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Using Peer-Facilitated Interventions With High-Risk Drinkers: Successes, Challenges, and Lessons Learned

Using Peer-Facilitated Interventions With High-Risk Drinkers: Successes, Challenges, and Lessons Learned. M. Dolores Cimini, Ph.D. University at Albany, State University of New York The 2007 National Conference for Advisors of Peer Education Groups The BACCHUS Network June 17-20, 2007

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Using Peer-Facilitated Interventions With High-Risk Drinkers: Successes, Challenges, and Lessons Learned

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  1. Using Peer-Facilitated Interventions With High-Risk Drinkers: Successes, Challenges, and Lessons Learned M. Dolores Cimini, Ph.D. University at Albany, State University of New York The 2007 National Conference for Advisors of Peer Education Groups The BACCHUS Network June 17-20, 2007 Marriott City Center - Denver, Colorado

  2. Learning Objectives • Participants will identify the key components that can lead to the successful implementation of peer-facilitated alcohol interventions for college students; • Participants will outline the challenges that are associated with the decision to implement peer-facilitated alcohol interventions; • Participants will discuss the importance of training, supervision, and ongoing data collection and evaluation to assess progress, and most importantly, changes in target behaviors, such as student drinking rates.

  3. Why Involve PeersTo Deliver Interventions? • Peer influence is a key factor in determining the behavior of college students • College students regard their peers as a credible and trusted source of information (National College Health Assessment, 2000) • Studies have shown that peers can bet as effective as professionals in delivering alcohol interventions to college students (Fromme & Corbin, 2004)

  4. Components of UAlbany Comprehensive AOD Program • Presidential Leadership • Campus AOD Task Force • Student Involvement/Leadership • Social Norms Marketing • Campus-Community Coalitions • Restricting Alcohol Marketing/Promotion • Alcohol-Free Options • Education • Early Intervention • Policy Evaluation/Enforcement • Parental Involvement • Treatment & Referral • Research and Program Evaluation Comprehensive Program

  5. Middle Earth Program Profile • History • 36 year longevity • Staffing • Professional Director • 1 Psychology Intern, 3 Graduate Assistants • 140 undergraduate students • Program Components • Hotline • Outreach Program, including peer theater, interfaces with newspaper and radio, workshops, and media campaign • Program Interfaces • University affiliation, academic courses, and funding • Student government affiliation and funding • Local, State, and Federal Grants

  6. Our First Study:Model Program Grant Project • To increase the percentage of University at Albany students who believe that their peers drink at least once a week or less by 10 percent through exposure to social norms within peer theater • To disseminate information concerning the effective components of the Middle Earth model peer theater program to colleges and universities on a local, state, and national level (Funded by Model Program Grant, U.S. Department of Education)

  7. Model Program Grant Evaluation Plan Hypothesis: Trained peer educators can have an additive effect in carrying out social norms interventions when compared to media campaigns alone. Evaluation Method: • Experimental vs. control group design • Pre-post evaluations with ACHA and CORE Social Norms surveys

  8. Middle Earth Peer TheaterOverall Findings • Significant decrease in frequency of alcohol use • Significant decrease in driving after drinking any amount of alcohol (f=9.47, p.<.01) and after having more than 4 drinks • Significant decrease in behaviors that were later regretted • Significant decrease in students’ definition of acceptable drinking in terms of occasions per week

  9. Middle Earth: Evaluation • Increase in participant engagement in protective behaviors, including • use of a designated driver • pacing drinks to one or fewer per hour • keeping track of how many drinks • Decrease in participant engagement in high risk behaviors, including • missing classes • physical injury to self • having unprotected sex.

  10. Middle Earth: Evaluation Project Goal: To increase the percentage of 1st year students who perceive that their peers drink once per week or less by 10%.

  11. Middle Earth: Evaluation

  12. The Next Step:“The Effects of Peer Facilitated Alcohol Interventions” Funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) $890,000

  13. Selecting Our Interventions:The NIAAA Report on College DrinkingApril 2002 http://www.collegedrinkingprevention.gov/

  14. NIAAA Recommendations forClassifying Intervention Effectiveness Tier 1: Evidence of effectiveness among college students Tier 2: Evidence of success with general populations that could be applied to college environments Tier 3: Promising: Evidence of logical and theoretical promise, but require more comprehensive evaluation Tier 4: Ineffective: No Evidence of Effectiveness From: “A Call to Action: Changing the Culture of Drinking at U.S. Colleges,” NIAAA Task Force

  15. Aims of Our Project • Test the efficacy of three peer-led, groupinterventions in reducing alcohol consumption and alcohol-related problems among “high-risk” judicially referred students • Examine possible mediators of intervention effectiveness (e.g., normative beliefs) • Examine possible moderators of intervention effectiveness (e.g., parental alcoholism, psychological distress)

  16. Project Design • Testing the effectiveness of three peer-facilitated alcohol interventions for judicially referred students: • Peer-Theater • Group Motivational Interviewing • Educational Lecture • Several secondary questions: • What Peer-Facilitated Interventions Work Best With Which Students?

  17. Methodology • Subjects: Any students living in residence who violate the University’s alcohol policy is eligible to participate • Data Collection: Baseline, 6-month follow-up, 12-month follow-up • Compensated $25.00 for completing each round of questionnaires • Randomly assigned to intervention

  18. Baseline Data:Spring 2005-Fall 2007 • N = 590 who completed the baseline measures and participated in the interventions • The vast majority of students we contacted ended up participating • 63% male • 83% white • Average age: 18.8 years

  19. Alcohol Consumption • Average drinks per week: 18.8 • Males: 20.7 • Females: 16.1 • National norms are about 5-6 for males, 3-4 for females • Also higher than campus norms, and campus norms for other “at-risk” groups

  20. Preliminary Findings & Trends • Overall, we’re finding small reductions in alcohol use, but few between group differences • The MI and Peer Theatre Groups may be more effective at reducing alcohol-related problems, but more comprehensive analyses are ongoing.

  21. More About OurPeer Intervention Programs Peer Theater • Social-norms based approach • Uses theatre presentations by peers (i.e., undergraduate students) to address topical scenarios related to college student alcohol use • Discussions occur after the theatre performances

  22. Can You Hear Us Now? 87% of UAlbany Students have not allowed alcohol to affect their academic performance (Source: Spring 2006 ACHA Survey)

  23. Can You Hear Us Now? 73% of UAlbany students eat before or while drinking alcohol (Source: Spring 2006 ACHA Survey)

  24. Peer-FacilitatedIntervention Programs(continued) Small-Group Motivational Interviewing Intervention • Small group motivational interviewing-based program led by peers • One session, two-hour intervention • Program components include values clarification exercises, social norms evaluations, expectancies related to alcohol use, and personal evaluation of alcohol consumption

  25. 5 Principles of Motivational Interviewing • Express Empathy • Develop Discrepancy • Roll w/ Resistance • Avoid Argumentation • Support Self-Efficacy

  26. Using Effective “O.A.R.S.” • Open-ended questions • Affirm • Reflect • Summarize Examples: “So on the one hand you’re planning to go to grad school, but your grades are being effected by going out so much.” “There’s nothing that concerns you about your drinking.”

  27. Peer-FacilitatedIntervention Programs (continued) Educational Lecture on Alcohol and Its Effects (Control Condition) • Standard alcohol lecture on factors such as prevalence rates, physiological implications, blood alcohol level, tolerance, protective factors, and social norms

  28. Managing Resistance to Social Norms • “Who did you survey to get these stats?” • “People must be lying on those surveys!” • “Based upon what I’ve seen around here, there’s no way these numbers are accurate!”

  29. Group Dynamics Issues • Group size • Gender make-up of the group • Friends randomly assigned to same group • Group “spokesman” • 4 types of Pre-contemplaters

  30. Recruiting Peer Educators • Select the best and the brightest student leaders • Consult colleagues who know students well • Send candidates special letter of invitation • Link peer education opportunity to future career-related opportunities • Interview potential candidates using role-play scenarios • Assess candidate attitudes toward alcohol use among college students and request permission to check judicial office records and Facebook/MySpace profiles

  31. Training Peer Educators • Schedule and conduct weekly supervision • Provide a theoretical foundation • Demonstrate interventions using videotaped sessions by expert professionals • Offer modeling of skills • Conduct role-plays during supervision • Discuss challenges, concerns of peers and consider student feedback in making modifications in intervention strategies • Provide both group and individual pre and post-intervention feedback • Review videotaped interventions during supervision sessions

  32. Retention of Peer Educators • Maintain highly selective recruitment and retention standards • Compensate peer educators for their work and project participation • Offer opportunities for face-to-face training and workshops from leading researchers and practitioners in the alcohol abuse prevention field • Maintain career-enhancing motivation opportunities (graduate school and job recommendations, etc.) • Discuss special leadership role of student facilitators within the broader peer education organization

  33. Challenges and Pitfalls • Scheduling of supervision meetings and intervention sessions • Peer facilitator “drift” • Peer facilitator difficulty accepting feedback and constructive criticism • Interpersonal conflicts among peer facilitators • Peer Facilitator non-compliance with supervision requirements • Peer facilitator boredom with intervention program over time • Peer facilitator personal issues behavior (alcohol use or other judicial violation) runs counter to project goals

  34. Q & A

  35. For Further Information M. Dolores Cimini, Ph.D. Assistant Director for Prevention and Program Evaluation University Counseling Center Director, Middle Earth Program University at Albany, SUNY Albany, NY 12222 518-442-5800 Email Address dcimini@uamail.albany.edu Web Address: http://www.albany.edu/counseling_center/

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