USAF Recruit Assessment Program

1. USAF Recruit Assessment Program LTC Thomas L. McKnight, MD MPH Chairman, AF Trainee Health Working Group Director, Health Promotion HQ AETC/SG Randolph AFB, TX

2. Historical Review RAP proposal to AFEB � 1997 Presidential Review Directive � 1998 IOM � 1999 & 2000 Presidential Special Oversight Board � 2000

3. Purpose Objectives Provide medical and risk factor data to aid clinical diagnosis and care 2. Assist in development of improved preventive medicine strategies 3. Establish baseline database � future studies evaluate health problems and post-deployment health issues

4. RAP: Information to Action To accomplish the objectives requires certain program components. Input: -Need a instrument that collects information to support the objectives -instrument delivery methods -data entry methods Output: -interpretation of responses with scoring algorithms -patient reports -clinical action reports (for one person) -aggregate reports (similar actions for similarly situated persons) Reports and data (for ad hoc reports) need to accessible for action-doers --whether for clinical care or --programmatic action, e.g., changing tobacco use policies at tech training. To accomplish the objectives requires certain program components. Input: -Need a instrument that collects information to support the objectives -instrument delivery methods -data entry methods Output: -interpretation of responses with scoring algorithms -patient reports -clinical action reports (for one person) -aggregate reports (similar actions for similarly situated persons) Reports and data (for ad hoc reports) need to accessible for action-doers --whether for clinical care or --programmatic action, e.g., changing tobacco use policies at tech training.

5. Air Force RAP Priorities Driven by operational value Automated Identified for personal intervention Longitudinal link with HEAR 3.0

6. An Alternative for Consideration Health Evaluation Assessment Review HEAR 3.0 with Trainee Module

7. Evolution of HEAR Project HEAR � TRICARE Region 6, 1995 HEAR 2.0 � Automated in PHCA -Preventive Healthcare Application HEAR 3.0 � Finalized March 02 Tri-Service Working Group & Advisory Group with civilian expert input (Yale review)

8. HEAR 3.0 Follows military member throughout career -older version already woven into MHS fabric Topic inclusion criteria: USPSTF � A, B, C Core questions with drill downs -minimum: 40 questions -maximum:145 questions

9. HEAR 3.0 Question Sources BRFSS NHANES National Health Interview Survey Patient Health Questionnaire Brief Patient Health Questionnaire Spirituality and Resiliance Assessment Packet Alcohol Use Disorders Identification Test National Comorbidity Survey Primary Care �PTSDS

10. AF RAP: When to Implement AF Basic Military Training (BMT) -Not ideal setting � intimidating situation -Short training period: 6 weeks -Mental Health presently evaluates recruits AF Technical Training (TT) -Less intimidating environment -More relaxed setting to complete assessment -Still same cohort � only 6 weeks older

11. AF RAP: First Steps Deploy HEAR 3.0 to Tech Training Bases Administer to airmen upon arrival from BMT Add Trainee Health Module to HEAR 3.0 -add childhood questions -remove chronic disease except asthma