COSC Program Update September 2011 Patricia Powell Program Manager

Combat and Operational Stress Control (COSC) COSC assists Commanders and Marine leaders in maintaining their warfighting capabilities. COSC implements activities focusing on: Force preservation and readiness Long-term health and well-being of the Marine and their family Leaders are key to COSC Leaders influence prevention, mitigation, early identification and referral for treatment Leaders set a command climate to reduce the stigma of seeking and receiving treatment COSC utilizes five Core Leader Functions (SMITR) Supported by Regional Training Coordinators RTC – COSC/SP/SA G7, MCCS

IOM Prevention Model USMC Treatment Providers and Resources USMC and TX Providers and Resources USMC OSCAR COSC as per IOM INJURED ILL READY REACTING STRESS CONTINUUM

Individual Responsibility Where Are You On The Stress Continuum? READY REACTING INJURED ILL 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 Chaplain & Medical Responsibility Individual Responsibility Unit Leader Responsibility

Factors that affect your decision to receive mental health services J-MHAT 7 Assessment Factors that affect your decision to receive mental health services Army % agree or strongly agree: Screen positive USMC % agree or strongly agree: Screen positive Army % agree or strongly agree: Did not screen positive USMC % agree or strongly agree: Did not screen positive Mental health services aren't available 28.2% 7.9 % 11.2 % 7.0% I don't know where to get help 17.0 % 5.8 % 4.7% 6.8 %* It is difficult to get an appointment 31.3 % 11.9 % 11.8 % 6.6% There would be difficulty getting time off work for treatment 49.3% 24.5 % 19.6 % 18.3 % It's too difficult to get to the location where the mental health specialist is 32.7% 14.2 % 15.7 % 12.5 % My leaders discourage the use of mental health services. 15.1 % 9.6% 4.0% 5.2%* Recent findings regarding barriers to mental health care Note: * = USMC numbers in bold higher than comparative US Army sample.

Key Initiatives COSC training OSCAR Team Training Resources and tools Deployment Cycle Training, known as Marine Operational Stress Training (MOST) OSCAR Team Training MARADMIN requires Bn-sized units to train & maintain OSCAR teams Outlines certifications & authorized training Provides guidance to complete reporting Resources and tools Behavioral Health Information Network (BHIN) Resource map

Behavioral Health Integration BHIN is integrated outreach resource Combat & operational stress is a risk factor for behavioral health issues Family violence, assault, substance abuse, suicide Assist with Subject Matter Expertise Set the tone to reduce stigma Strategic partnerships Target the right audience IOM prevention model utilized to ensure programs are in the right area of concern, eliminate program overlaps & potential gaps Early identification and referral Strategic partnerships includes working together with non-Marine Corps agencies to more efficiently partner. For examples join effort at WRC. Target right audience: tailor message to what Marines understand, include family, speak differently to officers, SNCOs, NCOs, junior Marines. IOM model shows distribution of programs and how the support; helps identify overlaps and potential gaps “An ounce of prevention is worth a pound of cure” is basis for teaching continuum. Others have found useful and adopted (SAPR, chaplains).

Operational Stress Control and Readiness OSCAR Teams: Team Members / Mentors (Selected Marines) Extenders (Corpsmen, Medical Officers, Religious Ministry Team) Providers (Mental Health Professionals) OSCAR Team Members/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 3000 Marines are OSCAR trained Mental Health Professionals Embedded at the Division/Regimental level OSCAR training: Builds teams to assist commanders in prevention, early identification, referral and support Incorporates mental health providers embedded in the operating forces, where they are needed most Develops OSCAR teams across the Marine Air Ground Task Force

OSCAR Team Structure (Infantry) XX DIVISION OSCAR Mental Health Providers (3, full time) OSCAR Psych Techs (4, full time) III INFANTRY REGIMENTS OSCAR Mental Health Providers (2, full time) OSCAR Psych Techs (2, full time) II INFANTRY BATTALIONS OSCAR Mentors (XO, SgtMaj, and selected Marines) OSCAR Extenders (Medical Providers, Chaplain, RP and Corpsmen) I INFANTRY COMPANIES OSCAR Mentors (XO, 1stSgt, and selected Marines) OSCAR Extenders (Corpsmen)

(56 hour course plus experience training) OSCAR Training Structure MEF MASTER TRAINERS (56 hour course plus experience training) 100 Certified to train trainers OSCAR TEAM TRAINERS (40 hour course) 200 Certified to train team members ADVANCED TEAM MEMBERS (32 hour course) ~50 Mentors able to provide informal briefings and assist trainers in conducting Team Training MENTORS (6 hour course) 50–75 per Battalion Mentors able to provide informal briefings

OSCAR Training Value for Leaders SgtMaj Barrett, Sergeant Major of the Marine Corps 3 min

OSCAR Way Ahead MARADMIN Sustainment Preparing for Generation 2 Certifying Master Trainers in all MEFs & MFR Preparing for Generation 2 Lessons learned from 18 months of OSCAR Team Training Conducting focus groups Integrating emergent priorities Developing trainer skills Developing specialized training OSCAR Providers OSCAR Executive Course If it’s not broken, don’t fix it Increase practical tools and promote positive case studies

Supporting Families Developing strategies with Marine Corps Family Team Building (MCFTB) to: Raise awareness and provide tools to help identify stress reactions and refer using a common frame of reference Conducted working groups with active duty spouses to review concepts and tools – Instructor Battalion &1/6 Foundational COSC training Leveraging OSCAR format Piloting with I MEF NOV 2011

Deployment Cycle Training Way Ahead Currently (2005): Marine Operational Stress Training (MOST) Generic COSC information with a medical bias Targets Warriors (Marines), Leaders & family members Planned Interactive, small unit discussion; practical use of concepts Lessons learned from OSCAR Training & Third Location Decompression Emerging priorities such as TBI protocols Content tailored to each specific point on the deployment cycle Unit leadership & OSCAR Team Members lead discussions Retain audience focus: Warriors (Marines), Leaders & family members

COSC Way Ahead Finalizing Marine Corps Order Developing AIRS Checklist Preparing for Third Location Decompression for PRP & EOD Updating Deployment Cycle Training (MOST) FY 2012 Strategy: Developing a strategic plan Institutionalizing COSC fundamentals Supporting the Commandant’s resiliency efforts Developing specific tool kits Building a scientific base Gathering best-evidence Developing communication plan Collaboration Staff development AIRS – Automated Inspection Reporting System

How You Can Help Let the Marines own it Support when asked Partner with the RTCs Institutionalize key concepts Promote seeking leadership tools Leadership principle: know yourself and seek self-improvement. It is part of every Marines job to be aware of any deficiencies and address them. Seeking timely help keeps the Marine functional and contributing to the unit mission. Not addressing emerging stress (or other) issues will most likely lead to greater impairment and further impact to the unit.

Points of Contact Questions? Ms. Patricia Powell, Program Manager, COSC patricia.powell@usmc.mil LtCol Curt Strader, OSCAR Lead, COSC curtis.strader@usmc.mil