NORTH STAR: An Evaluation of a Light-Touch, Evidence-Based Prevention Framework Within U.S. Air Force Squadrons

NORTH STAR is a community-based prevention assessment, planning, and implementation framework for military communities. It was developed and tested at the installation level in a randomized controlled trial, with encouraging findings. However, in that trial, a third of installations in the NORTH STAR condition failed to implement action plans. In this study, we moved the level of implementation to the military unit, reasoning that focusing on the operational level that experiences the consequences of psychological health challenges—the unit—would improve implementation. To accommodate this, we leveraged evidence-based interventions (EBIs) that were entirely digital and self-directed. This study was embedded within the True North initiative, with units nested within installations assigned to use the NORTH STAR framework or to assessment only. Results were discouraging, with no evidence that NORTH STAR squadrons had better risk/protective factor (RPF) profiles or lower rates of problems than control squadrons did. Commanders implementing their plans and service members (SMs) completing the EBIs that were selected based on needs assessments were the most prominent barriers. Leadership and SMs tired of the repeated assessments and had varied beliefs that self-directed EBIs could be helpful. There was not only increasing engagement but also increasing irritation with assessments over time. As the military moves forward in building a prevention infrastructure, it is critical to learn not only what works but also what is unsuccessful at engaging leaders and SMs in prevention and sustaining engagement long enough for prevention to fulfill its potential.