Jea vol48no1 1stqtr2018 by Employee Assistance Professionals Association

1st Quarter 2018 | VOL. 48 NO. 1

The magazine of the Employee Assistance Professionals Association

Duty of Care

Opportunity for EAPs |Page 20

PLUS:

Leading Benefits Trends Page 8

Project 95-Broadbrush Page 16

Is Your EAP Endangered or Enduring? Page 24

contents EAPA Mission Statement

1ST Quarter 2018 | VOL. 48 NO. 1

cover story

Duty of Care: Opportunity for EAPs

| By Ken Burgess, M.Ed., LPC; and Nancy Board, MSW

EA professionals are well aligned to assist organizations in positively contributing to the well-being of an assignee or business traveler. It doesn’t matter whether you’re providing internal or external services to the company, your expertise as an EA professional is worthy of notice. Anyone who is going on extended business travel and/or is being assigned to another country should be evaluated by the EAP as a normal part of the assignment process. The earlier EAP is engaged, the better.

features

Leading Benefits Trends EAPs Need to Know

|By Timothy Mutrie

With the evolution of a diverse, tech-savvy, flexible workforce, employee benefits must also evolve if EAPs and their client companies want to succeed in a competitive, global marketplace. This article describes a few of the benefits trends we are seeing at ACI Specialty Benefits, as well as questions that EAPs and their client companies need to ask themselves in order to drive utilization and cultivate inspired and engaged employees.

Project 95-Broadbrush: Lessons for Today – Part II

|By Jim Wrich

In this second installment of a three-part series, we continue to show the evolution of employee assistance into the EAP of today. Without discarding the Job Performance Focused Alcohol Identification approach, NIAAA advocated for the Broadbrush approach – but this didn’t happen without a prolonged battle within the field.

features I

s Your EAP Endangered or Enduring?

4 FRONT DESK

The Journal of Employee Assistance (ISSN 1544-0893) is published quarterly for $13 per year (from the annual membership fee) by the Employee Assistance Professionals Association, 4350 N. Fairfax Dr., Suite 740, Arlington, VA 22203. Phone: (703) 387-1000. Postage for periodicals is paid at Arlington, VA, and other offices. POSTMASTER: Send address changes to the Journal of Employee Assistance, EAPA, 4350 N. Fairfax Dr., Suite 740, Arlington, VA 22203. Persons interested in submitting articles should contact a member of the EAPA Communications Advisory Panel (see page 4) or the Editor, Mike Jacquart, by calling (715) 445-4386 or sending an e-mail to journal@eapassn.org. To advertise in the Journal of Employee Assistance, contact James B. Printup at development@eapassn.org. Send requests for reprints to Debbie Mori at d.mori@eapassn.org. ©2018 by The Employee Assistance Professionals Association, Inc. Reproduction without written permission is expressly prohibited. Publication of signed articles does not constitute endorsement of personal views of authors. Editor: Mike Jacquart Development & Donor Relations: Jim Printup Designer: Laura J. Miller, Write it Right LLC

5 LETTERS

Index of Advertisers

|By Don Jorgensen, PhD, CEAP The current age of acceleration demands that organizations either adapt to rapidly increasing change or they will soon become irrelevant. To not only survive but thrive in the marketplace, EAPs must determine where their organization sits on the “relevance curve” and what actions are necessary to re-position themselves for success. In other words: Evolution is guaranteed; survival is not.

To promote the highest standards of practice and the continuing development of employee assistance professionals and programs.

Aspiring to a ZeroSuicide Mindset

| By Sally Spencer-Thomas EA counselors need to avoid relying on out-of-date suicide risk assessment protocols, and instead be offered training in state-of-the-art interventions. Together with our client companies we must aspire to “zero suicide”.

departments 6 EAPA 2017 CONFERENCE & EXPO

ASAP..................................................13 EAPA Plan to Attend.........................IFC

10, 11, 27, EA ROUNDUP 33, 34

EAPA Conference on Demand.........IBC

12 LEGAL LINES

Pinnacle Treatment Centers.................5

14 THE WORLD OF EAP 28 INTEGRATION INSIGHTS

KGA, Inc.............................................21 SAPlist.com..................................17, 25 IFC: Inside Front Cover IBC: Back Cover

frontdesk Staying Relevant in Today’s Business World |By Maria Lund, LEAP, CEAP

ccording to a survey from the Society for Human Resource Management (SHRM), 22 percent of firms “did virtually nothing” to prepare their employees to live overseas. According to Nancy Board, coauthor of this issue’s cover story, it doesn’t matter whether you operate in an internal or external EAP, your expertise in providing solutions for difficult workplace problems is worthy of notice to HR and other senior officials for their expats and other business travelers. Companies that do business overseas are under increasing pressure to provide Duty of Care protection for their traveling employees. Since many EAPs already offer Critical Incident Response (CIR) services, Nancy suggests asking HR and other corporate leaders how your EAP can get involved in assisting traveling employees. In an often-dangerous and complex world, the EAP is in a perfect position to help. “Is Your EAP Endangered or Enduring?” asks Don Jorgensen in a thought-provoking feature article. Don describes how all organizations operate along a “relevance curve”, and proposes that each business must assess itself to determine how relevant it is to its customers. In any area where it might be lacking, the EAP must take

action to switch gears or to re-tool in order for the business to endure. Suicide is trending up across the globe and EAPs are focused on how to assist in prevention and response. Sally Spencer-Thomas, psychologist and survivor of suicide loss, describes state-of-the-art suicide prevention interventions that EA professionals can help implement in the workplace. Most of us are aware of the changes that technology, worklife balance, and other factors are having on today’s rapidly evolving workplaces. But what benefits trends are these changes driving? Tim Mutrie describes the innovative benefits that ACI Specialty Benefits offers for its EAP clients. Elsewhere in this issue, Jim Wrich, one of the original “Thundering 100”, picks up where he left off in the last Journal in describing more important developments and milestones in EAP history. Watch for the conclusion of this three-part series in the 2nd Quarter JEA. This issue marks the return of a legal column in the Journal by Robin Sheridan, JD, MILHR. In her first column, Robin presents recommendations for EA professionals who have questions about FMLA policies and procedures.

Finally, John Maynard and Mark Attridge offer important insights and observations in their respective columns. (Jeff Harris and Marina London will return in the next JEA.) v

EAPA Communications Advisory Panel Maria Lund, Chair – Columbia, SC maria.lund@firstsuneap.com

Mark Attridge – Minneapolis, MN mark@attridgeconsulting.com

Nancy R. Board – Seattle, WA nrboard@gmail.com

Daniel Boissonneault – Hamden, CT eap700@comcast.net

Mark Cohen – New York, NY mcohenintlcons@aol.com

Donald Jorgensen – Tucson, AZ donjorgensen@comcast.net

Eduardo Lambardi – Buenos Aires, ARG eap@eaplatina.com

Peizhong Li – Beijing, China lipeizhong@eapchina.net

John Maynard – Boulder, CO johnmaynard@spirehealth.com

Bernie McCann – Waltham, MA mccannbag@gmail.com

Igor Moll – Al Den Haag, the Netherlands l.moll@ascender.nl

David Sharar – Bloomington, IL dsharar@chestnut.org

letters Liked Jim Wrich Article

Don was also a founding board member of ALMACA and wrote the first EAP standards. He was an historic figure before the Thundering 100 were selected. I am available to assist in any way I can.

I thoroughly enjoyed reading Jim Wrich’s article, Project 95-Broadbrush in the 4th quarter JEA. I particularly enjoyed his reference to Harold Hughes and his contributions as an Iowan, since that has been my home base during my years in the profession. I used to think it was amazing hearing the stories about those “old timers” who were the foundation of our profession. However, after 35+ years in the profession, I guess I’ve become one of them as well! Ironically, the same night I finished Jim’s article, I also read a brief piece in our local monthly news, Des Moines CITYVIEW, about my prior boss, John Tapscott. In the mid-1970s, as the move toward “broadbrush” services was pursued, many of us, including Tapscott, recognized the need to expand the focus of services and better engage community participants (business, government, United Way, and treatment providers) to more effectively address employee performance and related personal issues. Jim Wrich’s article reminded me that over the history of our profession, there are numerous, unheralded, individuals and organizations who have provided significant roles in the development and, more importantly, the continuation and growth of our profession. I look forward to more of Jim’s reflections with his expertise and experience, but also encourage anyone to share your “history” as the EA profession continues.

Rob Baldino, LCSW, MBA, CEAP, SAP, SAE Care Plus Solutions, Inc. v

The Journal of Employee Assistance The Journal of Employee Assistance seeks more thought-provoking discourse among EAPA members (and JEA readers) in 2018. One great way of doing that is by submitting a letter to the editor on an article you’ve read in the Journal. For more information, contact the editor. Mike Jacquart, (715) 445-4386 or email journal@eapassn.org

LET’S FIGHT ADDICTION

TOGETHER

Tom Reynolds, CEAP Des Moines, IA

We transform companies, communities and lives

Enjoyed JEA Cover Story

Financial options available and in-network with most insurances. Free confidential assessment. Transportation available.

I noticed in reading the Journal of Employee Assistance 4th quarter 2017 issue that an EAP History project is underway. I would be happy to participate. I have been an EAPA member since 1990 and purchased the first national EAP firm from Don Sandin in 1997. Don Sandin’s firm Sandin, Murray and Sullivan was the first external EAP firm in the country incorporated in 1973. I still have one of their first accounts and contracts, Public Service Electric and Gas PSEG of New Jersey.

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eapa2017conference&expo Lights! Camera! Action! EAP Focus on the Workplace

Recap of the EAPA 2017 Conference & EXPO - Los Angeles

ournal of Employee Assistance editor Mike Jacquart attended “Lights! Camera! Action! EAP Focus on the Workplace,” EAPA 2017 Conference & EXPO - Los Angeles, held October 3-6 at the Westin Bonaventure Hotel & Suites. In this article, he shares some key findings from this important gathering. EAPA’s Conference on Demand is also available for anyone interested in downloading conference breakout sessions from either the 2016 or 2017 conferences. Full information is available at http://eapa.sclivelearningcenter.com/ index.aspx?PID=8163. October 4 – The opening keynote, “Wrestling with EAP Core Technology: Origins and Future Implications for the Profession,” was led by Paul Roman, EAP pioneer and an expert on the management of substance dependence in the workplace. The discussion was presented as an interview with EAPA CEO Greg DeLapp.

Cecilia Rachier from Kenya poses with Dave Sharar. Cecilia was the beneficiary of a scholarship with over $2,700 raised to allow her to attend the EAPA 2017 Conference. Many donors and several EAPA chapters (CN and NJ) contributed. (Photo by Chris Drake.)

immediate, in-assessment feedback; and links to online solution centers.

Sessions that JEA editor Mike Jacquart attended included:

Richard Bond, Manager, Workplace Services EAP, Optum; and CEAPs George Melgarejo, Reon Tesar, Peter Bunnell, and Tarsyia Waddell, presented Your Company’s Threat Management Team: EAP is Key. The discussion included a brief history of how threat management has evolved, examples of threat management procedures, and identifying key issues for EAP. Threat management has its roots in Occupational Safety and Health Administration (OSHA) workplace violence guidelines, and drug-free workplace policies. EAP is a perfect fit for such teams, according to Waddell. “EAPs have a long tradition of assisting in unforeseen situations that threaten employees, customers, and neighborhoods.” With widespread violence in today’s society, people are looking to professionals such as those working in EAP for answers, Waddell stated. “This includes employees, customers, and strategic partners.”

A New System for Integrating Mental Health into Workplace Wellness was led by Julie Marshall, PhD, CEAP, VP of Clinical and Operational Services with Cascade Centers, Inc.; and Anna Meiners, MA, Director of Account Services with Cascade. Marshall and Meiners discussed Whole Life Scale, a validated assessment tool that measures nine behavioral health issues and provides proactive intervention strategies. The nine issues, or domains, are: anxiety, anger, depression, sleep, post-traumatic stress disorder, relationships, stress, substance abuse, and work engagement. Capabilities of the scale include providing proactive direction to EAP and mental health services, increasing awareness of mental health issues, and integrating mental health into workplace wellness campaigns. The scale features individual summaries; 6

October 5 – Like 2016, the keynote address featured short, engaging EAP Talks (think TED Talks) about current EA topics from a number of individuals: Tim Mutrie, Vice President of Marketing and IT, ACI Specialty Benefits; Tamara Cagney, EAPA President; Kay Burd, Senior Director, Business Solutions, Workplace Options; Ivana Grahovac, Director of Advancement, Facing Addiction; and Nancy Espuche, Founder, KardBoard House. Mutrie spoke on the seven major disruptions shaping the future of EAP: 1) Telemental health is the new norm; 2) Services must be on-demand; 3) Robots are coming (actually, they’re here); 4) The new workforce is everyone; 5) Transformation of “the office”; 6) EAP identity question (embedded or stand-alone); and 7) Age of the influencer. Cagney discussed Cannabis @ Work, a new toolkit intended to give EA professionals information to assist their companies and clients. “Education will play a huge role for EAP,” she said. Specific cannabis issues were also discussed. All but four states allow medical or recreational use of marijuana, but for employers, it’s not legalization that’s the problem, it’s how they are supposed to balance workplace safety with employee rights. She posed the question, “Do employers need to reasonably accommodate employees using marijuana as medicine?”

Differences do occur substantially within age, gender, referral type, presenting concern, industry of the employer, and the delivery model of EAP. October 6 – Numerous awards were presented. (A complete list of award recipients is listed at the end of this article.) EAP in Russia: A Complicated History with a Promising Future was led by Anna Krymskaya, Program Director, Corporate Health LLC; and Ken Burgess, EAP Consultant. Krymskaya discussed the brief history of EAP in Russia, including obstacles and ideas for overcoming those barriers. To date, Corporate Health remains the only EAP based in Russia. Burgess spoke on his role in developing a substance abuse program at URAL Steel, which remains the only such program in Russia. EAPA Awards Recognize High Achievement Each year, the Employee Assistance Professionals Association (EAPA) recognizes and celebrates the achievement of members, individuals, and organizations who have distinguished themselves through their hard work and leadership in the EA profession. R. Paul Maiden received EAPA’s highest individual award, the Lifetime Achievement Award during the EAPA 2017 Conference & EXPO - Los Angeles. Other award recipients included Andrew Davies (EAPA Member of the Year); and Hellas EAP, Piraeus Bank Group (EAP Quality Award).

Sessions that JEA editor Mike Jacquart attended included: Workplace Impact of EAP was presented by Greg DeLapp, CEAP, CEO, EAPA; Dave Sharar, PhD, Director of Commercial Science, Chestnut Health Systems; and Mark Attridge, PhD, Attridge Consulting Inc. The session featured current “pooled” data on the workplace impact of EAP from more than 60 different EAP vendors, using the Workplace Outcome Suite (WOS). The session highlighted the importance of using the same tool as a profession when collecting outcome data, noting that all five measures used in the WOS (absenteeism, presenteeism, workplace distress, life satisfaction, and work engagement) show significant change after using this landmark tool.

The complete list of award winners is as follows: Global EA Champion Award, Carl Tisone; Lifetime Achievement Award, R. Paul Maiden; EAPA Member of the Year, Andrew Davies; EAPA Benefactor Award, EAP Expert; Best Delivery of CIR Services, R3 Continuum; Best Use of Technology in EA Award, ACI Specialty Benefits; EAP Quality Award, Hellas EAP, Piraeus Bank Group; EAPA Making It Happen Award, Joan Treece; Excellence in EA Business Development, EY Assist; Outstanding Chapter Award, Connecticut Chapter; Ross Von Wiegand Award, Mount Sinai Health System EAP, Local 1199 (SEIU) MAP. v 7

featurearticle Leading Benefits Trends EAPs Need to Know | By Timothy Mutrie

ost of us are well aware of the impact that technology, worklife flexibility, and diversity are having on the new workforce. In light of these forces, the following are a few of the benefits trends we are seeing at ACI Specialty Benefits, as well as questions that EAPs and their client companies need to ask themselves in order to drive utilization and cultivate inspired and engaged employees. Benefit Trend #1: Total, On-Demand Support Today’s EAPs must provide immediate support for any employee need. We support today’s “always-on” workforce by providing convenient, 24/7 program access through HIPAAcompliant video conferencing, telephonic, chat and text services, as well as resource-rich websites and mobile apps. Because we offer easily accessible comprehensive work-life and well-being resources, we consistently see double-digit utilization, twice the industry average, which means more employees are engaging program services and getting the help they need. EAP/employer questions: Does the EAP offer a full suite of well-being services that are valued by employees in uncertain

times, and that many have come to expect from their employer? Is the EAP making its services accessible to all employees, no matter where, when or how they work? Does it meet the needs of multiple generations? Is it keeping pace with updates in digital technologies? Benefit Trend #2: Convenience Services The pace of commerce is increasing, and employees’ time is increasingly not their own. To complicate matters, few employees have a stay-at-home partner who can take care of personal responsibilities. As a result, many EAPs are embracing a full suite of personal service offerings that align with the needs of modern families, from pet sitting to multigenerational caregivers. ACI offers both virtual and on-site corporate concierge and errand-running programs that support employees through professional assistance, taking both day-to-day and more unusual tasks off their hands, both directly and through a network of vetted service providers. The range of activities addressed by concierge and errand-running services is often limited only by the employee’s imagination (within certain practical and legal boundaries) and can include everything from

prescription pick-ups to grocery shopping, pet sitting, and home maintenance. These benefits have helped ACI clients boost employee loyalty and productivity, improve employers’ recruitment and retention efforts, and help companies achieve best place-to-work recognition. ACI frequently fulfills unusual requests as part of its concierge services. Errand runners have scoured New York City to find duck eggs for a client whose son is allergic to chicken eggs, and moved a client’s car back and forth between two states. Concierge specialists have also purchased ski socks and googles for a family of five going on their very first ski trip, and a special stroller and toothpaste for a client’s dog. EAP/employer question: Does the EAP provide the types of comprehensive convenience services that address the needs of employees in a wide variety of life situations? Do available services offer something for every kind of employee, from parents to pet owners, Gen Z to nevertirees? Are convenience services easy to understand and access, no matter where or when they are needed? Benefit Trend #3: Crisis Management Tragedy can impact the workforce at any time regardless of

where the incident occurs. Today’s EAPs need to be prepared to respond to a range of critical incidents, from natural disasters to violence in the workplace. In addition to being immediately on-hand with crisis outreach messaging and emergency resources, EAPs must be able to provide critical incident response (CIR) services to a variety of regional and global locations, virtual employees, and employees working non-traditional hours. In the event of a major critical incident or natural disaster, ACI posts an immediate outreach message on social media channels to reach customers, which they can receive on any mobile device with social media access, and immediately connect with us to receive assistance, including emergency resource referrals. When multiple clients are impacted, as was the case with last fall’s Las Vegas tragedy and California wildfires, ACI compiled emergency resources on its mobile-optimized blog, and sent an email out to all customers with relevant resources and information. For natural disasters and crises, having mobile-optimized blogs allows users to easily access services from any mobile device. For example, ACI created a blog post for the 2017 Northern California wildfires, providing emergency resource numbers, evacuation shelter information, and other local resources for all affected areas. The blog post also included a list of EAP support and referral services, from emotional support to charitable giving opportunities. Clients and employees could access this post from a mobile phone and call any

of the numbers with just a click. Accessibility like this makes it easy for individuals to get help. EAP/employer question: Have organizational leaders been trained in crisis preparedness? Did this training include dealing with offsite or otherwise non-traditional employees? Is the EAP prepared to provide immediate on-site and phone responses in the event of a workplace crisis? Does the EAP have the communications capability to reach all affected employees? What plans are in place to address a natural disaster when normal means of communication are interrupted? Benefit Trend #4: Strategic Partnerships In today’s complex employer environment, EAPs need to integrate services into existing payroll, benefits, and other human resources functions, as well as partner with other benefits providers to offer seamless communication and comprehensive workforce solutions. ACI strategically partners with clients and other providers, utilizing best practices in program promotion and benefits communication to deliver the most value to employers and employees. Monthly e-newsletters with links to mobile-optimized blog articles and benefits portals, in addition to short, informational training and orientation videos, and cross-referral to other benefits and resources, are highly effective in driving EAP awareness and utilization. For example, ACI promotional campaigns typically increase employee engagement by 20-25%. ACI partners with clients on targeted campaigns throughout

the year to increase utilization and address specific issues that may be impacting the client’s population. In one case, ACI Specialty Benefits worked with a client with over 100 locations nationwide that wanted to reinvigorate their benefit program following two years of moderately successful utilization rates. The goal was to ensure that users who could benefit from the support services knew what was available and could access services instantly. To achieve this goal, ACI Specialty Benefits formed a steering committee with client stakeholders across management, marketing, brand, training, and legal to create a three-month implementation plan that covered new materials creation, online tools development, and visibility strategy. As part of the engagement strategy, ACI produced a new benefits website that allowed users to submit direct requests for services, live chat with ACI specialists, and search for a wide range of available resources. The steering committee agreed on an official launch date, with a promotional plan that included email announcements, trainings and video orientations, social media promotional posts, and posting of benefit information across internal company websites. After a targeted relaunch campaign, including new interactive online tools, the client saw a 166% increase in users accessing services from the previous year, and 20-25% increased utilization during and immediately after email outreach campaigns, as compared to months in which no targeted efforts were made.

featurearticle EAP/employer question: Is the EAP working with other benefits providers to address issues that cross functions, such as supporting laid-off employees or those being moved into new roles? Can employees reach and access information from the EAP and other benefits providers through the same seamless technologies? Is the EAP capable of integrating technology and communications with other benefits to provide the best user experience? Achieving Results With the evolution of a diverse, tech-savvy, flexible workforce, employee benefits must also evolve if EAPs and their client companies want to

succeed in a competitive, global marketplace. ACI has implemented a mobile-first EAP experience with enhanced work-life convenience services, strategic program promotion, and 24/7 access to benefits with “aboveand-beyond” customer service. These changes have led to measurable improvements in EAP outcomes, including: • 37% increase in mobile engagement in one year; • 25% average EAP engagement increase following mobile-optimized promotional campaigns; and • 13.8% average utilization, notably higher than industry standards.

Summary These results show that EAPs are more relevant than ever, as long as providers adjust their services to meet the changing needs and expectations of employees. The monumental changes to organizations and the way the world does business are creating both new opportunities and challenges for today’s EA professionals. Is your EAP ready? v Timothy Mutrie is Vice President of Marketing and Technology for ACI Specialty Benefits and leads ACI’s award-winning IT team in delivering next-generation engagement and benefits technology for customers worldwide. He may be reached at tmutrie@ acispecialtybenefits.com. Editor’s note: ACI Specialty Benefits received the “Best Use of Technology in EA Award” at the EAPA 2017 Conference & EXPO - Los Angeles.

earoundup Morneau Shepell Acquires Chestnut Morneau Shepell, a leading human resources consulting and technology firm and one of the largest global providers of employee assistance programs (EAPs), announced that it has completed the acquisition of Chestnut Global Partners, an EAP and wellness services provider based in Bloomington, Illinois. “Chestnut Global Partners offers particular expertise in addiction treatment, mental health services, and credit counseling, and is recognized in the EAP industry as a leader in research,” said Rita Fridella, executive vice

president and general manager, employee support solutions, Morneau Shepell. “The company has a strong presence in the United States and around the world, and Morneau Shepell’s clients will now benefit from our expanded capabilities. As a result, our combined global reach will be unparalleled in the industry.” The acquisition is aligned with Morneau Shepell’s growth strategy, and further expands its presence in the U.S. and global marketplace. As part of the CGP acquisition, Moreau Shepell acquires ownership stakes in five joint venture companies that provide employee assistance services to client companies in

Brazil, China, Eastern Europe, India, and Russia. “With this acquisition by Morneau Shepell, Chestnut Global Partners (CGP), takes the next step in its evolution as a global provider of employee assistance services,” said Russ Hagen, Chief Executive Officer, Chestnut Health Systems. “CGP’s reputation for high-quality services that enhance the health and productivity of workers at companies around the world complements Morneau Shepell’s size, scope of services, and sophisticated technology platforms This is a ‘win-win’ transaction, one that will benefit both organizations, their client customers and the employees of those clients.”

earoundup Costly HR Harassment Mistakes There’s no shortage of reminders these days that harassment is still a major issue for employers. And it’s particularly challenging, as we’ve seen all too often lately in the news, when an executive is a harasser or a company culture implicitly condones or perpetuates sexual harassment or a hostile work environment. So, what can HR managers do? According to HR Daily Advisor, a major problem is lack of information in which HR doesn’t find out about the complaint until there’s three or four different complaints, and now HR can’t deal with it. One of the things that HR needs to do is to make sure that the supervisors and managers know that they need to report any complaints of harassment over to HR. HR can decide to deal with it or not to deal with it, but only HR is going to know whether the alleged perpetrator, under a different supervisor 1 year before, had the same kinds of complaints, so each of these supervisors thinks that it’s just a onetime deal. Read more here http:// hrdailyadvisor.blr.com/2017/12/05/ special-aeis-harassment-complaintsbiggest-costliest-hr-mistakes/

EAPA Introduces Cannabis@Work Marijuana is no longer just an issue for employers in a few states. As marijuana use, both medicinal and recreational, continues to become legally accepted in the U.S., it may ultimately be removed as a Schedule I drug under the Controlled Substances Act. This will change how employers approach cannabis at work.

Several major societal trends are converging to make cannabis in the workplace one of the biggest challenges facing employers and employee assistance professionals. The toolkit is intended to give EA professionals information to assist their companies and clients. The toolkit is organized in sections starting with the foundation of employer policies. Areas addressed include employer policy, safety, compliance, productivity, flexibility, legislation and litigation, and employee rights. EAPA encourages all EA professionals to use the info in this toolkit to help your organizations navigate the complex and challenging area of Cannabis@Work. The toolkit can be downloaded at http://www.eapassn.org/ Portals/11/Docs/Cannabis%20 @%20Work/Cannabis.pdf.

Supporting Victims of Sexual Harassment Sexual assault and sexual harassment are so widespread that it is nearly impossible for a business to not be impacted by sexual violence. As a result, it’s vital for your corporate clients to use this opportunity to support victims. Courtesy of Inc., the following are some steps to support victims of sexual violence and do something helpful about sexual harassment in the workplace. 1. Adopt a sexual harassment policy (and be sure to share it with employees.) 2. Provide mental health resources to employees. 3. Take all complaints seriously and immediately support the victim. 4. Train employees at least twice each year on sexual harassment.

5. Train supervisors and managers at least twice each year on sexual harassment. 6. Monitor the workplace and look for signs of sexual harassment. 7. Hire diverse individuals to balance power dynamics. 8. Consult with mental health experts for additional needs.

Barriers to Improving EAP Utilization More than 97 percent of large companies in America (over 5,000 employees) offer EAPs for individuals who need a professional to discuss personal or family issues. Even 75-80 percent of medium-sized and smaller companies make EAP services available to employees. These are usually free, even to employees who don’t opt for the company’s health insurance plans. But despite their low or no cost, slightly less than 7% of North American employees take advantage of EAP services. According to the Society for Human Resource Management (SHRM) these are the leading reasons. Employees don’t know what EAPs are (i.e. too much jargon). EAPs are hard to navigate (EAPs are often underutilized because they’re often bundled onto other products and services and subsequently are poorly communicated). Employees are scared to divulge personal information (individuals should know that information provided to EA professionals will only be released to a supervisor with the employee’s permission). They think the issue might seem too small (employees think EAPs are only for substance use or mental addiction, not for various wellness offerings). continued on page 27

legallines FAQs about the Family Medical Leave Act | By Robin M. Sheridan, JD, MILR

mployee attendance and performance issues are sometimes rooted in medical issues – either that of the employee or the employee’s family. The protections provided by the federal Family Medical Leave Act can provide the employee time off from work to resolve these issues. But an employee’s rights under FMLA are limited, and FMLA abuse has led employers to heightened scrutiny of leave requests. The following questions and answers are intended to help EA professionals guide employees to FMLA leave when appropriate. It’s important to stress that this article addresses the federal FMLA. Many states have their own version of FMLA and/or other statutory protections that may extend additional rights to employees. Q: Can an EA professional certify an employee’s need for FMLA? A: Maybe. A request for FMLA can be certified by a “health care provider,” and according to federal regulations this includes a clinical social worker and “any health care provider from whom an employer or the employer’s group health plan’s benefits manager will accept certification of the existence of a serious health condition to substantiate a claim for benefits.”

Q: If the EA professional is permitted to certify, can the employer reject the EA professional’s certification? A: Not if the request is proper. Employers don’t have discretion to deny proper requests, but they don’t have to approve every request merely because an employee (or provider) says “it’s FMLA.” First, the employee must be eligible for FMLA. This generally means that they have worked for the employer for at least 12 months and worked at least 1,250 hours during the 12 months prior to the start of the FMLA leave. Second, the employee has to have available leave. An eligible employee has a total of 12 weeks of FMLA per that employer’s FMLA year. An employer may administer FMLA by calendar year, a fixed 12-month period (e.g., fiscal year), a 12-month period measured forward from the first date an employee takes FMLA leave or a rolling 12-month period measured backward. Therefore, if he or she has already used FMLA time, the employee may not have much, or any, entitlement remaining. Third, the employee must timely submit a complete and sufficient application and certification form. Failure to

provide this information can result in delay and/or denial of the leave request. Fourth, the request must be for a covered reason: • The birth of a child or placement of a child with the employee for adoption or foster care; • To care for a spouse, child or parent who has a serious health condition; • For a serious health condition that makes the employee unable to perform the essential functions of his or her job; or • For any qualifying emergency arising out of the fact that a spouse, child or parent is a military member on covered active duty or called to covered active duty status. An eligible employee may also take up to 26 work weeks of leave during a “single 12-month period” to care for a covered servicemember with a serious injury or illness, when the employee is the spouse, son, daughter, parent, or next of kin of the service-member. The “single 12-month period” for military caregiver leave is different from the 12-month period used for other FMLA leave reasons. Q: Can an EA professional speak with the employer about a client’s FMLA request?

A: Yes, with authorization from your client. The employer may communicate directly with the certifying provider for clarification (e.g., illegible handwriting) and/or to authenticate the certification (i.e., not a forgery). However, when an employer wants to contact the certifying provider, it must be through human resources or administration – the employee’s direct supervisor should not make direct contact with you.

medical treatment, the employee must consult with the employer and try to schedule the appointment at a time that minimizes disruption to the workplace.  The employee must call in for absences as required by policy. If the policy requires a call to their supervisor, he/she must call their supervisor. If intermittent leave has been approved, the employee should explain, at each absence, that this absence is part of his/her intermittent FMLA leave. If the employee simply calls “off” or “sick,” the employer has no way of knowing that the absence is covered by FMLA. v

Q: Can the employer challenge the certification by requiring the client get a second opinion?

This article is educational in nature and is not intended as legal advice. Always consult your legal counsel with specific legal matters. If you have any questions or would like additional information about this topic, please contact: Robin Sheridan at (414) 721-0469 or rsheridan@hallrender.com.

A: Yes. The employer can request a second or third opinion about an FMLA certification. If the employer has reason to doubt the validity of a medical certification, it may require the employee to obtain a second opinion at the employer’s expense. For example, the employer may not believe that the certification states an adequate need for FMLA leave or that the medical condition is a serious health condition as required by the statute. The employer is permitted to designate the provider furnishing the second opinion, but the selected provider may not be employed on a regular basis by the employer. If the second opinion agrees with the original opinion, then the employer may not further challenge the request on that basis. However, if the second opinion disagrees with the original certification, then the employer is permitted a third opinion. The employer must again pay the costs of the medical exam. The employer and employee must jointly agree on the provider who will provide the third opinion. The opinion of the third provider is final. While awaiting the second (or third) opinion, the employee is provisionally entitled to FMLA leave.

Robin Sheridan is an attorney with Hall, Render, Killian, Heath & Lyman, P.C., the largest health care-focused law firm in the country. Please visit the Hall Render Blog at http://blogs.hallrender.com/ for more information on topics related to health care law.

Q: Other than as certifying provider, are there ways an EA professional can help their client with FMLA? A: Absolutely. Consider sharing the following tips.  Give as much notice as possible. In general, the employee must give at least 30 days advance notice of the need to take FMLA leave. If 30 days advance notice is not possible because the situation has changed or the employee does not know exactly when leave will be required, the employee must provide notice as soon as possible and practical. For planned 13 | W W W . E A PA S S N . O R G | •• • • • • • • • • • • • • • • • • • • • | JOURNAL OF EMPLOYEE ASSISTANCE | 1st Quarter 2018 |

theworldofeap EAP in the Philippines – On the Cusp of Change | By John Maynard, PhD, CEAP

o understand the people and culture of the Philippines, one has to start with the underlying cultural concept of bayanihan. In many rural areas, even today, when a family needs to move from one location from another, the whole community assists with the move, not only carrying the personal belongings, but also in many cases, the family’s traditional house made of indigenous materials. The men of the community lift the house on long bamboo poles and move it to the new site. Afterward, the family serves food to the volunteers as the community celebrates and socializes. Even in cases when houses cannot be physically carried, the bayanihan tradition of helping one another, especially in times of need, without expecting anything in return persists. Filipino values are still rooted strongly in mutual support and personal connections based on family, friends, religion, and even commercial relationships. Appropriately leveraging and supplementing this ancient tradition of pitching in to help neighbors and community is key to the future success and growth of EAPs in the Philippines. Unique Blend of East and West The unique history of the Philippines has produced a

complex culture that combines the traditional bayanihan spirit with more Western beliefs and attitudes. The first European to arrive was Ferdinand Magellan in 1521. Although Magellan was Portuguese, he was leading a Spanish expedition, so he claimed the Philippines for Spain. Magellan was killed by a local chief who fought to prevent the Christianization of the native population. Ultimately, most of the natives converted to Catholicism, and the Philippines remained a Spanish colony for 377 years until 1899, when it was ceded by Spain to the United States following the Spanish-American War. The country was then a US territory for 49 years, until it was granted independence in 1946. Today, the Republic of the Philippines is a rapidly emerging market with an economy transitioning from one primarily based on agriculture to being focused more on services and manufacturing. With a population of 103 million people, it is the eighth-mostpopulated country in Asia and the twelfth-most populous in the world. Most Filipinos live on just 11 of the more than 7,000 islands that make up the country. Nearly 85% of Filipinos identify themselves as Roman

Catholic, making the Philippines the third-largest Catholic nation in the world. Although the Philippine culture is quite Hispanic and Westernized on the surface, underlying and still influential indigenous attitudes and ways of thinking, including bayanihan, continue to guide Filipino behavior. Health and Mental Health Care Perhaps partly due to the strong cultural value of reliance on family, community, and church, healthcare and mental healthcare expenditures in the Philippines are relatively low. In 2014, total healthcare expenditures were below the World Health Organization’s minimum target of 5% of GDP, compared to a world average of 9.9%. Of the healthcare total, only 5% is spent on mental health-related care, and much of that goes to inpatient services. This state of affairs may be on the brink of significant change. The Philippine Mental Health Act approved in 2017 proposes a national mental health policy focused on integrating comprehensive mental health services into the national healthcare program. The intent is to promote mental health services to the population and protect the rights of those who use mental health services.

The Mental Health Act also includes a clause for the promotion and provision of mental health services in the workplace. Specifically, it dictates that, “Employers shall develop appropriate policies and programs on mental health in the workplace designed to: raise awareness on mental health issues; … identify and provide support for individuals at risk; and facilitate access of individuals … to treatment and psychosocial support.” EAPs Ready to Blossom Initiated by the needs of large multinational companies, the first Philippine-based EAPs were introduced in 2005. Growth in the EAP market has been slow and still consists largely of services to multinational corporations, sometimes contracted directly between local EAP vendors and the corporations, and sometimes subcontracted through global EAP firms. Jean Lim, the only CEAP based in the Philippines, is optimistic that the new 2017 Mental Health law will raise awareness of mental health issues and EAPs among corporate and business leaders, as well as among the general employee population. This should accelerate the growth of EAPs, especially among indigenous companies. Another factor adding to the growing visibility of EAPs in 2017 was the first annual conference of the Asia-Pacific Employee Assistance Roundtable (APEAR) ever held in the Philippines. According to Ms. Lim, government representatives invited to

speak at APEAR admitted that the conference was their first awareness and exposure to EAPs. Challenges and Opportunities Stemming from the strong bayanihan tradition, the cultural norm in the Philippines has long been for Filipino employees to turn to family or friends for help when they experience difficulties. Turning to outside counseling can represent a violation of that norm, so utilization of services like EAP has been very low. Company leaders, of course, have had this same philosophy, making EAP a hard sell with local firms. In recent years, however, the difficult economy and low wages have led more and more Filipinos to go overseas to work so they can send money home to their families. In fact, the Philippines is a leading source of overseas workers for many higher-wage countries. Unfortunately, the high number of overseas workers also has weakened family and social relationships, making the bayanihan tradition more difficult to sustain. As the pace of work increases, employees today are under more stress, with fewer traditional resources for getting support. Given their growing visibility in the marketplace, EAPs may be able to assist in filling this gap in needed services. With the market for EAP growing, one of the greatest challenges for EA firms in the Philippines is finding adequately trained staff and affiliates, especially in the provinces where many of the large business process outsourcing

(BPO) companies have facilities. Similarly, qualified referral resources for counseling or treatment needs beyond the scope of the EAP are few and far between. As is the case in many countries, the rapid changes in the Philippines are creating both difficult challenges and huge opportunities for EAPs. Our challenge as a profession is to find innovative solutions tailored to the local culture while protecting the integrity and quality of EAP core technology. v Let’s Continue the Discussion My thanks to Jean Lim, CEAP, Managing Director of PowerVision EAP Inc., and Phillippa Keys, Executive Director of In Touch Community Services, for taking the time to meet with me as I was preparing this column. Let’s continue the discussion of EAP in the Philippines and elsewhere around the world! If you have comments about this article or ideas for other countries we should explore in future issues, please send them in. You’re welcome to contact me directly anytime or to post your feedback, questions, or suggestions on EAPA’s LinkedIn group. Dr. John Maynard served as CEO of EAPA from 2004 through 2015. Prior to that, he was President of SPIRE Health Consultants, Inc., a global consulting firm specializing in EA strategic planning, program design, and quality improvement. In both roles, he had the opportunity to observe, meet, and exchange ideas with EA professionals in countries around the world. He currently accepts speaking engagements and consulting projects where he can make a positive difference. He can be reached at johnmaynard@ spirehealth.com.

featurearticle Project 95 –Broadbrush Lessons for Today Part II |By Jim Wrich

n this second installment of a three-part series, we continue to show the evolution of employee assistance into the EAP of today. Part I of this series can be read online here http:// www.eapassn.org/q4-17-Project95-Broadbrush-Part-I (requires EAPA member login). An Enduring Model The Mineral Mining Division of Kennecott Copper Company in Ogden, Utah had pioneered a different approach. With a program called Insight headed up by Otto Jones, they focused strictly on job performance but the referral was made to Otto, who was a licensed clinical social worker and had deep knowledge of alcoholism. Supervisors focused on job performance and attendance and if regular disciplinary measures failed to correct the situation they referred the employee to the Insight program. Otto then made a differential diagnosis and referred the employee to appropriate care in the community. By not affixing an alcoholism label on the program, it didn’t carry the stigma of previous workplace efforts. Otto found that about half the time the problem was alcoholism but with the rest of the participants it was some other disorder. However, utilization was so much higher than in the straight

alcoholism programs that in absolute numbers, Insight was reaching more alcoholics. Equally important, Otto wanted to know what difference Insight was making to the company. The overall improvement was stunning: a 52% reduction in absenteeism, a 74.6% decrease in weekly indemnity expense, and a 55.4% decrease in medical surgical costs. A few participants got worse and some stayed the same but a significant majority (77%) improved across the board. The savings added up to several times the cost of the program. Years later when I was Director of the EAP at United Airlines (UAL) we found similar results and while about 40% of the participants had a substance use disorder, they accounted for the lion’s share of cost savings. Our benefit to cost ratio for the program overall computed to 7 to 1 over 5 years based on pre-post absenteeism alone. Without discarding the Job Performance Focused Alcohol Identification approach, NIAAA advocated for the Broadbrush approach as well. OPCs were encouraged to propose whichever concept an employer was willing to adopt. Overall, Broadbrush emerged as the solid favorite. But it didn’t happen without a prolonged battle within the field as the Executive Director of National

Council on Alcoholism led the charges against the Broadbrush approach. In short, he didn’t like the name and didn’t believe it would identify alcoholics. Behind the scenes, others at NCA supported the concept, Ross Von Wiegand among them. When I asked him about titling my first book, “The Employee Assistance Program” he said, “It won’t turn anyone on, but it won’t turn anyone off, either.” The name stuck. Accountability During the course of our training from NIAAA, we tackled other thorny issues, the most important of which was how we would know whether or not we were really doing any good, not only for the individual but for their employers and unions. The two major markers were recovery and participant utilization, which we referred to as penetration. We kept it simple. If 10% of the workforce suffered from alcoholism, we asked how long it should take to identify and refer a number equivalent to that population at risk. At that time, the US economy was largely industrial and turnover was much lower than it is in today’s predominantly service sector economy. So we informally thought the period should be about 5 to 7 years, resulting in an annual penetration

rate of 1.5% to 2.0% per year for alcoholism referrals. In Broadbrush programs we assumed that mental health and family problems also affected about 10% of the workforce so another 1.5% to 2.0% should be added to the utilization rate. Thus, many of us adopted a first-time annual employee utilization rate of 3% to 4% as a benchmark. This computed to about 30 to 40 first-time employee referrals per year per 1,000 employees, with 15 to 20 being assessed alcoholic. In addition, we believed a significant number of family members should be served. Turning to recovery, the Hazelden data indicated that a 50% benchmark first-time continuous recovery rate after one year with improvement in life functioning and life style was a safe expectation for employed alcoholics and many of us adopted that as a goal. Later, Norm Hoffman, PhD. began an illustrious career at CATOR, an addiction treatment outcomes research firm in St. Paul, Minnesota. He developed a database of 75,000 adults and 11,000 adolescents, which continued to show that recovery was likely in a majority of cases if the right type, length, and level of treatment was provided. It took a while longer to empirically document the benefits for employers but eventually Benefit to Cost Analysis was developed. Until then, the Insight data was the gold standard for many of us as we traveled our states talking to corporate and union leaders. Equally important were the positive anecdotal reports from supervisors and union reps along with a reduction in grievances and labor unrest. These satisfied

even some of the most conservative managers as the Thundering Hundred implemented programs around the country. We also thought it was important to declare what a Broadbrush program was not. It wasn’t industrial social work, industrial psychology or industrial medicine. It wasn’t a treatment program or in-house AA. It was neither a place to coddle poor performers or to trigger punishment. Persuasion not coercion was the key. The earliest definition of what Broadbrush was “… a labor-management control system designed to earlier identify problem employees when their problems impair job performance and motivate them to receive assistance to resolve the problem.” As time passed this definition was refined and methods were developed to attract and assist employees before their problems adversely affected their performance. The heart of the program was A and R (Assessment and Referral). Finally, and most importantly, was the role and function of the person to whom employees with problems would be referred. With straight alcohol identification and referral programs the answer was easy: Usually it was a recovering alcoholic trained in motivational interviewing. But in Broadbrush programs, the role and credentials were more complex. Someone who knew how to identify and refer alcoholics was still essential, but they also needed to have sufficient familiarity with a host of other mental health, family, and concrete issues to make an accurate assessment and an appropriate referral. Technically, they needed to professionally perform three tasks:

• Accurately assess a broad range of issues distinguishing between presenting and primary disorders, • Bring the issues forth to the attention of the participant in a way that didn’t cause them to run out of the room, and • Persuade participants to take action that they would not have been able to take on their own, without resorting to illegal leverage tactics by threatening their job if they didn’t comply. One task we did not believe they should do was the treatment itself. We did not believe a single therapist could be competent to treat all of the disorders a Broadbrush program would attract. Moreover, if they got bogged down in delivering the

featurearticle direct care, we were concerned that they would not have time to handle new participants or the allimportant follow-up and continuing care, which for chronic issues could include weekly sessions for a period of time. We initially referred to them as Motivational Interviewers and later A and R resources. Very few professionals and virtually no recovering people were ready made for this role. While several dozen had emerged from the original Thundering 100 and the following group of NIAAA trainees, these numbers were miniscule in comparison to the hundreds and then thousands of workplaces that would eventually develop what were to become known as Employee Assistance Programs. Mountains and Valleys By 1975, we were riding high. Dozens of Fortune 500 companies were installing programs, insurance coverage was increasing, testimonials abounded, and positive data was accumulating. One might have believed that Broadbrush programs would always be a source of help for large numbers of alcoholics and other addicted people given their original objective, the support of NIAAA as the principal funding source, the initial makeup of the OPC group, the name of the field’s first professional association (The Association of Labor and Management Administrators and Consultants on AlcoholismALMACA), and the fact that some of the most compelling BCR data was based on the recovery of alcoholics. Unfortunately, a number of conditions and events evolved

over the years that militated to the contrary. Many great in-house Broadbrush programs – by then known as EAPs – emerged, such as Burlington Northern Railway, Bank of Montreal, Amoco, United Airlines, and a group that became known as the Employee Assistance Roundtable. But such programs became fewer and farther between and the alcoholism focus was all but lost in many of them. Over the years, I have completed performance audits of dozens of EAPs. In some the rate of Substance Use Disorder (SUD) referrals is where we as OPCs thought it should be, about 1.5% to 2.0% of the employee population per year, first-time participants. But in many programs the penetration into the alcoholism population had fallen to less than the incidence of the problem in the general population, barely onefourth of the standard we had set for ourselves in the mid-70s. Yet, the disease certainly hasn’t disappeared. Since Don Cahalan’s landmark study, “American Drinking Practices” in 1967 through present day studies published by NIAAA, the rate of alcoholism and other drug disorders has remained at about 9 percent, or 1 in 11 in the general population, with men being higher than women. So, the question is, “What happened?” The evolution of the Insight program provides a striking picture of what was to occur in the EA profession. Ever the entrepreneur, Otto Jones created a company, Human Affairs International (HAI), and began providing Insight to other employers on a contract basis. The company grew as the EAP concept caught

on around the country and by the mid-1980s HAI was providing services to some of America’s largest companies. The need for competent assessment and referral staff surged. The problem was that few of them had Otto’s skills as both a clinical social worker and an expert in recognizing and intervening in alcoholism. Otto preferred MSWs but like virtually all other health professionals, few had been trained in addictions and virtually none in the A and R function. In the beginning, Otto himself trained them. But when HAI grew into a national organization it had to contract with hundreds and then thousands of MSWs and other professionals nation-wide in order to demonstrate to prospective customers that it had a sufficient national network to service their multi-state workforces. Otto couldn’t train them all. Filling a Gap and Creating an Industry In the meantime, a couple of bright young innovators, Carl Tisone and Richard Hellan in St. Louis formed PPC Worldwide Service in 1975, which became the world’s largest commercial EAP provider. Recognizing how few companies had adequate mental health benefits, PPC offered a unique approach in which their contracted EAP counselors would provide brief therapy to employees. In essence, those charged with assessing and referring were doing the treatment themselves. Since some employers had more extensive mental health benefits than others, PPC provided service options based on numbers of EAP sessions ranging from 3 to 10.

This was a great model for some problems such as financial, legal, family, and marital, for which brief therapy was appropriate. But because brief therapy isn’t generally suitable for most chronic issues including addictions, PPC’s policy was to refer participants with those issues to outside addiction treatment resources unaffiliated with PPC. As national EAP referral networks were formed many individual A and Rs served multiple providers. Very few had the kind of training necessary to recognize and refer employees with alcohol problems. Instead, standard practice began to focus on the presenting problems, such as the marital, family, and financial issues that can be caused by addiction. However, addiction itself was not generally addressed unless presented, which was rare. Experience has shown that A and Rs must be trained in how to effectively inquire about addiction to break through the denial inherent in the condition. This starts by asking every referral about their personal and family background regarding drinking and drug use patterns. Other commercial EAP providers sprang up. Some addictions treatment centers that had been receiving referrals from in-house EAPs staffed largely by recovering alcoholics decided to get into the EAP business themselves so they could channel referrals into their own treatment programs. Many EA professionals considered this to be a conflict of interest that could compromise the integrity of the A and R process. The most logical group to protest would have been ALMACA, the field’s only professional association at the time.

But ALMACA itself had a conflict. Always strapped for money, a major source of its income was its annual conferences where most of the exhibitors and many attendees were sponsored by treatment centers. I recall commenting to Tom Delaney, who was the Executive Director of ALMACA that I feared we would someday find that half of the EAPs were owned by treatment organizations trying to put everyone into inpatient treatment while the other half would be owned by insurance companies trying to keep everyone out. By the mid-1980s most employees that had access to an EAP worked for employers that had contracted for service with a commercial provider. It’s Gotta be Easier than That There were exceptions to the commercial or external EAPs as they were called. At UAL in 1978 we developed an inhouse service that was widely recognized by ALMACA and others as one of the premier programs in the field. About 40% of the referrals were for alcoholism and other drug issues. Many organizations sought our consultation. But when we described the arduous 3-year task to implement the program for 50,000 employees, including 160 two-and-one-half hour training sessions for 4,000 key management personnel including the CEO, most EAP inquirers opted for the “turn-key” service of a large commercial provider. Soliciting proposals and managing a contract was much easier than the hands-on implementation and management required of a Director of a large in-house program,

and it involved little direct hiring of A and R staff or key employee orientation and training. Unfortunately, the Assessment and Referral resources were largely untrained in addictions. With rare exceptions, such as Dr. Dale Masi’s program at the University of Maryland, schools of social work, psychology, and medicine, taught virtually nothing about alcoholism and drug addiction. They certainly did not teach students how to intervene in the way an A and R needed to in order to function effectively. At UAL we found that in filling one A and R position, it was necessary to interview on average 10 candidates, and getting those 10 required weeding through more than 50 resumes. The worst fears of the OPCs and organizations such as NCA were beginning to be realized. Literally thousands of therapists untrained in alcoholism and effective assessment and referral techniques were becoming the heart of the EAP world. v NEXT ISSUE: Trouble brewing in paradise. Jim Wrich is one of the pioneers of Employee Assistance Programs (EAPs) - one of the original Thundering 100 who launched the modern EAP movement through Project 95-Broadbrush. In 1972, Jim implemented some of the first EAPs in the country. An early member of ALMACA, (later the Employee Assistance Professionals Association,) he served as First Vice President and was the founding President of the Employee Assistance Society of North America (EASNA). Since 1987 he has managed his own firm, J. Wrich & Associates, LLC. (JWA), a health systems performance company, which provides a broad range of consulting and cost analysis services to businesses and unions.

coverstory

Duty of Care Opportunity for EAPs

|By Ken Burgess, M.Ed., LPC; and Nancy Board, MSW

hat is Duty of Care (DOC) and how does it relate to changing expatriate assignments? Why is this an important topic for employee assistance professionals? How can they take advantage of this opportunity? For one thing, the locations of expat assignments are changing. In the past, Paris, London, Geneva, and other choice locations hosted significant numbers of expats. Some are still assigned to cities like these, but more remote and challenging locations like Al-Khobar, Saudi Arabia; Ulaanbaatar, Mongolia; and Luanda, Angola have become common. In addition to being challenging in terms of culture for Americans, many of these countries are also dangerous due to terrorism and other factors. That is where Duty of Care (DOC) comes in to play, and why it is so important. Duty of Care Overview DOC is the responsibility an employer has to keep its employees, contractors, and others, safe and free from any foreseeable harm while on the worksite, or while working anyplace else on behalf of the organization. (OSHA, Section 5A-1). For home-based employees working at a company work location, DOC responsi-

bilities apply to “working hours” only; for expatriates and business travelers, though, such responsibility continues 24/7. This is because expatriates and business travelers, whether employees or contractors, are in effect working for the company every hour they are away from home. As noted, in the US such regulations are tied closely to Occupational Safety and Health Administration (OSHA) procedures. In other countries, such as the UK, Canada, France, Belgium, the Netherlands, Germany, Spain, Australia, and New Zealand, specific DOC laws are on the books, such as the Corporate Manslaughter and Corporate Homicide Act in the UK. Many US companies fail to adequately prepare their expats and families – 22 percent of firms surveyed by SHRM stated that employers “did virtually nothing” to prepare their employees to live overseas (Mauer, 2013). It’s true that it’s difficult for any organization associated with expatriate assignments to provide all of the tools necessary for expatriate, family, and business traveler success. However, ignorance of these concerns is not an adequate defense for non-compliance, and US employers doing business in other countries need to improve their DOC policies.

Despite the positive effect that preparation and support have on expatriate success and productivity, some (perhaps many) US companies appear to be waiting to see what happens – in other words, if lawsuits actually arise. They have in the UK and other parts of Europe. Conversely, in the UK, DOC violators can, and are, sentenced to prison. (Editor’s note: See sidebar on page 22 for case examples.)

“EA professionals are well aligned to assist organizations in positively contributing to the well-being of an assignee or business traveler.” How the US Lags Behind in DOC Cigna and National Foreign Trade Council’s Global Mobility Trends Survey included responses from nearly 3,000 expats from more than 100 companies in 156 countries (Cigna and NFTC, 2015). The survey found that:  Three-fourth of respondents said their employer provided help moving household goods, setting up utilities, and other “settling-in”

needs (including medical), but they needed much more training and support as related to local culture and lifestyle.  Participants also expressed the need for an expat “Sherpa guide” – an experienced mentor with strong familiarity with the assignment area; someone who’s “been there, done that” and can credibly offer useful guidance based on this experience. DOC Requirements When an employer makes a decision to do business offshore, its DOC responsibilities (according to current HR practice literature) includes the completion of thorough due diligence in order to best determine the risks to the safety, security, and health of those to be sent on its behalf. The employers’ actions to mitigate those risks includes, but is not limited to: 1. Documented evaluation of the location where business is to be conducted: A comprehensive travel plan must be written and communicated to everyone involved in the expatriate assignment, including employees and their families. This plan takes the location assessment into consideration and provides services to mitigate the risks, including a way to always know where employees are, how to reach them in the event of an emergency, their responsibilities in accordance with the plan, and contracted services to provide emergency evacuation. Employers must be prepared to support employees or withdraw them from events such as political violence, terrorist acts, or

natural disasters. A kidnap and ransom policy for assignees is also recommended. 2. Health issues and concerns: Documentation of health issues and concerns need to be included in the travel plan. This includes employee orientation to assure that assignees understand their responsibilities. Risk mitigation includes emergency medical evacuation for all assignees. 3. Degree of difficulty anticipated in doing business in the host country: This includes socioeconomic conditions, language needs, and cultural and business etiquette and expectations. Other Considerations These examples represent the minimum, not the maximum needed to meet employer DOC responsibilities today (FIDI, 2017). Employers can be deemed to have breached their DOC responsibilities by failing to do everything that was reasonable to keep the employee, contractor, or family member safe from harm. How the EAP can Get Involved EA professionals are well aligned to assist organizations in positively contributing to the well-being of an assignee or business traveler. It doesn’t matter whether you’re providing internal or external services to the company, your expertise as an EA professional is worthy of notice. It begins with understanding what types of businesses you are supporting. First, do your homework.

• How well do you know the business practices of the customer organizations you serve? • Are employees traveling domestically, internationally or both? • If the latter, what countries/ locations are employees traveling to or where are they assigned? • How long are their assignments? • What challenges do these locations pose from a risk standpoint? • Are there policies in place related to Duty of Care? • Are there safety procedures in place that cover overseas travel and assignments? • Are these safety sensitive jobs?

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coverstory • Are there particular cultural dynamics that need to be assessed? Find out as much as you can about what physical and emotional safety protocols are in place to support traveling employees. Then assess the gaps

and recommend solutions in partnership with the HR/Safety/Risk Management team. EAP should be a regular resource for all employees, pre, post and during assignments. As an EA professional, you may ask, “How do I get a seat at the table?” It helps to have an estab-

lished relationship with the HR and Safety team in order to be recognized as a viable resource. But either way – ask. Most HR teams would love to have additional expertise in reviewing procedures and protocols. They may not think to ask you…so be pro-active and ask first.

Case Examples: Legal Actions Resulting from DOC Negligence

s explained in the main article, too few US companies adequately prepare their employees for international assignments. Meanwhile, the rest of the Western world continues to add emotional and behavioral health requirements to Duty of Care. In 2007, the United Kingdom passed the Corporate Manslaughter and Corporate Homicide Act. The law imposes criminal liability on corporations where there is a gross breach of Duty of Care resulting in the death of a person, such as employee, person on a work site, or business traveler. There have been fewer than 25 convictions since the law was implemented, but three of them occurred in 2017. In one case, two companies were fined in connection with the death of a worker who fell through the roof of a warehouse after he stepped onto a skylight in 2015. Odzil Investments Ltd owned the warehouse and was aware that the roof needed repairs. The work was carried out by Koseoglu Metalworks, which admitted to charges of corporate manslaughter, while Odzil and two of its directors were found guilty following a four-week trial. (Napley, 2017). In addition to the 2017 convictions, in the 2012 case of Lion Steel, a last-minute guilty plea by the company to the corporate manslaughter charge was agreed as part of a deal to remove the risk that one of the directors might face prison if convicted of manslaughter. Without the Act, it is unlikely that Lion Steel would have been prosecuted for corporate manslaughter (Grimes, 2013).

bomber. The company was found liable for failure to provide adequate security measures for their employees. A contractor was injured on a worksite in Germany and sued in the UK. The court ruled that the contractor was an employee of the UK company and that the employer failed to provide a safe working environment (Lockton Companies, 2015). • In Australia, the spouse of an employee on assignment was severely injured in a fall on a staircase at housing provided by the employer. Damages were awarded to the spouse against the employer (Lockton Companies, 2015). • British Petroleum (BP) was sued in the UK by families of employees killed during an Algeria gas plant terrorist attack in 2013 (Oil Industry News). References

Grimes, J. (2013, April 12). People Management. Corporate manslaughter cases increase. Retrieved from http://www2.cipd. co.uk/pm/peoplemanagement/b/weblog/archive/2013/04/12/ rise-in-corporate-manslaughter-cases.aspx. Lockton Companies (2015, July). Duty of care: Protecting traveling employees. Retrieved from http://www.lockton.com/whitepapers/Duty_of_Care.pdf. Napley, K. (2017, May 31). Three companies convicted of corporate manslaughter in a week. [Blog post]. Retrieved from https://www.lexology.com/library/detail.aspx?g=2bc3bff1090c-4ee0-98b6-b99d423426f7.

Other related actions include:

Oil Industry News (2016, January). Families of BP employees suing over 2013 Algerian gas plant attack. Retrieved from https://www.oilandgaspeople.com/news/6813/families-of-bpemployees-suing-over-2013-algerian-gas-plant-attack/.

• The employees of a French company working in Pakistan were killed by a suicide 22

Some additional questions to consider when evaluating DOC practices:

more sustainable world. She developed a network of CI and EA professionals in over 40 countries and received certification as a global professional in human resources. You can reach her at nancy.board@gw4w.org.

• Who is providing pre-travel/pre-destination cultural sensitivity training, host country destination services, and post-assignee support? • Is an emotional/psychological assessment conducted? • Is EAP support a standard offering for business overseas travelers and expat assignees? • What vendors are in place to assist employees during a crisis or major disaster? • Is there a medical evacuation contract in place? • Is psychological first-aid assessment built in? • Is there a Critical Incident Stress Management (CISM) protocol in place? • If so, which countries have psychological counseling assistance available with credible practitioners? • Where and how are families notified if crisis strikes? By whom? • How are families in the home country receiving care and support? What about the host country? • How is public relations handled in emergencies?

References

Cigna and National Foreign Trade Council’s Global Mobility Trends Survey Results. (2015, November). New York, NY: Author. Retrieved from https://www.cigna.com/newsroom/newsreleases/2015/cigna-and-national-foreign-trade-council-globalmobility-trends-survey-results. Claus, L. (2011). Duty of Care and Travel Risk Management Global Benchmarking Study. London: AEA International Pte. Ltd. Retrieved from https://www.internationalsos.com/duty-of-care. FIDI Global Alliance. (2017, March 20). Expat duty of care: How to stay compliant. Brussels, Belgium: Author. Retrieved from https://www.fidi.org/blog/expat-duty-of-care-compliancy. Mauer, R. (2013, July 8). Survey: Companies fail to train managers for overseas assignments. Society for Human Resource Management (SHRM). Retrieved from https://www.shrm.org/ resourcesandtools/hr-topics/global-hr/pages/fail-train-managersoverseas-assignments.aspx. Society for Human Resource Management (2017, May 1). Managing international assignments. Washington, DC: Author.

Don’t assume all HR professionals have the answers to these questions; but ask. Be willing to start the conversation. Be seen as a value-added resource to the organizations you serve.

Advertise in

Summary Finally, recommend that anyone who is going on extended business travel and / or is being assigned to another country be evaluated by EAP as a normal part of the assignment process. The earlier EAP is engaged, the better. Know what resources will be available for the employee and their family and help them make the necessary linkages. Helping organizations minimize reputational damage with comprehensive, clear protocols and procedures helps everyone. The EAP is in perfect position to assist in offering DOC services. v

Contact Jim Printup, Development & Donor Relations: (303) 242-2046, development@eapassn.org

Ken Burgess is a relationship-focused international behavioral health professional with more than 25 years’ experience. Ken has helped to develop and implement programming in more than 100 countries. He can be reached at ken@eapconsultant.com. Nancy Board is co-founder of Global Women 4 Wellbeing (GW4W), a 501© (3) not-for-profit organization dedicated to helping support more women to become healthy leaders for a

featurearticle Is Your EAP Endangered or Enduring?

Maintaining Relevance as an Organization | By Don Jorgensen, PhD, CEAP

ow is your EAP coping with what are no doubt some of the most challenging business changes you have ever faced? As Thomas Friedman noted in his recent book Thank You for Being Late, “the current age of acceleration demands that organizations either adapt to rapidly increasing change or they will soon become irrelevant.” To survive EAPs must successfully respond to the major global shifts affecting their workplace and the organizations they serve. However, to not only survive but thrive in the marketplace, EAPs must also determine where their organization sits on the “relevance curve” and what actions are necessary to re-position themselves for success. In other words: Evolution is guaranteed; survival is not. According to Friedman and other global analysts like Ito, Howe, and Susskind, three fundamental shifts are having a major impact on businesses worldwide; the Technology shift, the Market shift, and the Demographic shift. How is your organization adapting to the demands of each major challenge? The Technology Shift The pace of technological evolution is increasing exponentially, and EA organizations are challenged to keep pace. Until recently, smaller

EAPs offered agility, customization, and personalization as market differentiators, while larger EAPs promised economies of scale and efficiency. Although advanced technology and large data management is now accessible to all EAPs, it is conversely easier for larger providers to offer customized service delivery. (Think Amazon.) Worldwide access to smartphones has fundamentally altered both the means and expectations of access and service available anywhere, anytime. Value is no longer found in technological advantages but in the quality of service delivery and response, leading to the next major shift. The Market Shift EAP sellers used to offer “quality, speed, or value – pick any two.” Today’s purchasers expect all three. As workplaces remain in flux and as traditional job types continue to shrink or disappear, service needs and response continue to evolve. Booksellers, hospitality, and taxi industries have demonstrated that competitors can emerge from any direction, from any type of competitor, of any size, at any time. Online, free counseling services market directly to businesses, and what had been a competitive edge for an EA provider may no longer be relevant. EA providers must adapt to survive.

The Demographic Shift Millennials will likely comprise over 50% of workforces worldwide by 2020 while a large percentage of workers age 50 or older remain in the workforce. As workplace demographics evolve, new leaders emerge, and market pressures increase, the impact of these major shifts is further increasing the need for a workforce – often smaller with specialized skills (e.g. technological) to deliver new services. Such demands may broaden the gap between generations within the workforce, creating serious leadership challenges for employers – including EAPs – and the organizations they serve. The locations and distribution of workforce teams and individual workers are evolving as well. By 2022 India will become the most populated nation on earth, surpassing China. Experts estimate that during the next 30 years half of worldwide growth will occur in just nine countries, including five on the African continent. Winning the Battle for Relevance Just how can an EAP win the ongoing battle for relevance? Step One: Determine Where Your Organization Sits on the “Relevance Curve”

In his book, Winning the Battle for Relevance author Michael McQueen describes a business cycle common to both successful and failed businesses. Similar in shape to a bell curve, the relevance curve progresses through four phases.  Phase One – Every organization begins in a state of low relevance when they enter the marketplace as a largely unknown entity. EAPs that survive this early period rise along the curve as they begin to earn success and a positive reputation.  Phase Two – As the EAP gains momentum they enter phase two, a rising period of high relevance.

The organization has now become known in their field. In fact, the more successful an organization becomes the more likely it is that competitors start “borrowing” their methods or models. During this period of success and prominence the organization reaches the top of the relevance curve, which represents a tipping point. The danger for many organizations at this point is arrogance or complacency, as they fail to meet the increasing demands of technological or demographic shifts.  Phase Three – If arrogance or complacency occur, a downward slide (often unnoticeable at first) begins into irrelevance. Poorly led EAPs remain in denial at this stage, perhaps attributing a decline in business to a bad quarter or a bad year. All organizations reach a crisis (or opportunity) point somewhere during this phase, in which reevaluation and reinvention become necessary for survival.

 Phase Four – EAPs that fail to “self-diagnose” themselves continue to fade from irrelevance to obsolescence.

The life cycle of most organizations can be tracked in this manner. Consider, for example, the current placement of political parties, labor unions, or service clubs on their respective relevance curves. All have reached (or failed to recognize) crisis points in the current decade. The impact of this accelerated age has also caused these business cycles to become significantly shorter, and the failure of an organization to recognize a crisis point and adapt accordingly leads to a shorter life span as well. (Think Blockbuster Video vs. Netflix, for instance.) To maintain or regain market relevance the smart organization should conduct a periodic update of their own relevance curve followed by an in-depth review or self-diagnostic.

• Who and what are you? For example, instead of, “What is our service?” Ask, “What does our service stand for?” • Why do you do things that way? If you answer, “Because we’ve always done it that way,” you are not only alienating the younger workforce, but virtually guaranteeing that obsolescence is near. • Why do you perform a given service? Examine each service function or activity in detail. Are you conducting “brown bag seminars” for dwindling audiences or spending more on paper-based reporting or training materials, for example? If a service component is no longer desired or profitable, consider dropping it.

Step Two: Conduct a “SelfDiagnostic” Surprisingly in this age of acceleration, the second critical step is to hit the pause button. An internal reassessment allows the EAP to conduct an in-depth examination – well beyond the typical Strengths, Weaknesses, Opportunities, Threats (SWOT) analysis that often serves as simply a rote exercise for many businesses. Conducting a serious internal review allows a mature organization to reconnect with its core beliefs, rethink assumptions, and refocus its strategic direction accordingly. A critical review should address the following: 25

featurearticle • Where are you most vulnerable? Are you one decision or one new competitor away from obsolescence? • Can you offer services faster, cheaper? Chances are, someone can outdo you in these areas. If so, what do you offer that enhances value and transcends speed and cost? • Can you prove your relevance? First, what systems have you established to track and report meaningful outcomes and return on investment (ROI)? Second, do you know what outcomes are desired or expected by your respective customers or purchasers? If so, how are you able to demonstrate your value in a way that is meaningful to the purchaser? Step Three: Reposition Your Organization Once an honest self-diagnostic is completed, the third and final step requires an external focus and demands that the EA provider engage and communicate directly with the client organization. The answers to these challenging questions will guide EA leaders toward successfully redesigning or repositioning their organizations, services and delivery systems, and the methods used to connect with current and prospective clients. These questions are: 1. What motivates or impresses potential clients? (About any vendor or contract, not just you.).) Getting answers to subjective “thought” questions requires the use of multiple tactics to acquire valid, reliable, and useful response data. Whether you

choose to utilize survey tools or direct contact, the keys to success include asking the right questions (use this section as an outline) and choosing your sample carefully. Do not limit your survey only to EAP users. Ensure that your respondents include a diverse group of leaders, non-users, and employees across age, geographic, and gender groups. Do not limit your responses to checklists, yes/ no or Likert scales, but encourage comments and suggestions to enhance survey value. 2. What disappoints or frustrates them? (Do not make assumptions.) Ask not just about the EAP services and function specifically, but also add questions about other services for which the EAP may provide a solution or identify new opportunities for service. 3. Who else is currently meeting their needs? (Remember, your next competitor could come from any field, anywhere.) Does the organization speak highly of specific consultants providing services relevant to EAP services, e.g. training, supervisory consultation, health advisors or conflict management?? 4. How are you currently seen or perceived? (Perception is everything. Are you out of sight; out of mind?) Is your EAP easy to access? Are you viewed as an insurance addon, a disciplinary component or a responsive service partner? Are you known or valued at all by certain workplace groups? For example, how effectively are Millennials utilizing your services?

Recent EAP field survey responses have included statements like: “They don’t know who the EAP is,” “They don’t know if they have the time for the EA provider” “They don’t know if the EAP is worth the time.” Thus, any analysis of survey results must explore the question: Why is the EAP not relevant to them? It is true that an EAP is only relevant to the extent that it meets the needs of the client organization. 5. What are the knowledge or skills gaps, or unaddressed future needs? (This is the information used to identify unique opportunities or unmet demand e.g. supervisor skills training or teleservices.) You may also gain data relevant to this item from question #2. 6. Who are you not connecting with? (Consider age, gender or other worker demographics, leaders, managers, business sectors, etc.) Despite the ongoing technological shift human beings still crave connections. The demographic and marketing evolutions have created a new opportunity and demand for training and consultation for socalled “soft skills” such as team leadership, communication, and social reasoning. How are you communicating with your customers? If you currently limit communications to written reports or electronic means, seek direct (video) or faceto-face contact when possible. Presentations by the EAP at annual meetings or similar events provide opportunities for delivery of outcomes and ROI, discussion of future needs and service response,

and strengthen human connection and business relationships. 7. What is unique about your EAP? Every organization must be able to answer with clarity “Why choose your organization over another?” In this accelerated age of business what made your EAP unique three years may no longer be true – or relevant – today. Maintaining relevance requires every EAP to regularly re-examine their USP (unique selling proposition) or UVP (unique value proposition.) Next, however comes the critical question: “Does this difference your UVP - matter to the companies

earoundup Mental Health Issues Increasing: Survey Stressed? Depressed? Overwhelmed? The cognitive and emotional demands on managers have rarely been more complicated or intense. One recent global research survey of EAPs found that, combined, employee anxiety, stress, and depression accounted for over 80% of all emotional health cases in 2014, compared with 55% in 2012. In the UK alone, a 2014 report from the chief medical officer for England estimates, the number of sick days lost to “stress, depression, and anxiety” increased by 24% from 2009 to 2013. According to the Harvard Business Review, many executives embrace mindfulness and medita-

or organizations you serve?” If not, then your organization has hit or moved passed a critical point on your relevance curve and survival demands a serious organizational review. If your EAP is valued by the clients you serve then all is well – for now. Summary In essence, business no longer just involves transition, business is transition. The successful ones embrace it. To maintain relevance during this constant state of acceleration the smart EA organization does well to recall a comment attributed to Charles Darwin: “It is

not the strongest that survives but the most adaptable.” v Don Jorgensen is the owner of the Arizona-based Human Factor Consulting. He has over 25 years’ experience as owner of a multi-national EAP, speaker, and consultant in the areas of leadership, team development, and change management. He received the 2016 EAPA Lifetime Achievement Award and can be reached at donjorgensen@comcast.net.

References

Friedman, T. (2016). Thank You for Being Late: An Optimist’s Guide to Thriving in the Age of Accelerations. New York, NY: Farrar, Straus and Giroux. McQueen, M. (2013). Winning the Battle for Relevance. Melbourne, Australia: Nextgen Group Pty Ltd.

Continued from page 11

tion to better cope, while others take prescribed medication or selfmedicate to get their jobs done. Increasing numbers of managers across the globe recognize that they need help. This means that more and more people will rely on their personal devices to diagnose, monitor, and manage our mental wellness, HBR reports. The capabilities of these devices continue to get more sophisticated. There’s already a diversity of “digital therapist” apps to help users diagnose their moods, meditate, and let go of negative thoughts. Smart watches and fitness trackers monitor a user’s heart rate, sleep, and movement. There’s even text-analysis software that will alert users to emails that appear angry.

In the near future, face- and voice-recognition technology will likely be good enough to provide a richer experience to these and other cases. Read more here https://hbr. org/2017/10/what-happens-tomental-health-at-work-when-ourdevices-know-how-we-feel.

UAE: More Firms Offering Mental Health Support More companies are offering mental health support services for employees, including confidential phone lines, as awareness and recognition of the problem grows in the United Arab Emirates (UAE). continued on page 33

integrationinsights EAPs and the HERO Best Practices Scorecard |By Mark Attridge, PhD

his column reviews an assessment tool that is being used by leading employers to benchmark strategic initiatives in order to promote organizational health and employee well-being. EAPs should take advantage of this free tool to strengthen their role as behavioral health and risk management consultants. Healthy Companies Make More Money A study published in the Journal of Occupational and Environmental Medicine (see Grossmeier and colleagues, 2016) provides real-world evidence supporting the connection between achieving strong financial returns for a company (i.e., growth in stock prices that outperform the S&P 500 Index) and having wellness programs, policies and a work culture that support employee health and well-being. This study examined large employers who had scored high on the HERO best practices assessment. Two other studies recently published in the same journal also have found better than average company stock performance over time among employers with award-winning wellness programs. Being a healthy company appears to be correlated with a healthy bottom line.

But how do you know if a company is doing what it should to be healthy? One way to answer this question is to compare the firm against other high-performing companies and industry best practices. The HERO Scorecard The Health Enhancement Research Organization (HERO) is a non-profit organization based in Minnesota dedicated to identifying and sharing evidence-based best practices in workplace health and well-being. It has over 100 members who represent a mix of employers, wellness providers, and non-profit organizations. Several national EAP providers are members of HERO, including Aetna, Humana, and Optum Health. The HERO Health and WellBeing Best Practices Scorecard in collaboration with Mercer© (HERO Scorecard) was designed to help employers, health providers, and other stakeholders to identify and learn about workplace health and well-being best practices. Now in its fourth edition, it assesses whether a given company provides foundational components that support exemplary health and well-being programs. It uses a self-report survey format that asks 60 detailed questions in six dimensions. These sections include: Organizational

Culture and Support, Programs, Program Integration, Participation Strategies, and Measurement and Evaluation. There are also other sections (which are not scored) that ask about the company and employee demographics, program costs, and outcomes. The HERO Scorecard is a web-based tool available to the public at no cost via the HERO website (hero-health.org). Unlike surveys of employee engagement or employee health risks that need to be done by large samples of employees at a given company, the Scorecard is completed only once for a company. In a recent consulting project I did with a 16-member panel of experts in the worksite wellness industry, the HERO Scorecard was rated highest compared to other wellness program assessment resources from the Centers for Disease Control (CDC) and the Wellness Councils of America (WELCOA). Scorecard Benchmarking Data After submitting the responses online, a return email contains a free report that includes an overall score and a score for each of the six sections compared to benchmark average scores. Recent data reveals that the average employer total score is at 45% of the maxi-

mum possible 200 points, while scores on the six sub-sections range from 31% to 50% of the possible points. These scores indicate there is room for improvement among most employers in how they can create a great place to work and improve employee well-being. EAPs can help employers in reaching this goal. International Version of the Scorecard Since its introduction in 2006, over 2,000 companies in the United States have completed the HERO Scorecard. Based on this success, HERO also released an international version of the Scorecard in 2015. Most of the 150+ HERO International Scorecard users are from Brazil, Argentina, Canada, and multi-national companies based in the US. However, other international users include the United Kingdom, Dominican Republic, China, Singapore, Qatar, and India. As a result, EAPs active in countries outside of the United States can also use the HERO Scorecard with their customers. HERO Scorecard and EAPs When taking the Scorecard, EAP is listed as one of the 10 types of program “resources to support individuals in managing their overall health and well-being.” Also on the list are work-life services commonly provided in conjunction with EAP services (childcare/eldercare; financial/legal). Recent data shows that 72% of small companies (less than 500 employees) taking the Scorecard had an EAP. This is more than twice the national rate for having an EAP among similarly-sized

employers in the United States (based on other survey data). In addition, 95% of the larger companies who took the Scorecard had an EAP. Clearly, employers who are serious about creating a healthy work culture and supporting employee well-being are including the services of an EAP as part of their organizational strategy. Moreover, it’s worth noting how two HERO member companies collaborate with their EAP. The award-wining small employer Lincoln Industries in Nebraska has developed an integrated program that combines the EAP with wellness. Also, American Express recently partnered with their EAP from Beacon Health Options to create the Healthy Minds antistigma campaign. Integration Opportunities for EAPs Within a Company Many past users have found it beneficial to get ready to complete the Scorecard by bringing together the stakeholders from different departments within their organizations to discuss how best to respond to the questions. This can enhance the level of collaboration between the EAP and the stakeholders and can identify new opportunities for integration across programs. See my action plan suggestions below: 1. Encourage your EAP customer(s) to take the Scorecard each year. (Why not? It’s free.) 2. Benchmark the score of your EAP customer as compared to similar employers. 3. Assist your EAP customer to develop an action plan after completing the Scorecard.

4. Use the process for the EAP to become further integrated into the organization. 5. Repeat the process annually to examine year-by-year improvements. Opportunities for EAP Vendors to Compare Wellness Across Companies As featured in one of my past columns in JEA (Q1 2016), over 75% of EAP vendors now also sell wellness-related services. I see an opportunity for EAP vendors to begin offering a “wellness” checkup (using the HERO Scorecard) to their employer customers and use the range of scores obtained to then recognize customers with the highest scores. This benchmarking and recognition approach is already being implemented by the Capital BlueCross health plan in Pennsylvania and by Aetna health plan (as a pilot program in four states), which both offer annual workplace wellness awards to certain employers based on HERO Scorecard results. Like these innovative health plans, EAPs can also offer strategic consulting to employers who participate in wellness benchmarking. v Dr. Mark Attridge is an independent research scholar as President of Attridge Consulting, Inc., based in Minneapolis. He has created over 200 papers and conference presentations on various topics in workplace mental health, EAP, psychology, and communication. He has delivered keynote presentations at EAPA World Conferences in 2013 and 2016 and is past Chair of the EAPA Research Committee. He can be reached at: mark@attridgeconsulting.com. Jessica Grossmeier, PhD, MPH, Vice President of Research at HERO, contributed to this article. She can be reached at: jessica.grossmeier@hero-health.org.

featurearticle Aspiring to a Zero-Suicide Mindset |By Sally Spencer-Thomas

APs are an important link in the chain of survival for employees. EA professionals are often the first line of assessment for a given client and thus have the opportunity to provide critical prevention services. In addition, they can advise the HR departments of their client companies on how to implement suicide prevention initiatives in the workplace. This article will address how EAPs and their client companies can aspire to a zero-suicide mindset. Leading a Zero-Suicide Mindset When it comes to suicide prevention, bold leadership makes all the difference. EAP managers who understand this can make a big difference in the behavior of their counselors, their affiliate network providers, and the workplaces they serve. Leaders must push back on the idea that suicide is inevitable. Instead they can aspire to achieving zero suicide (Coffey, 2007). One such leader is Ed Coffey M.D., former Vice President and CEO of Behavioral Health Services, Henry Ford Health System in Michigan. In 2001, the Henry Ford Health System submitted a proposal within the Robert Wood Johnson Foundation’s “Pursuing Perfection

National Collaborative” by developing “Perfect Depression Care” to better serve their 200,000 patients (Henry Ford Health System, 2006; Coffey, 2016). Their Behavioral Health Services Division Team asked themselves,

“There is magic in aspiring to zero suicide – it ignites and provokes conversation and thinking. If we don’t have an ambitious model, we are not going to achieve it.” “How would we know when depression care was truly perfect?” In a watershed moment, a psychiatric nurse boldly raised her hand and stated, “If depression care was truly perfect, no patient would die from suicide.” It was a transformative moment for the department, and ultimately, for the world. At this time suicide prevention care at Henry Ford, like in many

places, was mostly reactive. When patients came in talking about suicide, health providers took notice but there really was no suicide specific care plan in place other than a “no-suicide contract.” Henry Ford failed to win the Robert Wood Johnson grant, but the health system went ahead with the proposed changes anyway, and their inspirational leadership has created an international movement. “Zero suicide” has become a galvanizing metric. The overall outcome of the care delivery overhaul that resulted from this paradigm shift was a dramatic and statistically significant 80% reduction in suicide, maintained for over a decade, including one year when the perfection goal of zero suicides was actually achieved (Hampton, 2010). Collaborative, patientcentered, and suicide specific care emerged. Near misses occurred when under the microscope – not for the purposes of blame, but to provide a supportive, learning culture that focused on continuous quality improvement in order to save lives. By focusing on continuous quality improvement of services, leaders can begin to see what is working and what is not. Leaders within the “zero suicide” effort learn to listen closely to the experiences of the people receiv-

ing the care and learn from their lived expertise. In the last few years three international summits (http://zerosuicide. org/) have been held to share the lessons learned. Many large healthcare systems are implementing this leadership mindset and the set of practices that accompany it and are seeing substantial change emerge. There is magic in aspiring to zero suicide – it ignites and provokes conversation and thinking. If we don’t have an ambitious model, we are not going to achieve it. While it may be true that if someone wants to die by suicide strongly enough they may find a way, EAP managers have an opportunity to implement training for both their line counselors and the companies they serve to ensure employees are not going to do it on their watch. Applying a zero-defect standard of care to suicide means that the entire organization reviews adverse outcomes related to suicide and adjusts performance accordingly. Robust performance improvement focused on the goal of zero suicides must become a central ingredient to managing EAP systems. The following are specific recommendations regarding suicide prevention that EA professionals can help implement in the workplace. Offer Suicide Prevention Training and Programming to Workplaces Throughout the year, EAPs can offer outreach programming that helps workplaces be partners in suicide prevention. One new tool EAPs can provide to help clients is to have employees

complete the new gap analysis tool by Resilience at Work (www. ResilienceAtWork.net) called, “Is Your Workplace Mentally Fit?” The site features a free, 24-point quiz that ranks an organization’s state of mental fitness. Statements include, “Mental health benefits are accessible, offered to all employees and are covered at the same level as physical health.” Participants are then asked to choose from the responses “not at all”, “partially true”, or “completely true.” Results will indicate the level of mental fitness of a client company, and thus the degree to which the EAP may be able to assist in incorporating suicide prevention training in the workplace. Oversee Peer Support Programs EAPs can also help workplaces develop and supervise peer support programs. A peer supporter acts as a trained and empathic liaison to EAPs. An example of a peer supporter would be an employee leader passionate about wellness willing to advocate for their coworkers’ mental health. Peer supporters act as trained and empathic liaisons to EAPs. They do not serve as counselors, but they can offer to accompany the employee to their first EAP session or in making the initial call to EAP. EAPs can provide guidance on the selection processes of workplace peer supporters, helping to ensure that nominated peers understand the role of the EAP. EAPs can also provide training on the need for boundaries and confidentiality. Ask the Suicide Question Effectively Most mental health professionals have not been trained in what

Dr. Shawn Shea describes as the “practical art” of asking the suicide question (Shea, 2011). Thus, many ask indirect questions in a way that communicates they really don’t want to know the truth. Instead of, “Are you thinking of harming yourself” or, “You are not suicidal, are you?” EA professionals can learn to ask direct questions that are much more likely to elicit truthful answers. Starting the conversation with observations and empathy is always a good step. For instance, “I’ve noticed (insert observed mood, behavior or life circumstance changes), and I’m concerned. Sometimes when people experience these things they think about suicide. I am wondering if you are thinking about suicide.” Using the word “suicide” is important because when clinicians use direct language they model comfort and confidence, and are more effective at opening the door to the conversation. Dr. Shea offers additional tactics: • Self-normalization: “If I was going through this I might consider…” • Behavioral incident (frame by frame): “Describe to me your worst point when you were overwhelmed, and walk me through step-by-step how your thinking changed. Tell me what happened when you experienced thoughts of suicide, even if just fleeting in nature…and then what happens…and then what…” • Shame attenuation (learned behavior for survival): “Given your past (insert specific childhood trauma or neglect), I wonder if you ever found

featurearticle it necessary to (insert judged behavior like lying, stealing, exaggerating) to…just get through.” • Gentle assumption: “What other ways have you thought of killing yourself?” • Symptom amplification: Set upper limits of quantity in question at a high level, for example, “Do you think about suicide 1,000 times a day?” • Denial of the specific: List specific means one by one, for instance, “Have you thought of killing yourself by jumping? By hanging? By firearms? Etc.” What should anyone do if they say “yes”? The first words out of the counselor’s mouth should be, “Thank you.” Expressing gratitude for the client trusting the relationship and for being courageous are important steps in reassurance. Then offer collaboration, “We will figure this out together” or, “I have some ideas that might help.” Say “No” to “No-Suicide” Contracts “No-suicide contracts” “attempt to assure that the client makes a commitment not to inflict selfinjurious behavior while in the care of the provider. Almost every mental health provider has been trained to do this when a client expresses suicidality. Yet there is no evidence that “no-suicide” contracts actually work. In fact, evidence exists that they don’t work. In one study of people who attempted suicide in an inpatient mental health facility, 65% had signed a “no-suicide contract”. A sur-

vey of psychiatrists who used “no-suicide contracts” found that 40% had a patient die or make a serious attempt after signing one (Freedenthal, 2013). Clients who receive such contracts often become mistrustful of clinicians because the contracts are seen as being more about protecting the clinician rather than serving the client. By engaging a client in a “no-suicide contract” a dynamic sometimes emerges whereby the client becomes hesitant to bring up the issue of suicidal thoughts or behaviors for fear of breaking the contract. Collaborate in Safety and Wellness Planning Instead of a “no-suicide contract,” clinicians should become familiar with structured safety and wellness planning. There are several tools that can help in this process. One is my3app (http://my3app.org/), another is SAMHSA’s Suicide Safe (https:// store.samhsa.gov/apps/suicidesafe/), and a third is the Virtual Hope Box (https://itunes.apple. com/us/app/virtual-hope-box/ id825099621?mt=8), which reminds people of their reasons for living. Each of these tools walk people through a graduated hierarchy of things they can do instead of attempting suicide, beginning with low-level self-soothing, distracting, or behavioral strategies. The next stage is reaching out to friends and family or trained peer supporters. If these efforts are not effective, individuals should seek professional or crisis support. Each of these steps is spelled out in great detail,

with names and numbers for easy access. When talking to people who are living with suicidal thoughts, many have told me their goal isn’t to be “safe” – that is the goal of the clinician – rather, their goal is to live fully-engaged lives. Once the white hot crisis of suicide has passed, working on wellness planning can help the person transition from staying safe to rebuilding his or her life. Predictive Suicide Risk Assessment is a Fallacy How good are clinicians at predicting suicide risk? Not very good, according to suicide risk researchers. Two recent studies concluded that 95 percent of socalled “high-risk patients” will not die from suicide, while roughly 50 percent of suicide deaths were among people in the lower risk categories (Murray & Devitt, 2017; Lange, et al, 2016; Chan, et al, 2016). Researchers found that multiple risk factors were no more predictive than a single risk factor. In fact, they concluded that relying on these instruments to predict risk may even be a harmful practice, as it takes the focus off of rapport building and treatment formulation. Instead of trying to predict behavior, assessments should be used to help develop treatments. Summary EA counselors need to avoid relying on out-of-date suicide risk assessment protocols, and instead be offered training in state-of-theart interventions. Together with our client companies we must aspire to “zero suicide”. v

Dr. Sally Spencer-Thomas is a clinical psychologist, inspirational international speaker, impact entrepreneur, and survivor of suicide loss. She may be reached at sallyspencerthomas@gmail.com.

References

Chan, M., Bhatt, H., Meader, N., Stockton, S., Evans, J., O’Connor, R., Kapur, N. & Kendall, T. (2016). Predicting suicide following selfharm: systematic review of risk factors and risk scales. The British Journal of Psychiatry, 209(4), 277-283. Coffey, E. (2007). Building a system of perfect depression care in behavioral health. Joint Commission Journal on Quality and Patient Safety, 33(4). Retrieved on September 17, 2017 from http:// ntap.us/wp-content/uploads/2015/01/ PerfectDepressionCarearticles.pdf.

earoundup Stress, overwork, and the isolation of being an expatriate abroad are among common causes. One company that provides mental health services to more than 40 companies in the country, said the concept was still very new to the Middle East but is necessary. Paul Firth told The National there is a bigger need for mental health services in the UAE due to the large expat population. “Here you are away from your home country and in a new environment, which is very multi-cultural. That brings a lot of great experiences but it also brings with it a lot of challenges,” said Firth, Director of Occupational Health and Corporate Wellness at Icas International. “For a lot of expats, they are here to work and they work

Coffey, E. (2016). Zero suicide as model for community transformation. Rotary Club of Madison. Retrieved on September 17, 2017 from https://youtu. be/FKbehPHmvuc. Freedenthal, S. (2013). The use of nosuicide contracts. Speaking of Suicide. Retrieved on September 17, 2017 from https://www.speakingofsuicide. com/2013/05/15/no-suicide-contracts/. Hampton, T. (2010). Depression care effort brings dramatic drop in large HMO population’s suicide rate. Journal of American Medical Association, 303(19), 1903-1905. Henry Ford Health System (2006). Pursuing perfect depression care. Psychiatric Services, 57(10).Retrieved on September 17, 2017 from http://ntap.us/ wp-content/uploads/2015/01/ PerfectDepressionCarearticles.pdf

Lange, M., Kaneson, M., Myles, N., Myles, H., Gunarantne, P. & Ryan, C. (2016). Meta-analysis of longitudinal cohort studies of suicide risk assessment among psychiatric patients: Heterogeneity in results and lack of improvement over time. PLOS ONE 11(6): e0156322. https://doi.org/10.1371/journal. pone.0156322. Murray, D. & Devitt, P. (2017) Suicide risk assessment doesn’t work. Scientific American. Retrieved on September 17, 2017 from https://www.scientificamerican.com/article/suicide-risk-assessmentdoesnt-work/. Shea, S. (2011) The Practical Art of Suicide Assessment: A Guide for Mental Health Professionals and Substance Abuse Counselors. Stoddard, NH: Mental Health Presses.

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extremely hard but we all need a release and, for a lot of people, it’s about talking to someone or accessing professional support when needed.”

Technology Providing Mental Health Help in India According to the National Mental Health Survey released in 2016, nearly 150 million Indians need mental health care services but less than 30 million are seeking care. This mirrors global trends. The World Health Organization reports that in low- and middle-income countries, 76-85% of people with mental disorders receive no treatment for their disorder.

There are a range of reasons for this, from a lack of awareness about mental illness to limited access to professional help and the cost of treatment. And yet Wysa, YourDOST, Lean On Me, and other new digital ventures in mental health are able to harness technology to leap over one of the biggest reasons people don’t seek treatment — stigma. The Economic Times reports that the anonymity and privacy these apps and websites offer goes a long way in removing the inhibitions those grappling with mental health issues might have in seeking professional help. “Yes, there is a shortage of mental health professionals in continued on page 34

earoundup India but it is not as if the ones that we have are overbooked, unlike in a country like the UK, where there is a one-year waitlist to see a psychologist,” says Jo Aggarwal, who terms Wysa a “fire extinguisher” that can fit in a user’s pocket. “The idea is that anybody can reach out and help these people. This is their first port of call,” states CR Chandrasekhar, a former professor psychiatry at NIMHANS in Bengaluru. Many people often go to “faith healers” and others before they finally turn to psychiatrists and psychologists, he adds.

Most Stressful Jobs in the UK It’s no surprise to learn that work, a place where most people spend the majority of their waking hours, is a major contributor to stress. A new report by the Health and Safety Executive revealed the most stress-inducing jobs in the U.K. The study also broke down the data and provided insights into the effects of different genders, ages, and workplace sizes on stress levels. The most stressed workers were people working in a professional capacity. The worst affected were welfare professionals, followed by nursing professionals, then legal professionals and teachers, and finally business professionals. The least stressed people worked in skilled trades, process plant and machinery jobs, manual labor, or jobs that require the basic use of handheld tools.

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The researchers also found that around 1,610 per 100,000 workers in the UK experienced a case of work-related stress, depression, or anxiety in the past year, a figure which has risen very slightly in recent years. Stress and anxiety also accounted for nearly half of all sick days taken. In the UK, that’s about 12.5 million working days. Most stress and anxiety was caused by workload, although lack of support, uncertainty, and bullying were big contributors, too.

US Promoting Opioid Alternatives The U.S. Food and Drug Administration (FDA) plans to encourage opioid addicts to use less harmful opioid drugs such as methadone and buprenorphine, a radical shift in policy that could agitate those in the addiction field who believe abstinence is the only effective treatment. The news agency Reuters reports that FDA Commissioner Scott Gottlieb outlined a proposal under which every addict who suffers a non-fatal overdose would be treated with an opioid substitute, for long periods if necessary, or even for life. The United States is battling a growing opioid abuse epidemic that claimed more than 33,000 people in 2015, more than any year on record, according to federal data. Drugs such as methadone and buprenorphine reduce pain in the same way that opioids do, but without delivering the “high” that leads to addiction. They are used

to help addicts taper off opioids, but insurers are not always willing to pay for the treatment. Gottlieb cited data from the Commonwealth of Massachusetts, which found a greater than 50 percent reduction in the risk of death from overdose among those treated with methadone or buprenorphine after an overdose. This kind of data “has immense implications for insurers and policymakers in deciding how to adopt these treatments,” he said. The FDA also plans to examine expanding the labels for existing medication-assisted treatment for everyone who presents with an overdose, based on data showing a reduction in deaths. v

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