EFFECTIVENESS OF ONE-YEAR PARTICIPATION IN SCHOOL-BASED VOLUNTEER-FACILITATED PEER SUPPORT GROUPS.

Wassef, Adel ; Mason, Gayle ; Collins, Melissa Lassiter 等

ABSTRACT

This study evaluated the effectiveness of one-year participation in a program of volunteer-facilitated peer support groups conducted in a southeast Texas high school. One hundred eighteen students who experienced emotional distress or behavioral problems voluntarily participated in weekly groups facilitated by adult volunteers who were not mental health professionals. Seventy-six participants anonymously assessed the program using an instrument developed to evaluate the group experience. Results indicated that the program was highly accepted by the students even though two-thirds had initially felt uncomfortable in the groups. There was significant improvement in the interpersonal, internal, and school domains. Two-thirds of the alcohol and substance users reported reducing their intake or abstaining. The beneficial effects reported by a majority of the participants indicate that schools opting to implement this early intervention program can look forward to encouraging results within one year.

Emotional distress and behavioral problems are common in high school students. Wassef et al. (Wassef, Ingham, Lassiter Collins, & Mason, 1995; Wassef, Lassiter Collins, Ingham, & Mason, 1995) have discussed the etiology of these phenomena and the obstacles related to the large-scale implementation of programs designed to assist students, as well as the difficulty of assessing their efficacy. This article presents the first-year results of the Student Assistance Program, which involves peer support groups. The areas in which improvement was found are highlighted.

METHOD

In the 1990-1991 academic year, the Student Assistance Program--an early intervention approach involving volunteer-facilitated peer support groups -- was launched in a southeast Texas high school. Fifteen hundred students were enrolled in the school: 51% male and 49% female; 69% Anglos, 17% Hispanics, 12% African Americans, and 2% Asians. Minorities were somewhat overrepresented in the school as compared with the community. English was the primary language in more than four-fifths of the students' homes. Spanish and Vietnamese were the languages for most of the remainder. Approximately 20% of the students received free or reduced-price lunches, reflecting the middle to low socioeconomic status of this population.

At the beginning of the school year, all students were provided with information about the support groups available for those who were experiencing emotional distress or behavioral problems. Students, family members, and school staff could also anonymously provide the names of those who, in their opinion, were having significant difficulties and might benefit from inclusion in the program. Participation in the groups, however, was strictly voluntary regardless of the type of referral or the perceived problem. A screening team, which included the school counselor, evaluated the applicants to confirm the need for help. Students who were experiencing problems that required immediate attention and those who needed hospitalization or out-of-school management were referred to outside resources (approximately 10% of the applicants).

The age range of the 118 participants was 14-19 years. They were assigned to small groups of 8-12 students based on their presenting problems. They met weekly on the school campus for 50 minutes during school hours. In the group meeting, the students discussed their concerns and stressors at home and school, as well as different coping strategies. Each group focused on one of the following topics: the consequences of substance use and how to remain abstinent; the effects of substance use by a relative (usually a parent) or a friend; parental divorce and remarriage; grief; school, family, relationships, and self-image; abuse (physical, sexual, or emotional); body image; the dual role of parent and student; depression; and minority issues. Each of the groups convened in the presence of two volunteer facilitators, who were not mental health professionals (a school staff member and an adult from the community). All volunteers received 2-3 days of training and ongoing in-service instruction (8 hours per year), in cluding how to play a nondirective role.

Group meetings were held on a rotating basis to preclude missing the same class. The school expected the participants to complete any work assigned during missed classes. Students received no educational credit for participation.

The facilitators contacted students who failed to show up for group meetings, encouraging them to resume participation or referring them to other sources of help. Students were not penalized for withdrawing from the groups (approximately 5%). At the end of the semester, participants who wanted to reenroll for the following semester were allowed to do so. New students were added to the existing groups. Since all students who qualified for the program were allowed to participate, there were no control groups.

At the end of the school year, the students anonymously completed the 24-item Self-Assessment Questionnaire (see Wassef, Mason, Lassiter Collins, O'Boyle, & Ingham, 1996). The first 14 items (see Table 1) measured the effect of participation on items related to interpersonal, internal and school domains. Possible answers were: positive effect, no effect, negative effect, encounter too brief to tell, and does not apply. The next 7 items dealt with overall program acceptability. Three questions dealt with dropping out of school and substance use. Reliability of the Self-Assessment Questionnaire has been established; Cronbach's alpha = .85 (Wassef et al., 1996).

RESULTS

Table 1 shows that more students reported positive effects of the peer support groups than no effects or negative effects for all of the first 14 items except impact on school attendance, for which almost half reported no effect. Table 2 shows that students who indicated their intention to join an in-school support group the following year exceeded those who intended to participate in an out-of-school group. Nearly nine out of ten stated that they would recommend the school group to a friend, two-thirds asked a friend to join, and a third referred a friend directly to the counselor for evaluation. Only 38.7% of the students expressed comfort with participating in the group at the beginning; however, by the end, only 3.2% remained uncomfortable. On a 5-point scale, 53.3% rated the general efficacy of the groups as 5 (highest), 30% as 4, 16.7% as 3, and none as 2 or 1.

As an indicator of pathology at the time of enrollment in the program, almost 23% of the students admitted to having considered dropping out of school, and 74% admitted to having used alcohol or drugs in the past. At the end of the year, two-thirds of the students in the latter group indicated that their alcohol and drug use had gone down (40.8% reduced their use and 26.5% stopped altogether). Two-thirds of the students who reported no change in the amount consumed reported increased awareness of alcohol and drug use as a problem.

DISCUSSION

Positive outcomes have also been reported for other programs. Wilhoit and Roesch (1989) noted improvement in attendance, drop-out rate, and disciplinary action when students were seen individually on a weekly basis. Eggert, Seyl, and Nicholas (1990) noted improvement in school grades, attendance, and drop-out rate for students who attended daily groups with teachers. Korczynski (1989) reported on weekly groups conducted by a trained psychiatric nurse without discussing outcome.

The program investigated here offers an economically feasible approach that combines low frequency of contact, a group format, and does not require mental health professionals as facilitators. The program provides well-accepted and easily accessible assistance that is not hindered by cost or stigmatized, as services received outside of school often are. That one-third of the respondents referred friends for evaluation indicates that the program could help students who otherwise might not be recognized as distressed. Additionally, while some adolescents may want to handle their problems without the intervention of an adult (Offer et al., 1991; Vieland et al., 1991), this study found that the students adapted well to the facilitators. The presence of facilitators protects students and reassures parents and school boards.

Several factors contributed significantly to the successful implementation of the program and to its recognition by state and national agencies. A task force consisting of school representatives and community leaders helped in developing program philosophy and procedures that were well received. This ensured the support of the school administration and created a sense of community and school ownership of the program. In addition, as group facilitators were not professional mental health providers, initial and continuing in-service training and the availability of school counselors were of great importance.

It should be emphasized that this is an early intervention program for students with mild to moderate problems. Students with severe problems are referred to traditional psychiatric services. Also, to enhance its acceptability, the program should be promoted as a self-help group approach run by volunteers to help normal students who are distressed, and not as a program for students with problem behaviors. Students who feel uncomfortable in the group setting should be encouraged to participate for a few sessions to determine for themselves if they wish to continue.

The size of the student body involved in the study and the absence of demographic data limit the generalizability of the program evaluation. It could be argued that since participation was voluntary, only students with minimal psychopathology and more supportive families were willing to join. Papini et al. (1990) noted that adolescents who perceived their parents as being warm and nurturing engaged in significantly more self-disclosure with their parents and peers. However, nearly a quarter of the students considered dropping out of school and 74% used alcohol and drugs, indicating significant pathology, which their families had failed to resolve. It can also be argued that voluntary participation was indicative of high motivation to change and, as a result, the problems would likely have been resolved without school intervention. As there was no control group, this possibility cannot be ruled out. However, that less than one-tenth of the students indicated they intended to seek support groups outside the sc hool system is evidence that the majority found such sources of help either unacceptable or inaccessible.

As with any self-report measure, students may have chosen the most socially acceptable response. This was not likely the case here, however, since data collection was anonymous and three-quarters disclosed using alcohol or drugs. Another possibility is that a sense of "group loyalty" increased the perception of positive effects or extended it to other areas. This again was unlikely, given the differences in reported efficacy (e.g., only 38% and 55% of the respondents reported a positive effect of the program on their school attendance and physical health, respectively, whereas 76% noted improvement in finding different ways to deal with the problems they faced).

Although the present study confirms the efficacy of the program, as proposed earlier by Wassef et al. (1996), and indicates that such an approach can be successful only one year after implementation, a more precise evaluation calls for assessment of the students' psychopathology before and after participation. Comparative studies evaluating the efficacy of this program, traditional groups offered by mental health professionals, and the standard help available in schools would also be valuable. Additionally, the program's long-term efficacy and the ideal duration and frequency of group meetings should be studied. Correlation between the reported (subjective) changes and objective changes in academic performance, school drop-out rate, disciplinary actions, and school attendance, as well as the assessments of teachers and parents, would be helpful.

CONCLUSIONS

The findings showed that one-year voluntary participants in school-based volunteer-facilitated peer support groups helped to alleviate adolesents' emotional distress and behavioral problems. The low cost of the program allows it to reach students who might otherwise not receive help.

This work has been supported, in part, by the Dickinson Independent School District. The authors would like to thank all of the volunteers who donated their time as peer support group facilitators; the Dickinson Independent School District Board of Trustees, Superintendent Bill Borgers, Ph.D., Principal Ron Ahlhorn, M.S., and Louise Bell, Ed.D., for their assistance and support; and Attallah Wassef, Ph.D., for his scientific and editorial advice.

Adel Wassef, M.D., University of Texas Health Science Center, Houston, Texas.

Gayle Mason, B.A., Melissa Lassiter Collins, B.A., and John VanHaalen, M.Ed., Dickinson High School, Dickinson, Texas.

Denise Ingham, M.D., Harris County Mental Health, Mental Retardation Authority, Houston, Texas.

Reprint requests to Adel Wassef, M.D., UT-Houston Harris County Psychiatric Center, 2800 South MacGregor Way, Houston, Texas 77021.

REFERENCES

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