Implementing a Screening and Brief Intervention in the EAP for At-Risk Drinkers

描述（由申请人提供）：员工援助计划（EAP）提供短期咨询和长期转介员工作为健康福利计划的一部分。EAP设置提供了一个独特的机会，进行筛查和简短的干预（SBIs）的风险饮酒。使用EAP来解决危险饮酒和防止更严重的酒精问题的发展可能是至关重要的，以减少这些问题的流行率在就业人员。不幸的是，大多数有风险的饮酒者并没有通过EAP被临床医生识别出来，如果被识别出来，也没有通过EAP为他们的饮酒提供服务。这项为期两年的服务研究的主要目标是了解如何在标准的EAP环境中实施风险饮酒的SBIs。大量证据支持SBIs在其他环境中的有效性，如初级保健和大学环境。然而，只有少数已发表的研究探讨了在工作场所实施SBIs的可行性。这些SBI干预通常持续约20 - 30分钟，并利用动机访谈方法。这些干预措施的简短性质可能使其具有整合的可行性，但从组织和工作人员的角度来看，EAP可能存在一些具体的障碍，使其难以实施。在目前的研究中，我们将首先与EAP工作人员进行焦点小组，以确定在EAP内实施和招募SBI风险饮酒的障碍和促进因素。利用这些信息，我们将进行一项随机试验，将SBI作为标准EAP治疗的附加治疗，与单独使用标准EAP治疗进行比较。EAP临床医生将提供SBI干预和EAP会话。干预将是客户第二次会议的附加内容。进入EAP后，客户将使用AUDIT-C进行风险饮酒筛查。在AUDIT-C上得分5分或更高的男性客户和得分3分或更高的女性客户将被随机分配到干预组（n = 50）或对照组（n = 50）。为了评估干预的有效性，我们将在3个月和6个月的随访中检查饮酒和健康结果。最后，我们将收集与将SBI添加到标准EAP护理相关的基本成本数据，并探讨为未来的成本效益研究收集管理数据的可行性。这个R21代表了我们在了解将酒精干预措施带入工作场所的潜在障碍并检查与此类干预措施相关的潜在功效和成本方面的第一个关键步骤。从这个试点试验的结果有显着的潜在影响标准的护理识别和干预与风险饮酒者在EAP设置。 公共卫生相关性：在标准EAP护理中广泛实施SBIs对于降低工作场所酒精使用障碍的患病率以及降低与未经治疗的高危饮酒相关的职业，社会和健康问题的成本具有巨大潜力。迄今为止，很少有研究审查了在EAP环境中实施SBI的情况，并且对可能遇到的障碍知之甚少。从这个试点试验的结果有显着的潜在影响标准的护理识别和干预与风险饮酒者在EAP设置。

DESCRIPTION (provided by applicant): Employee assistance programs (EAPs) offer short-term counseling and long-term referrals to employees as part of a health benefits package. The EAP setting presents a unique opportunity to conduct screening and brief interventions (SBIs) for at-risk drinking. Using an EAP to address at-risk drinking and to prevent more serious alcohol problems from developing may be critical to reducing the prevalence of these issues among employed individuals. Unfortunately, the majority of at-risk drinkers are not identified by clinicians through EAPs, nor are they provided services through EAPs for their drinking if identified. The main objective of this two-year services research study is to understand how to implement SBIs for at-risk drinking in a standard EAP setting. Substantial evidence supports the effectiveness of SBIs in other settings such as primary care and college settings. However, only a few published studies have examined the feasibility of implementing SBIs into workplace populations. These SBI interventions typically last about 20-30 minutes and utilize a Motivational Interviewing approach. The brief nature of these interventions may make it feasible to integrate, but there may be several barriers specific to the EAP from an organization and staff perspective that would make it challenging to implement. In the current study, we will first conduct focus groups with EAP staff to determine the barriers and facilitating factors associated with implementing and recruiting for a SBI for at-risk drinking within the EAP. Using this information, we will conduct a randomized trial of the SBI as an add-on to standard EAP care compared to standard EAP care alone. EAP Clinicians will deliver both the SBI intervention and EAP sessions. The intervention will be an add-on to the client's second session. Upon entering the EAP, clients will be screened for at-risk drinking using the AUDIT-C. Male clients scoring five or higher and female clients scoring three or higher on the AUDIT-C will be randomly assigned to either the intervention (n=50) or control (n=50) group. To assess the efficacy of the intervention, we will examine drinking and health outcomes at 3- and 6-month follow-ups. Finally, we will gather basic cost data associated with adding the SBI to standard EAP care and explore the feasibility of gathering administrative data for a future cost-effectiveness study. This R21 represents our first critical step in understanding potential barriers to bringing alcohol interventions into the workplace and examining potential efficacy and costs associated with this type of intervention. Results from this pilot trial have significant potential to influence standards of care for identifying and intervening with at-risk drinkers in the EAP setting. PUBLIC HEALTH RELEVANCE: Widely implementing SBIs in standard EAP care has a great potential for decreasing the prevalence of alcohol use disorders in the workplace as well as decreasing the costs of occupational, societal, and health problems associated with untreated at-risk drinking. To date, few studies have examined the implementation of an SBI in an EAP setting, and very little is known about the barriers that would be encountered. Results from this pilot trial have significant potential to influence standards of care for identifying and intervening with at-risk drinkers in the EAP setting.