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)为员工提供短期咨询和长期转介，作为健康福利计划的一部分。EAP设置为对高危饮酒进行筛查和简短干预(SBI)提供了一个独特的机会。使用EAP来解决有风险的饮酒问题并防止出现更严重的酒精问题，对于减少这些问题在就业人员中的流行可能是至关重要的。不幸的是，大多数高危饮酒者没有被临床医生通过EAP识别出来，如果他们被识别出来，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环境下为高危饮酒实施SBIs。大量证据支持SBIs在其他环境中的有效性，例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人群中实施SBI的可行性。印度国家统计局的这些干预措施通常持续约20-30分钟，并采用激励性访谈方法。这些干预措施的简短性质可能使整合成为可能，但从组织和工作人员的角度来看，可能有几个特定于EAP的障碍，这将使其实施起来具有挑战性。在目前的研究中，我们将首先与EAP工作人员一起进行焦点小组，以确定在EAP内实施和招募用于高风险饮酒的SBI相关的障碍和促进因素。利用这些信息，我们将进行一项随机试验，将SBI作为标准EAP护理的补充，与单独使用标准EAP护理进行比较。EAP临床医生将在履行机构的干预和EAP会议上发表讲话。这一干预将是客户第二次会议的附加内容。一旦进入EAP，客户将使用AUDIT-C筛查有风险的饮酒。男性客户在AUDIT-C上的得分为5分或更高，女性客户的得分为3分或更高，将被随机分配到干预组(n=50)或对照组(n=50)。为了评估干预的效果，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，我们将收集与将履行机构添加到标准EAP护理中相关的基本成本数据，并探索为未来的成本效益研究收集行政数据的可行性。R21是我们在了解将酒精干预引入工作场所的潜在障碍并检查与此类干预相关的潜在疗效和成本方面迈出的关键的第一步。这项试点试验的结果有很大潜力影响EAP环境中识别和干预高危饮酒者的护理标准。 公共卫生相关性：在标准的EAP护理中广泛实施SBIS具有巨大的潜力，可以降低工作场所酒精使用障碍的患病率，并降低与未经治疗的高风险饮酒相关的职业、社会和健康问题的成本。到目前为止，很少有研究审查在经济、社会和文化权利背景下履行履行机构的情况，对可能遇到的障碍也知之甚少。这项试点试验的结果有很大潜力影响EAP环境中识别和干预高危饮酒者的护理标准。

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.