Workplace SBI Product Development Work Group

1
Workplace SBI Product Development Work Group

• Funded through a Cooperative Agreement with the
  National Highway Traffic Safety Administration
  (NHTSA).

2
Agenda

• Briefly Review Status of Workplace SBI Project
• Review Results of BI/Referral/Treatment Delphi
• Review Results of SBI Training Delphi
• Discuss SBI Training Approaches
• Enlist Volunteers to Share SBI Materials
• Schedule Next Call

3
Status of SBI Project

• March, April, May Focused on
  Outreach/Promotion Screening
• Conducted 2 Delphi Assessments and Conference
  Call
• Summarized and Disseminated Findings
• Posted Sample Materials to SBI Project Website
  www.ensuringsolutions.org/solutions/solutions_show
  .htm?doc_id450551
• May, June, July Focused on BI/Referral/Treatme
  nt SBI Training
• Conducted 2 Delphi Assessments
• Will Summarize and Disseminate Findings following
  the Call
• Will Continue to Post Sample Materials provided
  by PDWG (please continue to send materials)
• Submitted Year 3 Proposal to NETS/NHTSA to Pilot
  Test SBI in Workplace Settings
• Proposed several designs/approaches
• Ranging from individual case studies of specific
  sites to large scale evaluation project
• Initial feedback on proposal is encouraging
• Sites have not been selected
• PDWG members interested in being considered as a
  Year 3 pilot site should contact Tracy McPherson
• Future Self-Generated Projects

4

• DELPHI RESULTS
• BRIEF INTERVENTION, REFERRAL,
• TREATMENT
• Bar Graph Key
• Red Original Item
• Blue Respondent Added Item (typically added by
  only 1-2 respondents)
• Items rated on scale from 1 to 5 (1nice to have,
  3important, and 5essential)

5
Who Should Get Alcohol SBI?
6
Availability of BI
7
Provider of BI
8
BI Approaches/Techniques
9
BI Tools
10
BI Measures
11
BI Sessions
12
Referral
13
Follow-up
14

Ranking Importance of Using BI to Address
Specific Issues

• Most Important to Least Important
• Alcohol
• Depression
• Drug Use
• Stress
• Tobacco Use
• Marital/Family Issues
• Anxiety
• Weight Management/Obesity (diet and exercise)
• Diabetes and Cardiovascular Disease Management
  (tied for least important)

15

• Key Messages A Workplace SBI program should have
  a BI, Referral, and Treatment component that
  includes (at the minimum)
• BI for employees who test positive for alcohol or
  drugs, or otherwise identified by on-the-job
  incident (e.g., supervisory referral) or sought
  treatment for a mental health and substance use
  problem.
• Availability of BI off the worksite at medical or
  behavioral health/EAP counselors office.
• EAP counselor available to provide BI.
• Use of MI/cognitive behavioral techniques aimed
  specifically at changing alcohol use behavior, or
  alcohol use in context of other mental health
  problem.
• Use of standardized screening tool that guides
  counselor in determining level and focus of BI.
• A referral resource network and ability to
  connect worker within 24 hours.
• Use of clinical and business outcomes to measure
  impact of using BI.

16

• DELPHI RESULTS
• SBI TRAINING
• Bar Graph Key
• Red Original Item
• Blue Respondent Added Item (typically added by
  only 1-2 respondents)
• Items rated on scale from 1 to 5 (1nice to have,
  3important, and 5essential)

17
Focus of SBI Training
18
Discussion Knowledge and Use of SBI Training
Programs

• Training is offered through SBIRT (medical SBI)
  in PA and NY and is focused primarily on alcohol,
  co-occurring issues have been raised in terms of
  recommending an appropriate assessment tool when
  co-occurring disorders exist (e.g., ASSIST, which
  is long/cumbersome).
• Training programs that offer certification
  included the Boston Medical Centers (Richard
  Saitz) online training and American College of
  Surgeons Committee on Training (COT) in-person
  training, focused primarily on alcohol and drug
  use. SBIRT in PA offers CECs for screening but
  not BI.
• PDWG wasnt aware of SBI training for other
  issues (e.g., mental health).
• PDWG wasnt aware of SBI training on issues other
  than alcohol.
• PDWG hadnt adapted an existing training program
  for their setting.

19
SBI Training Materials Identified by GWU

• Web-based Training
• American College of Emergency Physicians (ACEP)
  Alcohol Screening and Brief Intervention in the
  Emergency Department. http//acepeducation.org/sbi
  /
• Emergency Department Alcohol Education Projects
  Screening, Brief Intervention, Referral and
  Treatment (SBIRT). http//www.ed.bmc.org/sbirt/ind
  ex.htm
• AlcoholCME.org http//www1.alcoholcme.com/
• Training Guides
• American College of Emergency Physicians (ACEP)
  Brief Negotiated Intervention (BNI) Manual
  Screening and Brief Intervention for Unhealthy
  Alcohol Use in the ED. http//acepeducation.org/sb
  i/media/bni_manual.pdf
• Richard Saitz and Boston Medical Centers Alcohol
  Clinical Training (ACT). http//www.bu.edu/act/mda
  lcoholtraining/index.html
• NIAAA Helping Patients Who Drink Too Much A
  Clinicians Guide. http//pubs.niaaa.nih.gov/publi
  cations/Practitioner/CliniciansGuide2005/clinician
  s_guide.htm and http//www.niaaa.nih.gov/Publicati
  ons/EducationTrainingMaterials/guide.htm
• World Health Organizations AUDIT Guidelines for
  Use in Primary Care http//whqlibdoc.who.int/hq/20
  01/WHO_MSD_MSB_01.6a.pdf and Brief Intervention
  for Hazardous and Harmful Drinking A Manual for
  Use in Primary Care. http//whqlibdoc.who.int/hq/2
  001/WHO_MSD_MSB_01.6b.pdf
• William Millers Treatment Improvement Protocol
  (TIPS) Enhancing Motivation for Change in
  Substance Abuse. http//ncadi.samhsa.gov/govpubs/B
  KD342/
• American College of Surgeons Committee on Trauma
  (COT) Alcohol Screening and Brief Intervention
  (SBI) for Trauma Patients COT Quick Guide.
  (coming online soon, see http//sbirt.samhsa.gov/p
  roviders.htm)
• Veterans Affairs HCRC Teaching Guide for Health
  Care Providers Reducing Alcohol Use with Brief
  Intervention. http//www.hepatitis.va.gov/vahep?pa
  geprtop03-wp-01-res
• Motivationalinterview.org Training Resources
  http//motivationalinterview.org/training/index.ht
  ml

20
Where Should SBI Training be Offered?
21
Continuing Education Credits Competency
Certification
22
Discussion Continuing Education Certification

• PDWG felt that continuing education credits and
  certification were almost essential.
• Need to build SBI into CEAP and CADC specialty
  training programs.
• Certification and licensing exams need to include
  questions that demonstrate SBI competency.
• EAPA, EASNA, NASW, APA, and state govt agencies
  (as part of licensing requirements) were
  suggested as organizations that we should work
  with to develop continuing education and
  certification programs.
• Vendors need to communicate to network providers
  that SBI is a priority and that they need to get
  training (push model) need network training and
  buy in.
• Use data/outcomes resulting from implementing SBI
  to get stakeholder buy in (e.g., geographic,
  industry, or other specific data may be more
  convincing).
• Need to work directly with medical directors to
  make SBI important, a perception of importance
  can be gained through education, medical
  directors need to convey to the providers that
  its a priority.
• Need to educate providers on issue of
  reimbursement (e.g., CPT codes commercial
  industry will be paid w/out needing approval but
  state Medicaid still needs to make codes
  active/useable).
• Need to offer training to EAP/MBHO call center
  staff since some employers have telephonic only
  services.

23
Monitoring Quality of SBI Training
24
Discussion Quality Monitoring

• Quality of training can be monitored if
  collection of relevant data were built into
  software technologies that make it a
  standardized, routine process. This may be easier
  in telephonic call centers than in face-to-face
  settings.
• Requires competitors to come together and
  encourage/require provider panels to use quality
  monitoring techniques (e.g., BI checklists after
  a session). A PDWG member has paid practitioners
  to complete BI checklists in the past.
• BI checklists completed by counselors are
  feasible in the real-world (needs to be brief).
  Use of standardized patients, evaluating
  audiotaped sessions and providing feedback, and
  telephonic coaching easier to do as in-service
  trainings in call centers. These things are
  harder to do with network affiliates who conduct
  face-to-face.
• Clients could complete BI checklist too (e.g.,
  take home checklist or web link, as part of
  customer satisfaction survey) could make it a
  requirement.
• Contracts should require that SBI be measured-
  data collected, analyzed, and reported with a
  performance feedback loop to providers.
• Employers need to demand SBI in RFPs. Could
  include in SBI tool kit for the employer, sample
  RFP and SPD language/statements about what needs
  to be done/measured around SBI. The CDC Purchaser
  Guide may have language we could include.

25

• Key Messages A Workplace SBI program should have
  a training component that includes (at the
  minimum)
• BI training focusing on alcohol and mental health
  issues.
• Webinars, conference call, conference workshop,
  and off-site training opportunities.
• Continuing education credits and competency
  certification.
• Counselor and Client Use of BI Checklists for
  monitoring quality and fidelity.

26

Wanted Materials for Posting to the Website

• Materials on BI
• Materials on Referral and Treatment
• Materials on SBI training
• Focus can be alcohol use, drug use, depression,
  anxiety, stress, family/ marital problems,
  financial, legal, violence, diabetes, or CVD.
• May include BI guides, manuals, protocols,
  process descriptions, etc. for face-to-face,
  telephonic, web-based, email-based, or other
  method of delivering BI.
• May include referral protocols, recommended
  treatment guidelines, treatment resources,
  protocols for linking people to EAP counselor or
  treatment provider.

27
Next Steps

• Conduct Delphi on Evaluation in
  August-September
• Please Review Materials Posted to SBI Website
• Call or email feedback to Tracy McPherson at
  202-416-0413 or tracym_at_gwu.edu
• Schedule Next Call (late September)
• Will send out RSVP for date/time (TBD).
• Discuss results of Delphi
• Discuss Evaluation/Performance Measurement
• Develop outline for prototype SBI Tool Kit over
  next 4 weeks, share with PDWG in September