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

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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

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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.

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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)

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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
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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

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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
  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)

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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

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Middle Earth Peer TheaterOverall Findings

• Significant decrease in frequency of alcohol use
• Significant decrease in driving after drinking
  any amount of alcohol (f9.47, p.lt.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

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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.

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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.
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Middle Earth Evaluation
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The Next StepThe Effects of Peer Facilitated
Alcohol Interventions

• Funded by the
• National Institute on Alcohol Abuse and
  Alcoholism (NIAAA)
• 890,000

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Selecting Our InterventionsThe NIAAA Report
on College DrinkingApril 2002

• http//www.collegedrinkingprevention.gov/

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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
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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)

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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?

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Methodology

• 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
  questionnaires
• Randomly assigned to intervention

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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

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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

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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
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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.

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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

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Can You Hear Us Now?

• 87 of UAlbany Students have not
• allowed alcohol to affect their academic
  performance
• (Source Spring 2006 ACHA Survey)

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Can You Hear Us Now?

• 73 of UAlbany students eat
• before or while drinking alcohol
• (Source Spring 2006 ACHA Survey)

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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

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5 Principles of Motivational Interviewing

• Express Empathy
• Develop Discrepancy
• Roll w/ Resistance
• Avoid Argumentation
• Support Self-Efficacy

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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
  drinking.

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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

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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!

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Group Dynamics Issues

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

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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

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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

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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

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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

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Q A
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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_at_uamail.albany.edu
• Web Address
• http//www.albany.edu/counseling_center/