Integrating Targeted Screening & Brief Intervention Strategies t into a Comprehensive Alcohol l Abuse Prevention and Behavioral Health Program on a College Campus M. Dolores Cimini, Ph.D. University at Albany, State University of New York Washington State College Coalition Annual Meeting June 11, 2009 - Seattle University, Seattle, WA
Where We Began The Scope of the Problem
University at Albany Profile University Center within 64- campus SUNY System Urban Setting Research University NCAA Division i i I Students: Undergraduates - 12,457 Graduate Students - 4,977 Faculty: 967 Employees: 4,197 Degree Programs: Undergraduate - 61 Masters - 89 Doctorate - 39
Profile of Alcohol and Other Drug Use and Related Behaviors Reported by UAlbany Students Data from National College Health Assessment, American College Health Association Spring 2000,2004 & 2006 In-Class Administrations and Entering Student Questionnaire (ESQ) Summer 2006 Administration
Alcohol Use, Last 30 Days: Overall Comparisons - UAlbany 60% 50% 54.0% 51.4% 50.1% 40% 30% 20% 10% 29.9% 23.0% 23.0% 23.3% 18.6% 26.6% 0% Spring 2000 Spring 2004 Spring 2006 Did not use Used 1-9 days Used 10+ days
60% 50% 40% 30% 20% 10% Number of Times Consumed 5 or More Drinks Within Last Two Weeks: Overall Comparisons-UAlbany 52.0% 24.0% 16.0% 8.7% 40.7% 29.3% 20.0% 0% 10.1% 44.4% 26.6% 21.8% 7.2% 0% Spring 2000 Spring 2004 Spring 2006 0 Times 1-2 Times 3-5 Times 6+ Times
Negative Consequences: Overall Comparison-UAlbany Percent (%) Spring Spring Sprin 2000 2004 g 2006 Being physically injured 22.0 28.22 26.3 Physically injured another person 8.9 8.5 10.1 Being involved in a fight 11.0 17.2 13.9 Doing something later regretted Forgot where they were or what they have done Having someone use force or threat of force to have sex 45.0 49.7 44.5 40.00 43.33 43.2 3.7 2.1 0.9
Negative Consequences: UAlbany Comparisons With National Sample-Male Percent (%) Natʼ Sprin Natʼ Sprin l 200 g 2004 l 200 g 2006 4 6 Being physically injured 20.1 30.2 19.0 28.6 Physically injured another person 7.8 13.2 6.4 17.0 Being involved in a fight 10.8 23.5 9.5 19.9 Doing something later regretted Forgot where they were or what they have done H i f 39.9 53.9 37.8 49.7 33.8 46.5 33.2 50.0
Negative Consequences: UAlbany Comparisons With National Sample-Female Percent (%) Natʼ Sprin Natʼ Sprin l 200 g 2004 l 200 g 2006 4 6 Being physically injured 17.9 28.8 17.6 24.3 Physically injured another person 2.8 5.2 2.6 5.5 Being involved in a fight 4.2 12.9 3.9 10.2 Doing something later regretted Forgot where they were or what they have done Having someone use force or 36.4 47.6 34.2 43.0 28.7 41.7 27.7 39.0
Driving After Consuming 5 or More Alcoholic li Drinks UAlban Natʼl UAlban Natʼl UAlban UAlban y Spring 200 4 y Spring 200 6 y Spring y SPC 2006 2000 2004 2006 65 6.5 64 6.4 74 7.4 45 4.5 69 6.9 45 4.5
Relationship Between Alcohol Abuse and dreported dhealth lthconcerns UAlbany NCHA data tell us that students who engage g in high-risk drinking are also more likely to report the following: Broken bones Chlamydia Genital Warts Gonorrhea High Cholesterol l Mononucleosis Repetitive Stress Injury Strep Depression Other Substance Abuse Source: National College Health Assessment, American College Health Association Coordinated by E. Rivero, M. D. Cimini, B. Freidenberg, et al.
Data on Suicide Risk Based upon a representative sample of UAlbany students, we estimate that within the last year 913 University at Albany students seriously considered suicide 120 survived a suicide id attempt t Source: National College Health Assessment Spring survey of a random, representative sample of 549 UAlbany students. Conducted by the University Counseling Center.
Selecting Our Interventions: The NIAAA Report on College Drinking April 2002 http://www.collegedrinkingprevention.gov/ gov/
NIAAA Recommendations for Classifying 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 From: Effectiveness A Call to Action: Changing the Culture of Drinking at U.S. Colleges, NIAAA Task Force
Components of UAlbany Comprehensive AOD Prevention Program Presidential Leadership Campus AOD Task Force Student Involvement/Leadership Social i l Norms Marketing Campus-Community Coalitions Restricting Alcohol Marketing/Promotion Alcohol-Free Options Education Early Intervention Policy Evaluation/Enforcement Parental Involvement Treatment t t & Referral Research and Program Evaluation Comp prehen sive Progra m
Spectrum of Intervention Response: Alcohol Abuse Prevention Thresholds for Action Universal Prevention Social Norms & Social Marketing Campaigns Peer Services Early Intervention BASICS ASTP Interactive Education with Social Norms Specialized Treatment Outpatient Assessment, Treatment, & Referral
Stages of Change in Substance Abuse and Dependence: Intervention Strategies Precontemplation Contemplation Action Stage Stage Stage Maintenance of Recovery Stage Relapse Stage MOTIVATIONAL ASSESSMENT RELAPSE ENHANCEMENT AND TREATMENT PREVENTION STRATEGIES MATCHING & MANAGEMENT
What We Did: Interventions and Outcomes
The STEPS Model The STEPS Brief Screening and Intervention Model Targeting Students at Risk Sustaining Success Preventing High-Risk Alcohol Use & Promoting Healthy Behaviors E ngaging High-Risk Drinkers in Brief Alcohol Interventions Targeting High-Risk Drinkers Screening At-Risk Students for Alcohol Use & Related Behaviors
Screening and Follow-Up Assessment Measures: Survey Instruments for Project Participants Alcohol Use Disorders Identification Test (AUDIT) GPRA Assessment Tool Center for Epidemiological Studies-Depression Scale (CES-D) Daily Drinking Questionnaire (DDQ) Brief Alcohol Expectancies Questionnaire (BAEQ) Drinking Norms Rating Form (DNRF) Protective Behaviors Strategies Scale (PBSS) Readiness to Change Scale (RTC) Rutgers Alcohol Problem Index (RAPI) Brief Drinker Profile Campus-Wide Surveillance Data Campus Wide Surveillance Data The National College Health Assessment, American College Health Association (NCHA)
UAlbanyʼs Brief Alcohol Screening g and Intervention for College g Students Feedback Profile Typical Drinking Pattern Blood Alcohol Levels Drinking Norms Biphasic Curve Beliefs about Alcohol Effects Alcohol-Related Problems Calories consumed Financial Costs of Drinking Alcohol Use & Sex Family History Protective ti Factors Athletic Performance
Overview of Screening and Brief Intervention Methodology Target Population Assessment Points Project Project Project Winning STEPS First STEPS Healthy STEPS Student-athletes Baseline, 3-months, 6-months First-year students Baseline, 3-months, 6-months Students seeking campus healthcare Baseline, Discharge, 6-weeks, 6-months Mode of Web-delivered d Web-delivered d In-person Screening Mode of Intervention ti In-person- individual id or team-delivered In-person- individual id or web-delivered In-person, individual id Who Delivers Professional Professional Professional Intervention psychologists psychologists psychologists Assignment to Treatment Random Random N/A
Number of Interventions Completed Project Students Served to Date SAMHSA-CSAT Campus TCE-SBI Project 7,598 Project Healthy STEPS U.S. Department of Education Project First STEPS 5,513513 U. S. Department of Education Project Winning STEPS 378 Total # of Interventions 13,489
Project Healthy STEPS: S Goals Reduce alcohol use (amount and frequency) among students t identified d as high-risk drinkers through health care screening Reduce alcohol-related harms among students identified as high-risk drinkers through health care screening F d db h C S i dbi fi i T dc i E i Funded by the Campus Screening and Brief Intervention Targeted Capacity Expansion Grant, Substance Abuse and Mental Health Services Administration-Center for Substance Abuse Treatment, FY 2005
Highlights of Intervention Successes: Project Healthy STEPS 11% reduction in heavy episodic drinking 15% reduction in drinks consumed per week 9% reduction in peak drinking 17% reduction in peak BAC 29% correction in perceptions of peersʼ drinking
Additional Findings Lower perceived norms predicted lower subsequent drinking. (r =.21, p <.001) Use of more protective behaviors led to lower subsequent drinking. (r=-.39, p <.001)
Project First STEPS: Goals Reduce alcohol use (amount and frequency) among first-year students t identified as high-risk drinkers through online screening Reduce alcohol-related harms among first-year students identified as high- risk drinkers through online screening Funded by the Grant Competition To Reduce High-Risk Drinking or Violent Behavior Among College Students, FY 2005
Highlights of Intervention Successes: Project First STEPS Web-Delivered BASICS Intervention: 16% reduction in drinks consumed per week 13% reduction in peak drinking rates Face-to-Face BASICS Intervention: 32% reduction in drinks consumed per week 13% reduction in peak drinking rates
Additional Findings Changes in perceived norms were associated with changes in actual drinking behavior (r =.36-.53, p <.000) Higher engagement in protective behavioral strategies associated with a reduction of alcohol consumption (r = -.26 to -.40, p <.02)
Project Winning STEPS: Goals Reduce alcohol use (amount and frequency) among student-athletes identified as high-risk drinkers through online screening Reduce alcohol-related harms among student-athletes t thl t identified d as high-risk h ik drinkers through online screening Educate student-athletes about alcohol s impact on athletic performance Funded by the Grant Competition To Reduce High-Risk Drinking or Violent Behavior Among College Students, FY 2006
Highlights of Intervention Successes: Project Winning STEPS Majority of athletes drink less often than average student, BUT Up to a 50% reduction in negative consequences among high-risk drinkers completing intervention 79% increase in use of at least one protective behavior
The STEPS Comprehensive Suicide Prevention Program Model Sustaining Student Success Preventing Suicide Risk Behaviors & Promoting Healthy Behaviors Engaging Students, Faculty, Staff, & Families in Education About Suicide Prevention Training Potential Campus Responders & Strengthening a Campus Comprehensive Care Network Screening and Early Intervention for Students at Risk for Suicide and Related Risk Factors Partnerships Working to Prevent Student Suicide One Step at a Time
Components of UAlbany Comprehensive Prevention Program Presidential Leadership Campus Task Force: Brisk Student Involvement/Leadership Social Marketing/Social Norms Campus-Community Partnerships Education Gatekeeper Training Early y Intervention Policy Evaluation/Enforcement Parental Involvement Treatment & Referral Research and Program Evaluation Comp prehen sive Progra m
Spectrum of Intervention Response: Suicide Prevention Thresholds for Action Universal Prevention Stigma Reduction Media Campaign Peer Services (Peer Education and Hotline Services) Educational Brochures Early Intervention Save-A-Life" Gatekeeper Training Program for Faculty, Staff, and Students PRISM (Proximate Risk Index and Screening Measure) Screenings Consultations with faculty, staff, students, and parents Specialized Interventions CARE Net )Consultation and Resource Evaluation) Program Treatment and Referral Response to Urgent or Emergent Situations
Application of SBI Model to Suicide Prevention Goal 1: Reduce rates of student suicide, suicide attempts, and related mental/behavioral health problems Increase identification of proximate risk factors, such as depression, substance abuse, and other risk factors Increase early intervention ti with students t at risk for suicide through self-referral and/or referral by gatekeepers Goal 2: Increase utilization of campus mental health and related primary care services to reach the students in most need of them Increase student referrals to University Counseling Center I f lt / t ff lt ti t f
Risk Factors and Warning Signs Unwanted change or life crisis (loss, failure, humiliation) Depressed mood plus another intense psychological state or signs of agitation i e.g., difficulties sleeping, intolerable anxiety or panic, feelings of failure, helplessness, or hopelessness Marked deterioration in academic, social, or job functioning Abusing alcohol or drugs to cope or feel better Speech or actions suggesting suicide
Proximate Risk Indicators for Suicide id Measure (PRISM) Prevention-related, risk-factor focused screening measure (not a suicide prediction tool) Items selected for inclusion assess risk factors found in more than half of the cases of serious suicide attempts 1 Goal is to increase screening/self-selection and link at-risk students to counseling services Questions are responsive to needs of a variety of target populations ( students seeking health care, academic advisem,ent,, career services, etc.) 1 Hall et al. (1999)
University at Albany, State University of New York University Counseling Center Student Questionnaire Dear Student: To provide you with the highest level of care, we ask your help in completing the questions below. Please hand this form in to your provider during today s visit. If you have completed this form within the past month, please return the blank form to your provider. Information from this form that is discussed with your provider will remain confidential and this form will remain in your confidential University Counseling Center file. Thank You. Instructions: These questions concern how you have been feeling and doing over the past 7 days. Check the choice below each question that best describes how you have been. 1. Difficulties falling asleep or staying asleep? 0 No Days 1 One Day 2 Some Days 3 Most Days 4 Everyday Name: Email: PRISM Scores Mean = 11.1 Median = 11 Phone: Mode = 14 Date: Age: Male Female 2. Very anxious or nervous, unable to stop thinking, uncomfortably restless or physically agitated? 0 No Days 1 One Day 2 Some Days 3 Most Days 4 Everyday 3. Panic attacks, a sudden rush of intense fear, apprehension, or terror? 0 No Days 2 One Day 3 More Than One Day 4. Feeling sad or down for most of the day, like everything is an effort and/or very irritable and unhappy? 0 No Days 1 One Day 2 Several Days 3 Nearly Everyday 5. Having no hope or expectation that things will get better? 0 No Days 1 Once in a While 2 Often 6. Feeling trapped, helpless or like a complete failure? 0 No Days 1 Once in a While 2 Often 7. A painful loss or crisis in a relationship, valued activity or important goal? 0 No Days 1 One Day 2 Several Days 3 Nearly Everyday 8. Use of alcohol and/or substances? 0 No Days 1 One Day 2 Two or More Days For Office Use Only Circle One: Decline Accept N/A Circle One: Barr Bernier Cimini Dewitt-Parker Diaz-Myers Freidenberg Heslin Pokat Horner Monserrat SD = 4.8 Range = 0 to 21 PRISM PRISM-AUDIT: r=.25* r TOTAL SCORE (Questions 1 8) = Add the numbers left of the checks. Rivero Rosin Stanley Intern Pilot PRISM, Fall 2006.
The Save-A-Life Gatekeeper Training Program Key Concepts Ask the Question Make a Call Save a Life!
Knowledge Comfort 100% 90% 80% 70% 60% 50% 76% 89% 50 45 40 35 30 25 36.7 40.9 40% 30% 20% 10% 0% Pre Post 20 15 10 5 0 Pre Post t(69) = -6.945, p<.001 t(69) = -6.801, p<.001
Project Outcomes: Changes in Service Utilization 2004-2008 36% increase in number of clients seeking treatment at University Counseling Center 79% increase in number of consultations from faculty, staff, students, and parents 79 referrals to CARE Net Program Completed gatekeeper training for 90% of professional student services staff members
Project Outcomes on Proximate Risk for Suicide: Changes in Indices of UAlbany Student Alcohol Use Spring 2004-Spring 2008 32% increase in number of abstinent students 25% increase in number of students who abstain from heavy episodic drinking (5+ drinks on one occasion) 14% increase in number of students who drink once a week or less 17% reduction in number of students who think the typical UAlbany student drinks daily Source: National College Health Assessment, American College Health Association Spring in-class Survey Administrations (Stratified Random Sample)
Successes, Challenges, and Sustainability
Keys to Successful Implementation Buy-in at all university levels Clear statements of protocols and procedures Consistent implementation of stated procedures with appropriate tracking Training and communication with professional and support staff Process and outcome evaluation
Key Strategies for Sustainability Project Work Group and Steering Committee Presidentʼs Advisory Council on the Prevention of Alcohol Abuse and Related Risk Behaviors Annual Reporting and Strategic Planning Presentations and Publications Consultation With Colleagues Media Advocacy Addictions Research Center
Challenges and Barriers to Sustainability Infrastructure t issues Staffing Space Incentives for student participation in interventions Alignment of University Counseling Center goals and priorities ities with changing and increasingly complex student needs
Future Directions for UAlbany Develop, implement, and test the efficacy of drug-specific screening and intervention methods for college student drug users Develop, implement, and test the efficacy of the Project Winning STEPS screening and intervention ention methods for student-athletes using a multi-campus evaluation model Develop formal training/academic course curriculum in screening and brief intervention theory and practice for graduate and undergraduate students Develop technical assistance manuals for practitioners, outlining effective elements of projects and offering templates for implementation on other college campuses and communities on a local, state, and national scale Capitalize on opportunities to educate faculty, staff, students, and the community on effective intervention strategies on an annual basis
Thank You! Questions?
Special Thanks Our Funders: National Institute on Alcohol Abuse and Alcoholism New York State Office of Alcoholism and Substance Abuse Services Substance Abuse and Mental Health Services Administration-Center for Substance Abuse Treatment Substance Abuse and Mental Health Services Administration-Center for Mental Health Services U. S. Department of Education Our Interventionists: University at Albany Counseling Center staff Our University Colleagues: Department of Athletics Department of Residential Life Office of Conflict Resolution and Civic Responsibility University Health Center Our Consultants: Our Consultants: Drs. Mary Larimer and Jason Kilmer, University of Washington, Dr. H. Wesley Perkins, Hobart and William Smith Colleges
For Further Information M. Dolores Cimini, Ph.D. Assistant Director for Prevention & Program Evaluation Director, Middle Earth Peer Assistance Program Adjunct Clinical Professor, School of Education Email: dcimini@uamail.albany.edu University Counseling Center 400 Patroon Creek Boulevard, Suite 104 University it at Albany, SUNY, Albany, New York 12206 Phone: 518-442-5800 Fax: 518-442-3096 Website: www.albany.edu/counseling _center/