels 1-4 refer to the descriptions at Para 10 of this policy.
TYP/JAN 10
A-1
Requirement
TO No
Performance
Condition
Standard
Notes
C
L
A
2
Managing Others (Level 2)
1. In context of additional
As above.
2.1
State the impact that stress,
command or supervisory
√
traumatic stress and
responsibilities as a team
depression can have on
leader.
individuals operational and
occupational performance.
2. As an individual and as
2.2
Identify ways in which stress
a member of a management
√
can be managed for:
group.
a. Self
b. Subordinates.
c. Peers
3.
Supervised and
Unsupervised.
2.3
Describe measures to prevent
√
Deliberate Self-Harm (DSH) and
suicide.
4.
In and out of working
hours.
2.4
Describe the assistance - short of
√
medical care - available to
address traumatic stress and
5.
On and off duty.
other forms of stress.
Describe the procedures used to
6. When dealing with
2.5
access specialist medical care in
civilian and military
√
the management of stress cases.
personnel.
7. In all environments
TYP/JAN 10
A-2
Requirement
TO No
Performance
Condition
Standard
Notes
C
L
A
3
Command/Senior Management
(Level 3)
3.1
Identify ways of managing stress
1. As an individual and as
to maintain operational and
a member of a team.
√
occupational performance of the
unit/ directorate/ department.
2. Supervised and
3.2
Identify ways of managing stress.
Unsupervised.
As above.
√
Recognise the appropriate level
of pressure as a means of
3. In and out of working
3.3
training and developing
hours.
√
subordinates.
Recognise duty of care
4. On and off duty.
responsibilities including regard
3.4
to traumatic stress, DSH and
√
suicide prevention.
5. When dealing
with civilian and
military personnel.
6. In all environments.
TYP/JAN 10
A-3
Requirement
TO No
Performance
Condition
Standard
Notes
C
L
A
4
Specialist Stress Training
(Level 4)
4.1
Operate post traumatic incident
1. As an individual and as As above.
√
procedures.
a member of a team.
4.2
Identify individuals/groups at
√
risk from traumatic stress.
2. Supervised and
Unsupervised.
4.3
Perform non-medical traumatic
√
stress functions (eg mentoring).
3. On and off duty.
4.4
Operate traumatic stress
√
reporting and administration
procedures.
4. When dealing with
civilian and military
4.5
Conduct stress audit procedures
personnel.
√
for (up to) 1* organisations.
4.6
Plan stress management
5. In all environments.
interventions (up to) for 1*
√
organisations.
TYP/JAN 10
A-4
Requirement
TO No
Performance
Condition
Standard
Notes
C
L
A
5
OPERATIONAL SMT
5.1
Pre-Deployment
1. As an individual and as
5.1.1
Identify the particular stressors,
a member of a team.
√
signs, symptoms and
strategies likely to be
encountered in theatre.
2. Appropriate to rank and
responsibility.
5.1.2
Prepare individuals for
√
heightened stress levels in
the face of increased risk.
3. Supervised and
Unsupervised.
AC 64204
5.1.3
Prepare individuals for
heightened stress levels in the
√
face of separation and concern
4. On and off duty.
for family members.
5. When dealing
with civilian and
military personnel.
6. In the context of the
(planned) operational
environment.
TYP/JAN 10
A-5
Requirement
TO No
Performance
Condition
Standard
Notes
C
L
A
5.2
Through-Deployment
1. As an individual and as
5.2.1
Identify personnel at risk following
a member of a team.
As above.
Managing
circumstances/events in theatre
√
personnel is an
which pose an acute source of
Operational task
stress or trauma.
2. Supervised and
not a Training task
Unsupervised.
(some training to
achieve this task
may be given if
3. On and off duty.
the operational
circumstances
permit
4. When dealing
with civilian and
military personnel.
5. In the context of the
operational environment.
TYP/JAN 10
A-6
Requirement
TO No
Performance
Condition
Standard
Notes
C
L
A
5.3
Post-Deployment
1. As an individual and as
5.3.1
Identify personnel at risk following
a member of a team.
As above.
√
Managing
circumstances/events in theatre
personnel is an
which pose an acute source of
Operational task
stress or trauma.
2. Supervised and
not a Training task
Unsupervised.
(Retrospective
5.3.2
Revise specific knowledge and
√
training to achieve
skills to manage stress.
3. Including family
this task may be
members.
given if operational
5.3.3
Review appropriate support
√
events have
methodologies and procedures
dictated additional
used to access specialist medical
4. On and off duty.
support is needed -
care in the management of stress
hence Ser 5.6-5.8
cases.
5. When dealing
with civilian and
military personnel.
6. In the context of the
events that were
experienced on operations.
TYP/JAN 10
A-7
Document Outline