ALCOHOL AND OTHER DRUG CONTENT IN CORE COURSES: ENCOURAGING SUBSTANCE ABUSE ASSESSMENT.

ALCOHOL AND OTHER DRUG CONTENT IN CORE COURSES: ENCOURAGING SUBSTANCE ABUSE ASSESSMENT. AS WITH ALL OF THE HELPING professions, social workers see theirfair share of substance abusing clients. The authors suggest thatsuccessful intervention for alcohol and drug problems depends, in part,on the extent to which social workers assess their clients for substancemisuse. In the following study, MSW (MicroSoft Word) See Microsoft Word. students were taught about alcoholand other drugs in several different ways with varying degrees ofsuccess. Although one would expect that all alcohol and other drug (AOD See HD DVD. )specialists, social workers and otherwise, would ask clients standardquestions about the consequences of their substance use and abuse,practitioners in other specialties or clinical settings may not have thesensitivity, training or organizational support to assess their clientsroutinely for such problems. Yet this latter, much larger population ofclinicians, working in settings outside the specialized alcohol and drugtreatment system, have far greater opportunities for practicing earlydetection and referral. Since substance abuse problems have psychological, social, healthand economic consequences that call for a broad range of services,social workers, who often work in settings that provide a range ofservices, may be a client's first point of contact with communityservices (Gibelman & Schervish, 1997; Tam, Schmidt, & Weisner,1996). Social workers are among a group of professionals who serveclients in a variety of agency settings where problem drinkers and drugusers are present, such as health care, social services social servicesNoun, plwelfare services provided by local authorities or a state agency for people with particular social needssocial servicesnpl → servicios mpl sociales, rehabilitation rehabilitation:see physical therapy. ,welfare, and criminal justice (Weisner & Schmidt, 1993; 1995).Social workers' contacts with clients are important opportunitiesto identify substance abuse problems and either treat clients directlyor refer them for treatment. Thus, it is worthwhile for schools tobecome more familiar with educational procedures that train all clinicalstudents to assess clients for substance abuse. The Current Educational Context All curriculum advocates must be sensitive to the larger demandsfaced by social work educators. Following is a small test of someclassical educational options. Currently, there are two separate but interwoven in��ter��weave?v. in��ter��wove , in��ter��wo��ven , inter��weav��ing, inter��weavesv.tr.1. To weave together.2. To blend together; intermix.v.intr. nationalcurriculum pressures on MSW education. There is pressure for afirst-year generalist gen��er��al��istn.A physician whose practice is not oriented in a specific medical specialty but instead covers a variety of medical problems.generalistfocus and more required content. These pressures,combined with the continuing move away from a method focus tosubstantive/problem-based requirements, make minors/specialties anendangered species endangered species,any plant or animal species whose ability to survive and reproduce has been jeopardized by human activities. In 1999 the U.S. government, in accordance with the U.S. . Lennon (1998) collapsed the enrollment of MSWstudents into 15 primary fields of practice or social problemconcentrations. Four of those identified: mental health, familyservices, child welfare, and health constituted nearly two-thirds ofthose specified (pp. 82-84). Social work educators are thus faced with the classical existentialcurriculum dilemma: too little time, and too many demands. More thanone-half of social work schools have modest enrollments of 300 studentsor under, and more than one-third of these students are part-time. Theseschools are especially vulnerable (Lennon, 1998, p. 105). They areforced to choose from limited options. Those activities generatingmodest faculty and student interest may well disappear in a curriculumreorganization. Choices are limited for faculty facing the pressure for curriculumchange. One responsible approach to this dilemma, for those socialproblems other than the most popular three or four, is tocross-fertilize or integrate courses. With this educational model, thelikely decline in the field of practice/social problem concentrationoptions (e.g., school social work, gerontology gerontology:see geriatrics. , substance abuse,development disabilities, and planning), may be offset if the integratedcourse is taught by knowledgeable faculty who are able to bring case anddidactic di��dac��ticadj.Of or relating to medical teaching by lectures or textbooks as distinguished from clinical demonstration with patients. material into the generic courses. Alternative AOD Educational Practices MSW programs in the U.S. have used different strategies to heightenstudents' sensitivity to and appraisal of clients' alcohol-and drug-related problems. One approach has been to offer aspecialization in alcohol and other drugs (AOD) for which distinct AODclasses are taken as electives or as required course work and combinedwith AOD field placements. Another approach, available to all students,has been the provision of field experience and supervision inspecialized alcohol and drug treatment agencies without any necessarylinkage to formal, specialized, substance abuse courses. A third methodis the broadbrush approach of having the faculty integrate relevantalcohol and drug material into the standard curriculum. None of theseapproaches have been studied for their impact on students' clinicalassessment practices. AOD Efforts at Rutgers The Rutgers School of Social Work has operated an alcoholism minor(recently renamed Alcohol and Other Drugs) on the New Brunswick New Brunswick, province, CanadaNew Brunswick,province (2001 pop. 729,498), 28,345 sq mi (73,433 sq km), including 519 sq mi (1,345 sq km) of water surface, E Canada. campusfor about 20 years. The minor requires three specialized classroomcourses of three credits each and one year in the field at an alcoholand drug site. Starting in 1991, a five-year (1991-1995) facultydevelopment project at the Rutgers School of Social Work providedconditions to evaluate the specialized AOD minor in conjunction withcurricular integration of AOD content.(1) A primary goal of the faculty development project was to train thefive faculty members (who became AOD fellows for the first three years)so that they could better integrate alcohol and drug concerns into theirteaching and research. Prior to and during the time of the study, noneof the recruited faculty taught the specialized alcohol and drugcourses. However, to varying degrees during the training project and asplanned, all of the fellows integrated alcohol and drug material intotheir regular courses. Their integration of alcohol and drug materialwas more casual than the well-established AOD minor program. A separatesmall-scale evaluation of the faculty development project revealed thatthose students in courses instructed by AOD fellows reported thatsignificantly more activities relevant to alcohol or drugs took place intheir classroom compared to students enrolled in courses taught bynonfellows (Demone & Gassman, 1995). The courses taught by fellowswere not promoted as containing such content, so student enrollment wasnot influenced by a predilection for alcohol and drug studies. Thefellows' courses were open to all students including AOD minors. Given the educational requirements of the AOD minor and theassumption of probable response bias, the project staff was fairlycertain that the students minoring in AOD would report more extensiveassessment of clients for substance abuse problems than nonminors. Theresearch question, therefore, focused on whether courses with integratedAOD content would make any difference in students' assessmentpractices beyond what could be explained by the minor available to allstudents. In other words Adv. 1. in other words - otherwise stated; "in other words, we are broke"put differently , did students' tendencies to assessclients' substance abuse problems vary positively according to according toprep.1. As stated or indicated by; on the authority of: according to historians.2. In keeping with: according to instructions.3. their exposure to the fellows' courses? If this were found to bethe case, then integrating material into required courses in order toincrease students' assessment of alcohol and drug problems wouldreceive support as a viable educational strategy. Method Sample Forty-five MSW students enrolled at the Rutgers University Rutgers University,main campus at New Brunswick, N.J.; land-grant and state supported; coeducational except for Douglass College; chartered 1766 as Queen's College, opened 1771.Campuses and FacilitiesRutgers maintains three campuses. Schoolof Social Work, New Brunswick Campus during the fall 1992 semester se��mes��ter?n.One of two divisions of 15 to 18 weeks each of an academic year.[German, from Latin (cursus) s participated in the study. Approximately half of the sample consisted ofAOD minors (n=22) and the other half of nonminors (n=23). The sampleincluded the universe of minors and a comparable number of clinicalnonminors selected randomly (every nth case) from the registrar'slist after removing the names of AOD minors and administration, planningand policy majors. Both groups were entering their second year fieldplacement. Nonwhites constituted 29% of the sample. The average age forAOD minors was 35 years (SD=8.9) and for nonminors 34 years (SD=9.4).There were more female AOD minors, [chi square chi square (kī),n a nonparametric statistic used with discrete data in the form of frequency count (nominal data) or percentages or proportions that can be reduced to frequencies. ] (1, N=45)=4.29, p [isless than] .05. Letters mailed to the selected students introduced the study andinvited them to participate in an interview. Students were assured ofconfidentiality and that there would be no negative consequences todeclining to participate. The students were telephoned at home and thosegranting consent were interviewed in October or November 1992, with asecond interview attempted in March or April 1993. Seven students wereabsent for the second interview, three minors and four nonminors. Thus,a total of 38 students, or 84% of the original sample participated inboth interviews. The students' alcohol and other drug educational experiencesare summarized in Table 1. The number of courses taken that wereinstructed by faculty fellows is the key independent variable beingtested. An almost equal number of minors and nonminors enrolled incourses instructed by faculty fellows. Both groups reported considerableexperience working with alcohol- or drug-involved clients. Half of theminors and 39% of the nonminors reported present or prior work outsidetheir field placements with substance abusing clients. More nonminorsthan minors had already earned a certificate preparing them to work withsubstance abusing clients, 39% versus 23%, although this difference wasnot statistically significant. In general, many students with interestsin substance abuse apply to Rutgers because of the school'slongtime national reputation for graduate alcohol studies and theinternationally known Rutgers Center of Alcohol Studies. It isreasonable to assume that nonminors with credentials in substance abusecounseling avoided the formal minor in order to broaden their educationin other areas. Students selecting the minor reported takingsignificantly more formal AOD college courses r compared to nonminors,[chi square]=15.63, df=3 (2-sided), p [is less than] .001. As expected,most minors said they worked with alcohol- or drug-involved clients intheir field practicum practicum (prak´tikm),n See internship. at the time of the interview (68%), compared to35% of the nonminors, [chi square]=5.00, df=1 (2-sided), p=.03. Table 1. Self-Reported AOD Educational Experiences of the MSWStudent Sample (N=45) AOD Minors Non AOD Minors (n=22) (n=23)Number of faculty fellows'courses taken(a) 0 11 11 1 8 6 2 1 4Total number of specializedAOD courses(a) 0 0 10 1 9 7 2 6 4 3 5 0Works with AOD dependentclients outside fieldplacement Yes 11 9 No 11 14Certificate in AOD Yes 5 9 No 17 14Serves AOD clients incurrent field placement Yes 15 8 No 7 15 (a) Question was asked longitudinally across two semesters. Fourstudents were lost at follow-up. Overall, the background characteristics of the two groups ofstudents speak to a divergence in educational experiences. Minorsindicated learning about alcohol and drug studies primarily throughformal college courses and supervised practicum, whereas the nonminorsreported participation in certificate programs and clinical practiceoutside the university. Thus, although both groups had served clientswith substance abuse problems, minors were involved in a morestructured, rigorous and current AOD education program compared tononminors, whose training was probably not as current nor asacademically based. Measures The third author (at the time of the study a second-year MSWstudent minoring in research and employed as a research assistant on thetraining project) conducted structured telephone interviews to evaluatestudents' self-reported alcohol and drug education and fieldassessment practices. Exposure to courses with integrated alcohol anddrug material was measured by asking students each semester whether theywere enrolled in courses taught by AOD faculty fellows, whose names weresupplied. The students were not informed about the interest or trainingof the faculty in AOD education. Since two of the five faculty fellowswere teaching in the New Brunswick MSW program during this one yearstudy period, the students could have taken courses from zero, one ortwo faculty fellows. The AOD minor students were dummy coded withnonminors assigned to the comparison group. Assessment practices were explored via student self-report on 45items asked in the second interview only. Students were asked if theyusually assess clients' drinking in seven different areas: intake,need for treatment referral, family history, treatment history, legalhistory, use of self-help groups, and related health problems. The samequestions were repeated in reference to drug use. A fifteenth questionasked if they usually inquire about their clients' psychiatrichistories. "No" responses were counted as zero. For every"yes" response the students were asked a follow-up question,"When did you make this assessment?" Their response optionswere "during the first interview," "after the firstinterview," or "at the first and after the firstinterview." Responses were numbered to reflect the assumption thatearlier and more assessment was better for the well-being of the clientthan later and less assessment. Therefore responses were coded asfollows: "after the first interview" was scored as one,"during the first interview" was scored as two, and"during and after the first interview" was scored as three.Numeric values were summed, forming a scale ranging from 0 to 45 withChronbach Alpha internal consistency In statistics and research, internal consistency is a measure based on the correlations between different items on the same test (or the same subscale on a larger test). It measures whether several items that propose to measure the same general construct produce similar scores. of .93. A separate set of items asked students if they had assessed each ofthe 15 areas referred to above in the first interview that they had withtheir most recent client, with response options "yes,""no," "don't remember," and "notapplicable." "Yes" responses were enumerated This term is often used in law as equivalent to mentioned specifically, designated, or expressly named or granted; as in speaking of enumerated governmental powers, items of property, or articles in a tariff schedule. and summed,resulting in a second scale of 0 to 15, with internal consistency of.96. Prior to analysis, the dependent variables and number of coursestaken from faculty fellows were examined through various SPSS A statistical package from SPSS, Inc., Chicago (www.spss.com) that runs on PCs, most mainframes and minis and is used extensively in marketing research. It provides over 50 statistical processes, including regression analysis, correlation and analysis of variance. programsfor fit between their distributions and the assumptions of univariateanalysis (Iversen & Norpoth, 1987; Tabachnick & Fidell, 1996).Due to non-normal kurtosis KurtosisA statistical measure used to describe the distribution of observed data around the mean.Notes:Used generally in the statistical field, it describes trends in charts. , a logarithmic logarithmicpertaining to logarithm.logarithmic relationshipwhen the logs of two variables plotted against each other create a straight line. transformation was applied tothe scale that measures assessment in the first interview with the mostrecent client. Results The null hypothesis null hypothesis,n theoretical assumption that a given therapy will have results not statistically different from another treatment.null hypothesis,n stated that the number of"integrated" courses taken would have no effect onstudents' reports of assessing clients for alcohol and drugproblems. The data were analyzed using a general linear model simplefactorial factorialFor any whole number, the product of all the counting numbers up to and including itself. It is indicated with an exclamation point: 4! (read “four factorial”) is 1 × 2 × 3 × 4 = 24. application of analysis of variance. Student status as an AODminor and the number of courses taken from faculty fellows were theindependent variables. The "minor" variable was entered first(hierarchical method) because it was correlated with specialized courseenrollment (r=.55) and specialized field placements (r=.33). It wasassumed it would explain the largest mean difference on assessmentpractices. The interaction term ("minor" variable modified bythe number of courses taken from faculty fellows) was not significantand excluded from the analysis. A separate (2 x 3) analysis of variance(ANOVA anovasee analysis of variance.ANOVAAnalysis of variance, see there ) was conducted for each dependent variable scale. The results of the ANOVAs are shown in Table 2. As expected, AODminors reported greater general assessment of alcohol and drug problemsthan nonminors, 31.8 versus 22.0, respectively, F(1, 36)=4.23, p [isless than] .04. More interestingly, significant differences were foundin assessment practices depending on the number of courses studentsenrolled in with faculty fellows. Those who enrolled in two coursestaught by faculty fellows reported more extensive assessment ofclients' alcohol and drug problems (M=40.5) than did studentsenrolled in zero (M=25) or one (M=24) of these courses, F(2, 35)=4.38, p[is less than] .02. There is less than a 1 in 50 chance of obtainingthis F value spuriously. A multiple comparisons test using theBonferroni criterion (.05/3=p [is less than] .016) did not identifysignificant group effects (i.e., whether a student took zero, one, ortwo courses from faculty fellows), but this may be more of a function ofthe small sample size rather than the absence of differences. A visualinspection of the means shows clearly that students taking two coursesfrom fellows (as opposed to zero or one) had higher mean scores on thealcohol and drug problem assessment scale, and this accounted for mostof the overall effect. AOD minor status and taking courses from fellowsexplained 28% of the overall variability in reported general assessmentof substance abuse problems. The eta-squared statistic (.09 for AODMinor and .20 for number of courses taken from fellows) was used todetermine the proportion of the total variability explained by thegrouping variables as 31% for AOD minor status and 69% for takingcourses from fellows. [TABULAR DATA 2 NOT REPRODUCIBLE IN ASCII ASCIIor American Standard Code for Information Interchange,a set of codes used to represent letters, numbers, a few symbols, and control characters. Originally designed for teletype operations, it has found wide application in computers. ] Similar results were found in the second analysis. AOD minorsscored higher on the logarithmically log��a��rithm?n. MathematicsThe power to which a base, such as 10, must be raised to produce a given number. If nx = a, the logarithm of a, with n as the base, is x; symbolically, logn a = x. transformed scale measuringassessment of substance abuse problems in the first interview with themost recent client (M=2.5), as compared to nonminors (M=1.4),F(1,31)=7.21, p [is less than] .01. And of primary interest,students' reports of assessing these problems during their firstencounter with their most recent client varied significantly with thenumber of courses they had taken that were instructed by fellows duringthe period of this study, F(2, 30)=3.53, p [is less than] .04. There isless than a 1 in 25 chance of obtaining this result spuriously. TheBonferroni test of multiple comparisons did not identify significantgroup effects (p [is less than] 0.016), but this may be more a functionof small sample size rather than the absence of differences. A visualinspection of the mean for taking two courses from fellows (M=3.2) asopposed to zero (M=1.7) or one course (M=1.9) was responsible for theoverall effect. AOD minor status and taking courses from fellowsexplained 33% of the overall variability on the logarithmicallytransformed scale measuring assessment of substance abuse problems inthe first interview with the most recent client. The eta-squaredstatistic (.17 for AOD minor status and .14 for number of courses takenfrom fellows) was used to derive the proportion of the total variabilityexplained by the grouping variables as 54% for AOD minor status and 46%for number of courses taken from fellows. Discussion The dual focus of this study was on whether enrollment in coursesas an AOD minor and courses with integrated alcohol and drug contentbore any relationship to students' self-reports of assessingclients in their field placements for substance abuse problems. Theanalysis began by comparing the educational experiences of AOD minorswith nonminors. Compared to nonminors, AOD minors had enrolled in morespecialized formal college courses in alcohol and drugs either atRutgers or at other schools, and were more likely to report that theyserved clients with substance abuse problems in their current fieldplacement. No significant differences were found in the number ofcourses taught by faculty fellows taken by minors and nonminors duringthe study period. Also no significant differences were found between thetwo student groups on working with substance dependent clients outsidetheir field placement and on having earned certification as an alcoholor drug counselor. The authors examined whether exposure to courses with integratedmaterial had any effect on self-reported assessment beyond that whichcould be explained by the minor. Findings suggested that the greater thenumber of courses students took with integrated alcohol and drugcontent, the more they reported assessment of alcohol and drug problemsin their clients. This finding is consistent with the results of twoseparate analyses: one explored students' typical self-reportedassessment practices, and the second focused on students'self-reported assessment practices at a certain time with a specificclient. The self-report assessment scales covered a wide range of lifedomains that are commonly appraised when screening for alcohol and drug-related problems. Timing was also a component of the assessment scales;earlier and more frequent assessment was considered clinicallypreferential to assessment later and less often. Our findings suggest that offering specialized AOD courses and coreclinical courses with alcohol and drug content are both effectiveteaching choices. Both appear to improve students' self-reportedassessment for substance abuse in clients. Integrating alcohol and drugcontent into core clinical courses may be especially appealing toschools lacking the resources to offer a specialized alcohol and drugcurriculum. Students were not randomly assigned to course content or to groups,which presents a threat to the validity of results. The authors tooksteps to minimize effects of selection bias by statistically controllingfor known group differences. There were no differences across groups onnumber of courses students took by faculty. However, being an AOD minorcorrelated with two variables that showed cross-group differences,enrolling in specialized AOD courses and self-reports of serving AODclients in a current field practice. The authors statisticallycontrolled for these correlated variables by entering the factor AODminor (yes or no) first in the ANOVA which allowed examination of anyadditional effects of taking courses from faculty fellows. Thepossibility remains, however, that the findings are confounded byself-selection factors that were not measured. The sample size wassmall. The study took place in a school with an established reputationfor alcohol and drug education. Another potential threat to validity isthat the interviewer was not blind to group conditions, and thereby mayhave unwittingly influenced the results. Finally, all data wereself-reported. Despite these cautions, the study has many strengths. Ithas a quasi-experimental design, internally consistent scales, andstatistical control of known group differences. It provides a basicbuilding block in analyzing curriculum options. Conclusion Although several Rutgers faculty members were engaged in athree-year immersion into alcohol and drug subject matter, they were notasked to teach any of the specialized AOD minor courses. Instead theymodified their existing courses, adding alcohol and drug theory andclinical material as appropriate. Students reported that they learned toassess the clinical needs of clients in two didactic ways, specializedAOD minor courses and the integration of alcohol and drug material intothe general curriculum. Compared to students not exposed to eitherteaching style there was a significant difference. The specializedtraining provided the best alcohol and drug clinical assessment results,the integrated training was next, and those students taught in thegeneral courses showed the poorest assessment results according to theirself-report data. Relying exclusively on field education is a fourthoption not considered in this study. (1) The Social Work Faculty Development Program in Alcohol andOther Drug Abuse at Rutgers University was supported by the Center ofSubstance Abuse Prevention, the National Institute on Alcohol Abuse andAlcoholism, and the National Institute on Drug Abuse Grant #AA07517. Itwas one of seven such grants to schools of social work. The Rutgersproject director was Eileen Corrigan. REFERENCES Demone, H. W., & Gassman, R. A. (1995). Final report of thefive-year faculty development in alcohol and other drugs at RutgersSchool of Social Work. Rockville, MD: Center for Substance AbusePrevention The Center for Substance Abuse Prevention (CSAP) is an agency of the United States government under the Department of Health and Human Services (DHHS) and the Substance Abuse and Mental Health Services Administration (SAMHSA). . Gibelman, M., & Schervish, P. H. (1997). Who we are: A secondlook. Washington, DC: NASW NASW National Association of Science WritersNASW National Association of Social Workers (Washington, DC)NASW National Association of Social WorkersNASW National Association for Social Work (UK)Press. Iversen, G. R., & Norpoth, H. (1987). Analysis of variance (2nded.). Newbury Park, CA: Sage. Lennon, T. M. (1998). 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It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of : HarperCollins. Tam, T., Schmidt, L., & Weisner, C. (1996). Patterns in theinstitutional encounters of problem drinkers in a community humanservices network. Addiction, 91(5), 657-669. Weisner, C., & Schmidt, L. (1993). Alcohol and drug problemsamong diverse health and social service populations. American Journal ofPublic Health, 83(6), 824-829. Weisner, C., & Schmidt, L. (1995). Expanding the frame ofhealth services research Health services research is the multidisciplinary field of scientific investigation that studies how social factors, financing systems, organizational structures and processes, health technologies, and personal behaviors affect access to health care, the quality and cost of health care, in the drug abuse field. Health ServicesResearch, 30(5), 707-727. Accepted: 10/99. Address correspondence to: Ruth A. Gassman, Institute of SocialResearch, Indiana University Indiana University,main campus at Bloomington; state supported; coeducational; chartered 1820 as a seminary, opened 1824. It became a college in 1828 and a university in 1838. The medical center (run jointly with Purdue Univ. , 1022 E. Third St., Bloomington, IN 47405;e-mail: rgassman@indiana.edu. RUTH A. GASSMAN is associate scientist, Institute of SocialResearch, Department of Sociology Noun 1. department of sociology - the academic department responsible for teaching and research in sociologysociology departmentacademic department - a division of a school that is responsible for a given subject , Indiana University. HAROLD W. DEMONE,JR. is visiting scholar A visiting scholar, in the world of academia, is a scholar from an institution who visits a receiving university that hosts him where he or she is projected to teach (visiting professor), lecture (visiting lecturer), or perform research (visiting researcher , Heller Graduate School, Brandeis University Brandeis University,at Waltham, Mass.; coeducational; chartered and opened 1948. Although Brandeis was founded by members of the American Jewish community, the university operates as an independent, nonsectarian institution. ,and lecturer, Graduate School of Social Work, Boston College Boston College,main campus at Chestnut Hill, Mass.; coeducational; Jesuit; est. and opened 1863. Actually a university, the school's Chestnut Hill campus comprises colleges of arts and sciences and business administration, the graduate school, and schools of nursing . He is alsoemeritus professor and former dean, School of Social Work, RutgersUniversity. RAWAA ALBILAL is vice president and chief operating officer Chief Operating Officer (COO)The officer of a firm responsible for day-to-day management, usually the president or an executive vice-president. of a Metro 1 United Way in Newark, New Jersey. Preparation of this article was supported by the Center forSubstance Abuse Prevention Grant AA07517-02.