Brief Alcohol Intervention Training (BAIT) FOR TERTIARY STUDENTS
Project Report 2012
UWA School of Psychology and the UWA Health Promotion Unit
PROJECT TEAM Werner Stritzke Tricia Wylde Emma Dove David Erceg-Hurn
Page |2 1. BACKGROUND Australian and international literature highlights the importance of targeting alcohol harm minimisation initiatives at a particular subset of young people: tertiary students. These students drink at more hazardous levels and display a higher prevalence of alcohol-related conditions than their non-tertiary counterparts. There is a large evidence base showing that brief interventions can reduce excessive alcohol consumption among university students. These interventions involve providing students with personalised feedback about their drinking pattern, practical information about how to drink less, and strategies to increase motivation to reduce their drinking or seek expert help if indicated. Although brief interventions are effective, there are typically only a handful of people trained on any university campus to deliver them. 2. OBJECTIVES The aim of the Brief Alcohol Intervention Training (BAIT) project was to design and evaluate a sustainable training model that would increase the capacity to deliver campus-based brief interventions. The model has four components: (a) integration of a BAIT introductory teaching module into the psychology undergraduate and postgraduate curriculum to raise awareness among potential volunteers, (b) a four-hour workshop for student volunteers, (c) supervised practice in delivering brief interventions; and (d) a train-the-trainer path for postgraduate clinical psychology students to deliver training workshops. 3. STRATEGIES (a) Developed brief alcohol intervention training resources and procedures A review of protocols previously used in research evaluating brief in-person alcohol interventions among tertiary students, and of training modules used to train health professionals in the delivery of brief interventions, was undertaken. These had to be adapted to be suitable for the training of student volunteers with little or no prior health promotion knowledge or skills. This required the BAIT project team to develop a suite of comprehensive recruitment, training, and delivery resources. These included (i) teaching modules to raise awareness of and interests in campus based brief alcohol interventions; (ii) updated, easy-to-use intervention resources; (iii) a succinct step-by-step training manual; (iv) didactic materials for a training workshop that included the production of training videos and practice modules for hands-on skills training aimed at improving self-confidence and self-efficacy in delivering effective interventions, (v) evaluation tools and procedures to assess training outcomes and monitor adherence to intervention principles and procedures during delivery of interventions at campus events. Recruitment Resources BAIT ‘Taster’ lab PowerPoint presentation and exercises for large undergraduate psychology unit, including pre- and post-lab questionnaires; database templates; and BAIT information handouts. BAIT Introductory Lecture for Health Psychology unit in postgraduate clinical psychology training program, including PowerPoint presentation and handouts Training Resources BAIT 4-hour workshop PowerPoint presentation and detailed training notes BAIT Training videos BAIT for Tertiary Students Training Manual BAIT Training scenarios for workshop practice sessions
Page |3 Figure 1: Filming training videos 2011
Intervention Resources (BAIT Box) BAIT flipchart to guide in the delivery of brief interventions BAIT AUDIT pads with standard drink reference pictures BAIT Drink Check Feedback brochure - how risky is your drinking? BAIT Drink Check Motivational Interview brochure - thinking about change (AUDIT score 9-19) BAIT Drink Check Motivational Interview brochure - thinking about change (AUDIT score 20+) BAIT Referral Card Laminated Reference Cards of Australian Standard Drink Examples
Figure 2: BAIT Intervention Resources
Page |4 Data Collection/Evaluation Tools BAIT Taster lab questionnaire and database template BAIT Knowledge and Attitudes Questionnaire and database templates BAIT Training Evaluation Questionnaire and database template BAIT Training Workshop Observer Checklist for practice sessions BAIT Intervention Delivery Checklist and database template (b) Developed and delivered teaching module for undergraduate curriculum to promote training program to volunteer pool Recruitment of a large, motivated volunteer group is essential for broad, regular delivery of brief interventions at large campus events and campus-based health services. To raise awareness of the program among student volunteers, a teaching module was developed and integrated in the psychology curriculum. Psychology students have an intrinsic motivation and career aspirations to work in the health sector, and hence provide a valuable resource from which to recruit volunteers for the alcohol brief intervention program. The teaching module was delivered as a tutorial on brief intervention strategies and provided information on volunteer opportunities in the UWA Tertiary Alcohol Project and the benefits associated with the training program. (c) Developed and delivered teaching and supervision module for postgraduate curriculum to recruit skilled brief intervention trainers To increase the capacity of a larger skilled volunteer force it is essential to establish a sustainable mechanism for training. This was achieved by integrating brief intervention training in the internal placement program of the UWA clinical psychology training clinic. Postgraduate clinical psychology students received an introduction to brief intervention training combined with a supervision arrangement that will provide them with the capacity to not only deliver brief interventions but to train others in the effective delivery of brief interventions. (d) Conducted brief alcohol intervention training A four-hour training program was developed with four training modules:
MODULE 1: Alcohol: general information MODULE 2: Brief alcohol intervention MODULE 3: Motivational interviewing MODULE 4: Skills development
Figure 3: Delivering BAIT training 2012
Page |5 (e) Conducted brief alcohol interventions with students BAIT trainees were provided with an opportunity to deliver brief alcohol interventions with students at Orientation Day (24 February 2012) and Link Week (15 March 2012). O Day culminates in a day of live music, giveaways, food, hundreds of stalls and thousands of students covering James Oval and Koort Kwoba Dandjoo (Guild Village). Link week provides opportunities for new and current UWA students to ‘link’ back into essential resources and information relating to study and life at University. In addition, BAIT ‘graduates’ delivered brief interventions at two further events at the residential colleges on 3 April 2012 and 4 April 2012. Figure 4: Students delivering interventions on O Day
Figure 5: Engaging with students on O Day
(f) Evaluated brief intervention training The aim of the evaluation of the BAIT program was to examine if the recruitment strategies would increase the skilled health promotion volunteer pool, and if the training workshop and resources, and supervised intervention practice would build the competencies that underlie the sound delivery of brief alcohol interventions. These include trainees’ general knowledge about alcohol, specific knowledge about how brief interventions are conducted, practical skills required to deliver the intervention, and positive attitudes such as trainees’ confidence in their ability to competently deliver the intervention. We developed evaluation tools to assess the quality of training, trainee competencies, and fidelity of intervention delivery. These tools included: BAIT Knowledge and Attitudes Questionnaire o
A questionnaire that trainees completed before and after the four hour training workshop, that was designed to assess their knowledge about alcohol and brief intervention, and beliefs and attitudes relevant to the delivery of the intervention
BAIT Training Evaluation Questionnaire o
We solicited quantitative and qualitative feedback from students about the effectiveness and quality of the training workshop and materials
o
The quality of training can also be inferred via changes in knowledge, attitudes, and skills as measured by the other assessment tools
BAIT Intervention Delivery Checklist
Page |6 o
A checklist that measures the skill and fidelity with which trainees use brief advice and motivational interviewing principles and strategies when delivering the intervention at campus events.
4. OUTCOMES All of the objectives in designing a sustainable training model that would increase the capacity to deliver campus-based brief interventions were achieved. The components of the BAIT model are summarised in Figure 6.
Figure 6: UWA Brief Intervention Training (BAIT) Model Recruitment
Training and Intervention
Psychology Postgraduate Introductory Lecture
Train the Trainer Path and Supervision
UWA Psychology Undergraduate Lab Activity
Intervention Training
Delivering Intervention
UWA Health Promotion Student Volunteers
As illustrated in Figure 6, the existing ways of recruiting UWA health promotion students from the general student population were augmented by specifically targeting potential volunteers from the group of psychology undergraduate students in their second and third year of study (N=400+). Many of these students are intrinsically motivated to become involved in a health-related career, and hence such a targeted recruitment approach would increase the capacity to attract interested students to the volunteer pool for delivering health promotion activities on campus. In addition, the training model includes a train-the-trainer path (indicated by dashed arrows in Figure 6), where post-graduate students enrolled in the clinical psychology training program are introduced to brief interventions and receive information about the BAIT program. Both interested postgraduate and undergraduate students then complete the BAIT training at a comprehensive four-hour workshop, which is followed by supervised experience in delivering brief interventions at campus and residential college events or at student health services. Those postgraduate students who have successfully completed both the training workshop and intervention practice are eligible to become BAIT trainers and will gain supervised experience in the delivery of BAIT training workshops. While the workshop was primarily designed for student volunteers, it
Page |7 was also found to be a valuable experience by health promotion staff and drug and alcohol counselors who have attended the workshop. All components of the model have been delivered and tested, including the final step of the train-thetrainer path which involves the delivery of a BAIT workshop by postgraduate psychology students. The first student-delivered workshop was delivered on 26 April 2012. Overall, all of the components of the BAIT program worked very well. In particular, hands-on practice modules and supervised intervention experience using real-time skills assessment and immediate feedback proved very effective in building confidence and reinforcing skills. 5. EVALUATION The components of the BAIT model were evaluated with objective and subjective measures using the tools described above in the Objectives and Strategies section. (a) Recruitment and capacity building of the health promotion student volunteer pool The BAIT lab activity was administered to 439 undergraduate psychology students in October 2011. In the two months following this activity, 24 undergraduate students registered for the volunteer pool which is equal to the number of students registering throughout the entire year in 2010, and is over twice the rate of recruitment for the year 2011 prior to the BAIT lab activity. In addition, 8 postgraduate psychology students registered for the volunteer pool following an introductory lecture on the BAIT program. Thus, the rate of recruitment of student health promotion volunteers was substantially increased following the initiation of the BAIT program. (b) BAIT training workshop The first BAIT training workshop was attended by 19 health promotion volunteers and staff. Of these, 93% had attended a BAIT introductory lab or lecture which motivated them to attend the training, and 21% had some other prior experience in brief interventions. Participants ranged in age from 19 to 35 (mean = 24.7), with the majority being female (89%), and 13% were international students. Figure 7 shows participants’ mean responses on a 20-item questionnaire assessing knowledge about alcohol in general and about brief alcohol interventions specifically. Participants completed the questionnaire before and after the workshop. For each of the two domains there were 10 questions, so that scores for the total number of correct items could range from 0 to 10. As shown in Figure 7, there were large increases in both general and intervention specific knowledge. Following the workshop, participants on average correctly answered nearly 9 of 10 general alcohol knowledge items, and intervention specific knowledge improved more than twofold.
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Figure 8 shows participants’ mean responses to a 12-item questionnaire assessing participants’ subjective ratings of their (a) confidence [5 items] and competence [1 item] in conducting brief advice and feedback interventions using motivational interviewing skills, (b) perceptions of the strength of the evidence base for brief interventions [2 items], perceptions of the importance and value of brief interventions for university students [2 items], and (c) interest and intrinsic reward in working with students who drink at unsafe levels [2 items]. Participants completed the questionnaire before and after the workshop, with answer options ranging from 0 to 10.
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Participants showed large increases in their self-reported confidence and competence with mean ratings around 8 of 10 following the workshop. In addition, pre-workshop beliefs about the effectiveness of brief interventions, although already rated high, were further strengthened following the discussion of evidence during the workshop. Columns in the right part of Figure 8 show that the BAIT recruitment strategy to target students who would be intrinsically motivated to get involved in volunteer health promotion activities was successful. Workshop participants rated the importance and value of brief interventions for students very high (8-9 of 10) before and after the workshop. (c) BAIT Brief Intervention Delivery In the two months following the BAIT training workshop on 13 February 2012, newly trained BAIT volunteers conducted brief interventions at four campus events (Orientation Day - 24/2/12; Link Week 15/3/12; Pit Stop - 3/4/12; TAP Quiz Night - 4/4/12). A further seven events were scheduled over the next four weeks till the end of the first semester. Volunteers work in pairs with one delivering the intervention, and the other observing and recording on the BAIT Intervention Delivery Checklist whether the interviewer covers each of the components of the intervention in the correct sequence, and whether the interviewer applies the appropriate interviewing style and strategies associated with each component. At the time of writing this report, evaluation data have been processed for the first two events (i.e. Orientation Day and Link Week). A total of 121 AUDITS and brief interventions were administered at these two events, with 51% of students scoring in the ‘low risk’ range, 39.7% in the ‘risky’ range, 6.6% in the ‘very risky’ range, and 2.5% in the ‘possibly dependent’ range. Analyses of the Intervention Delivery Checklist data showed that BAIT volunteers delivered the intervention with a very high degree of fidelity. Compliance rates for the individual intervention strategies, components, and interviewing styles ranged from 95-100% on most items. Notable exceptions were a few items specifically pertaining to the brief intervention protocol for AUDIT scores indicating ‘possible
P a g e | 10 dependence’, where compliance dropped as low as 33%. These items pertained to explicitly stating that the AUDIT score was suggestive of alcohol dependence, and encouraging the student to seek professional help. Based on feedback from the student volunteers at debriefing it appears that they may have felt uncomfortable to suggest actions associated with the most serious level of risk to their student peers. With the benefit of the checklist data, this can now be addressed in future training workshops, as well as during feedback and debriefing of the BAIT volunteers. It is also noteworthy that the Checklist data show that compliance with the BAIT intervention protocol further increased with experience (i.e. at the second opportunity to deliver the intervention during the Link Week event), with compliance now 100% achieved for nearly all items on the Intervention Delivery Checklist. 6. SUSTAINABILITY The BAIT model was specifically designed to initiate a sustainable training program for student health promotion volunteers that would increase the capacity to deliver training to a larger number of students beyond what is possible with only the small number of health promotion staff employed on campus. The essential ingredient for achieving sustainability of the training program following the proposed project duration is the linkage of the existing UWA Tertiary Alcohol Project offered by UWA Health Promotion Services at the UWA Medical Centre with the undergraduate and postgraduate curriculum within the UWA School of Psychology. This linkage provides for routine promotion of the program to large numbers of potential volunteers, and ensures continuous availability of additional trainers from the ranks of clinical psychology postgraduate students. In addition the training program has been made available to staff from the North Metro Community Drug Service and Nursing staff at the University Medical Centre. Nursing staff will have the capacity to continue offering SBI both opportunistically and routinely as required. Now that the capacity to deliver brief interventions to tertiary students by skilled peer health promotion volunteers has been increased and sustainability of the training program is established, it is important to evaluate in the future the extent to which brief alcohol interventions delivered by trained student peers are successful in lowering rates of harmful drinking by university students. It is also important to further evaluate the effects of settings for delivery (e.g. health promotion events or opportunistically within the general practice at the University Medical Centre). 7. DISSEMINATION Information about the project was disseminated in several ways. Prior to the commencement of the project the BAIT project team met with staff at the Drug and Alcohol Office, the North Metro Community Drug Service, and the Campus Medical Centre to provide information about the project and seek consultation. Following development of the new resource kit and materials for the training and intervention, we had a liaison meeting in August 2011 with the Senior Workforce Development Officer from the Drug and Alcohol Office, the manager of the North Metro Community Drug Service, the director of the UWA Medical Centre, and a representative from the pool of registered student health promotion volunteers. Information about the UWA BAIT project was published in the autumn 2012 issue of the Local Drug Action Group Inc. newsletter “Hand On”. Presentation of BAIT project updates at bi-monthly meetings of Local Drug Action Group. An abstract about the UWA BAIT project was submitted on 30 March 2012 to the Australian Psychology Society for a presentation at the 47th APS National Annual Conference taking place in Perth from 27 to 30 September 2012. Project material has been provided to the McCusker Centre for Action on Alcohol and Youth (MCAAY) in April 2012.
P a g e | 11 Project material will be provided to Local Drug Action Group Inc. 8. OTHER MATERIAL The project developed a number of new BAIT print resources including: Sample of Drink Check AUDIT Updated and re-designed Drink Check feedback brochure – How risky is your drinking? Updated and re-designed Drink Check motivational interview brochure – Thinking about change (AUDIT score 9-19) Updated and re-designed Drink Check motivational interview brochure – Thinking about change (AUDIT score 20+) Tertiary Alcohol Project Referral card BAIT Drink Check flipchart – Exploring your drinking Brief Alcohol Intervention Training (BAIT) for Tertiary Students – Training Manual BAIT Taster Lab questionnaire BAIT Knowledge and Attitudes Questionnaire BAIT Training Scenarios for workshop practice sessions BAIT Training Workshop Observer Checklist for practice sessions BAIT Intervention Delivery Checklist BAIT workshop completion certificate template In addition, the project developed a number of media resources including: BAIT 4-hour workshop PowerPoint presentation BAIT training videos Photographs of BAIT volunteers delivering interventions, and of BAIT project team shooting training videos 9. CONTACTS Werner G. K. Stritzke, PhD School of Psychology University of Western Australia 35 Stirling Highway, Crawley WA 6009 AUSTRALIA Tel: +61 8 6488 3578 Fax: +61 8 6488 1006 werner.stritzke@uwa.edu.au Tricia Wylde Health Promotion Unit University of Western Australia 35 Stirling Highway, Crawley WA 6009 AUSTRALIA Tel: +61 8 6488 1734 Fax: +61 8 6488 1053 tricia.wylde@uwa.edu.au 10. FUNDING
The Brief Alcohol Intervention Training (BAIT) project was supported by a Community Alcohol Project Grant from the Western Australian Health Promotion Foundation (Healthway) and a STRIVE Project Grant from Local Drug Action Groups Inc.