Marine and Family Programs DivisionBehavioral Health Branch

AIRS Conference22 May 2012

Marine and Family Programs DivisionBehavioral Health Branch

AIRS Conference22 May 2012

Marines Taking Care of Marines Taking Care of MarinesMarines

……With With a Little Help From Our a Little Help From Our FriendsFriends

PurposePurpose

• Current statistics, training programs, and resources for Marines and families

• Opportunities for community-based assistance

BackgroundBackground

• Headquarters Marine Corps• Manpower & Reserve Affairs

• Marine and Family Programs Division

BH Branch SAPR BranchCOSCFAPSub AbuseSuicide Prevent

• Doctrine, policy, training, oversight

READYREADYREADYREADY REACTINGREACTINGREACTINGREACTING INJUREDINJUREDINJUREDINJURED ILLILLILLILL

Unit LeaderResponsibilityUnit LeaderResponsibility

Chaplain & MedicalResponsibility

Chaplain & MedicalResponsibility

Individual ResponsibilityIndividual Responsibility

• Good to go• Well trained• Prepared• Fit and

tough• Cohesive

units, ready families

• Distress or impairment

• Mild, transient• Anxious or

irritable• Behavior

change

• More severe or persistent distress or impairment

• Leaves lasting evidence (personality change)

• Stress injuries that don’t heal without intervention

• Diagnosable PTSD Depression Anxiety Addictive

Disorder

Stress ContinuumStress ContinuumStress ContinuumStress Continuum

BH Risk Factors• Multiple deployments• Combat exposure• Loss• Concussive events• Family issues• Op tempo issues eg. sleep disruption• Negative behaviors• Substance using peers• Decentralized support network• Stigma

Risk and Protective FactorsRisk and Protective FactorsRisk and Protective FactorsRisk and Protective Factors

BH Protective Factors• Ongoing unit cohesion• Connectedness• Morale• Peer-to-peer support• Resilience/strengthening factors (mind, body, spirit, social)• Calming techniques• Healthy coping mechanisms• Future orientation• Achievement motivation

• High op tempo• Unmet expectations• Deployment

experiences• Too much or too little

money• Strained

relationships• Repetitiveness/

Monotony• Loss of identity• Isolation• Availability of alcohol• Legal troubles

Understanding Operational StressUnderstanding Operational Stress

StressorPossible

manifestationWhat we are doing

about it

• Alcohol Prevention Campaign Plan

• Integrating behavioral health efforts including universal training

• Enhancing COSC training including OSCAR

• DSTRESS Line• Never Leave a Marine

Behind• Take a Stand• Prime for life• Trauma Informed Therapy• Parent/Child Inter Therapy• Motivational Interview• Cognitive Processing

Therapy

• Decreased job performance

• Alcohol abuse• Drug abuse• Driving under the

influence• Break down in

martial/child relationships

• Domestic violence• Physical Violence• Sexual assault• Suicidal ideations

Locating USMC BH ResourcesLocating USMC BH Resources

1. Google ‘MCCS’ (Marine Corps Community Services) at the appropriate installation

2. Marine and Family Programs/Services…

Combat Operational Stress Combat Operational Stress ControlControl

Combat Operational Stress Combat Operational Stress ControlControl

• OSCAR Teams:– At all battalions, squadrons (larger units)

– OSCAR Mentors (Selected Marines)

– OSCAR Extenders (Corpsmen, Medical Officers, Religious Ministry Team)

– Mental Health Professionals (Psychiatrists, Psychologists and Psych Nurses/Technicians) embedded at Division and Regiment levels

• OSCAR Mentors:– Identify small changes in behavior

– Quickly intervene when Marines show signs of negative stress reactions

– Refer for assistance when appropriate

– Reduce stigma concerning behavioral health

– Over 5000 Marines are OSCAR trained

Operational Stress Control and ResilienceOperational Stress Control and ResilienceOperational Stress Control and ResilienceOperational Stress Control and Resilience

“Have you talked to your OSCAR Mentor?”

Family AdvocacyFamily AdvocacyFamily AdvocacyFamily Advocacy

Family Advocacy OverviewFamily Advocacy Overview

• Family Advocacy is a command program designed to prevent and respond to incidents of child and spousal abuse. The program is staffed with clinicians, victim advocates, home visitors and prevention specialists who work as part of a coordinated response to meet the needs of service members and their families on the installation.

• General Counseling, Victim Advocacy, New Parent Support

• Emphasis on Evidence-based treatment and prevention programs• Parent-Child Interaction Therapy (PCIT) and Child-Adult Relationship

Enhancement• Trauma-Focused Cognitive Behavioral Therapy• Cognitive Processing Therapy - a DoD recognized treatment for PTSD

FAP OverviewFAP Overview

• Evidence Based Training Programs• Married and Loving It (MALI) – marital communication skills• REAL COLORS/REAL STRESS – stress mgmt• Crossroads Parenting – effective communication,

disciplining, nurturing skills• STOP (Skills, Techniques, Options and Plans) –

anger/stress mgmt skills for offenders• Century’s Anger Management• New Parent Support Program – Home visits to improve

nurturing and parenting skills for parents in the military with children ages birth to five years old.

Substance Abuse PreventionSubstance Abuse PreventionSubstance Abuse PreventionSubstance Abuse Prevention

Substance Abuse Prevention OverviewSubstance Abuse Prevention Overview

• Three Principal Tenets of the USMC Substance Abuse Program• Alcohol & Drug Prevention Education• Treatment• Drug Demand Reduction

• Substance Abuse Counseling Centers (SACCs)• Counselors and Prevention Specialists at major USMC installations• Screenings and assessments; Early Intervention education, Out-Patient treatment and Intensive Out-Patient treatment (depending on treatment needs of the individual).  • Prime For Life – an evidence-based motivational intervention program to change perceptions and behavior regarding substance abuse and risk.• No in-patient treatment. (Send to other military, VA, or civilian facilities.)  

Historic Trends in Binge Drinking

1998 2002 2005 2008

Marine Corps 45.4 54.2 53.2 57.6

Army 37.5 41.4 52.8 48.2

Navy 32.0 44.2 41.7 47.8

Air Force 29.6 34.0 33.9 39.0

Magnitude of the ProblemMagnitude of the ProblemMagnitude of the ProblemMagnitude of the Problem

Data from the DoD Survey of Health Related Behaviors Among Military Personnel, 1998-2008. Table 3.2.3

Prevalence of Binge Drinking Total Males Females

Marine Corps 57.3 58.9 32.0Army 48.3 51.0 28.0Navy 44.5 46.8 29.5Air Force 35.6 38.6 23.3

Civilian 40.6 42.9 23.8

Prevalence of Heavy Alcohol Use

Total Males Females

Marine Corps 29.0 30.1 11.1

Army 22.7 24.5 9.6

Navy 16.4 17.6 8.7

Civilian 13.6 14.7 5.5

Air Force 12.0 13.6 5.4

“For me, 18 beers is

‘responsible’”

Magnitude of the ProblemMagnitude of the ProblemMagnitude of the ProblemMagnitude of the Problem

Alcohol “Spokes of the Wheel”Alcohol “Spokes of the Wheel”Alcohol “Spokes of the Wheel”Alcohol “Spokes of the Wheel”

Suicide

Substance Abuse

Sexu

al A

ssau

lt

Family

Advocacy

COSC

18% had evidence of alcohol use at the time of death

24% had evidence of past alcohol abuse or dependence diagnosis

Over 50% of victims and offenders of sexual assault were associated with alcohol

30% of spouse abuse involved alcohol

80% of individuals with TBI met criteria for alcohol abuse and dependence

Data from internal Marine Corps Behavioral Health Program statistics: TBI data from RAND (2008)

Marine40% of off duty mishaps involved alcohol

Alcohol

Alcohol Alco

hol

Alcohol

Alcohol

Alcohol Abuse Prevention CampaignAlcohol Abuse Prevention CampaignAlcohol Abuse Prevention CampaignAlcohol Abuse Prevention Campaign

Increase Operational Readiness of the Marine Corpsby Reducing Alcohol Abuse and Misuse through

Revolutionary Changes to Prevention and Treatment

Three Foundational Efforts:• “Levels of Risk” replace “Responsible Drinking”• Change focus from the “Boom” being an alcohol-related

incident to the “Boom” being alcohol use• SNCOs and Officers must support, enable and mentor

NCOs in their ownership of this effort

Pending EFPB Action (March 2012)

USMC Alcohol Consumption Continuum

No RiskNo Risk Low RiskLow Risk High RiskHigh Risk

• 0 standard drinks per day

(Abstinence)

• No more than 4 standard drinks a day / 14 standard drinks a week- Men

• No more than 3 standard drinks a day / 7 standard drinks a week- Women

• No more than 1 standard drink per hour

• Consumes more than EITHER the single-day or weekly limits

• Consumes more than BOTH the single-day or weekly limits

• Drinking more than 1 standard drink per hour

Individual and Leadership Responsibility Individual and Leadership Responsibility Community & Medical ResponsibilityCommunity & Medical Responsibility

Levels of RiskLevels of RiskLevels of RiskLevels of Risk

“For me, 18 beers is

‘responsible’”

http://pubs.niaaa.nih.gov/publications/RethinkingDrinking/Rethinking_Drinking.pdf

USMC Alcohol Consumption Continuum - Science

No RiskNo Risk

Low RiskLow RiskNo more than 4 standard drinks a dayNo more than 4 standard drinks a day

/14 in a week (Men) and /14 in a week (Men) and

3 standard drinks a day / 7 in a week 3 standard drinks a day / 7 in a week (women)(women)

High RiskHigh RiskExceeds daily or weekly Low Risk TotalsExceeds daily or weekly Low Risk Totals

Only 2% of individuals who drink within both the “single-day” and weekly limits have alcoholism or alcohol abuse diagnosis.

Levels of RiskLevels of RiskLevels of RiskLevels of Risk

“For me, 18 beers is

‘responsible’”

http://pubs.niaaa.nih.gov/publications/RethinkingDrinking/Rethinking_Drinking.pdf

Drinking more than the single-day or weekly amounts is considered “high-risk”.

• About 1 in 4 people who drink this much meet criteria for alcohol abuse, the rest are at greater risk:

‘High Risk’ drinking chances of having an alcohol use disorder:• 1 time a month (20% chance)• 1 time a week (33% chance)• 2 times a week (50% chance)

Sexual Assault Prevention and Sexual Assault Prevention and ResponseResponse

Sexual Assault Prevention and Sexual Assault Prevention and ResponseResponse

Sexual Assault ReportsSexual Assault Reports

050

100150200250300350400450500

FY 07 FY 08 FY 09 FY 10 FY 11 FY 12

USMC Total Reported Sexual Assaults

Total Reported Assaults

MYTHMYTH Most offenders commit sexual assaults one timeFACTFACT Offenders commit on average 6 assaults, most of which go unreportedMYTHMYTH Most sexual assault reports are falseFACTFACT Rate of false reports is 2-7%MYTHMYTH Victims of sexual assault in the Marine Corps are only femaleFACTFACT Anyone can be the victim of sexual assault. Males are less likely to report than females because of stigma and culture

MythsMyths

New InitiativesNew Initiatives

• Take A Stand for NCOs• Officer/SNCO training (in development)• Command Team Training• Annual SAPR Training • Chaplain training• 24/7 Helplines (DOD and USMC installations)

CMC’s CommentsCMC’s Comments

Suicide PreventionSuicide PreventionSuicide PreventionSuicide Prevention

20.7

12.5

17.2

23.7

19.6

13.4

17.5

14.412.9

16.4

20.020.019.620.1

19.519.9

23 26 34 28 25 33 4252

82 80 85

112 103

146164

143237

73

163172

99

0

20

40

60

80

100

120

140

160

180

200

Suicides

Attempts

USMC Suicides and AttemptsUSMC Suicides and Attempts

* Last available civilian suicide rate information from the Centers for Disease Control and Prevention. Rate adjusted for Marine demographics.

** Includes 1 suspected suicide that have yet to be confirmed by the Armed Forces Medical Examiner.

*** Includes 8 suspected suicides that have yet to be confirmed by the Armed Forces Medical Examiner.

Source: HQMC (MFC-5) 1 May 2012

*Civilian Rate per 100,000

USMC Rate per 100,000

Through

April 2012

Never Leave a Marine BehindNever Leave a Marine Behind

Annual Suicide Prevention Training•Award-winning, evocative•Developed and tested by Marines•Separate modules for Jr. Marines, NCOs, SNCOs and officers

Recognize • Note changes in personality, emotions, or behavior. • Note withdrawal from co-workers, friends and family. • Note changes in eating and sleeping patterns. Ask • Calmly question about the distress you observed. • If necessary, ask the question directly: “Are you thinking about killing yourself?” Care • Actively listen, don’t judge. • Peacefully control the situation; do not use force; keep everyone safe. Escort • Never leave your buddy alone. • Escort to chain of command, chaplain, medical, or behavioral health professional.

RACE AcronymRACE Acronym

Never Leave a Marine BehindNever Leave a Marine Behind

Focus is on changing behavior• Mind, body, spiritual, and social fitness

• Peer-to-peer support• Frontline supervisor intervention• Command climate management

The DSTRESS LineThe DSTRESS LineThe DSTRESS LineThe DSTRESS Line

DSTRESS LineDSTRESS Line

Video link: search “dstress line” on YouTube

DSTRESS LineDSTRESS Line

Anonymous, 24/7 call center

Marine-to-Marine counseling that

gives any Marine, attached Sailor,

or family member ‘one of their own’

to speak with about everyday stress

or their heaviest burdens in life.

1-877-476-7734

Staffed by veteran Marines

and “Fleet Marine Force”

corpsmen, Marine family

members, and civilian

counselors specifically trained in

Marine culture.

DSTRESS LineDSTRESS Line

DSTRESS LineDSTRESS Line

More than just combat stress…

Enable the next step in help-

seeking

Referrals to Marine resources,

Navy Med, TRICARE, Military

One Source, VA …

www.dstressline.comwww.dstressline.com

• Free educational tools and products for Marines and families

• Standardizes behavioral health messaging

• Conveys back to stakeholders what information is important to whom

• Currently over 120K materials distributed •Additional Behavioral Health materials forthcoming

• An evaluation of the BHIN found:• 85% of the participants indicated that the BHIN website was extremely useful in meeting their COSC needs• 40% ordered materials for themselves• 32% ordered information for their command/workplace • 28% ordered for fellow Marines

http://bhin.usmc-mccs.org/

The “BHIN”The “BHIN”

Wider DOD ResourcesWider DOD Resources

• Military One Source

• Military Homefront - information, policy and guidance designed to help troops and their families, leaders, and service providers. Whether you live the military lifestyle or support those who do, you'll find what you need.

• Real Warriors - an initiative launched by the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) to promote the processes of building resilience, facilitating recovery and supporting reintegration of returning service members, veterans and their families.

• DOD Safe Helpline - live, one-on-one support and information to the worldwide DoD community. The service is confidential, anonymous, secure, and available worldwide, 24/7 by click, call, or text — providing victims with the help they need, anytime, anywhere.

I&R ResourcesI&R Resources

USMC Demographics Update• http://www.usmc-mccs.org/aboutmccs/

Behavioral Health Branch websites• Leaders Guide to Managing Marines in Distress – a quick reference to help leaders take care of Marines in distress because of their situation or behavior. It covers approximately 40 different problems Marines may face. http://www.usmc-mccs.org/leadersguide/• Family Advocacy Program - http://www.usmc-mccs.org/famadv/• Sexual Assault Prevention and Response - http://www.usmc-mccs.org/sapro/index.cfm?sid=ml• Substance Abuse Program - http://www.usmc-mccs.org/subabuse/• Suicide Prevention - http://www.usmc-mccs.org/suicideprevent/index.cfm?sid=ml• DSTRESS Line - http://www.dstressline.com/, additional videos at www.youtube.com/dstressline•The Behavioral Health Information Network (BHIN). http://bhin.usmc-mccs.org/

Community-based Support NeededCommunity-based Support Needed

• Community-based services can fill in gaps• Pervasive social stigma against help-seeking• The military culture is not for everybody• Budget realities limit availability

• Most USMC resources are for active duty personnel and dependents.• Reservists have limited access to benefits during drill periods and any periods of active duty service. Their dependents have much less access.• Non-retired veterans have very little access to USMC resources.

Marine and Family Programs DivisionBehavioral Health Branch

Questions?

Col Grant OlbrichProgram Manager

grant.olbrich@usmc.mil703-432-9707

Marine and Family Programs DivisionBehavioral Health Branch

Questions?

Col Grant OlbrichProgram Manager

grant.olbrich@usmc.mil703-432-9707