Journal of Employee Assistance Vol. 52 No. 2 2ndQtr2022 by Employee Assistance Professionals Association

The magazine of the Employee Assistance Professionals Association

2nd Quarter 2022 | VOL. 52 NO. 2

The Hidden Worker: Part II Considering Diverse Employee Needs during COVID-19 |Page 12

PLUS:

Mental Health Toolbox Growing For EAPs Page 18

The Facts Don’t Lie Page 26

ATIP: An Encouraging CIR Tool Page 34

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

contents EAPA Mission Statement

2ND Quarter 2022 | VOL. 52 NO. 2

cover story

The Hidden Worker: Part II – Considering Diverse Employee Needs during COVID-19

features

Brainspotting - A Useful Adjunct to Trauma Therapy

| By Josh Delahan, LCSW

| By Bryan McNutt, PhD, LMFT, CEAP

features

ATIP: An Encouraging CIR Tool for EAPs

| By Paula Harry MS, LCSW

Mental Health Toolbox Growing for EAPs

| By Ivan Steenstra, PhD, MS & Barb Veder, MSW, RSW

departments

The Facts Don’t Lie: Statistical Truths about the Business Value of EAPs

| By Mark Attridge, PhD, MA

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, Maria Lund, by calling (803) 530-2748 or sending an e-mail to journal@eapassn.org. To advertise in the Journal of Employee Assistance, contact 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. ©2022 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: Maria Lund Development Manager: Boyd Scoggins Designer: Varnau Creative Group

FRONT PAGE

Index of Advertisers

SAYING GOODBYE

EAPA CEAP®........................................2

LETTER TO THE EDITOR

SPOTLIGHT ON EACC

WEB WATCH

LEGAL LINES

EA ROUNDUP

EAPA – Denver Regional......................2 SAPlist.com....................................6, 15 Harting..................................................7 EAPA Annual Institute and Expo.........17 KGA....................................................31 Purchase EAP Conference.................33

frontpage EAPs Rise to the Challenge to Support Workplace Mental Health and Well-being | By Andrea Lardani and Bernie McCann, PhD, CEAP

he negative impact of COVID-19 on mental health has emerged as perhaps the defining issue for the contemporary global workplace. Multiple factors related to the pandemic have affected the wellbeing of individuals and the organizations in which they work. Research shows higher rates of depression, anxiety, and other psychological symptoms, particularly acute among women, young people, those with preexisting mental health conditions, health workers, and persons living in vulnerable conditions. Indications also point to an increase in incidents of domestic violence during the pandemic, a contributing factor in the development or worsening of psychological conditions. Like other health and well-being systems, mental health services have been severely disrupted during the pandemic. The evidence is clear that greater support for mental health from EAPs is needed more than ever. This unprecedented context compels EAPs to expand their toolbox to support individuals and to accurately measure client outcomes. Ivan Steenstra and Barb Veder illustrate this with the story of a man looking for his lost keys under a single lamppost. They outline the importance for EA professionals to assure that individuals receive the care most suited to their needs and to use the proper tools to measure improvement over time. In their article, the authors present various outcome tools effective for use with diverse presenting issues. EAPA Communications Advisory Panel Josh Delahan concurs that EAP practice requires variety, efficiency and effectiveness. He describes a brain/body/ mindfulness-based relational approach called Brainspotting and explains how it can be integrated with any preferred modality and is helpful for improving mental and emotional equilibrium in clients and EA professionals. Paula Harry presents a Critical Incident Response tool called Acute Traumatic Intervention (ATIP). This is a highly focused brief psychological first aid intervention, which she qualifies as ideal for use in EAP work. It is appropriate when clients are disturbed but still able to describe their experience. The goals of ATIP are to reduce emotional disruption, improve immediate functioning, and reduce the likelihood of more complex symptoms emerging. Bryan McNutt, author of this issue’s cover story, continues his exploration of the key role of EAPs in supporting diverse employees who have been especially hard hit during the pandemic. In this second article, he shows how EA professionals have the opportunity to nurture a workplace atmosphere that promotes psychological

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

Bernie McCann, Co-chair – Las Cruces, NM mccannbag@gmail.com

Mark Attridge – Minneapolis, MN mark@attridgeconsulting.com

Nancy Board – Seattle, WA nancy.board@des.wa.gov

Daniel Boissonneault – Hamden, CT eap700@comcast.net

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

Peizhong Li – Beijing, China lpeizhong@eapchina.net

Elena Sánchez Escobar – Madrid, Spain elena.sanchez@yees.es

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

safety. He notes that psychological safety inherently values diversity and inclusion, and as a result, fundamentally supports the needs of diverse employees. In another feature, Mark Attridge presents positive statistical data about the business value of EAPs. He provides succinct and data-driven facts that answer critical questions about the business value of EAPs, and offers a case study as an exemplar for EAP ROI. In the Legal Lines column, Robin Sheridan writes about new anti-discrimination laws forthcoming in 2022 in United States. She reinforces that Employee Assistance professionals should be aware of these changes, which will undoubtably affect both individual employees and their families and the organizations in which they operate. In the Spotlight on EACC column, with the new refreshed CEAP® credential now in place, Commissioner Ian Quamina—in conversation with upcoming nominees for three new commissioner positions—asks busy EA professionals why they decided to become an Employee Assistance Certification Commission (EACC) commissioner. The EACC and JEA Committee thank them for taking the time out of their busy schedules! Finally, readers are reminded to take a look at the “EA Roundup” and “Web Watch” to view more tools and resources for best practice.

Saying Goodbye to An EAPA Icon Highlights from his career at EAPA were the conversion of the EAPA database to make information and resources more accessible to members, the launching of a broad and interactive website and the CEAP Refresh which he hopes will be effective in credentialing more professionals to do EA work.

Chris Drake has retired – for the second time. He says this time it’s final. All of us who knew Chris and what he did for the profession are delighted for his road ahead, but we’re sad to see him go.

As he considers EAPA’s future, Chris hopes they will continue to innovate in their own practice and grow and support the ranks of EA professionals. He is excited about Julie Fabsik-Swarts for her fresh perspective on the association and its value proposition to members. Julie shares that “Chris has been the backbone of the Employee Assistance Professionals Association. For over 20 years he has commuted 2 hours each way to the office to serve the EA community-a tremendous work ethic! In addition to his career as a Naval Officer, Chris has significant education in finance and IT. His skills have helped EAPA have excellent financial records, all appropriate contracts, and skills in making all of IT systems work at peak capacity. We wish him well in his new life and hope he enjoys more time with his family and friends.”

For 20 years, Chris held the post of Financial Director at Chris Drake EAPA. Year in and year out, through all the changes the profession and association went through, Chris was a steady and strong force for EAPA and its members. Many of you probably remember being on the phone with Chris to sort out a problem or seeing him at the EAPA booth working with the team to keep the conferences rolling. Chris had an easy smile and gave the sense that no matter what was up, there would be a way to figure it out. Chris shared that he enjoyed supporting EAPA and doing this good, important work with his colleagues. He feels a strong sense of value in the profession and kept this though good times and bad. As he looks back over his tenure, he remembers truly enjoying the conferences – they were the highlight of his years. He loved bonding with his team and interacting with members – putting faces with the names of people with whom he had worked.

A hearty thanks to Chris for the gifts he so generously shared and congratulations to him on a fabulous and successful career in the EAP world. We are all better for it. We all wish him well as he moves on to catch up on family time with kids and grandkids (and fellow golfers) and sets a course on the next phase of enjoying life. 5

lettertotheeditor EAPs Work – Spread the Word it’s Confidential!

was continually absent from work when I was a substance abuse addict. And when I did make it in, my work performance and behavior significantly declined. My boss did the best she could to guide me toward getting help for my addiction, while constantly assessing how willing I was to seek out help myself. However, her main focus was on my work performance and related behavior.

After seeing no real progress, she finally asked Human Resources to step in and assign an EAP provider. HR said that the EAP would give me free counseling sessions and assist with any additional help I needed. My HR representative would periodically check on whether I’d called and would promote their usefulness; however, never did they specify the confidentiality I would have. I told myself: If my employer is suggesting that I call this number, well… what information are they going to relay back to my employer? If I ask my employer about what my confidentiality rights are, are they going to wonder why I am asking about confidentiality? Will that raise more questions and suspicion? So what did I do? I thanked them for the information and never used it. Sadly, I’m not the only employee who has gone through a scenario like this. I am just one of many employees who have been too scared to use EAPs to aid them in a crisis or other time of need. What may have been an avenue that could have stabilized my sobriety and improved my work performance, I shot down because of fear and ignorant these services were offered CONFIDENTIALLY. What’s more, EAPs work! A 2020 report about the Workplace Outcomes Suite, made available by the International Employee Assistance Professional Association, evaluated over 35,000 employees both before and after they received counseling by an EAP and examines changes represented in (1) Work Absenteeism; (2) Work Presenteeism – including Lost Production Time; (3) Work Engagement; (4) Workplace Distress; and (5) Life Satisfaction. Here are a few key highlights from that report: • The average employee case had 63 hours of unproductive time when in distress before EAP use. After counseling, the unproductive hours reduced by 43% – to 36 hours. • A typical EAP counseling case in the U.S. yielded cost savings ranging from about $2,000 – $3,500 per case attributed to improvements in work presenteeism and reduced absenteeism. • The ROI for EAP Counseling in the U.S. ranged from 3:1 for small size employers, 5:1 for medium size employers, and 9:1 for large size employers. EAPs not only benefit employee health and well-being, they clearly assist the organization as well. My hope is that after reading this, the reader will understand the importance of EAP. If you’re a business leader, remember: Your employees are counting on you, just as much as you’re counting on them. John Narine, DBA, CEAP 6 | JOURNAL OF EMPLOYEE ASSISTANCE | 2nd Quarter 2022 | • • • • • • • • • • • • • • • • • • • • | W W W . E A PA S S N . O R G |

spotlightoneacc ‘Why I Became an EACC Commissioner’ | By Ian Quamina, PhD, CEAP

ith the new CEAPR Refresh credential now in place, we switch gears in this column and—in conjunction with supporting upcoming nominations for the three new commissioners—ask busy EA professionals why they decided to become an Employee Assistance Certification Commission (EACC) commissioner. The EACC and JEA thank them for taking the time out of their busy schedules! Bryan Hutchinson kicks off the discussion.

Working with the commission has been both challenging and rewarding. It has been challenging because it has required broadening my awareness of EA issues and thinking through how the commission should be employing testing strategies. Being a commissioner has also been rewarding because we create test content, work through issues that arise with the CEAP R exam, answer exam appeals, and we get to work with other EA professionals and hear what their EA world is like. It is fascinating to discover the diversity of the employee assistance profession. Moving forward, the CEAP R Refresh is proving to be a very successful redesign. Ian Quamina and Sherry Courtemanche led the EACC through rethinking the CEAPR testing process. The CEAPR Refresh and all its challenges is a great example of how collaboration and EA expertise can improve the profession. I have thoroughly enjoyed the collaboration and collegiality of being a certification commissioner! – Bryan Hutchinson, MAC, SAP, CEAP I became an Employee Assistance Certification Commission (EACC) commissioner to educate EA professionals about the value of the CEAPR certificate, the only recognized credential of advanced practice in the employee assistance field. The credential assures consumers and employers that they are receiving services from a knowledgeable professional with a specific expertise in workplace and employee assistance practice. EAP work is a distinct skill set, separate from private practice or agency-based work. The CEAPR credential demonstrates the knowledge of the existence of the dual client relationship, management consultation, crisis intervention and risk assessment skills; employee assistance professional ethics; critical incident support services; and the understanding of the impact of workplace culture, policies and procedures and employment law. Now more important than ever, with the emergence and rapid growth of online mental health platforms that promote themselves as EAP providers, it is important to educate consumers about the value of the CEAPR. According to Chet Taranowski and Paul Tewksbury (2016), “failure to support certification and the requirements it represents may have an adverse effect on the integrity of the EAP field. This is a vital point since the CEAP represents the only ethically-informed and knowledge-based standard for EAP practice across the globe.” – Henri Menco, LICSW, CEAP Sr. EAP Clinical Manager Becoming involved with the EACC seemed a natural extension of the professional work in which I have been involved. I was fortunate when I first began working in the employee assistance field that my employer at that time emphasized the need to complete the requirements for my CEAPR. Completing the process helped me truly understand the unique skill sets required of employee assistance professionals. Learning about the history of EAPA and EASNA has helped me understand the nuances of providing services to companies and their employees. 8 | JOURNAL OF EMPLOYEE ASSISTANCE | 2nd Quarter 2022 | • • • • • • • • • • • • • • • • • • • • | W W W . E A PA S S N . O R G |

As I have considered opportunities to become more involved in EAPA, my background in ethics education and working with certification programs fit well with the direction of the organization. I became trained and began teaching the Elevating Ethical Awareness course. This was a tremendous opportunity to contribute to the ethics of professionals and to work with professionals in various roles in EAP work. When the EACC announced openings for a commissioner that seemed like another way to become more involved in EAP work. With the changes to the certification process, I was even more intrigued with the role of commissioner. A passionate supporter of certification for employee assistance professionals, I am honored to serve with great representatives on the EACC. – Susan Meyerle, LIMHP, CEAP Owner – The Insight Program, P.C. My EA career began over 25 years ago with a premier internal EAP at Motorola, Inc. Our director, Sheila Monaghan, encouraged involvement in EAPA at all levels, as well as the acquisition of the professional certification (CEAPR). At that time, I was affiliated with the Central Arizona chapter of EAPA, and eventually became involved at multiple levels of chapter leadership, culminating in a stint on the International EAPA Board. Throughout those assignments, I had the opportunity to observe the extensive efforts by the EACC in maintaining the quality of the CEAPR exam, thus ensuring that our profession maintain relevance and value in contributing to workplace health and productivity. When I was approached by the outgoing EACC Chair (my friend and colleague, Tim Lee) to be a part of EACC, I felt honored to participate in maintaining the quality of the certification and our profession. As the EACC worked on the CEAPR Refresh it further confirmed the commitment of this commission to our unique, impactful profession. – Craig Mills, MC, LPC, CEAP I decided to become a commissioner because if we want this profession to thrive, we need well-trained employee assistance professionals doing great work. The more competent and effective EA practitioners are, the better able they are to help employees and the more likely it is that companies will continue to find value and invest in offering high quality EA programs. I wanted to be part of strengthening the field by strengthening the CEAPR. With all of the challenges of the past two years, companies are looking for the best ways to support their employees through mental health and substance use challenges. I believe there has never been a better time to be an EA professional. As a profession we need to be well educated and prepared to meet the demands of today’s workforce. The upcoming generation is much savvier around proactively managing their mental health and expects their companies to support them in their mental wellness journey. A strong CEAPR credential is the best way to prepare the next generation of EA professionals to meet those expectations. – David Nix, MA, LPC, MAC, CEAP Becoming an EACC commissioner was something I considered doing after years of attending EAPA conferences and speaking with past commissioners, I believed that serving in this capacity would be the next step in my EA career. However, I had to wait until the vacancy for an International Commissioner was available. After a few years passed, I finally got the opportunity in 2019 to apply to the EACC with the hopes of being selected as the international commissioner. At that time, I believed (and still do) that having the representation of a CEAP who resides and works in employee assistance outside of North America was important. From my own experience, the role of the international commissioner is one that offers the perspective and experience of their respective cultural approaches, but it also validates and supports the EA work that we all do. Additionally, I enjoyed having the opportunity to work along with my fellow commissioners to refresh the CEAPR exam, so the CEAPR credential is more accessible and equally sustainable professionally. I can confidently state that serving as a commissioner over the last three years has been a tremendous privilege and I encourage all EAPA members, especially my international counterparts, to apply to serve in the future. – Abena Noel-Branker, M.Sc, CEAP 9 | W W W . E A PA S S N . O R G | • • • • • • • • • • • • • • • • • • • • | JOURNAL OF EMPLOYEE ASSISTANCE | 2nd Quarter 2022 |

webwatch

Adult ADHD Effective Job Strategies https://www.youtube.com/ watch?v=254UtlLrQgA&feature=emb_title

Books The History of Employee Assistance Programs in the United States https://amzn.to/2Z2KLMe

Individuals with adult ADHD or who know someone who has this disorder will benefit from the useful job search strategies at this video from Scott Shapiro, MD, a leading expert on adult ADHD.

Written by Dale Masi, PhD, and sponsored by the Employee Assistance Research Foundation, this book is a long overdue exposition of all the major innovations and evolution of the EAP field. It is an essential guide for purchasers, providers, and students of EAP.

Books Leading Workplace Addiction https://drjnarine.wordpress.com/

Books You are the Sheriff of ME Town https://www.metown.com

John Narine, DBA, CEAP, shares eight strategies to help business leaders provide compassion, encouragement, and practical guidance for employees who are struggling with substance abuse. With a powerful testimony and lessons learned from personal experience, along with excellent research, Narine’s work serves as an impactful book of wisdom, knowledge, and teaching for business leaders.

Julia Bain, CEAP, and retired EAP manager for the city of Albuquerque, takes readers on a journey of empowerment in which they have all the power as the sheriff of “Me Town.” James Porter, CEO of StressStop notes, “With practical steps for how to achieve this end, many, many people’s lives could be turned around by taking her straight-shooting advice to heart.”

Coronavirus Johns Hopkins: Resource Center https://coronavirus.jhu.edu/

Technology Appmkr https://www.appmakr.com/

Johns Hopkins, experts in global public health, infectious disease, and emergency preparedness have been at the forefront of the international response to the coronavirus pandemic.

Everybody is downloading apps these days, but maybe you’d like to create your own app. Doing so is neither complicated nor costly. Learn more at this site.

Technology One Mind PsyberGuide https://onemindpsyberguide.org

Post-COVID Predictive Index https://bit.ly/2RykkgK

There are so many apps out there these days! But which ones are effective? Apps and digital health resources are reviewed at this site, which includes its criteria for determining its ratings. Understanding and managing mental health are among other useful links.

In its latest report, find out what’s causing executive teams to struggle in a remote post-COVID world – and what they’re doing to build dream teams.

Mental Health Fresh Hope https://freshhope.us

Workplace Wellness CancerCareers.org https://www.cancercareers.org/

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

Who isn’t affected by cancer today? This site, formerly known as Cancer and Careers, helps patients, survivors, healthcare professionals, and employers navigate the practical and legal issues common after a cancer diagnosis.

Mental Health Psych Central https://psychcentral.com/ Founded by mental health expert John Grohol, Psych Central is a leading site on mental health with links about numerous mental health conditions and scores of articles ranging from the pandemic to seniors, the latest stories and trends, and more.

Mental Health The Best Mental Health Apps of 2021 https://www.verywellmind.com/best-mental-healthapps-4692902 Looking for mental health services can be intimidating, especially in a technology-driven world that offers so many options. Look no further than this list. 11 | W W W . E A PA S S N . O R G | • • • • • • • • • • • • • • • • • • • • | JOURNAL OF EMPLOYEE ASSISTANCE | 2nd Quarter 2022 |

coverstory The Hidden Worker: Part II

Considering Diverse Employee Needs during COVID-19 | By Bryan McNutt, PhD, LMFT, CEAP

hile virtually everyone has been affected in some way, shape, or form by the coronavirus pandemic, diverse employees have been especially hard hit. Part I of this series identified these workers and discussed their challenges and stressors, especially considering COVID-19. The conclusion will explore approaches EAPs can use to foster more sensitivity and advocacy for the workplace needs of diverse-identified employees.

EAPs as Facilitators of Organizational Self-Reflection Addressing systemic inequities, cultural biases, and various forms of stigma, prejudice, and discrimination within the workplace is a tall order. In addition, EA professionals are faced with the challenging task of supporting both individual employees and the needs of leadership. 12 | JOURNAL OF EMPLOYEE ASSISTANCE | 2nd Quarter 2022 | • • • • • • • • • • • • • • • • • • • • | W W W . E A PA S S N . O R G |

This is particularly difficult to navigate when attempting to support diverse employees who experience minority stress within an organization, due to the inherent culture of an organization that may implicitly perpetuate harmful biases against diverse employees. Biases cannot change unless they are first identified, thought about, and then talked about. Increasing opportunities to encourage self-reflection is critical to reducing implicit minority stress in the workplace. As employers and leaders are faced with the challenge of considering how to respond to the needs and concerns of diverse employees within their organizations, EAPs can play a key role. EA consultants can facilitate selfreflection among leadership and management about how an organization’s cultural beliefs, attitudes, values, and decisions may indirectly overlook, ignore, or minimize the unique needs and concerns of diverse employees. Promoting Psychological Safety: A Key Role of EAPs in Supporting Diverse Employees There is one key area of organizational life that EAPs can promote as a means for supporting the unique needs of diverse employees: Psychological Safety. EA professionals can create the greatest leverage for influencing support for diverse employees by providing management consultation and leadership coaching. Helping leaders and managers apply the principles of Psychological Safety in the workplace can be a critical foundation for working against detrimental organizational cultures and interpersonal biases that fuel minority stress and harms diverse employees. Psychological Safety is a perspective of organizational theory and group dynamics in the workplace that has gained a lot of traction in business literature and organizational development models throughout the past decade. It is derived from several different value-based components that shape interpersonal relations within a workplace culture. These include valuing: • • • • • •

Diversity; Mutual respect; Shared decision-making; Collective trust; encouraging a Sense of belonging; and prioritizing Fairness and equity.

Biases cannot change unless they are first identified, thought about, and then talked about.

These factors all contribute to a foundation that benefits diverse employees, whose perspectives and input are often not included at the decision-making table, or who tend to be overlooked, unheard, misunderstood, and disregarded. Psychological Safety inherently values diversity and inclusion, and as a result, it fundamentally supports the needs of diverse employees. Basic Assumptions of Psychological Safety 1). People are constantly managing interpersonal and emotional risk at work, consciously and unconsciously. This can inhibit the open sharing of ideas, questions, and concerns. A fundamental dimension of Psychological Safety in the workplace is how safety and threat are experienced on the interpersonal level of interaction and communication. Within a work context, this is often displayed by how emotional risks are taken, how diverse perspectives are valued and shared, and how concerns are expressed and responded to by leadership. When we consider the experiences of diverse employees, they experience not only basic workplace challenges but also the additional daily challenges of navigating the threats of minority stress. 2). Psychological safety describes a climate where people feel safe enough to take interpersonal risks by speaking up and sharing concerns, questions, or ideas. This is not only critical for supporting team efforts of problem-solving, mitigating costly errors, and promoting innovation, but it can also hold in check interpersonal bias, stigma, and prejudice. Since diverse employees tend to feel marginalized in the workplace, they often do not feel emotionally safe enough to speak up, especially if their opinions differ from the group norm. 13 | W W W . E A PA S S N . O R G | • • • • • • • • • • • • • • • • • • • • | JOURNAL OF EMPLOYEE ASSISTANCE | 2nd Quarter 2022 |

coverstory 3). Leaders of teams, departments, units, or other groups within organizations play an important role in developing psychological safety. We know that the shaping of an organization’s culture is often promoted and reinforced implicitly through the behavior, communication, and policy development of leaders and managers. Leaders and managers are critical gateways for influencing the shape and purpose of a work culture that operates from a position of Psychological Safety. Diversity and inclusion function best when Psychological Safety has been established. Research has also revealed that the lack of Psychological Safety results in low levels of recruitment and retention, decreased staff engagement and performance, and poor business and financial outcomes (Edmondson, 2019). For organizations, this means that having diverse representation among their employees is not enough. It is critical to foster a culture of work that demonstrates a willingness to listen to differing thought processes, perspectives, and opinions. If people do not feel safe voicing their opinions without fear of negative consequences to themselves, their status, or their career, then the effort of promoting diversity may be a greater disservice to the organization and the individual. As a result, promoting diversity and inclusion may cynically become examples of tokenism. The continued presence of minority stress in the workplace can undermine efforts of equitable and diverse representation. Unless the application of Psychological Safety is integrated within an organization’s cultural values of diversity and inclusion, then minority stress factors will remain, which can result in diverse employees who dread coming to work. If this persists, they will eventually move on from the organization. Team Relationship Outcomes of Psychological Safety There are four main team-based approaches that can help reinforce the experience of Psychological Safety in the workplace, which can also help promote a sense of trust, engagement, and belonging for diverse employees. Using management consultation interventions, EA professionals can facilitate opportunities for supervisors and leaders to nurture the following team-based qualities which, in turn, provide a more supportive and inclusive work environment for diverse-identified employees:

1). Learner Safety is encouraged when it is safe to… ask questions, experiment, make mistakes, look for new opportunities, innovate and create. 2). Challenger Safety is advanced when it is safe to… challenge the status quo, speak up, express ideas, identify barriers to change, and expose problems. 3). Collaborator Safety is promoted when it is safe to… engage in an unrestrained way, have mutual access, maintain an open dialogue, and foster constructive debate. 4). Inclusion Safety is encouraged when it is safe to… know that you are valued, treat all fairly, openly contribute, feel your ideas and perspectives matter, include all regardless of their role. Summary When considering the collective health of an organization, it is critical that organizational leaders and influencers (such as EA providers) remain attentive to the intersectional experiences and identities of diverse employees. This is especially relevant in the continuing wake of COVID-19, which has disproportionately impacted the lives of diverse employees. There remain critical opportunities for EA professionals to foster and nurture a workplace atmosphere that promotes sensitivity, psychological safety, and trust, so the diverse employee does not need to also be a hidden employee – whether by choice or by circumstance. Dr. Bryan McNutt, PhD, LMFT, CEAP, is a Licensed Clinical Psychologist who currently works as an internal employee assistance counselor with the Faculty and Staff Assistance Program at the University of California, San Diego. Dr. McNutt also serves as the president of the EAPA San Diego Chapter. He may be reached at bryanmcnuttphd@gmail.com

References

American Psychological Association (2021). Stress in America™ 2020: One Year Later, A New Wave of Pandemic Health Concerns. Washington, D.C. American Psychological Association (2021). Psychology and the post-pandemic workplace. https:// www.apa.org/members/content/secure/post-pandemic-workplace.pdf American Psychological Association, APA Working Group on Stress and Health Disparities. (2017). Stress and health disparities: Contexts, mechanisms, and interventions among racial/ethnic minority and low-socioeconomic status populations. Retrieved from http://www.apa.org/pi/health-disparities/ resources/stress-report.aspx Edmondson, A. (2019). The fearless organization. Ellingrud, K., Krishnan, M., Krivkovich, A., Kukla, K., Mendy, A., Robinson, N., Sancier-Sultan, S., & Yee, L. (2020). Diverse employees are struggling the most during COVID-19: Here’s how companies can respond. McKinsey & Company. Hancock, B. & Schaninger, B. (2021). “The elusive inclusive workplace.” McKinsey & Company. Human Rights Campaign & PSB Insights (2021). “COVID-19 continues to adversely impact LGBT people while initial phases of reopening create new economic problems”. LGBTQ-COVID19-EconImpact-Reopening-083120b.pdf Lorenzo, R., Voight, N., Tsusaka, M., Krentz, M., and Abouzahr, K. (2018). “How Diverse Leadership Teams Boost Innovation.” BCG Diversity and Innovation Survey. https://www.bcg.com/en-us/publications/2018/how-diverse-leadership-teams-boost-innovation Tebbe, E. A., Allan, B. A., & Bell, H. L. (2019). Work and well-being in TGNC adults: The moderating effect of workplace protections. Journal of Counseling Psychology, 66(1), 1–13. https://doiorg.pgi. idm.oclc.org/10.1037/cou0000308 Veles, B. L., Moradi, B., & Brewster, M. E. (2013). Testing the Tenets of Minority Stress Theory in Workplace Contexts. Journal of Counseling Psychology, 60(4), 532–542. https://doi-org.pgi.idm.oclc. org/10.1037/a0033346

coverstory Management Consultation Vignette: Derek & Sharon

erek is a 31-year-old, single, White, heterosexual, male, and employee of 4 years, who was recently promoted to a supervisory position 9 months ago, replacing a predecessor of 13 years, and inheriting a team of 6 employees. Derek reached out to the organization’s EAP for management consultation support due to recently increased stress in his supervisory relationship with a direct report team member, Sharon, a 52-year-old, divorced, Black, lesbian, female, and employee of over 20 years.

ron’s racial and sexual identity. Derek also stated that Sharon received a demotion last year, shortly before he was promoted to his current position. Derek stated that Sharon was demoted due to “problematic behavior,” and acknowledged that she has expressed frustration about lacking advancement opportunities: “She’s been passed over for promotions in the past. She even interviewed for my job but didn’t get it. I think she feels that she’s lost a lot of power. It’s been a big hit to her ego. She’s lost some responsibilities and status, and she thinks her work is beneath her.”

Derek described experiencing supervisory challenges with Sharon, citing that Sharon has had “technical difficulties” with adjusting to recent system platform changes, as well as demonstrating challenges with “competency” in her work. Derek stated, “Let’s just say that it’s well known that she has some issues, but I don’t want to get wrapped up in her issues while trying to be her manager.” When asked further about what he meant by “issues,” Derek described Sharon as being “defensive” toward colleagues. Derek stated, “I don’t see much of it myself. Most of the complaints are what I hear from other people. She’s not engaged in her work. There are competency issues with her finishing her work. She doesn’t seem to get what’s expected of her. She also assumes negative intentions from other people.”

Reflection Questions 1) Clarify between system v personnel factors: • What might be some indicators of systemic factors in this vignette that are related to the culture of the organization or department?

When asked to describe how he has attempted to engage with Sharon from a supervisory approach, Derek stated, “I think I’ve been over-indulgent with her. I’ve shown a lot of handholding, and it’s taken up too much of my time. I haven’t discussed any of my concerns with her directly. I worry that it could lead to a negative spiral of her feeling attacked. She’s defensive, and I don’t want to make this a racial thing or a gay thing.”

•

What might be might some indicators of personnel factors related to the manager or team member?

2) Clarify the role of emotion and the influence of personal bias: • What do you hear are the primary emotional concerns of the manager? •

What might be some emotional concerns of the team member?

•

Do you see any influence of personal or cultural bias influencing the manager’s view?

•

What do you hear are the manager’s main incentives and goals in this situation?

3) Consider how to encourage perspectives of psychological safety: • How might you help facilitate the manager’s selfreflection about promoting psychological safety with the team member? How about promoting a culture of psychological safety within the department?

Derek acknowledged feeling apprehensive in approaching Sharon with critical feedback due to Sha-

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featurearticle Mental Health Toolbox Growing for EAPs | By Ivan Steenstra, PhD, MS & Barb Veder, MSW, RSW

ou might have heard this story before:

An inquisitive man comes out of a pub and finds another man leaning against a lamp post, staring at the sidewalk. Slightly inebriated, the inquisitive man pauses for a while to look over for whatever the man leaning against the lamp post is looking for, but there is nothing there. Curiosity piqued, he asks the leaning man, “What are you looking for?” “My gold watch,” the leaning guy answers. “I lost it coming out of the pub” The other man then responds, “Oh, please let me help you find your watch!” Shortly after, another man leaves the pub and sees the two men searching, and he too asks, “What are you looking for?” “He lost his watch,” the inquisitive man responds. A woman gets out of the pub, asks the same question and then she too decides to help. After 15 minutes, a group of 5 is on the sidewalk (all a bit drunk) looking for the watch. After a while of searching, the woman asks, “So where did you lose the watch? 18

“Oh, I lost it a hundred meters to the right of here,” the man replies. The lady is perplexed and decides to go home, but not before asking: “Why are you looking over here then?” “Well,” the man says, “there’s light over here and the lamp post provides me support from falling over because I had a few too many.” What is the “gold watch” for EAP providers? What are the outcomes we are trying to achieve and measure? Traditionally EAPs report on utilization, (time to) access to care, and customer satisfaction, while providing evidencebased interventions. However, our clients come to us with a variety of issues that prevent them from functioning at an optimal level at work - clinical issues such as depression and anxiety, as well as many generalized issues beyond mental health concerns. Which tools are valid to capture these outcomes adequately? Is there a tool developed for our specific population? Does the tool have the validity required to capture the state of the individual and does it have the properties to detect change over time? Ultimately, we all agree on the importance of measuring outcomes in EAPs to: • • • •

Demonstrate the effectiveness of services; Show our value to customers; Be accountable to customers and clients; and Guide our choice of intervention.

What does our golden watch/population look like? From the Workplace Outcome Suite annual report 2021 (LifeWorks, 2021), we know that mental health issues (30%) were the most defining issue of EAP use. Specific issues within the mental health category included depression (8% of all cases), anxiety (7%), general emotional health (7%), behavioral conduct/anger (3%), grief (3%), and violence or trauma (2%). Next was the issue of personal stress (24%), which included a small subset of cases (n = 191; < 1%) who specified having issues related to the COVID-19 pandemic. About 1 in every 5 cases (20%) used the EAP for difficulties with a personal relationship (i.e., marriage; 14%) or family and work/life issues (6%). About 1 in every 5 EAP cases (20%) seek counseling for work-related issues, either occupational focused problems (14%) or work stress (6%). Alcohol misuse and drug problems accounted for less than 3% of cases. Other personal life issues (legal, financial, medical) accounted for the final 3% of cases. In LifeWorks’ North American trend data, 60% of clients present as struggling with issues such as anxiety, depression, grief, personal and workplace stress, and so forth. 40% of clients need support managing decisions around life changes like job, relationship, parenting, and interpersonal conflicts. In short, EAPs support clients with a wide variety of presenting issues. The choice of measures to monitor progress and evaluate effects depends on the outcomes we aim to achieve. The bias of clinicians is to define improvement in terms of decrease of clinical signs and symptoms. This is a good fit for only about half of all EAP cases; there is less relevance to measuring clinical improvement for those who, upon completion of a mental health screening, do not present with clinical distress. However, we 19 | W W W . E A PA S S N . O R G | • • • • • • • • • • • • • • • • • • • • | JOURNAL OF EMPLOYEE ASSISTANCE | 2nd Quarter 2022 |

featurearticle can define improvement in the primary objective of EAPs to support optimal functioning of employees in their ability to be productive at work. The Right Outcome Tool for the Right Issue The two most common presenting mental health issues in the general population are depression and anxiety (Kroenke et al., 2016). Generalized anxiety disorder (GAD) is a prevalent and disabling disorder distinguished by persistent worrying, anxiety symptoms, and tension. The natural course of GAD can be characterized as chronic with few complete remissions, a waxing and waning course of GAD symptoms, and the occurrence of substantial comorbidity, particularly with depression (Wittchen, 2002). Two important tools, the PHQ-9 for depression and GAD-7 for anxiety, have been widely adopted for measuring clinical symptoms. These brief scales are simple to use and administer and they measure results and help us shape a support pathway that provides a solid clinical direction to follow. However, the other half of our clients require support for a variety of issues like interpersonal struggles, life changes, family problems, workplace issues, and so forth, factors that are less relevant to clinical condition-based assessments like the PHQ-9 or GAD-7. Instead, these cases are better measured with the Workplace Outcome Suite (WOS). Since the aim of EAP is to meet mental health needs of employees as well as support non-clinical struggles, using only one tool of measurement across all presenting issues would not work. One tool would not meet the criterion of being sensitive to the issue at hand, measuring change to monitor progress, and showing effects over the course of counseling. In other words, the tool might not show improvement, even when improvement is in fact present. One method employed when using clinical tools to measure non-clinical issues involves not reporting on those clients that do not reach the clinical threshold (Schneider et al., 2020). This approach conflicts with the best practice of doing an “intention-to-treat” analysis approach where all cases receiving treatment are included in the analysis. It also means that the percentage of cases relevant to a single clinical outcome tool, like the PHQ-9, is further dwindling. It is key that clinical evaluative tools be used in the specific context of a condition or presenting issue and population. Best practice is to use outcomes related to the objective of EAP: to help employees reach optimal functioning at work, and to evaluate progress over time for clients, specific workplaces, and the overall book of business for EAP providers. If we want to measure the general success of an EA program, we want to measure improvements in work relevant outcomes like absenteeism, presenteeism, and workplace distress. Conversely, when we want to measure condition-specific success of treatment, a more specific tool measuring clinical progress is required in addition to the general measure of life impact. For applied contexts like EAP service delivery, the ultra-brief version of the clinical outcome area represented in the PHQ-4 (2 items from the PHQ and 2 items from the GAD), is recommended. Also suggested is the brief 5-item version of the WOS. Support for Mental Health from EAPs is Needed More than Ever Behavioral health issues have been exacerbated during the ongoing COVID-19 global pandemic (Abdalla et al., 2021). Results of the National Health Interview Survey and the U.S. Census Bureau (Panchal et al., 2021) showed that in the first half of 2019 (before the pandemic) 1 in every 10 Americans reported symptoms of depression or 20 | JOURNAL OF EMPLOYEE ASSISTANCE | 2nd Quarter 2022 | • • • • • • • • • • • • • • • • • • • • | W W W . E A PA S S N . O R G |

anxiety – but after the pandemic had taken hold this rate quadrupled to over 4 in every 10 adults in January of 2021 (i.e., 11.0% vs. 41.1%). Since early 2020 and continuing during the pandemic, the EAP industry has greatly expanded the number of methods to deliver counseling (Couser et al., 2020; Hughes & Fairley, 2020). Traditional emphasis on face-to-face interactions between employee and counselor in an office switched to reliance on technological modalities of delivery. This change in modality coincided with most EAPs also experiencing higher overall utilization rates for the number of employees using counseling (and most other EAP work/life and organizational services, too). The pandemic has resulted in higher usage levels for many providers of EAP services. For example, the International Foundation of Employee Benefit Plans (2021) found that the average level of EAP use among 237 employers in the U.S. increased from 7.4 counseling cases per 100 covered employees in year 2019 to 9.2 in year 2021. Similar results were also obtained from an industry-wide survey of 57 EAPs in the U.S., which found the average clinical case level utilization rate had increased from 7.4 counseling cases per 100 covered employees in year 2019 to 9.4 in year 2021 (Attridge, 2021). Most EAPs also reported increases in the rates of use of specialty services for organizational consulting and for personal financial or legal issues since the economic downturn associated with the pandemic. Summary The increased use of EAPs makes it even more important to use the most appropriate outcome measures. Shining our light in the place we need to be looking, and not relying on the support of a single lamp post that may not shine on a large enough area, will ensure that we have a clear understanding of each client’s circumstances. Using an array of tools facilitates our provision of care most suited to individual needs, and our measurement of when these needs have been met and their circumstances improved for the better. A more detailed list of tools and measurement resources follows the list of references for this article. Dr. Ivan Steenstra is the Director Research & Analytics at LifeWorks. He is a human movement scientist and epidemiologist with a PhD in Public and Occupational Health. He has over 40 peer reviewed and indexed publications and presented his work at numerous peer reviewed conferences. He is based in Toronto and can be reached at ivan.steenstra@lifeworks.com. Barb Veder is Vice President, Chief Enterprise Clinician, and Clinical Services Lead at LifeWorks. She can be contacted at barb.veder@lifeworks.com LifeWorks thanks Kelly Beaudoin, Katie Clegg, and Mark Attridge who also contributed to this article. References

Abdalla, S. M., Ettman, C. K., Cohen, G. H., & Galea, S. (2021). Mental health consequences of COVID-19: a nationally representative cross-sectional study of pandemic-related stressors and anxiety disorders in the USA. BMJ Open, 11(8), e044125. http://dx.doi.org/10.1136/bmjopen-2020-044125 Attridge M. (2021, September 22). Trends in workplace mental health during the COVID-19 pandemic: Implications for vendors of EAP services. Virtual presentation to the meeting of the Workplace Collaborative. http://hdl.handle.net/10713/16887

featurearticle Couser, G. P, Nation, J. L., & Hyde, M.A. (2020). Employee assistance program response and evolution in light of COVID-19 pandemic. Journal of Workplace Behavioral Health, 36(3),1-6. https://doi.org/10.1080/15555240.2020.1821206 Hughes, D., & Fairley, A. (2020). The COVID chronicles an employee assistance program’s observations and responses to the pandemic. Journal of Workplace Behavioral Health, 36(3),1-20. https://doi.org/10.1080/15555240.2020.1844569 International Foundation of Employee Benefit Plans. Mental health and substance use disorder benefits: Survey results 2021. [White paper.] Author: Held, J. Brookfield, WI: IFEBP. 2021. https://www.ifebp.org/store/Pages/Mental-Health-Survey-2021.aspx Panchal, N., Kamal, R., Orgera, K., Cox, C., Garfield, R., Hamel, L., et al. (2021). The implications of COVID-19 for mental health and substance use [White paper]. Kaiser Family Foundation. https://pameladwilson.com/wp-content/uploads/4_5-2021-The-Implications-of-COVID-19-for-MentalHealth-and-Substance-Use-_-KFF-1.pdf Roy-Byrne, P. P., & Wagner, A. (2004). Primary care perspectives on generalized anxiety disorder. Journal of Clinical Psychiatry, 65[supll 13], 20-26. Schneider, R. A., Grasso, J. R., Chen, S. Y., Chen, C., Reilly, E. D., & Kocher, B. (2020). Beyond the lab: Empirically supported treatments in the real world. Frontiers in Psychology, 11, 1969. https://doi.org/10.3389/fpsyg.2020.01969 Wittchen, H. U. (2002). Generalized anxiety disorder: prevalence, burden, and cost to society. Depression and Anxiety, 16(4), 162-171. https://doi. org/10.1002/da.10065

The Tools The Generalized Anxiety Disorder Screener (GAD-7) is a 7-question instrument that screens for the presence and severity of symptoms of anxiety (Spitzer et al., 2006). This is one of the most widely used screening and outcome tools available for anxiety. The GAD-7 has been shown in past research to have adequate levels of reliability and validity (Kroenke et al., 2007; Löwe et al., 2008). Since its release in 2006, the PHQ has been cited in over 14,000 scientific papers (according to Google Scholar, November 2021).Sample items include the following: (a) Feeling nervous, anxious, or on edge; and (b) Not being able to stop or control worrying. Instructions refer to how much the statement applied to the person over the past 2 weeks. Scores were categorized into levels of severity: low = 0 to 4, mild = 5 to 9, moderate = 10 to 14, and severe = 15 to 21. Clinical status for anxiety is defined as moderate or higher severity (scores of 10+). The Patient Health Questionnaire (PHQ-9) is a tool that is becoming more popular to measure the effectiveness of EAP counseling. The PHQ-9 is widely used for screening, diagnosing, monitoring and measuring the severity of depression (Kroenke, 2012). This scale has been used in many research studies and has established validity and reliability (Kroenke et al., 2001; 2002, Lowe et al., 2004). Since its release in 2001, the PHQ has been cited in over 24,000 scientific papers (according to Google Scholar, November 2021). The instructions state: “Over the last 2 weeks, how often have you been bothered by any of the following problems?” It has four response options of: (0) Not at all; (1) Several days; (2) More than half the days; and (3) Nearly every day. The PHQ-9 is scored by adding together the scores for all 9 items. Higher scores on this measure indicate greater depression. Scores are categorized into five levels of severity: Minimal = 0 to 4; Mild = 5 to 9; Moderate = 10 to 14; Moderately Severe = 15 to 19; and Severe 20-27. Based on recent reviews (Kroenke, 2012; Martin et al., 2006) clinical at-risk status for depression was categorized as Moderate or above (i.e., scores of 10+). The Patient Health Questionnaire (PHQ-4). The ultra-brief version of the PHQ-9 and GAD-7 measures is called the Patient Health Questionnaire 4 or PHQ-4 (Lowe et al., 2010). Past data on over 5,000 patients determined this measure has acceptable psychometric reliability and validity. Symptoms of depression in the past two weeks were assessed with the following: How often were you bothered by little interest or pleasure in doing things? 2) How often were you bothered feeling down, depressed or hopeless? Symptoms of anxiety in the past two weeks were assessed with the following: item 1) How bothered were you by feeling nervous, anxious, on edge? item 2) How bothered were you by not being able to stop or control worrying? Total score is determined by adding together the scores for each of the 4 items. Scores are rated as normal (0-2), mild (3-5), moderate (6-8), and severe (9-12). At-risk status is defined as Moderate or more severe (scores of 6+). 22 | JOURNAL OF EMPLOYEE ASSISTANCE | 2nd Quarter 2022 | • • • • • • • • • • • • • • • • • • • • | W W W . E A PA S S N . O R G |

The Workplace Outcome Suite (WOS) is a brief, psychometrically robust tool that documents the impact of EAP workplace intervention (Lennox et al., 2010; 2018; Attridge et al, 2018). The WOS, endorsed by the Employee Assistance Professionals Association (EAPA), is a well-established outcomes measurement tool that continues to grow in employee assistance provider use, popularity, and available data for reporting. It has been used in over 50 studies in the EAP contexts It has five scales: Work Presenteeism, Life Satisfaction, Work Absenteeism, Work Engagement, and Workplace Distress. It has acceptable scale reliability and validity for a brief measure (Morneau-Shepell, 2020) and norms for EAP counseling use (LifeWorks, 2021). Measurement Resources

ANXIETY– GAD-7 Löwe, B., Decker, O., Müller, S., Brähler, E., Schellberg, D., Herzog, W., & Herzberg, P. Y. (2008). Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population. Medical Care, 46(3), 266– 274. https://doi.org/10.1097/MLR.0b013e318160d093 Spitzer, R. L., Kroenke, K., Williams, J. B., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092–1097. https://doi.org/10.1001/archinte.166.10.1092 DEPRESSION – PHQ-9 Kroenke, K. (2012). Enhancing the clinical utility of depression screening. Canadian Medical Association Journal, 184(3), 281-282. https://doi.org/10.1503/ cmaj.11200 Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ‐9: validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606-613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x Kroenke, K., & Spitzer, R. L. (2002). The PHQ-9: A new depression diagnostic and severity measure. Psychiatric Annals, 32(9):509-515. https://doi. org/10.3928/0048-5713-20020901-06 Kroenke, K., Spitzer, R. L., Williams, J.B., Monahan, P.O., & Löwe, B. (2007). Anxiety disorders in primary care: Prevalence, impairment, comorbidity, and detection. Annals of Internal Medicine, 146(5), 317-325. Levis, B., Benedetti, A., & Thombs, B. D. (2019). Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: Individual participant data meta-analysis. British Medical Journal, 365, 1476. https://doi.org/10.1136/bmj.l1476 Löwe, B., Unutzer, J., Callahan, C. M., Perkins, A. J., & Kroenke, K. (2004). Monitoring depression treatment outcomes with the Patient Health Questionnaire-9. Medical Care, 42,1194–1201. doi:10.1097/00005650-200412000-0000 Manea, L., Gilbody, S., & McMillan, D. (2012). Optimal cut-off score for diagnosing depression with the Patient Health Questionnaire (PHQ-9): A metaanalysis. Canadian Medical Association Journal, 184(3):E191-E196. https://doi.org/10.1503/cmaj.110829 Martin, A., Rief, W., Klaiberg, A., & Braehler, E. (2006). Validity of the brief patient health questionnaire mood scale (PHQ-9) in the general population. General Hospital Psychiatry, 28(1), 71-77. https://doi.org/10.1016/j.genhosppsych.2005.07.003 BOTH ANXIETY & DEPRESSION – PHQ-4 (GAD-2 + PHQ-2) Kroenke, K., Spitzer, R. L., & Williams, J. B. (2003). The Patient Health Questionnaire-2: validity of a two-item depression screener. Medical Care, 11, 1284-1292. https://www.jstor.org/stable/3768417 Kroenke, K., Spitzer, R. L., Williams, J. B., & Löwe, B. (2009). An ultra-brief screening scale for anxiety and depression: The PHQ–4. Psychosomatics, 50(6), 613-621. https://doi.org/10.1016/S0033-3182(09)70864-3 WORKPLACE OUTCOME SUITE Attridge, M., Sharar, D., DeLapp, G., & Veder, B. (2018). EAP works: Global results from 24,363 counseling cases with pre-post data on the Workplace Outcome Suite (WOS). International Journal of Health & Productivity, 10(2): 7-27. http://hdl.handle.net/10713/8962 LifeWorks. (2021). Workplace Outcome Suite (WOS) Annual Report 2021: Global benchmarks for EAP counseling. White paper. Author: Attridge, M. Toronto, ON: LifeWorks. Lennox, R. D., Sharar, D., Schmitz, E., & Goehner, D. B. (2010). Development and validation of the chestnut global partners workplace outcome suite. Journal of Workplace Behavioral Health, 25(2), 107-131. https://doi.org/10.1080/15555241003760995 Lennox, R. D., Sharar, D., Schmitz, E., & Goehner, D. B. (2018). Validation of the 5-item short form version of the Workplace Outcome Suite©. International Journal of Health and Productivity, 10(2), 49-61. http://hdl.handle.net/10713/8973 Morneau Shepell. (2020). Workplace Outcome Suite (WOS) annual report 2020: Part 1 - decade of data on EAP counseling reveals prominence of presenteeism. Author: M. Attridge. White paper. Toronto: Author. http://hdl.handle.net/10713/13758

legallines New Anti-Discrimination Laws Forthcoming in 2022 | By Robin Sheridan, JD

s 2022 moves into high gear, the federal government, as well as certain state and local governing entities, continue to prioritize the importance of anti-discrimination laws. Indeed, many new laws were passed and signed in 2021 that went into effect in 2022.

Yet, as these new laws begin to pass, the variations and the timing at which the three levels of government (federal, state, local) enact these laws create challenges for employers. And while these new laws will not lead to every dispute ending like Tesla’s $137 million discrimination suit, many will impact employees and employers significantly. To read more about this landmark suit, check out an online article such as this one at https://www. npr.org/2021/10/05/1043336212/tesla-racial-discrimination-lawsuit New Anti-Discrimination Laws Around the United States Starting out West, the Oregon Crown Act, which became effective January 1, 2022, adds two definitions to the state statute, defining “protective hairstyle” and “race.” Specifically, Oregon defines “protective hairstyle” as: a hairstyle, hair color, or manner of wearing hair that includes, but is not limited to, braids, regardless of whether the braids were created with extensions or styled with adornments, locks, and twists. In doing so, Oregon joins states like New York, New Jersey, Virginia, Colorado, Washington, Maryland, Delaware, Connecticut, New Mexico, and Nebraska in preventing race-based hair discrimination. Continuing with the westernmost states, California signed a new anti-discrimination law related to health care. The new law signed October 1, 2021 (to be effective January 1, 2023) will require approved schools of nursing and nursing programs to include one hour of implicit bias training as part of the program’s graduation requirement. Registered nurses will also be required to complete one hour of implicit bias continuing education within the first two years of licensure. Similarly, down South, new anti-discriminations laws at both the city and state levels highlight the new anti-discrimination protections. In Charlotte, North Carolina, their City Council added more protections against employment discrimination effective Jan. 1, which ban bias on the basis of familial status, sexual orientation, gender identity, gender expression, veteran status, pregnancy, and natural hairstyles. Durham County in the same state also banned bias on the basis of natural hairstyles or textures, joining the aforementioned states and numerous other cities around the country. Additionally, in the South-Central region of the US, Texas passed two significant amendments to the state employment law that collectively went into effect on September 1, 2021. These amendments to the Texas Labor Code expand sexual harassment protections for employees in essentially all workplaces. Complainants can now wait longer to file. Specifically, employees go from having a 180-day limitation to a 300-day period in which to file sexual harassment allegations with the Texas Workforce Commission. This expansion, notably, does not apply for all other types of discrimination and harassment claims filed with the Commission, as the deadline remains 180 days. Additionally, not only can an employer be charged for violating the state’s prohibition on sexual harassment, but individual managers can be charged as well. Finally of note, coverage of the state laws now extends to employers with as few as one employee. 24 | JOURNAL OF EMPLOYEE ASSISTANCE | 2nd Quarter 2022 | • • • • • • • • • • • • • • • • • • • • | W W W . E A PA S S N . O R G |

Moving to the Midwest, Illinois signed into law an amendment to the Illinois Human Rights Act on March 23, 2021, prohibiting employers from considering an applicant and an employee’s criminal conviction record when making employment decisions, subject to two exceptions. The amendment adds a definition of “conviction record,” creating more stringent requirements than federal or Illinois law on the use of a candidate’s conviction record during employment decisions. In short—as for the exceptions— the first exception relates to whether the position presents an opportunity for the individual to commit a similar offense, as it pertains to their conviction during the course of their employment. The second exception relates to whether the individual’s employment would create an unreasonable risk to safety or property. Adding to this complexity, Illinois employers are now required to consider numerous mitigating factors when determining whether the use of a conviction record is allowable and must also engage in an interactive process with the applicant or employee before use of a conviction record. Continuing with America’s Heartland, the Dane County Board in Wisconsin unanimously voted in January 2021 to expand its anti-discrimination ordinance to include an individual’s hair. This vote highlights both the continued trend of prohibiting discrimination based on hairstyle but also delineates how an employer is bound not by just state law. Another example of the need to be aware of local ordinances is found in Ingham County Michigan, which became the first Michigan county to ban hair discrimination against public employees. Finally, states and cities throughout the Northeast continue to add anti-discrimination laws. New Jersey passed the “New Jersey Cannabis Regulatory, Enforcement Assistance, and Marketplace Modernization Act” in 2021. The law prohibits employers from discrimination against medical cannabis users while maintaining drug-free work environments at their discretion. Importantly, while federally speaking marijuana is not legalized, as of April 2021, states like Connecticut, Delaware, Rhode Island, New York, and Maine have taken it upon themselves by creating employment protection laws for authorized medical marijuana users. Virginia, for example, prohibits employers “from terminating, discipling, or otherwise discriminating against an employee “for such employee’s lawful use of cannabis oil pursuant to a valid written certification.” These protections are also seen at city and local levels. Effective January 1, 2022, a majority of Philadelphia employers will be prohibited from requiring prospective employees to perform a drug test for the presence of marijuana as a precondition of employment (subject to exceptions), joining New York City (effective May 10, 2020) and the state of Nevada. Conclusion It is evident from this survey of the new anti-discrimination laws enacted in 2021 and forthcoming in 2022 that lawmakers are continuing to add important protections for employees. Employee assistance professionals should be aware of the changes impacting both their practice and their clients’ employment. Special thanks to Joseph Ho, Law Clerk, for his contribution to this article. Questions should be directed to Robin Sheridan, rsheridan@hallrender.com, 414-721-0469, or another Hall Render attorney. Special thanks to law clerk Joseph N. Ho, for his assistance in drafting this article. Legal Lines articles are provided for informational purposes only. For legal advice regarding how the issues in this article relate to specific circumstances, Hall Render recommends that EAPs seek out their regular counsel who can provide appropriate context and advice for a particular situation. Robin Sheridan is an attorney with Hall, Render, Killian, Heath & Lyman, P.C., the largest health care-focused law firm in the country. Please visit the Hall Render Blog at http://blogs.hallrender.com/ for more information on topics related to health care law.

featurearticle The Facts Don’t Lie

Statistical Truths about the Business Value of EAPs

| By Mark Attridge, PhD, MA

he facts don’t lie. I have been researching and delivering professional trainings about the return on investment (ROI) for employee assistance programs for over 25 years – and there is a wealth of research that strongly supports the effectiveness of EAPs. See my review in 2019 on making the business case for EAPs and workplace mental health. Despite the evidence, some employers, benefits consultants, and insurance brokers still question the value of EAPs. This article presents succinct and data-driven facts that answer critical questions about the business value of EAPs, and it offers an ROI case study. Q1. Which “quality of life benefit” is purchased the most by employers in the United States? A recent national survey by the Bureau of Labor Statistics (BLS) conducted in March of 2021 asked employers which benefits they pay for as part of employee overall compensation. Six types of “quality of life” benefits were specified in the report. Among civilian workers (both private sector and state and local government employers), EAP topped the list, being offered by 55% of all employers. Each of the other five kinds of benefits were not as popular: wellness programs (offered by 45% of employers), flexible work schedules (13%), child care (11%), subsidized commuting (9%), and flexible workplace (7%). Other surveys of HR leaders about employee benefits also usually find that EAP is ranked number one among voluntary benefits. Q2. How many employers in the United States provide an EAP? The same BLS survey also asked employers which benefits were part of their paid employee compensation. My analysis of over 6.6 million employers reveals that over 3.2 million private sector employers purchased an EAP 26 | JOURNAL OF EMPLOYEE ASSISTANCE | 2nd Quarter 2022 | • • • • • • • • • • • • • • • • • • • • | W W W . E A PA S S N . O R G |

last year. That is a lot of profit-seeking business executives who invested in an EAP for their workforce. The report also indicates that over 182,000 public sector organizations purchased an EAP last year. That is a lot of leaders in government who decided it was in the best interest of the public to spend tax dollars on an EAP. Q3. Does providing an EAP benefit vary by the size of the employer? Based on the same BLS data, the rates of private sector workers with access to EAP benefits varied dramatically by company size: 29% of companies with 1-49 workers have an EAP; 49% with 50-99 workers have and EAP; 68% with 100-499 workers have and EAP; and 84% with 500 or more workers have an EAP. The same pattern exists for employees of state and local government organizations: 61% of public sector organizations with 1-49 workers have an EAP; 68% with 50-99 workers have and EAP; 70% with 100-499 workers have an EAP, and 90% with 500 or more workers have an EAP. These trends reflect how larger employers tend to pay higher wages and have richer employee benefits than do smaller employers, with the public sector being higher than the private sector in both areas. However, smaller size employers account for over half of the U.S. workforce and they are the fastest-growing market for EAPs (see JEA article by Carney & Knoepke). Q4. How many workers have access to an EAP? Based on the BLS data, roughly 58.4 million private sector employees had access to an EAP (based on 51% of 114.5 million total workers represented in their study). Another 14.6 million workers at the state or municipal levels of government had an EAP (based on 79% of 18.5 million total workers). Also, all 1.1 million workers at the federal level of government have access to an EAP that is part of the larger Federal Occupational Health program. When combined, about 74.1 million U.S. workers had an EAP benefit in year 2021. This adds up to a significant number of workers who have access to EAP services. Q5. How much does an EAP cost? Although there is no reliable public data source to answer this question, I can offer some estimates from my consulting experience. In general, as in most industries, the larger the size of the employer, the lower the price of the EAP. On average, using the recent 2021 BLS data on the percentage of micro, small, medium, and large sized employers that have an EAP, with corresponding per employee per year (PEPY) pricing of $30, $25, $20, and $15, respectively, I estimate the purchase cost in the U.S. for the average private sector employer to be $22 per employee per year (PEPY). Q6. How much is America spending on EAPs? Again, there is no credible national source to answer this question. But if we multiply the 74.1 million employees estimated to have an EAP benefit by my estimate of a $22 PEPY cost of the benefit, the result is $1.63 billion dollars. Q7. What is the hourly cost per employee to provide an EAP over a year? A full-time employee typically has a schedule of 40 hours of work expected per week. Over all 52 weeks in a year, this becomes 2080 total benefit-related work hours. The $22 PEPY cost when divided into the 2080 hours of compensated work time for the year is just one cent per hour. Q8. How much is the EAP cost as a percentage of the total employee benefits cost? According to the most recent Bureau of Labor Statistics’ national survey of employers in September 2021, the average private sector employer paid $26.36 in hourly wages and another $10.88 per hour for employee benefits. These benefits include financial contributions to employee retirement and savings, health insurance, paid leave, and many other voluntary benefits – such as EAP. Over a full year, the typical cost of benefits adds up to $22,630 per employee. Of this sum, the $22 annual cost of the EAP benefit per employee is only about one percent of the total benefit cost.

featurearticle Q9. How many workers use the EAP for counseling? How EAPs report their level of program use is not standardized and can be done in different ways. The clinical case rate is one of the most important metrics. The rate measures how many people during the year used the EAP for counseling per every 100 employees covered by the EAP benefit. In the past, this rate usually was about 5% or 5 counseling cases per 100 employees for external vendors of EAPs. Two new large national surveys – one that I did of 95 EAPs and the other by the International Federation of Employee Benefit Plans of 237 U.S. employers – both indicate this average rate in the U.S. has increased recently to 7.5% in year 2019 and now to 9.5% during the pandemic. However, the clinical case use rate for a specific employer can vary substantially from the average, with some being much lower (especially for employers who have a “free EAPs” that have extremely low use while their cost is hidden inside other insurance benefits) while other employers who integrate their EAP into the organization enjoy higher use in the 10-20% range. Q10. How much EAP utilization is needed for a break-even ROI? When the financial return for the program is equal to the cost of the investment in the program – $1 in return for every $1 invested – it is considered a cost-neutral or break-even type of business investment. How many employees need to use the EAP to get enough workplace-related cost savings from program outcomes to produce a $1:1 ROI? The answer to this question from research using EAP industry average results for the Workplace Outcome Suite© (WOS) is just one employee. See the 2020 LifeWorks white paper Part 1 for details and examples of ROI for small, medium, and large size employers in the U.S. ROI for EAP: Simple Case Study Example In the soon to be released 2021 WOS Annual Report by LifeWorks, I analyzed longitudinal data from over 28,000 EAP cases in the U.S. across many different EAPs to estimate reductions in the hours of work absence and the hours of unproductive time while working (called presenteeism). In the month just prior to using the counseling, the average employee client reported missing almost 8 hours of work and had 57 hours of lost productive time. After counseling, at the longitudinal follow-up, the average employee client reported missing less than 4 hours of work and had lowered their lost productive time to 41 hours per month. This difference from Pre to Post, after some conservative adjustments, was used to determine that an employee in similar degree of personal distress who did not use the EAP would have lost 48 hours of productive time over a three-month acute episode. The national average in hourly compensation in the BLS September 2021 report was $37.24 (wages + benefits) for private sector employees. Based on best practices in applied economics, compensation was multiplied by 1.3 to more realistically represent the influence that a healthy employee exerts on the shared productivity of coworkers and on overall work production. Thus, the business value per hour of productive work was $48.41. Using these inputs, the estimated cost savings was $2,324 for each EAP counseling case. Note that this result excludes additional savings in health care treatment costs and other outcome areas associated with a more comprehensive ROI model. For a case study company with 100 employees who pays the typical $22 per employee per year price for the entire EAP service, it is a $2,200 total annual investment. In this example, it takes just one employee counseling case to cover the investment with the $2,324 in workplace productivity-related cost savings. However, consider that if this company had a 5% use rate of the EAP, their ROI increases to $5:1 and if it had the pandemic-level use rate of almost 10% of employees who used the counseling, their total ROI would be $10:1. As an EA professional can plainly see, statistics don’t lie. EAPs provide a SOLID return on investment for businesses and other organizations! Dr. Mark Attridge is an independent research scholar as President of Attridge Consulting, Inc., based in Minneapolis. He can be reached at mark@attridgeconsulting.com. 28 | JOURNAL OF EMPLOYEE ASSISTANCE | 2nd Quarter 2022 | • • • • • • • • • • • • • • • • • • • • | W W W . E A PA S S N . O R G |

earoundup Suicide Discussion at Work is Vital

Many Don’t Report Problems to HR

In the United States, suicide is the second leading cause of death for people ages 10 to 34, the fourth among people ages 35 to 44 and the fifth among ages 45 to 54, according to data from the Centers for Disease Control and Prevention.

Employees are increasingly fearful of employer surveillance, according to a new study by Elements Global. The nationwide analysis revealed that the top HR-related queries, besides compensation and salary discussion, center around remote and workplace monitoring. Elements Global surveyed 1,000 American workers to find out more about their fears. Highlights include:

A feeling of isolation can be overwhelming for people struggling with mental health issues and suicidal thoughts. But there are behavioral signs to look out for — and for managers and colleagues who interact with team members on a daily basis, spotting these signs can be lifesaving.

• 2-in-3 workers aren’t reporting issues to HR because they don’t think action will be taken. • Roughly half (49%) don’t report issues to HR for fear of retaliation.

Changes to normal behavior, an increase in absenteeism and a decline in productivity can be enough cause to reach out and check in on someone, Bert Alicea, a psychologist and executive VP of EAP and work/life services at Health Advocate, told Employee Benefit News.

• 76% of workers using computers say they fear their boss monitors their communication. • 3-in-4 remote workers are concerned their employer monitors when and how much they work.

“Workplace training can help others feel more comfortable asking direct questions about the situation and uncover potential risks or factors that may shift that person’s mindset,” Alicea stated.

The good news: 83% of workers say they trust their HR manager or department. However, while a majority of people say they trust HR, that doesn’t mean they find HR effective, or that they don’t harbor other concerns when they consider making formal complaints. Two-thirds of workers say they’ve neglected to report something to HR because they didn’t think HR would fix the issue. The most frequently cited problems were having too much work, a personality clash, and bullying.

“Workplace leaders may ask what the workplace has to do with the mental health or the suicide risk of employees,” added Christine Yu Moutier, chief medical officer at the American Foundation for Suicide Prevention. “But the science is just so clear that suicide risk and prevention are related to a dynamic interplay between an individual’s internal factors like their DNA, their past trauma and the current environment. As working adults, we spend a lot of our time in our workplace culture.”

A reluctance to make reports is not just about the specific nature of the issue, or the employee assuming that HR won’t act. There’s also a fear of retaliation to contend with – 49% of workers who have neglected to report something cited this fear. Given that personality clashes, bullying, and sexual harassment are oft-cited issues, it’s no surprise this fear of retaliation is a high bar to cross.

Read more at https://www.benefitnews.com/news/embracing-the-taboo-why-its-critical-to-discuss-suicideat-work.

There is much room for progress in building trust and accountability at the center of employee-employer relationships, and the exponential rise in time spent working remotely will only make this issue more important. The EAP can play a key role.

featurearticle Brainspotting - A Useful Adjunct to Trauma Therapy | By Josh Delahan, LCSW

s EA professionals, we work with clients struggling with a multitude of presenting issues and provide solution-focused care. We each have our own go-to modalities and we often see clients improve. That said, what if there was an easily integrated modality that could substantially increase that improvement? For me, and over 13,000 other clinicians worldwide, that modality is Brainspotting – an approach that is useful for trauma of all kinds, including that resulting from COVID-19. Background Brainspotting (BSP) is a brain/body/mindfulness-based/relational approach developed by David Grand, PhD, a highlevel trainer, and author specializing in EMDR (Eye-Movement Desensitization and Reprocessing). It was during a performance-enhancement session of EMDR with an Olympic ice skater that he discovered BSP. When Dr. Grand was guiding his client’s horizontal eye movements he noticed that her eyes tended to freeze at a specific point in her visual field. When Dr. Grand held her focus on that eye-position (not yet standard EMDR prac30 | JOURNAL OF EMPLOYEE ASSISTANCE | 2nd Quarter 2022 | • • • • • • • • • • • • • • • • • • • • | W W W . E A PA S S N . O R G |

tice), she started to access new traumatic material, and was able to process previously addressed issues more deeply. Dr. Grand started to identify various reflexive responses in other clients as he moved his hands across their fields of vision such as blinking, eye freezes or wobbles, flinching, swallowing, etc. When he stopped moving his hand at those particular “spots” (or Brainspots) where the reflexes occurred, the client would process the presenting issue, and would often resolve it. Neuroscientists hypothesize that one’s eye position gains direct access to the areas of the brain related to a particular issue. “Where you look affects how you feel” is one of the mottos of BSP. Once the client brings up an issue, and a “Brainspot” is identified as connected, the client looks at that spot until the activation decreases or resolves entirely. When that activation resolves, the client no longer has symptoms related to that issue and is able to create new meaning around it. Since working with his first client in 2003, Dr. Grand has been expanding the development and implementation of BSP into a multi-faceted modality that has helped hundreds of thousands of clients improve their well-being. My Experience: How it Works I was trained in BSP in 2014 after practicing Somatic Experiencing and EMDR for over 10 years. I use it with clients for issues including PTSD, anxiety, phobias, depression, adjustment, compulsions, grief, attachment issues, performance, and more and have found it to be an effective companion to traditional styles of therapy. In sessions, I use a client-centered approach and invite the individual to talk about an issue until they identify any somatic activation (feelings in the body related to the presenting issue). At that point, I ask if they would like to process it using BSP. If they agree, we find a relevant eye-position connected to the somatic sensations, then hold that eye position as they mindfully focus on the thoughts, images, and sensations that arise, while I attune and hold space for them. In time, the activation decreases, and we return to our discussion about the topic. Typically, the client has new insights into the issue and often will have resolved it completely. Sometimes an issue is resolved after just one session, but for more complex issues the client will need to process the presenting issue several times, gaining insights and releasing somatic activation until the issue is no longer a concern. One helpful aspect of doing BSP is privacy; clients do not need to discuss the specific issue or what is happening during processing. Some clients choose to report their experiences during the “focused mindfulness” phase of the session, but it is not required. Much of what is happening is occurring in the mid-brain/brainstem, and clients often don’t have words to describe their experiences. For instance, “Shelly”, a domestic abuse survivor, consistently chose to keep almost all of what she processed to herself, so I would not know the topic she wanted to Brainspot. During one session, I noticed that her upper arms were turning bright red. After a minute or so, she reported that her arms were “burning”. I acknowledged what was going on, and she was surprised to find her arms almost glowing when she looked down at them. I reassured her that it was likely a manifestation of whatever she was processing and to just notice it and see how it transpired from there. After a few minutes, her skin color returned to

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featurearticle normal, and she reported that her SUDS (subjective units of disturbance - a 0 to 10 scale of discomfort) had lowered from 9 down to 0 for that issue. After the session, she shared that she had processed an assault by her ex-husband that included him grabbing her by the upper arms and shaking her. She was surprised to see that her body had been holding on to the activation of that decade-old event. Shelly’s experience speaks volumes to the idea that paying attention to what her body was telling her about the healing process was extremely important. We later discussed her new insights into how she could move forward, seeking healthier relationships in the future, and using traditional CBT techniques. In short, BSP enabled Shelly to discuss these issues without somatic activation blocking her ability to make more helpful choices, thus making her progress more attainable. EA Professional Self-care Working with clients can have a profound effect on our own mental and emotional equilibrium. Being triggered by a client’s experience is common and for some clinicians, can turn into vicarious traumatization (VT). I often work with therapists who have VT, and they are able to process it effectively with Brainspotting. The BSP community also offers free peer support groups for clinicians who would like to consult with fellow Brainspotters about challenging cases. Studies show that consultation and support decrease the likelihood of burnout. There is also a robust BSP social media community where a variety of topics are discussed, including questions about the modality, resources for clinicians and current research. Research and Endorsements Evidence-based practice (EBP) is important to ensure that we are using techniques that are proven to be helpful to our clients. While there are several studies that have been completed, and several in progress, (find more info at www.brainspotting.com), this is an aspect of BSP that requires more research. Two of the three “legs” of the EBP foundation are: 1) clinicians’ reports of client progress and 2) clients’ evaluation of the effectiveness of a modality. These two legs of the EBP foundation are very solid and continue to strengthen as more clinicians become trained in BSP and use it with their clients. Dr. Grand and other trainers have traveled around the world discussing and demonstrating BSP with luminaries and researchers in trauma-focused treatment. A few of the more recognizable names endorsing BSP as an effective tool for treatment include Bessel van der Kolk, Stephen Porges, Onno van der Hart, Daniel Amen, Gabor Maté, and Robert Scaer. How to find a BSP specialist • Seek out a therapist who performs BSP (Practitioners in the Midwest can be found at midwestbrainspottinginstitute.org). • Connect with a colleague at a BSP peer support group to use BSP or Use “self-spotting”, a technique where you can Brainspot yourself. Instructions on doing “self-spotting” can be found in Dr. Grand’s book, Brainspotting: The Revolutionary New Therapy for Rapid and Effective Change. Summary EAP practice requires variety, efficiency, and effectiveness. Brainspotting is a modality that can be integrated with other modalities and is extremely targeted and helpful for clients. BSP can also assist clinicians in complex cases to decrease activation and increase efficacy. If you are looking for a tool to enhance your practice, Brainspotting is worth a look. Josh Delahan, LCSW is a psychotherapist specializing in trauma, dissociation, and attachment issues as well as a professor at UW Milwaukee. He can be reached at jdelahan@uwm.edu.

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featurearticle ATIP: An Encouraging CIR Tool for EAPs | By Paula Harry MS, LCSW

mployee assistance professionals are increasingly asked by corporate clients to address critical incidents of various types. However, traditional critical incident response (CIR) methods used by EAPs, such as the Mitchell Model developed by Jeffrey Mitchell, have slowly been replaced by alternative methods designed to better address the need for more inter-connected, systemic interventions, as well as prevent the possibility of retraumatizing employees. The Multi-Systemic Resiliency Approach (MSRA), developed by Robert Intveld is one such model. While methods with a broad workplace and organizational approach, like MSRA, hold significant value, EA professionals can also benefit from a tool that they can use when working with individual clients. ATIP – an Effective Option Acute Traumatic Intervention Protocol (ATIP) is an effective, short-term intervention that can be used by EA pro34 | JOURNAL OF EMPLOYEE ASSISTANCE | 2nd Quarter 2022 | • • • • • • • • • • • • • • • • • • • • | W W W . E A PA S S N . O R G |

fessionals. Based on the same principles that underlie Eye Movement Desensitization and Reprocessing (EMDR), ATIP is a highly focused, quick psychological first aid intervention. Within 5-10 minutes, clinicians can guide clients to rapidly reduce acute disturbance following critical incidents. ATIP is intended to be administered as a brief intervention to facilitate stabilization and recovery either during or after a critical incident. This tool is also useful to help prevent PTSD and/or burnout with clients, and for EA professionals themselves. In order to understand how ATIP works, it is important to look at the history of its development and use. EMDR Eye Movement Desensitization and Reprocessing (EMDR) is known around the world as an evidence-based, trauma-focused therapy first developed by Dr. Francine Shapiro in 1989. Various research over the succeeding 30 years has established that rapid bilateral stimulation (BLS) reduces the intensity and vividness of trauma-related images and associated disturbance. BLS is most frequently administered in the form of eye movements; however, audio stimuli, and gentle tapping are also shown to be effective modalities. Early EMDR interventions, like other types of psychological first aid, emphasized the importance of swiftly mitigating the acute impact of traumatic events, thus facilitating adaptive recovery and functioning. The Role of Quinn and Kiessling During more than 15 years of responding to critical incidents around the US, Roy Kiessling LISW, founder of EMDR Consulting LLC of Cincinnati OH, recognized first-hand the need to provide relief for mental health responders experiencing secondary traumatization. Through collaboration with peers, service providers and recipients, Kiessling developed a technique to give swift relief to the caregivers in Texas at the Fort Hood military base, in New York City after the 9/11/2001 attacks on the World Trade Center Towers, and in New Orleans after Hurricane Katrina. Over time, both Kiessling and Gary Quinn, medical director for an emergency medical technician (EMT) team in Israel, recognized the need for a way to care for the responders as well as the impacted populations. Quinn developed the Immediate Stabilization Procedure (ISP) which is widely recognized as a powerful and effective stabilization tool. ISP involves safety oriented bilateral stimulation administered by the clinician through hand tapping delivered along with positive cognitions or ego strengthening statements. With Quinn’s ISP as a guide, Kiessling introduced a mental health first aid technique called Acute Traumatic Intervention Protocol (ATIP) in 2013. ATIP can be used after immediate exposure and up to several hours or days following a traumatic incident. It is not therapy, and is only appropriate to use with clients who have experienced a recent traumatic event. Anyone who has been involved in, or witnessed a crisis, natural disaster,

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featurearticle accident, assault or other critical incident, and has experienced distress or other symptoms associated with the experience, may benefit from ATIP. How it Works Adaptive information processing (AIP) is the theoretical underpinning of EMDR. When the brain’s adaptive information processing functions properly, elements of disturbing events – thoughts, emotions, sensations, sights, sounds and memories - do not continue to disrupt a person’s functioning over time. But when the brain’s AIP functions do not function properly, elements of disturbing events are repeatedly triggered, leading to symptoms widely recognized as Post-Traumatic Stress Disorder (PTSD) or other traumarelated conditions.

ATIP/CID reduces the likelihood of symptoms developing into more complex, trauma-related issues and shortens subsequent trauma-focused treatment.

Where SUD fits in The aforementioned EMT team in Israel was trained to administer short bursts of rapid bilateral stimulation (BLS) in the form of eye movements while observing and monitoring the patients’ reports of somatic disturbance. Reports of disturbance are rated using the Subjective Units of Disturbance (SUD) scale, which is commonly used in EMDR and other interventions. The SUD scale ranges from 0-10, with 0 being little or no disturbance and 10 being the most intense disturbance. When patients report decreased disturbance after 3-5 applications of BLS bursts and the EMTs observe improved stability, the patient can then be referred to the next appropriate level of intervention. Kiessling developed ATIP in 2013, and in 2019, he adapted ATIP to include Critical Incident Desensitizing (CID) for patients who struggled to verbalize their traumatic experiences. CID protocols can be used in the wake of a crisis, natural disaster, or other critical incident to reduce distress and symptoms associated with the traumatic experience. They are not therapy but a form of Psychological First Aid. Both ATIP and CID employ short bursts of BLS to reduce disturbance following a critical incident. The interventions differ in that CID is briefer than ATIP. The general goal of CID is reduced disturbance. ATIP is appropriate when patients are disturbed, but still able to describe their experience and apply the SUD rating scale. The general goal of ATIP is to reduce disturbance and improve immediate functioning. ATIP/CID training Similar to CPR, the ATIP/CID intervention can be taught to both professionals and paraprofessionals. ATIP/CID training uses lecture and discussion, video and live demonstration, and monitored practicum experiences to guide learners in applying the technique effectively. The lecture covers the basics of limbic function, neurobiology of memory formation, and an overview of traumatic stress reactions including dissociation. Participants are introduced to adaptive information processing, the underlying theory for ATIP/CIP. Briefly, when traumatic events occur, sensory information is encoded in networks of connected neurons. The strength of neuronal network connections is decreased when working memory is taxed with bilateral eye movements. The body’s natural coping and recovery process is facilitated when the intervention is paired with proactive guidance. After receiving ATIP, clients experience less overall negative impact, and the need for future treatment is reduced. More information on training can be found at www.emdrconsulting.com.

Help the Helpers The experience of providing services during or after critical incidents can lead to mental and emotional disturbances among responders. This is widely known as secondary traumatization. Relief workers who respond to traumatic events might become direct or indirect victims of the incident they are sent to serve. Responders can be overwhelmed by the magnitude, volume, depth and breadth of a traumatic incident. Without sufficient opportunity to rest or debrief, responders can also suffer trauma-related symptoms. Case Example #1 This is the case of a registered nurse (RN) who was involved in the discovery of a deceased co-worker in the workplace. The RN was referred via her EAP for three sessions within days of the event. She and I quickly identified the primary disturbance – a lingering image of the deceased co-worker, which the client rated with an initial SUD of 8 out of 10. I applied ATIP during the initial EAP session, and the client reported that the image had dissipated, and the SUD rating reduced to 4 out of 10. In the follow-up session, one week later, the RN identified a different disturbance – feelings and sensations of shock and disbelief regarding the event – which was rated with a SUD of 6 out of 10. ATIP was again applied, and the client reported the SUD rating reduced to 2 out of 10. For the final session, 3 weeks after the follow-up, the client reported the disturbing image had not recurred, returning to work was no longer debilitating, and the SUD rating related to the event remained at 2 out of 10. Case Example #2 This case involved a mental health provider who was informed by a manager that her spouse was the victim of an inmate attack at a nearby correctional institution earlier in the day and had since been transported to a local hospital. Before leaving to be with her family, the provider requested a contact with a peer support volunteer. Peer support volunteers are typically non-clinical institutional staff. During a brief contact of 10-15 minutes, the provider received ATIP to mitigate her disturbance about the news of the attack and reduce anticipatory anxiety. The provider was able to gain composure and attend to the needs of her family. Summary ATIP/CID is a brief, structured intervention that can be administered in under 15 minutes during, immediately after or in the days and weeks after a critical incident. It gives responders an effective way to take care of each other as well as incident survivors. In the past eight years, ATIP has been taught to sheriff’s deputies, military chaplains, teachers and other educators, medical providers, EA professionals, and administrative and correctional staff across the US, Canada, Turkey, and Hong Kong. ATIP/ CID reduces the likelihood of symptoms developing into more complex, trauma-related issues and shortens subsequent trauma-focused treatment. Paula Harry, MS, LCSW, is an EMDR-approved consultant, trainer, and an A-TIP/CID training provider. Ms. Harry encourages learners of ATIP and CID to consider the interventions as they would CPR. Both are administered at the scene of a critical incident as brief assistance to affected persons to minimize negative impacts of the event and to facilitate recovery and referral to the next appropriate level of service. Like CPR, ATIP/CID is best provided by people who have been properly trained. As a result, it is not necessary to be a licensed mental health professional to learn ATIP/CID, just as it is not necessary to be a medical professional to learn CPR and other first aid skills. Ms. Harry is a coach, trainer, and consultant affiliated with Roy Kiessling and EMDR Consulting, LLC. For more information contact Kiessling at roy@emdrconsulting.com or paulafharry@hotmail.com, respectively.

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