Technical Assistance Webinar Provider/Client Reminder and Recall - - PowerPoint PPT Presentation

Technical Assistance Webinar

Provider/Client Reminder and Recall Systems to Increase Colon Cancer Screening

Presented by: Pamela Gillen, ND Project Director University of Colorado Denver Fetal Alcohol and other Prenatal Substances Prevention Project (COFAS) Pamela has more than 40 years of experience in the field of health and prevention. Pamela has practiced as a public health nurse coordinator and nurse case manager for at risk pregnancies working with high-risk women of childbearing age. She has been a co-chair elect for National FASD Center for Excellence Expert panel. Pamela earned her Clinical Doctorate of Nursing from the University of Colorado Health Sciences Center, and earned her undergraduate degree in drug, alcohol, and addictive behaviors from Metropolitan State College

• f Denver.

Provider/Client Reminder and Recall Systems to Increase Colon Cancer Screening

Presented by: Katie Langland, MA Program Manager and Coordinator for Tribal Choice Denver Public Health Katie provided training and technical assistance to American Indian/Alaska Native groups under the Centers for Disease Control and Prevention Cooperative Agreement. While the Public Health Training Coordinator, Katie designed and developed health curriculum, website content, and trainings including patient navigation, preconception health, chronic disease reduction, and alcohol exposed pregnancy prevention. For Behavioral Interventions Incorporated, she trained internal and external customers on technical facets of the house arrest

• industry. As a two-time Peace Corps Volunteer, Katie

served as a Community Organizer and Health Educator in four rural indigenous Guatemalan communities and in rural Panama. She has obtained degrees in Spanish, International Studies, Elementary Education, and an Anthropology masters with a focus on Political Ecology and Sustainability.

• Funding for this webinar was made possible by the Centers for

Disease Control and Prevention DP17-1701, Cancer Prevention and Control Programs for State, Territorial, and Tribal Programs awarded to the Inter-Tribal Council of Michigan in support of the Three Fires Cancer Consortium. Webinar contents do not necessarily represent the official views of the Centers for Disease Control and Prevention.

• No commercial interest support was used to fund this activity.

Faculty Disclosure Statement

http://www.itcmi.org/asbiwebinar/

• Webinar Archive Video
• Resources

Resources

By the end of this webinar, participants will be able to:

• 1. Learn about the impacts of alcohol use during pregnancy.
• 2. Get introduced to Alcohol Screening and Brief Intervention

(aSBI).

• 3. Learn about the benefits of efficacy of adopting aSBI in a tribal

clinic setting.

Learning Objectives/Outcomes

Helping Native American Moms and Babies by Using Alcohol Screening and Brief Intervention

By Dr. Pamela Gillen & Katie Langland

Learning Objectives

Learn about the impacts of alcohol use during pregnancy. Get introduced to Alcohol Screening and Brief Intervention (aSBI). Learn about the benefits and efficacy of adopting aSBI in a tribal clinic setting.

Impact of Alcohol-Exposed Pregnancies

• Causes

uses lifel felong

• ng physical

sical, , behavioral, avioral, and intel tellectual lectual disabilities sabilities, , kn known wn as s Fe Feta tal l Al Alco cohol hol Sp Spectrum ctrum Disorders sorders (FA FASDs) Ds)

• In

Increases reases risk of mi f miscarriage, carriage, sti tillbirth, lbirth, prematurity, maturity, and d Sudden den In Infa fant nt Death th Syndrome drome (SID IDS) S)

Ef Effects ects of

• f FA

FASD SDs

• In

Intel tellectual lectual disabilities abilities

• Be

Behavioral havioral iss ssues ues

• Physical

sical diff fferences erences

FASDs are

COMPLETELY PREVENTABLE

with

NO ALCOHOL USE

DURING PREGNANCY

What percentage of pregnancies in the United States are unintended? a) 10% b) 25% c) 40% d) 45%

Percentage of Unintended Pregnancies

• 45%

45% U.S. pregnancies are unintended Alcohol and Unintended Pregnancies

• Majority due to not using or incorrectly

using contraception

• Most women don’t know they are

pregnant until 4-6 weeks

(CDC, 2016)

More than 3 million women in the US are at risk for an alcohol-exposed pregnancy.

10 10.2% .2% of pregnant women

aged 18 to 44 years report current alcohol use

(CDC, 2015)

What Is Considered A Standard Drink?

(NIAAA, 2005, n.d.b)

(Coles, 1994)

(CDC, 2015)

Ho How to w to Pre Preve vent nt Alco coho hol- Ex Expos posed ed Pr Pregn egnanc ancie ies

Ways to Prevent AEPs

1.

• 1. Re

Redu duce e risky ky dr drink nking ing

2.

• 2. Us

Use e bi birth h con

• ntrol
• l ef

effec ectively tively

Va

Validat dated ed set et of

• f screen

eening ing qu ques estions ions to

• identify

tify drinking ing patterns ns

Sh

Shor

• rt con
• nversat

ersation ion wi with h pa patient ents s wh who

• drink

k too mu much

Re

Referral ral to specia ialized lized treatm tment nt for patie ients nts wi with an alcohol l use disord rder er

Alcohol Screening and Brief Intervention

provides the steps required to plan, adapt, and implement alcohol SBI as a routine element of standard clinical practice. Planning and Implementing Screening and Brief Intervention for Risky Alcohol Use

 Ta

Talk k with th pati tients ents about ut risky y drinking nking levels els

 Ta

Talk k with th pati tients ents about ut health lth consequences sequences

 Use

se a va validat idated ed sc screening eening to tool with th all patie tients nts

 Refer

fer pati tients ents with th probable bable alcohol

• hol use

disorders sorders to to tr treatmen tment

Key to Reducing Risky Drinking

 Up to

to 1 drink nk per day fo for women en

 Up to

to 2 drinks nks per day y fo for men

 No more

e th than 3 drinks nks on one occasion asion fo for women en (and nd men over r age 65)

 No more

e th than 4 drinks nks on one occ ccasion asion fo for men

Lower Risk Drinking Limits

Remind

mind patie tients ts th the co conversatio versation n is s co confidential fidential.

Estab

tablish lish rapport port th through ugh eye contact tact and respectful spectful listening. tening.

Avoid

• id sti

tigmatizing matizing language guage

– DON’T SAY “You don’t drink do you?” Normalize

rmalize sc screening ening by y ask sking ing about

• ut alco

cohol hol as s part rt of f routi tine ne care.

STEP 1. Set the Stage for Screening

1.

• 1. NIA

IAAA AA Single gle Qu Question tion Alcohol

• hol Screen

een

2.

• 2. USAUD

SAUDIT IT-C C (Fi First rst 3 questions stions fr from th the AUDIT) IT)

STEP 2. Use Validated Screening Tools

Any answer over 0 is a positive screen and should be further assessed.

(Smith et al., 2009)

“How many times in the past year have you had X or more drinks in a day?”

(X = 5 for men; 4 for women)

Single Question Alcohol Screen

USAUDIT-C

QUESTIONS 1 2 3 4 5 6

SCORE

• 1. How often do you

have a drink containing alcohol?

Never Less than monthly Monthly Weekly

2-3 times a week 4-6 times a week Daily

• 2. How many drinks

containing alcohol do you have on a typical day you are drinking? 1 drink 2 drinks 3 drinks 4 drinks 5-6 drinks 7-9 drinks

10 or more drinks

• 3. How often do you

have X (5 for men; 4 for women & men over age 65) or more drinks

• n one occasion?

Never Less than monthly Monthly Weekly

2-3 times a week 4-6 times a week Daily

TOTAL

For men (under der 65), , a score re of f

8 or mo more is consid

sidered ered positive itive.

Fo For women en and older der men (65+) +), , a sc score e of f

7 or 7 or mor more e is considered

sidered positive. itive.

The Drinkers Pyramid

(Babor, Higgins-Biddle, & Robaina, 2016)

Af

Affir irm m

Ad

Advise se

Op

Open en do door

• r

Re

Rescr creen een an annu nual ally ly

Negative Screen

As Assess ess fur urther her

Positive Alcohol Screen

Con

• nversation

ersation wit ith h a p a pat atie ient nt who ho is is dr drin inkin ing g at at a a hi high gher er ris isk k le level el Aim ims s to to he help lp th the pat e patie ient nt ma make e he heal alth thie ier cho hoic ices es ab abou

• ut

t al alcoh

• hol
• l us

use

Brief Intervention

SBIRT and Youth Screening Guidelines

For elementary and middle school students, start with the friends question

less threatening, side-door opener to drinking

Because transitions to middle or high school increase risk, choose the question set that aligns with a student’s school level

As opposed to age, for students aged 11 or 14

Exclude alcohol use for religious purposes

Ask the Two Screening Questions

https://pubs.niaaa.nih.gov/publications/Practitioner/YouthGuide/YouthGuide.pdf

Assess Risk for Those that DO Drink

Age 1-5 days 6-11 days 12-23 days 24-51 days 52 + days < 11 12-15 Highest Risk 16 Brief MI + Possible referral 17 Low Risk Moderate Risk 18 Brief advice Brief advice or MI

On how many DAYS in the past year did the student drink?

https://pubs.niaaa.nih.gov/publications/Practitioner/YouthGuide/YouthGuide.pdf

P.O.S.I.T.

Developed specifically for ages 12-19 by National Institute on Drug Abuse Total 139 yes/no questions divided into 10 scales Shown to have good reliability and validity among adolescents in primary care settings Difficult to administer quickly while maintaining adolescent’s confidentiality

CH CHOICES OICES …

a program for women on choosing healthy behaviors to prevent AEP

4 or 2 session intervention for women of childbearing age at risk for an AEP

– provides education – explores ambivalence – promotes healthy choices

CHOICES

CHOICES is key ey in pro n providing ding wo wome men n wi with h too

• ols

ls to mak

• make

e he heal althy hy cho hoices ces ab abou

• ut
• red

educ ucing ing al alcoh

• hol
• l us

use

• r
• r
• us

using ng con

• ntrace

raception ption Ideally, women will choose to do both!

Key component

ponent of f CHOICES

Communication

mmunication skills lls th that t are goal-orien

• riented

ted and patient tient-cent centered ered

Designed

signed to to be supportive portive and nonjudgmental judgmental

Motivational Interviewing (MI)

UN UNDE DERST STANDING ANDING AMB MBIV IVALENC ALENCE

Res esponding ponding to to Amb mbiv ivalence alence

“I love throwing back a few with the guys on the weekend, but I do worry a little about my heart.” “I hate the calories in wine, but it helps me unwind after work.” “I’ve never really had any consequences from my alcoho hol l use, but I am concer erne ned that it increases my chances for risk.”

PROVID

VIDE

PE PERS RSON ONAL ALIZE IZED D

FEE

EEDBA BACK

“I’m willing to make some lifestyle changes as long as I don’t have to do anything different.”

Reduce Resistance to Change

Assess

ess readiness diness to to change nge drinking nking and/or /or alcohol

• hol use

Use MI strategies to elicit and reinforce “change talk” Review

view a daily ily journal rnal with th pati tients ents to to ta talk about ut drinking inking and birth th co control trol use se

Support

pport women en in choosing

• sing th

their r own goals ls

Components of CHOICES

Inf nform

• rmation

ation ab abou

• ut imp

mplem ement enting ing CH CHOI OICE CES S can an be be fo foun und d at at ht https://w ps://www.cdc.g ww.cdc.gov/ncbdd

• v/ncbddd/fas

d/fasd/choic d/choices es- imp mplem ementing enting-ch choices.htm

• ices.html

So Why Do We Want to Provide Prevention Services?

Not all prenatal alcohol-related conditions show the identifying physical characteristics Not a clinical diagnosis

(Bertrand et al., 2004)

Associated Conditions with a Range of Effects for an Individual Prenatally Exposed to Alcohol:

Fetal Alcohol Syndrome (FAS) Partial FAS (pFAS) Alcohol-related neurodevelopmental

disorders (ARND)

Alcohol-related birth defects (ARBD) Neurobehavioral disorders associated with

prenatal alcohol exposure (ND-PAE)

(Hartje et al., 2015a; Pierce-Bulger, 2011; Senturias et al., 2015)

Fetal Alcohol Spectrum Disorders (FASDs)

• Continuum of disorders ranging from mild

intellectual & behavioral issues to extreme issues

• May lead to profound disabilities or premature

death

• Caused solely by prenatal alcohol

exposure and are NOT hereditary

• Last a lifetime but there are benefits from

early diagnosis, support, & services

(NCBDDD, 2015)

Facial Dysmorphia

(Astley & Clarren, 2001; Bertrand et al., 2004)

small palpebral fissures

Fetal Alcohol Syndrome

Prenatal and/or postnatal growth deficiency Height and/or weight ≤10th centile Deficient brain growth, abnormal morphogenesis,

• r abnormal neurophysiology

Including ≥1 of the following: Head circumference ≤10th percentile Structural brain anomalies Recurrent nonfebrile seizures

(Clarren , 1994)

(Streissguth & Little, 1994)

Prevalence of FASD Combined rates of 10.9 to 25.2 per 1000 of FAS and PFAS (1.1% -2.5 %)

May, et al, Rocky Mountain Community Plains

Complete FASD continuum 24-48 per 1000 (2.4%-4.8%)

including ARND

Maternal Alcohol Exposure

Documenting maternal alcohol exposure is important, but often difficult to obtain Birth mothers may feel stigmatized and are hesitant to admit to using alcohol during pregnancy Documentation is not essential for diagnosing FAS but IS essential for ND-PAE and ARBD

(FASD Regional Training Centers Curriculum Development Team, 2015, Competency V, pg. 8)

Provider Questions for Patient

How often do you drink beer, wine or liquor? In the past 3 months before you knew you were pregnant, how many times did you have 4 or more drinks in a day? During your pregnancy, how many times did you have 4 or more drinks in a day?

(Bax, Geurts, & Balachova, 2015)

Cognitive or Developmental Deficits

Executive Functioning Deficits

Motor Functioning Delays

Attention Deficit or Hyperactivity

Poor Social Skills

Other Problems (e.g., difficulty responding appropriately to common parenting practices)

Approaches for FASD Treatment

(FASD Regional Training Centers Curriculum Development Team, 2015)

Medical Considerations

Role of PCP Identification, diagnosis and management of FASD  Medical home

(FASD Regional Training Centers Curriculum Development Team, 2015)

Other Medical Issues

Eye/vision and ear/hearing involvement Palatal concerns Growth concerns Immune system concerns

(FASD Regional Training Centers Curriculum Development Team, 2015)

QUESTIONS?

Thank you! Dr. Pam Gillen: pamela.gillen@ucdenver.edu Katie Langland, MA: klangland@yahoo.com