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Allen Heineman , PhD, ABPP ( Rp ) Feinberg School of Medicine Department of Physical Medicine and Rehabilitation Northw PowerPoint Presentation
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Development of a Substance Abuse Screener for Vocational Rehabilitation. Allen Heineman , PhD, ABPP ( Rp ) Feinberg School of Medicine Department of Physical Medicine and Rehabilitation Northwestern University Center for Rehabilitation Outcomes Research Rehabilitation Institute of Chicago.

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slide1

Development of a Substance Abuse Screener for Vocational Rehabilitation

  • Allen Heineman, PhD, ABPP (Rp)
  • Feinberg School of Medicine
  • Department of Physical Medicine and Rehabilitation
  • Northwestern University
  • Center for Rehabilitation Outcomes Research
  • Rehabilitation Institute of Chicago
slide2

Why Conduct This Study?

  • Substance use disorders occur frequently among persons with disabilities
  • Substance use adversely affects employment and community integration
  • Most cases remain undetected without systematic screening
  • No practical, accessible, and valid screening instrument exists for use by VR counselors and other rehabilitation personnel
  • There is a great need for a screening tool in employment-focused rehabilitation settings
slide3

Barriers to Routine Screening

  • The lack of a brief screening instrument specifically validated for persons with disabilities
  • The lack of an instrument that includes items to assess the abuse of prescription medications
  • Administration barriers for persons who have sensory, physical, or cognitive impairments
slide5

Why Use the Substance Abuse Subtle Screening Inventory-3?

  • Long history of research and development
  • Use in a large number of system-wide applications
  • Inclusion of “subtle” items that contribute to its sensitivity
  • Readability
  • Automated scoring
  • Fast report generation
  • Ready availability
  • Established training support
  • Easy adaptation for web-based and other electronic applications that provide flexibility in application and accessibility for persons with sensory disabilities
slide6

Objectives

  • Feasibility Study
    • Evaluate the psychometric properties of the SASSI-VR using data drawn from a sample of persons with disabilities who also have SUD
    • Evaluate various forms of administration with who have a variety of disabilities
    • Develop a medication abuse subscale
    • Evaluate the feasibility and efficiency of the SASSI-VR as a screening tool
  • Validation Study
    • Evaluate the accuracy, sensitivity, and specificity of the SASSI-VR
    • Evaluation Trial
    • Estimate rates of SUD among VR clients with various primary disabilities
    • Dissemination Activities
    • Disseminate the modified screening instrument and research findings to rehabilitation via toolkits, stand-alone products and on-site training
slide7

Hypotheses

  • The SASSI-VR will demonstrate adequate psychometric properties with a heterogeneous sample of persons with disabilities who also have SUD
  • … be administered effectively with consumers using several forms of administration
  • …determine the SASSI-VR to be an easy to administer, feasible and efficient screening tool for their needs
  • …demonstrate adequate accuracy, sensitivity, and specificity
  • Field offices that screen clients with the modified SASSI-VR will identify and refer a larger proportion of consumers for SUD treatment services than field offices that do not screen with the SASSI-VR
slide8

Other Data Sources

  • Diagnostic Interview Schedule
  • Rehabilitation Service Administration’s Case Service Report (RSA-911) data base
  • Administration log and agency survey
slide9

Methods for Validation Component

  • Facilities
    • 6 state Vocational Rehabilitation offices in southern Ohio and Chicago
    • Community rehabilitation agency
    • One-stop job center
  • Sample
    • Goal: 1,000 consumers with diverse characteristics
  • Instrumentation
    • SASSI-VR
    • 69 items (12 alcohol, 17 other drugs, 40 subtle items)
    • 6 random answer pattern items
slide10

Sample Characteristics

  • N=955
  • Location
    • Ohio: 51%
    • Chicago: 49%
  • Race
    • 58% African-American
    • 38% Caucasian
    • 4% Other
  • Hispanic Origin
    • 5%
  • Gender
    • 52% Female
  • Marital Status
    • 56% Never Married
    • 15% Divorced
    • 14% Married
    • 7% Separated
    • 5% Unmarried Couple
    • 3% Widowed
  • Education
    • 26% < High School
    • 45% High School
    • 29% Post-Secondary
slide12

Diagnostic Interview Schedule

  • Criterion Positive
    • Abuse: 2.4%
    • Dependence: 19.7%
    • Overall: 22.1%
  • Location Variation: Any Substance Use Disorder
    • Ohio: 27.5%
    • Chicago: 16.5%
slide15

Methods for Evaluation Trial

  • Sample
    • 40,000+ cases/year
    • Minimum of 5,000 cases/group, allowing for attrition, noncompliance
  • Facilities
    • ½ of the VR field offices in
      • Illinois (total of 51 field offices)
      • Ohio (53)
      • West Virginia (32)
  • Instrument
    • Validated and shortened SASSI-VR
slide17

Data Analysis Overview

  • Classical test theory, item response theory, exploratory factor analysis
  • Consumer preference ratings
  • VR counselor ratings of feasibility and screening efficiency
  • Comparison of SASSI-VR scores and decision rules with diagnoses provided by DSM-IV substance abuse diagnoses from the DIS
  • Hierarchical linear modeling to predict SUD identification and referrals
  • Contingency table analysis using chi-square statistics to compare SASSI-VR identified SUD across disability categories
slide18

Project Outcomes

  • Toolkits
  • Validated SASSI-VR
  • Recommendation that qualified substance abuse treatment professionals be involved in a formal assessment for persons who score in the problematic range
  • Documented sobriety-oriented activities
  • Published articles in one or more referred journals for researchers and clinicians
slide19

Acknowledgments

  • Project Team
    • Rehabilitation Institute of Chicago
      • Kendall Stagg
      • Holly Demark
      • Annelouise Tookoian
      • Arethea Crudup
    • West Virginia University
      • Margaret Glenn
    • Ohio State University
      • John Corrigan
    • SASSI Institute
      • Frank Miller
      • Linda Lazowski
    • Wright State University
      • Dennis Moore
      • Mary McAweeney
      • Bridget Gerber
  • Rehabilitation Research and Training Center (RRTC) on Substance Abuse, Disability, and Employment

For more information: a-heinemann@northwestern.edu