1. Marine Intercept Program: The Evolution of Caring Contacts
Headquarters, United States Marine Corps
August 2017
Mary Ellen Stone
Point of Contact: v1

2. Purpose Overview of “caring contacts” Systematic literature review
Marine Intercept Program (MIP) background
Preliminary descriptive analysis results of USMC MIP
Discussion
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3. Caring Contacts Motto (1976), Motto and Bostrom (2001)
Provide caring contacts to individuals post-discharge
Letters, s, texts, in-person contact, phone calls, postcards
Researcher, care provider, social worker, psychiatrist, case manager, etc.
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4. Literature Review Inclusion criterion:
Empirical or systematic literature review, US/UK/Australia/Canada/Japan, suicide ideation (SI)/suicide attempt (SA)/Death outcome
Must contain a caring contact component (not just case management)
Search terms using Web of Science and Google Scholar:
“suicide,” “caring contact,” “brief intervention contact,” “suicidal”
Sample size: 13
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5. Literature Review
Reference
Outcome
Main Findings
Design
Beautrais et al., 20101
Repeated self-harm
No significant differences when controlled for previous self-harm
Postcard intervention may be effective only for selected sub-groups
Randomized Controlled Trials (RCT) Emergency Department
Carter et al., 20051
Self-poisoning
No significant differences (significant in unadjusted analysis)
RCT hospital patients
Carter et al., 20071
No significant reduction in proportion of repeating self-poisoning in postcard group
Significant reduction in the rate of repetition (small effect size)
RCT follow-up
Carter et al., 20131
Self-poisoning, psychiatric admissions
No difference between groups for any repeat episode self-poisoning admissions or psychiatric admission, but a significant reduction in event rates
Chesin & Stanley, 20132
Psychosocial suicide interventions
Mixed results
Recommend more rigorous studies
Literature review
Comtois & Linehan, 20062
Psychosocial suicide treatments
No effective intervention in preventing completed suicide except Motto & Bostrom (2001)
Daigle et al., 20111,3,4
Tertiary interventions of suicide attempt (SA)
Caring contact interventions vary significantly in their implementation
Recommend more rigorous studies and standardizing implementation
Harmon et al
Military suicide prevention
Lack of empirical evidence demonstrating effective suicide prevention programs within U.S. services
Hawton et al., 20161
Suicide, suicide ideation (SI), SA
No significant effects for postcards on deaths by suicide in four post-interventions
One trial showed significant treatment effect for suicidal ideation
Meta-analysis of RCTs (Beautrais et al., 2010 and Carter et al., 2005)
Lizardi & Stanley, 20102,3,4
Treatment suicide attempt
Found no caring contact interventions had long-term effect in reducing number of repeat attempts
Luxton et al., 20132
Suicide, SA, SI
Repeated follow-up contacts may have a preventive effect on suicidal behaviors.
Milner et al., 20151,2,4,5
Brief contact suicide interventions
Results vary significantly
No significant reduction in the odds of suicide
Contact interventions cannot be recommended for widespread clinical implementation, need further assessment
Meta-analysis of RCTs (Beautrais et al., 2010; Motto & Bostrom, 2001; Carter et al., 2013)
Motto & Bostrom 20012
Suicide rate
Survival curves showed significantly lower rate at two years, differences in rates diminished thereafter
RCT psychiatric inpatients
1 Postcards, 2 Letters/ s, 3 In-person, 4 Telephone, 5 Green card/crisis card
Design: literature review, meta-analysis, RCT, follow-up, etc.
No case management. Has to incorporate a caring contact component.
Self-harm and self-poisoning are indicators of suicide risk.
Randomized controlled trial
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6. Literature Review - Conclusions
Effectiveness
Best practices identified or patterns which appear to be most effective (if possible)
Limitations
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7. Literature Review – Future Research Needs
RCTs and replication to discern effectiveness and effect size
Best practices (mode, duration, frequency, contact provider)
Cost effectiveness
Application to both SIs and SAs
Military application and evaluation
Should caring contact look the same for military population?
Marine Intercept Program
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8. MIP Background
Purpose of MIP is to prevent repeat suicide ideations and/or attempts, as well as death by suicide.
Protocol
1, 3, 7, 14, 30, 60, and 90 days
Phone call with MIP counselor (Community Counseling Program clinician)
Caring contact, suicide screener (Columbia Suicide Severity Rating Scale), Veterans Affairs Safety Plan
Tracking
Suicide Tracking and Reporting Tool (START)
Update Commander per their request or if having difficulty reaching Marine or attached Sailor
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9. Preliminary Descriptive Results of USMC MIP
MIP Participant
(2,242)
Declined MIP
(628)
Not Offered MIP
(658)
Totals
(3,528)
Gender
Male
83% (1,856)
80% (497)
84% (546)
83% (2,899)
Female
17% (379)
20% (128)
16% (101)
17% (608)
100% (2235)
100% (625)
100% (647)
100% (3,507)
Race
White
63% (1,379)
64% (395)
66% (417)
63% (2,191)
African American
12% (256)
13% (78)
12% (75)
12% (409)
American Indian/Alaskan
2% (41) --
2% (13)
2% (63)
Asian
3% (68)
3% (94)
Hawaiian/Pacific Islander
<1% (17)
<1% (26)
Hispanic
16% (344)
15% (93)
14% (86)
15% (523)
Other/Declined
4% (99)
4% (24)
4% (25)
4% (148)
100% (2,204)
98% (615)
100% (635)
100% (3,454)
Marital Status
Single
61% (1324)
60% (364)
60% (377)
60% (2065)
Married
37% (809)
37% (223)
37% (234)
37% (1,266)
Divorced
2% (49)
3% (19)
3% (18)
3% (86)
100% (2,182)
100% (606)
100% (629)
(3,417)
Zero cells or n<10 for legally separated and widowed categories.
99% of MIP Participants Marines, 98% Declined MIP Marines, 100% not offered MIP Marines.
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10. Frequency of MIP Participation Type by Calendar Year
Chi-square = 51.1 p<.0001
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11. Frequency of History of Suicide Attempt and/or Ideation
Chi-square = 10.0 p<.01
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12. Frequency of Participation Type by Age
Cells with zeros have been removed from analysis. Chi-square = 84.2 p<.01
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13. Discussion
Caring contacts may have roots in the 1970s, but the intervention is still in its infancy regarding best practices and effectiveness.
Further research, especially within the military population, is necessary to determine effectiveness, cost-effectiveness, impact, and best practices.
Empirical literature indicates that caring contacts have potential, but there are several limitations and gaps in knowledge to implement caring contacts service-wide.
MIP will require a comprehensive evaluation, beginning with implementation.
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14. HQMC Marine & Family Programs Division, Behavioral Health Branch
Contact Information
Mary Ellen Stone
HQMC Marine & Family Programs Division, Behavioral Health Branch