Journal of Employee Assistance 1st Quarter 2020, vol. 50 no. 1 by Employee Assistance Professionals Association

1st Quarter 2020 | VOL. 50 NO. 1

The magazine of the Employee Assistance Professionals Association

A Next-Gen EAP for Todayâ&#x20AC;&#x2122;s Workforce

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Bonus! Read Cover Story for PDH! See page 4.

PLUS:

DIY Genetic Testing

Financial Stress

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Proactive Stress Management Page 22

Save the Date! EAPA 2020 Houston Hilton Americas Houston, Texas USA

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Tuesday, October 27 â&#x20AC;&#x201C; Thursday, October 29

Pre-Conference October 25-26 | EXPO Dates Ocober 26-28

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contents EAPA Mission Statement

1ST Quarter 2020 | VOL. 50 NO. 1

cover story

A Next-Gen EAP for Today’s Workforce

| By Susan Skinner, MS, CEAP Next-Gen EAP focuses on proactive and continuous engagement. It leverages technology to extend EAP expertise and support to workforces around the globe, while it also guides individuals to connect directly with a trained professional to resolve personal challenges.

features

DIY Genetic Testing: Opportunity for EAPs

| By Tamara Cagney Imagine opening your test results and reading that you have an increased risk for dementia, cancer, or heart disease. Scant support is available in these areas – meaning there are opportunities for EAPs to fill this knowledge gap.

Financial Stress: The Workplace Epidemic of the 21st Century

features

Proactive Stress Management for EAP Clients

| By James Porter Following Dr. Everly’s lead, I developed a six-step stress prevention model – that can be used in the workplace – to help EA professionals teach employees how to manage stress proactively.

Applying the MSRA Approach to Mass Shooting Incidents

| By Robert Intveld, LCSW, CEAP

EAP response to mass shootings and/ or acts of terrorism are no longer unusual requests. MSRA recognizes the interconnectedness of the systems involved in recovery from critical incidents and their contribution in fostering a resilient outcome.

departments 4 FRONT DESK 5 WEB WATCH

6 TECH TRENDS

| By Cindy Sheriff, MA, CEAP EAPs are in a unique position to work with HR to address the epidemic of employees dealing with financial stress. Financial solutions begin with knowledge.

8 LEGAL LINES 26, 27, EA ROUNDUP 32, 33, 35

To promote the highest standards of practice and the continuing development of employee assistance professionals and programs. 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 Larnita Day at development@eapassn.org. The JEA is published only in digital format since 1st Quarter 2019. Send requests for reprints of issues published BEFORE 2019 to Debbie Mori at d.mori@eapassn.org. ©2020 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: Larnita Day Designer: Laura J. Miller, Write it Right LLC

Index of Advertisers EAPA Plan to Attend.........................IFC EAPA Best Value Package................BC Harting EAP..........................................5 KGA, Inc.............................................17 SAPlist.com .................................11, 23 IFC: Inside Front Cover BC: Back Cover

frontdesk Taking on Change in the Pursuit of Greatness | By Maria Lund, LEAP, CEAP

hange does not come easily for most of us. But change we must, not only as individual practitioners but also as a profession. Flipping the challenge of change on its head, we can look at the gain we hope to achieve from doing the work of change. As EA practitioners, this gain is not just for us, but also for our customers and clients as well. In an important and insightful cover story, Susan Skinner explains how we can use change to our advantage to make our EA services less reactive and more proactive. Susan explains the core principles of next-gen EAP, which include, but certainly are not limited to how, “a greater range of access options lowers barriers to effective utilization.” For those who run or promote EAPs, this is a great read. A reminder that by �� reading the cover story and answering a 5-item multiple choice quiz at https://tinyurl.com/quiz0120. EA professionals can earn one free PDH. Interest in DIY (do-it-yourself) genetic testing is growing, and it is providing an increasing service opportunity for EAPs. Tamara Cagney explains how EA professionals can help with the emotional aftermath many employees experience after learning more

(perhaps more than they wanted to know) about their origins.

“restoring safety and fostering resilience” in the workplace.

Elsewhere in this issue, stress management is another important theme. When employees are stressed financially, their physical and emotional health, and productivity are negatively affected. The EAP is uniquely positioned to help, but utilization of financial services is “usually anemic”. CEAP Cindy Sheriff outlines a blueprint for reversing this trend.

Legal Lines columnist Robin Sheridan presents important guidance in responding to subpoena requests. Finally, guest Tech Trends columnist Diana Wicker offers vital tips toward ensuring cybersecurity for your EA practice.

Whether triggered by personal finance problems or other life issues, managing stress is a need most of us have as we seek to keep pace with daily demands and constant change. James Porter walks readers through his six-step prevention model, steps that “can be applied to a whole host of stressful situations from dealing with a difficult boss, co-worker or client to managing a grueling commute or a growling customer.” An unfortunate change in our world is that mass shootings have become all too frequent occurrences. The impact of these events spreads across employees, employers and the public. As a variation on traditional Critical Incident Response (CIR) methods, Robert Intveld describes how the Multi-Systemic Resilience Approach (MSRA) better meets the need for a more widespread, interconnected approach for

As always, happy reading! v

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

Mark Attridge – Minneapolis, MN mark@attridgeconsulting.com

Nancy R. Board – Blooming Grove, NY nancy.board@gw4w.org

Daniel Boissonneault – Hamden, CT eap700@comcast.net

Tamara Cagney – Discovery Bay, CA tcagney@sandia.gov

Andrea Lardani – Buenos Aires, ARG andreal@grupowellnesslatina.com

Peizhong Li – Beijing, China lipeizhong@eapchina.net

John Maynard – Boulder, CO johnbmaynard8@gmail.com

Bernie McCann – Waltham, MA mccannbag@gmail.com

Radhi Vandayar – Johannesburg, South Africa radhi@hlconsulting.co.za

webwatch Disability Inclusion Job Accommodation Network https://askjan.org Do you have questions about the Americans with Disabilities Act? Job Accommodation Network (JAN) is a leading resource on the ADA, including a comprehensive list of various disabilities and suggestions for workplace accommodations, which the EAP can help devise.

Mental Health Fresh Hope https://freshhope.us Fresh Hope is based upon six tenets/principles seen as a foundation for living well in spite of a mental health diagnosis. The tenets/principles are for both the person who has a diagnosis as well as for the loved ones of those who have a diagnosis. Mental Health Suicide Rate by Country 2019 http://worldpopulationreview.com/countries/suiciderate-by-country/ Suicide occurs throughout the world, affecting individuals of all nations, cultures, religions, genders, and classes. In what countries are suicide rates the highest? Lowest? This site offers a comprehensive list and useful data.

Employee Benefits Employee Benefit Adviser www.employeebenefitadviser.com This site features workplace benefit news for advisers, brokers, and consultants, as well as tools for business growth and development. Financial Resources CareConnect USA https://careconnectusa.org/ Established in 2005, the North Carolina-based firm publishes reputable helplines for financially stressed employees and their families. The vetting process of service providers is extensive and ongoing.

Sexual Assault National Sexual Violence Resource Center https://www.nsvrc.org The NSVRC believes in the power of information, tools, and people. Links include e-learning, library, projects and more. v

Human Resources Human Resource Executive http://hrexecutive.com/leading-the-pack/ Human Resource Executive® recently released what they consider to be the best HR and trainings introduced to the market during the past 12 months. The awards spotlight innovative new solutions that are helping business leaders meet the HR needs of their organizations. The winners also illustrate the increasing prominence of artificial intelligence in emerging HR technologies.

Is Excited to Release

Mental Health Family Guide to Mental Illness and the Law https://pitt.co1.qualtrics.com/jfe/form/ SV_3fsw6FhODHyA29L A new online self-assessment can help people identify their most comfortable supportive role when interacting with someone with a mental illness. The self-assessment tool presents five scenarios and, for each scenario, asks users to check the response that best matches the way they are inclined to respond. This tool does not collect any identifying information and is located on a secure server at the University of Pittsburgh.

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techtrends Cybersecurity for EA Professionals and Small EAPs | By Diana Wicker, MSW

ou can learn about and implement cybersecurity even as a solo EA professional or if you work for a small EAP. The first step is to simply read. The US Federal government is diligently pushing to update regulations and create guidelines and frameworks that are easily accessible and understandable so everyone can comply. A great place to start is https://www.itgovernance usa.com/federal-cybersecurity-and-privacy-laws.

ties in 2006. They apply to electronic protected health information (ePHI) – computer, tablet, smart phone, internet, cloud services, etc.  HITECH Act – Rolled in with the American Recovery and Reinvestment Act of 2009, these regulations added on to HIPAA privacy and security regulations providing the Breach Notification Rule, Electronic Health Record regulations, and Accounting of Disclosures for TPO (treatment, payment, health care operations).  NIST Cybersecurity Framework – First released in 2014, the current edition was updated in 2018 providing a self-assessment for businesses to assist in preventing, detecting, and responding to cyberattacks.

Step 2: Watch Let’s say you’ve done the reading and some of it is still over your head. Look for videos to understand how these frameworks are intended to be used. Many government agencies are holding webinars and releasing how-to video tutorials. A great place to start is:  Privacy, Security & HIPAA: https://www.healthit. gov/topic/privacy-security-and-hipaa.  Risk Management Framework: https://csrc.nist. gov/projects/risk-management/risk-managementframework-(RMF)-Overview  Cybersecurity Framework: https://www.nist.gov/ cyberframework

Step 5: Vendors When in doubt, hire out. IT consulting firms abound. Seek one familiar with HIPAA, HITECH and the most up-to-date guidelines and frameworks. They will review your office setup and help ensure that everything is set up properly. LinkedIn has a helpful resource for finding professionals by specialty: https://www.linkedin.com/profinder/information-security-consulting Easy things you can do with the equipment you have:

Step 3: Attend Cybersecurity is hands on. Not everyone has experience updating settings on computers, smart phones, tablets and other electronic equipment. Many local technical schools, colleges and universities hold continuing education classes in computer skills.

1. Modem/Router – How the Internet Gets to You  Update the name of the device to something unique.  Change the device’s default password to something unique.  Update the firmware on your wireless router to apply the latest security patches. (Firmware is preinstalled software on a device and controlled by the manufacturer. Security updates repair errors in the programming that are often at risk from hackers.)  Turn off unnecessary ports and services (such as FTP servers) that are not routinely used. (FTP servers or online services are a way to quickly and easily

Step 4. Do Download and use SRA Tool 3.1. https://www. healthit.gov/topic/privacy-security-and-hipaa/security-risk-assessment-tool This is a free resource from the federal government to help you track:  HIPAA Security Rule – These regulations were finalized in 2003 and applied to most covered enti6

transfer files from one place to another, such as loading documents for display on a website. FTP was not designed to be a secure service and can be open to attack. If you use one, be certain encryption and security protocols are in use.)  Encryption on your router [WPA2-PSK (AES) or WPA3 (SAE)] are the safest standards. (Wi-Fi Protected Access security standard was released in 2003. Pre-Shared Key personal/home/small network authentication mode originated in 1997. Advanced Encryption Standard implemented in 2001. Simultaneous Authentication of Equals standard implemented in 2018.)

you need a Business Associate Agreement (BAA) with the vendor. 4. The Cloud – 3rd Party Services and Vendors This is software that lives on the internet that you log into – Get a BAA if it can access PHI. (BAAs are an original requirement of HIPAA since 2002.) The BAA is a written agreement defining the party’s responsibilities concerning PHI. 5. The Internet of Things – Smart Toys Does it listen? Does it record? Does it respond? If so, it is NOT HIPAA compliant. Turn these devices OFF in your clinical areas! (This applies to any device in your home or office that connects to internet via Wi-Fi, Bluetooth, 3G, 4G, or other service. Examples of devices that apply: smart cars, thermostats, doorbells, locks, appliances, televisions, gaming systems, speakers, watches)

2. Machine – How You Do Your Work • Encrypt your machines (i.e. computer, laptop, tablet, smart phone) with a password. • Set a password or PIN for the operating system. • Turn on anti-virus protection. • Turn on security updates. • Do not set programs, apps or websites to autofill passwords to login. Use a password keeper app instead.

Summary Oh, and heads up. Just in case you missed the announcement – The FAX machine is dead. The Centers for Medicare & Medicaid have decreed that in 2020 the FAX can no longer be used for health care information. Businesses would be wise to follow the government’s lead. Look for a HIPAA compliant cloud fax/email service. v

3. Software – Where Your Data Lives  Set a password or PIN on all software that might contain personal health information (PHI). (Think of PHI as information that lives in your wallet. If it is something you would carry in your wallet, it is probably PHI.) Here is the official regulated list of 18 PHI Identifiers: https://en.wikipedia.org/wiki/Protected_ health_information)

Diana Wicker is the Director of Compliance and Reporting for First Sun EAP, an employee assistance program based in South Carolina. She has 25 years of experience in social work and the EAP industry. Diana has a master’s degree in social work and started working with regulatory compliance in college, observing residential care inspections completed at a Department of Social Services emergency residential child care facility, Department of Disabilities Community Training Home, Department of Veteran’s Affairs Community Care Home, and a Joint Commissions Hospital Inspection.

 Encrypt your data at rest and in transmission. This means email, too.  Know how your software interacts– Be mindful of integrated apps and what they can access. (For example, Microsoft Outlook has a button in the right corner of the ribbon “get add-ins.”) This tab opens the Microsoft Online store to show you apps that complement/work together with Outlook. As convenient, and tempting, as it is to tie all programs you work with together to quickly and easily share information, be mindful of what programs may have PHI – such as an email message – and what programs might “butt heads” as it were. If another program can interact with PHI,

Diana has written policy and procedure manuals for Hospital Social Work department, including the Quality Assurance program, based upon the Joint Commissions regulations. Diana maintains the compliance manuals and staff trainings for First Sun EAP, focusing on both federal and state requirements for confidentiality, privacy, security, and health care. Contact Diana at diana.wicker@firstsuneap.com. Editor’s note: Diana is filling in this quarter for EAPA Director of Communications Marina London. Marina will return in the 2nd quarter JEA.

legallines You’ve Been Served with a Subpoena… Now What? | By Robin Sheridan, JD, MILR

egardless of whether it asks for the production of documents or for testimony, anyone served with a subpoena should always contact counsel. There are often specific rules that will affect the response depending on the subject matter (whether it is a criminal or civil proceeding) or the jurisdiction (state courts have different rules about disclosure of certain protected information). This article will discuss some general parameters so you know what to expect, and so you can ask the right questions when you receive a subpoena.

requesting the production of documents or testimony—issued in the course of a judicial or administrative proceeding. This is so long as one of the following is true: • A valid patient authorization accompanies the subpoena; • An order of the court or administrative tribunal accompanies the subpoena; or • The EAP or EAP vendor must have received satisfactory assurances from the party seeking the information that reasonable efforts have been made by such party to either give the subject individual notice of the request or secure a qualified protective order.

HIPAA The first step is to understand whether you are subject to HIPAA. The federal Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) protects the confidentiality and security of protected health information (“PHI”). Employee Assistance Plans (“EAPs”) that are covered entities and the EAP vendors that act as their business associates are subject to HIPAA. Not all EAPs will qualify as covered entities, and consequently, the vendors they work with will not qualify as business associates. EAPs that themselves provide medical care, e.g. are staffed by licensed health care providers who assist employees with health issues, generally qualify as covered entity health plans subject to HIPAA. However, EAPs that only provide referral services based on publicly available information generally are not considered to be providing medical care, are not health plans as defined by HIPAA, and therefore are not subject to HIPAA’s requirements. That said, even if HIPAA is not applicable to an EAP, the EAP is still subject to the requirements of other state and federal laws.

Satisfactory Assurances While the first two conditions listed above are easily ascertainable, the third one often presents challenges. Satisfactory assurances that the subject has been provided notice of the subpoena relating to his or her EAP records requires that the requestor provide a written statement and accompanying documentation showing that the requestor made a good faith attempt to provide written notice to the individual at the individual’s known or last known address. The notice must include sufficient information about the litigation or proceeding in which the PHI is requested to permit the individual to raise an objection to the court or administrative tribunal. Before producing any records or providing any testimony, the time for the individual to raise objections must have elapsed either without any objections or the resolution of all objections, and the disclosures must be consistent with such resolution. A qualified protective order, with respect to PHI, means an order of the court or administrative

Protected Health Information (PHI) HIPAA allows a covered entity to disclose PHI necessary to respond to a valid subpoena—whether 8

tribunal, or a stipulation by the parties to the proceeding, that prohibits the parties from using or disclosing the PHI for any purpose outside the proceeding and that requires the return or destruction of the PHI (including all copies) at the end of the proceeding. Satisfactory assurances with respect to a protective order requires that the requestor provide a written statement and accompanying documentation showing that a qualified protective order is in place, or the party seeking the PHI has requested a qualified protective order from the court or tribunal. If the requestor does not provide such satisfactory assurances, then the EAP or its vendor may refuse to disclose the requested PHI or, before providing any responsive PHI, it must itself make reasonable efforts to provide adequate notice to the individual or to seek a sufficient qualified protective order.

Finally, state and federal jurisdictions have rules of civil procedure that govern both the issuance of and response to subpoenas. Generally, these rules will be the same whether the subpoena is issued on behalf of the client, another interested party or an investigative body. Such procedural rules may afford additional protections for confidential patient information that the EAP must follow. All EAPs should have policies and procedures in place to identify applicable laws and ensure compliance. Because the time for responding to subpoenas is often limited, it is a good idea to also identify in advance competent counsel to contact as soon as a subpoena is received. Practical Takeaways  If a subpoena is requesting particularly sensitive information, or if you believe there may be another law that restricts your ability to respond to the subpoena, counsel can assist with a preemption analysis, guide your response and assist in filing a motion to quash the subpoena, if necessary.

Special Notice Please note: HIPAA only sets the floor when it comes to security and confidentiality protections for PHI. If there is a more stringent state or federal law, meaning that the law offers PHI greater protection or offers the individual to whom the PHI pertains greater rights, that state or federal law will take precedence. For example, some states do not permit the disclosure of medical records in response to a subpoena and instead require a signed patient authorization or a court order. In those states, a subpoena is insufficient to authorize PHI disclosure regardless of whether the process outlined in HIPAA is followed. Additionally, there are often more stringent laws providing greater protection for particularly sensitive health information, such as information pertaining to minors, genetic testing results, HIV/AIDs or other STD records, behavioral and mental health records and records relating to alcohol, drug or other substance use disorders (“SUDs”). For instance, federal regulations governing the disclosure of substance use disorder records require a signed patient authorization or court order for disclosure of such information and require the court to follow a particular process in issuing such an order. Those regulations additionally prevent any use of SUD records in certain types of proceedings for certain reasons. For EAPs that are not subject to HIPAA, these more stringent state and federal laws may still apply.

 Where a subpoena is requiring the appearance and testimony of a witness, the individual subpoenaed should still appear at the place, date, and time on the subpoena even if counsel will be arguing that the subpoena is invalid and that the witness is prevented from testifying under applicable law.  When responding to a subpoena, the EAP or testifying personnel should ensure that only that information necessary to respond to the subpoena is provided, such as only providing information regarding the requested individual, the identified dates of service, and the identified health issues.  If the EAP or provider feels that it is not in the best interest of the subject individual to disclose the information, the EAP should collaborate with counsel in making that argument to the appropriate court or administrative tribunal. v Editor’s note: The recommendations provided in this article are for educational purposes only and are not to be construed as actual legal advice. Always consult with a local attorney. Robin M. Sheridan is an attorney with Hall, Render, Killian, Heath & Lyman, PC, the largest health care-focused law firm in the U.S. Contact Robin at (414) 721-0469, rsheridan@hallrender.com.

featurearticle DIY Genetic Testing: Opportunity for EAPs | By Tamara Cagney

Will I Develop Cancer? “When I got engaged my fiancé and I decided to take an at-home genetics test from 23andMe, just to find out if we had any health risks we should know about. My mom had Alzheimer’s, which particularly concerned me. When my risk came back at 12.5 percent I had no idea what that meant for my future”.

n employee leaves a message on the EAP line: “I just found out I have a sister!” Another employee comes in for the first session and exclaims: “My Dad is not my Dad, I’m not Italian and I have 3 brothers.” An employee who knows he was adopted sends in a spit sample to learn about his ethnicity and discovers he has a full sister. “She was at MIT 5 years after I was.” “I thought it’d be fun to learn a little about my genetic ethnicity, to trace how all the pieces came together.” But she ended up getting far more than she bargained for. When she went on the AncestryDNA site to view her DNA matches, there were no connections between her and her father.

Discovering family secrets is jarring but another area of concern is the medical information you can discover regarding risk of inherited diseases or conditions. Imagine opening your results late at night on your computer and reading that you have an increased risk for dementia, cancer, or heart disease. There is scant support offered in these areas. What does this mean? Is it certain? While a direct-to-consumer genetic test can estimate your risk, it cannot tell you for certain whether you will or will not develop certain forms of cancer, Alzheimer disease, or other conditions. Many other factors, including gender, age, diet and exercise, ethnic background, a history of previous cancer, hormonal and reproductive factors, and family history also contribute to a person’s overall risk of disease. These factors would be discussed during a consultation with a doctor or genetic counselor, but in many cases they are not addressed when using at-home genetic tests. Employees may make important decisions about disease treatment or prevention based on inaccurate, incomplete, or misunderstood information from their test results. Patient advocacy groups strongly recommend that people considering using DIY genetic testing for Alzheimer disease, cancer or other conditions talk with a genetic counselor about the reasons they want to undergo testing and how they would cope with the results.

Recreational Genetics Business has never been better for what’s often called “recreational genetics,” and that includes opportunities for EAPs. More on that later in this article. Traditionally, public records including birth and marriage certificates, census statements, interviews and immigration data were the main sources of information for making ancestral links. But today Ancestry, 23andMe, MyHeritage, and smaller competitors have analyzed the genes of more than 26 million people worldwide, according to a study published by the MIT Technology Review. People pay around $100, spit into a vial and ship it off to a company that then adds their DNA to vast and ever-expanding databases. According to a Pew Research Center survey, roughly one-in-seven U.S. adults (15%) say they have used a mail-in DNA testing service from a company such as Ancestry. Most of them say they did so to learn more about their family origins, and a notable share (about four-in-ten) are surprised by what countries or continents their ancestors came from. Roughly a quarter (27%) of those people have used mail-in DNA testing learn about close relatives they didn’t know about previously.

It’s Harder to Keep Secrets We dance round in a ring and suppose, but the secret sits in the middle and knows.” - Robert Frost. 10

Sending in DNA samples can abruptly reveal long-kept family secrets ― affairs, donors, adoptions, long-lost siblings or entire new branches of a family. Both 23andMe and AncestryDNA have warnings about uncovering unanticipated information about family in their terms of service. One of the biggest benefits of athome DNA testing—its speed and ease—can also cause emotional whiplash. Forget painstakingly combing through documents. New relatives can appear with the click of a mouse. Opportunities for EAPs It does not take much imagination for an EA professional to figure out what an impact this will have at work. A flood of personal phone calls? A struggle with depression and loss of identity? Negative emotions, such as fear, anger, stress, hostility, sadness, and guilt? Are employees spending more time thinking about who to confront or how to reach out rather than focusing on their work? This type of disruption can interfere with productivity and performance, impact physical and emotional health, and affect relationships at work and home life. The popularity of DIY genetic testing offers several opportunities for EAPs:  Offering proactive education. Educating leadership and employees about the popularity and impact of “recreational” genetic testing will require EA professionals to be proactive. Some organizations are even starting to offer genetic testing as an employee benefit. Levi Strauss & Company intro-

duced genetic testing as a benefit for employees at its San Francisco headquarters last fall: free genetic screening to assess their hereditary risks for certain cancers and high cholesterol. Of the 1,100 eligible Levi’s employees, more than half took the genetic tests. Instacart, Nvidia, OpenTable, Salesforce, SAP, Slack, Stripe and Snap, General Electric Appliances and Visa have also offered the screenings as an employee benefit.  Explaining risks and benefits of testing. Whether your company offers testing as a benefit, or individual employees are exploring on their own, there is agreement among the experts that education on the pros and cons of testing should be provided to employees. Employers should be encouraged to offer consumer information to employees in this rapidly growing area. As noted earlier, it doesn’t require a lot of imagination for an EA professional to see how detrimental genetic testing might be on an employee’s mind in terms of stress, presenteeism, and other factors. Presenteeism alone is a good reason for a skeptical employer to consider having the EAP present educational trainings on this topic. EA professionals can reach out to find knowledgeable experts to provide proactive Brown Bag sessions on risks and benefits of DIY genetic testing.

personnel. EAPs also have an important role to provide counseling when buried family secrets are revealed. EA professionals should encourage discussions about what people are looking for, what they will do with surprising information, and how this seemingly recreational testing may impact them and their families. The following three sections illustrate examples: 1. Not Just Adoptees Historically, birth mothers were counseled to ‘put it in the past, forget about it, and get on with your life’ and encouraged to believe that they are “giving their child a better life and it is best not to disrupt that life.”

 Providing consultation. EAPs are also ideally positioned to provide initial consultation to those considering testing and encouraging that all medical results be reviewed with medical 11

featurearticle In recent decades, professional advice to parents putting a child up for adoption has changed, and adoptive parents are now more likely to opt for open adoptions from the beginning and to be empowered to contact their biological children. For many people who know they were adopted or conceived with assistance from donor sperm or eggs, gene testing finally gives them the information they need that was previously in sealed adoption records. They now have a way to search for biological siblings and parents without a paper trail from an adoption agency or fertility clinic. Today they can opt into large online databases like 23andMe and Ancestry.com and find biological relatives who have also had genetic tests. Even if parents desire secrecy, the advent of home tests has made that a risky proposition.

when the story of their life is rewritten. Genetic testing results can shake some individuals’ foundations. 3. The Surprise Affects Everyone “My sisters were freaking out. They didn’t want me to say anything,” an EAP client says. “They said to keep it a secret. Why do you need to know? Why open the door? Why open the can of worms?” There are people who have walked this path like Catherine St Clair, who discovered through Ancestry. com that her biological father wasn’t the same person who raised her. St Clair founded an online support group and has a mantra for these situations. “I’m sorry,” she says, “I’m not a cause of the problem. I’m the result of it.” Still, she is sympathetic to the upheaval these revelations can cause. “You have to try to put yourself in the shoes of this person who’s about to be blindsided. There’s an adult out there that is their child that they never knew about. Maybe they had an affair at the beginning of their marriage and they changed their ways ... this is going to cause a major tear in their family. It could. We always try to prepare for the worst.” But the fallout from discovering that your genetic identity isn’t what you expected isn’t just an internal struggle. Friends and family can be less than supportive. DNA results don’t just reveal unexpected dads. There are many people who’ve discovered so-called “secret siblings,” proof of their father’s (and sometimes mother’s) infidelities. The choice of whether or not to reach out to these half-brothers and sisters is always a difficult one as reactions are never predictable.

2. The Search for Self “I looked in the mirror, and I didn’t know who I was anymore,” she says. “Every Hispanic person I saw on the street, I thought, ‘Are you my cousin?’ ” “In a few short months, I went through a complete identity shift, lost my connection with my heritage, gained a brother and was looking up pictures of my biological father.” Half a century into her life, a client’s familial and cultural identity can change in an instant. For many people not expecting to find any surprises in their DNA, the experience of mailing off a sample and discovering that their family is not as they thought it was can be profoundly disorienting—even life-changing There’s an Ancestry ad where a man trades in his lederhosen for a kilt. And another where a woman traces her ancestry to the matriarchal Akan people of Ghana to conclude, “When I found you in my DNA, I learned where my strength comes from.” And yet another where a man bonds with his Irish neighbor after finding out his own DNA is 15 percent Irish. But losing your cultural identity can be traumatic. Cultural identity is the identity or feeling of belonging to a group. It is established on the core values shared by a group – values that include language, style of dress, their way of talking, habits and many others. Counselors recognize that it is important for people to feel a sense of national identity and to be able to identify with and belong to social or ethnic groups. It’s difficult to predict how someone will react

Suggestions for EA Professionals  Remind employees there can be a reason why something is secret. Family secrets are as old as families. The reasons for keeping them haven’t changed much. To cover up a lie. To protect someone. To avoid social stigma. These secrets otherwise would have—or even did—go to the grave. The generation whose 50-year-old secrets are now being unearthed could not have imagined a world of mail-in DNA kits. DNA tests have unearthed affairs, secret pregnancies; quietly buried incidents of rape and incest, and even fertility doctors using their own sperm to inseminate patients. 12

selors who specialize in adoption, which does have some overlap with assisted-reproduction families, are the most familiar with some of the issues. But donor conception has unique issues as does uncovering longburied family secrets. Other suggested resources include:

 Encourage employees to see a counselor first. While EAPs don’t often get the chance to offer guidance before the employee receives surprising news, it is helpful to suggest that everyone considering sending away for a 23andMe kit, or using a company benefit for genetic testing, should see a counselor like an EA professional – who can recommend taking time to think about the potential fallout and what the results may mean. Anyone who submits their DNA to these websites is opening themselves up to surprising and discomforting revelations.

• Genetic Literacy Project: Knowledge Without Context: Why Consumer Genetic Tests Can Spark Needless Fears, Behavioral Changes • Yale Medicine: Is an At-Home DNA Test an Ideal Gift, Really? • Your DNA Is Not Your Culture, https://www. theatlantic.com/science/archive/2018/09/yourdna-is-not-your-culture/571150/, Sarah Zhang, September 25, 2018

 Ask employees to address key questions about testing. As the Centers for Disease Control and Prevention puts it: Think before you spit. • Start with, “What am I looking for?” • Consider what genetics mean to your identity and think about your goals in exploring your DNA history. • What role should DNA play in your sense of self or identity? • Where do your rights to learn these secrets end and the rights of others to keep them begin? • Does the right to know the truth about one’s lineage supersede the rights of those who seek to conceal the truth? • What constitutes a family? • Do you have family members you trust to talk to about anything you might uncover?

… While recognizing there are online forums One result of uncovering family secrets with the development of gene testing is the online communities that have sprung up around adoptees and donor-conceived people. There are closed groups on Facebook as well as websites and wikis: We Are Donor Conceived, DNA for the Donor Conceived, the Donor Sibling Registry, DNA Detectives and DNAadoption. com, to name a few. Individuals have become activists in this arena. Catherine St Clair started a group on Facebook called DNA NPE Friends, where NPE refers to “not parent expected.” (NPE comes from the genetic genealogy term “nonpaternity event,” which St Clair and others have refashioned to include both parents; another increasingly common term is “misattributed parentage.”) “People don’t get that it really is a significant trauma,” says St Clair, “You feel completely alone and isolated. It’s like having an infection that’s deep under your skin that keeps festering and it’s painful and it’s getting worse and worse. Only after it’s exposed to air can it start to heal.” v

 Warn employees about stress and anxiety risks of testing. Direct-to-consumer genetic testing for Alzheimer disease or cancer risk can be stressful and anxiety-producing. Health organizations and patient advocacy groups strongly recommend that people considering genetic testing for gene variations, including those included in direct-to-consumer genetic tests, talk with a medical genetic counselor about the reasons they want to undergo testing and what the results could mean for their health.

Dr. Tamara Cagney is the immediate past president of EAPA. She has provided Employee Assistance Program (EAP) services for over 40 years in both the public and private sectors, in unionized and non-unionized settings. Tamara is the chief trainer for EAPA’s two-day trainings for DOT substance abuse professionals (SAPs) focused on assessment, level of care, and follow-up testing determinations and return-to-work issues for DOT-regulated employees. For additional resources about DIY genetic testing or other information, contact Tamara at tcagney@sandia.gov.

 Tell employees that resources can be scarce …Unfortunately there aren’t many psychological resources available for people who stumble across family secrets with DNA testing—or even for those who want to use the tests to shine a light on complicated family matters they already know about. Perhaps coun13

coverstory A Next-Gen EAP for Today’s Workforce | By Susan Skinner, MS, CEAP

rganizations are made up of people – executives who make the big decisions and staff at all levels who come to their worksite or work remotely to get the job done. One day, many of these same jobs may be replaced by machines that don’t break down – emotionally, at least – but until then, effectively managing people is what makes all organizations tick. The Employee Assistance Program (EAP) industry grew out of a central idea: When an employee at any level of the organization comes to work compromised or impaired (e.g., addiction, anxiety, depression), personal and organizational performance suffers. Over the years, EAPs have expanded their reach and range of services to address the increasing complexity of modern life. People can’t conveniently compartmentalize their lives. The emotional drain of experiencing childcare and eldercare issues, problems with family and relationships, legal or financial worries impact employees at home and at work.

lem exists in the EAP industry: the emphasis on driving fees lower and lower has led many of the nation’s EAPs to purposefully limit meaningful interaction with the same “at-risk” employees with the same employees they are contracted to help. Components of a Next-Gen EAP How does a next-gen EAP differ from a typical employee assistance program? • Focuses on proactive and continuous engagement versus only at “point of need”; • Leverages technology to extend EAP expertise and support to a global workforce; • Utilizes that same technology to reduce employee hesitancy to connect with trained professionals to resolve personal challenges; • Offers a comprehensive set of user-driver programs and tools for a range of conditions, behaviors, and life events; and • Consistently delivers superior outcomes to more employees at all levels of the organization.

Blurred Lines between Work and Life Today, the business landscape is shifting, with blurred lines between work and life, global competition, rapid market and technology changes, rise of the gig economy, and increased workforce mobility. Just as news comes in ever-shorter cycles, employers and employees alike operate in a state of constant flux. These broad environmental dynamics are occurring alongside a parallel set of personal challenges and major life events (e.g., having a baby, getting a promotion, relocating), all with their associated daily demands. One of the most essential functions of an EAP is to provide confidential support services – on demand, when and where employees need them – as well as tools to help keep employees present-minded, focused, prepared, and resilient. While the challenges have never been greater, the reality is that a widespread but little recognized prob-

Structural Problems While healthcare costs continue to rise, market rates for full-service EAPs have dramatically fallen more than 40% since 1990, forcing many vendors to cut corners and deliver less (Sharar, 2019). Many purchasers have grown content to pay as little for the service as possible in order to have it, and many EAP vendors have been willing to do so. In order to make their business models work, these EAP vendors have managed to convince purchasers that nebulously defined “utilization” ought to be the overriding metric of success. The emphasis on utilization rather than on outcomes is easy to “game.” Since there is no industry-standard definition, EAP vendors are free to define utilization to their advantage – where a website visit, administrative telephone inquiry 14

or downloaded help-sheet counts toward “utilization.” Many EAP vendors define utilization using this inflated approach that is silent on the most important metric, certainly from a clinical and financial standpoint: outcomes. Indeed, isolated from view and lacking true valid comparative measures of effectiveness, most EAPs operate without measuring – let alone improving – their outcomes. Instead of results, many EAP vendors have focused on low price and low-cost features, leading to an environment where marginal vendors are able to “compete” with optimal ones. While companies continue to engage these low-cost, low-impact EAPs, they ultimately do so at great expense, as “at risk” and underperforming employees are not adequately engaged, assessed, or treated. As a result, employers get less for their shrinking benefit dollar, often in areas where their needs and the potential returns are the highest. Benefit consultants are missing strategic opportunities to improve workforce well-being and contain medical plan claims. Everyone loses over what are essentially pennies on the benefit dollar.

A bare-bones EAP that discourages and limits interaction with credentialed counselors results in employers spending money on services that do not adequately address the needs of their employees and their families who are grappling with major issues (e.g., depression, loneliness, anxiety, substance abuse) and life circumstances (e.g., marital conflict, financial woes, stress). A Changing Landscape When job candidates are screened, employers look at their work histories, educational attainment, skill sets, and culture fit. They typically know nothing about their candidates’ mental health issues, family history of suicide, recent losses or personal difficulties – all common risk factors that can impair job performance, productivity, and morale. The scope and severity of personal problems that employees bring to the workplace are the manifestation of several alarming societal trends, in particular the increasing prevalence of suicidal behavior and widespread cross-generational loneliness and isolation.

coverstory According to a report by the Centers for Disease Control and Prevention, 47,000 Americans died by suicide in 2017, up 33% from 1999 (Heldegaard, Curtin, Warner, 2018). Researchers have found that the majority of suicides are related to problems with relationships, substance abuse, health, jobs, or finances. We have also seen a rise in drug overdoses. There were more than 70,000 drug overdose deaths in 2017, the highest number of drug overdose deaths for any single year in US history (CDC). What are termed “deaths of despair”, suicides and drug overdoses (including those from prescribed opioid painkillers) – are an ever-escalating problem contributing to the declining trend in life expectancy in the U.S. over the past several years.

Alienation – feeling despondent, lonely, and without purpose – affects millions, and is so widespread that social isolation may be as great a public health hazard as obesity or tobacco use. According to a study conducted by AARP, approximately 42.6 million U.S. adults age 45 and older were suffering from loneliness (AARP Foundation, 2018). Moreover, a Cigna survey suggests that Generation Z, adults between ages 18 and 22, may be the loneliest segment of the population, which doesn’t bode well as this generation enters the workforce en masse (Cigna, 2018). Carla Perissinoto, a geriatrician at the University of California-San Francisco states that social isolation hasn’t received sufficient attention. “Policy in this country doesn’t address this kind of concern, because many health care workers believe that social factors have nothing to do with medicine.”

Typical EAP

Next-Gen EAP

Reactive. Utilized only when issues significantly surface (at the “point of personal need”) often after the problems have been long-festering. Performance management, drug-free workplace referrals and onsite support services may be excluded.

Proactive. Focuses on prevention/early intervention that improves job performance, physical health and personal wellbeing. EAP is well-utilized, provides expertise on the human side of business strategy from crisis management to organizational resilience.

Vendor-Centered Access. Automated or customer service representative direction to website resources or list of network counselors to contact for selfscheduling.

Participant-Centered Access. Multiple means of access to licensed counselors and coaches (voice, text, chat, tele-video), Personally arranged and confirmed in-person care achieves twice the rate of participant follow-through compared to participant self-serve options.

Uses Technology for website-based information and provider self-search, CBT, and symptom-tracking apps are for self-use, not integrated with EAP.

Leverages Technology to reduce employee hesitancy to connect; supplements personal care with sciencebased, user-driven tools; global analytics help employers monitor workforce emotional health, personal dashboards help participants monitor and achieve their personal goals. EAP Apps are integrated with synchronous and asynchronous access to counselors.

EAP utilization metrics based on touchpoints (calls or emails to request services, web page visits, training participants, downloaded articles) and contacts with a licensed professional. Counseling is session-focused.

Outcomes metrics based on level of engagement, cases of service with licensed professionals, symptom improvement, quality of life improvement, increased job productivity, averted claims to medical plan. Counseling is solution-focused. Continuous internal and external integration within human capital initiatives. High levels of engagement, life event-focused benefit communication, integration with other benefits and services offered by employer.

Initial roll-out campaign with annual EAP reminders, passive approach to communication and promotion of EAP. Low levels of meaningful engagement and utilization. Source: Personal Assistance Services.

No age group is exempt from feelings of isolation and loneliness. These trends are not expected to be reversed or arrested, in part due to social, cultural, and even business drivers (such as increased mobility and flux, which make it harder to form and maintain relationships). It is also driven by ubiquity of social media, which blur the lines between appearing, and actually feeling, connected. Suffice it to say that EAPs that emerged several decades ago to address such issues as alcoholism and drug dependency, face far greater challenges today. We have tools and body of evidence to do a much better job of identifying and treating current-day problems, but the prevalent EAP service delivery models described in the previous section ill-equip – indeed ill-serve – employers and employees who desperately need solutions.

All employees, including senior management, may eventually have personal issues that spill over into the workplace. Next-Gen EAP addresses not only the well-being issues that compromise employee productivity, and performance but also impact other key performance indicators such as retention, engagement, and healthcare costs.  Support for senior leadership and human capital management: Next-Gen EAP offers expertise on the human side of business strategy, from crisis management to organizational resilience.  Going digital: Next-Gen EAP increases �� engagement and leverages technology to deliver personalized care through people’s preferred means of communication. Science-based screening, self-paced education and mindfulness exercises are supplemented with options to text with a coach, request additional services or speak directly with a licensed EAP counselor for in-the-moment support. The technology uses

Toward a Next-Gen EAP Next-Gen EAP is based on the following core principles:  Success measured by outcomes shifts the focus to value, quality, and prevention that help keep employees from needing more costly medical plan services down the line.

Continued on page 34

 A greater range of access options lowers barriers to effective utilization – from digitally delivered screening, education and progress tracking to on-demand access to a licensed counselor via voice, text, or chat.  Systemic, targeted outreach “normalizes the EAP”. Educating employees about the range of available life event support services helps to eliminate the perceived stigma often associated with seeking traditional EAP services.

KGA Life Services Because when it comes to work-life, experience matters most.

 Participant-centered care models are transformational and contribute to higher quality service delivery and better participant outcomes. �� EAP participants who play an active role in the management of their mental and physical health are more likely to follow their clinician’s treatment recommendations. They also have higher expectations of their provider in terms of advocacy, clinical customer service, and customized care.

Ask us how we can help enhance your EAP with KGA’s work-life fulfillment services. 800.648.9557 info@kgreer.com kgreer.com

 The implicit function of an EAP is an organizational tool to retain talent and manage performance. 17 | W W W . E A PA S S N . O R G | •• • • • • • • • • • • • • • • • • • • • | JOURNAL OF EMPLOYEE ASSISTANCE | 1st Quarter 2020 |

featurearticle Financial Stress

The Workplace Epidemic of the 21st Century | By Cindy Sheriff, MA, CEAP

hen employees are stressed financially, their physical and emotional health as well as their productivity are negatively impacted. According to the American Psychological Association (APA) 72 percent of Americans are stressed about their finances. Of this total, 22 percent report this stress as being extreme (APA, 2015). The impact of financial stress on employee productivity is significant. Consider the outcomes of a recent Mercer survey: • Employees spend an average of 13 hours per month worrying about personal finances at work. • Financially stressed employees are 5 times more likely to be stressed by finances at work. • These productivity losses have been calculated as roughly 5% of total payroll costs (Mercer, 2017).

When you consider both the prevalence of financial stress in the workplace and the willingness of employees to receive assistance, a proactive EAP can leverage the financial coaching component of the EAP to significantly impact these workers. Educating Call Center Staff is Vital EAP utilization of financial services is usually anemic. CLC, a provider of financial coaching to over 130 US-based EAPs, reports that typical utilization of financial services is less than one percent of overall utilization. Considering that 72 % of the workforce admits to being financially stressed there is a huge opportunity to bring value to existing clients. The first step is to have a financial coaching provider educate EAP call center staff as to the breadth and depth of financial services available. EAP staff may be under false assumptions that financial coaching is just for extreme hardship or retirement assistance. In reality, a financial coach can assist the employee with hundreds of financial issues such as deciding whether to lease or buy a car, mortgage advice, debt consolidation etc. Next the EAP staff should be trained by the financial service provider on the co-occurrence of financial stress with the EAP presenting issue. Often times the staff can facilitate this connection by asking questions during the intake uncovering financial stress as a contributing factor. Simply asking the EAP caller if financial stress could be contributing to the presenting issue will often times reveal the connection and create the opportunity for a referral to a financial coach. During my employment with CLC/MSA (My Secure Advantage) we have worked with several EAP call centers in providing this training and assisting with intake script “tweaking”. Most intake staff have their own style of presenting information gathering. Therefore, we encourage intake staff to

While productivity losses exist at all ages of workers, the highest and fastest growing group is the Millennials, who average more than three hours a week dealing with their personal finances during work according to Review of Industry Research (Bank of America Report, 2017). What many employers have found informative from this research is that employees want their employers to help.  Half of employees surveyed say they would take a more active role in managing their finances if they had a regularly scheduled financial review with a financial coach (50 percent) who assisted in developing a personalized action plan (49 percent).  Eighty-six percent of employees would participate in a financial education program provided by their employer.  At least 40 percent of employees would like their employers to take a more active role in supporting their financial lives, such as bringing in financial professionals, offering education tailored to their age and finances, and providing access to a personalized money coach. 18

use their own judgment as to where to insert the additional questions. We also discuss under what circumstances it would not be appropriate to probe for financial stress-related information. Presenting issues where this type of question would not be appropriate include extreme distress, suicidal ideation, and other areas of crisis. Through education and training with the EAP call center staff, the caller benefits from a more holistic EAP intervention, therefore achieving better outcomes through an increase in utilization. During a pilot program with one of CLC’s EAP clients, we experienced an increase in financial coaching utilization increase of 70%.

The combination of Mike receiving help with his clinical presenting issue and the underlying cause resulted in an increase in productivity and a decrease in absenteeism as evidenced by the change in his financial wellbeing score. At CLC/MSA every EAP referral is given a survey accessing their financial stress and associated loss productivity. The productivity loss is measured by the caller’s self-report. Had Mike not received this intervention, it is quite possible he might have been referred to a psychiatrist and prescribed medication, which would have helped his anxiety but not addressed the root of his problem.

“EAPs are in a unique position to work with HR departments to further address the epidemic of employees dealing with financial stress. Financial solutions begin with knowledge. The EAP can educate the HR department not only on the productivity-related loss but also other costs.”

Training and Education for HR EAPs are in a unique position to work with HR departments to further address the epidemic of employees dealing with financial stress. Financial solutions begin with knowledge. The EAP can educate the HR department not only on the productivity-related loss but also other costs. The American Institute of Stress breaks down the following areas: • Health issues: 75% of doctors’ visits are stress related; • Workplace accidents: 60-80% of on-the-job accident are stress related (distracted or inattentive employees); and • Employee turnover: 40% of employee turnover is due to stress.

Case Example Mike is a production supervisor in a manufacturing facility who has been exhibiting increased tardiness and absenteeism. Mike contacts the EAP at the suggestion of his supervisor. When he calls the EAP, he tells the intake clinician that he is missing work due to high levels of anxiety, particularly when driving in heavy traffic to and from work each day. When Mike is asked a question designed to reveal any co-occurring financial stress, he admits his anxiety is due to credit card debt from a prior period of unemployment and agrees to speak with a financial coach as well as an EAP counselor. Mike receives counseling to learn cognitive behavioral techniques to assist him in reducing his anxiety. He also has telephonic sessions with a financial coach who works with him to create a spending plan, offers debt management options, and an adjustment of his tax withholding increases his net income.

HR departments will benefit by offering training, either provided by the EAP or the EAP’s financial provider on the symptoms of a financially stressed employee. Just as EAPS have traditionally trained employers on how to recognize a troubled employee in general, today there is a need is for a specific training on how to recognize a financially troubled employee. The training should include the opportunity for an EAP referral when an employee exhibits behavior such as avoiding medical care, 401K withdrawals or asking for payday advances. Wellness Programs that Take the Next Step Many employers are seeking financial wellness programs that go beyond traditional EAP offerings. The human resource consulting firm Aon Hewitt polled Continued on page 21 19

featurearticle Why Financial Problems Matter to a Company Lack of financial wellness impacts an organization in three critical ways:  Productivity. Nearly half (44%) of employees worry about personal finances while at work. Nearly one-third (29%) actually spend time at work dealing with personal financial problems. The total time spent worrying about finances is also substantial. Almost half (46%) spend between 1-3 hours worrying about money.  Retention and benefits. Almost half (49%) of employees are somewhat likely to look for new jobs, with the majority of those leaving citing financial concerns. An overwhelming (71%) of employees satisfied with their benefits list it as an important reason why they remain with their employer. Roughly half (49%) of employees surveyed say that they are counting on employers’ benefits programs to help with their financial needs.  Health-related costs. Roughly one-quarter (26%) of employees put off doctor visits due to economic conditions. This potentially allows minor medical issues to escalate into more costly problems. Employees who have levels of stress due to financial debt: • Have twice the rate of heart attacks; • Are three times more likely to have ulcers and other digestive tract issues; • Are much more likely (44%) to suffer from migraines; and • They experience a 500% increase in anxiety and depression.

Employees’ financial problems are their employer’s financial problems because they inevitably spill over into the workplace. There are several seriously negative implications, which then impact company profits:  Absenteeism. Financially stressed employees use more sick leave and are absent from work more often.  Presenteeism. Although employees are at work, they spend time on activities unrelated to their jobs, such as talking to creditors. The Integrated Benefits Institute reports that presenteeism can account for three times more lost work than absenteeism.  Health concerns. Unhealthy workers produce lower quantity and quality of work and have higher health costs. Distress over financial matters is contributing to irritability, anger, fatigue, and sleeplessness for over 52% of Americans.  Work conflicts. Tardiness, incomplete work tasks, and accidents result when workers’ personal issues interfere with their jobs.  Dissatisfaction and lack of commitment. Financially-stressed workers are less satisfied with their pay regardless of the money they make. Their disenchantment with work can lead to a lack of pride in their jobs and negative feelings about employers. v Source: Reeta Wolfsohn, CMSW, founder of the Financial Social Work discipline (www.financialsocialwork.com) Financial Social Work certifies social workers and non-social workers in the U.S. and other countries and offers a 12-month financial wellness program “MY MONEY MYSELF” that includes a monthly downloadable workbook, monthly coaching group, and a private Facebook group.

Continued from page 19

more than 400 companies and found that three out of four are somewhat or very likely to expand employee benefits designed to promote financial well-being. Twenty five percent are likely to assist employees in learning and executing skills to manage their money (Aon Hewitt, 2014). With the workforce facing this epidemic and looking for solutions, the EAP can leverage their existing programs to offer a springboard and additional value to assist their clients in addressing this challenge.

Tips for Increasing Use of EAP

ost organizations are not reaping the full financial benefits of having an EAP. Business Management Daily offers the following suggestions for boosting use of the EAP:

Program Features What features should employees look for in financial wellness programs? The key lies in their versatility. Financial wellness programs should meet the differing needs of Millennials struggling with college loans and Baby Boomers thinking about retiring. According to Brad Barron, CEO of CLC and MSA other critical program components include a multi-dimensional platform that includes:

 Make it convenient. Employees are more likely to use the EAP if counselors are a short drive from work, or they can access them 24/7 by phone or online.

• One-on-one financial coaching; • Online tools with self-directed learning modules; • Classroom-based education; and • Integration with other benefits and programs.

 Emphasize confidentiality. Employees are more likely to use EAP services if they are not concerned about co-workers knowing about it.  Host wellness seminars. For instance, free lunchtime “brown bag” sessions on topics like stress management or time management.

The ultimate mission of a financial fellness program is to improve the employee’s overall financial well-being by supporting his/her ability to manage both short term and long-term needs.

 Inform families. Let employees’ families know they can contact you. Offer information about your services, hours, and phone numbers.

Summary A proactive EAP can use this opportunity to increase the EAP utilization, but more importantly position themselves as a valuable strategic partner to assist employers who seek to implement a robust financial wellness initiative. v

 Publicize, publicize, publicize. Promote your EAP regularly through emails, website updates, and free posters and refrigerator magnets that list hours and phone numbers.

Cindy Sheriff, MA, CEAP, is a behavioral healthcare consultant with CLC/My Secure Advantage. She has over 35 years’ experience in the behavioral health industry. She may be reached at cinsheriff@gmail.com.

 Remind employees there’s more to EAP than they might think. Stress that the EAP is available for personal reasons such as financial concerns, relationship counseling, and others.

References

American Psychological Association (2015, February 4). Paying with our health.

 Encourage staff to bookmark the EAP. Add a link on a company intranet to the EAP site.

Aon Hewitt (2014). 2014 hot topics in retirement: Building a strategic focus.

 Train supervisors. Teach them how to recognize work problems and to recommend using the EAP as an option for improving work performance. v

Bank of America (2017). Review of industry research.

Mercer (2017). Inside employees’ mindsTM: Insights on financial wellness. Retrieved from https://www.mercer. com/our-thinking/wealth/inside-employees-minds.html.

featurearticle Proactive Stress Management for EAP Clients | By James Porter

n his book, “A Clinical Guide to the Treatment of the Human Stress Response”, Professor George Everly of Johns Hopkins University, writes: “The history of stress management has been largely reactive. Stress management was initially conceived as a way to manage stress when it becomes excessive. More forward thinkers see that stress management can be proactive and preventative in nature.” Dr. Everly is right. Most people apply what they learn about stress management like a bandage at the end of a bad day. If they do it at all, it’s usually reactive: “Maybe I’ll try to meditate or go for a walk tonight when I get home, because work today was really stressful.” This is how the thinking goes for most people. But research tells us that people who practice yoga or meditate or who exercise regularly, are more productive, happier, healthier, and less stressed than those who don’t. Yet very few people ever make this proactive connection. Sure, a Band-Aid may help a person heal faster. But it doesn’t prevent the next injury from occurring. In the same way, it isn’t the occasional use of stress management that does the most good, it’s creating a resilience routine, which can help EAP clients prevent stress rather than just manage it. Following Dr. Everly’s lead, I developed a sixstep stress prevention model – that can be used in the workplace – to help EA professionals teach employees how to manage stress proactively. These six steps can be applied to a whole host of stressful situations from dealing with a difficult boss, coworker or client to managing a grueling commute or a growling customer.

Maria Ronda, CEAP, who works for an EAP provider in Maryland, recommends using a stress assessment tool like The Stress Profiler to help employees understand, exactly what their triggers are and what areas of their life are causing the most stress. “Raising awareness is crucial for getting people on board with the idea that managing stress is important. The more they know about why they need to manage stress the more likely they are to establish a proactive routine. “Encourage employees to connect the dots between their symptoms of stress and their sources of stress,” she continues. “When a certain supervisor walks into the room and the employee feels her heart beating out of her chest, she’s connected the dots between a symptom of stress and its apparent source. When a newly hired salesperson notices perspiration under his arms before a big presentation, he’s connected the dots between a source of stress and a symptom.” Dr. Heidi Hanna, author of the book “Stressaholic”, puts it this way: “Most people try to cover up their stress symptoms, but they would be better served by paying close attention to them and doing something adaptive like breathing deeply or changing their perspective on the issue.” IBH Population Health likes to use the instructional guide I authored, “Stop Stress This Minute.” Dr. Ryan Morgan of IBH explains: “I’m always surprised by how much people gravitate to the stress number system, which is described in the first chapter. Giving people a scale, from 0-10 on which to rate their stress, really helps them to raise their awareness of how their levels of stress fluctuate throughout the day.” Here is how the scale works: 0 is the total absence of stress or tension and 10 is a panic attack. During their workday, most people fluctuate between a 2 and a 7. Although it’s entirely subjective, the scale is easily understood, and helps people realize when their stress levels are getting a little too high, thus encouraging them to take action to lower their stress.

Step 1: Raising awareness Recognize the symptoms of stress, including rapid heartbeat, cold hands, dry mouth, perspiring when you don’t expect it, and muscle tension and figure out, in real time, what is causing them. 22

Once a person develops an awareness about who or what is causing them stress, as well as their shifting levels of stress are throughout the day, then they know exactly how to apply the remaining five steps to cope with stress, on the fly while it’s happening. That’s the goal of proactive stress management. Step 2: Problem-solving Look at the problems identified in step one and do some creative problem-solving to eliminate, reduce or prevent them from happening. Maybe an employee with a difficult boss needs to talk to his or her supervisor, or to someone in HR or maybe even to a co-worker who isn’t bothered by this boss. Dr. Eric Gustafson, also of IBH, likes the problem-solving approach. “I had a client who was dealing with a difficult commute. We explored her options: Working from home, requesting flex hours, moving closer to work or in the opposite direction of traffic, or making better use of her commuting time by taking public transit where she could work on a laptop while traveling.” Dr. Gustafson explains: “A lot of times people have trouble doing problem-solving because they don’t see the big picture. They don’t realize how they can transform a stressor into a solution. In this particular case, the employee got permission to work from home for two days a week, and by requesting flex hours, was able to avoid peak traffic times on the other three days.” Step 3: Cognitive Restructuring Teach employees how their thinking can be a major source of stress.

Cognitive Restructuring is a term borrowed from Cognitive Behavioral Therapy (CBT). Dr. Albert Ellis, one of the cofounders of CBT, changed the whole field of psychology by moving it away from Freudian Psychoanalysis and into the cognitive behavioral model, which could produce results in as little as five sessions. Ellis was inspired to create this new form of “cognitive” therapy when he realized how often his clients’ thinking was “faulty, irrational and muddled.” He reasoned that if he could get them to recognize when their thinking was irrational, then they could easily change it. As an EAP counselor, you can use this same approach by getting people to notice their negative self-talk. If the client says “I’ve got the world’s worst boss,” that’s an overly negative self-statement that only makes their stress worse. Encourage them to change that self-talk to be more accurate. “My boss isn’t always bothering me, last week, she let me go home early when I wasn’t feeling well.” Employees don’t have to sugar coat their self-talk, as long as they continually modify and correct thoughts that are overly negative. Dr. Rae Hadley of IBH teaches her clients cognitive restructuring because it’s such an effective technique to use. “Employees quickly see how often their distorted thinking plays a major role in creating stress.” For step 3 they use the first two articles from The Thinking Person’s Stress Management Workbook. This book describes Dr. Albert Ellis’s A+B=C equation. In this equation, A stands for the Activating event, which could be any source

of stress. B stands for your Beliefs about that event, and C stands for the Consequence of A+B, which is what you feel inside as the result of what has just happened. Hans Selye, the Canadian scientist whose research in the 1930s put stress on the map once said: “It’s not so much what happens to you but how you take it.” Selye’s quote confirms the fact that a lot of the control over how stress affects us occurs as the result of our interpretations, thoughts and beliefs at point B. As Dr. Gustafson explains, “This is an incredibly empowering idea. The whole world believes that A=C. That any stressor automatically leads to stress. When you introduce the idea that a client

featurearticle can control his or her stress by controlling their reaction at B, it can be life-changing.”

helps employees to better handle the ups and downs of their day. This is how stress management morphs into stress prevention. Eileen Hodiak, LCSW, CEAP, Director of the FirstHealth of the Carolinas EAP, encourages her clients to start small. “Just suggesting that someone walk for 30 minutes a day is a big request. In so doing, you could be setting them up for failure. That’s why I tell each person to start small when setting up a resilience routine. Whether it’s meditation, walking or stretching, start with just 5-10 minutes a day. Once that tiny habit is WELL in place, then they can build on it.” Dr. Ryan Morgan of IBH uses “Stop Stress This Minute” to reinforce the lessons of step 5. “There are ten quick 2-minute exercises and relaxation techniques that people can practice to build their resilience to every-day stressors. I tell people to try all ten and choose the one they like best and do that for 5 minutes every day. The technique people choose most is abdominal breathing.” From the psychometric data they have gathered, it’s clear that IBH has created a highly effective resilience program. In this program, state employees can have up to ten coaching sessions over the course of 4-6 months. Each participant agrees beforehand to do some sort of skill practice for 10 minutes each day. “We’ve seen significant changes in all ten areas that are tested on the Stress Profiler assessment, including how well people cope with anger, worry, time pressure, financial stress, change, and stress symptoms,” Gustafson explains. “Overall, participants’ scores on The Profiler have gone from an average of 212 before the intervention down to 168 afterwards, a drop of over 42 points on the scale.”

Step 4: Mindfulness Understand the therapeutic value of staying in the present moment. When a person leaves the present moment, and allows his/her mind to wander off into the future, they may get anxious. And when they go back into the past to dig up old hurts, people may get angry and resentful. So, staying in the present moment has therapeutic value. It can be a refuge from both anxiety and anger. Remind your clients not to let a minor incident that occurs on a Monday, affect how they feel about someone (like their boss or a co-worker) on a Friday. By adopting this stay-in-the-moment approach (rather than a narrative view of life where one bad moment taints how they see a person in the next moment) employees soon realize that their boss (or their coworker) is not “bad” all the time. Bud Wassell, MS, CEAP, LPC Coordinator, Employee and Family Resources (EFR) Program, Yale New Haven Health System, practices mindfulness himself and teaches it to his clients. He has a regular meditation group that meets for a half-hour, once a week, for six weeks, at the hospital. Wassell gradually built up a demand for his mindfulness meditation classes, by inserting short mindfulness meditations into other programs he was offering on stress and resilience. “I’d do a short session at the beginning of meetings, on retreats or at any event in the hospital where it might work. Employees started requesting it more and more and that’s when I started my six-week classes. “I’ve tested the participants in these classes with a perceived stress and burnout scale and have seen significant reductions of up to 25% in their scores pre and post,” Wassell adds. One client of Wassell’s in particular typifies their experience. “After your meditation class I had mental clarity and I was more productive all day. I was able to get a lot done and I felt good doing it.’”

Step 6: Social Support Seek out social support as a hedge against all kinds of stress. As an EA professional, you are supplying some of this much needed support. Help employees to see if they are dealing with a toxic boss, a difficult coworker or a long commute, that finding someone to talk to about it, can really help. David Mitchell of Employee Assistance of the Pacific tries to make it easy for his clients to reach their EAP in a time of need.

Step 5: Resilience Establish a resilience routine. As Wassell’s story and further research confirms, a regular practice of yoga, exercise and/or meditation 24

“I want our phone number to be riding around in their wallet or purse, 24/7/365. That’s why we hand out our contact information on a stress-testing card. It’s the size of a business card, but they are much more likely to keep it with them than a regular business card. People use it repeatedly to test their stress levels but more importantly, it reminds them that we are there whenever they need a helping hand with their stress or any other mental health problem.”

becoming chronic problems with stress, requiring more in depth intervention. v Jim Porter, CEO of StressStop, is author of “The Stress Profiler,” “Stop Stress This Minute” and “The Thinking Person’s Guide to Managing Stress,” which together have sold over 400,000 copies. Mr. Porter has presented programs on stress at MIT, BYU, the FBI, CIA, and others. He has presented at numerous professional conferences including EAPA, WELCOA, IRAE, National Wellness and NCEAPA. He may be reached at jim@stressstop.com.

References

Brusman, M., Porter, J., (2018). The stress profiler. Retrieved from https://stressstop.com/collections/workbook/products/the-stress-profiler.

Using the Six Steps with Clients Whenever I put on a presentation on stress prevention, I leave my audiences with these six simple ideas for incorporating each of the six steps: • Use a 0-10 stress number scale to monitor stress levels throughout the day. • Make a list of the top ten sources of stress and use creative problem-solving to eliminate at least 3 problems on the list. • Recognize an A when it occurs and choose how to respond at B. • When feeling frazzled, take one deep breath to bring yourself back into the present moment. • Establish a resilience routine and make it a habit. Start with just five minutes a day. • Connect with at least one person every day.

Ellis, Dr. A., Lange, Dr. A. (1994). Carol Publishing: How to keep people from pushing your buttons. Everly, G. Jr., Lating, J., (2012). Springer: A clinical guide to the human stress response, 3rd Edition. Hanna, Dr. H., (2014). Wiley: Stressaholic. Porter, J., (2017). Stop stress this minute, (WELCOA), https://stressstop.com/collections/workbook/products/ stop-stress-this-minute. Porter, J., MALS, Rosch, P., M.D. (2015). StressStop. https://stressstop.com/collections/workbook/products/thethinking-persons-stress-management-workbook.

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As an EA professional, don’t think you have to walk through all six steps with every client. Dr. David Hunnicutt, former president and CEO of WELCOA explains: “The beauty of this model is that your clients can use it at whatever step works for them in whatever situation they find themselves in.” And there is a growing interest in this type pf approach. When I lectured at MIT, I noticed that, as a group, they were very interested in cognitive restructuring. When I have spoken at Army bases, there’s definitely a greater interest in resilience.”

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

Summary As you work with individual clients, you will get a sense of which steps they are ready for. Whatever steps you choose to teach them, always emphasize the proactive and preventative nature of this approach. When they learn they can detect stress early on– by becoming aware of stress symptoms and fluctuating levels of stress – and learn to deal with them in real time, they can prevent day-to-day issues from 25

earoundup EAPA DOT/SAP Trainings Set

increases over time, according to Delotte. The complete reports can be found at https://bit.ly/2PiNprs and https://bit.ly/2Yogdmi.

The following two-day EAPA DOT/SAP qualification and requalification trainings will prepare SAPs to provide services that will follow DOT rules and regulations: February 14 - 15, 2020: Las Vegas, Nevada Hilton Garden Inn Vegas Strip South (Registration coming soon) April 24 - 25, 2020: Baltimore, MarylandRenaissance Baltimore Harborplace Hotel (Registration coming soon) June 11 - 12, 2020: Denver, CO- Hilton Garden Inn Denver Union Station (Registration coming soon) October 30 - 31, 2020: Houston, Texas- Hilton Americas – Houston (EAPA 2020 Houston Conference & EXPO - Registration Opens Summer 2020) For more info visit http://www.eapassn.org/SAP.

Affordable Health Treatment Still Hard to Find Eleven years after Congress passed a law mandating that health insurers offer equal access for mental and physical health care, Americans are actually finding it more difficult to obtain affordable treatment for mental illness and substance abuse, reports the Washington Post. Barriers to parity continue despite consensus that more must be done to confront the nation’s devastating opioid epidemic, rising suicide rates, and surging rates of teen depression and anxiety. A report by Milliman, a risk management and health-care consulting company, revealed that patients were much more likely to resort to out-of-network providers for mental health and substance abuse treatment than for other conditions. The disparities have grown since Milliman published a similarly pessimistic study two years ago. The latest study examined the claims of 37 million individuals with commercial preferred provider organization’s health insurance plans in all 50 states from 2013 to 2017. According to psychiatrist Tom Insel, people with serious mental illness have better access to care with Medi-Cal (state of California Human Services-sponsored program) than commercial insurance – unthinkable for medical conditions, he said. Cathryn Donaldson, a spokeswoman for America’s Health Insurance Plans, said insurers are working diligently to ensure they are complying with the federal parity law. But the national shortage of mental health providers, along with the many clinicians who do not want to participate in insurance networks, contribute to more patients needing to go out-of-network for care, she said. Read more here https://wapo.st/2r9cSeI.

Workplace Mental Health Investment is Good for Business Poor mental health among the workforce imposes tremendous costs on Canadian employers. And yet, obstacles to investment in workplace mental health remain, including a lack of knowledge of best practices, as well as a lack of evidence that investments can have a positive impact on the bottom line. To overcome these barriers, Canadian employers require real-world evidence that workplace mental health programs are an investment that yields valuable returns, rather than a cost. A recent study by Delotte Insights, the first of its kind conducted within the Canadian context, offers such evidence. According to the Delotte report, key findings for organizations include: 1.) Invest in proactive programs that promote positive mental health in addition to treatment—this means going beyond delivering interventions for poor mental health to also promote positive mental health and well-being. 2.) Prioritize investments in the highest-impact areas, such as leadership training and return-to-work programs. A similar report, also conducted by Delotte, found that employers who spend more on their workers’ mental health make more money. For every dollar spent, the median ROI is $1.62 by the third year, and

EAPA Conference Sessions Offered at Special Price EAPA has released a new online conference recordings package that provides unlimited access to both 26

this year’s EAP Conference in St. Louis and last year’s conference in Minneapolis. Through Oct. 31, 2020, purchasers of the package can view or review as many sessions from both conferences as they want — any time at their convenience — AND receive PDHs or other continuing education credit while doing so. Keynote sessions are full multimedia re-creations with synchronized audio, video and slides. Breakout sessions include synchronized audio and slides. All session handouts are also included and can be downloaded any time. The new package is available to EAPA members for just $199, and to non-members for $299. More info at https://eapa.sclivelearningcenter.com/ MVSite/default.aspx.

but the relationship between salary and suicide warrants more research. The study was limited to the states that participated in the 2012 and 2015 National Violent Death Reporting System, a program the CDC developed to study the causes of violent deaths. The report is the most comprehensive study on suicide and work to date. More info at https://bit.ly/2OOUQHX.

Benefits Survey Reveals What’s Hot Certain job benefits such as student loan repayment, paternity leave, telecommuting, standing desks, and telemedicine are gaining notable upward traction, according to the Employee Benefits Survey, released by the Society for Human Resource Management (SHRM). Survey highlights include:  Standing desks continue to rise in popularity. Currently, 60 percent of employers offer this benefit, compared to one-quarter just five years ago.  Onsite lactation/mother’s rooms are offered by 51 percent of employers, up 16 percentage points from 2015.  The number of employers offering family leave above the time required by the federal Family and Medical Leave Act increased by 6 percentage points. Additionally, while paid leave for new fathers has gone up only slightly since 2018, it has seen a steady rise over the past five years (up 14 percentage points) and is now within 4 percentage points of paid leave for new mothers.  Telecommuting on a part-time basis is on the rise, now offered by 42 percent of employers. Flexible working benefits continue to rise in popularity, and, as a result, telecommuting of all types is increasing, as are most types of flexible scheduling.  Company-provided student-loan repayment benefits have risen from 4 percent in 2018 to 8 percent in 2019. This category is expected to make further gains if pending federal legislation is passed. The complete SHRM report can be found at https:// bit.ly/2P8U0Vh.

Jobs with Highest Rates of Suicide in U.S. The Centers for Disease Control and Prevention (CDC) has analyzed suicide deaths among workingage Americans in 17 states to understand how different types of work influence a person’s risk of killing oneself. The CDC found that the suicide rate for people ages 16–64 years old rose 34% between 2000 and 2016, from 12.9 to 17.3 suicides per 100,000 workers. The federal agency also reported that suicide rates varied widely across occupational groups and that people involved in certain types of work, such as construction and extraction or production jobs, may be at a higher risk of suicide than other workers. They include: Men: Construction and extraction jobs, 1,404 suicides; transportation and material moving, 817; production, 679; and maintenance and repair, 621. Women: Office and administrative, 268; health care practitioners, 225; sales, 212; and food prep and service, 154. The occupational groups with the highest suicide rates for male workers had median annual wages below $45,500. For women, the occupational groups with the highest suicide rates also had median annual wages below $45,500. The highest paying professions, conversely, did not have high suicide rates. Correlation does not mean causation,

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featurearticle Applying the MSRA Approach to Mass Shooting Incidents | By Robert Intveld, LCSW, CEAP

ith the increasing frequency of mass shooting incidents, EAPs should consider reviewing the traditional Critical Incident Response (CIR) approach to meet the challenging needs of organizations and employees affected by these horrific events. Today, responding to mass shootings requires interacting with more emergency management operations, fielding more management consultations, coordinating with more onsite professionals, and intervening with more significantly impaired employees and disrupted systems. EAPs also know that each time there is a mass shooting incident, they are not responding to just an isolated incident. There will be numerous requests for EAP CIR from multiple workplaces within neighboring communities. For instance, while Walmart was the epicenter of the incident in El Paso, Texas, the entire community was impacted as well – in addition to communities across the border into Mexico. Moreover, each shooting incident leads to a pervasive sense of fear and vulnerability that can ripple across the entire country. As an example, an EA professional who responded to the El Paso shooting reported that their EAP was also getting calls from a client company in Oklahoma who had experienced a shooting incident six months prior. They also wanted onsite support, thus increasing the number of CIR requests per incident.

MSRA addressed an ongoing gap in CIR services that other response protocols failed to take into consideration. EAPs require an approach that addresses the needs of multiple stakeholders, balances the demands of a dual-client structure, and offers a response with the flexibility to adapt to a variety of workplace cultures. To achieve this goal, multiple systems must be mobilized and coordinated in a united effort to address the need for restoring safety and fostering resilience (Intveld 2015). This overarching theme also applies in response to mass shootings. In keeping with the MSRA approach, EAPs need to strengthen their focus on helping restore organizational fortitude and its connection to employees, early on in their response. Focal Points of MSRA While a complete review of MSRA is beyond the scope of this article, there are several interventions that are emphasized and enhanced when addressing mass shooting incidents. They include: • Management Consultation; • Creating and operating within Safe Zones; • Deploying appropriate group interventions; and • A return-to-work process.  Management Consultation (MC) Key information to be obtained beyond the typical CIR assessment must include questions to help understand the level of disruption the organization has sustained and its impact (physical and emotional) on employees. Questions about the following areas are critical: proximity of the organization to the shooting incident; damage it may have sustained; accounting for the whereabouts of all employees, including any traumatic loss that may have incurred, and whether a police investigation

The Multi-Systemic Resiliency Approach (MSRA) MSRA, developed by this writer in 2013, recognizes the interconnectedness of the systems involved in recovery from critical incidents and their contribution in fostering a resilient outcome (Intveld, 2015; Walsh 2007). The development of 28

barrier line has been in place. It is particularly helpful if the management consultation team is cognizant of the kind of emergency management operations that are underway so that they can help deploy EAP response professionals. Securing onsite providers is a primary task of the MC process. While this may seem routine, there is a race to secure providers by all the EAPs, both regional and national, plus crisis vendors serving their clients in the impacted area. Local providers with acceptable training in CIR (determined by the EAP) are often on multiple EAP networks. The demand for these providers will be high. While there will be a surge of general “crisis counselors” willing to help, there are only so many providers with CIR training and fewer still with an understanding of EAP. Using untrained providers creates ethical challenges (EAPA Code of Ethics 2009), not to mention potential harm to both clients and counselors.

operations within the Recovery Stage involve setting up community resources for victims of the shootings. These will include Reunification Centers (safe areas where victims can connect with family members, i.e. students with parents), and Family Assistance Centers (safe locations with access to multiple community resources, such as American Red Cross, FBI, transportation, childcare, crisis counselors) with access to law enforcement as they carry on their investigation. Secondary to these community safe zones, local organizations can set up their own Corporate Safe Zones. These are temporary locations where employees can gather safely and securely in the event the workplace becomes unavailable. They serve an important transitional function, not only for access to EAP services, but to create a space where the natural sources of resilience, (connection with significant others, group cohesion, organizational leadership and communications) can flourish. Families can be invited to participate as well. During the crisis and its immediate aftermath, in addition to worrying about their own safety, employees worry about each other. A Corporate Safe Zone is a space where, at minimum, they can go for social support and to hug each other! Do not underestimate the power of this seemingly simple intervention (Craig, 2019). In addition, Corporate Safe Zones allow restoration of contact and communication with leadership, regular corporate briefings, access to EAP services, and other wellness resources. These zones may be located in branches, satellite offices, treatment centers, churches, restaurants, hotels, schools, anywhere that can accommodate employees outside the restricted areas until the workplace is ready to resume operations. Pre-incident preparedness plans may have already determined locations.

“The development of MSRA addressed an ongoing gap in CIR services that other response protocols failed to take into consideration. EAPs require an approach that addresses the needs of multiple stakeholders…” Local providers are also part of the impacted community and may be going through their own reactions. Since the intervention timeline is expanded during mass shooting incidents, EAPs need flexible providers who can work extra hours and/or days to maintain continuity of care. In the absence of providers, an ad hoc process to secure temporary, onsite professionals to deliver ethical EAP CIR, must be in place. On-Demand EAP CIR training, along with coaching, may provide that solution as well as serving the greater need of EAP preparedness.

 Deploying Appropriate Group Interventions During the MC and subsequent communication with organizational leadership, it is crucial to identify those who may have been injured, were in the proximity of the shooting incident, or experienced a tragic loss, as they are at higher risk for experiencing trauma (May, 2015). Medical intervention to those injured is the first priority. Efforts to assist victims in reconnecting with family and/or significant others offers the best

 Creating and Operating within Safe Zones Immediately following the Response Stage of Emergency Management Plans where law enforcement has secured the area and neutralized the threat, 29

featurearticle path as increasing safety and emotional support. Following these initial courses of recovery, there may be appropriate candidates for one-on-ones and/ or group interventions.

period of time, to counter the intense level of fear they may still be experiencing. If not addressed, connection and trust with their organization may erode and return to work delayed. One intervention that can be extremely helpful, is a mock return to work. The coordination and logistics of a mock return to work are discussed with organizational leadership and mapped out within the Corporate Safe Zone. Mock returns allow employees to return to the workplace site, and move around freely without having to actually work. These practice runs give employees a chance to see that any damage has been repaired, the site is visibly secure, and that a return to a normal work routine is progressing. The first day of the mock return can be very stressful, but it is an important first step of returning to work. Some employees may not feel ready. They may be encouraged by being offered a ride or prefer a buddy to return with. These details can be worked out during the time in the Corporate Safe Zone. EAP will be part of the mock return as well, helping with the onsite adjustment. This is a good place and time for a resiliency group intervention. The intervention will reinforce the normalcy of their reactions, enhance group cohesiveness, and strengthen resilience both within and outside the workplace. Once the workplace has resumed operations, a short-term, EAP onsite presence can be made available for those who desire additional support.

When considering group intervention, group selection is critical. If there are natural employee groups or teams who had similar exposure and/or reactions, these may be good candidates for group interventions. A Psychological First Aid (PFA) Group should be considered for this type of intervention. According to the National Child Traumatic Stress Network, psychological first aid is designed to reduce the initial distress caused by traumatic events and to foster shortand long-term adaptive functioning and coping. When delivered in a group format, it can provide a structure for catharsis, self-learning, group cohesion, symptom management, and universality (the idea that someone’s reactions are shared by others) (Everly, 2006). There are two essential elements when providing PFA Group interventions: EAP responders must adjust the group process to the cognitive functionality of the employees; and be aware of research that indicates conflicting support for single session debriefing interventions (van Emmerik, 2002), (Bisson, 2003). PFA groups must integrate some or all of PFA’s 8 Core Actions. Examples can be found through the National Center for PTSD in its PFA for Schools Field Manual. Follow-up activities are also essential (Everly, 2006). This may include outreach services to determine further need of one-on-one support, and/or PFA or resiliency-based support groups.

Traumatic Loss and Grief Deaths that are untimely, sudden, and/or violent are the most common source of trauma (Norris, 2002).

 A Return-to-Work Process Returning to the workplace can be difficult. Even if officials have deemed it “safe” to return, employees returning to or near where a shooting took place can trigger stress; including emotional, psychological and physical reactions. Such reactions are normal. Even if the shooter was apprehended or is deceased, the “perception of fear” rises when thinking of returning to the workplace. Consultation with organizational leadership on how to address this is imperative. Employees will need visual cues and recurring messages that reinforce safety over a

In MRSA we talk about Collegial Grief as it relates to one’s level of connection to the deceased (Intveld 2015). This connection varies among colleagues and thus the impact and feelings associated with loss will vary. Collegial Grief applies to many of the deaths related to EAP onsite requests. In mass shooting incidents, however, employees can experience the impact of traumatic loss no matter the level of connection. The realization that it could have been any one of us, or any one of our family members; can be overwhelming. There will be a pervasive sense of loss within the community. 30

A request for a grief-focused intervention may seem obvious, even logical. However, an assessment for the clinical readiness and timing such an intervention should be carefully conducted. The first priority of all CIRs is safety. All interventions must be focused on helping restore physical and emotional safety. While interventions will have a grief element, the impact of the critical incident and on one’s coping skills becomes paramount. Once safety and stabilization has been achieved, additional grief-focused interventions can be considered. Keep in mind that while the EAP response is initially on safety, additional resources for stress management, the fostering of resilience, and trauma support are being provided by multiple community agencies. Our role in EAP CIR, consistent with MSRA, is to help employees connect to these powerful resources. Referrals to the treatment community for working through traumatic loss, at some point, may be appropriate. In the event the EAP is asked to provide some form of grief support group around traumatic loss, EA professionals must remember that we provide crisis intervention, not treatment, and use of a group model must reflect this fact.

BSI Group; Organizational Resilience Index Report 2017. Retrieved from https://www.bsigroup.com/LocalFiles/en-US/ Organizational-Resilience/Index-report-for-web.pdf.

Summary EAP response to mass shootings and/or acts of terrorism are no longer unusual requests. Their presence challenges our foundational, professional training, not to mention our own core, personal beliefs. They tax our own internal EAP resources. We have learned a great deal about what works and what areas need to be emphasized. Incidents of this magnitude highlight our partnerships with organizational clients. Getting it right matters. v

Powell, A. (2019, March 15). In praise of ordinary people. Retrieved from https://news.harvard.edu/gazette/story/2011/09/in-praise-ofordinary-people/.

EAPA Code of Ethics. (2009, August). Retrieved from http://www. eapassn.org/About/About-Employee-Assistance/Ethical-Issuesand-Codes. Everly, G. S., Phillips, S., Kane, D., Feldman, D., Brief Treatment and Crisis Intervention. (May 2006). Gun Violence Archive. (n.d.). Retrieved from https://www.gunviolencearchive.org/. May, C. L., & Wisco, B. E. (2015, September 21). Defining Trauma: How Level of Exposure and Proximity Affect Risk for Posttraumatic Stress Disorder. Psychological Trauma: Theory, Research, Practice, and Policy. Mass shootings becoming more frequent. (2014, October 15). Retrieved from https://www.hsph.harvard.edu/news/hsph-in-thenews/mass-shootings-becoming-more-frequent/. Norris, F.H. (2002). 60,000 disaster victims speak: Part 1. An empirical review of the empirical literature, 1981–2001. Psychiatry: Interpersonal and Biological Processes, 65, 207–239. Peterson, S. (2018, June 29). PFA and SPR. Retrieved from https:// www.nctsn.org/treatments-and-practices/psychological-first-aidand-skills-for-psychological-recovery. Piotrkowski, CS., Brannen SJ., Exposure, threat appraisal and lost confidence as predictors of PTSD symptoms following September 11, 2001; Am J Orthopsychiatry 2002 Oct. 72(4):476-85.

Resilience in the workplace: How to be more resilient at work. (2019, July 4). Retrieved from https://positivepsychology.com/ resilience-in-the-workplace/.

Silverstein, J. (2019, August 6). There have been more mass shootings than days this year. Retrieved from https:// www.cbsnews.com/news/mass-shootings-2019-moremass-shootings-than-days-so-far-this-year/. Van Emmerik, AA, Single sessions debriefing after psychological trauma: a meta-analysis. Database of Abstracts of Reviews: Quality-assessed Reviews. University of York. 2014.

Robert Intveld, LCSW, CEAP, is the owner of Robert Douglas and Associates, www.eap-rda.com and author of “EAP CIR: Multi-Systemic Resiliency Approach”. For more information about Robert’s trainings and services contact him at: rintveld@verizon.net

Walsh, A., Traumatic Loss and Major Disasters: Strengthening Family and Community Resilience; Family Process, Vol. 46, No. 2, 2007

References

Bisson, J., Single session early psychological interventions following traumatic events. Clinical Psychology Review, Vol. 23, Issue 3, May 2003.

Walsh, F., & McGoldrick, M. (2004). Loss and the family: A systemic perspective. In F. Walsh & M. McGoldrick (Eds.), Living beyond loss: Death in the family (2nd ed, pp. 3–26). New York: Norton.

Brymer M., Taylor M., Escudero P., Jacobs A., Kronenberg M., Macy R., Mock L., Payne L., Pynoos R., & Vogel J. Psychological first aid for schools: Field operations guide, 2nd Edition. (2012). Los Angeles: National Child Traumatic Stress Network.

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Marijuana Breath Tests Look Promising for Employers

with good friends,” says Litsa Williams, co-founder of the site What’s Your Grief? “We don’t have a framework for that, and we may feel we have less of a right to have emotions about that.” Emotions can vary widely and aren’t often ones someone wants to have in a work environment. Anger, guilt, and tears can rise to the surface. “Grief reactions can be unique to our relationship to the person who died, but also include all of our life experiences and other things from our past, ranging from our own mortality to personal losses,” Williams adds.

Employers have never had accurate drug testing options to determine when an employee might have ingested marijuana and, therefore, if they are likely to still be impaired. As a result most employers have policies that impose a maximum penalty for any positive test for the drug. According to HR Morning, “breathalyzer” tests slated for release in 2020 use advanced technology to measure whether an individual has recently smoked, vaped, or even eaten marijuana products. The devices show immediate results, which means employers can quickly deduce whether an employee is impaired and should be kept from working. This advancement marks a big change from current tests, which detect cannabis use as long as 30 days before testing, meaning it can’t show whether someone is high at the present time or used the drug while off duty. Employers are most concerned when it comes to safety-sensitive activities, including operating dangerous equipment or driving. However, there is a drawback to the new tests. Unlike alcohol, there is currently no legal standard for impairment based on the amount of THC detected. Still, one startup lab says its product will let employers make a call about whether an employee is fit for work by indicating how recently they ingested a THCcontaining substance.

SAD Affects 10 Million Americans Seasonal affective disorder (SAD) impacts more than 10 million people in the U.S., Boston University reports. Typically, during the winter months with less daylight SAD is associated with mood changes— depression, for instance. People who suffer from SAD may find that they have difficulty waking up in the morning, that they have less energy, an increased appetite, and greater difficulty concentrating. Conversely, the opposite occurs spring and summer, where people will perhaps sleep a little less, and are more active and energetic. Light boxes (being exposed to 10,000 lux is recommended) are among treatment options for those with SAD. Read more here https://neuroscience news.com/seasonal-affective-disorder-1515/.

Competitive People Have Higher Drug Risk

Coping with the Sudden Death of a Co-Worker

A study from Spain suggests hostile and competitive people are more likely to abuse drugs and alcohol. “There are still many questions to answer but what we discovered is very significant,” points out Dr. Rosario Ruiz Olivares, head researcher at the University of Cordoba (Spain). Nevertheless, Olivares said that what could be called an addictive personality “does not exist.” But the study confirms there is a strong correlation between a personality characterized by hostility and competitiveness and consumption of illegal substances, such as cocaine, cannabis, and hallucinogens, reports PsychCentral. In the study, socio-demographic and personality questionnaires were completed by 3,816 young people

Approximately 85 percent of Baby Boomers plan to work until their 70s or 80s, according to the U.S. Senate’s Special Committee on Aging. This means that workplace deaths are likely to become more common. As a result, an increasing number of workplaces have an EAP on call to bring in grief counselors when they are needed. As reported by Fast Company, for a lot of workers, the fact they have any reaction at all to the death of an acquaintance—someone they may have only chatted with in the office breakroom—is surprising. “People think, ‘Why am I feeling this?’ But sometimes working with someone for five years can be, unfortunately, more significant than the time we spend 32

in the province of Cordoba between the ages of 18 and 29. “In the future, we would like to broaden the sample to a national level and study behavior patterns according to the person’s gender,” states Olivares.

schizophrenia increase the likelihood of smoking (although the evidence was weaker in this direction for schizophrenia). The same group published a similar study in British Journal of Psychiatry in 2019 in collaboration with the University of Amsterdam, showing evidence that tobacco smoking increases the risk of bipolar disorder.

Addressing Stressful Commutes Are employees stressed out before they even arrive at the office? In a new survey from global staffing firm Robert Half, half of professionals (50%) said traveling to and from work is stressful.  Men and workers ages 25 to 40 have the highest levels of stress about traveling to work.  More workers ages 25 to 40 (54%) and men (52%) described their trips as too lengthy.  In a separate survey, senior managers said their company offers flexible scheduling to avoid peak traffic times (43%) and telecommuting (40%) to help alleviate employees’ stressful trips. “When workers have difficult commutes into the office, their engagement and productivity can suffer the rest of the day. This may affect staff satisfaction and retention in the long run,” said Paul McDonald, senior executive director for Robert Half. “With the current employment environment favoring job seekers, organizations can’t afford to ignore the issue and lose their best team members to other opportunities.” For more tips on how to deal with a bad commute, visit the Robert Half blog at: https://bit.ly/2r1qrN0.

EAPA Announces Revamp of CEAP Credential Over the course of the next six months, the Employee Assistance Certification Commission (EACC), in conjunction with EAPA staff, will complete the development of a new and improved certification process, which will include standardized online coursework, a simpler user interface, and an opportunity for EA professionals with different levels of experience to become certified. The new CEAP will also align better with 21st century employee assistance best practices, taking into account changes in technology and evidenced based instruments like the Workplace Outcomes Suite (WOS). The EACC has drafted an outline of proposed revisions to the CEAP. Please feel free to forward your comments and questions about the draft to the chair of the EACC, David Nix at dave.nix@att.net.

Medical Marijuana Proves Difficult Juggling Act

Smoking may Increase Risk of Mental Illness

With medical marijuana increasingly available in the U.S., employers are facing a difficult juggling act between workplace safety and workers’ disability rights. The Advocate reports that, in Louisiana, they might also face the workplace challenge of differentiating between the medically approved marijuana being used and recreational marijuana that by law is illegal. Louisiana’s medical marijuana program, which got started earlier this year, allows patients suffering from a limited list of illnesses, ranging from cancer to intractable pain, to obtain a “recommendation” from a doctor to receive the drug sold only

Research from the U.K. suggests smoking tobacco may increase the risk of developing depression and schizophrenia. The University of Bristol believes the study adds to a growing body of work suggesting that smoking can have adverse effects on mental health. It is well-known that smoking is much more common among people with mental illness, especially depression and schizophrenia. However, most studies that have looked at this association have not been able to determine if this is a cause-and-effect relationship. According to PsychCentral, researchers found evidence that tobacco smoking increased risk of depression and schizophrenia, but also that depression and

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analytics to help employers monitor and address the emotional health of their workforce and to help participants achieve their personal goals and improve their quality of life.

Editor’s note: Copyright © Personal Assistance Services. Used with permission. Important! This article has important and specific information to use in your practice. By reading and answering a 5-item multiple choice quiz at https://tinyurl.com/quiz0120, you can earn one free PDH.

 AI and machine-learning drives pathways to personalized, human-delivered, compassionate care. Next-Gen EAP leverages technology to expedite human-to-human connection with the right experts to successfully resolve personal challenges and address the conditions of loneliness and isolation.

References

AARP Foundation (2018). A national survey of adults 45 and older: Loneliness and social connections [pdf] doi.org/10.26419/res.00246.001 Cigna (2018, May 1). New Cigna study reveals loneliness at epidemic levels in America: Research puts spotlight on the impact of loneliness in the U.S. and potential root causes. Retrieved from http://cigna.newshq.businesswire. com/press-release/new-cigna-study-reveals-lonelinessepidemic-levels-america

 EAP as a change management platform: Job-hopping, gig workers, and the fluid nature of modern work and life have heightened employee anxiety and sense of dislocation. Next-Gen EAP is about managing all manner of change at the individual and organizational level.

Hedegaard, H., Curtin, S. & Warner, M. (2018, November). National Center for Health Statistics (NCHS) Data Brief, No. 330. Suicide mortality in the United States, 19992017. (U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics.)

Summary Due to a misplaced emphasis on “utilization” (for which there is no industry standard definition) rather than on outcomes, millions of employees and their families are insufficiently engaged and inadequately treated...while employers spend millions of dollars on programs that limit meaningful engagement and intervention by their very design. Next-Gen EAP focuses on proactive and continuous engagement. It leverages technology to extend EAP expertise and support to workforces around the globe, while it also guides individuals to connect directly with a trained professional to resolve personal challenges. It also affirms new ways of thinking about mental health and wellness. For instance, an increasing number of new health companies are encouraging people to think and talk about nutrition as a problem of personal technology, where losing weight isn’t about self-deprivation, but about optimization. Ultimately, all roads lead to one overarching idea: Your EAP is only as good as its results in in demonstrably improving performance and productivity at all levels of the organization.

Sharar, D.A. (2019). Journal of Employee Assistance, 49(2): 10-13, 33.

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

Feedback on this article is welcome by emailing journal@eapassn.org. v Susan Skinner, MS, CEAP, is the founder, CEO, and president of Personal Assistance Services (PAS) in St. Louis, MO. She may be reached at spskinner@paseap.com.

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as a tincture at nine state-approved pharmacies around Louisiana. The Americans with Disability Act is a federal law prohibiting discrimination against those with disabilities on the job and in the public sphere. Louisiana disability law does not carve out medical marijuana use as protected at this time, but it may happen in the coming years, panelists said. More info at https://bit.ly/2sCJmOQ.

“The question of ‘Does diversity training work?’ sets up a false dilemma,” said Eden King, an associate “professor of psychological sciences at Rice and one of the authors of “Examining Why and for Whom Reflection Diversity Training Works,” which appeared in a recent edition of Personnel Assessment and Decisions. “Asking this question is setting up whether something works or doesn’t, but diversity training isn’t an either/or issue — there are many shades of gray and factors that must be considered,” King continued. “By saying, ‘Here’s a one-hour session that will solve everything for everyone,” companies are really oversimplifying a complex topic, and as a result, some people stop listening altogether — and that’s the last thing you want to have happen.” The researchers did find some evidence that racial sensitivity and other diversity-related issues can be improved through training, but King noted that the issue is not as simple as determining if training works — you must also understand why and for whom it is effective.

The Difference between a Resolution and a Goal Happy New Year! Many individuals are entering 2020 with optimism and are undertaking a resolution. The desire to improve is laudable and should be encouraged. But what’s the best way to approach growth? Hyatt-Fennell suggests preparing for success by measuring goals with these three guidelines:  Measurable. Make your goal specific. How will you know when you’ve achieved your objective? Be concrete and write your goal down.  Reasonable. Choose an incremental goal. It’s probably not realistic that you’ll become fluent in Mandarin this year, but perhaps you could use a language app twice per week to grow in your conversation skills with your overseas colleagues before the international symposium next year.  Iterative. Set monthly reminders in your calendar to check in on your goal. Don’t be afraid to adjust your expectations or redouble your efforts as the year moves on. The goal is progress, not perfection.

Stop Saying You’re ‘Busy’ We would all be happier if we stopped using “busy” to describe ourselves and our lives. According to Megan Wycklendt, author of, “Six reasons you’d be happier if you stopped saying ‘busy,’” here are three things that being “busy” does.  It keeps you from being present. Being busy implies that you are preoccupied. As soon as the word “busy” comes out of your mouth, life instantly becomes more hectic! Instead of enjoying the present moment and your surroundings, the only thing you are doing is running through a to-do list in your head.  It disconnects you from other people. “I’m too busy.” Even saying the word makes me feel stressed and disconnected. Saying you’re too busy is like telling the other person they have too much time. It can be demeaning and come off self-centered, even if you are in fact “busy.”  It doesn’t accurately portray your life. Summing up your life as “busy” doesn’t say much. If you need to sum your life up in one word, try using the words “active,” or “involved.” These words have more positive connotations, and many times it’s what you mean anyway. v

Rethinking Diversity Training Within the past couple of years, Starbucks and Sephora have come under fire for racial insensitivity. They responded to the criticism and negative publicity by closing their stores for companywide diversity training. But does this type of training actually work? The short answer is yes, it can, but new research from Rice University finds that factors such as personality type and personal circumstances must be considered when determining what type of training to offer or how the training should be administered. 35

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