Jea vol47no3 3rdqtr2017 by Employee Assistance Professionals Association

3rd Quarter 2017 | VOL. 47 NO. 3

The magazine of the Employee Assistance Professionals Association

EAPs and the Opioid Crisis |Page 16

PLUS:

Relevant EAP Apps Page 20

High Conflict in the Workplace Page 24

Coaching the Uncoachable Executive Page 30

Plan to attend the 2017 EAP Conference & EXPO in Los Angeles

2017 EAP Conference & EXPO: October 3-6 Pre-Conference Training: October 3 | EXPO: October 3-5 The Westin Bonaventure Hotel & Suites | Los Angeles | www.thebonaventure.com Conference information: Debbie Mori

Manager - Association Services Employee Assistance Professionals Association 703.387.1000, x310 d.mori@eapassn.org

EXPO Information: Joan Treece

Advertising Manager Employee Assistance Professionals Association 303.242.2046 admanager@eapassn.org

Education • Training • Networking • EXPO • Business Opportunities

www.eapassn.org/2017Conference

contents EAPA Mission Statement

3rd Quarter 2017 | VOL. 47 NO. 3

cover story

EAPs and the Opioid Crisis

|By Bernie McCann, PhD, CEAP As the demographics of opioid use disorders shift to include greater numbers of the working-age population, EAPs are increasingly encountering cases of abuse and addiction among covered workers and their families. Enhancing our services are key in curbing abuse.

features

Helping Clients Enhance Emotional Intelligence

|By Mel Burt-Gracik, MA, M.Div.

Emotional intelligence recognizes that emotions can impact behavior and affect people – positively and negatively – therefore it’s important to show employee clients how to manage those emotions, especially when under stress.

features

Using CARSSM to Address High Conflict in the Workplace

|By L. Georgi DiStefano, LCSW; and Bill

Eddy, LCSW, Esq. This article introduces readers to CARSSM, a new approach for effectively addressing, high-conflict situations with clients, co-workers, or supervisors in the workplace. The focus is on the high-conflict behavior.

Coaching the Uncoachable Executive

|By Steve Albrecht, DBA The coach must help the executive uncover his or her intrinsic motivation to change. In other words, find a reason they would change this behavior even if they were not being pressured to change.

departments 4 FRONT DESK 5, 11, EA ROUNDUP 28, 29

Relevant EAP Apps: This Year’s Top 10 List

|By Kathleen Greer

The mobile app industry continues to grow. When used in combination with EAP counseling, apps can provide both useful information and motivation. This article describes the top 10 behavioral health apps for 2017.

EFFECTIVE 6 MANAGEMENT CONSULTING 12 THE WORLD OF EAP 14 TECH TRENDS 22, 23 WEB WATCH 32 INTEGRATION INSIGHTS

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) 258-2448 or sending an e-mail to journal@eapassn.org. To advertise in the Journal of Employee Assistance, contact the Advertising Manager, Joan Treece, at (303) 242-2046 or admanager@eapassn. org. Send requests for reprints to opsadmin@eapassn.org. ©2017 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 Advertising Manager: Joan Treece Designer: Laura J. Miller Impact Publications, Inc.

Index of Advertisers ASAP....................................................9 EAPA Plan to Attend.........................IFC EAPA Conference on Demand.........IBC Harting EAP..............................7, 17, 25 KGA, Inc.............................................23 SAPlist.com..................................13, 29 The SASSI Institute............................11 IBC: Back Cover IFC: Inside Front Cover

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| JOURNAL OF EMPLOYEE ASSISTANCE | 3rd Quarter 2017 |

frontdesk Addressing the Opioid Epidemic |By Maria Lund, LEAP, CEAP

he skyrocketing increase in the use of opioids has emerged as a major health problem across a broad spectrum of ages, social classes, and geographic locations across the world. In this issue’s cover story, Bernie McCann, PhD, CEAP, points out that, “EAPs are increasingly encountering cases of abuse and addiction among covered workers and their families.” As EA professionals, we are frequently at the forefront of personal and workplace intervention efforts stemming from substance use, which means we can play an important role in stemming the tide of this disturbing trend.

This issue of the JEA also features the theme of resolving conflict and miscommunication in the workplace, which is at the heart of many performance problems. L. Georgi DiStefano and Bill Eddy introduce readers to CARSSM, a new approach for effectively addressing highconflict situations with clients, co-workers, or supervisors in the workplace. The authors describe each of the four steps in CARSSM and walk us through a specific example of this method. Continuing with the theme of improving communication in

the workplace, Mel Burt-Gracik discusses emotional intelligence (EQ). She describes how EQ recognizes that emotions impact behavior and affect people – positively and negatively. As EA professionals, we can guide employee clients in how to manage their emotions and grow their emotional intelligence, which can lead to better performance, especially when they are under stress. Both CARS and EQ strategies imply the client wants to change his or her behavior. What about instances in which this isn’t the case? Steve Albrecht, DBA, explains the numerous reasons why many executives do not want to be coached toward change. “The coach must help the executive uncover his or her intrinsic motivation to change,” Albrecht states. “In other words, find a reason they would change this behavior even if they were not being pressured to change.” SM

In a focus on technology, Kathleen Greer writes on the “Top 10 Well-being Apps.” She describes each of these leading apps for 2017, and includes a primer on how they were evaluated for this list. Finally, Jeff Harris, John Maynard, Marina London, and

Mark Attridge offer important practice insights and observations in their respective columns. 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 – Seattle, WA nrboard@gmail.com

Daniel Boissonneault – Hamden, CT eap700@comcast.net

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

Donald Jorgensen – Tucson, AZ donjorgensen@comcast.net

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

Peizhong Li – Beijing, China lipeizhong@eapchina.net

John Maynard – Boulder, CO johnmaynard@spirehealth.com

Bernie McCann – Waltham, MA mccannbag@gmail.com

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

David Sharar – Bloomington, IL dsharar@chestnut.org

earoundup States Stepping Up Drug Interventions The presence of fentanyl in the illicit drug supply has put law enforcement officials and the medical community on high alert in more than a dozen states, accelerating the battle against opioids on all fronts. Stateline, an initiative of The Pew Charitable Trusts, reports that states, counties, and cities are responding to the crisis by stockpiling the overdose reversal drug naloxone, funding more drug treatment, and ramping up police surveillance of drug trafficking. In addition, a handful of states are stiffening penalties for selling the lethal drug. Standardized approaches to detecting the presence of the deadly drug and communicating its dangers — to drug users, people in treatment or those recently released from prison or jail, and their friends, family, and advocates — also are starting to emerge. As the number of overdose victims who visit hospital emergency departments grows and overdose deaths increase, addiction experts are suggesting unusual initiatives to protect the lives of drug users. The Massachusetts Medical Society recommended that the state create a first-in-the-nation “safe injection” clinic where people can use drugs and be observed by medical professionals who can rescue them if they overdose. However, the clinics run counter to federal drug laws, and are not expected to be widely used in the U.S. any time soon, although safe drug consumption sites are under discussion in Seattle and in cities in New York, including Albany, Ithaca, New York City, and Syracuse.

Maryland Gov. Larry Hogan declared the opioid crisis a state of emergency with the goal of promoting communication between state and local officials. The state also dedicated another $50 million to fighting the epidemic.

Initial Phase of EAP History Project Complete The initial phase of the Employee Assistance Research Foundation History Project is complete. The first phase consists of eight video interviews with eight key informants focused on the development of EAP and Work-Life in the U.S. and Canada over the last 50 years. The interviews were conducted by Dr. Dale Masi, distinguished scholar, Professor Emeritus, and employee assistance consultant. Dr. Masi, with the approval of the EARF Grants Committee, selected the individuals because of their expertise in significant conceptual themes that formed the EA field. The interviews can be viewed at the Employee Assistance Digital Archive (www. eaarchive.org), housed by the University of Maryland Baltimore. In the next phase of the project, Masi will conduct a literature review to document the history and milestones of EAPs in the U.S. and Canada. Dr. Anne Roche, Flinders University in Australia, will focus on EAP history and development outside of North America.

Opioid Abuse Affecting Many Businesses: Survey A March 2017 survey by the National Safety Council (NSC)

revealed 70 percent of business owners say narcotic painkillers have affected their business. The NSC recommends implementing the following steps to monitor the use of opioids in the workplace:  An EAP: The cost of helping an employee who might have a problem with opioid abuse is 25 to 200 percent more cost effective than replacing that person.  Employee education: Bearing in mind that the employee-patient relationship is a confidential one, employees should still be educated about the dangers of opioids in the workplace – including operating heavy equipment while on medication.  Supervisor training: Management should be educated on how to identify possible employee abuse. Managers also need to understand that a person with a disability is protected by the Americans with Disabilities Act and not infringe upon his or her rights.  A clear, written policy: Together with a company’s legal department, a policy should be put in place — similar to a company’s restrictions on the use of alcohol or illegal drugs.  Drug testing: Employers and those who are conducting drug screens need to be aware that recently, with easy access to synthetic urine online, individuals who are abusing drugs have found ways to skirt the system. Currently, only 14 states in the U.S. ban the sale and purchase of synthetic urine.

Continued on page 11

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effectivemanagementconsulting The Performance Meeting Part II: Constructive Feedback

|By Jeffrey Harris, MFT, CEAP

n my previous column, I suggested two techniques for disarming a defensive employee during a performance meeting. In the conclusion of this two-part article, I will recommend techniques that EA professionals could share with a manager who wants to give constructive feedback to an underperforming employee.

Action. If the manager thinks of conflict as bad, he or she will get nervous about a conflict, and avoid it as long as possible. But delay only leads to the conflict escalating, requiring the manager to confront the problem, and often poorly. When managers lack practice, skill, or mentoring in how to provide constructive feedback,

The Problem of Ineffective Feedback According to a survey on manager-led development effectiveness conducted by the Corporate Leadership Council (CLC), ineffective feedback discussions result in:

“The opportunity for the EA consultant is to model and mentor constructive feedback for managers...”

• 40% of employees not being motivated to avoid repeating mistakes; • 18% of employees getting angry during feedback conversations; and • 44% of employees being unclear on how to address their weaknesses. According to CLC, “managers fail to conduct constructive feedback discussions, because they avoid conflicts instead of managing them.” Roxanne Lulofs describes the conflict avoidance cycle in her book, Conflict: From Theory to

conflicts will result in a less than satisfying discussion for manager and employee alike. This makes such talks unpleasant and leads to the desire to avoid them altogether. The opportunity for the EA consultant is to model and mentor constructive feedback for managers who lament that performance meetings are undesirable or ineffective. The CLC has suggested a good model for providing constructive feedback. Consider prompting managers to provide these three elements for a highly effective discussion.

1. Conduct an Open Discussion While the manager must discuss performance weaknesses with their employee, it helps to start by fostering an open and positive discussion. Have the manager share his/her intention to contribute to the employee’s success. This sets a non-confrontational tone for the meeting, making the employee feel comfortable. The manager should invite the employee to give his/her perspective as well. I have observed many managers squirm at the suggestion of seeking the employee’s perspective, usually due to conforming to a stubborn culture of punitive feedback. I simply remind the manager that he/she loses no authority or influence by providing an open discussion. In fact, the manager will likely find the employee more receptive to feedback. 2. Conduct an Evidence-Based Discussion It helps to keep the focus on facts by describing observed patterns in performance. Continue by including clear examples of the employee’s strengths, and explain how those strengths positively impact performance. The manager can balance the discussion by describing the consequences of the employee’s weaknesses.

The effectiveness of this feedback is the juxtaposition of ideal performance being tied to strengths, and consequences tied to weaknesses.

Consulting Toolkit & Expand Your EAP’s Value,” this seminar is designed specifically for EA consultants with intermediate experience in an EAP, as well as candidates for the CEAP and EAS-C certificates. My partner in this presentation will be Markus Dietrich, LMHC, CEAP, the Global Manager of EAP & Work-Life for DuPont. I hope that you’ll join us. Mention the event to an interested co-worker. v

3. Conduct a Forward-Looking Discussion Managers can get trapped by dwelling on the past, which cannot be rewritten. Rather, encourage the manager to focus on future behaviors so the employee has the opportunity to develop and succeed. Managers can start by pointing out how the employee’s strengths can be used to improve observed weaknesses. The manager should be clear about the steps necessary to avoid the consequences of future mistakes, and provide tangible steps to address the weaknesses. The effective discussion should end with the manager encouraging the employee to avoid future mistakes.

Let’s Keep the Discussion Going The author invites readers to network about all types of effective management consulting topics by connecting with him on LinkedIn (linkedin.com/in/jeffharrisceap) and Twitter (@jeffharrisceap). Jeffrey Harris, MFT, CEAP, has provided management consulting to a wide variety of organizations throughout his 23-year career in employee assistance, including corporate, educational, government, and union organizations. The author also has extensive experience as a manager and executive coach, from which he draws insight for his consulting. Jeff currently serves as Program Manager of EAP & WorkLife at the University of Southern California.

The 90-Day Dry Run Much of my consulting effectiveness comes from my real-world experience as a manager for 13 years. Early on, I discovered that several of my team members were caught off-guard by my feedback during their annual performance evaluation. Vowing never to surprise an employee again, I began promoting a “90-day dry run” in which I engaged employees in a practice evaluation three months before the scheduled official evaluation meeting. (I used the same criteria and forms.) When there were gaps between the employee’s performance and the manager’s expectations, we discussed possible actions or corrections that would give me something tangible and positive to document over a three-month period. When I share this technique with managers, I remind them of their part of the contract, which is to increase observation so that the employee’s gains can be documented. Announcing an Intensive Seminar on Management Consulting Would you like to take your consulting skills to the next level? I will be presenting a 7-hour pre-conference training at EAPA’s 2017 World EAP Conference in Los Angeles. Titled “Masterful Consultation: Deepen Your 7 | W W W . E A PA S S N . O R G | •• • • • • • • • • • • • • • • • • • •

| JOURNAL OF EMPLOYEE ASSISTANCE | 3rd Quarter 2017 |

featurearticle Helping Clients Enhance Emotional Intelligence “To help your client increase his emotional vocabulary, provide a list of feelings and begin each session by tuning into the emotions he experienced during the past hour. What happened that caused these feelings?”

| By Mel Burt-Gracik, MA, M.Div.

nvision the following scenario: Sally is between back-to-back meetings, running to her office to grab a folder, thinking through the new tasks on her list after the last meeting and what she needs to do to prepare for the next one. As she rounds the corner, she sees her colleague, Fred, walking down the corridor. Sally darts into an adjoining hallway without even thinking about it. She simply doesn’t have time today and so her gut reaction to Fred is to avoid him. Now Fred is an affable co-worker, but he can’t seem to read subtle, or even direct clues that, “Sally just can’t talk about the TPS Reports right now.” If Sally bumps into him, she’s setting herself up for a lengthy discussion she simply doesn’t have time for. The question is: How can Sally and Fred use emotional intelligence to work together more productively? What is Emotional Intelligence? According to TalentSmart, a leading provider of emotional intelligence (EQ) training, 58% of job performance is attributable to emotional intelligence. Moreover, 90% of top performers have a high EQ. (TalentSmart, 2017). Psychologists Peter Salovey and John Mayer created the concept of emotional intelligence. They define it as, “the ability to engage in sophisticated information

processing about one’s own and others’ emotions and the ability to use this information as a guide to thinking and behavior. That is, individuals high in emotional intelligence pay attention to, use, understand, and manage emotions, and these skills serve adaptive

“No article about EQ would be complete without mentioning the more familiar term, ‘IQ’ or intelligence quotient. Unlike IQ, which tends to be fairly fixed throughout life, EQ is fluid and can increase by practicing new behaviors. This is a good thing, as success in a job may depend on learning new social skills.” functions that potentially beneﬁt themselves and others,” (Mayer, J.D., Salovey, P., Caruso, D., 2008). This concept recognizes that emotions can impact behavior and affect people – positively and negatively – therefore it’s important

to show employee clients how to manage those emotions, especially when under stress. Are they able to identify the source of their emotions and those of others? Can they use emotional information to make productive choices? In layman’s terms EQ may be thought of as an individual’s ability to: • recognize and understand our emotions and reactions (selfawareness); • manage, control, and adapt our emotions, mood, reactions, and responses (selfmanagement); • harness our emotions to motivate ourselves to take appropriate action, commit, followthrough, and work toward the achievement of our goals (motivation); • discern the feelings of others, understand their emotions, and utilize that understanding to relate to others more effectively (empathy); and • build relationships, relate to others in social situations, lead, negotiate conflict, and work as part of a team (social skills) (Scuderi, R., n.d.). What Emotional Intelligence is Not The concept of emotional intelligence is not always readily understood. Researchers note that emotional intelligence is not

To combat this tendency, I recommend trying UNC psychology Professor Barbara Fredrickson’s Positivity Ratio of 3 positive experiences to every 1 that is negative (Frederickson, B., 2009). Let’s say your client struggles with negative selftalk. Have him start catching himself making negative statements and then stating three positive things that are also true. For example, let’s say he is running late to a meeting and he usually beats himself up for always being late. He might instead think, “I was on time to two other meetings today, and the meeting prior to this one I was five minutes early. Yesterday, I even paid a bill early!” This practice will help enhance the EQ components of self-worth and optimism. Check out Dr. Fredrickson’s free positivity ratio assessment to help clients track their positivity over time. It’s at https://www.positivityratio.com.

agreeableness, optimism, happiness, nor is it calmness or motivation. “Such qualities, although important, have little to do with intelligence, little to do with emotions, and nearly nothing to do with actual emotional intelligence” (Mayer, J.D., 2009). To clarify, emotional intelligence is distinct from personal qualities. In an American Psychologist article, Mayer and his colleagues suggested, “… groups of widely studied personality traits, including motives such as the need for achievement, self-related concepts such as self-control, emotional traits such as happiness, and social styles such as assertiveness should be called what they are, rather than being mixed together in haphazard-seeming assortments and named emotional intelligence” (Mayer, J.D., et al., 2008). IQ and EQ Differ No article about EQ would be complete without mentioning the more familiar term, “IQ” or intelligence quotient. Unlike IQ, which tends to be fairly fixed throughout life, EQ is fluid and can increase by practicing new behaviors. This is a good thing, as success in a job may depend on learning new social skills. A prominent study highlighted in The New York Times found that between 1980 and 2012, jobs with high social skill requirements grew by nearly 10 percentage points as a share of the U.S. labor force (Miller, C., 2015).

 Help clients improve their “emotional vocabulary.” On a cloudy day, unpleasant emotions can feel like a shroud of gray, dismal energy. “I feel bad.” Unfortunately, “bad” isn’t really an emotion and until we know what emotions we are having and their potential

Helping Clients Enhance their EQ As an EA professional, you have likely found yourself helping clients like Sally who need support working with a colleague with lower emotional intelligence OR like Fred, who are suffering some of the consequences of lower EQ and could benefit from improving it. The following sections describe some basic tips to help your clients enhance their emotional intelligence.  Teach clients to use the “3:1” Positivity Ratio. Positive emotions feel good, but at the end of the day, if your client interacted with a colleague 10 times and 5 of those interactions were positive, 4 neutral, and 1 negative, they would likely only focus on the negative. According to psychologist Dr. Rick Hanson, this is due to our negativity bias. Our brains are really good at remembering and holding onto the bad and pretty terrible at doing the same for the positive (Hanson, R., 2016). 9 | W W W . E A PA S S N . O R G | •• • • • • • • • • • • • • • • • • • •

| JOURNAL OF EMPLOYEE ASSISTANCE | 3rd Quarter 2017 |

featurearticle cause, it is hard to take action and eradicate them. This is where an individual’s emotional vocabulary comes into play. A key component of EQ is emotional self-awareness or the ability to understand the nuanced series of emotions you may be experiencing, the root cause of each of them, and how these emotions affect you and others. Just as a sommelier can discern distinct flavors in a glass of wine, so someone high in this aspect of EQ can distinguish between joy, happiness, or elation. To help your client increase his emotional vocabulary, provide a list of feelings and begin each session by tuning into the emotions he experienced during the past hour. What happened that caused these feelings? As your session continues, ask him to identify the emotions he felt as specific examples came up.  Recognize that an increased EQ promotes empathy. Once your client has a better grasp of his own emotional landscape, he is better equipped to understand the emotions of other people. When he struggles with a challenging colleague or person in his home life ask him to think through what the other person might be feeling and needing. Paint a picture of empathy with even greater depth by asking him what else might be going on in the other person’s life that could be contributing to their emotional landscape. Lastly, practice compassion by walking him through wishing that other person well.

Summary If your client is Sally, you have helped her work on the EQ

elements of assertiveness and emotional expression. She is able to confront Fred and directly share how she is feeling: “Hi Fred, so good to see you today. I really wish I could chat right now. I’m feeling a bit stressed as I’m in-between meetings and stretched for time at the moment. Would it be okay if I emailed you about the TPS Reports in the morning?” If Fred is your client, help him learn that empathy and emotional attunement are likely skills he is lacking. Ask Fred questions geared to help him identify reallife examples, such as the one with Sally, where he lacked the ability to perceive the emotions of others, what the person was likely feeling in the situation, and how he could have behaved differently. “What might Sally have been feeling in that moment Fred?” “Frazzled and stressed I suppose.” “Yes, I think you may be right. Given what she was feeling, what do you think she wanted from you?” “She probably wanted me to see that she was stressed and to not engage her at that moment.” For almost any client, enhancing emotional intelligence can promote more optimal interactions and productivity in the workplace. v Mel Burt-Gracik, M.A., M.Div., is a board-certified coach who is also certified in Emotional Intelligence (EQ-i & EQ360), StrengthsFinder, and the MyersBriggs Type Indicator. Her company, Flourish, helps businesses, teams, and individuals build work cultures focused on strengths in order to increase productivity and maximize individual self-management. For more information, contact her at mel@flourishforyou.com.

References

Frederickson, B. (2009). Positivity: Top notch research reveals the 3 to 1 ratio that will change your life. New York: NY: Three Rivers Press. Hanson, R. (2016, October 26). Confronting the negativity bias [Blog post]. Retrieved from http://www.rickhanson.net/how-your-brain-makes-youeasily-intimidated/ Mayer, J.D. (2009, September 21). What emotional intelligence is and is not [Blog post]. Retrieved from https:// www.psychologytoday.com/blog/thepersonality-analyst/200909/what-emotional-intelligence-is-and-is-not Mayer, J.D., Salovey, P., & Caruso, D. (2008). Emotional intelligence: New ability or eclectic traits? American Psychologist, 63, 503-517. doi:10.1037/0003-055x.63.6.503 Miller, C.C. (2015, October 16). Why what you learned in preschool is crucial at work. The New York Times. Retrieved from https://www.nytimes. com/2015/10/18/upshot/how-the-modern-workplace-has-become-more-likepreschool.html Scuderi, R. (n.d.). Sorry, but EQ is way more important than IQ these days [Blog post]. Retrieved from http://lifehack. org/articles/communication/emotionalintelligence-why-important.html TalentSmart. (2017). Emotional intelligence (EQ) stats. Retrieved from http:// www.talentsmart.com/

Advertise in Contact Joan Treece

Advertising Manager

(303) 242-2046 admanager@eapassn.org

earoundup CGP Releases Annual Trends Report Chestnut Global Partners (CGP) recently completed its annual trends report, which identifies the four leading developments shaping the EAP and wellness industries in 2017. The trends report is based on utilization patterns among CGP’s user base, and a survey of its customers to gain insights and perspectives on the coming year. The trends cited: • requests for EAP support due to increasing anxiety; • top 3 industry needs: 1) increased utilization rates, 2) improved collaboration and coordination of care, and 3) the production of measurable outcomes that improve the perceived value of EAP by customers; • procurement, which is increasingly involved in EAP purchasing decisions; and • EAP ROI analyses are becoming more “CFO-friendly.” The full report can be found here http://chestnutglobalpartners. org/Portals/cgp/Publications/ Trends-Report-April2017.pdf. (Editor’s note: The trends report is also examined in this issue’s World of EAP column.)

EAPA Research Committee Seeks Doctoral Essays In 2010, EAPA’s Research Committee conducted a survey of in progress or recently completed

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dissertations in the field of employee assistance. The intent was to support and disseminate scholarly work in the EA field. This effort led to a number of conference presentations, publications, and the development of professional networks for aspiring scholars of the EA profession. The EA Practice Based Research Network (PBRN) is continuing to engage doctoral students pursuing work in EA and workplace behavioral health. For more information on research interests and objectives, read the PBRN’s white paper at http:// archive.hshsl.umaryland.edu/ handle/10713/4876. If you are a scholar interested in EA, or know of someone who is, contact Daniel Hughes, Ph.D., CEAP at daniel.hughes@ mountsinai.org.

Half-Million Canadians Miss Work due to Mental Health A new poll finds 40% of Canadians report their mental health has disrupted their lives in some way over the past year, according to Global News. Seventeen percent of Canadians say they’ve taken time off work and school to deal with a personal mental health issue. And another eight percent report they’ve taken time away from their professional lives to help a family member or close friend grappling with mental illness, the pollsters revealed. “This could be the catalyst for change in the workplace. While it’s alarming to know that this

many people are [taking time off work] it also speaks to people recognizing ‘I’m not myself today and I need to take a mental health break,’” Jennifer McLeod Macey, vice-president of the polling firm’s Health Research Institute, told Global News. But there is good news. Canada issued its first national standard on workplace mental health. It’s a tool unique to Canada, although many countries are already looking at its guidance to employers. It helps workplaces consider the psychological factors at play for employees, from work-life balance to civility and respect to having autonomy and influence over your work. EA Roundup continued on page 28

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theworldofeap Survey Explores Global EAP Delivery | By John Maynard, PhD, CEAP

o you ever wonder how many external EA firms are active in today’s global market? Accurate answers are elusive for a number of reasons, among them the ongoing churn of acquisitions, start-ups, and closings; as well as the reality that many firms are not engaged with EAPA or other professional associations who might have an interest in tracking industry data.

tiple countries within a particular geographic region or a specific continent. Local/national EAP providers focus their efforts primarily within a single country.

Chestnut Global Partners (CGP) recently surveyed its EAP partners around the world to examine the number of external EAP firms and the perceived needs of the field that must be addressed to sustain the growth of EAP services in the future (Hagen, et al., 2016). Matt Mollenhauer, CGP Managing Director, wrote about the survey findings in the CGP 2017 Trends Report (Mollenhauer, 2017). The following information is adapted with permission from his article and the survey results.

Six EAP firms were identified by CGP as global service providers. Global providers typically build local relationships that allow services to be delivered in each country served. They are broadening their capability to deliver services remotely via technology. Using a global EAP firm can be an attractive option for many organizations, as it allows employers to work with a single vendor to provide EAP services for all its employees, regardless of where they are located. Often, however, several global providers subcontract with the same local/ national EAP provider to deliver services within a particular country. As a result, the global firms may face challenges in differentiating their unique value in that market.

Global, Regional, and Local/ National EAP Firms According to the CGP survey, there are more than 839 external EAP firms in the world. These firms can be categorized into three groups based on the geographical scope of their services. Global EAP providers deliver services throughout the majority of countries in the world. Regional EAP providers offer services in mul-

The survey identified 56 regional EAP firms serving multiple countries. Regional firms face many of the same challenges as their global counterparts, although they may have the advantage of recruiting and managing somewhat smaller and less diverse provider networks. Many purchasers may prefer working with one or more regional EAPs, feeling that a regional firm can provide more culturally sensi-

tive services to employees while still being large enough to offer multiple service delivery platforms. Local/national EAP firms are differentiated by their emphasis on delivering services within all or part of a single country. According to CGP’s survey, there are currently about 777 local/national EAP firms in the world, nearly 75% of which are located in the United States. Local/national EAP firms can grow independently or as subcontractors to regional and/ or global EAP firms. They vary widely in terms of clinical capability, service delivery infrastructure, and knowledge about EAP best practices or workplace cultures. Local/national EAP firms offer perhaps the greatest opportunities for growth in the worldwide EAP market, especially in developing countries. Top Issues for Preserving EAP Market Vitality CGP’s survey participants were also asked to identify what they saw as the most important needs that the field must address to sustain and grow the EAP market worldwide. The top four needs identified were: 1. Increase utilization rates. Consistent research findings over time and across cultures reveal that up to one-third of the working population every year experiences mental health concerns (Steel et al., 2014). However, a recent survey suggests

that only 4-5% of employees typically access available EAP services each year (Attridge et al., 2013). Addressing this long-term concern may require changes in pricing strategies and finding new ways to increase awareness and trust of EA services within working populations. 2. Improve collaboration and coordination of care. Successfully connecting clients with appropriate treatment or other resources is a core component of EA services. In many countries, the scarcity of qualified treatment resources makes appropriate referral and follow-up difficult. This sometimes forces the EAP to operate as a de facto treatment program. The growing use of mobile and wireless technology platforms may help overcome some of the current geographical constraints or other barriers and make evidence-based treatment and follow-up services more readily available to clients. 3. Increase purchasers’ perceived value of EAP by measuring valid outcomes. Despite more than 500 applied research papers that conclude that workplace behavioral health intervention is generally effective, most of these remain unpublished, proprietary, or simply not shared with the purchasing organization (Attridge, 2013; Taranowski & Mahieu, 2013). As the use of valid tools like CGP’s Workplace Outcome Suite becomes more widespread, and carefully constructed outcome research like the EARFfunded “Impact of EA Services on Workplace Outcomes” study (Richmond & Wood, 2015) becomes more widely published, EAPs need to assure that the information gets to current and prospective purchasers.

4. Improve adherence to standards of quality. EAPA has published EA program standards and professional guidelines since 1981. Other associations and organizations have published their own standards, usually drawn from EAPA’s standards. However, most customer organizations and even many long-time EA practitioners are unaware of what the standards are or where to find them. Without agreed-upon quality standards, the EAP field will never achieve the perceived value and professional acceptance to which it aspires. Let’s Continue the Discussion My thanks to Chestnut Global Partners for allowing use of their survey information and to Matt Mollenhauer for taking the time to review and discuss the survey with me as I was preparing this column. Let’s continue the discussion of needs and trends in the global EAP market! You’re welcome to contact me directly anytime or to post your feedback, questions, or suggestions on EAPA’s LinkedIn group. v

Hagen, R., Sharar, D., & Mollenhauer, M. (2016). State of global EAP and top needs in the industry. Employee Assistance European Forum, Bucharest, Romania. Mollenhauer, M. (2017). EAP survey reveals market segments and top industry needs. 2017 Trends Report. Chestnut Global Partners.

Steel, Z., Marnane, C., Iranpour, C., Chey, T., Jackson, J., Patel, V., & Silove, D. (2014). The global prevalence of common mental disorders: a systematic review and metaanalysis 1980-2013. International Journal of Epidemiology, 43(2), 476-493. Richmond, M. & Wood, R. (2015). Impact of EA Services on Workplace Outcomes. EAPA’s 2015 World EAP Conference, San Diego, California. Taranowski, C. & Mahieu, K. (2013). Trends in EAP implementation, structure, and utilization, 2009-2010. Journal of Workplace Behavioral Health, 28(3).

Dr. John Maynard served as CEO of EAPA from 2004 through 2015. Prior to that, he was President of SPIRE Health Consultants, Inc., a global consulting firm specializing in EA strategic planning, program design, and quality improvement. In both roles, he had the opportunity to observe, meet, and exchange ideas with EA professionals in countries around the world. He currently accepts speaking and consulting projects where he can make a positive difference. He can be reached at johnmaynard@spirehealth.com.

References Attridge, M. (2013). The business value of employee assistance: A review of the art and science of ROI. EAPA’s 2013 World EAP Conference, Phoenix, Arizona. Attridge, M., Cahill, T., Granberry, S., & Herlihy, P. (2013). The NBC industry profile of external EAP vendors. Journal of Workplace Behavioral Health, 28(4).

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techtrends Four Tech Trends that will Impact EA in the Near Future | By Marina London, LCSW, CEAP

have written in this column about the accelerating pace of technological advances impacting behavioral healthcare. Case in point, over the course of a single week, I learned of four important developments that may have an immediate, or almost immediate, impact on employee assistance. 1. Talkspace About two years ago, I wrote a blog post about a company called Talkspace. The firm promised users that, “for $25 a week, a client can text an assigned therapist whenever they want, and the therapist texts back when he/she can. Unlimited. Anonymous.” I was concerned that EAPs were too late to adopt new technology – especially tech that appeals to Millennials like text. Were we in danger of having the rug pulled from under us? Talkspace has received millions of dollars in venture capital funding. Not so much for employee assistance. Two years later, Talkspace trumpets they have, “been successful in delivering more affordable and accessible care to more than 500,000 people.” Additionally, they claim to have offered their texting service “to employees at more than 40 companies through Talkspace, and the higher utilization and lower

cost resulted in a 61% decrease in hours missed from work due to mental health issues.” They have barreled into employee assistance turf and positioned themselves as a go-to workplace behavioral solution. What will be our response? 2. Robot therapists The University of Southern California is road testing Ellie, a virtual therapist. Ellie is designed to detect signs of depression and post-traumatic stress disorder in patients by tracking and responding to visual and verbal cues. The project was funded by the Defense Advanced Research Projects Agency (DARPA) to treat veterans suffering with PTSD. Ellie’s co-creator, Professor Louis-Philippe Morency, hopes he will be useful in helping patients be more truthful in therapy, allowing them to be treated more successfully. “One advantage of using Ellie to gather behavior evidences is that people seem to open up quite easily to Ellie, given that she is a computer and is not designed to judge the person.” “These indicators are contextualized by the questions asked by Ellie, such as whether the previous question was intimate or not?” Ellie may be adept at listening and

responding, but she doesn’t offer any treatment. Morency stresses that Ellie is not a substitute for a human therapist. Rather, Ellie is used in tandem with a doctor as a data-gatherer, able to break down walls that may exist due to a patient’s unwillingness to disclose sensitive information to a human. Morency further explains, “The behavioral indicators that Ellie identifies will be summarized to the doctor, who will integrate it as part of the treatment or therapy. Our vision is that Ellie will be a decision support tool that will help human doctors and clinicians during treatment and therapy.” Which EAP company will be the first to incorporate Ellie-like robots into their services? When in the future will Ellies be the first-line providers to respond when an employee calls their EAP? 3. The availability of genetic health risk reports, without a prescription On April 6, 2017, 23andMe, a DNA genetic testing and analysis company, announced that they were the only company authorized by the U.S. Food and Drug Administration (FDA) to offer ten genetic health risk reports including late-onset Alzheimer’s disease, Parkinson’s disease, celiac disease, and a condition associated with harmful blood clots.

employees comfortably use Facetime and Skype in their personal lives, they have a corresponding comfort with accessing help online. It’s convenient, and eliminates transportation costs. Check out skytherapist.com and inpathy.com.

The very next day, an article, “Getting your genetic disease risks from 23andme is probably a terrible idea” was published. The article sounded an alarm, explaining: “If you could know whether you were going to develop a debilitating, inevitable, untreatable disease at age 50, would you want to? 23andMe is offering you that opportunity — but they’re not going to ask you that question.

How long before these players directly market themselves to companies as EAP-like products? Aetna’s Teladoc app offers employees video healthcare. How long before the insurance giant offers a Tele-EAP? The infrastructure is already in place. v

“The central problem is this: 23andMe aims to give you all the information you want about your genetic background, but they don’t want to be responsible if that knowledge actually affects you. Are you upset by results that indicate you’re likely to spend the last years of your life dependent on a caretaker, shaking uncontrollably, and losing the ability to speak? Talk to someone else. You’re not 23andMe’s problem anymore.

Marina London is Manager of Web Services for EAPA and author of iWebU (http://www.iwebu.info), a weekly blog for mental health and EA professionals who are challenged by social media and Internet technologies. She previously served as an executive for several national EAP and managed mental health care firms. She can be reached at m.london@eapassn.org.

References

23andMe (n.d.) Retrieved from https://www.23andme.com Aetna Teladoc app. (n.d.) Retrieved from https://www.teladoc.com

“You can’t unring that bell. [emphasis mine] And if a company is going to sell customers their right to know, they should have to provide help when that knowledge hurts.”

Chodosh, S. (2017, April 7). “Getting your genetic disease risks from 23andme is probably a terrible idea” [Blog post]. Retrieved from http://www.popsci.com/23andme-is-probably-terrible-idea. Inpathy.com. (n.c.) Retrieved from https://inpathy.com/how-itworks/types-of-care/

Who knows if and when the FDA will require companies like 23andMe (and there will surely be more), to provide genetic counseling, or even a list of organizations and individuals who provide genetic counseling. But this development is clearly an opportunity for EAPs with multiple points of engagement.

iWebU.info (2015, April 29). Web Secret #360: Talkspace. [Blog post]. Retrieved from http://www.iwebu.info/2015/04/websecret-360-talkspace.html iWebU.info (2016, December 21). Web Secret #446: skytherapist.com [Blog post]. Retrieved from http://www.iwebu. info/2016/12/web-secret-446-skytherapistcom.html iWebU.info (2017, May 17). Web Secret #467: Slouching towards Gattaca [Blog post]. Retrieved from http://www.iwebu. info/2017/web-secret-467-slouching-towards-gattaca

EAPs can: • Provide lunch-and-learn presentations or training programs that explain to employees the advantages and liabilities offered by this new frontier in medical science. • Add genetic counselors to their existing affiliate provider lists in anticipation of this need. • Consider offering genetic counseling as an addendum to more traditional EAP services.

Jolly, N. (2016, October 1). Meet Ellie: the robot therapist treating soldiers with PTSD [Blog post]. Retrieved fromhttp://www. news.com.au/technology/innovation/meet-ellie-the-robot-therapist-treating-soldiers-with-ptsd/news-story/0201fa7cf336c60918 2cffd637deef00 Morath, E. (2016, February 18). Gig economy attracts many workers, few full-time jobs [Blog post]. Retrieved from https://blogs. wsj.com/economics/2016/02/18/gig-economy-attracts-manyworkers-few-full-time-jobs/ SimSensei. (2017). University of Southern California Institute for Creative Technologies. Retrieved from http://ict.usc.edu/prototypes/simsensei/

4. Tele-EAP While many EAPs struggle to get a toe into teletherapy, companies offering behaviorally related teleplatforms are proliferating. Because more and more 15 | W W W . E A PA S S N . O R G | •• • • • • • • • • • • • • • • • • • •

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coverstory EAPs and the Opioid Crisis

“One of the clearest changes in the new face of opioid abuse involves a major socio-demographic shift among users into the adult working population. In 2015, prescription opioid misusers were typically white, middle class, older adults (age 26-50), and living outside large urban areas.”

|By Bernie McCann, PhD, CEAP

s the demographics of opioid use disorders shift to include greater numbers of the working-age population, EAPs are increasingly encountering cases of abuse and addiction among covered workers and their families. Expanding media coverage and a growing body of epidemiological studies have raised awareness about the alarming rise in abuse, addiction, and deaths from both illicit and prescription opioids. In the U.S., the number of deaths from opioid overdoses continues to rise, reaching more than 33,000 in 2015, which was the highest number ever recorded. Opioids, which include prescription drugs and illicitly manufactured heroin and fentanyl, accounted for more than 60 percent of all drug-related overdoses that year. Even more revealing is that 91 Americans die every day from an opioid overdose (Centers for Disease Control and Prevention, 2017). Problem is Widespread This issue is not confined within American borders, as Canada has become the world’s second-largest consumer of prescription opioids, second only to the United States. Opioid-related deaths have quadrupled in the province of Ontario, and doubled

in British Columbia. While North America’s rate of opioid use is far ahead of any European country, opioids and sedatives have also been identified as the most prevalent substances in prescription drug abuse in Europe. Globally, these substances account for the highest illicit drug-related burden of disease (Degenhardt, et al., 2013). The increase in the nonmedical use of these medications has emerged as a major health problem among a broad spectrum of ages, geographic locations, and social classes. In fact, prescription opioids are the most frequently abused class of drugs in the U.S. The impact of this phenomenon on the U.S. healthcare system is further demonstrated by the five-fold increase in admissions for opioid addiction over the past decade and a 150-percent rise in emergency department visits involving prescriptions or illicit opioids. How Did We Get Here? Due to increased awareness of chronic pain, support from organizations that treat pain, changes in medications, treatment guidelines, and alleged aggressive marketing by pharmaceutical companies, prescriptions for opioid pain medications (such as hydrocodone and oxycodone) have quadrupled since the 1990s.

These drugs override the brain’s decision-making center and are associated with acute physical withdrawal symptoms, which for some individuals can create a high risk for abuse or addiction. Prescription opioid addiction can occur when patients develop a tolerance for the medication as prescribed and no longer get the same level of relief. The relatively rapid emergence of chemical tolerance toward more easily obtainable opioids (both prescription and illicit) has resulted in an increase incidence of abuse, dependence, and overdoses. In the U.S., an estimated two million people currently meet DSM criteria for abuse or addiction to prescription opioid pain relievers. Close to half (44 percent) of Americans know someone who is addicted to a prescription pain reliever (National Safety Council, 2017). The numbers of those who abuse these substances, while historically high, has actually declined slightly since 2014, a result of various efforts to more closely monitor opioid prescriptions. Unfortunately, an unintended consequence of these measures has been an escalation in user transition to heroin, which in many areas has become cheaper and easier to obtain than prescription opioids.

changed to heroin when the medications became more difficult to obtain (Jones, 2013). To avoid withdrawal symptoms, some individuals may alternate between these substances, when one is more readily available than the other.

Consequently, while the numbers of those misusing prescription pain relievers may have begun to level off, the number of overdose fatalities from heroin and other illicit street opioids continues to rise. In fact, the number of individuals suffering from heroin addiction has climbed above the 500,000 mark (Kolodny, et al., 2015).

 Existing mental health conditions – Individuals with mood disorders and post-traumatic stress disorder who self-medicate are at particular risk for substance and opioid use disorders. Best practices with mood disorder patients at greater risk for misuse can incorporate case management protocols such as motivational counseling, opioid agreements, regular or random toxicology screens and compliance checklists, as appropriate (Quello, Brady, & Sonne, 2005).

Demographic Changes are Striking One of the clearest changes in the new face of opioid abuse involves a major socio-demographic shift among users into the adult working population. In 2015, prescription opioid misusers were typically white, middle class, older adults (age 26-50), and living outside large urban areas. This is significantly different from earlier patterns noted in the 1960s-1980s, when users were typically young minority men from urban centers. Not surprisingly, the majority of recent opioid-related emergency visits, treatment admissions, and overdose deaths have occurred among adults over 26 (Cicero, Ellis, Surratt & Kurtz, 2014; Hughes, et al., 2016). Changes in gender are also evident. Deaths and treatment admissions from these medications have risen faster for females. They are more likely than men to have chronic pain, to be prescribed prescription pain relievers at higher doses, and to use them for longer periods of time. In addition, they may become dependent more rapidly than men. Males are still more likely to overdose on prescription opioids, but the gap between genders is closing (Centers for Disease Control and Prevention, 2013).

 Multiple drug users – Nine in 10 people who use heroin use it with at least one other drug, and many with at least two other drugs. Comprehensive assessments of individuals reporting multiple substance abuse experiences may assist in identifying more high-risk individuals, especially since

Those at Higher Risk Risk factors for opioid abuse and addiction include family history of substance abuse, age, multiple psychosocial stressors, frequent contact with high-risk individuals and environments, history of thrill-seeking behavior, smoking, severe depression or anxiety, and previous drug or alcohol rehabilitation. However, some specific factors are notable:  The connection to chronic pain – More than 90 million Americans (approximately one-third of the U.S. population) show symptoms of chronic pain, which is responsible for 25 percent of missed workdays and $100 billion in annual costs (Jamison, Serraillier, & Michna, 2011). Many first-time heroin users report they began their opioid use with prescription pain medications and 17 | W W W . E A PA S S N . O R G | •• • • • • • • • • • • • • • • • • • •

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coverstory this pattern of use poses greater potential for overdose, health complications such as HIV and hepatitis infections, and other dangerous behaviors. Additionally, contemporary heroin users report greater use of other substances such as alcohol, other opiates, cocaine, amphetamines, and hallucinogens, which suggests these users may have a higher risk for treatment dropout, relapse, and difficulty attaining and maintaining recovery (Perkins & Shannon, 2016).  Accidental death by overdose – Worldwide, an estimated 70-100,000 people die from opioid overdose annually (United Nations Office on Drugs and Crime, 2013). The increased use of both prescription and illicit opioids is significantly associated with a greater threat of accidental death by overdose. More recently, drug overdoses involving synthetic opioids have multiplied, most likely due to

the emergence of illicit fentanyl, which is often combined with heroin or sold as heroin, posing a lethal threat to inexperienced users. While overdose deaths between 1999-2015 increased for all age groups, the greatest increase for 2015 was in adults aged 55-64, although since 2005 adults aged 45-54 showed the highest overall rates of fatal overdose (Centers for Disease Control and Prevention, 2017). Current Approaches to Treatment Today, three different FDAapproved medications and several evidence-based counseling approaches are available to treat opioid dependence. One of the biggest problems in addiction treatment is preventing relapse, and incorporating medications can ease cravings and withdrawal symptoms that may trigger relapse. Medication-assisted treatment, particularly when combined with

What are Opiates and Opioids? The wide spectrum of narcotic substances incorporates both legitimate pain medications and illicit substances. While they share many physiological and psychological effects, these substances have different origins and routes to initiation. Opiates such as morphine, heroin, and codeine are derived from opium harvested from unripe poppy seed pods. At one time, opioids referred to synthetic opiates only (chemical preparations created to simulate opium). They are collectively known as pharmaceutical opioid analgesics, or simply prescription pain medications, and include opioids such as hydrocodone (e.g., Vicodin®) and oxycodone (e.g., OxyContin® and Percocet®). Today, the term opioid is used for the entire family of opiate-like drugs, regardless of whether they are natural, synthetic, or semi-synthetic. - Bernie McCann, PhD, CEAP

psychosocial therapies such as 12-step groups, motivational counseling, behavioral therapies, recovery support, and relapse prevention efforts effectively decrease opioid use, reducing opioid-related overdose deaths and infectious disease transmission. Available medications include buprenorphine and naltrexone, which have expanded choices beyond the more traditional methadone introduced in the 1960s. Unfortunately, residual stigma to these evidence-based treatments persists, based on the misunderstanding that these medications substitute one addiction for another. More accurately, they do not produce euphoria but rather ease withdrawal symptoms and restore balance to the brain affected by addiction (American Society of Addiction Medicine, 2013; National Institute on Drug Abuse, 2016). Unfortunately, not all insurance plans cover all available opioid treatment options. According to a recent survey of mental health and substance abuse benefits offered by work organizations, 91 percent included some type of mental health/substance abuse benefit, including EAPs. Of organizations providing substance abuse treatment benefits, 89 percent cover outpatient sessions, 85 percent cover inpatient treatment, while only 67 percent cover prescription drug therapies. Additionally, except for online resources (56 percent) less than half of surveyed work organizations offered education and awareness about substance abuse prevention or treatment to workers

(International Foundation of Employees Benefit Plans, 2016). Our current understanding of substance use disorders and the effectiveness of evidence-based treatment for opioid dependency reinforces the understanding that addictions are chronic conditions for which there are useful treatments, but rarely simple cures. EA professionals have an ethical responsibility to be knowledgeable about these treatments and to present them as viable options to clients. Because prescription drugs are safe and effective when used properly and are broadly marketed to the public, the notion that they are also harmful and addictive when abused can be difficult to convey. Using assessment questions to gauge opioid involvement, reviewing appropriate clinical options, and engaging EAP clients through the treatment spectrum can heighten interventions aimed at preventing individuals from progressing from misuse and abuse to addiction or even overdose. (Editor’s note: These recommendations are explained in greater detail on page 34, “Enhancing Services are Key in Curbing Abuse.”) Summary EAPs are frequently at both the forefront and the nexus of efforts to intervene with substance use disorders. Some have questioned use of the term “crisis” when referring to today’s increase in opioid abuse and addiction. However, as EA professionals, we play a unique and

important role in responding to the needs of employees, union members, and families struggling with these conditions. Bernie McCann, PhD, CEAP, is an independent EAP consultant and researcher. He has over 20 years of experience in EAP consultation and program management, as well as workplace wellness initiatives, workplace trainings, and professional development seminars. He is a published author in peer-reviewed journals and trade publications. He can be reached at mccannbag@gmail.com.

References

American Society of Addiction Medicine. (2013). FDA Approved medications for the treatment of opiate dependence: Literature reviews on effectiveness and cost-effectiveness. Chevy Chase, MD: Author. Centers for Disease Control and Prevention (2013). Prescription painkiller overdoses: A growing epidemic, especially among women. Atlanta, GA: Author. Retrieved from www.cdc.gov/vitalsigns/prescriptionpainkilleroverdoses/ index.html. Hedegaard, H., Warner, M., & Miniño, A.M. (2017). Drug overdose deaths in the United States: 1999-2015. NCHS Data Brief No. 273. Hyattsville, MD. Retrieved from www.cdc.gov/nchs/ products/databriefs/db273.htm. Cicero, T.J., Ellis, M.S., Surratt, H.L., Kurtz, SP. (2014). The changing face of heroin use in the United States: A retrospective analysis of the past fifty years. JAMA Psychiatry.71:821–826. doi:10.1001/jamapsychiatry.2014.366.

Degenhardt, L, Whiteford, H.A., Ferrari, A.J., Baxter, A.J., Charlson, F.J., Hall, W.D., Freedman, G. (2013). Global burden of disease attributable to illicit drug use and dependence: Findings from the Global Burden of Disease study. The Lancet, 382(9904): 1564-74. doi:10.1016/S01406736(13)61530-5. Hughes, A., Williams, M.R., Lipari, R.N., Bose, J, Copello, E.A., Kroutil, LA. (2016). Prescription drug use and misuse in the United States: Results from the 2015 National Survey of Drug Use and Health. NSDUH Data

Review. Retrieved from www.samhsa. gov/data/. Kolodny, A, Courtwright, D.T., Hwang, C.S., Kreiner, P, Eadie, J.L., Clark, T.W., Alexander, G.C. (2015). The prescription opioid and heroin crisis: A public health approach to an epidemic of addiction. Annual Review of Public Health, 36: 559-574. doi:10.1146/ annurev-publhealth-931914-122957. International Foundation of Employees Benefit Plans. (2016). Mental health and substance abuse benefits, 2016 survey results. Brookfield, WI: Author. Jones, CM. (2013) Heroin use and heroin use risk behaviors among nonmedical users of prescription opioid pain relievers - United States, 2002-2004 and 2008-2010. Drug and Alcohol Dependence. 132(1-2):95- 100. doi:10.1016/j.drugalcdep.2013.01.007. Jamison, R.N., Serraillier, J & Michna, E. (2011). Assessment and treatment of abuse risk in opioid prescribing for chronic pain. Pain Research & Treatment. (2011). ID 941808. doi:10.1155/2011/941808. National Institute on Drug Abuse (2016). Effective treatments for opioid addiction. Bethesda, MD: Author. Retrieved from www.drugabuse.gov/effectivetreatments-opioid-addiction-0. National Safety Council (2017). Adding up the impact – The real costs of substance in your workplace. Retrieved from www.nsc.org/forms/substance-useemployer-calculator/index.aspx. Quello, S., Brady, K. & Sonne, S. (2005). Mood disorders and substance use disorder: A complex comorbidity. Science and Practice Perspectives. 3(1), 13-21. Substance Abuse and Mental Health Services Administration. (2017, January 23). U.S. Dept. of Health and Human Services. Revised Mandatory Guidelines by the Secretary of Health and Human Services. Federal Register, 82(13), 7920-7970. World Health Organization and United Nations Office on Drugs and Crime. (2013) Opioid overdose: preventing and reducing opioid overdose mortality. New York, NY: United Nations.

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featurearticle Relevant EAP Apps This Year’s Top 10 List

“How often do counselors and work life specialists actually recommend apps during the initial EAP assessment? ‘On average, 18% of the time,’ according to a 2017 KGA survey. ‘This was a 47% increase over 2016, with 90% of the staff strongly agreeing that it is ‘easier to recommend apps that have been previously vetted.’”

|By Kathleen Greer

or the past three years, KGA, a New Englandbased EAP provider has tested and released an annual list of “Top 10 Well-being Apps.” Although initially designed to put the right app in the hands of EA counselors, KGA’s app project has proven to be an effective way to build awareness of EAP services and improve engagement. EAP Options Abound Overall app usage is rapidly expanding across the globe with an estimated mobile app market reaching $189 billion by 2020. A total of 259,000 mobile health apps were produced in 2016 (Sarasohn-Kahn, 2016). Clinical health apps are also increasing in numbers, although some app companies have folded due to the financial pressures of performing scientifically valid clinical trials. Such rapid growth has made the selection of which apps to recommend confusing. Paid apps are losing in popularity but still have value to EAPs, particularly when they are proven to be effective. However, overall, trends are showing that the app market will continue to generate increasing revenue in the foreseeable future (Golmack, 2017).

250 Apps Evaluated KGA wanted to reach out to their covered lives through a proactive health promotion program to identify apps that could complement KGA’s hightouch EAP product. Leadership also wanted to ensure that counselors were recommending high-quality downloads. All of the 250 behavioral health apps evaluated and recommended are available on iOS and Android. KGA focused their selection process on free or low-cost apps by reviewing customer reviews, ratings, popularity, and history of updates. Narrowing the List Various criteria were used to shorten the list to 35 apps that clients could use as an adjunct to counseling. For example, the apps were each tested by counselors and work-life specialists to confirm their reliability, simplicity, and efficiency, as well as their overall aesthetics. They particularly focused on the efficacy of the apps, especially for severe stress, anxiety, and sleep deprivation. Counselors were asked to comment on the particular apps they tested. Some apps didn’t make the cut for clinical reasons. For example, the counselors liked the “7 Minute Workout” app, but found that the photographs of the

exercise models showed bodies that were unrealistically perfect, thin, and muscular. Since the “10 Best Apps” list is available to the public, counselors worried that the app would be body-shaming to its users. The Sleep Time Smart Alarm Clock app was rejected because it was “not easy to use and more frustrating than it’s worth.” The Suicide Safe app was not selected because it is made for clinical rather than public use. Another food app was rejected because it didn’t “offer anything that you couldn’t get online.” The Top 10 Behavioral Health Apps for 2017  Mood Kit – This app offers professional psychology tips and tools for everyday life to help improve mood and overall wellbeing. Counselor: “The items in Mood Kit are very specific and simple, not overwhelming.”  Happify – Happify is a mental health app that provides effective tools and programing to help take control of emotional well-being. It helps combat stress, anxiety, depression, and constant negative thoughts. Counselor: “I think it creates a positive message of mindfulness and encourages taking a break and checking in with yourself.”

 Insight Timer – This app is the most popular free meditation app in the Apple store. It has a timer with a pleasant chime, which can be used for silent or guided meditation. Insight Timer has more than 5,000 guided meditations from some of the world’s best meditation teachers. There is also a support group feature for those who want to be part of a meditation community. Counselor: “A great simple app to begin and practice meditation. Offers timed

“The mobile health app industry continues to grow. When used in combination with EAP counseling, apps can provide both useful information and motivation.” and guided meditation… free, simple, and straightforward.”  Pacifica – This mental wellness app provides users with psychologist-designed tools to address stress, anxiety, and depression based on Cognitive Behavioral Therapy, mindfulness meditation, relaxation, and mood/health tracking. It offers a user-friendly way to monitor emotions and can be a great adjunct to counseling or helpful on its own. Counselor: “Pacifica sends you reminders to check in around mood and anxiety during the craziness of

life. It not only allows you to track stress, anxiety, and mood, but also allows you to track exercise and diet.”  C25K – This app offers a structured plan for new runners to gradually build strength and stamina. C25K is great for those who like a tailored running plan that does not require a personal trainer or running group. Counselor: “I actually started the program last night, and already I feel motivated by it. I was surprised at that and also liked the helpful FAQs.”  Mind the Bump – This meditation app is perfect to help individuals and couples mentally and emotionally prepare for having a baby and becoming a new parent. Mind the Bump helps users to reconnect with their partner and focus on one’s changing body throughout pregnancy. Counselor: “I really like how this app encourages you to connect with your partner.”  Fooducate –This weightloss app is ideal for individuals who want to lose weight with the help of a free coach and a supportive community. Fooducate allows users to track food intake and mood. Counselor: “I particularly liked that they rated many different kinds of foods and their brands. It’s a great way to track calories and get information about various foods.”  Lumosity – This app improves memory and attention through comprehensive brain training. Lumosity is great to use when you are traveling or have

some time to kill, and it helps to strengthen the power of the brain with fun and engaging games. Counselor: “Lumosity is pleasurable and not intimidating. It’s also informative about strengths or weaknesses in learning.”  Relax and Rest Guided Meditations – This meditation app offers three programs of varying lengths (breath, deep rest, whole body), which allow the listener to relax deeply regardless of how much time the user has to meditate. The calming voice and music can help to put someone with sleeping difficulties into a deep sleep, and help reduce anxiety. Counselor: “I love this app and use it all the time. It has short 6-9 minute meditations that I can quickly do when I get home from a long day at work or right before bed. It helps to relax and center me, which is important after hectic days.”  Cozi Family Organizer – This family organization app’s features include a shared calendar, shopping lists, and to-do lists that everyone in the family can access on the go. Counselor: “Each family member is color coded so you can easily see where everyone needs to be on that day and at what time. It also emails the weekly schedule on Sunday to all family members.”

App Promotion The next challenge was to introduce the apps to the employees and family members we serve. The promotion included: • introductory letters;

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featurearticle • 7,000 cards provided to employees at benefit/health fairs; and • a social media campaign launched on Facebook, Twitter, and LinkedIn. Summary The mobile health app industry continues to grow. When used in combination with EAP counseling, apps can provide both useful information and motivation. “In a way, apps and web pages have replaced our traditional tip sheets,” states Kristin Matthews, Clinical Manager at KGA.

How often do counselors and work life specialists actually recommend apps during the initial EAP assessment? “On average, 18% of the time,” according to a 2017 KGA survey. “This was a 47% increase over 2016, with 90% of the staff strongly agreeing that it’s “easier to recommend apps that have been previously vetted.” “This is a fabulous way to reach our younger population,” noted one HR client. v

Inc., which provides EAP services to over 100 organizations. Kathy can be reached at greer@kgreer.com.

References

Golmack, S. (2017, February 20). Current trends and future prospects. Smashing Magazine. Retrieved from https:// www.smashingmagazine.com/2017/02/ current-trends-future-prospectsmobile-app-market Sarasohn-Kahn, J. (2016, October 21). The mobile health app glut [Blog post]. Retrieved from http://www. healthcareitnews.com/blog/mobilehealth-app-glut

Kathleen Greer is founder and chairman of the Framingham, Mass.-based KGA,

webwatch Disability Management Disability Management Employer Coalition http://dmec.org/ Through its chapters and education programs, the Disability Management Employer Coalition (DMEC) provides strategies, tools, and resources to minimize lost work time, improve workforce productivity, and maintain legally compliant absence and disability programs. Emotional Intelligence Test Your Emotional Intelligence http://www.ihhp.com/free-eq-quiz/ Test your emotional intelligence with this free quiz. The test assesses how you can improve managing your emotions under stressful conditions.

Employee Assistance Integrating and Curating TED Talks for EAPs https://www.slideshare.net/randy rebman/integrating-and-curatingted-talks-for-eaps Have you used TED talks? When you select a TED talk, what criteria do you use? What are the benefits of using TED talks? Check out this link to learn more.

www.ebri.org The Employee Benefit Research Institute (EBRI) encourages the development of sound employee benefit programs and public policy through objective research and education. Links include issue briefs, surveys, and more.

Employee Benefits Employee Benefit Adviser www.employeebenefitadviser.com Workplace benefit news for advisers, brokers, consultants – also tools for business growth and development.

Center for Financial Social Work www.financialsocialwork.com The Center’s mission is to empower individuals to make healthy, long-term financial decisions. The center educates and supports professionals who wish to provide financial well-being to their clients.

Employee Benefits Employee Benefit Research Institute

Financial Wellness

webwatch Human Resources HR Dive http://www.hrdive.com/ The latest on talent acquisition, HR management, compensation and benefits, and much more. Mental Health Equal Employment Opportunity Commission https://www.eeoc.gov/eeoc/ publications/ada_mental_health_ provider.cfm The EEOC document, “The Mental Health Provider’s Role in a Client’s Request for a Reasonable Accommodation at Work” helps therapists and other health professionals advise clients on the Americans with Disabilities Act (ADA) and what accommodations they be entitled to. Mental Health International Society for Mental Health Online www.ismho.org This is an international community exploring and promoting mental health in the digital age. Members, which include researchers, clinical practitioners, and others, meet online to discuss issues and collaborate on projects. Mental Health Speaking About Depression Community Blog https://speakingaboutdepression. wordpress.com/ Established by Patricia and John Gallagher, this blog is a safe community where anyone can talk about the effects of depression on their lives. Links include a depression FAQ, lifting the spirits of the elderly, and share your story.

Substance Abuse National Institute on Drug Abuse www.drugabuse.gov Learn the facts about the most commonly abused drugs, in addition to the latest in drug abuse research, clinical trials, and more.

Workplace Bullying Civility Partners http://civilitypartners.com Civility Partners offers a variety of civility consulting services in order to effectively eradicate workplace bullying and create a positive workplace.

Substance Abuse A Substance Use Cost Calculator for Employers https://www.nsc.org/forms/sub stance-use-employer-calculator/ index.aspx The National Safety Council and national nonprofit Shatterproof collaborated with NORC at the University of Chicago to design an easy-touse tool providing business leaders with specific information about the cost of substance use (including prescription drug abuse and misuse, opioid and heroin addiction) and others.

Workplace Wellness Cancer and Careers www.cancerandcareers.org This nonprofit helps patients, survivors, healthcare professionals, and employers navigate the practical and legal issues common after a cancer diagnosis. v

Substance Abuse The Fix https://www.thefix.com/ The Fix is a leading website about addiction and recovery, featuring breaking news, exclusive interviews, investigative reports, essays, blogs on sober living, and more. TED Talks The Most Popular Talks of All Time https://www.ted.com/playlists/171/ the_most_popular_talks_of_all What makes a great leader? How can I find happiness? Is it really possible to make stress your friend? The talks at this site are among ones that TED fans just can’t stop sharing.

KGA WORK-LIFE SERVICES Because when it comes to work-life, experience matters most. Ask us how we can help enhance your EAP with KGA’s work-life fulfillment services. 800.648.9557 info@kgreer.com kgreer.com

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featurearticle Using CARSSM to Address High Conflict in the Workplace “Once identified, the EA professional can talk with a client about dealing with problems regarding a co-worker, supervisor, or manager who has a high-conflict pattern of behavior. The focus is on the high conflict behavior, so that neither the EA professional nor the client are labeling the co-worker as a ‘high-conflict person.’”

| By L. Georgi DiStefano, LCSW; and Bill Eddy, LCSW, Esq.

ost of us have had a bad day at work. We may have overreacted to a certain situation, become negative before understanding the complete picture, or perhaps we

were just grumpy on a particular day. On the other hand, people with high-conflict personalities (which we will refer to in this article as HCPs) get stuck in a repeated pattern of over-reaction

and negativity. Among other traits, these individuals exhibit unbridled emotions and extreme behaviors. This article introduces readers to CARSSM, a new approach for effectively addressing

What is a BIFF Response ? ®

Dealing with high-conflict personalities and their irate behavior can leave anyone at a loss. A CARSSM technique known as a BIFF Response®, can defuse hostile written communications or other misinformation. BIFF is simple: Brief (so it doesn’t trigger a hostile response), Informative (straightforward information, not defensive, emotional, opinionated or argumentative), Friendly (pleasant greeting) and Firm (ends the hostile conversation). Rule #1 is to ask an employee client: “Do I need to reply to this at all?” Have the individual read the email/ text with a critical eye: Is there anything that really requires a response? (A deadline, an appointment, a needed decision). The client should look for valid matters and ignore the barbs. A decision on an appointment time is valid. An accusation that the employee never communicates is invalid. Asking what time to pick up a child from school is valid. Saying everybody is mad at you/blaming you is not valid.

Additionally, a decision needed for a concrete issue is only valid if it’s new. Further demands to discuss the same matter are not valid and need no reply, or a shorter, onetime only version – of what the client said previously. The employee should never take the bait when the next re-worded email with the same demand comes along. If the employee client needs to reply, he/she should follow BIFF: • Brief: Keep it simple. Long explanations and arguments trigger arguments for HCPs. • Informative: Focus on straightforward information, not arguments, opinions, emotions or defending yourself (you don’t need to). • Friendly: Have a friendly greeting (such as “Thanks for responding to my request”); close with a friendly comment (such as “Have a good weekend”). • Firm: Have a response to end the conversation, or offer two choices on an issue and ask for a reply by a certain date.

Example: Team member email: “Who do you think you are? You’re messing up the whole project and making me look bad! You know we were supposed to turn in those figures yesterday, but no! You’re so important you didn’t offer the courtesy of rearranging your meeting. I couldn’t get it done and it’s your fault!” Employee: “Hi co-worker A, I appreciate your concern for getting reports in on time. As I mentioned in my email to everyone last week, my meeting could not be rescheduled. I’ve attached a copy of the email for you. You’ll see that Ms. Boss gave us an extension until Friday. I am available all afternoon. What time can you meet to finish the figures? Have a good morning. –Me” - Trissan Dicomes, BIFF Response Coordinator for the High Conflict Institute

The CARS MethodSM These skills can be used in step-by step progression or individually at any given time, just be sure to at least “connect” each time one is used. The four steps in this method are connecting, analyzing options, responding to misinformation, and setting limits. (An illustration of the CARS MethodSM is provided on page 27.)

high-conflict situations with clients, co-workers, or supervisors in the workplace. High-Conflict Characteristics The four primary characteristics of someone with a high-conflict personality are: • preoccupation with blaming others; • all-or-nothing thinking; • unmanaged emotions; and • extreme behaviors.

 Connecting: Advise your client that it is very important to “connect” with a difficult person before addressing any specific issue or situation. Using an “EAR” statementSM is a good starting point. For instance: “I can see how frustrated you are (empathy). I will pay attention to your concerns (attention). I have a lot of respect for your efforts in solving this problem (respect).” This concept may be difficult for a client to accept at first. After all, why should they be respectful or empathetic with someone who is giving them grief?” The EAP can help the client learn that EAR StatementsSM usually calm down upset people right away so they can then use problem-solving skills. Our experience has repeatedly shown this to be true. (More information is

These are usually the most common and observable characteristics. However, there are also secondary characteristics: frequently rigid or controlling behavior; thinking dominated by negative emotions; inability to reflect on their own behavior; difficulty empathizing with others; and constantly recruiting “negative advocates” to help them attack their “targets of blame.” These characteristics lead HCPs into a range of high-conflict workplace behavior: being uncivil; bullying; spreading rumors; purposefully misrepresenting others; pitting employees against each other; sabotaging work projects; and demeaning subordinates, whether in public or in private. Once identified, the EA professional can talk with a client about dealing with problems regarding a co-worker, supervisor, or manager who has a high-conflict pattern of behavior. The focus is on the behavior, so that neither the EA professional nor the client are labeling the co-worker as a “highconflict person.” Adapting Your Approach The next step in addressing this type of behavior involves teaching clients to adapt their approach when dealing with a HCP. We emphasize using RAD: • Recognize a pattern of high-conflict behavior. • Adapt your approach by focusing on future behavior rather than trying to give the person feedback about past behavior. HCPs do not respond well to negative feedback. We suggest that clients “feed it forward” instead, which focuses on the future (upcoming work projects, tasks, events, etc.) and doesn’t trigger as much defensiveness. • Deliver the four key skills of CARSSM, which the client can use to manage their own responses. 25 | W W W . E A PA S S N . O R G | •• • • • • • • • • • • • • • • • • • •

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featurearticle presented in the sidebar, “EAR” Statements Assist Individuals with Personality Disorders, below.)  Analyzing options: The second step of CARSSM is to assist clients in reviewing their immediate and long-term options. Over the course of several sessions, the EA professional can help an individual come to terms with a course of action. An important point here is that many clients have been so

stressed by their experience with an HCP that even simple solutions do not come to mind. Standard pro/con lists and other traditional discussion tools can be effective at this stage. A key takeaway for the client should be that the HCP is not going to change. Therefore, how the client manages the situation, and examines their options and expectations is fundamental to their own well-being. Of course, some situations will war-

rant involvement from Human Resources, especially if policies or procedures have been violated. The EAP is often essential in helping make that determination.  Responding to misinformation: HCPs can stir the workplace pot and create great fear and dissention. They have the ability to recruit individuals as negative advocates. The negative advocate is often not a high-conflict person, but has been

“EAR” Statements Assist Individuals with Personality Disorders The CARSSM technique known as “EAR” statementsSM use empathy, attention, and respect in addressing conflicts. Individuals with personality disorders, primarily those in Cluster B, “often appear as dramatic, emotional, and erratic” (American Psychiatric Association, 2013. p. 646). EAR statementsSM seem to be exceptionally helpful when assisting individuals with these disorders. Note that not all personalitydisordered individuals are highconflict people. While some are clearly HCPs who focus on a specific target of blame, others do not have targets of blame and are mostly hard on themselves. In the case of Cluster B, these are persons with a Borderline, Narcissistic, Histrionic, or Antisocial personality disorder. The following are examples of using EAR statementsSM with these groups.  Narcissistic HCPs seem to have an underlying fear of being seen as helpless or inferior. Therefore, EAR statementsSM that focus on respect and attention can be particularly effective. (“I

respect your hard work on this issue and I’m interested in hearing your suggestions.”)  Borderline HCPs are preoccupied with fears of abandonment. When they feel abandoned (even if they aren’t), they can become enraged, vindictive, and sometimes violent. EAR statementsSM that focus on empathy and attention are very helpful. (“I can see how upset you are about this. Let us see what we can do to deal with this problem.”)  Antisocial HCPs can be the most dangerous in the work environment. EA professional guidance is absolutely essential to navigate this situation. Chronic lying, lack of remorse, and manipulation are hallmarks of this category. EAR statementsSM that focus on respect can be helpful in the short term, but clients will also need to learn strategies to protect themselves. The EAP will need to be involved in protecting the work environment from the possible predatory behavior of these individuals. (“I respect your energy and drive. Just keep in mind the rules we all need to follow to succeed here.”)

 Histrionic HCPs are usually not high-conflict people because they do not focus on a target of blame. However, they often see themselves as victims and fear being ignored. As a result, attention is an effective EAR technique with this group. (“It sounds like you’ve been in a tough situation. Tell me more.”)

According to research, “approximately 15% of U. S. adults have at least one personality disorder” (American Psychiatric Association, 2013). Yet another sizable percentage have traits of these disorders that make them difficult to deal with in the workplace. Conservatively, that’s at least 25 percent of the U.S. workforce. This makes EAR techniques important tools for EA professionals to add to their toolkits. To learn more about EAR, visit http://www.highconflictinstitute.com/ calming-upset-people-with-e-a-r. - L. Georgi DiStefano and Bill Eddy

Reference

American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th Ed). Arlington, VA: Author.

drawn into the drama and lends credibility to the HCP, even though the advocate typically does not present facts or offer information that would add to clarity of the issue. EAPs should encourage all clients, especially supervisors and managers, to address such misinformation promptly. Utilize team meetings, memos, other workplace gatherings, and email to set the record straight. With respect to written communication, the CARS MethodSM

includes a technique we call a “BIFF Response®.” BIFF stands for brief, informative, friendly, and firm. (Eddy, 2014b). (See sidebar on page 24 for examples.) The takeaway for a client is that ignoring misinformation or rumors is a mistake. Conflict will spread, not diminish, when HCPs are involved.  Setting limits: An EAP can be instrumental in helping an employee set appropriate limits

within the organization’s policies, procedures, and Human Resource directives. The previous CARSSM steps lay the groundwork for setting limits. This includes establishing a limit by having the client focus on the desired behavior. Then, clarify the policy to focus on the behavior the organization wants. Next, explain the benefits of the desired behavior as well as the consequences for not demonstrating the recommended behavior.

An Example of the CARS Method Ted has a reputation as a manager with a short fuse. Erik has been called into Ted’s office. Ted is furious that a contractor, STEVCO, has been late with an order. He does not want to hear excuses and wants to send a message to the firm that he will not tolerate such poor performance. He directs Erik to cancel upcoming orders with STEVCO and find a more competent replacement. Erik is familiar with the company’s outside vendors and realizes that no other competitor has the resources or job knowledge necessary for the upcoming projects. Such an action would create major problems for their company. Erik meets with his employee assistance professional for guidance. The EA professional teaches him the four–step CARS MethodSM, which Erik uses in his next conversation with Ted: Erik: “Ted, I know the delay is very upsetting to you. I have spoken directly to STEVCO and they fully realize the difficulty it has created. They have devised a backup plan.”

Ted: “Too little too late. They are out!” Erik: “This is certainly your decision. You have every right to be angry and upset. It is very important that these projects are completed according to your timetable. But if we change vendors at this time, I’m afraid we will go from the frying pan into the fire. The other vendors have only performed minor jobs for us. We have no idea if they have the capacity to handle a major project.” Ted: “I’m so angry. What a headache.” Erik: “I agree! I have a proposal. Why don’t I do some research on the top vendors? You make the selection and we give them a challenging project in the next quarter to see how they handle it. In the meantime, we keep STEVCO working on the next set of projects. They understand that you are dissatisfied and will secure the services of an additional contractor. That should keep them on their toes. If the new contractor works out, we can divvy up the work as you see fit. If they don’t, we have not jeopardized all of our projects.”

Ted: “Good, that sends a strong message to STEVCO, let’s proceed.” Erik: “Excellent! I will put everything in motion and keep you updated.” Summary: Erik recognized that if he followed through with Ted’s emotional directive, he would have created havoc for the company, so he sought guidance from his EAP and learned the CARS MethodSM.  He connected with Ted by giving him empathy, attention and respect.  Then he helped Ted analyze options by making a proposal that Ted recognized was in his interests.  He responded to Ted’s misconception about the expertise of the other vendors.  Finally, Erik helped Ted set limits appropriately with STEVCO by bringing on another vendor, while protecting the company by continuing with STEVCO projects. This allowed Ted to exercise his authority and express his displeasure, without causing substantial harm to their company. - L. Georgi DiStefano and Bill Eddy

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featurearticle It should be emphasized that focusing on what the client/organization wants is another aspect of the “feed it forward” approach described earlier. Summary The time has come for EAPs to introduce strategies to help employees and managers at all levels gain the skills necessary to effectively interact with HCPs. These abilities typically don’t occur intuitively, so teaching the CARS Method SM can help curb this growing problem. v

earoundup Coaches, Self-help Groups on the Rise in India The rate of participation in counseling and self-help groups remains low in India. However, that may be because the discussion around mental health has only just started opening up, according to the Hindustan Times. “The idea is for one to be heard, especially if one is suffering from depression, as people tend to open up more in group circles,” stated Gaurav Agarwal, who formed the group Listening Circle – Share & Listen, earlier this year. This is not the only such effort. Harsh Arora’s life hack group, started four years ago, now has 600 members, who meet once a month at coffee shops and members’ houses in Delhi NCR. “Ever since news of WHO’s year-long campaign ‘Depression: Let’s Talk’ came

L. Georgi DiStefano, LCSW, and Bill Eddy, LCSW, Esq. are consultants and trainers with the High Conflict Institute, and are the co-authors of the award-winning book, “It’s All Your Fault at Work: Managing Narcissists and Other High-Conflict People and New Ways for Work Coaching, Manual and Workbook.” Ms. DiStefano has extensive clinical/ management experience in mental health, EAP service, and addiction treatment, and was inducted into the California Social Work Hall of Distinction in 2014. Mr. Eddy, the President of the High Conflict Institute, speaks worldwide on managing high-conflict situations in legal disputes and workplace conflicts.

References

American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th Ed). Arlington, VA: Author. Eddy, B. (2014a). So, what’s your proposal? Shifting high-conflict people from blaming to problem-solving in 30 seconds. Scottsdale, AZ: Unhooked Books. Eddy, B. (2014b). BIFF: Quick responses to high-conflict people, their personal attacks, hostile email and social media meltdowns. (2nd Ed.). Scottsdale, AZ: Unhooked Books. Eddy, B., & DiStefano, L.G. (2015). It’s all your fault at work: Managing narcissists and other high-conflict people. Scottsdale, AZ: Unhooked Books.

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out, we’ve been getting more calls from people who have depression or feel lonely,” says Arora. “People open up to strangers more.”

Marijuana Legalization Coming to Canada? Canada could soon become the second country in the world to legalize recreational marijuana nationwide, reports Time magazine. Uruguay became the first nation to legalize marijuana in 2013, but it has been slow to establish a market for the substance. However, given Canada’s proximity to the U.S., legalization in America’s neighbor to the north would be far more likely to affect conversations about how to deal with marijuana in the U.S. than issues in countries farther away.

The lessons that Canada would likely learn while forming a market for marijuana — such as how rules vary among provinces that share borders — would be ones that the United States could learn from, just as states like Oregon and Washington have had the benefit of learning from Colorado’s “growing pains” on the issue, according to Time. In fact, Canada’s recreational marijuana task force consulted with Washington and Colorado to prepare for its legalization bill. An official with the investor network Arcview Group told Time that Canada would be in a solid position to establish a lucrative export business for marijuana. Elsewhere, Germany recently legalized medical marijuana, and other nations are considering relaxing their laws. EA Roundup continued on page 29

earoundup Should Marijuana be Removed from Drug Screens? Employers are in a quandary. Should they stop testing job applicants for marijuana use now that more states have legalized it for medicinal or recreational purposes and popular acceptance of the substance has spread? Twenty-eight states and the District of Columbia have legalized medical marijuana. Eight of those states (Alaska, California, Colorado, Maine, Massachusetts, Nevada, Oregon, and Washington) and the District of Columbia have also legalized marijuana for recreational use. Surveys are showing that employers in states that have legalized the recreational use of marijuana are gradually removing the substance from pre-employment drug testing panels, according to the Society for Human Resource Management (SHRM). Experts agree that HR should consider the nature of the job and industry when contemplating whether to continue testing candidates for marijuana. “The most important consideration is what type of job the applicant is applying for?” says Kathryn Russo, an attorney at the Jackson Lewis law firm in Long Island, N.Y. “Drug testing is about safety. If you have an applicant applying for a dangerous job, like driving a forklift, I doubt an employer will be OK with a recreational marijuana user in that role.” If employers decide against a zero-tolerance policy on marijuana, experts said that HR should assess a candidate’s ability to perform the required job functions

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and review whether a reasonable accommodation is applicable or required by federal and state disability rights laws.

EEOC Issues Workplace Harassment Guidelines Workplace harassment is virtually an epidemic in the U.S. According to the Equal Employment Opportunity Commission (EEOC), one-third of the nearly 100,000 charges it receives annually now include a harassment allegation. But the agency is taking steps to help both workers and managers handle the problem. The new guidance comes on the heels of a 95-page report assembled by a task force to prevent harassment in the workplace. The end result was four checklists the EEOC urges employers to use to stymie harassment. The detailed lists focused on the following key areas: leadership and accountability, anti-harassment policy, reporting and investigations, and compliance training. Read more at http://bit.ly/ 2q2ciMo.

“For example, many feel that they need an app for their intervention when they actually could use a responsive-design website (a website that works well across different mobile and non-mobile platforms),” stated Brie Turner-McGrievy, an assistant professor at the University of South Carolina, on BioMed Central. “It’s because of this misconception that our team decided to share some lessons learned and guidance in choosing between mobile responsivedesign websites vs. mobile apps for research interventions.” To learn more about the case studies (two chose a mobile app and two selected a mobile website) go to http://blogs.biomedcentral. com/on-health/2017/05/12/web-orapp-whats-best-for-your-mobilebehavioral-intervention/. v

Web or App? Which is Best for You? As the world becomes more mobile, so do the methods EA professionals use to help employee clients improve their health. While apps can be an effective way to collect data and deliver behavioral interventions, they are not always the most cost and time-efficient delivery platform. 29

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featurearticle Coaching the Uncoachable Executive

“The coach must help the executive uncover his or her intrinsic motivation to change. In other words, find a reason they would change this behavior even if they were not being pressured to change.”

|By Steve Albrecht, DBA

f we take the idea that you can lead a horse to water but you can’t make it drink to the business arena, how can companies use coaching to help their leaders improve their performance or behavior, when they don’t think they need it? I work with two types of employees when it comes to coaching; pick the one you’d rather be in the room with. One says, “I’m so glad you’re here! I know I’ve got some rough edges, some blind spots, and I need to improve the way I communicate with my staff and my boss. We have a lot to talk about and I want to get right to work.” Chance of success: high. The other type says, “I don’t know why you’re here or I’m here. It’s probably because one of my team got hurt feelings and complained. Maybe my style is a bit rough, but I get things done. Besides, the clients love me and I make this place a lot of money. Can we get on with whatever this is? I have a lot of work to do.” Chance of success with this type of client? Poor to middling. Coaching Executives is a Thorny Issue For help with this thorny issue, I spoke with Jordan Goldrich, COO of the San Diegobased executive coaching firm, CUSTOMatrix. Jordan holds an LCSW license and is a Master-

“The other type says, ‘I don’t know why you’re here or I’m here. It’s probably because one of my team got hurt feelings and complained. Maybe my style is a bit rough, but I get things done. Besides, the clients love me and I make this place a lot of money. …’” Certified Executive Coach. Coaching an executive can be an extremely challenging task, according to Jordan. “Most executives who don’t want to be coached are referred by their managers for coaching for several reasons. They’re very valuable because of their technical knowledge or business expertise, but their interpersonal style creates a negative impact on their

key stakeholders and superiors. Or they are part of a leadership development program, where everyone must have coaching and they don’t want it because they are legitimately too busy, don’t trust or respect the coach, or don’t believe it will be valuable for them.” Jordan also sees executives as having either a lack of insight or a skewed view of their impact on their organization and the people in it. “They’re genuinely not aware of the impact they’re having on others,” he explains. “Or they recognize they’re having a negative impact but can’t believe their impatience, frustration, anger, and even sarcasm with employees is more of a problem than lack of production, late deadlines, fuzzy thinking, and lack of accountability of the people who are complaining. In addition, many don’t believe they can control their behavior.” It’s interesting to note the mindset that Jordan sees in these executives and senior leaders who are seen as abrasive. They believe they are like warriors, achieving a level of success in overwhelmingly complex strategic roles. Jordan adds, “They believe they are not being recognized for their contribution. They may even feel they are being disrespected.” Abrasive Leader as a Client These internal challenges can manifest in significant hurdles for

Summary Poorly performing employees sometimes leave under the executive client’s “new and improved” leadership approach because they can no longer hide behind the formerly abrasive behavior of their manager. However, the coaching process benefits those who participate fully. The challenge in all behavior and performance change is getting business leaders to leverage their own intrinsic motivations to change. Then they are able to see the wisdom of good ideas, positive suggestions, and the need to embrace them, regardless of whether they initially like the coaching intervention. v

Jordan in his role as a coach. He says of the abrasive leader as a client, “They believe that the request to change is part of a politically correct culture where, as one executive said to me, ‘Kids are not allowed to play tag because it will harm their self-esteem.’” The coach must help the executive uncover his or her intrinsic motivation to change. In other words, find a reason they would change this behavior even if they were not being pressured to change. If the coaching is successful, they conclude that they should change because they want to be more consistent with their own core beliefs and values. “I have met many sincerely religious people,” Jordan says. “Or they may change because they recognize they want to win or achieve even greater things than they already have.” In many situations, Jordan finds self-assessment instruments can help executive clients. “Assessment instruments provide a wealth of information in an economical way. Their self-ratings on specific items deepen their understanding of their own motivations, and personality, communication, decision, and influence styles. The assessment reports and debriefs can combine to create new options for behavior changes. “I typically use two self-assessments, plus a 360 evaluation, which may include my interviews with key stakeholders,” he adds. “Since I’m certified in the following assessments – Myers-Briggs Type Indicator, FIRO-B, California Psychological Inventory, WorkPlace Big Five, Conflict Dynamics Profile, DiSC, and the Hogan Personality Inventory – they are part of my coaching toolkit as well.”

Dr. Steve Albrecht is a keynote speaker, author, podcaster, and trainer. He holds a doctorate in Business Administration (DBA); M.A. in Security Management; B.S. in Psychology; and a B.A. in English. He is board-certified in HR, security, coaching, and threat management. He worked for the San Diego Police Department for 15 years and has written 17 books on business, HR, and criminal justice. He can be reached at DrSteve@ DrSteveAlbrecht.com. Editor’s note: This article originally appeared in “Psychology Today” and is reprinted with the author’s permission.

Demonstrating Success With serious internal and external obstacles in the executive’s path, how does this client demonstrate success? Coaching, like other soft skills improvements, may not have an obvious immediate benefit, but more of a behavioral and performance shift, which could appear over a span of weeks or months. Obviously, business owners and C-level executives don’t always have a lot of patience for the slow-andsteady approach to improvement. Jordan uses subjective evaluations, like feedback from internal customers, peers, superiors and other stakeholders, achieving goals, and meeting deadlines. Even employee turnover is a measure.

The Journal of Employee Assistance seeks more thought-provoking discourse among EAPA members (and JEA readers) in 2017. One great way of doing that is by submitting a letter to the editor on an article you’ve read in the Journal. For more information, contact the editor,

Mike Jacquart, (715) 445-4386 or email journal@eapassn.org. 31

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| JOURNAL OF EMPLOYEE ASSISTANCE | 3rd Quarter 2017 |

integrationinsights EAP Integration with Behavioral Health Risk Management |By Mark Attridge, PhD

his column addresses the integration of EAPs with other workplace services. This particular article explores what employee assistance providers can do to better manage the behavioral health risks of the workplaces they serve. Why Risk Management is Needed 1. A key reason for better managing behavioral health risks is simply because they are so common in most workplaces. Recent epidemiologic research indicates that 20% of full-time workers in the U.S. meet criteria for diagnosis at a clinical level for having one or more behavioral health disorders in past 12-months. This rate increases to 1 in 3 over a person’s lifetime. Behavioral health conditions include anxiety disorders, phobias, substance abuse disorders, and other forms of addictions (i.e., gambling, sex, food). Yet, studies show that the majority of at-risk workers do not get the appropriate clinical treatment they need. In addition, there are also unpredictable behavioral health risks associated with experiencing critical incidents in the workplace such as violence, robberies, accidents, or suicides.

2. A second reason to better manage behavioral health risks is the large costs they can have on employers. A recent global research review that I conducted with data from over 130,000 employees users of EAP counseling showed that, on average, durng the month preceeding use of the EAP, 27% of employees had missed work and more than half (56%) had a problem being fully productive when they were at work (i.e., presenteeism). This adds up to 66 hours of lost productive work time from combined absenteeism and presenteeism per employee during the month before seeking help from the EAP. Using an hourly compensation rate of $35 (the most recent national average in the private sector in the US from December 2016), this adds up to a cost of over $2,300 for just one month of work! If the typical distressed employee has an episode of distress lasting three months, the workplace cost increases to almost $7,000. For a company with 1,000 employees, 20% of whom are at-risk, the total cost adds up to $1.4 million in lost productivity. (This is assuming the employees are left unreated.) Costs can run even higher when also taking into account areas such as disability

claims, increased health care claims, and others. All told, it is clear that corporate clients of EAPs have good reason to be concerned about behavioral health risks. Even more important, how can EAPs become better integrated into other workplace health programs and organizational initiatives to prevent high costs from occurring? Identifying Risks through Screenings and Referrals to the EAP The best approach to control costs is to identify and treat those individuals most at risk before problems become more severe and more costly. Simple tactics to start with involve creating operational processes to make cross-referrals to at-risk employees between the EAP and other related employee benefit and wellness programs (see my column in 3rd Quarter 2015 JEA for examples). The EAP can share researchvalidated brief screening tools with other programs as a way of quickly flagging employees who may be at risk and could benefit from a more thorough assessment by the EAP counselor. Recommended tools include the AUDIT or MAST for alcohol, DAST for drugs, PHQ-9 for depression, GAD for anxiety,

Reducing Risks through EAP Counseling Once employees at risk for mental health and addiction problems are indentifed and referred to the EAP, how effective is brief counseling in reducing clinical symptoms and work performance deficits? Reviews of over 75 research and evaluation studies of EAPs from Canada, the U.S., and the UK documented the general effectiveness of workplace mental health counseling. This landmark study, published in 2013 by the National Behavioral Consortium, asked vendors to provide their average results for an entire year of follow-up surveys of clients who had used the EAP. Data from 45 EAP vendors revealed an industry average outcome of 86% of clients reporting an improvement in their problem after use of counseling from the EAP. Research also shows that these improvements in clinical problems correlates with improvements in productivity and absence after EAP use. Reducing the Cost Burden Through EAP Counseling In a different sample size from the same global research I mentioned earlier, which in this case examined over 220,000 employee users of EAP counseling, I found that an average of 27 hours of lost productivity were restored after use of the EAP (from 66 hours lost per month before to 39 hours lost per month after). Most of this improvement in work performance

was in the area of presenteeism (20.7 fewer hours) with less from absenteeism (6.6 fewer hours). Financially speaking, using the same $35 hourly rate for employee compensation noted earlier, this reduction in cost for one month is estimated at $945 per each EAP case. If the original level of risk burden would have continued for a three-month clinical episode if untreated, the level of workplace cost prevented by the EAP intervention would be much higher – at $2,835 per case. Performing these kinds of cost estimates can be done using EAP ROI Calculator tools (see feature article in 4th Quarter 2016 JEA). Due to improved clinical outcomes (even when clinical intervention is brief) EAPs can reduce the workplace costs associated with behavioral health conditions – and that is good news for any corporate client (and EAP) for that matter. Summary Focusing on behavioral health risk management offers many opportunities for EAPs. It uses the language of benefits directors and coprorate health programs rather than the more clinically oriented language typical of EAP and mental health providers. The general prevalence and high costs associated with these risks needs to be better communicated with EAP client organizations to drive demand for action on these issuses. EAPs can also become more involved in sharing screening tools with partner programs within the organization to identify, and then refer, at-risk employees to the EAP for clinical treatment and assistance.

Finally, the effective clinical treatment provided by EAPs has been documented as reducing the levels of behavioral risks and decreasing the workplace costs typically incurred by behavioral health conditions. Each of these recommendations have already been attained by leading EAPs. My advice is to position EAPs as a risk management tool for organizations. Resources and References For more information about behavioral health risk research, go to the Employee Assistance Digital Archive at the University of Maryland Baltimore, where you can download (at no cost) a file of 100 slides from a recent presentation and a list of reference citations. See http://hdl.handle. net/10713/6571 Dr. Mark Attridge is an independent research scholar as President of Attridge Consulting, Inc., based in Minneapolis. He has created over 200 papers and conference presentations on various topics in workplace mental health, EAP, psychology and communication. He has delivered keynote presentations at EAPA World Conferences in 2013 and 2016 and is past Chair of the EAPA Research Committee. He can be reached at: mark@attridgeconsulting.com



PHQ-4 for both depression and anxiety (2 items each), or the GAIN-SS for mental health and substance abuse.

Get

Global Exposure while contributing to

the EAP profession —

Contribute an article to JEA! Contact: Contact: Mike Mike Jacquart, Jacquart, Editor Editor 715-445-4386 715-445-4386 journal@eapassn.org journal@eapassn.org

33 | W W W . E A PA S S N . O R G | •• • • • • • • • • • • • • • • • • • •

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coverstory

Continued from page 19

Enhancing Services are Key in Curbing Abuse More than 70 percent of employers in the U.S. are feeling the direct impact of prescription drug misuse in their workplaces, and many recognize that impaired workers are a concern for safety and liability, according to a recent survey (National Safety Council, 2017). To help employers and unions address this latest upsurge in drug abuse, EAPs should partner with management, unions, human resources, safety, and medical/disability management to promote employee and organizational well-being by increasing educational efforts and enhancing services. Some examples include:

illicit substances, while recognizing there may be distinct differences in clinical profiles, substanceusing risk behavior, and even treatment. Many common substance abuse assessment tools have not been validated in individuals with chronic pain, thus additional queries on this subject may increase client disclosures. • Use motivational counseling to encourage clients to examine high-risk opioid use and opt for treatment when indicated. • Remain engaged with clients as they enter addiction treatment, during treatment, through post-treatment and return to work transitions – to provide critical support and increase positive outcomes.

• Promote awareness of the dangers associated with opioids and pain medications to workers, their families, and workplace managers. • Educate workers and their families on safe storage and disposal of prescription drugs.

• When appropriate, coordinate EAP contacts with periodic and random urine drug screening programs to offer additional support to those in recovery.

• Target workers in industries or job functions at higher risk of musculoskeletal disorders with specific outreach messages regarding risks of opioid pain medication abuse and use of alternative pain relief approaches.

Note: Effective October 1, 2017, the U.S. Departments of Transportation and Health and Human Services proposed revision of the Mandatory Guidelines for Federal Workplace Urine Drug Testing Programs will take effect, expanding workplace testing for the Schedule II opioids hydrocodone, hydromorphone, oxycodone, and oxymorphone. US federal agencies will add these substances to drug-free workplace testing programs. If past practices are any indication, many employers with similar programs are likely to follow suit (Substance Abuse and Mental Health Services Administration, 2017). v

• Offer information and consultation for management, including training in observational skills to maintain a safe, impairment-free workplace. • Encourage referrals to EAPs or other resources with a preventive and disability focus rather than a punitive approach. • Collaborate with benefits staff, health insurers, and disability managers to advocate for coverage and access to appropriate medicationassisted addiction treatment, prescription drug monitoring procedures to promote safe utilization, and network providers that offer alternative pain management.

National Safety Council (2017). Adding up the impact – The real costs of substance in your workplace. Retrieved from www.nsc. org/forms/substance-use-employer-calculator/index.aspx. Substance Abuse and Mental Health Services Administration. (2017, January 23). U.S. Dept. of Health and Human Services. Revised Mandatory Guidelines by the Secretary of Health and Human Services. Federal Register, 82(13), 7920-7970.

• Increase assessment and diagnostic opportunities by routinely asking clients about chronic pain, use of pain medications and experiences with

- Bernie McCann, PhD, CEAP

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