1. 2121 K Street, NW, Suite 210 Washington, DC 20006 Center for Integrated Behavioral Health Policy Department of Health Policy, George Washington University Medical Center

2. Implementing Alcohol Screening and Brief Intervention in Your EAP Chesapeake EAPA January 6, 2011 Eric Goplerud PhD Tracy L. McPherson, PhD

3. Presenters  Eric Goplerud, PhD Research Professor and Director Center for Integrated Behavioral Health Policy Ensuring Solutions to Alcohol Problems Department of Health Policy George Washington University Medical Center Washington, DC goplerud@gwu.edu  Tracy L. McPherson, PhD Assistant Research Professor Center for Integrated Behavioral Health Policy Ensuring Solutions to Alcohol Problems Department of Health Policy George Washington University Medical Center Washington, DC esap1234@gmail.com

4. Learn about and receive a copy of the World Health Organization’s AUDIT- C/AUDIT – a brief, validated alcohol screening tools that can be integrated into routine EAP practice to identify risky alcohol use. Learn to relate appropriate levels of brief intervention to level of alcohol use risk. Today’s Objectives:

5. Learn to use SBIRT protocols informed by Motivational Interviewing (MI) to assist clients in behavioral change. Learn about NIAAA’s alcohol education and self-management resources (e.g., “Rethinking Drinking”) for clients. Today’s Objectives:

6. Learn about the “BIG” Initiative EAP learning collaborative and how you can benefit Learn about (and take-away) “BIG” materials and resources to help you integrate alcohol SBIRT in your EAP practice. Learn about research findings and implementation tips from EAP pilot tests. Bonus Elements:

7. Agenda Background and Rationale  Workplace SBIRT Project  The BIG Initiative What is SBIRT? Alcohol Screening Tools Components of Brief Intervention Motivational Interviewing Strategies SBIRT Protocols Using AUDIT (with/without MI)

8. Bonus Elements Implementation Tips from Pilots EAP Pilot Test Findings More “BIG” Resources Demonstrating Impact and Value  Easy-to-Use Outcome Measures

9. Seed Funding:  NHTSA  CSAT  SAMHSA  NETS  Alkermes Corporate Sponsors Pilot Sites:  Aetna  OptumHealth  ValueOptions Trainer:  Denise Ernst PhD, Training and Consultation http://www.deniseernst.com http://www.deniseernst.com Workplace Alcohol SBI Project Partners: The BIG Initiative

10. 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)

11. Conducted extensive literature review, surveys, interviews, convened advisory panel. Developed a conceptual model (a feasible approach) of workplace SBI. cont…

12. A Feasible EAP Approach (telephonic or face-to-face)

13. 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…

14. EAP industry-wide initiative kicked- off in Dallas at EAPA to adopt alcohol SBIRT as routine practice by 2011. Learning collaborative facilitated by GW which brings together 80+ organizations in the SBIRT “supply chain”. What is “BIG”?

15. EAPs/MBHOs Employers Professional Associations Clinicians SBIRT/MI Experts Researchers and Consultants Pharmaceutical Companies Federal Agencies “BIG” Members

16. 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 Brief Intervention Group (“BIG”)

17. 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?

18. www.EAPBIG.org FREE SBIRT Training Materials and Resources Connect with BIG members on LinkedIn Earn CE/PDHs by participating in BIG events  EAPA chapter meetings; regional and national conference events  EASNA annual meeting How can you benefit from “BIG”?

19. Heavy drinking (5+ drinks on one occasion) increases risk of depression, sleep problems, hypertension, and cancer 3 in 10 adults drink at levels that increase risk of physical, mental health, and social problems (NIAAA) So…Why Should EAP Providers Care About Alcohol SBIRT and BIG?

20. Alcohol Problems Nearly as Prevalent as Diabetes Alcohol Abuse & Dependence Diabetes 17.6 million 1 18.2 million 2 A References: 1.Grant BF, et al. Alcohol Res. and Health. 2006; 29:77. 2.National Center for Chronic Disease and Prevention and Health Promotion. National Diabetes Fact Sheet. http://www.cdc.gov/diabetes/pubs/estimates.htm. Accessed June 25, 2008.

21. How Many Get identified? ~ 8% of U.S. adults has a diagnosable alcohol use disorder (NSDUH, 2005) 92% 8%

22. How Many Get Identified? Health plans identify <1% of members (NCQA, 2007)

23. Office of Applied Studies. (2004). Results from the 2003 National Survey on Drug Use and Health: National findings. Rockville, MD: Substance Abuse and Mental Health Services Administration.

24. Alcohol problems have a profound impact on the workplace, its employees and their families:  80% of problem drinkers are employed  60% of alcohol-related absenteeism, tardiness, and poor work quality are caused by at-risk drinkers  20% of employees have covered for a coworker, required to work harder, or injured due to coworkers drinking more reasons…

25. Economic Costs of Alcohol Problems Greater than High Blood Pressure, Asthma and Diabetes… …Combined $185 billion 1,2 $40 billion 2 $11 billion 2 $98.1 billion 2 Alcohol Abuse & Dependence High Blood Pressure Asthma Diabetes References: 1.National Institute on Alcohol Abuse and Alcoholism. Updating Estimates of the Economic Costs of Alcohol Abuse in the United States: Estimates, Update Methods, and Data. http://pubs.niaaa.nih.gov/publications/economic-2000. Accessed June 25, 2008. 2.The George Washington University Medical Center. Ensuring Solutions to Alcohol Problems. Primer 1: Treating Alcoholism as a Chronic Disease. http://www.ensuringsolutions.org/usr_doc/PDF_Version_of_Primer.pdf. Accessed June 18, 2008.

26. EAPs play a vital role to employers and workers  Millions of workers rely on EAP for confidential help for mental health, substance use, work stress and family issues.  Employers see EAP as a crucial resource.  EAPs are uniquely positioned to “case find” (alcohol misuse is not a common presenting problem). more reasons…

27. Brief, evidence-based approaches exist for EAP providers to enhance existing practice and increase value of services. “BIG” provides EAP providers with materials and resources to do SBIRT. Making the right thing to do, the easy thing to do. More reasons…

28. Alcohol identification rates by EAP providers remain abysmal!  ~ 160,000 EAP alcohol cases each year (Amaral 2009)  Baseline identification <1 to 5% (GW pilot studies) Historically EAP providers have focused on workers with alcohol addiction. EAP providers have not focused on early intervention to identify at-risk drinkers but don’t meet diagnostic criteria. “BIG” Challenges

29. Who Are We Trying to Reach? 5% (6.25 million) Daily Harmful Drinking or dependence behavior 20% (26.25 Million) At Risk Exceed daily limits 70 % ( 87.5 Million) Occasional or non drinkers, seldom exceed daily limits for alcohol consumption  1% Historical EAP focus  25% engaged in risky, harmful or hazardous drinking  32.5 million people could benefit from brief intervention 1%(1.25) Addicted Spectrum of Alcohol Use

30. How do we identify workers at risk? “Case Finding” through SBIRT

31. What is SBIRT?  S: Screening using a validated tool  BI: Brief Intervention using an evidence-based framework  RT: Referral to Treatment  SBIRT: Screening, Brief Intervention and Referral to Treatment  Follow-up: administrative, clinical, outcomes  MI: Motivational Interviewing

32. Approach developed in the medical setting (trauma, ED), backed by scientific evidence of effectiveness. Recent efforts to adapt for EAP and other behavioral settings (e.g., community health centers). What is SBIRT?

33. Increase early identification of clients at risk for alcohol problems. Build awareness and educate clients on U.S. guidelines and risks associated with alcohol use. Motivate at-risk clients to reduce unhealthy, risky alcohol use; adopt health promoting practices. Motivate clients to seek help for alcohol use. Aim of SBIRT

34. http://pubs.niaaa.nih.gov/publi cations/arh28-1/toc28-1.htm http://pubs.niaaa.nih.gov/publi cations/arh28-2/toc28-2.htm Evidence behind SBIRT

35. Identification Rates at 5 months approached U.S. population estimates  18.5% using AUDIT screening tool  6% based on “presenting problem”  At baseline: < 1% (prior vendor data) Aetna Pilot Findings McPherson, T.L., Goplerud, E., Derr, D., Mickenberg, J., Courtemanche, S. (in press, 2010). Telephonic Screening and Brief Intervention for Alcohol Misuse Among Workers Contacting the Employee Assistance Program: A Feasibility Study. Drug and Alcohol Review.

36. 78% agreement to follow-up by EAP clinician 72% set an appointment for face-to-face counseling Findings at 5 Months McPherson, T.L., Goplerud, E., Derr, D., Mickenberg, J., Courtemanche, S. (in press, 2010). Telephonic Screening and Brief Intervention for Alcohol Misuse Among Workers Contacting the Employee Assistance Program: A Feasibility Study. Drug and Alcohol Review.

37. Pre-SBI Time Period (n=681) Post-SBI Time Period (n=383) p-value EAP Alcohol Identification Hazardous alcohol use7.5% (51) 20.1% (77) <0.0001 Alcohol abuse/dependence7.1% (48) 10.4% (40) 0.0536 OptumHealth EAP Replicated Findings Greenwood, G., Goplerud, E., McPherson, T.L., Azocar, F., Baker, E., & Dybdahl, S. (in press, 2010). Alcohol Screening & Brief Intervention (SBI) in Telephonic EAP. Journal of Workplace Behavioral Health.

38.  Alcohol use to intoxication (5+ drinks) declined 38.4%  Use of any illegal drugs decreased 49.6%  Nearly 50% of those who received a BI changed patterns of misuse N = 11 States Federal SBIRT Demonstration Findings Adapted from Tom Stegbauer, DHHS, 2008

39. QUESTIONS?

40. Components of SBIRT

41. SBIRT Core Components Screening Identification of behavioral problems/risk (alcohol, tobacco,drugs, depression) Brief Intervention Raises awareness of risks and reinforces staying at low risk Referral to TX Referral of those with more serious or complicated mental or substance use conditions Brief Intervention/ Brief Treatment Cognitive behavioral, medications with clients who acknowledge risks and are seeking help High Moderate Low Adapted from Tom Stegbauer, DHHS, 2008

42. Heterogeneity of Alcohol Use Never exceeds daily limits Exceeds daily limits No distress or harm Exceeds daily limits Harmful Daily or near daily heavy drinking Impaired control 3-5 criteria Daily or near daily heavy drinking Chronic or relapsing 6-7 criteria Functional impairment None Mild (“At-risk”) Moderate (Harmful use) Severe (Dependence) Chronic dependence 70%~21%~5%~3%~1% DSM-IV Abuse/Dependence EAP and Workplace BH Programs

43. NIDA Single-Item Drug Use "How many times in the past year have you used an illegal drug or used a prescription medication for non-medical reasons?” Identifies overall drug use Positive screen = 1 or more Provide BI /RT Barclay, Laurie (2010). Single Screening Question May Identify Drug Use in Primary Care. Arch Intern Med. 2010;170:1155-1160

44. NIAAA Single-Item Alcohol Use "How many times in the past year have you had X or more drinks in a day?"  X = 5 for men, 4 for women  Identifies unhealthy alcohol use  Positive screen = 1 or more (provide BI) Barclay, Laura (2009). Single Screening Question May Accurately Identify Unhealthy Alcohol Use. J Gen Intern Med.

45. Alcohol Screening (handout)  AUDIT-C  AUDIT

47. 47 AUDIT Alcohol Use Disorder Identification Test Developed by WHO English:http://whqlibdoc.who.int/hq/20 01/WHO_MSD_MSB_01.6a.pdfhttp://whqlibdoc.who.int/hq/20 01/WHO_MSD_MSB_01.6a.pdf Spanish:http://www.who.int/substanc e_abuse/activities/en/AUDITmanualS panish.pdfhttp://www.who.int/substanc e_abuse/activities/en/AUDITmanualS panish.pdf Detects Alcohol Problems in the Last Year AUDIT-C <2 min AUDIT <5 min

48. AUDIT Domains

49. AUDIT-C Hazardous Use (AUDIT Items 1-3)

50. AUDIT-C Scoring Items # 1-3 scored 0-4 points Add up points Positive prescreen =  4+ men  3+ women and adults over age 65 Administer remaining AUDIT items # 4-10 Provide BI, if using only AUDIT-C

51. Dependence Symptoms (Items 4-6)

52. Harmful Use (Items 7-10)

53. AUDIT Scoring Add up points  Items # 1-8 scored 0-4 points  Items 9-10 scored 0, 2 or 4 points 8+ indicates at-risk, harmful or hazardous drinking

54. World Health Organization (WHO) Recommended Levels of Brief Intervention (4 Zones) Adaptations of WHO for EAP  3 Risk Level Intervention AUDIT Interpretation Levels of Brief Intervention

55. WHO

56. “BIG” Adapted – 3 levels

57. AUDIT Online

58. http://rethinkingdrinking.niaaa.nih.gov/

60. QUESTIONS?

61. What is Brief Intervention?

62. ….IT’S NOT THIS!

63. BI: Definition & Implications Short, non-confrontational health counseling technique. A practice to identify a real or potential alcohol use problem, and to motivate an individual to do something about it. Effective with other conditions (e.g., tobacco and drug use, depression, diabetes).

64. BI: Definition & Implications Not a quick fix treatment. Persons with addiction or a mental health disorder require specialist care or other treatment modalities beyond BI. May help identify persons with a disorder and facilitate referral.

65. Elements of BI Screening score feedback Education (risks, guidelines) Normative feedback Simple advice Enhance motivation Assist with action plan Give encouragement Provide resources Close on good terms Ask for permission Provide Referral

66. Screening Score Feedback Low risk “ From your responses, your drinking is in a healthy range which puts you at lower risk for many health and emotional concerns than those who drink at higher ranges.”

67. Screening Score Feedback Moderate and High Risk " From your responses, your drinking puts you at higher risk for many health and emotional concerns than those who drink at lower ranges. These questions have been given to thousands of people, so you can compare your drinking to others. Your score was [#]…on a scale of 0-40 which places you in the category of [moderate or high] risk.

68. Education Discuss health risks of alcohol and other substances “Unhealthy alcohol use can put you at risk for injury, accidents, and health problems such as depression, diabetes, cancer, insomnia, high blood pressure, stroke, heart and gastrointestinal problems, and other conditions.”

69. Education Review drinking guidelines “The recommended guidelines for healthy adults are no more than 1 drink per day (or 7 drinks per week) for women and adults over age 65, and no more than 2 drinks per day (or 14 drinks per week) for men.”

70. Normative Feedback Provide feedback on how client’s use compares to others (i.e., men, women, adolescents, general population) “Your alcohol consumption is similar to [different from/higher than] most people (about 72% of adults) in the U.S. who never exceed the recommended guidelines.”

71. “Reducing your consumption to safer drinking levels can decrease your risk.” “Cutting back on the number of drinks you typically have each day can decrease your risk of health problems.” “I advise you to Cut Back your alcohol consumption.” Simple Advice

72. “Cut Back”/Moderation  Recommend drinking or using at “moderate levels” which are safe/within guidelines.  Not a request to Abstain/STOP.  Alcohol: (m) 2-14-5, (w) 1-7-4 (Adapted from NIAAA, 10th Report to Congress 2000)

73. “Based on my assessment, you are at-risk for future health problems…I advise you to cut back/quit.”  Non-judgmental feedback and appraisal of risks by a practitioner….  10-30% patients will significantly reduce (alcohol/tobacco/diabetic) risky behavior. (WHO, 1996; CSAT TIP 24, 1997) Non-Judgmental Tone

74. Exploring Motivation using MI Strategies Explore Ambivalence  Pros and Cons of Alcohol Use Explore Readiness  Importance and Confidence Rulers Explore Goals  quit, cut down, make no change? Elicit Change Talk – Use your OARS  “I really want to cut-back on drinking with the guys after work.”

75. Using Your OARS O = Open Questions A = Affirmations R = Reflections S = Summary Source: Mary Velasquez, HOT EAPA Motivational Interviewing Training, September 1, 2010

76. What are the good things about your ____? What are some of the less good things? What concerns do you have about your ____? If you were to change, what would it be like? Where does this leave you now? Source: Mary Velasquez, HOT EAPA Motivational Interviewing Training, September 1, 2010 Exploring Pros/Cons

77. 0 10 Importance Ruler “ How important is it to you to ____ ( e.g., quit using, begin treatment)? If 0 was “not important,” and 10 was “very important,” what number would you give yourself ?” Source: Mary Velasquez, HOT EAPA Motivational Interviewing Training, September 1, 2010

78. Exploring Importance Why are you at x and not y? (always start with the higher number) What would have to happen for it to become much more important for you to change? Source: Mary Velasquez, HOT EAPA Motivational Interviewing Training, September 1, 2010

79. Confidence Ruler “ If you decided right now to ___ (e.g., stop drinking, using drugs, enter treatment), how confident do you feel about succeeding with this? If 0 was ‘not confident’ and 10 was ‘very confident’, what number would you give yourself?” 0 10 Source: Mary Velasquez, HOT EAPA Motivational Interviewing Training, September 1, 2010

80. Building Confidence What would make you more confident about making these changes? Why have you given yourself such a high score on confidence? How could you move up higher, so that your score goes from x to y? How can I help you succeed? Source: Mary Velasquez, HOT EAPA Motivational Interviewing Training, September 1, 2010

81. Assist with Action Plan If you were to decide to change, what might your options be? What is your next step? How will you do that? Are there any ways you know about that have worked for other people? Is there anything you found helpful in any previous attempts to change? Source: Mary Velasquez, HOT EAPA Motivational Interviewing Training, September 1, 2010

82. Assist with Action Plan Who will you ask to help you? What might get in the way? What have you learned from the things that went wrong last time you tried? How will you deal with those challenges? Source: Mary Velasquez, HOT EAPA Motivational Interviewing Training, September 1, 2010

83. Give Encouragement “ I believe you can take that next step to…” “I believe you’ll be able to implement that plan when you have those challenges.”

84. Provide Resources Rethinking Drinking (booklet, online) http://rethinkingdrinking.niaaa.nih.gov/ Tips for Cutting Down on Your Drinking Mixing Alcohol and Medication

86. http://rethinkingdrinking.niaaa.nih.gov/

87. http://pubs.niaaa.nih.gov/publications/tips/tips.pdf

88. http://pubs.niaaa.nih.gov/publications/Medicine/Harmful_Interactions.pdf

89. Close on Good Terms Say “Thank You” “Thank you for taking a few minutes to talk with me about your alcohol use. I appreciate your openness and sharing your experiences/thoughts with me today.”

90. Ask for Permission “I would like to see how things are going for you over the next few months. Would you mind if I followed up with you?”

91. Provide Referral High Risk Cases: Referral to Specialist/Treatment e.g.,  addiction specialist  behavioral health provider  alcohol disease management  chemical dependency program  community resource (e.g., mutual help)  other referral sources Moderate Risk Cases (as appropriate)

92. Provide Referral “Based on the information you provided, I would encourage you to consider getting additional help for dealing with issues related to alcohol.” “I would like to refer you/put you in touch with a provider on your health plan.” “What do you think about this?”

93. It’s SBIRT using MI strategies (It’s not MI) Sample Protocols  “SBIRT Basic” (no MI)  “SBIRT MI-Informed” How does it all fit together?

94. Sample Protocols (handouts)

98. QUESTIONS?

99. BONUS ELEMENTS

100. Bonus Element: Implementation Tips

101. Tips Normalize screening (and outcomes measurement) procedures “We ask all clients who contact the EAP these questions.” Give a reason for asking “We are trying to understand the impact of EAP counseling in the workplace.” Stress the need to follow-up “It’s important that I follow-up with you to see how you’re doing, what is the best way to reach you?” Adapted from: CGP’s Workplace Outcomes Suite: Overview, Rationale, and Implementation. Rik Lennox, Chestnut Global Partners

102. More Tips Ask permission to follow-up “ May I follow-up with you in X (days/months)?” Get good “locater” information “What is the best way to reach you?” Stress confidentiality “Answering these questions is completely voluntary and confidential, we will not share it with your employer.” Adapted from: CGP’s Workplace Outcomes Suite: Overview, Rationale, and Implementation. Rik Lennox, Chestnut Global Partners

103. Integrate Screening and Outcome Measures at Intake  before EAP consultation, counseling  embed in existing intake assessment  often called “baseline” or “pre-test” Adapted from: CGP’s Workplace Outcomes Suite: Overview, Rationale, and Implementation. Rik Lennox, Chestnut Global Partners Recommendations

104. Integrate Screening and Outcome Measures at Follow-up  After EAP consultation, counseling  embed in existing follow-up procedure  often referred to as “post-test”  time period varies (30, 45, 60, 90 days; 6, 12, 24 months)  consider instrument recommendations when selecting time period (e.g., 90 days for “Workplace Outcomes Suite”) Adapted from: CGP’s Workplace Outcomes Suite: Overview, Rationale, and Implementation. Rik Lennox, Chestnut Global Partners Recommendations

105. Bonus Element: EAP Pilot Tests

106. Aetna EAP Approach

107. BI, Referral, & Follow-up

108. Aetna EAP Pilot Site Characteristics:  large U.S. employer (financial services)  147,000 employees  non-emergent, self-referral cases  dedicated EAP team Evaluation Design:  compared baseline to post-SBIRT implementation at 5-months

109. Participation  93% completed the AUDIT-C  87% completed the AUDIT AUDIT-C prescreen  40% positive, asked remaining 7 items  60% negative, stopped at item #3 Findings at 5 Months

110. AUDIT screen  Identification approached U.S. population estimates  18.5% using AUDIT screening tool  6% based on “presenting problem”  At baseline: < 1% (prior vendor data) Findings at 5 Months

111. 78% agreement to follow-up by EAP clinician 72% set an appointment for face-to-face counseling Findings at 5 Months McPherson, T.L., Goplerud, E., Derr, D., Mickenberg, J., Courtemanche, S. (in press, 2010). Telephonic Screening and Brief Intervention for Alcohol Misuse Among Workers Contacting the Employee Assistance Program: A Feasibility Study. Drug and Alcohol Review.

112. Pre-SBI Time Period (n=681) Post-SBI Time Period (n=383) p-value EAP Alcohol Identification Hazardous alcohol use7.5% (51) 20.1% (77) <0.0001 Alcohol abuse/dependence7.1% (48) 10.4% (40) 0.0536 OptumHealth EAP Replicated Findings Greenwood, G., Goplerud, E., McPherson, T.L., Azocar, F., Baker, E., & Dybdahl, S. (in press, 2010). Alcohol Screening & Brief Intervention (SBI) in Telephonic EAP. Journal of Workplace Behavioral Health.

113. Bonus Element: More “BIG” Resources (handout)

115. World Health Organization (WHO) SBIRT Manuals English: AUDIT http://whqlibdoc.who.int/hq/2001/WHO_MSD_MSB_01.6a.pdf http://whqlibdoc.who.int/hq/2001/WHO_MSD_MSB_01.6a.pdf BI Manual http://whqlibdoc.who.int/hq/2001/WHO_MSD_MSB_01.6b.pdf http://whqlibdoc.who.int/hq/2001/WHO_MSD_MSB_01.6b.pdf Spanish: AUDIT http://www.who.int/substance_abuse/activities/en/AUDITmanualSpani sh.pdf http://www.who.int/substance_abuse/activities/en/AUDITmanualSpani sh.pdf BI Manual http://www.who.int/substance_abuse/activities/en/BImanualSpanish.pdf

116. AUDIT Online

117. 117 NIAAA 2005 Guidelines http://pubs.niaaa.nih.gov/publications/Practitioner/CliniciansGuid e2005/clinicians_guide.htm

118. Free Online Training Video Cases: Helping Patients Who Drink Too Much Free CME/CE credit for physicians or nurses http://www.niaaa.nih.gov/Publications/Edu cationTrainingMaterials/CME_CE.htm

119. 119 AMA Approved Billing Codes Providers can be reimbursed for SBI http://www.ensuringsolutions.org/resources/resources_show.htm?doc_ id=385233&cat_id=2005

120. Reimbursement for SBI PayerCodeDescription Fee Schedule Commercial Insurance CPT 99408 Alcohol and/or substance abuse structured screening and brief intervention services; 15 to 30min $33.41 CPT 99409 Alcohol and/or substance abuse structured screening and brief intervention services; greater than 30min $65.51 Medicare G0396 Alcohol and/or substance abuse structured screening and brief intervention services; 15 to 30min $29.42 G0397 Alcohol and/or substance abuse structured screening and brief intervention services; greater than 30min $57.69 Medicaid H0049 Alcohol and/or drug screening $24.00 H0050 Alcohol and/or drug service, brief intervention, per 15 min $48.00

121. Bonus Element: Measuring Performance and Client Outcomes – Demonstrating Impact and Value

122. Program Performance:  Participation  Rates of identification  Rates of screening  Rates of BI  Rates of referral to treatment for high risk cases  Rates of follow-up  Rates of refusal for SBIRT services SBIRT Performance Measures

123. Measure Behavior Change Over Time (Intake to Follow-up) Client Outcomes (consumption, risk):  Alcohol use Business Relevant Outcomes:  Presenteeism  Productivity  Absenteeism  Other outcomes (e.g.,WOS))

124. Outcome Measures  WOS  WLQ

125. Chestnut Global Partners Workplace Outcomes Suite (WOS)

126. WOS Developed by Rik Lennox, Dave Sharar et al., Chestnut Global Partners Free, with licensing agreement 20 items, 5 scales (5 items each) Scales used stand-alone or together Workplace focus (not clinical outcomes) Short, sensitive to change Administered at EAP Intake and at 90 days

127. WOS Scales Absenteeism  # hours away from work in past 30 days, can be monetized Presenteeism  proxy for productivity, extent to which problems inhibit work Work Engagement  measure of "over" involvement with the job Life Satisfaction  gauges importance of job to "life“ Workplace Distress  looks at "distress at work" across all problems

128. WOS Read more:  Sharar and Lennox (2009). A New Measure of EAP Success. Society of Human Resource Management. http://www.chestnutglobalpartners.org/LinkClick.aspx?filetic ket=oE7rAAU5GMM%3D&tabid=364  Lennox, R.D., Sharar, D., Schmitz, E., Goehner, D.B. (2010). Development and Validation of the Chestnut Global Partners Workplace Outcome Suite. JWBH, 25, 107-131. http://www.informaworld.com/smpp/content~content=a922 042152~db=all~jumptype=rss http://www.informaworld.com/smpp/content~content=a922 042152~db=all~jumptype=rss

129. WLQ (Work Limitations Questionnaire)

130. WLQ Developed by Debra Lerner, Tufts Medical Center http://160.109.101.132/icrhps/resprog/thi/wlq.asp Available with licensing agreement 8 item (WLQ-Short Form) “presenteeism” or “on-the-job disability” measure Four scales, used together Designed for assessing groups of individuals currently employed Indicates the degree health problems interfere with the ability to perform job roles, and productivity impact of these work limitations.

131. WLQ Scales Time Management Scale  Difficulty performing a job easily at the beginning of the workday and starting the job soon after arriving at work. Physical Demands Scale  Ability to perform job tasks that involve sitting and standing in one position and repeating the same motion repeatedly. Mental-Interpersonal Demands Scale  Difficulty concentrating on work and ability to interact with people on-the-job. Output Demands Scale  Ability to complete work.

132. WLQ Productivity Loss Score  Estimates percent difference in an employee’s at-work productivity compared to employees who do not have health-related work limitations (a healthy benchmark group).

133. Read more:  Lerner, D., Amick, B.C., Rogers, W.H., Malspeis, S., Bungay, K., Cynn, D. (2001). The work limitations questionnaire. Medical Care. 39, 72-85. http://www.ncbi.nlm.nih.gov/pubmed/1117654 5 http://www.ncbi.nlm.nih.gov/pubmed/1117654 5  WLQ website: http://160.109.101.132/icrhps/resprog/thi/wlq. asp http://160.109.101.132/icrhps/resprog/thi/wlq. asp

134. THANK YOU

135. Tracy L. McPherson, PhD Assistant Research Professor esap1234@gmail.com 202-994-4307 Center for Integrated Behavioral Health Policy Department of Health Policy, George Washington University Medical Center Eric Goplerud, PhD Research Professor goplerud@gwu.edu 202-994-4307