1. 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

2. 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 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 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. 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.

3. Why Involve Peers To Deliver Interventions? Peer influence is a key factor in determining the behavior of college students 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) 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) Studies have shown that peers can bet as effective as professionals in delivering alcohol interventions to college students (Fromme & Corbin, 2004)

4. 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 Components of UAlbany Comprehensive AOD Program

5. Middle Earth Program Profile History History 36 year longevity 36 year longevity Staffing Staffing Professional Director Professional Director 1 Psychology Intern, 3 Graduate Assistants 1 Psychology Intern, 3 Graduate Assistants 140 undergraduate students 140 undergraduate students Program Components Program Components Hotline Hotline Outreach Program, including peer theater, interfaces with newspaper and radio, workshops, and media campaign Outreach Program, including peer theater, interfaces with newspaper and radio, workshops, and media campaign Program Interfaces Program Interfaces University affiliation, academic courses, and funding University affiliation, academic courses, and funding Student government affiliation and funding Student government affiliation and funding Local, State, and Federal Grants Local, State, and Federal Grants

6.  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, (Funded by Model Program Grant, U.S. Department of Education) Our First Study: Model Program Grant Project

7. 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 Experimental vs. control group design Pre-post evaluations with ACHA and CORE Social Norms surveys Pre-post evaluations with ACHA and CORE Social Norms surveys

8. Significant decrease in frequency of alcohol use Significant decrease in frequency of alcohol use Significant decrease in driving after drinking any amount of alcohol (f=9.47, p.<.01) and after having more than 4 drinks Significant decrease in driving after drinking any amount of alcohol (f=9.47, p.<.01) and after having more than 4 drinks Significant decrease in behaviors that were later regretted Significant decrease in behaviors that were later regretted Significant decrease in students’ definition of acceptable drinking in terms of occasions per week Significant decrease in students’ definition of acceptable drinking in terms of occasions per week Middle Earth Peer Theater Overall Findings

9. 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.

10. 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%.

11. Middle Earth: Evaluation

12. The Next Step: “The Effects of Peer Facilitated Alcohol Interventions” Funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) $890,000

13. Selecting Our Interventions: The NIAAA Report on College Drinking April 2002 http://www.collegedrinkingprevention.gov/

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

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

16. Testing the effectiveness of three peer- facilitated alcohol interventions for judicially referred students: Testing the effectiveness of three peer- facilitated alcohol interventions for judicially referred students: Peer-Theater Peer-Theater Group Motivational Interviewing Group Motivational Interviewing Educational Lecture Educational Lecture Several secondary questions: Several secondary questions: What Peer-Facilitated Interventions Work Best With Which Students? What Peer-Facilitated Interventions Work Best With Which Students? Project Design

17. Methodology Subjects: Any students living in residence who violate the University’s alcohol policy is eligible to participate Subjects: Any students living in residence who violate the University’s alcohol policy is eligible to participate Data Collection: Baseline, 6-month follow- up, 12-month follow-up Data Collection: Baseline, 6-month follow- up, 12-month follow-up Compensated $25.00 for completing each round of questionnaires Compensated $25.00 for completing each round of questionnaires Randomly assigned to intervention Randomly assigned to intervention

18. Baseline Data: Spring 2005-Fall 2007 N = 590 who completed the baseline measures and participated in the interventions N = 590 who completed the baseline measures and participated in the interventions The vast majority of students we contacted ended up participating The vast majority of students we contacted ended up participating 63% male 63% male 83% white 83% white Average age: 18.8 years Average age: 18.8 years

19. Alcohol Consumption Average drinks per week: 18.8 Average drinks per week: 18.8 Males: 20.7 Males: 20.7 Females: 16.1 Females: 16.1 National norms are about 5-6 for males, 3- 4 for females 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 Also higher than campus norms, and campus norms for other “at-risk” groups

20. MenWomenTotal Peak Drinks Past 30 11.99.010.7 >6 Drinks Past 30 5.64.55.1 >9 Drinks Past 30 3.82.23.1 Friend Per/Week 25.022.023.7 Typ. Stud. Per/Week28.622.426.0

21. Preliminary Findings & Trends Overall, we’re finding small reductions in alcohol use, but few between group differences Overall, we’re 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. The MI and Peer Theatre Groups may be more effective at reducing alcohol-related problems, but more comprehensive analyses are ongoing.

22. More About Our Peer Intervention Programs Peer Theater Social-norms based approach Social-norms based approach Uses theatre presentations by peers (i.e., undergraduate students) to address topical scenarios related to college student alcohol use 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 Discussions occur after the theatre performances

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

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

25. Peer-Facilitated Intervention Programs (continued) Small-Group Motivational Interviewing Intervention Small group motivational interviewing-based program led by peers Small group motivational interviewing-based program led by peers One session, two-hour intervention 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 Program components include values clarification exercises, social norms evaluations, expectancies related to alcohol use, and personal evaluation of alcohol consumption

26. 5 Principles of Motivational Interviewing Express Empathy Express Empathy Develop Discrepancy Develop Discrepancy Roll w/ Resistance Roll w/ Resistance Avoid Argumentation Avoid Argumentation Support Self-Efficacy Support Self-Efficacy

27. Using Effective “O.A.R.S.” Open-ended questions Open-ended questions Affirm Affirm Reflect Reflect Summarize SummarizeExamples: “So on the one hand you’re planning to go to grad school, but your grades are being effected by going out so much.” “There’s nothing that concerns you about your drinking.”

28. Peer-Facilitated Intervention 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 Standard alcohol lecture on factors such as prevalence rates, physiological implications, blood alcohol level, tolerance, protective factors, and social norms

29. Managing Resistance to Social Norms “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, there’s no way these numbers are accurate!” “Based upon what I’ve seen around here, there’s no way these numbers are accurate!”

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

31. Recruiting Peer Educators Select the best and the brightest student leaders Select the best and the brightest student leaders Consult colleagues who know students well Consult colleagues who know students well Send candidates special letter of invitation Send candidates special letter of invitation Link peer education opportunity to future career-related opportunities Link peer education opportunity to future career-related opportunities Interview potential candidates using role-play scenarios 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 Assess candidate attitudes toward alcohol use among college students and request permission to check judicial office records and Facebook/MySpace profiles

32. Training Peer Educators Schedule and conduct weekly supervision Schedule and conduct weekly supervision Provide a theoretical foundation Provide a theoretical foundation Demonstrate interventions using videotaped sessions by expert professionals Demonstrate interventions using videotaped sessions by expert professionals Offer modeling of skills Offer modeling of skills Conduct role-plays during supervision Conduct role-plays during supervision Discuss challenges, concerns of peers and consider student feedback in making modifications in intervention strategies 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 Provide both group and individual pre and post-intervention feedback Review videotaped interventions during supervision sessions Review videotaped interventions during supervision sessions

33. Retention of Peer Educators Maintain highly selective recruitment and retention standards Maintain highly selective recruitment and retention standards Compensate peer educators for their work and project participation 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 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.) Maintain career-enhancing motivation opportunities (graduate school and job recommendations, etc.) Discuss special leadership role of student facilitators within the broader peer education organization Discuss special leadership role of student facilitators within the broader peer education organization

34. Challenges and Pitfalls Scheduling of supervision meetings and intervention sessions Scheduling of supervision meetings and intervention sessions Peer facilitator “drift” Peer facilitator “drift” Peer facilitator difficulty accepting feedback and constructive criticism Peer facilitator difficulty accepting feedback and constructive criticism Interpersonal conflicts among peer facilitators Interpersonal conflicts among peer facilitators Peer Facilitator non-compliance with supervision requirements Peer Facilitator non-compliance with supervision requirements Peer facilitator boredom with intervention program over time Peer facilitator boredom with intervention program over time Peer facilitator personal issues behavior (alcohol use or other judicial violation) runs counter to project goals Peer facilitator personal issues behavior (alcohol use or other judicial violation) runs counter to project goals

35. Q & A

36. 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@uamail.albany.edu Web Address: http://www.albany.edu/counseling_center/