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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
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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?
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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
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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
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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
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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
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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
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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)
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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
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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…
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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
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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
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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
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2. 2. INDIVIDUAL LEVEL
3.BASE COMMUNITY
4. LOCAL COMMUNITY1. LEADERSHIP
INTEGRATED4-PRONGED COMMUNITYAPPROACH
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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…..
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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
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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%
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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
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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
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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
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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!
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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
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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
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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
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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
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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
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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
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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