A Review of the Effectiveness of a Combat and Operational Stress Control Restoration Center in Afghanistan.

BACKGROUND: The management of Combat and Operational Stress Reactions (COSR) within an operational environment is a multidimensional process. The aim is to help prevent behavioral health problems, preserve combat power, and increase return to duty rates for combat stress related casualties. In some COSR cases, enhanced services are required and the Combat and Operational Stress Control (COSC) Clinic refers Service Members (SMs) to the Freedom Restoration Clinic (FRC). The purpose was to describe a deployed restoration center in Afghanistan and examine the long-term effectiveness of those services.

METHODS: The data analyzed were obtained by a retrospective clinical records review from the participants' responses to the Outcome Questionnaire-45.2 (OQ-45.2) and a 30-Day Post-Restoration Program Survey created by the occupational therapist. The OQ-45.2 was administered pretreatment and immediately post-treatment. In addition, the OQ-45.2 and 30-Day Post-Restoration Program Survey was sent electronically by secure e-mail to each participant 30 days after treatment. These outcome measures were part of the standard operating procedures and were ongoing for the duration of the FRC restoration program. Descriptive statistics and frequencies were computed to describe participant characteristics. Paired t-tests were used to compare the means of the OQ45.2 total and subscale scores at pretreatment versus post-treatment and post-treatment versus 30-day follow-up.

FINDINGS: There were 37 participants with an average age of 29 years, primarily Army (81.1%), served in combat-support roles (75.6%), and reported no exposure to combat (89.2%). The results showed a statistically significant decrease (p < 0.001) in OQ-45.2 scores from pre to post for the total score and for each subscale. There was no significant difference in means when comparing post versus 30 days. Lastly, the top five utilized classes were anger management (78%), goal setting (76%), resiliency (76%), stress management (76%), and positive thinking (76%); 81% of SMs reported that they are almost always or sometimes using the lessons learned from the FRC.

DISCUSSION: This performance improvement project described an occupational therapist's role within a COSC restoration center and examined the effectiveness of the FRC program. There were several limitations: no control/comparison groups, use of only one clinical assessment tool, and a short follow-up. This performance improvement evaluation provides some empirical support for the utility of the COSC FRC program in reducing psychological distress in SM in a deployed environment.