Journal of Employee Assistance 4th Quarter 2019 Vol. 49 No. 4 by Employee Assistance Professionals Association

4th Quarter 2019 | VOL. 49 NO. 4

The magazine of the Employee Assistance Professionals Association

Adding Life Coaching to the EAP |Page 14

Bonus! Read Cover Story for PDH!

PLUS:

Implicit Organizational Trauma Principles Page 10

More Changes in the Works for DOT SAPs Page 18

Preventing Suicide Page 22

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contents EAPA Mission Statement

4TH Quarter 2019 | VOL. 49 NO. 4

cover story

Adding Life Coaching to the EAP

| By Debbie Jongkind, RD, LDN, PCC, NBC-HWC

Over the past thirty years, life coaching has developed into a respected profession, but only recently has the life coach partnered with the EA professional. Adding coaching to the array of services offered by the EAP has introduced the wider employee population to the support and benefits provided by a coach.

features

Principles for Addressing Implicit Organizational Trauma

| By Bryan McNutt, PhD, LMFT, CEAP

Implicit organizational trauma can exist in the workplace on a systemic level that goes beyond the individual employee. Researchers have identified six primary principles that assist in guiding the application of trauma-informed approaches within organizational settings.

More Changes in the Works for DOT SAPs

| By Tamara Cagney

There have been many changes in U.S. Department of Transportation (DOT) drug and alcohol testing regulations, with still more to come in 2020. Let’s take a look at regulations that have already changed, new requirements that are in the works, and possible changes to testing procedures in the near future.

features

Preventing Suicide in the Workplace: New Guidelines, Recommendations Issued

| By Jodi Frey, PhD, LCSW-C, CEAP;

Sally Spencer-Thomas, PsyD; & Amanda Mosby, MA

The authors of this article have been working to develop and issue the first National Guidelines for Workplace Suicide Prevention. The guidelines and recommendations are presented.

What EAPs Should Know About Non-Medical Home Care Services

| By Peter Tourian and Rich Paul, MSW, CEAP As the U.S. population continues to age, so will the number of caregivers in the workplace who will require support from EA professionals. This article addresses how the EAP can do just that.

departments 4 FRONT DESK 6 LEGAL LINES

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 Patt Manda at development@eapassn.org. The JEA is published only in digital format since 1st Quarter 2019. Send requests for reprints of issues published BEFORE 2019 to Debbie Mori at d.mori@eapassn.org. ©2019 by The Employee Assistance Professionals Association, Inc. Reproduction without written permission is expressly prohibited. Publication of signed articles does not constitute endorsement of personal views of authors. Editor: Mike Jacquart Development & Donor Relations: Patt Manda Designer: Laura J. Miller, Write it Right LLC

Index of Advertisers ASAP....................................................7 EAPA Plan to Attend.........................IFC

8 TECH TRENDS 16, 17, EA ROUNDUP 21, 32 26-27 EAP CONFERENCE WRAP-UP 33, 35 WEB WATCH

EAPA Best Value Package................BC Harting EAP..........................................5 KGA, Inc.............................................17 SAPlist.com .................................11, 23 IFC: Inside Front Cover BC: Back Cover

frontdesk Complex Services for an Increasingly Challenged Workforce

| By Maria Lund, LEAP, CEAP

s life becomes more challenging for the employees we serve, and as the workplace evolves and shifts, so too must our EA practice, our knowledge base, and our service array. This issue covers a number of emerging service needs and areas of requisite knowledge important to the quality and relevance of our work. In this issue’s cover story, Debbie Jongkind describes life coaching as a service worth considering for the wider employee population as a whole. While there is an overlap between counseling and coaching, the sole objective of a coach “is to help clients identify and employ their own strengths and resources to achieve …personal and professional goals.” Coaching services can be a healthy addition to our suite of EA services for our clients and for our businesses. By reading the cover story and answering a 5-item multiple choice quiz (at bit.ly/PDH_Q4JEA2019) you can earn one free PDH. Providing effective service to elders and others who may need home care or assisted care presents another area for deepening our EA practices. Authors Peter Tourian and Rich Paul explain that EA professionals need to be more familiar with the populations who might benefit from such care and with the wide range of caregiving options. In addition, EA professionals are well positioned

to provide important assistance and emotional support to employees who experience feelings of loneliness and isolation as they proceed through the caregiving experience. Death by suicide has become a global public health crisis and one that has touched most every EA professional in some way. Authors Jodi Frey, Sally Spencer-Thomas, and Amanda Mosby explain the newly introduced National Guidelines for Workplace Suicide Prevention, and present a number of key recommendations for our profession. These are key tools we can use to save lives. Elsewhere in this issue, many EAPs are challenged to assist in instances of workplace trauma –emotional difficulties that often exist beyond an individual employee. Bryan McNutt outlines the six principles for traumainformed care that EA professionals can use to effectively address implicit organizational trauma. There are also emerging complexities that come from legal and service mandates. In this issue, Tamara Cagney discusses the many changes that are occurring relative to the work of SAPs in the U.S. Department of Transportation (DOT) drug and alcohol testing regulations. In the conclusion of a two-part article, Legal Lines columnists Robin Sheridan and Heather

Mogden present important guidance about issues related to transgender support in the workplace. Finally, technology is an increasingly vital aspect of our EA practices, and Tech Trends columnist Marina London discusses the important impact that artificial intelligence is having on mental health services. As always, happy reading! v

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

Mark Attridge – Minneapolis, MN mark@attridgeconsulting.com

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

Daniel Boissonneault – Hamden, CT eap700@comcast.net

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

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

Peizhong Li – Beijing, China lipeizhong@eapchina.net

John Maynard – Boulder, CO johnbmaynard8@gmail.com

Bernie McCann – Waltham, MA mccannbag@gmail.com

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

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legallines Transgender Support (Part II) Is Gender Dysphoria a Disability Under the ADA?

| By Robin Sheridan, JD, MILR; and Heather Mogden, JD

For Starters… The first question can simply be, “How can I help you?” Request written authorization to speak with the employer on the employee’s behalf or to join the employee in such a meeting. If the employee has posed a simple fix, the employer may agree regardless of whether any accommodation is legally required. When the fix isn’t simple, or when the simple fix isn’t working, the employer will need to analyze the claimed disability and the reasonableness of available accommodations under the ADA’s requirements.

n part one of this two-part article, we explained that no court has definitively held that gender dysphoria—(GD) the diagnosis associated with transgenderism—is a disability under the Americans with Disabilities Act (ADA), but several federal courts have said it could be, which is legally significant. Moreover, the U.S. Supreme Court is slated to decide in its 2019-2020 term whether employees are currently protected from discrimination on the basis of sexual orientation and gender identity under existing bans on discrimination on the basis of sex. The point is, the social and legal trends are leaning toward recognition and resolution of unique transgender issues. Consequently, when a client suggests that workplace barriers exist due to GD, there are a number of key points EA professionals will want to keep in mind. Last time, we discussed maintaining confidentiality and the proper use of pronouns. We will briefly review the importance of using the proper pronoun, and then pick up from there.

ADA Requirements The ADA generally requires employers to provide reasonable accommodations for disabled employees. A reasonable accommodation is one: (a) that enables the employee to perform the essential functions of the job despite his or her disability; (b) that does not pose an undue hardship—phrased by some courts as a determination that the cost of the accommodation is not disproportionate to the benefit; and (c) that is consistent with any recommendations of a medical or mental health professional who examined the employee. Reasonable accommodations typically include job restructuring, part-time or modified work schedules, reassignment to a vacant position, acquisition or modification of equipment or devices, appropriate adjustment or modifications of examinations, training materials or policies, the provision of qualified readers or interpreters and other similar accommodations. In a transgender context, the most commonly requested accommodations include traditional accommodations such as:

Using the Right Pronouns A person who was born a man but identifies as a woman is called a transgender woman and goes by “she.” A person who was born a woman but identifies as a man is called a transgender man and goes by “he.” Always use the pronoun for the gender with which the employee identifies. Using the wrong gender pronoun is called misgendering, and, as one expert explained, “misgendering transgender people can be degrading, humiliating, invalidating, and mentally devastating.” Interactive training, applicable to all levels of employees and managers, can help organizations avoid issues with misgendering. EA professionals can provide critical assistance to an employer’s proactive approach in this regard, helping to build the relationship between the organization and the transgender employee.

 Allowing employees to take leave or making scheduling adjustments for medical or mental health treatment related to their disability; 6

employers will likely see more requests for transgender accommodations, and EA professionals should be poised to assist.

 More condition-specific accommodations like using particular gender pronouns;  Allowing employees to wear the uniforms of the gender with which they identify;  Allowing employees to choose the name on their name tags; and of course the more controversial accommodation of;  Allowing employees to use particular bathrooms or locker rooms. It is important to note that unisex restrooms may not be considered a sufficient accommodation.

Summary This article is educational in nature and is not intended as legal advice. Always consult your legal counsel with specific legal matters. If you have any questions or would like additional information about this topic, contact Robin Sheridan, (414) 721-0469, rsheridan@hallrender.com; or Heather Mogden, (414) 721-0457, hmogden@hallrender.com. v

Assist Clients in Interactive Accommodation Discussions As a part of its compliance with ADA, the employer generally must participate in an interactive discussion with a disabled employee to identify a possible accommodation. Providing a new name tag and uniform are simple enough accommodations, but almost everyone is familiar with the body of transgender “bathroom” cases, an issue that may soon be taken up by the United States Supreme Court. These cases routinely have made national news, sparking debate over transgender issues. While these lawsuits have typically been filed under Title VII or Title IX, many of the arguments presented need only minimal tweaking to support an ADA claim—that is, if GD is found to be a disability supporting such a claim. In light of the Massachusetts and Pennsylvania decisions finding that GD is not expressly excluded from the ADA’s definition of disability, an organization refusing to provide accommodations may be more likely to face claims under the ADA, and just as likely to face claims under Title VII, and, depending on the identity of the employer, Title IX as well. Of course, providing the accommodation isn’t entirely risk-free. The petition for review before the Supreme Court was filed by *cisgender students asserting that their school’s policy of allowing transgender students to access bathrooms and locker rooms consistent with their gender identity violated their constitutional rights of bodily privacy. (*Cisgender refers to a person who identifies as their birth gender, i.e., a male who identifies as male or a female who identifies as female.) If the Supreme Court agrees with the Third Circuit in that case and denies the cisgender students’ claims,

Editor’s note: This article addresses the question of whether gender dysphoria is a disability under the ADA. The reader should note, however, that discrimination based upon sexual identity, sexual orientation, etc. is prohibited under many states’ fair employment laws, as well as in a growing number of federal jurisdictions. Robin Sheridan and Heather Mogden are attorneys with Hall, Render, Killian, Heath & Lyman, PC, the largest health carefocused law firm in the country. Visit the Hall Render Blog at http://blogs.hallrender.com for more information on topics related to health care law.

techtrends New Uses of AI in Mental Health & Impact on EA | By Marina London, LCSW, CEAP

cience fiction is rapidly becoming reality, as new uses of artificial intelligence (AI) in mental health are being not just developed but implemented. While traditional EAPs and EA clinicians may value in-person face-to-face interactions with clients above all other interventions, advances in technology need to be closely scrutinized, perhaps even adopted, lest we get blindsided by competitors or worse yet rendered irrelevant. Earlier this year, a LinkedIn Pulse article written by futurist Bernard Marr was published with the breathless title “The Incredible Ways Artificial Intelligence Is Now Used In Mental Health”. With over 32,000 followers, Pulse is a news platform providing daily news about computer software. Marr reports on a variety of websites, apps, and entities on the cutting edge of technology.

After analyzing half a million Facebook posts from people who consented to provide their Facebook status updates and medical records, they were able to identify depression-associated language markers. What the researchers found was that linguistic markers could predict depression up to three months before the person receives a formal diagnosis. Other researchers use technology to explore the way facial expressions, enunciation of words and tone and language could indicate suicide risk. Ultimately, the scientists at WWBP hope that their insights and analyses will help individuals, organizations, and governments choose actions and policies that are not just in the best economic interest of the people or companies, but which truly improve their well-being. AI Resources In addition to researchers, there are several companies using artificial intelligence to help tackle the lack of available mental health resources:

World Well-Being Project The Pulse article introduces the work of The World Well-Being Project (WWBP), which is pioneering scientific techniques for measuring psychological wellbeing and physical health based on the analysis of language in social media. The Project is based out of the University of Pennsylvania’s Positive Psychology Center and Stony Brook University’s Human Language Analysis Lab. As a collaboration between computer scientists, psychologists, and statisticians, the project sheds new light on the psychosocial processes that affect health and happiness and explores the potential for unobtrusive well-being measures to supplement – and in part replace – expensive survey methods. Researchers from the WWBP analyzed social media with an AI algorithm to pick out linguistic cues that might predict depression. It turns out that those suffering from depression express themselves on social media in ways that those dealing with other chronic conditions do not, such as mentions of loneliness and using words such as “feelings,” “I” and “me.”

 Quartet for enterprise’s platform flags possible mental conditions and can refer patients to a provider or a computerized cognitive behavioral therapy program. They directly court corporations, promising that “we use proprietary analytics to identify people with underlying or latent mental health conditions and connect them to care.” Quartet is a medical model all the way, identifying the primary care physician as the coordinator of employee mental health needs. EAPs are never mentioned.  Ginger’s contribution is a chat application used by employers that provides direct counseling services to employees. Its algorithms analyze the words someone uses and then relies on its training from more than 2 billion behavioral data samples, 45 million chat messages, and 2 million clinical assessments to provide a recommendation. They market themselves 8

enlightened EAP. Larger EAPs may wish to partner directly with the company behind a specific app, offering a co-branded product. What apps should you consider? For the past four years, KGA, a technologically progressive EAP company, has vetted well-being apps in order to recommend its top 10 choices for EA professionals. EAPA members can access the Journal of Employee Assistance - Vol. 48 no. 4 - 4th Quarter 2018 article “Top 10 Well-Being Apps for 2018” in the JEA Archive. Another way to find a vetted app is to use PsyberGuide, a website whose goal is to provide accurate and reliable information about software designed to treat schizophrenia, bipolar disorder, depression and anxiety disorders. PsyberGuide is committed to ensuring that this information is available to all, and that it is free of preference, bias, or endorsement.

directly to employers stating, “Give your employees and their dependents around the globe an end-to-end behavioral healthcare solution that’s clinically validated to help them feel better and more productive.” EAPs are never mentioned.  CompanionMx, Inc., is a “digital health technology company with a proven platform (aka app) for proactive mobile mental health monitoring for better clinical outcomes. Born out of the Massachusetts Institute of Technology Media Lab and clinically validated at Harvard Medical School teaching hospitals and multiple Veterans Affairs clinics, the Companion™ system uses active monitoring of voice and passive monitoring of other smartphone metadata to continuously produce acoustic and behavioral biomarkers that predict core symptoms of mood and anxiety disorders.” In essence, the app allows patients being treated with depression, bipolar disorders, and other conditions to create an audio log where they can talk about how they are feeling. The AI system analyzes the recording as well as looks for changes in behavior for proactive mental health monitoring.

Summary Apps are easy. The more complex challenge is to compete with the Ginger.ios of this world. There are several effective approaches. First, educate your current and prospective client organizations about what makes employee assistance unique and more than competitive. Most of the apps and even the platforms we previously discussed before use a one-size-fits-all approach. In this scenario, CBT is the new Kool-Aid and pretty much the only approach used. EAPs, on the other hand, conduct comprehensive assessments that deliver customized counseling and/ or referrals to the treatment approach and level of care needed by the employee. EAPs follow through and follow up. They are not beholden to just one treatment modality. EAPs provide fitness for duty assessments – no one is relegating that delicate and critically important task to AI (as of yet.) EAPs provide an evaluation of the workplace factors and impact relevant to each case. Secondly, bigger players may find opportunity in partnering with some of these platforms. My perception is that few of these companies have been approached by EAPs seeking to create a hybrid approach.

 Bark is a parental control phone tracker app that monitors major messaging and social media platforms to look for signs of cyberbullying, depression, suicidal thoughts and sexting on a child’s phone. Its website trumpets: • 3.5 million children protected. • 16 school shootings prevented. • 10,000 severe self-harm situations detected.

In the face of these and other innovations, often backed by millions of dollars of VC funds, developed at the most prestigious institutions, slickly marketed to our current or potential client organizations, what’s an EAP to do? When it Comes to Apps, Don’t Wait! At this point every EAP, no matter how small, should be using apps as an adjunct to EAP intervention, or as part of assigned “homework.” There is no cost associated with referring a client to an app, many of which are free or cost the client less than $10 a month. Doing so identifies you as a technologically

Continued on page 20 9

featurearticle Principles for Addressing Implicit Organizational Trauma | By Bryan McNutt, PhD, LMFT, CEAP

esearch has revealed that organizations, like individuals, are susceptible to developing chronic stress and becoming affected by traumatic experiences at the institutional level (Bloom, 2010; Carr, 2001). Many EAPs are challenged in addressing experiences of workplace trauma, which may be diffuse and subtle, existing on a systemic level beyond the individual employee. Collective traumatic reactions may be implicit and unspoken throughout the organization. Examples of implicit organizational trauma include workplace cultures that tolerate misogynistic comments, show indifference to bullying and intimidation, excuse biases against sexual and gender identity, and minimize the adverse emotional impact caused by corporate mergers, downsizing, or environmental changes in the workplace. Implicit traumatic reactions among employees may manifest and include: increased absenteeism, attrition, decreased productivity, and excuses to avoid the workplace (e.g., requests for telecommuting); expressions of cynicism, low morale, interpersonal callousness and irritability; and common signs of burnout that include anxiety, apathy, emotional fatigue, and the desire to quit a job (Akgun, Al-Assaf, & Bakar, 2008; Kaçmaz, 2005; Lewis, 1994). In order to effectively mitigate these implicit forms of organizational trauma, it is critical to promote a workplace culture that is trauma-sensitive.

trauma-informed approaches within organizational settings (Elliot, Bjelajac, Fallot, Markoff, & Reed, 2005; Harris & Fallot, 2001; SAMSHA, 2014). While EA professionals are well-acquainted with the application of such principles on an individual level of providing clinical care, we can also provide an essential role for incorporating these approaches on an organizational level. 1. Safety This first principle emphasizes the organizational goal of promoting an environment that prioritizes the experience of feeling safe – physically, interpersonally, and environmentally. Safety is not only defined by the removal of a threat. Feeling safe often occurs when one feels genuinely acknowledged, and responded to with consistency, reassurance, and respect. When safety is present, conditions thrive for human connection, social bonding, and emotional expression. The following are questions for EA professionals to explore with the managers, supervisors, and organizational leadership of their corporate clients:  Do staff feel safe in the work organization? Why or why not? How do you know?  How are employee concerns or complaints addressed? Do these responses feel relevant and meaningful to those who have disclosed concerns?  When work environment changes are anticipated, how proactively are these matters being discussed with staff?  How does management respond to incidents of harmful workplace behavior (e.g., verbal aggression, threats, and intimidation)? How well is it communicated that such behaviors are not tolerated? How clear are the consequences of such behavior?  What changes could be made to address safety concerns?

Six Principles of a Trauma-Sensitive Workplace Trauma-informed care is based on the recognition that the experience of traumatic distress is widespread, that it may manifest in a variety of ways among individuals, families, and systems, and that interventions must be sensitive to refrain from creating the experience of re-traumatization (SAMSHA, 2014; Steele & Kuban, 2011). Researchers have identified six primary principles that assist in guiding the application of 10

Through the use of management consultations, EA professionals can encourage supervisors to ensure that their staff are wellinformed and well-rehearsed in the safety protocols and emergency plans established for the workplace, in the event that a physically threatening incident occurs. Offering emergency response training may help employees feel empowered in their sense of safety and security. EA professionals also have an opportunity to promote sensitivity to feelings of safety by being proactive in their communications, discussing safety concerns with management and staff, modeling openness in encouraging such conversations, and periodically checking in with employees to clarify their general sense of feeling emotionally and physically secure at work. 2. Trustworthiness and Transparency Openness and transparency are essential to developing a sense of trust in any relationship. These qualities are critical to mitigating the adverse effects of implicit trauma. Organizational leadership that is viewed as distrustful by employees may be interpreted as being relationally disengaged, out of touch, and secretive in its decision-making. This sense of separateness can promote a distinct feeling of an inequitable power differential, which can contribute to feelings of unfairness, suspicion, and cynicism. Critical questions for the EA professional to explore with management in relation to this principle include:

 How is trust promoted throughout the organization?  How well do staff trust leadership and management? How do you know?  How does the organization communicate genuine support for employees?  What changes could be made to address trust concerns?

EA professionals can encourage managers and supervisors to consider how their communication with employees may foster or inhibit feelings of trustworthiness. For example, EA professionals can provide guidance in communication approaches that help employees remain fully informed of rules, procedures, and schedules, in order to maintain clear expectations and mitigate chances that employees will feel isolated or marginalized. EA professionals also can coach leadership through implementing organizational changes effectively, such as being mindful that some employees may feel easily overwhelmed when they don’t have enough time or information to process and emotionally integrate the consequences of significant systemic change.

current presence and use of peer support within an organization:  Does the organization offer opportunities for peer-led support among co-workers?  What opportunities can be provided that encourage peer co-workers to share their experiences of workplace stressors and challenges?  What kinds of opportunities do staff have to explore peer-led problem solving and ideas about self-care strategies in managing work-related challenges?  What barriers exist to offering peer support in the organization?

EA professionals can use their unique position within an organization to educate management and leadership about the value of

3. Peer Support The principle of peer support is focused on enhancing a sense of mutual self-help, collaboration, and relational bonding. Within an organizational setting, common outcomes of successful peer support are increased feelings of trustworthy relationships among co-workers, reassurance of the ability to cope and adapt to workplace challenges, and the promotion of resilience. The following are further questions that may help explore the 11

featurearticle peer-led support activities, while also helping facilitate the initial steps for establishing peer support opportunities for themselves. Voluntary peer support groups have proven to be particularly helpful for workers in the helping professions, such as nurses, caregivers, and caseworkers. This is a vital point as individuals like these are especially vulnerable to experiencing emotional burnout and compassion fatigue. Such support groups provide non-judgmental outlets for co-worker engagement that focus on shared recognition of their common experience, mutual acknowledgement and validation of work-related stressors, opportunities to explore problem-solving, and the sharing of ideas about self-care strategies.

The creation of task forces and committees, for example, provide opportunities for equal representation of interests in an organization can be a meaningful process that demonstrates the valued input of everyone. Also, making changes to rigid boundaries within the workplace can also help promote a sense of mutuality, such as removing “management only” break lounges or privileged parking spaces. 5. Empowerment, Voice, and Choice One of the primary challenges in addressing implicit organizational trauma involves recognizing that individuals who already feel powerless will rarely make assertive requests for more collaborative engagement and acknowledgement. That is, unless this is modeled and encouraged by those in positions of leadership. Implicit trauma can manifest through individuals becoming gradually more disengaged, avoidant, and peripherally involved with the life of the organization. The more influence individuals genuinely experience at every level of an organization, the more likely they will feel empowered, share in the collective investment of the organization, and develop trust in the possibility of self-advocating for their needs. Essential questions for EA professionals to ask in relation to this principle include:

4. Collaboration and Mutuality This principle recognizes that everyone within an organization has a part to play in promoting collective emotional health and well-being. Implicit organizational trauma is exacerbated when individuals feel excluded and kept from participating in various aspects of an institution’s decision-making process, particularly surrounding decisions that may influence their own emotional well-being. Promoting collaboration and mutuality demonstrates an acknowledgement of the importance of fostering a sense of shared partnering and a leveling of power indifferences within an organization. This can help create a work environment where there is a shared sense of responsibility and ownership for co-creating a workplace where trust and reciprocity are valued. EA professionals can explore the following questions with organizational decision-makers:

 How well does the organization foster opportunities for everyone to feel a sense of empowerment, voice, and choice?  What might be some policies or practices that do the opposite — that take voice, choice, and decisionmaking away? What might be some steps to adjust or change these policies and practices?

 What kinds of power differentials exist within the organization?  How does the organization promote partnership opportunities between top-level administrators and line staff?  What types of changes could be made to help decrease the power differential in the organization?  How well is each level of the organization involved in decision-making? How does management know?

EA professionals can assist organizational leaders in evaluating the adverse impact of policies and workplace procedures that may inhibit the feeling of empowerment among organizational staff, while also exploring opportunities for encouraging influence. For example, maintaining a regular staff satisfaction survey that is facilitated by a contracted third party can be a critical first step to demonstrating an objective interest in the needs of employees. EA professionals can also help by facilitating a collaborative discussion between leadership and staff about the survey results, in order to help promote a sense of empowerment and shared interest in the collective well-being of the organization.

Through the use of executive coaching and management consultations, EA professionals can help organizational leaders explore opportunities to level the power differentials between themselves and staff employees. 12

6. Cultural, Historical, and Gender Issues Implicit organizational trauma can often be reinforced by overlooking the cultural biases that exist within an organization’s institutional history. In addition, individuals within an organization who belong to social minority groups may feel particularly vulnerable to experiencing traumatic distress. Critical questions that EA professionals can explore with organizational leadership regarding this principle include:

implicit trauma by nurturing a work culture that is more emotionally safe and secure, relationally responsive and consistent, and psychologically efficacious and resilient. v

 How well is diversity and inclusion of differences supported by the organization?  What types of policies and practices may overlook the diverse needs and identities of employees? How might these policies and practices be adjusted to demonstrate more sensitivity to diversity?  How well does the organization demonstrate sensitivity to gender-related physical and emotional safety concerns that include gender-specific spaces and activities?

Akgun, Al-Assaf, & Bakar (2008). Reducing Burnout among Hospital Professionals. Journal of Employee Assistance, 38(3).

Dr. Bryan McNutt, PhD, LMFT, CEAP, is a Licensed Clinical Psychologist who currently works as an internal employee assistance counselor with the Faculty and Staff Assistance Program at the University of California, San Diego. Dr. McNutt also serves as the president of the EAPA San Diego Chapter.

References

Bloom (2010). Organizational stress and trauma-informed services. In: Levin B., Becker M. (eds). A Public Health Perspective of Women’s Mental Health. Springer, New York, NY Harris, Carr (2001). Understanding emotion and emotionality in a process of change. Journal of Organizational Change Management, 14(5), 421–434. Elliot, Bjelajac, Fallot, Markoff, & Reed, (2005). Traumainformed or trauma-denied: Principles and implementation of trauma-informed services for women. Journal of Community Psychology, 33(4), 461-477.

EA professionals have an ethical responsibility to consistently maintain sensitivity to the diverse experiences, identities, and needs of individuals within the workplace. Through the influence of management consultations, EA professionals can also encourage the promotion of sensitivity to diversity through leadership decisions. For instance, the creation of an equity, diversity, and inclusion committee can be incredibly important to demonstrate that the diverse needs of employees are being considered. Changes in the work environment can also assist, such as the installation of gender-neutral restrooms, private nursing and lactation spaces, and the assurance of ADA accommodations.

Harris & Fallot (2001). Using trauma theory to design service systems. New Directions for Mental Health Services, 89. Jossey Bass. Kaçmaz (2005). Burnout Syndrome. Journal of Istanbul Faculty Medicine, 68(1): 29-32. Lewis (1994). Critical incident stress and trauma in the workplace: Recognition, response, recovery. Levittown, PA.: Accelerated Development. Steele & Kuban (2011). Advancing trauma-informed practices: Bringing trauma-informed, resilience-focused care to children, adolescents, families, schools and communities. The National Institute for Trauma and Loss in Children. Substance Abuse and Mental Health Services Administration. (2014). SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. HHS Publication No. (SMA) 14-4884. Rockville, MD: Substance Abuse and Mental Health Services Administration.

Summary The recognition of an institution’s vulnerability to developing implicit organizational trauma is critical for fostering and sustaining an emotionally healthy work environment. EA professionals can play a critical role in promoting and encouraging traumasensitive approaches within an organization through consultation with management and executive leadership, engagement with labor representatives, coaching of work supervisors, and trainings for teams on the departmental level. Such approaches may help support an organization’s sensitivity to recognizing and responding to 13

coverstory Adding Life Coaching to the EAP | By Debbie Jongkind, RD, LDN, PCC, NBC-HWC

ver the past thirty years, life coaching has developed into a respected profession, but only recently has the life coach partnered with the EA professional. Historically, working with a personal life coach was limited to top-level executives or those who could afford to privately hire a coach. Adding coaching to the array of services offered by the EAP introduced the wider employee population to the support and benefits provided by a coach. As an example, our delivery of life coaching at Workplace Options began when corporate clients started specifically requesting a life coaching component as part of their EAP. In the early days the requests were sporadic, and support was delivered by a licensed clinician on staff. Seeing a growing demand and looking to serve our customers in additional ways (and increase EAP utilization), we developed a formal coaching program, which allowed us to expand our services to support more employees. Since that time, life coaching has been provided by professional coaches, rather than counselors, and has become part of our holistic well-being approach.

also qualified to offer support with goals. Coaches, however, are not qualified to assess a client’s mental health or provide treatment. During sessions, coaches rely heavily on methods that draw upon an individual’s intrinsic motivation to change. As a result, coaching sessions are very client-driven, meaning the client is considered the expert on themselves, while the coach acts as a guide. While counselors may also have a person-centered approach to service delivery, the counselors are the experts and take the lead in planning treatment and case management. A Flexible Delivery Model At Workplace Options, we mostly deliver life coaching telephonically, with coaches sometimes using email or text messaging to share resources or offer post-session support. Our program typically follows a six-session model, but the actual number of sessions available to employees is determined by their employer as part of the EAP contract. Follow-up sessions are scheduled at intervals that best support the client and can be held weekly, biweekly, or monthly. This differs from counseling, in which sessions are typically scheduled weekly. Flexibility in follow-up sessions for coaching gives clients time to implement action steps discussed during previous sessions.

Defining Life Coaching Coaches and counselors are similar in that they both provide one-on-one support to people seeking change in their lives. They differ in the type of support they offer and the needs of the people they serve. In counseling, certified clinicians highly trained in psychotherapy use their skills to treat individuals who are struggling emotionally. Their goal is to help people feel and function better. While counselors are primarily focused on emotional health, coaches partner with individuals who are interested in reaching their maximum potential. A coach’s sole objective is to help clients identify and employ their own strengths and resources to achieve their personal and professional goals. There is overlap between the two professions, as counselors are

Life Coaching Example Yvonne* called Workplace Options to take advantage of her EAP benefit and connect with a life coach. During the first session, the coach learned that Yvonne had a very busy professional and personal life and was motivated to improve her time management skills. Yvonne articulated that she wanted to develop a plan that would help her accomplish her tasks at work and allow time for her outside responsibilities and leisure activities. She said she felt like she was always trying to play catch-up with her work projects as well as her 14

personal ones. Instead, she wanted to see herself as competent, relaxed, and ahead of the curve. Yvonne decided that she would evaluate how she spent her time over the next few weeks and bring those observations to her follow-up session. During the second session, Yvonne relayed her observations to the coach and discussed how she seemed to be more productive in the morning. Working with the coach, she brainstormed ways to rearrange her schedule to accomplish some of her more important tasks in the morning. She began experimenting with this schedule change in the weeks that followed. Knowing she would be talking with her coach kept Yvonne motivated to implement change. Subsequent follow-up sessions gave her a chance to discuss new ideas for improving her daily schedule and time to examine the obstacles that seemed to derail her best made plans. Yvonne had her sixth and final session with the coach about three months after she had started the program. She shared that she felt better about how she was spending her time; she felt more productive at work and had even started going back to the gym two nights per week, which gave her increased energy. She was also setting aside about 30 minutes each evening to reassess her day and organize her priorities. Yvonne had designed a system that was working for her during this busy phase of her life and was feeling more competent and relaxed. I reached out to our Vice President of Clinical Crisis and Specialty Services, Kennette Thigpen, PhD, MSW, LCSW-S, for perspective on how a counselor may have handled the situation differently. Dr. Thigpen explained that a counselor might have assessed if there were cognitive distortions impacting Yvonne’s feelings of wanting to feel competent, relaxed, and ahead of the curve or probe to understand if there were other risk factors or past traumas that could be playing a role. Like the coach, the counselor could have also provided support with managing schedules, ensuring to practice self-care, and setting boundaries to balance her personal and professional life. However, the counselor may have taken a more direct approach, where a coach is trained to rely on the client’s own selfdiscovery process. Offering a life coaching component as part of the EAP benefit gives employees like Yvonne the opportunity to select which approach best supports a given situation. Employees who are looking for guidance with life

changes but do not need or want counseling, can still be served by their EAP when life coaching is available. Value Within EAP In this respect, life coaching may provide a lower barrier to entry for EAP support, allowing the EAP to serve a greater percentage of employees. This could, in turn, serve as a bridge for employees to access other services provided by their EAP. For example, when a coach recognizes a client needs clinical support, the coach can facilitate the transition to a counselor. Providing life coaching also benefits EAPs by allowing counselors to operate at the top of their skill set. Utilizing coaches to help individuals work on reaching their personal and professional goals frees up clinicians to use their specialized skills and training to assist individuals who are struggling emotionally or are in a crisis. The Importance of Training Ensuring coaches are trained at the highest level was a critical factor for Workplace Options in integrating life coaching into its EAP services. While there are currently no licensing requirements for life coaching, the International Coach Federation (ICF) has set industry standards for the coaching profession. Not only did we commit to having employees trained to ICF standards, we developed our own comprehensive coach training program that is approved by both the ICF and the National Board for Health and Wellness Coaching (NBHWC). The curriculum includes an emphasis on vision-setting, goal-setting, relapse prevention, empathy, improving self-efficacy, building support, and the power of reflection. This differs from the training and continuing education that counselors are required to complete to maintain licensure, which includes human development, family systems, ethics, and counseling strategies. As part of the ethics and standards of the coaching profession, coaches are trained to remain focused on their area of expertise and notice when a client may need additional support beyond their scope, such as counseling. Because of the integrated nature of an EAP, referral to clinical support is immediate and an easy transition for the client. How Coaching, Counseling Work Together As an example, Janet* called her EAP and requested to engage in life coaching. During the initial telephonic 15

coverstory Summary For Workplace Options, life coaching has been a positive addition and a natural fit. In addition to expanding the resources we offer, it is also attracting participants who might not otherwise utilize their EAP. Most importantly, it is helping many individuals tap into their full potential. *These case studies are based on actual situations, but the names and other details have been changed or omitted to protect the anonymity of the individual receiving support. v

coaching session, Janet described herself as disorganized, talked about a desire for career change and possibly starting her own business. She also mentioned that since she was recently divorced, and in a new relationship, she was experiencing anxiety in determining how she should consider these factors in her decision-making process. Although Janet was emotionally stable and did not exhibit any risk of harm, she did bring up her relationship concerns numerous times. This prompted the coach to share with Janet that she also had a counseling benefit, which could assist her with the emotions of her recent divorce and new relationship concerns. With Janet’s permission, the coach had a counselor join in on the call. Life coaching was put on hold so Janet could fully engage in her counseling sessions, with the understanding she could return to coaching later if she was still interested in the service. In the event a coach finds a client to be in crisis, coaches are trained to follow a crisis protocol where a counselor joins the call immediately for in-themoment support.

Debbie Jongkind, RD, LDN, PCC, NBC-HWC, is Workplace Options’ Vice President of Global Coaching Services. Jongkind is a professional certified coach, a National Board-Certified Health and Wellness coach and a registered, licensed dietitian. Jongkind helped develop Workplace Options’ Live Well Wellness Global Coach Training Program, which has been recognized by both the International Coach Federation (ICF) and the National Board for Health and Wellness Coaching (NBHWC). The author may be reached at debbie.jongkind@workplaceoptions.com.

earoundup The Role of Genetics in Suicide

wide significance in the meta-analysis of suicide attempts in mood disorders, suggesting that it is picking up something that bipolar disorder and major depression have in common, perhaps depressive symptoms. The entire article can be viewed here https://bit.ly//W01OOR.

Increasing rates of suicide constitute a major threat to public health worldwide. Faced with this increasing burden of suicidal behavior, researchers have redoubled their efforts to explain risk factors and preventive strategies for suicide. Genetic contributions to suicidal behavior have long been suspected on the basis of family, twin, and adoption studies. Genome-wide association studies (GWASs), which have successfully detected numerous genetic markers for a variety of psychiatric and other common illnesses, have until now failed to find statistically significant markers for suicide. Recent results, as reported by the American Journal of Psychiatry, represent an important step forward in the genetics of suicidal behavior. In people with bipolar disorder, suicide attempts were associated in a small but significant way with a common genetic marker on chromosome 4. Although this marker does not immediately implicate any particular genes, the marker also reached genome-

EAPA Names Award Winners Each year EAPA recognizes and celebrates the achievement of members, individuals, and organizations who have distinguished themselves through their work and leadership in the EA profession. At the EAPA 2019 Conference and EXPO in St. Louis, Jim Nestor received the Lifetime Achievement Award, which honors an EAPA member who has made a significant contribution to EAPA and the EA profession over an extended period of time. Other award recipients this year include: Dirk Antonissen (Global EA Champion), First Sun EAP 16

earoundup (Excellence in Business Development), the New York City EAPA Chapter (Outstanding Chapter Award), Renu Khosla (Ross Von Wiegand Award) and the International Employee Assistance Digital Archive (Best Use of Technology in EAP), among others. The awards were presented on Thursday, Sept. 26, at the EAPA Annual Awards Reception.

physical and mental health risks in Dublin, Limerick and Sligo. More info at https://www.eapinstitute.com/

U.S. Government Wants New Suicide Prevention Hotline With 45,000 deaths by suicide in 2016 alone, according to the Centers for Disease Control and Prevention (CDC), the U.S. government wants to make the current, 10-digit hotline number – 800-273-TALK (8255) – easier to access. With the current number, callers are routed to one of 163 crisis centers, where counselors answered more 2.2 million calls last year, reports the Associated Press. A law passed last year required the Federal Communications Commission (FCC) to study assigning a three-digit number for suicide for suicide prevention, similar to 911 for emergencies. The FCC said there is “overwhelming support” for a three-digit number (988) because it would be easier for people in crisis to access help. However, the new, shorter number would likely lead to additional calls, which would mean more

Study Supports Therapy over Meds A recent study published in JAMA Psychiatry that compared various treatments for posttraumatic stress disorder (PTSD) concluded that while psychotherapy and medications are comparable in the short term, a psychotherapybased approach is superior to medication in the long term. The findings support the conclusions of many professional guidelines, which recommend psychotherapy as the primary treatment for PTSD, with medications as a secondary option. That said, the analysis was based on only 12 studies—many with a small number of participants—which highlights the need for more clinical studies of patients with PTSD. “Our results confirm the recommendations of many treatment guidelines—that psychotherapeutic treatments should be preferred as first-line treatments,” the authors wrote. “We found limited evidence to recommend pharmacological treatments as monotherapies, when sustained and long-term symptom improvement is intended.” However, the authors also cautioned that only six of the 12 included studies had long-term data, so the conclusions are somewhat constrained. Researchers pointed out that smaller-scale trials can help identify the efficacy of novel treatments when compared with a placebo. However, larger trials are needed for precision studies; in other words, determining if a patient is more likely to benefit from psychotherapy or an antidepressant.

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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.

EAP Institute Plans Seminars

800.648.9557 info@kgreer.com kgreer.com

The EAP Institute has planned a number of oneday seminars in Ireland in 2019 and 2020. “Drugs and alcohol at work: managing reasonable suspicion” will be held Thursday, Nov. 14, in Dublin. View details here https://www.eapinstitute.com/drugalcohol.php. Additional EAP Institute seminars will include a strategy for developing an integrated health and wellbeing programme, which will include workplace 17

featurearticle More Changes in the Works for DOT SAPs | By Tamara Cagney

here have been many changes in U.S. Department of Transportation (DOT) drug and alcohol testing regulations during 2018 and 2019, with still more to come in 2020. With that in mind, let’s take a look at regulations that have already changed, new requirements that are in the works, and possible changes to testing procedures in the near future.

the active ingredients are created chemically. DOT accompanied the addition of these new drugs with the direction to use the more inclusive term “opioids” rather than “opiates”. Other changes included:  The DOT added a new section reiterating that, in the DOT testing program, only urine specimens can be collected and need to be analyzed at Health and Human Services (HHS) certified laboratories.  Medical Review Officers (MROs) now have the authority to order additional testing to obtain more information on positive tests for amphetamines and for THC without consulting the DOT.  The DOT added language further emphasizing the existing DOT prohibition on the use of DNA testing on DOT drug-testing specimens.  The final rule moved the list of Substance Abuse Professional certification organizations to ODAPC’s website.  Outdated compliance dates were removed and links were updated. Readers can view the final rule on ODAPC’s website www.transportation.gov/odapc/frpubs.

Changes That Have Already Occurred It is very important when you are delivering services as a DOT Substance Abuse Professional (SAP) to keep up to date with DOT changes and proposed changes. To help SAPs remain current, they are now required to subscribe to the Office of Drug & Alcohol Policy and Compliance (ODAPC) list-serve at https://www.transportation.gov/odapc/ ListServe_Notices. Consider signing up for the FTA newsletter in addition to the ODAPC list serve to keep up to date on DOT SAP developments. The FTA newsletter can be found at https://www.transit.dot.gov/regulations-and-guidance/safety/drug-alcohol-regulationupdates-newsletters. Unauthorized use of DOT-branded items (such as logos or emblems) on an SAP’s website, publications, etc., could be a basis for the DOT to initiate a Public Interest Exclusion proceeding. In response to the opioid epidemic in 2018 the DOT added four commonly abused opioids: hydrocodone, hydromorphone, oxymorphone, and oxycodone. Some common names for these semisynthetic opioids include OxyContin®, Percodan®, Percocet®, Vicodin®, Lortab®, Norco®, Dilaudid®, and Exalgo®. The term “opiates”, which was previously used in the DOT regulations refers to naturally occurring opiates such as opium, morphine and codeine, made directly from poppy plants. An “opioid” is a substance that is synthetic or partly synthetic. This means

Testing Rates 2019 also brought an increase in random testing rates for the Federal Transit Administration (FTA). Employers were previously able to administer random tests equal to 25% of their safety-sensitive workers. When 1% of random test samples are positive for any of the DOT agencies the random testing rate is automatically increased. As a result, FTA rates increased from testing 25% of employees back up to 50% when the positive rate across the transit industry rose above 1%. It is anticipated that Federal Motor Carrier Safety Administration (FMCSA) rates may also return to 50% in 2020 due to the addition of opioids to testing panels. 18

Cannabidiols (CBDs) In December 2018, President Donald J. Trump signed into law the Agriculture Improvement Act of 2018, commonly known as the “2018 Farm Bill”. This includes legislation allowing hemp cultivation and the transfer of hemp-derived products across state lines. The legislation defines hemp as a cannabis plant that contains no more than 0.3 percent of tetrahydrocannabinol (THC), the chemical compound in cannabis associated with psychoactive effects. With the passage of this legislation, hemp-derived products, including cannabidiol (CBD), have become widely available. DOT policy has not been affected by the passage of the Agriculture Improvement Act of 2018, and all products derived from hemp or marijuana are still prohibited. While currently deemed legal in some states, all hemp and CBD products are strictly prohibited for use by DOT regulated drivers.

Requirements in the Works: The Clearinghouse The FMCSA is establishing the Commercial Driver’s License (CDL) Drug and Alcohol Clearinghouse. This new database will contain information pertaining to violations of DOTcontrolled substances and alcohol testing program for holders of CDLs. FMCSA says the rule is intended to make sure drivers who have tested positive or refused a test have completed the DOT’s SAP return-to-duty process before driving commercially again, and to make sure employers are meeting their drug and alcohol testing responsibilities. Employers will be required to query the Clearinghouse for current and prospective employees’ drug and alcohol violations before permitting those employees to operate a commercial motor vehicle. Employers will be required to annually question the Clearinghouse for each driver they employ. State Driver Licensing Agencies will also be required to consult the Clearinghouse whenever a CDL is issued, renewed, transferred, or upgraded. SAPs will be required to register for the Clearinghouse and enter data regarding assessment and compliance. They will be able to start registering sometime in fall 2019. Employers or employees will now be required to enter the SAP’s name in the Clearinghouse at the beginning of the process to allow SAPs to enter the required data. This will mean SAPs will need to change the first steps of their assessment process to make certain their name is entered. Records of drug and alcohol program violations will remain in the Clearinghouse for five years, or until the driver has completed the return-to-duty process, whichever is later. For more information on the Clearinghouse, visit https://clearinghouse.fmcsa.dot.gov/.

“It is anticipated that Federal Motor Carrier Safety Administration (FMCSA) rates may also return to 50% in 2020 due to the addition of opioids to testing panels.” Commercially-available hemp products, including CBD, have not been inspected by the FDA and therefore have not been proven to diagnose, treat, prevent, or cure any illness. Some of these products do not list all ingredients, making it impossible to know definitively how much CBD, THC, or other synthetic cannabinoids they may contain. Use, which is defined as oral ingestion, intravenous use, smoking/vaporization or any other method through which hemp-derived products may enter the body, could expose the user to THC. It is possible to test positive for THC on a urinalysis by using a CBD or hemp product. It can be impossible to determine where a CBD or hemp product was manufactured and what level of THC it may contain. Even trace amounts of THC can accumulate in the body and be detected in a urinalysis screening. This means that more safety-sensitive workers who think they are using products that do not contain any THC are testing positive and are jeopardizing their jobs if not their professions.

Possible Future Changes For the past several years DOT testing regulations have been “harmonized” to match the Health and Human Services Substance Abuse and Mental Health Services Administration (SAMHSA) language and regulations. This means it is important to keep an eye on developments in SAMHSA. Continued on page 20 19

techtrends

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Finally, if you are using technology in your EAP work, publicize it, feature it front and center in all of your marketing materials, at sales presentations, and during client company renewal meetings. v

“The Incredible Ways Artificial Intelligence Is Now Used In Mental Health”. Bernard Marr. LinkedIn Pulse. https://www.linkedin.com/ pulse/incredible-ways-artificial-intelligence-now-used-mental-bernardmarr/ May 12, 2019

Marina London is the Director of Communications 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.

Quartet for enterprise https://www.quartethealth.com/plans/

The World Well-Being Project http://wwbp.org/

Ginger https://www.ginger.io/for-employers CompanionMx, Inc. https://companionmx.com/ Bark https://www.bark.us/ “Top 10 Well-Being Apps for 2018”. Kathleen Greer. Journal of Employee Assistance - Vol. 48 no. 4 - 4th Quarter 2018. http://www.eapassn.org/JEAArch

References and Resources

June 26, 2019. Web Secret 578: New uses of AI in mental health. iWebU. info blog post. http://www.iwebu.info/2019/06/web-secret-578-newuses-of-ai-in-mental.html

featurearticle

August 9, 2017. Web Secret 479: PsyberGuide. iWebU.info http://www.iwebu.info/2017/08/web-secret-479-psyberguide.html

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Currently SAMHSA is completing a final oral fluid drug testing rule that we could see published to the Federal Register in early 2020. SAMSHA is also working on a hair testing rule. DOT will need to publish their own rule-making documents if it follows suit. SAMSHA is also considering adding fentanyl to the drug testing panel. The US Navy has already added fentanyl and norfentanyl to their testing panel. New Jersey has introduced a state bill to test drivers for methadone. Although methadone is a DOT disqualifying medication, it is not currently tested for in the DOT testing panel. HR. 2285 would require the Department of Health and Human Services to add methadone to the Mandatory Guidelines for Federal Workplace Drug Testing programs. It would also require DOT to include methadone in its drug testing. In other developing issues Tennessee’s Workers Compensation Act now requires MROs to reject any prescription that was issued more than six months before the drug test. The Army also has a 6-month cutoff for prescriptions to be considered a legitimate reason for a positive test. DOT has not yet issued similar guidance.

New research from Johns Hopkins found that those that vaped cannabis reached higher and faster blood THC concentrations. Under current DOT cutoff levels of 50ng/ml screening and 15 ng/ml confirmation those that vaped had more positive urine tests with higher concentrations for longer periods of time. Summary Remember that part of your role as a DOT SAP is to keep abreast of changes and proposed rulemaking. Feel free to comment whenever DOT is seeking input. Feedback from SAPs is highly valued by DOT. v Dr. Tamara Cagney is the immediate past president of EAPA. She has provided Employee Assistance Program (EAP) services for over 40 years in both the public and private sectors, in unionized and non-unionized settings. She is currently a distinguished member of the staff at Sandia National Laboratories where she provides internal EAP services. She also provides clinical consultation to the Northern California Teamsters’ Assistance Program. Tamara is the chief EAPA trainer for EAPA’s two-day trainings for DOT substance abuse professionals (SAPs) focused on assessment, level of care, and follow-up testing determinations and return-to-work issues for DOT-regulated employees. For more information, contact Tamara at tcagney@sandia.gov..

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expenses for crisis centers. For instance, if the number of calls to the hotline doubled, centers would require an additional $50 million annually to handle the increase, the FCC said, citing the federal agency that funds the hotline, the Substance Abuse and Mental Health Services Administration (SAMHSA).

But for many, working into their late sixties and seventies is a financial necessity, reports Provision Living. Learn more at https://bit.ly/2nuNqi3

Workplace Surveillance: How Much is Too Much? Workplace surveillance is becoming more and more commonplace, it is now not unusual for firms to record staff telephone calls, monitor emails, log the addresses of websites visited and record activity on CCTV, reports HR Director. “Despite it being around for a while, we have noticed an increased use of email, Internet and telephone monitoring,” said Vanessa Bell, Head of Employment with Prettys. “More employers are also taking it upon themselves to check in on employees’ social media platforms and regularly monitor the posts being uploaded.” Some businesses take employee surveillance even further to check on staff efficiency and effectiveness but, Bell explained, “In some cases this can do more harm than good. There have been examples of some employers using software to monitor the whereabouts of staff in the office and even look at how long people spend in break-out rooms. “For me, this is a step too far and, rather than improve productivity, this may well have a negative effect, with staff conscious about their movements being tracked.” Bell added: “Employment law cases that deal with monitoring will always consider whether the employee has a reasonable expectation of privacy in relation to the communication in question and if so, was the employer’s interference with that privacy proportionate.”

A Global Look at Therapy Across the globe people are turning to mental health services like therapy in order to tackle issues of daily life such as depression, anxiety, and relationship dynamics. But what does therapy look like in the United Kingdom? France? Mexico? Brazil? Canada? China? And what does it cost in each of these countries (and others)? The following is a brief summary: Sarah Floyd with No Panic Sheffield, a U.K. charity that provides mental health assistance to those with anxiety disorders, says therapy is definitely more acceptable. “In fact, I’d almost be inclined to say it’s starting to become fashionable, just like having a personal trainer became fashionable eight to 10 years ago. Now it’s all about having some kind of therapist,” she said. Therapy in Canada is widely accepted, especially in larger cities. “Due to everyone having provincial health insurance, people are much more open and accepting of private pay therapy as it is one of the few things that they do have to pay for,” said Andrew Sofin, president of the Canadian Association for Marriage and Family Therapy, who offers psychotherapy for couples in Montreal. Therapy wasn’t really acknowledged in China until a couple of decades ago, said Steven Vinay Gunther, a practicing psychotherapist in Shanghai. It’s grown in popularity in the last 15 years or so, especially through psychological workshops. The complete article can be found at https://bit.ly/2kqezRW

Do Diagnoses Offer Scientific Value? A study that examined key contents of a classic mental health handbook has questioned whether psychiatric diagnoses that identify distinct conditions offers any scientific value. A Psychiatry Research paper describes how researchers found many inconsistencies and contradictions in the Diagnostic and Statistical Manual of Mental Disorders, which is now in its fifth edition (DSM-5). Researchers from the UK-based University of Liverpool and the University of East London examined the “heterogeneous nature of categories” in the DSM-5.

Seniors Worry About ‘Ageism’ A survey of 1,000 working seniors revealed many fear the consequences of aging in the workplace. One in three says they’ve experienced “ageism,” and an additional 36% are concerned about being laid off because of their age. For nearly half (44%) of working seniors, mental or physical limitations have prevented them from completing professional tasks.

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featurearticle Preventing Suicide in the Workplace | By Jodi Frey, PhD, LCSW-C, CEAP; Sally Spencer-Thomas, PsyD; & Amanda Mosby, MA

New Guidelines, Recommendations Issued

Cultivating a Caring Culture One of the key strategies from the guidelines is for managers to “cultivate a caring culture focused on community well-being.” EAPs, especially programs that are strategically positioned within work organizations to have the ears of upper managers, are in a prime position to partner with work leaders to influence development of policies and communication messages that demonstrate care and concern, while also providing access to support services. As an example, the “Intensive Care Unit” (ICU) program initiated by DuPont’s EAP was successful in helping workplace leaders communicate messages designed to reduce stigma about mental health and foster a culture that supports emotional health and well-being. ICU is now available to the public at no cost through the American Psychiatric Association’s Center for Workplace Mental Health. The program includes a 5-minute video designed to be shared with all employees, in addition to a written guide for leaders with sample emails and other communications designed to reduce stigma about mental health problems and encourage help-seeking behavior among employees. The program also provides surveys that EAPs or other workplace leaders can disseminate to evaluate changes over time within the work organization once ICU has been implemented.

ith over 47,000 suicide deaths in the U.S. last year, suicide has become a major public health crisis. This deadly trend has significant implications for the workplace and EAPs as pressure mounts on employee assistance (EA) and other behavioral health professionals to take a more active role in suicide prevention. Incorporating Suicide Prevention Strategies in the Workplace As EA professionals, we are in prime positions to help workplace leaders develop strategies to prevent suicide, while also working one-on-one with employees to help them through a potential suicide crisis. The authors of this article have been working to develop and issue the first “National Guidelines for Workplace Suicide Prevention”, which were released during September 2019 – Suicide Prevention Month. The guidelines are supported by three leading suicide prevention organizations including the American Foundation for Suicide Prevention, the United Suicide Survivors International and the American Association of Suicidology. They are research based, incorporating recommendations and feedback from hundreds of stakeholders, including many leading EAPs and professional organizations like the Employee Assistance Professionals Association (EAPA). They also outline actionable steps that EAPs and workplaces can take to improve suicide prevention programming in their work organization and/or professional organization. As a first step, the authors encourage EAPs to work with workplace leaders to publicly take the pledge to make suicide prevention a health and safety priority. Click here to read how to take the pledge.

Expanding Guidelines The new workplace suicide prevention guidelines recommend employee screening as part of the overarching self-care orientation guideline. EAPs have long been involved in employee screening at the workplace. Many offer free depression screenings to reduce stigma and connect with employees who might otherwise be suffering in silence and isolation. 22

One suggestion in the guidelines is to add questions about suicide risk to depression screening. For example, using the PHQ-9 (Kroenke, Spitzer, & Williams, 2001) provides EA professionals with a specific question, the 9th item of the screen, that asks, “Over the last 2 weeks, how often have you been bothered by thoughts that you would be better off dead, or of hurting yourself?” In another example, recent research on suicide prevention with working-aged men demonstrated an effective method for EAPs to integrate online depression screening for the workplace with a more detailed online suicide screen, such as the ColumbiaSuicide Severity Rating Scale or C-SSRS (Posner et al., 2011). This project, “Healthy Men Michigan,” which is run by the second author of this article, showed that online anonymous screening for depression and suicide were effective methods for reaching out to working-aged adults at risk for suicide. The online program not only provided immediate feedback to individuals who took the screening, but connected them to critical resources, including but not limited to their EAP. To learn more about this integration of depression and suicide risk screening only, please contact Dr. Frey directly. ISPs: Promoting Self-Assessment Another example of how EAPs can promote self-assessment is through a relatively new program called the Interactive Screening Program or ISP. The ISP is an online and anonymous assessment program that helps to reduce stigma about suicide and mental

health, while providing increased access to anonymous screening, professional support and referral through the EAP. The ISP is based on a number of suicide theory and evidencebased intervention principles, including identifying and addressing an individual’s personal barriers to treatment. It was recently adapted for use in the workplace. The ISP incorporates questions from the PHQ-9, mentioned above and other evidence-based screening questions available upon request, which asks about suicidal ideation and attempts; problems related to depression such as anger and anxiety; alcohol and drug abuse, and eating disorder symptoms. The ISP is designed to connect employees with EAPs to encourage additional help-seeking through their existing workplace and community-based services. Finally, EAPs can decrease stigma about mental health and support services by including suicide specific resources such as promoting the National Suicide Prevention Lifeline (1-800273-8255) or crisis text line for employees who would prefer to text a counselor rather than talk (Text HOME to 741741). These should be posted on EAP websites and other communications offering employees 24-hour support, in addition to the EAP, whenever they might need to talk with someone.

do not receive formal training in comprehensive suicide risk assessments and response. A number of available skills trainings can improve this situation. Training focused on evidence-based counseling practices like restriction of access to lethal means (e.g., Counseling on Access to Lethal Means or CALM), emotional regulation skills (e.g., Dialectical Behavioral Therapy or DBT), collaborative safety agreements (e.g., Collaborative Assessment & Management of Suicidology or CAMS and Suicide Safety Planning), and follow-up contacts are great examples of continuing education that EAPs should be encouraging and even requiring of their counselors.

More Training Needed EA providers need to be adequately trained to effectively assess and respond to suicide risk. Unfortunately, the majority of clinicians in the U.S., and elsewhere, 23

featurearticle It is a complex intervention that requires specialized training, but it is one of the few talk-therapies that has been shown to have significant impact on preventing future suicide behaviors.

 CALM is an online and free evidence-based training that provides mental health professionals with skills-based learning on how to assess access to firearms and to work with clients and families to provide counseling to reduce access, especially when suicide risk is high.

 CAMS is an approach that also has strong empirical support to help reduce suicide risk. While there are trainings that one can take to learn key components, CAMS is a broader framework that focuses on developing a therapeutic relationship in which the clinician engages the client in a “highly intervention assessment process” and involves the client in all aspects of safety planning and treatment.

 DBT is a popular and well-researched clinical intervention that is based on cognitive behavioral therapy, which is used successfully in EAPs. DBT blends behavioral problem-solving with acceptance-based strategies to help clients enhance their efficacy and ability to regulate emotions and come to acceptance.

EAP Case Study on Suicide Ideation, Risk

t was not long into her EAP job that Jane Doe received a positive response to Question 9 on the Patient Health Questionnaire (Kroenke et al., 2001) that asks about suicide ideation. A positive response to this item signaled to Jane that she needed to conduct a more thorough suicide assessment. While trained to use the Columbia-Suicide Severity Rating Scale (C-SSRS; Posner et al., 2011), she had recently attended a training at the American Association of Suicidology where she saw Dr. David Jobes present the CAMS approach to suicide assessment and clinical work (approach is briefly described in the main article, under the heading More Training Needed). During this presentation, Dr. Jobes focused on the use of collaboration to elicit information through conversations about suicide risk and to work in partnership with a client at risk on a suicide safety plan. One of the main things she remembered about the collaborative approach was to balance how she asked questions from the assessment form with more openended questions, using skills such as active listening and empathic probing.

question before” and from that point forward, the “assessment” was more relaxed for both the client and for Jane, and the client talked more openly about his suicide intensity and other risks. Jane then worked collaboratively with her client to identify what he would do in the next 24 and 48 hours should his thoughts of suicide return. Their collaborative safety plan included building a hope box (e.g., physical reminders of reasons for living), creating a list of people to call, practicing coping and distracting tactics, and reaching out to crisis resources like the 24/7 National Suicide Prevention Lifeline (1-800-273-8255). Follow Up is Crucial While follow up has historically been one of the key components of EA practice, pressure to do more with less has unfortunately led many EAPs to forego active follow-up with clients. When it comes to responding to suicide risk, follow-up is even more critical after a clinical emergency and is actually one of the most effective clinical interventions that we have to prevent suicide (Motto & Bostrom, 2001; Carter, Clover, Whyte, Dawson, & D’Este, 2005). As an EA professional, Jane made sure to follow up a few days after this appointment to make sure her referrals and safety net for her client were in place and that he continued to use his suicide safety plan to manage suicide ideation and ongoing risk. v

Therefore, while she prepared to ask the client questions from the C-SSRS, she first asked, “Please tell me about where you hurt and what hurts.” The client responded, “No one has ever asked me that 24

This approach might be better suited for EAPs that have a more robust session model; however, many of the techniques included in the CAMS approach can be adapted to short-term EA models such as integration of motivational interviewing, suicide safety planning and suicide teachable moment brief interventions.

training to help individuals feel more comfortable asking questions about suicide risk and practicing listening for other risk factors that might signal a need for a formal referral for assessment and possible treatment. QPR offers a variety of training options - at the individual, organizational and professional levels which can also be completed online, a popular option for busy workplaces. SafeTALK is a four-hour in person workshop where participants learn to recognize the signs of suicide, engage someone in crisis, and connect them to an intervention resource for more support. Working Minds is designed to help workplace administrators and employees better understand and prevent suicide with two- and eight-hour training options. These programs, which can be taught to professionals and peers alike, help to further support the idea that “Suicide Prevention is Everyone’s Business!” (quote from American Association of Suicidology)

Suicide-specific Trainings Additionally, more general skills-based suicide-specific trainings that offer one- or two-day skills based training in suicide assessment and response include Recognizing and Responding to Suicide Risk, offered by the American Association of Suicidology, and Assessing and Managing Suicide Risk, offered by the Suicide Prevention Resource Center. Both of these trainings provide mental health professionals with an introduction to assessing acute warning signs of suicide, chronic risk factors and protective factors, while teaching methods to conduct a comprehensive suicide assessment and risk formulation and working with the client to develop a suicide safety plan. These essential skills are paramount to EA professionals whose direct practice work focuses primarily on early intervention with assessment and referral, coupled with short-term counseling. For clients struggling with suicide, a referral outside of the EAP would be essential to provide the employee with additional support; however, the EAP can and should have a role in supporting that employee to create an initial suicide safety plan until additional help is available, and working to support the employee, and the manager when appropriate, to work through the suicide crisis and transition back to work.

All three of these programs focus on:  Training employees to feel more comfortable asking questions directly about suicide risk;  Reducing stigma about suicide help-seeking, improving awareness of referral resources, like the EAP and National Suicide Prevention Lifeline, and  Teaching when to call outside resources, including emergency services such as 911 for additional support. Suicide Postvention When a death by suicide occurs at the workplace or involves an employee who dies offsite, it is critical that employers respond in an empathic and caring manner. To accomplish this, we recommend that EAPs reach out to workplace leaders following a suicide death to offer support to help ensure safety and a quick return to regular operations. Following a workplace crisis such as an employee suicide, EA professionals are often asked to partner with leaders in human resources to review and revise policies and programs that support surviving family members and grieving coworkers. The “Manager’s Guide to Suicide Postvention in the Workplace” is available at no cost and has been evaluated and used by EAPs and HR managers with diverse work organizations, earning positive feedback.

Gatekeeper Trainings Furthermore, EA professionals can offer brief suicide prevention gatekeeper training to employees at all levels of the work or professional organization. Gatekeeper trainings are akin to teaching CPR to provide life saving techniques in healthcare. Programs such as QPR (Question, Persuade & Refer), safeTALK, and Working Minds do a great job preparing lay people to feel more comfortable asking about suicide and referring another person to a resource for additional assessment and support. Specifics about each program are discussed briefly below, but they all incorporate role-playing into their

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eapa2019conference&expo EAPA 2019: St. Louis Conference Wrap-up Editor’s note: This article describes some of the key sessions from the 2019 EAP Conference. Did you miss sessions you wanted to see? Or perhaps you were unable to attend the conference? The Conference Recordings Unlimited Viewing Pack provides one year of unlimited access to the 2018 & 2019 conference sessions. All sessions count toward CEAP certification and recertification. Look for an announcement about the availability of the package on the EAPA website. WEDNESDAY, September 25 – Mary Bartram, Ph.D., RSW and Alain Contant, Director of EAP, Health Canada gave an interesting presentation on “GenderBased Analysis to Employee Assistance Programs: A Canadian Jim Nestor receiving the 2019 Lifetime Achievemnt Perspective”. In an afternoon EAP Award from President Libby Timmons Talk, Marina London, LCSW, CEAP gave a thought provoking and entertaining presentation “Upgrade or Die?” about the imperatives of staying ahead of the technology curve while maintaining the relevance of employee assistance. EAPA President Libby Timmons declares the 2019 EAP THURSDAY, September 26 – Psychological Safety and Team Dynamics: A Great Conference open Frontier for EAP delivered by Dave Nix, LPC, CEAP was one of the very best sessions given at the conference. Many participants hoped that Nix would eventually deliver an all-day pre-conference training on this important topic. The EAPA Annual Awards reception celebrated the achievements of Jim Nestor (Lifetime Achievement Award), the New York City Chapter (outstanding chapter), and PsyBar (EAPA Sponsor/ Advertiser Exhibitor Award) among others. (Editor’s note: See list in Roundup section on pages 16-17.) Attendees flock to register. 26 | JOURNAL OF EMPLOYEE ASSISTANCE | 4th Quarter 2019 | •• • • • • • • • • • • • • • • • • • • • | W W W . E A PA S S N . O R G |

FRIDAY, September 27 – There were two panel-based presentations on cybersecurity: Have You Been Hacked Yet? with James Harting, LCSW, CEAP; Brian Moran, Founding Partner, Brimor Labs; and Maria Lund, MA, LPC, CEAP immediately followed by Cybersecurity for EAPs given by Harting, LCSW, CEAP; Diana Wicker, MSW; Moran, Founding Partner, Brimor Labs; and Lund, MA, LPC, CEAP. Wicker is First Sun EAP’s chief technology officer, an interesting role for a social worker. Attendees from all over the US and the world

The closing event was a luncheon followed by a presentation of a one-woman show “Drunk with Hope” presented by Tara Handron, MA, Regional Vice President, Caron Treatment Centers. Before her involvement with treatment facilities, Handron was a professional performer, having acted with Second City. Her play is a moving tribute to the struggles of women in early recovery. v All photos courtesy of EAPA. Attendees visited the EXPO to network and speak with over 90 exhibitors

The EAPA 2020 EAP Conference & EXPO will be held in Houston, Texas, on the following dates: Main Conference Dates: Oct. 27 – Oct. 29 Pre-Conference Training Courses: Oct. 25 - Oct. 26 Enjoying a light-hearted moment during a breakout session

featurearticle What EAPs Should Know About Non-Medical Home Care Services

| By Peter Tourian and Rich Paul, MSW, CEAP

any EA professionals rely on geriatric care managers and individuals in the work/life field when making referrals for home care services. However it is helpful for them to understand the basic characteristics of quality home care agencies and the impact these services can have on an employee’s emotional well-being. In addition, as the population continues to age, so will the number of caregivers in the workplace require resource and referral support from EA professionals.

 Home health care – medical care services, like skilled nursing care, physical therapy, occupational therapy, and speech therapy, provided in the home  Assisted living – residential facility and limited care for those who need some assistance with daily activities but do not require care in a nursing home  Nursing home – residential facility and a high level of long-term personal or nursing care for persons (such as the aged or the chronically ill) who are unable to care for themselves properly.

Impact of Caregiving on the Workplace More than 40 percent of the workforce are caregivers struggling with work and family demands. The financial and human toll are significant: Sixty-nine percent of employees who care for a family member or friend report having to rearrange their work schedule, decrease their hours, or take unpaid leave to meet their caregiving responsibilities (Feinberg, Reinhard, Houser, & Choula, 2011). Research studies have demonstrated the negative impact caregiving has on career advancement, earnings, job retention, and physical and emotional well-being. (National Alliance for Caregiving and AARP, 2009). Due to increased recognition of the financial and emotional strain of caregiving, employers are acknowledging that home care assistance should be part of their benefit strategies to attract and retain talent. The aging U.S. population will only compound these challenges.

If the employee’s relative does not need medical care and prefers to remain at home, then home care is the best solution because it addresses not only physical and emotional needs but also helps manage social isolation. The emotional aspect of care is crucial on numerous fronts. Elderly individuals who report feelings of loneliness tend to attribute their mental state to illness, loss of spouse, and lack of friends. Poor health and functional status are also associated with greater feelings of loneliness. Home care offers companionship for isolated individuals. Due to the stress involved in juggling their own work and home schedules to care for aging parents, employee caregivers also need emotional support – assistance the EAP can help provide. Understanding home care is key, as EA professionals are ideally positioned to serve as a conduit to these often-needed but frequently misunderstood services. Many health plans are increasingly using nonmedical home care as part of the post-acute care continuum to alleviate cost pressures and prevent relapse or re-hospitalization. A Premier study found that about 30% of emergency room visits by patients with chronic illnesses probably could have been prevented and handled in a less costly outpatient setting, and those unneeded ER

Reviewing Care Options When an employee contacts the EAP or Work/Life program for assistance with caregiving, the EA professional needs to consider the range of caregiving options:  Home care – non-medical support in the home for activities of daily living 28

visits amounted to $8.3 billion in additional spending. (Modern Healthcare, 2019). While home care has been reimbursable by Medicaid for some time, it only recently became a covered benefit under many Medicare B plans.

shorter hospital stays. Individuals are sent home the same day or after a very short hospital stay. They too are candidates for home care. For the working caregiver it can be overwhelming to determine the right level of care and provider for their loved one. If the preference of the older adult is to age at home then the first question is determining whether or not medical assistance is required. AARP offers a caregiver helpline at 1-877-333-5885, where they provide guidance and advice on a caller’s caregiver needs. The EAP is often the first point of contact for an employee seeking emotional support as well as care referrals for a loved one. In a case like this, once an assessment indicates that no medical support is needed and the client prefers to remain at home, home care services are probably indicated. The employee should be given a list of factors to consider when reviewing the home care services of a specific vendor. This point is crucial, because an EA clinician should be required to give a list of home care providers, never a single provider.

What is Home Care? EA professionals and laypersons sometimes confuse home care, home health care, assisted living, and other similar support services, but the differences are significant. Home care is considered non-medical support that allows individuals to maintain independence and remain in their home. Home care provides assistance with daily living tasks without the need to move the person to a senior care facility. Home care can:  Support Activities of Daily Living (ADL) such as eating, bathing, getting dressed and transferring.

“Due to the stress involved in juggling their own work and home schedules to care for aging parents, employee caregivers also need emotional support – assistance the EAP can help provide.”

1. Are the caregivers employees of the home care provider or are they contractors? When possible we recommend that EAPs refer to an agency that employs its caregivers. When caregivers are employees of an agency, each home care office location must be guided by state and local licensure and certification requirements. In addition, the home care provider assumes the burdens and responsibilities of being the human resource, quality assurance, scheduling (including back-up planning) and education department for every caregiver. In contrast, families who use private caregivers or organizations that offer contracted caregivers must be aware of the hidden costs of being the employer of record. They become responsible for hiring, managing and paying caregivers. They also will take on the complicated aspects of payroll taxes, Workers’ Compensation, and other liability requirements. A critical function of the home care provider is to ensure that an optimal match is made between a caregiver and care recipient. This process ensures the selected caregiver has the professional skill level to meet the client’s physical and emotional needs. All of these aspects of quality home care become more

 Support Instrumental Activities of Daily Living (IADL) such as cleaning and maintaining the house, traveling within the community, preparing meals, and medication reminders.  Provide post-hospitalization care including scheduling and attending follow-up visits, medication monitoring, and ADL/IADL support.  Offer emotional support through companionship that addresses issues of loneliness and isolation.

Home Care for More than the Elderly While 70 percent of individuals 65 and older will likely benefit from home care assistance at some point, these services benefit more than the aging population. Increasingly, home care services are being provided to wounded warriors and Veterans requiring assistance at home, individuals on disability leave and mothers requiring pre- and postnatal support due to a complex pregnancy. In addition, the increase in same day surgeries and other advances in medical care have resulted in much 29

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challenging when the caregiver is a contractor versus an employee of the home care organization.

Most often, individuals considering home care say: 1) “I want to live independently” and 2) “I don’t want a stranger in my home.” Few things are as personal and vital to each of us as our independence and the security we feel in our home. This underscores the value of high-quality home care services. Everyone deserves a caregiver they can trust and feel a connection to who will provide the best level of care.

2. What background checks and screenings are conducted on caregivers? EA professionals and the employee need for home care providers to attest that their caregivers: • Undergo a national and state background check; • Meet driver eligibility guidelines before being assigned to a client who requires transportation services; and • Have acceptable references and work authorizations.

Summary Because caregiving itself can lead to greater feelings of loneliness and isolation, employees also need emotional support. Caregivers consistently describe the isolation of the caregiver’s role as one of the most stressful aspects of caregiving. They consistently report higher levels of stress than noncaregivers, and chronic stress is associated with poorer health outcomes and higher rates of mortality (Springer, 2018). As such, any working caregiver contacting the EAP should be told of the full scope of EAP services that may not only assist their loved one but themselves as well. All too often working caregivers minimize the impact that caregiving has on them emotionally and physically. v

3. What ongoing supervision, training and support are provided to caregivers? Quality home care providers should require newhire training for all caregivers, regardless of experience. This should include experiential learning to ensure they are familiar with any medical equipment needed in a client’s home. In addition, ongoing supervision and performance evaluations should be a prominent part of a home care organization’s policies and guidelines. 4. How does the home care provider encourage and support communication and updates between caregivers, the client and their family members?

Peter Tourian is the founder and CEO of SYNERGY HomeCare. Tourian has been a pioneer in the home care industry for the past 20 years, introducing transformational practices that continue to grow SYNERGY HomeCare’s business, already one of America’s largest home care companies.

Technology plays a critical role in all our lives and the same is true in the home care industry. Through a technology platform, family members or responsible parties can learn more about each caregiver providing care in the home, read care notes and see all scheduling activities. They can use these applications as their communication hub. In addition, caregivers can record all changes they observe so that family and other health care professionals are kept up to date. Some home care providers also leverage technology that allows their office to know exactly when a caregiver arrives and leaves a client’s home. This regular communication provides peace of mind to families.

Rich Paul, MSW, CEAP, is Chief Partnership Officer for SYNERGY HomeCare, responsible for business development and strategic partnerships. Prior to joining SYNERGY he worked for 25 years in the employee assistance field, consulting with employers on solutions to improve employee well-being, resiliency, work/ life balance and engagement. Rich may be contacted at richpaul@ synergyhomecare.com

References

Castellucci, M. (2019). Unnecessary ED Visits from Chronically Ill Patients Cost $8.3 Billion. Modern Healthcare. Feinberg, L., Reinhard, S., Houser, A., Choula, R. (2011) Valuing the invaluable: 2011 update–The growing contributions and costs of family caregiving in 2009. AARP Public Policy Institute.

5. The employee should expect the home care agency will conduct a comprehensive home assessment with the client and develop a customized care plan.

Springer, C. (Spring 2018) Health effects of social isolation and loneliness. Journal of Aging Life Care.

featurearticle Strategies for Reducing Stress when Work and Caregiving Clash | By Jennifer L. FitzPatrick, MSW, LCSW-C, CSP

mployee assistance professionals are all too familiar with the dilemmas many people are facing as incredibly busy, often highly stressed employee caregivers. As a result, the EAP should consider sharing the following strategies with employees who are also busy with caregiving responsibilities.

about FMLA options in order to plan a coordinated effort to offer the best possible caregiving an older loved one.  Take planned breaks away from caregiving and work. Many employee caregivers report that all of their personal time off is allocated toward taking care of their loved ones. Work with the employee to figure out a way how he/ she can integrate some kind of break into his or her life. Can the busy worker commit to a weekly yoga class? Can he/she meet a friend for lunch on a monthly basis? What about devoting at least 15 minutes each day to take a relaxing bath or read a magazine?

 Make sure the employee’s managers’ and colleagues understand that he/she is also busy caregiving. While an employee doesn’t need to share every painstaking detail with a boss, it is important that he/she knows you are a caregiver and understands a little about what that involves. Often, working caregivers are reluctant to share these details, much the way some working mothers are reluctant to discuss childcare issues because they don’t want their boss to doubt their commitment to the job. In reality, however, many employers are willing to make special arrangements to retain you based on your individual needs — especially if you are a top performer at your job. As an employee assistance professional, you have likely given this advice to your clients but, if applicable to your own situation, it’s important for you to follow it yourself!

Summary As an employee assistance professional, you have likely supported countless clients facing circumstances like these. However, don’t forget that if you are also coping with an elderly parent or other loved one, always strive to treat yourself with the same empathy and compassion that you would offer a struggling client. v Jennifer L. FitzPatrick, MSW, LCSW-C, CSP, is the author of “Cruising through Caregiving: Reducing the Stress of Caring for Your Loved On” and a gerontology instructor at Johns Hopkins University. Her company, Jenerations Health Education, helps reduce stress while boosting productivity, morale, and revenue through generational awareness. She can be reached by going to www.jenniferfitzpatrick.com or on twitter @fitzpatrickjen or her book is at https://cruisingthroughcaregiving.com/

 The employee may wish to think about taking advantage of the FMLA. How could the Family Medical Leave Act (FMLA) be best utilized for a given situation? When would be a good time to take it? Should it be taken all at once or in shorter increments? The employee caregiver should talk to his/her caregiving crew

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“Although diagnostic labels create the illusion of an explanation,” says lead author Dr. Kate Allsopp at the University of Liverpool, “they are scientifically meaningless and can create stigma and prejudice.” An important finding was that, while no two psychiatric diagnoses use the same decision-making rules, there is a great deal of overlap of symptoms between them. The researchers also observed that diagnoses don’t say much about the individual and which treatment could be most helpful. Furthermore, they found that nearly all diagnoses underplay the impact of trauma and distressing events.

managerial respondents rated their team’s burnout as an eight or higher. For workers, the average burnout level was five, but more than a quarter of respondents rated their burnout as falling between eight and 10.

Read Cover Story, Earn One Free PDH! EAPA will offer a free PDH for reading the cover story of each issue of the JEA and answering a 5-item multiple choice quiz. Read Adding Life Coaching to the EAP by Debbie Jongkind in this issue and answer the multiple choice questions here (URL is case sensitive): bit.ly/PDH_Q4JEA2019. Instructions are provided at the end of the quiz on how to get your free PDH.

It’s not Just Cannabis Use; Vaping on the Rise

Recovering from Identity Theft

The number of confirmed or suspected severe lung illnesses linked to vaping has now climbed to 805 cases across 46 U.S. states and the Virgin Islands, HealthDay News reported recently. There have also been 12 confirmed deaths in 10 states: California (two cases), Florida, Georgia, Illinois, Indiana, Kansas (two cases), Minnesota, Missouri, Mississippi, and Oregon, officials added. “Although the investigation continues, no consistent e-cigarette or vaping product, substance, additive or brand has been identified in all cases, nor has any one product or substance been conclusively linked to lung injury in patients,” said Dr. Anne Schuchat, principal deputy director of the U.S. Centers for Disease Control and Prevention. The investigation has been hampered by the fact that there are so many different vaping products on the market being used in many different ways, officials explained. There’s also the possibility that some people have been sickened by exposure to more than one type of product, according to Schuchat. Read more here https://bit.ly/2ogXDyQ.

While any interruption to an employee’s work day about his or her financial matters can be unsettling, due to its highly personal nature perhaps none is more disturbing than identity theft. And yet, identity theft is not unusual. Each year, over 8 million people have their lives turned upside down due to identity theft. Why is identity theft such a big deal? Consumer. gov states that, “You will be responsible for what the thief does while using your personal information. You might have to pay for what the thief buys. This is true even if you do not know about the bills.” Think identity theft can’t happen to you or a loved one? Think again! According to identityforce.com:  In 2017, 6.64 percent of consumers became victims of identity fraud — that’s about 1 in 15 people.  One in five victims of identity theft have experienced it more than once.  Over 1 million children in the U.S. were victims of identity theft in 2017, costing families $540 million in out-of-pocket expenses.  Of particular note to the EAP, emotional distress is reported by 77.3 percent of identity theft victims.

Just What Causes Burnout? A new survey from Accountemps showed that 96% of all senior managers believe their teams experience various degrees of burnout. But according to Accountemps, the two groups disagreed on the causes of burnout. Employees ranked constant interruptions as the top cause, while senior managers said unmanageable workloads were the primary issue. The survey also found that, on a scale of one to 10, with 10 being the highest level of burnout, 1 in 5

In other words, if your chances of winning the lottery were 1 in 15, like the odds of being an ID theft victim, we’d all have family, friends, and colleagues who are millionaires! The ID Theft Recovery Hotline is 877-283-8576. This agency will help victims in all aspects of getting back their good name. v 32

webwatch assistance providers worldwide. Data featured in the WOS is based on a global research review of nine EAP vendors and internal programs from Australia, Canada, and the United States that represented more than 232,000 cases.

Cannabis The Health Effects of Cannabis and Cannabinoids http://www.nationalacademies.org/hmd/Reports/2017/ health-effects-of-cannabis-and-cannabinoids.aspx In one of the most comprehensive studies of recent research on the health effects of recreational and therapeutic cannabis use, this report from the National Academies of Sciences, Engineering, and Medicine offers a rigorous review of relevant scientific research.

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

Cannabis EAPA Cannabis@Work Toolkits http://www.eapassn.org/CannabisatWork Major societal trends are converging to make cannabis in the workplace one of the biggest challenges facing employers and EA professionals. The toolkits are intended to give EA professionals information to assist their companies and clients. Both kits can be downloaded at this link.

Expatriates Relocating Partner Survey Report https://www.ey.com/Publication/vwLUAssets/ey2018-relocating-partner-survey-final-report/$File/ey2018-relocating-partner-survey-final-report.pdf According to NetExpat’s Relocating Partner Survey Report, employers confirm that the number-one reason for employees not accepting an international assignment is the potential disruption of the career of their relocating spouse or partner. Read more at this site.

Caregiving Care.com https://www.care.com This site’s motto is, “Trusted by families. Loved by caregivers.” Important links include a free search for care in your area. Senior care, child care, and even pet care are among options.

Financial Resources CareConnect USA https://careconnectusa.org/ Established in 2005, the North Carolina-based firm publishes reputable helplines for financially stressed employees and their families. The vetting process of service providers is extensive and ongoing.

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

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

Elder Care National Association of Area Agencies on Aging https://www.n4a.org This organization’s primary mission is to build the capacity of its members so they can help older adults and people with disabilities to live with dignity and with choices in their homes and communities for as long as possible. An eldercare locator is among the resources offered.

Mental Health Autism Society of America https://www.autism-society.org/ The Autism Society is the nation’s leading grassroots organization. It strives to increase public awareness about the day-to-day issues about people across the spectrum, advocate for appropriate services for individuals of every age, and provide the latest information regarding treatment, education, research, and advocacy.

Employee Assistance 2018 Workplace Outcome Suite (WOS) Report http://www.eapassn.org/Portals/11/Docs/WOS/ WOS2018AnnualReport.pdf The WOS, an EAPA-endorsed tool, demonstrates the effectiveness of EAPs in quantifiable business terms. The WOS is made up of data contributed by multiple employee

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By utilizing this guide, EA professionals can collaborate with workplace leaders to assess needs and then plan and facilitate supportive interventions such as psychological first aid, crisis intervention and other psychological and social support as needed. EA professionals can review the guide for ideas on how to advise the workplace to prepare for anniversaries or other important times during the work year that might trigger emotional responses related to the employee who died by suicide.

tion of hospital treated deliberate self-poisoning. British Medical Journal, 331(7520), 805. Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ‐9: validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606-613. Motto, J. A., & Bostrom, A. G. (2001). A randomized controlled trial of post-crisis suicide prevention. Psychiatric Services, 52(6), 828-833. Office of the Surgeon General (US); National Action Alliance for Suicide Prevention (US). (2012). 2012 National Strategy for Suicide Prevention: Goals and Objectives for Action: A Report of the U.S. Surgeon General and of the National Action Alliance for Suicide Prevention. Washington (DC): US Department of Health & Human Services (US). Available from: https://www. ncbi.nlm.nih.gov/books/NBK109917/.

Summary The EA profession has a responsibility to educate the workplace about the magnitude of suicide in the U.S. By taking a stronger public health approach to suicide prevention, EA practitioners can help implement approaches that prevent suicide and use interventions such as gatekeeper training and universal screening to identify adults struggling at work and connect them to community-based resources that can provide the support they need. We must couple substantive, evidence-based care while working to help change the culture of the work organizations we support to allow for more open and honest conversation and a perspective that suicide prevention is everyone’s business. v

Osteen, P. J., Frey, J. J., & Ko, J. (2014). Advancing training to identify, intervene, and follow up with individuals at risk for suicide through research. American Journal of Preventive Medicine, 47(3), S216-S221. Posner, K., Brown, G. K., Stanley, B., Brent, D. A., Yershova, K. V., Oquendo, M. A., & Mann, J. J. (2011). The Columbia–Suicide Severity Rating Scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults. American Journal of Psychiatry, 168(12), 1266-1277. Stone, D. M., Simon, T. R., Fowler, K. A., Kegler, S. R., Yuan, K., Holland, K. M., & Crosby, A. E. (2018). Vital signs: trends in state suicide rates—United States, 1999–2016 and circumstances contributing to suicide—27 states, 2015. Morbidity and Mortality Weekly Report, 67(22), 617.

Jodi Jacobson Frey, PhD, LCSW-C, CEAP is an associate professor whose teaching and research focus on adult behavioral health including Employee Assistance, suicide prevention, substance use and adult well-being. Connect with Dr. Frey at jfrey@ssw.umaryland.edu or follow her on Twitter @JodiJFrey

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Sally Spencer-Thomas, PsyD is a Clinical Psychologist and inspirational international speaker who helped develop the nation’s first initiative for suicide prevention in the workplace, Working Minds. Spencer-Thomas has held leadership positions for the International Association for Suicide Prevention, the American Association for Suicidology, United Suicide Survivors International and the National Suicide Prevention Lifeline. Connect with Dr. Spencer-Thomas at www.SallySpencerThomas. com and on Facebook (@DrSallySpeaks), Twitter (@sspencerthomas) and LinkedIn.

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

Amanda Mosby, MA is a Program Manager at the University of Maryland Baltimore. She has more than 15 years of experience coordinating research studies and academic projects targeted toward improving the behavioral health and well-being among individuals and families.

References

Carter, G. L., Clover, K., Whyte, I. M., Dawson, A. H., & Este, C. D. (2005). Postcards from the EDge project: Randomised controlled trial of an intervention using postcards to reduce repeti-

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

Sexual Assault National Sexual Violence Resource Center https://www.nsvrc.org The NSVRC believes in the power of information, tools, and people. Links include e-learning, library, projects, and more. Sexual Assault Select Task Force on the Study of Harassment in the Workplace www.eeoc.gov/eeoc/task_force/harassment/report.cfm This comprehensive report presents information on areas such as employee responses to harassment, risk factors for harassment, and many more.

Mental Health FAQs About Suicide https://crisiscentre.bc.ca/frequently-asked-questionsabout-suicide What are some of the warning signs? What can we do if we think someone is suicidal? This site addresses many of the tough questions.

Technology Appmkr https://www.appmakr.com/ Everybody is downloading apps these days, but maybe you’d like to create your own app. Doing so is neither complicated nor costly. Learn more at this site.

Mental Health Fresh Hope https://freshhope.us Fresh Hope is based upon six tenets/principles seen as a foundation for living well in spite of a mental health diagnosis. The tenets/principles are for both the person who has a diagnosis as well as for the loved ones of those who have a diagnosis.

Technology PsyberGuide https://psyberguide.org/ This non-profit website is dedicated to helping individuals seeking to make responsible and informed decisions about computer and device-assisted therapies for mental illnesses Technology World Well-Being Project http://wwbp.org/ The WWBP is pioneering scientific techniques for measuring psychological well-being and physical health based on the analysis of language in social media. The Project is based out of the University of Pennsylvania’s Positive Psychology Center and Stony Brook University’s Human Language Analysis Lab.

Mental Health Getting Started with Mindfulness www.mindful.org/mediation/mindfulness-getting-started You want to try mindfulness techniques, but don’t know where to start. This site shows you how. Mental Health International Society for Mental Health Online www.ismho.org ISMHO is a community that explores and promotes mental health in the digital age. Members meet online to discuss current issues and collaborate on projects to further its mission.

Workplace Conflict CPP Global Human Capital Report https://shop.themyersbriggs.com/Pdfs/CPP_Global_ Human_Capital_Report_Workplace_Conflict.pdf “Workplace Conflict and How Businesses can Harness it to Thrive” was commissioned by CPP, Inc. in partnership with OPP, Ltd., to shed light on the nature of conflict – defined as any workplace disagreement that disrupts the flow of work. The research project analyzed the workplace attitudes about conflict from 5,000 full-time employees in Europe and the Americas. v

Mental Health Suicide Rate by Country 2019 http://worldpopulationreview.com/countries/suiciderate-by-country/ Suicide occurs throughout the world, affecting individuals of all nations, cultures, religions, genders, and classes. In what countries are suicide rates the highest? Lowest? This site offers a comprehensive list and useful data. 35

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