Jea vol47no4 4thqtr2017 by Employee Assistance Professionals Association

4th Quarter 2017 | VOL. 47 NO. 4

The magazine of the Employee Assistance Professionals Association

Key Individuals Interviewed for

EAP History Project |Page 20

PLUS:

Study Links EAP and Work Performance

Project 95-Broadbrush

Page 8

Page 16

Duty to Warn Page 24

contents EAPA Mission Statement

4TH Quarter 2017 | VOL. 47 NO. 4

cover story

Key Individuals Interviewed for EAP History Project

|By Dale Masi, PhD, CEAP;

Jodi Jacobson Frey, PhD, CEAP

Dr. Masi conducted video interviews with seven key EAP subject matter experts (SMEs) who were instrumental in the development of EAPs. This article covers the method and process for compiling these interviews.

features

Study Links EAP and Work Performance

|By Melissa Tamburo, PhD; Jeffrey Mintzer, MSW

Federal Occupational Health (FOS), the largest provider of occupational health services in the federal government has validated positive EAP results using the Workplace Outcome Suite (WOS). The remarkable nearly 70-percent reduction in absenteeism alone highlights the value of offering support to employees who are challenged with personal concerns.

Project 95-Broadbrush: Lessons for Today – Part I

|By Jim Wrich As one of the original “Thundering 100”, I was privy to early views on alcoholism and how to treat it. A vital, yet new employment premise determined that 95% of alcoholics were in the workplace – hence the term “Project 95.”

features

Duty to Warn: Understanding When to Breach Confidentiality

|By Robin Sheridan, JD, MILR

Employee assistance professionals are keenly aware of the obligations of confidentiality to their clients. Not as well known, however, is when they are obligated by law to breach confidentiality. The “duty to warn” is an exception to normal confidentiality standards.

Changing Landscape of Mental Health in Canada

| By Mark Attridge, PhD; Dylan Davidson,

BAA; and Joti Samra, PhD, R.Psych.

Changes over the past decade have produced many promising trends in workplace mental health, although certain problems remain. That is the consensus of a recent research project that examined the evolution of workplace mental health policies and strategies in Canada.

departments 4 FRONT DESK EFFECTIVE 6 MANAGEMENT CONSULTING 10, 11, 28, EA ROUNDUP 29, 34 12 TECH TRENDS 14 THE WORLD OF EAP 22,23 WEB WATCH

To promote the highest standards of practice and the continuing development of employee assistance professionals and programs. The Journal of Employee Assistance (ISSN 1544-0893) is published quarterly for $13 per year (from the annual membership fee) by the Employee Assistance Professionals Association, 4350 N. Fairfax Dr., Suite 740, Arlington, VA 22203. Phone: (703) 387-1000. Postage for periodicals is paid at Arlington, VA, and other offices. POSTMASTER: Send address changes to the Journal of Employee Assistance, EAPA, 4350 N. Fairfax Dr., Suite 740, Arlington, VA 22203. Persons interested in submitting articles should contact a member of the EAPA Communications Advisory Panel (see page 4) or the Editor, Mike Jacquart, by calling (715) 445-4386 or sending an e-mail to journal@eapassn.org. To advertise in the Journal of Employee Assistance, contact the Advertising Manager at admanager@ eapassn.org. Send requests for reprints to Debbie Mori at d.mori@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 .................................................13 EAPA Plan to Attend ........................IFC EAPA Conference on Demand ........IBC Harting EAP .............................7, 17, 25 KGA, Inc. ...........................................23 Pinnacle Treatment Centers ................5 SAPlist.com .................................29, 31 The SASSI Institute ...........................11 IFC: Inside Front Cover IBC: Back Cover

frontdesk History and Trends in the EA Profession |By Maria Lund, LEAP, CEAP

he employee assistance field is rich in history, and nowhere is that more apparent than in this issue of the Journal of Employee Assistance. Last year, the Employee Assistance Research Foundation (EARF) announced it was sponsoring a major research effort – to present the first comprehensive history and evolution of EAPs around the world. As part of this extensive EAP History Project, Dale Masi, PhD, interviewed seven key individuals who were instrumental in the development of EAPs. In this issue’s cover story, Dr. Masi and Jodi Jacobson Frey describe the process used in arranging and recording these important video interviews. As well as serving as one of the subject matter experts (SMEs) for the video project, Jim Wrich, one of the original “Thundering 100”, recalls important EAP history in Project 95-Broadbrush. In this article, the first in a series, Jim describes early views on alcoholism and how to treat it. A vital employment premise determined that 95% of alcoholics were in the workplace – hence the term “Project 95.” Thus, the stage was set for Jim and his group, through this project, to

launch the modern EAP movement. Jim, an early member of ALMACA (now EAPA), will describe other important developments and milestones in EAP history in future articles. Continuing with the history and research theme, Melissa Tamburo, PhD; and Jeffrey Mintzer, MSW, describe how Federal Occupational Health (FOH) has validated positive results using the Workplace Outcome Suite (WOS). Their article, which reiterates the importance of the WOS in measuring positive workplace outcomes, is noteworthy since FOH serves more than 360 federal agencies. Extensive research unveiled a number of progressive trends pertaining to workplace mental health in Canada. Mark Attridge, PhD, MA; Dylan Davidson, BAA; and Joti Samra, PhD, R.Psych, describe their important and exciting findings in each of five key areas. Elsewhere, Robin Sheridan, JD, MILHR, explains how EA professionals can navigate the slippery slope of determining when to breach employee client confidentiality in “duty to warn” cases. Robin describes how specific procedures vary, case by case, and state by state.

Finally, Jeff Harris, Marina London, and John Maynard 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

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effectivemanagementconsulting Managing Millennials Myths and Opportunities |By•Jeffrey•Harris,•MFT,•CEAP

ou would think that based upon grumblings heard from managers about Millennials, nothing is getting done in the workplace. How many of these myths have you heard from managers? “Millennials have been coddled all their lives, and they expect that from me.” “Their noses are always in their phones, but they don’t have real relationships.” “They’re not really invested in staying with our company… they seem disloyal.” Myths like these are quickly uttered by managers who feel that Millennials are disrespectful because their work style and preferences are not the same as the managers and directors of today, many of which are Baby Boomers. As an EA consultant, you are in a position to help managers overcome stereotypes and adopt a new appreciation and respect for Millennial employees. How Generational Work Styles Are Formed The cause of most friction or distrust between generations in the workplace is due to a specific population’s work style, which includes nuances like use of technology, where a given work project gets done, employer loyalty, and whether spare time goes into

completing work or stepping away to play. Attitudes about work differ between generations because of the cultural forces that shaped views about work during the formative years of each generation’s youth and young adulthood. Some of those cultural forces have included:

“As an EA consultant, you are in a position to help managers overcome stereotypes and adopt a new appreciation and respect for Millennial employees.” Parental values and rolemodeling. Was the employee raised by dual-income parents, or a single parent? Did the parents emphasize higher education or learning a trade? Did the parents effectively role-model work-life balance? The economy of the time. Was the national economy expansive or austere? What was the job market like, and what type of industries were thriving at the time? Current events in the news. Did larger events promote a sense of safety or dread?

Emerging technology. The constant evolution of technology shaped the creation of new industries (macro) and changed the way people got work done (micro). Baby Boomers Baby Boomers, those born between 1946 and 1964, were raised in a post-war era of prosperity and the rapid expansion of the middle class and “the American Dream.” They are so-named because of the literal explosion of birth rates after World War II. Their generation experienced the Vietnam War, the Civil Rights Movement, and the Women’s Rights Movement. Boomers tend to be individualistic and goal oriented. The empowerment of social movements has led them to believe that they can change everything they touch. The technological breakthrough of their time was the advent of the personal computer. Generation X Generation X (or Gen-Xers) were born between 1965 and 1980. Key events included Watergate, Three Mile Island, the Iran-Contra scandal, and an economic decline. Their era is marked by disappointment in leaders, “latchkey kids” and more blended and singleparent families. As workers, they prefer more autonomy and hold less respect for

that are scheduled on a routine basis. Millennials prefer “huddles” or “on-demand meetings.” Suggest that the manager find a blend, and ensure that the invitees are an essential fit for the meeting. How the team finds essential information or learns new things. While Boomers are linear learners who like to attend classes, Millennials are largely “ondemand” learners. Managers can help the team understand multiple points of view and promote diverse perspectives as the team learns or explores. v

authority, which resulted in a boom of entrepreneurial spirit. They are outspoken, adaptable, and more willing to take risks. Millennials Millennials (sometimes called Generation Y) are considered those born between 1981 and 1993. Events shaping their generation include the Columbine shootings and September 11th. The world economy in which they work is increasingly defined as knowledge-based. As a generation, they have been nurtured, protected, and praised for minimal effort. They have high expectations for reward and recognition, often seeking constant feedback. They prefer to work in businesses that act like startups, with steep learning curves and quick advancement. Millennials tend to have more loyalty to their own career path than to any single employer, but are willing to stay if there’s a clear promotion pathway. They prefer to connect with the meaning and purpose of their work, rather than just accepting job assignments. It is believed that self-expression is more important than self-control. Millennials are used to teams and in school they grew accustomed to groupstyle projects.

Let’s Keep the Discussion Going For more consulting tips on managing Millennials, contact me through my LinkedIn profile (linkedin. com/in/jeffharrisceap) and Twitter (@jeffharrisceap). Jeffrey Harris, MFT, PCC, 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.

Common Causes of Generational Conflict Generational conflict usually centers around four essential team activities, as generational work styles differ in the approach to each activity. These causes, and suggestions for dealing with each potential problem include: Choosing where and when to work. Help managers create clear policies about benefits and accountability for remote work, shift flexibility, work-life balance, and a focus upon productivity rather than clock-watching. How communication should occur among team members. Younger staff are accustomed to rapid responses and may feel frustrated if they haven’t heard from older colleagues quickly. Older staff may feel offended by the lack of face-to-face interaction. Help the manager create a culture where the “receiver” responds with the same technology as the “sender.” How, when, and why the team comes together for meetings. Boomers and Gen Xers like meetings 7 | W W W . E A PA S S N . O R G | •• • • • • • • • • • • • • • • • • • • • | JOURNAL OF EMPLOYEE ASSISTANCE | 4th Quarter 2017 |

featurearticle Study Links EAP and Work Performance | By Melissa Tamburo, PhD, and Jeffrey Mintzer, MSW

he largest provider of occupational health services in the federal government has validated positive EAP results using the Workplace Outcome Suite (WOS). The Federal Occupational Health (FOH), a component of the Program Support Center, serves more than 360 federal agencies and reaches approximately 1.8 million federal employees. FOH has been providing EAP services since 1980 using a “hybrid” model consisting of both internal staff and a large vendor/supplier. The FOH is the U.S. Department of Health and Human Services’ recognized expert in employee

health programs. Over 10 years ago, FOH integrated EAP and work/life services, with many of the federal agencies finding these resources valuable for their employees.

measures of productivity, work and social relationships, perceived health status, attendance and tardiness, and global assessment of functioning.

Background FOH has a rich history of advancing knowledge in the EAP field. FOH was an early supporter of measuring program outcomes. In fact, Selvick, Stephenson, Plaza, and Sugden (2004) published one of the few studies that demonstrated statistically significant outcomes from FOH’s EAP. The researchers’ findings showed significant improvement from pre- to post-EAP intervention on

Key WOS Findings In an effort to better understand the current impact of our services, FOH used an industry gold-standard tool, the Workplace Outcome Suite (WOS). This tool is a fiveitem measure that is psychometrically tested and easy to administer telephonically during the intake process. It consists of five scales that measure absenteeism, presenteeism, work engagement, life satisfaction, and workplace distress.

CGP, EAPA Complete Important Report on WOS

hestnut Global Partners (CGP) and the Employee Assistance Professionals Association (EAPA) recently completed an important annual report on the use of EAP. The report focuses on the use of CGP’s Workplace Outcome Suite (WOS) in assessing over 16,000 users both before and after EAP use. The report demonstrates how EAP intervention improves the following workplace constructs: absenteeism, presenteeism, work engagement, workplace distress, and life satisfaction.

This year’s report contains pooled results across all WOS users but also adds new significant data from last year, that being: Workplace outcome data across four industries, various presenting concerns, sources of referral, and comparison of internal versus external EAP models. The WOS is now in use by hundreds of EAP organizations and stands apart from other outcome measures as it is psychometrically tested, validated, workplace-focused, easy to administer, and available free of charge with a licensing agreement.

“EAP providers are currently not paid in proportion to their effectiveness, and this is unlikely to change unless the profession embraces improved outcome measurement,” said David Sharar, Chief Clinical Officer with CGP’s Commercial Science Division. Highlights of the free report were scheduled for discussion by Dr. Sharar and Greg DeLapp, EAPA CEO, in the breakout session, “Workplace Impact of EAP by Industry and Model” at EAPA’s World EAP Conference, October 3-6, 2017 in Los Angeles. v

In October 2015, FOH began collecting data on specific outcomes for clients who accessed the EAP. A random sample of clients were asked to answer the brief questionnaire; three months later, these respondents were contacted for follow-up and asked the same questions. The sample size (based on setting a standard error of three percentage points to achieve a 97% confidence level) consisted of 4,800 respondents who completed both the pre- and post-tests. A paired-sample t-test was used to examine changes in average scale scores from before respondents used EAP to after services were rendered. All five constructs used in the WOS were found to be statistically significant, and demonstrated the positive influence of using the EAP. Specifically:

tive sense of well-being. This measure captures a perceived improvement in one’s quality of life or sense of well-being (Sharar, Pompe, and Lennox, 2012), which bode well for increased job satisfaction and employee retention. Finally, findings show a 10-percent reduction in workplace distress. ROI Analysis Return on investment analysis is forthcoming, and is expected to demonstrate significant value to the federal government and the agencies that use FOH’s EAP. We recently published an invitation to federal customers to review the relationship between key performance indicators and robust EAP usage, highlighting WOS data gleaned from our marketing campaign. “Our experience is that this type of marketing effort often results in spurring customers to contact their FOH account executives, either in response to the specific email campaign, or in response to the email campaign reminding the customer of something they need or want from FOH,” states Veronica Morrow, Associate Director, Employee Assistance and Work/Life Programs with FOH.

• 69.2 percent reduction in absenteeism • 22.8 percent reduction in work presenteeism • 2.8 percent improvement in work engagement • 24.2 percent improvement in life satisfaction • 10.0 percent reduction in workplace distress The five measures make a compelling case for the importance of FOH’s EAP services and their influence on employee performance. The remarkable nearly 70-percent reduction in absenteeism alone highlights the value of offering support to employees who are challenged with personal concerns. Presenteeism is a less obvious variable, and focuses on “functional impairment,” or the ability to attend to work tasks while physically at the job. Research has shown that behavioral health concerns (e.g., depression, anxiety, and stress) are the primary driver of lost productivity, with absenteeism following closely behind (Sullivan, 2017). A reduction of nearly 23 percent in presenteeism demonstrates that FOH’s EAP is successfully working with clients to address their concerns, allowing them to focus more effectively on the job. Comparatively, the nearly three-percent improvement in work engagement is a seemingly small impact. However, these findings are consistent with other studies that use the WOS and show that the EAP does have a demonstrable impact on how invested in or passionate EAP users are about their jobs. The WOS uncovered more than a 24-percent improvement in life satisfaction among EAP users. Life satisfaction is a global measure that addresses the impact of work and life issues on one’s general, affec9

featurearticle Summary In conclusion, FOH’s EAP demonstrates a very strong correlation between the EAP intervention and improvement to an employee’s work performance in a variety of dimensions. All constructs show statistically significant change over time, and the findings demonstrate that EAP services produce a positive impact that is clearly better than not having an EAP or one that is not robust. These findings show promise as we look to validate the positive effects the FOH’s EAP has on people’s lives. In addition to the services available for individual employees, FOH’s EAP is a broad-brush program that includes services for supervisors and workplace leaders.

Services include expert guidance to agency leadership in managing the organizational impact of change, building a resilient workforce, unlimited consultations with supervisors/managers on performance management concerns, and consultation and onsite response to critical incidents. FOH offers EAP and work/life services as part of its integrated resources. Additional services include organizational development and leadership, and psychological testing and evaluation to further improve the comprehensive and supportive resources for an agency’s employees. v At the time of this writing, Melissa Tamburo, PhD, LCSW-C, was the Acting Director, EAP and Work/Life Programs

with the FOH. Jeffrey Mintzer, MSW, is the Deputy Director, Behavioral Health Services, with the FOH. He can be contacted at Jeffrey.Mintzer@foh.hhs.gov.

References Amaral, T. (1999). Benchmarks and performance measures for employee assistance programs. The Employee Assistance Handbook, 161-178. Selvik, Stephenson, Plaza, & Sugden, B. (2004). EAP impact on work, relationship, and health outcomes. Journal of Employee Assistance, 34(2), 18-22. Sharar, Pompe, & Lennox, R. (2012). Evaluating the workplace effects of EAP counseling. Journal of Health & Productivity, 6(2), 5-14. Sullivan, S. (January 17, 2017). Employee assistance practice-based research network series. The Future of Workplace Behavioral Health Research.

earoundup EAPA Announces New Labor Chapter For the first time in its history, the Employee Assistance Professionals Association (EAPA) has a new Labor Chapter, open to all labor-affiliated members as well as those members who are labor friendly. Labor-based professionals were a huge part of EAPA’s early growth going back to the original Association of Labor/Management Administrators and Consultants on Alcoholism (ALMACA). To honor that heritage, and to provide for a labor presence, the chapter does not have geographical borders. Instead, after an inau-

gural meeting at the EAPA 2017 Conference and EXPO in Los Angeles, there will be three virtual meetings per year. Annual chapter dues are $30, and can be added to an existing EAPA membership. Alternatively, the Labor Chapter affiliation can be selected when joining EAPA. Read more here http://www. eapassn.org/LaborChapter.

No-Cost Therapy Underway in Britain England is in the midst of an ambitious effort to treat depression, anxiety, and other mental illnesses.

According to The New York Times, the rapidly growing initiative, which has gotten little publicity outside of England, offers virtually open-ended talk therapy free of charge at clinics throughout the country. This includes remote villages, industrial suburbs, isolated immigrant communities, and high-end enclaves. The goal is to create a primary care system for all of Britain. Mental health care varies widely across the Western world, but none have gone this far to provide open-ended access to talk therapies backed by hard evidence, reports the Times. Experts say the English program is the first broad test of real-world

earoundup treatments that have mainly been studied in carefully controlled lab conditions. Read more here https://www. nytimes.com/2017/07/24/health/ england-mental-health-treatmenttherapy.html

ROI Theme at EAP Forum in Greece The 5Th EAP Forum was held in Athens, Greece at the Hotel Royal Olympic. It was sponsored by Hellas EAP, a leading provider of EAP services in Greece and a member of the International Chapter of EAPA in Greece. The theme of the forum, held May 17, was “EAP & ROI Proven Workplace Outcomes.” Speakers included a mix of business and human resources professionals, EAP clinicians, academic researchers and consultants. The presentations featured a pair of keynote presentations from international consultants, three presentations from experts in Greece, and a panel discussion. The growing interest in workplace mental health from both science and business perspectives was noted in the opening remarks provided by Professor Nikolaos Georgopoulos, rector at the University of Piraeus and by Konstantinos Lamprinopoulos, Chairman of the Board for the Hellenic Management Association. Christina Mazouropoulou, a psychologist and senior account manager for Hellas EAP, presented a talk on the Workplace Outcome Suite (WOS) – Measurement and Effectiveness of the EAP in

Greece: Hellas EAP Data. She described the results from 110 EAP clinical cases in 2016, in which respondents completed the 5-item Greek version of the WOS measure at the start of counseling and again several months afterwards. Significant improvements were found for the outcomes of absenteeism (65% reduction), presenteeism (32% reduction), workplace distress and life satisfaction (both scored 13% improvement). However, no change was found in work engagement. The day concluded with a Panel Discussion of Challenges and Success Stories. The panelists included Rena Bardani (Director of Social Affairs at Hellenic Federation of Enterprises), Eftichia Kasselaki (executive general manager at Piraeus Bank), Evangelia Papadimitriou (affiliate support executive at Lidl Hellas), Dr. Anastasia Rush (founder and CEO of Hellas EAP) and Lou Servizio (Chestnut Global Partners, Brazil). Further information can be found at https://www.hellaseap.gr/ site/forum-en-2017/ – Mark Attridge provided this report.

Innovative Sensor Keeps Tabs on Alcohol Intake Electrical engineers are developing a wearable sensor to help people manage their intake of alcohol. Worn like a watch, the innovative sensor picks up vapors from the skin and sends the data to a server, according to Florida International University News. If

the alcohol reading is high, via an app, a designated loved one gets an alert to check in on the user. The easy-to-wear device is designed to help address issues with social drinking and addiction. Shekhar Bhansali, inventor of the sensor, explains that people struggling with alcoholism typically will lapse when it comes to self-reporting their alcohol intake. Also, alcohol clears the body within eight hours so someone who has to take a urine test in the morning can technically sleep off any binge drinking they may have undergone the night before. The wearable sensor detects alcohol off the skin within 15 to 20 minutes of consumption. continued on page 28

techtrends The Decline of In-Person Counseling Impact on Employee Assistance

| By Marina London, LCSW, CEAP

entered the employee assistance field in 1991, hired as a “senior consultant–operations” for Personal Performance Consultants (PPC), perhaps the largest EAP in the USA at the time. Essentially, I was the clinical director of one of dozens of EAP offices scattered across the country, delivering a generous, up to 8-session model, to Fortune 50 employees and their dependents. That office model is essentially extinct in 2017. Today, over 25 years after my first job in employee assistance, we are witnessing the perfect storm that may lead to the virtual extinction of in-person counseling. Of course, in 2017 the word “virtual” has a very different meaning than it had in 1991. In the 21st century, virtual means, “not physically existing but made by software to appear so.” In fact, 2017 is turning into the year when apps and platforms geared toward a virtual or digital counseling/coaching experience gained ascendancy. Here are a few: Lantern. Instead of therapy, Lantern offers “coaching.” Users share problems via text messages and receive highly structured strategies for feeling better in that moment, such as guided meditation or breathing exercises. In 2016, Lantern raised $17 million for its mobile-based mental health coaching program. (Lantern starts at $49 a month.)

T2 Mood Tracker. This free app enables users to track their own mental health, helping them to identify patterns and triggers by which they might gain greater insight and control over changes in mood. Who is behind this app? Like many innovations in tele-behavioral health, it’s the U.S. Department of Defense. The reasoning is simple: There are too many war veterans in need of help, and not enough VA counselors. Ginger.io. This app combines the concept of smartphone-based fitness tracking with live human feedback and care from a coach or therapist and/or a psychiatrist to help with medication support. It works with text message exchanges as well as videoconferencing. (Cost starts at $129 a month.) 7cups.com. “Free, anonymous and confidential online text chat with trained listeners, online therapists & counselors.” betterhelp.com. “Convenient, affordable, private online counseling. Anytime, anywhere.” Sam. Using artificial intelligence, Sam provides users with instant access anytime to help them lose weight. Sam is powered by IBM’s Watson, an advanced computer that understands questions asked in natural language. That’s

right – Sam isn’t even a human being. The website states: “Talk to Sam, Your Digital Therapist.” And I could have listed dozens more. PsyberGuide How do you know which apps are legit and effective? Fortunately, there is PsyberGuide, (https:// psyberguide.org,) initially created as a nonprofit website dedicated to consumers seeking to make informed decisions about computer and device-assisted therapies for mental illnesses. PsyberGuide is also intended for professionals and researchers seeking to enhance their knowledge in this area, ensuring that this information is available to all, free of preference, bias, or endorsement. If you go to their “Product Listing,” you will note that each app is listed along with a PsyberGuide rating that corresponds to the amount of research and support backing the product. In addition, there is an App Quality Score on a scale of 1 to 5. Finally, there is a link to an expert review – if one exists. How is that for “thorough” evidence-based vetting? The founder of PsyberGuide, Stephen Schueller, PhD, is a member of the Internet World Health Research Center, a remarkable institution

whose mission is to harness the power of technology to reach those most in need with effective interventions that can be administered via the Internet or a mobile device.

References

True Evidence-based Apps: Growing Need for EAPs Employee Assistance Programs would do well to develop some of these capabilities or even consider a partnership with one or more of these app/platform companies. This need is especially prevalent when one considers that people born in 1993 are the last of the Millennial generation. Their cohorts will dominate the workforce for the next 50 years. In a couple of years, Gen Z will begin to enter the workplace. They have never known a world without Facetime or Skype.

Ginger.io (n.d.) Retrieved from https://ginger.io

Combine money, the U.S. military, IBM, millions of dollars in venture capital funding and a growing number of users who are perfectly comfortable with digital media; and then couple that with a demand for immediate responsiveness. It isn’t difficult to foresee a precipitous decline in the demand for in-person counseling – especially in more rural areas where seeing a counselor may require a long drive, and options for treatment are limited by geography.

PsyberGuide (n.d.) Retrieved from https://psyberguide.org

7cups.com (n.d.) Retrieved from https://7cups.com betterhelp.com (n.d.) Retrieved from https://www.betterhelp.com

IBM Watson (n.d.) Retrieved from https://ibm.com/watson Joyable.com (n.d.) Retrieved from https://joyable.com Lantern (n.d.) Retrieved from https://golantern.com Pai, A. (2016, February 10). “Lantern raises $17M for its mobilebased mental health coaching program.” mobihealthnews. Retrieved from http://mobihealthnews.com/content/lanternraises-17m-its-mobile-based-mental-health-coaching-program.

Sam (n.d.) Retrieved from http://talk2sam.com T2 Mood Tracker (n.d.) Retrieved from http://t2health.dcoe. mil/apps/t2-mood-tracker Talkspace for Business (n.d.) Retrieved from https://talkspace.com/online-therapy/therapy-for-business

Even more disruptive, some of these companies, like Talkspace and Joyable, bypass EAPs and market themselves directly to corporations. Joyable.com even trumpets on its site, “Digital therapy just got better by reaching more employees and reducing healthcare costs. Bite-size activities. Big-size outcomes. “How do you make digital therapy enjoyable and effective for your employees? Simple. With 5-minute activities that are easy to do — and backed up with clinical proof.” Summary Those of us in employee assistance understand why an app can’t hold a candle to a full service EAP. But many client companies will not, and they will jump on the evidence-based app bandwagon. It behooves us to get there first. v 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.

theworldofeap EAP in Italy Beginning to Overcome Challenges | By John Maynard, PhD, CEAP

taly boasts stunning mountains and alpine lakes, gorgeous coastlines, and world famous art, fashion, and cuisine. Along with its near neighbor, Greece, Italy is acknowledged as the birthplace of western culture. What a treat, then, to learn that 2017’s Employee Assistance European Forum (EAEF) conference would be held in Milan. Milan is Italy’s second-largest city, and besides being renowned for fashion and design, it is Italy’s main financial, industrial, and business center - a most appropriate place for a gathering of EA professionals from around Europe and the world. The EAEF conference in June had a record 100 attendees from 25 countries and showcased the continued growth and maturation of EAP across Europe. I was fascinated to learn about the unique features of EAP in each country, and at the same time, the many interconnections among EA professionals throughout Europe, including Italy. Economic Ups and Downs Italy’s diverse, but somewhat vulnerable, industrial economy has experienced significant volatility over the last 40 years. In general, the Italian economy enjoyed strong growth from the 1950s until

the 1990s, and Italy became one of the original Euro zone countries. However, by the late 1990s, the economy began slowing, with economic growth lagging behind Europe’s average in most years. By 2005, Italy had the worst economic statistics of all Euro zone countries. With its already shaky economy, Italy was particularly vulnerable and hard hit by the global recession in 2007-2008. A number of structural features within the Italian economy helped create and perpetuate its economic struggles, and also contributed to a relatively slow start to the EA field. Geographically, Italy’s industrial economy is clustered mainly in the north, while southern Italy is less economically developed and suffers higher unemployment. A large “underground” economy, estimated as high as 17% of Italy’s GDP, means the government struggles to collect enough tax revenue to finance its needs. A history of government corruption and high government spending aggravates already difficult conditions. Recently, the migration crisis in the central Mediterranean region has added to economic stresses. Health and Mental Health Care Since 1978, health care in Italy has been delivered through a national health service funded

by taxes and providing universal coverage to all citizens and residents. Routine waiting times are often up to several months in large public facilities and a few weeks in smaller private facilities, although more urgent cases can be seen more quickly. A “free market” option with much shorter wait times is available for patients who opt to pay completely out-of-pocket. Mental health care in Italy was assigned in 1978 to regional public Mental Health Departments, which are charged with the management and planning of community-based medical and social activities related to prevention, treatment, and rehabilitation in their defined areas. Unfortunately, while the 1978 law that created the Mental Health Departments set out general principles and guidelines (such as using multi-disciplinary teams to provide effective continuity of care), it did not provide funding or specific standards for service provision and staffing. Only after a new national plan for mental health, which included funding and standards, was launched in 1994 did the comprehensive network of mental health services in each district really become effective (Piccinelli et al., 2002). For the private sector, the difficult economy, along with the availability of comprehensive

public mental health services, meant that Italian companies had very little interest in anything like EAPs. Some US-based multinational companies did expand their EAP services into their Italian locations but services, including client intakes, were still based outside the country. Not until the early 2000s did these multinationals begin to arrange for more local intake services. New Laws and the Great Recession Stimulate EAP Interest In 2004-2005, both the European Union and the Italian government began holding workplaces more accountable for prevention of psychosocial risks, including stress and interpersonal conflicts. When the recession took hold a few years later, stress levels soared, and the private sector began searching for solutions. Thus, the convergence of several forces in the early 2000s – new Italian and EU labor regulations, a serious recession, and continued maturation of EAPs in nearby European countries – finally resulted in the emergence of the EA field, at least in northern Italy. Nevertheless, progress remains slow. Even today, companies rarely implement ongoing fullservice EAPs, tending instead to seek more time-limited services in response to specific situations. For example, they may contract for EAP response services after a critical incident, specific training topics, or focused consultations about interpersonal communication issues or company reorganizations. According to Italian EA professionals, it remains difficult to communicate to company

decision-makers that EAPs can be an investment in improving productivity and reducing costs, as opposed to being an employee benefit only. When EAPs are offered, they are often underpromoted, resulting in low utilization and further compounding the difficulty of communicating their potential full value. Challenges and Opportunities For a generation, the Italian economy has struggled. This has made companies cautious about risking resources to offer benefits like EAP, which they may see as overlapping with services already available through the health system. At the same time, Italians traditionally have relied on their families, rather than outsiders, for emotional support in times of difficulty, so the demand for workplace-based services has been low. Ironically, the same economic difficulties that have produced caution by employers, are beginning to break down barriers to individuals asking for outside professional help. As individuals have had to move to other cities or regions to find jobs, family is less available, and attitudes toward professional assistance are becoming more positive. For example, a recent survey of Italian adults (Munizza et al., 2013) found that 98% were aware of depression, and 62% had experienced it, either directly or indirectly. Virtually all (99%) thought that the best way to recover from depression was to seek help from outside professionals, especially psychologists. This important social shift, only now coming into

focus, should increase demand for EAP services and improve utilization rates within existing programs. As in so many countries, the future for EAP in Italy is bright. The challenge will be to continue to educate the business community about the possibilities of EAP and to continue to grow the professionalism of those who sell and deliver EA services. v Let’s Continue the Discussion I would like to thank the following individuals for taking the time to answer my questions as I was preparing this column: Laura Sinatra of EAPItalia World; Laurence Duretz and Diego Scarselli of Psya Italia; and Miguel Cristobal and Carla Boyer of Healthy Work. Let’s continue the discussion of EAP in Italy and other countries! You’re welcome to contact me directly anytime or to post your feedback, questions, or suggestions on EAPA’s LinkedIn group. Dr. John Maynard served as CEO of EAPA from 2004 through 2015. Prior to that, he was President of SPIRE Health Consultants, Inc., a global consulting firm specializing in EA strategic planning, program design, and quality improvement. In both roles, he had the opportunity to observe, meet, and exchange ideas with EA professionals in countries around the world. He currently accepts speaking and consulting projects where he can make a positive difference. He can be reached at johnmaynard@spirehealth.com.

References Munizza, C., Argentero, P., Coppo, A., Tibaldi, G., Di Giannantonio, M., Picci, R. & Rucci, P. (2013). Public beliefs and attitudes towards depression in Italy: A national survey. PLoS One, 8(5): e63806. Published online 2013 May 20. Piccinelli, M., Politi, P. & Barale, F. (2002). Focus on psychiatry in Italy. The British Journal of Psychiatry, 181(6), 538-544.

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

orty-five years ago, two representatives from each state traveled to Pinehurst, North Carolina to participate in a three-week training program that was to ultimately change the landscape of workplaces in America and around the world. In time, this disparate group came to be known as “The Thundering 100”. They were called upon to meet a challenge which had long vexed medical professionals, corporate managers, and the criminal justice system. It had ruined millions of families and careers, created consternation in the workplace, swelled jail cells and hospital emergency rooms and left lasting scars on both the individuals who were afflicted and their loved ones. The challenge was to intervene earlier in the progression of alcoholism. That meant not waiting until an alcoholic had gone all the way to the bottom of the heap, through hospitals, jails, and mental institutions. They would be trained to recognize the earlier, subtler signs and symptoms to trigger an intervention while the alcoholic still had a job, a family and some modicum of self-respect. The setting would not be the streets or courtrooms but the workplace. Several years earlier, a terminally ill alcoholic truck driver in

Iowa in the depths of despair, was slumped down in his bathtub with water up to his throat and the barrel of a loaded pistol in his mouth. For reasons not entirely understood, he decided to give life one more chance. After finding God and AA. he went on to ultimately serve three terms as Iowa’s governor and one term in the US Senate. As a recovering alcoholic, Harold Hughes became a bigger than life figure. While only a freshman Senator, he was the prime mover in establishing the Comprehensive Alcohol Abuse and Alcoholism Treatment and Rehabilitation Act of 1970 – Public Law 91-616. Known as the Hughes Act, it established The National Institute on Alcohol Abuse and Alcoholism (NIAAA). In the following session, he shepherded PL 92-255 through congress to create the National Institute on Drug Abuse (NIDA). The training at Pinehurst was part of a grand scheme launched by NIAAA to earlier identify alcoholics nationally. By then research was confirming the incidence and prevalence of the problem in the general population, its enormous public costs and its wide swath of personal and family destruction. In contrast to this bleak picture, there was a growing belief among a small group of pioneer treatment providers and recovering alcoholics that recovery was not only possible

but likely if the disease was treated earlier and as a primary illness using a multi-disciplinary approach that addressed its physical, emotional, and spiritual dimensions. Developed in the 1960s by Dan Anderson, PhD. and Nelson Bradley, MD, this approach later became known as the Minnesota Model of addictions treatment. It departed from typical treatment practice at that time, which was largely based on false assumptions. Each of the major disciplines had their own take on alcoholism and how to treat it: The psychological approach saw alcoholism as a symptom of a deeper underlying disorder needing to be addressed first before the alcoholism could be successfully treated. The medical approach subscribed to the disease concept provided there was tissue damage, such as cirrhosis of the liver or brain damage. The social work model viewed alcoholism as the result of sociological conditions – poor parenting, bad environment, and other factors – all of which were largely beyond the ability of either the patient or therapist to change. Finally, there was the psychiatric approach, which for all practical purposes viewed alcoholism as a valium deficiency.

All of these methods mistook the effects of the disease for its causes while seeing the alcoholism as second or third in importance behind whatever disorder the practitioner had been personally trained to treat. And that disorder was never alcoholism.

“The statistics are staggering and, sadly, the increased number of people becoming afflicted each year exceeds the number…who begin a recovery program for the first time.” He continued, “Unfortunately, AA. and other programs have no choice but to deal with people who have reached the acute stages of the illness because our current system takes so long to identify the problem. The reason…is that fewer than five percent of the alcoholic population fit the skid-row derelict stereotype which is the current image the general public has of an alcoholic.” He went on to say that the employment setting offered a new approach which could provide the earlier identification so badly needed. The premise was that only five percent of alcoholics were on skid-row, the other 95% were in the workplace, thus the term “Project 95.” More important was the belief that by the time someone had lost their family, health, job and often their freedom, they had largely lost their motivation to stop drinking even if they realized it was slowly killing them.

The Multi-disciplinary Treatment of Addiction By 1972, outcome data from Hazelden and other treatment programs began to accumulate on the multi-disciplinary approach that reinforced long-held anecdotal information from members of Alcoholics Anonymous: recovery was possible and the right kind of intervention worked. The Minnesota Model utilized all of the essential professional disciplines organized in a coherent protocol. It focused first on alcoholism as a chronic, primary disease and second on the medical, psychiatric, psychological, spiritual, and sociological features which attended it. It also recognized that some people had what would later be termed a comorbid disorder – two or more primary illnesses which exacerbated each other, each of which needed to be addressed if recovery from the others was to be fully realized. When acute medical and psychiatric conditions were present, they were addressed beforehand to avoid a crisis and better enable the patient to respond to the alcoholism treatment protocol. This protocol translated into a new kind of treatment team that included medical staff, a psychologist, a clinical social worker, and clergy. Most notably, the leader of the treatment unit itself was a recovering alcoholic who had been trained in effective counselling techniques and who through first-hand experience was intimately familiar with the ways alcoholics could deceive themselves and others in order to continue drinking. Anderson and Bradley recognized the critical importance of modeling recovery and knew that the experience of a recovering person could not be replicated in a classroom. From the Streets to the Workplace Prior to Pinehurst, NIAAA had put together a crack team of professionals and lay people who really understood the disease of alcoholism and how alcoholics were accessing both to AA. and formal treatment. Self-proclaimed as “The Dirty Thirty”, one member was Don Godwin who was to become the Chief of the Occupational Programs Branch of NIAAA. In the forward to my first publication, “Project 95-Broadbrush”, he wrote: 17

featurearticle Of all the referral resources – family, friends, clergy, medical professionals, therapists, courts – far and away the one which “The Dirty Thirty” considered most promising was the employer. For starters, the last thing an alcoholic wanted to lose was his job because it not only represented the last vestige of self-respect but provided the money needed to continue to drink. Moreover, the disease had often progressed to the point that there were serious money problems. With the prospect of getting fired, the idea of quitting drinking became more palatable and the involvement of a recovering person in the workplace helped light the lamp of hope. The employer, on the other hand, had a vested interest that other institutions such as courts and churches did not have – the bottom line. As the research rolled in, the impact of alcoholism on corporate profit was stunning. On the level where the work was performed, enlightened managers and their union counterparts had long recognized that a small percentage of employees were causing the preponderance of their headaches. Usually excessive drinking was involved and customary disciplinary measures seldom yielded a permanent solution. Most importantly, the structured characteristics of the workplace provided defined boundaries, which employees without personal problems could work within, but which alcoholics found increasingly difficult to navigate. So there we were at Pinehurst, roughly one hundred of us. NIAAA offered Single State Agencies created by the Hughes

Act grants of $50,000 per year to fund two Occupational Program Consultants, one for the private sector and the other for the public employers. About half of us were recovering alcoholics who knew a lot about alcoholism and little about anything else while the other half were professionally trained— nurses, clinical social workers, psychologists, MAs in counseling, medical doctors -- who knew a lot about a wide range of personal problems but very little about alcoholism. Getting Acquainted At first, there was competition and suspicion with each group enamored of its own rectitude and painfully eager to teach the other what it absolutely knew they needed to know. This was especially true of the recovering folks, of which I was one. It may have been the only place on earth where a group of drunks could feel superior to professionals and we were enjoying our moment. When we had been in the throes of our disease, many of us had personally experienced the futile efforts of professionals untrained in alcoholism. We were true believers: We knew that we knew! And we certainly knew that they didn’t know. On the other hand, some of the professionals had trouble fathoming how anyone could even dream of sending an unpolished motley crew like us out to meet captains of industry. Fortunately, we had a splendid leader who saved us from ourselves. A silver-haired father figure who was the Acting Chief of the Occupational Programs Branch of NIAAA, Will Foster, was a recovering alcoholic himself and read

the scene perfectly. A few days into the training, he addressed “... the alkies in the room …” at a plenary session. Noting our “… superiority complex …” and using biological terms that had no medical significance, he told us to knock it off. He told us that we were experts only about our own recovery. With greater refinement, he also told the professionals to learn from the alkies because, theories aside, we had “… been there …” They needed what we had to offer – our experience, strength and hope – and above all our commitment. And, no course of study could impart that to them. There is nothing like a good shot of humility to clarify things and engender appreciation for the views of others. We jelled as a group and the divisions evaporated. Together, we developed the quiet sense of urgency that is felt by recovering people who know what the end will be for the suffering alcoholic who struggles in a downward cycle trying to use their own unaided will to reduce the consequences of their disease. We couldn’t be casual about alcoholism – untreated a tragic end was inevitable. At the same time, as a group we broadened and deepened our awareness of the many psychiatric and social factors that would affect our main objective to not just get a person on the road to recovery but to keep them there. This would require dedication and a depth of study that went beyond any narrow, personal anecdotal experiences. Above all, we needed to be professional, and we had great instructors from labor, industry, and the field of alcoholism who

pointed us in the right direction. Looking back, we were giving each other the best we had of ourselves. By the time we completed our formal NIAAA training 18 months later in New Orleans, we had become so close that we didn’t want it to end. So we formed OPCA – the Occupational Programs Consultants Association – which met as a group for many years thereafter at the annual EAPA convention. The Challenges and the Excitement In the months and years that followed we addressed many crucial questions all the while sharing what we were learning through direct experience. Paul Roman, a young PhD from Tulane University, followed our progress from the beginning and developed what was to become the CORE technology for the field. It was ultimately incorporated into the program standards of both professional associations, EASNA and EAPA. In 1972, led by Maryland and Minnesota, state legislatures began to mandate treatment of alcoholism, drug addiction, and mental health issues. Until then, insurance companies refused to cover “mental and nervous disorders” and alcoholism was one. And in 1974, the Joint Commission on Accreditation of Hospitals promulgated alcoholism treatment standards, which brought respectability to the treatment field. Alcoholism Only or Something More? The first major issue we wrestled with at Pinehurst and throughout the 1970s was the type of program we would promote.

A number of companies had tried with varying degrees of success to address workplace alcoholism by training first-line supervisors in the signs and symptoms of the disease, using them to intervene directly and to refer those whom they thought were alcoholics to an in-house recovering AA member. Pioneering companies such as DuPont and Eastman Kodak had experienced the remarkable transformation AA could make in a person’s life, this approach was known as a “Straight Alcohol Identification Program.” As time passed, it became apparent that while dramatically helping some alcoholics there were problems with this strategy. First, supervisors were hard to train and it didn’t last long. It wasn’t a natural part of their function as managers. They did not have occasion to use what they had learned often enough to get good at it. Not wanting to “accuse” someone of being alcoholic, they usually waited until late stage symptoms emerged. Then, in spite of the training, the decision to intervene was largely subjective and its implementation was inconsistent. Supervisors with strong religious beliefs regarding drinking might see a problem everywhere, while those who had a drinking problem themselves did not see it anywhere. Of equal importance, even though alcoholism afflicts employees from top to bottom in an organization, no one above the first-line supervisory level was ever identified. Firstline supervisors simply do not confront senior executives on personal matters. Finally, threatening to fire someone because of a medical condition was illegal and

led to the possibility of a lawsuit or union unrest. Eventually the strategy moved towards identifying job performance and attendance problems and using these as the trigger to refer people. We thought supervisors would be comfortable in an area consistent with their natural role. More than anything, the appearance of a “witch hunt” could be avoided. Referred to as the Job Performance Alcohol Identification Program, it too was fraught with problems. Supervisors were admonished not to diagnose alcoholism or even discuss it but to stick strictly to job performance. But, the person to whom they were to refer the employee was an alcoholism paraprofessional. Moreover, it didn’t take into account that not all employees with performance problems suffered from alcoholism – in fact, at least half did not. But there was another alternative presented to the OPCs at Pinehurst. This model will be discussed in part two of this three-part article. v NEXT ISSUE: An enduring model, accountability, mountains and valleys. Jim Wrich is one of the pioneers of Employee Assistance Programs (EAPs) - one of the original Thundering 100 who launched the modern EAP movement through Project 95-Broadbrush. In 1972, Jim implemented some of the first EAPs in the country. An early member of ALMACA, (later the Employee Assistance Professionals Association,) he served as First Vice President and was the founding President of the Employee Assistance Society of North America (EASNA). Since 1987, he has managed his own firm, J. Wrich & Associates, LLC. (JWA), a health systems performance company that provides a broad range of consulting and cost analysis services to businesses and unions.

coverstory Key Individuals Interviewed for EAP History Project |By Dale A. Masi, PhD, CEAP; and Jodi Jacobson Frey, PhD, CEAP

n April 2016, the Employee Assistance Research Foundation (EARF) announced it was sponsoring a major research effort – to present the first comprehensive history and evolution of EAPs across the world. Dr. Masi was contracted to research the history for the U.S. and Canada. In addition to a comprehensive narrative literature review, she conducted video interviews with seven key EAP subject matter experts (SMEs) who were instrumental in the development of EAPs. In addition, she was also interviewed for the project. This article covers the method and process for compiling these interviews.

Selection of Interviewees With the approval of the EARF History Project Committee, Masi interviewed the following seven SMEs: Carl Tisone, founder of the Employee Assistance Research Foundation and former President/ CEO and co-founder of PPC, Inc. and PPC Worldwide. Carl was among the primary persons most responsible for the rise of EAPs internationally. Jim Wrich, one of the original “Thundering 100” and an influential proponent of EAPs

in the earliest days of their development. Jim authored one of the original publications on EAPs, The Employee Assistance Program, and he is the former (and first) director of the United Airlines EAP. (Editor’s note: Part one of Jim’s Project Broadbrush series appears elsewhere in this issue of the JEA.)

“Because the project involved human subjects, the study protocol was reviewed and approved by the University’s Institutional Review Board (IRB)...” John Burke, President of Burke Consulting. John is an expert in acquisitions and mergers and international consulting in development and strategic positioning services for vendors of EAP, work/life, and general and behavioral health services. Dave Sharar, Chief Clinical Officer at Chestnut Health Systems. Dave specializes in contemporary EAP issues and international concerns; co-developer of the Workplace Outcome Suite, the field’s only validated tool that spe-

cifically measures the workplace impact of EAP services. Rita Fridella, Executive Vice-President and General Manager Employee Support Solutions, Morneau Shepell. Rita is an expert in EAP development in Canada, and a board member of the Employee Assistance Society of North America (EASNA). Rick Csiernik, professor at King’s University College in Ontario, Canada. Rick specializes in contemporary Canadian EAP issues, and is a prolific researcher and author. Fran Rodgers, founder and CEO of Work Family Directions, is a pioneer in the area of work/ life, and a corporate consultant on women’s issues in the workplace. Dale Masi, Professor Emeritus, University of Maryland, is an expert in design and evaluation of EAPs, creator of the model EAP for the U.S. federal government, and author of 15 books and numerous articles on EAPs. (Dr. Jodi Jacobson Frey interviewed Masi, for a total of eight interviews.) UMBSSW Serves as Subcontractor Masi subcontracted the video project with the University

Interview Transcribing, Analyzing, Producing Audio from the interviews was also transcribed verbatim by REV, a professional transcription company with expertise in qualitative research methods. Dr. Frey and her two students then analyzed the data using “line-by-line” coding to identify units of information and link them to broader concepts and themes in the data. After the data was independently coded from all the transcriptions, they used a system of constant comparative analysis to further develop the generative themes.

of Maryland (Baltimore) School of Social Work (UMBSSW), led by Dr. Jodi Frey, the Chair of the School of Social Work’s EAP Sub-Specialization Program. The interviews were conducted at the School of Social Work’s Media Lab, and directed and produced by Tom Mitchell. Because the project involved human subjects, the study protocol was reviewed and approved by the University’s Institutional Review Board (IRB) prior to selection and notification of the interviewees. As per the IRB’s requirements, Dr. Masi obtained informed consent from all of the SMEs prior to the interviews. As part of this process, each interviewee agreed to have their identity shared in the dissemination of results from this study.

Research Efforts Underway The video interviews described in this article are just one part of the larger EAP History Project, which was established to document the history and evolution of EAPs worldwide, from their earliest beginnings to the present. The Employee Assistance Research Foundation (EARF) Board of Directors awarded two grants in 2016 to support the project. Professor Ann Roche, PhD, Director of the National Centre for Education and Training on Addiction (NCETA) at Flinders University in South Australia, was selected to lead the research focused on developments outside of the United States and Canada; while Professor Emeritus Dale Masi, PhD, CEAP, was selected to lead the research efforts pertaining to those two countries. Both research teams are conducting systematic literature reviews and archival research of unpublished documents, as well as interviewing key individuals who have helped shape the field. Together, the various components of the EAP History Project will result in a scholarly review and analysis of why and how the EAP field has evolved to this point, with a special emphasis on how cultural and other differences among countries affect EAP development and effectiveness. EARF and The Journal of Employee Assistance will continue to publish information about the EAP History Project as it becomes available. v

Creating the Interview Guide Drs. Masi and Frey created a semi-structured interview guide for use during the interviews. The guide enabled us to conduct qualitative interviews and increase the rigor of the process, while still allowing enough flexibility to ask probing questions and further investigate ideas that came up during the course of the conversation. Each interview lasted approximately one hour. All SMEs were asked questions focused on their perceptions of the EAP field in relation to its most influential historical milestones, and the impact of globalization and technology. Other questions were unique to the interviewee based on his/her expertise. Special Training Required In order to be considered a full research team member by the IRB, UMBSSW administrative and technology staffs were trained on human subjects protocols. As previously noted, Dr. Masi conducted seven of the interviews and the eighth was conducted by Dr. Frey at the UMBSSW Media Lab, which has broadcast-quality digital and analog media production capabilities. Interviewees used the Skype platform from their home or office. Two UMBSSW students in the EAP SubSpecialization program were trained to take detailed notes during the interviews, one of them was present in the studio to complete this task during each interview.

John Maynard, PhD, CEAP, On behalf of the Employee Assistance Research Foundation (EARF). John Maynard is a charter member of the EARF Board of Directors and currently serves on the Board’s History Project Oversight Committee.

coverstory Media Lab technicians used Final Cut Pro X software to produce the final edited interviews. The file was then encrypted and sent electronically to the University’s Media Center for inclusion in the final product. Upon completion of the video interviews, Dr. Masi recorded a general introduction for the video interviews that precedes each presentation and offers an overview of the entire EARF History Project. Summary A full report on the findings of the video interviews will be published by the Employee Assistance

Research Foundation as part of the overall EAP History Project. The video interviews are now available to the public and are permanently housed at the Employee Assistance Digital Archive in the University of Maryland Baltimore’s Health Sciences and Human Services Library (www.eaarchive.org). Additionally, the IRB provided approval for the videos to be available on the EAPA (www. eapassn.org/EAPHistory) and interviewee’s websites. Direct links to the individual interviews are provided below: v

Fran Rodgers Interview: https://archive. hshsl.umaryland.edu/handle/10713/6501 Jim Wrich Interview: https://archive.hshsl. umaryland.edu/handle/10713/6503 Dale Masi Interview: https://archive.hshsl. umaryland.edu/handle/10713/6502 John Burke Interview: https://archive.hshsl. umaryland.edu/handle/10713/6506 Rick Csiernik Interview: https://archive. hshsl.umaryland.edu/handle/10713/6504 Rita Fridella Interview: https://archive. hshsl.umaryland.edu/handle/10713/6505 Dave Sharar Interview: https://archive. hshsl.umaryland.edu/handle/10713/6507

For more information, contact Dale at dalemasi@eapmasi.com.

Carl Tisone Interview: https://archive.hshsl. umaryland.edu/handle/10713/6500

webwatch Addiction National Council on Problem Gambling http://www.ncpgambling.org/ The mission of the NCPG is to lead state and national stakeholders in the development of comprehensive policy and programs for all those affected by problem gambling. A helpline network (1-800-522-4700) is among the key resources offered. Crisis Intervention International Critical Incident Stress Foundation https://www.icisf.org/ The mission of the ICISF is to provide leadership, education, training, consultation, and support services in comprehensive crisis intervention and disaster behavioral health

services to the emergency response professions, other organizations, and communities worldwide. Crisis Intervention International Foundation of Red Cross and Red Crescent Societies http://www.ifrc.org/ The IFRC is the world’s largest humanitarian organization, providing assistance without discrimination as to nationality, race, religious beliefs, class or political opinions. Disability Inclusion Job Accommodation Network Webcasts https://askjan.org/webcast/ Available at no cost, JAN webcasts educate managers, employees, on disability etiquette, assistive

technologies, management techniques, and the latest on accommodations and the employment provisions of the Americans with Disabilities Act (ADA). Domestic Violence Safe at Work Coalition www.safeatworkcoalition.org This organization offers guidelines for assisting employee victims of domestic violence – as well as providing guidance to companies wishing to develop and implement programs and policies around employee and workplace safety. Elder Care National Association of Area Agencies on Aging https://www.n4a.org/ This organization’s primary mission

webwatch is to build the capacity of its members so they can help older adults and people with disabilities live with dignity and choices in their homes and communities for as long as possible. An eldercare locator is among the key resources offered. Employee Engagement Building on Engagement, Measuring the Impact In this podcast, you’ll hear how IBM Smarter Workforce Institute and Globoforce’s WorkHuman® Research are enhancing the measurement of employee engagement through the Employee Experience Index. IBM and Globoforce leaders discuss this global measure of a workplace and its impact on the business and its people. Listen and download the Index here: https:// ibm.co/2wWL2j6. Financial Wellness Care Connect USA https://careconnectusa.org/ Financial wellness is becoming an increasing requested EAP service. Helplines, as well as tax debt and mortgage relief, are among the resources offered. There is even a trusted helplines app.

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Email the Advertising Manager admanager@eapassn.org

Mental Health Lantern https://golantern.com Instead of therapy, Lantern offers “coaching.” Users share problems via text messages and receive highly structured strategies for feeling better in that moment, such as guided meditation or breathing exercises. Mental Health Recovery Oriented Language Guide http://mob.mhcc.org.au/media/5902/ mhcc-recovery-oriented-languageguide-final-web.pdf Because language matters in mental health, the Mental Health Coordinating Council (MHCC) developed this useful guide.

Technology Tawk.to https://www.tawk.to/ Tawk.to is a free messaging app that lets you monitor and chat with visitors on your website, mobile app, or from a free customizable page. 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 you 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. v

Substance Use and Addiction Faces & Voices of Recovery http://facesandvoicesofrecovery.org/ This site was launched on the premise, “that all Americans have a right to recover from addiction to alcohol and other drugs.” Links include a news section, share your story, resources, and more. Technology Internet World Health Research Center http://health.ucsf.edu/ The mission of the IWHRC is to harness the power of technology to reach those most in need with effective interventions that can be administered via the Internet or a mobile device. Technology PsyberGuide https://psyberguide.org/ There are thousands of mental health apps. This site helps users choose the right ones. The site features a product guide.

KGA 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

featurearticle Duty to Warn

Understanding When to Breach Confidentiality | By Robin M. Sheridan, JD, MILR

mployee assistance professionals are keenly aware of the obligations of confidentiality to their clients. Not as well known, however, is when they are obligated by law to breach confidentiality. The “duty to warn” is an exception to normal confidentiality standards, and, depending on a practitioner’s location, license, and situation, may mandate that EA professionals warn third parties whom they believe their client may harm (or of possible client self-harm).

State Variations in the Law Each duty-to-warn law articulates the specific conduct that triggers the action required by EA professionals to satisfy the duty. These laws vary significantly not only from state to state but also depending on the professional’s applicable license. Therefore, it is critical that the EA professional understand his or her duty under the laws of the state(s) in which they practice. Information Triggering the Duty to Warn The standard for reporting varies. For example, Massachusetts law mandates that mental health professionals report, “an explicit threat to kill or inflict serious bodily injury upon a reasonably identified victim or victims, and

the client has the apparent intent and ability to carry out the threat.” Texas laws permit a mental health professional to report, “a probability of imminent physical injury by the client to the client or others or . . . a probability of immediate mental or emotional injury to the client.” Who Must Be Warned Some states require EA professionals to notify only the potential victim or only law enforcement personnel, while others impose a duty to warn the potential victim and law enforcement or to perform another action entirely. EA professionals in Massachusetts, for example, may discharge the duty to warn by arranging for voluntary or involuntary hospitalization of the client in lieu of a warning. Sources of Threatening Information In some states, only information received directly from the client triggers the duty to warn. In others, the duty is also triggered when a client’s family member reports the client’s threats to EA professionals. Notable Cases The following cases illustrate circumstances that precipitate duty to warn, the differences of that duty under various state laws, as well as the complicated aftermath of whether to make the decision to warn.

Emerich v. Philadelphia Center for Human Development, Inc. (Pennsylvania, 1998) Gad Joseph was receiving treatment from a counselor, while his live-in girlfriend, Teresa Hausler, was also undergoing treatment for mental issues at the same facility. The counselor was aware that Joseph and Hausler lived together and that Joseph had abused her. As a result, she ended her relationship with Joseph. Joseph told the counselor that he wanted to kill Hausler. The counselor immediately scheduled a therapy session with Joseph, who later indicated that he would not harm Hausler. She called the counselor to inform him that she would be returning to gather her clothes from her old apartment, but the counselor warned her not to return and instead to leave immediately. Hausler ignored the warning and her former boyfriend shot and killed her upon entering the apartment. The court found in favor of the counselor, ruling that the counselor had a duty to warn when a specific and immediate threat of serious bodily injury was conveyed by the patient regarding a readily identifiable victim. In this case, the court held that the counselor’s warning to Hausler satisfied the mental health professional’s duty to the victim.

Thus, duty to warn identifiable third parties now entailed a broader, more general duty to protect the public.

Ewing v. Goldstein (California, 2004). A licensed marriage and family therapist (MFT) treated former police officer Geno Colello for his work-related injuries as well as a recent breakup with his wife. During a call with his therapist, Colello admitted to having suicidal thoughts, and the therapist asked to speak with Colello’s father, who had reported that Colello had lost his desire to live, and could not handle seeing his ex-spouse date another man, (Keith Ewing), and that Colello considered harming Ewing. Collelo was voluntarily committed. The next morning, Colello’s dad advised the therapist of his son’s upcoming release. The therapist phoned the admitting psychiatrist, urging him to keep Collelo under observation for the weekend. The psychiatrist declined and discharged him. The next day Colello murdered Ewing and then killed himself. Ewing’s parents filed a wrongful death suit against the therapist, alleging he had a duty to warn their son of the risk Colello posed. The court rejected the therapist’s argument that the threat of violence did not come from the patient himself and held that threats communicated by a patient’s family constitute “patient communications,” triggering the duty to warn.

What Would You Do? As described in the previous cases, numerous factors can affect the scope of an EA professional’s duty to disclose. To illustrate this point, consider how EA professionals in several different states might respond to the same statement made by a client. Statement #1: “My supervisor is out to get me. I have a gun and am thinking of using it.” Statement #2: “My co-worker told me he is really angry at his supervisor. He is ex-military and I know he has guns at home. I’m worried he is going to hurt someone.” In the state of Colorado Research and analysis prepared by attorney Brian Sabey, (720) 282-2025, BrianSabey@hallrender.com

Volk v. DeMeerleer (Washington, 2016). Jan DeMeerleer, the outpatient client of a psychiatrist, reported suicidal and homicidal thoughts to the psychiatrist during treatment for bipolar and associated disorders, although he never named nor indicated a specific intention to harm a person. Later, DeMeerleer killed his former girlfriend and her son before returning home and killing himself. The former girlfriend’s estate sued, alleging that the psychiatrist breached his duty of reasonable care for any foreseeable victims because there was a special relationship between the psychiatrist as a mental health professional and DeMeerleer as a patient. The court ruled that a psychiatrist may be liable for homicides committed by a client if the harm was foreseeable, even though the client never identified the victims as targets of violence. The court held that duty exists in outpatient settings as well, expanding the potential legal liability for psychiatrists, increasing the breadth of individuals to whom a duty may be owed, and requiring providers to dive deeper into statements made by patients to assess any potential threats and the likelihood of violence. 25 | W W W . E A PA S S N . O R G | •• • • • • • • • • • • • • • • • • • • • | JOURNAL OF EMPLOYEE ASSISTANCE | 4th Quarter 2017 |

featurearticle The duty to warn is established in Colorado Revised Statutes 13-21-117, which provides that mental health providers have no liability for failing to warn or protect individuals against potential violence by persons receiving treatment, “except where the patient has communicated to the mental health provider a serious threat of imminent physical violence against a specific person or persons, including those identifiable by their association with a specific location or entity.” In cases where there is a duty to warn, providers must, “make reasonable and timely efforts to notify the person or persons . . . [who are] specifically threatened, as well as to notify an appropriate law enforcement agency or to take other appropriate action.” One Colorado case is particularly useful in this matter. In McCarty v. Kaiser-Hill Co., a patient called his psychologist at 1:30 a.m. and described his strong negative feelings towards his supervisors. He expressed concern that he might not be able to control his anger. The patient was feeling “sort of homicidal,” and mentioned that he knew martial arts and, if provoked, could kill someone. The patient expressed that, “They don’t deserve to die, but they do deserve to have their ass kicked.” The psychologist determined that this communication constituted a serious and imminent threat triggering the psychologist’s duty to warn, and accordingly, he warned the patient’s supervisor. The patient was fired. The patient then sued the psychologist, claiming he had violated confidentiality. The

court rejected this claim, finding instead that under these facts, as a matter of law, the psychologist had a duty to warn the supervisor. In light of the McCarty decision, it is likely that a duty to warn would arise if an employee were to state to his EA professional, “My supervisor is out to get me. I have a gun and am thinking of using it.” The more difficult case is Statement #2. The language of the statute can reasonably be read to mean that “the patient” who communicates the threat must be the same individual who poses the threat: the statute provides for immunity from liability for failing, “to warn or protect any person against a mental health patient’s violent behavior…except where the patient has communicated [a threat].” However, Colorado case law suggests a broader interpretation under which any communication of a patient’s threat, whether from the patient directly. or from another patient, may be sufficient to trigger the duty. In Halverson v. Pikes Peak Family Counseling & Mental Health Center, a rape victim brought a case against the mental health clinic where she was a patient. While in treatment, she disclosed to the clinic’s employees that she felt threatened by her assailant’s words and actions. The trial court dismissed her complaint, interpreting Colorado law to require that the threats be communicated to the mental health professional by the assailant. The appellate court reversed the decision, reinstating the victim’s

claim, reasoning that if the prospective victim communicates the violent threat of a fellow patient, this triggers the duty to warn, and stated that the duty to warn or protect applies, “when the violent patient’s threats have been communicated to the health care provider.” Accordingly, the EA professional’s duty under Statement #2 may turn on whether or not the co-worker was also a patient of the EA professional. In the state of Indiana Research and analysis prepared by attorney Charise Frazier, (317) 977-1406, CFrazier@hallrender. com, with assistance from law clerk Amanda Ray. Generally speaking, mental health service providers, including but not limited to licensed social workers, have a duty to warn if the patient communicates an actual threat of physical violence against an identifiable victim or if the patient makes a statement indicating an imminent danger that they will use physical violence to harm or cause personal injury to others. Statement #1 will likely trigger the EA professional’s duty to warn because it constitutes a statement indicating an “imminent danger” to the client’s supervisor. Indiana case law does not require that the client use affirmative language (such as I “will” use a gun to harm my supervisor) in their communications to their mental health provider. In this case, the client’s intent that they are “thinking” of using the gun to harm their supervisor is sufficient to trigger the EA professional’s duty to warn. For example, in Dennie v. Methodist

Hospitals Inc., a patient’s statement that he “could” take his gun to kill everyone in the room triggered the provider’s duty to warn. Accordingly, the counselor must warn by using any of the following options under the statute. The options include: • reasonable attempts to communicate the threat to the victim; • reasonable efforts to notify a police department or other law enforcement having jurisdiction in the patient’s or victim’s place of residence; • filing a civil commitment under IC 12-26; • reasonably preventing the patient from using means of harm until law enforcement can take custody of the patient; and • reporting, within a reasonable period of time after receiving knowledge of the threat, to a physician or psychologist who is designated by the employer of a mental health service provider as an individual who has the responsibility to warn. As for Statement #2, it would likely not trigger Indiana’s duty to warn requirement. Under Indiana law, the counselor only holds a duty to warn where the person uttering the threat is their patient. No liability exists for mental health service providers where the statement is hearsay. In the state of Washington Research and analysis performed by attorney Stephen Rose, (425) 278-9337, SRose@hallrender. com

Relying on Section 315, the court in Petersen v. State held that there is a duty to warn the potential victim of a psychiatric patient when, “a special relation exists between the actor and the third person which imposes a duty upon the actor to control the third person’s conduct.” Stated another way, once a special relationship exists between the EA professional and his/her patient, the EA professional owes a duty of reasonable care to any foreseeable victim of the patient. A court will consider the following factors to determine whether a duty to warn should be imposed on the EA professional: • the EA professional’s ability to control the patient; • the public’s safety from violent assault; • the difficulty inherent in attempting to predict whether a patient represents a substantial risk of harm to others; • the goal of placing the mental patient in the least restrictive environment and safeguarding the patient’s right to be free from unnecessary confinement; and • the social importance of maintaining the confidential nature of psychotherapeutic communications. With respect to Statement #1, the EA professional likely has the “special relationship” which triggers the duty to warn, which under Washington law is a duty of “reasonable care.” Under this factual scenario the patient has expressed a homicidal thought against a particular individual, which probably

makes injury to that individual foreseeable. This scenario likely requires the EA professional to warn the supervisor. In Washington, the duty to warn is based on the relationship between the professional and the potential actor. In Statement #2, the statement is of a person, who is not the potential actor, speculating what someone else might do. Since there is no “special relationship” between the EA professional and the potential actor, there is probably not a duty to warn in this case. Practical Takeaways Be transparent with clients. Obtain a written informed consent or statement of understanding at the initiation of treatment, making sure the exceptions to confidentiality are clearly explained to, and acknowledged by, the client. Know the law in your jurisdiction. First, determine which states’ laws apply, including potentially the state(s) where you are licensed and the state where the client receives treatment. Second, if a duty to warn exists, know which and whose statements or conduct trigger the duty. And finally, consider the standards for reporting. Note, also, that the duty to warn does not absolve EA professionals of other client confidentiality obligations. When the duty is triggered, provide only the information necessary to warn the third party and/or authorities consistent with applicable laws. Consult counsel. The stakes are high for the potential victim, the client, your

featurearticle employer, and yourself. Breach of the duty to warn could result in professional liability for failing to appropriately treat the client who causes harm as well as liability to the individual(s) harmed, which can include the client. If you suspect that confidentiality should be breached, contact an attorney familiar with health law in your state(s).

statements of the client as well as any information provided by others about the client. Document your considerations in determining whether to warn and identify anyone you consult. Document the time, phone number, recipient and substance of your warnings, if made. Thoroughly document any responses, actions, or lack of response. v

Document. In healthcare, if it isn’t documented, it didn’t happen. Document the time, location, nonverbal behavior, and actual

Editor’s note: The recommendations provided in this article are for educational purposes only and are not to be construed as actual legal advice. Always consult with a local attorney regarding duty-to-warn

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In Canada, Wellness For Men by Men A branding strategy that has a “masculine look and feel,” is at the centre of a workplace health program that hopes to reach men in male-dominated industries in British Columbia, Canada. Powerplay: Men’s Health at Work was developed through research and focus groups with men working for northern trucking companies at the Ridley Island coal terminal in Prince Rupert, as well as municipal workers in Terrace, and as chemical plant employees in Prince George. “We know that men have higher rates of chronic disease than women in rural and northern communities,” said Joan Bottorff, the director of the Institute for Healthy Living and Chronic Disease

Prevention at the University of British Columbia. “We found out they’re actually pretty interested in health and being healthy,” Bottorff told Robert Doane, host of the Canadian Broadcasting Company (CBC) Daybreak North program. Bottorff said the takeaway was that messages needed to be direct and clear and that men were more likely to participate in healthy eating and physical activity if challenged to do so through friendly competition. The program is structured around a series of challenges like the Fuel Up Challenge, where participants are encouraged to work as a “hockey team,” scoring goals by eating well and exercising. “We learned that if we could engage men in working together to change their healthy eating and

law and circumstances. Authors in this article are attorneys with Hall, Render, Killian, Heath & Lyman, P.C. in Milwaukee, Wis. For more information, contact Robin Sheridan at (414) 721-0469 or email her at rsheridan@hallrender.com. Robin Sheridan, JD, MILR has experience in all aspects of employment law and human resources management, including hiring, discipline, discharge, drug testing, disability accommodation, union avoidance, discrimination and civil rights claims, implementation of family and medical leave and wage and hour laws. She was admitted to the Bar in Wisconsin, Michigan, Minnesota, and Arizona.

physical activity, it really resonated with them,” said Bottorff. Read (and listen) more here http://bit.ly/2sr6NFH

Are Smartphones Ruining a Generation? More comfortable online than partying, post-Millennials are safer physically than adolescents have ever been. But they are on the brink of a mental health crisis, reports The Atlantic. “I think we like our phones more than actual people,” said one teen user of Snapchat. This teenager is far from alone in the amount of time she spends online. Born between 1995 and 2012, members of this generation are growing up with smartphones, have an Instagram account before

earoundup they start high school, and do not remember a time before the Internet. The Millennials grew up with the web as well, but it wasn’t ever-present in their lives, on hand all of the time, day and night. A 2017 survey of more than 5,000 American teens found that three out of four owned an iPhone. Jean Twenge, author of the forthcoming book, iGen: Why Today’s Super Connected Kids are Growing up Less Rebellious, More Tolerant, Less Happy – and Completely Unprepared for Adulthood – and What That Means for the Rest of Us – preaches moderation. “Prying the phone out of our kids’ hands will be difficult, even more so than the quixotic efforts of my parents’ generation to get their kids to turn off MTV and get some fresh air,” Twenge states. “But more seems to be at stake in urging teens to use their phone responsibly, and there are benefits to be gained even if all we instill in our children is the importance of moderation. Significant effects on both mental health and sleep time appear after two or more hours a day on electronic devices. The average teen spends about two and a half hours a day on electronic devices. Some mild boundary-setting could keep kids from falling into harmful habits.”

Absence of Healthcare Support at Crisis Levels in India The rise in awareness on drug abuse has brought to light the absence of healthcare support for the victims in cities and rural areas alike in India, reports The Hindu. In the absence of sufficient number of trained professionals,

the treatment for substance abuse victims has become a challenge. According to one estimate, there are only 3,500 psychiatrists and 1,000 psychologists for a country with nearly 1.3 billion people. Mental health accounts for 0.16% of the Union Health Budget. The National Mental Health Survey 2015-16 didn’t include Telangana (one of the 29 states in India), and the figures are not available for substance abuse morbidity. The same study points out that every sixth Indian needs mental health help. In any case, the lack of healthcare support is making treatment a real challenge.

Telemedicine Coverage Soaring: Report

CEO of American Well. “Access to behavioral services is even more challenging than access to medical care, the conversational nature of behavioral services makes video encounters perfect alternative to physical ones and the notion of privacy couldn’t be better addressed when you have the encounter in your own home.” The push by these companies into telemedicine, or telehealth, comes as insurance companies and government health programs provide more reimbursement for online healthcare services including video consultations. Nearly all employers (96%) allow telehealth services for medical services and related treatments in states where it’s allowed, according to NBGH. continued on page 34

Insurance coverage of mental health services via telehealth technology is surging to unprecedented levels amid an opioid abuse epidemic and increased access to behavioral healthcare, according to telemedicine companies and a leading report. The National Business Group on Health (NBGH) said 56 percent of employers in 2018 plan to offer telehealth for behavioral health services as a covered benefit. That’s more than double the percentage of employers offering telehealth mental health services this year, NBGH says in its annual health benefits survey. “While telehealth has shown a breakneck growth, more than doubling itself year over year for quite some time, behavioral telehealth has shown an even more astounding growth rate due to three simple reasons,” said Roy Schoenberg, 29

featurearticle Changing Landscape of Mental Health in Canada |By Mark Attridge, PhD, MA; Dylan Davidson, BAA; and Joti Samra, PhD, R.Psych.

hanges over the past decade have produced many promising trends in workplace mental health, although certain problems remain. That is the consensus of a recent research project that examined the evolution of workplace mental health policies and strategies in Canada. The study focused on the five areas of legal advances, shifts in business priorities, changes in education and training, media trends, and research priorities. Multi-method Approach to Research Three research methods were utilized for the project. First, we reviewed empirical and business literature to investigate the state of workplace mental health in 2007 and find out what has changed. Second, we interviewed 87 key informants from across Canada, who collectively represented a wide breadth and depth of knowledge and expertise across aspects of workplace mental health. Finally, we surveyed 2,148 Canadians working in human resources, management, government, mental health services, EAP, and other roles. More specifically, we wanted to assess these individuals’ attitudes, opinions, and knowl-

edge of current mental health practices in the workplace. This article presents highlights from the full 80-page report (Samra, 2017).

“Examples of this change include laws in several Canadian provinces that provide specific protections for accommodating workers with a mental health disability…” Then and Now Only 10 years ago, efforts to promote workplace mental health in Canada were generally unsystematic, fragmented, and in some cases, frivolous. Mental health in the workplace was often considered peripheral and certainly secondary to physical-related illnesses and injuries. Respondents to our survey characterized the 2007 state of workplace mental health as being a stigma-laden area.

The business case for addressing workplace mental health issues was also in its early stages, and research was only just beginning to reliably measure employee health and connect it to work performance. However, workplaces were characterized as less stressful and with fewer demands on time and more resources provided than what is typical in today’s work environments. A decade later, much has changed. Work-related stress and mental health problems such as depression are acknowledged as global issues affecting a wide range of professions and workers. The workplace is seen as a major source of psychosocial risks and thus is recognized as the ideal venue for protecting the health and well-being of workers. Accordingly, there has been a remarkable increase in new policies, initiatives, approaches, and strategies targeted at improving mental health in the workplace. Some of the most meaningful changes have occurred at the personal level in the form of increased awareness, understanding, and compassion for workers with mental health and/or addiction issues.

The Evolving Legal & Standards Landscape In 2007, the political landscape changed dramatically with the formation of the first-ever Mental Health Commission of Canada (MHCC), which included an advisory committee on mental health in the workplace. Six years later, the National Standard of Canada for Psychological Health and Safety in the Workplace was released. This document, known as “the Standard”, provides a comprehensive framework employers can use to assess, respond, and evaluate workplace psychological health and safety. Considered a first of its kind in the world, the Standard is championed by the MHCC, and developed through a consensus approach by the two leading standards-making organization in Canada – the Bureau de normalisation du Quebec (BNQ) and the CSA Group. Another advance came in 2015 when the Public Service Alliance of Canada and Canadian government established a joint task force to address mental health in the workplace. It should come as no surprise then, that in our survey, 72% of respondents reported that legislation to protect employees with mental health issues in the workplace is better today than in 2007. Examples of this change include laws in several Canadian provinces that provide specific protections for accommodating workers with a mental health disability; the bolstering of compensation for mental health injury under workers’ compensation laws, particularly for those in high risk

positions (e.g., first responders); and explicit definitions and protection against acts of workplace bullying and harassment. The Evolving Business Landscape Significant shifts in attitude about mental health have occurred in the business community, particularly among leaders and CEOs of large organizations. These changes include an increase in awareness, understanding, value, and prioritization of addressing psychological health and safety issues. Noteworthy changes in behavior have also occurred on both organizational and individual levels. This has especially been the case in terms of development and utilization of resources and supports for managers, supervisors, and other workplace leaders. In our survey, 67% said that employees with mental illness are treated better at work today than in 2007. Greater value is now placed on considering the psychological health and safety of the work environment. This value is demonstrated through emerging awards that recognize employers with good practices as being desirable places to work. Indeed, the business community in Canada has been a major catalyst for promoting workplace mental health issues as essential to employee recruitment, engagement, and retention. An example of this was the series of bi-annual meetings hosted by the Global Business and Economic Roundtable on Addiction and Mental Health.

of mental health educational and training programs is better now than in 2007. Many evidencebased mental health resources have emerged over the last decade. These resources, including webinars, workshops, and online university certificates, have resulted in enhanced public awareness about mental health, as well as reducing barriers to accurate information. Prominent examples include Mental Health Works (by the Canadian Mental Health Association), Mindful Employer Canada, and Workplace Strategies for Workplace Mental Health (by Great-West Life Centre for Mental Health in the Workplace). All told, these resources enhance the likelihood of implementing

The Evolving Education and Training Landscape Most (73%) of survey respondents reported that the availability 31

featurearticle workplace mental health initiatives for employers, regardless of their financial limitations or geographic location. Additionally, education in psychological health and safety is now being incorporated into professional trade shows and conferences, such as The Better Workplaces Conferences held by the Conference Board of Canada and the Bottom Line Conference by CMHA. This reflects the broadening value that professions are placing on psychological

health and safety as a foundational training piece for all work environments. Further, advanced training in psychological health and safety in the workplace are now available at the University of Fredericton, Humber College, and other academic institutions. The Evolving Public Media Landscape Societal shifts in the general public’s attitudes toward mental health issues have reduced stigma.

Recommendations for EA Professionals The findings of this research study have numerous implications for the EA profession in Canada and other countries. EA professionals should get more involved with advancing legislation and regulatory changes that support workplace mental health. This includes serving on EAPA member chapters and industry legislative committees, as well as encouraging political advocacy among staff. EA professionals should educate both employees and corporate leaders about the widespread prevalence of mental health issues in the workplace and that they are preventable and treatable. Websites, smart phone apps, and other technological tools offer the modern EAP many avenues for increasing awareness and access to resources. EA professionals should create additional opportunities for positive media by collaborating with employers to present together at professional and business conferences on mental health topics. Individuals with appropriate experience and/or expertise can share their own stories and advice through blogs, online videos, contributing articles to business publications, and offering presentations for local civic events and community groups. As they say in Ontario, “Every door is the right door” for opportunities to raise awareness about mental health. EA professionals should collect better empirical data on the quality and workplace outcomes of their counseling, management, and crisis services. These metrics are needed as inputs to demonstrate the business value of EAPs to corporate clients. EAPs can also collaborate with university professors and consultants to share their data, and thus contribute to new research on workplace mental health. v – Mark Attridge, PhD

Mental health is increasingly being viewed as an important component of overall health; the World Health Organization proclaims, “There is no health without mental health.” General awareness of mental health has increased, and thus the average person’s understanding of mental health issues has become less judgmental and more compassionate. These changes have been reflected in shifting stories and broader attention in the media. Celebrities and influential individuals have increasingly spoken publicly about their own personal struggles, resulting in increased exposure, accessibility, and normalizing of mental health challenges. For example, our survey found that 73% felt that attitudes toward workplace mental health issues are better now than they were in 2007. Furthermore, additional information about mental health disorders is now widely accessible, particularly through the expansion of venues such as social media, blogs, and specialty publications (such as Moods Magazine) that provide personal and intimate realworld stories. One such example is popular Canadian athlete Clara Hughes serving as a spokesperson for Bell Canada’s Let’s Talk nationwide anti-stigma campaign for mental health. The Evolving Research Landscape Several landmark industry and government white papers on workplace mental health were generated in Canada during the past decade. In addition, global scientific literature now has over 1,000 papers exploring workplace mental

health topics. Past emphasis on studying individual factors has been augmented by an increasing focus on broader organizational and work environment factors that affect employee mental health, and ultimately drive company success. Enhanced value within the scientific community is also being placed on participating in collaborate initiatives between researchers and businesses. This has resulted in companies’ deepening knowledge not only about workplace mental health in general, but also their impact on absenteeism and productivity (including presenteeism) in real-world settings. Evidence of the cost-effectiveness of prevention and treatment services provided by workplace wellness, EAPs, and mental health providers, has increased substantially in the past 10 years. Employers who used to question the impact and return on investment (ROI) of mental health programs are now asking how to identify best practices for promoting and integrating these services in order to drive program awareness and use. For instance, every year millions of men in Canada (and all over the world) shave off their moustaches during November to raise money (over $750 million since 2004) for the Movember Foundation. The foundation funds innovative projects that promote men’s health, such as the BroMatters.ca website for preventing depression in Canadian working men. Gaps Remain Although much progress has been made, certain problems and gaps stubbornly remain.

Our study indicated that cultural gaps were the most commonly reported concern (36% of key informants), followed by gaps in leadership (33%), and gaps in resources (23%). Cultural gaps indicated the need to further address the stigma of mental health and addiction in the workplace and admit that many businesses still enable a work culture that ignores the role of psychological factors or that focuses solely on the physical aspects of worker safety and disability. Leadership gaps included a lack of training and education for leaders, a lack of awareness of the benefits to the business of addressing mental health issues in the workplace, a lack of rigor in selecting which specific organizational initiatives to pursue, and a lack of emotional intelligence of some leaders. Resource gaps included a lack of workplace research, poor dissemination of the existing body of research, inadequate workplace accommodation for mental health disability and return-to-work practices, and low utilization or ineffective employee assistance and family programs that are not properly integrated to the workplace. A new book by Mary Ann Baynton and Leanne Fournier, The Evolution of Workplace Mental Health in Canada, shares the stories of individuals who contributed to this transformation and highlights results of the research study. The Great-West Life Centre publishes both the book and the research report for Mental Health in the Workplace. v

Adapted from: Samra, J. (2017). The Evolution of Workplace Mental Health in Canada: Research Report (20072017). Retrieved from https://www. workplacestrategiesformentalhealth.com/ pdf/Evolution_Research_Project_Full_ Report__Jan_2017_0.pdf The research project, led by Joti Samra, was supported by the GreatWest Life Centre for Mental Health in the Workplace (the Centre), as well as the Mental Health Commission of Canada, and was conducted through the University of Fredericton. The project was completed through support from students Dylan Davidson and Marissa Bowsfield, as well as advisory committee members Mark Attridge, Graham Lowe, and Martin Shain. In addition, the Centre’s Program Director, Mary Ann Baynton, was instrumental in creating and nurturing this project as part of the Centre’s 10th anniversary. Dr. Mark Attridge is an independent research scholar as President of Attridge Consulting, Inc., based in Minneapolis. 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. Dylan Davidson, B.A.A. is a Master’s student in Clinical Psychology at the University of Manitoba. His graduate research on efforts to improve public mental health literacy is supported by the Canada Graduate Scholarship and the University of Manitoba. Dr. Joti Samra, R.Psych. is the director of an organizational, research and media consulting practice and also maintains an active clinical practice located in Vancouver, British Columbia. She is a national thought leader on issues relating to mental health, with particular expertise in issues relating to workplace psychological health and safety. Joti is Co-Founder and Clinical Director of Boreal Wellness Centers, and Program Lead for the Centre for Psychological Health Sciences at the University of Fredericton. Contact her at info@ drjotisamra.com or visit https://www. workplacestrategiesformentalhealth.com/ centre-initiatives.

earoundup Positive Testing for Marijuana Increasing Marijuana is still illegal federally, but as states decide to legalize, studies have shown that the rate of employees testing positive for marijuana is increasing, reports Smart Approaches to Marijuana (SAM). Between 2015 and 2016 in Colorado, this rate increased 11%, and the national positivity rate for marijuana in the U.S. workforce increased 4% in the same period. This is even more important when HR specialists and business leaders consider that under many metrics, marijuana is actually more harmful than alcohol for job performance. Overall positivity in drug testing among the combined U.S. workforce in 2016 was 4.2 percent, an increase over the previous year’s rate of 4.0 percent, and the highest annual positivity rate since 2004 (4.5 percent), according to the annual Quest Diagnostics Drug Testing Index. “This year’s findings are remarkable because they show increased rates of drug positivity for the most common illicit drugs across virtually all drug test specimen types and in all testing populations,” said Barry Sample, PhD, senior director, science and technology, for Quest Diagnostics. SAM is the leading, non-partisan national organization offering a science-based approach to marijuana policy in the nation. Read more here http://www. insurancejournal.com/news/ national/2017/05/17/451343.htm

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Mental Health Support Worse for Public Sector Employees Workplace well-being support is worse in the public sector than in the private sector, according to a major survey by the mental health charity Mind. The survey of over 12,000 employees across public and private sectors in the UK found there is a higher prevalence of mental health problems in the public sector, as well as a lack of support available when people do speak up. Of those with a mental health problem, 90 percent of public sector staff disclosed it to their employer, compared with 80 percent in the private sector. When taking time off for mental health reasons, 69 percent of public sector workers were honest about the reason for needing time off, compared with 59 percent of private sector staff. Thirty-eight percent of public sector employees said the workplace cultured allowed staff to be open about mental health problems, compared with 29 percent in the private sector. The impact is significant. Public sector survey respondents said that, on average, they had taken nearly three days off in the last year, compared to just under one day on average for workers in the private sector. Almost half (48 percent) of public sector workers have had time off because of their mental health, compared with less than a third (32 percent) of the private sector workforce. Mind is calling on the next government to make mental health in the workplace a key priority.

Fentanyl Worse than Heroin: Report Note to SAPs in particular: The New York Department of Health and Mental Hygiene warns that fentanyl, a synthetic opioid, is fifty times more potent than heroin, and is responsible for a recent spike in fatal overdoses. During 2016, 1,374 people died from fentanyl-related causes in NYC alone; a 46 percent increase from the previous year. It is considered one of the deadliest street drugs to ever hit the U.S. “Fentanyl is so deadly,” says Manhattan District Attorney Cyrus R. Vance, Jr., “that there were more overdose deaths than homicides in New York last year. The availability of the drug – which may be combined with other drugs, unbeknownst to users – has exponentially increased the life-threatening risks of abusing narcotic substances, leading to an extreme public safety crisis that necessitates a swift and committed reaction from law enforcement and health officials.” v

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