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 CoRC 101 Dr. Milton H. Cambridge Demand Reduction Prevention and Outreach Coordinator

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 2 Overview Review CoRC Foundational Principles Comprehensive Community Approach Leadership Driven ! CAIB/IDS 4 Tiered Approach Universal/Primary Prevention Selected/Secondary Prevention Targeted/Tertiary Prevention CoRC Metrics CoRC CONOPS and Toolkits: 7 Steps of Prevention Planning Process CoRC Logic Model

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 3 Overview Best Practices/Lessons Learned Ideas for Improving CoRC Implementation

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 4 Community Approach to Population 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) HEALTH POPULATION

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 Community Prevention Model for Population Health Community Airmen/Families Military Treatment Facility Wing Leadership Installation Support IDS Academia Public Affairs Unit CCs/First Sgt Squadrons Assuring the Conditions For Population Health The Future of the Publics Health in the 21st Century, November 2002

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 7 CoRC: AF Functional Community Players Public Affairs Legal Security Forces Medical Treatment Facility Chaplains Mission Support/ Services Senior Leadership CC/1 st Sergeants

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 INDIVIDUAL LEVEL 3.BASE COMMUNITY 4. LOCAL COMMUNITY 1. LEADERSHIP INTEGRATED 4-PRONGED COMMUNITY APPROACH

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 9 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

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 10 Surgeon Generals Toolkit: Bucket 1 Universal/Primary Prevention Population outreach: Screening population/surveillance Take temperature of risk on base Education and feedback at teachable moments

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 11 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 Generals Toolkit: Bucket 2

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 12 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 tree When to refer to ADAPT and when to incorporate into existing treatment plan Surgeon Generals Toolkit: Bucket 3

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 13 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 Generals Toolkit: Bucket 4

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 14 The 7 Steps of Program Planning Assess the Readiness of the Community Assess the Levels of Risks and Protective Factors Translate the Risk and Protective Factors into Priorities Examine the Resources in the Community Select a Target Population Apply Best Practices and Guiding Principles Evaluate the Program

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 15 AF Readiness Level Substance Misuse: A Clear and Present Danger Alcohol Misuse is involved in 33% of Suicides 57% of Sexual Assaults 28.5% of Domestic Violence Incidents 44% of PMV Accidents 33% of AD (17-24) commit 81% of ARIs

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 16 AF Readiness Level AD AF FY 04 – 0.45% Drug Positive Rate Equals – 1,572 AD Airmen Drug Positive Discharge over 1500 Airmen because Drug Positives Costs – 36 – 79K to produce each trained Airmen Cost to the AF – Over 93 Million Dollars per Year

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 17 AF Readiness Level CSAF- Must Reduce ARIs and Drug Positives via The Culture of Responsible Choices (CoRC)- July 2005

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 18 Risk Factors AF- Wide Age (17-24) * Male* Availability of Alcohol and Drugs* Underage Drinking/Binge Drinking* Single Status High OPS TEMPO/Deployments Stress Sensation-Seeking High Priority Risk Factors*

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 19 Protective Factors AF- Wide AF is a Family* Excellent Health Care System* Healthy Alternatives* Fitness Activities First Term Airmen Centers Network of Helping Professionals* Opportunities for Education and Training* High Priority Protective Factors*

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 20 Protective Factors AF- Wide Wingmans Culture* Culture of Airmen* Suicide Intervention Program* Enforcement of Underage Drinking Laws* AF Zero Tolerance Policy* Strong Leadership* Implementation of CoRC*

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 21 Examine Resources Leadership ADAPT/DR Base Prevention Coalitions i.e. CAIB, IDS, Cross-Functional Oversight, CoRC Steering Committee under the IDS Primary Care, Security Forces, OSI, Chaplains, Public Affairs, Health Educators, Family Advocacy, Outreach Managers and Other Helping Professionals

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 22 Examine Resources Off Base Coalitions- Community Anti Drug Coalitions of America (CADCA) Department of Justice Enforcing Underage Drinking Laws (EUDL) Grants Community Prevention Agencies Churches, Schools, etc.

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 23 Examine Resources Center for Substance Abuse Prevention (CSAP) Model Programs Online Prevention Training Centers For The Advancement of Prevention Technologies (CAPTs) Strategic Prevention Framework (SPF) National Survey on Drug Use and Health (NSDUH)

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 24 Examine Resources NIAAA 2002 – A Call to Action Changing the Culture of Drinking on College Campuses National Academy of Sciences, Institute of Medicine (IOM) – Reducing Underage Drinking: A Collective Responsibility Research Triangle Institute (RTI) – Survey of Health-Related Behaviors Among Military Personnel (1980 – 2005) IC & RC

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 25 Examine Resources Other ADAPT and DR Folks Networking AF Best Practices and Lessons Learned ADADT/DR World-wide Conferences CoRC Tactical Communication Plan – Dec 2006 CoRC Steering Committee CAIB/IDS CoRC CONOPS and Toolkits

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 26 Examine Resources All 72 SG toolkit documents found at: Bucket 1: Resources for universal/primary prevention through population-level outreach and screening Bucket 2: Resources for selected/secondary prevention through targeted, individualized, non-anonymous alcohol and drug screening at Primary Care/Flight Medicine during PHA and routine care Bucket 3: Resources for Behavioral Health targeted prevention through assessment for alcohol related problems (misuse, abuse, and dependence) and drug use at all Life Skill's intakes Bucket 4: Resources for ADAPT/DDR staff to use in their role as the Commanders' substance use subject matter experts

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 27 CoRC Target Populations Primary – AD Secondary - > 24 AD Tertiary – Civilians, Retirees, and Family Members

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 28 Best Practices CoRC is based on the adaptation of the Best Practice and nationally acclaimed F.E. Warrens Responsible Drinking Program

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 29 Guiding Principles 2005 CORONA Tasker Community Prevention Model to Population Health CoRC 4 Tiers CSAP 6 Prevention Strategies

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 30 Guiding Principles Prevention Research NIAAA A Call to Action: Changing the Culture of Drinking on College Campuses IOM 2003 – Reducing Underage Drinking: A Collective Responsibility

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 31 Evaluation CoRC Metrics 25% reduction in ARMs from Baseline Year 25% reduction in Drug Positives from Baseline Year Other Measures Process, Outcome and Impact Program Evaluation

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 32 CoRC Logic Model What are the Risk and Protective Factors to be addressed ? (The Goals) Reduce ARMs by 25% Reduce Drug Positive by 25%

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 33 CoRC Logic Model What services and activities will be provided ? 6 CSAP Prevention Strategies: Dissemination of Information, Prevention Education, Alternative Activities, Community-based Processes, Environmental Approaches, and Problem Recognition and Referral Urinalysis – Smart Testing

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 34 CoRC Logic Model Who will participate in or be influenced by the program ? AD 17-24

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 35 CoRC Logic Model How will the activities lead to expected outcomes ? If CoRC is implemented AF-wide according to the CONOPs than AD will be more informed With Strong Command support and if all 6 CSAP Prevention Strategies and Smart Testing are implemented than we will achieve the CoRC goals AF-wide

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 36 CoRC Logic Model What immediate changes are expected for AD ? (The short- term outcomes) A 25 % reduction in ARMs and UA+s

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 37 CoRC Logic Model What changes will CoRC ultimately like to create? ( The long- term impacts) A change in the AF Culture

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 38 Summary: 7 steps for a Prevention Planning Process Assess the Readiness of the Community Assess the Levels of Risks and Protective Factors Translate the Risk and Protective Factors into Priorities Examine the Resources in the Community Select a Target Population Apply Best Practices and Guiding Principles Evaluate the Program

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 39 CoRC Best Practices: Kadena Air Base, PACAF

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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 45 Best Practices Davis Monthan AFB - EUDL Project, Leadership Tier Barksdale AFB - Individual Tier Little Rock AFB - Base Community Tier Malstrom AFB - EUDL Project, Local Community Tier

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 46 Other Best Practices/Lessons Learned A monthly listing of those turning 21 are sent to First Sergeants from Alpha roster- ACC Placing stickers on menus and doors of local establishments –ACC Attending Underage Drinking Task Force and University Task Force Meeting to share ideas and gain synergy – ACC Responsible Choices through Education, Support and Accountability – USAFE Integrating CoRC into the Air Commando Culture - AFSOC

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 47 Ideas for Improving CoRC Implementation Strong Leadership Commitment !!! Implement under CAIB/IDS Appoint Base-level CoRC POC Do a local Needs Assessment Comprehensive Community Approach

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 48 Ideas for Improving CoRC Implementation Add a Best Practices/Lessons Learned section to CoRC Website Use CoRC CONOPS to train Periodically Update Toolkits on CoRC Website Increase the pool of Resources at the CoRC Website

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 49 Questions ?