RESEARCH PRESENTATION:UNIVERSITY OF MARYLAND / OPTUMHEALTH BEHAVIORAL SOLUTIONS / BLUE SHIELD OF

CALIFORNIA FOUNDATION

Greg Greenwood, Research ScientistOptumHealth Behavioral Solutions

Judith Shinogle, Senior Research AssociateUniversity of Maryland - Baltimore

What: • Retrospective analyses of EAP and Behavioral Health (BH)

data from 2004 – 2007

Why: • To identify the service patterns and the costs associated

with DV

Who: • EAP callers across OptumHealth book of business

When: • 1/1/04 to 7/1/07

EAP/BH Services & Costs Associated DV

EAP/BH Services & Costs Associated DV

How: • Identified EAP callers who presented with DV, or

whom EAP screened positive for DV

• Identified a 2:1 matched non-DV comparison group

• Measured EAP and behavioral health services and costs for 1 year post EAP call

Funding Agencies: • Blue Shield California Foundation

• Robert Wood Johnson Foundation

What Do We Need to Know?

• Number and characteristics of callers with DV identified by the EAP

• Type of EAP and BH services associated with DV

• Costs of services related to DV

• First time examination of EAP services associated with DV as well as behavioral costs and utilization

Study Objectives

• Describe employer characteristics of DV cases and non-DV controls.

• Identify other presenting issues associated with DV.

• Describe EAP-risk-identified issues associated with DV.

• Describe EAP telephonic services associated with DV.

• Measure EAP/BH services and costs 1-year post EAP call.

EAP/BH Data Methods

1/1/04 through 7/1/07 the EAP receives approx. 40,000calls per month

• DV cases (N=1,565) were identified when:

– EAP callers self-identified DV as a presenting issue (n=173), or– EAP specialists identified DV through risk assessments (n=662) or– Both (n=730)

• Controls (N=3,544) randomly selected (matched on age and gender) with ~2 controls: 1 case

• EAP data– Demographics, employment, presenting issues, risk-identified

issues, EAP telephonic interventions

• BH data:

– Service utilization & costs 1-year post EAP call

Employer Characteristics

• Domestic violence is found in all industries.

• Significantly higher percentages of DV found in the:

– Financial and Insurance Industries

– Information Industries

– Transportation and Warehousing Industries

– Utilities

Presenting Issues Associated with DV

DV cases (N=1565) compared to controls (N=3544) were significantly more likely to self present with the following other issues:

• Marital• Addiction • Others’ addictions• Anger• Childhood abuse • Crisis • Housing needs • Legal • Safety

EAP Risk-Identified Issues Associated with DV

DV cases (N=1565) compared to controls (N=3544) were more likely to screen positive on EAP risk assessments for:

• Alcohol use

• Anger

• Childhood abuse

EAP Presenting Issues for Those Identified with DV Through Risk Assessment

DV cases (N=662) identified through risk assessment compared to other DV cases (N=903) were more likely to present with the following issues:

• Addiction

• Anger

• Child

• Crisis

• Legal

• Marital

• Depression

EAP Telephonic Interventions Associated with DV

Beyond DV-specific telephonic interventions such as safety planning, self-care, community resources, and so on, other EAP telephonic interventions that were more commonly delivered to DV cases (N=1565) compared to controls (N=3544) were:

• Education regarding child abuse-neglect concerns.

• Substance abuse screening and brief intervention.

• Suicide safety planning and contract.

One Year After EAP Intervention Cost and Utilization

• One year after EAP intervention find no significant difference in behavioral health care costs.

• Median number of outpatient session was four (compared to 5 for controls).

• Median number of inpatient days for those with any days was 104 (compared to 77 for controls).

• Median total behavioral cost for IPV cases was $300 compared to $350 for controls.

• More research needed to see how EAP services changed costs over time.

Key Findings

• DV cases are from a variety of industries including arts, entertainment, recreation industry; financial and insurance; retail trade; and transportation and warehousing.

• DV cases present to EAPs with a variety of other issues such as housing, legal, safety and addictions.

• DV cases often screen positive for anger, alcohol abuse and child abuse.

• DV cases were treated in EAPs for DV but also for addiction, child neglect and suicide safety.

• Post-EAP services, DV behavioral health care costs andutilization are on par with other cases treated by EAPs.

Some Unanswered Questions & Future Analyses

• What is the relationship of industry to EAP use and BH costs?

• What factors affect behavioral health utilization and costs? What are the trends in behavioral health costs due to EAP treatment? Do certain treatments have differing affects?

• Were there pre-EAP differences between DV cases and non-DV controls in behavioral health utilization?

• What is the relationship between receipt of telephonic EAP services and post-EAP service utilization among DV cases?

Question & Answer

Contact Information: • Judy Shinogle - shinogle@umbc.edu