Research findings of associations between workplace environment, employer policies and behavioral healthcare utilization

1. Linking Workplace Polices and Programs with Treatment Utilization: Preliminary Findings Presenters: Brandeis University: Bernie McCann, M.S., CEAP MHN: Deirdre Hiatt, Ph.D. Addiction Health Services Research Conference Boston, MA October 21, 2008 Brandeis/Harvard Center on Managed Care and Drug Abuse Treatment (Funded by the National Institute on Drug Abuse 3P50 DA010233)

2. Substance Abuse Treatment Pathways in Employer-Sponsored Programs: Research Team Brandeis/Harvard Center on Managed Care and Drug Abuse Treatment Brandeis University: Elizabeth L. Merrick, Ph.D., M.S.W. Constance M. Horgan, Sc.D. Dominic Hodgkin, Ph.D. Sharon Reif, Ph.D. Bernard McCann, M.S., CEAP Harvard University: Thomas G. McGuire, Ph.D. Vanessa Azzone, Ph.D. MHN: Deirdre Hiatt, Ph.D. Center for Survey Research, UMass – Boston: Mary Ellen Colten, Ph.D.

5. Product Impact on Pathways to Treatment Individual’s decision to seek mental health or substance abuse treatment Contact EAP EAP visits Specialty Visits Contact Integrated EAP Integrated MBHC EAP visits Specialty visits Contact MBHC Specialty visits O bservable in MHN data Not observable *Other sources = general medical providers, self-help, & other sources Other sources* Other sources* Other sources*

9. Sample Demographics Percent of enrollees (N = 697,389 enrollees ) For EAP enrollees, n = 129,639 For Integrated enrollees, n = 567,750 Product Type EAP Integrated Gender: Female 46.7% 50.9% Male 53.3% 49.1% Age: < 18 19.8% 29.2% 18-35 38.7% 25.4% 36-55 34.4% 33.1% > 55 7.1% 12.3% Product Type EAP Integrated Enrollee: Employee 64.7% 43.3% Spouse 11.9% 21.6% Dependent 23.4% 35.1% Region: Northeast 8.3% 12.3% Midwest 9.8% 12.8% South 27.3% 36.2% West 54.7% 38.8%

10. Environmental Factors (N = 697,389 enrollees ) *Data gathered for benefit year 2005 Percent of Enrollees b y Product Type* EAP Integrated Industry sector: Service 33.4% 18.9% Blue collar (Construction; Transportation & Manufacturing) 44.6% 48.7% White collar (Sales, Information/Financial & Government) 21.9% 32.3% No union presence in workforce 58.5% 58.3% Less than 50% union membership in workforce 25.3% 21.9% More than 50% union membership in workforce 16.2% 19.8% Employer is subject to Federal Drug-Free Workplace Act 7.9% 15.6% Any employee is subject to Federal Agency Drug Test regs 48% 56.1% Experienced unusual or high level of stress in last year 44.4% 49.7%

11. Employer Policies (N = 697,389 enrollees ) *Data gathered for benefit year 2005 Percent of Enrollees b y Product Type* EAP Integrated Majority of employees have access to health benefits 87.4% 95.8% Employer focus on workplace health & wellness = low 10% 5.8% Employer focus on workplace health & wellness = medium 35.4% 28.5% Employer focus on workplace health & wellness = high 54.6% 67.7% Employer has written workplace substance abuse policy 91.9% 96% Substance abuse policy has zero tolerance for violations 7.2% 2% Substance abuse policy requires treatment for violations 84.7% 94% Conducted EAP Worksite activities (orientations, classes, etc.) 39.9% 23.2% Employer level of workplace behav hlth product promotion = low 10.7% 14.8% Employer level of workplace behav hlth product promotion = med 63.5% 32.7% Employer level of workplace behav hlth product promotion = high 25.9% 52.5%

12. Predictors of Any Claim: Covariates Enrollee type [ref = Dependent] Gender [ref = Male] Female Employee < 18 Age group [ref = 36-55] 18-35 > 55 EAP product 1 Integrated product *Values significant P <.01; **P<.05 Logistic regression odds ratios; N = 697,389 enrollees

13. Predictors of Any Claim: Environmental Factors Industry sector [ref = White Collar] Logistic regression odds ratios; N = 697,389 enrollees Blue Collar Any union Subj to DFWA/Fed drug test regs Govt DFW mandates [ref = none] Level of unionization [ref = none] *Values significant P <.01; **P<.05 Past year worksite stress [ref = none] Unusual/ Significant 1 2.56* EAP product Integrated product

14. Predictors of Any Claim: Employer Policies/Workplace Activity Zero tolerance for policy violation 1 Conducted any worksite EAP activities? [ref = None] Substance abuse policy details [ref = Treatment required for policy violations] Conducted EAP worksite activities No written SA policy EAP product Integrated product * Values significant P <.01; **P<.05 Logistic regression odds ratios; N = 697,389 enrollees