Intervention Summary

STEPS Comprehensive Alcohol Screening and Brief Intervention Program

The STEPS Comprehensive Alcohol Screening and Brief Intervention Program, developed for college students, aims to reduce alcohol use frequency and quantity as well as the negative consequences associated with alcohol use. Based on the Brief Alcohol Screening and Intervention for College Students (BASICS) model, reviewed by NREPP separately, the three versions of STEPS are designed to meet the distinct and complex needs of three groups of college students engaging in high-risk drinking: first-year students (Project First STEPS), students seeking primary health and mental health care on campus (Project Healthy STEPS), and student athletes (Project Winning STEPS). The versions reviewed for this summary were Project First STEPS and Project Healthy STEPS.

All versions of STEPS begin with screening students in the target population using the Alcohol Use Disorders Identification Test (AUDIT). First-year students complete an online screening during the first month of college, and student athletes complete an online screening after a team meeting held in a campus computer lab. Students seeking primary health and mental health care on campus complete a "paper-and-pencil" screening as part of the intake process.

Students in these groups with an AUDIT score suggesting high-risk alcohol use are invited to complete baseline questionnaires and participate in an in-person, one-on-one brief intervention. The baseline questionnaires identify risk behaviors and beliefs involving alcohol consumption, including the perceived drinking behavior of peers. After completing the questionnaires, each student receives a personalized feedback profile that details his or her own drinking patterns and beliefs about alcohol use contrasted with the drinking norms of college students and facts about the negative consequences of drinking. The profile also reviews the protective strategies the student is already using to reduce heavy drinking and negative consequences and suggests the use of additional strategies. Personalized feedback profiles are tailored to the needs of each target population. For example, student athletes receive personalized feedback profiles that address alcohol use and athletic performance.

Students completing the baseline questionnaires then participate in a brief intervention with a trained psychologist or other service provider at the university counseling center. Like the feedback profiles, sessions are tailored to the target population. During the intervention session, the service provider delivers the information contained in the feedback profile using a motivational interviewing framework. Students complete follow-up questionnaires that mirror the baseline questionnaires 3 and 6 months after the brief intervention to assess changes in behavior and perceptions and reinforce the information provided during the session. Students who show signs of alcohol dependence during the intervention are referred to community-based agencies specializing in the treatment of alcohol and drug dependence.

Descriptive Information

Areas of Interest	Substance use disorder prevention
Outcomes	1: Use of protective strategies when drinking 2: Alcohol use 3: Negative consequences of alcohol use 4: Perceptions of other students' alcohol use
Outcome Categories	Alcohol
Ages	18-25 (Young adult)
Genders	Male Female
Races/Ethnicities	American Indian or Alaska Native Asian Black or African American Hispanic or Latino Native Hawaiian or other Pacific Islander White Race/ethnicity unspecified
Settings	School
Geographic Locations	Urban
Implementation History	More than 16,000 students have been screened for risky alcohol use within the STEPS program since its inception at the University at Albany, State University of New York. Of these students, about one third met criteria to receive a brief intervention, and outcome data were collected for students completing the brief intervention.
NIH Funding/CER Studies	Partially/fully funded by National Institutes of Health: No Evaluated in comparative effectiveness research studies: Yes
Adaptations	No population- or culture-specific adaptations of the intervention were identified by the developer.
Adverse Effects	No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories	Selective Indicated

Quality of Research

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 1

Cimini, M. D. The STEPS Comprehensive Screening and Brief Intervention Program: Program narrative and studies. Albany: University at Albany, State University of New York.

Study 2

Cimini, M. D. The STEPS Comprehensive Screening and Brief Intervention Program: Program narrative and studies. Albany: University at Albany, State University of New York.

Supplementary Materials

Instructions for Completion and Scoring of the STEPS Program Fidelity Checklist

Intervention Fidelity Checklist

Intervention Fidelity: Summary of Relevant Materials and Implementation Systems

Martens, M. P., Ferrier, A. G., Sheehy, M. J., Corbett, K., Anderson, D. A., & Simmons A. Development of the Protective Behavioral Strategies Survey. Journal of Studies on Alcohol, 66(5), 698-705.

The STEPS Comprehensive Screening and Brief Intervention Program: Summary of Assessment Measures

Outcomes

Outcome 1: Use of protective strategies when drinking
Description of Measures	Use of protective strategies when drinking was measured using the Protective Behavioral Strategies Survey (PBSS), a 20-item questionnaire. The PBSS assesses protective alcohol use behavior across three subscales: limiting consumption, manner of drinking, and harm reduction. For each protective strategy (e.g., "use a designated driver," "avoid drinking games"), the respondent indicates the frequency of use using a 5-point scale ranging from 1 (never) to 5 (always).
Key Findings	In one study, first-year college students were randomly assigned to receive either Project First STEPS or a Web-based personalized drinking feedback intervention (PFI) derived from BASICS. From baseline to 6-month follow-up, use of protective strategies increased in the Project First STEPS group and decreased in the PFI group (p < .001). In a second study, Project Healthy STEPS was compared with the group-based Alcohol Skills Training Program (ASTP). College students presenting for primary health or mental health care received Project Healthy STEPS, while those who were judicially mandated due to a violation of campus alcohol policies were randomly assigned to receive either Project Healthy STEPS or ASTP. From baseline to 6-month follow-up, use of protective strategies increased among students seeking primary health or mental health care who received Project Healthy STEPS and decreased among mandated students receiving ASTP (p < .001). Among mandated students, use of protective strategies increased in the Project Healthy STEPS group and decreased in the ASTP group, but the differences were not significant. An analysis was conducted that examined the use of protective strategies among first-year students, comparing those from the second study who received Project Healthy STEPS with those from the first study who received the Web-based PFI. From baseline to 6-month follow-up, use of protective strategies increased in the Project Healthy STEPS group and decreased in the PFI group (p < .001).
Studies Measuring Outcome	Study 1, Study 2
Study Designs	Experimental, Quasi-experimental
Quality of Research Rating	2.6 (0.0-4.0 scale)

Outcome 2: Alcohol use
Description of Measures	Alcohol use was measured using the Daily Drinking Questionnaire (DDQ). Using the DDQ, respondents describe their past-month drinking, indicating the number of drinks they typically consumed on each day of the week; the number of days they consumed alcohol; and, as a measure of peak drinking, the greatest number of drinks they had on any one occasion. As a measure of heavy drinking, respondents also indicate how many times in the past 2 weeks they had 5 or more drinks (men) or 4 or more drinks (women) in one sitting. Responses were used to calculate average drinks per week and maximum blood alcohol concentration (BAC).
Key Findings	In a study comparing Project Healthy STEPS with the group-based Alcohol Skills Training Program (ASTP), college students presenting for primary health or mental health care received Project Healthy STEPS, while those who were judicially mandated due to a violation of campus alcohol policies were randomly assigned to receive either Project Healthy STEPS or ASTP. From baseline to 6-month follow-up, the average drinks per week (p < .001), peak drinking in the past 30 days (p < .001), episodes of heavy drinking in the past 2 weeks (p = .019), and peak BAC in the past 30 days (p < .001) decreased among students seeking primary health or mental health care who received Project Healthy STEPS and increased among mandated students receiving ASTP. Among mandated students, the average drinks per week (p = .005) and peak BAC in the past 30 days (p = .05) decreased in the Project Healthy STEPS group and increased in the ASTP group from baseline to 6-month follow-up.
Studies Measuring Outcome	Study 2
Study Designs	Quasi-experimental
Quality of Research Rating	2.7 (0.0-4.0 scale)

Outcome 3: Negative consequences of alcohol use
Description of Measures	Negative consequences of alcohol use were measured using the Rutgers Alcohol Problem Index (RAPI). The RAPI is a 23-item questionnaire assessing the frequency of specific alcohol-related social, behavioral, and health problems among adolescents and young adults. Using a scale ranging from 0 (never) to 4 (more than 10 times), respondents indicate the number of times in the past 6 months they experienced each situation (e.g., "caused shame or embarrassment to someone," "neglected responsibilities") while drinking alcohol or because of their alcohol use.
Key Findings	In a study comparing Project Healthy STEPS with the group-based Alcohol Skills Training Program (ASTP), college students presenting for primary health or mental health care received Project Healthy STEPS, while those who were judicially mandated due to a violation of campus alcohol policies were randomly assigned to receive either Project Healthy STEPS or ASTP. Compared with mandated students receiving ASTP, who had an increase in negative consequences from baseline to 6-month follow-up, students seeking primary health or mental health care (p = .033) and mandated students (p = .001) who received Project Healthy STEPS had decreases in negative consequences during this time period.
Studies Measuring Outcome	Study 2
Study Designs	Quasi-experimental
Quality of Research Rating	2.5 (0.0-4.0 scale)

Outcome 4: Perceptions of other students' alcohol use
Description of Measures	Perceptions of other students' alcohol use were measured using the Drinking Norms Rating Form (DNRF). Using the DNRF, respondents estimate the past-month drinking of a typical student at their school, indicating the number of drinks typically consumed on each day of the week; the number of days on which alcohol is consumed; and, as a measure of peak drinking, the greatest number of drinks consumed on any one occasion. As a measure of perceived heavy drinking, respondents also indicate how many times in the past 2 weeks a typical student had 5 or more drinks (men) or 4 or more drinks (women) in one sitting. Responses were used to calculate perceived average drinks per week.
Key Findings	In a study comparing Project Healthy STEPS with the group-based Alcohol Skills Training Program (ASTP), college students presenting for primary health or mental health care received Project Healthy STEPS, while those who were judicially mandated due to a violation of campus alcohol policies were randomly assigned to receive either Project Healthy STEPS or ASTP. Among mandated students, the estimate of others' drinks per week decreased in the Project Healthy STEPS group and increased in the ASTP group from baseline to 6-month follow-up (p = .005).
Studies Measuring Outcome	Study 2
Study Designs	Quasi-experimental
Quality of Research Rating	2.5 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study	Age	Gender	Race/Ethnicity
Study 1	18-25 (Young adult)	67.2% Female 32.8% Male	84% White 9.6% Hispanic or Latino 2.4% Black or African American 2.4% Race/ethnicity unspecified 1.6% Asian
Study 2	18-25 (Young adult)	52% Male 47.8% Female	86.4% White 8.9% Hispanic or Latino 5.3% Race/ethnicity unspecified 5.1% Asian 4.1% Black or African American 0.9% American Indian or Alaska Native 0.2% Native Hawaiian or other Pacific Islander

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

Reliability of measures
Validity of measures
Intervention fidelity
Missing data and attrition
Potential confounding variables
Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome	Reliability of Measures	Validity of Measures	Fidelity	Missing Data/Attrition	Confounding Variables	Data Analysis	Overall Rating
1: Use of protective strategies when drinking	3.3	4.0	2.4	1.8	2.0	2.3	2.6
2: Alcohol use	3.3	3.3	2.5	1.5	2.7	2.7	2.7
3: Negative consequences of alcohol use	2.7	3.0	2.5	1.5	2.7	2.7	2.5
4: Perceptions of other students' alcohol use	2.7	3.0	2.5	1.5	2.7	2.7	2.5

Study Strengths

The measurement instruments used in the studies demonstrate robust psychometric properties. The intervention is based on BASICS, the characteristics of which are well documented. Mechanisms were put in place to support and document fidelity. Appropriate methods to handle missing data were put in place. The use of random assignment in the design of one study helped reduce potential confounding factors. The statistical techniques used in both studies were appropriate to the study questions they were intended to answer.

Study Weaknesses

Attrition was moderate in both studies. In one study, design features that might have helped control for potential confounds were compromised to some extent by the way in which the study was actually conducted.

Readiness for Dissemination

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

Cimini, M. D. Module 1. The STEPS program: Integrating targeted screening and brief intervention strategies into a comprehensive alcohol abuse prevention and behavioral health program on a college campus [PowerPoint]. Albany: University at Albany, State University of New York.

Cimini, M. D. Module 2. Meet them where they are: Reaching at-risk target populations with the STEPS program [PowerPoint]. Albany: University at Albany, State University of New York.

Cimini, M. D. Module 3. Engaging students in brief interventions [PowerPoint]. Albany: University at Albany, State University of New York.

Cimini, M. D. Module 4. Sustaining the STEPS Comprehensive Alcohol Screening and Brief Intervention Program on your campus [PowerPoint]. Albany: University at Albany, State University of New York.

Diaz-Myers, A. X. Engaging college students in brief alcohol interventions: The practical application of BASICS within the STEPS model program. Albany: University at Albany, State University of New York.

University at Albany, State University of New York. STEPS program referral flow chart for interventionists. Albany: Author.

University at Albany, State University of New York. STEPS program referral flow chart for reception staff. Albany: Author.

University at Albany, State University of New York. The STEPS Comprehensive Alcohol Screening and Brief Intervention Program: Program narrative and studies. Albany: Author.

University at Albany, State University of New York. The STEPS Comprehensive Alcohol Screening and Brief Intervention Program: Protocol and data management manual. Albany: Author.

University at Albany, State University of New York. The STEPS Comprehensive Alcohol Screening and Brief Intervention Program: Training handout packet. Albany: Author.

Other materials:

Informed Consent and Limited Release of Information Agreement
Instructions for Completion and Scoring of the STEPS Program Fidelity Checklist
Intervention Fidelity Checklist
Program brochure
Sample Brief Intervention Session Record Form
Sample Personalized Feedback Forms
Sample Release of Information Form
Sample Service Record Form
Sample STEPS Program Student Screening Form
STEPS Program Follow-Up Locator Form
Student Evaluation Form
Training Evaluation Form

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

Availability of implementation materials
Availability of training and support resources
Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation Materials	Training and Support Resources	Quality Assurance Procedures	Overall Rating
3.6	3.5	3.3	3.5

Dissemination Strengths

The implementation materials are well organized, detailed, easy to follow, and developmentally appropriate for the intended audience. The implementation checklist provides a framework for those implementing the program. The training content is appropriate for higher education settings, and the training materials address issues unique to screening and brief intervention. Technical assistance is available to new implementers before and after training. Evaluation forms are well aligned with the implementation materials. A fidelity checklist is available to help monitor implementation quality and the degree to which the program is delivered as intended. Data management resources and support are available.

Dissemination Weaknesses

Limited guidance is provided on use of the implementation checklist. The fidelity checklist addresses the provision of key elements of the program but does not address fidelity to motivational interviewing, which provides the framework for the one-on-one brief intervention session.

Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description	Cost	Required by Developer
Implementation binder, including PowerPoint slides, fidelity checklist, forms, flowcharts, and protocol and data management manual	Free	Yes
Brochure for students	Free	No
Screening tools to assess student alcohol use	Free	Yes
Support for setup of computerized baseline and follow-up assessments (through SurveyMonkey or similar platform)	$200	Yes
Setup of computerized personalized feedback profile generation system	$1,500-2,000, depending on the types and number of survey instruments to be used	Yes
2-day, on-site training, including technical assistance and consultation immediately before and after training	$2,000 for up to 50 participants (includes travel expenses for 2 trainers)	Yes
Technical assistance and consultation by phone and email before and after training	Free	No

Replications

No replications were identified by the developer.