Journal of Employee Assistance Vol. 50 no. 2 - 2nd Quarter 2020 by Employee Assistance Professionals Association

2nd Quarter 2020 | VOL. 50 NO. 2

The magazine of the Employee Assistance Professionals Association

The ‘Antidote’ for Anti-EAP Trends |Page 12

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

PLUS:

Cannabis in the Workplace Page 18

Threat Assessment Teams and EAPs Page 24

Impact of the Coronavirus on EAPs Page 32

contents EAPA Mission Statement

2ND Quarter 2020 | VOL. 50 NO. 2

cover story

The ‘Antidote’ for Anti-EAP Trends

| By David A. Sharar, PhD I’m defining anti-EAP (A-EAP) as the application or “bolting on” of trendy fads or novel frameworks that attach onto or replace EAP with little or no basis in science or demonstrated valid outcomes. My intent …is not to make a case that is anti-technology or anti-innovation but rather offer pro-evidence with valid outcome data.

features

Cannabis in the Workplace: A Continually Changing and Complicated Issue

| By Tamara Cagney In this complicated and changing environment, EA professionals can help employers ensure that their policies regarding drug testing comply with the laws of the states in which they operate, are clear and enforced consistently.

Threat Assessment Teams and EAPs

| By Daniel Hughes, PhD, CEAP Threat Assessment Management (TAM) is based on sophisticated problem solving skills and represents a form of professional practice or knowledge work that is within the reach of most seasoned EA professionals.

features

Trauma-Informed Care: Best Practices for EAPs

| By Leah Szemborski

When EA professionals look for signs of trauma and reliably practice the principles of Trauma-Informed Care (TIC), short-term interventions can be more effective, both for individual recovery as well as workplace culture improvement.

Impact of the Coronavirus on EAPs: Managing the Fear of Communicable Disease

| By Jeff Gorter, MSW, LMSW Most business continuity preparedness plans focus solely on medical or logistical issues; few address the emotional impact. That’s a risk, as your plans are only as good as the people enacting them.

departments 4 FRONT DESK 8 A DIFFICULT EAP CASE 10 LEGAL LINES 16 TECH TRENDS 5, 6, 27 EA ROUNDUP 22 WORKPLACE VIOLENCE OPINION

To promote the highest standards of practice and the continuing development of employee assistance professionals and programs. The Journal of Employee Assistance (ISSN 1544-0893) is published quarterly for $13 per year (from the annual membership fee) by the Employee Assistance Professionals Association, 4350 N. Fairfax Dr., Suite 740, Arlington, VA 22203. Phone: (703) 387-1000. Postage for periodicals is paid at Arlington, VA, and other offices. POSTMASTER: Send address changes to the Journal of Employee Assistance, EAPA, 4350 N. Fairfax Dr., Suite 740, Arlington, VA 22203. Persons interested in submitting articles should contact a member of the EAPA Communications Advisory Panel (see page 4) or the Editor, Mike Jacquart, by calling (715) 445-4386 or sending an e-mail to journal@eapassn.org. To advertise in the Journal of Employee Assistance, contact Larnita Day at development@eapassn.org. The JEA is published only in digital format since 1st Quarter 2019. Send requests for reprints of issues published BEFORE 2019 to Debbie Mori at d.mori@eapassn.org. ©2020 by The Employee Assistance Professionals Association, Inc. Reproduction without written permission is expressly prohibited. Publication of signed articles does not constitute endorsement of personal views of authors. Editor: Mike Jacquart Development & Donor Relations: Larnita Day Designer: Laura J. Miller, Write it Right LLC

Index of Advertisers EAPA Plan to Attend.........................IFC Harting EAP..........................................5 EAPA DOT SAP Trainings....................7 EAPA CEAP®.......................................9 SAPlist.com..................................11, 23 EAPA Best Value Package................BC IFC: Inside Front Cover BC: Back Cover

frontdesk Coronavirus, Cannabis, and Trauma, Oh My! | By Maria Lund, LEAP, CEAP

n our profession we work amidst a number of threats to our customers, clients, and even our own business success. EAP has been successful in large part because of our ability to adapt and respond to the needs of the workplace, marketplace, and communities. In this issue, we discuss a number of pressing challenges and how we can best address them. In our cover article, Dave Sharar describes the wave of “anti-EAP” vendors marketing tech-based services to our customers, sometimes as a replacement for EAP. Dave explains that we need to shift our brand and practice to being scientific practitioners to educate customers about the best-practice services we provide. In her Tech Trends response, Marina London points to specific strategies to remain strong in this new competitive landscape. A reminder that by reading by reading Dave’s cover story and answering a 5-item multiple choice quiz at https://bit.ly/PDH_Q2JEA2020 EA professionals can earn one free PDH. In light of the Coronavirus pandemic, this issue features an article by Jeff Gorter who shares tips for EA practitioners, leaders, and managers to help manage

panic and promote safety. We have a clear opportunity to offer guidance, support, and help to our customers and clients through this unfolding crisis. Tamara Cagney writes about cannabis in the US workplace. She describes it as “a moving target that continues to develop as a result of a myriad of changing laws and court rulings.” She details many of these changes and points to how EA professionals can effectively guide and serve our customers and clients. Dan Hughes explains the philosophy and steps for a model for Threat Assessment Teams. This is a powerful way for EA practitioners to connect with an employer and is proven to reduce risk. Dan also shares an opinion piece on gun control and violence where he proposes ways to move forward. There are more practice tips in Leah Szemborski’s article on Trauma-Informed Care. She walks us through the principles and model as they apply to manager referrals and EA counseling and points out how the model has use beyond clients presenting with trauma. Elsewhere in this issue we present an actual case with responses from two veteran CEAPs. What would you do? Share your opinion by emailing journal@eapassn.org.

Finally, Legal Lines columnist Robin Sheridan with Kristen Chang present information about federal and state laws expanding protection for health care workers against workplace violence. These may extend to EA professionals serving in health care settings. 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

earoundup EARF Announces Publication of The History of EAP in the US

organizations. A “Cases & Latest Updates” link, which includes FAQs, is offered at https://www.cdc.gov/ coronavirus/2019-ncov/cases-updates/index.html (Editor’s note: See also the feature article on coronavirus in this issue, beginning on page 32.)

The Employee Assistance Research Foundation (EARF) is pleased to announce the open access release of its latest research initiative: “The History of EAP in the United States,” written by principal investigator Dale Masi, PhD, CEAP, Professor Emeritus at the University of Maryland and former director of the MSW EAP specialization program. The book addresses a critical deficiency in the EA knowledge base: the need for a definitive resource that accurately documents the history and evolution of EAP in the U.S. The history covers antecedents and early years, the emergence of external providers and the affiliate network model, continued expansion/diffusion/integration in the 1990s and 2000s, and future directions. It can be downloaded for free here: http://www.eapassn.org/Portals/11/Docs/EAP%20 History/The_History_of_EAPs_in_the_US.pdf.

Employees Appear Ready for Digital Healthcare What do employees think about digital health? This was the impetus for launching ‘Health on Demand’, a collaboration of Mercer Marsh Benefits, Mercer and Oliver Wyman. They surveyed more than 16,000 workers and 1,300 employers in 13 markets around the world to compare and contrast the separate views of workers and employers on the future of healthcare. Nearly half of US workers (49%) said they are excited by the prospect of a digital transformation of healthcare. Importantly, 48% said they would have Continued on page 6

Coronavirus Serves as Reminder for Employers The recent outbreak of coronavirus that began in China and has spread across the globe reminds employers of the need to educate employees (and themselves) to cope with the Covid-19 outbreak. This article outlines a few of these strategies. Your corporate clients should strive to keep their safety policies and practices up to date. If they haven’t already, they should consider what policies or practices they can adopt (or adapt) in light of the pandemic. Employee education is an important part of every safety program. The site www.pandemicflu.gov (linked to the Centers for Disease and Prevention) offers a variety of educational information for employers and employees alike, such as the differences between seasonal flu and pandemic flu, planning and preparedness resources, and others. In particular, the Centers for Disease Control and Prevention (CDC) site - https://www.cdc.gov/ provides updated information as it becomes available. Links include info on: how the CDC is responding to the outbreak, symptoms of Covid-19, protecting yourself from Covid-19, and resources for the community regarding not only businesses and employees, but also schools and childcare, travel, and community and faith-based

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earoundup

Continued from page 5

Business Travel Impacts Mental Health

more confidence in a digital health solution if it were offered by their employer, and 26% even say they would be more likely to stay with an employer that offered digital health solutions. The solution that the most workers said they would value, both globally and in the US, is an app that “helps find the right doctor or medical care when and where needed.” The desire for more convenient, personalized health care was a clear theme that emerged from survey results. There were some interesting variations. In the UK, the most popular solution was wearable technology to help self-manage chronic conditions. And in China, where 76% of workers say they are responsible for the healthcare of a family member (compared to an average of 53% across all 13 countries), the most popular digital health solution was “companion robots that help elderly relatives stay healthy at home”, the solution that ranked near last or last in each of the 12 other countries surveyed. More info here https://bit.ly/2V3a4MW.

According to a recent survey by YouGov and NexTravel, approximately one-fifth of business travelers experienced some type of mental health issue caused by business travel. Not surprisingly, the more business trips you take, the more likely that stress-related issues may appear. A study last year from Columbia University noted that issues of insomnia, anxiety, and alcohol dependence, were common among frequent business travelers. “Poor behavioral and mental health outcomes significantly increased as the number of nights away from home for business travel rose,” the university said about the report, published in the Journal of Occupational and Environmental Medicine. Read more here https://bit.ly/2SGeyr5.

Is ‘Digital Rehab’ on the Way? New Mental Health Certification Introduced

Could “digital rehab” help with the addiction crisis in the US? One of the problems is that there aren’t enough care programs to meet the demand, and to get into one, you have to tangle with red tape. It’s not surprising then, that only 17.5% of the two million people addicted to opioids were able to get care in 2016, according to the National Institutes of Health. Telemedicine and online drug prescription present an opportunity to reach people suffering from opioid addiction on their own schedule. As reported by Fast Company, that’s where the digital rehab program “Boulder” comes in. Instead of traveling to a dedicated rehab center that may not be close to home, a patient can come to Boulder through a hospital. Once inside the hospital, a doctor hands their patient a tablet loaded with Boulder’s software, and the patient conducts their first session over video there. Boulder CEO Stephanie Papes says part of the program’s success can be attributed to its ability to be responsive to patients’ individual needs. Unlike other programs, where a relapse might get a patient kicked out, at Boulder, if a person relapses, the doctor adjusts the treatment accordingly. The hope is that by taking a less punitive approach, patients won’t be inclined to send in fake results. More info here https://bit.ly/2V6ONSo.

Roughly one in five employees experience a mental health condition each year, and because serious mental illness results in over $193 billion in lost earnings each year, it’s a subject too big to be ignored by companies. This is why Mental Health America (MHA) recently announced a new national employer certification program to guide employers, the Bell Seal for Workplace Mental Health. The Bell Seal program assesses workplaces in five categories: workplace culture, health insurance and benefits, employee perks and programs, legal and ethical compliance, and leadership and community engagement. The Bell Seal recognizes employer advances in workplace mental health by awarding levels of bronze, silver, gold, and platinum. By becoming Bell Seal-certified, an organization sets itself apart as a workplace that values mental health and a mentally healthy work environment for all employees. Any employer – large or small – is encouraged to apply. The Bell Seal application process operates on a rolling basis, so that MHA can accept applications year-round. Because all workplaces are different, an employer can aspire to receive recognition at four levels – Bronze, Silver, Gold, and Platinum. Read more here https://bit.ly/2vJaygH.

continued on page 27 6

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adifficulteapcase You’re the EAP, What Would YOU Do? Editor’s note: The following depicts an actual EAP case and then asks several EA professionals what they would have done had it been their case. JEA readers are encouraged to share their opinions by contacting either individual below or by emailing journal@eapassn.org.

since you have no release, no information or opportunity to make any contact with the referring company. Therefore, you need to maintain confidentiality. Action plan: Since the person is “incoherent”, it is unlikely there will be any reliable expectation of getting a release or communicating in a rational manner. Therefore, an immediate determination should be taken to decide if the employee needs to be sent by EMS to transport to the ER for medical or psychological stabilization and/or detox. Given the situation it is highly likely the client will be transported to the ER. You could always ask for information of next of kin, significant others etc. to discuss transportation or meeting the client at the hospital. If the client declines this information, you know the ER will be asking the same information. Stabilization of the client needs to be the focus of this interaction, the company can be involved at a later date.

A senior IT executive is dropped off at an external EAP office via a client company’s limousine. The employee is very agitated and thought disordered to the point of incoherence. He cannot articulate why he has been sent to the EAP. The client company did not call you to give you a heads up or explain the situation. You are momentarily paralyzed. You wonder if you can contact the company or whether that would violate the client’s confidentiality. You also aren’t immediately sure what to do with the client. What should you do? Mike Klaybor, Houston, Texas states: drmike@klayborandklaybor.com

If any assessment is possible after observation and attempt to have a coherent discussion, obtain permission and a release to contact the your company representative or HR to get additional information about the reason for sending the employee to you.

First of all, yes, this is quite a difficult case and situation as it raises many questions. I developed my response and then called Dr. Debra Reynolds, retired EAP/Behavioral Health Benefits Director from United Airlines to discuss her reaction to the scenario from a manager’s perspective. We concurred on the following response after our discussion.

Opportunity: This is a good example of why companies need EAP, with understanding of how and when to communicate with the EAP. In the above example, it could be said that the company was “dumping” the client to the EAP. Keep in mind, companies are not trained in mental health and they understand EAP deals with emergencies and mental health concerns. The EAP may use this an opportunity to open the door to other consultation or training with the company upper management or other staff in how to use the EAP and obtain the best results for the company and its employees.

Determination of referral: Even though the client arrived in a company limo, it could be reasoned the company was aware of the client’s incapacity to drive and did not want to incur liability by allowing the client to drive. You must assume that this is technically a self-referral, 8

Kristin Matthews, VP, Clinical and Work Life Services, KGA says: matthews@krgreer.com

contact the company and next of kin. But given the emergent nature of his presentation, this is a situation where breach of confidentiality may be warranted. I would likely reach out to my contact at the company, let him/her know there was a medical emergency with an employee just referred to the EAP, and try to obtain any background information as well as names of emergency contacts. The client’s health is clearly in danger and the company, as well as family members, may have critical information for the employee’s medical triage and care.

The good news is that someone in a senior leadership role noticed that this employee was in trouble and attempted to get him some help. Many leaders look away or dismiss troubled employees outright. The bad news is, without more information and collaboration with the client company, the only choice is to call 911 and get the person to the ER. This employee may be psychotic, under the influences of substances, or suffering from an acute medical condition. He requires a complete medical and psychiatric evaluation, which are clearly beyond the scope of the EAP.

Once the immediate crisis is over, I might use this situation as an opportunity to review best practices when referring employees to the EAP. I would likely suggest manager trainings and perhaps leadership training in recognizing behavioral health symptoms in the workplace. v

Ideally, the employee could provide permission, in writing or in front of the ambulance crew, to

Isn’t it time you earned your CEAP®? The Certified Employee Assistance Professional (CEAP®) certification is the only professional credential denoting mastery of the EAP body of knowledge and commitment to the ethical standards necessary for effective EA practice. For more information, visit http://www.eapassn.org/Credentials/CEAP

legallines Legislative Push Protecting Health Care Workers Against Violence May Impact EA Professionals | By Robin Sheridan and Kristen Chang

National Developments In November 2019, the House of Representatives passed H.R. 1309, the “Workplace Violence Prevention for Health Care and Social Service Workers Act.” If it passes in the Senate, the proposed law would give OSHA 42 months to issue requirements to health care employers to implement comprehensive workplace violence prevention plans. As proposed, the legislation defines covered health care facilities very broadly and includes all employees of all medical, correctional, residential/ long-term care and non-residential facilities, and even social service settings. Accordingly, the proposed legislation would impact EA professionals employed by, or contracted to work in, a health care facility – both as a training resource and as a recipient of training. As a result, EA professionals who work in, or work for, health care facilities should monitor the proposed law.

he federal government and individual states are currently expanding laws to protect health care workers against workplace violence and raising the penalties for causing harm to health care employees. In some instances, the legislation may provide employee assistance professionals with protections as health care workers and will almost certainly impact EA professionals counseling individuals in health care settings. Workplace Violence Workers in health care settings often face the risk of workplace violence as a result of their interaction with patients and clients. While patients/ clients cause most of the violence, health care workers may also experience a heightened risk of violence due to the actions of family members and associates. This is because health care jobs sometimes require close contact with individuals who are unstable due to substance abuse or weapons, as well as working in stressful work environments that may trigger or negatively impact co-workers. Moreover, their work settings have greater public access and less security in terms of physical barriers and security personnel. In fact, according to the Occupational Safety and Health Administration (OSHA) of the U.S. Department of Labor, the rate of reported workplace violence incidents that required a worker to take days off to recuperate after suffering injuries was more than four times greater in the health care industry compared to the average in all private industries combined. Because of these significant risks, health care workers, professional associations and policymakers are looking for ways to curb violence against health care workers.

State Developments At the state level, legislatures, professional associations, and others are also making strides in expanding protections for health care workers. Approximately 36 states impose higher penalties on workplace violence against nurses. Currently, at least five states (California, Delaware, Florida, Oklahoma, and South Carolina) have proposed legislation related to violence against health care workers. In January 2020, Wisconsin enacted legislation that increases penalties for harm done to nurses and health care providers in certain circumstances. More specifically, the new law makes it a felony to intentionally cause physical harm to a nurse, someone acting under a nurse’s supervision, a health care provider who works in a hospital or an individual who works in an emergency services role or setting 10

such as an ambulance driver, emergency medical responder, or emergency department worker. As legal developments continue, EA professionals should expect to see more legislation in this area. Consequently, EA professionals should be aware of whether such laws apply to them as health care workers under their state laws. EA professionals should also be prepared to counsel health care workers who face (or cause) violence in states with legislation that address these issues. In Wisconsin, for example, a health care provider is defined to include, among others, a psychologist, social worker, marriage and family therapist or professional counselor. Privacy Considerations for EA Professionals who Experience Violence in the Workplace An EA professional covered by a law mandating heightened penalties for violence against health care workers is assaulted in his or her workplace or while he or she is operating in a professional capacity may report the crime to law enforcement officials. However, the information that may be provided to law enforcement is likely limited under the HIPAA, 42 CFR Part 2 (the Substance Use Disorder rules) if applicable, and/or state privacy rules. While HIPAA, many state laws and 42 CFR Part 2 permit the disclosure of limited information to report a crime on the premises, the exceptions are generally limited to making the initial report. Additional information beyond that specifically identified in the laws as being acceptable in an

initial report cannot be provided to law enforcement absent written authorization from the patient/client or another applicable exception in the privacy laws. The key consideration when determining the applicability of this exception is who is initiating the disclosure. The crime on the premises exception permits the EA professional to initiate a disclosure to law enforcement to report the crime using the minimum necessary information permitted by the applicable law. It does not extend to responding to requests for information from law enforcement, even where such requests are made in order to investigate the reported crime on the premises.

are not considered health care workers under their state’s laws are encouraged to contact their local legislators and lobby for the same protections that are provided to traditional health care providers. v Editor’s note: The recommendations provided in this article are for educational purposes only and are not to be construed as actual legal advice. Always consult with a local attorney regarding specific legal matters. Robin Sheridan and Kristen Chang are attorneys with Hall, Render, Killian, Heath & Lyman, P.C., 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.

Counseling Health Care Workers who Face Violence EA professionals who are counseling victims of health care workplace crimes should encourage their clients who, as health care workers, are subject to the privacy rules above, to report the crime to the employer so that the employer can assist the employee with a report to authorities. An EA professional’s knowledge of the employer’s leave of absence policies and state law impacting crime victims will also be an important service to these clients. In addition to the federal Family and Medical Leave Act (FMLA), employees may have protection for absences under state FMLA laws and/or state victim leave laws. Summary Given the increased violence in virtually all workplace settings, EA professionals who 11

coverstory The ‘Antidote’ for Anti-EAP Trends | By David A. Sharar, PhD Preface and Reference: Certain workplace fields parallel to EA, such as organizational psychology and development, are rapidly adopting new approaches, and in particular tech-based products, that serve companies but with little or no research backing. This article uses and extrapolates some of the arguments and viewpoints from organizational psychology that closely align with what is happening in the EA field. Please see Rotolo, Church, et al in (2018) “Putting an End to Bad Talent Management: A Call to Action for the Field of Industrial and Organizational Psychology”, Industrial and Organizational Psychology, 11(2), pp 176-219. In particular, the figure that accompanies this article was adapted from the above reference (p. 183). See the following link https://bit.ly/37h85Xz Please note: My intent in this article is not to make a case that is anti-technology or anti-innovation but rather offer pro-evidence with valid outcome data.

The start-up firm is pitching a package of technology-enabled solutions they claim will address workplace mental health issues by delivering progressive and “cutting edge” benefit offerings, especially for Millennial-age workers who tend not to use traditional EAPs or mental health benefits. They also emphasized the ineffectiveness of traditional EAPs due to “low” utilization rates and the inability to overcome “stigma”. The package included an app for depression & anxiety, online CBT, texting and video, and a variety of digital self-help programs. The pair provide some attention-grabbing claims about both the process and supposed impact of the product, which actually turn out to be steeped in data but lacking in real and persuasive outcome data. Despite the lack of real outcome data, Janet’s VP – who is under daily pressure to reduce benefit costs while simultaneously improving access – asks Janet to quickly work with IT to lead an implementation project with the technology firm. Janet returns to her office with a sour stomach. She thinks to herself, “Really? I operate a program with above average utilization that uses validate screenings, has excellent linkage to ongoing care, and actually measures workplace outcomes. She asks herself: • Will it replace or supplement what I do? • Where exactly does this digital platform start and stop? • Where is the evidence that it even works?”

“

anet” (fictional but believable background and scenario) is a clinical psychologist with a Psy.D. and a seasoned internal EAP Director working for a large, multi-location manufacturing company where she manages a hybrid program – a combination of internal EAP staff and a local external vendor she has worked with for over a decade. Since Janet was academically trained as a “scientist-practitioner”, she recognizes the need to examine “best practices”, review literature, and conduct internal research before implementing major design changes to her company’s EAP. One day, the VP of Employee Benefits calls Janet to a meeting and introduces her to two people from a technology start-up firm – one is a marketing executive and the other a software development engineer. The VP met these people in an exhibit hall where they had a booth at a global human resources conference.

Janet worries she will come across as ‘anti-change’ or ‘resistant’ if she pushes back and asks too many questions. Her VP seemed awestruck by the claims of the start-up firm. EAP Context too often Lacking Do Janet’s concerns even matter since this “technology” train has already left the station? Who is controlling the conversation and making promises 12

about the power of digital to greatly improve “low usage” and enhance outcomes? Make no mistake – some of these technology-based disrupters are outspoken about their intent to replace traditional and long-standing EAPs. There are reasonable studies which demonstrate that certain types of technology-enabled modalities serving certain kinds of clients are comparable or equivalent to face-to-face services. But the use of technology-enabled modalities has not been empirically studied in the context of EAP – where the prevailing method of capitated funding creates incentives to “steer” clients to the cheapest available modality as a way to avoid more expensive “high touch” modalities such as face-to-face counseling. We also lack consolidated and reliable utilization statistics that examine the use of one or more modalities across cases and looks at the impact of problem severity, length or intensity of a particular modality, and the subsequent effect on clinical or workplace outcomes. The use of technology likely does significantly enhance access but access to what? Consider a case where a multi-problem, high-severity client is referred from an EAP call center to an e-CBT web-based platform and that client logs in and engages the e-CBT for 30 minutes but then gives up. Did the use of a single modality for 30 minutes, counted in a utilization report, produce an actual or positive workplace or clinical outcome? What type of client will most likely benefit (or make no progress) by using one modality over another – or a combination of modalities? As the field is flooded with a plethora of new technology-enabled products, there is a complete lack of standardized and validated measures to evaluate the effectiveness of these platforms. When validated measures are used, extremely low response rates and very short follow-up periods for the post-test render the outcome evaluation meaningless. We simply don’t know the answer to the above questions – especially in the world of EA.

be or are currently good for clients and the field, I’m naming this disruptive phenomenon anti-EAP (A-EAP) to be provocatively “tongue-in-cheek”. I’m defining A-EAP as the application or “bolting on” of trendy fads or novel frameworks that attach onto or replace EAP with little or no basis in science or demonstrated valid outcomes. A-EAP creates a “buzz” among employers and benefit consultants to demonstrate “quick wins” with promises of impacting health benefit cost reduction agendas or appear as fixes to solve vexing employee well-being issues – but with little concern that purported outcomes are largely unsubstantiated or available for scholarly review and criticism. Very few of these firms can actually provide concrete evidence in a peer-reviewed study that backs up their product. There is now so much amorphous content inside the anti-EAP movement – repackaged, hackneyed, and even some solidly promising – that our field needs to separate the wheat from the chaff. There are new A-EAP approaches that clearly have merit and could potentially improve access and outcomes but lack empirical research backing. There are also other methods that are simply ineffectual and falsely legitimized. But can EA professionals or employer purchasers distinguish between the two? We jump on the bandwagon of A-EAP approaches out of fear of that we will be seen as behind, disconnected, or afraid of innovation and change. Our ultimate fear is we will risk losing employer contracts or funding for internal programs if we fail to embrace A-EAP approaches. Are some A-EAP firms misdiagnosing the “undertreatment” and “low utilization” problem by making the assumption that a) EAPs are a dying concept, and b) technology is the best solution? We need to be open to A-EAP but assert a counter-argument when evidence is lacking and there is no valid outcome data. Science-Practice Gap Rapid adoption of A-EAP may be a good marketing and sales strategy, but it shortcuts fundamental aspects of what we learned in that long-ago graduate class in research methods, further dividing the science-practice gap. This gap is about academics in the “helping” disciplines losing touch with the needs of practitioners, and practitioners losing their perspective or grounding in basic social/behavioral science and program evaluation.

What is Anti-EAP? The previous example with “Janet” is an illustration of a significant “disrupter” in the EAP marketplace that could cause our field to radically change, or even eliminate many of the approaches or tools that EAPs have relied on for decades. Even though some disrupters will 13

coverstory Many of my entrepreneurial EAP colleagues who endorse the “populist” approach (# 4 in the Figure) and the rapid adoption of EAP disrupters believe the scientific vetting process is too slow and impractical, overly focused on methodological minutia, and out of touch with real-life business needs. They point to academics being obsessed with peer-reviewed publications and ignoring practical business and employee well-being issues. Academics who have focused on EAP and workplace behavioral health (and scientist-practitioners like Janet earlier in this article) believe the field has pulled itself toward a non-evidence-based path in its quest to remain relevant and noticed by employers and buyers of EAP. Scientist-practitioners see the adoption of new, bright, shiny A-EAP approaches as possibly wellconceived but frequently lacking in rigorous vetting, putting forth invalidated and unpublished claims, and

basing these claims on either no or poorly executed “proprietary” research. Some A-EAPs may not only be ineffectual but possibly harmful to certain types of clients – particularly those clients with multiple presenting problems and higher levels of problem severity. As a proponent of the “scientist-practitioner” approach I believe that we have a responsibility to understand – before widespread implementation -- which new “value-added” approaches (or interventions) will actually lead to favorable outcomes for clients and employers. Unfortunately, we typically do not start researching or evaluating “frontier” products or methods until they have already reached a high level of acceptance and are “bolted on” to what we still call “EAP”. As a scientist-practitioner, what kind of thinking and expertise does Janet bring to the table?

Figure 1

Before fully embracing a new approach she conducts a “pilot project” and gathers data on how it works and why it works.

toring and EAP “check-ins” for those clients with higher severity problems who were referred by EAP to ongoing and specialized care. Most contemporary EAPs cannot provide longitudinal data regarding the final disposition of clients referred beyond the EAP.

Janet takes the time to do a literature review to see which practices and interventions exhibit evidentiary characteristics, if the research is available.

Practitioners themselves (like the fictitious Janet) need to do their own evaluations leading to more evidentiary-based innovations but also collaborate with (and invest in) academic behavioral health and workplace researchers or evaluators to broaden the range of scientific knowledge in the EA field. It is possible to shorten the “vetting” period for purported innovations (or disrupters) and avoid overly simplistic or grandiose claims that have little or no research backing – or the adoption of new products that lack an evidence-base. The Employee Assistance Research Foundation (EARF), organized by EAP pioneer Carl Tisone in 2007, set out to accomplish this objective. The EARF experienced some real success in funding and supporting several excellent EAP-focused studies and sponsored several scientific journal articles. EARF and EAPA are working together to make renewed strides to broaden the base of support for Carl’s original vision. I look forward to continuing a dialogue on this subject and hearing your thoughts and ideas.

She considers potential theories behind internal organizational data or even external data and does not draw inferences from spurious relationships. She looks for the root cause of a problem and links data to that root cause. Janet realizes that statistical power hinges on adequate sample size, and what kinds of validity problems are inherent with small samples. If she is lucky enough to have a large sample she focuses on effect size. Janet asks for outcome data before embracing a new product and knows how to evaluate hyped-up data that is typical of marketing pitches. She consults with decision-makers to understand the challenges of addressing high-impact conditions, such as untreated behavioral health and work effects. These factors increase the likelihood that Janet will implement a scientifically-based innovation rather than one that lacks research support.

Summary In closing, we need to radically shift our trajectory towards the top three boxes in Figure 1 (from 3 to 7-9) to change our brand to become more of a “profession”. We need to close the divide between practitioners and scientists and embrace the scientist-practitioner philosophy as a form of everyday practice. This is the antidote for A-EAP and a framework to ensure our long-term viability in the face of threats that could change our very essence. v

Reducing Negative A-EAP Forces Figure 1 accompanying this article outlines a process flow, starting with the creation of new products (1), demands from the marketplace (2), and benefits/HR strategy (3). The goal is to pursue a path of “tried and true” pragmatic science where new approaches are evidence-base and embedded into best practice (the top three boxes which move directly from number 3 to 7-9). Unfortunately there are components of EAP that are non-evidencebased and still became a common practice (from 3 to 5 and 9), and others that have evidence from the past but are slowly fading into oblivion (from 3 to 8 and 6). One example of moving from 3 to 8 to 6 is the fading practice of rigorous follow-up case moni-

David Sharar is the CEO of Chestnut Health Systems. He codeveloped the Workplace Outcome Suite, a free and scientifically validated tool designed so EA providers can accurately measure the workplace effects of EA services. He can be reached at dsharar@chestnut.org Editor’s note: Earn a FREE PDH for reading this article at https://bit.ly/PDH_Q2JEA2020.

techtrends Response to “The ‘Antidote’ for Anti-EAP Trends” | By Marina London, LCSW, CEAP

completely agree with David Sharar’s perspective that employee assistance (EA) is experiencing an onslaught of disruptive anti-EAP marketing and pressure to use apps and other technologies that have not been vetted as effective in an EAP context. I too have written about this challenge to our field. Since 2008, I have been writing a weekly blog iWebU.info (http://www.iwebu.info) that focuses on “disruptive trends and technologies in the 21st century” impacting EA and mental health.

EAPs do not do a good job of explaining what is unique about our work and its value to either our client companies or our covered lives. We need to figure out a sleek, sophisticated, and engaging way of promoting ourselves – this is not necessarily a matter of ad dollars but more about creative thinking and learning from the very industries that are threatening us. Talkspace is yet another company that directly markets to corporations offering their services as an alternative to EAPs. (see https://business.talkspace.com) When the company first started, they offered “unlimited” texting with a counselor for $49 a week. A 2018 Talkspace 30-second ad shows a young woman sitting on a couch and then a voice says: “I feel incredibly grateful that I stumbled upon Talkspace. I was matched to the perfect therapist. She makes me think, in the best way possible. This has been a life-changing experience.” Lindsay S, Talkspace user.” (see https://youtu.be/jFUJXHlASHo) I would venture to say that we could create a similar ad promoting EAP on our smartphones. I am not a marketing maven, but doing the same thing year after year and expecting a different result is a sure sign of the madness in our industry.

In a blog post from 2018, “Web Secret 541: Bypassing EAPs,” I wrote: The biggest threat to EAPs are mental health apps and platforms that are selling directly to employers. They are less expensive than EAPs, and over promise spectacular results. They also use slick marketing techniques and state of the art tech - which most EAPs lack. And they are usually headed - and started - by technologists - not clinicians. ….. What do these companies do better do better than EAPs? They sound cool, use great marketing and exhibit social media savvy. They trumpet evidence-based interventions up front and central. Promise hi tech anywhere anytime service delivery. They are user friendly and offer “fun” visual tracking of progress - typically through apps.

In a 1st Quarter 2019 Journal of Employee Assistance Tech Trends column, “Moving Towards EAP 2.0,” I wrote: Lyrahealth.com is typical of the mental health platforms that compete directly with EAPs for corporate dollars...

What do EAPs do better than these companies? CBT is the new Kool-Aid and pretty much the only approach used. What is completely missing is the powerful and valuable EAP assessment that delivers customized counseling and/or referrals to the treatment approach and level of care needed by the employee AND an evaluation of the workplace factors and impact relevant to each case. [my emphasis]

In the “employers” section of their website https:// www.lyrahealth.com/employers they state: “Lyra replaces hard-to-navigate EAPs with an innovative approach that engages 10X more employees and helps them become measurably healthier, happier, and more productive. Lyra makes it easy for employers to support and improve workforce behavioral health and emotional well-being. 16

delivery systems. Adding apps to EAP services is easy. In 2018, the JEA published an article that lists the best apps for EAPs. See Journal of Employee Assistance - Vol. 48 no. 4 - 4th Quarter 2018: “Top 10 Well-Being Apps for 2018”, by Kathleen Greer, http://www.eapassn.org/JEAArch (members only).

Lyra replaces your EAP with a new approach to mental health that is intuitive, intelligent, and effective. From anxiety and depression to stress and relationships, we deliver the right care, right away and help members feel better quickly. That’s why 94% of members love Lyra.” You can’t get more direct than that.

3. EAPs should use the latest in marketing and sales techniques to market themselves to corporations and employees. This should include sophisticated social media campaigns. This does not require a big budget – it’s about working smart. The gig economy makes it easy and inexpensive to hire the expertise to accomplish this – check out a company like Fivver (https://www.fiverr.com) and there are others.

While I also agree with Dave that we need more research that supports what EAPs do, I am concerned that: 1. Smaller EAPs do not have the in-house expertise nor the resources to conduct research. But we do have the Workplace Outcomes Suite as well as PsyberGuide, a nonprofit website dedicated to helping those seeking to make responsible and informed decisions about computer and device-assisted therapies for mental illnesses. (https://psyberguide.org/apps/) If you go to their “Product Listing,” you will note that each app is listed along with a PsyberGuide rating that corresponds to the amount of research and support backing the product. In addition, there is an App Quality Score on a scale of 1 to 5. Finally, there is a link to an expert review - if one exists. http://www.iwebu.info/2017/08/web-secret-479psyberguide.html. 2. The threat is already here. How do you compete right now with the Lyras of this world?

4. As technology advances and becomes mainstream, your EAP needs to be ahead of the curve, incorporating virtual reality, chatbots with machine learning, and anything else that we can’t even imagine into the services provided by the EAP. Other suggestions: First opportunity In addition, there are opportunities for EAPs to be disruptive to the anti-EAP companies. In a first quarter 2020 article in the Journal of Employee Assistance, former EAPA president Tamara Cagney wrote that DIY genetic testing (such as offered by 23andme) is an opportunity for EAPs. 23andMe does not offer services to help users cope when they discover they have the genetic marker for a potentially fatal disease. This presents an excellent opportunity for EAPs to provide supportive genetic counseling services. No one else is doing it. This is a first to market scenario. The first step is to add genetic counseling to your roster of services and hire a genetic counselor.

In a course that Mike Klaybor, PhD, CEAP, and I update and deliver once a year at EAPA’s EAP Conference and EXPO, “Planning and Implementing a 21st Century EAP from Zero to Go”, we recommend the following steps: 1. You need to seamlessly incorporate technology into all EAP services. You need to provide anytime anywhere and anyhow access to those services. Enable texting to make appointments, and speak with an EAP counselor via video. All of this should be EASY to use. There are a number of online appointment platforms, and all of us already use Facetime or Skype. Even the smallest EAP company can offer these technological bells and whistles.

Second opportunity Another opportunity for EAPs is to help employees and their families, as well as client companies, cope with the profound changes in our society brought on about by advances in technology. As soon as we establish best practices, we are faced with a new evolution: What are we going to do when virtual reality is perfected and our clients check out of life to disappear into worlds that have no reality?

2. Instead of reinventing the wheel, your EAP should form partnerships with apps and other tech startups to offer the latest in treatment modalities and

continued on page 35 17

featurearticle Cannabis in the Workplace

A Continually Changing and Complicated Issue | By Tamara Cagney

he issue of cannabis in the workplace in the US is like a moving target that continues to develop as a result of a myriad of changing laws and court rulings. Some recent examples: • A New Jersey court ruled that employers must reimburse employees for medical cannabis, despite its continued illegality under federal law. • In Nevada, where recreational legalization went into effect January 1, 2020, employers cannot deny employment to applicants testing positive for cannabis, with some safety-related exceptions. • In New York City, pre-employment cannabis drug tests generally won’t be allowed. • Illinois law prevents employers from disciplining or terminating employees for using “lawful products off the premises of the employer during nonworking hours.”

States that currently have such anti-discrimination provisions include Arizona, Arkansas, Connecticut, Delaware, Illinois, Maine, Massachusetts, Minnesota, Nevada, New Jersey, New Mexico, New York, Oklahoma, Pennsylvania, Rhode Island, and West Virginia. Staggering Costs; Impairment Guidelines Unclear CurrentCompliance.org, which catalogues drug testing laws, called cannabis related costs “staggering.” According to one study, in states where medical cannabis is legal, Social Security Disability Insurance claims rose 9.9 percent post-legalization. Occupational Health & Safety magazine offered additional warnings of increased workers’ compensation claims, health care and liability insurance premiums, and litigation costs. Eleven states, including California, Oregon, Washington, Illinois and Colorado, have legalized the personal use of cannabis. Legalized recreational cannabis is seeing an uptick in protections as well. Nevada, Maine, and New York City prohibit employers from testing for cannabis during the employment application period altogether. Employers can still prohibit employees from working while impaired, but cannabis remains in someone’s system far longer (up to 30 days) than alcohol, so how can impairment be proven? And few guidelines exist in cases where a disciplined employee contests a penalty. There are a myriad of methods for testing for cannabis but the most commonly used methods, urinalysis and blood testing, do not indicate whether the employee is impaired at the time of the test. New technology for breath testing claims to show impairment but has a much shorter window of time (60-90 minutes) by which the test must be taken. In addition, it has yet to be proven reliable in detecting impairment. As a result, a positive drug test does not necessarily demonstrate that an

Lack of Uniform Laws EA professionals and employers are undoubtedly aware of the ever-changing landscape of cannabis laws across the country. Complicating matters for larger employers is that these evolving statutes are creatures of state law with little uniformity across jurisdictions. Thirty-two states now allow for medical cannabis use. Each state has its own system for handling medical cannabis. Some states limit the potency of the available cannabis, while other states restrict when it can be used, limiting it to only a specified list of illnesses. When cannabis was first legalized under state medical cannabis programs, many states permitted employers to terminate employees testing positive for cannabis, even if they were legal card holders under a state program. However, states that later enacted medical cannabis programs began including anti-discrimination provisions prohibiting employers from taking action against employees based on their status as lawful medical cannabis users. 18

employee is impaired at work or has used cannabis while working.

And as EA professionals know, no one is immune from developing cannabis use disorders. Addiction to cannabis is real. NIDA reports that cannabis use can lead to the development of problem use, which takes the form of addiction in severe cases. Recent data suggest that 30 percent of those who use marijuana may have some degree of marijuana use disorder. And of even more concern for the employees of the future, young people who begin using marijuana before the age of 18 are four to seven times more likely to develop a marijuana use disorder than adults.

Cannabis Use Unsafe for Safety-Sensitive Employees One thing is clear about cannabis in the workplace: “It is unsafe to be under the influence of cannabis while working in a safety-sensitive position,” says the National Safety Council (NSC), which found – what common sense tells us, that such impairment can lead to injury or death for both operators under the influence and others. NSC laid out its position in a recent policy statement, in support of transferring medical cannabis users to non-safety sensitive positions. The American Industrial Hygiene Council has concurred with that idea. A “safety-sensitive” position impacts the safety of the employee or others as a result of performing the job. Being under the influence adds another layer of risk. Cannabis, NSC says, is the most widely used “illicit” substance in the world. “The amount of THC [tetrahydrocannabinol] detectable in the body does not directly correlate to a degree of impairment,” the Safety Council acknowledges. But it adds that “there is no level of cannabis use that is safe or acceptable for employees who work in safety-sensitive positions.

Impact on Workers Compensation The area of Workers Compensation and paying for the medical care of injured workers is another area where changes regarding medicinal cannabis are striking. A few years ago, the New Mexico appellate court issued a decision that required insurers to provide reimbursement for an injured worker using medical cannabis to treat their injury. This was a first of its kind decision and seems to be signaling a trend. In 2017, a New Jersey administrative law judge ruled that a workers’ compensation carrier was responsible for reimbursement of medical cannabis for an injured worker who was using the cannabis to treat one of their covered injuries. And in Minnesota, an insurance carrier paid for an injured workers’ use of medical cannabis to treat muscle spasms. In contrast, other states, like Arizona, take the opposite position that a workers’ comp carrier cannot be compelled to pay for medical cannabis because it remains illegal on the federal level. Medical cannabis also remains absent from treatment guidelines. In the cases where it was found to be proper treatment for an injured worker, the physician only “prescribed” it after trying other forms of treatment unsuccessfully. Even if cannabis is used as a medical treatment for a workplace injury, much like when they are prescribed opioids, they may be prevented from returning to work. Further, if they’re allowed to return to work, it raises issues about whether medical cannabis would violate the drug free workplace rule.

Cannabis Use Leads to More Accidents, even Addiction A study of postal workers by the National Institute on Drug Abuse asserts that employees who tested positive for cannabis had 55% more industrial accidents, 85% more injuries, and 75% greater absenteeism compared to workers who tested negative. The dangers aren’t limited to a physical accident, such as in construction or manufacturing. There is a significant risk from office workers’ impaired judgment. Think about a bookkeeper, an accountant, or a programmer, all of whom have jobs where accuracy is at a premium. A study by the Rocky Mountain High Intensity Drug Trafficking Area found that the annual rate of emergency department visits related to cannabis increased 52% after legalization in Colorado. And the Insurance Institute for Highway Safety found that police-reported collisions increased more than 5% in the rate of crashes per million vehicle registrations, after cannabis was legalized in Colorado, as measured against states where the drug is not legal.

Continued on page 21 19

featurearticle

CBD Use Increasing Even Though it’s Not Authorized

n December 2018 the Agricultural Improvement Act of 2018, Pub. L. 115-334, (Farm Bill) removed hemp from the definition of marijuana under the Controlled Substances Act. Under the Farm Bill, hemp-derived products containing a concentration of up to 0.3% tetrahydrocannabinol (THC) are not controlled substances. As a result, CBD oil, or cannabidiol mixed with a carrier oil, is going mainstream and increasingly found on store shelves such as CVS, Rite Aid, and Walgreens. An estimated 64 million people have tried CBD in the past 2 years according to a survey by Consumer Reports of more than 4,000 adult Americans, using it for pain, insomnia, anxiety, and other health problems. This has created many questions for both employers and employees. The primary one is “Can I test positive if I use CBD products?” Problems arise when employees test positive for THC but then claim to be using a “THC-free” or “pure CBD” product. If the product has less than 0.3% of THC, and the employee isn’t smoking or using other marijuana products, we generally would expect the employee’s drug test to return a negative test result.

Transportation’s drug testing regulations to use marijuana. Since the use of CBD products could lead to a positive drug test result, Department of Transportation-regulated safety-sensitive employees should exercise caution when considering whether to use CBD products.” Drug-Testing Resources A good resource to give employees about the dangers of using CBD products if the employee is subject to drug testing is the Consumer Reports article “Can You Take CBD and Pass a Drug Test?” https://www.consumerreports.org/cbd/can-you-takecbd-and-pass-a-drug-test/ In February 2020, the Department of Transportation issued new guidance on CBD, https://content.govdelivery.com/accounts/USDOT/bulletins/27bd19f. Safety-sensitive employees who are subject to drug testing specified under 49 CFR part 40 (Part 40) include: pilots, school bus drivers, truck drivers, train engineers, transit vehicle operators, aircraft maintenance personnel, fire-armed transit security personnel, ship captains, and pipeline emergency response personnel, among others.

What You Might Not Know about CBD While employers and DOT do not test for CBD, CBD products often have more THC than claimed. For example, a 2017 JAMA study found that 18 of 84 CBD products, all purchased online, had THC levels possibly high enough to cause intoxication or impairment. And those elevated levels might also be high enough to cause an employee not to pass a drug test. It is also possible that over time, the small amounts of THC allowed in CBD products could build up in the body to detectable levels. DOT’s Drug and Alcohol Testing Regulation, Part 40, does not authorize the use of Schedule I drugs, including marijuana, for any reason. CBD use is not a legitimate medical explanation for a laboratory-confirmed marijuana positive result. Therefore, Medical Review Officers will verify a drug test confirmed at the appropriate cutoffs as positive, even if an employee claims they only used a CBD product. It remains unacceptable for any safety-sensitive employee subject to the Department of

Opportunity for EAPs EA professionals working with employers who have DOT-regulated employees can assist employers in reviewing their policies and revising their policies to address CBD use; training their managers and supervisors on how to address situations where an employee defends a positive drug test by claiming use of CBD; educating employees about CBD; and having a conversation with their drug testing providers about CBD and the lab’s drug testing and reporting processes. The best advice for employees who get tested: Stop or skip using CBD products if faced with drug testing at work. That’s the only way to ensure that CBD won’t trigger a positive test result for THC. And that includes stopping use of topical CBD lotions, oils, and cosmetic products. v - Tamara Cagney

Shifting Perspectives Legislation legalizing recreational cannabis is everywhere – and more and more states are heading in that direction. In many industries where there are safety sensitive jobs and many jobs involve operating heavy equipment and manufacturing drug use in the workplace will always be a serious concern for employers. Increased access to cannabis combined with a decreased perception of harm have resulted in a variety of protections being enacted for cannabis users. What does all this mean for employers who aspire to maintain zero tolerance drug policies? Experts are advising employers to start treating cannabis use more akin to how employers treat alcohol. Of course, there may be exceptions, say for employees in certain safety-sensitive positions or those subject to federally mandated testing procedures. But the days of blanket zero tolerance drug policies, at least for cannabis, may be behind us. Additionally, employers must understand the intersection between the Americans with Disabilities Act (ADA) and medical cannabis usage. While employers are never required to permit on-the-job cannabis usage, they are required to reasonably accommodate an employee’s qualifying disability under the ADA and must still engage an employee in the usual interactive process under the ADA. When adverse employment decisions appear too closely related to the disability itself, rather than cannabis usage, courts have reacted negatively. In addition, mainstream attitudes toward cannabis usage are changing. Moral opposition to cannabis use will not be a good defense for an employer if a disabled individual seeks relief from legally using cannabis under state law.

In states that require accommodation, if an employer wishes to maintain a zero-tolerance drug free workplace policy, it should consider identifying and developing a legally defensible business justification for why it is unreasonable to accommodate off-duty cannabis use. This will require the employer to study medical cannabis usage and consult with legal counsel. If no such legally defensible business justification exists, the employer may consider modifying its policy for the business. 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. Tamara is the chief trainer for EAPA’s two-day trainings for DOT substance abuse professionals (SAPs) focused on assessment, level of care, and follow-up testing determinations and return-to-work issues for DOT-regulated employees. Tamara can be contacted at tcagney@sandia.gov.

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Contact Larnita Day, Development & Donor Relations:

Opportunity for EAPs In this complicated and changing environment, EA professionals can help employers ensure that their policies regarding drug testing comply with the laws of the states in which they operate, are clear and enforced consistently. Additional consideration is obviously needed for unionized facilities, including looking closely at applicable collective bargaining agreements, and understanding that labor arbitrators often view off-duty conduct differently than workplace misconduct.

(303) 242-2046, development@eapassn.org 21

workplaceviolenceopinion Run, Hide, Fight

The Case for ‘Common Sense’ Gun Control |By Daniel Hughes, PhD, CEAP

The Role of Firearms The role of firearms in America’s westward expansion would become mythic. Gun culture and the legend of the American West became synonymous. In 1873 Colt introduced the Single Action Army (SAA) revolver known as “the Peacemaker.” It quickly became standard issue among the U.S. Cavalry. Similarly, Winchester produced its model 1873 repeating rifle. Together these weapons earned the reputation as the guns that “won the west”. A modified version of the SAA known as the Colt Frontier was engineered to use ammunition compatible with the Winchester 1873. Accordingly, a well-armed cowboy of the day would carry both the Colt Frontier and the Winchester capable of firing the same bullets. Reportedly, these weapons were involved in the historic Arizona Gunfight at the OK Corral. Fast forward to today and incidents of gun-related mass violence have become commonplace. Schools, workplaces, night clubs, movie theatres, and concert venues are all targets for armed assaults. In 2017, over 50 people were killed at a country music festival in Las Vegas. School shootings, such as Columbine and Sandy Hook, are particularly horrific. Recently, a group of Florida high school students shamed politicians for protecting guns rather than students. Today the country remains divided over its relationship to firearms. Political arguments on all sides are driven by deeply held positions regarding the ownership and use of firearms. For some, gun ownership is an inalienable right protected by the United States Constitution. For others, guns are driving an American public health crisis. This issue has become a wedge dividing individuals and communities.

was first introduced to American gun culture in 1960 when I spent six weeks in Wyoming. I was ten years old and spent the summer with my uncle, Cleo “Doc” Davis. Uncle Cleo was a self-identified “cowboy” who was born in Scotts Bluff, Nebraska and raised in Laramie, Wyoming. He served in the Merchant Marine during World War II and trained as a chiropractor on the GI Bill. Following his marriage to my mother’s sister, they settled in Wyoming where he opened a practice. I arrived in Casper, Wyoming, after a two-and-ahalf-day train journey. We attended a re-enactment of the Pony Express commemorating the 100th anniversary of the legendary trans-continental Postal rides. As I watched, two riders completed a flawless, albeit furious, exchange of a mail pouch. The crowd whooped and cheered with delight. I quickly learned that Wyoming was far from Brooklyn. It was a summer of new experiences. I visited Yellowstone, attended rodeos, wore cowboy boots, explored alpine forests, and was introduced to the thrill of hunting. Uncle Cleo was a classic outdoorsman. He had grown up hunting and fishing. Each year he would obtain a license and harvest an elk. He would dress out the animal and prepare it for freezing. Elk meat would provide his family protein throughout the year. It was a lifestyle he cherished. He taught me to shoot responsibly, emphasizing safety. Repeatedly, he would remark that “all guns are loaded and every horse kicks.” He also cautioned that one should respect the power of nature. “Out here weather can kill you,” he’d say. These were valuable common sense lessons for a 10-year-old kid from the city. Today, in the wake of multiple school shootings, we teach 10-year-olds to “run, hide, and fight.”

Return to Wyoming In 1991, I returned to Wyoming with my family. We planned a road trip from Riverton to Glacier 22

National Park. I spent some time with “Doc” Davis, who had acquired a valuable collection of over 200 firearms. He had aged and no longer participated in his annual elk hunt. However, he was proud of his gun collection, which included a variety of shotguns, pistols, hunting rifles, and antique muzzle loaders. Each evening he would show me items from his collection including a “Dirty Harry” 357 magnum revolver, a vintage German Luger, and a prized pair of Centennial Commemorative Colt Peacemakers. My young son was mesmerized as he too was instructed that “all guns are loaded and every horse kicks.” Following a visit to the local gunsmith, Doc and I spent a day at the firing range where he instructed me in the use of his favorite hunting rifle, a 257 Weatherby. Owning a gun in Wyoming was as natural as owning blue jeans or boots. He asked his wife to give me the Peacemakers when he died. “Doc” Davis died three years later. To my knowledge he never shot a man nor was he ever involved in a gun-related accident. The Conundrum Facing America Herein lies the conundrum facing America, guns are no more evil than hammers, knives, airplanes or automobiles. Each can be used to kill. However, firearms can be and increasingly are used for malevolent purposes. Accordingly, it would seem that common sense solutions to gun ownership are needed. As a society we have imposed reasonable restrictions on access

to alcohol, tobacco, and automobiles. I have no problem restricting access to firearms for violent criminals, including those convicted of domestic violence. Similarly, people with certain mental health conditions such as major depression with suicidal intent should be protected from easy access to guns. Accordingly, carefully regulated background checks make sense. This will not prevent all homicides or suicides but rather reduce their prevalence and create opportunities for prudent intervention. I oppose arming teachers. Children should not be allowed unrestricted access to firearms. We don’t give teenagers the keys to the car without instruction. Adults should be held responsible that children are taught basic life skills and safety techniques. Lastly, access to military grade weapons such as automatic assault rifles, rocket-propelled grenades, and stinger missiles should be regulated. It defies reason that a troubled 16-year-old adolescent could be permitted to purchase an AR-15. Unfortunately, these issues are frequently distorted and manipulated for political and economic advantage.

proud to own them and pass them along to my children. Uncle Cleo understood that gun ownership was both a privilege and a responsibility. The development of common sense regulations addressing the public health impacts of firearm violence will require flexible solutions and the capacity for reasonable compromise. It would seem that teaching our children that “all guns are loaded and every horse kicks” is preferable to teaching them to “run, hide, and fight.” v Daniel Hughes, PhD, CEAP, is an Associate Professor of Environmental Medicine and Public Health and an Employee Assistance Professional who lives, works and writes in New York City. He may be reached at daniel.hughes@mountsinai.org.

Summary Americans have historic attachments to firearms. This is a cultural reality that should not be dismissed nor ignored. Guns are part of America’s material heritage. They are part of our national history and identity. Eventually, my aunt sold “Doc” Davis’ entire firearm collection including the Peacemakers. I wish she hadn’t. I would have been 23

featurearticle Threat Assessment Teams and EAPs | By Daniel Hughes, PhD, CEAP educational settings were being invited to join TAM teams. This has provided EA practitioners with an excellent opportunity to draw on their behavioral/ mental health expertise and demonstrate the added value of EA practice.

“The FBI has designated 27 shootings in 2018 as active shooter incidents.” U.S. Department of Justice (2019)

ince 9/11, EA practitioners have embraced the methods and techniques of critical incident response (CIR). Unfortunately, active shooter incidents involving acts of intentional violence have become increasingly commonplace (Blaire & Schweit, 2014). Frequently, these events occur in the workplace and require employee assistance intervention (Inveldt, 2020). This article will discuss the emerging field of Threat Assessment Management (TAM) and its implications for EA practice.

The TAM Model: Three Phases The TAM model evolved from the Exceptional Case Study Project (ESCP) conducted by the United States Secret Service (Fein & Vossekuil, 1999). This influential report involved a retrospective analysis of 83 assassinations or near assassinations of public figures. It concluded that prevention would rest on “three distinct yet highly interconnected phases: identification, assessment, and management” (Simon & Meloy, 2017:631). The following is a brief look at each phase.

Background On April 16, 2007, a troubled student went on a shooting rampage at the Virginia Polytechnic Institute. By day’s end thirty-two people were killed, seventeen were injured, and the shooter committed suicide. An entire university community was traumatized, and Virginia Tech’s external EAP was fully engaged with the CIR efforts. In response to this, and other tragedies, both law enforcement officials and behavioral health professionals began to focus on prevention. Accordingly, TAM teams evolved as a best practice and potential deterrent to mass shootings (Simons and Meloy, 2017). They are based on the notion of a pathway to violence, which provides a framework to understand risk-based mindsets, motivations, intentions, and behaviors (Fein, Vossekuil & Holden, 1995). Broadly defined, TAM includes a set of investigative techniques designed to identify, assess, and manage the risks of targeted violence (Simmons & Meloy 2017:627). Targeted violence refers to planned predatory, instrumental or offensive violence. Frequently, these behaviors are detectable, thus providing opportunities for intervention (Fein & Vossekuil, 1998; US Department of Defense, 2012). Universities quickly embraced this approach and soon many of our EA colleagues embedded in higher

Identification The first phase begins with procedures to identify persons of concern who may be on a pathway to violence. Typically this involves the reporting of observed behaviors, threatening statements, and communications, including electronic and social media posts. Reports are triaged and, if considered serious, passed along to the TAM team for further evaluation. Assessment The second phase relies on thoughtful data collection and analysis in which multiple sources of information and behaviors are examined. Personal, employment, and medical histories are all relevant. All sources of information are to be used discretely. Access to firearms should be considered. Clearly, steps must be taken to protect the individual’s confidentiality and legal rights. Ultimately, the goal is to determine if the individual is moving from thoughts of violence to action. Management The third phase involves a range of interventions from individual interviews to consultation with 24

significant others and law enforcement officials. Interventions should be progressive, carefully tailored to the situation and designed to reduce the risk of violence. Interventions may include mediation, de-escalation techniques, surveillance, and in cases of criminal behavior, legal action. Some states have implemented red flag laws permitting temporary removal of firearms. Interventions that increase risk should be avoided.

process with waxing and waning levels of risk. Therefore, team members must be thorough, persistent, and composed. Interdisciplinary Focus By definition, threat assessment teams are interdisciplinary in composition. Typically, they include human resource, legal, medical, security, behavioral health (including EAP), information technology, and forensic consultation. Their effectiveness is greatly enhanced by senior management representation and support. The integrated systems approach allows each discipline to contribute according to its expertise and the nature of the situation encountered. Decisions are based on consensual agreement and shared responsibility for interventions. At Mount Sinai the TAM team is led by the Senior Vice President responsible for security issues throughout the system. It meets on an as needed basis. I was invited to join the team as a result of my involvement in critical incident response initiatives, my advocacy of the TAM approach, and my clinical experience with angry and distressed individuals. For example, potentially violent employees are frequently referred to the EAP for assessment and de-escalation counseling. Similarly, employees being stalked by an intimate partner are referred to the EAP for counseling and referral to the security department for safety planning assistance. Frequently, this involves obtaining a court-sanctioned restraining order. HR and legal professionals assume the lead if disciplinary action, including termination, is indicated. Fitness for duty evaluations include our organizational medical staff. Decision making is a shared responsibility managed by the TAM leader and our forensic consultants. An important function of a threat assessment team is to collect and analyze data from multiple sources that could provide insight into the motivation, intention and preparation regarding a person of concern. The goal is to prevent an incident of violence from occurring. Clearly, EA professionals can play an important role within this team-based approach. However, EAPs must advocate for their inclusion and demonstrate their value. It requires a commitment to the process, organizational alignment, and a willingness to upgrade their skill sets to include methods and techniques rooted in behavioral science, specifically forensic psychology.

Six Core Principles The TAM process is based on six core principles: 1) Targeted violence is the end result of an understandable, often discernable process of thinking and behavior (i.e. the pathway to violence); 2) Targeted violence stems from an interaction between the individual, the situation, the setting, and the target; 3) An investigative, skeptical, inquisitive, mindset is required; 4) Effective threat management is based on facts rather than traits, characteristics or impressions (i.e. evidence based); 5) An “integrated systems approach” should guide the process; and 6) The central question of a threat assessment is whether a person actually poses a threat rather than has made a threat. These six core principles lay out the basic elements of TAM. People on the pathway to violence demonstrate discernable behaviors that may include angry communications or threatening statements. Their interactions can be contentious, adversarial, and litigious. Perceived grievances are salient. Stalking and probing behaviors are significant, and the acquisition of weapons and firing range practice are frequently alarming. An understanding of the context is critical as the focus should be on the individual and the situation. This is particularly important in workplace investigations. TAM teams must emphasize facts over impressions, traits or opinions. It is an evidence-based process involving structured professional judgment. It requires interdisciplinary perspectives to analyze a complex situation involving a person of concern and their environment. The goal is to determine the potential risk of violence as opposed to the level of anger and acrimony. It is a fluid and dynamic 25

featurearticle Case Example Recently I participated in a threat assessment evaluation involving a highly trained employee in a safety sensitive position. He was engaged in an acrimonious whistle blower complaint. His superior thought he was angry and disruptive to team operations. The employee had a background in law enforcement and access to firearms, further alarming the administration. Recent shootings in academic health care facilities also elevated concern. Based on his observed anger and agitation the TAM team recommended an EA consultation. I interviewed the employee and conducted a thorough assessment focusing on both risk and protective factors. He reported a diagnosed history of PTSD, secondary to his experiences in law enforcement. Additionally, he had experienced a series of childhood traumas for which he had sought treatment. He was stressed and upset by what he perceived as organizational hostility. However, he was insightful and capable of using EA counseling to sort through his emotions. He had strong and protective social supports. I was able to help him ventilate, manage his anger, and develop a plan to move forward without posing a risk to himself or to others. I advised the TAM team that the employee was stressed but composed and not an imminent risk. Eventually, he was able negotiate a mutually acceptable resolution to his complaints without incident.

As behavioral health experts, employee assistance professionals are frequently asked to respond to situations involving employees who may pose a threat to themselves or others. While each case needs to be carefully assessed, experienced EA professionals are well qualified to evaluate and assist with these situations. Moreover, *embedded practitioners with intimate knowledge of organizational culture and dynamics are well positioned to participate in thoughtful, evidence-based risk assessments. (*This term refers to services provided by EA practitioners employed by and within the context of the host workplace.) TAM discussions are sensitive, confidential, and discrete. Although this may pose challenges for external providers, it is consistent with the basic principles of EA practice. Interestingly, many university-based EA practitioners have become critical members of organizational threat assessment teams. Summary Ideally, TAM is an activity best suited to an EA practitioner who is closely aligned with the sponsoring organization. It requires a working relationship with multiple internal stakeholders. Interested practitioners should be skilled, composed, and committed to the process. As noted, EA practitioners interested in threat assessment roles are advised to upgrade their skill sets to include methods and techniques rooted in behavioral science, specifically forensic psychology, and the previously mentioned core principles. The referenced article by Simons and Meloy (2017) is an excellent place to start. For more information, I would suggest contacting the Association of Threat Assessment Professionals (ATAP) at https://www.atapworldwide.org. v

Discussion Sadly workplace violence is on the rise and active shooter drills have become commonplace. Incidents involving intentional acts of targeted violence are particularly horrific. They impact schools, universities, government, military, health care, retail and manufacturing establishments – all of which are serviced by EAPs. TAM has the potential to move EA practice toward prevention rather than post-event response. It is based on sophisticated problem solving skills and represents a form of professional practice or knowledge work that is within the reach of most seasoned EA professionals (Hughes, 2007). TAM’s goal is to prevent incidents of targeted violence. Conceptually, TAM is consistent with the core technology of organizational consultation (Hughes 2010). It is a value-added activity that supports investment in a professionally staffed EAP.

Daniel Hughes, PhD, CEAP, is the Director of the Mount Sinai Health System’s EAP, an Associate Professor of Environmental Medicine and Public Health and a member of the Association of Threat Assessment Professionals (ATAP). He lives and practices in New York City. He may be reached at daniel.hughes@mountsinai.org.

References

Blaire, P. & Schweit, K. (2014). A study of Active Shooter Incidents in the United States between 2000 and 2013. Department of Justice, Federal Bureau of Investigation. Department of Justice (2019). Retrieved from https://www.fbi.gov/ file-repository/active-shooter-incidents-in-the-us-2018-041019.pdf.

Hughes, D. (2010). The key role of participant observation in organizational consultation. Journal of Employee Assistance, 40(4): 20-23. Inveldt, R. (2020). Applying the MSRA approach to mass shooting incidents. Journal of Employee Assistance, 50(1): 28-31.

Fein, R., Vossekuil, B. &Holden, G. (1995). Threat Assessment: An approach to prevent targeted violence (Publication NCJ 155000). Washington, DC: U.S. Department of Justice, Office of Justice Programs, National Institute of Justice. Fein, R. & Vossekuil, B. (1999). Assassination in the United States: An operational study of recent assassins, attackers, and nearlethal approaches. Journal of Forensic Sciences (44) 321-333.

Simons, A. & Reid Meloy, J. (2017). Foundations of Threat Assessment Management. In V.B. Van Hasselt, M.L. Bourke (eds.) Handbook of Behavioral Criminology.

Hughes, D. (2007). EA Practice as Knowledge Work. Journal of Employee Assistance, (37)4.

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Loneliness at a Record High Level

Tips for Coping with Depression in the Workplace

Three in five adults experience loneliness and social isolation, pushing the social determinant of health and mental health challenge to its highest level on record, according to the 2020 Loneliness Index from Cigna. Using survey data from over 10,400 adults and the UCLA Loneliness Scale, the 2020 Loneliness Index assesses self-reported and subjective feelings of loneliness or social isolation. Nearly 61 percent of all respondents reported to have at least some level of loneliness, which is a seven-percentage point increase from last year’s Index report. The reasons for the increase in loneliness and social isolation are manifold, the Cigna researchers said. Notably, the researchers identified a link between the loneliness increase and the work habits of the average American. Most individuals will complete nearly 90,000 hours of work across their lifetimes, and perhaps surprisingly, it’s those who work less than they’d like who are more apt to feel lonely. Employee loneliness is having a bad impact on business, Cigna added, with those who report loneliness being less productive, more likely to miss work, and less able to submit quality work. Cigna encouraged employers to foster better culture within their offices as a part of the payer’s efforts to address social isolation. Offices may promote a culture of openness, while pushing the use of technology to make connections with co-workers and other teambuilding activities.

Do any of your employee clients with depression struggle to make it through their workday? As well as the obvious – help from the EAP – the following are some additional coping strategies from Blue Sage Career Strategies:  Start with small changes at work. Is it the employee’s job that’s actually making him depressed? Both internal and external factors in the workplace can contribute to depression. Ask the client to take a look at the list of reasons his job may be making him depressed and identify some small changes that might make a big difference. Sometimes, even a change as simple as making taking a 30-minute lunch break out of the office can do a world of good.  Break assignments or tasks into small chunks. The employee client with depression needs to ask, “What is the first thing I need to do for this project?” Work with a manager to break the assignment into small pieces and set reasonable deadlines for each piece. Working in small chunks feels more manageable and less overwhelming than looking at a massive project the employee may be facing.  Allow extra time to complete job-related tasks. Brain fog is real. It takes extra time to cut through the fog and complete a task. It’s important for the employee to acknowledge that he is moving a little slow and allow more time to complete each task. The client is recovering from an illness and needs to give himself a break. v 27

featurearticle Trauma-Informed Care Best Practices for EAPs

| By Leah Szemborski

he National Council of Behavioral Health calls trauma from adverse childhood experiences the “hidden epidemic” (2020). “Trauma-Informed Care [TIC] is an organizational structure and treatment framework that involves understanding, recognizing, and responding to the effects of all types of trauma” (Trauma Informed Care Project, 2018). TIC isn’t a clinical intervention, although it certainly helps to inform clinical intervention. Rather, TIC is a way of seeing and responding to people who have likely been impacted by trauma by providing safety, compassion, and mindfully avoiding re-traumatization. If unaware of the presence and impact of traumatic experiences, EA professionals will miss opportunities to support employees and employers in recognizing and responding to the trauma epidemic.

sensitive and tearful over constructive criticism, or a person who becomes patronizing and derogatory toward co-workers may both be indicating past trauma experiences. An EA professional may employ well-meaning interventions that have little to no effect if underlying trauma is not addressed or acknowledged. Trauma manifests in many ways, and unless a person is intentionally looking for the signs, it may be missed completely. Trauma-informed helpers are trained to see trauma where others just see chaos. Developing the TIC Model Trauma-Informed Care has been a work in progress for over 40 years. It began with research on war veterans and post-traumatic stress, and expanded to include individuals who had experienced other major life trauma within the mental health community. In the 1990s SAMHSA began to look at trauma in the context of women and gender, and in 1994 convened the Dare to Vision conference to look at and address issues of trauma, especially as it related to female abuse victims and the re-victimization from well-meaning service institutions. From there the idea of “Trauma-Informed Care” began to increase momentum, and in 2001 the National Center for Child Traumatic Stress was born. This organization began to steer evidence-based interventions to inform clinical practice and organizational structures that supported, empowered, and assisted recovery in individuals who have experienced trauma. These initiatives were integrated in many service systems including schools, juvenile justice, child welfare, and health care systems. In 2012 the US Department of Health and Human Services, along with SAMHSA created a trauma-informed approach guided by 10 principles (Encyclopedia of Social Work, 2013). Over time these

Background: ACEs Many helping professionals have heard of the ACEs (Adverse Childhood Experiences) study. The original study investigated childhood abuse and neglect and the correlation to health and well-being later in life. Nearly 66% of participants had at least one ACE, and more than 20% of participants had three or more. In addition, researchers found that as the number of ACEs went up, so did the risk for many types of health problems including: alcoholism, depression, drug use, poor work performance, financial stress, domestic violence, smoking, suicide attempts, and more (Center for Disease Control and Prevention, 2016). An employee who presents with chronic anxiety, depression, high reactivity, or other maladaptive behaviors might be expressing symptoms of past trauma. For example, an employee who is overly 28

10 principles have been whittled down to six, which are described in detail later in this article.

Finally, EA professionals can adopt trauma-informed interventions with their clients.

Introducing TIC to a Workplace In the workplace, many managers often feel illequipped or frustrated at their inability to “manage” difficult employees. Well-meaning leaders may try walking on eggshells so as not to upset the person, come down hard with punitive measures, or simply throw their hands up in exasperation. EA professionals are in a position to coach managers on the idea of trauma-informed care by helping them to see their employee’s behaviors through a traumainformed lens. This strategy not only helps the manager be better equipped to deal with chaotic or upsetting behaviors in a calm, compassionate way, but may also help the manager not to take negative interactions personally, or blame themselves for problems the employee may cause. When employees and leaders begin to understand trauma, its impacts, and best ways to respond, there is often a sense of relief and higher sense of control in managing difficult interactions and behaviors in the workplace.

Case Study Consider one team of nurses in a small primary care clinic. The manager called EAP because the team culture was very unhealthy—negativity, mistrust, and sometimes outright aggression towards one another. The manager had tried everything he knew— talking to each person individually, team building activities, and finally threats of corrective action. His efforts resulted in minimal improvements at best. The responding EA professional utilized the six principles of TIC to intervene in effective and empowering ways that made a lasting impact on the team. Principle 1: Safety. This refers to both physical safety as well as psychological safety. Traumainformed care stresses the need for interactions that help others feel secure—all voices will be heard, respected and validated, and no one will suffer retaliation for unpopular ideas or mistakes. In the case above the EA professional decided to meet with the entire nursing team in order to assess team dynamics, explore root issues, and prompt individuals to commit to positive change. Prior to the meeting she initiated safety by coaching the manager on appropriate responses to negative or critical comments. The EA professional believed it was crucial that people be able to speak honestly without any retaliation or critical remarks from the leader.

Pushback to TIC is Lessening In some instances managers may feel like traumainformed care is “coddling” a person who just needs to learn how to behave. Unfortunately this attitude still persists in the workplace, and in society at large, but the good news is that with the great work and education being done through organizations like SAMHSA and the National Child Traumatic Stress Network, attitudes are changing and stigma is breaking around trauma, and mental illness as a whole. More and more organizations, leaders, managers, and employees alike are eager to adopt trauma-informed care practices in their personal and professional lives.

Principle 2: Trustworthiness and transparency. Organizations that operate with transparency communicate openly and honestly. They help both employees and customers feel informed and confident about policies, procedures, services, and expectations.

Foundation of TIC As mentioned, Trauma-Informed Care (TIC) is based on six key principles (SAMHSA, 2014). EA professionals can advocate for a traumainformed approach in multiple ways; first, by integrating the six foundational principles (explained below) within their own EAP work. Second, by educating client organizations about trauma-informed approaches when appropriate.

After laying the ground rules for the meeting, the EA professional was transparent in explaining what precipitated EAP involvement and the purpose of the meeting—to assess and resolve root issues that perpetuate conflict and negativity, with the intention of creating a more cohesive, healthier team dynamic. She explained that the conflict resolution process can be uncomfortable—even tense at times, but tension is often a necessary part of the process. 29

featurearticle She stated that she believed every person could tolerate and work through the discomfort, however, if the conversation turned unsafe (such as name calling, yelling, aggressive gestures, etc.) she would intervene immediately.

into job duties they weren’t certain they could perform, therefore making a lot of incorrect assumptions and mistakes. In turn, seasoned staff perceived that new staff just didn’t care or were not as invested in the work. The EA professional pointed out the contrasting perspectives, and the team was able to problem-solve the issue by suggesting an informal peer-support process: new staff would be paired up with seasoned staff members for weekly meetings to ask questions, problem solve issues, or discuss concerns.

As participants began to open up it wasn’t long before one gentleman, Tom, became upset. He pointed his finger at a co-worker, saying loudly, “You never listen! You act like you’re so much better than everyone with your holier-than-thou attitude!” The EA professional was quick to put her hand up and say in a loud voice, “STOP!” All eyes turned to her and it got quiet immediately. The EA professional reiterated the ground rules and helped Tom voice his concerns in a more appropriate way.

The leader agreed to pilot this for three months. There were some snags in the execution, but the outcome was largely successful. Not only did new staff gain confidence in their skills, trust was built within the team, and experienced staff found that their mentees had insights and resources to offer as well. This process of peer support, collaboration, and mutuality proved to be a win for everybody.

The EA professional demonstrated trustworthiness in following through on her commitment to ensure safety in the meeting. Many people commented to the leader afterward how glad they were that Tom wasn’t allowed to berate others in the meeting, as this was a behavior that he exhibited frequently without repercussions. In addition, by boldly enforcing limits on unacceptable behavior, the EA professional was modeling for the manager, who needed to improve his skills in this area to ensure psychological safety for the team.

Principle 5: Empowerment, voice, and choice. Those who survive trauma know the vulnerability and fear resulting from those experiences. Offering safe environments where individuals are encouraged to speak up and make meaningful decisions regarding their life, work, and leisure is integral to recovery.

Principle 3: Peer support and mutual self-help. Modern business is no longer a top-down world. Good ideas, strength, and support can come from anyone, in any position, as long as individuals are open to be both supporting and supported. EA professionals can help companies implement policies, procedures and development opportunities that leverage peer support and mutuality.

At the initial nurse meeting, the EA professional was careful to ensure everyone’s voice was heard within the context of a safe, supportive environment. Some great solutions were born from that meeting, but one meeting was not enough to resolve the deeply rooted issues. In the second meeting the EA professional brought educational materials about personality differences and conflict styles. She was careful to use a strengthsbased perspective, but was also direct and honest about problem areas. As the EA professional discussed the trait of sensitivity, Jennifer became very upset and tearful. She explained that she was offended, and felt like she was being targeted.

Principle 4: Collaboration and mutuality. This principle implies that there are power differentials in basically every relationship. When possible, organizations can move beyond those dynamics in order to share power and make collaborative choices that encourage participation and ownership from everyone involved.

The EA professional thanked Jennifer for being honest, and silently assumed that this conversation had likely been a “trigger” for Jennifer who may have a history of trauma based on her highly reactive response to the conversation.

During the nurse team meeting it became apparent that some of the frustrations were stemming from inadequate onboarding—individuals were “thrown” 30

The EA professional gave Jennifer an option to either continue in the discussion, or take a break from the meeting and talk privately afterwards. Jennifer decided to abruptly pack up her things and walk into the hall, shutting the door loudly behind her.

professional could see that there were some on the team who were perpetrating victimization by their aggressive reactions and controlling behavior. By approaching this team with a trauma-informed lens, the EA professional was able to embrace the six principles of TIC to provide safe and effective interventions on the group level, as well as engage some individuals to do their own work privately. In addition, she was able to coach the leader on how to utilize TIC principles in the workplace to enhance safety, teamwork, and collaboration, while still holding each person accountable to standard expectations. Organizational leaders and EA professionals might be ready to embrace the six principles of TIC, but may not be sure how to begin. There are many training and consulting programs available online and in person to support EAPs on their trauma-informed journey. A few organizations that can help include the Traumatic Stress Institute (https://traumaticstressinstitute.org/) and ACES Connection (https://www.acesconnection.com/).

When the EA professional met with Jennifer afterwards, they were able to have a candid conversation about her reactions. Jennifer explained that when she was young her mom always made fun of her for being sensitive, and the group discussion made her very agitated. The EA professional validated Jennifer’s willingness to share this. She also gently pointed out how Jennifer’s reactions affected the team and offered that she could make an appointment to talk more about her triggers and how she could better manage her reactions in the workplace. The EA professional wanted to validate Jennifer and her experiences, but also empower her to make some positive changes—if she wanted to. Because Jennifer felt supported by the counselor, she was open to meeting again.

Manager Referrals and Consultation EA professionals are in a position to provide basic education to organizations on TIC, as well as coach employers on ways they can put these principles into practice. In addition, EA professionals can also consult with leaders to work with “difficult,” or emotionally volatile employees who may have a history of trauma. Instead of responding to emotional outbursts with punitive measures, managers might refer the employee to the EAP where they can be assessed and, if relevant coached on strategies to regulate emotions and calm the overactive fight or flight system. These interventions don’t have to be limited to individuals with trauma histories—the great thing about TIC is that the principles are safe, effective, and empowering for any individual, regardless of their exposure to trauma.

In addition, the EA professional followed up with the manager regarding Jennifer’s reaction in the group. Since this type of occurrence happened frequently among the team, the manager was open to suggestions on how to handle these kinds of situations. Going forward he committed to accept and validate an employee’s feelings before asserting expectations, and then follow up with a “how can we solve this together?” type of response that invited dialogue and collaboration from the employee rather than defensiveness. Principle 6: Cultural, historical, and gender issues. Every person has a story—experiences, perceptions and events that have shaped them to be who they are. Trauma-informed care sees every life within a broader context and acknowledges the impact these experiences have on the person today.

Trauma Informed EA Counseling Considering the pervasiveness of trauma, EA professionals might consider conducting a simple trauma screening as part of their standard assessment, especially if the client’s concerns are chronic or pervasive.

Through her work with the nursing team, it became apparent to the EA professional that there were some in the group who had histories of trauma, and their current perceptions and reactions were shaped by those past experiences. In addition, the EA

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featurearticle Impact of the Coronavirus on EAPs

Managing the Fear of Communicable Disease | By Jeff Gorter, MSW, LMSW

or fall prey to unsubstantiated “quack scams” (“I heard that Oil of Oregano is a sure-fire way to protect against coronavirus, and I found a helpful website that will take my credit card order!”).

Perfect Opportunity for Panic This creates a perfect environment for panic, which does nothing to address the challenge but instead wastes time, money, and emotional resources, often leaving us with a false sense of “having done something.” There is a real and tangible danger of panic as suspicions grow and disrupt companies, organizations, and communities when coordination and support is most needed. History has shown that isolation usually only breeds more fear, not comfort, as the potential for a xenophobic or racially scapegoating atmosphere can quickly develop – which is emotionally toxic to any organization. Finally, the speed of social media fosters an “echo chamber” of skepticism and conspiracy theories, leading some to delay or avoid treatment (“I don’t want to go to a hospital…what if they quarantine me?”)

Role of Business Leaders and EAPs Business leaders play a critical role in addressing these fears, sharing real information and helping employees feel safe and confident at the workplace; in order to maintain the continued operation of your people and your business. But most business continuity preparedness plans focus solely on medical or logistical issues; few address the emotional impact. That’s a risk, as your plans are only as good as the people enacting them. EAPs play a critical role in addressing the behavioral health impact, particularly in coaching business leaders to lead during this challenging period. Here are some leadership tips that have proven effective in past public health crises to manage fear and encouraging hope and resilience: Maximize employee trust and effectively communicate risk and health information  Ensure you have appropriate crisis management and travel risk support.  Communicate early and often.  Share what you know and what you don’t know as the situation develops, with the assurance that you will share info as it becomes available and is verified. For example, a message such as “At this point, we are able to confirm that four of our team members are in quarantine for observation and their status at this time is stable. We cannot confirm when they will be released, but we will share that information as soon as it becomes official, along with regular updates as this situation develops.”  Use reputable sources, such as the U.S. Centers

nxiety about the spread of communicable disease such as Covid-19 (Coronavirus) is understandable, even unavoidable as traditional and social media coverage continuously provides us with daily, if not hourly, updates. Based upon available information about Covid-19, governmental actions related to travel restrictions, quarantines, and organizational decisions for offices, travelers and study abroad programs are already in effect and more will likely be enacted. And while the World Health Organization (WHO) and all affiliated nations are working to contain and counter this virus, realistically this disruptive event will likely last for months, leading many to respond with fear. From an emotional perspective, fear makes perfect sense – viral disease of any kind often triggers a vague and shadowy dread, when we are told of a threat without clear indications of what we can do about it.

for Disease Control and Prevention (CDC) for ongoing information (https://www.who.int/emergencies/ diseases/novel-coronavirus-2019).  Appoint a consistent messenger from the organization with the authority to disseminate information. Often this is a Senior Executive who is well-known and has an established reputation of leadership in the organization.  Use a flexible style of communication, sending a consistent message through a variety of mediums (email, text, corporate websites, etc.)  Ensure a two-way dialogue with monitoring of employee feedback. For example, soliciting employee input on concrete ways to support impacted team members or their families is often an effective and welcome avenue to focus altruistic initiatives.  Be attentive and responsive to the wide variety of react the same way; some may be anxious, others

may express anger, while others “just want to get back to work” (i.e. finding comfort and grounding in their predictable routines). Effective leaders are able to allow each group to adapt as best fits their milieu. Maximize adaptive behavior change  Create a central source of authoritative information regarding corporate response, resources, updates, etc. Some companies utilize and direct employees to their established website for updates, while others send out a daily Status Communique to keep the workforce informed.  Access and distribute fact sheets from a reliable source. Again, the CDC and the World Health Organization websites are dependable sources of factual information regarding illness prevention and precautions. continued on page 34

Precautions and Guidelines are Crucial

long with leadership support, EAPs can also serve as a trusted and verifiable conduit of practical information to all employees, particularly when it comes to promoting common-sense precautions to prevent the spread of any respiratory virus, including Covid-19. The following guidelines from the CDC offers reasonable and recommended actions all business leaders can encourage, and all employees can adopt:

Finally, accepting ambiguity is challenging -- no one can predict the exact sequence of events and the health crisis related to Covid-19 is not over. This challenge, as with any challenge, starts with managing our own stress and purposefully engaging in healthy coping skills. The following simple but effective guidelines help maintain the physical and emotional balance needed to respond to any substantive change and adapt accordingly, regardless of the stressor:

• Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing. • If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol. Always wash hands with soap and water if hands are visibly dirty. • Avoid touching your eyes, nose, and mouth with unwashed hands. • Avoid close contact with people who are sick. • Stay home when you are sick. • Cover your cough or sneeze with a tissue, then throw the tissue in the trash. • Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe.

• Maintain regular sleep and dietary patterns as best you can – there is surprising comfort and strength in attending to the basics. • Physical exercise (may require adaptations). • Be reasonably and appropriately cautious (see CDC guidelines). • Avoid isolating; stay connected with support systems (may require adaptations). • Avoid over-exposure to traditional network or social media reports re: Covid-19. • Keep moving forward -- set and act on small achievable goals. • Utilize the full range of EAP resources (electronic, print, 1-800-support lines, etc.) v - Jeff Gorter

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 Describe rationale for any policy/operational changes (travel restrictions, moves to a work-fromhome modality, etc.)  Ensure equal access and distribution of resources. While certain departments or areas may not be directly impacted, the entire organization will be concerned and will welcome the offer of appropriate resources calibrated to their situation.

to businesses and communities. He has responded directly to the Sept. 11 terrorist attacks, Hurricane Katrina, the Virginia Tech shootings, the Deepwater Horizon Oil spill, the earthquake/tsunami in Japan, the Newtown Tragedy, the Orlando Pulse Nightclub Shooting and the Las Vegas Shooting. He may be reached at jeff.gorter@r3c.com.

References

Pandemic Influenza Preparedness; Journal of Homeland Security and Emergency Management, 2006. The Centers for Disease Control and Prevention; www.cdc.gov.

Reduce negative social and emotional impact and improve healthy coping  Distribute information about coping and emotional self-care strategies via social media, print, website, etc. EAPs play a key role in assisting companies in this arena.  Promote resilience – set manageable goals, maintain optimism, take reasonable steps to ensure safety, encourage giving/receiving emotional support in creative ways, etc.  Utilize your EAP for telephonic support and as a resource for information.

World Health Organization; www.who.int, 2020.

Tips for raising awareness of your EAP:

Support key personnel in critical functions  Train workforce leaders on the importance of stress management and psychosocial support.  Empower staff with promotion of reasonable work adaptations (allow time to care for children if schools are closed, etc.)  Recognize that a range of emotional reactions such as grief, anger, fear, etc., are normal responses to this highly unusual situation.  Check-in often with information, support, and encouragement.

Get on a local speaking circuit. Don’t get pigeonholed into only hanging out with EA colleagues or just networking at EAP events. Utilize or join Chamber of Commerce, civic groups (think Lions, Rotary, etc.) and others to raise awareness of an issue or about EAP in general. Joining a business association related to EAP, such as the Society for Human Resource Management (SHRM) is another possibility. Have an elevator speech ready. If someone asked, “What does your EAP do?” would you know what to say in roughly 30 seconds? The following is an idea that one EA professional has used: “Anything worth losing sleep about, is worth coming in for.”

Summary The Covid-19 crisis, like many health challenges, will be resolved through the skill and expertise of medical health care practitioners, researchers, and epidemiologists who are already in pursuit of solutions. As EA professionals, our goal is to support and affirm the business leaders and employees who look to us for guidance, comfort, and yes, courage. And courage, to quote consultant Mathew Kelly, is “not the absence of fear, but the acquired ability to move beyond fear.” Let’s help them move. v

Utilize social media. Some people are intimidated about getting involved in social media, but don’t underestimate how much Millennials use these platforms to communicate. If you are on social media, how often? It should be on a regular basis to remain current.v

Jeff Gorter, MSW, LCSW, is VP of Crisis Response Services at R3 Continuum. Mr. Gorter brings more than 30 years of clinical experience including consultation and extensive on-site critical incident response

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Resources

EAPs have the opportunity to develop presentations about how to limit and manage screen time. And EAP counselors can develop the expertise to help clients of all ages manage our devices and social media. Once you have developed these services, promote them to your current and prospective client companies and the employees you serve. None of the anti-EAP companies are doing this. v

DIY Genetic Testing: Opportunity for EAPs - Tamara Cagney, Journal of Employee Assistance Vol. 50 no. 1 - 1st Quarter 2020 https:// issuu.com/eapa/docs/jea_vol50no1_1stqtr2020 “Planning and Implementing a 21st Century EAP from Zero to Go”, 2019 EAP Conference recordings. Presenters: Dr. Mike Klaybor, Marina London LCSW, September 24, 2019. St. Louis, Missouri. https://eapa. sclivelearningcenter.com/MVSite/MVStore.aspx?confID=3283 Tech Trends, “Moving Towards EAP 2.0,” Marina London. Journal of Employee Assistance Vol. 49 no. 1 - 1st Quarter 2019. Pages 6-7. 11. https://issuu.com/eapa/docs/jea_vol49no1stqtr2019

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.

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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 (members only). “Web Secret 541: Bypassing EAPs”. iWebU.info blogpost 10/17/18. Marina London http://www.iwebu.info/2018/10/web-secret541-bypassing-eaps.html?m=1

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Trauma screenings can provide valuable information to guide more targeted, short-term interventions as well as make better referrals to longer term care. Short-term interventions may include grounding and emotion regulation strategies to improve coping, but long-term interventions are usually indicated for individuals with chronic or pervasive trauma histories. There are many free trauma assessments online, such as the Life Events Checklist recommended by SAMHSA and HRSA (2020).

Leah Szemborski, LPC, has over nine years of experience in EAP counseling. She takes special interest in issues of trauma and domestic violence, as well as providing education and consultation to businesses on these critical topics.

References

Center for Disease Control and Prevention (2016). Adverse Childhood Experiences (ACES). Retrieved November 28, 2018 from website: https://www.cdc.gov/violenceprevention/acestudy/index.html Encyclopedia of Social Work (2013). Trauma-Informed Care. Retrieved November 19, 2020 from website: https://oxfordre.com/socialwork/view/10.1093/acrefore/9780199975839.001.0001/acrefore-9780199975839-e-1063. DOI: 10.1093/acrefore/9780199975839.013.1063

Summary Trauma from childhood experiences has been called the hidden epidemic. When EA professionals look for signs of trauma and reliably practice the principles of TIC, short-term interventions can be more effective, both for individual recovery as well as workplace culture improvement. On the other hand, if EA professionals are unaware of trauma and the principles of TIC, they may unwittingly cause more harm, or make recommendations that are not effective. EA professionals can use their knowledge of TIC to provide high quality client care, as well as coach, consult and support organizations in creating happy, healthy work cultures where employees can thrive. v

National Counsel for Behavioral Health (2020). Trauma from Adverse Childhood Experiences: The Hidden Epidemic. Retrieved February 12, 2020 from website: https://www.thenationalcouncil.org/webinars/trauma-from-adverse-childhoodexperiences-the-hidden-epidemic/. SAMHSA (2014). Guiding principles of trauma-informed care. Spring 2014, 22(2). Retrieved December 7th, 2018 from website: https://www.samhsa.gov/samhsaNewsLetter/Volume_22_ Number_2/trauma_tip/guiding_principles.html SAMHSA & HRSA (2020). Life Events Checklist. Retrieved January 21, 2010 from website: https://www.integration.samhsa. gov/clinical-practice/screening-tools Trauma Informed Care Project (2014). What is TIC? Retrieved December 4th, 2018, from website: http://www.traumainformed careproject.org/index.php

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