Back to our roots integrating a screening and brief intervention in addressing alcohol problems
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Back to Our Roots: Integrating a Screening and Brief Intervention in Addressing Alcohol Problems. Karen Chan, PhD Associate Behavioral Scientist RAND Corporation October 6, 2006 EAPA Conference. Objectives. Ray Mitchell EAP Roots Recommendations for EAP clients with problem drinking

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Back to our roots integrating a screening and brief intervention in addressing alcohol problems

Back to Our Roots: Integrating a Screening and Brief Intervention in Addressing Alcohol Problems

Karen Chan, PhD

Associate Behavioral Scientist

RAND Corporation

October 6, 2006

EAPA Conference


Objectives
Objectives

  • Ray Mitchell

    • EAP Roots

    • Recommendations for EAP clients with problem drinking

  • Paul Davis

    • Process of conducting research in the EAP

    • Balancing clinical, research, and corporate needs for successful collaboration

  • Karen Chan

    • Outcome data on a brief intervention

    • Role-play brief intervention

  • Ray Mitchell

    • Discussion with audience

    • Future Directions


Introduction
Introduction

  • Our Roots

    • EAPs originated from Occupational Alcoholism Programs (consistent with the AA movement)

  • The Winds of Change

    • Origins of EAPs have lost focus as EAPs broadened to treat all types of problems

    • While 15-31% of the workforce presents with problem drinking, 1.5% present to the EAP with alcohol and substance use concerns.

    • Early identification and prevention/intervention is needed before problems get more severe and costly.


What we know about employee drinking
What we know about employee drinking

  • 140 million Americans work (Dept of Labor, 2004)

  • 82% of the labor force work full-time (Dept of Labor, 2004)

  • 61% of employees drank in the last month (NSDUH, ‘04)

  • 5% of the workforce meet alcohol abuse criteria and 4% of the workforce meet alcohol dependence criteria (Summers & Goplerud, 2005)


Drinking continuum
Drinking Continuum

(Institute of Medicine, 1990).

ALCOHOL USE

None Light Moderate Substantial Heavy

abuse dependence

problem use addiction

None Mild Moderate Substantial Severe

PROBLEMS


Work factors affecting drinking
Work Factors Affecting Drinking

  • Performance regulation expectancies

  • Workplace norms

  • Job stress (unwinding time, skipped meals, job problems)

  • Unsupportive supervisors

  • Job visibility

  • Job instability and dissatisfaction


Limited research on eaps
Limited Research on EAPs

In general, cost-effective

  • $5.1 million saved per year (Blum & Roman, 1995)

  • $7,750 saved per employee & 75% reduction in inpatient costs (Marsh and McLennan Companies, 1994). 

    EAPs “succeeded” in returning employees with alcohol problems to effective performance (Roman & Blum, 2002)

  • No comparison group, none to very brief follow-ups, selection bias, limited measures of outcome, no standardized EAP model

    EAPs for Addictive Behaviors

  • Receive fewer sessions, more likely to be referred out, and less likely to resolve their problems within the EAP; 6% identified for an addictive behavior (Chan, Neighbors, & Marlatt, 2004)


Aps involvement
APS Involvement

  • Based on Need

    • Client Needs

    • Corporate Needs

  • Origins of APS Involvement

  • Setting the Stage on a Corporate Level


Research in an eap setting
Research in an EAP Setting

  • Is research doable in an EAP setting?

  • Cost-benefit analysis

  • Research Liaison

  • Areas of Focus:

    • Client Care

    • Clinician Support

    • Logistics

    • Recruitment

    • Balancing organizational/research needs


Research in an eap setting1
Research in an EAP Setting

  • Client Care

    • Corporate Clients

      • Addressing possible corporate concerns regarding employee participation

    • EAP Clients

      • Participant Selection

        • Safety – EAP and University response

        • Nature of the Presenting Concern

        • Individual vs. Couples/Family

      • Ensuring Client Needs Are Addressed

        • Address needs during feedback

        • Additional Sessions


Research in an eap setting2
Research in an EAP Setting

  • Clinician Support

    • Training

      • 13 hours CEU for MI training by UW Faculty

      • Checklists, Scripts, and Paperwork

      • Equipment

    • Incenting

      • Additional time/pay for transitioning

      • Cheerleading for the mission

    • Supervision/Feedback

      • Individual

      • Group


Research in an eap setting3
Research in an EAP Setting

  • Logistics

    • Client paperwork

      • confidentiality

    • Clerical support for Clinicians

    • After-hours services


Research in an eap setting4
Research in an EAP Setting

  • Recruitment

    • Ongoing Clinician support/scripts

    • Incenting clients

      • Normalizing paperwork

      • Assuring needs will be met (extended sessions)

      • Addressing resistance (studying range of etoh use)

      • Emphasizing benefits

      • Allowing choice/flexibility

        • Time/location for paperwork

        • Taping

      • Expressing appreciation


Research in an eap setting5
Research in an EAP Setting

  • Balancing Organizational/Research Needs

    • More power! The never-ending search for more subjects

    • University vs. corporate culture

    • Setting workable limits


Research in an eap setting6
Research in an EAP Setting

  • Celebrating Success

    • Clinician feedback

    • Clinical results to follow….



A brief intervention for screened problem drinking in an eap
A Brief Intervention for Screened Problem Drinking in an EAP

Outline

  • Description of Study

  • Motivational Interviewing

  • Study Findings and Implications

  • Role-play the brief intervention


Acknowledgements
Acknowledgements

  • G. Alan Marlatt

  • Mary Larimer

  • Clayton Neighbors

  • Franchesca Nguyen

  • Steve Zellmer

  • Paul Davis

  • Ray Mitchell

  • Kelly Bui

  • Bonnie Burlingham

  • EAP therapists and clients

  • Shirley Murphy

  • Meenakshi Jaim

  • Neha Chawla

  • Diane Logan

  • Michel Davila

Funding Agencies

NIAAA F31 #AA 14753

UW Alcohol and Drug Abuse Institute


Background
Background

  • Low identification of problem drinking

  • High referral of clients with addictive behaviors outside the EAP

  • Research revealing the efficacy of a one-session brief intervention utilizing motivational interviewing in other settings

  • Huge prevention and intervention potential with the short-counseling model of the EAP


Health Screen

(49% screened positive)

1st Session

EAP Services as Usual (SAU)

Baseline Assessment

2nd Session

(BI)

2nd Session

(SAU)

Brief Survey

(After 2nd Session)

Follow-up Assessment

(3 months after BL)


Brief intervention
Brief Intervention

Personalized Feedback

  • Typical Drinking Patterns

  • Beliefs About Alcohol

  • Drinking Situations

  • Negative Consequences

    …conducted using a Motivational Interviewing style.



Stages of change
Stages of Change problem drinking?

Precontemplation

Contemplation

Relapse

Preparation

Maintenance

Action

Prochaska and DiClemente, 1982


Motivational interviewing a definition

Motivational Interviewing is a problem drinking?

person-centered

directive

method of communication

for enhancing intrinsic motivation to change by exploring and resolving ambivalence

Motivational InterviewingA Definition


Mi principles
MI Principles problem drinking?

  • Express Empathy

  • Develop Discrepancy

  • Roll with Resistance

  • Support Self-Efficacy


Motivational interviewing strategies
Motivational Interviewing Strategies problem drinking?

  • Open-Ended Questions

  • Affirm and Support Your Client

  • Reflectively Listening

  • Summarizing

  • Roll with Resistance

  • Elicit Self-Motivational Statements (Change Talk)


Elicit provide elicit providing feedback
Elicit – Provide – Elicit: problem drinking?Providing Feedback

  • Information exchange

  • Balanced Conversation

  • Elicit readiness and interest

  • Provide feedback neutrally

  • Elicitthe patient’s interpretation and follow it

    (Rollnick, Mason, & Butler, 1999)


Project findings

Project Findings problem drinking?

Does MI make a difference on client outcomes?

How did the brief intervention compare to services as usual?



Brief intervention vs eap services as usual
Brief Intervention problem drinking?vs. EAP Services-as-usual


Brief intervention vs eap services as usual1
Brief Intervention problem drinking?vs. EAP Services-as-usual


Brief intervention vs eap services as usual2
Brief Intervention problem drinking?vs. EAP Services-as-usual


Brief intervention vs eap services as usual3
Brief Intervention problem drinking?vs. EAP Services-as-usual


How did the clients rate the bi
How did the clients rate the BI? problem drinking?

1. Treatment satisfaction

  • Both groups rated equally high

  • 96.15% of BI clients would recommend this type of session to a friend.

  • Number of sessions

    - No additional EAP sessions needed for the BI group

    3. Problem resolution for clients’ presenting problems

    • According to therapists’ ratings, 91% of clients had their presenting problems resolved in the EAP.


  • Implications
    Implications problem drinking?

    • Screening may not be enough

    • Talking and not avoiding

    • “One stop shop”

    • Cost-effectiveness

    • Prevention and Intervention opportunity


    Role play
    Role-Play problem drinking?

    • Charles: 55 Year old self-employed, married male, father of a 16 year-old daughter, seeking help with career development after losing his job as a manger in a high tech firm 2 years ago as a result of a RIF.


    Questions or comments
    Questions or Comments? problem drinking?

    Please contact Karen at [email protected]


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