CORE StrategiesCampus 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
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
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
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.
• 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 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.
CORE’s Evidence-Based Components
• Screening– AUDIT– DAST– GAIN Short Screen
• Brief Intervention– Feedback– Motivational Interviewing
• Brief Treatment– MET/CBT5
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
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
Brief InterventionGuiding 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
“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
MotivationalMotivational InterviewingInterviewing
Stages of Change ModelProchaska & DiClemente, 1986
Precontemplation
Contemplation
Determination
Action
Maintenance
Relapse
“Problem . . . what problem?”
• 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 TreatmentMotivational Enhancement Therapy/Cognitive
Behavior Treatment-5 sessions
(MET/CBT-5)
Screening Survey Data (n=811)
Gender
Male 340 43%
Female 454 57%
Age
18 195 25%
19-20 253 33%
21-24 157 20%
25-34 90 12%
35-44 48 6%
45+ 28 4%
Reported Binge Drinking
Never 453 56%
<Monthly 189 23%
Monthly 93 11%
Weekly 59 7%
Daily/
Almost Daily
6 1%
Combined DAST and AUDIT Scores
Risk 236 29%
No Risk 575 71%
Study Participant Follow-up DataDemographic Data 6 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%
Alcohol and Drug Use Enrollment to Follow-up
Alcohol/Drug Use Enrollment 6 Months
Any Alcohol 38 88% 31 72%
Alcohol to Intoxication 34 79% 25 58%
Other Drugs 20 47% 14 33%
Specific Drug Use
Cocaine/Crack 2 5% 1 2%
Marijuana 18 42% 13 30%
Heroin/Opiates 7 16% 1 2%
Hallucinogens 2 5% 0 0%
Benzodiazepines 1 2% 1 2%
Suboxone 1 2% 0 0%
Brief Intervention vs. Brief TreatmentBrief Treatment
Alcohol/Drug Use (n=17) Enrollment 6 Months
Percent
Change
Any Alcohol 13 76% 10 59% -23%
Alcohol to Intoxication 11 65% 5 29% -55%
Other Drugs 9 53% 4 24% -56%
Brief Intervention
Alcohol/Drug Use ( BI only) n=26 Enrollment 6 Months Change
Any Alcohol 25 96% 21 81% -16%
Alcohol to Intoxication 23 88% 20 77% -13%
Other Drugs 11 42% 10 38% -9%
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
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
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)
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
