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

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

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

3. 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 Objectives

4. 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.” LEARNING COLLABORATIVE Adapted from Institute for Health Care Improvement and National Center for Child Traumatic Stress

5. 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. NCHIP Mission

6. PUBLIC HEALTH APPROACH Host - Individual Environment – Campus & Community Agent - Alcohol

7. COLLABORATIVE COMPOSITION

8. 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 LEARNING COLLABORATIVE EXPERT FACULTY

9. Model for Collaborative on High Risk Drinking Participants (32 Colleges) Start Campus Improvement Team Started with 5 – 7 members each Reduce High Risk Drinking and Related Harms Prework Develop Framework Faculty Meeting February, 2011 LS 1 June 2011 Individual LS2 Jan 2012 Environmt LS 3 July 2012 System Summative Congress July 2013 P P P AP2 AP1 AP3 D D D A A A S S S Supports: Faculty Experts NCHIP Staff Email (list-serve) Small Group Calls Monthly All Collaborative Calls Monthly Team Reports LS – Learning Session AP – Action Period PDSA – Plan, Do, Study, Act

10. Act Plan Study Do Model for Improvement BTS Engine for Improvement What are we trying to Aim accomplish? How will we know thata Measures change is an improvement? What change can we make that Ideas will result in improvement? The Model encourages you to act your way into learning, rather than thinking your way into acting Act Plan Study Do From: The Improvement Guide, Associates in Process Improvement Lloyd Provost, API

11. Multi-Tiered Measurement Strategy High-risk Drinking Rate Drinking-related Harms Rate “Within the last month have you experienced the following as a consequence of your drinking?” • Did something you later regretted • Forgot where you were or what you did • Got in trouble with the police • Had sex with someone without giving your consent • Had sex with someone without them giving consent • Had unprotected sex • Physically injured yourself • Physically injured another person • Seriously considered suicide Medical Care Encounter Rate Law Encounter Rate Measures that capture change in key processes affecting drinking outcomes • Prevention • Risk Identification • Acute Toxicity • Brief Intervention OUTCOME Measures Capture results related to the project aim – high risk drinking and related harms [universal] PROCESS Measures Capture quantitative and qualitative data about the impact of a particular change or process affecting drinking outcomes [institution specific] CONTEXT Measures Capture information about the environment in which the improvement work is occurring [institution specific] Program Evaluation: has the collaborative been successful?

12. Common Set of Measures -- Collective and Team Advantages RUN CHARTS – HIGH-RISK DRINKING RATES 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 C median=47.70 median=56.64 median=26.62

13. SURVEY FREQUENCY CONTEXT

14. CAMPUS ALCOHOL SYSTEM INITIATIVES 238 Ongoing PDSAs Intervention Policy Enforcement Individual Screening Environment Treatment Policy Education Community/State

15. 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 SYSTEMS APPROACH

16. 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 LESSONS LEARNED 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

18. Meet DCHIP Campus Improvement Team DCHIP Aims and Goals Selected Campus Efforts addressing High Risk Drinking PRESENTATION AGENDA

19. Dartmouth College Health Improvement Project (DCHIP) Campus Improvement Team Campus Systems Starting July 2012 Campus Environment NOW Individual Interventions Started June 2011

20. 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 DCHIP GOALS

21. 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. ASPIRATIONAL AIM

22. DCHIP’s INDIVIDUAL INTERVENTIONS along the spectrum Referral to DHMC Intensive Outpatient Tx Program Recovery Support Pre-Matriculation Programs 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

24. Primary Care Screening PDSA Started with small PDSA in July 2011 and modified our sign-in slip And modified our EMR template for encounter notes

25. 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

26. How are we doing with primary care screening? • Reaching our screening goal of 90% • Working on improving delivery of BMI

27. 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 BASICS (Brief Alcohol Screening and Intervention of College Students)

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

29. 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

30. 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 BASICS: EFFECTIVENESS AT DARTMOUTH

31. We found a significant reduction in the: Quantity of alcohol consumed Number of days a student drank Number of hours a student drank A PROMISING STORY The impact of BASICS at 90 days * Our AOD Coordinator has a fabulous “effect size”

32. 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

34. BASICS Timeliness PDSA & NU Nights Implementation

35. 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 yearsb. Decrease the rate of self-reported harms, both frequency and severityc. 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 behaviorsb. 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. Aim Statements

36. 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.

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

38. Changes and Results

39. Results: Timeliness # of Days Incident toReferral Incident to Intervention

40. Results: Timeliness

41. 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. Lessons Learned

42. 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).

43. NU Nights Implementation Timeline

44. 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 NU Nights Survey Card

45. Results: NU Nights

46. Results: NU Nights

47. 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 Summary

48. 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

49. Why a Learning Collaborative is Awesome Observations about the NCHIP Experience 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

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