Onsite screening and enhanced EAP counseling improves overall health, depression, and work outcomes: Four-wave longitudinal pilot study at a community health center in Vermont

Abstract

Over a 2-year period, patients at a rural community health center in Vermont were screened on-site for multiple behavioral health risk factors and, if found at risk, were offered no-cost counseling on-site at the health center. The treatment was delivered by two licensed employee assistance program (EAP) counselors highly proficient in an evidence-based motivational interviewing approach. Longitudinal data at four time points were examined: baseline; end of treatment (3 months); and 3 and 6 months post-treatment. Tests of paired data of baseline versus each later time point found significant improvement for global health (Patient-Reported Outcomes Measurement Information System [PROMIS]-10) in the total sample (N = 120); depression symptoms (Patient Health Questionnaire 9-item scale [PHQ-9]) among a subsample with depression as a clinical issue (n = 68); and work presenteeism and estimated hours of lost work time among the employed subsample (n = 46). Improvement in global health was significantly associated with improvement (reductions) in hours of lost work productivity at all later times (r = .33, .35, .50). Improvement in global health was moderated by level of household income (more improvement among patients with lower income levels), but not by clinical or demographic factors. Practical implications for behavioral health screening and intervention (BSI) in medical settings and onsite EAP counseling programs are discussed.

Keywords:

• Depression
• work productivity
• EAP counseling
• global health
• risk screening

Acknowledgments

The authors want to recognize the support of Diane Dalmasse (Director of the State of Vermont Division of Vocational Rehabilitation), Joelle Judge, JD (Senior Project Manager on the Vermont Health Care Innovation Project), and Georgia J. Maheras, Esq. (Deputy Director of Health Care Reform for Payment and Delivery System Reform and Director of the Vermont Health Care Innovation Project). The authors would like to thank our project manager Deborah Buley, PhD, and our two counselors Andy Kelley, MSW, and Susan Hall, MA (both from Invest EAP Centers for Wellbeing), for their contributions to the study. A special thank you to Richard Brown, MD, MPH, University of Wisconsin, School of Medicine and Public Health, who provided important consultation and training. A preliminary report on this study was presented at the Vermont Worksite Wellness Conference (Attridge & Dickens, 2018).

Disclosure statement

Dr. Attridge was hired by Invest EAP Centers for Wellbeing to conduct this research project. Steve Dickens is a senior executive at Invest EAP Centers for Wellbeing.

Disclaimer

The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of the State of Vermont or of the United States Department of Health and Human Services or any of its agencies.

Additional information

Funding

Funding for this study was provided by the State of Vermont, Vermont Health Care Innovation Project, under Vermont’s State Innovation Model grant, awarded by the Center for Medicare and Medicaid Services Innovation Center (CFDA Number 93.624] Federal Grant #1G1CMS331181-03-01.