Allen Heineman , PhD, ABPP ( Rp ) Feinberg School of Medicine Department of Physical Medicine and Rehabilitation Northw

1. 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

2. 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

3. 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

5. 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

6. 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

7. 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

8. Other Data Sources • Diagnostic Interview Schedule • Rehabilitation Service Administration’s Case Service Report (RSA-911) data base • Administration log and agency survey

9. 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

10. 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

11. Age Distribution

12. 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%

13. Rating Scale Analyses

14. Sensitivity and Specificity

15. 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

17. 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

18. 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

19. 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