DISTANCE EDUCATION IN THE FACILITATION OF AN ADDICTION INTERVENTION PROGRAM. Dr. Leann Kaiser, PhD and Susan Templeton

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1 DISTANCE EDUCATION IN THE FACILITATION OF AN ADDICTION INTERVENTION PROGRAM Dr. Leann Kaiser, PhD and Susan Templeton

2 THE POPULATION The Wind River Indian Reservation (over 2 million acres) in Fremont County, Wyoming Wind River is home to both the Northern Arapaho and Eastern Shoshone Tribes Population ratio is 4:1, Arapaho majority An average of 82% are high school graduates, and 15% have attained a bachelor s degree or higher ( US Census B u r e a u )

3 THE PROBLEM Persons of American Indian descent are dying from alcohol and drug related causes at a rate three times higher than their white counterparts (Landon, 2014). They also die very young. New vital statistics from the Indian Health Services clinic show that the modal age of death is years of age for a member of the Wind River Indian Reservation in Wyoming with a diagnosis of drug and alcohol dependent. The modal age of death on the Wind River Indian Reservation for all other diseases is years of age.

4 # Deaths FIGURE 1 An American Indian patient from the Arapaho or Shoshone tribe on the Wind River Reservation diagnosed with drug and alcohol dependency will lose years of life due to addiction ( R. Har t, W ind R iver psyc h o logist, p ersonal c o m m u n icatio n, 2 014). 140 Figure 1 Numbers of Deaths by Age and Diagnoses 120 Shoshone/Arapaho 100 Un-Natural Alcohol Deaths Diabetes 80 Heart Tobacco/No Alcohol 60 Lung Cancer, Emphas, COPD Colon Cancer 40 Combined Drugs Cannabis 20 Opiates Amphetamines Cocaine 0 Sedative/Anxiolitic Age of Death

5 FUNDING ISSUES On the Wind River Reservation, two outpatient Indian Health Services clinics, and a substance abuse treatment center, the White Buf falo Recovery Center, serve 10,964 people. The family poverty rate among American Indians is 32% - three times the national poverty rate in the United States (Akee, 2014) These healthcare services are chronically underfunded. The US Commission on Civil Rights Report found that in 2003, the Indian Health Service appropriation amounted to $2533 per capita- over a thousand dollars below the $3803 per capita appropriated for federal prisoners (Katel, 2006).

6 THE ONLINE SOLUTION Online distance education can address the need for alcohol treatment by supporting existing programs in a cost effective way. Distance education can fill the gap for patients on waiting lists to receive treatment. Mobile technology has the ability to reach rural areas, incarcerated populations, and the age demographic target. Distance education can prepare patients for their face -to-face counseling sessions, making them more effective.

7 ONLINE INTERVENTIONS Literature supports the efficacy of online addiction interventions. One study of university students, for example, found that a brief online intervention about alcohol use decreased participants total alcohol consumption by 26% over a six - week period of time, and participants alcohol related personal and legal problems decreased by 30% in a six -month period (Kypros, 2004). Brief interventions can produce results as promising as intense treatment (Bien, 1993).

8 THE GOALS The first goal of this learning program is to act as a brief intervention to motivate patients to complete their treatment at White Buffalo. The second goal is to serve people who are currently on the waiting list to get treatment. They can take steps to recovery immediately though online education. By asking patients to be on a waiting list, it may be setting them up for relapse.

9 THE TOPICS Four units of instruction are planned on topics of mental health- Depression, Grief & Loss, Trauma, Substance Abuse. These topics were selected as the most needed by the director of the White Buffalo Recovery Center and a psychologist at Indian Health Services. Instruction will be completed prior to patients entering the existing outpatient treatment program. The four units can be completed in either two weeks, or four weeks time. The timing will depend on current waiting list lengths.

10 DELIVERY METHOD Each unit will be one hour of instruction that learners will complete individually via computer. An LMS, like Canvas, will deliver the content. A counselor will act as instructor, receiving responses and providing feedback. Once or twice a week, a group therapy session will meet to discuss the current unit of instruction.

11 SAMPLE LEARNING OBJECTIVES The instructional unit on Depression will have four main learning objectives: Learners will be able to identify the symptoms of depression, the biological factors, and environmental factors that contribute to long-term depression on a quiz. Learners will be able to write about which symptoms and factors are most applicable to them in short paragraph form. Learners will be able to orally, and in writing, discuss skills that combat depression. Learners will be able to connect these skills to their own experiences, in writing, and at group therapy sessions.

12 ASSESSMENT Learners will be assessed on their participation. Participation will be assessed through quizzes, short answers, online discussions, and by physical presence at group meetings. No grades are given, but learners who do not complete 80% of the activities and group sessions will not be considered as having completed the modules. The instruction itself will be assessed on its ability to help learners finish outpatient treatment.

13 THEORETICAL BASIS Psychology perspective: Cognitive Behavioral Therapy (examining one s own negative thoughts and thinking errors) Learning Science perspective: Design Based Research Cognitive Theory of Multimedia Learning

14 THE NEXT STEPS This online intervention program will be tested in spring/summer The feedback from participants and healthcare workers will inform revisions. If the results are positive, the White Buffalo Treatment Center will decide to either maintain it as a brief intervention, or incorporate expanded modules into the full outpatient program.

15 IDEAS, FEEDBACK, APPLICATION As this online addiction intervention is currently in development, any ideas or feedback you have are helpful.

16 FURTHER AREAS OF RESEARCH Expanding distance mental health education to also serve the Indian Health Services clinics. Creating a smart phone app to help monitor alcohol cravings and/or moods. Like a migraine diary, or a food diary, it can help patients recognize patterns and triggers.

17 REFERENCES Akee, R.K.Q., Taylor, J. (2014) Social and economic change on American Indian reser vations: A databook of the U.S. Census and the American Community Sur vey Retrieved from taylorpolicy.com /us-databook on Sept 10, Bien T.H., Miller W.R., Tonigan J.S., Brief inter ventions for alcohol problems: a review. ( 1993). Addiction, 88 (3), p ). Cloud, R.N., Peacock, P. L. (2001). Internet screening and inter ventions for problem drinking: Results from the pilot study. Alcoholism Treatment Quar terly 19 (2), p Kypros, K., Saunders, J., Williams, S., McGee, R., Langley, J., et al. ( 2004). Web -based screening and brief inter vention for hazardous drinking: a double blind randomized controlled trial. Addiction, 99 (11), p Landon, M., Roeber, J., Naimi, T., Nielsen, L., Sewell, M. (2014). Alcohol - Attributable Mor tality Among American Indians and Alaska Natives in the United States, American Journal of Public Health, 104, S3. Saitz R., Palfai T.P., Freedner, N., Winter M.R., MacDonald, A., Lu, J., et al. (2007). Screening and brief inter vention online for college students: the ihealth study. Alcohol and Alcoholism, 42 (1), p28-36.

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