1. The Denver Collaborative to Reduce Alcohol-Exposed Pregnancy Kellie Teter, Karen Peterson, Pam Gillen, Grace Alfonsi & Team October 2012 PSEP Meeting

2. Context Denver Health and Hospital Authority (Denver Health) is the largest safety net health care system in Colorado, and in fact in Region VIII It is an integrated health care system, joining a hospital with neighborhood community health centers Denver Public Health (DPH) is a Department of Denver Health

3. Context, cont. Through its Community Health Services, Denver Health provides primary care (medical, dental and mental health) to about 20% of adults and 35% of children residing in Denver County Over 3500 deliveries occur yearly at Denver Health Despite this integrated system and efforts to streamline services, however, Denver Health and DPH continue to operate within numerous silos

4. Context, cont. No alcohol or contraceptive use data (except anecdotal) from entirety of DH system The STD clinic at DPH has data in reproductive age women (2010 – 11) –34% report binge, 20% heavy, and 19% both binge and heavy drinking –Therefore, 35% report risky drinking –The risky drinking women have an ineffective contraception rate of 60% Binge drinking = 4 or more drinks on at least one occasion in the last 90 days Heavy drinking = 8 or more drinks/week during at least one week in the last 90 days

5. LEAN Process

6. Identifying Initial Condition Black box about what happens at this step because no consistent documentation is required }

7. Initial Condition

8. Target Condition

9. Progress: EMR Questions DH is adopting a new electronic medical record (EMR) Team was able to identify and influence key participants in the EMR process to ensure alcohol, drug and tobacco screening would be mandatory components of the EMR SBIRT questions formed the backbone of these sections Contraceptive questions still in progress but will be detailed as the CHS sites are Title X sites

10. New EMR: Alcohol/Drug Questions

11. New EMR: Tobacco Questions

12. Progress: Educational Modules Prior to rollout of EMR in 1/13, plan is to educate staff about AEP so that they utilize the new EMR capability well Team has been developing 10-minute educational modules to deliver in clinic settings across the DH system

13. Educational Modules, cont. Team educators will negotiate with the clinics about how much time is available and which topics are most important for their staffs Goal is to deliver as many modules as possible –as a single presentation –as short presentations spread over time

14. Module topics 1.How much is too much? 2.Why is too much alcohol bad news? 3.Fetal development and substance use 4.Use vs. Abuse vs. Dependence 5.Techniques to cut down and/or quit alcohol use 6.Youth Health and substance use 7.Marijuana information and side effects

15. What is one drink? 1/2 Oz. Absolute Alcohol 12 oz. Beer X 4% alcohol =.48 oz. AA 4 oz. Wine X 12% alcohol =.48 oz. AA 1.2 oz. Liquor X 40% alcohol =.48 oz. AA Beer Table wine Hard Liquor Module 1: How much is too much?

16. Alcohol Metabolism Approximate Blood Alcohol Concentrations (BAC) 130 pound woman (after 1, 2 or 3 drinks in one hour) Module 2: Why is too much alcohol bad news?

17. Timeline of Fetal Development Module 3: Fetal development and substance use

18. Diffusion of Alcohol Across Placenta Following ONE Drink Module 3: Fetal development and substance use

19. lifetime abstinence current abstinence low risk drinking hazardous drinking harmful drinking dependence symptoms dependence 25% 71% 4% Module 5: Use vs. Abuse vs. Dependence Encourage to continue current behavior Brief Intervention Refer for Treatment

20. 25% 71% 4% Module 5: Use vs. Abuse vs. Dependence Low-risk or no Alcohol Use Excessive Alcohol Use Alcohol Dependent

21. Posters/Presentations Denver Health Day of Celebration (5/12) Colorado AHEC Conference (9/12) APHA Conference (11/12) CityMatCH Conference (12/12)