Greg Greenwood, Research Scientist OptumHealth Behavioral Solutions

2. Research Presentation:University of Maryland / optumHealth Behavioral solutions / Blue shield of California foundation Greg Greenwood, Research Scientist OptumHealth Behavioral Solutions Judith Shinogle, Senior Research Associate University of Maryland - Baltimore

3. EAP/BH Services & Costs Associated DV 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

4. 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

5. 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

6. 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.

7. EAP/BH Data Methods 1/1/04 through 7/1/07 the EAP receives approx. 40,000 calls 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

8. 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

9. 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

10. 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

11. 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

12. 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.

13. 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.

14. 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.

15. 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?

16. Question & Answer Contact Information: Judy Shinogle - shinogle@umbc.edu