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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
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