Prevention Profiles: Take Five - M. Dolores Cimini (University at Albany)


Dolores Cimini

Audio file

M. Dolores Cimini, PhD., who serves as director for the Center for Behavioral Health Promotion and Applied Research at the University at Albany, The State University of New York, New York is our guest this episode. She discusses why it's important to evaluate prevention products, gives advice about working with students, and much more.
Rich Lucey: Hi, this is Rich Lucey with the Drug Enforcement Administration's Community Outreach and Prevention support section, and welcome to this episode of Prevention Profiles: Take Five.
I'm excited today to have my long-time friend and colleague Dolores Cimini from the University at Albany as today's guest.
And so let me tell you a little bit about Dolores before we get into our five questions for the interview.
Dr. Dolores Cimini is a New York State licensed psychologist and Director of the University at Albany's Center for Behavioral Health Promotion and Applied Research.
The screening and brief intervention program developed by Dr. Cimini, known as the STEPS Program, has earned ten national awards for best practices and innovation in behavioral healthcare, and it was listed in SAMHSA's National Registry of Evidence-based Programs and Practices in January of 2014.
Dr. Cimini currently sits on the APA's Commission of Accreditation and the Center for Substance Abuse Prevention's National Advisory Council.
So with that, Dolores, welcome to the podcast.

Dr. Dolores Cimini: Thank you.
I'm delighted to be here.

Lucey: So we're really excited to have you chat with us for a bit to remind our listeners Prevention Profiles: Take Five is a relatively new podcast series that we run off of our website, and it gives me the opportunity to ask five questions of federal, national, state and local individuals who are working to prevent drug abuse among college students, are involved in prevention research and science and to talk a bit about current and emerging issues on this topic.
Before I get into the first question, of course I always like to do this when I'm talking to Dolores.
In the interest of self-disclosure, I am an alum of the University at Albany, and while we are certainly trained to not really have favorites, I always look at this university with keen interest since I went to school there.
So Dolores, again it's a real pleasure to have you.
So let's jump into our first question.
Soon after DEA launched last July, you wrote a "View from the Field" for us that focused on evidence-based programs, and one of the tips that you gave around selecting an evidence-based program is let the buyer beware.
Can you elaborate on that a little bit?
Cimini: Sure.
It seems as if every day when I open my email box I find a new ad for a product or a book or another item that addresses alcohol and other drug abuse prevention or a related behavioral health issue.
Typically when we look at programs such as this, ideally what we want to see is that they are backed up by research and experimental studies to demonstrate their effectiveness.
What is happening more and more, however, is that companies and products are being promoted, and the products really look beautiful.
They're being promoted without necessarily having the research to back them up.
And so what seems to be happening is that some of these companies are promoting their products.
They're writing to Vice-Presidents for Student Affairs who are looking for quick solutions to deal with very, very serious problems.
The companies are writing to prevention specialists, talking about the important need for their programs.
But yet when asked about results of experimental studies to support the effectiveness of their programs and to demonstrate outcomes, the information supporting these outcomes by and large may be absent.
So it's really incumbent for the prevention professional to ask those hard questions, to ask about the data that supports the effectiveness of new programs and products.
For a number of years we have had the National Registry of Evidence-based Programs and Practices developed by SAMHSA where researchers could put their programs and interventions forward for rigorous peer review.
And preventionists could go on these, this website, this registry and look at whether a particular program they're considering has the background in terms of evidence-based and outcomes to support its effectiveness.
Unfortunately a couple of months ago the NREPP site was ended, and so now there seems to be a void in terms of places that a preventionist can go to to look for information on effectiveness.
And in my professional opinion, this void that the loss of NREPP has caused for prevention professionals opens up the opportunity for some programs and some products to be put out there without having results.
So let the buyer beware essentially means look at the research behind the product.
Ask those hard questions and make sure that you are confident as a prevention professional that the product that you are looking at, the product you are potentially purchasing does have evidence of effectiveness behind it.

Lucey: So and it's really good advice.
So I mean I think the bottom line is you have to do your homework a little bit.
I think it's whether you're buying an appliance or a car or even groceries.
I mean people compare all the time and they need to figure out what works best for them.
But just because it's shiny and new doesn't necessarily mean it's the best fit for you.
I do want to; I think it's important to make a little bit of a distinction what you were talking about with NREPP, and correct me if I'm wrong.
But I do think the site NREPP is still accessible to see what's currently on there, but what SAMHSA is doing is changing the way in which any new programs get listed.
And so they've stopped the solicitation of the programs that get listed, but I do think you can still go to the site and see previous programs that were on there.
Is that correct?
Cimini: I believe you can.
There is a message on the website saying that there are no longer new programs being evaluated for the, for the NREPP site.
So one thing to be aware of though in this type of circumstance is that data does tend to get dated, and so as a result of that it's really important to look at the currency of the date and more importantly the fit for the programs listed on NREPP for your particular institution of higher education.

Lucey: Great, so good advice on that.
So let me move on to our second question.
I mentioned, you know, early on that, I mean, I'm an alum of University, but you and I have known each other for a long time, going back to early in my career working in New York State and then throughout my various roles in the federal government.
And during that time the university has gone through a significant number of changes in leadership especially at the president's level.
What do you think is the key to your school's prevention efforts withstanding or surviving if you will so much transition?
Cimini: Well, let me give a bit of background on my experiences at the University at Albany.
I started working here about 27 years ago, and between 1991 and actually last year I have been through 12 college presidents.
And that sounds very challenging and even alarming to many of my colleagues who are preventionists, but to me it has proved one thing and that is that the work in prevention of a college and university is really done by the people on the ground, the boots on the ground so to speak.
And so what tends to happen is that programs and services continue even through transitions.
In the early 2000's the Higher Education Center on Alcohol and Other Drug and Violence Prevention of the U.S.
Department of Education disseminated a model for comprehensive prevention programs.
And if we look at our programs at the University at Albany through these times of transition, we have been able to keep most of the elements of these prevention programs.
For example, we had an alcohol and drug prevention task force that stayed active through the presidential transitions.
We've engaged in social norms programming.
We've been very involved in engaging students in interventions.
We've continued to do research.
We've had a campus community coalition that has had national recognition.
We've engaged in alcohol-free alternatives for students.
We've engaged our parents in the work that we do.
And all of those things have continued despite presidential transitions.
And one of the most important things that has helped us through our changes in presidential leadership is to have an alcohol and drug prevention task force that consists of faculty, staff, students and community representatives because then whenever a new president came, we would be able to say we are doing model prevention programs on our campus.
We have this under control.
You don't need to worry about us.
Because new presidents have a lot to worry about and a lot to learn when they come to a new campus.
And to be able to continue our interventions and to give our new presidents the confidence that having our comprehensive program in place gives them really makes a difference.
If there were to be one downside, however, in terms of presidential transitions and one area where there might be a challenge around presidential transitions, that is in the area of implementing new policies.
An example that we have right now that we're dealing with is implementing a new policy for a tobacco-free campus.
We've been working on that since 2009, but with presidential transitions happening as quickly as they have on our campus, it wasn't until just now that we've had a president in place who is moving this forward and in fact at lightning speed.
So the one downside is in the area of policy when there's presidential transition, but the boots on the ground, the dedicated staff members who do prevention every day are really what makes prevention programs continue on college campuses with presidential support of course.

Lucey: Yeah, and so a couple of quick things I noted.
So, and you have a lot of elements that have withstood all of those transitions, but sometimes you really have to make it hard on them to remove the element.
I mean if you've shown success with it, you kind of make it hard for the president to take it away because they'll lose something if they do.
But I like what you just said about the tobacco-free initiative.
Sometimes with transitions, sometimes the planets just align and, you know, their interest and passion if you will aligns with yours, and you get to strike while the iron is hot, right?
Cimini: Yeah.

Lucey: And so you've been working on this initiative like you said for like the past eight or nine years kind of treading water, but now you're moving quickly because you've got a president who's in line with it.

Cimini: Yes, and having data to support the effectiveness of our interventions has helped us as has national recognition for three of our programs, the Middle Earth Peer Assistance Program, the Committee on University and Community Relations, and our STEPS Comprehensive Alcohol Screening and Brief Intervention Program.
The president was very, very surprised in fact that we've had such national recognition and that staff from Student Affairs have actually brought in over eight million dollars in grants to build and support initiatives.
That's typically done by academic faculty in many colleges and universities.
But it really has been something that's made a difference for us.
And it can be done by many, many campuses in partnership with faculty.
So you know, one doesn't have to be daunted by being in Student Affairs to really conduct and research and work towards national recognition.
Lucey: Great, so I'll move on to our third question.
Another thing I've always admired about you is you also are a staunch advocate for diversity, whether that is around race, ethnicity, gender, sexual orientation, disability issues; that's just to name a few.
As a field, how do you think we're doing with incorporating diversity into drug abuse prevention efforts on college campuses?
Cimini: Well, I would say that in terms of moving us forward in alcohol and other drug prevention we still need to do some work on building and enhancing diversity across all areas.
And this really is the case for many, many fields for a number of reasons.
First of all, individuals from diverse and marginalized backgrounds such as people of color, people with disabilities, people from the LBGT community and folks who represent other areas of diversity are not very present on our college campuses because to be honest they haven't had as many opportunities to go to college, obtain graduate degrees and get the highest level of degree, the doctorate or the M.D.
And so there are fewer individuals nationally that represent diversity in a variety of fields.
Secondly, colleges and universities while there are laws that help us support diversity, encourage diversity, make sure we keep in line with regulations around diversity, there's a lot more than that that has to occur.
HR departments in colleges and universities know what they need to do in terms of recruitment of folks with diverse backgrounds, but more than that has to happen.
There really needs to be a program-specific commitment to diversity.
What do I mean by that?
 What I mean by that is that we need to recruit individuals from diverse backgrounds to really match the changing face of our students in our colleges and universities.
And then once we recruit individuals from diverse backgrounds, we need to do what we can to support and retain them through things like promotions, professional development opportunities, helping them link with supportive colleagues on our campuses.
So there's a lot that we can do.
I'm pleased to see that in many of our parent organizations, our professional organizations such as NASPA and the American College Health Association, the membership has become more and more diverse and there are special interest groups that represent the diversity of our professionals.
But in terms of alcohol and drug prevention specifically, we can do more in terms of looking at the content of our professional conferences and our training programs and asking from the get go in the call for programs, How does you proposed program address diversity?
And really weaving it throughout from beginning to call for, to call to programs to the actual presentations that are delivered in conferences.

Lucey: Great, so I think that what I get out of that is that we are making strides.
I think that you said, you know, certainly within some of the membership organizations we have seen an increase in diversity, but just much like anything else, you know, we can do more and we can do better.
So I appreciate your insights around that issue of diversity.
I want to move on to our fourth question.
You've already mentioned the Middle Earth Peer Assistance Program.
One of your areas of responsibility is to oversee that initiative that's been nationally recognized for its student-led prevention efforts.
So what advice do you have for people who are just getting started in developing a peer educators group or just working with students in general?
Cimini: Well, I could talk for hours and hours about this, but I'm gonna condense my comments to perhaps what is most important.
I have always been so passionate about working with undergraduate students and mentoring undergraduate students within our Middle Earth Peer Assistance Program which has a hotline service, a peer education and peer wellness coaching program, as well as other types of services where we collaborate with folks on campus to do our work.
And one of the most interesting things, talk about data, that I want to mention right now is one of our graduate students who's defending her dissertation on Wednesday did a study on the effectiveness of engaging in peer education, not for the students that utilize peer education services but for the students who are trained as peer educators.
She was able to do a controlled study that really showed that training peer educators through a solid, through a solid training program with lots of supervision enhances their own health behaviors, their health self-advocacy, the confidence in engaging in health behaviors and their, their own health outcome.
So that's a great thing to see.
It's one of the first studies that was ever done in that area.
In terms of beginning programs in peer education, there are several areas that I would recommend colleagues focus on.
First of all, focus your program.
Define clearly what is the scope of what you want to train your students in.
Is it going to be on alcohol and other drugs?
Is it going to be on sexual violence prevention?
Is it going to be in another area or are there multiple areas that you're going to be covering?
And in all cases it would be very important to train your students on the warning signs for alcohol and other drug overdose as well as suicide risk because those things tend to go together, and to let the students know what places there are on campus to offer help for peers that they might be working with.
Second, staffing and resources are very important to take a look at.
It's important that you have enough time as a preventionist to lead an undergraduate prevention program, a peer education program because the students will require a lot from you.
You also need to make sure that you have essential things like space, financial support and support from colleagues and stakeholders.
The third thing to look at is to have a clear training protocol.
That may be through an academic course.
It may be through a volunteer training program.
No matter what the type of training is, it's important that it's supported by evidence and outcomes and that it's really driven by research on what works.
It's also very important that one does not do a one-shot training, but there needs to be ongoing supervision of the students because we did a study in 2006 through an NIAAA grant looking at training our undergraduate students in motivational interviewing, and what we learned is that we need to not only train students in the skills that they need to deliver as peer educators but also supervise them preferably weekly or even more often to make sure they keep up their skills because undergraduate students may tend to drift and their skills deteriorate a bit.
And that happens to all of us when we're not practicing new skills.
And then recruitment and marketing, those are very important not only to recruit and retain your peers but also to market services so that students on your college campus use them.
So social media is very important in those areas, faculty nominations, letting faculty and staff know about the services that your program offers, and also this is a great place to infuse diversity.
Reach out to diverse groups on your college campus.
We're very proud to see that our Middle Earth Program is more than 50% comprised of students of color, students from the LGBT community and students with disabilities and students from other marginalized backgrounds.
So our students who were formerly the majority are now no longer the majority.
So we're very, very diverse, and that has been the result of our focus on diversity and recruitment.
The next area to focus on is to look at evaluations.
Data, data, data, that's very, very important not only to demonstrate evidence that your peer program is working, because that's now many times  resources on college campuses are provided, but also to show when opportunities for local and national recognition come up that your program may be worthy of national recognition.
And that will as a result reap other benefits for the future of your peer education program.
Another important factor in terms of building evidence that your program is working is perhaps to create an organizational resume.
In the same way as we as individuals have resumes relating information about our job history, it's important to create a resume showing the history of your peer education program, how it works, a description of the program, its evidence of impact, listing some awards and listing, and links where there are examples of your, of our work.
So that is very important.
And lastly, liability.
This is hardly ever a topic of discussion when developing peer education programs.
There needs to be evidence of a formal relationship between you as the supervisor and your students, whether through an academic course relationship where students register for a course that you're delivering or documentation through a letter of appointment that your student and you are in a supervisory/student relationship.
Also in terms of liability, because the work we do does involve some risk.
Students may become suicidal.
They may become; they may experience overdoses of alcohol and other drugs.
They may need emergency assistance.
We need to let agencies on our campus such as our counseling center and health center know of our peer programs.
We need to link with agencies in the community and have an agreement that if any of the students that we're working with need assistance that there is a path to get that assistance.
So that's a long answer to a question on an area I'm very passionate about.

Lucey: Well, your passion certainly comes through on that, and the students there are certainly lucky to have you as their mentor on this very important issue.
So I'll transition now to our final question.
So for our listeners, whether they are new to this field or if they've been around a while like you and I have, what words of encouragement would you like to give them about working to prevent drug abuse among college students?
Cimini: Well, I'd like to give encouragement toward two areas.
First, be patient.
There are going to be very clear, very evident demands and expectations on those around us, particularly our university administration, our Vice-Presidents for Student Affairs, our colleagues, our community stakeholders to quote unquote fix alcohol and other drug and related issues right away.
These issues are causing problems for them as an institution or as community stakeholders and for the students themselves.
They are, they are causing many, many types of issues.
But in order to see notable change, in order to see positive outcomes, it takes time.
It took ten years for us to notice reductions in alcohol use and associated negative consequences among our students, but we kept going.
We fought the good fight.
And when people said, you know, your interventions aren't working.
Why don't you just give up?
 We just kept going.
So being persistent and being patient is very important.
And then the second piece of advice is love your data.
Our Vice-President for Student Affairs loves data.
He made tee-shirts for all of us one year saying in fact "I Love Data".
And so we wore those, and that really showed me the importance of measuring the effectiveness of the interventions and prevention strategies we deliver and also sharing these outcomes with key stakeholders on our campus and in the community.
That's really the only way that we can help our interventions move forward.
And also in support of the data we collect, there can never be enough of student testimonials and descriptions of experiences they've had that are consistent with the data that we provide.
Lucey: Well, I really do appreciate those words of encouragement.
They are completely in line with clear messaging.
Be patient and love your data.
That's a great place to end.
Dolores, it's always a pleasure to talk with you.
We really appreciate you spending some time with us on Prevention Profiles: Take Five.

Cimini: Thank you very much.
Lucey: And for all of our listeners, we hope you enjoyed the podcast and stay tuned for another episode in the future.
And for now take care and have a good day.