Using Peer-Facilitated Interventions With High-Risk Drinkers: Successes, Challenges, and Lessons Learned M. Dolores Cimini, Ph.D. University at Albany,

Using Peer-Facilitated Using Peer-Facilitated Interventions With High-Risk Interventions With High-Risk

Drinkers: Successes, Challenges, Drinkers: Successes, Challenges, and Lessons Learnedand Lessons Learned

M. Dolores Cimini, Ph.D. M. Dolores Cimini, Ph.D. University at Albany, State University of New YorkUniversity at Albany, State University of New York

The 2007 National Conference for Advisors of Peer Education GroupsThe 2007 National Conference for Advisors of Peer Education GroupsThe BACCHUS NetworkThe BACCHUS Network

June 17-20, 2007June 17-20, 2007Marriott City Center - Denver, ColoradoMarriott City Center - Denver, Colorado

Learning ObjectivesLearning Objectives

Participants will identify the key components that can lead Participants will identify the key components that can lead to the successful implementation of peer-facilitated alcohol to the successful implementation of peer-facilitated alcohol interventions for college students;interventions for college students;

Participants will outline the challenges that are associated Participants will outline the challenges that are associated with the decision to implement peer-facilitated alcohol with the decision to implement peer-facilitated alcohol interventions;interventions;

Participants will discuss the importance of training, Participants will discuss the importance of training, supervision, and ongoing data collection and evaluation to supervision, and ongoing data collection and evaluation to assess progress, and most importantly, changes in target assess progress, and most importantly, changes in target behaviors, such as student drinking rates.behaviors, such as student drinking rates.

Why Involve PeersWhy Involve PeersTo Deliver Interventions?To Deliver Interventions?

Peer influence is a key factor in determining the Peer influence is a key factor in determining the behavior of college studentsbehavior of college students

College students regard their peers as a credible College students regard their peers as a credible and trusted source of information (National and trusted source of information (National College Health Assessment, 2000)College Health Assessment, 2000)

Studies have shown that peers can bet as Studies have shown that peers can bet as effective as professionals in delivering alcohol effective as professionals in delivering alcohol interventions to college students (Fromme & interventions to college students (Fromme & Corbin, 2004)Corbin, 2004)

Presidential LeadershipCampus AOD Task ForceStudent Involvement/LeadershipSocial Norms Marketing Campus-Community CoalitionsRestricting Alcohol Marketing/PromotionAlcohol-Free OptionsEducationEarly InterventionPolicy Evaluation/EnforcementParental InvolvementTreatment & ReferralResearch and Program Evaluation

Co

mp

rehen

sive P

rog

ramComponents of UAlbany

Comprehensive AOD Program

Middle Earth Program ProfileMiddle Earth Program Profile

HistoryHistory 36 year longevity36 year longevity

StaffingStaffing Professional DirectorProfessional Director 1 Psychology Intern, 3 Graduate Assistants1 Psychology Intern, 3 Graduate Assistants 140 undergraduate students140 undergraduate students

Program ComponentsProgram Components HotlineHotline Outreach Program, including peer theater, interfaces with Outreach Program, including peer theater, interfaces with

newspaper and radio, workshops, and media campaignnewspaper and radio, workshops, and media campaign Program InterfacesProgram Interfaces

University affiliation, academic courses, and fundingUniversity affiliation, academic courses, and funding Student government affiliation and fundingStudent government affiliation and funding Local, State, and Federal GrantsLocal, State, and Federal Grants

To increase the percentage of University at To increase the percentage of University at Albany students who believe that their peers Albany students who believe that their peers drink at least once a week or less by 10 percent drink at least once a week or less by 10 percent through exposure to social norms within peer through exposure to social norms within peer theatertheater

To disseminate information concerning the To disseminate information concerning the effective components of the Middle Earth model effective components of the Middle Earth model peer theater program to colleges and peer theater program to colleges and universities on a local, state, and national leveluniversities on a local, state, and national level

(Funded by Model Program Grant,(Funded by Model Program Grant,

U.S. Department of Education)U.S. Department of Education)

Our First Study:Our First Study:Model Program Grant ProjectModel Program Grant Project

Model Program GrantModel Program Grant Evaluation Plan Evaluation Plan

Hypothesis:Hypothesis:Trained peer educators can have an additive Trained peer educators can have an additive effect in carrying out social norms interventions effect in carrying out social norms interventions when compared to media campaigns alonewhen compared to media campaigns alone..

Evaluation Method:Evaluation Method:Experimental vs. control group designExperimental vs. control group designPre-post evaluations with ACHA and CORE Pre-post evaluations with ACHA and CORE

Social Norms surveysSocial Norms surveys

Significant decrease in frequency of alcohol useSignificant decrease in frequency of alcohol use Significant decrease in driving after drinking any Significant decrease in driving after drinking any

amount of alcohol (f=9.47, p.<.01) and after amount of alcohol (f=9.47, p.<.01) and after having more than 4 drinkshaving more than 4 drinks

Significant decrease in behaviors that were later Significant decrease in behaviors that were later regretted regretted

Significant decrease in students’ definition of Significant decrease in students’ definition of acceptable drinking in terms of occasions per acceptable drinking in terms of occasions per week week

Middle Earth Peer TheaterMiddle Earth Peer TheaterOverall FindingsOverall Findings

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: EvaluationMiddle Earth: Evaluation

27

56

29

13

31

18

0

10

20

30

40

50

60

ME Players Academic Lecture

Pre-TestPostDifference

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

-9

9

-10

-5

0

5

10

ME Player AcademicLecture

% Increase in Frequent Binge Drinking

ME PlayerAcademic Lecture

Middle Earth: Evaluation

The Next Step:The Next Step:“The Effects of Peer “The Effects of Peer Facilitated Alcohol Facilitated Alcohol

Interventions”Interventions”

Funded by the Funded by the

National Institute on Alcohol Abuse and Alcoholism National Institute on Alcohol Abuse and Alcoholism (NIAAA)(NIAAA)

$890,000$890,000

Selecting Our Interventions:Selecting Our Interventions:

The NIAAA Report The NIAAA Report on College Drinkingon College Drinking

April 2002April 2002

http://www.collegedrinkingprevention.gov/http://www.collegedrinkingprevention.gov/

NIAAA Recommendations forNIAAA Recommendations forClassifying Intervention EffectivenessClassifying Intervention Effectiveness

Tier 1:Tier 1: Evidence of effectiveness among Evidence of effectiveness among college studentscollege students

Tier 2:Tier 2: Evidence of success with general Evidence of success with general populations that could be applied to populations that could be applied to college environmentscollege environments

Tier 3:Tier 3: Promising: Evidence of logical and Promising: Evidence of logical and theoretical promise, but require more theoretical promise, but require more comprehensive evaluationcomprehensive evaluation

Tier 4:Tier 4: Ineffective: No Evidence of Ineffective: No Evidence of EffectivenessEffectiveness

From: “A Call to Action: Changing the Culture of Drinking at U.S. Colleges,” NIAAA Task Force

Aims of Our ProjectAims of Our Project

Test the efficacy of three Test the efficacy of three peer-led, grouppeer-led, group interventionsinterventions in reducing alcohol consumption and in reducing alcohol consumption and alcohol-related problems among “high-risk” alcohol-related problems among “high-risk” judicially referred studentsjudicially referred students

Examine possible mediators of intervention Examine possible mediators of intervention effectiveness (e.g., normative beliefs)effectiveness (e.g., normative beliefs)

Examine possible moderators of intervention Examine possible moderators of intervention effectiveness (e.g., parental alcoholism, effectiveness (e.g., parental alcoholism, psychological distress)psychological distress)

Testing the effectiveness of three peer-Testing the effectiveness of three peer-facilitated alcohol interventions for facilitated alcohol interventions for judicially referred students:judicially referred students:Peer-TheaterPeer-TheaterGroup Motivational InterviewingGroup Motivational InterviewingEducational LectureEducational Lecture

Several secondary questions: Several secondary questions: What Peer-Facilitated Interventions Work Best What Peer-Facilitated Interventions Work Best

With Which Students?With Which Students?

Project DesignProject Design

MethodologyMethodology

Subjects: Any students living in Subjects: Any students living in residence who violate the University’s residence who violate the University’s alcohol policy is eligible to participatealcohol policy is eligible to participate

Data Collection: Baseline, 6-month Data Collection: Baseline, 6-month follow-up, 12-month follow-upfollow-up, 12-month follow-up

Compensated $25.00 for completing Compensated $25.00 for completing each round of questionnaireseach round of questionnaires

Randomly assigned to interventionRandomly assigned to intervention

Baseline Data:Baseline Data:Spring 2005-Fall 2007Spring 2005-Fall 2007

N = 590 who completed the baseline N = 590 who completed the baseline measures and participated in the measures and participated in the interventionsinterventions The vast majority of students we contacted The vast majority of students we contacted

ended up participatingended up participating

63% male63% male

83% white83% white

Average age: 18.8 yearsAverage age: 18.8 years

Alcohol ConsumptionAlcohol Consumption

Average drinks per week: 18.8Average drinks per week: 18.8Males: 20.7Males: 20.7Females: 16.1Females: 16.1

National norms are about 5-6 for National norms are about 5-6 for males, 3-4 for femalesmales, 3-4 for females

Also higher than campus norms, and Also higher than campus norms, and campus norms for other “at-risk” campus norms for other “at-risk” groupsgroups

MenMen WomenWomen TotalTotal

Peak Peak Drinks Drinks Past 30Past 30

11.911.9 9.09.0 10.710.7

>>6 6 Drinks Drinks Past 30Past 30

5.65.6 4.54.5 5.15.1

>>9 9 Drinks Drinks Past 30Past 30

3.83.8 2.22.2 3.13.1

Friend Friend Per/WeePer/Weekk

25.025.0 22.022.0 23.723.7

Typ. Typ. Stud.Stud.

Per/Per/WeekWeek

28.628.6 22.422.4 26.026.0

Preliminary Findings & Preliminary Findings & TrendsTrends

Overall, we’re finding small Overall, we’re finding small reductions in alcohol use, but few reductions in alcohol use, but few between group differencesbetween group differences

The MI and Peer Theatre Groups may The MI and Peer Theatre Groups may be more effective at reducing alcohol-be more effective at reducing alcohol-related problems, but more related problems, but more comprehensive analyses are ongoing. comprehensive analyses are ongoing.

More About OurMore About OurPeer Intervention ProgramsPeer Intervention Programs

Peer TheaterPeer Theater

Social-norms based approachSocial-norms based approach Uses theatre presentations by peers (i.e., Uses theatre presentations by peers (i.e.,

undergraduate students) to address topical scenarios undergraduate students) to address topical scenarios related to college student alcohol userelated to college student alcohol use

Discussions occur after the theatre performancesDiscussions occur after the theatre performances

Can You Hear Us Now?Can You Hear Us Now?

87% of UAlbany Students 87% of UAlbany Students have have notnot

allowed alcohol to affect their allowed alcohol to affect their academic performanceacademic performance

(Source: Spring 2006 ACHA Survey)(Source: Spring 2006 ACHA Survey)

Can You Hear Us Now?Can You Hear Us Now?

73% of UAlbany students 73% of UAlbany students eateat

before or whilebefore or while drinking alcohol drinking alcohol

(Source: Spring 2006 ACHA Survey)(Source: Spring 2006 ACHA Survey)

Peer-FacilitatedPeer-FacilitatedIntervention ProgramsIntervention Programs

(continued)(continued)

Small-Group Motivational Interviewing Small-Group Motivational Interviewing InterventionIntervention

Small group motivational interviewing-based Small group motivational interviewing-based program led by peersprogram led by peers

One session, two-hour interventionOne session, two-hour intervention Program components include values clarification Program components include values clarification

exercises, social norms evaluations, expectancies exercises, social norms evaluations, expectancies related to alcohol use, and personal evaluation of related to alcohol use, and personal evaluation of alcohol consumptionalcohol consumption

5 Principles of Motivational 5 Principles of Motivational InterviewingInterviewing

Express EmpathyExpress Empathy

Develop DiscrepancyDevelop Discrepancy

Roll w/ ResistanceRoll w/ Resistance

Avoid ArgumentationAvoid Argumentation

Support Self-EfficacySupport Self-Efficacy

Using Effective “O.A.R.S.”Using Effective “O.A.R.S.”

Open-ended questionsOpen-ended questions

AffirmAffirm

ReflectReflect

SummarizeSummarize

Examples: Examples:

““So on the one hand you’re planning to go to grad So on the one hand you’re planning to go to grad school, but school, but your your grades are being effected by going out so grades are being effected by going out so much.” much.”

““There’s nothing that concerns you about your drinking.”There’s nothing that concerns you about your drinking.”

Peer-FacilitatedPeer-FacilitatedIntervention Programs Intervention Programs

(continued)(continued)

Educational Lecture on Alcohol and Its Educational Lecture on Alcohol and Its Effects (Control Condition)Effects (Control Condition)

Standard alcohol lecture on factors such as Standard alcohol lecture on factors such as prevalence rates, physiological implications, blood prevalence rates, physiological implications, blood alcohol level, tolerance, protective factors, and social alcohol level, tolerance, protective factors, and social normsnorms

Managing Resistance to Social Managing Resistance to Social NormsNorms

““Who did you survey to get these stats?”Who did you survey to get these stats?”

““People must be lying on those surveys!”People must be lying on those surveys!”

““Based upon what I’ve seen around here, Based upon what I’ve seen around here, there’s no way these numbers are there’s no way these numbers are accurate!” accurate!”

Group Dynamics IssuesGroup Dynamics Issues

Group sizeGroup size

Gender make-up of the groupGender make-up of the group

Friends randomly assigned to same groupFriends randomly assigned to same group

Group “spokesman”Group “spokesman”

4 types of Pre-contemplaters4 types of Pre-contemplaters

Recruiting Peer EducatorsRecruiting Peer Educators

Select the best and the brightest student leadersSelect the best and the brightest student leaders

Consult colleagues who know students wellConsult colleagues who know students well

Send candidates special letter of invitationSend candidates special letter of invitation

Link peer education opportunity to future career-related Link peer education opportunity to future career-related opportunitiesopportunities

Interview potential candidates using role-play scenariosInterview potential candidates using role-play scenarios

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

Training Peer EducatorsTraining Peer Educators

Schedule and conduct weekly supervision Schedule and conduct weekly supervision

Provide a theoretical foundationProvide a theoretical foundation

Demonstrate interventions using videotaped sessions by expert Demonstrate interventions using videotaped sessions by expert professionalsprofessionals

Offer modeling of skillsOffer modeling of skills

Conduct role-plays during supervisionConduct role-plays during supervision

Discuss challenges, concerns of peers and consider student feedback in Discuss challenges, concerns of peers and consider student feedback in making modifications in intervention strategiesmaking modifications in intervention strategies

Provide both group and individual pre and post-intervention feedbackProvide both group and individual pre and post-intervention feedback

Review videotaped interventions during supervision sessionsReview videotaped interventions during supervision sessions

Retention of Peer Retention of Peer EducatorsEducators

Maintain highly selective recruitment and retention Maintain highly selective recruitment and retention standardsstandards

Compensate peer educators for their work and project Compensate peer educators for their work and project participationparticipation

Offer opportunities for face-to-face training and workshops Offer opportunities for face-to-face training and workshops from leading researchers and practitioners in the alcohol from leading researchers and practitioners in the alcohol abuse prevention fieldabuse prevention field

Maintain career-enhancing motivation opportunities Maintain career-enhancing motivation opportunities (graduate school and job recommendations, etc.)(graduate school and job recommendations, etc.)

Discuss special leadership role of student facilitators within Discuss special leadership role of student facilitators within the broader peer education organizationthe broader peer education organization

Challenges and PitfallsChallenges and Pitfalls

Scheduling of supervision meetings and intervention sessionsScheduling of supervision meetings and intervention sessions

Peer facilitator “drift”Peer facilitator “drift”

Peer facilitator difficulty accepting feedback and constructive Peer facilitator difficulty accepting feedback and constructive criticismcriticism

Interpersonal conflicts among peer facilitatorsInterpersonal conflicts among peer facilitators

Peer Facilitator non-compliance with supervision Peer Facilitator non-compliance with supervision requirementsrequirements

Peer facilitator boredom with intervention program over timePeer facilitator boredom with intervention program over time

Peer facilitator personal issues behavior (alcohol use or other Peer facilitator personal issues behavior (alcohol use or other judicial violation) runs counter to project goalsjudicial violation) runs counter to project goals

Q & AQ & A

For Further InformationFor Further Information

M. Dolores Cimini, Ph.D.M. Dolores Cimini, Ph.D.Assistant Director for PreventionAssistant Director for Prevention

and Program Evaluationand Program EvaluationUniversity Counseling CenterUniversity Counseling Center

Director, Middle Earth ProgramDirector, Middle Earth Program

University at Albany, SUNYUniversity at Albany, SUNYAlbany, NY 12222Albany, NY 12222

518-442-5800518-442-5800

Email AddressEmail [email protected]@uamail.albany.edu

Web Address:Web Address:http://www.albany.edu/counseling_center/http://www.albany.edu/counseling_center/