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The International Journal of the Addictions, 18(1), 11 1-124, 1983
Development of a Competency-Based Training Curriculum for Substance Abuse Counselors in Alaska
Bernard Segal, PhD
Center for Alcohol and Addiction Studies University of Alaska, Anchorage
Paul 2. Wasserman, MA
Janice Oglietti, MA
University of Alaska, Anchorage
Anchorage, Alaska 99504
Abstract
The development of a comprehensive competency-based substance abuse curriculum is reviewed and described. The curriculum, which is designed to help persons to further their understanding of alcohol and drug abuse, and/or to help strengthen counseling skills, can be adopted to meet a wide variety of delivery methods. The curriculum, which can be delivered at a university or within a treatment setting, offers a flexible and innovative way of providing substance abuse training to alcohol and drug workers and to those in health and health-related professions.
INTRODUCTION
The critical need to expand treatment and prevention programs in Alaska required that the Center for Alcohol and Addiction Studies (CAAS; the center) place a high priority on helping people to become qualified professional workers
111
Copyright 0 1983 by Marcel Dekker, Inc. 0020-773X/83/1801-0111$3.50/0
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1 I 2 SEGAL, WASSERMAN, AND OGLlETTl
in alcohol and drug treatment programs, In Alaska the need is especially pressing because of the particular nature of the state, which represents contrasting cultures attempting to “survive” in a vast area undergoing great social and economic fluctuation. More specifically, many alcohol programs are attempting to operate in isolated regions or communities. These programs are being con- ducted by people who are not only experiencing cultural conflict themselves, but who are not able, because of geographical and, at times, language and cultural factors, to keep abreast of developments and advances in treatment in the field of alcoholism. Contributing to this state of affairs is that much of the work going on in alcoholism (treatment, education, training, and research) is largely based on concepts and models applicable to the “lower 48” population. In most cases the blanket importation of traditional approaches is inapplicable to Alaska if such approaches are not altered to meet some of Alaska’s unique needs, particularly when applied to some of the Native regions of the state. What is needed is to begin to provide relevant training to those involved in direct delivery of services in order to upgrade knowledge about alcoholism and its treatment and prevention. A secondary function is that such knowledge can serve as a knowledge base which, when combined with knowledge of the social and cultural factors related to alcoholism and alcohol abuse, can facilitate an approach which is responsive to the divergent needs of Alaska.
Thus, in response to this need, the center has been working together with the State Office of Alcoholism and Drug Abuse to develop and implement a comprehensive “Program of Studies in Substance Abuse Counseling,” designed to provide a broad-based, yet highly flexible, curriculum, focusing on both achieving competencies and gaining practical knowledge.
The total program of study, which incorporates a competency-based format. is also designed to explore various aspects of addiction to alcohol and other drugs, and to examine the factors contributing to the cause, nature, treatment, and prevention of alcoholism and drug abuse. The total program thus constitutes a program of addiction studies, with special emphasis on substance abuse counseling.
The establishment of such a program of studies within a university setting not only ensures that the programs being offered would meet professional standards, but that the program would also be representative of a niultidiscipli- nary approach. Additionally, the comprehensiveness of the program would ;also serve to provide academic course work and training in alcoholism and substance abuse for related allied health and human service providers, working in either the public or private sector. The program would also allow students enrolled in specific university programs, such as Nursing, Counseling, Social Work, etc., to pursue a specialization or minor in addiction studies or in substance abuse counseling.
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COMPETENCY-BASED TRAINING CURRICULUM 113
The chief feature of the curriculum, however, is that it was also developed to meet State Substance Abuse Counselor Certification Standards, and to help prepare potential applicants for meeting State Certification requirements. In addition, the curriculum implementation design employs a set of innovative outreach modalities, in addition to the more traditional campus-based instruc- tion. These modalities were designed especially for the purpose of making the training curriculum available and accessible to students and to those employed in substance abuse programs in Alaska’s diverse and remote villages, many of which do not have immediate access to educational and/or training programs provided by the university.
What is also unique about this curriculum is that its format and competency- based approach can be adopted and/or applied to other countries which also have geographic and/or ethnic diversity. The curriculum may also be particularly relevant to developing nations in which alcoholism and drug abuse may be an emerging problem.
The remainder of this paper presents a brief description of the historical background and the developmental processes involved in the derivation of the curriculum, followed by an overview of the curriculum and a discussion of its content and delivery modalities.
H ISTOR ICAL OV E RV I EW
In order to understand the problems and needs associated with substance abuse manpower development and training in Alaska, it is helpful to be somewhat familiar with the often unique and special nature of the state, its geography, people, and cultures, and with the nature of Alaska’s alcoholism and other drug problems and impacts. Perhaps the single most important characteristic, at least from a logistical standpoint, is Alaska’s immense size. The 586,400 square miles which comprise the state of Alaska are equivalent to one-fifth the size of the entire continental United States. The distance between its eastern and western borders is approximately 2,300 miles, it measures about 1,200 miles from north to south, it spans four separate time zones, and it includes over 33,000 miles of coastline.
Temperatures in Alaska may range from 100°F to -80°F in the interior, annual rainfall may vary from 200 inches in the southeast to almost none in the desertlike tundra of the Arctic Slope; annual snowfalls in the mountains of southcentral Alaska have been recorded in excess of 75 feet, and much of the state is exposed to prolonged periods of darkness during the winter months. Alaska’s population, according to a 1977 census estimate, is 41 1,211, of which approximately 17%, or nearly 70,000 people, are Alaskan Natives, principally Eskimo, Aleut, Athabascan, and Tlingit-Haida Indians. This number (total
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114 SEGAL, WASSERMAN, AND OGLIISTTI
population) represents an increase of more than 100,000 people since the official 1970 census. The median age for Alaska is 22.9 years, compared to 28.1 years for the United States as a whole.
Alaska’s population density average is .72 persons per square mile, com- pared to a national average of 60 persons per square mile. Alaska’s population density may also be compared to Washington, D.C.’s estimate of 13,278 persons per square mile. It may be noted that if Washington. D.C., shared Alaska’s population density, there would be no more than about 44 people living in the nation’s capital instead of over 800,000.
The challenges of living in a state of such immense size, diversity, and extremes are paralleled by the imperatives for dealing with a host of alcohol- related problems of comparably extreme proportions.
Per capita sales of alcoholic beverages in Alaska increased by 36% between 1960 and 1970, and by an additional 26% between 1970 and 1976. By compari- son, per capita sales for the nation as a whole increased by 30% between 1960 and 1970 and remained stable between 1970 and 1976. Similarly, per capita consumption of beverage alcohol in Alaska rose from 2.52 gallons per capita in 1958 to 4.74 gallons per capita in 1976, which represents an increase of 88%. Per capita consumption for the United States as a whole rose 35%, from 1.98 gallons per capita in 1958 to 2.61 gallons per capita in 1976. Thus Alaska’s level of per capita consumption is nearly twice the national average.
It is estimated that as much as 12.5% of the adult population in Alaska are problem drinkers, compared to 7% nationally. The rate of death for alcoholism in Alaska as a whole is four times greater than the national rate, and the rate for Alaskan Natives is over 15 times greater than the national rate.
Finally, the related social, health, and economic cost attributable to alcohol- ism and alcohol abuse in Alaska is currently estimated to be over $50 million annually.
Drug use and abuse in Alaska does not approach the same level of use, nor does it have the same social, health, and economic impact as does alcohol; but drug use and its health and social impacts are on the rise, particularly among youth. Since alcohol abuse and alcoholism is the state’s primary health and social problem, there is a primary need for trained and qualified counselors to deal with its use and abuse. CAAS’s emphasis, therefore-in accordance with the State Certification Standards (which call for a single category of “Substance Abuse Counselor”)-was to initiate a program of study which focused on addic- tions counseling, with substantial emphasis being given to understanding alcohol- ism and its treatment.
In summary, Alaska’s geography, climate, cultural diversity, and population growth and distribution combined with its unusually high levels of alcohol consumption, problem drinkers, and alcohol-related impacts, and emerging drug use and abuse, serve to create a complex set of needs and challenges to
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COMPETENCY-BASED TRAINING CURRICULUM 115
which the human service system, and particularly alcohol and drug treatment programs, must respond creatively and effectively. What follows is a description of our response to the training/education/manpower development needs as they exist in Alaska, developed within the University of Alaska, Anchorage, and in cooperation with the Anchorage Community College.
CURRICULUM DESIGN: OBJECTIVES AND PRIORITIES
The curriculum was designed to meet the following primary objectives:
1. Prepare currently employed alcoholism and drug abuse program personnel to meet the Standards for State Certification
2. Provide substance abuse education and training of high academic quality for those persons preparing to enter the field (undergraduate students)
3. Provide allied human service program personnel with continuing education in substance abuse studies
It was also designed to meet the following secondary objectives:
1.
2 . 3.
Create a standardized course of study which could be delivered throughout the state Maximize accessibility of the program to rural and Native Alaskans Establish substance abuse studies as an accepted part of the higher educa- tion system
It became clear quite early in the design process that a curriculum would be needed which:
1. Was competency based to coincide with the standards for State Certification 2. Could be made part of existing degree programs at the associate of arts and
baccalaureate levels 3. Would include courses of interest to a wide range of health and human
service workers 4. Was part of the statewide university system 5. Was relevant to rural and Native audiences and could be offered to residents
living far from a community college or university campus 6 . Was multidisciplinary in nature and drew upon existing academic resources
In order to accomplish the objectives and to meet the needs outlined above, the center began by analyzing:
1. Formal substance abuse training and education programs already developed elsewhere in the country
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SEGAL, WASSERMAN, AND OGLIETTI 116
2.
3.
4.
5. 6 .
7 .
Certification standards for substance abuse counselors developed in other states The Littlejohn Report and the training packages developed by the National Center for Alcohol Education and the National Drug Abuse Center Manpower development and training needs assessments conducted by Alaska’s State Office of Alcoholism and Drug Abuse The Alaska State Counselor Certification Standards The input provided by a majority of the state’s substance abuse program directors regarding the functions of program staff, the unique needs of Native counselors, and the current resources for staff development or training The input provided by a cross-section of University of Alaska faculty regard- ing the nature and basic dimensions of a comprehensive professional course of study
The following curriculum program represents the center’s response to its objectives and to the results of the analytical review outlined above.
CURRICULUM CONTENT
The “Substance Abuse Counselor Training Program,” or “Addictions Curriculum,” consists of two specific programs. The first, primarily designed to meet the needs of those desiring to enter the field and/or those currently working in the field, leads to an Associate of Arts degree with a specialization in Substance Abuse Counseling. (These courses are described as basic courses.) The second area represents a specialized core of courses (described as advaizced courses) designed to lead to a minor in Addiction Studies for students enrolled in bachelor’s degree programs such as Nursing, Psychology, Counseling, Social Work, etc. The completion of this minor area would help qualify students to work in drug or alcohol treatment programs and/or to be able to deal with problems of substance abuse encountered in their health or health-related profession.
Basic and Advanced Courses
The basic courses specific to the Associate of Arts degree are described below. This basic program, designed for undergraduate students, can be delivered at community colleges or as part of lower-division course offerings at a univer- sity or college. (No course numbers are listed since they are unique to the University of Alaska’s numbering system.)
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COMPETENCY-BASED TRAINING CURRICULUM 117
Sociology Nursing
Psychology Justice Biology Psychology Sociology Sociology
Total
3 cr. 2 cr.
3 cr. 2 cr. 2 cr. 3 cr. 3 cr.
20 cr. &
Substance Abuse as a Contemporary Problem General Emergency Care (An American Red Cross
Advanced First Aid Certificate or completion of Emergency Medical Training will be accepted as a satisfactory challenge to and in lieu of t h s two- credit course, General Emergency Care)
Substance Abuse Counseling I Ethics and Law Physiology of Drug and Alcohol Abuse Substance Abuse Counseling I1 Prevention and Public Education in Substance Abuse Case Management
The advanced courses comprising the program of Addictions Studies as part of a bachelor’s degree program are as follows:
Anthropology Anthropology Anthropology Education Justice Nursing Psychology Psychology Psychology Psychology Sociology Psychology Psychology Bus. Admin. Bus. Admin.
Total
2 cr. 3 cr. 3 cr. 1 cr. 3 cr. 2 cr. 3 cr. 3 cr. 2 cr. 1 cr. 3 cr. 3 cr. 3 cr. 3 cr. 3 cr.
38 cr.
Drinking-Related Stress in Village Alaska Culture and Personality Contemporary Issues among Native Alaskans “Here’s Looking at You” Curriculum Alcohol Concerns in the Alaska Legal Spectrum Nutrition Statistics for the Social System Techniques of Psychotherapy Special Topics in Substance Abuse Counseling Psychopharmacology of Prescription Drugs Advanced Project or Research in Alcoholism Rehabilitation Crisis Intervention Management Principles and Practices Personnel Management
The two sets of courses listed above serve as the basis for five specific program options. These options are described below.
Program Options
Certificate of Completion in Addiction Studies
A Certificate of Completion in Addiction Studies may be conferred by the institution providing the course work after successful completion of the specific
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118 SEGAL, WASSERMAN, AND OGLIETTI
(basic; 20 credit hours) addiction courses comprising the specialization in Substance Abuse. The certificate can be earned by enrolling as a nondegree or special student, taking only the specialized course of study; i.e., just taking the designated basic courses.
Associate of Arts Degree with Specialization in Substance Abuse Counseling
This program of study includes all course work required for the Certificate of Completion plus completion of additional credit hours for achievement of the AA degree as required by the institution offering the degree. Course work in such areas as biology, psychology, and sociology, as well as practicum experience, will be required, together with elective credits. Successful com- pletion of this course of study will yield an Associate of Arts degree with a specialization in Substance Abuse Counseling.
Adiianced Certificate of Completion in Addiction Studies
The Advanced Certificate of Completion in Addiction Studies may be conferred by the institution providing the courses after successful completion of the 20-credit-hour (basic) curriculum plus 12 additional credit hours selected from among advanced coursework. The Advanced Certificate of Completion can be earned in either one of two ways:
1 .
2 .
Enrollment as a nondegree student, completing the specialized course of study constituting the requirements for the Advanced Certificate, or Enrollment as a student seeking a Bachelor of Social Work degree or other baccalaureate degree.
Bachelor of Social Work Degree with Substance Abuse Counseling Major
This program, leading to a full baccalaureate degree in social work, includes all credits in the advanced curriculum, as well as full training in the theory and practice of social agency objectives and techniques, together with general uni- versity distribution and social work degree requirements. Students in this program, advised by the Department of Social Work of the university, will emphasize substance abuse counseling as the specialty area in their program of study.
While many of the courses in this curriculum are deliverable off-campus, students must fulfill all university and department rules and regulations as described in the university’s catalog, including admission, minimum grade point average, and minimum residency. Possible baccalaureate degree programs at the other two major university campuses in Alaska (Fairbanks and Juneau) are
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COMPETENCY-BASED TRAINING CURRICULUM 119
presently being considered and are likely to be adopted as specializations within a psychology major for either a Bachelor of Arts or Bachelor of Science degree.
Continuing-Education or Major Elective Courses
In addition to contributing to a major area of study, some of the advanced addictions courses are also designed as continuing-education courses to assist substance abuse counseling practitioners and supervisors, and other profes- sionals, to maintain competencies, to upgrade skills, and to expand their educa- tion. The advanced courses are also designed to provide major electives for baccalaureate degree candidates. Courses in this curriculum are deliverable statewide through the same modes as the previously outlined curricula courses.
PROGRAM DELIVERY METHODS
Competency-Based Instruction
The center’s basic, advanced, and continuing-education curricula reflect what we believe is an innovative program of study combining basic knowledge with competency-based training and skill development. Central to the innova- tive approach is a “competencies checklist,” developed by the center to assess competencies achieved in each course. This feature, upon which nontraditional delivery depends, not only outlines course content and skills to be mastered, but also provides a unique way to evaluate course effectiveness and student performance. Figure 1 presents an illustration of a competencies-based check- list. What follows is a description of potential methods of providing coursework.
On-campus: All of the courses in the center’s curricula can be offered in a traditional campus setting either as semester-long courses or in concen- trated study fashion, drawing upon the facilities and expertise of the established institution. On-site: Courses in the curriculum can be taught on-site in institutions and agencies which provide substance abuse treatment or prevention services. Each course in the curriculum has been divided into one-half- credit units, and each half-credit unit can be offered over 8 hours of instruction. It is this feature of the curriculum which makes on-site delivery practicable. Concentrated Instruction: Concentrated instruction, on-campus or on-site, may be offered in either of two ways: a. Operating within the framework of the University of Alaska’s estab-
lished policy, 1 full credit can be earned within a 3-day period (but only 1 credit may be earned within 1 week). A series of 1-day, one-half-credit units can be offered in combination over any period of time sufficient to satisfy the requirements of any
b.
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ADVANCED CURRICULUM
COMPETENCIES CHEC - Competencies for Rehabil i tat ion
I. Knowledge o f Rehabil i tat ion
o f Substance Abusers -
1. Understand the dependency
2. Interpersonal relationships
3. Problems leading t o relapse 4. Client resistance and re-
involving cl ient 5. Significant-other involve-
ment in relapsing 6 . Role o f interpersonal
relationships and self-image 7. Family impact o f cl ient
change and on cl ient change 8. A l -Anon and Ala-Teen 9 Daily living skills
able t o client
struggle
in mot ivat ion
10. Communi ty services avail-
11. Employment and self-esteem 12. Vocational guidance and
counseling 13. Employment problems of
the substance abuser 14. Impact o f cl ient values
and attributes o n long- term sobriety
15. Societal view of the non- drinker
16. Long-term and ongoing physical rehabilitation needs
II. Rehabilitation Skills 1. Teaches dai ly l iv ing skills 2. Motivates clients fo l lowing
relapses 3. Maintains perspective while
working w i t h relapsing cl ient
dependency needs while counseling
5. Utilizes knowledge of family interactions while counseling
6. Utilizes communi ty resources for rehabilitation
7. Utilizes knowledge o f physical rehabilitation needs in goal setting
4. Utilizes knowledge of
ourse Instructor o r Certifier
-IST
Date ield Supervisor
Certifier
Fig. 1. Example of a competencies-based checklist.
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COMPETENCY-BASED TRAINING CURRICULUM 121
course in the curriculum, provided no more than 1 credit is earned in any 1 week.
Correspondence/SeEfStudy : Credit in designated courses can be earned to a maximum of 12 credits through correspondence. Designated faculty, utilizing the CAAS-approved curricula (course) materials, including video- cassettes, satellite telephone conferences, and other innovative educational materials and techniques, will review lessons completed by candidates at sites remote from campuses, will monitor the candidate’s progress on a periodic basis, and will grade the final evaluative instrument for each half- credit unit. Course Challenge: Students may draw upon their previous experience to demonstrate competencies required in the curriculum by utilizing the university’s established procedures for challenging courses, up to a total of 8 credits. In the substance abuse curriculum both full and half-credit sections of courses may be challenged. Challenge involves demonstration of competencies using the same evaluation instrument as is used for the course or section when offered on campus, on-site, as practicum, or as a correspondence course. The evaluation instrument may be a written exam or an oral exam, or may involve direct observation of the student’s com- petency in an actual work environment. In all cases, such evaluations must be administered by designated faculty or other personnel.
6. Practicum: Practicum credit is similar to correspondence credit, wherein the student completes lessons, reading assignments, examinations, and any other course requirements (by mail, and/or at the direction of faculty- designated individuals on-site). This is possible because required competen- cies have been identified for each half-credit unit in the curriculum. Utilizing a competencies checklist developed and provided by the center, the candidate’s supervisor may certify the achievement of required com- petencies by the candidate through observation and supervision of the candidate’s job performance and progress on the job, while at the same time, the candidate will utilize center-developed course materials in con- junction with the supervised work experience. Time spent on the job developing the competencies to a point where they are ready for demon- stration may be counted as contact time (contact hours) for the course, provided the time is properly recorded in the format which is provided by the center. As part of each one-half credit earned through practicum, a designated faculty adviser will meet with the candidate and supervisor prior to the undertaking of the practicum credit to explain the competen- cies required and the evaluative criteria to be applied for each. The desig- nated faculty member will also meet with the candidate and supervisor prior to completion o f the course to verify progress and provide any further guidance desired. In addition to meeting the formal practicum requirements,
4.
5.
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122 SEGAL, WASSERMAN, AND OGLIETTI
students, working with their adviser, may also consider undertaking specific independent research projects to broaden their skills. Or working together with the adviser, students can develop a project relevant to helping improve services at their respective agencies.
Evaluation of the Training Program
Part of any educational/training program should be an evaluation of the effectiveness of the program. A unique aspect of this program is that it has an inherent evolution process due to its emphasis on a competency-based approach. Thus, in order to evaluate each student’s performance, the individual instructor and/or work supervisor can complete a competency-based checklist (see Fig. 1) which evaluates the extent to which competencies have been achieved. The competency certification form, shown in Fig. 2 , can be applied to each of the specific competencies stressed in specific courses. Students’ programs, as well as the instructor’s ability to facilitate competency-based learning, can be assessed by means of the competency checklist. Since achievement of skills is the chief emphasis of the addictions curriculum, the competency-based evaluation is considered to be our primary evaluation approach. Complimentary approaches, to specifically assess knowledge gained, can be achieved by means of pre-post evaluations, standard examination procedures during the delivery of the course, and by follow-up of how many students achieve State Certification and remain employed after varying periods of time. As can be observed, the evaluation process is an ongoing one, but the key emphasis on evaluation rests with assessing competencies subsequent to the completion of each course or course segment.
In summary, it is believed that we have developed a practical educational/ training approach responsive to the needs of the state. Consistent with this approach, the State Office of Alcoholism and Drug Abuse has taken initial steps to implement a certification procedure for alcohol and drug counselors. Since certification implies the recognition of an individual’s conformance to a set of standards which, in part, set forth educational requirements, the training program will help program recipients meet such requirements. Thus, the training to be undertaken will not be an independent effort but will be “tied into” the state training plan, and coordinated with steps taken by the State Office to implement certification standards for alcohol counselors. In this context, the major way in which villages and other remote communities can benefit from this program is that their local counselors can participate in regional training efforts and/or can benefit from training in their own communities to work toward achieving certification. Communities can help identify local resources to teach courses and/or supervise students. The center, by providing curriculum material, can help the course to be developed and implemented. In essence, each
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,
v) C m v) -I
0 P m
C v) rn c) 0 C z v) m K z D 0 0
m
z P m
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G v)
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Has demonstrated the comp. 5 level !z
in question at an above average level
I Has demonstrated the comp. at or near highest
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17-4 SEGAL, WASSERMAN, AND OGLIETTI
corninunity can begin t o review what its needs are, and CAAS can provide the assistance to help initiate coursework.
ACKNOWLEDGMENTS
This project was funded in part by Grant Number 06-9460 from the Alaska State Office of Alcoholism and Drug Abuse. The assistance of Margaret R. Wolfe and Stephen W. Haycox in formulating this curriculum is greatly appreciated.
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