Prescription Abuse in the Workplace Webinar

Prescription Abuse in the Workplace Webinar


Good afternoon, everyone. My name is Ted Miller
and I direct SAMHSA’s Prevention of Prescription Abuse in the Workplace Technical Assistance
Center. Thank you for joining today’s Webinar featuring evidence-based and promising workplace
programs to prevent prescription drug abuse. We plan to end at 3:45. This is not an open
line due to the number of participants on the call. If you want to make a comment or
ask a question, please press “7#” or use the chat box. This session is being recorded
and we plan to post it on the SAMHSA Web site. Joining us from SAMHSA is our Project Officer,
Dr. Deborah Galvin. Good afternoon and welcome. Thank you for joining our third prevention
of prescription drugs in the workplace webinar this afternoon. We want to thank you for joining
today’s webinar as we listen to presenters from four model programs addressing prescription
drug abuse in the workplace. Prescription drug abuse continues to be a major emphasis
for SAMHSA, as scores of people both young and old face the debilitating effects of this
abuse. Ted. Our speakers today are Heather Healy of the
Flight Attendant Drug and Alcohol Program, Fred Brason of Operation Opioid SAFE, Dr.
Diane Deitz of the ISA Group, and Dr. Joel Bennett of Organizational Wellness & Learning
Systems, Inc. Heather Healy is a licensed clinical social worker in Maryland and the
District of Columbia. She directs the Association of Flight Attendants-CWA, AFL-CIO Employee
Assistance Program. The past 15 years, she has developed and expanded pure-based EAP
services for flight attendants, their families, and partners at 19 airlines in 5 countries
in 66 locations. She has been in the EAP industry for 30 years and is a field instructor at
the University of Maryland School of Social Work. Heather.
Good afternoon, everybody. Let me start out by providing you with some background about
the Flight Attendant Drug and Alcohol Program, especially its fit with aviation safety, before
I segue into some of the risk factors, interventions, and tools that we have developed for flight
attendants around prescription drug use. Next slide.
So what is FADAP? FADAP is an FAA-sponsored safety initiative, which funds prevention,
early intervention, and recovery support services targeted for flight attendants. FADAP offers
a range of educational resources and services to help all aviation stakeholders develop
customized partnership activities to address flight attendant alcohol and/or drug abuse
within their specific organization. FADAP was started in September 2010 under
FAA appropriations language and now also under FAA authorization language. FADAP was originally
conceived and is now being managed by the Association of Flight Attendants. These services
are available for all flight attendants regardless of employer or affiliation. This includes
nonunion and union flight attendants performing in commercial, corporate, and military aircrafts.
FADAP uses trained peer flight attendants to deliver early intervention, referral to
treatment and post-treatment support services, and uses the entire workplace including flying
partners and flight attendant leaders/managers for case referral.
FADAP addresses one health issue—substance use—whether it’s called “misuse,”
“abuse,” or “dependency.” Whether it’s by alcohol or drugs or whether the
substances are legal or illegal. Why offer FADAP, especially when FAA regulation already
requires a management-sponsored EAP or employee assistance program? Unfortunately, the management
employee assistance program model, which relies heavily on supervisory observation to make
a referral to EAP, doesn’t fit the flight attendant work culture. The flight attendant
workplace is 30 to 40,000 feet above ground. Rarely does a flight attendant interact with
supervisory structure, unless there’s a pending disciplinary action. Flight attendants
can go months, if not years, without management contact. So, to rely on supervisory observation
of changes and performance behavior and appearance to identify impairment offers little if no
early intervention value. More importantly, if you wait until declining or impaired performance
shows up on the job, safety may already be at risk. The best practice around safety provides
a proactive approach to identifying and correcting
hazards and risks before they have safety consequences. We know that
impaired health may result in impaired performance, which in turn puts safety at risk. For safety-sensitive
employees like flight attendants, this is particularly true. Flight attendants are first
responders with primary safety and security responsibilities. Their duties include sustaining
a safe and secure cabin environment while performing all of their duties and responsibilities
during normal and abnormal operations. The creation of a culture of safety really needs
to involve those who are part of that culture. The supervisory observation model
of flight attendants is not only not very practical in relation to how flight attendants
work, but also lacks input in partnership with the very work group whose behavior is
seeking to be modified for safety purposes. FADAP provides management and flight attendants
the opportunity to come together, discuss, share, and create effective best practices
around health issues like substance use. There are other reasons why we are offering
FADAP. Many are related to elevated risk and vulnerability. The data that we do have suggests
a high rate of substance use in the flight attendant population. The 2012 data that you
see in front of you was derived from responses from an anonymous survey of over 2,000 flight
attendants, developed with the help of FADAP peer reps at over 25 airlines. Nine percent
of flight attendants self-reported that they are showing up hungover. Thirty-five percent
of flight attendants within the past 12 months were reporting that they were drinking more
than they should have. Within the past 12 months, 40 percent of the flight attendants
reported that they were drinking up to the cutoff time; 16 were drinking past the regulation
cutoff time. Fifteen percent were using pain medication on duty, 20 percent mixing drugs
and alcohol, and 13 percent that others verbalize worry about their use.
When we look at two variables, the use of pain medication on duty and the mixing of
drugs and alcohol, we really recognize the opportunity for education for drug use both
on and off the plane. Another vulnerability factor is sex; 70 to 80 percent of flight
attendants are female, which makes them more vulnerable to health-related problems and
rate-of-disease progression compared to males consuming the same quantity of drugs.
Finally, FAA data on test violations confirms that 10-plus-year pattern of increasing drug
and alcohol test violation rates for flight attendants between years and compared to pilots.
Several factors may put flight attendants at risk for drug use, including medication
and non-medical use of prescription medications. Flight attendants are primarily tested using
the DOT FAA-authorized five-panel tests. This includes PCP, marijuana, cocaine, natural
opiates, and methamphetamines. It doesn’t include synthetic opiates, anti-anxiety meds,
or sleep meds. So it offers no deterrent or early intervention around many of our most
impairing and most commonly used medications. Flight attendants travel internationally.
As such, they have access to U.S.-controlled substances as over-the-counter substances
in many international destinations. In fact, many hotels include shopping for medications
and delivering them directly to the flight attendant’s
room as one of their concierge services. We are all aware of the little training that
most doctors in the United States have around substance use. Flight attendants are equally
at risk of seeing such doctors. Additionally, however, these doctors may also fail to fully
appreciate or understand that flight attendants are not just responsible for customer service
but primarily function as first responders. With little understanding of the flight attendant
duties, these doctors may put the flight attendant at risk for the use of pharmaceuticals, which
impact their fitness duty. As aviation employees, flight attendants suffer occupational injury
and illnesses far in excess of those experienced in other sectors of private industry. For
example, in 2008, aviation employees suffered 200 percent more reportable injuries and illnesses
than employees in the coal mining industry. Flight attendants have to manage ever-changing
wake and sleep cycles, time zone changes, long work hours, and minimal rest periods.
Pharmaceuticals are an easy and reliable tool to manage the need to quickly fall asleep
on demand and to stay asleep, to manage fatigue and a lack of energy, and of course to manage
pain. What we do know is that many of our pharmaceuticals
with continued use over time create dependency. Rarely do we hear of a flight attendant being
prescribed limited quantities of drugs or being forewarned about the potential for dependency
by their prescriber, which puts them at risk for what I call “migratory dependence.”
We also know that for successfully treated substance-abusing flight attendants, their
continued risk of occupational injury and the stresses of the occupation, including
the exposures to trauma, puts their recovery at continued risk of the script pad. So, prescription
drug use continues to be a recovery management issue even after recovery.
In short, the goal of FADAP is to create a culture of safety by helping flight attendants
evaluate themselves for substance abuse across their entire professional life span, just
like any other medical condition. We ask people to screen themselves for health conditions
like diabetes and skin cancer at routine intervals across their life span. Why not substance
use and abuse? After all, I may not be symptomatic, but next year, I might. To help
flight attendants conduct self-screenings, we created a
short occupational-specific drug screening tool for working flight attendants. Rather
than using a generic drug screening tool, we wanted one that spoke directly to flight
attendants and had meaning in terms of their work behavior. With the help of CSAT and RTI,
we were able to produce and validate the screening instrument, which has the same reliability
as FDAST. If a flight attendant answers yes to two or
more of the below items, they are encouraged to contact a FADAP peer for follow-up help.
I have not shown up for a trip because of my use of a drug or medication one or more
times in the past 12 months. I have used a flying partner’s prescription medication
one or more times in the past 12 months. I have shared my prescription medication with
a flying partner one or more times in the past 12 months. I have used a prescription
pain medication while performing my flight duties one or more times in the past 12 months.
I have bid my flying schedule to avoid a drug test one or more times in the past 12 months.
I have bid my flying to have access to drugs or medication one or more times in the past
12 months. The
screening instrument was turned into a 10-by-16
poster, which flight attendant leadership and managers have posted throughout their
crew rooms. Other posters have been created and made available for downloading at the
FADAP Web site. Again, the audience is not just the afflicted but the affected. The FADAP
program reaches out to flight attendants whose flying partners are concerned about them.
Unlike a management EAP, FADAP does not have to wait for a beneficiary to contact them
for service. FADAP can conduct a cold call to a flight attendant with the hopeful outcome
of an earlier intervention. In addition to substance use education through the Web site
and posters, FADAP offers a peer-answered 24/7 helpline for flight attendants concerned
about others or themselves. FADAP also offers flight attendants specific Internet and phone
12-step recovery meetings called Wings of Sobriety meetings, where a flight attendant
who is not quite sure if they have a problem can listen into others and try to see if they
can identify in. FADAP also offers seminars and conferences to educate FADAP peers, flight
attendant leaders, managers, and other aviation personnel. And our fourth annual conference
will be in Baltimore, and any information on registration can be found at FADAP.org.
Finally, we are in the process of building a wellness app for flight attendants, offering
a number of tools to combat prescription drug abuse, including the drug screening tool that
you have just seen. In line with our efforts to enhance safety
by addressing substance use as a health issue, we are really challenging the aviation industry
to reconsider the disciplinary approach to substance abuse. Does the disciplinary approach
drive the abuser underground, thereby increasing safety risks? If employees can come forward
without fear of discipline and with a commitment that they will get the right care at the right
level in a timely fashion, aren’t we really enhancing safety? Currently, we have been
working with our FADAP advisory board to build a database to track workplace outcomes for
flight attendants following treatment engagement. Hopefully, this will add to the body of data
that supports a health-related approach to workplace substance abuse. The five factors
that we are gearing up to track are absenteeism, engagement, presenteeism, safety, and interpersonal
relations. Finally, we recognize that you really can’t expect anyone to buy into substance
abuse as a health condition unless the stigma and shame around it are significantly reduced.
Consistent with the national campaign to destigmatize the disease of addiction, FADAP is working
to destigmatize addiction in the aviation workplace. At any venue or media opportunity,
we are having recovering flight attendants share their story, and we are giving addiction
a face through the flight attendant recovery pin. This pin is available for any recovering
flight attendant to wear, and we hope it sparks an open conversation just as much as cancer
survivor pins and wristbands do today. In order for FADAP to be successful, we need
to help both the afflicted and affected feel safe in asking for assistance. I’ve already
described the 24/7 peer staff line and the outreach peers can conduct. FADAP also offers
referral to treatment programs that have been specially trained on how to work with flight
attendants, and of course the FADAP peer continues in the recovery planning process. In addition
to the FADAP peer, another layer of support has been created called the FADAP mentor for
a recovering flight attendant. This is a person who is willing to give her or his time and
expertise to a newly treated flight attendant who is returning to flying. The mentor is
a flying buddy who has already learned the road to how to fly and stay in recovery. The
mentor does not replace the 12-step sponsor. Our goal is to make recovery the norm, but
we can’t if prescription drug use continues to undermine recovery. One of the things we
are currently doing is making the flight attendant job description available to medical providers
through the app that we are currently constructing. We also provide flight attendants in recovery
a wallet card, which we call the “Dear Doctor” card. Basically, the Dear Doctor card says,
“Dear Doctor, I want you to be aware that I’m in recovery from blank. I have sensitivity
to all opiates, barbiturates, and other mood-altering substances. While I take full responsibility
for my recovery, I need your help to maintain my sobriety and recovery. Please consult the
standards for pain management put forward by the Joint Commission on Accreditation of
Healthcare Organizations or the World Health Organization stepladder approach to pain treatment.
While I am not currently using and have not since—“ (whatever year you put in there)
“please consider my recovery as an active health condition that needs a specialized
approach. I’m not only your patient, I’m your partner in caring for me. Thanks for
being mine.” We also provide recovering flight attendants with the Medication for
Recovering Persons handbook, which is a guide for maintaining sobriety while receiving treatment
for other health problems. We are providing treatment summaries to primary care physicians.
Typically in the treatment world, people don’t release those records, which means that the
primary care providers has no glimpse into the history of treatment. It is standard if
a primary care physician refers someone to a specialist for any other health condition
to get information back. We are making sure that that information is received back by
the primary care. Finally, if the primary care person does not have a specialization
in an addiction and are unwilling to learn about addiction, we are providing the recovering
person with referrals to new providers. So in short, some of the steps that you might
be able to take to abate prescription misuse is create an employee and employer partnership.
Develop a peer assistance program particularly if your work force is pretty independent and
does not have significant contact with a supervisory structure, and develop a destigmatizing campaign.
Thanks, Ted, I’m going to turn it back over to you.
Hello? Hello, Ted, your phone may be muted. I believe he is un-muted now. Thank you, Ted.
I should tell you that I muted it and un-muted it. Something went wrong somewhere.
Thank you, Heather, that was very enlightening. Our next speaker, Fred Brason, is the president
and CEO of Project Lazarus. Project Lazarus is a community-based opioid overdose prevention
model that started in North Carolina and has spread elsewhere, including to military and
tribal communities. Fred is a chaplain. He serves on the advisory board for North Carolina’s
prescription monitoring program. He co-chaired the expert committee, guiding development
of SAMHSA’s opioid overdose prevention toolkit, which is worth checking out if you haven’t.
In 2012, he received the Robert Wood Johnson Foundation community health leadership award.
Fred? Thank you, Ted, I appreciate it. Good afternoon
to everyone. Just to give some preliminary information as I go through the first couple
of slides, because Operation Opioid SAFE is primarily the Project Lazarus initiative in
replication at Ft. Bragg in Fayetteville, North Carolina. If you can back that slide
up one more second, I wanted to cover a couple of things on the title. The premise of our
model that we are continuing on at the base is preventing opioid poisonings, presenting
responsible pain management, and promoting substance use treatment and support services—mainly
all of those to ensure that that person in pain can receive the appropriate treatment
in whatever modality that will be—opioids or non-opioids—without any obstacles or
stigma. At the same time, we want to make sure that the individual that may have had
a use above and beyond prescriptions—whether it be a substance use disorder or addiction
dependency issues—that they have same opportunity for treatment and care without any obstacles
and stigma. On the bottom of this slide is Major Michael Bartoszek’s information, and
he is at the Womack Army Medical Center at Ft. Bragg. He’s able to be contacted. Next
slide. Just a brief overview of the model so you
know conceptually what I’m talking about as I go through operation Opioid SAFE. In
building a community model, we find it to bring the public aware of the problem, dealing
with all sector groups and creating coalitions that are collaborating and partnering in addressing
the issue—again, not with a blame sort of attitude—just working with all of the solutions
in order to make sure that it’s safe and secure for those who have it and for those
who don’t need it effective treatments and using data and evaluation drive that. Community
education, working with the prescribing community, hospital systems, emergency department policies
surrounding prescribing of controlled substances, working with law enforcement for diversion
control, and also integrating them into the local behavioral health substance abuse treatment
that’s available in each and every community so that the right person is getting help and
not just incarcerated. Supporting pain patients—people with pain—on knowing about alternatives,
care, wellness, and nutrition. We talk about making the locks on the antidote to opioid
overdose available—which we are doing both at the community level and at Ft. Bragg—and
other addiction treatment, all modalities, medication-assisted treatment, and other modalities
that may or may not be available but to ensure that they become available. Next slide.
The objectives: to introduce available opioid prescribing guidelines, review evidence for
best practices, and dissect opioid risk mitigation program, which is ongoing to ensure do we
have the outcomes that we are looking for. To give you data that is slightly out of date,
but to give you some idea of the magnitude of what we are talking about. This was reported
to Congress: a total of 930 limb amputations, 251 minor amputations, 44,000 cases of traumatic
brain injury, almost 40,000 cases of PTSD. Chronic pain is widespread among these patients,
and 40 percent of chronic pain patients are treated with opioids within the military and
at Ft. Bragg at any given time. Next slide. Just, again, to show you the prescribing levels
at Ft. Bragg from 2004 to 2009. And when you see those years of the uptick in those prescribing,
those actually surround deployments both to Iraq and Afghanistan when you had major brigades
and divisions being deployed to be in the theater. Obviously, creating more, unfortunately,
opportunity for injury for their training or in the actual theater itself. Ft. Bragg
at the time had been averaging about eight overdoses per month. Abuse and dependence
is unknown because most of it’s unreported due to fears of career threatening, being
discharged from the Army—all of those are factors. There are really no known studies
on the opioid use or overdoses within the military to know the full magnitude of the
problem. And the Army substance abuse program currently rolls about 20 to 40 patients a
month for opioid addiction. With the providers, what we did was provide
them with an educational packet, provide them lectures to give the primary care providers
both within the medical center and but the outlying clinic that care for the active duty
soldiers and their families to improve knowledge and comfort level with opioid therapy, but
just to understand and to know the different pain treatment options that may be available
for their soldiers besides just writing a prescription, and then creating detoxification
pathways regarding the buprenorphine—to have that exist for patients who no longer
medically benefit from opioids. The studies of efficacy for the opioids among active duty
soldiers are done person by person. There is not a blanket “this is how we do for
everybody” because everybody is different. They don’t look at maximum dose, they look
at the individual and their compliance factors and the risks and benefits of the opioid medication
to determine whether to keep them on lower or find other means for treatment. Next slide.
In the general community, when we are looking at pain in an individual, the top three there—the
substance abuse and mental health are primarily other indicators for morbid conditions that
have to be at least assessed and/or addressed within those individuals. But when we start
talking about the military, we are adding more to that with traumatic brain injury and
elements of PTSD, which we know from the recent wars is fairly common unfortunately within
the military, both active and veterans. So it’s that much more that the prescriber
provider in the Department of Defense and the VA system has to go steps further in appropriately
assessing the risk factors and weighing the benefit factor for those individuals receiving
opioid medications. Next slide. The Womack Army Medical Center. I helped them
initiate building a bridge back, which is a buprenorphine program. At the time, Tricare,
which is the insurance coverage for active duty soldiers, covered up to 180 days, basically
for a detox method of utilizing buprenorphine for those active duty soldiers. At that time,
there was not any coverage for medication-assisted treatment or for long-term provision of buprenorphine
or methadone for those individuals. At the time when we first engaged with Ft. Bragg
at the Womack Army Medical Center, there was no bridging with buprenorphine. We were able
to pull some of the doctors together and get them certified with their X added to their
DEA so that they could prescribe buprenorphine to those patients that they wanted to wean
off opioids, whether because the efficacy was failing or because there was addiction
abuse dependency issues with it. Next slide. Here was how we sort of mapped that out. Obviously,
it is more than what I’m going to run through, but I wanted to have the slide available to
you with the substance abuse program in the Army to make sure that as assessments were
done, that it was rapid as far as working with that active duty soldier and getting
them into the detoxification buprenorphine program in order to find what may be the best
treatment for them dealing with an addiction, misuse, abusive situations with that. To get
them at least physically at a place where they can deal with any external life issues
and address PTSD and others that their opioid use had been masking. These are kind of the
methods of going through that program. As you can see, literally under the induction
procedures, walking the patient over to the clinical pharmacist when criteria was met,
and then the clinical pharmacist administer Suboxone as prescribed, the first week observed,
and then the patient returning to the clinical pharmacist in 60 minutes. Again, watching
them, reporting with them, discussing with them, and strong, active face-to-face case
management. Next slide. Then as we looked at the active duty soldiers
to determine what is the best practice for chronic pain management and opioid prescribing.
The physicians there, Dr. Tony Dragovich, at the time, came up with a green light, yellow
light, red light that we deal with every day on the streets. Basically, to look at what
are the low factors of someone who, obviously, good compliance, no problems with the current
opioid misuse measures. Looking at whatever those might be. If they were less than nine
and only one nine are risk factors that I’ll go through. No remoter urine screens; obviously
they are appropriate for the medication. The levels of monitoring can be lightened, although
they do not stop. Then we move into the moderate stage of beginning greater than nine. The
one minor risk factor, abnormal urine screens, their dosing, and any history of substance
abuse—again not only with them, but in the family and in their environment. Taking benzodiazepines
or methadone additionally, and of course, any documented history of PTSD or TBI, and
the same for the high. Again, moving up the dosing factors. Greater than nine on the misuse
measures and any kind of a documented previous overdose that they may have survived. All
of those are looked again on an individual basis, and then based on that determination,
how frequently they are seen, how they are monitoring, and how they are case managed
because, again, a factor in the high category that they may still need that medication,
we just want to ensure their safety, appropriate measures to have that in place, and then making
sure that they don’t create a further risk and the benefits outweigh the risks on an
individual basis. Next slide. Here is just a breakdown further of what I
just talked about. Again, I put the slide in just you had it and can look at it ongoing
and can determine to see what the green and the yellow and the red lights, so to speak,
on how to work with those individuals. Again, for any risk factors, therapy is stopped,
and then alternatives are looked at moving them into the detox mode and other modalities
or moving them into the substance abuse programs within the military and helping with those
situations ongoing. Next slide. The risk factors and assessments. Again, this
is just a brief synopsis of that. I’m not going to read all of these. Aggressive complaining
about the need; unapproved use of medication to treat another symptom, which unfortunately
in society and cultures is common. You know, I had a little bit more pain so I took a little
bit more of the medication, or I was taking my medications because of my back injury from
jumping out of an airline. Playing basketball I happened to roll my ankle, so I took a little
bit more of that medication in order to address the ankle. Those kinds of discussions take
place again to raise the level of awareness of the risks to keep that individual safe.
Moving into the major categories, you know, if there is any selling going on, prescription
forgery, any stealing or borrowing, injecting, taking the medication other than how it was
prescribed, whether it was crushing or injecting, any concurrent abuse of alcohol or illicit
drugs, repeated visits to other clinicians or other emergency rooms without informing
the direct prescriber. Again, we use pain agreements and so forth that if they start
to breach those then appropriate measures can be taken. Medicated-related deterioration
and function are at work and again we held to a high scale in this. The functionality
of the individual. How are they able to function? Are they able to go back to their unit on
these medications, or does there need to be a look at, through the Warrior Transition
Brigade, moving into another unit or if their injuries are sufficient enough that they will
be moving away from the Army and becoming one of our veterans. Next slide.
The risk and the benefit is that function piece.
Not just looking at your pain scale from 1 to 10 because we believe that somebody’s
3 can be somebody else’s 7; somebody else’s 7 can be somebody else’s 3, you know. How
best can that individual function with the pain that they are dealing with on the medications
that they are taking at that time. What are the goals? If somebody can function well,
it’s what somebody might say is a three and they are able to do all of the things
that they want to do, then it might be a goal of let’s get you to that three and then
work from there, rather than looking at every individual and then trying best to make them
entirely pain free, which over time can take more opioids, more medication, and so forth.
But working that out with the individual together, in collaboration on working those goals. And
then, of course, any adverse effects and watching compliance through the entire process, again
for safety’s sake, and realizing that lives change through the process. There could be
many factors going on when some solider is looking to have had a lifelong career in the
military and they had a career-ending injury, you’re dealing with the aspects of depression,
change of life, and all of those factors that can weigh heavily on the use of opioids and
perhaps interfere with the appropriate prescribing that’s done for the injury that they have.
All of those factors are looked at ongoing. Again, balancing the risk and benefit so that
the risks don’t outweigh those benefits as best as possible. Next slide.
With physical profiles, when we’re looking at someone who is being prescribed, no evidence
of impairment on stable doses of opioids, use caution during titration—moving them
down, and escalation—moving them up, which again is frequent with opioid prescribing,
but those are more risky times for those individuals. Of course, always use caution with methadone
because of its half-life within the body, the time that it takes to build up in order
to appropriately match the pain and get rid of the pain and then, of course, any use of
polypharmacy, benzodiazepines with the opioids. As either one of those moves up the scale
or risk, so does overdose. Monitor those very closely. Looking at that from a functioning
perspective where both are frequently prescribed either together or a soldier is getting one
from one doctor and one from another doctor, and without that communication, unaware. Thankfully,
at least in the military, if they are seeing all military prescribers, their medical record
will indicate that. Next slide. Case management. Again, to ensure compliance,
screen for the emergence of risk factors because on Day 1 when it is assessed for the opioid
medication does not necessarily mean that things don’t change in 6 months. Life issues
go on and all of those factors that I talked about—that’s a continuing assessment that
needs to be done. Resource intensive. Making sure that what needs to be made available
to that soldier and family are made available and the appropriate referral mechanisms for
that. Again, removing obstacles and removing stigma within their lives. I anticipate much-improved
outcomes. Setting those goals, working together on those goals to achieve those goals and
then determining the factors as to why they cannot be met or why they are not being met.
Then, evidence for case management in other fields of medicine, you know, that information
is out there. That education is out there. It is just appropriating it and implementing
it within our medical systems, whether it’s military or otherwise. Next slide, please.
Patient education we initiated is very crucial. For the Operation Opioid SAFE, using the National
Opioid Use Guideline Group out of Canada, and there’s the Web site for that education.
There are many other modalities available for education pieces around the country, and
look for those. The patient support system we found to be crucial as we did in the community
piece to make sure that the community, the family, and the friends, and everyone surrounding
that individual is aware of the issues, aware of the care, aware of the risks and the benefits,
aware of the medication, and making sure that they are supportive in that. In the military,
thankfully, they have a captive audience. It is following orders. If the medical center
is asking for that soldier to bring in their family for training and discussion, then that
is done. If their unit sergeant, master sergeant, captain, or whoever that may be—if they
are in the barracks—are called in to make them aware of the medication they are on,
these are things to look for, this is an overdose plan just in case, how to administer naloxone
(which I’ll get into), and so forth—all of those are factors brought into play for
the overdose prevention education and naloxone rescue. It takes everybody within that person’s
life and not just one on one with the prescriber. Next slide please.
With Ft. Bragg, we have a 20-minute video—where this is now on YouTube that can be brought
up—with four patients who had problems with opioids in the military telling their story.
Telling what happened. How they had wake-up calls in that. How they were able to overcome
those. How the buprenorphine treatment helped them to detox and look at other methods of
treatment for their pain, whether it be implants or other and how they turned their lives around
and changed their life. So we found that showing that as a peer sort of mechanism with the
active duty soldiers helped a great deal. That here were these gentlemen, they’re
soldiers, they’re coworkers—if you want to call it—may be in their unit or from
another unit, telling their story, being open about it, about how they were to overcome
it. We all know that in recovery, that’s very, very important. It’s true in the military
also. So it is an important education piece to personalize the experience and to ensure
that the soldier doesn’t feel like it’s just them, that they are not alone. Next slide,
please. As we introduced the opioid overdose rescue
medication, naloxone, to the military, they picked
up the Project Lazarus kit using the intranasal formulations to provide those to active duty
soldiers who were at risk for an overdose. Again, at risk is not because they are abusing
or misusing, it simply is their level of compliance, perhaps their history of any other issues
previously or just because of their dosing. It wasn’t only provided to them, but it
was provided to spouse, family, brigade sergeant, or barracks sergeant so that they were all
aware of that. At this time, they are using the intranasal in the blue box kits and providing
those to those patients. What they did find with the families was an advocate for that
soldier, especially a spouse situation. Here are the risks of the medication; here are
the benefits. With those risks, overdose can occur if an individual uses more than what’s
prescribed or takes something else with it. They found those strong components for making
sure that the soldier remained in compliance. So all of those factors helped in this scenario
and, hopefully, they would never have to use the rescue medication, but getting it into
their hands raised that awareness, raised the education and knowledge perspective, and
changed the behavior ongoing. The program is still going on at Ft. Bragg and about to
widen from there across the base. Next slide. The major leap forward in the risk and benefits
was instituting the basic safeguards—the urine screens for positive and negative screening,
standardized opioid addiction stratification before initiating opioids. It does not have
to be the first line of defense with pain, but looking at all factors, standardized provider
encounters, screening for abhorrent drug-related behaviors, close coordination between specialists
and the primary care, and improve the basic plan treatment through provider education.
Here, the important piece of collaborative risk management, engaging everybody within
that—and we will see on the next slide—because it is more effective than targeting the opioid
therapy and, again, keeping that soldier safe. Next slide.
Management that continues collection of data. Looking at outcomes and looking at goals.
What are the fatal overdoses? What are the State vital statistics and medical examiner
data? On the nonfatal overdoses occurring on base and within the local community and
looking at all of that from Texas to North Carolina to see what kind of substance abuse
visits are happening in the local emergency department, in the hospitalizations. Also,
looking at the database with the controlled substance reporting system, the prescription
drug monitoring program, which is vitally important. The Department of Defense does
not download their prescribing data into State systems. That goes into a Federal system,
but what we were able to do at Ft. Bragg was all the prescribers there have access to the
controlled substance reporting system in North Carolina. So if a soldier is receiving medication
on base and off base, they would, at least, know about it even though the prescribing
community in North Carolina would not know what was being done on base. That would at
least cover that avenue and all controlled substance for each and every active duty soldier,
the controlled substance system has access to ensure their safety and that there is
no abhorrent behavior. Next slide. The whole process is managed through an interdisciplinary
pain management clinic. The providers in this clinic provide direct evaluation and treatment
for most at-risk soldiers. Again, primary care and assigned a case manager. The pain
specialist—whether the pharmacy or the relevant specialist, even if it is the addiction treatment
specialist—whatever is necessary within that individual’s life, any behavioral health
issues and all of those are all brought to bear and everybody communicating with each
other again to ensure that the best treatment is being provided with the greatest safety
measures possible and they are not at risk because of the treatments that they are receiving
that we had been seeing at Ft. Bragg previously. Next slide.
Improving patient autonomy—a thorough 20-minute informed consent. The risks and the benefits
that I talked about just as a brief summary. Education on diagnosis and the treatment of
opioid overdose, and empowering the key people in the patient’s life. Giving them the education.
Bringing them into the mix and having everybody engaged in the care for that soldier for whatever
capacity that needs to be done. Again, whether it is family, whether it is friends, or whether
they are actually in the barracks and working with the soldiers there. Next slide.
Previous to initiating Operation Opioid SAFE, there were 15 overdoses per 400 soldiers in
the Warrior Transition Brigade, which statistically is a huge number. But after the first year
of initiating Operation Opioid SAFE, that dropped down to 1 per 400 hundred and, of
course, the buprenorphine and the detoxing, you know, assisted with that, as well as the
education, the interventions, the naloxone. But now with Tricare covering medication-assisted
treatment, there are more treatment modalities available for those soldiers to overcome any
substance or disorder addiction issues and, hopefully, maintain or enhance their career
going forward or not to have the problem follow them through the Veterans Administration and
the rest of their lives. Now, one of the obstacles that we continue to have in a program such
as this is military medical turnover. It is very frequent. Anything in the military. Always
on deployment, retirement, changes of bases. To receive the consistency to the program
to keep it ongoing has been an issue. Thankfully, now we are in a place where for the next couple
of years or so, we will be able to implement all parts of the program to each and every
clinic through the entire base and other bases and other military. Marines and so forth—they
have also inquired using the same program that we have initiated there. Next slide.
This is just our Web site. There is information there. But I encourage you also, for those
who want to reach out to Major Michael Bartoszek, there is his email information, my email information,
and happy to help with any of those who would like further information. With that, Ted,
I will turn it over to you. Thank you very much.
Thank you Fred. That’s a terrific program. Sure. Thank you.
The next speaker, Dr. Diane Deitz, has been a Senior Scientist at ISA Associates in Alexandria,
Virginia, for 17 years. Her work focuses primarily on workplace substance abuse prevention and
on work site health promotion. Diane. Thanks, Ted. Good afternoon, everyone. You
can go to the next slide, please. In today’s session, I’m going to describe our particular
Web-based approach to prescription drug abuse—why we like this kind of program; how it is set
up. We will review specific components of the Smart Rx Program, discuss some findings
from a field test that we did using the program, and then summarize some implications for workplaces.
I would like to say that this project started over 10 years ago. The idea was initiated
in working on another SAMHSA project, a workplace managed care project where the managed care
organization that we were working with had noticed a big increase in the prescribing
of drugs with abuse potential and was concerned about having some type of intervention that
addressed that. So we wrote a grant to develop this program and to reach folks who were being
prescribed these medications to them more information and a brief intervention. Next
slide, please. The reason that we like the Web-based approach in workplaces, we used
to do a lot of training sessions, getting people in for classes. But more and more,
we were not able to get as many people into the sessions. With the Web-based approach,
we are able to reach a large number of users. There is flexibility. The person can go to
the parts of the program that are the most meaningful to them or where they have issues.
These types of programs we find are especially effective for issues like substance abuse
prevention and things that there are sensitivity and stigma around that. It is something that
they can go back for repeated use. They can set goals and there can be a continuation
of learning. Next slide. As far as the theory that drives our programs
then, what drove the Smart Rx is a social learning theory to increase sort of knowledge
and awareness of both the benefits and risks of prescription drugs that they are taking.
We give people lots of interactive exercises, videos, and testimonials where they can hear
people who have been in similar situations and view this as a brief intervention to help
users recognize the warning signs and to, hopefully, seek help. Next slide.
The
intended population that we were targeting was anyone who is using a prescription medication
with abuse potential or contemplating use of this type of medication. You know, there
are many people who didn’t know they had a problem, wouldn’t have identified themselves
as having a problem. So we took a broad-based approach in this of a wellness focus with
programs; sometimes when you do a hard hit on this substance abuse prevention program,
there are not many people lining up for it. But we found when it’s embedded in a wellness
approach that that has the benefit of getting people in who may recognize that they do indeed
have some issues with medications that they are taking. There’s also a reciprocal nature
that if you give people information on taking better care of themselves, that can help offset
perhaps an overreliance on medications. Next slide.
The administration of the program happened through workplace promotion. We worked primarily
with the Wellness Department; set up incentives and intranet announcements to get people aware
of the program and interested in using it. The specific guidelines of utilization were
determined by the workplace as far as, you know, these are instructions on that they
could use the program during work hours or this was something that was supposed to be
on their own time. It is, of course, a self-administered program. We have a tracking system in the
program that allows us to see, like, how often a person is going in, for how long, and which
sections of the program they are viewing. From what we are seeing, it takes on average
1 to 2 hours for a person to go through. Many people look at segments that are particular
to their medication or their issues, and people were going in multiple times to use the program.
Next slide. The next series of slides go through screen
captures of the program. I will tell you components of the program and our philosophy and how
we address this issue. The program was fully narrated. It’s an educational tutorial that
is linear in approach, although people could choose sections that they wanted to look at.
As far as the major modules in the program, there are assessments. There are facts on
medications, what they are about, the benefits, their risk. The section on substance abuse
prevention was Smart Rx use, and then a section on managing your health. Next slide.
In the assessment, we ask people what drugs they were currently taking, any concerns that
they had, any sort of red flags for unusual use of the medications, and then they were
given recommendations of the program to go through. They were strongly recommended or
recommended for them using. We use an approach that’s called soft tailoring that it is
highlighted what they should be going through and then when they would return on subsequent
visits, they would see what components they already used and where they need to go. That’s
in contrast to some programs, when you fill out a certain set of questions, then you are
sort of tracked through the program and components that they need to see. We really felt that
people were coming at this in different stages with different awareness. We wanted them to
be able to see all of the program. Next slide, please.
In medication facts, just to go over a bit about the types of medications and conditions
that we addressed in the program. There were medications for anxiety, medications for sleep,
medications for depression, stimulants, and then pain medications. The focus on medication
facts was to give them information on treatment options, information that could be used for
talking points with their physicians so that they had a better knowledge base and understanding
on whatever medication that they were taking. Next slide. I think we skipped one. Is it
possible to go back? Next one. As far as with medication facts, there were
a number of interactive exercises for them to see how they worked— what the effect
was on their body, what the interactions were with these types of medications—so that
they understood more about the purpose of what they were taking and how it was working.
Next slide. There was a section with each of the medications
where there was a pharmacist who answered a number of common questions and concerns
that a person might have in terms of what are typical side effects of different medications,
what do they do if the medication is not working initially, or what happens if it was working
and stops working or if they feel better—to give them, you know, more information on taking
medications appropriately, taking medications as prescribed, and following, you know, what
the doctor had said for their treatment approach. Smart Rx use, which was the area where we
got into talking about problems with medications. We had many interactives for them to take
charge of the way that they’re handling situations. There are assertiveness training
in here, skills training—it was designed to increase their efficacy in being able to
talk to a doctor to advocate for themselves. And these are (what you see on the screen)
are a number of women with different styles of communicating, and after they would go
through an exercise, they would be asked, you know, did they handle this in an appropriate
way, or how would they have done this better? How might they have been able to talk to their
doctor in a more effective way? Next slide. And then, of course, information on avoiding
medication problems, discussing more what is drug misuse, not taking your medication
as it was prescribed. What are signs and symptoms of dependence or tolerance, and what are your
warning signs if you are getting into possible drug addictions, so that they can be more
aware of what problems are, if they are experiencing a problem, and then what to do in terms of
getting help. We did have a number of testimonials in here of people who had been prescribed
various medications that got into trouble. They discussed the whole sequence of how it
happened for them, how they came to an awareness that they were not taking medications as prescribed
or perhaps that they had a problem, and how that was resolved for them—what steps they
took to get to a better place. Next slide. In managing your health, the purpose of this
was to educate people on other ways of approaching problems that was to counteract an overreliance
of medications. In fact, we asked, what’s the first thing that happens if you’re experiencing
pain? Is the first that happens that you reach for the pill bottle, or do you sometimes use
other things? Do you have a balanced approach in how you deal with these issues? What are
your triggers? Do you practice any relaxation techniques? Do you exercise? And actually
gave them skills on how to set up a relaxation routine for themselves so that they had alternatives
to always using medications for problems. Next slide.
We did this type of approach on managing your health for every type of condition, whether
they had anxiety or sleep disorders or a pain problem, so it would be specific guidance
to that particular condition. If they were an insomniac and taking sleep medication,
there would be instruction on good sleep hygiene or if they have pain. You can see on this
slide here that with pain management that it’s a
collaborative thing. It’s often a multi-modal approach that while medications are very effective
and have a place, that there are other things that you can have in your repertoire and toolbox
to draw on. Next slide. I’ll go over this field test that we conducted
to look at the effectiveness of program. We did do a pre-test/post-test design. We recruited
370 employees that were either randomly assigned to use the Web-based program or treatment
as usual and had a number of self-report outcomes on attitudes, knowledge, behaviors that were
related to taking prescription medications. Next slide.
Our population was women, and I will say that the first version of Smart Rx was developed
for women only. This was in response to women being prescribed medications with abuse potential
at a much higher rate than men. We have subsequently made a gender-neutral version of the program.
We did find with this that people were interested in the program. Recruitment went actually
better than we anticipated. We had a low attrition rate. We recruited a lot of medical personnel,
nurses, medical technical since we were at a hospital. This, again, is a population that
has higher access to medications and has certain vulnerabilities given that. A lot of the employees
that enrolled in our program did not use a computer as a regular part of their job, but
we had kiosks that were set up in the Wellness Department that they could go in there, have
a private area, and then if computer access was an issue for them at home, they could
use the computers that were provided in the Wellness Department. Next slide.
This is just an overview of the measures that we used in the field study. It’s a combination
of attitudes, self-efficacy, some indices on substance use. So we looked at knowledge
of prescription drug abuse and dependencies. The quality of patient-physician interactions
and then their confidence in being able to address a drug issue and to seek treatment
for that. Next slide. This just highlights a few of the findings
that we had with drug facts. We had thought that there may be somewhat of a ceiling effect
because there were a lot medical personnel, that they would know
about abuse and dependence. But actually, it looks like that’s an area where there
could be more medication and medical training and more education because we saw movement
in experimental control group on that. We had positive effects with the physician interactions
on being able to take medications as prescribed, and then in being able to manage problems
where there was something that came to their awareness of having a drug substance use problem.
We also did find positive results on the age. I didn’t put that in here with actual reported
drug use. We did not see change from pre to post on this. It could have been a short time
post intervention and also maybe concerns about reporting that in the workplace. Next
slide. I included in here some quotes on what people
were saying and the types of comments that we got from users after the study was completed—that
we heard that people were saying they were able to ask more questions, that they were
able to pay attention to what the doctor was saying to them. People were reporting that
they did try other types of things. For example, losing weight to have less aches and pains
and, hopefully, not need to rely on medications for pains as much. People found that it boosted
their confidence in talking to physicians as well. Next slide.
And as far as the implications of this, it is a mechanism for primary prevention and
early intervention of prescription drug use. It has appeal in that it is lower in cost.
You can reach a number of people with it. It does require buy-in by workplaces, promotional
campaign. It’s best viewed as a component of a comprehensive substance abuse program,
that it’s one area of also adding other services and other types of intervention for
people. Next slide This is just contact information, and that’s
it for me. Thank you, Ted, I will give it back to you.
Really useful approach, Diane. Our final speaker is Dr. Joel Bennett, the President of Organizational
Wellness & Learning Systems. He has 20 years of experience helping employers in tribal
organizations to improve their health culture, reduce stress, and prevent substance abuse.
His evidence-based Team Awareness and Team Resilience Programs are widely used. In 2008,
he received the service leadership award from the National Wellness Institute. Joel?
Good Afternoon. Can you guys hear me? Yes.
Great. It always happens that when I start a webinar,
the guys come along and start cutting down the trees. So I can’t predict it but if
you hear some background noise, I’m sorry about that. Okay.
What I’m doing today is showing—if we can go back a slide to the first slide—this
is a set of sample slides from an upcoming training that I have adapted to fit into or
be independent of the Team Awareness and Team Resilience curriculum. What you are seeing
is only a sample set of slides, so unlike the previous presentations, I’m actually
going into what participants in a workplace would see, and we have piloted this and we
are still in development. So, if anybody listening has interest in this or feedback, we are going
to be doing an upcoming webinar training in the next month or two, helping people to use
this same curriculum. The other thing that along with this slide deck is a Jeopardy game.
So when we do workplace training, we always include some sort of a game. I’m not going
to be showing that today. I’ll make comments about where that game is. Another tool that
we also created is a case study of prescription sharing in the workplace—an actual case
study that we were able to get access to, and problem solving around that case study.
So the actual training has three tools. It has the webinar—I’m sorry—the slide
deck. It has the game and it has that case study. You will see some other tools as we
go through it. This is called Empowered Health Consciousness and Prescription Drugs, with
the idea that we put the idea of empowering people around this concept of health consciousness
first and prescription drugs second. Always in our workplace work, we focus on health
and wellness primarily, and then bring in the risks for addictions secondarily. Again,
this is for workplace and parents. Okay, next slide.
So as a result of this workshop, participants will be able to define health consciousness
as key to preventing prescription drug misuse and abuse with both the major risk factors
associated with the increase in prescription drug misuse and abuse, as well as healthy
alternatives and protective factors that can diminish those risks. Three, take action steps
to implement those healthy options for themselves and other who may be at risk, and four, use
the above skills to reduce prescription drug misuse and abuse in their own work setting.
Next slide, please. So it’s really important from the feedback
we have gotten to clarify upfront that if you are currently taking prescription medications,
this training supports your continued use as prescribed. In addition, we encourage you
to review how you use in ways that support your health and wellbeing. So this training
also will review processes and healthy lifestyles and alternatives that you are invited to consider.
So, what we are doing with this training, while it’s a primary prevention training,
we recognize that employees who are in the training may currently be under medication.
So we found that that could provide a defensive response if they are just told that prescription
medications are not something that they want to do and they should only look at alternatives.
It’s very important that we clarify up front that this is for health consciousness. Next
slide. Heather mentioned earlier these different distinctions. We describe up front the differences
between use, misuse, and abuse. I’m not going to go into this. It’s just a clarification
point for the audience. Next slide. So, the idea of health consciousness is this
idea that we can pay attention to what we are taking into our bodies, getting exercise
and rest, and using our body and mind together for a health enhancing purpose. And by bringing
in right away body and mind, we do talk a lot about mind-body practice, and later on
and a variety of complementary and alternative approaches to dealing with pain, anxiety,
and stress. The emphasis of this training is what can you do to take better care of
yourself? Next slide. This is an outline of the entire piece. It’s
very comprehensive, and when fully rolled out will probably take 3 hours. It’s like
a half-day; however, we have different components to make it multi-modular so people can take
different pieces. Each part, as we get started, we’ll play the Jeopardy game. We do a round
of the Jeopardy game where we have different groups participating. Usually two, depending
on the size, or three. We start off doing that and then we go to a next part. So you
can see the program is structured into two sections—the knowledge acquisition, awareness,
talking about why is this problem occurring, population risks covers special populations
(I’m really interested in getting more of Fred’s work because we also have stuff on
military), social risks, and then some review. Application is the scenarios that I’ll be
showing a little bit of as well, and some on brain health and healthy alternatives.
Okay, next slide. So here are some samples from the first section
on knowledge. Next slide. We talk about awareness, and this does come from team awareness where
we cut across national statistics, State-level statistics, community-level statistics, and
then your workplace. The whole idea here is creating awareness of the growing epidemic
at the national level, but also kind of telescoping into where do you play a role in this epidemic
and what in your workplace are the roles that you and your coworkers play that might contribute
to the health consciousness, which would be the alternative. So the roles that we focus
on are the roles of the coworker, the coworker of people who might be at risk, the role of
a parent of teens, the role of a child of an aging parent—in our research we found
that are a lot of sandwich generation workers who are having to deal with parents who are
misusing and abusing prescription drugs—and then, of course, your role as a worker. We
are trying to build awareness across all of these levels, with the goal of building that
responsibility, that responsiveness in those roles. Next slide.
This is an example of a slide that we use to create awareness where you can see the
sort of leading media articles that have evolved over the past 14 years on messages that the
media have been giving that have resulted in increased—I mean the population has—the
epidemic has increased even though we have been told and warned that this is about to
happen and is continuing to happen. This slide is used to start—to generate conversation.
Are people aware of these articles? Are they mindful of this? Because what we are trying
to do here is start people on the track of engaging them into conversation as we do in
our facilitated training. Next slide. So then, who is responsible for this epidemic?
The second part—and again I’m just showing samples—where
does responsibility lie? This next section we’ll show you an animated slide where I
engage the audience or the facilitator engages the audience. And, again, we’ll do a facilitator
training on these next series of slides. Next slide.
So where does the responsibility lie for this growth in prescription misuse? I asked the
audience. Well, one possibility is it’s complex. Is the individual responsible? Is
the media responsible? I will stop and pause and ask for feedback about what they feel
is part of this complex array of factors that result in this increase in the problem. Again,
it’s used to create awareness. Next slide. Does the responsibility lie in you? What’s
your story? Are you at risk based on a number of factors, upbringing, problem childhood,
unresolved trauma, availability, personality, values—do you think these are important?
Is that where it lies? Is each person responsible for their own health regardless of what the
risk factors and society are—the complex risk factors? So, again, engage in conversation,
which is what I would be doing right now with others on the phone if anybody who has answers
to these questions and you want to engage in this conversation, please go ahead and
type them in. Next slide. The next section is, well, what about at work? There’s the
culture at work. What about policies? Do supervisors model healthy behavior? Have you received
any prevention training? What about availability at work? Do the health benefits that you have
at work allow you to be at risk or prevent you from being at risk? What about wellness
programs? So, again, engaging the audience in these questions.
Does the workplace as the employer, do you and your coworkers have any responsibility
for this? Next slide. What we say is we are doing—well, you know–despite all of these
complexities and all these different factors, this training is designed to focus on health
consciousness in the workplace. After we have had this conversation, we are now asking the
participants to say, can you take a look at how you can make this workplace a healthy
environment to prevent misuse and abuse? Let’s look at all of
these factors that are highlighted here in this last column. Next slide.
This is a handout where I’m going to walk you through where we talk about what are the
motivations for misuse and abuse. You’ll see it’s taken from a 2010 article. What
we are doing here is we are just giving information, so I’ll just go through this quickly. You
can see that the primary motivations we have identified are pain, relaxation, energy, weight
loss, attention, anxiety, panic, and tension. Next slide.
All we are doing is kind of doing some informational work here. Next slide. Again, more informational.
The reason we are doing it incrementally instead of just giving it all at once is, of course,
not overwhelming people with information and also helping to show the adverse effects associated
with potential misuse of each of these different motivators. Next slide.
Now we do the flip chart. What are the benefits and risks of each of these different categories?
That’s a flip chart involving the audience participating, and then we, of course, ask
you if you have any of these risks and get help. There we always, always, always promote
the Employee Assistance Program, or we promote the Wellness Program or review whatever HR
benefits are available. Next slide. Then we say, well the rest of this training
is to focus on the healthy alternatives and what if you know someone at risk. The idea
here with Team Awareness and Team Resilience is that we always train employees on peer
referral and on encouragement and compassion on how do you approach someone that might
be at risk. What I’ve talked about right now 15:25:00:00 is just all a setup for the
remainder of that training. Next slide. Here are some other samples. This would be—now
we focus on when we get to talking about special populations for parents; we review these points
taken from a number of different places. Next slide.
Here you can see we have created—when we actually get to the application section of
the training—we created scenarios. You can see college, you know, for parents who have
children in college, team sports, and weight loss issues. Again, there is a special focus
on parents and reaching parents through the workplace because of the rise of the problem
with young adults and emerging adults and college-age populations. Then you can see
that there’s a military for those who might be a spouse or have a child in the military.
Then, aging parents—aging dad and aging mom and workplace. You can see in these different
scenarios—we actually ask the audience, which one do you want to select? They are
hyperlinked. You can see an example of one on the next slide. This would be Grandpa Al
who has had previous problems with depression and through Medicare has access to antidepressants
without pay. This is, I think, similar to what Diane Deitz had talked about with Smart
Rx using scenarios. Al has figured out how to get two doctors to prescribe him even though
his State has a pharmacy control program and a lock-in program. By the way, we talk about
those earlier in the training so they are familiar with what those are. Al’s wife
does not read well and will give Al the drug he wants. Al is now taking four times the
prescribed daily dosage. His adult children have grown increasingly concerned about his
dependence. If you can show evidence that Al is at an increased risk of death from overdose,
what would you do? So again, we go through the discussion, and then in the discussion,
the facilitator then provides clarifying information. This would be another example of an interactive
to engage the employee population and get them to understand that they have ways, tools,
and skills for dealing with any one of these scenarios. Again, I’m only providing one
scenario here. Next slide. I know we are about to run out of time so
I’m going to go quickly. The next two slides are just to review. We’re starting to move
toward wellness and healthy alternatives and talking about the importance of healthy diet
and exercise and stretching and body posture. And
creating this open loop for positive feedback such that with a healthy lifestyle, there’s
less pain and less stress, more sleep and greater recovery from workload and high energy
bursts. Next slide. That’s in contrast to poor diet and the negative habits, which feeds
into our stress management module as well within Team Awareness and Team Resilience.
Next slide, please. So the final part then—as I said, this is
modular, so facilitators can pick and choose which elements they are going to use. Here
we start talking in more depth about healthy alternatives. Next
slide. Again, we review what health consciousness is. Next slide. And this is our last slide.
Helping the employee understand that they can access protective factors, that they have
the ability to access protective factors, that by the time we get to this point in the
training, there has been a lot of positive engagement and fun and energy generated. We
just kind of review again that anybody can use healthy alternatives and self-reminders
to keep in a state of health consciousness. Putting ourselves in situations that pull
us to choose health consciousness, and reach out and being with others who push or nudge
us to choose health consciousness. So, just to wrap it up, this is, I think, the final
slide. And my contact information is available for those who are interested. Thank you.
Thank you, Joel. Wonderful speakers we have had. I wish we had the ability to give a round
of applause. We have some time left for questions. If you would like to ask a question, you can
either press “7#” and wait for the operator, or you can enter your question in the chat
box. I know that we had one question come up in the chat box for Heather, which asked
Heather whether occupational culture has been a risk factor for you. I expect that probably
varies between airlines. It has. What we do find is that the airlines that have longest
tenure tend to have some of the early beliefs about the flight attendants and it being a
party scene and those kinds of things, rather than its current view as a safety-sensitive
occupation. We do have flight attendants who are still stuck in some of that pre-2001 belief
that being a flight attendant is all about being in a party atmosphere. We’re hoping
that continues to shift over culture where everyone is demanding safety first. Having
fun, yes, but safety first. Operator, do you have any questions?
No callers in the queue at this time. Participants who have dialed in can press 7 followed by
the pound sign if they would like to speak in the conference.
I have another one over here on the edge, which was for Diane. Somebody was interested
in whether you are finding that there’s much interest in adopting this program, Diane,
or whether you are having trouble getting the interest up.
Wait a minute. I’m sorry. I started answering you while I was muted. Can you hear me?
Yep. Okay. We are—we just recently made the gender-neutral
version. We had concerns about it just being for women and how marketable that was. So,
that was actually within the last 6 months or so we made the gender-neutral version.
It is sort of now out of my bailiwick. I don’t do that sort of promotion with it. I can’t
answer that for sure, Ted. Joel, a similar question for you—I know
you just started rolling this out—how was the pilot received? Oh, people were totally
engaged. They definitely like having to play the Jeopardy game. I will say that the combination
of the game with the information was, I think, a key part of making this work. And pacing
that out—well, time for the game, time to learn, time for the game, time to learn. I
didn’t talk about the case study, but that was very also compelling that to actually
hear a live case study, I mean a real case study, and do some problem solving about that
was very engaging. So, still tweaking, still polishing, but I think it’s very promising.
Are there any of the listeners out there who have their own programs that are exciting?
We would love to either hear about those for a minute now or to have you email me [email protected]
and tell us about them because we are interested in what’s being tried in the workplace and
how it’s going. Fred, I saw a couple of questions here for
you about how, whether the National Guard or the Reserves have gotten involved in this
at all within the same program or whether they are just sticking to their own programs.
I know they have stuff through CaTCA. Right. That’s correct. They do have their
own programs. Where we engage them is at the community level to ensure that individual,
at least in North Carolina, are looking at the county-based services to ensure that they
are reaching out too, that they are fully aware of the services within that community
and that they can go to. Obviously, we are working with the individual medical community
in those counties to sort of adopt the same medical practices that Ft. Bragg is doing
through our subscribers toolkit and so forth. I don’t think I see any other questions.
I would like to thank our speakers and participants for joining us today. If you want the slides
from this presentation before you sign off, go over to that documents file on the bottom
right and download it. I know I downloaded the set. We also will be posting both the
slides and recording of the presentation on SAMHSA’s Web site once we get all of the
508 compatibility done. Our next PAW webinar is scheduled for later this summer. I hope
to see you there and I wish you all a great day. Thank you. Thank you.

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