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1st Quarter 2017 | VOL. 47 NO. 1

The magazine of the Employee Assistance Professionals Association

Bridging the Generation Gap


How to Start, Sell, and Grow an EAP Page 14

Bonus! Four extra pages! |Page 8

Leading EFAP Trends in Canada Page 26

Cognitive Challenges in the Workplace Page 30


contents EAPA Mission Statement

1st Quarter 2017 | VOL. 47 NO. 1

cover story


Bridging the Generation Gap

|By Nancy Grunnet, MS, RODP There is a strong business case for EAP consultants to equip workplace managers with the skills needed to provide Millennials with support, guidance, and direction. The skills necessary are skills EAP consultants already know, practice, and teach.



How to Start, Sell, and Grow an EAP

|By Marina London, LCSW, CEAP, and Michael Klaybor, Ed.D., CEAP

It was obvious from our personal experiences, including attending EAPA conferences, that while there is great interest in starting and marketing an EAP, there were no articles, books, or trainings that would teach interested parties how to accomplish such a complex task. To fill that gap, we created an all-day workshop that was unveiled at the 2016 World EAP Conference in Chicago.


Reaching Millennials

|By Bernie McCann, PhD, CEAP For Baby Boomer and Gen Y supervisors and managers struggling to reach and engage Millennials, EAPs can provide a workplace resource to foster an appreciation of generational diversity within the organization.



Leading EFAP Trends in Canada

|By Barb Veder, MSW, RSW Only one-third of individuals who need mental health-related services in Canada will receive treatment. As a result, great efforts have been made to increase awareness and promote the open discussion of mental health.


Cognitive Challenges in the Workplace

|By Joel Becker, PhD, CEAP

Unlike a physical injury or developmental disability, the symptoms of cognitive decline are not always apparent and are often misconstrued as the effects of emotional or familyrelated problems. There is a great deal of relief that is experienced by affected individuals when they realize that someone understands and accepts their condition.


To promote the highest standards of practice and the continuing development of employee assistance professionals and programs. The Journal of Employee Assistance (ISSN 1544-0893) is published quarterly for $13 per year (from the annual membership fee) by the Employee Assistance Professionals Association, 4350 N. Fairfax Dr., Suite 740, Arlington, VA 22203. Phone: (703) 387-1000. Postage for periodicals is paid at Arlington, VA, and other offices. POSTMASTER: Send address changes to the Journal of Employee Assistance, EAPA, 4350 N. Fairfax Dr., Suite 740, Arlington, VA 22203. Persons interested in submitting articles should contact a member of the EAPA Communications Advisory Panel (see page 4) or the Editor, Mike Jacquart, by calling (715) 258-2448 or sending an e-mail to To advertise in the Journal of Employee Assistance, contact the Advertising Manager, Joan Treece, at (303) 242-2046 or admanager@eapassn. org. Send requests for reprints to ©2017 by The Employee Assistance Professionals Association, Inc. Reproduction without written permission is expressly prohibited. Publication of signed articles does not constitute endorsement of personal views of authors. Editor: Mike Jacquart Advertising Manager: Joan Treece Designer: Laura J. Miller Impact Publications, Inc.

Index of Advertisers ASAP...........................................................9 EAPA Plan to Attend................................IFC Hazelden Betty Ford Foundation.................7 Harting EAP..............................................BC, 29 The SASSI Institute...................................15


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frontdesk New Year, More Pages in Journal |By Maria Lund, LEAP, CEAP


he Journal of Employee Assistance is a core benefit for EAPA members, and our intention is for it to provide consistent value to you and your professional practice. With that goal in mind, I am pleased to announce that the JEA is now a 36-page magazine! In the majority of issues, the extra pages will allow us to run more articles and further emphasize research. In this particular JEA, we present a thorough recap of the 2016 World EAP Conference, including a complete list of award winners. This issue also features a look at the Millennial employees who are having such a big impact on today’s workplaces and our EA practices. What services do they want from EAPs? Perhaps even more important, what services can we, as EAP practitioners, offer them? The author of this issue’s cover story, Nancy Grunnet, MS, RODP, points out that, “Training opportunities for EA professionals are growing during the current influx of Millennials into the workplace.” Nancy explains the numerous ways in which EA professionals can help bridge this generation gap to create a stronger organization. Overcoming this obstacle is also crucial because “stereotypes have become so skewed that older employees fear not being able to relate to younger workers.”

In a related article, Bernie McCann, PhD, CEAP, explains that, for supervisors and managers struggling to reach and engage Millennials, EAPs can offer valueadded services for employers by providing coaching and training to enhance appreciation of the gifts of generational diversity within the work organization.

Elsewhere, Mark Attridge, Jeff Harris, and John Maynard offer useful insights and observations in their respective columns. Happy New Year, and happy reading! v

Of course, older employees also have special workplace needs. Joel Becker, PhD, CEAP, points out that EAPs also offer valuable services to employees who are experiencing cognitive and emotional decline due to a medical condition, injury, or other issue. (Younger workers may also experience setbacks like these, but they are more prevalent among employees in their 40s, 50s, or 60s.)

We round out this issue of JEA with other important topics. Literature is severely lacking on starting, selling, and growing an EAP. Marina London, LCSW, CEAP, and Michael Klaybor, Ed.D., CEAP, present key points they discussed in a vital pre-conference training on this subject matter at the 2016 World EAP Conference. Readers told us in the recent survey that they want to see more articles on pertinent EAP issues our colleagues in Canada are facing. Barb Veder, MSW, RSW, does just that in “Leading EFAP Trends in Canada.”

EAPA Communications Advisory Panel Maria Lund, Chair – Columbia, SC

Mark Attridge – Minneapolis, MN

Nancy R. Board – Seattle, WA

Tamara Cagney – Livermore, CA

Mark Cohen – New York, NY

Donald Jorgensen – Tucson, AZ

Eduardo Lambardi – Buenos Aires, ARG

Peizhong Li – Beijing, China

John Maynard – Boulder, CO

Bernie McCann – Waltham, MA

Igor Moll – Al Den Haag, the Netherlands

David Sharar – Bloomington, IL

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earoundup FMCSA Establishes Drug Testing Clearinghouse The U.S. Department of Transportation’s (DOT) Federal Motor Carrier Safety Administration (FMCSA) announced on Dec. 2, 2016, a Final Rule that establishes a national drug and alcohol clearinghouse for commercial truck and bus drivers. The clearinghouse database will serve as a central repository containing records of violations of FMCSA’s drug and alcohol testing program by commercial driver’s license (CDL) holders. Once the clearinghouse is established, motor carrier employers will be required to query the system for information concerning current or prospective employees who have unresolved violations of the federal drug and alcohol testing regulations that prohibit them from operating a commercial motor vehicle (CMV). It also requires employers and medical review officers to report drug and alcohol testing program violations. The Final Rule requires motor carriers, medical review officers, third-party administrators, and substance abuse professionals to report information about drivers who: • Test positive for drugs or alcohol; • Refuse drug and alcohol testing; and • Undergo the return-to-duty drug and alcohol rehabilitation process. The national drug and alcohol clearinghouse Final Rule goes into full effect in January 2020. To

learn more about the Final Rule, go to public-inspection.federalregister. gov/2016-27398.pdf.

IBEC Releases Mental Health Guide The Irish Business and Employers’ Confederation (IBEC) recently released a guide titled Mental Health and Wellbeing: A Line Manager’s Guide. EAP Institute Director Maurice Quinlan said that, “Mental health issues are a growing cause of longterm absence from work, having increased for males from 8% in 2003 to 15% in 2009 and for females from 8% in 2003 to 11% in 2009.” The guide, published by the IBEC in association with See Change (a national mental health stigma reduction partnership), provides managers with guidance on mental health and well-being. It serves as a very useful tool for managers in dealing with employee mental health. For more information, contact Maurice Quinlan at

Surgeon General Issues Landmark Report “While addiction has been a problem for centuries, what’s different now is that we have the tools to address it, and now is when we have to marshal the resources and the will to do so,” said U.S. Surgeon General Vivek Murthy about the landmark report, Facing Addiction in America. The report, highlighting the U.S. drug and alcohol problem, examines the science and demands

an evidence-based, integrated public health response. Roughly 21 million Americans have substance use disorders – a number that exceeds the number of Americans sick with all cancers combined and roughly mirrors that of diabetes. And yet, addiction is under-recognized and undertreated, according to Murthy. Overall, only one in ten people with substance use disorders receives treatment, according to Murthy. Approximately one in five individuals receives treatment for opioid disorders, but this number is less frequent for other addictions. The Surgeon General’s report underscored the magnitude of substance use disorders and their ripple effects on long-term health and communities. The societal consequences of alcohol and drug misuse include decreased productivity, higher healthcare costs, unintended pregnancies, crime, and violence. “I think that the report is really important, because it gives a coherent narrative around addiction to the public from the Surgeon General’s office for the first time,” said Richard N. Rosenthal, MD, medical director of addiction psychiatry at Mount Sinai Behavior Health System in New York. “It really breaks new ground in the sense that it presents, in a very coherent way, what we know in terms of the evidence base for the neurological underpinnings of addiction. I think this can be grasped by most folks who read it,” Rosenthal said. To learn more, go to http:// Psychiatry/Addictions/61531. Continued on page 11

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effectivemanagementconsulting Managers Get What They Give The Neuroscience of Positivity

|By Jeffrey Harris, MFT, CPC, CEAP


f I were to tell you that I just experienced a fantastic week, but my Tuesday was awful, what would you ask me next? Over 90% of people that I give this scenario to will say, “Sorry to hear that, what happened on Tuesday?” This sympathetic gesture will require me to share the setbacks, disappointments, and little crises that made the day rotten. In this way, your question has me reliving the distress of the day, as if it were happening right now. But in my original statement, I told you that the vast majority of my week was fantastic. How might my response and mood have been different had your question been to ask, “Tell me what made your week so great?” You would likely see my eyes light up and my mood brighten as I share stories of good food, good friends, and possibly some great outcomes at work. It is not my intention to shame anyone for a thoughtful and caring inquiry. But the fact remains that the questions we pose to other people will trigger a neurobiological response, the outcome of which is entirely predictable in either scenario. Put another way, one of my first clinical supervisors told me, “You deserve the answers you get, based upon the questions you ask!” Managers Get What They Give Managers who seek the consultation of an EA professional about a troubled employee will often report their exasperation at the negativity, defensiveness, and closed-mindedness presented

by that employee. They are likely unaware that their own questions or statements in a discussion are setting the course for a negative response. Far too often, managers try to fix an employee’s weaknesses, rather than encouraging development of their strengths. Alternatively, by focusing upon the positives, managers are not denying the negatives but are engaging the employee in desirable performances or behaviors. In consultations with managers, while being diplomatic and respectful, acknowledge the manager’s frustration while also suggesting that they have the ability to shape the discussion toward a more positive outcome by viewing themselves differently in a manner supported by neuroscience. The Neuroscience of Positivity In their book, Connected: The Surprising Power of Our Social Networks and How They Shape Our Lives, authors Nicholas Christakis and James Fowler describe how emotions pass from one person to another due to some interesting human features. First, they report that humans are biologically hardwired to mimic others in their outward expressions, and in so doing, we turn our inner state to be congruent with that display. When a manager criticizes, is disagreeable, or causes the employee to feel minimized or marginalized, this has the effect of shutting down the part of our brain that does the best thinking. The negatively-charged

conversation will activate conflict aversion and protective behaviors. And the manager will likely see the employee become reactive and hypersensitive. In the act of dwelling upon weaknesses, the manager’s words may negate prior recognition or praise. The science on this is really solid. The human brain, sensing conflict, will produce the hormones cortisol and adrenaline, which trigger the fight-flight-freeze response. On the other hand, comments that are positive and encouraging will activate the release of oxytocin, the hormone that produces a sense of well-being. Oxytocin improves our communication skills and activates behaviors such as collaboration and trust building. But oxytocin metabolizes in our body more rapidly than cortisol, so its effects are brief and less pronounced. This explains the catchphrase you’ve heard, that it takes three compliments to neutralize one negative comment. B.L. Fredrickson, in the Journal of Personality and Social Psychology, reports that “Positive emotions momentarily broaden people’s attention and thinking, enabling them to draw on higherlevel connections and a wider-thanusual range of precepts and ideas. In turn, these broadened outlooks often help people to discover and build consequential personal resources (cognitively, psychologically, socially, and physically).” According to Christakis and Fowler, induced positive emotion benefits the workplace as it widens

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the scope of attention, broadens behavioral repertoires, and reduces the lingering effects of negative emotions. Additional benefits to positivity in the workplace include increases in intuition, creativity, flexibility, openness, and the ability to integrate new information. Furthermore, a positive workplace is associated with a range of team performance-enhancing changes, including greater altruistic behavior, increased creativity, and more efficient decision-making. Building a Manager’s Positivity Toolkit When you consult with a manager who is a “critical Carla” or “negative Ned,” consider exploring with them the manager behaviors that are most likely to produce oxytocin. These include:

• Being receptive to having difficult conversations; • Painting a picture of mutual success; • Stimulating discussion and curiosity; • Showing concern for others; and • Starting meetings by asking, “What went well today?” Also, why not try the neuroscience of positivity in your own consultation? Ask the manager to jot down the things that he or she appreciates about a challenging employee. What talents, strengths, or good characteristics does he/ she have? Everyone typically has at least some good characteristics. This may require you to be tenacious in facilitating the manager’s search for those strengths. v

Let’s Keep the Discussion Going For those of you who would like to have a tool for managers on this topic, send me a message on LinkedIn, and I will send you a worksheet titled, “Ways to Increase Positivity as a Leader.” The author invites you to network around all topics of effective management consulting through his LinkedIn profile at www.LinkedIn. com/in/JeffHarrisCEAP and Twitter at Jeffrey Harris, MFT, CPC, CEAP, has provided management consulting to a wide variety of organizations throughout his 22-year career in employee assistance, including corporate, government and union organizations. The author also has extensive experience as a manager and executive coach, from which he draws insight for his consulting. Jeff currently serves as Program Manager of EAP & WorkLife at the University of Southern California.


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Reach out today. We’re here for you and your members. Contact National & Strategic Account Director Sunithi Kuruppu, MSW, at 703-625-4516 or to discuss how we can partner to provide the most-effective resources and treatment options to your members.

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coverstory Bridging the Generation Gap

Millennials are Providing Training Opportunities for EAPs “As noted earlier, stereotypes have become so skewed that older employees fear not being able to relate to younger workers. Ironically, relationship and connection is exactly what Gen Y is seeking from its leadership.”

|By Nancy Grunnet, MS, RODP


raining opportunities for EA professionals are growing during the current influx of Millennials into the workplace. However, stereotypes of this generation regarding work, recognition, and rewards can become skewed. Many older employees fear they will not be able to relate to their younger cohorts, which may result in them avoiding or isolating people in this age group. Ironically, relationships and connections are exactly what these young workers are seeking in the workplace! Millennials, also known as Generation Y, desire communication and feedback that is authentic, as opposed to traditional workplace relationships that are typically more distant in nature. As a result, EAP consultants are positioned to provide much-needed skills training in relationship development, communication, and feedback. The World of Work Has Changed Before we can adequately address the needs of younger workers, it’s helpful to take a look at where we’ve been. In the 1950s, employers offered an unspoken, long-term arrangement in which employees who followed the rules and did their jobs were taken care of into their golden years. In the 1950s, the average tenure at an organization was 23 years.

Tenure has drastically decreased. According to the U.S. Department of Labor, the average amount of time someone spends at a typical job today is only 4.6 years. Millennials do not work under the same safety net of long-term employment as past generations. Historical Effect on Viewpoints Because previous generations stayed at their jobs for decades, they developed specific values about work. The Traditionalist generation* viewed work as an obligation. Baby Boomers* saw work as a lifelong quest. Management strategies focused on leading employees for the long haul. Supervisors implemented five- to ten-year management plans. Developing a personal leadership style was rarely considered. Instead, organizations tended to manage based on policy expectations. Gen Xers* have typically viewed work as largely contractual in nature. Because employees tended to stay for longer periods of time and the relationship between work and worker was formal, leadership flaws were often overlooked, ignored, or simply accepted as commonplace. (Editor’s note: *See sidebar on page 10 for more on generational differences.)

A Marked Difference in Views Enter the Millennial generation. Raised to experience and live life in the present, with the world readily available at their fingertips, Millennials view work as a place to make a difference. They see work as a place to achieve – work is a place to challenge and be challenged. Perhaps immature when they first entered the workplace, postrecession data notes that Millennials are self-confident, ambitious, and seeking security within a stable job market. Unfortunately, they still carry the burden of stereotypes like the “trophy generation,” widely believed to be pampered and spoiled with a sense of entitlement. Workplaces Need the Help of EAPs There are a number of ways in which EA professionals can help bridge this generation gap.  Promote the development of people skills. As EAP consultants, we encounter managers who were promoted because of their skill proficiency. They were good accountants, programmers, or nurses. It’s rare that a manager is promoted because they demonstrated superior people skills. We hear organizations say, “Our people are our greatest assets,” and, “We value employee input.” In reality, in many workplaces, employees never receive

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process their thoughts and observations. Listening in order to understand will result in gained respect. Millennials will interpret a closed door as meaning that leadership does not want to talk to them. Failure to engage in casual conversation means leadership does not like them.

feedback or they are made to feel like a nuisance when asking questions or seeking input.  Be aware that failure to recognize diverse viewpoints perpetuates stereotypes. We are privy to comments about Millennials having a sense of entitlement. We’ve heard examples of times when a Millennial complained to Human Resources that someone in higher authority was not available, didn’t give them the training they needed, or in some way was not supportive. The message believed by management: “This has never been a problem before, so therefore the entitled stereotype must be true.” Millennials question authority, but not because they think they are entitled. Rather, they seek relationships with those in authority who are able to give them support, guidance, and direction in order to accomplish their goals. This desire upsets the status quo of distant, long-term management. As noted earlier, stereotypes have become so skewed that older employees fear not being able to relate to younger workers. Ironically, relationship and connection is exactly what Gen Y is seeking from its leadership.

 Emphasize relationship development. Relationships mean communicating on a regular basis. One-on-ones provide an ideal platform in which to regularly communicate. Whether weekly or monthly, a 15- to 30-minute one-on-one meeting keeps the manager and the Millennial on track, monitoring workrelated targets and projects. Millennials appreciate time carved out just for them.  Utilize personal inventory tools. Millennials want leadership to get to know them as individuals. The DISC personality test and Myers-Briggs Type Indicator are tools that will help both the manager and the Millennial learn more about how their individual tendencies impact their work and relationships with co-workers. Millennials want to know more about their business leaders and how best to interact with them. EA professionals need

 Recognize that essential management skills are within the scope of EAP. The time is ripe for EAP consultants to help address areas like these. Training topics such as communication, relationship development, and feedback are squarely within the skills of EA professionals. These competencies have historically been deemed “soft skills” in line with previous generations’ strategies to manage over the long haul. However, these skills are essential strategies when assisting Millennials in today’s workplace.  Develop an action plan. As EAP consultants, we can make a difference. Poll workplace managers to gain insight into the struggles they experience when managing Millennials. Use the results to communicate the business necessity for people skills training. Design training modules that link change to the input required to attain a given result.

Training Points That Hit Home There are a number of key points that trainings on people skills need to include.  Communicate, communicate, and communicate. Communication must involve an emphasis on listening. Millennials need a sounding board to 9 | W W W. E A PA S S N . O R G | •• • • • • • • • • • • • • • • • • • • • • • • • • • • | JOURNAL OF EMPLOYEE ASSISTANCE | 1st Quarter 2017 |

coverstory to encourage managers to take the DISC and Myers-Briggs themselves and share the results with their team members.  Stress Millennials’ need for feedback. Failure to comment on a Millennial’s work means they have no information in which to problem solve or make decisions. A failure to

compliment their work means their manager did not think they did the job well. In the eyes of a Millennial, feedback is not necessarily viewed as punitive. Feedback models based on giving critical or punitive information are not helpful. For example, the “sandwich” model, in which a compliment is given before and after critical or

Generation Viewpoints Views of Authority and Rules Traditional (born 1945 or earlier): They are respectful of authority figures and follow rules without question. Baby Boomer (born 1946-1964): Boomers are respectful of authority figures. They question the system versus calling out individual authority. Generation X (born 1965-1980): They are not impressed with authority and antiquated rules. Wary and distrustful, they openly question rules and authority. Generation Y/Millennials (born 1981-1997): Rules are things that become outdated, fluid, and change over time (think tech influence). They need information to make their own choices and decisions, and they seek guidance and direction in order to do so. An authority figure is not the same thing as an authentic figure. Views of Communication and Feedback Traditional: No news is good news. Communicate privately only when necessary. Baby Boomer: Communication is needed to keep things fair. Feedback is necessary. Documentation about the feedback keeps the system fair. Generation X: They understand the need for “the system” but are distrustful and therefore dismissive of it. They seek feedback in order to self-correct. Generation Y: They need information to make decisions and choices. No communication is bad. No feedback is not good either. v - Nancy Grunnet

punitive feedback, does not offer information to correct or problem solve. Millennials prefer to receive information that functions as “game film.” Feedback models that are based on giving information that describes the effect or impact their behavior had is extremely helpful to employees in this age group. Summary The time is now. There is a strong business case for EAP consultants to equip workplace managers with the skills needed to provide Millennials with support, guidance, and direction. The skills necessary are skills EAP consultants already know, practice, and teach. We have an opportunity to bridge the gap between generations and usher in practices that will empower Millennials to do what they long to do: make a lasting mark on the world and the workplace. v Nancy Grunnet is the CSRA Regional VP for First Sun EAP. She has nearly 20 years’ experience working with organizations to help employees succeed at every level. Manager/supervisor skill building, coaching, and team development along with generations in the workplace are some of the areas of her expertise. She has served as SC Diversity Council Board Member and SCEAPA Board Member.


Bureau of Labor Statistics, U.S. Department of Labor. (2014). Median employee tenure. Washington, DC: Author. Retrieved from http://www.bls. gov/opub/ted/2014/ted_20140925.htm Hobart, B., & Sendek, H. (2014). Gen Y now: Millennials and the evolution of leadership, Second Edition. San Francisco, CA: Wiley. Zemke, R., Raines, C., & Filipczak, B. (2013). Generations at work: Managing the clash of Boomers, Gen Xers and Gen Yers in the workplace, Second Edition. New York, NY: American Management Association.

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earoundup Few Canadian DOA Policies Measure Effectiveness While the majority of Canadian employers have a formal drug and alcohol policy in place, few of them evaluate their effectiveness, according to a new Conference Board of Canada report. “Problematic substance use in the workplace is an emerging concern for Canadian employers in all industries, which is why many have implemented formal policies,” said Mary Lou McDonald, Director of Workplace Health, Wellness and Safety Research with the Conference Board of Canada. “However, to improve the health and well-being of their employees, Canadian organizations should measure the effectiveness of these policies. This would allow proper assessments of their actions in dealing with substance misuse issues.” Among the 179 employers surveyed, 72 percent reported having a formal drug and alcohol policy. However, only 32 percent of employers surveyed reported that they evaluated the effectiveness of their drug and alcohol support programs and policies. Organizations that did conduct evaluations were much more likely than their counterparts to rate their programs as “very” or “extremely” effective. Metrics used to evaluate the effectiveness of drug and alcohol support programs and policies include employee assistance program/employee and family assistance program (EAP/EFAP) utilization rates, statistics on the

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number of workplace injuries or accidents, absenteeism rates, and referrals to treatment.

Marijuana Access Expands in US Election Day 2016 proved to be a historic occasion in the US for initiatives favoring expanded access to marijuana. On November 8, California and Nevada joined West Coast early adopters Alaska, Oregon, and Washington in choosing to legalize marijuana for adult recreational use. On the East Coast, Maine and Massachusetts legalized marijuana for adult recreational use, reports EAPA President-Elect Tamara Cagney. Arizona voters, however, rejected an initiative to legalize marijuana sales for recreational purposes. Election night also saw voters approve new laws expanding or permitting the lawful use of marijuana for medical purposes in Arkansas, Florida, Montana, and North Dakota. According to Cagney, the important focus for EA professionals is that marijuana remains a Schedule I drug under the federal Controlled Substances Act, which means that it is neither lawful to use nor possess as a matter of federal law. “Although none of these new legalization efforts aim to change state employment law, employers in the affected states will no doubt be faced with a chorus of questions about how the changes will affect enforcement of their workplace substance abuse policies,” she said.

Suicide Survivors Often Try Again A common and yet highly inaccurate belief is that people who survive a suicide attempt are unlikely to try again. In fact, just the opposite is true. Within the first three months to a year following a suicide attempt, people are at highest risk of a second attempt — and this time perhaps succeeding. A recent analysis of studies that examined successful suicides among those who made prior attempts found that one person in 25 had a fatal repeat attempt within five years. A new study reveals just how lethal suicide attempts are. The study, led by Dr. J. Michael Bostwick, a psychiatrist at the Mayo Clinic, tracked all first suicide attempts in one county in Minnesota that occurred between January 1986, and December 2007, and recorded all the deaths by suicide for up to 25 years afterward. Eighty-one of the 1,490 people who attempted suicide, or 5.4 percent, died by suicide, 48 of them in their first attempt. The findings were reported in the American Journal of Psychiatry. When everyone who succeeded in killing themselves was counted, including those who died in their first attempt, the fatality rate among suicide attempters was nearly 59 percent higher than had been previously reported. For those who attempt suicide, the chances of a subsequent suicidal death decrease greatly if one or more follow-up appointments are scheduled, and they reduce even further if the person keeps the appointments, Dr. Bostwick said. Continued on page 34

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theworldofeap EAP and EAPA Flourishing in South Africa | By John Maynard, Ph.D., CEAP


APA-South Africa is one of EAPA’s most successful international branches. With eight local chapters of its own, EAPA-SA has members throughout South Africa, holds an annual conference that draws close to 400 delegates, and is widely recognized as the national voice of the EA profession. With the support of the branch and its leadership, along with both government and private sector initiatives, the EA field in South Africa today is growing in size, increasing in professionalism, and catalyzing the growth of EAP in other African nations. Origins As in the United States, EAPs in South Africa were born from a merging of services focused on occupational alcoholism, industrial safety, and human resources. In the late 1970s, several multinational companies expanded corporate alcohol policies to their facilities in South Africa. In the early 1980s, the South African National Council on Alcoholism and Drug Dependence (SANCA) launched efforts to support EA services and consultations in workplaces. On a parallel track, in 1983, the South African Chamber of Mines (the nation’s largest employer) appointed a consultant to study the feasibility of EAPs to support safety efforts in the mining industry. This milestone study endorsed the value of EAPs, and in 1986, the Chamber of Mines established the first of an

eventual seven counseling centers, all of which remain in operation today. Also in the 1980s, the Institute for Personnel Management set up a National Committee for EAP. In 1997, the committee affiliated with EAPA and formally became the EAPA-South Africa Chapter and, later, the EAPA-SA Branch. Meanwhile, the South African Department of Public Service and Administration mandated the establishment of EAPs in all government departments. In the last 20 years, the EA profession has grown significantly to the point where the vast majority of large employers provide EA services, usually through external contracts. Even smaller employers are adding EAPs at a brisk pace. Effect of Apartheid on EAP Apartheid, in which racial groups were divided and kept apart by law, was official government policy in South Africa from 1948-1994. Since the apartheid system officially ended, both blacks and whites have shared equal rights under the law. However, the economic disparity that existed during apartheid has persisted. The South African census in 2012 found that the average black family earned just one-sixth as much as the average white family. The impact of apartheid on early EAPs was significant. Services and resources during apartheid were available mostly only to white employees and families.

The landmark Chamber of Mines feasibility study was also hampered by an apartheid-related lack of cooperation from labor unions with respect to EAP goals. Nevertheless, the counseling centers created in response to the study were made accessible to all mine workers regardless of race. When these centers eventually de-affiliated from the Chamber of Mines, their non-racially based services became available to all industries, not just mining. This represented a major step forward for EAPs and stimulated the creation of other independent EA service providers. A related legacy of apartheid was the historical lack of treatment facilities and helping resources available to non-whites. Although facilities are now integrated and available to all races, the number of resources still has not caught up with the backlog of need. The continuing economic disparity between racial groups aggravates the lack of access to help for many employees. Another, perhaps less obvious, effect of apartheid was its influence on the model of treatment and intervention offered in South Africa. Because the early emphasis was to serve whites, a treatment model largely based on US and European ideals took hold and continues today. For many non-white South Africans, this model fails to sufficiently incorporate and address traditional cultural concepts of

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spirituality, such as the important role of ancestors. Fortunately, cultural sensitivity and awareness is becoming a growing strength of the EAP community, as well as the treatment sector, and even healthcare in general. EAPA-SA is a leader in this effort. The Challenge of HIV/AIDS South Africa is believed to have more people with HIV/AIDS than any other country in the world. A United Nations report in 2016 estimated a prevalence rate of 19.2% among South Africa’s adult population. The HIV-positive rate was estimated in 2008 to be 45 times higher for black South Africans than for whites. The sheer magnitude of the HIV/AIDS issue has led to significant government and industry attention. Legislation mandates that employers maintain HIV/ AIDS workplace policies emphasizing awareness, prevention, and, in some cases, intervention. These policies are often independent of and entirely separate from EAP policies and programs. Recognizing that HIV/AIDS is never an isolated issue and is often the cause and/or result of other psychosocial issues, the hope for the future is that HIV/AIDS programs can be integrated into South African EAPs. In addition to eliminating inefficiencies and overlapping services, such integration could also bring greater administrative infrastructure, monitoring, and evaluation to the HIV/AIDS efforts. Opportunity Through Cultural Sensitivity As in other countries, technological innovations are now making it possible to provide EA services to people in more remote and varied settings

in South Africa. With this expanded reach comes an increasing awareness of the need for a more culturally sensitive design and operation of EAPs. With eleven official languages, a history of racial and economic division, and a wide variety of ethnic and cultural subpopulations, South Africa has one of the most diverse workforces in the world. Reflecting this diversity, EAPs in South Africa are emphasizing multi-lingual services, adding staff and network providers from the main cultural and ethnic groups, and incorporating culturallyspecific resources to address the needs of particular populations. Let’s Continue the Discussion My thanks to Professor Lourie Terblanche of the University of Pretoria; Dr. Pravesh Bhoodram of the South Africa Department of Correctional Services; Mr. Tinyiko Godfrey Chabalala, President of EAPA-SA; and members of the EAPA-SA Board for taking the time to answer my questions and provide helpful background information as I was preparing this column. Let’s continue the discussion of EAP in South Africa! More in-depth information is available from EAPA-SA, and of course, you’re welcome to contact me directly anytime or to post your feedback, questions, or suggestions on EAPA’s LinkedIn group. v

is now ONLINE www.eapassn. org/JEAArch

Dr. John Maynard served as CEO of EAPA from 2004 through 2015. Prior to that, he was President of SPIRE Health Consultants, Inc., a global consulting firm specializing in EA strategic planning, program design, and quality improvement. In both roles, he had the opportunity to observe, meet, and exchange ideas with EA professionals in countries around the world. He currently accepts speaking engagements and consulting projects where he can make a positive difference. He can be reached at

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featurearticle How to Start, Sell, and Grow an EAP

“The intent of our training was to create an engaging teaching experience and leave participants with an understanding of the nuts and bolts necessary to launch and successfully run an EAP.”

|By Marina London, LCSW, CEAP, and Michael Klaybor, Ed.D., CEAP


t was obvious from our personal experiences, including attending EAPA conferences, that while there is great interest in starting and marketing an EAP, there were no articles, books, or trainings that would teach interested parties how to accomplish such a complex task. To fill that gap, we created an all-day workshop that was unveiled as a pre-conference training opportunity at the 2016 World EAP Conference in Chicago. We wanted to cover every aspect of building/growing an EAP, including staffing, implementing, and nurturing a fledgling program. Using hands-on experience in selling and running EAPs, we aimed to provide a boots on the ground, nitty gritty learning experience that would give participants the “tools of the trade.” We used videos, web-based examples of best practices, sample presentations and paperwork, and discussions. The intent of our training was to create an engaging teaching experience and leave participants with an understanding of the nuts and bolts necessary to launch and successfully run an EAP. These are the topics we addressed: EAP 101 We encouraged anyone interested in starting an EAP to acquire some foundational knowledge first. If they are a licensed clinician – get the Employee Assistance Specialist

– Clinical (EAS-C) certificate. If they are already doing EAP work – obtain the CEAP® credential. Attend a World EAP Conference. Become an EAPA member to access the Journal of Employee Assistance archive, the Annotated

“Correctly pricing services is essential to the success of any EAP. We covered costing formulas, including Per Employee Per Month (PEPM), versus charging a flat fee, as opposed to charging by the case, as well as low-end versus boutique pricing.” Bibliography of EAP Statistics and Research Articles, and the Conference on Demand. Join an EAPA chapter or branch and network with fellow EA professionals. Define the Scope of Services and Staff Accordingly We outlined core EAP services, including providing

counseling to employees and management consultations. Then we discussed add-on services, such as sexual harassment prevention training, nutritional counseling, CIR, wellness, smoking cessation, etc. Once the scope of services are decided, the next step is to hire the necessary staff and affiliate providers. We recommended hiring, at minimum, master’s level clinicians from a variety of professional backgrounds including psychologists, social workers, and RNs. We also discussed giving preference to hiring individuals with EAS-C training or the CEAP®. We described the range of EAP staffing, explaining the roles of the account manager, director of clinical services, sales, etc. We also talked about filling in staffing gaps by using after hours’ coverage companies, and specialized services to provide critical incident response and Fitness for Duty evaluations. Pricing EAP Services Correctly pricing services is essential to the success of any EAP. We covered costing formulas, including Per Employee Per Month (PEPM), versus charging a flat fee, as opposed to charging by the case, as well as low-end versus boutique pricing.

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EAP Marketing/Sales Materials and Techniques We discussed the components of a successful marketing presentation and marketing materials. This should include a representative list of current client companies, ROI data, and a brochure. We also used existing EAP websites to demonstrate how to create a compelling online presence. Finally, we outlined how to prepare for a sales call. Rolling out the EAP We explained that introducing a new EAP involves creating an internal client company profile, including a description of the organization’s culture, key contacts, demographics, and insurance plans. Communicating the existence of the program to employees and management should be done via multiple channels, including email, posting on company intranet, videos, and in-person orientations. We showed sample PowerPoints and examples of both effective and ineffective EAP orientation videos. Running the EAP We looked at sample statements of understanding and consents to release information. We encouraged the use of evidence-based assessment tools such as the AUDIT, reading the Workplace Outcome Suite (WOS) Annual Report, and using the WOS. We discussed using specialized EAP software to manage cases, and creating an internal policy and procedures manual for staff. We also talked about the importance of maintaining program visibility by using wellness and lunch-andlearn programs, regular newsletters, blog posts, and other communications

geared toward employees and managers. Finally, we reviewed the essential components of an effective EAP utilization report. Technology We described and demonstrated a range of service delivery technologies including HIPAA compliant and encrypted platforms for video, text-based and email counseling, as well as creating an app. We discussed issues related to informed consent, backup plans, time zone considerations, online etiquette, and ethics. We talked about implementing a social media marketing plan, including which channels to use. We also addressed best practices for the use of technology, including obtaining Distance Credentialed Counselor (DCC) training.

iWebU,, a weekly blog about the Internet and social media for mental health and EA professionals who are challenged by new communication technologies. She previously served as an executive for several national EAP and managed mental health care firms. She can be reached at Michael Klaybor, Ed.D., CEAP, brings 25 years’ experience as a Certified Employee Assistance Professional to this training, which includes executive coaching, training and consulting of new EAPs in Moscow, Croatia, and Sakhalin Island on the topics of substance abuse evaluations, stress management, wellness, workplace violence, CISM, and fitness for duty evaluations. He specializes in workplace problems, anxiety, stress, and chronic pain management treatment. Dr. Klaybor has utilized videoconferencing training and services to EAPs in over 20 countries. He can be reached at: drmike@ He is co-owner of EAP in a Box,

Preparing for the Future of EAP Lastly, we talked about trends impacting the future of employee assistance, such as increasingly heterogeneous employee populations, growing mobile device penetration, and the potential for a wave of DNA-based treatments and approaches for mental illnesses and substance use disorders. We also urged participants to become knowledgeable about cybersecurity issues as the potential for data hacking incidents is increasing. Summary We had 25 participants in this first-ever training program, and anticipate further improving and developing this workshop to incorporate attendee feedback and ongoing developments in employee assistance. v Marina London, LCSW, CEAP, is Manager of Web Services for EAPA and author of

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featurearticle Reaching Millennials

Responding to Generational Diversity in the Workplace “For Baby Boomer and Gen X supervisors and managers struggling to reach and engage Millennials, EAPs can provide an effective workplace resource to foster an appreciation of generational diversity within the organization. … EAP-sponsored coaching and leadership mentoring programs can help retain Millennials, again offering EAPs an opportunity to show employers added value.”

|By Bernie McCann, PhD, CEAP


enerations typically share similar values, beliefs, and expectations. They also tend to exhibit similar preferences in areas such as employment and communication, which isn’t surprising given their common experiences using channels such as online, TV, mobile phone, etc. These generational-shaping influences are most obvious as members of this group move into adulthood. Of particular interest to EAPs, HR, and other workplace professionals, is the generation known as Millennials – individuals who were born between 1981 and 1997. This age group has been variously described as optimistic, team-oriented, and high achievers (Broido, 2004; Howe and Strauss, 2003). Millennials are the largest age group to emerge since the Baby Boomer generation. They comprise just over 23 percent of the total US population, are the most racially and ethnically diverse segment, and contain more individuals from singleparent, blended, or same-sex parent families (Frey, 2014). In 2015, at 53.5 million-strong, this generation (also known as Generation Y) became the largest portion of the US labor force and now makes up one-third of all employees. Additionally, given

its disproportionately large share of immigrants, and those transitioning from college to the working world, the Millennial generation’s share of the workforce will continue to grow to 50 percent by 2020. Millennials are the most educated generation in history. They are skilled in technology, selfconfident, able to multi-task, and they have plenty of energy. They are also voracious consumers of information. These individuals typically query and gather data then arrive at their own conclusions – and on their own schedule. They collect all types of health and lifestyle information through a wide range of online and social networks. They prefer to integrate technology with health (via their smartphones or tablets) and are eager to try new technological approaches (apps) to wellness. Mental Health Issues Common Among Millennials Data from Transamerica’s Millennial Survey: Young Adults’ Healthcare Reality indicates the most common health conditions among Millennials are depression (21 percent), obesity (18 percent), and anxiety disorders (16 percent) (Transamerica, 2015). According to the American Psychological

Association’s annual report Stress in America, Millennials report more stress and less ability to successfully manage it than previous generations, and they also cite their most stressful life pressures as work, money, and job stability. Close to half (44 percent) of this group report anger or irritability due to stress and overall are more likely to engage in unhealthy behaviors like eating, drinking alcohol, and smoking in an attempt to relieve stress. The report states that 12 percent of Millennials have a diagnosed anxiety disorder, which is almost twice the percentage of Baby Boomers. A recent BDA Morneau Shepell white paper, The Impact of Anxiety on Different Generations of Employees, discovered that 30 percent of Millennial EAP users have general anxiety at intake, with two-thirds of Millennials interviewed linking their anxiety to declining work performance. They also reported higher levels of associated absenteeism than Generation X and Baby Boomers (Bensinger, Dupont & Associates, 2013a). In a subsequent white paper, The Impact of Depression on Different Generations of Employees, Millennial EAP clients again scored highest in rates of

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Both Generation X and Millennial employees (as well as an increasing number of Baby Boomers) reject the idea of a simple phone number as the only point of access to goods or services. Mobile devices running iOS and Android now account for 45 percent of web browsing and are poised to soon become the primary way most people experience the Internet. This means that EAPs without mobile access or a social media presence seriously risk compromising their utilization. As of October 2015, 86 percent of those 18-29 years old have a smartphone, as do 83 percent of those 30-49 years old, and 87 percent of households with annual earnings above $70,000 (Pew Research Center, 2015). If a generationally savvy EAP offers platforms to engage these younger employees online, they will be more likely to access the EAP and to be satisfied with that experience. On the other hand, if an EA provider insists on offering only in-office or telephonic access, these clients may very well decline to use the EAP’s services.

depression and levels of associated presenteeism than Generation X and Baby Boomers (Bensinger, Dupont & Associates, 2013b). Considering that serious mental illnesses often manifest in early adulthood and stress is a risk factor for depression and anxiety, it seems prudent to educate Millennials on the signs of psychological distress and encourage them to seek intervention at its onset in order to avoid further complicating mental health issues. One positive demographic data point is that with the advent of the Affordable Care Act, the percentage of Millennials with health insurance has risen from below 70 percent in 2012 to 89 percent in 2015. Reaching Millennials is Crucial Unfortunately, EAP workforce penetration and utilization has sunk to some of its lowest levels in decades. Various sources have identified rates of between 3 and 5 percent (Dunning, 2014). However, employees in workplaces that extensively promote an EAP and provide worksite activities are more likely to use EAP counseling services than those in organizations that mount less vigorous promotion of EAPs and where no worksite activities are conducted (Azzone, McCann, Merrick et al., 2009). This relatively poor level of communication about available services, combined with concerns over privacy protections and lack of confidentiality, seem to be the two main factors for low EAP usage. To counter this growing downward trend, EA providers wishing to raise workplace penetration rates must recognize that Millennials are a key population group to reach. However, increasing utilization numbers is simply not possible without addressing the access challenges posed by both Millennials and the emerging population group, Generation Z. The challenges to greater participation in EAPs by these current and emergent generational segments are:

Your Opinion Matters! We want to know what readers think of various articles in the Journal of Employee Assistance. Each quarter we will use the EAPA LinkedIn group to refer EAPA members to an article in the most recent JEA and encourage feedback – along with a link to the electronic version of the journal –

• Easy mobile access; and • Perceived safeguards of personal information. This includes both personally identifiable information and sensitive personal information. Without assurances that these type of data will be protected, few Millennials will be willing to participate in EAP interactions.

Be on the lookout for it! 17

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featurearticle Similarly, if your web-based portal is not smartphone configured, no matter how great your work balance tips are, you will receive fewer clicks. And what about those printed monthly health newsletters or the old paycheck stuffers? Odds are that Millennials will never read them. Contemporary strategies to ensure EAP promotions and information are reaching Generation Facebook (individuals born after 1980) must include increased use of technology – online and social media platforms. Utilizing social media as a communication platform can build relationships and trust with an emerging Millennial EAP client base, particularly if the social media venues are used effectively. The Centers for Disease Control and Prevention supports this approach: “Integrating social media into health communications allows communicators to leverage social dynamics and networks to encourage participation, conversation, and community – all of which help spread key messages and influence health decision mak-

ing. Social media helps reach people when, where, and how they want to receive health messages; it improves the availability of content, and may influence satisfaction and trust in the health messages delivered” (CDC, 2011, p. 1). Bridge Generation Gaps to Reach Millennials Another approach (or platform in today’s parlance) for EA professionals to reach Millennials, and to provide value-added services to employers, is to offer coaching, training, and educational events, regardless of whether they are on-site or web-based. For Baby Boomer and Gen X supervisors and managers struggling to reach and engage Millennials, EAPs can provide a workplace resource to foster an appreciation of generational diversity within the organization. Today there exists an extensive, yet still emerging, literature regarding how to bridge these generational gaps and how to best blend the various age groups together into productive workforces. For EAPs, offering expert consultation, coaching,

and facilitating training presentations to better understand this phenomenon will benefit all four generations currently working together. As continuous learners, Millennials are likely to value receiving training through their employers in order to acquire new skills and remain competitive in today’s workplace. EAPsponsored coaching and leadership mentoring programs can help retain Millennials, again offering EAPs an opportunity to show employers added value. In terms of topics, training and career development offerings for Millennials might include business writing and coaching and mentoring young leaders, especially if they are offered through web platforms. Mentoring works both ways: younger employees can help older workers, not just the other way around. In other words, EAPs may also offer to help Millennials share their technological prowess by coaching other generations in the workplace. This is another service that may be appealing to employers.

Current Generations in the US Workforce Born between

Age span

Number (in millions)

The Millennials

Percent of Workforce





Generation X





The Baby Boomers





The Silent Generation





Generation (or Generation Y)

(or The Traditionalists)

Source: Pew Research Center analysis of US Census Bureau, 2015 Current Population Survey data

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Summary The challenges posed in reaching Millennials with EAP services and messages are clearly not insurmountable. Like any other service provider or manufacturer, efforts by EAPs to research and effectively address the unique characteristics of this population will offer a positive return on investment. Since the full numbers of this workforce group will not peak until 2020, there remains ample time to identify and adopt targeted initiatives, which will ensure an expansion of appropriate EAP services for Millennials. v

Howe, N., & Strauss, W. (2003). Millennials go to college. Washington, DC: American Association of Collegiate Registrars. Myers, K., & Sadaghiani, K. (2010). Millennials in the workplace: A communication perspective on Millennials’ organizational relationships and performance. Journal of Business Psychology, 25(2), 225-238. doi:10.1007/s10869-010-9172-7 Office of Disability Employment Policy, U.S. Department of Labor. (2009). Employee Assistance Programs for a new generation of employees: Defining the next generation. Washington, DC: Author. Retrieved from employeeassistance.pdf Pew Research Center. (2015). Technology device ownership, 2015. Washington, DC: Author. Retrieved from

Bernie McCann, PhD, CEAP, is an independent EAP consultant. He has over 20 years of experience in EAP consultation and program management, as well as workplace wellness initiatives, workplace trainings, and professional development seminars. He also conducts research and is a published author in peerreviewed journals.

Rikleen, L. (2011). Creating tomorrow’s leaders: The expanding roles of Millennials in the workplace. Chestnut Hill, MA: Boston College Center for Work & Family. Retrieved from http://www. PR%209_12_2011.pdf Transamerica Center for Health Studies. (2015). Millennial survey: Young adults’ healthcare reality. Los Angeles, CA: Author. Retrieved from https://www.transamericacenterforhealthstudies. org/docs/default-source/research/tchs-2016-millennial-surveyembargoed.pdf?status=Temp&sfvrsn=0.27898996882113725


American Psychological Association. (2015). Stress in America: The impact of discrimination. Washington, DC: Author. Retrieved from Azzone V., McCann, B., & Merrick E. (2009). Workplace stress, organizational factors and EAP utilization. Journal of Workplace Behavioral Health, 24(3), 344-356. doi:10.1080/15555240903188380

Advertise in

Bensinger Dupont & Associates. (2013). Anxiety and work: The impact of anxiety on different generations of employees. Chicago, IL: Author. Retrieved from Bensinger Dupont & Associates. (2013). Depression and work: The impact of depression on different generations of employees. Chicago, IL: Author. Retrieved from Broido E.M. (2004). Understanding diversity in millennial students. New Directions for Student Services, 106, 73–85. doi:10.1002/ss.126 Centers for Disease Control and Prevention, U.S. Department of Health and Human Services. (2011). The health communicator’s social media toolkit. [Report CS215469-A]. Atlanta, GA: Author. Retrieved from ToolsTemplates/SocialMediaToolkit_BM.pdf

Contact Joan Treece Advertising Manager (303) 242-2046

Deloitte. (2016). The 2016 Deloitte millennial survey: Winning over the next generation of leaders. Nicosia, Cypress: Deloitte Touche Tohmatsu Limited. Retrieved from hotnews/millennial-survey-2016 Dunning, M. (2014, January 5). Employee Assistance Programs underutilized by employees. Business Insurance. Retrieved from NEWS03/301059979 Frey, W. (2014). Diversity explosion: How new racial demographics are remaking America. Washington, DC: Brookings Institution Press.

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integrationinsights Implications of Pricing for EAP Integration and ROI |By Mark Attridge, PhD


key people and to other programs. As noted, the size of an organization’s budget allocated for EAP services is crucial.

The Organizational Health Map In my 3rd Quarter 2015 column, I introduced a general conceptual model and visual map that described the most common partners for EAP integration. They included individuals in HR, benefits, leaders of unions, and men and women in executive and leadership roles. These key individuals can invite the EAP to play a more strategic role within the business. The point is, when fully integrated into an organization, the EAP can do much more than just consult with managers and provide confidential counseling to troubled employees. It can also help to create a healthy place to work that connects employees to a wide range of support programs. But this can only happen when the EAP has the opportunity for meaningful and regular access to

EAP Utilization: “Free” EAP vs. Direct Pricing Models To examine the implications of product pricing and the portion of a budget allocated for EAP integration, we must recognize the rise of minimal EAP products in North America that are touted as being “free.” This kind of EAP is indeed sold at no direct cost to the organization. Instead, the real cost lies in hidden or embedded services that are rolled into much larger bundled fees (often disability or other health care insurance products). With no line item budget accountability and minimal promotion, this kind of EAP typically offers a very limited set of services – mostly telephonic counseling, website-based educational resources, and access to crisis response services. In a 2013 published survey of 82 external vendors of EAP – see the National Behavioral Consortium (NBC) study in the Journal of Workplace Behavioral Health – different models of pricing for EAPs were examined, as well as the rates of program utilization across all customers. Among the vendors with a predominately “free” EAP model, annual program utilization was

his article explores the implications of a financial budget devoted to EAP services and how it either promotes, or limits, the opportunities for creating effective partnerships and integration. I will summarize key points from my EAP Talks keynote presentation at EAPA’s 2016 World EAP Conference in Chicago.

very low. On average, they had 1.6 individual cases of EAP counseling per every 100 covered employees per year, and these cases averaged 3.1 counseling sessions per case. On the other hand, the utilization profile in this same data for the 43 other vendors with predominately direct pricing (either capitated or fee-for-service models) revealed a comparatively much higher level of program utilization. EAP vendors with direct pricing contracts had, on average, 4.9 individual cases of EAP counseling per every 100 covered employees per year, and these cases averaged about 2.6 counseling sessions per case. Thus, even though the individual clinical experience was similar (both types had about three sessions per case), the full-service, higherpriced EAP delivered three times the total number of individual users of counseling from the EAP than the “free” EAP. Delivering Greater ROI When considering the dollar value of workplace outcomes for a typical counseling case, having a greater number of more total EAP cases generates more net business value back to the purchaser when considering the dollar value of workplace outcomes for the typical EAP counselor case. I completed

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per year per every 100 covered employees. In contrast, these same usage rates in the directly priced vendors were comparably much higher: 1.3 work/life users and 1.8 organizational EAP services used.

a meta-analysis study, also presented at EAPA’s 2016 World EAP Conference, which reviewed findings from research projects at 20 different small and large EAPs with an aggregated sample size of over 200,000 EAP cases from all over the world. When comparing the work experience during the month before EAP use versus against the month after use of EAP counseling, the average result was seven: 7 fewer hours of work absence and 20 fewer hours of lost work productivity (less presenteeism) for the typical employee user of EAP counseling. In addition, the average case had an outcome of 27 hours (or 3.3 workdays) of lost productive time that was restored after EAP counseling. Considering that the clinical case rate utilization rate of the directly priced EAPs was roughly three times greater than that of the “free” EAPs (4.9 vs. 1.6), this means that about 132 hours of lost productive time (LPT) were avoided by the direct pricing EAPs per every 100 employees in the covered population, compared to only 43 hours of LPT avoided for the “free” EAPs. The cost savings argument is even greater when also considering the savings from additional areas of outcomes beyond just productive work time.

In other words, the “free” EAPs had a 2.0% total use rate (all services combined), while the directly priced EAPs offering a more comprehensive mix of services had a 8.0% total use rate, which is four times higher. The NBC study revealed substantial variation between full-service vendors with some having double or even triple the industry average. Note also that, in generally speaking, internal or hybrid types of EAPs (which have one or more fulltime employees of the organization dedicated to the EAP program) typically have higher usage rates, larger budgets, and greater reach into the organization than external vendor EAPs. Promise or Peril for Integration of EAP? Comparing these utilization rates paints a vivid picture of two very different kinds of EAPs for purchasers to choose from. The “free” EAP offers a minimal level of utilization primarily for individual counseling services, but almost no workplace-based services to the organization. Conversely, the directly priced model provides nearly 10 times the level of organizational

The usage rates for other core services were also extremely low among the 5 “free” EAP vendors: only 0.2 work/life users and 0.2 organizational EAP services used

Continued on page 35 21

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worldeapconferenceroundup Soaring on the Winds of Change: Recap of 2016 World EAP Conference


ournal of Employee Assistance editor Mike Jacquart attended “EAP Innovation: Soaring on the Winds of Change,” EAPA’s 2016 World EAP Conference,” held October 31 - November 3 at the Sheraton Grand Chicago. In this article he shares key findings from this important gathering. EAPA’s Conference on Demand is also available for anyone interested in downloading conference breakout sessions from either the 2015 or 2016 conferences. Full information is available at DAY ONE – The annual Chapter and Branch and Leader Development session was expanded this year. Run by the EAPA Board of Directors, the session featured “Leading a Volunteer Organization” by Steve Smith with Rosecrance Health Network. Finding enough volunteers can be a real challenge for any organization, Smith said. “You need job descriptions to find out where they fit. You need a consistent way of training, which creates greater buy-in, what do YOU want to do?” Smith noted. Success stories from EAPA Chapter and Branch Leaders, and award presentations, were other highlights. Day One concluded with the always popular EAPA Expo Grand Opening Reception (formerly known as the EAPA Marketplace Reception). Some of the many vendors included: Center for Discovery, Cigna, Harting EAP (Daybreak EAP Software), and National Association to Area Agencies on Aging. Held on Halloween, the festivities included plenty of candy and costumed attendees, including a Cat in the Hat, various ghouls, and even a Ghostbuster or two.

Everyone outdid themselves with their Halloween costumes at EAPA’s EXPO Grand Opening Reception.

High Stakes Fitness for Duty Evaluations: When Concerns of Violence Arise was led by George Vergolias, Psy.D., Associate Medical Director with R3 Continuum. Among other areas, participants learned the differences between affective and predatory violence, and how to determine when to refer for Fitness for Duty versus Threat of Violence evaluations. “Clinical judgment is often only 50%, we have to consider other factors,” he said. “Can we mitigate risk? We can’t predict, but we can manage risk factors.” Bev Younger, Ph.D., LCSW, Clinical Associate Professor with the University of Southern California School of Social Work, presented Rapidly Diversifying EAPs: Strategizing for the Future. This session addressed the continuing diversification of internal and external EAPs, and offered strategies for adapting to accelerating change. “From factories to labor policies; like the ADA, FMLA and others, to broad brush EAPs, managed care, digital delivery, and the Affordable Care Act, EAPs have always needed to adapt to employee needs,” she explained. “Is diversity a loss of Core Technology or a necessary adaptation?” questioned Younger.

DAY TWO – The opening keynote, “Moving from Victim to Victor through the Power of Forgiveness” was led by Lyndon Fitzgerald Harris, co-director with Tigg’s Pond Retreat Center. Lyndon presented groundbreaking ideas from the new science of forgiveness. “We need to create a culture of forgiveness in the workplace,” he stated. Sessions that JEA editor Mike Jacquart attended included: 22

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DAY THREE – Wednesday’s keynote address was quite different from the norm. The address included short, engaging EAP Talks (think TED Talks) about current EA topics from Jeff Harris, MFT, CEAP, Program Manager, EAP & WorkLife Services, University of Southern California; Marina London, Web Services, EAPA; Sally Spencer-Thomas, Psy.D., President & CEO, Carson J Spencer Foundation; and Mark Attridge, Ph.D., President, Attridge Consulting. Harris spoke on how EAP practitioners can build credibility as consultants. “Make it your business to know their business, including microcultures,” he explained. “Trust is everything. Deliver consistent, good results and don’t challenge a manager in front of a team. Get periodic feedback, and follow up.” London posed the question, “Is EAP ‘Tech Proof?’” It dawned on her that certain things in Vegas (scantily clad women, slot machines, circus shows, and magic acts) remianed unchanged even though she hadn’t been there in decades. Along similar lines, in spite of today’s ever-changing technological innovations, London maintained that certain aspects of society, and EAP, will remain “tech proof.” For instance: there will still be a need for human contact, and there will still be a focus on mental health. “The very act of helping is tech proof,” she said. Spencer-Thomas discussed how EAPs can be shining lights of hope in the social movement of suicide prevention. She concluded her compelling talk by having the lights turned off. Then she asked audience members who’ve been affected by suicide – first indirectly, and then directly – to hold up their lit cell phones. As the room went from dark to heavily lit, it became apparent how many of us had been affected by suicide, and what a terrible thing it is to feel depressed, in the dark, with nowhere to turn. “No one should die in isolation and despair,” she said. Attridge led a talk on how EA professionals can better integrate EAP into other workplace programs. The effort is worthwhile because EAPs can enhance their business value by creating connections with other health and benefit programs within the same organization.

Sessions that JEA editor Mike Jacquart attended included: The EAP Connection to Military Sexual Trauma and Campus Sexual Assaults was led by Patricia Herlihy, Ph.D., RN, CEO and founder of Rocky Mountain Research; Lauren Bloom, a grad student at the University of Maryland; and Leah Marshall, a college sexual violence prevention advisor. Herlihy said that sexual assault has a tremendous ripple effect – from the victim and survivor, to family, co-workers, friends, and even the community. “It’s not just rape, but unwanted touching, grabbing, threatening, offensive remarks, and threatening and unwelcome advances.” According to the Media Report “Protect Our Defenders,” in 2014, 85% of victims did not report crimes. Bloom pointed out that sexual violence is not just physical in nature, but also includes voyeurism, sharing intimate images, catcalling, and leering. There is a common misconception that there is something the victim could have done to prevent the assault. “There is too much onus on the individual,” she said. “Whether it’s college, the workplace, or the military, it’s difficult to acknowledge how prevalent this problem really is,” Marshall said. “This is not a women’s issue or a men’s issue, it’s a human issue,” she stressed. “Power and control can occur in any relationship, anyone can be a perpetrator.”

This year, the conference attendance totaled over 800 people from all over the world.

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worldeapconferenceroundup Innovations in Suicide Risk Assessment, Management, Recovery, and Grief Support, was led by Sally Spencer-Thomas and Bernie Dyme, LCSW, President and CEO, Perspectives Ltd. “A co-worker’s suicide has a deep, disturbing impact on workmates,” said Thomas. “For managers, tragedies pose challenges no one covered in management school. Survivors may feel: ‘When is the next shoe going to fall?’ Since co-workers often have more face-to-face time than family, we need to do a better job promoting what mental health is.” “We need to make suicide a health and safety priority,” Dyme stated. “Reduce stigma, open dialogue, promote EAP, and find champions willing to tell their stories. Encourage discussion about mental health, and determine if and how to make accommodations for those with mental health conditions and issues.”

With the Chicago Cubs in the World Series, Cubs’ fever could be found all over the Windy City.

Understanding the Changing Latino Demographic and Diverse Latino Cultures, was presented by Gerardo Canul, Ph.D., behavioral health consultant with GK Partners in Wellness. The growth in the Latino population in the U.S. requires EAPs to have a plan of action in order to offer effective EA services. “It’s important to understand core cultural Latino values and beliefs,” Canul explained. For instance, he noted that Latinos typically have a philosophy of collectivism versus individualistic beliefs. “The value of being a member of a community of family takes priority to individualism. Cooperation is valued over competitiveness.”

Top 10 Rated World EAP Sessions Selected by session attendees: • Signs and Symptoms: Barriers to Recovery and Challenges Employees Encounter after Treatment • Balancing the Needs of Employees with Cancer, their Co-workers, and Managers • Innovations in Suicide Risk Assessment, Management, Recovery, and Grief Support • EAP Proof of Success: Reducing Malpractice Claims for Physicians • Change! Transition! Resilience! Expressing Transformation through Dance, Music, and Drama • Workplace Conflict: What to Do and What to Avoid! • Navigating Mental Health for Airline Pilots • The Struggle is Real: Lessons Learned on the Front Lines from Internal EAP Managers • Understanding the Changing Latino Demographic and Diverse Latino Cultures • EAP Industry Outcomes for Employee Absenteeism and Presenteeism: A Global Research Analysis

DAY FOUR – The last day of the conference featured the President’s Breakfast in which EAPA President Lucy Henry and President-Elect Tamara Cagney spoke to the audience. Cagney offered her vision for the EA field in a well-received address, and the incoming Board of Directors was also installed. Also unique was Creating a United Vision for the EAP Field. Participants included Greg DeLapp, EAPA CEO; and organizational EA presidents Jeffrey Gorter, MSW, National Behavioral Consortium; Kaoru Ichikawa, Ph.D., CEAP, Asia Pacific Employee Assistance Roundtable; Judy Plotkin, MSW, Employee Assistance Society of North America; and Igor Moll, MWO, Employee Assistance European Forum. v 24

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EAPA Awards Recognize High Achievement EAPA Member of the Year Honors a current EAPA member for outstanding contribution to EAPA within the last 24 months. Boyd Scoggins, CEAP, Alabama chapter officer

Each year, the Employee Assistance Professionals Association (EAPA) recognizes and celebrates the achievement of members, individuals, and organizations who have distinguished themselves through their work and leadership in the EA profession.

EAPA Newcomer Recognition Award Given to a new member who has made an impact at the chapter, branch, national level of the association in driving EAPA membership, visibility, and/or growth. Christian Ellis-Frederick, CEAP, Indianapolis, IN, president-elect of Indiana chapter

Dr. Don Jorgensen received EAPA’s highest individual award, the Lifetime Achievement Award during EAPA’s 2016 World EAP Conference in Chicago. Other award recipients this year included Boyd Scoggins (EAPA Member of the Year); China National Petroleum Corporation (EAP Quality Award); South Carolina Chapter (Outstanding Chapter Award) and Metropolitan Tokyo (Outstanding Branch Award).

Emeritus Member Honorary membership category. The individual must be retired from any active paid EA work and have served EAPA in at least two elected or appointed positions at the chapter, branch, or international level. John Maynard, CEAP, Colorado chapter Randi Wood, CEAP, Colorado chapter

The complete list of award winners is as follows: Best Delivery of CIR Services Given to an EAP for exceptional response following a crisis incident. Morneau Shepell – EAP based in Canada – CIR services provided in aftermath of largest and costliest natural disaster in Canadian history, a wildfire in Alberta, Canada.

Excellence in EA Business Development Rewards marketing, communication or advertising campaigns, content marketing, website, blog, social media, and other efforts that promote employee assistance. Mary Olsen, NYC chapter

Best Use of Technology in EA Award Given to an EAP, chapter, or branch, individual or entrepreneur for cutting edge use of technology in the delivery of EA services. Bon Secours Richmond EAP – based in Virginia – sophisticated use of cutting edge technology permeates every aspect of EAP service delivery.

Hennessy Scholarship Winners Receive two full registrations to attend the conference. Dr. Marcellinus Nwaogu, Lagos, Nigeria (non-labor affiliated) Abby Alconcher, Chicago, IL, USA (labor affiliated) Lifetime Achievement Award Honors an EAPA member who has made a significant contribution to EAPA and the EA profession over an extended period of time. Donald Jorgensen, CEAP, Tucson, AZ, Arizona chapter

EAP Quality Award Honors an EAP that demonstrates adherence to the EAP Standards and Guidelines for EAP Programs and includes an exemplary, continuous quality improvement component. China National Petroleum Corp. – EAP covers 20,000 Chinese employees working in Africa, the Middle East, Central Asia, and Latin America.

Outstanding Branch Award Metropolitan Tokyo Branch Outstanding Chapter Award South Carolina Chapter

EAP Advertiser/Exhibitor/Sponsor/Exhibitor Award Given to a 2016 advertiser/exhibitor/sponsor who has a track record of providing exceptional support to EAPA. Harting EAP

President’s Award Awarded by outgoing EAPA president Lucy Henry to an individual who has helped make her term in the office successful. John Waller, CEAP, North Carolina chapter

EAPA Making It Happen Award Given to a remarkable individual who has done something truly exceptional to help EAPA in its mission. Alex Shukoff, EAPA conference photographer for decades and creator of the beloved conference slide show.

Ross Von Wiegand Award Honors an individual supporter of labor who exemplifies exceptional cooperation and working relationships. Charley Galassini, CEAP, IBEW Local 701, Plainfield, IL, NIEAPA v 25

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featurearticle Leading EFAP Trends in Canada Numerous Issues are Driving Changes

“Only one-third of individuals who need mental health-related services in Canada will receive treatment. As a result, great efforts have been made to increase awareness and promote the open discussion of mental health.”

|By Barb Veder, MSW, RSW


ver the past few years, there have been significant workplace changes in both mental health and in the role of Employee and Family Assistance (EFAP) programs in Canadian organizations. Recent developments in technology, changing attitudes and opinions of the public and employers, a 24/7 work culture, and other factors have pressured businesses to improve upon behavioral health and workplace well-being services for their employees. In Canada, nine basic themes have been driving these changes, areas that I will discuss in the remainder of this article:  There is greater awareness about the importance of mental health among both the general public and business leaders. Only one-third of individuals who need mental health-related services in Canada will receive treatment. As a result, great efforts have been made to increase awareness and promote the open discussion of mental health. Case in point, the Toronto Globe and Mail’s “Breakdown: Canada’s Mental Health Crisis” is a popular report that matches investigative journalism with human interest stories on mental health (Globe and Mail, 2016). Canadian speed skater and cyclist Clara Hughes discusses the importance of mental health during Bell Canada’s annual mental health ini-

tiative and Bell’s successful “Let’s Talk” campaign. While Bell has been a prominent leader in promoting mental health in the workplace, other companies are taking their own unique approaches. One such organization, The Great West Centre for Mental Health, provides free public resources to increase the knowledge and awareness of psychological health in the workplace, which turns knowledge into action with practical strategies and tools for employers (GWLCMHW, 2016).  Anti-stigma and social change campaigns for men’s mental health are emerging. Men often delay seeking help for mental health issues like depression due to perceived stigma and gender norms. Organizations such as the Movember Foundation are committed to addressing men’s physical and mental health and actively supporting programs for social change, which are increasingly being driven by digital technology. For example, the foundation has funded Queens University’s “The Caring Campus: An Intervention Project.” This led to the creation of an app to help male students’ self-monitor changes in substance abuse patterns and access resources for support (Movember, 2016). It’s important to note that these “e-mental health solutions,”

including online resources, social media, and mobile phone apps, are continuing to grow in popularity as tools to help males overcome stigma and access the proper mental health supports.  The voluntary 2013 National Standards for a Psychologically Safe Workplace is having an impact on employers. Championed by the Mental Health Commission of Canada (MHCC), in collaboration with the Bureau de normalisation du Québec (BNQ) and CSA Standards, the National Standards for a Psychologically Safe Workplace (i.e. the Standard) was developed in 2013 to also help protect employees from psychological harm in the workplace and to promote psychological well-being. Benefits to employers include reduced absenteeism, short‐ and long‐term disability costs, turnover, and risk of legal issues related to psychological harm to employees; enhanced recruitment and reputation as a favorable place to work; higher levels of employee engagement, creativity, and innovation; and lower rates of error and physical injury (Psychologically Safe Workplaces, 2011). To assess the impact of adopting the Standard, a three-year research study will document the progress of 40 organizations across the country. Led by Dr.

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solution-focused leadership skills, which can be transferred to a variety of professional settings and situations.

Merv Gilbert of the Centre for Applied Research in Mental Health and Addiction (CARMHA), Faculty of Health Sciences, at Simon Fraser University, the study will commence in early 2017. The outcome will help identify successful practices, formulate programs, and develop educational tools and processes to help other organizations adopt the Standard and promote mentally healthy workplaces.

 Interest in, and use of technology to access mental health and educational services, is increasing. As mentioned, Canadians are increasingly turning to their computers, tablets, and smartphones to access information and assistance about their health concerns. The benefits of visiting a website, using an app, or accessing online health services such as e-counselling, video counselling, or text messaging to access support are numerous. They include around-the-clock accessibility, anonymity, easy navigation of services, the ability to overcome barriers to traditional in-person treatment, and the ability to cater to learning differences and various lifestyles. A research study by Morneau Shepell found that these benefits, along with 18 to 30 year olds’ adoption of digital modes to gather information, is driving a shift in EFAP usage patterns across the country. It’s been proven that EAP providers who rely on digital technologies are better able to attract this younger, historically more difficult to engage demographic of EFAP services (Veder et al, 2014).

Interim results are already promising, as early findings are suggesting that: • An overwhelming 80% of participating organizations have already reviewed or updated their policies to account for psychological health and safety in the workplace; • Nearly two-thirds (67%) already have a policy statement on psychological health and safety; and over 60% are taking action to create respectful workplaces, enhance psychological health and safety knowledge among workers, support work-life balance, provide stress management training, and build resilience among workers (GWLCMHW, 2015).  New university certifications pertaining to mental health are emerging. Canada is also seeing select colleges and universities begin to offer courses on psychologically healthy workplaces, such as the University of Fredericton’s online certificates in psychological health and safety. Developed by Dr. Joti Samra, R. Psych., with the support of GreatWest Life’s Centre for Mental Health in the Workplace, the Canadian Centre for Occupational Health and Safety, and the Mental Health Commission of Canada, these certificates are helping today’s leaders address potential negative psychosocial factors in the workplace and supporting employees who are experiencing mental health issues (University of Fredericton, 2016). EFAP providers are also joining forces with highly regarded educational institutions to push the mental health envelope. The Workplace Mental Health Leadership™ certificate program, developed by Morneau Shepell in partnership with Bell Canada Mental Health and the Anti-Stigma Research Chair and Faculty of Health Sciences at Queen’s University, represents the first certification of its kind in Canada. The program uses evidence-based and industry best practices (including the previously mentioned Standard) to help participants grasp the legal, ethical, and business concerns for mental health in the workplace. The program also supports the development of empathetic and

Upcoming features include:  Lessons Learned from Fukushima Disaster  Leveraging Technology to Improve Services  Suicide Risk Assessment

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featurearticle  EFAP providers continue to offer work/life and physical wellness services in addition to mental health counseling. Business doesn’t stop at 5 p.m., so it’s no surprise that many people are currently experiencing high levels of stress, fatigue, and depression (WHO 2015). What may be surprising, though, is their inability to access treatment. Faced with a lack of available resources, limited access to professional help, prevalent stigma around mental illness, and/or insufficient benefit coverage, those suffering often aren’t able to receive the care they need. For this reason, many EAP providers are now including behavioral, mental health, and work/life services in their employee assistance offerings. Programs such as Morneau Shepell’s Depression Care counseling—based on Cognitive Behavioral Therapy—help people develop the skills and resilience to recover from, or manage, depression. Studies show that employers who add these types of programs to their EAPs can see a 4.8 to 1 return on their investment, proving that not only can they help their people break down the barriers of seeking support, and get healthier and higher performing employees, but it also makes good business sense (Veder et al, 2016).  EAP business partnerships between vendors in the US and Canada are serving clients in both countries. We’re also seeing an increasing trend among multinational corporations toward vendor consolidation. This arrangement allows for simplified procurement and administration processes, as well

as increased purchasing power through greater economies of scale—leading to lower costs for EAP services. Such partnerships help harmonize benefits across borders, leading to the enhancement and greater consistency of employers’ employee value

“Canada is also seeing select colleges and universities begin to offer courses on psychologically healthy workplaces, such as the University of Fredericton’s online certificates in psychological health and safety. … EFAP providers are also joining forces with highly regarded educational institutions to push the mental health envelope.” proposition on a global basis. Even within the mid-market segment, more and more companies have business activities that span both countries, with local employees in each jurisdiction. As such, EAP providers are increasingly required by organizations to provide a consistent level of access and support to individuals regardless of where they live.

Therefore, multinational and global players are able to leverage their existing proprietary infrastructure (i.e., call centers, networks, account managers, etc.) and local market expertise. Conversely, for EAP providers with purely domestic operations, there is a need to cooperate (whether it’s through qualified referrals, subcontracting, or more formal partnership agreements), to not only win new business, but also retain existing clients.  Collaboration is increasing between EAP providers and union or employee peer support groups to offer mental health crisis assistance and trainings in the workplace. Peer support groups and EAPs can complement one another by providing different, though necessary support services during incidents or crisis situations in the workplace. Common in industries like mining, aviation, rail transportation, and major manufacturing; non-clinical mental health initiatives involve bringing individuals together who have shared similar experiences. These peer support groups, facilitated by EA professionals, can raise individuals’ efforts in dealing with the challenges they face (Van Den Bergh and Hoffman, 2012). They also augment traditional clinical care, and are growing in popularity across Canada (Speakers’ Spotlight, 2016).  Better integration between disability management and EA professionals ensures a more effective return to work for employees on leave. It takes an entire team—including case managers, physicians,

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nurses, return-to-work coordinators, HR staff, rehabilitation specialists, mental health practitioners, supervisors, and others—to help employees on disability return to work. Increasing numbers of employers are integrating their employee assistance and shortterm disability programs as to better manage risk. These programs work together to better understand the underlying and often interrelated behavioral and mental health aspects of disability claims, and to provide additional information and supports as early as possible. A combined program has the unique ability to be planned and implemented specifically to address issues along the entire continuum of health—from prevention to recovery (Morneau Shepell, 2016a). Some EAP providers have taken this idea one step further by creating specialty return-to-work programs to ensure that their case managers are “best-in-class .” Summary As we’ve seen, new legislation and certification, an increased demand for digital solutions, further acknowledgement of good mental health as a driver for business success, greater collaboration among EAP providers and vendors, and better integration among employee wellness and disability programs are just a few of the forces driving changes in EAP offerings across Canada. As we move into 2017, we expect these trends to continue as mental health in the workplace remains a focus and business priority—both for employers and their employees. v

Barb Veder is the Vice President of Clinical Services and Research Lead with the Canadian-based Morneau Shepell, considered a leading pioneer in delivering alternative EAP counseling modalities. Contact Barb at


Globe and Mail. (2015). Breakdown: Canada’s mental health crisis. Retrieved from http:// Great-West Life Centre for Mental Health in the Workplace. (2015). Psychological health and safety case study articles. Toronto, ON, Canada: Author. Retrieved from https://www. workplacestrategiesformentalhealth. com/psychological-health-and-safety/ psychological-health-and-safety-casestudy-articles-october-2015 Morneau Shepell. (2016). Absence and disability management. Toronto, ON, Canada: Author. Retrieved from http:// absence-and-disability-management Movember Foundation. (2013). Mental health funding. Toronto, ON, Canada: Author. Retrieved from https://

ON, Canada: Morneau Shepell. Retrieved from sites/default/files/documents/3187-onlineefap-service-offerings-re-examininguser-demographics-and-access-patterns/8611/reportmorneaushepelldigitalresearch1114_1.pdf Veder, B., Dunmarra, K., Bettencourt, L., Bourgeois, L., Wittes, P., & Fasciano, Y. (2016). Depression care: Helping employers help employees. Toronto: Morneau Shepell. Retrieved from Wang, J., Ho, K., Attridge, M., Lashewitz, B.M., Patten, S.B., Marchand, A., … Merali, Z. (2006). Preferred features of e-mental health programs for prevention of major depression in male workers: Results from a Canadian national survey. Journal of Medical Internet Research, 18(6):e132. doi:10.2196/jmir.5685 World Health Organization. (2015). Mental disorders. Geneva, Switzerland: Author. Retrieved from mediacentre/factsheets/fs396/en/

Psychologically Safe Workplaces. (2011). National standard of Canada for psychological health and safety in the workplace – backgrounder and FAQ. Ottawa, ON, Canada: Mental Health Commission of Canada. Retrieved from Speakers’ Spotlight. (2016). Stéphane Grenier. Retrieved from http://www. University of Fredericton. (2016). Psychological health & safety in the workplace. Fredericton, NB, Canada: Author. Retrieved from http://www.ufred. ca/online-programs/school-of-appliedoccupational-health-specialties/centrefor-psychological-health-sciences/onlinecertificate-programs/online-certificate-inpsychological-health-and-safety/ Van Den Bergh, N., & Hoffman, C. (2012). Emerging trends for EAPs in the 21st century. New York, NY: Routledge. Veder, B., Tian, A., Beaudoin, K., Bettencourt, L., Dunmarra, K., Fasciano, Y., … Jankowski, H. (2014). Online EFAP service offerings: Re-examining user demographics and access patterns. Toronto,

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featurearticle Cognitive Challenges in the Workplace

“For an employee experiencing cognitive and emotional decline due to a medical condition, injury, or compromised cognition, the EAP provides a source of hope both to that individual and to their employer.”

| By Joel Becker, PhD, CEAP


t is an undeniable reality that Americans are now compelled to work later into their lives. As a result, our country’s workforce has increased in age. This phenomenon is the result of a number of factors, including increased longevity, tougher economic times, and modifications to retirement options. Unfortunately, the aging process is often accompanied by cognitive decline and the anxiety of adapting to a changing workplace. Even in younger people, illness, injury, effects of medications or surgery, and/or genetic predisposition can adversely affect productivity and job sustainability. In this article, I will highlight key cognitive functions that have particular relevance for working individuals. I will also address specific contributions that can be made by employee assistance professionals as an important resource in identifying and supporting employees that become cognitively challenged. The EAP offers an invaluable service to both employees and employers in screening, treating, and devising an effective treatment plan with appropriate accommodations to reintegrate the employee into the workplace. For an employee experiencing cognitive and emotional decline due to a medical condition, injury, or compromised cognition, the EAP provides

a source of hope both to that individual and to their employer. With some employees, the transformation is rapid and dramatic as a result of injury or disease; in others it may be gradual and subtle as part of cognitive changes occurring in the normal aging process. As a result, agerelated changes have become more common, along with a higher incidence of neurological conditions in older employed adults. They include: Signs and Symptoms of Cognitive Decline • Increased difficulty with learning and retaining new information; • Periods of confusion and decreased alertness; • Increased reliance on instruction repetition and reiterated reminders; • Taking longer to complete a given task; • Inability to sustain multitasking; • Lower frustration threshold/ more easily angered; • Decrease in motivation; • Apparent lack of engagement, loss of work ethic and energy; • Avoidant, apathetic, less socially interactive; • Depression and withdrawal; • Difficulties with coordination and balance; • An observable tremor;

• Speech/articulation difficulty; and/or • Worsening of mood or intensification of an affective disorder. Case Study #1: Cognitive impairment caused by concussion Jeff is a 58-year-old senior computer engineer at a major information technology company. Three months ago, while cleaning the roof gutters on his house, Jeff fell from a ladder and landed on his head. He was seen at a local ER and diagnosed with a concussion. After seven days of convalescence, Jeff was cleared by his family physician to return to work. However, what followed was an unexpected series of challenges that neither Jeff, his internist, nor his supervisor could ever have anticipated. Jeff first discovered something was wrong after a few days back on the job. While doing a routine computer task, he couldn’t remember where he left off and was forced to retrace his steps in order to proceed. As a result of what is technically referred to as a “working memory difficulty,” it now takes Jeff significantly longer than usual to complete a given task, much to the disappointment of both himself and his supervisor. As a member of a highly technical and evolving industry, Jeff must keep up by assimilating new information and learning how to

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use new data systems and devices. After 10 years with the company, Jeff prided himself in his uncanny ability to grasp a new program or algorithm within one reading of a technical manual. However, since his injury, Jeff found that he now had to read and reread the material two to three times before he could retain and apply the information. He struggled with sequencing and he forgot people’s names. An eight-to-10hour work day grew more taxing, as Jeff increasingly succumbed to the stress of intense concentration and mental challenge. This is a phenomenon that neuropsychologists refer to as “cognitive fatigue.” For the first time in his career, Jeff experienced an unprecedented degree of self-doubt, frustration, and fear for his job. Jeff found himself angry, depressed, and less socially engaged. That shouldn’t be surprising, since troubling feelings and a loss of interest in interpersonal contact are frequently observed complications of cognitive decline. Individuals who have sustained concussions may continue to suffer from the impact of their original injury over an extended period of time. In a competitive work environment with high expectations, job-related pressure can result in vulnerabilities and emotional stress. Diagnosis and Treatment Because Jeff’s company had an EAP, his situation was handled with care, sensitivity, and a genuine commitment to helping a valuable employee get back on track. A supportive supervisor and onsite EAP consultant contacted his internist, who ultimately referred

Jeff for a neuropsychological evaluation that wound up confirming the persistent presence of Jeff’s post-concussion symptoms. Upon being informed that his perceived cognitive challenges were in fact real, Jeff was relieved to find out that not only did his company’s health plan offer a number of cognitive rehabilitation options, he learned the EA professional would also assist in obtaining reasonable accommodations during his extended recovery. Case Study #2: Cognitive impairment caused by disease Mary is a 42-year-old physician’s assistant at a busy outpatient orthopedic clinic located in a major hospital. Over the past year, she noticed intermittent periods of confusion and memory loss. More recently, Mary found herself misplacing charts and forgetting the names of patients she knew for years. She described herself as “having good days and bad days.” On good days she felt fully functional; on bad days she dreaded making an error and possibly harming a patient. Diagnosis and Treatment Mary scheduled a visit with her primary care physician, who ordered several diagnostic evaluations. Diagnostic imaging led to a diagnosis of Mild Cerebral Microvascular disease, and a condition known as Transient Ischemic attacks or TIAs. The fluctuations in the efficiency of blood supply to the brain were the likely explanation for Mary’s fluctuations in cognitive performance. Fortunately for Mary, as in the case of Jeff, it was possible to

objectively identify and treat diseaseaffected cognition. Much to Mary’s relief, the EAP was able to assist her care providers in implementing a treatment plan that included appropriate work accommodations and lifestyle changes. The EAP remained an ongoing resource for Mary, which boosted her functionality and confidence until such assistance was no longer needed. Support An employee experiencing cognitive challenges tends to minimize the impact of increased difficulties on functioning. When problems become more self-evident, the employee may experience embarrassment, fear, frustration, and a decrease in self-worth. Supervisory support, flexibility, and knowledge of accommodation options are key to maximizing employee productivity following an injury or illness accommodations. According to the Job Accommodation Network (JAN), there is great variability in employers’ willingness to implement accommodations for qualified employees. I had the pleasure of interviewing Alan King, COO of Workplace Options, a Fortune 500 company that works with domestic and international employers. King believes that the level of comfort an employee has in communicating difficulties, and a corresponding supportive work environment, are the two most important factors in addressing cognitive challenges. King believes that openly working with an employee and their family can be invaluable in maintaining the health of the individual and their ability to remain on the job.

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featurearticle Many of the patients I have treated over the years who experience subtle changes in their cognition and memory wait until their jobs are in peril before seeking help. Fear of jeopardizing their position and losing peer respect are common reasons given for not reaching out sooner. In addition, the fear of developing a neurodegenerative condition such as Alzheimer’s disease is ubiquitous.

However, after evaluating these patients, I often find that they are not struggling with a neurodegenerative disease; rather, there are specific cognitive changes due to different causes. Working in partnership with the struggling worker, their employer, and their family is integral to maximizing workrelated adjustments and supporting the individual and their needs.

Evaluation and Treatment Resources  Neuropsychological evaluation: A good neuropsychological evaluation will develop a profile of the employee’s cognitive strengths and weaknesses along with recommendations to maximize adjustment at work.  Primary care physician: The PCP should always be kept in the loop regarding any individual who is suspected of having cognitive

The Value of Aging Employees An undeniable trend in Western societies is that more people are not only living longer, they are also working longer. This trend, combined with the inevitable fact that aging can result in cognitive challenges, makes addressing these growing challenges crucial for retaining and maximizing the contributions of aging employees. A recent study (Center for Retirement Research at Boston College, 2015) focused on the relationship between age-related cognitive decline and work ability. For 10% of respondents, there was a steep decline in cognitive ability over 10 years. Shifting to a less demanding job or retiring early was much more likely for this subgroup. However, the vast majority of individuals who participated in the study (90%) were able to remain in their current occupational role through variables such as utilizing cognitive reserve (recognizing their cognitive capacity), maintaining a healthy lifestyle, and understanding the specific cognitive requirements of their jobs.

knowledge, such as an educator, that individual can likely continue to work well into their later years. In contrast, for a career such as a surgeon, proficiency and speed often declines, which can directly affect the outcome (i.e. successful surgery). Don’t Underestimate Value The value of an aging employee should not be underestimated. Older workers offer assets based on experience and knowledge of their particular occupation. These individuals are highly reliable, consistent in their attendance, and often will go the extra mile. Older employees can serve as peer mentors, teach aspects of job functions, and add to the knowledge base of their teams. Recent studies have found that key variables in retaining and maintaining work satisfaction of older employees are based on two factors: supervisory support and job flexibility. Examples of job flexibility include allowing brief rest breaks during the workday and flexibility in the hours that the employee is required to work accounting for personal needs such as medical appointments. The ability of the EAP to recognize the possibility of age-related cognitive changes as a factor affecting employee performance can substantially help in understanding what is needed for job retention and employee satisfaction for older employees. v

Normal Aging From an EAP perspective, it’s important to understand what normal aging involves. Typically, there is a decrease in “fluid” cognitive ability (the ability to learn and apply new information) while “crystallized” cognitive abilities (learned skills and acquired knowledge) will remain intact. The implications of these differences are substantial. When a position is heavily based on acquired

- Joel Becker, PhD

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The good news is that as first-line health care professionals, EAP practitioners can offer much-needed relief, support, resources, and targeted referrals, which in turn can make an invaluable difference to a cognitively challenged employee. v

challenges. If the employee has not had a recent physical examination, referring to the PCP should be the first step.  Community support groups for individuals who suffer from neurological diseases such as Parkinson’s disease, Multiple Sclerosis, Alzheimer’s, and Traumatic Brain Injury.  Mental health support: Individuals who are coping with cognitive decline or a neurological disorder often benefit from consultation with mental health clinicians who can provide therapy and support for the individual, couple, and/or family.  Occupational therapist: This health care professional can be very helpful in implementing strategies to manage psychomotor and/or sensory challenges.

Dr. Joel Becker specializes in the maintenance of cognitive health in the workplace. A clinical neuropsychologist and CEAP, Dr. Becker created the Cognitive Functional Assessment Screening Tool (CFAST*) to initially screen and help refer employees experiencing cognitive decline due to age or injury. * Research version.

Cognitive Health Awareness in the Work Environment Cognitive health in the workplace will continue to grow in its importance over the next decade and beyond. The following are some suggestions in promoting awareness and programs that will support cognitive health:

Tips for raising awareness of your EAP:

 Key professionals in an organization, including employee assistance, Human Resources, and occupational health professionals, can help managers and supervisors understand the importance of cognitive health and work with employees who are experiencing cognitive challenges.  Create an environment that promotes awareness and support of neurocognitive health while encouraging working with employees who manifest cognitive challenges.  Make cognitive health awareness part of an overall workplace wellness initiative. Promote educational services, exercise, and nutrition programs, as well as professional development and socialization opportunities to maintain employee physical, mental, and emotional health.

Get on a local speaking circuit. Don’t get pigeonholed into only hanging out with EA colleagues or just networking at EAP events. Utilize or join Chamber of Commerce, civic groups (think Lions, Rotary, etc.) and others to raise awareness of an issue or about EAP in general. Joining a business association related to EAP, such as the Society for Human Resource Management (SHRM) is another possibility. Have an elevator speech ready. If someone asked, “What does your EAP do?” would you know what to say in roughly 30 seconds? The following is an idea that one EA professional has used: “Anything worth losing sleep about, is worth coming in for.” Utilize social media. Some people are intimidated about getting involved in social media, but don’t underestimate how much Millennials use these platforms to communicate. If you are on social media, how often? It should be on a regular basis to remain current.

Summary Unlike a physical injury or developmental disability, the symptoms of cognitive decline are not always apparent and are often misconstrued as the effects of emotional or family-related problems. There is a great deal of relief that is experienced by affected individuals when they realize that someone understands and accepts their condition. 33

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earoundup Workplaces Impacting Mental Health in UK More than one-third of UK employees say their working environment is having a negative effect on their mental state of mind, and one in two feel that their workplace “does not manage mental health issues well,” reports While 60 percent admit that mental health issues affect their everyday life, half of those who have suffered from a mental health issue did not take time off work. “Not only are workers reporting that their place of work is impacting negatively on their mental state of mind, but the majority are also calling for employers and employees to share responsibility and to do more to manage mental resilience and mindfulness in the workplace,” said Dave Capper, executive director of Westfield Health, which conducted the survey. The business cost of mental ill health among the UK workforce is thought to total £26 billion, notes Brian Dow, director of external affairs at Rethink Mental Illness. “Although this issue has been swept under the carpet in the past, it is now a concern where employers are requesting help,” he stated.

Swiping Away a Drinking Problem? An app has been developed that helps people struggling with alcohol addiction to reduce

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their alcohol intake, or to quit drinking completely, reports Medical Xpress. A study into the effectiveness of the app, called “Breindebaas,” began in November 2016. The app was developed by the University of Twente, Tactus International, Saxion University of Applied Sciences, and the University of Amsterdam. The intent of the app is to disrupt subconscious processes that feed alcohol addiction. The app shows study participants all types of beverages, along with the simple instruction to pull non-alcoholic beverages towards them by using a swiping motion, and to push alcoholic beverages away. Ideally, participants do this as quickly as possible in order to unlearn unconscious associations. The app must be used twice a week for a period of three weeks, with each training session lasting ten minutes. Researchers believe that repeated training will alter the brain’s reaction and thought patterns.

This cycle can lead to a workplace that some may consider emotionally abusive. Researchers asked 70 employees to complete a survey tallying incidents of incivility and its effects for 10 business days. The results suggested that workers exposed to uncivil behavior are more likely to behave unkindly themselves. Even among employees who wanted to be friendly and polite, workplace bullying sapped their energy and patience, leading them to behave in aggressive ways. Researchers also found incivility was more common in workplaces perceived as political (defined as the drive for workers to do what is best for themselves rather than what is best for the company). The study’s authors suggest offering staff clear feedback about appropriate workplace behavior to reduce the perception that a workplace is politicized, thereby reducing workplace aggression. This feedback can be either formal or informal. v

Rude Behavior is Contagious: Study

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Incivility, otherwise known as unsociable or rude behavior, in an often politically charged workplace can spread like a virus from one employee to another, according to a study published in the Journal of Applied Psychology. Researchers say workplace unkindness can leave employees feeling psychologically fatigued, and that exhaustion can cause them to mistreat other workers.

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integrationinsights EAP services. These services typically include:

Continued from page 21

In his example, even though the difference in price between the Level 1 EAP and the Level 3 EAP was $20 vs. $40+ Per Employee Per Year (PEPY); their ROIs were roughly $2:1 vs. $10:1. This was because the much higher investment in Level 3 EAP produced:

• Management consultations; • Topic-specific trainings; • CISD/crisis incident response; • Employee orientations; and • Supervisor training sessions.

• Higher overall usage; • Greater EAP collaboration with mangers and with other partner programs, and • Enhanced focus on follow-up and long-term management of referrals made by the EAP for high-risk clinical cases (i.e., depression, anxiety, and alcohol/drug).

It is these organizational services that represent the best mechanisms for the EAP to become more integrated into the organization. The contrast in service levels for EAPs with different budgets is depicted in the graphic on page 21. The left side of the figure shows the “empty house” that results from a minimal investment by the organization in a “free” EAP that isn’t used much and is largely disconnected from most programs and people in the organization. On the other hand, the right side of Figure 1 illustrates the “full house” version that occurs when there is a significant investment by the organization in a “comprehensive EAP.” This version is integrated into other programs and with key people in the organization. A more organizationally focused EAP also has several tactical advantages over “free” or more basic EAPs that function mostly as stand-alone counseling services. Integrated EAPs typically enjoy higher referral rates of referrals into the EAP from managers in the organization, and also use SBIRT risk-screening best practices to identify and refer employees who need clinical treatment due to more serious mental health or addictions problems. Both of these operational practices generate a higher number of the kinds of EAP users who have the greatest potential for high dollar cost-savings back to the employer in areas of lost productive time, health care and disability costs, occupational accidents, and employee turnover.

This analysis revealed how the high investment EAP has a much different expection from the purchaser as to how and for where and how it can the EAP can provide value back to the organization. Summary I believe that it is through forging strong partnerships, resulting in greater integration, that EAPs can provide the most value to their client organizations. But, as with other areas of investment, EAP is most effective when it is fully funded. The willingness of the purchaser to invest in the EAP has clear implications for how much the EAP can become integrated into the organization, and thus ultimately for the level of business value expected from the EAP. In summary, you get (or don’t get) what you pay for with EAP services. It is important that businesses, HR professionals, and brokers of employee benefits and related insurance products understand this key difference between types of EAPs based on pricing. CALL FOR CASE STUDIES: In future articles, I would like to profile EAPs or vendors that are partnering with client organizations and other programs in innovative ways. Please contact me with your suggestions for a case study.

Indeed, Dr. Tom Amaral’s presentation at the EAPA’s 2013 World EAP Conference examined the effect that three different levels of financial investment in EAP had on the mix of EAP services used, the associated outcomes, and return on investment.ROI. The highest total ROI was found for the type of EAP with the highest level of investment.

Dr. Mark Attridge is an independent research scholar as President of Attridge Consulting, Inc., based in Minneapolis. He has created over 200 papers and conference presentations on various topics in workplace mental health, EAP, psychology, and communication. He has delivered keynote presentations at EAPA World EAP Conferences in 2013 and 2016 and is past Chair of the EAPA Research Committee. He can be reached at:

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