I n t e g r i t y - S e r v i c e - E x c e l l e n c e

Headquarters U.S. Air Force

1

Culture of Responsible Choices (CoRC) MTF Toolkit for Implementation

Insert your name here

2I n t e g r i t y - S e r v i c e - E x c e l l e n c e

Where the AF stands…why CoRC?

3I n t e g r i t y - S e r v i c e - E x c e l l e n c e

The Problem

Impact of drug use and alcohol misuse Clear and present danger to the mission Reduces readiness Wastes critical resources Erodes our Core Values/the Culture of Airmen

4I n t e g r i t y - S e r v i c e - E x c e l l e n c e

5.0

10.0

15.0

20.0

25.0

30.0

Ra

te (

%)

DoD 20.8 24.1 23.0 17.2 15.5 17.4 15.4 18.1

AF 14.3 17.7 16.5 14.5 10.6 10.4 11.7 12.3

1980 1982 1985 1988 1992 1995 1998 2002

DoD/Air Force Heavy Alcohol Use* Trend2002 DoD Survey of Health Related Behaviors Among Military Personnel

* > 5 drinks on the same occasion at least once a week in the past 30 days

Increase from 1998

I n t e g r i t y - S e r v i c e - E x c e l l e n c e 5

Heavy Alcohol Use* Past 30 Days, Ages 18–55

*standardized 2001 NHSDA

0

5

10

15

20

25

30

35

40

Civilian* Air Force

Perc

en

tag

e

18–25 26–55

Note: 18-25 yr estimate significantly different from civilian estimate at 95% confidence

* > 5 drinks on the same occasion each week in the past 30 days

6I n t e g r i t y - S e r v i c e - E x c e l l e n c e

Total AF: Alcohol Related Events

48995226 5302 5304

4215

6441

0

1000

2000

3000

4000

5000

6000

7000

CY00 CY01 CY02 CY03 CY04 CY05

Total AREs

7I n t e g r i t y - S e r v i c e - E x c e l l e n c e

Total AF: Underage Drinking

1774

22842157

1970

1401

2014

0

500

1000

1500

2000

2500

CY00 CY01 CY02 CY03 CY04 CY05

Underage Drinking

8I n t e g r i t y - S e r v i c e - E x c e l l e n c e

Substance Misuse: A Clear and Present Danger

Must reduce Alcohol Related Events!

80+% ADAPT referrals not Abusing/Dependent on Alcohol “Alcoholism” cannot/should not be our sole focus!

Alcohol misuse is involved in: 33% of suicides 57% sexual assaults 28.5% domestic violence cases 44% PMV accidents

33% of our members commit 81% of our ARI’s

(17-24 year olds)

9I n t e g r i t y - S e r v i c e - E x c e l l e n c e

AF Illicit Drug Use

AD AF FY04 0.45% Drug Positives (1,572 total) Discharge ≃ 1500 Airmen a year b/c of drug positives $36-79k avg. cost to produce each trained Airman

Demand Reduction (Detection and Deterrence)

Detection is important to the mission But once caught, we lose an airman

Deterrence is vital to the mission Effective prevention results in saving an airman

Comprehensive approach to further reduce use

10I n t e g r i t y - S e r v i c e - E x c e l l e n c e

The best models for change…

11I n t e g r i t y - S e r v i c e - E x c e l l e n c e

Community Approach toPopulation Health Services

0%

100% Excellent

Poor

Prevention and Education

Leadership Supports Health Behavior Change

Installation Policies Enhance Health

Primary Care

Early Intervention

Specialty Care

Treatment of Disease

Helping Agency Support (IDS)

HEALTHHEALTHPOPULATIONPOPULATION

12I n t e g r i t y - S e r v i c e - E x c e l l e n c e

Research Says….

Comprehensive community approach ideal: Leadership Driven, Environmental Change, Information,

Early Identification and Intervention, Policy/Deterrence, & Alternative Activities

Key: Identify those at of risk Population based screening/assessment

Good evidence for brief interventions Tailored feedback (in-person and mailed), Brief

Interventions, Primary Care, Web-based programs, etc…Based on SAMHSA and NIAAA recommendations for prevention and early intervention in

youth & young adults

13I n t e g r i t y - S e r v i c e - E x c e l l e n c e

Culture change requires emphasis on prevention: Leadership sets the tone -Commanders’ program! Wide range of prevention efforts Broad community involvement Medics offer enhanced screening and early intervention Create prevention opportunities outside of MTF

Should be responsibility (not morality) based

Standardize elements & evaluation

Implementation must be locally tailored/flexible

Changing the Culture

2. 2. INDIVIDUAL LEVEL

3.BASE COMMUNITY

4. LOCAL COMMUNITY1. LEADERSHIP

INTEGRATED4-PRONGED COMMUNITYAPPROACH

15I n t e g r i t y - S e r v i c e - E x c e l l e n c e

The Road from 0-0-1-3 to CoRC…..

16I n t e g r i t y - S e r v i c e - E x c e l l e n c e

0-0-1-3: Basics

Science-based community program from F.E. Warren 0-0-1-3 is a slogan that is part of a larger program

0 underage drinking, 0 DUIs, 1 drink/hour, 3 drinks per sitting max

Wing Commander’s Program ADAPT is a team player--not the lead All installation IDS/CAIB members had a role Public Affairs, Security Forces, Services, Command

Master Chief/First Sergeants, and Chaplains have particularly involved roles

4 core levels of change: Strong Leadership, Individual, Base, & Community

17I n t e g r i t y - S e r v i c e - E x c e l l e n c e

Prevention: 0-0-1-3 Results

0

10

20

30

40

50

60

AlcoholRelated

Incidents

DrivingUnder theInfluence

UnderageDrinking

1st Quarter 2004

1st Quarter 2005

68%68%

64%64%

93%93%

18I n t e g r i t y - S e r v i c e - E x c e l l e n c e

0-0-1-3’s Savings in Resources

*68% decrease in alcohol related incidents 8% increase in available-for-duty rate (or 38 more airmen) ≃ 230 duty days not lost to Alcohol-Related Incidents

*70% decrease in Article 15s CCs / Shirts with more time for mission / morale / welfare

Contrary to popular myths, Services showed a profit! MWRF NIA increased $173K / Club profit of $13K

*Comparison of First Quarter 2004 to First Quarter 2005

19I n t e g r i t y - S e r v i c e - E x c e l l e n c e

From F.E. Warren to AF Program

March 05: Chief of Staff of the Air Force (CSAF) Task:Develop an AF plan & product based on 0-0-1-3 HQ AF Personnel (DP): primary POCs for CoRC

Other functional groups are collaborators CoRC built from best of science and AF programs Launch Air Force wide in April 2006

20I n t e g r i t y - S e r v i c e - E x c e l l e n c e

CoRC:AF Functional Community Players

Public Affairs

Legal

SecurityForces

Medical Treatment

FacilityChaplains

Mission

Support/

Services

Senior LeadershipCC/1st Sergeants

21I n t e g r i t y - S e r v i c e - E x c e l l e n c e

CSAF: Basics for CoRC

Guiding principles Commander’s program Responsible drinking vs. abstinence only Incident deterrence Attention to prevention: alcohol misuse and abuse Emphasize Common Airman Culture

Program goals over first year (baseline year FY04) Decrease alcohol-related incidents (ARIs) by 25%

- Underage drinking, DUIs, crimes, etc.

- Reevaluate goal after year 1 Decrease confirmed drug positives by 25%

Reevaluate goal after year 1

WORK HARD – PLAY SMART!

22I n t e g r i t y - S e r v i c e - E x c e l l e n c e

CoRC Basics

1. Leadership Driven Program: Message and support from top down

2. Individual Level Opportunities for Change Assessment/Screening of risk in all personnel Education/awareness Brief Interventions and treatment when needed Responsibility and commitment

3. Base Community Opportunities for Change Develop range of alternate activities Consistent and equitable detection/enforcement Media campaign promoting responsibility Monitor AF metrics/consider base specific metrics

4. Local Community Opportunities for Change Assess threat and availability of drugs and alcohol Develop coalition with community agencies

23I n t e g r i t y - S e r v i c e - E x c e l l e n c e

CoRC:Roles and Responsibilities

HQ Personnel (DP): Deliver Concept of Operations

Functional groups developed area specific Toolkits

MTF role at the base level: Enhanced screening and early intervention Participation in outreach Serve as subject matter expert consultants to the CC

24I n t e g r i t y - S e r v i c e - E x c e l l e n c e

Surgeon General’s Toolkit:Bucket 1

Universal/Primary Prevention 

Population outreach: Screening population/surveillance

Take “temperature” of risk on base

Education and feedback at teachable moments

25I n t e g r i t y - S e r v i c e - E x c e l l e n c e

Selected/Secondary Prevention

Targeted, individualized, non-anonymous alcohol and drug screening at Primary Care and Flight Medicine

PHA: Everyone screened annually, feedback provided, and referred as needed

Routine Care: Options for screening, brief intervention and referral as part of routine care

Surgeon General’s Toolkit:Bucket 2

26I n t e g r i t y - S e r v i c e - E x c e l l e n c e

Targeted/Tertiary Prevention

Screening, Assessment & Brief Intervention Designed for behavioral health outside of ADAPT

Family Advocacy and Life Skills Support Centers

Tools to identify and treat “sub-clinical” alcohol misuse

Improved identification of substance use disorders

Options for screening at each new intake

Improved decision treeWhen to refer to ADAPT and when to incorporate into

existing treatment plan

Surgeon General’s Toolkit:Bucket 3

27I n t e g r i t y - S e r v i c e - E x c e l l e n c e

Subject Matter Consultation Guidance for ADAPT and DDR PMs about their

role as CC consultants for CoRC implementation Booklet with core consultant competencies References and Resources Resources and opportunities for training

Surgeon General’s Toolkit:Bucket 4

28I n t e g r i t y - S e r v i c e - E x c e l l e n c e

See Surgeon General’s Toolkit for Details about

Each Bucket