1. CORE Strategies Campus Outreach and Resource Enhancement Presented by: Marjorie Joseph, MSW, and Donna Caldwell, PhD “Promising Practices from Around the Globe” Conference Newport, RI 9/28/07 Funded by the Center for Substance Abuse Treatment

2. 1 of 12 Campus Screening and Brief Intervention (SBI) grants awarded under the umbrella of CSAT’s Screening, Brief Intervention, Referral, Treatment Projects Unique characteristics of Bristol Community College only community college only 100% commuter college only college with no Greek life or sports only project with 100% non-mandated participation

3. Community Characteristics Target Population 524,000 residents of Bristol County in Southeastern Massachusetts. Fall River and New Bedford are the largest cities in the county with approximate populations of 90,000+ each Geographical, Cultural & Ethnic Issues Ethnically diverse and economically underdeveloped region. Nearly 40% of the residents in Fall River & New Bedford speak a language other than English at home, compared with 20% for the whole Commonwealth of Massachusetts. Substance abuse and related problems are a longstanding regional problem Student Population 6,900 students in credit-granting courses (FY 2005); thousands more in other non-credit classes and programs 70% female, 30% male Minority students make up 11.2% of the student population Non-traditional students are the norm rather than the exception No dormitories and limited on-campus student life

4. Campus SBI Screening quickly assesses the severity of substance use and identifies the appropriate level of intervention. The goal is early identification of students that are at risk for hazardous use of drugs or alcohol using psychometrically sound instruments.Screening Brief intervention focuses on increasing insight and awareness regarding substance use and motivation toward behavioral change. Research has demonstrated that even a single brief intervention can be effective in reducing potentially problematic substance use.Brief intervention Brief treatment (5 sessions) is offered to students experiencing drug or alcohol related problems. Referral to treatment provides students identified as needing more extensive treatment with access to additional services.Referral to treatment

5. CORE’s Evidence-Based Components Screening –AUDIT –DAST –GAIN Short Screen Brief Intervention –Feedback –Motivational Interviewing Brief Treatment –MET/CBT5

6. Screening Survey Alcohol Use Disorders Identification Test (AUDIT) –WHO collaborative project –10 questions scored on a scale of 0-4 Score of 8 or more is considered a positive screen Drug Abuse Screening Test (DAST-10) –Harvey A. Skinner PhD, Addiction Research Foundation –10 yes or no questions Score of 0-2 No or low level of risk Score of 3-5 Moderate level of risk Score of 6-8 Substantial level of risk Score of 9-10 Severe level of risk Global Appraisal of Individual Need (GAIN) Short Screener –Michael Dennis, PhD, Chestnut Health System –Screens for the presence of various mental health symptoms

7. Elements of Effective Brief Therapeutic Interventions (FRAMES) Feedback on the student’s level of risk Responsibility of the student for changes Advice to change Menus of options that are available Empathy for the student’s concerns Self-Efficacy of the student to make good choices

8. Brief Intervention Guiding principle: People are most likely to change when the motivation comes from themselves, rather than being imposed by someone else. Respectful reflective listening is emphasized rather than confrontation –Simple advice and education for students at no to low risk –Structured protocol using motivational interviewing for students at moderate or greater risk Ambivalence about change is normal Abstinence may not be the student’s goal

9. “Is a directive, client centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence” Rollnick, S. & Miller R. (1995) What is Motivational Interviewing? Behavioral and Cognitive Psychotherapy, 23, 325-334.  Explores student’s motivation to change  Addresses student’s ambivalence about change  Encourages student to make healthier choices around alcohol, illegal drug, and other substance use  Seeks to move student through stages of change Motivational Interviewing

10. Stages of Change Model Prochaska & DiClemente, 1986 Precontemplation Contemplation Determination Action Maintenance Relapse “Problem... what problem?”

11. Evidence-based manualized treatment protocolEvidence-based manualized treatment protocol  2 sessions of motivational interviewing  3 sessions of cognitive behavioral skill building  First used at SSTAR as part of CSAT Effective Adolescent Treatment grant Brief Treatment Motivational Enhancement Therapy/Cognitive Behavior Treatment-5 sessions (MET/CBT-5)

12. Screening Survey Data (n=811) Gender Male34043% Female45457% Age 1819525% 19-2025333% 21-2415720% 25-34 9012% 35-44 48 6% 45+ 28 4% Reported Binge Drinking Never45356% <Monthly18923% Monthly9311% Weekly597% Daily/ Almost Daily 61% Combined DAST and AUDIT Scores Risk23629% No Risk57571%

13. Study Participant Follow-up Data Demographic Data6 months n=43 Gender Female Male 26 17 60% 40% Age <21 21-25 26-35 36-45 average age 19 13 6 5 44% 30% 14% 12% 25.1 yrs Employment at Enrollment Full Time Part Time Not working 14 19 10 33% 44% 23%

14. Alcohol and Drug Use Enrollment to Follow-up Alcohol/Drug UseEnrollment6 Months Any Alcohol3888%3172% Alcohol to Intoxication3479%2558% Other Drugs2047%1433% Specific Drug Use Cocaine/Crack25%12% Marijuana1842%1330% Heroin/Opiates716%12% Hallucinogens25%00% Benzodiazepines12%1 Suboxone12%00%

15. Brief Intervention vs. Brief Treatment Brief Treatment Alcohol/Drug Use (n=17) Enrollment6 Months Percent Change Any Alcohol1376%1059%-23% Alcohol to Intoxication1165%529%-55% Other Drugs953%424%-56% Brief Intervention Alcohol/Drug Use ( BI only) n=26Enrollment6 MonthsChange Any Alcohol2596%2181%-16% Alcohol to Intoxication2388%2077%-13% Other Drugs1142%1038%-9%

16. Challenges and Successes: “lessons learned” Challenge 1: No mandated participants –Developmentally appropriate –Respectful –Non-judgmental –Not confrontational or “preachy” Challenge 2: Most students have not yet experienced negative consequences that they clearly link to their use of drugs or alcohol –Relevant to a broad range of experiences –Focus is on healthy choices –Does not demand total abstinence

17. Challenge 3: Limited health and mental health services on campus prior to the grant –Staff training –Expanded Health Services in collaboration with SSTAR Family Health Center –Enhanced linkage with other BCC programs (College Success Seminar, Transition Program, Advisement, Student Life) –Enhanced support and resources for faculty –Increased collaboration with SSTAR and other community agencies

18. Challenge 4: CORE needed to create and identify windows of opportunity to open the discussion about drugs and alcohol across the campus. –Role of social marketing –Culture change among students, faculty and staff Orientation Freshman seminar New student testing and registration Classroom presentations Community events without alcohol (including professional staff and faculty meetings)

19. Post-Grant Sustainability Support from the top-down –Mass DPH –President and Deans of BCC Expanded Health Services –Includes building SBI into all aspects of care –Integration of SBI into mental health counseling –College website includes drug/alcohol information/links –Development of electronic screening Integration into the college culture –No-alcohol events on campus from orientation to graduation –No-alcohol events for faculty and staff events –Training of key college personnel Student Life, Advisement, Counseling, Freshman Seminar, Intrusive Advisement Integration into the larger community –Expanded collaboration with SSTAR –Participation in BOLD –Participation in Healthy Cities Initiative