1. Marine and Family Programs Division Behavioral Health Branch AIRS Conference 22 May 2012 Marine and Family Programs Division Behavioral Health Branch AIRS Conference 22 May 2012 Marines Taking Care of Marines … With a Little Help From Our Friends

2. Purpose Current statistics, training programs, and resources for Marines and families Opportunities for community-based assistance

3. Background Headquarters Marine Corps Manpower & Reserve Affairs Marine and Family Programs Division BH BranchSAPR Branch COSC FAP Sub Abuse Suicide Prevent Doctrine, policy, training, oversight

4. READYREADY REACTINGREACTINGINJUREDINJUREDILLILL Unit Leader Responsibility Unit Leader Responsibility Chaplain & Medical Responsibility Chaplain & Medical Responsibility Individual 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 dont heal without intervention Diagnosable PTSD Depression Anxiety Addictive Disorder Stress Continuum

5. 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 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

6. 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 Stress Stressor Possible manifestation What 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 STRENGTHEN MITIGATE IDENTIFY TREATREINTEGRATE 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

7. Locating USMC BH Resources 1. Google MCCS (Marine Corps Community Services) at the appropriate installation 2.Marine and Family Programs/Services…

8. Combat Operational Stress Control

9. 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 Resilience Have you talked to your OSCAR Mentor?

10. Family Advocacy

11. Family 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.Family Advocacy General Counseling, Victim Advocacy, New Parent SupportGeneral CounselingVictim AdvocacyNew 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

12. FAP 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 Centurys 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.

13. Substance Abuse Prevention

14. Substance Abuse Prevention Overview Three Principal Tenets of the USMC Substance Abuse ProgramUSMC Substance Abuse Program Alcohol & Drug Prevention Education Treatment Drug Demand Reduction Substance Abuse Counseling Centers (SACCs)(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.)

15. 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 Problem Data from the DoD Survey of Health Related Behaviors Among Military Personnel, 1998-2008. Table 3.2.3 Prevalence of Binge Drinking Total MalesFemales Marine Corps 57.358.932.0 Army 48.351.028.0 Navy 44.546.829.5 Air Force 35.638.623.3 Civilian 40.642.923.8

16. Prevalence of Heavy Alcohol Use TotalMalesFemales Marine Corps 29.030.111.1 Army 22.724.59.6 Navy 16.417.68.7 Civilian 13.614.75.5 Air Force 12.013.65.4 For me, 18 beers is responsible Magnitude of the Problem

17. Alcohol Spokes of the Wheel Suicide Substance Abuse Sexual Assault 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) Marine 40% of off duty mishaps involved alcohol Alcohol

18. Alcohol Abuse Prevention Campaign Increase Operational Readiness of the Marine Corps by 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)

19. USMC Alcohol Consumption Continuum No Risk Low Risk High 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 Community & Medical Responsibility Levels of Risk For me, 18 beers is responsible http://pubs.niaaa.nih.gov/publications/RethinkingDrinking/Rethinking_Drinking.pdf

20. USMC Alcohol Consumption Continuum - Science No Risk Low Risk No more than 4 standard drinks a day /14 in a week (Men) and 3 standard drinks a day / 7 in a week (women) High Risk Exceeds 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 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)

21. Sexual Assault Prevention and Response

22. Sexual Assault Reports

23. MYTH Most offenders commit sexual assaults one time FACT Offenders commit on average 6 assaults, most of which go unreported MYTH Most sexual assault reports are false FACT Rate of false reports is 2-7% MYTH Victims of sexual assault in the Marine Corps are only female FACT Anyone can be the victim of sexual assault. Males are less likely to report than females because of stigma and cultureMyths

24. New 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)USMC installations

25. CMCs Comments

26. Suicide Prevention

27. USMC 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

28. Never 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

29. 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, dont 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 Acronym

30. Never 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

31. The DSTRESS Line

32. DSTRESS Line Video link: search dstress line on YouTube

33. DSTRESS 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

34. Staffed by veteran Marines and Fleet Marine Force corpsmen, Marine family members, and civilian counselors specifically trained in Marine culture. DSTRESS Line

35. More than just combat stress… Enable the next step in help- seeking Referrals to Marine resources, Navy Med, TRICARE, Military One Source, VA …

36. www.dstressline.com

37. 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

38. Wider 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.Military Homefront troops and their familiesleadersservice providers 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.Real WarriorsDefense Centers of Excellence for Psychological Health and Traumatic Brain Injury 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. DOD Safe Helpline

39. I&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/http://www.usmc- mccs.org/leadersguide/ Family Advocacy Program - http://www.usmc-mccs.org/famadv/http://www.usmc-mccs.org/famadv/ Sexual Assault Prevention and Response - http://www.usmc- mccs.org/sapro/index.cfm?sid=mlhttp://www.usmc- mccs.org/sapro/index.cfm?sid=ml Substance Abuse Program - http://www.usmc-mccs.org/subabuse/http://www.usmc-mccs.org/subabuse/ Suicide Prevention - http://www.usmc- mccs.org/suicideprevent/index.cfm?sid=mlhttp://www.usmc- mccs.org/suicideprevent/index.cfm?sid=ml DSTRESS Line - http://www.dstressline.com/, additional videos at www.youtube.com/dstresslinehttp://www.dstressline.com/ www.youtube.com/dstressline The Behavioral Health Information Network (BHIN). http://bhin.usmc-mccs.org/http://bhin.usmc-mccs.org/

40. Community-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.

41. Marine and Family Programs Division Behavioral Health Branch Questions? Col Grant Olbrich Program Manager grant.olbrich@usmc.mil 703-432-9707 Marine and Family Programs Division Behavioral Health Branch Questions? Col Grant Olbrich Program Manager grant.olbrich@usmc.mil 703-432-9707