Technical Assistance Webinar
Provider/Client Reminder and Recall Systems to Increase Colon Cancer Screening Presented by: Pamela has more than 40 years of experience in the Pamela Gillen, ND field of health and prevention. Pamela has Project Director practiced as a public health nurse coordinator and University of Colorado Denver nurse case manager for at risk pregnancies working Fetal Alcohol and other with high-risk women of childbearing age. She has Prenatal Substances been a co-chair elect for National FASD Center for Prevention Project (COFAS) 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 of Denver.
Provider/Client Reminder and Recall Systems to Increase Colon Cancer Screening Katie provided training and technical assistance to American Indian/Alaska Native groups under the Centers for Disease Control and Prevention Presented by: Cooperative Agreement. While the Public Health Katie Langland, MA Training Coordinator, Katie designed and developed Program Manager and health curriculum, website content, and trainings Coordinator for Tribal Choice including patient navigation, preconception health, Denver Public 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.
Faculty Disclosure Statement • 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.
Resources http://www.itcmi.org/asbiwebinar/ • Webinar Archive Video • Resources
Learning Objectives/Outcomes 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.
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 ong 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 of 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
Percentage of Unintended Pregnancies What percentage of pregnancies in the United States are unintended? a) 10% b) 25% c) 40% d) 45%
Alcohol and Unintended Pregnancies • 45% 45% U.S. pregnancies are unintended • Majority due to not using or incorrectly using contraception • Most women don’t know they are pregnant until 4-6 weeks
More than 3 million women in the US are at risk for an alcohol-exposed pregnancy. (CDC, 2016)
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. Re Redu duce e risky ky dr drink nking ing 1. 2. Us Use e bi birth h con ontrol ol ef effec ectively tively 2.
Alcohol Screening and Brief Intervention Va Validat dated ed set et of of screen eening ing qu ques estions ions to o identify tify drinking ing patterns ns Sh Shor ort con onversat ersation ion wi with h pa patient ents s wh who o 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
Planning and Implementing Screening and Brief Intervention for Risky Alcohol Use provides the steps required to plan, adapt, and implement alcohol SBI as a routine element of standard clinical practice.
Key to Reducing Risky Drinking 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 ohol use disorders sorders to to tr treatmen tment
Lower Risk Drinking Limits to 1 drink Up to nk per day fo for women en to 2 drinks Up to nks per day y fo for men than 3 drinks No more e th nks on one occasion asion fo for women en (and nd men over r age 65) than 4 drinks No more e th nks on one occ ccasion asion fo for men
S TEP 1. Set the Stage for Screening 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 oid 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 out alco cohol hol as s part rt of f routi tine ne care.
S TEP 2. Use Validated Screening Tools 1. NIA IAAA AA Single gle Qu Question tion Alcohol ohol Screen een 1. 2. USAUD SAUDIT IT-C C 2. (Fi First rst 3 questions stions fr from th the AUDIT) IT)
Single Question Alcohol Screen “How many times in the past year have you had X or more drinks in a day?” (X = 5 for men; 4 for women) Any answer over 0 is a positive screen and should be further assessed. (Smith et al., 2009)
USAUDIT-C Q UESTIONS 0 1 2 3 4 5 6 S CORE 1. How often do you Never Less Monthly Weekly 2-3 4-6 Daily than have a drink times times monthly containing alcohol? a a week week 2. How many drinks 1 2 3 4 5-6 7-9 10 or more containing alcohol do drink drinks drinks drinks drinks drinks drinks you have on a typical day you are drinking? 3. How often do you 2-3 4-6 Daily Never Less Monthly Weekly than have X ( 5 for men; 4 times times monthly a a for women & men over week week age 65 ) or more drinks on one occasion? T OTAL
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)
Negative Screen Af Affir irm m Ad Advise se Op Open en do door or Re Rescr creen een an annu nual ally ly
Positive Alcohol Screen As Assess ess fur urther her
Brief Intervention Con onversation 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 out t al alcoh ohol ol us use
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
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