7 Attributes of an Effective EAP

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7 Attributes of an Effective EAP

In all the talk about standards, core technology and return oninvestments, key EA strategies are lost in the fog. Let’s get back to the

basics.By Kirk C. Harlow, PhD

Employee assistance programs are as varied as the organizations they serve: Someprovide assessment and referral only, some deliver services encompassing the fullrange of core technology, still others offer brief counseling. Two EA professionalorganizations, EAPA and EASNA, have developed standards for the field, and a numberof groups have embarked on accreditation of programs.

Nonetheless — despite extensive discussions of standards, core technology and returnon investment — it seems some basic practices, key strategies for providing effectiveEA services, have been lost in the shuffle. Drawing together the lessons of practice andresearch, however, can provide us with seven key attributes of an effective EAP.

1. Know the organization

Organizations are a lot like people — they come in different flavors. To address theneeds of the organization and its employees, you must understand the character of the organization. Among the questions you should be able to answer are: What are theprinciple aims of the organization? What are the types and responsibilities of the jobsin the organization? What values does the organization embrace? What is the structureof the organization?

This knowledge, along with comprehension of other organizational information, isessential to putting EAP services into a context. Too often employees are seen as if

they come to the EAP out of nowhere, when in fact they wear their organization’smantle into the room. And supervisors’ confidence in an EAP is directly related to abelief that the EA professional understands the company’s situation.

2. Embrace All Customers

EAPs serve a variety of customers, including line employees, supervisors, humanresource professionals, legal staff and senior management. The effective EAP mustunderstand and address the different needs of these groups. Often their interestsconverge. For example, both the supervisor and the employee will want theemployee’s depression addressed, although it may be for different reasons.

On the other hand, senior managements’ concern for the bottom line may push EAP

services into a role as little more than the managed behavioral healthcare gatekeeper. The legal staffs’ orientation toward reducing risk exposure may constrain thenecessary partnership between the EAP and supervisors.

Accommodating the disparate interests of these stakeholder groups may be aSisyphean task. The effective EAP can, however, use an understanding of stakeholderperspectives to create strategies to influence beliefs and strengthen a focus oncollaboration.

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3. Be Visible

Common sense tells us that to be effective, an EAP must be seen. Attitudinal researchhas shown that the visibility of the EAP not only increases utilization, but alsoincreases the perceived value of the program among those who have not used it.

Lessons from advertising suggest that someone must be exposed as many as six timesto a message before it has an effect. In addition, the message must continue to bevisible, or its effect will deteriorate. Being visible should go beyond the commonpractices of brochures, payroll stuffers, training, and Web sites. The goal of visibility isto make consulting the EAP one of the obvious choices on relevant problems.

Many EAPs also participate in safety meetings, or in supervisory and managementtraining programs conducted by training staff. Others create advisory boards and buildrelationships with company decision-makers. An effective EAP insinuates itself as fullyas possible into the culture of the organization.

4. Be Empowered

Empowerment is, in many ways, a precursor to the first three items on this list. Beingempowered is being imbued with the sense that the actions needed to be an effectiveEA program actually can be carried out. It is the willingness to take risks necessary toaccomplish EAP goals. Empowered EAPs have faced down corporate counsel bybringing in outside attorneys to offer alternative interpretations of the law. Othershave carried out interventions on CEOs with substance-abuse problems, even at therisk of losing jobs or contracts.

EA professionals are change agents. Targets can run the gamut from assessingemployee needs of and setting the process in motion to addressing a dysfunctionalwork group to participating in the development of organizational strategy. For an EAPto be empowered and sit at the organizational table, it must develop legitimacy. How

does that happen? By demonstrating competency in both employee assistance andbusiness.

5. Be Data-Oriented

Businesses love data. They especially love pie charts, bar graphs and flow charts. Theeffective EAP must understand that data-oriented presentations are the lingua francaof business. Data-heavy reports and presentation are as important for the image theyconvey as they are for the information they present.

But being data-oriented is not just for dazzling decision-makers. It is a means forimproving the effectiveness of the EAP. Even limited EAP data-sets, with informationsuch as client age, gender, department and problem type, can provide important

insight. Comparing utilization rates for specific problems to expected rates based onpopulation research can tell you if there may be unmet needs among your employees.Looking for problem patterns among different employee cross-sections can help you toidentify areas to target interventions. Surveys of various customer groups can tell youabout the effectiveness of your marketing efforts or underlying resistances to EAPusage.

To be data-oriented means to bring scientific evidence into decisions, not justanecdotes. Evidenced-based treatment — in which practice guidelines are used to

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define the elements of effective treatment of psychological problems — areincreasingly available. The challenge to the effective EAP is not to just know theevidence, but also to be an advocate for the availability of effective treatment.

Valid screening instruments used as part of assessment help accurately identifyproblems. These tools also help ensure that EAPs do not overlook the fact that

individuals can bring more than one problem with them, for example psychiatric co-morbidity with substance abuse or substance abuse with marital problems. Screeninginstruments also establish a benchmark for determining if a positive change hasoccurred.

Finally, being data-oriented means contributing in whatever way possible to researchthat advances the quality and effectiveness of EAP practice. Participation may be assimple as contributing information to a wider data-set, or it may involve undertakingscientific research within the EAP.

6. Facilitate Early Identification

Research has indicated that the longer a problem goes on, the more severe it will get,

and the more it will cost the organization, as well as others outside of the organization.Some of the costs to the organization may include higher health-related costs, lostproductivity, and losses from accidents and injuries.

Early problem recognition involves specific actions to identify and motivate individualsto come to the EAP in the early stages of problems. A number of organizations recentlyhave implemented early identification processes for depression and substance-abusescreening, often using Web sites to provide the screening instruments.

The screening efforts noted above are important elements of the process, but they are just a beginning. Research indicates that incorporating screenings into the annualphysical exam, combined with the referral of the physician, can motivate individuals to

seek mental-health and substance-abuse treatment. Substance-abuse and mental-health screenings could be integrated into the health screening used at healthfacilities. Effort can be made to inform and instruct family members and co-workersabout methods to encourage others to contact the EAP.

In sum, one goal of the effective EAP is to increase the means by which those in needare encouraged to use the EAP before the problem becomes serious.

7. Be a Learning Organization

Make learning an integral element of the organization’s culture. The goal of learningorganizations is to strengthen individual and organizational competence to accomplishstrategic aims, innovate, renew and shape the future.

There are two sources for learning: First are outside sources such as continuingeducation, books, journals and computer-based training. In most instances, thesesources are focused on developing individual competencies. They do not, however,create a common body of knowledge in the organization or the cross-fertilization of ideas. It is possible, of course, through the involvement of entire work groups inlearning processes, to bring about more organization-wide learning. Organizations, forexample, carry out organizational development and internal-training programs. Someeven have started organizational book clubs.

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The second means of organizational learning is often called knowledge management. This is the process of taking knowledge from across the organization and making itavailable through data systems to all members of the organization. One aspect of thisprocess, knowledge engineering, involves identifying best practices, whether individualor organizational, and articulating the processes. For example, an organization maydescribe the process by which a high-performing individual is successful at creating

follow-through on referrals.

While learning organizations must have sources of learning, they also must havemechanisms for turning learning into actions that strengthen use of competencies,innovation, renewal and strategy development. For example, self-directed work teamsare one often-recommended approach. Regardless of the organization’s structure,learning organizations must enable communication that effectively flows upward,downward and laterally. Importantly, learning organizations must value informationirrespective of the source.

The effective EAP should be a learning organization for several reasons. First,continuous improvement can only come through continuous learning. Second, for mostpeople learning is like a form of fuel: Without it, people become complacent or burn

out. Third, learning not only enables the EAP to adapt to change, but it gives the EAPthe competence to define the future.

There is little doubt that every reader could add to this list. I encourage you to do justthat. It is my view that every organization should take time away from the day-to-dayoperation for reflection on its guiding principles.

Kirk Harlow, PhD, is president of DecisionStat, a human-resource consulting firmwith specialization in EAP evaluation, quality improvement and survey-based feedback systems. Harlow has been involved in the EA field for more than 15 years and has

published numerous articles on EAP evaluation. He can be reached at [email protected].

(Winter 2002)

Treatment Bias?

Advocates say discrimination against people in recovery is rampantBy Bob Curley

People in recovery face discrimination in the workplace, health care and everyday life,and litigation may be the only way to force changes in some cases, experts told apanel convened at the annual meeting of the American Bar Association (ABA) inWashington, DC.

“Where are the lawyers?” asked Deb Beck, president of the Drug and Alcohol ServiceProviders Organization of Pennsylvania, who charged that managed-care firmsroutinely violate the minimum insurance laws on the books in 40 states, includingPennsylvania.

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“Managed care has to be taken to task,” Beck said. Pointing to efforts to pass lawsrequiring addiction to be treated on par with other health conditions, she added,“Parity won’t solve that; it will be just another type of coverage to be denied ... Wedon’t need parity; we need people to enforce the laws.”

Beck was among more than a dozen advocates who presented testimony before a Join

Together’s Policy Panel on Discrimination Against Individuals in Treatment andRecovery, cosponsored by the ABA.

“This is an issue I unfortunately have encountered from time to time, both personallyand in my professional life,” said Alfred P. Carlton, president-elect of the ABA. “Wemust work to end discrimination of any kind, but especially for people seekingtreatment for addiction. It’s a disease and should be treated as such.”

Former First Lady Betty Ford said that while up to 80% of Betty Ford Center clientsused to be able to pay for their treatment through insurance, today just 20% to 25%can access their insurance benefits. Not even lawyers are immune to addiction-relateddiscrimination, she added.

When the Betty Ford Center recently tried to set up a residential treatment programfor lawyers, doctors and other professionals, nearby residents picketed and told clientsto go home. “They threatened to videotape our patients going to and from the homesand make public their tapes,” Ford testified. “The ignorance and hate were surreal. Afew residents stood up and spoke in our support, but were shouted down. So, the BettyFord Center, maybe the best-known treatment center in the world, has to findalternative housing for our patients.

“NIMBY is alive and well in 2002,” said Ford.

Robert Newman, MD, director of the Baron Edmond de Rothschild ChemicalDependency Institute at Beth Israel Medical Center in New York, said that people with

addictions are “subjected to conditions that would be unthinkable in any other medicalpractice,” such as having their medication levels capriciously reduced or eliminated, orbeing told to deal with their problems through behavior modification rather thanmedical intervention.

“You’re talking about horrid malpractice of medicine,” said policy panel member LisaMojer Torres, a New York attorney who represents clients with opiate addictions.

Brent Coles, the mayor of the city of Boise, Idaho, agreed: “When you have a 16-year-old with a chronic, acute disease, we would have to find her treatment if she haddiabetes,” he said. But 90% of Idaho cities offer residents no access to addictiontreatment, said Coles. Even Boise, with its 200,000 residents, does not have a singledetoxification center, he said.

“Eighty-five percent of narcotics addicts in US have no access to methadonetreatment,” added Newman. “My doctor can treat a patient for pain relief withmethadone, but if he does so for addiction, it is illegal.”

Newman said that the only hope for fighting such discrimination is through litigation.

‘Hysterical Terminations’

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Having a drug arrest on your record or a history of addiction also dogs people inrecovery in the workplace — even after years of sobriety.

Susan Rook, director of communications and outreach for the advocacy group Facesand Voices of Recovery, said a recent Peter D. Hart survey found that one in fourpeople in recovery have experienced discrimination in the workplace or in seeking

health care, and one in five fear being fired if their employer finds out they are inrecovery from addiction.

Citing a pattern of “systematic and illegal discrimination against people who are inrecovery,” Rook said, “When personal prejudices influence my ability to get a job,receive an earned promotion, get and keep health insurance, life insurance, housingand other basic benefits of being a member of a community — then someone else’sopinion of me matters. And that personal prejudice is not merely stigma ... (it’s)discrimination.”

Rook stressed that despite the risks, it is important for people in recovery to speak outagainst violations of their basic civil rights. “It’s not just about what other people say,but what those of us in recovery don’t say,” Rook testified. “The public silence of

people in recovery speaks volumes. Our silence says to others that we have somethingto be silent about. By our silence, we let others define us.”

Adele Rappaport, a lawyer in the Detroit office of the Equal Employment OpportunitiesCommission, said that people with addictions are frequently the target of “hystericalterminations.” She told the story of a client who told his employer that he neededaddiction treatment, and instead was fired for violating the company’s zero-tolerancepolicy. “What kind of personnel decision is that?” she asked.

Unfortunately, the Americans with Disabilities Act (ADA), which ostensibly providessome protection for people with addictions, provides little help. Rappaport estimatedthat 95% of people with addictions fail to meet the ADA’s standard for disability (e.g.impairment of a major life function), while others run afoul of the law’s exclusion of coverage for current users of illicit drugs.

Nonetheless, addiction remains the most common personnel problem in mostworkplaces, accounting for 20% of voluntary employee assistance program referralsand 50% of supervisory referrals, according to Dorothy Blum, vice president of theEmployee Assistance Professionals Association. Employers should be warned thatdiscriminating against people with addictions not only will harm their bottom line in thelong run, but also opens companies up to litigation, said Blum.

The workplace woes experienced by people with addictions are compounded in manycases by a criminal record, which makes finding a job even more difficult.

“Many ex-offenders with drug-related offenses are also currently in recovery ortreatment. Logically, their ability to truly recover and move on in their lives is directlyconnected to their ability to obtain and maintain employment,” said Robin Runge,coordinator of the program on women’s employment rights at the D.C. Employment

Justice Center, during her testimony before the policy panel.

But Runge, who works with ex-offenders trying to get jobs, said having a criminalrecord is often the primary barrier to employment for people in recovery — especiallywith the increase in the use of criminal background checks after 9/11.

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“For example, I had a client who was a teaching assistant in the D.C. public schools forover a year when a background check showed that she had been arrested over 20years ago for drug possession,” said Runge. “Although the employer knew about thisarrest when she was hired, they used this background check as a basis to fire her.”

In a recent survey, 59% of California employers said they would never hire anyone

with a felony drug conviction — even though such discrimination is illegal in mostcases.

“We need to help employers understand that hiring someone with an arrest from 10years ago is no more risky than hiring someone without a criminal record,” said Runge.“In fact, they may find that the employee with the record is harder working and morecommitted.”

(Winter 2002)

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Leadership Lacking?

EAPs can help instill integrity in an era of ethical scandalsBy William G. Durkin, PhD, MBA

Is leadership lacking in the executive ranks of America’s corporations? With recent andcontinuing accounting scandals, some would suggest that that’s the case, and that wehave lost our way. With increasing skepticism of corporate honesty and integrity, newemphasis will be placed on regulatory issues. But is that enough?

Not quite. Corporate management must rekindle its emphasis on “doing the rightthing” even when nobody is looking — and there are few within organizations that canbetter enable this than employee assistance professionals.

The lost trust of the American public, and particularly investors, must be repaired. The

ideals of honesty, integrity and good character, so much a part of the fabric of ourbusiness ethic, even today, must be reemphasized at all levels of the corporation. Thevast majority of businessmen and women adhere to a strong code of ethics. CEO’s andboards of directors need to demonstrate and reinforce the fact that nothing less isexpected.

Encouraging Ethics

Once a valued perk in the senior management suite, executive coaching has beenrapidly embraced as a developmental tool for other levels of management.

Executive coaches, in addition to helping clients hone management skills, have

traditionally placed a focus on emphasizing the integrity of individual behavior and, byextension, the integrity of the organization. Forward-looking companies increasinglysee the advantages of offering individualized and personalized assistance toexecutives who they see as having solid but yet-unmet potential.

Unlike mentors, coaches are frequently drawn from the outside and provide support onlifestyle, management style and business issues. They act as a detached observer andadvisor in helping individuals meet their personal and professional goals.

Executive coaching has been around since the 1980s, when it first became popularwith executives looking to increase their skills and to attain more responsibleleadership roles. Some need help with administrative skills such as time management,others need help learning how to manage people, and still others need a sounding

board to work through difficult ethical issues. Even skilled managers, like skilledathletes, use coaches to improve their game.

Coaching at its core is getting help when you need it and want it. The executive coachis part personal consultant, part sounding board, and part manager, free to givehonest opinions and sometimes hard advice.

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As an EA professional, if you noticed a ring of familiarity with the description of theexecutive coach, you should. It describes the relationship that EA professionalsfrequently have with clients.

The Role of EAPs

EA professionals work with clients on personal problems and issues that have thepotential to impact performance. The pressures and confusion that accompanypersonal problems can often lead a person to rationalize or compromise and makedecisions that they would not make under less stressful circumstances.

The EA professional is often in a position to clarify issues and define appropriatebehavior during these difficult periods.

Many companies have downsized or merged with other companies, creating leanerstaffs with as much or more responsibility and looking to grow profits even further.Some of the resulting pressures have contributed to ethical lapses we are witnessingtoday. Often faced with competing priorities and demands, executives, like mostpeople, can confuse their priorities and make decisions that, in today’s environment,

can not only cause them significant personal harm, but place the company atsignificant risk.

The EA professional as a coach can offer a more objective and stabilizing view of whatis important and “right” in the decision-making process. Companies must devote moretime and energy to developing staff and creating a culture where ethical behavior willalways be the road traveled.

In this regard, the EAP can play an important role as part of a company’s overall risk-management strategy.

Coaching the Staff

A coach ideally is a trusted friend and ally. Personal issues, in addition to businessissues, are not out of bounds in a coaching relationship since both affect each other. Acoach should be able to give advice and guidance through understanding the needs of the person being coached and the dynamics of the organizational environment.

The coach should understand the language and dynamics of business. The coachengages the individual and listens. A coach leads the person to frame his or her issuesin a way that leads toward manageable change and then employs methods andstrategies to help that person achieve the needed change.

Coaching is an ongoing alliance between coach and client within a supportiveorganization. A coach is a safe ear for the client, allowing an immediately available

sounding board and opportunity to reality-test ideas, anxieties and plans. Thisaccelerates the learning process and behavior change through frequent feedback andinsight.

There are few in an organization that can fill this coaching role better than EAP staff.EAPs can use internal staff or, when that is not possible, select outside coachingresources.

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Confidentiality, always an issue in EAPs, also is an issue in coaching relationships. It isbest handled by clearly defining and agreeing on what type of information, if any, willbe shared with the organization. There should be no hidden agendas.

And high on everybody’s agenda today must be the reaffirmation of a commitment toprincipled behavior in business. The EAP is certainly one of the already existing

corporate vehicles that can play a significant role in that task.

Bill Durkin PhD, MBA, formerly EAP manager for ARCO, is president of WGD Associates, Executive Coaching. He can be reached by phone at 818-790-4903, by e-mail at wdurkin@wgd associates.com, or www.wgdassociates.com.

(Winter 2001)

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Trek to Ground Zero

Tennessee EAP team helps soothe trauma after Trade Centerattacks

By Jenny Nash

Like almost every other American after the terrorist attacks on Sept. 11, DougAndreasen wanted to help in some way. Andreasen — an employee assistanceprogram (EAP) counselor at St. Mary’s Assist in Knoxville, Tenn. — realized that he andhis fellow EAPs possessed skills that could help people deal with the emotionalaftermath of the attacks.

Andreasen, who is trained in Critical Incident Stress Debriefing (CISD), also is vicepresident of the East Tennessee EAP Association chapter, which had been wondering

how to best spend several thousand dollars in its treasury. Andreasen suggested thatthe chapter sponsor a volunteer CISD team to go to New York City.

"If we were saving it for a rainy day," Andreasen said, "it rained on Sept. 11." He ranthe idea by the executive committee and chapter members, then sent an e-mail toEAPA national headquarters. He got the green light on Friday, Sept. 14, and on Sundayat 6:30 a.m., Andreasen and four colleagues headed up Interstate-81 en route to New

York City.

On the drive, the five-member team went over the profile of the company they wouldbe visiting, its locations, any CISD services that had already been provided, thenumber of employees and the range of impact the attacks had on them. Some

employees’ coworkers had been killed, others had lost friends and family members inthe attack, and some had children in schools close to the World Trade Center. Manyhad been working blocks from the attack and watched as planes flew into the towersand people jumped to their deaths.

As the team approached from New Jersey, 13 hours later, members got their firstglimpse of Manhattan’s altered skyline.

"The southern third was dark; no lights shone from the buildings. There was, however,an extremely bright, white light coming up from the ground illuminating a column of smoke that rose a thousand feet into the air, Ground Zero," Andreasen said. "We wereall quiet for a moment. It was real and much bigger then we had realized."

A policeman stopped the car as they exited the tunnel into Manhattan, shone aflashlight inside and then waved them on. But the siege atmosphere didn’t stop there.All trucks were stopped and searched before they could enter the city. There were atleast two police cars on every block, and Humvees and troop-filled trucks traversedManhattan.

As the group checked into the Hilton at 52nd Street and Sixth Avenue, the site of theNational EAPA conference in November 2000, soldiers in camouflage fatigues alsowere checking in. The hotel was filled with Federal Emergency Management Agency

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workers, Centers for Disease Control personnel and emergency response teams fromthe Army Corp of Engineers. "It was quite a contrast from the conference just 10months earlier," said Andreasen.

That evening, the Tennessee team took a walk down Sixth Avenue.

"Spontaneous memorials were everywhere, in Times Square, on the side of a pizzashop, under a stop sign, on the sidewalk," Andreasen said. "Flowers, candles, postersdrawn by children, and missing person fliers, thousands of them, taped to everything."

Over the next two days, the group met with almost 200 employees. Originallyscheduled for one company, they visited two companies — an advertising agency with200 employees and a global mail and document services firm with 280 workers — atsix different sites. The team’s services were requested by the company that providesEAP and behavioral health services for both firms, and they worked closely with theEAP manager while developing a critical-incident management plan.

Team member Vicki Thal, an independent EAP practitioner, said that although New York City has a legion of individuals and agencies trained to respond to traumatic

events, the magnitude of the disaster warranted a need for many more providers of CISD services. In addition, existing providers "were as much of a victim as the victimswere," Andreasen said. "If you’re an EAP in Manhattan, it’s kind of tough to tell who’sthe patient and who’s the counselor."

"On the Monday New York City employees returned to work, there weren’t enoughcounselors available," Thal said. "National EAPA sent out a national request for EAPsavailable to help out — and we responded."

The employees shared experiences and presented needs as varied as the city itself.

Working at different sites alone, in pairs and trios, the team met with people in small

groups, determining which employees might need more help than others and meetingwith those people one-on-one. Team member Vicki Thal, an independent EAPpractitioner, walked through the companies’ offices and talked with people to let themknow assistance was available.

"We were there on the first official day back to work for New Yorkers while the traumawas still unfolding and different people were still in the crisis phase," said teammember Shoray Kirk, an EAP counselor. "What we did, for the most part, was a lotmorefluid, flexible — more like educating, consulting, coaching and comforting — thanthe structured, one-size-fits-all approach of formal CISD model."

The five counselors had previously conducted critical incident stress debriefings withpeople who witnessed coworkers burned or crushed to death, drownings,

electrocutions, as well as numerous other horrible events. But, as Thal put it, "Neverhave I had to meet with so many people whose sense of safety had been damaged ordestroyed."

The group heard horrific stories the likes of which they’d never heard before. Williamscontinues to think about the regional sales manager who went back to work on Sept.13, and instead of watching the sun rising over the World Trade Center as he usuallydid, he watched it rise over a mountain of rubble.

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The manager brought in a woman who had been temporarily reassigned to thecompany’s Long Island office because she kept having flashbacks of people jumpingfrom the towers. She didn’t know when she’d be able to return to Manhattan.

"Another woman, the mother of an 11-year-old girl, was worried about her daughter,who was having nightmares, wouldn’t sleep in her own room and wouldn’t let her

mother out of her sight. The girl was literally following her mother from room to roomin the house. The mother was exhausted from being awakened at night, trying to workand managing her own anxiety," said Williams.

For most of the employees who were in Manhattan at the time of the attacks, theworld had shifted beneath their feet. Not only had they witnessed the terrible eventsfirst-hand, trying to make sense of what they’d seen, but they spent the rest of the daysimply trying to get home or to a safe place.

Andreasen saw one young man who, after wandering downtown for hours after theattack, had walked several miles from the Trade Center to the Upper West Side of Manhattan, where he heard about a ferry he could catch home to New Jersey. Hewaited three hours for his turn to board.

"When it reached the other side of the Hudson, he was met by men in full biohazardsuits and had to run a gauntlet of fire hoses spraying decontaminate on him,"Andreasen said.

It illustrates, he said, how completely the attack changed people’s perceptions aboutthe world around them, how nothing could be assumed to be safe.

In helping people cope with these anxieties, Thal found that focusing on day-to-day lifehelped. "When folks seemed stuck with an unyielding sense of doom, they appeared tobe concentrating on the global aspects of the attacks," she said. "Focusing on a morepersonal area of their lives seemed to provide relief."

Another comforting fact for people, Thal said, was that the team came from Tennessee.

"They thought, if people in Tennessee experienced anxiety and were having a difficulttime comprehending what happened, then it made sense that the people whose citywas attacked would experience more anxiety and struggle more with their sense of safety," she said.

Kirk found that the Tennessee connection had another benefit: "The fact that we cameall that way to help touched them."

The five volunteers in turn have been touched by their experiences in New York City.

"We all were impressed with the resilience of New York people after their city wasattacked," Thal said. "It gave me a renewed faith in mankind’s ability to moveforward."

The group also has gotten a few lessons about providing critical incident stressmanagement on such a large scale. Thal says that, in this type of crisis, the debriefersneed to make sure that they get debriefed too.

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"As EAPs, we’ve learned about operating in a new area of traumatic events, and I’velearned that following CISM services, my emotions have been impacted too," she said."We debriefers go through stages similar to those who have experienced traumaticloss — although the stages are certainly not as profound."

Jenny Nash is a Tennessee-based writer and editor.

(Winter 2001)

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Surviving ChaosManagers can take action to get through moments of crisis

By Deb Clifford

Thousands of businesses across America, if not the world, were stunned by theterrorist attacks on the World Trade Centers in New York and the Pentagon inWashington. When I heard the news, I was just starting a management developmentclass for a financial services client. Needless to say, nothing prepares you for leading,guiding and facilitating a class about personal and professional growth in the midst of such a crisis.

We were all in shock. My head spun, my stomach turned and my knees weakened.What to do? My 15 participants were looking to me and I was in shock just like they

were. Together we decided to break for 90 minutes to take care of the importantthings like calling to check in on our families and loved ones. We needed this time tocollect ourselves, see and hear what was happening and try to gather our senses.

As a corporate leadership consultant, I knew that this terrible tragedy would put myskills to the test. Along with the participants, I quickly created a plan that would helpus all make it through the attacks and following chaos. The following tips can helpmanagers of all types of business make it through periods of crisis:

BE — Be with each other, be genuine and vulnerable. Don’t try to pretend things arenormal, they aren’t and they will never be the same again. One of the people in myclass remarked, "If we cancel class, they win." We all agreed. We moved forward, stillnumb, but going forth together. As we continued with the class, some felt a bit

empowered that we were prevailing despite the terrible tragedy.

DO — Gather to collectively "do" something, feel enabled by gathering supplies, givingblood, writing letters. Company-sponsored blood and food drives are a positive move,action in which many employees find comfort.

SHARE — Share your feelings, bring human intimacy to each other. We started ourclass by talking about how we felt and sharing our feelings. To start withoutacknowledging or recognizing our fears, anger and confusion would be untrue to usand dishonor the situation and those affected by it. I began by calling the classtogether and stating my vulnerabilities as a class facilitator. I said: "Please help me.None of us know exactly what to do, so hear my idea and work with me and we’ll getthrough this."

CREATE — Create rituals to stay connected: music, moments of silence, candlelighting. I started the second day of the class with a reading of a song from the musicalGodspell: "Out of the ruin and rubble, we can build a beautiful city." We then shared amoment of silence.

REMEMBER — Commemorate this time, wear ribbons, create a mural or an area of remembrance within the workplace. Soon after the attacks, politicians and businessleaders began wearing red, white and blue ribbons on sport jackets and blouses.

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Symbols can be very powerful, and even the smallest token can bring huge amounts of comfort to those who are suffering.

LISTEN — Understand, listen and give people the time and space to deal with theirgrief. During the classes, I’ve reminded students that it’s extremely important that weall be honest and share thoughts about the events of the day and listen to what we’re

each saying.

CONNECT — Connect with each other with much care — be more patient in that line,speak more softly, counter the anger within with love and kindness at everyopportunity.

We have the courage and freedom to work through this terrible time in our nation’shistory and our workplaces are the perfect settings for the love and support that weneed to do just that.

Deb Clifford is the founder and president of Inspired People, a leadership consultingcompany in Simsbury, Conn. She can be contacted by e-mail at

[email protected] .

(Winter 2001)

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The AftermathEmployers can provide long-term support after world-altering events

By Laurie Martin, CTS

Sept. 11, 2001. That’s the day we stopped taking things for granted — like our abilityto feel safe and free in the world as we knew it. That’s the day we started feelingvulnerable in our homes and workplaces. It’s the day we all became victims of terrorism.

Months later, with the horrific images of loss and destruction embedded in ourmemories, many are still searching for a new sense of normalcy as we fear thepolitical, social and economical uncertainties of the future.

Following any traumatic experience, there’s a period of grieving as we mourn ourlosses. That’s when productivity, morale, and relationships at work and at home maysuffer.

That’s when it’s important to provide support. Open and honest communication helpsto build workplace camaraderie – and that means happy, healthy and motivatedworkers. It may also minimize expenses related to short- or long-term absences, lowproductivity or hiring and training costs if employees leave.

There are many ways you can support your employees through this or any criticalincident. Here’s how you can help send your employees the message that you do care:

• Encourage open and honest communication about the incident and howit is affecting others.

• Watch for signs of stress like: insomnia; lack of energy; loss of appetite orover indulging in food, drugs, alcohol or tobacco; headaches; stomach aches;etc.

• Provide assistance to individuals and groups who are having difficultycoping.

• Take a ‘proactive’ role by offering workshops or information sessions onthe topics of trauma and grief.

• Encourage your staff to talk openly with their families and friends. Unlessyou ask, you may not know how your children or teens are feeling.

If anything good could ever come from such horrendous acts of terrorism, we mightacknowledge the way people everywhere have pulled together. Perhaps we treasureour families and friends more. We may have come to realize how patriotic we areabout this great continent and even gained a new respect for our leaders.

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Perhaps we can find some peace of mind in the additional safeguards beingimplemented at borders and airports. Or maybe there’s a stronger feeling of camaraderie and safety at work.

Laurie Martin, a principle of TERMS Inc. (Trauma Education Risk Management Services), is one of only a handful of certified trauma specialists in Canada. She can be

contacted at 519-836-6878 or [email protected].(Spring 2002)

Eldercare: The New Frontier

EAPs respond to the needs of aging

By Bob O’Toole, MSW and Mary Lynn Pannen, BSN, CCM

A baby boomer will turn 55 years old every seven seconds for the next 20 years, and

their parents are living longer than any generation in history. In fact, the fastest-growing age group in our society is not all those babies in strollers — it’s people over85 years of age.

This longevity can be a mixed blessing. While new medications, technology andsurgical procedures have prolonged lives, they also have created unprecedenteddemand among the elderly for assistance to get through each day — bathing,dressing, mobility, toileting, managing money, shopping, cooking and cleaning.

Caregiving takes a heavy toll on work and family life, and employers nationwide areseeing their bottom lines affected by America’s aging. Among those who haveprovided hands-on care, 67% reported it has significantly affected their family life, and

41% said it interfered with work. More than 10% of those who have provided long-termcaregiving said they had given up promotions or jobs as a result. According to anAugust 2001 AARP survey, 44% of the nation’s 76 million baby boomers, ademographic bubble born between 1946 and 1964, have responsibility for both agingparents and children.

Trying to manage the care of aging parents or a disabled family member while tryingto meet work and family responsibilities is a challenge that faces a rapidly growingsegment of our population. Exacerbating the challenge are societal changes that havealtered the structure and roles of the American family, including the movement of women — traditional at-home caregivers — into the workplace since the 1970s, thegrowing number of single-parent households and increases since World War II in thegeographic distance between adult children and their parents, which has created a

new generation of long-distance caregivers.

In response to this growing dilemma, employee assistance programs are increasinglybeing called upon to provide innovative and comprehensive approaches to helpworkers cope with caring for their elderly relatives.

A Shared Problem for Workers and Employers

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As the phenomenon of working and long-distance caregiving continues to grow,employers are learning that this has an impact on their bottom line. Recent studiesfunded by AARP, The National Alliance for Caregivers, MetLife and The NationalAlzheimer’s Association estimate costs of this burgeoning crisis to employers to be asmuch as $31 billion annually. This cost will increase significantly over the next twodecades.

Research shows that the impact that eldercare responsibilities has on the workplacefalls into six major categories:

• Replacement costs for employees who leave due to caregivingresponsibilities.

• Increased use of sick leave and Family Medical Leave Act time to care for anaging parent.

• Presenteeism: Costs due to workday interruptions while the employeecontacts doctors, home health aides and other paid caregivers.

• Costs associated with supervising employed caregivers.

• Lower productivity due to high rate of stress-related disorders among workingcaregivers.

When a working caregiver tries to contact local social service or health care agenciesfor help they discover that a frightening phenomenon is emerging in America; whilethe population of frail older persons is growing steadily, the care and services availablefor them is shrinking rapidly. Steep cuts are occurring in the once generous Medicarehome health care benefit. With billions of federal dollars now needed to pay for thewar on terrorism and to strengthen our economy by supporting critical industries suchas airlines, funds for social and health care programs for frail elders will continue to

grow scarce.

Third-party insurance, including Medicare and retiree health benefits, rarely pays forthe costs of functional and custodial services needed by frail elders.

Once working caregivers recover from the shock that Medicare and other retireehealth care insurance covers little of the care and support needed by their parents,long-distance caregivers and those with demanding jobs who live closer must searchfor help elsewhere. To respond to the growing need among working caregivers, EAPsmust develop innovative and comprehensive responses for their clients.

EAPs Respond

How do EAPs develop an effective workplace response to caregiver stress, at a timewhen corporate budgets are growing tighter and employee health benefits areincreasing at a double-digit rate?

To offer employers an integrated service product that covers the mental health,resource, informational and service needs of employees, EAPs should explore thepotential of working jointly with a network of professionals who can offer theireldercare expertise in a cost-effective manner. Such an arrangement adds a powerfulnew capacity to respond to a workplace crisis and relieves the employer of the

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confusion and frustration of retaining multiple providers to respond to employee work-life needs.

Once a luxury that only large national corporations could afford, eldercare benefitsprograms now come in a variety of formats with services as simple as toll-free callcenters and Web sites with information about local eldercare program. Employees also

have access to a growing list of services, discounts, and even assistance byexperienced professional geriatric specialists. Several private work-life companies,originally established to provide child-care services, now offer a selection of eldercarebenefits. A more cost-effective alternative is emerging, developed by consortiums of eldercare providers nationwide.

Affordable Expansion Of Eldercare Services

Joint ventures between EAPs and for-profit and non- profit eldercare specialists reduceoverhead and development costs while keeping the EAP as the coordinator of abroader range of critical responses to workplace stress. Cost-sharing models allowsponsoring companies or organizations to pay a modest monthly fee per employee ormember to help their employees and to minimize the lost productivity and profits that

are the side effects of caregiver stress. Integrating such voluntary benefits asemployee-endorsed long-term care insurance can further reduce the costs of eldercareservices to employees and their families.

Because of their strong focus and expertise in behavioral health issues, many EAPshave chosen to leave the problems of working and long-distance caregivers to work-life specialists, who offer a more broad-based social service response to childcare andeldercare needs.

Since many EAP professionals are trained primarily as psychotherapists, they oftenlack the functional expertise or training in issues of aging, caregiving and the relatedphysical, emotional and support services required. Partnering with a network of eldercare specialists, such as geriatric care managers, can support the EAPprofessional and their clients in understanding complex caregiving situations. Thisadditional expertise and extensive database of resources also can provide validationand emotional support, assist in the development of a plan, locate communityresources, and provide information and education for the working caregiver.

Partnerships Between EAPs, Employers, Eldercare Providers

Many caregivers wait until a crisis arrives before taking the initiative to plan for theirolder adult’s needs. By waiting until the time of a crisis, caregivers place themselves ina situation where information and resources must be located immediately, and a

response to the crisis is urgent. Critical decisions must be made, but information maybe inadequate, the caregiver’s thinking may be clouded and emotions may run high.

Eldercare issues, however, begin long before a crisis arrives. With the added expertiseand resources that a partnership with eldercare professionals provides, EAPs can helpworkers think about eldercare now and think through inevitable issues before theyhappen. Adult children, for example, should be talking with aging parents and relativesabout sensitive issues like finances, health care proxies, living wills and communityresources while they’re healthy. The more they know about the limitations of their

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existing insurance coverage and the true costs of eldercare, the more likely they willbe to consider obtaining private long-term care insurance coverage while they can stillafford it and can meet underwriting requirements.

Adult children often need help to broach those subjects. Human resource, benefits,wellness, EAP and work-life providers all can share responsibility for the eldercare

initiative and develop a coordinated educational program to publicize these issues.

Employees who are educated in advance about the various aspects of caregiving —including emotional, financial, legal and day-to-day issues — and are helped to planahead will be armed with resources when they need them. Employees who are awareof assistance available through their integrated service will save time and frustration.

They will know to call for assistance early in the process and will be equipped with thesupport, information and resources needed to meet their elder’s needs. They will beable to put a plan into action with the help of their eldercare professional.

Importantly, employers will benefit from the employee’s preparedness, from the timeand energy saved by the employee’s direct access to an experienced professional.

Care Insurance as a Voluntary Benefit?

Providing long-term care insurance as a voluntary, employee-paid benefit also isgrowing in popularity because employees and their extended family members areeligible for substantial discounts through the power of group purchasing.

While private long-term care insurance has been available for nearly 20 years, healthyelders and baby boomers are just beginning to consider the importance of owning thiscoverage. Thus far, estimates are that fewer than 10% of middle-aged and older adultshave purchased a long -term care policy. Surveys show that those who havepurchased such policies are pleased with their coverage.

An American Council of Life Insurance study reported, "We found that about half of long-term care policyholders currently receiving benefits report they would have tomove to a nursing home without their insurance benefits. And more than 70% reportthat their long-term care insurance policy pays all of the costs of the services theyneed. And that goes a long way toward reducing the financial and emotional burden onfamily caregivers."

Bob O’Toole, MSW, LICSW, is president of Informed Decisions Inc. in Dedham,Mass., a private company specializing in corporate elder-life planning issues. Afounding member of the National Association of Professional Geriatric Care Managers,he is a former editor of the Geriatric Care Management Journal. Mary Lynn Pannen,BSN, CCM, is president of Sound Options Inc. in Tacoma, Wash. Her company provideschildcare and eldercare services and consultation to companies and EAPs nationally.

Sidebar:

Eldercare Benefits Resources

The National Family Caregiver Support Program — Developed by theAdministration on Aging of the US Department of Health and Human Services. Visitwww.AOA.gov.

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Elderlifeplanning.com — A well-established and reliable source of Internetinformation and support for family caregivers. Launched in 1996, this Web siteprovides user-friendly resources about caring for aging parents and help in locatingresources.

The Eldercare Locator — Administered by the National Association of Area Agencies

on Aging and the National Association of State Units on Aging. Call 1-800-677-1116.

National Association of Professional Geriatric Care Managers — Write 1604 N.Country Club Road, Tucson, Ariz. 85716-3102; call 520-881-8008; fax 520-325-7925; orvisit www.care manager.org.

Fact Sheet: Elder Life Planning for Worksites and Organizations — FromInformed Decisions Inc. Call 1-800-375-0595.

Fact Sheet: Work and Eldercare — Available from the Family Caregiver Alliance.Visit www.caregiver.org.

Washington Business Group on Health — Write 777 N. Capitol St. NE, Suite 800,Washington, D.C. 20002; or call 202-408-9320.

(Spring 2002)

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Workplace-Triggered Problems

A behavioral risk audit case study: How loss, risk data can help EAPs buildstronger relationships with employers

By Rudy M. Yandrick

Employee assistance programs historically have been effective at helping employeesresolve personal behavioral problems. They long have been deficient, however, atinvestigating the role of the workplace in triggering personal problems and interveningwith organizational issues that cause or instigate outbreaks of such problems — asituation due in large measure to the common belief that EAP providers are counselorsor behavioral health providers.

Perhaps this explains why — as the study discussed in the "EAP Ethics and Quality"

article in EAP Digest’s Fall 2001 issue revealed — EA services today have minimalworkplace presence, receive sparse supervisory referrals and are severelyundervalued.

To counteract this, EAPs need to establish themselves as behavioral risk specialists,expanding beyond the core technology into organizational development at theexpense of managed care, clinical case management and mental health counseling —areas into which many programs have ventured.

If EA is practiced as a risk-management discipline, it first needs to have the capabilityto measure an organization’s preventable losses. Losses occur from five genericbehavioral types, which manifest in everything from theft to absenteeism to alcoholabuse (see accompanying list). By identifying risk factors that contribute to losses,data-supported solutions, including close-to-the-customer EA services, can berecommended with the certainty that it is in the employer’s best interest.

One approach to auditing behavioral risks involves a two-part process: a recordsreview to investigate losses and a workforce survey to measure risk factors.

Behavioral Risk Audit: A Case Study

Recently, two Pennsylvania-based firms, NewMode Workforce Solutions and TheBehavioral Risk Institute, partnered to perform such an audit. The audited employerwas a mid-size transportation company — WillHaul — comprised chiefly of managers,office employees, over-the-road drivers and mechanics.

Four categories of loss were studied: Operating revenue and net income; accidentsand injuries; stress- and lifestyle-related losses; and workforce conduct andperformance problems.

Datakeeping practices and records vary greatly from one company to the next, so lossanalyses must be tailored to the organization. Furthermore, some data can be directlymeasured in dollars, others only by numeric equivalents. For this reason, with WillHaul,

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the goal was to build an evidentiary body of data on preventable losses, rather than togenerate a bottom-line financial statement.

From 1995 through 2000, the company’s operating revenues increased an average of 2l% annually, which at first glance suggests the company was growing at a healthypace. Net income during that period, however, took the shape of an inverted bell

curve, from a loss of 2.3% of operating revenue in the early 1990s to a profit of 6%then back to a loss of 0.9% in 2000.

The primary reason for the net-income loss was excessive workers’ compensation,along with property/casualty and medical costs. WillHaul was self-insured andtherefore directly liable. Workers’ compensation claims had increased 92% over theprior two years, and property/casualty and medical claims increased 85% and 21%,respectively, over the last year.

The workers’ compensation and property/casualty losses were due, primarily, to aspate of catastrophic over-the-road accidents beginning in mid-1999, the likes of whichthe company had never experienced. Less-than-catastrophic accidents had increasedas well. Given the increases in the frequency and severity of accidents, the escalation

in claims seemed more than just bad luck.

Meanwhile, WillHaul had a 13% annual utilization rate for EAP services. It was knownthat the company’s employees and their family members were experiencing aninordinately high number of personal problems. How ever, without previously beingprivy to the full extent of behavior-related problems — including accidents — and thelosses they generated, the EAP had been relegated to applying band-aids to personalproblems as they came to attention. This situation illuminates the importance of EAPsbecoming more organizationally focused in order to become workplace preventionspecialists.

WillHaul also was spending more than $1,000 a year over national averages, peremployee, for health coverage, despite the fact that the company was using anaggressive third-party administrator with a strong wellness philosophy. A sizable partof these medical losses were preventable.

Finally, WillHaul had an excessive number of driver-conduct and performance-relatedproblems. For example, its driver turnover increased gradually from 43% to 72% overthe prior four years, despite fact that the company’s drivers primarily made day tripsrather than overnight hauls — a strong correlate of driver turnover in the truckingindustry.

Besides turnover, WillHaul also was experiencing a great number of log violations,which include driver performance problems and record-keeping errors, as well asverbal and written warnings and suspensions.

The Risk Factors

Most employees exhibit counterproductive behaviors not because of one or twoproblems, or risk factors, but because of an aggregation of many — most of whichworkers are not cognizant of at any given moment. Typically, employers lay behavioralproblems at the feet of the individuals exhibiting those behaviors, which fits in nicelywith behavioral health-focused EAPs that seek to "fix" the individual through privatetherapeutic intervention.

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In reality, it is a combination of organizational, personal, and interpersonal or grouprisk factors that leads to the behaviors. This helps to explain why an employee mightseem to suddenly overreact in an adverse situation, when in reality he or she hascrossed over a tolerance threshold, causing the counterproductive behavior to "lurch"forward.

In surveying WillHaul, 101 different risk factors were measured and 28 registeredelevated scores among drivers, 27 among employees and 15 among managers. Forthe drivers and employees, in particular, the numbers indicated a heavy volume of problems and issues to be carrying on their backs. Significant risks were found inorganizational and leadership practices, home-life concerns, health issues, manager-employee and work-team relationships. This amalgam of risk factors, then, bore downon the organization to create greater loss potential.

Given the nature of the trucking business, the audit concluded that the weight of therisk factors had a deteriorating effect on the quality of relations between drivers, whohaul the goods, and dispatchers, who make the logistical arrangements and assignroutes to drivers. One thing that a trucking company doesn’t want is upset ordistracted drivers, who are its revenue producers — as well as its loss leaders — when

accidents and other over-the-road incidents occur.

The Organizational Context

Contextual information to complement the loss and risk data was obtained by askingemployees for their insights through a series of write-in questions and gatheringinformation on the historical growth and development of the company.

In brief, the audit found that WillHaul did not have suitable conduct and workperformance standards, had a leadership team that had failed to coalesce into astrong decision-making unit, was reactive rather than proactive in its problem solving,had no integrated system for compiling loss data, and, ironically, placed financialperformance above safety. In the final analysis, WillHaul, was a diversifying companythat had outgrown its small-company infrastructure.

Finally, the Solutions

On the strength of these various data sets, loss-reduction goals and 20 differentsolutions, which could be phased in over a few years, were specified. They include:

• An integrated data management system to track preventable losses;

• Organizational development steps, such as a mission statement and 360-degree manager-employee performance evaluations;

• Knowledge and competency development, such as a team-building curriculumfor the maintenance shop;

• Supportive programs and services, such as an informal driver mentoringprogram to be held in conjunction with training school for new drivers; and

• Proactive health and lifestyle management.

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Today, WillHaul is creating an implementation plan. Management and employees havebeen receptive to the process, which has also strengthened the position of the EAP inthe company. As WillHaul gains better control over its preventable, behavior-relatedlosses, the company will be fine, and it is expected that, in a couple of years, thecompany’s net revenues will increase at a rate that matches its growth in operatingrevenues.

Rudy M. Yandrick is president of The Behavioral Risk Institute, a Pennsylvania-based product development and data analysis firm. He is also vice president of NewModeWorkforce Solutions, an EAP based in York, Pa. He is author of Behavioral RiskManagement, published by Jossey-Bass Inc. Publishers in 1996.

(Fall 2000)

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An Opportunity for Self-Regulation

EASNA, COA join forces for EAP accreditation.By Suzanne Claeys, MA, CEAP

The Council on Accreditation for Children and Family Services (COA) has joined forceswith the Employee Assistance Society of North America (EASNA) to developaccreditation for EAPs. The joint endeavor is supported by funds from the SubstanceAbuse and Mental Health Services Administration (SAMHSA) and the Center forSubstance Abuse Prevention (CSAP), Office of Managed Care.

EASNA had been providing accreditation since 1990. But Barbara Marsden, EASNApresident and manager for Genesis EAP in Davenport, Iowa, says EASNA sought to

partner with a recognized accrediting agent because of the growing number of EAPsrequesting accreditation. “We sought a partnership because the process was growingfaster than our volunteer group could effectively handle,” she said. She says EASNAchose to partner with COA because of COA’s experience in accrediting EAPs withinfamily service organizations and because both organizations share similar values,goals and review processes. Under the partnership, the New York City-based COA willhave responsibility for the overall facilitation and management of the accreditationwhile EASNA’s Standards and Accreditation committees will have regular input.

he accreditation standards of both organizations are being meshed during beta teststhat concluded in September. Beta tests are being conducted at The Bank of Montreal,Ceridian Performance Partners, EAP International, Magellan Behavioral Health and theUS Department of Health and Human Services.

Dr. Dale Masi, a member of EASNA’s Accreditation Committee and president of MasiResearch Consultants in Washington, DC, has been commissioned by COA to serve asprogram administrator, overseeing the beta testing and the combining of thestandards. “Accreditation is an essential requirement for EAPs. It provides us with thenecessary standards and criteria for professional practices,” says Masi.

Christina Thompson, vice president of EAPs for Magellan Behavioral Health, Columbia,Md., says accreditation is basically an issue of self-regulation. Without it, the field isvulnerable to being regulated by another group or profession that may not have thebest interests of EAP in mind or who may confuse EAP with managed care. “Mostothers don’t understand EAP, and we run the risk of having our boundaries blurredwith managed care due to the integration of many EAPs with managed care. EAPprofessionals who live and breathe EAP every day are the ones who need to define andregulate EAPs,” she says.

COA’s president and CEO, David Liederman, says that because accreditation reflectsorganizational compliance with standards of best practice, it will assure EAPpurchasers that clients are being well-served.

As a joint endeavor of Family Service America and the Child Welfare League of America, COA has been accrediting private and public organizations since 1977. The

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agency currently accredits nearly 1,200 private and public organizations that provideservices to more than 6 million individuals and families throughout North America.

Charlie Williams, a program analyst with CSAP’s Office of Managed Care, said EASNAapproached his agency to fund the project. “My agency got involved because so manyEAPs are now provided by managed care companies,” he said. He also said SAMHSA’s

involvement makes this one of the most significant public/private initiatives to benefitthe EAP field in some time.

But beyond developing the new standards, he says, the greater challenge will be tosell accreditation in the marketplace.

Accreditation’s true test: The marketplace

In the US, healthcare providers must be accredited by a recognized accrediting agentin order to receive reimbursement for services. But not so with EAPs, which are paidfor out of an employer’s pocket.

So what might compel an EAP to seek accreditation? For an answer, consideraccreditation’s impact on the Canadian EAP market. Canada’s experience could bewriting on the wall for US EAP providers.

Marilyn Hayman, past president of EASNA and former CEO of EAPlus in Ottawa, saysaccreditation is more the rule than the exception in Canada. (The Canadian Centre onSubstance Abuse even lists whether an EAP provider has EASNA accreditation in itsGuide to Employee Assistance Programs and Services in Canada published in 1997.

The guide is available at www.ccsa.ca under “resources,” then “databases” or for a feeby calling 613-235-4048.) “Canadian organizations recognize EASNA accreditation asthe mark of a quality EAP. Many organizations now require EASNA accreditation inorder to submit proposals,” says Hayman. She says that’s forced smaller vendors tobecome accredited in order to compete for contracts with Canada’s Big Three EAPvendors — CHC of Mississauga, Ontario; Family Guidance International of Thornhill,Ontario; and Warren Shepell Consultants of Toronto.

Market competition also may lead internal EAPs to consider accreditation, according toHélène Bélanger, eastern regional manager of The Bank of Montreal’s EAP, which hasbeen EASNA accredited since 1992. She says a number of good external vendorswould be interested in taking over the bank’s EAP. But accreditation ensures that herinternal services meet or exceed those of the externals.

Quality, however, was the foremost reason for seeking accreditation. “Our first reasonfor seeking accreditation was to fulfill our mission to provide the best professionalservices to the employees of the Bank of Montreal,” says Bélanger. She saysaccreditation has evolved into a continuous quality improvement process for herprogram because every EAP policy and procedure written and every service providedis considered with the EASNA standards in mind.

Willie Garrett, manager of clinical services at Minneapolis-based Ceridian PerformancePartners, one of the EASNA/COA accreditation beta test sites, also views accreditationas a quality assurance issue, one that helps EAPs improve processes at the same timeit confirms “we’re doing things right.” In his opinion, accreditation will help EAPs gaincredibility with employers because it verifies that an EAP meets prescribed standardsfor quality service.

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The quality assurance issue is reiterated in comments from Gwyn Jones, nationalclinical director of EAP services for Warren Shepell Consultants of Toronto. When hercompany’s business increased in the mid-1990s, Jones says Shepell soughtaccreditation as a way to ensure it was meeting customer needs. “We sought EASNAaccreditation because we wanted to know how we could maintain the level of excellence with which we began EAP services and continue to ensure an appropriate

quality assurance process.”

Hayman says the gold seal an accredited EAP receives will ultimately make adifference to purchasers. “Having a gold seal in a proposal tells a prospective clientthat an EAP has opened its practice to peer review and that it must constantly updateits program to meet the quality and professional standards developed by EASNA andCOA. This is a major marketing advantage because quality sells.”

Accreditation is the most important issue the EAP industry has faced in the last 20-30years,” says Jodie Collins, president and CEO of Denver-based EAP International, thefirst site to be beta tested. “It will define and differentiate EAPs from other types of services being offered to employers. It will be important to our customers to be able tolook to an independent accrediting body to help them understand what they arebuying.”

Readers interested in learning more about accreditation may contact Jennifer Levitz at COA at 212-797-3000 or the project director, Dr. Dale Masi, at 202-223-2399. Also, the13th Annual EASNA Institute, which will be held April 26-28 in Chicago, will feature anaccreditation track and a training for prospective reviewers immediately following theInstitute.

Suzanne Claeys, MA, CEAP, is chair of EASNA’s Accreditation Committee and administrator of Alcoa’s EAP in Davenport, Iowa. She can be reached at 319-459-2940.

7 Attributes of an Effective EAP

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