Research-Based Training to Identify Substance Misuse - Podcast Transcript

Have you ever wondered who was doing the research that will impact your future? The research podcast lets you met those people, and learn how the University of Kentucky is exploring and strengthening our understanding of the world through research and discovery.

Here's Alicia Gregory, director of Research Communications.

Alicia: Today we’ll meet Kalea Benner, Director of Undergraduate Studies at the UK College of Social Work. Her research focuses on training social work students to identify substance misuse. She starts by telling us what motivated her to pursue research.

Kalea Benner: My first research project involved a child who had been given to the state by his mother. He was 13 years old. He came to the state office with two bags of possessions in two large black trash bags. And, was told to have a good life. And, I just remember thinking- I remember feeling appalled, trying not to judge that mother and those circumstances, but feeling a lot of empathy for this young man, and thinking about what his life would be like. So my first research project sort of stemmed from that. Does this happen very often? Is this just an anomaly? Or is this something that kids are consistently dealing with? Especially adolescents. It really sparked my interest in finding out more.

Then I had a second experience. I was a school social worker, and I was working with a child at the time, who's ten years old in fifth grade. And, he became aggressive towards his principal, and this principal basically said, you're out, you're done, until you get on Ritalin, you're not coming back. It's been a few years ago, Ritalin hasn't been preferred drug for ADHD for a long time, but I remember just being indignant. I was mad, I was angry. You can't kick a kid out of school. And what do you think this ten year old's going to be doing? You know, his parents are working all day, he's home by himself, and you're going to send him home. And, that's not really incentive for returning to school. And, so I'm going to research that. Can a principal really do that? And, yes, a principal really can kick, because I'm thinking, this kid needs to be in school suspension, not out of school suspension, and I was wrong. And, it just kind of lit a fire in me. I need to know more so I can better serve the population that I'm working with.

Alicia: So, tell me a little bit about the area of research you focused on, and what you're doing right now.

Kalea Benner: Since I finished my PhD, one of the areas that I've been focusing on is substance use training for social work students and social work practitioners too. One of the things that I knew from my own experiences as a social work practitioner, even with a decade of experience under my belt, it was still hard for me to ask about substance use. And, in today's world, when it's prescription drugs, when a doctor has said and given you permission to use that medication, it's even harder. And, so, whenever I became a social work educator, that was one thing I wanted to help my students do; gain confidence in asking those tough questions, know that they weren't being intrusive, know that it was part of every assessment, to be able to understand what substance misuse looked like, what it sounded like. There's all kinds of codes. "Oh, I just- I just party a little bit." There's "I get messed up sometimes". And, then there's also people who minimize. "Oh, I don't do it more than anybody else." Or, "It's common, you know, for my age." Which is, you know, a good excuse for college age students. And, so I had to learn a lot myself, but then I wanted to instill that confidence and that knowledge in social work students as well, because I knew that they'd be practitioners and having to ask those hard questions.

Alicia: So, what has been some of the most fulfilling moments for you in terms of your research?

Kalea Benner: So, my research has been a lot of fun, for all that there are challenges within it. One of the things I think our social work students love, is that the training is actually multidisciplinary. And, so not only are social works students receiving this training, but also the residence at Family and Community Medicine are also receiving the same identical training. And, so that helps validate for them their need for it, but it also helps them know their importance- at being at the table, and being a provider to help prevent substance misuse. It's also fun to work with the multitude of professionals, you know. Everybody's involved; from pharmacists, to physicians, to the social works, to the nurses, to the dietitians even, who work with people in helping meet their holistic needs. So, that's a lot of fun too. Knowing that there's good professionals that people have as supportive resources.

Alicia: So, how has your research impacted the way that you train your students?

Kalea Benner: So, It's impacted it significantly I think. You know, I used to think that we needed to help educate students so that they'd know why they were doing what they were doing. But what I've learned is, they need to not only know why, but they need to know how. Sometimes the knowing why doesn't always easily translate into skills and knowing. And, one of the hardest parts about assessing for substance misuse for social workers is just starting that conversation, and then not being intimidated by it. Some people are more naive about drug and alcohol use than others, and some are kind of savvy and can, you know, understand what- what language means. But, all of us have to follow up and ask those harder questions, even when maybe the other person is saying "this is my business." We still have to say, do you think it's affecting other parts of your life, even though it is their- obviously still their business. And, I think that's a tough sell. So, one of the pieces that education has brought to my research, and research has brought to my education, is that fact that we need to learn that application, we need to learn the skills to actually apply that knowledge, not just the knowledge and assume that then we'll have the skills necessary to apply it.

Alicia: Excellent. So, tell me in a little bit more detail about this grant. The interdisciplinary grant with the SBIRT training model? What is that specifically?

Kalea Benner: Okay. So, SBIRT stands for Screening, Brief Intervention and Referral to Treatment. And so the screening piece of that is really based on a medical model. So, it's everything you’ve heard about how much is in an appropriate drink. People can put, oh no, “I don't binge because I only have one or two drinks at a time”, but yet that one or two drinks contains what we would consider four or five different alcoholic versions. For alcohol, you have to have a certain number before you can screen positive for potential misuse. For drug use, and abuse, any amount of illegal drug use is considered a positive screen, whereas, for prescribed medication, it's if they've used it whenever it hasn't been for the situation prescribed. And, so it can be a little bit different. So, the screening part is really based upon the medical model.

The brief intervention and referral to treatment is based on motivational interviewing. So, students actually learn skills from theory, Motivational Interviewing Theory, that they can then apply to working with their clients. It's really a great intro for students, because the theory and the model helps them set boundaries. I'm not responsible for you, you're responsible for you. So, how can you and I work together to identify what, you know, would maybe help you change?

It's also based on Transtheoretical Change Theory. In which, the, you know there's different stages that people can be in. And, it starts at pre-contemplative, so a stage is before I even thought that I need to change any behavior at all, here I am. And it helps students identify what stage so that they don't keep banging their head, asking about this. Okay, I'm not even there yet. You're way ahead of me, so you need to, you know, find something else to focus on. And, it also helps students have tools if somebody's not there yet. You know, if they're not even thoughtful or intentional that maybe drug or alcohol use is altering their life in some way that they don't necessarily even want. It helps students get the tools then to be able to start that conversation. And, sometimes, for some people, it takes multiple conversations before they're even willing to change. But, it also has students use specific tools. Like, there's a readiness ruler. It's a fairly common scale of 1 to 10, how ready are you to maybe think about changing those behaviors related to drug or alcohol use. And, then people pick a number. If you picked 4, and you told me you were at 4, I would praise that. But then, you're thinking, probably that, well I've picked a low number, why is she acting like that's a good thing? So, then I would explain that because you're at a 4, there's some thought there, right. Tell me about those thoughts. What would be better? What would maybe look different for you? So, it gives students specific tools to use with clients to help clients then look at what they're actually doing.

Alicia: So, is this a tool that is just being used by social work students, or is it wider than that?

Kalea Benner: Oh, it's, and that's a multidisciplinary part. So, a nurse can use this, in fact, we have a SBIRT grant in the College of Nursing here as well. So, physicians can use that. So, it's really designed to be interdisciplinary. So, it provides all health providers with that same tool to use. Which, isn't that great for a client or a patient to have the same consistent messages from all the health providers that they come in contact with? That also helps them start thinking about change.

Alicia: That's excellent.

Kalea Benner: Yeah.

Alicia: Because I know, I mean, a lot of people won't seek help for that issue, but if it's addressed in their primary care setting, they might be more likely to actually do something about it.

Kalea Benner: And, so what we know is you're exactly right. People who want help maybe don't even know that they want help. But people maybe who are starting to think about "I maybe need to start doing something different," they don't typically say to somebody, you know, I might want to change this up a little bit. What they do, is they go to their doctor because they haven't been feeling well, they've been having stomach aches or headaches, or some kind of physical ailment. And, so typically, it's those patients that we screen then, that we can identify, we need to start this process with. The great news about this too, is that insurance, including Medicaid, is now starting to pay for that screening process. Because, in the past, physicians, you know, had a huge barrier. I get x amount of time, my patients has these complaints, I don't know if they're related to substance abuse or not, and I don't have any time to find out. Now that they're getting funded for it, they can spend that time to actually find out. Then, if a person does screen positive, they can actually be handled off to a social worker to help deal with some of those other issues.

Alicia: That's wonderful.

Kalea Benner: It's fabulous. Absolutely. I'm so excited about it. And, our department of family and community medicine has implemented, and they've done two pilot screenings so far, in which they screen everybody who comes in. And, that's pretty cool too. Because Kentucky, as you know, has a high rate of drug and alcohol use. And, if that's our point of access, then we need to take full advantage, because once we get access, we have resources, but we can't impose resources upon people. And, we can't identify people who need those resources if they're not able to come in. So, the doctor's office is a great first point of contact.

Alicia: So, how did you end up at UK?

Kalea Benner: So, great, great question. I really love UK. People are so supportive here. I wanted to be at a Research 1 Institute. I wanted to be in a college of social work, and I wanted to be in a place that valued people. I've, you know, heard stories from colleagues, and I just wanted to make sure that I felt good about the place. I also wanted to be in a place where I could truly have that balance as a researcher and an educator, because I see that they're so intrically tied. And, I felt that UK gave me that opportunity. Some of the things that I was working on before was also present at UK, so I was able to step right in to some of those. And, it certainly has felt like home. I've been here a year and a half, and I'm very much glad to be here.

Alicia: Excellent. I would think that some of the multidisciplinary things you were talking about, having all of those different areas here is a benefit.

Kalea Benner: Absolutely. So, and that's another piece about UK. It's not just the size of it, but it's really-- because it's a research 1 institute, and because it's a land-grant institute, it fills that obligation to every person in this commonwealth. And, so it's preparing practitioners to help people across the commonwealth, and I wanted to be a part of that.

Alicia: So, what would you tell someone who's thinking about joining the research enterprise here at UK?

Kalea Benner: I would tell them that I think we have wonderful infrastructure here. I've been so grateful to have the assistance for not just pre-award, but post-award as well. And, even just brainstorming with colleagues on appropriate grant funding sources, appropriate research. I guess endeavors to fit specific funding needs. That's been a great part of that too. I have never had the collegiality that I've had since I've been at UK. There's tremendous infrastructure here for undergraduates to do research, and I love that. So, not only do I get to work with social work students who are interested, but also work with students across campus that maybe I've connected with in a class, maybe have just looked at my bio and seen common interests too. But, that's really a neat piece about UK too. Working with undergraduates in research, you know, they're wide open, they have lots of time, lots of energy, and lots of great ideas, too. And, so that's a really fun piece of the research project too, is extending that education beyond the classroom, to extend into actual knowledge and awareness of their world, and where they're going to go as a future practitioner, whatever role that might be. Because today's world is not, I do my job, you do yours, it's more about how can we do our jobs together to collectively be more effective. Any job ultimately should serve people. I think this generation gets that. Which is kind of fun.

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