TPC Journal-Vol 11-Issue-3 - FULL ISSUE

The Professional Counselor | Volume 11, Issue 3 357 with the risks and benefits of study participation. Although this curriculum was approved for all ninth graders at the school, parents were given the option to opt their child out of the survey portion of this lesson. The study survey was given prior to their first lesson, then repeated following their ninth lesson. None of the students or families opted out of the survey portion of the MCARR program. Measure The survey we constructed included non-identifying demographic items, 20 Likert-type scale items, and two open-ended questions. The 20 Likert-type scale items included items from the following subscales: Substance Use Days, CRAFFT Items, Readiness to Change, and Attitudes Regarding Riskiness of Substance Use. The following sources of material informed the development of our MCARR survey: the Youth Risk Behavior Surveillance System (Kann et al., 2018); the CRAFFT 2.0 survey (Knight, 2016); Screening, Brief Intervention, and Referral to Treatment (SBIRT) screening and interviewing (S. K. Harris et al., 2014); and the National Institute on Alcohol Abuse and Alcoholism guidelines (NIAAA; 2011). Substance use was measured by asking participants to retrospectively estimate their drug or alcohol use in the prior 30 days, a time period consistent with national surveys of youth substance use (Zapolski et al., 2017). Then participants completed six items from the CRAFFT 2.0 survey (Knight, 2016). These questions used a yes/no format, each question relating to a letter in the CRAFFT acronym describing situations or circumstances involving drug or alcohol use. Using the 30-day interval, our survey asked participants the following CRAFFT questions: “Have you ever ridden in a CAR driven by someone (including yourself) who was ‘high’ or had been using alcohol or drugs?,” “Do you ever use alcohol or drugs to RELAX, feel better about yourself or fit in?,” “Do you ever use alcohol or drugs while you are by yourself, or ALONE?,” “Do you ever FORGET things you did while using alcohol or drugs?,” “Do your FAMILY or FRIENDS ever tell you that you should cut down on your drinking or drug use?,” and “Have you ever gotten into TROUBLE while you were using alcohol or drugs?” In general, higher scores indicate higher risk for a substance use disorder (Knight, 2016; Knight et al., 2002). The CRAFFT can be used as a self-report screening tool and has been shown to have strong psychometric properties (e.g., Dhalla et al., 2011; Levy et al., 2004). In an early study of 538 participants, the CRAFFT demonstrated sensitivity, specificity, and predictive value in identifying adolescents with substance use problems (Knight et al., 2002). Further, in a study of 4,753 participants, the CRAFFT 2.0 demonstrated strong concurrent and predictive validity (Shenoi et al., 2019). Readiness to Change items were informed by components of the brief negotiation interview in SBIRT (D’Onofrio et al., 2005; Whittle et al., 2015) and substance use attitudes items were adapted from the Youth Risk Behavior Surveillance System (Kann et al., 2018). Knowledge items were developed based on NIAAA guidelines and norms, such as alcohol volume in various types of beverages and adult low-risk use levels (Alcohol Research Editorial Staff, 2018). Item composition of the four subscales is presented in the supplementary materials (Appendix A). Procedure The MCARR is intended to be a universal intervention for students in at least one grade, with ninth graders as the primary target population. MCARR consists of nine learning modules each lasting 1.5 hours, offered once per month in a classroom with 15–20 students in each meeting. The nine modules are: 1) Orientation to the MCARR Program and Community Building, 2) Personal Coping, 3) Attitudes and Messages About Use, 4) Alcohol, 5) Community Partners, 6) Assumptions and Low-Risk Limits, 7) Cannabis, Nicotine, and E-Cigarettes, 8) Opioids and Cocaine, and 9) Review: Decisions. Each module, including the learning objectives and a summary of activities, is provided in Appendix B.