Evaluation of Telephonic Alcohol Screening and Brief Intervention (SBI) in

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Evaluation of Telephonic Alcohol Screening and
Brief Intervention (SBI) in an Employee
Assistance Program (EAP) Gregory Greenwood, PhD,
MPH1 Eric Goplerud, PhD2 Tracy L. McPherson,
PhD2 Eugene Baker, PhD1 Francisca Azocar,
PhD1 1OptumHealth Behavioral Solutions 2Center
for Integrated Behavioral Health Policy,
Department of Health Policy, George Washington
University Medical Center

• Measures
• AUDIT-C and AUDIT (Babor et al, 1989 Babor et
  al, 2001).
• EAP Administrative Data Positive alcohol screen.
• SBI Intervention
• Alcohol screening is integrated into telephonic
  clinical intake conducted by EAP clinical
  consultant.
• Figure 1 presents an overview of the EAP SBI
  workflow.
• AUDIT score classifies member into one of four
  risk categories
• Risk Zone I no or low-risk drinking
• Risk Zone II hazardous drinking
• Risk Zone III harmful drinking
• Risk Zone IV abuse or dependence drinking
• Table 1 presents components of the brief
  intervention. The BI approach was modified using
  the WHO FRAMES approach. The components include

• Abstract
• Background Substantial empirical support exists
  for alcohol screening and brief intervention
  (SBI) in medical, but not non-medical settings.
  Workplace settings remain underutilized for
  delivering evidenced-based health services. A
  public-private partnership attempted to fill this
  gap by translating the World Health Organization
  (WHO) alcohol SBI protocol for delivery in
  telephonic EAP. Methods A pretest-posttest,
  one-group, pre-experimental design is used to
  examine the feasibility and preliminary impact of
  an alcohol SBI pilot program implemented by EAP
  clinical consultants in three call centers
  serving members of a large health plan. The SBI
  intervention is adapted based on the World Health
  Organization (WHO, Babor et al., 2001, 2004)
  alcohol SBI protocol. The intervention includes
  systematic routine alcohol screening using the
  AUDIT during clinical intake, brief counseling
  using motivational interviewing (MI) for at-risk
  drinking, alcohol education, referral to
  face-to-face counseling or other treatment as
  appropriate. Results From August 2008 through
  February 2009, EAP completed 367 full AUDIT
  screens using a new online tool. Of these, 231
  (63) were females, and 136 (37) were males.
  Screening results were 287 (78) Risk Zone I (no
  or low-risk drinking), 41 (11) Risk Zone II
  (hazardous drinking), 9 (3) Risk Zone III
  (harmful drinking), and 30 (8) Risk Zone IV
  (abuse or dependence drinking). All together, 30
  (10) were referred to substance use behavioral
  health services, and 247 (81) to follow up EAP.
  Comparing alcohol identification rates pre- and
  post-SBI launch, we found 80 (22) screened
  positive for alcohol misuse 6-months post-SBI
  launch compared to 31 (4.5) who screened
  positive for misuse 6 months pre-SBI (plt.001).
  Conclusions Integrating telephonic alcohol SBI
  into existing EAP services resulted in improved
  rates of identification of risky alcohol use and
  delivery of EAP telephonic brief interventions,
  We believe it requires the unique, strategic
  collaboration of private and public stakeholders
  in order to effectively translate and integrate
  evidence-based protocols into large national
  managed behavioral health organizations, as well
  as the commitment and partnership of key
  stakeholders such as health plans and employers.
  Future advances in evaluating and improving EAP
  telephonic alcohol SBI protocols include
  assessing the impact on member health and
  productivity at follow-up including changes in
  risky drinking (alcohol consumption) and
  productivity at 30, 60, and 90 days. Sponsor
  OptumHealth Behavioral Solutions.
• Introduction
• It is estimated that the health care costs
  associated with alcohol problems amount to almost
  36 billion annually and, as almost 80 of the
  16.3 million adults who drink in risky or
  hazardous ways are employed either full- or
  part-time, these costs extend to employers
  (NIAAA, DHHS 2000). Risky drinkers cause 60 of
  alcohol-related absenteeism, tardiness and poor
  work quality and utilize roughly twice the
  health care resources of healthy employees
  (Witbeck et al., 2000). Analysis of more than 360
  controlled trials on treating alcohol use
  disorders found that SBI was the single, most
  effective treatment method of more than 40
  methods studied (Miller Wilbourne, 2002).
  Return on investment for alcohol SBI typically
  exceeds 21, consistent with the savings
  associated with diabetes or depression disease
  management programs (French Fleming, 2002).
  Whereas substantial empirical support exists for
  SBI in medical settings, there is very little in
  workplace settings. This collaborative
  public-private partnership aims to fill this gap
  by translating medical research into behavioral
  healthcare practice settings that can potentially
  reach tens of thousands of workers each year, and
  potentially save employers and health plans
  millions of dollars.
• Research Objectives
• Objective 1 Describe alcohol SBI results from
  the multi-site pilot study.
• Objective 2 Measure and compare alcohol
  identification rates 6-months pre-alcohol SBI
  launch vs. 6-months post-SBI.
• Design and Methods

Figure 1. Overview of EAP SBI Workflow
Table 1. Brief Intervention Components FRAAMES
Table 2. Monthly Number of Completed Screens,
Risk Levels, and Referrals
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Contacting Author Information Gregory
Greenwood, PhD, MPH Gregory_L_Greenwood_at_uhc.com
415-265-7858