From tents to sheets: An analysis of the CF Experience with Third Location Decompression after Deployment

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Appendix 2: CF Policy and Directives on Reintegration

Chief of Defence Staff Order 119
UNCLAS CDS 119

SIC LAD

BILINGUAL MESSAGE/MESSAGE BILINGUE

SBJ: DECOMPRESSION INITIATIVE AND STRESS MITIGATION DIRECTION

REFS:
 
A. DCDS DIRECTION TO INTERNATIONAL OPERATIONS 02/00 REV ONE
 
B. NDHQ COS J3 350 271400Z JUN 02 FRAG O 027
 

1. FOLLOWING A HIGHLY SUCCESSFUL SIX MONTH TOUR IN AFGHANISTAN, 3 PPCLI BATTLE GROUP COMPLETED A DETAILED DECOMPRESSION INITIATIVE AND STRESS MITIGATION PROGRAM. THE INITIAL LESSONS LEARNED FROM THEIR PROGRAM HAVE MAPPED OUT THE WAY AHEAD THAT THE CF WILL FOLLOW FOR ALL DEPLOYED OPERATIONS. THIS DIRECTION SHOULD BE READ IN CONJUNCTION WITH CHAPTER 16 AND PARA 1220 OF CHAPTER 12 OF REF A.
    
    
2. THE EXACT IMPACT OF THE 3 PPCLI BATTLE GROUP PROGRAM WILL ONLY BE DETERMINED AFTER A LONG TERM ASSESSMENT, BUT THE INITIAL LESSONS LEARNED HAVE BEEN POSITIVE. THESE LESSONS ARE SUFFICIENTLY SOUND TO WARRANT PROMULGATION OF THIS INITIAL DIRECTION TO FORCE GENERATORS AND TASK FORCE COMMANDERS CONCERNING THE DEVELOPMENT OF DECOMPRESSION AND STRESS MITIGATION PROGRAMS SPECIFIC TO THEIR MISSIONS. ALTHOUGH THE LESSONS LEARNED FROM THE 3 PPCLI BATTLE GROUP PROGRAM ARE SPECIFIC TO A LAND FORCE UNIT, THE PRINCIPLES CAN EQUALLY BE APPLIED TO ALL MISSIONS AND/OR COMPONENTS OF A JOINT TASK FORCE. THE ONUS IS ON TASK FORCE COMMANDERS TO ASSESS THE IMPACT THEIR MISSION HAS HAD ON THEIR PERSONNEL AND DEVELOP PLANS TO SATISFY THEIR DECOMPRESSION AND STRESS MITIGATION REQUIREMENTS.
    
    
3. THE OBJECTIVES OF DECOMPRESSION INITIATIVE AND STRESS MITIGATION PROGRAMS ARE TO MINIMIZE FAMILY REINTEGRATION STRESS AND ENSURE EARLY IDENTIFICATION OF ANY POTENTIAL HEALTH PROBLEMS BY PROVIDING SERVICE MEMBERS THE OPPORTUNITY TO REFLECT ON AND RECOGNIZE WHAT HAD BEEN ACCOMPLISHED DURING THEIR TOUR, TO GAIN A SENSE OF CLOSURE, AND TO FACILITATE A SMOOTHER REINTEGRATION TO CANADIAN SOCIETY. THIS CONCEPT WILL BE FURTHER DEVELOPED BY THE ADM (HR-MIL) BEST PRACTICE EXCHANGE SCHEDULED FOR 20-21 JAN 03. IN GENERAL, PROGRAMS ARE TO CONSIST OF FOUR PHASES:
    
   3.A. PHASE ONE. PREPARATION BOTH OF DEPLOYED PERSONNEL AND THEIR FAMILIES AT HOME (PART OF REDEPLOYMENT ACTIVITIES WHILE THE FORMER ARE STILL IN THEATRE)
    
   3.B. PHASE TWO. DECOMPRESSION IN A THIRD LOCATION (IF ASSESSED BY THE TASK FORCE COMMANDER AS REQUIRED)
    
   3.C. PHASE THREE. REINTEGRATION IN CANADA AT GARRISON LOCATIONS
    
   3.D. PHASE FOUR. POST MISSION FOLLOW UP
    
    
4. PHASE TWO, THE DECOMPRESSION IN A THIRD LOCATION, WAS INCLUDED IN THE 3 PPCLI BATTLE GROUP PLAN BECAUSE OF THE SIGNIFICANT CIRCUMSTANCES THAT WERE EXPERIENCED BY THE BATTLE GROUP IN AFGHANISTAN. THE CIRCUMSTANCES THAT INFLUENCED THE BATTLE GROUP REINTEGRATION STRATEGY WERE:
    
   4.A. THE BATTLE GROUP WAS MADE UP OF DETACHMENTS FROM 12 UNITS AND INDIVIDUAL AUGMENTEES FROM 17 OTHER SOURCES
    
   4.B. THE OPERATIONAL AND LIVING CONDITIONS IN THEATRE FOR THE BATTLE GROUP WERE SEVERE
    
   4.C. THE BATTLE GROUP SUFFERED A MAJOR TRAUMATIC ACCIDENT, AND
    
   4.D. DUE TO OPERATIONAL CIRCUMSTANCE, MISSION LEAVE AND R AND R WERE NOT AUTHORIZED. PERSONNEL WERE ACCORDED ONLY FOUR DAYS OF FORCED REST OUTSIDE OF AFGHANISTAN
    
    
5. TASK FORCE COMMANDERS A FORCE GENERATORS ARE TO DEVELOP DECOMPRESSION INITIATIVES AND STRESS MITIGATION PROGRAMS FOLLOWING THE FOUR PHASE MODEL DESCRIBED ABOVE. SPECIFICALLY:
    
   5.A. THE REINTEGRATION PLAN MUST BE SHAPED BY OPERATIONAL REQUIREMENTS TO FACILITATE THE ORDERLY RETURN OF DEPLOYED CF PERSONNEL. IT IS RECOGNIZED THAT THE EXTREME CIRCUMSTANCES EXPERIENCED BY THE 3 PPCLI BATTLE GROUP WILL NOT NECESSARILY APPLY TO OTHER CF OPERATIONS AND THIRD LOCATION DECOMPRESSION PROGRAMS WILL NOT BE REQUIRED FOR ALL MISSIONS
    
   5.B. EDUCATION AND PREVENTIVE SOCIAL WORK WILL BE COMPONENTS IN ALL PHASES. INDIVIDUAL AND GROUP COUNSELLING WILL BE AVAILABLE BUT NOT COMPULSORY IN ALL PHASES. FORMAL SCREENING TO IDENTIFY POSSIBLE AREAS OF CONCERN ABOUT INDIVIDUAL PHYSICAL, PERSONAL, SOCIAL, PSYCHOLOGICAL AND SPIRITUAL WELL BEING WILL BE CONDUCTED IN PHASE FOUR
    
   5.C. THE INTENT OF ALL PLANS MUST BE FOR SERVICE MEN AND WOMEN TO MEET THEIR FAMILIES AFTER MAKING A CLEAN BREAK FROM THE MISSION AREA. THEY ARE TO BE WELL RESTED AND IN GOOD SPIRITS AFTER HAVING COMPLETED THEIR MISSION
    
    
6. TASKS FOR TASK FORCE COMMANDERS. ALL TASK FORCE COMMANDERS ARE TO:
    
   6.A. ASSESS THE REINTEGRATION REQUIREMENTS FOR PHASES ONE AND TWO AND SUBMIT PLANS TO THE DCDS FOR APPROVAL
    
   6.B. PROVIDE, AS PART OF THEIR PLAN, AN ESTIMATE OF INCREMENTAL FUNDS AND/OR PERSONNEL REQUIRED FOR EXECUTION. FOR SMALLER MISSIONS, IT IS RECOGNIZED THAT A TAV COULD BE REQUIRED TO EXECUTE THE PLAN FOR THE TASK FORCE
    
   6.C. SUBMIT INITIAL CONCEPT OF OPERATION FOR THEIR DECOMPRESSION AND STRESS MITIGATION PLANS TO THE DCDS THREE MONTHS PRIOR TO REDEPLOYMENT. HEALTH SERVICE SPECIALIST ADVICE IS TO BE SOUGHT OUT THROUGH NDHQ J4 HSS IN DEVELOPING THE CONCEPT OF OPERATION. FOR SITUATIONS WHERE CIRCUMSTANCES WARRANT CHANGES TO THE INITIAL CONCEPT AFTER SUBMISSION, TASK FORCE COMMANDERS ARE TO ADVISE THE CHAIN OF COMMAND AS SOON AS POSSIBLE.
    
   6.D. SUBMIT FINAL PLANS TO THE DCDS ONE MONTH PRIOR TO REDEPLOYMENT
    
    
7. TASKS FOR FORCE GENERATORS. FORCE GENERATORS ARE TO:
    
   7.A. TAKE THE LEAD FOR PHASE THREE AND FOUR INCLUDING FINANCIAL RESPONSIBILITY
    
   7.B. ENSURE PLANS INCLUDE ALL RESERVISTS AND INDIVIDUAL AUGMENTEES SERVING WITH THE DEPLOYED TASK FORCE
    
    
8. REF A WILL BE UPDATED TO INCLUDE A SPECIFIC ANNEX TO CHAPTER 16 ON DECOMPRESSION AND STRESS MITIGATION. AS AN INTERIM MEASURE, REF B CAN BE USED AS A MODEL TO GUIDE PLANNING. SPECIALIST ADVICE IS AVAILABLE FORM NDHQ J4 HSS AND J7 LESSONS LEARNED. TASK FORCE COMMANDERS ARE ENCOURAGED TO DRAW ON THESE RESOURCES IN THEIR PLANNING PROCESS. FOR FUTURE TASK FORCE COMMANDERS, DECOMPRESSION AND STRESS MITIGATION IS TO BE INCLUDED IN THE PRE-DEPLOYMENT PACKAGE THEY RECEIVE FROM NDHQ PRIOR TO DEPLOYMENT

 

DCDS Directions for International Operations

Chapter 12: Post Deployment Requirements

1220. REINTEGRATION PLANS

 

1. Phase One – Preparation of Deployed Personnel and their Families at Home. During the planning process for the Reintegration Plan, in-theatre preparation for the redeployment begins and continues until the commencement of the actual redeployment. At the same time, Deployment Support Groups, Unit Rear Parties and Force Generator Mounting Bases should coordinate closely with Military Family Resource Centres 12-16/19 (MFRCs) on their role during this phase and throughout the reintegration process. Large missions with NCE/NSE/Major units deployed prepare to conduct all of the activities identified in their Reintegration Plan and in the Redeployment Checklist while still in-theatre. Small missions will conduct only those activities they have the capability for while deployed IAW their DCDS approved plan. Regardless of the Operation/Roto, all redeploying personnel will complete all Phase One activities IAW the Redeployment Checklist before the sign-off of Phase Three by the OC AAG, i.e., before the commencement of disembarkation and other authorized leave.
    
2. In-theatre Briefings. Two to four weeks prior to redeployment, in-theatre briefings will be given to all deployed personnel. As directed, a one-on-one interview with a padre/social worker/mental health rep may be included for all or specific individuals. However, as a minimum, every individual will receive coordinated briefings on the following subjects:
    
   a. Post-deployment Stress;
    
   b. Family Reintegration;
    
   c. Workplace Reintegration; and
    
   d. Others as identified by TF Comd.
    
   a. Post-deployment Stress Briefing. This briefing should cover such issues as potential medical/psychological concerns, environmental concerns, significant events experienced during the deployment. TF Comds should consider the requirement for one-on-one interviews with all or selected members to be conducted by a padre, social worker or mental health specialist depending on the need and/or resources available in-theatre. Additionally, the added stresses experienced by augmentees and reservists, many of who will be returning to units, locations, jobs or academic institutions without any peer support and understanding of their deployment experience, require an additional briefing to help mitigate these unique concerns. The resources available to reservists through their CFLC Unit Employer Support Representative should be included in this briefing,
    
   b. Family Reintegration Briefings. Family reintegration briefings, to the deployed member and to their family are an integral part of the deployment stress management program and have a positive effect on CF members' and their families' abilities to cope with the stress of deployment and reunion. MFRCs have the means to run briefings for families of deployed members during the deployment and in preparation for their return. Feedback from the MFRCs on the concerns voiced by the deployed members' families should be an integral part of the in-theatre briefing, and
    
   c. Workplace Reintegration Briefing. This briefing by a member of the immediate chain of command of those being briefed, should address major work related transition issues, which will have an impact on their personnel as they return from their deployment to routine garrison activity.
    
3. Phase Two – Decompression in a Third Location. If the requirement has been identified, this phase will require the direct support of both Force Generator and other specialist personnel. The aim of this phase is to provide a safe, clean and restful location that will enable all members to make a clean break from the mission and deployment area, and leave for home rested and in good spirits.
    
4. Phase Three – Reintegration in Canada at Garrison Locations. This phase is complete when an individual who has redeployed has completed: all AAG activities; any medical or other specialist requirements identified to that point that require immediate intervention; their Redeployment Checklist has been completed to the end of Phase Three; and both the individual and the OC AAG have signed off. (Both the URS and the member are to retain a copy of the Completed Phase Three Redeployment Checklist.) Members may then proceed on disembarkation and other authorized leave.
    
5. Phase Four – Post -Mission Follow-up. This phase normally commences on return from all mission related leave and includes all administrative, medical and mental health follow-up activities as identified in the Redeployment Checklist, and any other specialist intervention if the requirement has been identified. It routinely extends for six months from the date of return to Canada. Key medical activities include: the post- deployment Tuberculin (PPD) testing (C plus 90); the Enhanced Post -Deployment Screening Interview (ideally C plus 90 to 120 but NLT 180); and the Medical Examination (normally done following the Enhanced Post-Deployment Screening Interview unless already completed in Phases One through Three). This phase is complete when all post-mission follow-up activities have been completed and the Deployment Checklist has been signed off by the appropriate Medical Authority, the CO and the member for either A-PHASE 4 COMPLETED or B-PHASE 4 COMPLETED and the member has been advised by the MO/Medical specialist of recommended follow-up action(s). Members who are advised to continue follow-up action(s) will be monitored by both the Medical/specialist staff, as appropriate, and the CO until the issue is resolved or other actions are warranted. (URS: a completed copy of the Redeployment Checklist will be placed on the members' personnel file.)
    
6. Post-Deployment Operational Stress Injury (OSI) Follow-up. Due to the effect that Operational Stress Injuries (OSI) could have on CF members and on the effectiveness of operational units, consideration of the impact of OSI must be forefront in our command culture, especially in the awareness of deployed commanders. Therefore, all Task Force Commanders and unit Commanding Officers will assume a pro-active role in promoting a culture of support, understanding and caring towards injured personnel. In addition to the CF requirement that all personnel be given a post-deployment reintegration briefing, all members originating from non-formed units shall receive an OSI Reintegration Letter (Annex Q) as an enclosure to the Task Force Commander's letter to the Commanding Officer of the member's parent unit in Canada. (Ref O))

 

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Appendix 3: Documents reviewed

DND/CF Resources

Emberson, Judy. Canadian Forces Preparing for Reunion Stress Briefing, 07 April 2000
 

Couture, LGen C. Assistant Deputy Minister (Human Resources-Military), Military HR Strategy 2020: Facing the People Challenges of the Future, Minister of National Defence, 2002.
 

Dowdon, Craig. Quality of Life in the Canadian Forces: Results from the National Survey – CF Spouses Final Report. Director Human Resources Research and Evaluation, National Defence Headquarters. Ottawa. March 2002.
 

Duxbury, L., Higgins, C., The 2001 Work Life Balance Study: Key Findings in the Department of National Defence (DND). Director Human Resources Research and Evaluation, National Defence Headquarters, April 2002.
 

Leveille, Capt L., Attitudinal Variables Related to an Evaluation of Flexible Tour Lengths for an Operational Deployment. Director Human Resource Research and Evaluation. National Defence Headquarters, Ottawa, September 2003.
 

Zamorski, Mark, MD, MHSA, Evaluation of an Enhanced Post-deployment Health Screening Program for Canadian Forces Members Deployed on Operation Apollo (Afghanistan/SW Asia)- Preliminary Findings and Action Plan, 13 June 2003
 

3PPCLI/5000-1(CO) 3PPCLI BG Reintegration Proposal 10 April 2002
 

5000-1(Adjt) 3PPCLI BG Reintegration Plan, Concept of Operations Phase 2 (Third Location) 22 May 2002
 

3000-16 (Comd) Redeployment and Reintegration Op Order 01-Op Apollo July 2002
 

3350-1 (MHS) After Action Report Psychologist Visit to Guam in Support of Returning Members of Op Apollo 7 August 2002
 

Lessons Learned –Redeployment and Reintegration Op Apollo 08 Aug 2002
 

3350-Op Apollo (Achap) Lessons Learned –Redeployment and Reintegration Op Apollo 24 September 2002
 

Chief of Defence Staff Order 119, December 2002
 

3000-01/Op Apollo (G1) 1 CMBG Initial Comments – Reintegration OP Apollo February 2003
 

3000-1/Op Apollo (Comd) Op Apollo Post Operation Report – Phase V 5 February 2003
 

3000-10-1 (DLFR 3-9-2) Army Review of Op Apollo POR/LL in Advance of OP Athena 19 March 2003
 

Director, Quality of Life, Briefing Note for ADMHRMIL, Screening and Reintegration Best Practices Exchange, 18 March 2003
 

3350-165/A27 Lessons Learned Staff Action Directive (SAD) April 2003
 

3350-10 (Op Athena) LFCA Mounting Instruction – Op Athena, May 2003
 

CANFORGEN 094/03 CDS 080 161630Z July 2003
 

CANFORGEN 154/03 DCDS 280 311 515z Op Athena Reintegration Plan for Roto 0 Dec 2003
 

3350-10-Op Recovery (G4) LFCA OP Palladium 13 and Op Athena 0 Recovery, Reintegration and Reconstitution Order January 2004
 

3451-4 (Surg Gen) Professional technical Guidance – Op Athena Post Deployment Medical Screening 13 January 2004
 

6600-1A (MMHS) Land Forces Western Area Peer Support Training Proposal and Requirements, 22 January 04
 

OP Athena – R3 Lessons Learned LFCAHQ, 29 March 2004
 

DCDS Direction for International Operations Chapter 12, Personnel Support
 

DCDS Direction for International operations Chapter 14, Stress Management
 

DCDS Direction for International Operations Chapter 16, Health Services Support
 

CF Military Foreign Service Instructions
 

External Resources

Australian Defence Force, The ADF Mental Health Strategy: Presentation to Commanders, June/July 2002.
 

Bolton, E, Litz, B, Glenn, M, Orsillo,S, Roemer, L, The Impact of Homecoming Reception on the Adaption of Peacekeepers Following Deployment, Military Psychology, 2002, 14(3).
 

Collier, D. Hurray Up and Wait: An Inside Look at Life as a Canadian Military Wife. Creative Bound Inc, November 1994.
 

English, Dr. Allan. Leadership and Operational Stress in the Canadian Forces. Canadian Military Journal, Autumn 2000, p33-38.
 

Fillion, J., Clements, P., Averill, J., Vigil, G., Talking as a primary method of peer defusing for military personnel exposed to combat trauma. Journal of Psychosocial Nursing, Vol 4, No.8
 

Hurlburt, Kris, Precious Lives to Be Honoured, Sharing the Front Line and the Back Hills, Baywood Publishing 2002.
 

MacDonald, C, Chamberlain, K, Long, N, Mental Health, Physical Health, and Stressors Reported by New Zealand Defence Force Peacekeepers: A Longitudinal Study, Military Medicine, vol 163, July 1998.
 

Majekodunmi, B, United Nations Human Rights Field Officers, Sharing the Front Lines and the Back Hills, Baywood Publishing, 2002 137-148.
 

McNally, Richard, Bryant, Richard, Ehlers, Anke, Does Early Psychological Intervention Promote Recovery from Posttraumatic Stress? American Psychological Society, Vol 2, No. 2, November 2003
 

Medecins Sans Frontieres Canada, Peer Support Network Policy and Procedures Manual, January 2002.
 

O'Neill, M, Kramer, E, The Peace Corps Volunteer Safety Support System, Sharing the Front Line and the back Hills, Baywood Publishing, 2002, 157-160.
 

Robinson, Kim, Separation from Families, Sharing the Front Lines and the Back Hills, Baywood Publishing, 2002.
 

Rosebush PA. Psychological Intervention with Military Personnel in Rwanda. Military Medicine, Vol 163, August 1998.
 

Thompson, M, Gignac M, A model of Psychological Adaptation in Peace Support Operations: An Overview, Defence and Civil Institute, April 2001.
 

Thompson, M, Blais, A, Febbaro A, Pickering D, McCreary, D, The Development of the Multidimensional Measure of Post Deployment Reintegration: Initial Psychometric Analyses & Descriptive Results, Defence Research and Development Canada. September 2003
 

Thompson, M, Pasto, Luigi, Psychological Interventions in Peace Support Operations: Current Practices and Future Challenges, Defence Research & Development Canada, December 2002.
 

Tiesinga II Committee, Post Cambodia Complaints Study 1 & II for the Secretary of State for Defence, Government of the Netherlands, 21 September 1998
 

Zimmerman G, Weber W,. Care for the Caregivers: a program for Canadian military chaplains after serving in NATO and United Nations peacekeeping missions in the 1990's. Military Medicine, Vol 165, September 2000.

 

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 Appendix 4: Letter to the Minister

 

July 29, 2004

 

The Honourable William Graham, P.C., M.P.
Minister of National Defence
National Defence Headquarters
Major-General George R. Peakes Building
13^th floor, North Tower
101 Colonel By Drive
Ottawa, Ontario
K1A 0K2

BY HAND

Dear Minister Graham:

 

I am pleased to provide you with my Office's report entitled "From Tents to Sheets: An Analysis of the CF Experience With Third Location Decompression After Deployment". The report concerns the value of a decompression period as part of the deployment process.  This was an issue that arose during my trip to Op Athena in Kabul, in November 2003.  At that time, I noted that there was a lack of defined criteria upon which Operational Commanders could decide whether a decompression period was necessary in any given set of circumstances.
 

The report was given to the Chief of Defence Staff on 27 May 2004, and contributed to the finalization of the Canadian Forces policy on Screening and Reintegration, approved by Armed Forces Council on 16 June 2004.  General R.R. Henault supports the public release of this report.
 

As noted in the report, one of the most important factors is ensuring a successful reintegration, including a decompression period, is open and timely communication about the intent and purpose of decompression with affected members, their families and their treatment providers. For these reasons, I have come to the conclusion that it would be in the interest of the DND/CF community to have my report and its recommendations made public.
 

Pursuant to paragraph 38(2)(b) of the Ministerial Directives, I intend to publish the report on the expiration of 28 days from this date.

 

Yours truly,

(original signed by)

André Marin
Ombudsman

Enclosure (1)

 

Cc: Ms. Hélène Gosselin, Acting Deputy Minister
     General R.R. Henault, Chief of Defence Staff

 

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