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NCHIP Learning Collaborative on High Risk Drinking Progress Report

April 2012

NCHIP (National College Health Improvement Project) was founded in 2011 by Dartmouth College President Jim Yong Kim to improve student health at colleges and universities, with an emphasis on high risk drinking, through the application of population health solutions. Building on a collaborative model of rapid change created by the Institute of Healthcare Improvement, NCHIP has brought evidence to bear on the practice and measurement of outcomes.

The Collaborative—NCHIP's inaugural effort—began in April 2011 as teams from 32 colleges and universities came together to test multiple change ideas targeted at individual drinkers, the environment in which they drink, and the larger system, all in an effort to reduce high-risk drinking and its related harms on their campuses.

High-risk drinking affects nearly four of ten college students and contributes to approximately 1,800 student deaths each year. The Collaborative represents an unprecedented approach to improving the health of college students.

Beginning in June 2011, teams from the participating schools met for their first face-to-face learning session, the start of a two-year process. The teams work with experts to make change and promote learning across the Collaborative. Their work is facilitated through three face-to-face learning sessions – with work also taking place between the sessions. Additionally, the teams participate in monthly Collaborative calls, and use a web-based work space to report progress and results.

From July to December in 2011, the teams engaged in rapid tests of change called "Plan, Do, Study, Act," or PDSAs designed to reduce harmful drinking. This first round of PDSAs focused primarily on initiatives involving the individual college drinker.

More than 170 PDSAs were undertaken by the teams, with a vast majority of these changes focused on individual-drinker initiatives such as increasing student and parent awareness and engagement, screening to identify potential at-risk students, and implementing brief interventions with students following an alcohol-related incident. The primary goal was to find the right intervention for the right person at the right time.

College and university teams have been encouraged to develop and implement measurement plans that allow for monthly data collection to monitor their progress. These measures consist of student survey data on high-risk drinking and its related harms, as well as information on the rates of medical and law enforcement intervention in incidents involving alcohol. This frequent measurement will allow teams to track and assess the impact of their changes over time.

The second face-to-face learning sessions, in January 2012, emphasized the environment—the places and spaces in which high-risk drinking takes place on and around college campuses. The college teams considered policies and codified standards for behavior in the community, and the enforcement, communication, and messaging of those policies as a foundation for embarking on comprehensive environmental change. The teams are currently engaged in sustaining individual-drinker initiatives, and also planning and executing tests of environmental change.

The third learning session, to be held in July 2012, will focus on the overall system of alcohol prevention and sustainability. The components of this work will include addressing the entire student population and multiple problem areas, linking evidence-based strategies in meaningful ways to create maximum effectiveness, implementing each strategy fully, continuing to measure and evaluate performance, and working across campus departments and communities in sustaining these efforts.

The Learning Collaborative is not yet halfway over, but has already accomplished a great deal. Promising preliminary results indicate that the Green Team, a student-run organization whose members monitor student college events where alcohol is served at the request of a party's hosts, is making a positive difference. The goal of the Green Team, modeled after the successful Quaker Bouncers program at Haverford College, is to provide students with the skills to recognize and intervene effectively in potentially dangerous situations involving alcohol. Other schools in the Collaborative are developing their own unique programs based on Dartmouth's success with The Green Team. Equally promising is the incorporation of alcohol screenings during on-campus primary care visits. Students who report high-risk drinking receive an evidence-based brief intervention from their primary care provider at that appointment.

July 2013 will mark the end of the two-year Collaborative period, culminating in a summative congress to synthesize, summarize, and broadly disseminate NCHIP's findings. We expect the work to continue beyond this time, particularly as teams track data and progress, and learn whether these groundbreaking efforts lead to a reduction in high-risk drinking and its related harm.