Alcohol Brief Counseling in the United States Air Force: An Air Force-­‐Penn State Clearinghouse Collabora;ve Project Partnership with the USAF •
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Penn State Clearinghouse AFMOA Mental Health Clinic Staff ADAPT Partnership •
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Nature Aims and goals Unique Challenges Process ADAPT Alcohol and Drug Abuse Preven;on and Treatment Program Promote readiness Minimize nega;ve consequences of substance abuse Provide comprehensive educa;on and treatment Return iden;fied substance abusers to unrestricted duty status or to assist in their transi;on to civilian life Alcohol Brief Counseling Individual preven;on program Targets those referred to ADAPT for an ARI who do not meet defini;onal criteria for an SUD Intended to help pa;ents decrease problem drinking Goal is to increase pa;ent’s interest in examining own drinking paRerns and reducing own risk Key Assump;ons of ABC Episodic heavy drinking is generally transi;onal A significant minority engages in destruc;ve risk behaviors Confronta;onal approaches increase resistance to change The individual is responsible for, and capable of, behavior change Who Pa;ent •
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Mandatory referral following an Alcohol Related Incident No formal diagnosis of dependence or abuse Counselor •  Mental Health Technician •  Cer;fied alcohol and drug abuse counselors •  Supervised by an ADAPT program manager ABC 1.0 Model Referral to ADAPT Evalua;on (SUAT) and Brief Interview No Diagnosis Final Session on Final Module (If necessary) and Close out Diagnosis of Dependence or Abuse Referral to ABC Follow-­‐up Session Based on Addi;onal Assigned Modules Referral to Provider Brief Consulta;on and Feedback Follow-­‐up Session Scheduled Based on Risk Level (AUDIT) Treatment Team Mee;ng Comple;on of AEM and Change Plan ABC Counselor Assigns Addi;onal Educa;on Modules ABC 1.0 Strengths ü Informed by research and theory ü Draws on interven;on components and techniques that have been associated with posi;ve change ü Incorporates mo;va;onal interviewing ü Emphasizes need for tailoring interven;on to meet individual needs ü Manual is clear, well-­‐wriRen and well-­‐organized ABC 1.0 Limita;ons X  No published program evalua;ons have been administered to study effec;veness of ABC 1.0. X  ABC 1.0 lacks standardiza;on and consistent implementa;on protocols. X  The ABC 1.0 manual does not provide direc;on on how to conduct ini;al interviews. X  The key decision points (diagnos;c criteria and dosing plan) lack clear ra;onale and implementa;on clarity X  Module 1 on base skills is no longer being delivered on a consistent basis. ABC 2.0 Primary Goals Maintain core evidence-­‐based components Manual refinement and standardiza;on Prac;cal, cost-­‐effec;ve training for providers Ability to evaluate ABC 2.0 – Manual Refinement Clarifica;on of ABC 2.0 goals, explicit guidance on decision points, and inclusion of base skills (e.g., MI, SUAT, DSM diagnos;c criteria). Standardiza;on of program content, including assignment of materials, assessments, and semi-­‐
structured interview formats. Reduc;on of reliance on clinical judgment and increasing data driven decision-­‐making with addi;on of key decision point criteria. Referral to ADAPT: Command, Medical, or Self-­‐
iden9fica9on Evalua9on (SUAT) and Brief Interview Diagnosis of SUD or other mental health diagnosis Referral to treatment Treatment Team Mee9ng ABC 2.0 Process No Diagnosis Referral to ABC Session 1 -­‐Results of assessment delivered in semi-­‐
structured interview format -­‐MI-­‐focused discussion on pa9ent concerns -­‐Assignment of Alcohol Educa9on & Value Explora9on Modules Session 3 + -­‐Discuss pa9ent concerns -­‐Follow up on change plan -­‐Evalua9on Session 2 -­‐Discuss pa9ent concerns -­‐Follow up on AEM &VEM: semi-­‐
structured interview format -­‐Develop change plan: semi-­‐
structured interview format Assign addi9onal modules & session Refer to treatment Case Closure ABC 2.0 -­‐ Training Mul;-­‐media web-­‐delivered training that can be sustained ADAPT staff members must demonstrate knowledge aRainment (>80% on quizzes) ADAPT staff members must complete clinical supervision in conjunc;on with online training Module Three: Engagement and Listening Skills Training Module Format ABC 2.0 – Evalua;on: Goals ABC 2.0 Goals Educate the pa;ent on nega;ve consequences of drinking alcohol Iden;fy the triggers associated with problem drinking Develop awareness of resistance and coping skills Mo;vate the pa;ent to change risky behavior paRerns Develop and implement a realis;c change plan ABC 2.0 Evalua;on: Outcomes Standardized Measures ABC 2.0 Next Steps: Pilot Primary Goals: Examine whether staff members adhere to the curriculum, decision-­‐making protocols, dosage, quality and consistency of ABC 2.0 delivery, including fidelity of the mo;va;onal interviewing component. Evaluate the effec;veness of ABC 2.0 based on the following outcomes Decreased alcohol misuse and increased ability to resist alcohol Increased content knowledge regarding alcohol use and misuse Increased awareness and use of resilience and coping skills Improved mood Increased readiness for change Improved fitness for duty and performance ra;ngs Fewer work days missed Provide data and recommenda;ons to present to funding sources (i.e., Congress). ABC 2.0 Pilot: U;lity of Training Par;cipants – ADAPT Staff members across 6 installa;ons Procedures Training Fidelity of interven;on delivery Fidelity of mo;va;onal interviewing ABC 2.0 Pilot: Effec;veness of ABC Par;cipants – 400 pa;ents remanded to ABC due to an ARI Procedures Phased roll out of ABC 2.0 to allow for naturally occurring comparison between ABC 1.0 and ABC 2.0 Measures are those included within the standard care ABC 2.0 program Things to Consider •  Poten;al to have an impact on many SMs •  Things that can’t be controlled •  Future implica;ons for preven;on science in the military •  Lessons to keep in mind from community based preven;on research Comments and Ques;ons