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Center for Integrated Behavioral Health Policy Department of Health Policy, George Washington University Medical Center. Alcohol Screening, Brief Intervention, and Referral to Treatment (SBIRT) in the Workplace: Connecting with the “BIG” EAP Industry Initiative. - PowerPoint PPT Presentation
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Center for Integrated Behavioral Health Policy
Department of Health Policy, George Washington University Medical Center
Eric Goplerud, Ph.D., Tracy McPherson, Ph.DNIATx Webinar
November 18, 2010
Alcohol Screening, Brief Intervention, and Referral to Treatment (SBIRT) in the
Workplace:
Connecting with the “BIG” EAP Industry Initiative
Seed Funding: NHTSA CSAT SAMHSA NETS Alkermes
Corporate SponsorsPilot Sites:
Aetna OptumHealth ValueOptions
Trainer: Denise Ernst PhD
Workplace Alcohol SBI Project: The BIG (Brief Intervention Group)
Initiative
3
Historical Context of EAPs in US Began in 1950’-60’s with a primary focus on Alcohol and Substance
Abuse/Addiction among workers. Originally programs were internal to organizations, known as Occupational
Alcohol Programs and staffed by recovering substance users. Interventions focused on medical withdrawal, 28 day inpatient treatment and
mutual support group involvement (Alcoholics Anonymous). In the early 90’s EAP service delivery moved from internal programs to
external managed care driven programs using large networks of general mental health providers resulting in reduced focus on substance use intervention and identification.
The qualifications and professional training of general mental health provider professionals had with regard to alcohol use focused primarily on addiction and not inappropriate use interventions.
Increased adoption of EAPs
4
http://www.shrm.org/Research/SurveyFindings/Documents/08-0335_BenefitsSR_FINAL_.pdf
Percentage of workers with access to EAPs is growing
5
Stoltzfus E (2009) Access to Wellness and Employee Assistance Programs in the United States. Bureau of Labor Statistics, 2009. http://www.bls.gov/opub/cwc/cm20090416ar01p1.htm
Overall Aim: Adapt alcohol SBIRT approaches developed in medical settings for work-related settings:
EAP Occupational health & safety Health promotion and wellness Disease management
NHTSA/CSAT Workplace SBI Project (2006-2010)
Conduct extensive literature review, surveys and interviews
Convened Workplace SBIRT Product Development Work Group.
Developed a model of workplace SBI.
cont…
8
80% binge and heavy drinkers are employed.1 9% heavy drinkers work full-time.1
Young adult workers (age 18-25) have highest rates of SU disorders2
9.2% worked with a hangover in the past year.3 Heavy drinkers are more likely to have worked for 3+ employers in the past year.4 Heavy drinkers are more likely to have skipped work 2+ days in the past month.4 Workers reporting alcohol dependence/abuse more likely to have missed 2+ days of work due to illness or injury .4 9 in 10 heavy drinkers work for small and medium sized firms.5
1Substance Abuse and Mental Health Services Administration, Office of Applied Studies (2008). Results from the 2007 National Survey on Drug Use and Health: National Findings (NSDUH Series H-34, DHHS Publication No. SMA 08-4343). Rockville, MD. 2Substance Abuse and Mental Health Services Administration. (2006). “Substance Use Disorder and Serious Psychological Distress, by Employment Status” The NSDUH Report Issue 38. 3Frone, M. R. (2006). Prevalence and distribution of alcohol use and impairment in the workplace: A U.S. national survey. Journal of Studies on Alcohol, 76, 147-156. 4 Larson, S.L., Eyerman, J., Foster, M.S., and Gfroerer, J.C. (2007). Worker Substance Use and Workplace Policies and Programs (DHHS Publication No. SMA 07-4273, Analytic Series A-29). Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies. 5Larson, S.L., Eyerman, J., Foster, M.S., and Gfroerer, J.C. (2007). Worker Substance Use and Workplace Policies and Programs (DHHS Publication No. SMA 07-4273, Analytic Series A-29). Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies.
U.S. Workplaces at Risk
A Feasible Workplace SBIRT Approach
(telephonic or face-to-face)
Developed protocols that could be seamlessly integrated into existing EAP practice. Conducted “proof of concept” studies to pilot test approaches and protocols in EAPs. Launched “BIG Initiative” to facilitate EAP adoption of alcohol SBIRT through dissemination of materials and pilot test findings, and training.
cont…
EAP industry-wide campaign kicked-off in Dallas at EAPA to adopt alcohol SBIRT as routine practice of US and Canada EAPs by October 2011.System change campaign, similar to NIATx Action CampaignLearning collaborative facilitated by GW which brings together 100+ organizations in the workplace SBIRT “supply chain”.
What is “BIG”?
EAPs/MBHOsEmployersProfessional Associations CliniciansSBIRT/MI ExpertsResearchers and ConsultantsPharmaceutical CompaniesFederal Agencies
“BIG” Members
National Highway Traffic Safety AdministrationSubstance Abuse and Mental Health Services AdministrationNetwork of Employers for Traffic SafetyAetna Behavioral Health/EAPOptumHealth/UBHValueOptionsOffice of Drug and Alcohol Policy and Compliance, Department
of Labor Office of Demand Reduction, Office of National Drug Control
Policy, Executive Office of the PresidentU.S. Nuclear Regulatory CommissionDepartment of DefenseMaine State Government Federal Occupational Health (FOH)University of Maryland School of Social Work Chestnut Behavioral HealthFirst Sun EAPSELECT, IncCIGNAMagellanAnthem/WellPointMasi ConsultingBurke Consulting
Caterpillar Northrup Grumman Johns Hopkins University and Hospital JP Morgan ChaseHawaii Business Health CouncilNational Business Group on HealthUPSAmtrakContinental Airlines RAND CorporationBaltimore Gas & ElectricHalliburton 3MEAPAEASNACenter for Clinical Social WorkNAADACAssociation of Flight AttendantsAONSt John’s MercyFirst AdvantageThe Rainier GroupReckitt-Benckiser
Brief Intervention Group (“BIG”)
Four Committees Board of Directors – thought leaders,
industry decision-makers provide direction of BIG strategy
Clinical – change EAP provider and network affiliate practice
Systems and Operations – change call center and internal EAP practice
Quality Improvement – identify common metrics (program performance, client outcomes)
What does “BIG” do?
www.EAPBIG.orgShare experiences, materials, support, competition with others in industryGain attention of purchasers and internal organizational leadershipReverse trend towards commodity pricing of EAPs by demonstrating valueReceive free SBIRT Training, Resources, CEUs
How do participants benefit from “BIG”?
16
Prescreening = AUDIT-C (items 1-3)1. How often do you have a drink containing alcohol?
Never Monthly or less 2-4 times a month 2-3 times a week 4 or more times a week
2. How many drinks containing alcohol do you have on a typical day when you are drinking? 1 or 2 3 or 4 5 or 6 7, 8 or 9 10 or more
3. How often do you have five or more drinks on one occasion? Never Less than monthly Monthly Weekly Daily or almost daily
17
Full Screening = AUDIT-C + 7 Remaining AUDIT Items4. How often during the last year have you found
that you were not able to stop drinking once you had started? Never Less than monthly Monthly Weekly Daily or almost daily
5. How often during the last year have you failed to do what was normally expected from you because of drinking? Never Less than monthly Monthly Weekly Daily or almost daily
6. How often during the last year have you needed a first drink to get yourself going after a heavy drinking session? Never Less than monthly Monthly Weekly Daily or almost daily
7. How often during the last year have you had a feeling of guilt or remorse after drinking? Never Less than monthly Monthly Weekly Daily or almost daily
8. How often during the last year have you been unable to remember what happened the night before because you had been drinking? Never Less than monthly Monthly Weekly Daily or almost daily
9. Have you or someone else been injured as a result of your drinking? No Yes, but not in the last year Yes, during the last year
10. Has a relative or friend or doctor or another health worker been concerned about your drinking or suggested you cut down? No Yes, but not in the last year Yes, during the last year
18
Based on risk level
RISK Normative Feedback
ETOH Education
BI using Motivational Interviewing
Appropriate Referral(s)(counseling,
DM, community, other treatment)
Follow-up (Admin, Clinical)
Low(0-7)
(EAP Standard)
Moderate(8-19) or
High (20-40) (30/60 days)
Brief Intervention
Aetna / GWUAlcohol SBIRTPilot Research Findings
20
Site Characteristics: Large U.S. Employer (Financial Services Industry) 147,000 employees 33% young adults(≤30 yrs), 53% adults(31-50),14% older adults(≥51) 70% female, 30% male 93% self- or management referrals Non-emergent, self-referral cases
Design: Pre-test Post-test One Group Pre-experimental
Training: Face-to-Face and Telephonic Coaching
21
Pilot: Initial Results @ 5 months 295 employees offered SBIRT 93% (n=274) completed AUDIT-C (7% ineligible/refused) Prescreen Results (n=110 positive)
22
Pilot: Initial Results @ 5 months 87% (n=96) prescreen positives completed full AUDIT Screening Results (n=50 positive screens)
23
Pilot: Initial Results @ 5 months
IDENTIFICATION RATE (Aetna) 18.23% based upon standardized screening for
hazardous/harmful drinking or alcohol dependence 6% based upon presenting problem while using SBIRT protocol
IDENTIFICATION RATE (prior vendor data) < 1%
78% agreement to follow-up (members offered SBI at intake)
72% set an appointment for face to face counseling (members offered SBI at intake)
EAP Return On InvestmentUsing SBI and The Work Limitations QuestionnairePreliminary Findings
Work Limitations Questionnaire -SFDeveloped and well validated tool by Dr. Debra Lerner (Tufts University) to measure
productivity and presenteeism
Generates -A summary score of productivity loss due to presenteeism
Productivity Loss Score - estimated percent difference in an employee’s at-work productivity compared to employees who do not have health-related work limitations (a healthy benchmark group).
Degree of Impact of Health Problems (Physical & Emotional Health) on Work
Four scale scores (4 work limitation scales) Time Management Physical Mental-Interpersonal Output
Past 2 Weeks Self Report
rate the frequency of difficulty (or, on one scale, ability) performing specific job demands persons who are currently employed
Suitable for Repeating at Multiple Time Intervals
WLQ Levels of Data
Summary Score
% Productivity Lost Compared to Benchmark
Job Level
% Time with Impaired Job Performance
Task Level
% Time with Impaired Task Performance
Time Management
Physical Demands
Mental-Interpersonal Demands
Output Demands
25 Items
Average Audit Score: All Cases
10.62
5.01
0
2
4
6
8
10
12
Audit Score Average
IntakePost Intervention
Average AUDIT Score: Moderate and High Risk at Intake
16.81
9.44
02468
1012141618
Average Audit Score
IntakePost Intervention
40.7
19.423.8
11.9
40.4
18.6
32.5
15.3
9.54.7
.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
WLQ Scales
Job Performance Deficits Underlying Productivity Lost
Initial Score
Discharge Score
Most
Limited
Least Limited
WLQ Productivity Loss Due to Overall Presenteeism
8.89%
4.50%
0.00%1.00%2.00%3.00%4.00%5.00%6.00%7.00%8.00%9.00%
Presenteeism Score
Intake Post Intervention
31
Initial Productivity Loss
Discharge Productivity Loss
Productivity Cost Savings Impact
Population 343 343
% Productivity Loss
8.89% 4.50% 4.38% gain in productivity
Average Productivity $/EE
$2,878 $1,458 $1,420
Total Productivity Cost
$987,207 $500,086 $487,120
WLQ EAP Participant Productivity Loss and Estimated Cost Impacts
0
100
200
300
400
500
600
9-Jun 9-Jul 9-Aug 9-Sep 9-Oct 9-Nov 9-Dec 10-Jan Feb (est)
ValueOptions EAP SBI Pilot
alcohol screens
alcohol positives
audit completed
Pre-SBITime
Period(n=681)
Post-SBI Time
Period(n=383)
p-value
EAP Alcohol Identification Hazardous alcohol use 7.5% (51) 20.1% (77) <0.0001 Alcohol abuse/dependence 7.1 (48) 10.4% (40) 0.0536 EAP Telephonic Alcohol Interventions Alcohol education & risk reduction
9.8% (67) 13.3% (51) 0.0465
Alcohol intervention options 9.5% (65) 10.7% (41) 0.5442
OptumUnited Alcohol SBI Pilot
Greenwood G, Goplerud E, McPherson T (2010) Delivering brief alcohol-related interventions with a telephonic EAP. Journal of Employee Assistance. 16-18.
34
What comes next? The BIG Initiative Strategic Plan
Wider and deeper penetration of EAPs to deliver alcohol SBIRT
Broad, ubiquitous training of office-based clinicians in SBIRT. EAPA, EASNA, NAADAC, CCSW common SBIRT training
plan.
Outcomes evaluations, especially business relevant outcomes
Extension of BIG to additional conditions Broadening financial base for sustainability
35
Workplace SBIRT Resources World Health Organization’s SBI Manuals:
AUDIT: http://whqlibdoc.who.int/hq/2001/WHO_MSD_MSB_01.6a.pdf Brief Intervention: http://whqlibdoc.who.int/hq/2001/WHO_MSD_MSB_01.6b.pdf
SAMHSA SBIRT Initiative: http://sbirt.samhsa.gov/
Motivational Interviewing: www.motivationalinterview.org/ TIP 35 Manual: www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat5.chapter.61302
Workplace SBIRT Toolkit: www.ensuringsolutions.org/solutions/solutions_show.htm?doc_id=450551
Alcohol Education/Self-Help: Rethinking Drinking: www.rethinkingdrinking.niaaa.nih AlcoholScreening.Org
Workplace SBI Publications: What Employers Can and Should Do About Excessive Alcohol Use:
www.ensuringsolutions.org/resources/resources_show.htm?doc_id=673239&cat_id=963 Literature Review www.ensuringsolutions.org/allies/allies_show.htm?doc_id=431629&cat_id=969 McPherson, T.L., Goplerud, E., et al. (2009). Workplace alcohol screening, brief intervention, and
referral to treatment (SBIRT): A survey of employer and vendor practices. Journal of Workplace Behavioral Health, 24(3).
EAPA Learning Center (Free session) New Tools for EAPs to Deliver Higher Levels of Value (2009 World Conference)
http://www.softconference.com/eapa/sessionDetail.asp?SID=184750
THANK YOU!