Background: Substantial empirical support exists for SBIRT in medical, but not non-medical settings such as the workplace. Workplace settings remain underutilized for delivering evidenced-based health services. This research aims to translate medical research into behavioral healthcare practice in a telephonic employee assistance program (EAP). The primary objective is to assess feasibility and impact of SBIRT on key performance measures (e.g., rates of screening, identification). Design: Pretest-posttest, one-group, pre-experimental. Methods: An alcohol SBIRT program (based on WHO recommendations) was implemented in one call center serving one large client business. Routine and urgent cases were offered screening (AUDIT) during intake, brief counseling using motivational interviewing, alcohol education, referral to face-to-face counseling or other treatment (e.g., alcohol disease management), and telephonic follow-up (30, 60, 90 days). Results: At 5 months, 93% of members contacting the EAP completed the AUDIT-C: 40% prescreened positive and 52% went on to screen at moderate or high risk. Overall estimate of identification (18%) approached general U.S. population estimates. Most members agreed to clinical follow-up; almost three-quarters set an appointment for face-to-face counseling. Follow-up data collection is ongoing. Conclusions: The integration of routine alcohol SBIRT into EAP practice is not only feasible in telephonic delivery systems, but also increases identification and opportunity for brief motivational counseling for risky drinking. When SBIRT is seamlessly integrated members are willing to answer questions about alcohol use and participate in follow-up. Sponsor: Aetna Behavioral Health 

Background: Substantial empirical support exists for alcohol SBI in medical, but not non-medical settings such as the workplace.  Employee assistance programs (EAPs) provide a unique opportunity to deliver evidence-based alcohol interventions to workers who drink in unhealthy ways. Through a public-private partnership this study attempts to fill a research gap by adapting the WHO alcohol SBI protocol for delivery in telephonic EAP. Methods: A pretest-posttest, one-group, pre-experimental design is used to examine the implementation of routine screening (AUDIT) and brief motivational counseling for risky drinking in three EAP call centers serving members of a large health plan. Results: From August 2008-February 2009, the EAP completed 367 screens, 78% scored in Zone I (no/ low-risk drinking), 11% Zone II (hazardous drinking), 3% Zone III (harmful drinking), and 8% Zone IV (abuse or dependence).  Approximately 10% were referred to SA/MH services and 81% to follow-up EAP.  Identification rates at 6-months post-SBI launch were 22% compared to 4.5% at baseline (p<.001). Conclusions: Integrating telephonic alcohol SBI into existing EAP services resulted in improved rates of identification and delivery of BI. We believe it requires the unique, strategic collaboration of private and public stakeholders and commitment and partnership of health plans and employers, to effectively translate and integrate evidence-based protocols into large national MBHOs. Future advances in evaluating and improving EAP telephonic SBI include assessing the impact on worker health (e.g., alcohol consumption) and productivity at follow-up.

Background: In 2009, The National Business Coalition on Health (NBCH) included a number of questions on health plan policies surrounding SBI in their annual survey, the eValue8 RFI. These questions represent a set of standards for alcohol care that were developed collaboratively by the business community, health plans, and a panel of substance abuse experts. By increasing awareness and the attention given to alcohol problems, and specifically on SBI for alcohol problems, NBCH hopes to increase the availability and quality of these services in a variety of settings. Methods: Eighty-nine United States-based health plans, representing over fifty million covered lives, responded to the 2009 eValue8 RFI. Each of these plans responded to a number of questions that detailed plan policy on SBI issues. Results: Most plans (78%) reported working directly with hospital or trauma centers to encourage SBI for alcohol problems. The most common methods used by plans were disseminating guidelines for SBI in trauma settings (62%), offering payment for SBI services delivered in an emergency setting (60%) and offering SBI training to trauma center practitioners (20%). A slightly higher percentage of plans (85%) reported taking active measures to encourage SBI for alcohol problems in behavioral health settings. Additional results detailing plan policies for SBI services in other settings are also presented. Conclusions: While much work remains to be done in this area, health plans have begun to adopt policies that encourage SBI services in a variety of settings. 

Background: Most indicators suggest that treatment for alcohol lags behind treatment for other illnesses. The National Business Coalition on Health (NBCH) is working to improve the quality of care for alcohol problems by working collaboratively with both the business community and commercial health plans to develop clear, evidence-based standards for the identification and management of these conditions. Participating health plans complete a yearly survey (eValue8) that monitors the plan’s performance against these standards. Methods: Eighty-nine United States-based health plans, representing over 50 million covered lives, completed the eValue8 survey in 2009. Results: Although participating health plans continue to identify only a small proportion of their members as having alcohol abuse or dependence (.89%) most plans report working directly with practitioners and trauma centers to conduct SBIRT for alcohol problems. Results from the survey also suggest that most health plans recommend that practitioners use well-validated and highly rated screening instruments to screen for alcohol problems (89%), a significant increase since 2005, when only 51% of plans made this recommendation (p<.05). Additional results from the alcohol section of eValue8, and their changes over time, are also presented. Conclusions: While health plan identification rates for alcohol problems remain low, results from the eValue8 survey suggest that health plans are increasingly adopting policies and recommendations that encourage appropriate screening and treatment for alcohol problems. 

Background: Substantial empirical support exists for alcohol SBI in medical, but not non-medical settings such as the workplace - an underutilized venue for alcohol interventions. This research aims to translate medical SBI into behavioral healthcare practice in a work-related setting - the EAP - where millions of workers can be reached annually. The primary objectives are: a) assess feasibility of adapting medical SBI practices for telephonic EAP; b) develop feasible, practical training, implementation, and quality/fidelity monitoring protocols/processes that can be integrated into existing practices; c) assess impact of implementing systematic, routine alcohol SBI on key performance measures (rates of screening, alcohol problem identification, treatment initiation); and d) assess preliminary client outcomes (self-reported alcohol use, mental wellbeing, and productivity). Pilot studies were conducted by U.S. EAP providers using pretest-posttest, one-group, pre-experimental designs. SBI processes were adapted based on the WHO alcohol SBI protocol. It includes systematic screening using the AUDIT-C/AUDIT during clinical intake, BI using motivational interviewing, referral to face-to-face counseling or other treatment as appropriate, and telephonic follow-up to address alcohol use and original presenting problem.  Findings suggest that integration of routine SBI by EAP consultants at intake is not only feasible in a telephonic delivery system, but also increases alcohol problem identification to levels found in the general U.S. population and, hence, the opportunity for brief motivational counseling for risky drinking. Furthermore, it is clear that when SBI is integrated as part of routine EAP practice, members are willing to answer questions about their alcohol use and participate in follow-up.