Prevention Profiles: Take Five - Diane Fedorchak (UMass Amherst)

Rich Lucey: Hi, this is Rich Lucey and the Drug Enforcement Administration and the Community Outreach and Prevention Support Section and welcome to this edition of Prevention Profiles Take Five.
 
I’m very pleased today to have as guest, Diane Fedorchak and I’m going to tell you a little bit about Diane from the University of Massachusetts Amherst and then we’ll get into our, our five questions.
 
Diane Fedorchak currently serves as Interim Director of the Center for Health Promotion at the University of Massachusetts Amherst.
 
Diane has worked in the Health Education Department at UMass Amherst since 2000, specializing in alcohol and other drug abuse prevention.
 
Diane also is Director of the BASICS Program, which we’ll talk about in a just a little bit.
 
She’s also Coordinator of the Fresh and Sober Program and an active member of the Campus and Community Coalition to Reduce High Risk Drinking.
 
So with that, Diane, welcome to the podcast.
 
 
Diane Fedorchak:  Thank you so much, Rich.
 
Thank you for having me, I’m honored to be on.
 
 
Lucey:  Absolutely.
 
So we’re going to jump right into the first of our five questions and I want to provide a little bit of context, especially for our listeners who aren’t completely sure what BASICS is and maybe what it’s not.
 
So in 2002, the National Institute on Alcohol Abuse and Alcoholism released its report about drinking on college campuses.
 
And the report highlighted four tiers of effectiveness to prevent high-risk drinking among college students.
 
Now one of the strategies in the top tier, meaning there is strong evidence to demonstrate its effectiveness, is brief motivational enhancement interventions, which I think people know more commonly as brief motivational interviewing.
 
Now one of the programs that built upon that strategy is Brief Alcohol Screening and Intervention for College Students, otherwise known as BASICS and it certainly has gained popularity by being showcased at several national conferences over the last few years.
 
So Diane, I know you are the Director of the BASICS program at UMass Amherst.
 
What would you say is the biggest challenge people have with implementing BASICS?

 
Fedorchak:  Well, you know, I think people get excited about implementing BASICS and rightfully so, so it is a great program, it is a tier-one program and it really has great effectiveness.
 
And I would say the one challenge people have is not going through the implementation steps and wanting to train everyone without a narrow focus.
 
Now I’m not saying don’t include as many colleagues as you can in motivational interviewing training, because I think MI provides excellent skills and techniques and enhances people’s confidence to have difficult conversations across a wide spectrum.
 
But it’s a little bit different from BASICS training.
 
So my suggestion is to take the time to plan and identify partners, collaborators and stakeholders and gain their buy-in before implementing a program.
 
Schools have found it helpful to national data, data from successful programs and resources like the College AIM, the Alcohol Intervention Matrix to gain stakeholder buy-in.
 
You know, it’s important to identify your target population, who will be providing, who will you be providing BASICS to and why.
 
This is based on your campus data and your specific campus needs, you know, and perhaps even the students you have or will have access to.
 
You know, and maybe there’s an administrator on your campus that has a specific need for you to address.
 
So you also might have to do some data collection to figure some of this out.
 
Like for instance, if you’re targeting alcohol transports, then you’ll need to see how many there are on average each semester.
 
So defining your target population will assist in determining staffing models.
 
So without getting into too much detail, other implementation steps and questions really need to be answered and I think that that’s where sometimes lies a really big challenge, just jumping in without answering some of the questions.
 
So some of the questions just blurted out are who will deliver the intervention?
Will you use professional staff?
We have grad students.
 
How many sessions will you do?
Typically BASICS is a two-session format.
 
Some schools do it in one, some schools do it in three.
 
Some schools like ourselves, we use a small group format for the first session with an individual follow-up for the second session.
 
Where are they going to take place?
What physical office will they be in?
You know, you also have to figure out what will your assessment be and how will students complete the assessment.
 
So you have to develop the tool and then give it to students.
 
Will it be pen and paper?
Will it be on the computer?
And BASICS says that you need to have a feedback sheet and give students feedback sheet and use the skills and techniques of motivational interviewing to give them back this information, so that they can begin to build discrepancy over their behaviors.
 
And so if they can kind of set their own agenda on that, any changes they want to make.
 
So what does that feedback sheet look like?
How will it be generated?
How are you going to communicate to the students, back and forth and to your refers?
How are you going to train your staff and what’s the supervision structure look like?
So as you can see, there’s a lot of different questions that need to be answered before we start training staff and before we start implementing BASICS.
 
So again, my suggestion is to really take the time to think through an implementation plan and then also included in that is thinking about follow-ups.
 
Are you going to do some follow-ups?
Are you going to have students, say in three months, in six months, what does your use look like now?
So that you can show that you’re actually having some effective in your, in your program and how are you going to report back your success.
 
 
Lucey:  So I mean, excellent advice and I know that this is actually one of the challenges, right?
With highlighting or showcasing, you know, quote, unquote “model programs” or programs that are somewhat seen as a gold standard for effectiveness, is people hear about them at conferences or maybe their boss hears about it at a conference and then comes back to the campus and says here, implement this.
 
And you don’t even really know why you’re implementing it, for one thing.
 
But like you just said, there are so many different steps and questions that you really need to do your homework first, before you full out implement the program.
 
 
Fedorchak: Correct.
 
Yeah, and really doing that homework and really building a strong infrastructure.
 
That’s really what’s going to help you institutionalize your program and build a sustainable program.
 
 
Lucey: Excellent.
 
So staying on the BASICS theme, I want to move onto our second question.
 
Actually just very recently, within the last week, I had a conversation with someone who works at a community college and they are thinking about implementing BASICS on their campus.
 
So that got me wondering if there are any unique considerations about using BASICS in that setting, because I think a lot of times these model programs and effective strategies are traditionally born out of your traditional four-year residential schools.
 
So what advice do you have for community colleges, who might be considering this strategy for their campus?
 

Fedorchak:  You know, that’s an excellent question.
 
I mean, most of the BASICS programs that are out there are really connected to policy violations, so there is a stream of influx of students coming in and most community colleges are commuter schools.
 
So it really could be a challenge to implement a sustainable program.
 
So you know, I would say to walk through the steps that I just really quickly outlined there and try to identify a target population.
 
Is there a particular target population that you could target for this and how so.
 
And it might be small and that’s really OK.
 
And you know, in thinking about this question, I think that community colleges might also find success in training colleges on motivational interviewing and how to identify someone who is struggling with substance abuse and then how to refer that to you.
 
You know, so community colleges might have to put a lot more focus here in the beginning stages of implementation and have a smaller target population.
 
But it’s really going to be unique to each school, but it is, it’s a really big consideration, because how do you, how do you get that?
You know, they’re commuting, they’re living off-campus, their demographics of students, they might be a little bit older, you know, they may not be getting in trouble with alcohol or they might be, so how do you identify those students, I think is going to be a challenge.
 
So working with colleagues and really thinking through the implementation steps unique to their school.
 
 
Lucey: So I think that the key, what I heard, though, is that it certainly could be used at community colleges, that there are just unique considerations.
 
I mean, I know for myself, years ago as someone who was an athletics coach at a community college, you know, there are policy guidelines and such for student athletes on community colleges.
 
And certainly any student needs to follow the community college’s alcohol and drug policies.
 
So there certainly are policy considerations and if there are mandated students who have infractions against that policy, it’s not out of the realm of possibility that a BASICS type program could be implemented for those types of students.
 
 
Fedorchak:  Oh, not at all.
 
No, and that would be a very appropriate use of the BASICS program, absolutely.
 
Working, you know, again, finding those key stakeholders, so finding that athletic director and really getting in there and how you can help support your athletics teams and your athletic program by reducing their high-risk drinking and their drug use is going to increase your athletic performance.
 
And you can provide them a service for when athletes either violate a policy or there’s a drug testing policy, too.
 
You could be a part of the drug testing policy.
 
So you could be offering a service that is actually needed.
 
Absolutely.
 
 
Lucey: Great.
 
Well, I know that the particular person that I was speaking with intends to be listening to our podcasts in the future, so I know that this is great advice for her as she’s looking to implement it on her campus.
 
So I’ll move onto our third question and staying with BASICS, even though the program was primarily built around the whole issue of alcohol abuse prevention among college students, can the principles around BASICS be used around other drugs, more specifically say marijuana?
Are you aware of other campuses that are doing this and maybe successes or challenges they’re having with that?
 

Fedorchak: You know, I mean, I would say an enthusiastic yes.
 
I mean, there is so much research about the effectiveness of the motivational interviewing and brief interventions and the positive behavior change in general that, you know, using MI with these brief interventions really shows that we help students.
 
Students and people make positive behavior changes, so it would make sense that we use these techniques for other substances, including marijuana.
 
Now yes, yes, yes, BASICS was designed for alcohol, the “A” in BASICS is for alcohol, but so many of our students are also using marijuana, so our high-risk students are also more likely to be using marijuana.
 
We, at UMass have enhanced the marijuana section of our assessment and our feedback sheets, so we can use what works with the alcohol in BASICS to provide feedback regarding marijuana use.
 
And then we just include that in our three and six-month follow-ups, so what we’re seeing is that BASICS is helping to reduce high-risk drinking across all drinking measures and we’re also seeing that with marijuana as well.
 
So you know, I definitely believe that all that we’re doing within BASICS and those techniques absolutely could work and do work with marijuana.
 
Some schools are calling it CASICS, so they’re calling it Cannabis … they’re putting this, they’re changing the “B” into a “C”, so CA being Cannabis Screening and Intervention for College Students, so BASICS/CASICS.
 
BASICS is just kind of known as BASICS.
 
Nobody really knows what it stands for in our campus, so call BASICS and you’re going to talk about alcohol and other drugs and that just works for us.
 
And on our website address that yes, we will talk about whatever substances you might be using, it just kind of makes sense.
 
Now it’s going to be interesting to see what happens when the dispensaries open here in Massachusetts in July.
 
We might see more students for marijuana, you know, we might see different issues pop up, but we can absolutely address them in this one-on-one intervention, using MI, using brief interventions and using all the components of BASICS and remembering to do our assessment and follow-up.
 
Like I think that’s key, when you change a program, a program like BASICS that has 30 years of data behind it, in order to stay true and deliver a program of fidelity, if you make a change, then you got to evaluate it.
 
So we’re really doing that and seeing that it is not taking away from alcohol; it’s enhancing the marijuana piece and we are seeing reductions in both alcohol and marijuana use.
 
 
Lucey: That’s excellent.
 
I know … so at its core, the whole foundation of BASICS is for a trained individual to sit down, in a small group, or primarily one-on-one, with a student and talk to them, not in a judgmental way, but just in a matter of fact educational way about their own substance use and how that compares to their peers, according to survey data.
 
And then assessing where they are in terms of wanting to make a change around that.
 
 
Fedorchak: Sure, yep.
 
 
Lucey:  So I’m hearing what you’re saying that, you know, you could fill in the blank in terms of the substance.
 
It could be alcohol, it could be prescription drugs, it could be marijuana, it could be cocaine, right?
I mean, I guess it’s all dependent, but it’s, the bottom line is still having that empathic conversation with the student and assessing are they ready to make a change in their behavior.
 
 
Fedorchak:  Absolutely.
 
And identifying, I mean, BASICS, for our highest, highest, highest risk students, BASICS doesn’t work.
 
It doesn’t work for those students, but what it does do is help us identify those students, so that we can refer them and get them connected with other resources that they need.
 
So it makes sense to ask about other substances, because that jacks up the higher risk-ness of it.
 
 
Lucey: So I’m glad you said that, because I think it’s really important to make very clear and I know you and I have had this conversation and with others around the country, BASICS in no way, shape or form is considered treatment.
 
 
Fedorchak:  Correct.
 
 
Lucey:  It is in its very nature, it is screening and intervention and in fact, it can very closely align with a school’s SBIRT, or Screening and Brief Intervention and Referral to Treatment …
Fedorchak:  Correct.
 
 
Lucey: … program.
 
So what you just mentioned, so for the highest risk of students, for which BASICS is really not the appropriate strategy, it will give you an opportunity to identify those students and then refer them to the appropriate treatment provider for a more formal diagnosis.
 
 
Fedorchak:  That is correct.
 
You know, and because of the work of our colleague, Jason Kilmer, we’ve many, many, many years, implemented the Patient Health Questionnaire Nine, the PHQ9, which is a depression and suicide screen.
 
So what we know about alcohol and suicidality, what we know about college students and suicidality, it makes sense.
 
We have this captive audience and we can’t … we have this captive audience who are at higher risk for depression and suicidality and alcohol use and other drug use, like it all kind of goes together.
 
So it makes sense to take a few minutes and ask them those questions and we do.
 
Now you can’t just throw everything at this assessment, everything you’re like worried about, but what sense to you, you can.
 
And what we’ve find is that, yeah, we have a handful of students who are scoring positive on that ninth question, which is our suicide screen.
 
And out of that handful, most of them just need a lecture, support and they’re OK.
 
And there’s a few of them that need to be walked to the counseling center and that’s great.
 
That’s a great intervention and an appropriate for it.
 
So just by an example of that, we are adding a couple of other components into BASICS that wasn’t originally there 30 years ago when it was developed.
 
Another big component is sleep.
 
College students and sleep.
 
We know they struggle so much with sleep, so it makes sense to ask them about their sleep and help them connect the dots between their alcohol use and/or their marijuana use and oh, gee, that might have an impact on why you’re exhausted every morning.
 
So you know, adding some other components that make sense, that are related to substances really feels appropriate within the BASICS program and still holds true to the fidelity of the program.
 
 
Lucey: Excellent.
 
So I’ll move onto our fourth question.
 
I’m going to actually now take a right turn off the BASICS program and talk to you about recovery.
 
So you are very open about being a person in long-term recovery from addiction and what that means to you.
 
And over the past few years, the recovery movement has seemed to really take hold on college campuses.
 
Why do you think that is?

 
Fedorchak:  Yeah, I know.
 
Isn’t that so fabulous?
You know, I believe a lot of things came together around the same time and I really connect it being under President Obama’s administration and some different things that took place.
 
I remember a very specific moment in time at one of the last Department of Education’s National Meetings.
 
Now I cannot remember for the life of me which meeting it was or who the actual keynote speaker was and I’ve tried to look it up, but I can’t figure out exactly who that person was, but I remember sitting there with a hundred, hundreds of my closest colleagues from across the country.
 
And I remember somebody from the Department of Ed, so somebody who was a President Obama …


Lucey: An appointee?
 

Fedorchak:  Appointee, thank you.
 
Appointee, stood at that podium and addressed hundreds of us and stated that he was a person in long-term recovery.
 
And I swear to you, colleagues in recovery in that room, including myself, all sat up a little bit straighter.
 
And I remember sitting there thinking, whoa! Did he just say he was in recovery?
And then I was blown away a little bit, I’m like, did he just do that in a way that maintained twelve step anonymity?
You know, for me, this was really a pivotal shift in the larger conversation.
 
And I started seeing different conference sessions talking more openly about recovery.
 
I saw different colleagues in different conference sessions eager to identify themselves as being a person in long-term recovery and that there was this new sense of pride.
 
And there’s also some language that was being provided to us around how to talk and identify, of being in recovery in a way that didn’t break some traditions in Alcoholics Anonymous or other twelve step programs, that is foundational to those programs, right?
So some new language was being, being provided.
 
And that really for me was a pivotal shift.
 
And you know, I was doing some reflecting on this and a little bit of research and you know, we’ve really got to, got to thank Brown University and Rutgers University and they were really the first in the ‘70s and ‘80s to pave the way for school-based recovery support services.
 
They were quickly followed by Texas Tech and Augsburg College, you know.
 
I’m proud to have started out our recovery support services during what’s been kind of called the second wave of recovery, collegiate recovery movement and that was in like the late ‘90s, 2000s, is like that second wave movement.
 
And then more schools started providing recovery support services, using a variety of models.
 
You know, and it was then in the early ‘90s, early 2000s, excuse me, late ‘90s, early 2000s, we started seeing some research that was being conducted and that was really helpful in implementing and sustaining recovery-based programs.
 
Texas Tech developed a curriculum that was funded through SAMHSA and the Department of Education.
 
So the schools can kind of use these, this curriculum to plan and implement their recovery support program that was suited for their schools.
 
So then we started seeing some of this federal money that was being, being offered to help this, help and address this often unseen population.
 
And then in the mid-2000s, collegiate recovery communities really began appearing across the country and honestly, some of that came from schools benefiting from some private start-up funds, through Stacy Matheson.
 
I remember like to get a Stacy grant, like that was kind of like the buzzword at conferences and she was part of transforming youth recovery.
 
And then the Association of Recovery in Higher Education was formed and are currently having their ninth annual conference.
 
So I really found, for me, it was a pivotal moment at that national meeting of the elected official standing at that podium saying he was a person in long-term recovery.
 
And then later, President Obama in his ultimate wisdom had Michael Botticelli, being his drug czar from Massachusetts and he identifies as a person in long-term recovery, and you know, and then President Obama had a proclamation out in 2011, where he named September would be Recovery Month, you know.
 
So really out there and starting to be in the common vernacular and that it was OK to say you were a person in long-term recovery.
 
And we had models doing that and saying that for us and we had schools that had been doing this work for a really long time and that just kept staying with it, until the rest of us, you know, continued to catch up.
 
And then there was some money available and then the ball just continued to roll.
 
And you know, now we’ve got a really nice publication put out around recovery, schools or colleges and stuff, that nice publication that’s out.
 
So yeah, it’s been really, really great to watch it blossom and really support students.
 
 
Lucey:  Well, thank you for your reflection on that.
 
And I think it is important to mention that unfortunately stigma does still exist.
 
I mean, with all of the national conversation and people openly talking about it, but I do believe that, you know, people like yourself, on campuses, in communities and whether they have a national platform or not, talking about this openly and recognizing that, you know, addiction is just like any other chronic disease, whether we’re talking hypertension, cancer, diabetes and so it’s, it really has been a long time coming out of the shadows, if you will.
 
 
Fedorchak: Yes, absolutely.
 
 
Lucey: And being open about it.
 
So, so thank you for your reflections on that.
 
 
Fedorchak: Yes, yes.
 
 
Lucey: So I’ll segue to our final question and this is your opportunity, more or less, to speak directly to the listeners, but what do you want to say to encourage your peers, the professionals who are working to prevent drug abuse among college students who are listening to this podcast.
 
What words of encouragement do you have for them?
 

Fedorchak: Yeah, I mean, I mean, the first thing I would say is to take the long view.
 
And when you do good prevention work in one area, it pushes the work to another area.
 
You know, and then you have to be creative, so it feels like we’re always addressing sometimes the same thing.
 
There’s always alcohol; it’s not going away and now it’s like, oh, how do we address marijuana.
 
And you know, so we really have to stick with it and as you talked about a little bit earlier, you know, sometimes our administrators go to conferences and come back with a good idea or they sit in front of Google and like hey, you should … and I’m like, oh, yeah, we really should, shouldn’t we?
You know, like we have to stay in there.
 
We have to be creative, we have to, we have to implement evidence-based strategies and do that every chance we can and when we are implementing evidence-based strategies and we’re working on an environmental approach, then we can try creative things that may or may not work, because we have a base of programs that in theory are working.
 
I would also say that, you know, a lot of time we put our time and energy in getting the reluctant onboard.
 
I can’t tell you how many times people are like, how do you get that, you know, that, that absentee landlord to show up?
Or how do you get that provider onboard with X, Y or Z?
Or how do you get that professor or that administrator.
 
You know, instead, finding your allies and your partners and start with them and build momentum from there.
 
And oftentimes what happens is, those people will help you build momentum.
 
They’ll get the other ones onboard or they won’t, you know.
 
And the reluctant won’t matter anymore, because you’re building and growing your program.
 
So shift the energy towards the reluctant to really who your allies and your partners and where the momentum is.
 
And then, you know, finding mentors for your support, within your institution and outside your institution, now working at conferences is really an excellent place for this.
 
I have found it extremely helpful to have outside supports and outside takes on whatever’s, I’m going through in my institution, it’s helpful to have like an outsider perspective from a different institution.
 
And I have found prevention colleagues to be accessible and available to meet new people and giving freely of their time and experience.
 
I remember when I was beginning to start our collegiate recovery community, a piece of it’s still called Fresh and Sober.
 
Around the early 2000s I finally had the opportunity and I finally got the guts up to go up to Lisa Legman and I said, I said to her, hi.
 
My name’s Diane, I’m from UMass and I’ve been stalking you.
 
And we laughed and I said, no, really.
 
I’ve been stalking you at conferences and I’ve wanted to meet you and I finally got the nerve up to say hi to you.
 
And that was really the beginning of a great collegial shift and a really great friendship.
 
And she was open to that.
 
So use that.
 
Go up to people, meet them and find your mentors and your support.
 
Lastly, you know, I don’t think the caregivers always take care of themselves.
 
And it’s something that’s often overlooked.
 
So I’m really encouraging people to find ways to take care of themselves.
 
And for me, it’s like finding ways to take care of myself throughout the day.
 
You know, at night, I’m pretty good at taking care of myself, but how do I, how do I do that throughout my workday?
So you know, that’s just a couple of things that I would say to my colleagues.
 
 
Lucey: Excellent.
 
I really appreciate a couple of those takeaways, especially you know, caregivers absolutely, we do need to take care of ourselves, but also spending time mainly on your allies.
 
I mean, we have such precious time to work on these issues that we really don’t have the time to waste spinning our wheels.
 
And so, I really appreciate the advice that you’ve given.
 
So Diane, thank you again so much for spending time with us and I’m sure that the podcast listeners for this episode will really appreciate the insight that you’ve had around BASICS and recovery in general and the advice that you’ve just given them.
 
 
Fedorchak: Well, thank you for the opportunity, Rich.
 
 
Lucey: And so with that, I say to our listeners, thank you for joining us for this episode of Prevention Profiles Take Five.
 
I hope you’ve enjoyed it and please stay tuned for future episodes of the podcast series and with that, I say take care and have a great day.