Development of a Substance Abuse Screener for Vocational Rehabilitation

1. Development of a Substance Abuse Screener for Vocational Rehabilitation Allen Heineman, PhD, ABPP (Rp) Feinberg School of Medicine Department of Physical Medicine and Rehabilitation Northwestern University Center for Rehabilitation Outcomes Research Rehabilitation Institute of Chicago

2. Why Conduct This Study? • Substance use disorders occur frequently among persons with disabilities • Substance use adversely affects employment and community integration • Most cases remain undetected without systematic screening • No practical, accessible, and valid screening instrument exists for use by VR counselors and other rehabilitation personnel • There is a great need for a screening tool in employment-focused rehabilitation settings

3. Barriers to Routine Screening • The lack of a brief screening instrument specifically validated for persons with disabilities • The lack of an instrument that includes items to assess the abuse of prescription medications • Administration barriers for persons who have sensory, physical, or cognitive impairments

5. Long history of research and development Use in a large number of system-wide applications Inclusion of “subtle” items that contribute to its sensitivity Readability Automated scoring Fast report generation Ready availability Established training support Easy adaptation for web-based and other electronic applications that provide flexibility in application and accessibility for persons with sensory disabilities Why Use the Substance Abuse Subtle Screening Inventory-3?

6. Feasibility Study Evaluate the psychometric properties of the SASSI-VR using data drawn from a sample of persons with disabilities who also have SUD Evaluate various forms of administration with who have a variety of disabilities Develop a medication abuse subscale Evaluate the feasibility and efficiency of the SASSI-VR as a screening tool Validation Study Evaluate the accuracy, sensitivity, and specificity of the SASSI-VR Evaluation Trial Estimate rates of SUD among VR clients with various primary disabilities Dissemination Activities Disseminate the modified screening instrument and research findings to rehabilitation via toolkits, stand-alone products and on-site training Objectives

7. Hypotheses • The SASSI-VR will demonstrate adequate psychometric properties with a heterogeneous sample of persons with disabilities who also have SUD • The SASSI-VR will be administered effectively with consumers using several forms of administration • VR counselors will determine the SASSI-VR to be an easy to administer, feasible and efficient screening tool for their needs • The SASSI-VR will demonstrate adequate accuracy, sensitivity, and specificity • Field offices that screen clients with the modified SASSI-VR will identify and refer a larger proportion of consumers for SUD treatment services than field offices that do not screen with the SASSI-VR

8. Other Data Sources • Diagnostic Interview Schedule • Rehabilitation Service Administration’s Case Service Report (RSA-911) data base • Administration log and agency survey

9. Methods for Validation Component • Facilities • 6 state Vocational Rehabilitation offices in southern Ohio and Chicago • Community rehabilitation agency • One-stop job center • Sample • Goal: 1,000 consumers with diverse characteristics • Instrumentation • SASSI-VR • 69 items (12 alcohol, 17 other drugs, 40 subtle items) • 6 random answer pattern items

10. N=955 Location Ohio: 51% Chicago: 49% Race 58% African-American 38% Caucasian 4% Other Hispanic Origin 5% Gender 52% Female Marital Status 56% Never Married 15% Divorced 14% Married 7% Separated 5% Unmarried Couple 3% Widowed Education 26% < High School 45% High School 29% Post-Secondary Sample Characteristics

11. Age Distribution

12. Diagnostic Interview Schedule • Criterion Positive • Abuse: 2.4% • Dependence: 19.7% • Overall: 22.1% • Location Variation: Any Substance Use Disorder • Ohio: 27.5% • Chicago: 16.5%

13. Rating Scale Analyses

14. Sensitivity and Specificity

15. Methods for Evaluation Trial • Sample • 40,000+ cases/year • Minimum of 5,000 cases/group, allowing for attrition, noncompliance • Facilities • ½ of the VR field offices in • Illinois (total of 51 field offices) • Ohio (53) • West Virginia (32) • Instrument • Validated and shortened SASSI-VR

17. Data Analysis Overview • Classical test theory, item response theory, exploratory factor analysis • Consumer preference ratings • VR counselor ratings of feasibility and screening efficiency • Comparison of SASSI-VR scores and decision rules with diagnoses provided by DSM-IV substance abuse diagnoses from the DIS • Hierarchical linear modeling to predict SUD identification and referrals • Contingency table analysis using chi-square statistics to compare SASSI-VR identified SUD across disability categories

18. Project Outcomes • Toolkits • Validated SASSI-VR • Recommendation that qualified substance abuse treatment professionals be involved in a formal assessment for persons who score in the problematic range • Documented sobriety-oriented activities • Published articles in one or more referred journals for researchers and clinicians

19. Rehabilitation Research and Training Center (RRTC) on Substance Abuse, Disability, and Employment Project Team Rehabilitation Institute of Chicago Kendall Stagg Holly Demark Annelouise Tookoian Arethea Crudup West Virginia University Margaret Glenn Ohio State University John Corrigan SASSI Institute Frank Miller Linda Lazowski Wright State University Dennis Moore Mary McAweeney Bridget Gerber Acknowledgments For more information: a-heinemann@northwestern.edu