presentation - American College Health Association

Learning Collaborative on High-Risk Drinking ACHA Presentation May 30th, 2012

ACHA presentation

   

Patricia Lanter, NCHIP Ann Bracken, Dartmouth College Lisa Currie, Northwestern University Jason Kilmer, University of Washington

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Objectives

 Describe the application of improvement methodology to the college health environment  Review the measurement strategy for the initiative – both qualitative and quantitative  Explain the approach that teams use to engage in and report on cycles of process improvement  Present teams’ experiences in participating in the collaborative and the improvements that they have made to date  Faculty expert perspective on NCHIP 3

LEARNING COLLABORATIVE

What Is a Learning Collaborative? “The learning collaborative approach is an adoption and improvement model that is focused on spreading and adapting best practices across multiple settings and creating changes within organizations that promote the delivery of effective practices.”

Adapted from Institute for Health Care Improvement and National Center for Child Traumatic Stress

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NCHIP

MISSION  The Learning Collaborative on High-Risk Drinking will improve the health of the college student population using proven, evidence-based practices.  The objective of this Learning Collaborative is to work together to effect measurable change in reducing the rate of high-risk drinking at participant institutions, as well as the harms that result from this behavior. 5

PUBLIC HEALTH APPROACH

Host - Individual

Agent - Alcohol

Environment – Campus & Community

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COLLABORATIVE COMPOSITION

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LEARNING COLLABORATIVE EXPERT FACULTY

FACULTY EXPERTS • • • • • • • • •

JASON KILMER, PhD - University of Washington DOLORES CIMINI, PhD – University at Albany, SUNY MICHAEL FLEMING, MD – Northwestern University LINDA MAJOR, - University of Nebraska, Lincoln BOB SALTZ, PhD – Pacific Institute for Research and Evaluation TRACI TOOMEY, PhD – University of Minnesota TOM WORKMAN, PhD – Baylor College of Medicine TOM CASADY, University of Nebraska, Lincoln LLOYD PROVOST, Associates in Process Improvement 8

Model for Collaborative on High Risk Drinking Participants (32 Colleges)

Reduce High Risk Drinking and Related Harms

Start Campus Improvement Team Started with 5 – 7 members each

Prework Develop Framework Faculty Meeting February, 2011

P

P

LS 1 June 2011 Individual

D

A S

AP1

LS2 Jan 2012 Environmt

P D

A S

AP2

LS 3

D

A

July 2012 System

S

AP3

Summative Congress July 2013

Supports: Faculty Experts NCHIP Staff LS – Learning Session AP – Action Period PDSA – Plan, Do, Study, Act

Email (list-serve) Small Group Calls Monthly All Collaborative Calls Monthly Team Reports

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BTS Engine for Improvement

Model for Improvement What are we trying to accomplish?

Aim

How will we know that a change is an improvement? What change can we make that will result in improvement?

The Model encourages you to act your way into learning, rather than thinking your way into acting

Act Act

Plan Plan

Study Study

Do Do

Lloyd Provost, API

Measures Ideas

From: The Improvement Guide, Associates in Process Improvement 10

MULTI-TIERED MEASUREMENT STRATEGY

OUTCOME Measures Capture results related to the project aim – high risk drinking and related harms [universal]

• •

High-risk Drinking Rate Drinking-related Harms Rate PROCESS Measures “Within the last month have you experienced the following as a consequence of your drinking?” 1. 2. 3. 4. 5. 6. 7. 8. 9.

Capture quantitative and qualitative data about

Did something you later regretted Forgot where you were or what you did impact of a particular change or process the Got in trouble with the police affecting drinking outcomes Had sex with someone without giving your consent Had sex with someone without them giving consent [institution specific] Had unprotected sex Physically injured yourself Physically injured another person Seriously considered suicide

 Measures that capture change in key processes affecting drinking CONTEXT outcomes Measures • Prevention Capture information about the environment in • Medical Care Encounter Rate which the improvement work is occurring • Risk Identification • Program Law Encounter Rate has the collaborative been successful? [institution specific] • AcuteEvaluation: Toxicity • Brief Intervention

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RUN CHARTS – HIGH-RISK DRINKING RATES COMMON SET OF MEASURES -- COLLECTIVE AND TEAM ADVANTAGES  Teams report and learn from one another  Teams monitor progress (frequently and regularly) as they ‘perturb’ the system with tests of change and implementation of evidence-based initiatives  Can compare year to year for events that are not ongoing (orientation, homecoming etc) A

B

70.00

70.00

60.00

60.00

C 70.00 60.00

median=47.70

median=56.64

50.00

50.00

50.00

40.00

40.00

40.00

30.00

30.00

30.00

20.00

20.00

20.00

10.00

10.00

10.00

0.00

0.00

median=26.62

8 - 2011

9 - 2011

10 - 2011

11 - 2011

0.00 8 - 2011

9 - 2011

10 - 2011

11 - 2011

9 - 2011

10 - 2011

11 - 2011

12 - 2011

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SURVEY FREQUENCY CONTEXT

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CAMPUS ALCOHOL SYSTEM INITIATIVES

238 Ongoing PDSAs Intervention Policy

Enforcement

Individual

Environment

Screening

Treatment Policy Education

Community/State

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SYSTEMS APPROACH

PLANTING THE SEEDS…

 Address the entire student population  Address multiple areas and events  Evidence-based strategies linked together in meaningful ways to create maximum effectiveness  Implement each strategy fully; measure and evaluate to continue making improvements  Work together across campus departments and with the community 16

LESSONS LEARNED

SUCCESSES • • • • •

32 institutions committed to participate A common focus on student health and well-being is clear Local / faculty expertise has been remarkable Past and current work by teams is impressive Schools are starting to see changes in drinking on their campuses

CHALLENGES • Range of improvement knowledge among teams • Varied contexts within the collaborative • Range of buy in from teams / leadership • Learning how to best facilitate collaboration • Harnessing local team expertise • Measuring monthly can be challenging to implement 17

DARTMOUTH COLLEGE HEALTH IMPROVEMENT PROGRAM (DCHIP) ANN BRACKEN MD PHD MAY 31, 2012

PRESENTATION AGENDA

 MEET DCHIP CAMPUS IMPROVEMENT TEAM  DCHIP AIMS AND GOALS

 SELECTED CAMPUS EFFORTS ADDRESSING HIGH RISK DRINKING

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DARTMOUTH COLLEGE HEALTH IMPROVEMENT PROJECT (DCHIP) CAMPUS IMPROVEMENT TEAM

Individual Interventions

Started June 2011

Campus Environment

Campus Systems

NOW

Starting July 2012

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DCHIP GOALS

FOR 2011-2012 ACADEMIC YEAR  Screen 95% of incoming class (prior to matriculation) for alcohol abuse and provide feedback  Screen 90% of all primary care clinical encounters at Dick’s House  100% of students with an alcohol policy violation will complete the BASICS I program within 2 weeks of incident  Increase use of Good Sam (medical amnesty) to over 75% of all alcohol-related interactions with Dept. of Safety & Security  Conduct test cycles on 2 innovative strategies for addressing high-risk pre-gaming in the residence halls each term

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ASPIRATIONAL AIM

WITHIN 3 YEARS  Eliminate Dartmouth-Hitchcock Medical Center Emergency Department visits for BAC >0.25, by eradicating this level of intoxication from our campus community.

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DCHIP’S INDIVIDUAL INTERVENTIONS ALONG THE SPECTRUM

PreMatriculation Programs

Referral to DHMC Intensive Outpatient Tx Program

Recovery Support

Primary Care Screening

BASICS for students with an alcohol incident 23

MEASURE, MEASURE, MEASURE

 4 NCHIP Measures    

High risk drinking: 5 or more drinks in a sitting Alcohol Related Harms Monthly Medical Encounter Rate Monthly Law Enforcement Encounter Rate

Blood Alcohol Content (BAC) for medical encounters Process measures around delivery of interventions Assessment of high-risk environments at Dartmouth

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PRIMARY CARE SCREENING PDSA 1. Started with small PDSA in July 2011 and modified our sign-in slip 2. And modified our EMR template for encounter notes

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VERY BRIEF INTERVENTION TOOL

Developed a very simple NIH alcohol use message for providers to give to students who say “yes” to high-risk drinking One card- back and front *Designed by our AOD coordinator, Brian Bowden

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HOW ARE WE DOING WITH PRIMARY CARE SCREENING?

• Reaching our screening goal of 90% • Working on improving delivery of BMI

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BASICS (Brief Alcohol Screening and Intervention of College Students)

How is BASICS implemented at Dartmouth?  Targeted toward students who have an alcohol incident  First - online assessment  Next- a motivational interview to “meet students where they are” with their alcohol use and help them to make informed decisions about the impact of their alcohol consumption  ½ hour BMI session with our AOD coordinator  GOAL- all students with incident get BMI within 2 weeks of incident 28

HOW ARE WE DOING WITH OUR BASICS GOAL?

• • • •

We have not achieved the stated goal, although we are improving Online completion ~ 90% within 3 weeks BMI completion- 56% within 2 weeks, -69% within 3 weeks 96% of the referred students will complete BMI by > 4 weeks

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BASICS AT DARTMOUTH OVER TIME: UPS AND DOWNS OF ACADEMIC SCHEDULE

Tracking monthly measures for NCHIP demonstrates the realities of the Dartmouth academic calendar and the D-Plan

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BASICS: EFFECTIVENESS AT DARTMOUTH

 We used students’ responses to the on-line BASICS assessment at baseline and 90 days to investigate effectiveness of the BASICS program  BASICS data were downloaded from the BASICS web-site by OIR  The final dataset consisted of 94 students with complete data from Time 1 and Time 2

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A PROMISING STORY The impact of BASICS at 90 days

We found a significant reduction in the:  Quantity of alcohol consumed

 Number of days a student drank  Number of hours a student drank * Our AOD Coordinator has a fabulous “effect size”

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USING DATA TO INFORM CHANGE IN THE ENVIRONMENT The NCHIP Collaborative has helped us to :  Reduce the silo effect  Facilitate data collection and sharing  Look at problems and solutions from all sides  Use the small tests of change model to move pilots forward On the horizon:  Environmental strategies- moving stated and lived policy closer, new residence hall intervention  BASICS with all athletes- Dartmouth Peak Program  Studying our bystander interventions- Green Team and Bringing in the Bystander 33

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Northwestern University

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NORTHWESTERN’S GLOBAL AIM 

Reduce high risk drinking and harms associated with drinking: a. Decrease the binge drinking rate by 10% every year for the next three years b. Decrease the rate of self-reported harms, both frequency and severity c. Decrease the rate of harms to others, both frequency and severity



Increase positive behaviors associated with alcohol: a. Increase the number and frequency of self-protective behaviors b. Increase the number and frequency of helping behaviors toward others



Increase participation in timely and appropriate interventions among students who have been involved in an alcohol-related incident.

Northwestern University

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BASICS Timeliness PDSA (Individual Level) SPECIFIC AIM  Increase timeliness from incident to BASICS intervention.  Increase consistency of referrals to the appropriate intervention.  Increase referring staff’s comfort level in assigning an appropriate intervention.

Northwestern University

Gathered input from referring staff in order to revise referral protocol.

Developed referral form for referring staff to give to students.

Trained referring staff on referral protocol.

Referral form revised further based on staff input.

Emphasized consistency and accountability.

Implemented revised referral form. Students given clear instructions and messages.

Referring Staff are from: Student Conduct, Residential Life, Athletics.

Northwestern University

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What did you try?

What did you measure?

What were your findings/results?

What changes did you make to your process/system?

Implemented training for referring staff on referral protocol.

Staff confidence and consistency in referring to BASICS.

Number of referrals have increased; consistency and confidence seems to have increased.

• Clarified referral protocol. • Provided training for referring staff.

Implemented use of a referral form.

Timeliness: # of days for • Incident to Referral • Referral to Contact • Incident to Intervention

Significant decreases in all three areas.

• Implemented referral form. • Emphasized need for consistency and accountability with referring staff.

Referring staff and intervention staff gave students consistent messages.

Student cooperation with scheduling process, timeliness.

Appears to have contributed to improvements in timeliness.

• Ensured referring and intervention staff were all saying “must” not “should”.

Northwestern University

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40 35 30

# of Days

25 20

Feb/Mar/Apr/May

Sept/Oct

15 10 5 0 Incident to Incident to Letter Referral

Referral to

Incident to LetterContact to Contact Incident to Session Intervention 1

Northwestern University

Average Days from Incident to First BASICS Session 45.0 40.0 35.0

Days

30.0 25.0 20.0 15.0 10.0 5.0 0.0 2011 Pre-Implementation

Fall Quarter Time Frame

Northwestern University

Winter Quarter

 Simple changes can have a big impact.  Clear referral protocol  Referring staff training  Clear referral form  Consistent messaging  Clarify the roles of the referring staff and the intervention staff  Have enough providers trained before you begin!  Be consistent in messaging and in holding students accountable for completion.

Northwestern University

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NU Nights Implementation (Environment Level) SPECIFIC AIMS  Offer late night social events each Friday, starting at 10pm or later, as a social alternative to off-campus parties.  Should contribute to the reduction in high risk alcohol consumption, as stated in our global aims.  Collect participation, satisfaction and impact data to support continued funding from NU and additional funding from Associated Student Government (ASG).

Northwestern University

NU Nights Implementation Timeline June 2011

Summer 2011

Fall 2011

Winter 2012

Spring 2012

Kirstin Nordhaus ‘12, NU Student Representative at Learning Session 1, proposed creation of Late Night Social Events Program.

Developed proposal for NU Nights for the incoming VP of Student Affairs.

Recruited students for organization which would run NU Nights.

NU Nights student organization starts planning events, based on student surveys and freshman interests collected via AlcoholEdu for College in summer 2011.

Survey card developed to collect data at events.

Associated Student Government passed a resolution expressing support for their proposal. VPSA approved proposal; provided seed money and a GA position.

Northwestern University

GA hired by Center for Student Involvement to support event planning.

First NU Nights events held in April, in collaboration with other student organizations and supported by social media efforts. 1. “Chicago” showing with dance lessons. 2. Bingo Night.

NU Nights Survey Card 1. 2. 3.

4. 5.

Class Year On-Campus or Off-Campus Living status What would you have most likely done tonight if you didn’t attend this event? Choose 1 answer. • Stayed home • Studied • Gone to a bar • Attended a party off-campus • Attended a party on-campus • Attended a Greek life party • Attended another social event • Other (please explain): Suggestions for future events Email for NU Nights Listserv

Northwestern University

What would you have done tonight if you had not attended this event? n = 179 (from two events) 30% 25%

Percent

20% 15% 10% 5%

0% Hung out at home

Studied

Gone to bar or Gone to a party Attended a club cultural event

Other

N/A

Activity

Northwestern University

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What would you have done tonight? - By Housing Type n = 179 (from two events) 45% 40%

Percent

35% 30%

On-Campus

25%

Off-Campus

20%

N/A

15% 10% 5% 0% Hung out at home

Studied

Gone to bar or club

Gone to a party

Activity

Attended a cultural event

Northwestern University

Other

N/A

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Summary The NCHIP Collaborative has helped us to :  Implement changes we had been considering but had not acted upon  Look critically for the small changes that could add up to big changes  Enhance partnerships  Leverage resources for program implementation  Push for the revitalization of our AOD Coalition Challenges  VPSA Transition created an accountability vacuum

Northwestern University

Observations about the NCHIP Experience

Why a Learning Collaborative is Awesome • Schools acknowledge they have their own unique challenges and cultures, but… • There’s every opportunity to learn from other schools given some really significant similarities

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Observations about the NCHIP Experience

Why a Learning Collaborative is Awesome • Data are being collected on campus like never before • How and what we measure can tell a very different story • Some of the data over time reflect changes in thinking by members of the collaborative

Observations about the NCHIP Experience

Why a Learning Collaborative is Awesome • Key stakeholders get on the same page. • Schools are involving students, which impacts buy-in and brings an important perspective to the table.

Observations about the NCHIP Experience

Why a Learning Collaborative is Awesome • Members of the collaborative learn about best practices for impacting individuals, the environment, and systems. • Through the collaborative, members can identify strategies for overcoming barriers and affecting change on campus

Observations about the NCHIP Experience

Lessons Learned and Future Directions • No need to reinvent the wheel • We can make adjustments to wheels that are in place

• The PDSA cycles allow for strategic shifts & changes & to learn from what worked or didn’t work as well • With the fall comes new students, who will be greeted with new programs & policies enacted this year • Importance of sustaining & extending this effort • Role of emerging technology

THANK YOU!