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

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


Title: Middle Earth: A Model Alcohol Prevention Program Author: Delores C imini Last modified by: mdc64 Created Date: 10/10/2000 4:17:15 PM Document presentation format – PowerPoint PPT presentation

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Title: 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
  • The 2007 National Conference for Advisors of Peer
    Education Groups
  • The BACCHUS Network
  • June 17-20, 2007
  • Marriott City Center - Denver, Colorado

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.

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)

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
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
  • Student government affiliation and funding
  • Local, State, and Federal Grants

Our First StudyModel 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
  • 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)

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

Middle Earth Peer TheaterOverall Findings
  • Significant decrease in frequency of alcohol use
  • Significant decrease in driving after drinking
    any amount of alcohol (f9.47, and after
    having more than 4 drinks
  • Significant decrease in behaviors that were later
  • Significant decrease in students definition of
    acceptable drinking in terms of occasions per

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.

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.
Middle Earth Evaluation
The Next StepThe Effects of Peer Facilitated
Alcohol Interventions
  • Funded by the
  • National Institute on Alcohol Abuse and
    Alcoholism (NIAAA)
  • 890,000

Selecting Our InterventionsThe NIAAA Report
on College DrinkingApril 2002
  • http//

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
  • Tier 3 Promising Evidence of logical and
    theoretical promise, but require more
    comprehensive evaluation
  • Tier 4 Ineffective No Evidence of

From A Call to Action Changing the Culture of
Drinking at U.S. Colleges, NIAAA Task Force
Aims of Our Project
  • Test the efficacy of three peer-led, group
    interventions 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)

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?

  • Subjects Any students living in residence who
    violate the Universitys 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
  • Randomly assigned to intervention

Baseline DataSpring 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

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
  • Also higher than campus norms, and campus norms
    for other at-risk groups

Men Women Total
Peak Drinks Past 30 11.9 9.0 10.7
gt6 Drinks Past 30 5.6 4.5 5.1
gt9 Drinks Past 30 3.8 2.2 3.1
Friend Per/Week 25.0 22.0 23.7
Typ. Stud. Per/Week 28.6 22.4 26.0
Preliminary Findings Trends
  • Overall, were 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.

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

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

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

Peer-FacilitatedIntervention Programs
  • Small-Group Motivational Interviewing
  • 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

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

Using Effective O.A.R.S.
  • Open-ended questions
  • Affirm
  • Reflect
  • Summarize
  • Examples
  • So on the one hand youre planning to go to
    grad school, but your grades are being effected
    by going out so much.
  • Theres nothing that concerns you about your

Peer-FacilitatedIntervention Programs
  • 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

Managing Resistance to Social Norms
  • Who did you survey to get these stats?
  • People must be lying on those surveys!
  • Based upon what Ive seen around here, theres
    no way these numbers are accurate!

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

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
  • Assess candidate attitudes toward alcohol use
    among college students and request permission to
    check judicial office records and
    Facebook/MySpace profiles

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

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
  • Maintain career-enhancing motivation
    opportunities (graduate school and job
    recommendations, etc.)
  • Discuss special leadership role of student
    facilitators within the broader peer education

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
  • Peer facilitator boredom with intervention
    program over time
  • Peer facilitator personal issues behavior
    (alcohol use or other judicial violation) runs
    counter to project goals

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
  • Web Address
  • http//
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