7 Attributes of an Effective EAP

In all the talk about standards, core technology and return on

investments, key EA strategies are lost in the fog. Let’s get back to the
basics.
By Kirk C. Harlow, PhD

Employee assistance programs are as varied as the organizations they serve: Some
provide assessment and referral only, some deliver services encompassing the full
range of core technology, still others offer brief counseling. Two EA professional
organizations, EAPA and EASNA, have developed standards for the field, and a number
of groups have embarked on accreditation of programs.

Nonetheless — despite extensive discussions of standards, core technology and return

on investment — it seems some basic practices, key strategies for providing effective
EA services, have been lost in the shuffle. Drawing together the lessons of practice and
research, however, can provide us with seven key attributes of an effective EAP.

1. Know the organization

Organizations are a lot like people — they come in different flavors. To address the
needs of the organization and its employees, you must understand the character of
the organization. Among the questions you should be able to answer are: What are the
principle aims of the organization? What are the types and responsibilities of the jobs
in the organization? What values does the organization embrace? What is the structure
of the organization?

This knowledge, along with comprehension of other organizational information, is

essential to putting EAP services into a context. Too often employees are seen as if
they come to the EAP out of nowhere, when in fact they wear their organization’s
mantle into the room. And supervisors’ confidence in an EAP is directly related to a
belief that the EA professional understands the company’s situation.

2. Embrace All Customers

EAPs serve a variety of customers, including line employees, supervisors, human

resource professionals, legal staff and senior management. The effective EAP must
understand and address the different needs of these groups. Often their interests
converge. For example, both the supervisor and the employee will want the
employee’s depression addressed, although it may be for different reasons.

On the other hand, senior managements’ concern for the bottom line may push EAP
services into a role as little more than the managed behavioral healthcare gatekeeper.
The legal staffs’ orientation toward reducing risk exposure may constrain the
necessary partnership between the EAP and supervisors.

Accommodating the disparate interests of these stakeholder groups may be a

Sisyphean task. The effective EAP can, however, use an understanding of stakeholder
perspectives to create strategies to influence beliefs and strengthen a focus on
collaboration.

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3. Be Visible

Common sense tells us that to be effective, an EAP must be seen. Attitudinal research
has shown that the visibility of the EAP not only increases utilization, but also
increases the perceived value of the program among those who have not used it.

Lessons from advertising suggest that someone must be exposed as many as six times
to a message before it has an effect. In addition, the message must continue to be
visible, or its effect will deteriorate. Being visible should go beyond the common
practices of brochures, payroll stuffers, training, and Web sites. The goal of visibility is
to make consulting the EAP one of the obvious choices on relevant problems.

Many EAPs also participate in safety meetings, or in supervisory and management

training programs conducted by training staff. Others create advisory boards and build
relationships with company decision-makers. An effective EAP insinuates itself as fully
as possible into the culture of the organization.

4. Be Empowered

Empowerment is, in many ways, a precursor to the first three items on this list. Being
empowered is being imbued with the sense that the actions needed to be an effective
EA program actually can be carried out. It is the willingness to take risks necessary to
accomplish EAP goals. Empowered EAPs have faced down corporate counsel by
bringing in outside attorneys to offer alternative interpretations of the law. Others
have carried out interventions on CEOs with substance-abuse problems, even at the
risk of losing jobs or contracts.

EA professionals are change agents. Targets can run the gamut from assessing
employee needs of and setting the process in motion to addressing a dysfunctional
work group to participating in the development of organizational strategy. For an EAP
to be empowered and sit at the organizational table, it must develop legitimacy. How
does that happen? By demonstrating competency in both employee assistance and
business.

5. Be Data-Oriented

Businesses love data. They especially love pie charts, bar graphs and flow charts. The
effective EAP must understand that data-oriented presentations are the lingua franca
of business. Data-heavy reports and presentation are as important for the image they
convey as they are for the information they present.

But being data-oriented is not just for dazzling decision-makers. It is a means for
improving the effectiveness of the EAP. Even limited EAP data-sets, with information
such as client age, gender, department and problem type, can provide important
insight. Comparing utilization rates for specific problems to expected rates based on
population research can tell you if there may be unmet needs among your employees.
Looking for problem patterns among different employee cross-sections can help you to
identify areas to target interventions. Surveys of various customer groups can tell you
about the effectiveness of your marketing efforts or underlying resistances to EAP
usage.

To be data-oriented means to bring scientific evidence into decisions, not just

anecdotes. Evidenced-based treatment — in which practice guidelines are used to

2
define the elements of effective treatment of psychological problems — are
increasingly available. The challenge to the effective EAP is not to just know the
evidence, but also to be an advocate for the availability of effective treatment.

Valid screening instruments used as part of assessment help accurately identify

problems. These tools also help ensure that EAPs do not overlook the fact that
individuals can bring more than one problem with them, for example psychiatric co-
morbidity with substance abuse or substance abuse with marital problems. Screening
instruments also establish a benchmark for determining if a positive change has
occurred.

Finally, being data-oriented means contributing in whatever way possible to research

that advances the quality and effectiveness of EAP practice. Participation may be as
simple as contributing information to a wider data-set, or it may involve undertaking
scientific research within the EAP.

6. Facilitate Early Identification

Research has indicated that the longer a problem goes on, the more severe it will get,
and the more it will cost the organization, as well as others outside of the organization.
Some of the costs to the organization may include higher health-related costs, lost
productivity, and losses from accidents and injuries.

Early problem recognition involves specific actions to identify and motivate individuals
to come to the EAP in the early stages of problems. A number of organizations recently
have implemented early identification processes for depression and substance-abuse
screening, often using Web sites to provide the screening instruments.

The screening efforts noted above are important elements of the process, but they are
just a beginning. Research indicates that incorporating screenings into the annual
physical exam, combined with the referral of the physician, can motivate individuals to
seek mental-health and substance-abuse treatment. Substance-abuse and mental-
health screenings could be integrated into the health screening used at health
facilities. Effort can be made to inform and instruct family members and co-workers
about methods to encourage others to contact the EAP.

In sum, one goal of the effective EAP is to increase the means by which those in need
are encouraged to use the EAP before the problem becomes serious.

7. Be a Learning Organization

Make learning an integral element of the organization’s culture. The goal of learning
organizations is to strengthen individual and organizational competence to accomplish
strategic aims, innovate, renew and shape the future.

There are two sources for learning: First are outside sources such as continuing
education, books, journals and computer-based training. In most instances, these
sources are focused on developing individual competencies. They do not, however,
create a common body of knowledge in the organization or the cross-fertilization of
ideas. It is possible, of course, through the involvement of entire work groups in
learning processes, to bring about more organization-wide learning. Organizations, for
example, carry out organizational development and internal-training programs. Some
even have started organizational book clubs.

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The second means of organizational learning is often called knowledge management.
This is the process of taking knowledge from across the organization and making it
available through data systems to all members of the organization. One aspect of this
process, knowledge engineering, involves identifying best practices, whether individual
or organizational, and articulating the processes. For example, an organization may
describe the process by which a high-performing individual is successful at creating
follow-through on referrals.

While learning organizations must have sources of learning, they also must have
mechanisms for turning learning into actions that strengthen use of competencies,
innovation, renewal and strategy development. For example, self-directed work teams
are one often-recommended approach. Regardless of the organization’s structure,
learning organizations must enable communication that effectively flows upward,
downward and laterally. Importantly, learning organizations must value information
irrespective of the source.

The effective EAP should be a learning organization for several reasons. First,
continuous improvement can only come through continuous learning. Second, for most
people learning is like a form of fuel: Without it, people become complacent or burn
out. Third, learning not only enables the EAP to adapt to change, but it gives the EAP
the competence to define the future.

There is little doubt that every reader could add to this list. I encourage you to do just
that. It is my view that every organization should take time away from the day-to-day
operation for reflection on its guiding principles.

Kirk Harlow, PhD, is president of DecisionStat, a human-resource consulting firm

with specialization in EAP evaluation, quality improvement and survey-based feedback
systems. Harlow has been involved in the EA field for more than 15 years and has
published numerous articles on EAP evaluation. He can be reached at
kharlow@decisionstat.com.

(Winter 2002)

Treatment Bias?
Advocates say discrimination against people in recovery is rampant
By Bob Curley

People in recovery face discrimination in the workplace, health care and everyday life,
and litigation may be the only way to force changes in some cases, experts told a
panel convened at the annual meeting of the American Bar Association (ABA) in
Washington, DC.

“Where are the lawyers?” asked Deb Beck, president of the Drug and Alcohol Service
Providers Organization of Pennsylvania, who charged that managed-care firms
routinely violate the minimum insurance laws on the books in 40 states, including
Pennsylvania.

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 “Managed care has to be taken to task,” Beck said. Pointing to efforts to pass laws
requiring addiction to be treated on par with other health conditions, she added,
“Parity won’t solve that; it will be just another type of coverage to be denied ... We
don’t need parity; we need people to enforce the laws.”

Beck was among more than a dozen advocates who presented testimony before a Join
Together’s Policy Panel on Discrimination Against Individuals in Treatment and
Recovery, cosponsored by the ABA.

“This is an issue I unfortunately have encountered from time to time, both personally
and in my professional life,” said Alfred P. Carlton, president-elect of the ABA. “We
must work to end discrimination of any kind, but especially for people seeking
treatment for addiction. It’s a disease and should be treated as such.”

Former First Lady Betty Ford said that while up to 80% of Betty Ford Center clients
used to be able to pay for their treatment through insurance, today just 20% to 25%
can access their insurance benefits. Not even lawyers are immune to addiction-related
discrimination, she added.

When the Betty Ford Center recently tried to set up a residential treatment program
for lawyers, doctors and other professionals, nearby residents picketed and told clients
to go home. “They threatened to videotape our patients going to and from the homes
and make public their tapes,” Ford testified. “The ignorance and hate were surreal. A
few residents stood up and spoke in our support, but were shouted down. So, the Betty
Ford Center, maybe the best-known treatment center in the world, has to find
alternative housing for our patients.

“NIMBY is alive and well in 2002,” said Ford.

Robert Newman, MD, director of the Baron Edmond de Rothschild Chemical

Dependency Institute at Beth Israel Medical Center in New York, said that people with
addictions are “subjected to conditions that would be unthinkable in any other medical
practice,” such as having their medication levels capriciously reduced or eliminated, or
being told to deal with their problems through behavior modification rather than
medical intervention.

“You’re talking about horrid malpractice of medicine,” said policy panel member Lisa
Mojer Torres, a New York attorney who represents clients with opiate addictions.

Brent Coles, the mayor of the city of Boise, Idaho, agreed: “When you have a 16-year-
old with a chronic, acute disease, we would have to find her treatment if she had
diabetes,” he said. But 90% of Idaho cities offer residents no access to addiction
treatment, said Coles. Even Boise, with its 200,000 residents, does not have a single
detoxification center, he said.

“Eighty-five percent of narcotics addicts in US have no access to methadone

treatment,” added Newman. “My doctor can treat a patient for pain relief with
methadone, but if he does so for addiction, it is illegal.”

Newman said that the only hope for fighting such discrimination is through litigation.

‘Hysterical Terminations’

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Having a drug arrest on your record or a history of addiction also dogs people in
recovery in the workplace — even after years of sobriety.

Susan Rook, director of communications and outreach for the advocacy group Faces
and Voices of Recovery, said a recent Peter D. Hart survey found that one in four
people in recovery have experienced discrimination in the workplace or in seeking
health care, and one in five fear being fired if their employer finds out they are in
recovery from addiction.

Citing a pattern of “systematic and illegal discrimination against people who are in
recovery,” Rook said, “When personal prejudices influence my ability to get a job,
receive an earned promotion, get and keep health insurance, life insurance, housing
and other basic benefits of being a member of a community — then someone else’s
opinion of me matters. And that personal prejudice is not merely stigma ... (it’s)
discrimination.”

Rook stressed that despite the risks, it is important for people in recovery to speak out
against violations of their basic civil rights. “It’s not just about what other people say,
but what those of us in recovery don’t say,” Rook testified. “The public silence of
people in recovery speaks volumes. Our silence says to others that we have something
to be silent about. By our silence, we let others define us.”

Adele Rappaport, a lawyer in the Detroit office of the Equal Employment Opportunities
Commission, said that people with addictions are frequently the target of “hysterical
terminations.” She told the story of a client who told his employer that he needed
addiction treatment, and instead was fired for violating the company’s zero-tolerance
policy. “What kind of personnel decision is that?” she asked.

Unfortunately, the Americans with Disabilities Act (ADA), which ostensibly provides
some protection for people with addictions, provides little help. Rappaport estimated
that 95% of people with addictions fail to meet the ADA’s standard for disability (e.g.
impairment of a major life function), while others run afoul of the law’s exclusion of
coverage for current users of illicit drugs.

Nonetheless, addiction remains the most common personnel problem in most

workplaces, accounting for 20% of voluntary employee assistance program referrals
and 50% of supervisory referrals, according to Dorothy Blum, vice president of the
Employee Assistance Professionals Association. Employers should be warned that
discriminating against people with addictions not only will harm their bottom line in the
long run, but also opens companies up to litigation, said Blum.

The workplace woes experienced by people with addictions are compounded in many
cases by a criminal record, which makes finding a job even more difficult.

“Many ex-offenders with drug-related offenses are also currently in recovery or

treatment. Logically, their ability to truly recover and move on in their lives is directly
connected to their ability to obtain and maintain employment,” said Robin Runge,
coordinator of the program on women’s employment rights at the D.C. Employment
Justice Center, during her testimony before the policy panel.

But Runge, who works with ex-offenders trying to get jobs, said having a criminal
record is often the primary barrier to employment for people in recovery — especially
with the increase in the use of criminal background checks after 9/11.

6
“For example, I had a client who was a teaching assistant in the D.C. public schools for
over a year when a background check showed that she had been arrested over 20
years ago for drug possession,” said Runge. “Although the employer knew about this
arrest when she was hired, they used this background check as a basis to fire her.”

In a recent survey, 59% of California employers said they would never hire anyone
with a felony drug conviction — even though such discrimination is illegal in most
cases.

“We need to help employers understand that hiring someone with an arrest from 10
years ago is no more risky than hiring someone without a criminal record,” said Runge.
“In fact, they may find that the employee with the record is harder working and more
committed.”

(Winter 2002)

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 Leadership Lacking?
EAPs can help instill integrity in an era of ethical scandals
By William G. Durkin, PhD, MBA

Is leadership lacking in the executive ranks of America’s corporations? With recent and
continuing accounting scandals, some would suggest that that’s the case, and that we
have lost our way. With increasing skepticism of corporate honesty and integrity, new
emphasis will be placed on regulatory issues. But is that enough?

Not quite. Corporate management must rekindle its emphasis on “doing the right
thing” even when nobody is looking — and there are few within organizations that can
better enable this than employee assistance professionals.

The lost trust of the American public, and particularly investors, must be repaired. The
ideals of honesty, integrity and good character, so much a part of the fabric of our
business ethic, even today, must be reemphasized at all levels of the corporation. The
vast majority of businessmen and women adhere to a strong code of ethics. CEO’s and
boards of directors need to demonstrate and reinforce the fact that nothing less is
expected.

Encouraging Ethics

Once a valued perk in the senior management suite, executive coaching has been
rapidly embraced as a developmental tool for other levels of management.

Executive coaches, in addition to helping clients hone management skills, have

traditionally placed a focus on emphasizing the integrity of individual behavior and, by
extension, the integrity of the organization. Forward-looking companies increasingly
see the advantages of offering individualized and personalized assistance to
executives who they see as having solid but yet-unmet potential.

Unlike mentors, coaches are frequently drawn from the outside and provide support on
lifestyle, management style and business issues. They act as a detached observer and
advisor in helping individuals meet their personal and professional goals.

Executive coaching has been around since the 1980s, when it first became popular
with executives looking to increase their skills and to attain more responsible
leadership roles. Some need help with administrative skills such as time management,
others need help learning how to manage people, and still others need a sounding
board to work through difficult ethical issues. Even skilled managers, like skilled
athletes, use coaches to improve their game.

Coaching at its core is getting help when you need it and want it. The executive coach
is part personal consultant, part sounding board, and part manager, free to give
honest opinions and sometimes hard advice.

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As an EA professional, if you noticed a ring of familiarity with the description of the
executive coach, you should. It describes the relationship that EA professionals
frequently have with clients.

The Role of EAPs

EA professionals work with clients on personal problems and issues that have the
potential to impact performance. The pressures and confusion that accompany
personal problems can often lead a person to rationalize or compromise and make
decisions that they would not make under less stressful circumstances.

The EA professional is often in a position to clarify issues and define appropriate

behavior during these difficult periods.

Many companies have downsized or merged with other companies, creating leaner
staffs with as much or more responsibility and looking to grow profits even further.
Some of the resulting pressures have contributed to ethical lapses we are witnessing
today. Often faced with competing priorities and demands, executives, like most
people, can confuse their priorities and make decisions that, in today’s environment,
can not only cause them significant personal harm, but place the company at
significant risk.

The EA professional as a coach can offer a more objective and stabilizing view of what
is important and “right” in the decision-making process. Companies must devote more
time and energy to developing staff and creating a culture where ethical behavior will
always be the road traveled.

In this regard, the EAP can play an important role as part of a company’s overall risk-
management strategy.

Coaching the Staff

A coach ideally is a trusted friend and ally. Personal issues, in addition to business
issues, are not out of bounds in a coaching relationship since both affect each other. A
coach should be able to give advice and guidance through understanding the needs of
the person being coached and the dynamics of the organizational environment.

The coach should understand the language and dynamics of business. The coach
engages the individual and listens. A coach leads the person to frame his or her issues
in a way that leads toward manageable change and then employs methods and
strategies to help that person achieve the needed change.

Coaching is an ongoing alliance between coach and client within a supportive

organization. A coach is a safe ear for the client, allowing an immediately available
sounding board and opportunity to reality-test ideas, anxieties and plans. This
accelerates the learning process and behavior change through frequent feedback and
insight.

There are few in an organization that can fill this coaching role better than EAP staff.
EAPs can use internal staff or, when that is not possible, select outside coaching
resources.

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Confidentiality, always an issue in EAPs, also is an issue in coaching relationships. It is
best handled by clearly defining and agreeing on what type of information, if any, will
be shared with the organization. There should be no hidden agendas.

And high on everybody’s agenda today must be the reaffirmation of a commitment to

principled behavior in business. The EAP is certainly one of the already existing
corporate vehicles that can play a significant role in that task.

Bill Durkin PhD, MBA, formerly EAP manager for ARCO, is president of
WGD Associates, Executive Coaching. He can be reached by phone at
818-790-4903, by e-mail at wdurkin@wgd associates.com, or
www.wgdassociates.com.

(Winter 2001)

10
 Trek to Ground Zero
Tennessee EAP team helps soothe trauma after Trade Center
attacks

By Jenny Nash

Like almost every other American after the terrorist attacks on Sept. 11, Doug
Andreasen wanted to help in some way. Andreasen — an employee assistance
program (EAP) counselor at St. Mary’s Assist in Knoxville, Tenn. — realized that he and
his fellow EAPs possessed skills that could help people deal with the emotional
aftermath of the attacks.

Andreasen, who is trained in Critical Incident Stress Debriefing (CISD), also is vice
president of the East Tennessee EAP Association chapter, which had been wondering
how to best spend several thousand dollars in its treasury. Andreasen suggested that
the chapter sponsor a volunteer CISD team to go to New York City.

"If we were saving it for a rainy day," Andreasen said, "it rained on Sept. 11." He ran
the idea by the executive committee and chapter members, then sent an e-mail to
EAPA national headquarters. He got the green light on Friday, Sept. 14, and on Sunday
at 6:30 a.m., Andreasen and four colleagues headed up Interstate-81 en route to New
York City.

On the drive, the five-member team went over the profile of the company they would
be visiting, its locations, any CISD services that had already been provided, the
number of employees and the range of impact the attacks had on them. Some
employees’ coworkers had been killed, others had lost friends and family members in
the attack, and some had children in schools close to the World Trade Center. Many
had been working blocks from the attack and watched as planes flew into the towers
and people jumped to their deaths.

As the team approached from New Jersey, 13 hours later, members got their first
glimpse of Manhattan’s altered skyline.

"The southern third was dark; no lights shone from the buildings. There was, however,
an extremely bright, white light coming up from the ground illuminating a column of
smoke that rose a thousand feet into the air, Ground Zero," Andreasen said. "We were
all quiet for a moment. It was real and much bigger then we had realized."

A policeman stopped the car as they exited the tunnel into Manhattan, shone a
flashlight inside and then waved them on. But the siege atmosphere didn’t stop there.
All trucks were stopped and searched before they could enter the city. There were at
least two police cars on every block, and Humvees and troop-filled trucks traversed
Manhattan.

As the group checked into the Hilton at 52nd Street and Sixth Avenue, the site of the
National EAPA conference in November 2000, soldiers in camouflage fatigues also
were checking in. The hotel was filled with Federal Emergency Management Agency

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workers, Centers for Disease Control personnel and emergency response teams from
the Army Corp of Engineers. "It was quite a contrast from the conference just 10
months earlier," said Andreasen.

That evening, the Tennessee team took a walk down Sixth Avenue.

"Spontaneous memorials were everywhere, in Times Square, on the side of a pizza

shop, under a stop sign, on the sidewalk," Andreasen said. "Flowers, candles, posters
drawn by children, and missing person fliers, thousands of them, taped to everything."

Over the next two days, the group met with almost 200 employees. Originally
scheduled for one company, they visited two companies — an advertising agency with
200 employees and a global mail and document services firm with 280 workers — at
six different sites. The team’s services were requested by the company that provides
EAP and behavioral health services for both firms, and they worked closely with the
EAP manager while developing a critical-incident management plan.

Team member Vicki Thal, an independent EAP practitioner, said that although New
York City has a legion of individuals and agencies trained to respond to traumatic
events, the magnitude of the disaster warranted a need for many more providers of
CISD services. In addition, existing providers "were as much of a victim as the victims
were," Andreasen said. "If you’re an EAP in Manhattan, it’s kind of tough to tell who’s
the patient and who’s the counselor."

"On the Monday New York City employees returned to work, there weren’t enough
counselors available," Thal said. "National EAPA sent out a national request for EAPs
available to help out — and we responded."

The employees shared experiences and presented needs as varied as the city itself.

Working at different sites alone, in pairs and trios, the team met with people in small
groups, determining which employees might need more help than others and meeting
with those people one-on-one. Team member Vicki Thal, an independent EAP
practitioner, walked through the companies’ offices and talked with people to let them
know assistance was available.

"We were there on the first official day back to work for New Yorkers while the trauma
was still unfolding and different people were still in the crisis phase," said team
member Shoray Kirk, an EAP counselor. "What we did, for the most part, was a lot
morefluid, flexible — more like educating, consulting, coaching and comforting — than
the structured, one-size-fits-all approach of formal CISD model."

The five counselors had previously conducted critical incident stress debriefings with
people who witnessed coworkers burned or crushed to death, drownings,
electrocutions, as well as numerous other horrible events. But, as Thal put it, "Never
have I had to meet with so many people whose sense of safety had been damaged or
destroyed."

The group heard horrific stories the likes of which they’d never heard before. Williams
continues to think about the regional sales manager who went back to work on Sept.
13, and instead of watching the sun rising over the World Trade Center as he usually
did, he watched it rise over a mountain of rubble.

12
The manager brought in a woman who had been temporarily reassigned to the
company’s Long Island office because she kept having flashbacks of people jumping
from the towers. She didn’t know when she’d be able to return to Manhattan.

"Another woman, the mother of an 11-year-old girl, was worried about her daughter,
who was having nightmares, wouldn’t sleep in her own room and wouldn’t let her
mother out of her sight. The girl was literally following her mother from room to room
in the house. The mother was exhausted from being awakened at night, trying to work
and managing her own anxiety," said Williams.

For most of the employees who were in Manhattan at the time of the attacks, the
world had shifted beneath their feet. Not only had they witnessed the terrible events
first-hand, trying to make sense of what they’d seen, but they spent the rest of the day
simply trying to get home or to a safe place.

Andreasen saw one young man who, after wandering downtown for hours after the
attack, had walked several miles from the Trade Center to the Upper West Side of
Manhattan, where he heard about a ferry he could catch home to New Jersey. He
waited three hours for his turn to board.

"When it reached the other side of the Hudson, he was met by men in full biohazard
suits and had to run a gauntlet of fire hoses spraying decontaminate on him,"
Andreasen said.

It illustrates, he said, how completely the attack changed people’s perceptions about
the world around them, how nothing could be assumed to be safe.

In helping people cope with these anxieties, Thal found that focusing on day-to-day life
helped. "When folks seemed stuck with an unyielding sense of doom, they appeared to
be concentrating on the global aspects of the attacks," she said. "Focusing on a more
personal area of their lives seemed to provide relief."

Another comforting fact for people, Thal said, was that the team came from
Tennessee.

"They thought, if people in Tennessee experienced anxiety and were having a difficult
time comprehending what happened, then it made sense that the people whose city
was attacked would experience more anxiety and struggle more with their sense of
safety," she said.

Kirk found that the Tennessee connection had another benefit: "The fact that we came
all that way to help touched them."

The five volunteers in turn have been touched by their experiences in New York City.

"We all were impressed with the resilience of New York people after their city was
attacked," Thal said. "It gave me a renewed faith in mankind’s ability to move
forward."

The group also has gotten a few lessons about providing critical incident stress
management on such a large scale. Thal says that, in this type of crisis, the debriefers
need to make sure that they get debriefed too.

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"As EAPs, we’ve learned about operating in a new area of traumatic events, and I’ve
learned that following CISM services, my emotions have been impacted too," she said.
"We debriefers go through stages similar to those who have experienced traumatic
loss — although the stages are certainly not as profound."

Jenny Nash is a Tennessee-based writer and editor.

(Winter 2001)

14
 Surviving Chaos
Managers can take action to get through moments of crisis

By Deb Clifford

Thousands of businesses across America, if not the world, were stunned by the
terrorist attacks on the World Trade Centers in New York and the Pentagon in
Washington. When I heard the news, I was just starting a management development
class for a financial services client. Needless to say, nothing prepares you for leading,
guiding and facilitating a class about personal and professional growth in the midst of
such a crisis.

We were all in shock. My head spun, my stomach turned and my knees weakened.
What to do? My 15 participants were looking to me and I was in shock just like they
were. Together we decided to break for 90 minutes to take care of the important
things like calling to check in on our families and loved ones. We needed this time to
collect ourselves, see and hear what was happening and try to gather our senses.

As a corporate leadership consultant, I knew that this terrible tragedy would put my
skills to the test. Along with the participants, I quickly created a plan that would help
us all make it through the attacks and following chaos. The following tips can help
managers of all types of business make it through periods of crisis:

BE — Be with each other, be genuine and vulnerable. Don’t try to pretend things are
normal, they aren’t and they will never be the same again. One of the people in my
class remarked, "If we cancel class, they win." We all agreed. We moved forward, still
numb, but going forth together. As we continued with the class, some felt a bit
empowered that we were prevailing despite the terrible tragedy.

DO — Gather to collectively "do" something, feel enabled by gathering supplies, giving

blood, writing letters. Company-sponsored blood and food drives are a positive move,
action in which many employees find comfort.

SHARE — Share your feelings, bring human intimacy to each other. We started our
class by talking about how we felt and sharing our feelings. To start without
acknowledging or recognizing our fears, anger and confusion would be untrue to us
and dishonor the situation and those affected by it. I began by calling the class
together and stating my vulnerabilities as a class facilitator. I said: "Please help me.
None of us know exactly what to do, so hear my idea and work with me and we’ll get
through this."

CREATE — Create rituals to stay connected: music, moments of silence, candle

lighting. I started the second day of the class with a reading of a song from the musical
Godspell: "Out of the ruin and rubble, we can build a beautiful city." We then shared a
moment of silence.

REMEMBER — Commemorate this time, wear ribbons, create a mural or an area of

remembrance within the workplace. Soon after the attacks, politicians and business
leaders began wearing red, white and blue ribbons on sport jackets and blouses.

15
Symbols can be very powerful, and even the smallest token can bring huge amounts of
comfort to those who are suffering.

LISTEN — Understand, listen and give people the time and space to deal with their
grief. During the classes, I’ve reminded students that it’s extremely important that we
all be honest and share thoughts about the events of the day and listen to what we’re
each saying.

CONNECT — Connect with each other with much care — be more patient in that line,
speak more softly, counter the anger within with love and kindness at every
opportunity.

We have the courage and freedom to work through this terrible time in our nation’s
history and our workplaces are the perfect settings for the love and support that we
need to do just that.

Deb Clifford is the founder and president of Inspired People, a leadership consulting
company in Simsbury, Conn. She can be contacted by e-mail at
dclifford@inspiredpeople.com.

(Winter 2001)

16
 The Aftermath
Employers can provide long-term support after world-altering events

By Laurie Martin, CTS

Sept. 11, 2001. That’s the day we stopped taking things for granted — like our ability
to feel safe and free in the world as we knew it. That’s the day we started feeling
vulnerable in our homes and workplaces. It’s the day we all became victims of
terrorism.

Months later, with the horrific images of loss and destruction embedded in our
memories, many are still searching for a new sense of normalcy as we fear the
political, social and economical uncertainties of the future.

Following any traumatic experience, there’s a period of grieving as we mourn our

losses. That’s when productivity, morale, and relationships at work and at home may
suffer.

That’s when it’s important to provide support. Open and honest communication helps
to build workplace camaraderie – and that means happy, healthy and motivated
workers. It may also minimize expenses related to short- or long-term absences, low
productivity or hiring and training costs if employees leave.

There are many ways you can support your employees through this or any critical
incident. Here’s how you can help send your employees the message that you do care:

• Encourage open and honest communication about the incident and how
it is affecting others.

• Watch for signs of stress like: insomnia; lack of energy; loss of appetite or
over indulging in food, drugs, alcohol or tobacco; headaches; stomach aches;
etc.

• Provide assistance to individuals and groups who are having difficulty

coping.

• Take a ‘proactive’ role by offering workshops or information sessions on

the topics of trauma and grief.

• Encourage your staff to talk openly with their families and friends. Unless
you ask, you may not know how your children or teens are feeling.

If anything good could ever come from such horrendous acts of terrorism, we might
acknowledge the way people everywhere have pulled together. Perhaps we treasure
our families and friends more. We may have come to realize how patriotic we are
about this great continent and even gained a new respect for our leaders.

17
Perhaps we can find some peace of mind in the additional safeguards being
implemented at borders and airports. Or maybe there’s a stronger feeling of
camaraderie and safety at work.

Laurie Martin, a principle of TERMS Inc. (Trauma Education Risk Management

Services), is one of only a handful of certified trauma specialists in Canada. She can be
contacted at 519-836-6878 or terms@sympatico.ca.(Spring 2002)

Eldercare: The New Frontier

EAPs respond to the needs of aging

By Bob O’Toole, MSW and Mary Lynn Pannen, BSN, CCM

A baby boomer will turn 55 years old every seven seconds for the next 20 years, and
their parents are living longer than any generation in history. In fact, the fastest-
growing age group in our society is not all those babies in strollers — it’s people over
85 years of age.

This longevity can be a mixed blessing. While new medications, technology and
surgical procedures have prolonged lives, they also have created unprecedented
demand among the elderly for assistance to get through each day — bathing,
dressing, mobility, toileting, managing money, shopping, cooking and cleaning.

Caregiving takes a heavy toll on work and family life, and employers nationwide are
seeing their bottom lines affected by America’s aging. Among those who have
provided hands-on care, 67% reported it has significantly affected their family life, and
41% said it interfered with work. More than 10% of those who have provided long-term
caregiving said they had given up promotions or jobs as a result. According to an
August 2001 AARP survey, 44% of the nation’s 76 million baby boomers, a
demographic bubble born between 1946 and 1964, have responsibility for both aging
parents and children.

Trying to manage the care of aging parents or a disabled family member while trying
to meet work and family responsibilities is a challenge that faces a rapidly growing
segment of our population. Exacerbating the challenge are societal changes that have
altered the structure and roles of the American family, including the movement of
women — traditional at-home caregivers — into the workplace since the 1970s, the
growing number of single-parent households and increases since World War II in the
geographic distance between adult children and their parents, which has created a
new generation of long-distance caregivers.

In response to this growing dilemma, employee assistance programs are increasingly

being called upon to provide innovative and comprehensive approaches to help
workers cope with caring for their elderly relatives.

A Shared Problem for Workers and Employers

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As the phenomenon of working and long-distance caregiving continues to grow,
employers are learning that this has an impact on their bottom line. Recent studies
funded by AARP, The National Alliance for Caregivers, MetLife and The National
Alzheimer’s Association estimate costs of this burgeoning crisis to employers to be as
much as $31 billion annually. This cost will increase significantly over the next two
decades.

Research shows that the impact that eldercare responsibilities has on the workplace
falls into six major categories:

• Replacement costs for employees who leave due to caregiving

responsibilities.

• Increased use of sick leave and Family Medical Leave Act time to care for an
aging parent.

• Presenteeism: Costs due to workday interruptions while the employee

contacts doctors, home health aides and other paid caregivers.

• Costs associated with supervising employed caregivers.

• Lower productivity due to high rate of stress-related disorders among working

caregivers.

When a working caregiver tries to contact local social service or health care agencies
for help they discover that a frightening phenomenon is emerging in America; while
the population of frail older persons is growing steadily, the care and services available
for them is shrinking rapidly. Steep cuts are occurring in the once generous Medicare
home health care benefit. With billions of federal dollars now needed to pay for the
war on terrorism and to strengthen our economy by supporting critical industries such
as airlines, funds for social and health care programs for frail elders will continue to
grow scarce.

Third-party insurance, including Medicare and retiree health benefits, rarely pays for
the costs of functional and custodial services needed by frail elders.

Once working caregivers recover from the shock that Medicare and other retiree
health care insurance covers little of the care and support needed by their parents,
long-distance caregivers and those with demanding jobs who live closer must search
for help elsewhere. To respond to the growing need among working caregivers, EAPs
must develop innovative and comprehensive responses for their clients.

EAPs Respond

How do EAPs develop an effective workplace response to caregiver stress, at a time

when corporate budgets are growing tighter and employee health benefits are
increasing at a double-digit rate?

To offer employers an integrated service product that covers the mental health,
resource, informational and service needs of employees, EAPs should explore the
potential of working jointly with a network of professionals who can offer their
eldercare expertise in a cost-effective manner. Such an arrangement adds a powerful
new capacity to respond to a workplace crisis and relieves the employer of the

19
confusion and frustration of retaining multiple providers to respond to employee work-
life needs.

Once a luxury that only large national corporations could afford, eldercare benefits
programs now come in a variety of formats with services as simple as toll-free call
centers and Web sites with information about local eldercare program. Employees also
have access to a growing list of services, discounts, and even assistance by
experienced professional geriatric specialists. Several private work-life companies,
originally established to provide child-care services, now offer a selection of eldercare
benefits. A more cost-effective alternative is emerging, developed by consortiums of
eldercare providers nationwide.

Affordable Expansion Of Eldercare Services

Joint ventures between EAPs and for-profit and non- profit eldercare specialists reduce
overhead and development costs while keeping the EAP as the coordinator of a
broader range of critical responses to workplace stress. Cost-sharing models allow
sponsoring companies or organizations to pay a modest monthly fee per employee or
member to help their employees and to minimize the lost productivity and profits that
are the side effects of caregiver stress. Integrating such voluntary benefits as
employee-endorsed long-term care insurance can further reduce the costs of eldercare
services to employees and their families.

Because of their strong focus and expertise in behavioral health issues, many EAPs
have chosen to leave the problems of working and long-distance caregivers to work-
life specialists, who offer a more broad-based social service response to childcare and
eldercare needs.

Since many EAP professionals are trained primarily as psychotherapists, they often
lack the functional expertise or training in issues of aging, caregiving and the related
physical, emotional and support services required. Partnering with a network of
eldercare specialists, such as geriatric care managers, can support the EAP
professional and their clients in understanding complex caregiving situations. This
additional expertise and extensive database of resources also can provide validation
and emotional support, assist in the development of a plan, locate community
resources, and provide information and education for the working caregiver.

Partnerships Between EAPs, Employers, Eldercare Providers

Many caregivers wait until a crisis arrives before taking the initiative to plan for their
older adult’s needs. By waiting until the time of a crisis, caregivers place themselves in
a situation where information and resources must be located immediately, and a
response to the crisis is urgent. Critical decisions must be made, but information may
be inadequate, the caregiver’s thinking may be clouded and emotions may run high.

Eldercare issues, however, begin long before a crisis arrives. With the added expertise
and resources that a partnership with eldercare professionals provides, EAPs can help
workers think about eldercare now and think through inevitable issues before they
happen. Adult children, for example, should be talking with aging parents and relatives
about sensitive issues like finances, health care proxies, living wills and community
resources while they’re healthy. The more they know about the limitations of their

20
existing insurance coverage and the true costs of eldercare, the more likely they will
be to consider obtaining private long-term care insurance coverage while they can still
afford it and can meet underwriting requirements.

Adult children often need help to broach those subjects. Human resource, benefits,
wellness, EAP and work-life providers all can share responsibility for the eldercare
initiative and develop a coordinated educational program to publicize these issues.

Employees who are educated in advance about the various aspects of caregiving —
including emotional, financial, legal and day-to-day issues — and are helped to plan
ahead will be armed with resources when they need them. Employees who are aware
of assistance available through their integrated service will save time and frustration.
They will know to call for assistance early in the process and will be equipped with the
support, information and resources needed to meet their elder’s needs. They will be
able to put a plan into action with the help of their eldercare professional.

Importantly, employers will benefit from the employee’s preparedness, from the time
and energy saved by the employee’s direct access to an experienced professional.

Care Insurance as a Voluntary Benefit?

Providing long-term care insurance as a voluntary, employee-paid benefit also is

growing in popularity because employees and their extended family members are
eligible for substantial discounts through the power of group purchasing.

While private long-term care insurance has been available for nearly 20 years, healthy
elders and baby boomers are just beginning to consider the importance of owning this
coverage. Thus far, estimates are that fewer than 10% of middle-aged and older adults
have purchased a long -term care policy. Surveys show that those who have
purchased such policies are pleased with their coverage.

An American Council of Life Insurance study reported, "We found that about half of
long-term care policyholders currently receiving benefits report they would have to
move to a nursing home without their insurance benefits. And more than 70% report
that their long-term care insurance policy pays all of the costs of the services they
need. And that goes a long way toward reducing the financial and emotional burden on
family caregivers."

Bob O’Toole, MSW, LICSW, is president of Informed Decisions Inc. in Dedham,

Mass., a private company specializing in corporate elder-life planning issues. A
founding member of the National Association of Professional Geriatric Care Managers,
he is a former editor of the Geriatric Care Management Journal. Mary Lynn Pannen,
BSN, CCM, is president of Sound Options Inc. in Tacoma, Wash. Her company provides
childcare and eldercare services and consultation to companies and EAPs nationally.

Sidebar:

Eldercare Benefits Resources

The National Family Caregiver Support Program — Developed by the

Administration on Aging of the US Department of Health and Human Services. Visit
www.AOA.gov.

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Elderlifeplanning.com — A well-established and reliable source of Internet
information and support for family caregivers. Launched in 1996, this Web site
provides user-friendly resources about caring for aging parents and help in locating
resources.

The Eldercare Locator — Administered by the National Association of Area Agencies

on Aging and the National Association of State Units on Aging. Call 1-800-677-1116.

National Association of Professional Geriatric Care Managers — Write 1604 N.

Country Club Road, Tucson, Ariz. 85716-3102; call 520-881-8008; fax 520-325-7925; or
visit www.care manager.org.

Fact Sheet: Elder Life Planning for Worksites and Organizations — From
Informed Decisions Inc. Call 1-800-375-0595.

Fact Sheet: Work and Eldercare — Available from the Family Caregiver Alliance.
Visit www.caregiver.org.

Washington Business Group on Health — Write 777 N. Capitol St. NE, Suite 800,
Washington, D.C. 20002; or call 202-408-9320.

(Spring 2002)

22
 Workplace-Triggered Problems
A behavioral risk audit case study: How loss, risk data can help EAPs build
stronger relationships with employers

By Rudy M. Yandrick

Employee assistance programs historically have been effective at helping employees

resolve personal behavioral problems. They long have been deficient, however, at
investigating the role of the workplace in triggering personal problems and intervening
with organizational issues that cause or instigate outbreaks of such problems — a
situation due in large measure to the common belief that EAP providers are counselors
or behavioral health providers.

Perhaps this explains why — as the study discussed in the "EAP Ethics and Quality"
article in EAP Digest’s Fall 2001 issue revealed — EA services today have minimal
workplace presence, receive sparse supervisory referrals and are severely
undervalued.

To counteract this, EAPs need to establish themselves as behavioral risk specialists,

expanding beyond the core technology into organizational development at the
expense of managed care, clinical case management and mental health counseling —
areas into which many programs have ventured.

If EA is practiced as a risk-management discipline, it first needs to have the capability

to measure an organization’s preventable losses. Losses occur from five generic
behavioral types, which manifest in everything from theft to absenteeism to alcohol
abuse (see accompanying list). By identifying risk factors that contribute to losses,
data-supported solutions, including close-to-the-customer EA services, can be
recommended with the certainty that it is in the employer’s best interest.

One approach to auditing behavioral risks involves a two-part process: a records

review to investigate losses and a workforce survey to measure risk factors.

Behavioral Risk Audit: A Case Study

Recently, two Pennsylvania-based firms, NewMode Workforce Solutions and The

Behavioral Risk Institute, partnered to perform such an audit. The audited employer
was a mid-size transportation company — WillHaul — comprised chiefly of managers,
office employees, over-the-road drivers and mechanics.

Four categories of loss were studied: Operating revenue and net income; accidents
and injuries; stress- and lifestyle-related losses; and workforce conduct and
performance problems.

Datakeeping practices and records vary greatly from one company to the next, so loss
analyses must be tailored to the organization. Furthermore, some data can be directly
measured in dollars, others only by numeric equivalents. For this reason, with WillHaul,

23
the goal was to build an evidentiary body of data on preventable losses, rather than to
generate a bottom-line financial statement.

From 1995 through 2000, the company’s operating revenues increased an average of
2l% annually, which at first glance suggests the company was growing at a healthy
pace. Net income during that period, however, took the shape of an inverted bell
curve, from a loss of 2.3% of operating revenue in the early 1990s to a profit of 6%
then back to a loss of 0.9% in 2000.

The primary reason for the net-income loss was excessive workers’ compensation,
along with property/casualty and medical costs. WillHaul was self-insured and
therefore directly liable. Workers’ compensation claims had increased 92% over the
prior two years, and property/casualty and medical claims increased 85% and 21%,
respectively, over the last year.

The workers’ compensation and property/casualty losses were due, primarily, to a

spate of catastrophic over-the-road accidents beginning in mid-1999, the likes of which
the company had never experienced. Less-than-catastrophic accidents had increased
as well. Given the increases in the frequency and severity of accidents, the escalation
in claims seemed more than just bad luck.

Meanwhile, WillHaul had a 13% annual utilization rate for EAP services. It was known
that the company’s employees and their family members were experiencing an
inordinately high number of personal problems. How ever, without previously being
privy to the full extent of behavior-related problems — including accidents — and the
losses they generated, the EAP had been relegated to applying band-aids to personal
problems as they came to attention. This situation illuminates the importance of EAPs
becoming more organizationally focused in order to become workplace prevention
specialists.

WillHaul also was spending more than $1,000 a year over national averages, per
employee, for health coverage, despite the fact that the company was using an
aggressive third-party administrator with a strong wellness philosophy. A sizable part
of these medical losses were preventable.

Finally, WillHaul had an excessive number of driver-conduct and performance-related

problems. For example, its driver turnover increased gradually from 43% to 72% over
the prior four years, despite fact that the company’s drivers primarily made day trips
rather than overnight hauls — a strong correlate of driver turnover in the trucking
industry.

Besides turnover, WillHaul also was experiencing a great number of log violations,
which include driver performance problems and record-keeping errors, as well as
verbal and written warnings and suspensions.

The Risk Factors

Most employees exhibit counterproductive behaviors not because of one or two

problems, or risk factors, but because of an aggregation of many — most of which
workers are not cognizant of at any given moment. Typically, employers lay behavioral
problems at the feet of the individuals exhibiting those behaviors, which fits in nicely
with behavioral health-focused EAPs that seek to "fix" the individual through private
therapeutic intervention.

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In reality, it is a combination of organizational, personal, and interpersonal or group
risk factors that leads to the behaviors. This helps to explain why an employee might
seem to suddenly overreact in an adverse situation, when in reality he or she has
crossed over a tolerance threshold, causing the counterproductive behavior to "lurch"
forward.

In surveying WillHaul, 101 different risk factors were measured and 28 registered
elevated scores among drivers, 27 among employees and 15 among managers. For
the drivers and employees, in particular, the numbers indicated a heavy volume of
problems and issues to be carrying on their backs. Significant risks were found in
organizational and leadership practices, home-life concerns, health issues, manager-
employee and work-team relationships. This amalgam of risk factors, then, bore down
on the organization to create greater loss potential.

Given the nature of the trucking business, the audit concluded that the weight of the
risk factors had a deteriorating effect on the quality of relations between drivers, who
haul the goods, and dispatchers, who make the logistical arrangements and assign
routes to drivers. One thing that a trucking company doesn’t want is upset or
distracted drivers, who are its revenue producers — as well as its loss leaders — when
accidents and other over-the-road incidents occur.

The Organizational Context

Contextual information to complement the loss and risk data was obtained by asking
employees for their insights through a series of write-in questions and gathering
information on the historical growth and development of the company.

In brief, the audit found that WillHaul did not have suitable conduct and work
performance standards, had a leadership team that had failed to coalesce into a
strong decision-making unit, was reactive rather than proactive in its problem solving,
had no integrated system for compiling loss data, and, ironically, placed financial
performance above safety. In the final analysis, WillHaul, was a diversifying company
that had outgrown its small-company infrastructure.

Finally, the Solutions

On the strength of these various data sets, loss-reduction goals and 20 different
solutions, which could be phased in over a few years, were specified. They include:

• An integrated data management system to track preventable losses;

• Organizational development steps, such as a mission statement and 360-

degree manager-employee performance evaluations;

• Knowledge and competency development, such as a team-building curriculum

for the maintenance shop;

• Supportive programs and services, such as an informal driver mentoring

program to be held in conjunction with training school for new drivers; and

• Proactive health and lifestyle management.

25
Today, WillHaul is creating an implementation plan. Management and employees have
been receptive to the process, which has also strengthened the position of the EAP in
the company. As WillHaul gains better control over its preventable, behavior-related
losses, the company will be fine, and it is expected that, in a couple of years, the
company’s net revenues will increase at a rate that matches its growth in operating
revenues.

Rudy M. Yandrick is president of The Behavioral Risk Institute, a Pennsylvania-based

product development and data analysis firm. He is also vice president of NewMode
Workforce Solutions, an EAP based in York, Pa. He is author of Behavioral Risk
Management, published by Jossey-Bass Inc. Publishers in 1996.

(Fall 2000)

26
 An Opportunity for Self-
Regulation
EASNA, COA join forces for EAP accreditation.
By Suzanne Claeys, MA, CEAP
The Council on Accreditation for Children and Family Services (COA) has joined forces
with the Employee Assistance Society of North America (EASNA) to develop
accreditation for EAPs. The joint endeavor is supported by funds from the Substance
Abuse and Mental Health Services Administration (SAMHSA) and the Center for
Substance Abuse Prevention (CSAP), Office of Managed Care.

EASNA had been providing accreditation since 1990. But Barbara Marsden, EASNA
president and manager for Genesis EAP in Davenport, Iowa, says EASNA sought to
partner with a recognized accrediting agent because of the growing number of EAPs
requesting accreditation. “We sought a partnership because the process was growing
faster than our volunteer group could effectively handle,” she said. She says EASNA
chose to partner with COA because of COA’s experience in accrediting EAPs within
family service organizations and because both organizations share similar values,
goals and review processes. Under the partnership, the New York City-based COA will
have responsibility for the overall facilitation and management of the accreditation
while EASNA’s Standards and Accreditation committees will have regular input.

he accreditation standards of both organizations are being meshed during beta tests
that concluded in September. Beta tests are being conducted at The Bank of Montreal,
Ceridian Performance Partners, EAP International, Magellan Behavioral Health and the
US Department of Health and Human Services.

Dr. Dale Masi, a member of EASNA’s Accreditation Committee and president of Masi
Research Consultants in Washington, DC, has been commissioned by COA to serve as
program administrator, overseeing the beta testing and the combining of the
standards. “Accreditation is an essential requirement for EAPs. It provides us with the
necessary standards and criteria for professional practices,” says Masi.

Christina Thompson, vice president of EAPs for Magellan Behavioral Health, Columbia,
Md., says accreditation is basically an issue of self-regulation. Without it, the field is
vulnerable to being regulated by another group or profession that may not have the
best interests of EAP in mind or who may confuse EAP with managed care. “Most
others don’t understand EAP, and we run the risk of having our boundaries blurred
with managed care due to the integration of many EAPs with managed care. EAP
professionals who live and breathe EAP every day are the ones who need to define and
regulate EAPs,” she says.

COA’s president and CEO, David Liederman, says that because accreditation reflects
organizational compliance with standards of best practice, it will assure EAP
purchasers that clients are being well-served.

As a joint endeavor of Family Service America and the Child Welfare League of
America, COA has been accrediting private and public organizations since 1977. The

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agency currently accredits nearly 1,200 private and public organizations that provide
services to more than 6 million individuals and families throughout North America.

Charlie Williams, a program analyst with CSAP’s Office of Managed Care, said EASNA
approached his agency to fund the project. “My agency got involved because so many
EAPs are now provided by managed care companies,” he said. He also said SAMHSA’s
involvement makes this one of the most significant public/private initiatives to benefit
the EAP field in some time.

But beyond developing the new standards, he says, the greater challenge will be to
sell accreditation in the marketplace.

Accreditation’s true test: The marketplace

In the US, healthcare providers must be accredited by a recognized accrediting agent

in order to receive reimbursement for services. But not so with EAPs, which are paid
for out of an employer’s pocket.

So what might compel an EAP to seek accreditation? For an answer, consider

accreditation’s impact on the Canadian EAP market. Canada’s experience could be
writing on the wall for US EAP providers.

Marilyn Hayman, past president of EASNA and former CEO of EAPlus in Ottawa, says
accreditation is more the rule than the exception in Canada. (The Canadian Centre on
Substance Abuse even lists whether an EAP provider has EASNA accreditation in its
Guide to Employee Assistance Programs and Services in Canada published in 1997.
The guide is available at www.ccsa.ca under “resources,” then “databases” or for a fee
by calling 613-235-4048.) “Canadian organizations recognize EASNA accreditation as
the mark of a quality EAP. Many organizations now require EASNA accreditation in
order to submit proposals,” says Hayman. She says that’s forced smaller vendors to
become accredited in order to compete for contracts with Canada’s Big Three EAP
vendors — CHC of Mississauga, Ontario; Family Guidance International of Thornhill,
Ontario; and Warren Shepell Consultants of Toronto.

Market competition also may lead internal EAPs to consider accreditation, according to
Hélène Bélanger, eastern regional manager of The Bank of Montreal’s EAP, which has
been EASNA accredited since 1992. She says a number of good external vendors
would be interested in taking over the bank’s EAP. But accreditation ensures that her
internal services meet or exceed those of the externals.

Quality, however, was the foremost reason for seeking accreditation. “Our first reason
for seeking accreditation was to fulfill our mission to provide the best professional
services to the employees of the Bank of Montreal,” says Bélanger. She says
accreditation has evolved into a continuous quality improvement process for her
program because every EAP policy and procedure written and every service provided
is considered with the EASNA standards in mind.

Willie Garrett, manager of clinical services at Minneapolis-based Ceridian Performance

Partners, one of the EASNA/COA accreditation beta test sites, also views accreditation
as a quality assurance issue, one that helps EAPs improve processes at the same time
it confirms “we’re doing things right.” In his opinion, accreditation will help EAPs gain
credibility with employers because it verifies that an EAP meets prescribed standards
for quality service.

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The quality assurance issue is reiterated in comments from Gwyn Jones, national
clinical director of EAP services for Warren Shepell Consultants of Toronto. When her
company’s business increased in the mid-1990s, Jones says Shepell sought
accreditation as a way to ensure it was meeting customer needs. “We sought EASNA
accreditation because we wanted to know how we could maintain the level of
excellence with which we began EAP services and continue to ensure an appropriate
quality assurance process.”

Hayman says the gold seal an accredited EAP receives will ultimately make a
difference to purchasers. “Having a gold seal in a proposal tells a prospective client
that an EAP has opened its practice to peer review and that it must constantly update
its program to meet the quality and professional standards developed by EASNA and
COA. This is a major marketing advantage because quality sells.”

Accreditation is the most important issue the EAP industry has faced in the last 20-30
years,” says Jodie Collins, president and CEO of Denver-based EAP International, the
first site to be beta tested. “It will define and differentiate EAPs from other types of
services being offered to employers. It will be important to our customers to be able to
look to an independent accrediting body to help them understand what they are
buying.”

Readers interested in learning more about accreditation may contact Jennifer Levitz at
COA at 212-797-3000 or the project director, Dr. Dale Masi, at 202-223-2399. Also, the
13th Annual EASNA Institute, which will be held April 26-28 in Chicago, will feature an
accreditation track and a training for prospective reviewers immediately following the
Institute.

Suzanne Claeys, MA, CEAP, is chair of EASNA’s Accreditation Committee and

administrator of Alcoa’s EAP in Davenport, Iowa. She can be reached at 319-459-2940.

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