Transcript Center for Integrated Behavioral Health Policy Department of Health Policy, George Washington University Medical Center Alcohol Screening, Brief Intervention, and Referral to Treatment.

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
Eric Goplerud, Ph.D., Tracy McPherson, Ph.D
NIATx Webinar
November 18, 2010
Workplace Alcohol SBI Project:
The BIG (Brief Intervention Group) Initiative
Seed Funding:
 NHTSA
 CSAT
 SAMHSA
 NETS
 Alkermes
Corporate Sponsors
Pilot Sites:
 Aetna
 OptumHealth
 ValueOptions
Trainer:
 Denise Ernst PhD
Historical Context of EAPs in US
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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
http://www.shrm.org/Research/SurveyFindings/Documents/08-0335_BenefitsSR_FINAL_.pdf
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Percentage of workers with
access to EAPs is growing
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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
NHTSA/CSAT
Workplace SBI Project (2006-2010)
Overall Aim:
Adapt alcohol SBIRT approaches developed
in medical settings for work-related settings:
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EAP
Occupational health & safety
Health promotion and wellness
Disease management
cont…
Conduct extensive literature review,
surveys and interviews
Convened Workplace SBIRT Product
Development Work Group.
Developed a model of workplace SBI.
U.S. Workplaces at Risk
 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.
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A Feasible Workplace SBIRT Approach
(telephonic or face-to-face)
cont…
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.
What is “BIG”?
EAP industry-wide campaign kickedoff 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 Campaign
Learning collaborative facilitated by
GW which brings together 100+
organizations in the workplace
SBIRT “supply chain”.
“BIG” Members
EAPs/MBHOs
Employers
Professional Associations
Clinicians
SBIRT/MI Experts
Researchers and Consultants
Pharmaceutical Companies
Federal Agencies
Brief Intervention Group (“BIG”)
National Highway Traffic Safety Administration
Substance Abuse and Mental Health Services Administration
Network of Employers for Traffic Safety
Aetna Behavioral Health/EAP
OptumHealth/UBH
ValueOptions
Office of Drug and Alcohol Policy and Compliance, Department
of Labor
Office of Demand Reduction, Office of National Drug Control
Policy, Executive Office of the President
U.S. Nuclear Regulatory Commission
Department of Defense
Maine State Government
Federal Occupational Health (FOH)
University of Maryland School of Social Work
Chestnut Behavioral Health
First Sun EAP
SELECT, Inc
CIGNA
Magellan
Anthem/WellPoint
Masi Consulting
Burke Consulting
Caterpillar
Northrup Grumman
Johns Hopkins University and Hospital
JP Morgan Chase
Hawaii Business Health Council
National Business Group on Health
UPS
Amtrak
Continental Airlines
RAND Corporation
Baltimore Gas & Electric
Halliburton
3M
EAPA
EASNA
Center for Clinical Social Work
NAADAC
Association of Flight Attendants
AON
St John’s Mercy
First Advantage
The Rainier Group
Reckitt-Benckiser
What does “BIG” do?
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)
How do participants benefit from
“BIG”?
www.EAPBIG.org
Share experiences, materials, support,
competition with others in industry
Gain attention of purchasers and
internal organizational leadership
Reverse trend towards commodity
pricing of EAPs by demonstrating value
Receive free SBIRT Training, Resources,
CEUs
Prescreening = AUDIT-C (items 1-3)
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2.
3.
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How often do you have a drink containing alcohol?
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Never
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Monthly or less
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2-4 times a month
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2-3 times a week
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4 or more times a week
How many drinks containing alcohol do you have on a typical day when you are drinking?
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1 or 2
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3 or 4
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5 or 6
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7, 8 or 9
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10 or more
How often do you have five or more drinks on one occasion?
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Never
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Less than monthly
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Monthly
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Weekly
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Daily or almost daily
Full Screening = AUDIT-C + 7 Remaining
AUDIT Items
4.
How often during the last year have you found
that you were not able to stop drinking once
you had started?
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5.
6.
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8.
Never
Less than monthly
Monthly
Weekly
Daily or almost daily
9.
No
Yes, but not in the last year
Yes, during the last year
Has a relative or friend or doctor or another
health worker been concerned about your
drinking or suggested you cut down?
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Never
Less than monthly
Monthly
Weekly
Daily or almost daily
Have you or someone else been injured as a
result of your drinking?
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10.
Never
Less than monthly
Monthly
Weekly
Daily or almost daily
How often during the last year have you been
unable to remember what happened the night
before because you had been drinking?
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Never
Less than monthly
Monthly
Weekly
Daily or almost daily
How often during the last year have you
needed a first drink to get yourself going after
a heavy drinking session?
How often during the last year have you had a
feeling of guilt or remorse after drinking?
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Never
Less than monthly
Monthly
Weekly
Daily or almost daily
How often during the last year have you failed
to do what was normally expected from you
because of drinking?
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7.
No
Yes, but not in the last year
Yes, during the last year
 Brief Intervention
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)
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(30/60 days)
Aetna / GWU
Alcohol SBIRT
Pilot Research Findings
 Site Characteristics:
 Large U.S. Employer (Financial Services Industry)
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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
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Pilot: Initial Results @ 5 months
 295 employees offered SBIRT
 93% (n=274) completed AUDIT-C (7% ineligible/refused)
 Prescreen Results (n=110 positive)
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Pilot: Initial Results @ 5 months
 87% (n=96) prescreen positives completed full AUDIT
 Screening Results (n=50 positive screens)
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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)
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EAP Return On Investment
Using SBI and The Work Limitations
Questionnaire
Preliminary Findings
Work Limitations Questionnaire -SF
Developed 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
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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)
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Past 2 Weeks
Self Report
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Time Management
Physical
Mental-Interpersonal
Output
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
Job Level
Task Level
% Productivity
Lost Compared
to Benchmark
% Time with
Impaired Job
Performance
% Time with
Impaired Task
Performance
Time
Physical
Management Demands
MentalInterpersonal
Demands
Output
Demands
25 Items
Average Audit Score:
All Cases
10.62
12
10
8
5.01
Intake
Post Intervention
6
4
2
0
Audit Score Average
Average AUDIT Score:
Moderate and High Risk at Intake
16.81
18
16
14
12
9.44
10
Intake
Post Intervention
8
6
4
2
0
Average Audit Score
Most
Limited
Job Performance Deficits Underlying Productivity Lost
Initial Score
45.0
40.7
40.4
40.0
Discharge Score
32.5
35.0
30.0
25.0
20.0
Least
Limited
23.8
19.4
18.6
15.0
15.3
11.9
9.5
10.0
4.7
5.0
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WLQ Scales
WLQ Productivity Loss
Due to Overall Presenteeism
9.00%
8.89%
8.00%
7.00%
6.00%
5.00%
4.50%
4.00%
3.00%
2.00%
1.00%
0.00%
Presenteeism Score
Intake
Post Intervention
WLQ EAP Participant Productivity Loss
and Estimated Cost Impacts
Initial
Discharge Productivity
Productivity Productivit Cost Savings
Loss
y Loss
Impact
Population
343
343
% Productivity
Loss
8.89%
4.50%
4.38% gain in
productivity
Average
$2,878
Productivity $/EE
$1,458
$1,420
Total Productivity $987,207
Cost
$500,086
$487,120
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ValueOptions EAP SBI Pilot
600
500
400
alcohol screens
alcohol positives
300
audit completed
200
100
0
9-Jun
9-Jul
9-Aug
9-Sep
9-Oct
9-Nov
9-Dec
10-Jan
Feb (est)
OptumUnited Alcohol SBI Pilot
Pre-SBI
Time Period
(n=681)
Post-SBI
Time Period
(n=383)
p-value
7.5% (51)
20.1% (77)
<0.0001
7.1 (48)
10.4% (40)
0.0536
Alcohol education & risk reduction
9.8% (67)
13.3% (51)
0.0465
Alcohol intervention options
9.5% (65)
10.7% (41)
0.5442
EAP Alcohol Identification
Hazardous alcohol use
Alcohol abuse/dependence
EAP Telephonic Alcohol Interventions
Greenwood G, Goplerud E, McPherson T (2010) Delivering brief alcohol-related interventions with a
telephonic EAP. Journal of Employee Assistance. 16-18.
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
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 Broadening financial base for sustainability
Workplace SBIRT Resources
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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
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SAMHSA SBIRT Initiative:
 http://sbirt.samhsa.gov/
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Motivational Interviewing:
 www.motivationalinterview.org/
 TIP 35 Manual: www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat5.chapter.61302
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Workplace SBIRT Toolkit:
 www.ensuringsolutions.org/solutions/solutions_show.htm?doc_id=450551
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Alcohol Education/Self-Help:
 Rethinking Drinking: www.rethinkingdrinking.niaaa.nih
 AlcoholScreening.Org
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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
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THANK YOU!