Journal of Employee Assistance Vol 51 No. 4 4thQtr2021

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4th Quarter 2021 | VOL. 51 NO. 4

The magazine of the Employee Assistance Professionals Association

Lessons Learned from 9/11 & Applications to COVID |Page 12


‘Soft Touch’ Engagement Techniques Page 18

9/11 Anniversary Reflection Page 26

Special Report! Workplace Outcome Suite Page 30



RECORDINGS Purchaseall allaccess accesspackage packagefor foronline onlineaccess access recordings conference Purchase totorecordings ofofallallconference sessions recorded at the 2018 and 2019 EAPA conferences. CE credit is still sessions recorded at the 2018 and 2019 EAPA conferences. CE credit is still available for the most recent conference year. Enjoy unlimited access to available for the most recent conference year. Enjoy unlimited access to EAPA Conference Recordings through June 30, 2022. EAPA Conference Recordings through October 31, 2020.

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contents EAPA Mission Statement

4TH Quarter 2021 | VOL. 51 NO. 4

cover story


Lessons Learned from 9/11 & Applications to COVID

| By Jeff Gorter, MSW, LMSW

At its core, every crisis is intensely personal and unique, both in its context and its impact to each worker and each workplace. But due to their size, scale and scope certain events – like 9/11 or the pandemic – have the capacity to remind us of our shared humanity.



Utilizing ‘Soft Touch’ Engagement Techniques for EAPs

| By Daniel Hughes, PhD, CEAP;

Acanthus Fairley, LCSW; & Barbara Leese, LCSW, SAP The “Soft Touch” protocol involves the identification of distressed employees/ work groups, EAP initiated outreach employing PFA techniques, the elicitation of an event narrative, and assessment/referral for care as needed.


EAP & University Collaboration Addresses Employee Depression

| By Kim Hauge, PHR, SHRM-CP, CWP; and Bruce Sherman, MD, FCCP, FACOEM

The Kent State and EAP collaboration provided a basis to optimize use of each organization’s capabilities and strengths to improve awareness and reduce the stigma of depression and increase employee help-seeking as part of a broader, ongoing well-being initiative.



9/11 – A Personal & Professional Recollection

| By John Maynard, PhD

Fear is contagious. That is, after all, the whole point of terrorism, to instill contagious fear in us. But calm, confidence, compassion, and even altruism can be contagious, too. EA professionals were a particularly powerful healing influence in the aftermath of 9/11. …


The History of EAPs in the United States – Part III

| By Dale Masi, PhD

The Boston College Occupational Alcoholism and Drug Training Program was the sole NIAAA-funded training effort that would go on to produce social work graduate students in occupational alcoholism and employee assistance programming.

departments 4 FRONT PAGE

To promote the highest standards of practice and the continuing development of employee assistance professionals and programs. The Journal of Employee Assistance (ISSN 1544-0893) is published quarterly for $13 per year (from the annual membership fee) by the Employee Assistance Professionals Association, 4350 N. Fairfax Dr., Suite 740, Arlington, VA 22203. Phone: (703) 387-1000. Postage for periodicals is paid at Arlington, VA, and other offices. POSTMASTER: Send address changes to the Journal of Employee Assistance, EAPA, 4350 N. Fairfax Dr., Suite 740, Arlington, VA 22203. Persons interested in submitting articles should contact a member of the EAPA Communications Advisory Panel (see page 4) or the Editor, Mike Jacquart, by calling (715) 445-4386 or sending an e-mail to To advertise in the Journal of Employee Assistance, contact The JEA is published only in digital format since 1st Quarter 2019. Send requests for reprints of issues published BEFORE 2019 to Debbie Mori at ©2021 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, Write it Right LLC Development Manager: Boyd Scoggins Designer: Laura J. Miller


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frontpage Regaining Our Momentum in the Post-COVID World | By Andrea Lardani and Bernie McCann, PhD, CEAP


and Barbara Leese explain how “soft touch” engagement techniques have enhanced EAP services – workplace violence (WPV) assistance in particular – at the Mount Sinai Health System in New York City. The shared experience of the pandemic and other social disruptions has given us a glimpse of what may be a radically different work and life environments of the future, and as noted, positive developments appear to be emerging to from it. And many will agree the pandemic has shown that work-life balance has become more important to each of us.

here is no question that the COVID-19 pandemic has had a substantial impact on our lives, and it will likely continue to do so. It has disrupted work, education, health care, the economy, relationships, and even politics and social discourse. Many were forced to rethink nearly every aspect of their lives—including hard choices, like whether to interact with extended family, how to interface with co-workers, and even if they wanted to continue to patronize shops, in-person services, and the like. Now work organizations across the globe are attempting to transition into what soon may become a post-pandemic environment, as many are fully reopening, vaccination numbers continue to increase, and employers are faced with the challenges of regaining momentum. Reducing uncertainty around returning to work will be critical for a successful reopening. (The challenges in hybrid work and in returning to work are presented in the “tear-out” resource on page 6.) So much has changed in the past year that may require careful thinking about what employees will need to resume their pre-pandemic stride, and a hoped-for return to full operations and attendance may increase stress levels, once again. It is good to remember, however, that COVID is not the first seminal event that many of us have experienced. In this issue’s cover story, Jeff Gorter describes some important lessons learned from 9/11 and how they can help guide the EAP response to the current crisis. While it’s true there are differences between the two crises, Jeff explains that, like 9/11, utilizing a tailored approach and incorporating lived experiences into our response are paramount in continuing to instill calm, compassion, and sensitivity in the individuals we serve. The pandemic has also brought novel approaches to service delivery to the forefront. Through descriptions and case examples, Daniel Hughes, Acanthus Fairley,

EAPA Communications Advisory Panel Andrea Lardani, Co-chair – Buenos Aires, ARG

Bernie McCann, Co-chair – Las Cruces, NM

Mark Attridge – Minneapolis, MN

Nancy Board – Seattle, WA

Daniel Boissonneault – Hamden, CT

Tamara Cagney – Discovery Bay, CA

Peizhong Li – Beijing, China

Maria Lund – Columbia, SC

Elena Sánchez Escobar – Madrid, Spain

Radhi Vandayar – Johannesburg, South Africa

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(The importance of lived experiences also comes to light in an article by former EAPA CEO John Maynard in which he recalls his encounters on the scene at Ground Zero twenty years ago.) In terms of COVID, as noted, work-life balance has been brought to light like never before. When encouraging employees to have a positive approach to achieving a balance, instead of thinking

of work and life as opposites, perhaps we should think of work as a part of life, and to remember that each of us has a limited number of resources, so it’s helpful to think about what makes sense for each individual when it comes to work and home life, and how to set realistic expectations for both. The EA profession can be proactive leaders in creating a work environment that allows employees to set reasonable work hours, and prioritize schedules that maximize physical and mental health, leisure, and family times. Individual resilience is often formed and sustained through organizational elasticity. Humans and work groups are highly influenced by the behaviors of others, especially with regular contact and exposure. When employees feel fully integrated into a strong healthy network or environment, resilience, productivity, and well-being can increase across the organization, and then we can truly regain our momentum. Be sure to check out the other important features and columns in this issue. Happy reading. v

Get your free PDH! A reminder that by reading this issue’s cover story and answering a 5-item multiple choice quiz at, you can earn one free PDH. Upon completion of the quiz, contact Julie Rochester ( to notify her that you have successfully completed the quiz, and she will forward the earned PDH certificate.

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

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What Employees & Employers Need to Know About Returning to Work Amidst COVID


s employees and family members that spent the past year, or longer, at home start transitioning back to in-person workplaces, many are considering the challenges that lie ahead as a result of this shift. One thing is clear, MANY employees prefer a hybrid work environment over going back to “business as usual.”  Nearly one-third (29%) of working professionals will quit their job if not allowed to continue working remotely with their current employer. Another 62% of employees will prefer employers that continue to offer work from home (WFH) in the future.  An overwhelming 81% of working professionals enjoy working remotely, with 65% stating that remote work has positively affected their work-life balance.  The biggest WFH challenges include home distractions (59%), remaining motivated (45%), and communication (37%) – which brings us to the next point. According to the Hopes and Fears 2021 global survey performed by PwC to 32,500 workers in 19 countries: • Only 10% of the employees wish to return full time to the office. • 77% said they are ready to acquire new skills. • 80% trust they can adapt to new technologies in the workplace. • Remote work will persist after quarantine and 72% prefer a combination of remote and workplace.

non-urgent questions for regular meetings rather than sending multiple emails or instant messages. Here are more suggestions: Mental health needs aren’t going away. Employers must continue using, if not expanding, virtual care: According to HR Dive, employers may be able to improve access to mental healthcare by reducing or waiving costs to employees. In light of COVID, employers must increase visibility: Returning to work, whether now or later, requires that leaders are front and center where people can see them so they can understand what’s changed, what is changing, and the direction the organization is taking.

Employers must not overlook the need for employee ENGAGEMENT: Without physical proximity managers need to use NEW avenues for relationship-building with remote workers. Some tips for the hybrid work that is likely continuing due to the Delta variant:

Employers must clarify policies and procedures: Over the past year, it’s likely that organizational guidelines changed due to COVID. It’s important for employers to create an outlet for employees to ask questions, without fear of reprimand, to ensure that workers understand what is expected of them. v

 Managers should use instant messaging for the types of interactions that occur in the hallways with office-based staff. Ask how their day is going, send a link to a helpful article or share a joke.  Share calendars! Doing so allows remote staff to see when they have the best chance of catching the manager between meetings. Remote staff can save

Additional sources: Weber Shandwick, KRC Research, Fast Company, Live Career, Employee Benefit News.

Editor’s note: This wellness article is provided by the Journal of Employee Assistance as a reader service, and may be reproduced freely and distributed to employees, family members, and the general public. 6 | JOURNAL OF EMPLOYEE ASSISTANCE | 4th Quarter 2021 | •• • • • • • • • • • • • • • • • • • • • | W W W . E A PA S S N . O R G |

spotlightoneacc The Latest on CEAP® Refresh Commissioners Address Key Questions

| By Bryan Hutchinson, Laura Jacobson, Ian Quamina


pproximately five years ago, the Employee Assistance Certification Commission (EACC) began collecting data to assess the viewpoints of current certificate holders about their CEAP® certification and its role in their professional work. The goals were to determine satisfaction with the credential, and to seek feedback in shaping the future direction of the CEAP®. Since that time, the EACC has been busy disseminating this information, as well as gathering information from EA and from other fields that have advanced certification, in order to create an improved pathway to certification for the EA profession. EACC commissioners have played a crucial role in compiling standards, processes, and teaching materials to create a process that will allow a less burdensome path to certification without diluting the value of the CEAP®. The following is the latest on their efforts.

up and running and we anticipate launch within the next few weeks*. We have developed and fine-tuned the 5 Module content and presentations, including all the voice-over narrations, along with the knowledge questions and end of module assessments. EAPA is now working on integrating the modules with the current EAPA technology vendor. (*Laura’s response was written in early August 2021.)

Ian Quamina: We are nearing completion of Phase I of the CEAP® Refresh process, which entails the development and roll out of an initial modular-based self-paced online certification course. The development of the course content is now completed and packaged into five modules that covers knowledge across the three domains. Additionally, we have credibly identified entry points for EA professionals with different levels of experience and training to become certified.

JEA: The EACC has been busily working on the CEAP® Refresh for roughly five years. Where does the process stand? What has been accomplished, and what still needs to be done?

JEA: What has been the biggest obstacle toward revamping the CEAP® to date?

Bryan Hutchinson: The CEAP® Refresh is almost to the finish line! Ian Quamina and Sherry Courtemanche have done a magnificent job of translating the CEAP curriculum into an easily understandable format that delivers course content in a way that gives the right amount of information to test the applicants’ understanding of the EAP field. Passing the CEAP’s five challenging sections will be tough and will demonstrate the applicant’s mastery of EAP knowledge.

Bryan: The biggest obstacles have been meshing the different tech systems so that course content and testing technology match in an intuitive manner. Laura: The biggest obstacle, which has also been one of the biggest surprises, has been the difficulty that we have had in merging the different technologies to support the new process. This has been a challenge, but one that EAPA staff is working on every day in conjunction with the vendor we have chosen to launch the CEAP®.

Laura Jacobson: The EACC, along with EAPA staff, is in the final stages of getting the new CEAP® Refresh 8

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Ian: More of a challenge than an obstacle – was how timeconsuming it was reviewing the existing bank of CEAP® test questions to identify questions (that were still aligned to our 21st century employee assistance practices) that we can use for the initial online certification course. After our diligent process of elimination, we ended up with a smaller pool of test questions. Therefore, a major element of the next phase of the CEAP® Refresh would be the development of new test questions to support new course content.

Laura: Candidates who initiate the new CEAP® Refresh have up to 90 days to complete all five modules but can do it as quickly as they would like. I anticipate that, once up and running, we will have candidates that complete the modules and assessments within a few weeks of initiation. Ian: We look forward to unveiling the new CEAP curriculum, and we hope to have our first round of candidates complete the initial self-paced online certification course soon after. v

JEA: What has been the most unexpected surprise in redoing the CEAP®?

Bryan R. Hutchinson currently serves as the Director of Employee Assistance Program services for the International Association of Machinists, District 141 on United, American and Hawaiian Airlines. In this capacity, he is responsible for Employee Assistance issues for IAM District 141 members and their families. Bryan currently holds the following certifications: CEAP, (Certified Employee Assistance Professional), SAP (Substance Abuse Professional), LAP-C, (Certified Labor Assistance Professional), and MAC (Master Addictions Counselor).

Bryan: The CEAP is a very robust and comprehensive measure of a candidate’s knowledge of the EAP field. A very pleasant surprise is how well the certification had held up over the years. The CEAP® curriculum has been consistent over the past 35+ years, with slight modifications periodically. This means the Refresh did not have to be a total rebuild, which is a testament to the EAPA staff and the volunteers who have served on the EACC. The CEAP® remains a comprehensive assessment that has consistently shown EAP competence and has signaled EAP consumers that a professional with the CEAP credential will provide superior services in the most efficient and professional manner possible. ®

Laura Jacobson, LICSW, CEAP, SAP, is the Director of EAP Clinical Services at KGA, Inc. She is the current Chair of the Employee Assistance Certification Commission (EACC), an international Board that informs EAP certification guidelines and standards. She may be reached at Ian B. Quamina, PhD, CEAP, is a 2020 EAPA President’s Award of Service recipient and an EA Digital Archive Ambassador who holds a PhD in Organizational Leadership with specialization in Human Resource Development and a Master of Social Work (MSW) degree with a specialization in Employee Assistance Program (EAP). While physically based in South Florida, Ian is the designated External Mental Health Professional for UN Agencies in Trinidad and he is the Head of Clinical Services for Families in Action, an external EAP provider based in Trinidad and Tobago with coverage throughout the English, Dutch, French and Spanish speaking Caribbean. He may be contacted at

Laura: In addition to the challenge noted earlier, I have been pleasantly surprised at how much the content has held up through time, as well as how dedicated and committed the Commissioners and EAPA staff have been to accomplish this goal. Ian: A great benefit to our CEAP® Refresh is the ability to embed EA related articles and videos in our modules’ course content. The unexpected surprise was realizing that we do not have much current (last five years) content that we can use. If such articles and videos do exist, I encourage persons to submit to our International Employee Assistance Digital Archive. If they do not exist, then this is a great opportunity to write an article and share it with our Journal of Employee Assistance.

The Journal of Employee Assistance The Journal of Employee Assistance seeks more thought-provoking discourse among EAPA members (and JEA readers). One great way of doing that is by submitting a letter to the editor on an article you’ve read in the Journal. For more information, contact the editor.

JEA: What do you see as a timeline for issuing the first new CEAP® certificates? Bryan: This is dependent on the technology synching up. Once that happens, the first CEAP® certificates could be issued quickly.

Mike Jacquart, (715) 445-4386 or email 9

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

Employee Assistance The Intersection of ACEs and Addiction Hosted by Hazelden Betty Ford addiction psychiatrist Stephen Delisi, this webinar takes a closer look at specific adverse childhood experiences implicated in chronic illness. Participants must register to view the recording.

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

Employee Assistance You Learn You Turn: Coping with Grief Lucy Henry with First Sun EAP shares how grief affects us in the workplace and shares positive ways to process grief. Employee Assistance International Employee Assistance Digital Archive The International Employee Assistance Digital Archive is always adding to its important EA depository of information for the employee assistance profession. Recent submissions at include but are not limited to:

Diversity, Equity, Inclusion Dismantling Racism Works Web Workshop This web-based workbook was originally designed to support the Dismantling Racism Works two-day basic workshop. The workbook is now offered as a resource to the entire community. Employee Assistance 10 Essential Messages for C-Level CIRs Compiled by Tim Hobart, CEO with H&H Health Associates, this link directs readers to Tim’s latest video on Workplace Critical Incidents.

• Officer Wellness – Mental Resiliency, Dave Hughes, others; • Returning to normal and the office? I am not so sure, Brad Harrington; • Officer Wellness Module, Lisa Callander; and • National Consortium on Preventing Law Enforcement Suicide Toolkit.

Employee Assistance EduWeb The EAPA South Africa chapter has created EduWeb, a new online education portal, as part of its long-term strategy as a leader in EAP education.

For more information about the EA Digital Archive, contact Jodi Frey at or Pat Herlihy at Employee Assistance Total Brain Total Brain is a powerful neuroscience-based mental health and brain performance app. It includes a mental health index that allows users to compare themselves to others throughout the pandemic. v

Employee Assistance Not Safe For Work (NSFW) Podcast episode/3PAAV9zgpMQ3m9lcPrPAb2 Hosted by Charles Epstein of BackBone, Inc., this podcast offers a humorous take on workplace issues, offered on Fridays as an end-of-week stress reliever. For more information, contact Charles at 10

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earoundup EAPA Town Hall Meeting Set for December 9

emergency order in 90-day increments, meaning the waiver could be revoked with little notice, disrupting patients’ relationships with therapists and other behavioral health providers. Another key question for telehealth companies is whether virtual visits will be reimbursed at the same level as in-person care. The Centers for Medicare and Medicaid Services offered some insight into how it views the future of telehealth in a proposed rule. Under the rule, providers offering mental health care via telehealth would be required to hold in-person visits with patients every six months, and it would also limit the use of audioonly visits. Read more at

The next EAPA virtual Town Hall gathering as well as the Annual Business meeting is scheduled for Thursday, Dec. 9 from noon-2 p.m. Eastern time in the EAPA Zoom Room. Meetings are hosted by the EAPA Board of Directors and include updates from the Board committees, task forces, and EAPA staff. All EAPA Chapter/Branch Leaders/Officers are encouraged to attend, and all EAPA members are welcome to attend and join the lively discussion. Forward any questions or suggestions for agenda topics to Detailed agendas and log-in instructions are emailed to all current EAPA members prior to each meeting. More info on additional EAPA chapter meetings and conferences can be found at https://

Many Managers Fear a Remote Work Future The current remote-work debate in industries has often been cast as a battle between the old guard and its assumed necessities and a new guard that has found a better way to get things done. Ed Zitron writes in The Atlantic that, “Remote work empowers those who produce and disempowers those who have succeeded by being excellent diplomats and poor workers, along with those who have succeeded by always finding someone to blame for their failures.” Zitron adds that remote work “removes the ability to seem productive (by sitting at your desk looking stressed or always being on the phone), and also, crucially, may reveal how many bosses and managers simply don’t contribute to the bottom line.” Certainly, many people need to go to a physical location to work, both for social reasons as well as for practical ones. You can’t cook a burger on Slack, or clean an office on Zoom, as but two examples. But for millions of people who spend most of their days sitting at a computer, the pandemic proved that remote work is just work. While many executives and managers spent the early months of the pandemic telling their employees that “remote work wouldn’t work for us in the long term,” they are now forced to argue with the tangible proof that remote work does in fact work. What’s next is anyone’s guess.

Questions Remain About Virtual Care The COVID-19 pandemic reshaped the way many Americans receive health care, largely by ushering in new strategies that made telehealth easier to access. However, as policymakers wrestle with which pandemic-induced changes will remain after the crisis, health care providers are insisting that virtual care is here to stay — and clamoring for clarity as they navigate their own paths forward. Medicare officials are proposing extending waivers to keep some telehealth services easier to access through 2023, and while that offers some stability over the coming months, the future of the field — including coverage, the types of virtual care that will be offered and how people will be able to access services — is still in transition, and the uncertainty has left telehealth companies in a quandary over how to plan for their futures. This remains a precarious situation even though telehealth use has surged over the past year, peaking in April 2020 but remaining 38 times above pre-pandemic levels as of February 2021, a McKinsey & Co. analysis found. A key problem lies in the fact that regulators have allowed mental health clinicians to practice telehealth across state lines during the public health emergency. The Biden administration has been extending the

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coverstory Lessons Learned from 9/11 & Applications to COVID | By Jeff Gorter, MSW, LMSW


hile the COVID 19 pandemic continues to dominate the news cycle – and our lives! – it can seem challenging to reflect on a tragedy that occurred 20 years ago, rather than the one calling for our attention right now. For the next generation of employees entering the workforce, the terrorist attacks of September 11, 2001, were an event studied in History class, and even for many who were in the workforce then, it’s becoming a distant memory. But I believe the lessons learned from 9/11 are more pertinent than ever and can help guide the EAP response to our current crisis.

Get your free PDH! A reminder that by reading this issue’s cover story and answering a 5-item multiple choice quiz at, you can earn one free PDH. Upon completion of the quiz, contact Julie Rochester ( to notify her that you have successfully completed the quiz, and she will forward the earned PDH certificate.

Striking Similarities Let’s begin by acknowledging the striking similarities in these two events. While on the surface they would seem to be vastly different, their impact on the business community – and how EAPs support them – are in surprising alignment:

 Both events have had a global emotional impact unlike any other. Although there have been many large-scale mass tragedies over the last 20 years, most have been local or regional in nature – few events have triggered the sense of shock, vulnerability, and fear on a world-wide scale as 9/11 and COVID 19. Just as in the days following the 9/11 attacks, EAPs have played a key role in helping companies adapt and even thrive in the midst of the current crisis. Some hard-earned lessons from 9/11 that apply equally well to today include:

 Both 9/11 and COVID changed everything about how business is conducted. From travel procedures to safety/security protocols to the work environment itself, corporations have been challenged to reexamine long-held practices. Questions about how, where, and by whom critical functions are performed are leading to many changes and adaptions that are likely to be permanent, just as they were after 2001 (Remember when you didn’t have to take your shoes off at the airport?)

Lessons Learned  It begins with people! No matter how secure your IT system is, regardless of how detailed your policies and procedures are, if your employees are not emotionally ready to return to work, your business will grind to a halt. The emotional well-being of the workforce has once again been highlighted as the lynchpin to recovery, and companies that attended to their worker’s behavioral health, as well as their physical health, are experiencing a more productive, loyal, and engaged employee population. Comprehensive, well-integrated EAPs have long been helping to shape a culture of health with their corporate customers since 9/11, promoting ease of service access, crisis leadership consultation, and frequently

 Both 9/11 and COVID 19 required a massive expenditure of time, money, and resources by companies to restore functional operations and confidence. Few organizations can say they are conducting business in exactly the same way they did prior to either event, or changes were often implemented quickly. The effectiveness of those initiatives, however, may or may not be readily apparent, adding to the overall anxiety of leaders and line workers alike. (“Did we do the right thing? Are we doing enough?”) 12

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updated “take and use” wellness strategies calibrated and pertinent to the current need, time, and place. Whether the immediate crisis is a terrorist attack, a hurricane, an active shooter, or a pandemic, EAPs have a strategic role in offering a curated suite of resources that address the human element. The EAP industry learned this following 9/11 and we have incorporated this with every major incident since.

• Have had their loyalty rewarded so they remain employees over the short haul and the long haul.” Core EAP domains such as leadership consultation, stress management, sobriety, childcare/eldercare and a myriad of other behavioral health concerns were cast into clear focus in 2021, just as they were in 2001. A comprehensive high quality Employee Assistance Program provides solutions to these issues that support the effective and continuous operation of any business.

 Believe in resilience. Although both 9/11 and the pandemic are events that pushed our emotional strength to the limit…yet we have endured! I don’t say this lightly, nor do I want in any way to minimize or dismiss the personal pain and loss so many of us have experienced – the grief from COVID 19 has been real and profound, just as it was after 9/11. But by that same token, I don’t want to diminish the incredible resilience shown by so many in response to crisis. From the heroic service of frontline healthcare workers…to the dogged determination to adapt to remote work…to simple expressions of care and kindness on a Zoom call…the ability of the human spirit to rise to – and rise above! – tragedy has been on full display. At R3 Continuum (formerly Crisis Care Network), we saw similar examples after 9/11, when business leaders made the strategic decision to resume operations in NYC as a bold declaration of unbroken spirit, and line workers returned to their posts as an act of patriotism. We are stronger than we give ourselves credit for, both personally and professionally.

NEW Lessons Learned Building on these commonalities, it’s important to consider “new” lessons learned. By incorporating strategies that may have been influenced by 9/11 but that are unique to COVID-19, we can be empowered to respond to the needs of any given moment. These include:  Utilize a tailored response. The terrorist attacks of 9/11 taught us that a “one size fits all” crisis response approach did not meet the needs of the wide range of impacted employees. For example, the

 Employee Assistance is an integral part of an effective business continuity plan. Too often business leaders may mistakenly think of EAP service as an add-on “feel good” benefit relegated to the HR department. Savvy leaders, however, understand that maintaining the well-being of their workforce is just as critical as ensuring supply chain integrity. For example, the success of the business depends on both. As an Executive from the Marsh Crisis Academy (a unit of Marsh McLennan Consulting Firm, which lost 295 employees in the attacks) shared with R3 Continuum at the time: “There is no business recovery without people who: • Are healthy enough to return to work and be productive; • Are assured enough of their safety to not feel afraid to return to work; • Have had their trust in the leadership established so that they desire to return to work; and

KGA Work-life Services Because when it comes to work-life, experience matters most. Ask us how we can help enhance your EAP with KGA’s work-life fulfillment services. 800.648.9557

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coverstory choice of the World Trade Center (a symbol of financial strength) was clearly intended as a threat to those working in the financial sector – they felt like direct targets, and fear was a dominant emotion. The First Responders working at Ground Zero assigned a different meaning to their efforts, staying focused on rescue/recovery of civilians and coworkers alike – exhaustion and grief were most commonly expressed. Different groups needed different things at different times, and no two experiences were exactly alike. The current pandemic has only punctuated this truth, as outbreaks have come in waves and impacted different populations and professions in widely disparate ways. From healthcare workers to food distribution employees to elementary education teachers and beyond, each has experienced COVID-19 through a unique lens. Issues around diversity, equity, and inclusion only further highlight the imperative to have the right person deliver the right response at the right time. At R3 Continuum, we have found that speaking a word of calm into the midst of chaos has never required more skill, compassion, and sensitivity.

 Encourage adaptive capacity. Unlike 9/11, COVID 19 has not been defined by a date or time; the protracted and ongoing crisis is unlike any other we have faced in our lifetimes. Adjusting our personal and professional lives has been a long period of trial-anderror requiring flexibility, creativity, and an abundance of grace. As such, the capacity of employers and employees alike to adapt to a fluid and frequently changing landscape has been nothing short of miraculous. Labor productivity, while clearly dependent on a wide range of factors, is certainly one indicator to loosely gauge the adaptive capacity of the US workforce; that is, being able to adapt to a changed work environment, stay at work and be productive at work. A recent US Bureau of Labor Statistics report indicated that the second quarter of 2021 is the fourth consecutive quarter with increases in both output and hours worked, following historic declines in those measures in the second quarter of 2020. Over those four quarters, nonfarm business sector (i.e., About 80% of US workforce, including manufacturing, service, retail, etc.) output increased 15.8 percent and the index is now 1.2 percent above the level seen in the fourth quarter of 2019, the last quarter not affected by the COVID-19 pandemic. (https://www. While there have undoubtably been stumbles, where we are now is a far cry from where we were in early 2020 and this expression of functional resilience on behalf of US workers is worth acknowledging.  Incorporate lived experiences. The events of 9/11 and COVID-19 are seminal moments, tragic milestones that will forever mark reference points in the story of our lives (“Was that pre-COVID, or post?”). But the events themselves are only the beginning – the way we responded is much more compelling and reflective of our personal agency. How we endured, what we let go of, and where we grew are lived experiences that hold tremendous value. In older days this might have been called “wisdom” and can offer guidance to both individuals and organizations. As one small example, I recall being at Union Square in NYC in the days after 9/11. It had become a central gathering location for those seeking information about missing loved ones, as well as a place for communal comfort. Among the thousand heartbreaking signs posted on the fence asking, “Have you seen (my father, mother, sibling, etc.) …?”, one sign caught my attention – a 14

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Summary At its core, every crisis is intensely personal and unique, both in its the context and its impact to each worker and each workplace. But due to their size, scale, and scope certain events – like 9/11 or the pandemic – have the capacity to remind us of our shared humanity. Few of us were untouched by these events, none of us were unmoved by these tragedies. And, as EA professionals, we are in a position to ensure that no employee has to walk these journeys alone, and to remind them that “hope is alive.” (See picture at left.) v Jeff Gorter, MSW, LCSW, is VP of Crisis Response Services at R3 Continuum. Mr. Gorter brings more than 30 years of clinical experience including consultation and extensive on-site critical incident response to businesses and communities. He has responded directly to the Sept. 11 terrorist attacks, Hurricane Katrina, the Deepwater Horizon Oil spill, the earthquake/tsunami in Japan, the Newtown Tragedy, the Orlando Pulse Nightclub Shooting, the Las Vegas Shooting, and the breach of the US Capitol. He may be reached at

sheet of cardboard brightly painted with the words “Hope is Alive”. This simple declaration of resilience, in the midst of unthinkable pain, had a profound impact on me. This moment of lived experience buoyed me up at the time, and I have recalled it often when I have responded to other mass events, including COVID-19.

lettertoeditor COVID-19: Changing the Face of EAP COVID-19 has changed the way we run our EAP. We made many changes in the face of the pandemic to protect the health of our staff and to pivot to serve the changing needs of our customers and clients. Many of those are still in place and we continue to evaluate what is working well and what we can improve in our efforts to enhance the well-being of both leaders and employees. We have created new programs, added services, formed new partnerships, altered processes, and found new ways to connect to those we serve. We have also changed many of the ways our staff work and collaborate. I got to see, in a new way, the depths of the caring that our staff have for our customers and clients. They pulled together to become more creative in terms of helping both employees and leaders to make it through 2020. It was remarkable to witness their grit and ability to manage their personal life challenges and at the same time showing up to provide beautiful, tender care and resources to those in need.

There wasn’t a week that went by where I didn’t hear a story that made me feel proud to be part of this team and part of this profession. As the COVID-19 crisis continues to evolve and as the challenges to organizations and individuals expand into new frontiers, our staff continue to be creative in looking at how to encourage and support leaders and employees toward mental well-being. Going forward, we are seeing an unprecedented opportunity to help both employees and leaders with their wellbeing. Employers are more open to funding support and employees and leaders are more open to accessing help. This is what we are here to do, and it is exciting. The challenge comes in balancing the external facing creativity and care we are providing with care of our own leaders and staff. First Sun will be focused on creative ways to foster our own support systems and incorporate well-being initiatives. Maria Lund, President, COO First Sun EAP 15

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legallines Changes in Workplace Safety – Part II | By Robin Sheridan


s noted in part one of this series, the past year has changed the workplace in many ways, not the least of which is the attention to worker safety. Legal Lines picks up where we left off in the third quarter issue by continuing the discussion on OSHA, the WVPA, and more.

to file a whistleblower complaint if they experience retaliation for providing assistance to OSHA during an inspection, file a safety and health complaint with OSHA, report a work-related injury or illness, or complain about [COVID-19] exposure or any other workplace hazards to management…”

Retaliation In addition to the activities described in Part I, OSHA has stated that it will establish “an added focus to ensure that workers are protected from retaliation.” During inspections, the agency’s compliance safety and health officers “will inform workers of their right

Additional Accountability for Employers A mandatory vaccination policy requires the consideration of employees’ need for accommodation based upon religious and/or disability. Such a policy now also requires consideration of the impact on the employer’s OSHA log. In the April 20, 2021, update to its COVID-19 FAQs, OSHA said that adverse reactions to the COVID-19 vaccine are generally recordable as work-related illness (for purposes of OSHA) when the employer has mandated vaccination. However, OSHA further explained, that if receipt of the vaccine is not truly and absolutely voluntary, it is considered mandatory for OSHA purposes and the absence must be recorded as work-related:

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“… an employee’s choice to accept or reject the vaccine cannot affect their performance rating or professional advancement. An employee who chooses not to receive the vaccine cannot suffer any repercussions from this choice. If employees are not free to choose whether or not to receive the vaccine without fearing adverse action, then the vaccine is not merely ‘recommended’ …”

Email Blast! Each issue of the JEA is released to members via an email that includes space to advertise your EAP!

Employees should, therefore, be encouraged to report absences related to the COVID-19 vaccine to their employer. Required recording of vaccinationrelated absences will make employers more aware of the impact of their policy and further emphasizes the careful consideration needed before taking adverse action against an employee for refusing to vaccinate.

Contact Boyd Scoggins, Development Manager: (303) 242-2046,

Protection from Violence The Workplace Violence Prevention for Health 16

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Care and Social Service Workers Act (“WVPA”) currently under consideration by Congress, would direct OSHA to issue a standard requiring employers in the health care and social services industries to develop and implement workplace violence prevention plans to protect nurses, physicians, social workers, emergency responders and others. According to the bill’s sponsor, Rep. Joe Courtney (D-CT), there is more on-the-job violence in health care than any other sector in the American economy and the rates are on the rise. There were 13.6 nonfatal injuries inflicted by other individuals for every 10,000 full-time workers across the private healthcare and social assistance industry in 2019, according to data from the Bureau of Labor Statistics. The average for all industries was 2.9 incidents in 2019. Yet there are no federal requirements, and only 10 states have laws or regulations that include workplace violence prevention requirements in the health-care sector, according to the committee report.

violent incident. The measure couldn’t be construed to limit or prevent healthcare and social service workers from reporting violent incidents to law enforcement.  Facilities that don’t comply could be subject to civil penalties. Covered facilities are proposed to include hospitals, residential treatment facilities, corrections/ detention facilities, community care settings, psychiatric treatment facilities, drug abuse and substance use disorder treatment centers and freestanding emergency centers. Expressly excluded from coverage is the office of a physician, dentist, podiatrist or any other health practitioner that is not physically located within a covered facility. The standard also would cover field work settings, such as home-based hospice and social work, as well as emergency and transport services. It would not include child day care services. Directly hired, contracted, subcontracted, and temporary employees who work at the above settings or perform those services are the intended beneficiaries, but employees privately hired by individuals to perform health services in their residence would be excluded. It appears, therefore, that EA professionals would not be protected by the WVPA as it is currently drafted. Comments and concerns about this exclusion should be directed to state legislators.

If passed, employers would be required to implement a workplace violence prevention plan for covered employees within six months:  Each workplace plan would have to be developed with meaningful participation of employees and address specific conditions at a covered facility. Plans would include procedures for: • Identifying environmental and patient-specific risks to employees. • Implementing engineering or work practice controls to address hazards, such as security systems, weapon detectors, entry procedures, and adequate exit routes. • Reporting, responding to, and investigating incidents. • Training employees on workplace violence and coordinating with other employers who have employees at the facility.

State Initiatives Many states (and some localities) have enacted, and continue to enact, paid sick leave, laws prohibiting discrimination based upon vaccination status and other employee-safety related rules, regulations and/or ordinances. Employers in California have several new initiatives to address, including:  A requirement that they provide notice to all employees in the event of a COVID-19 exposure in the workplace, which must include information of any benefits to which they are entitled, including workers’ compensation, leave or paid sick time, and including the disinfection and safety plans to address the outbreak. The law also provides the state Division of Occupational Safety and Health authority to shut down a workplace in the event of an outbreak or violation of safety rules.  An employer with five or more employees is now required to provide eligible employees up to 12 workweeks of unpaid but protected leave during a 12-month period to bond or care for family and for qualifying

 Employers would have to conduct a timely investigation of each violent incident and document the findings and corrective measures taken. They also would have to provide annual training to employees and additional training for supervisors to recognize high-risk situations.  An employer would have to retain records related to its plan, violent incident logs, and investigations for at least five years.  Employers would be prohibited from discriminating or retaliating against an employee for reporting a

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featurearticle Utilizing ‘Soft Touch’ Engagement Techniques for EAPs | By Daniel Hughes, PhD, CEAP; Acanthus Fairley, LCSW; & Barbara Leese, LCSW, SAP


uring the COVID pandemic many EAPs developed novel approaches to service delivery. Most programs migrated from face-toface counseling models to virtual platforms. The Mount Sinai Health System’s EAP developed new employee engagement strategies based on existing sampling methodologies. This flexible approach, referred to as “Cluster Ball” was deployed to reach distressed front line health care workers (HCW) such as ICU staff, physicians, nurses, nurse practitioners, physician assistants, therapists, EMTs and others during the pandemic (Hughes & Fairley 2020). The goal of this article is to discuss how the “Cluster Ball” strategy has been adapted with “soft-touch” techniques to address workplace violence (WPV).

the principles of Psychological First Aid (PFA). This process depends on organizational support, existing workplace relationships, and workplace integration. The approach is broadly normalized within the context of the crisis (SAMSHA, 2010). The strategy can be used effectively by internal, external, or hybrid practitioners with onsite capacity. The Soft Touch Process As the pandemic waned in NYC, the EAP shifted its focus to the traumatic impact of Workplace Violence (WPV) on healthcare workers. The National Institute for Occupational Safety and Health (NIOSH) defines workplace violence as “violent acts (including physical assaults and threats of assaults) directed toward persons at work or on duty” (OSHA, 2016). OSHA goes on to state that health care and social service employees experience the highest levels of WPV in the civilian workforce. (This stems primarily from violent behavior of their patients, clients, and/ or residents). As a result, we had learned during the pandemic that our employees appreciated active EA engagement during periods of high stress. Consequently, we adapted the PFA approach to support engagement elsewhere. Logically, the ClusterBall techniques previously developed in our emergency rooms ICUs and respiratory care units were transferred to employees who had experienced WPV. We discovered that PFA in the hands of skilled counselors was an effective engagement and mitigation tool. The “Soft Touch” protocol involves the identification of distressed employees/work groups, EAP initiated outreach employing PFA techniques, the elicitation of an event narrative, and assessment/referral for care as needed. Operationally, the EAP is alerted through the organization’s existing health and safety mechanisms. These include daily Employee Health Service, Security and Risk Management reports.

What is a ‘Cluster Ball’? “Cluster Ball” is an active engagement strategy that locates identified areas of employee and organizational need known as clusters. Subsequently, it relies on supervisors, peers, and others to identify distressed employees or work groups for EA outreach (snowball). It is based on cluster and snowball sampling methodologies and is aligned with the core technologies of individual assessment and organizational consultation (Bloom & Roman, 1985). The approach evolved during the pandemic as leaders turned to the EAP for critical incident consultation and support. It was established by our mental health leadership team, which promoted the service to front line supervisors (Hughes and Fairley 2020). Organizational integration facilitates a “boots on the ground” rapid response intervention. It is an active approach that does not depend on websites, call centers or self-referral. Rather, it requires excellent communication skills and knowledge of the organizational culture. Once the employee/work group is identified as distressed, the EAP counselor initiates contact employing 18

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Soft Touch and the WPV Dashboard These data sources are filtered to create a Workplace Violence dashboard, which provides the EAP with real time information on WPV events. The dashboard collects WPV information throughout the organization that includes time, location, participants involved, severity, incident type (OSHA), and a brief textual description of the event. The EA counselors use this information to initiate the intervention. Managers and supervisors are asked to provide background and contact information. Upon contact, the EA professional self-identifies and acknowledges the WPV incident as a disruptive event (Hughes, 2020). The process begins with a simple and gentle checkin – hence the term “soft touch.” The counselor begins with several simple questions including, How are you? Are you currently safe? Do you need anything? Can we help? Further discussion is voluntary, and some employees decline. If the employee chooses further engagement, they are asked to share the event in their own words. This story forms the basis of a therapeutic narrative. Safety and well-being are prioritized. Follow-up services are offered but are optional. This subtle approach reflects an excellent example of trauma-informed counseling (SAMSHA, 2014). To illustrate we offer several case examples.

The counselor ended the session by asking the employee how he would like to proceed including options for follow-up if desired. This option was offered once post-event stability was achieved. The employee stated that he felt cared for knowing the EAP was there if needed. He returned to duty stating he felt fine and would call if any concerns arose in the future.  An employee did a routine check in on a patient and was assaulted resulting in head trauma. She was concussed and emotionally traumatized. The EAP was contacted by employee health services (EHS) in order to assist the employee.

The counselor began with a “soft touch” approach, inquiring how the employee was doing. The employee reported persistent post-concussion symptoms that required a short-term disability leave. She stated that she felt shame and guilt for not “knowing better” and “letting her guard down.” The counselor reframed the incident helping the employee to see how she had performed professionally.

Case Examples:  After a 12-hour shift a HCW went into the patient’s room for a routine check. As the employee approached the bedside the patient punched him in the face. As trained, the employee made a virtual report of the incident that was forwarded to EAP.

The EAP counselor contacted the employee to offer support. During the call, the employee openly described what happened and the feelings evoked by the incident. The employee described feeling shame, guilt, anger, and frustration. The employee stated he would feel better once he returned to work. The counselor worked with the employee to explore his coping mechanisms, his ability to look for a solution to his fear, and helped him to reframe the event. In the latter case, the counselor helped the employee see those things he did correctly while avoiding negative ruminations. 19 | W W W . E A PA S S N . O R G | •• • • • • • • • • • • • • • • • • • • • | JOURNAL OF EMPLOYEE ASSISTANCE | 4th Quarter 2021 |

featurearticle At the end of the first encounter, the employee reported feeling relieved after reviewing the event. The counselor suggested several follow-up contacts to further explore the incident and its impact. The HCW was supported during her leave of absence and assisted throughout the return-to-work process. Lastly, the EAP counselor suggested a referral for long-term counseling. The HCW was appreciative and open to this suggestion.

described the incident. She reported she had never been spoken to so disrespectfully and threatened on the job. She also expressed feelings of fear, sadness, and anger as well as sleep disturbance and exhaustion. As a result, she planned a short-term leave of absence. Self-care was stressed during this time and practical safety precautions were offered. The employee was asked if she would like the EAP counselor to check in after a week to see how she was doing. The employee immediately responded with gratitude and affirmed that a follow-up would be helpful to address any underlying trauma. At this time, the employee required assistance advocating for herself and understanding the procedure to return to work. It was determined that the employee would benefit from several more sessions to better process the event.

 A HCW in her third trimester of pregnancy was admitting a patient. Without provocation or warning, the patient became agitated and punched her multiple times in her abdomen. Initially, she continued to work but stopped to process her strong emotions. The EAP counselor was contacted by a member of senior management for assistance. The event was also listed on the Workplace Violence dashboard. The counselor decided to engage the Soft Touch protocol.

The Importance Rapid Response As stated, the soft touch protocol depends on the “real time” identification of impacted employees. The EA response is triggered by WPV dashboard reports and administrative referrals. Employees seem to feel most comfortable with discrete cell phone contact. Counselors are deployed quickly. Prompt response (0-48 hours) supports both engagement and reasonability. This approach has been appreciated by staff and management alike. Despite initial reservations by the EA staff, employees seem to experience the approach as being non-intrusive. Of course, they are free to decline service if desired. Typically, employees appreciate expressions of organizational support in the wake of a WPV incident.

A rapid response ensued. The EAP counselor placed a call to the employee employing PFA techniques. The employee was asked, “How are you doing?” and “How can I be of help?”. The employee had never been involved in any physical altercation and was shocked that the patient would assault a pregnant woman. The counselor and employee explored how to manage this stress, moral injury, and shock. More specifically, the employee and counselor investigated ways in which she could physically protect herself and discuss the event with her supervisor. The employee asked for a follow-up contact for additional support and resilience building. The next contact revealed this employee to be very resilient. She was grateful for EAP support, as she continued to process the event. The employee is currently out on maternity leave after safely delivering her baby. The EAP will follow up with her upon her return.

Reasonable Response The unsolicited nature of EAP outreach requires “reasonability”, which means the contact should make sense to the employee. It is not a “robocall.” The approach should be warm, rapid, and normalized within the organizational culture. The reasonability of active engagement was established during the COVID-19 pandemic. The shift to WPV is a logical progression and modifying the program’s engagement techniques is perceived as “reasonable.” Conceptually, “soft touch” embraces the tenets of trauma-informed counseling and reflects a form of organizational “Post Traumatic Learning” (Albott et. al., 2020). Importantly, the usual EA understandings around privacy and confidentiality are strictly maintained.

 While screening a visitor in the lobby of the hospital, a HCW was verbally abused by a visitor with “racial and gender discriminating provocative” remarks. The visitor took the employee’s photo and threatened to assault her outside the hospital after her shift. The EAP was contacted by senior leadership for supportive follow-up.

The counselor contacted the employee and asked how she was doing. The employee was tearful as she 20

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Discussion/Summary The COVID-19 pandemic has transformed the nature of EAP service. Not since the 9/11 attacks have EAPs so thoroughly re-evaluated their service packages. The current crisis has generated many opportunities for innovation. It has created time for learning and growth. Clearly, persistent exposure to stress can lead to employee disengagement, burnout, depression, and PTSD. The high incidence of WPV in health care has intensified the burden on an already stressed workforce. Potential remedies include the development of active engagement techniques such as the “soft touch protocol.” As noted, the “soft-touch” protocol is rooted in the principles of PFA and designed to promote safety, calm, connectedness, self-efficacy and assistance (SAMHSA 2010). It is both subtle and operationally therapeutic. Its goal is to facilitate resilience and the restoration of performance through an active rapidly deployed intervention. Timely and supportive outreach communicates organizational concern. As with Critical Incident Response (CIR), soft touch requires a level of organizational integration and on-site capacity. Employees are encouraged, but not pushed, to discuss the event in a safe, frequently virtual, space. A skilled EA practitioner can thoughtfully explore the event. Focused discussion gives the employee an opportunity to pivot and create a therapeutic narrative that supports healing and restoration. Negative ruminations should be reframed and clarified. Once engaged and stabilized WPV victims are offered follow-up services. These include further assessment, medical care, ongoing psychological support, and worker’s compensation services as needed. v


Albott, C.S., Wozniak, J.R., McGlinch, B.P., Wall, M.H., Gold, B.S. and Vinogradov, S. (2020). Battle buddies: Rapid deployment of a psychological resilience intervention for health care workers during the coronavirus disease 2019 pandemic. National Institutes of Health. Retrieved from https://www.ncbi.nlm.nih. gov/pmc/articles/PMC7199769/ Hughes, D. and Fairley, A. (2020). The COVID Chronicles, An employee assistance program’s observations and responses to the pandemic. Journal of Workplace Behavioral Health. December 1, 2020: Hughes, D. (2020). Threat Assessment Teams and EAPs. Journal of Employee Assistance, 50(2), 34-38. Occupational Health and Safety Administration. (2016, October). Guidelines for preventing workplace violence for healthcare and social service workers (No. 3). United States Department of Labor. Retrieved from publications/osha3148.pdf Roman, P. M. and T. C. Blum (1985). The core technology of employee assistance programs. ALMACAN: Association of Labor-Management Administrators and Consultants on Alcoholism Newsletter 15(3), 8-19. Substance Abuse and Mental Health Services Administration. (2010). Psychological first aid for first responders’ tips for emergency and disaster response workers. Retrieved from https:// Substance Abuse and Mental Health Services Administration. SAMHSA’s Concept of Trauma and Guidance for a TraumaInformed Approach. HHS Publication No. (SMA) 14-4884. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.

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

Contact Boyd Scoggins, Development Manager: (303) 242-2046,

Acanthus Fairley, LCSW, is an Employee Assistance Counselor at the Mount Sinai Health System’s EAP as well as an Eldercare Professional. Acanthus works to triage employee mental health and occupational health concerns while working to help stabilize the lives of caregivers. She can be reached at Barbara Leese is a Licensed Clinical Social Worker (LCSW) and Substance Abuse Professional (SAP). Her primary areas of expertise are occupational and educational stress and anxiety, workplace violence, depression, trauma, high-stress careers in healthcare, relationships, and eating issues.

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featurearticle EAP & University Collaboration Addresses Employee Depression

| By Kim Hauge, PHR, SHRM-CP, CWP and Bruce Sherman, MD, FCCP, FACOEM


ith growing evidence of the workforce health and productivity costs associated with depression – while recognizing that the current medical system focuses much more on physical illness – employers are expanding their efforts to address this important behavioral health priority. At Kent State University (KSU), members of the benefits team were concerned by data regarding employee mental health issues, and a review of online health risk assessment data indicated that risk for depression was significant. In fact, substantial costs were associated with depression-related treatment for employees and family members, with antidepressants one of the top 10 utilized prescription medications. Additionally, depression was cited as a recurring reason for family and medical leaves. These findings prompted KSU staff to prioritize depression-related issues by adopting a multi-year initiative beginning in 2013, which focused on improving the awareness and management of depression and related mental health conditions.

DC) and the Employers Health Coalition (Canton, OH). Right Direction provides a turnkey set of resources and expert guidance on workplace mental health, including how to launch a mental health campaign for employers. The Right Direction platform includes guidance documents for employers and EAPs as well as an array of related communications materials and other resources. The tools are downloadable, customizable, and focused on helping organizations raise awareness, reduce stigma, and facilitate help-seeking behaviors for mental health in the workplace. Purpose The goal of this article is to describe the collaboration process between KSU and their EAP, present some high-level results from the initiative, and provide insights gained from the experience, with the hope that readers may benefit from applying these “realworld” lessons learned in their daily work. Methodology Strategic planning with IMPACT began in 2013, approximately 6 months prior to implementation of the initiative. Collaboration involved joint development of a strategic and operational plan along with organizational metrics to assess program participation and outcomes measures. KSU had primary responsibility for program implementation, supplemented by EAP in-person support for awareness and educational offerings, as described in greater detail, below. IMPACT provided *de-identified EAP utilization data at baseline and on an ongoing basis to inform strategic planning and provide insight into the effect of program implementation. KSU along with Employers Health representatives shared responsibility for review of aggregated,

The Challenge in Getting Started Implementing an effective organization-wide depression awareness program is challenging, requiring a thoughtful and comprehensive approach that includes strategic planning, change management, program development, and establishment of measures of program effectiveness and success. For that reason, KSU sought assistance from the organization’s EAP, IMPACT Solutions (Beachwood, OH). The two organizations chose to implement Right Direction ( offerings as part of the planned mental health initiative. Right Direction is a free, online resource developed jointly by the American Psychiatric Association’s Center for Workplace Mental Health (Washington, 22

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de-identified medical and pharmacy claims as well as EAP utilization data. (*De-identified refers to data that has been stripped of identifiers that could link to an individual’s name. In essence, it’s an extra layer of confidentiality.)

KSU and their EAP partner to identify and prioritize focus on population-level work/life issues contributing to individuals presenting with mental health and stress/anxiety-related medical concerns. Development of implementation plan: This enhanced understanding allowed KSU and the EAP to refine communication efforts about mental health issues, support, early intervention and available resources through the EAP and other campus partners, which included the HR Employee Wellness Office, University Health Services, Be Well Solutions (a complimentary on-site or telephonic health coaching offering), Recreational Services, and KSU faculty experts. Collaborative educational programs by KSU and the EAP helped employees recognize symptoms and factors that may be affecting their mental health and connected them to free and confidential resources for intervention and treatment. In the course of strategic planning discussions, EAP staff described their experience with KSU personnel and family members reporting self-stigmatization and reluctance to seek help. Accordingly, destigmatizing mental health issues and help-seeking behaviors from the EAP were incorporated as an important part of communications efforts, and continue to be a central theme. To that end, available Right Direction content provided relevant and supportive communications, and was incorporated into the broader communications offerings as described below.

Development of process and outcomes measures: In this study, various methods of EAP use were selected as measures of employee engagement, including visits to the IMPACT Solutions website, calls to IMPACT by KSU employees and family, and participation in IMPACT Solutions-provided counseling. With variability among EAP utilization rates, it seemed most reasonable to use historical data (year

“For employers to be successful at promoting use of behavioral health services – whether via EAP or the health plan – collaboration is a critical component that can facilitate meaningful interaction and results. … Kent State’s partnership with IMPACT Solutions … resulted in increased use of EAP-provided behavioral health services.”

Promotion to employees: Communications and awareness initiatives jointly developed and implemented by KSU and EAP staff included the following components, as listed below. Both KSU and EAP staff felt that a multichannel communications initiative would be likely to engage a broader range of individuals. To summarize practices following program implementation, employee wellness information was shared every 7-10 days using multiple forms of media, including targeted emails, notifications on employer intranet, and weekly features in the digital faculty and staff newsletter. In addition, monthly postcard mailings were delivered to the homes of employees. Employee specific events were held periodically throughout the year (i.e. Fac/Staff Rec & Play Days, Open Enrollment & Wellness Fairs, health fairs, walk and talks, etc.)

prior to Right Direction implementation) as a baseline, and then address incremental changes in EAP use following roll-out of the communications campaign.  An early step in the planning process was to better understand existing EAP utilization patterns in an effort to identify opportunities to increase appropriate use. Review of aggregate EAP reports enabled KSU to gain more insight into who (faculty, staff, women, men, etc.) and for what reasons (i.e. family or marital stress, financial, legal, etc.) individuals were using EAP resources.  Next, KSU was able to integrate EAP utilization data with medical and pharmaceutical claims data in a de-identified database. These combined data allowed 23

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featurearticle vices, resources, and ongoing support for those recovering from behavioral health conditions. Through this process, the EAP became known as part of the health and wellbeing resources that are available to all Kent State employees and family members, rather than as a vaguely defined service to which employees have access.

 Customized communications. KSU displayed and distributed Right Direction materials, co-branded with IMPACT Solutions contact information. Materials included posters, wallet cards, coasters and newsletters. Focus areas for communication included increasing awareness of depression symptoms, with ways to seek help and support for co-workers who may be experiencing depression, as well as details regarding the EAP’s scope of services for managing depression.

Data analysis: Prior to data collection and analysis, KSU Board approval was attained to assure the protection of individual privacy and confidentiality. In order to evaluate program outcomes, employee health and well-being data from KSU before and after Right Direction program implementation were aggregated into a single research database. EAP utilization data obtained from IMPACT Solutions, along with medical claims data obtained from the employee health plans, were combined with employee demographic data from the employer’s human resources department, and de-identified using an encryption tool by a third-party vendor prior to analysis. This dataset was then used for the detailed analysis.

 Educational sessions. IMPACT Solutions provided 36 in-person education and training sessions across all Kent State campuses, reaching more than 400 managers and employees.  Ongoing communications. Monthly updates, wellness newsletter articles, posters, a dedicated mental health webpage, and monthly wellness emails featuring topics on depression, anxiety, building resiliency, stress management, financial wellness, gratitude, and other mental health-related topics were distributed. Communications continually featured Right Direction and IMPACT Solutions co-branding alongside KSU wellness initiatives, and were generally focused on depression, stress, and anxiety as well as clinical manifestations of these mental health conditions.

Results: Program outcomes were evaluated using baseline, pre-implementation data (January 2013-April 2014) for comparison purposes. Post-launch evaluation was completed for three sequential periods (from May 2014 through December 2017) and annualized to control for slight differences in the respective time periods. Key findings from the first-year post-launch KSU/Impact collaborative implementation of Right Direction included the following: • An increase in the proportion of individuals selfreferring to the EAP with behavioral health as their primary concern; 15% at baseline, increasing to 17% at the first 6 months following launch, and to 24% at one-year post-launch. • A 10% increase in traffic to the EAP website for searches relating to behavioral health concerns, with a nearly 4-fold increase in visits to the EAP website for all services. • An increase in the proportion of EAP use driven by employee and family member outreach in comparison to mandatory organizational referrals. • A one-year increase in overall EAP utilization rate from 13% to 15%, with a subsequent annual increase to nearly 34%.

 Employee events. During its first launch year in 2014, Right Direction and IMPACT resources were distributed at 10 benefits enrollment fairs serving more than 800 employees, and at an employee appreciation event attended by 1,600 employees. In subsequent years, distribution was expanded to include other employee health and well-being events. Throughout the multi-year duration of this continuing effort, the EAP was actively involved in providing in-person information sessions alongside the human resource team provided to KSU supervisors, managers, faculty, and staff. Initial discussions focused on the prevalence of mental health concerns, particularly depression, providing education about perceptions of the person suffering from the condition and those engaging with that individual.

Most importantly, these sessions gave EAP personnel opportunities to familiarize themselves with employees and enhance their value to them by explaining the depth and breadth of their resources, and emphasizing how they can provide preventive ser24

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Discussion: For employers to be successful at promoting use of behavioral health services – whether via EAP or the health plan – collaboration is a critical component that can facilitate meaningful interaction and results. In this setting, Kent State’s partnership with IMPACT Solutions in the implementation of the Right Direction campaign and subsequent offerings, resulted in increased use of EAP-provided behavioral health services. It is likely that the initial increase in EAP use was a driver for the subsequent increases in use of broader EAP offerings. While the potential value of EAP services for employers may seem obvious, employers are often challenged to operationalize the process due to competing priorities – and often historical precedent. The willingness of IMPACT to engage in analytics, coupled with integration of Right Direction resources to address unmet employer needs, provided a basis for a compelling and successful multi-year collaboration.

basis of participation rates, rather than development of effective solutions to specific employer concerns. While this specific study focused on mental health and depression in particular, future collaboration between the KSU and IMPACT might focus on additional employee and family issues such as finances, elder care, and relationships. Further, the data suggest that as individuals better understand the value of their EAP, their willingness to use EAP services for other reasons is likely to increase. Use of data to inform planning: Outcomes measurement was central to evaluating implementation of the Right Direction communications campaign. Without detailed information, it would have been challenging at best to evaluate program effectiveness. EAP utilization rates, reasons for outreach to EAP and aggregate demographic (age, gender, job category) attributes of those using EAP services provided insights into opportunities to further improve EAP utilization rates. Partnership with IMPACT Solutions provided vital data to yield a clearer understanding of the impact of this initiative. The willingness of the EAP to share information – and importantly, to allow integration of utilization data with employee claims data – yielded a broader understanding of the data and has set the stage for future analyses to identify employee population subgroups that appear to be underutilizing the EAP as a resource. It is vital to ensure that confidentiality to individual data is maintained. EAP willingness to provide the aggregate reporting was helpful, as was use of a thirdparty vendor to de-identify and integrate eligibility, claims and EAP datasets. Organizations desiring to improve behavioral health services use are encouraged to use a systematic and data/metrics-driven approach to evaluate their efforts, to ensure that communications are effective at increasing awareness of available offerings, and that utilization of provided services increases appropriately in relation to communication efforts. Over the long term, a consistent, data-driven approach to evaluation can help to identify unmet population and sub-population health needs, while also providing evidence for program effectiveness. Identification of specific, population-level problem

Collaboration with EAP: General info: Employers have an opportunity to capitalize on the existing relationship they have with their EAPs, where trust built from longstanding relationships may be an important consideration to promote greater employee and family member acceptance of the offering. Many employers are exploring the use of digital solutions for behavioral health concerns, in part because of their ease of access and anonymity for users, but employee trust remains an important consideration. The overall approach: The Right Direction program represented a starting point for KSU and IMPACT Solutions to build a broad depression awareness and management initiative, targeting EAP capabilities as a source of support for affected employees and family members. The EAP’s willingness to put a face with the services supported the trust-building that was necessary to promote self-referral and continued outreach. No overall increase in medical claims was observed for depression-related concerns, suggesting that the use of EAP resulted in a high rate of symptom resolution without the need for medical care. Collaboration to this extent may well differ from the “traditional” EAP-employer vendor-client relationship, which is more narrowly focused on service delivery and reporting, with success defined on the

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featurearticle 9/11 – A Personal & Professional Recollection | By John Maynard, PhD


t 7 a.m. Tuesday morning, 9/11/2001, I was sitting in our dining room in Boulder, Colorado eating breakfast. My wife, Sue, was upstairs getting ready for work. Suddenly, she came downstairs, turned on the TV, and called me into the family room. Sue had heard on NPR that there had just been an explosion near the top of the North Tower of the World Trade Center. As we watched the initial coverage, we witnessed live video of a jetliner crashing into the South Tower. It almost immediately became clear that both explosions had been caused by planes flying into the towers, and that it must have been intentional.

the screen, it went black. United had cut all intranet access systemwide. That’s when she called us. Return to Work – A Changed Environment Danna returned to work on 9/22. Her first flight after returning was from JFK to LAX; it had virtually no passengers. Over time, people did gradually return to flying, but the experience had changed for both passengers and airline workers. Passengers, of course, began experiencing significantly more scrutiny and security checks. Access to airport gates was limited, as were items that could be carried aboard or in checked luggage.

A Father’s and Mother’s Fears – The Personal Side of 9/11 Instantly, Sue and I became alarmed on a very personal level. Our daughter, Danna, was a United Airlines flight attendant based in New York City. We had no idea if she was flying that morning or at home. Neither she nor we had cell phones back then, and when we called her home, we got no answer. Glued to the unfolding live coverage, I remained at home close to our phone. Sue went to work, where she found everyone also gathered around TVs. Finally, 2-3 long hours after our initial call to her, Danna called to say she was safe but shaken. She had returned home from a flight late the night before, slept in a little, and gone to the grocery store. When she got home, her phone was ringing. Close friend and fellow flight attendant, John Raulli was on the line. He said there had been a crash, and he thought it might be UA175, which both Danna and John had worked many times. He didn’t have access to a computer, so he asked her to log in to the United employee intranet to see who the crew was that morning. They knew most of them well; in fact, two of them had just become engaged the week before. As Danna was looking at

“While they performed admirably when they needed to, they paid a price in terms of their own secondary trauma. Thirty percent of them left their peer positions after 9/11.” Public and self-perception of flight attendants changed dramatically. No more were they simply servers in the sky; they saw themselves – and passengers saw them – as safety professionals and first responders in emergencies. They felt more supported and knew that they could count on passenger help if needed. At the same time, they felt more vulnerable. Most became more vigilant, more aware of their surroundings, both on the plane and in other public settings. Some felt, as Danna described it, that “the magic was gone.” Taken together, the higher-stakes environment created by greater awareness of both their safety responsibilities and their vulnerability increased 26

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flight attendant turnover for a time. But it also set the stage for a greater recognition of the value of mutual support and cooperation in times of crisis.

for educating flight attendants about trauma, developing, and distributing supportive literature to every AFA member, and studying the impact of 9/11 on overall flight attendant well-being. Even with all this inter-organizational cooperation, of course, the bulk of the responsibility to support affected flight attendants and their families fell to the AFA EAP’s own peer counselors. While they performed admirably when they needed to, they paid a price in terms of their own secondary trauma. Thirty percent of them left their peer positions after 9/11. Even today, the need for additional support for those on the front lines of helping others remains under-appreciated.

As EAP Director for the Association of Flight Attendants-CWA since 1999, Heather Healy relied heavily on this mutual support and cooperation as she mobilized EAP services in the wake of 9/11. The AFA EAP operates primarily through a system of about 250 trained peer EAP representatives, who together provide assessment, referral, and critical incident response services to 50,000 AFA members and their families at 20 airlines in five countries. When all domestic and international flights were shut down on 9/11, many AFA members were stranded away from home in both the US and overseas. Peer support for members and their families was crucial, as was mutual support among AFA’s counterpart organizations in other countries. When AFA EAP was unable to provide needed support to members stranded in other countries, peer programs in those countries provided in-person assistance; similarly, AFA EAP supported flight attendants from other countries when they were grounded in the US. Within the US, the AFA’s own peer support network was supplemented by additional support from the entire EAPA community, especially in the Washington DC area. SAMHSA stepped forward to provide grants

A Front-Line Experience – Helping the FBI Help Others Once I knew that Danna was safe, and we all began to recognize the scope of the terrible toll on life and our collective sense of personal safety, I, like many others wondered how I could contribute. Through the EAPA network, I learned that Peter Schweitzer, who was then providing assistance to the Port Authority of New York and New Jersey police department, was recruiting volunteers to assist other front-line responder organizations. I contacted Peter and asked how I could help.

I had been trained in the Critical Incident Stress Debriefing (CISD) process, which was, at that time, still the state-of-the-art trauma response. In addition, I had realworld experience, starting in the Army during the Vietnam War, where one of my “additional duties” as a young Lieutenant here in the States was acting as the Survivor Assistance Officer for families whose son or spouse had been killed in Vietnam. Later, in 1976, I had been part of our local Mental Health Center team to assist in the morgue and with victims’ families in the aftermath of the Big Thompson flash flood in Colorado, which killed 144 people and required the helicopter evacuation of 800 more the following morning. Yet, I still wondered whether I The FDNY Hook & Ladder No. 24 station erected a memorial for those who gave could really handle the challenge their lives on that ill-fated day in 2001. 27

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featurearticle when Peter said the FBI needed someone to help with their employees and other first-responders at and near Ground Zero. I told Peter I’d call him back. I thought to myself, “If not me, who?” The job needed to be done, I was trained, and I couldn’t not do it. I called Peter back to accept. I arrived in New York City in late September, about 2½ weeks after 9/11. Our core FBI assistance team consisted of two special agents, an FBI chaplain, and me as the mental health specialist. Occasionally, others participated, depending on the activity. Besides conducting in-office CISD sessions for FBI staff based at and near Ground Zero, we also spent

time making ourselves visible and available to workers at the unfortunately named Fresh Kills Landfill site, where much of the rubble from Ground Zero was being taken for careful searching to find human remains and personal effects. Finally, we tried to be out among on-site first responders near Ground Zero, offering informal support and opportunities to talk. Often, we just sat down next to first responders on a break and said nothing, waiting for them to speak if they wanted to. They usually did. Over those first few weeks and months after the attacks, hundreds of other EA professionals also put aside their other tasks and responded to the needs of people and organizations who were affected directly and indirectly, not only in New York, Washington, and Pennsylvania where the four planes went down, but in communities and countries around the world. For all of us it was painful work, but at the same time, it was healing and affirming to be able to contribute. The affirmation of the value of our contributions extended not only to us as individuals, but also to the EA profession. Within weeks of 9/11, articles about employee assistance programs appeared in dozens of print and online publications, including the Wall Street Journal, Fortune, and the Los Angeles Times. In my own column in the September/October 2001 issue of the EAP Association Exchange magazine, I noted, “Once again, EAPA and the employee assistance profession have been called upon to provide crucial services in a time of great upheaval. And once again, we have responded – and continue to respond. As individuals and as a profession, we have a right to be proud!” (Maynard, 2001)

Synopsis of the Ill-fated 9/11 Flights 1. American Airlines Flight 11: a Boeing 767 aircraft, departed Logan Airport at 7:59 a.m. en route to Los Angeles with a crew of 11 and 76 passengers, not including five hijackers. The hijackers flew the plane into the northern facade of the North Tower of the World Trade Center in New York City at 8:46 a.m. 2. United Airlines Flight 175: a Boeing 767 aircraft, departed Logan Airport at 8:14 a.m. en route to Los Angeles with a crew of nine and 51 passengers, not including five hijackers. The hijackers flew the plane into the southern facade of the South Tower of the World Trade Center in New York City at 9:03 a.m. 3. American Airlines Flight 77: a Boeing 757 aircraft, departed Washington Dulles International Airport at 8:20 a.m. en route to Los Angeles with a crew of six and 53 passengers, not including five hijackers. The hijackers flew the plane into the western facade of the Pentagon in Arlington County, Virginia, at 9:37 a.m. 4. United Airlines Flight 93: a Boeing 757 aircraft, departed Newark International Airport at 8:42 a.m. en route to San Francisco, with a crew of seven and 33 passengers, not including four hijackers. As passengers attempted to subdue the hijackers, the aircraft crashed into a field in Stonycreek Township near Shanksville, Pennsylvania, at 10:03 a.m. v

EAPA’s 2001 Conference – An Opportunity to Share and Reflect EAPA’s Annual Conference in 2001 was scheduled to be held October 28-31, just seven weeks after 9/11. Moreover, for the first (and still only) time ever, the conference was to be held outside the US – in Vancouver, BC. Many international flights were still shut down and many companies were still banning employee travel, especially internationally. Nevertheless, the EAPA Board felt strongly that the conference should go on as scheduled, both to demonstrate EAPA’s resilience and to provide an 28

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opportunity for EA professionals to come together as a community for mutual sharing and support. Although the number of attendees dropped significantly from previous years, those who were there found it a powerful and valuable experience. At the opening plenary session, then EAPA President, Linda Sturdivant, invited attendees “to say aloud the names of relatives, friends, and co-workers they had lost in the terrorist attacks.” She described herself as “overwhelmed to hear 25 or 30 names voiced, some in whispers, others John Maynard (far right) poses with unidentified FBI personnel at a landfill site, almost in shouts.” It was a where much of the rubble from Ground Zero was being taken for careful searchmoment, she said, that she will ing to uncover human remains and personal effects. always remember and treasure (Sturdivant, 2001). continue to maintain avenues to share experiences, I, too, will always remember and treasure the learn from each other, and provide mutual support great honor of being recognized at the conference as when needed. EAPA’s 2001 Member of the Year, in part for my service to the FBI and others in NYC in the aftermath Acknowledgements of 9/11. My sincere thanks to Heather Healy, EAP Director for the Association of Flight Attendants-CWA, and In Retrospect Peter Schweitzer, who provided and mobilized signifiFear is contagious. That is, after all, the whole cant EA support for law enforcement, other frontline point of terrorism, to instill contagious fear in us. workers, and airline employees in the New York City But calm, confidence, compassion, and even altruarea; for taking the time to talk with me as I was preism can be contagious, too. EA professionals were a paring this story. Thanks also to the hundreds of EA particularly powerful healing influence in the afterprofessionals and others who gave of themselves to math of 9/11 because they often were able to leverhelp all of us respond to the events of 9/11. v age the natural bonds that exist among peers and Dr. John Maynard served as CEO of EAPA from 2004 through co-workers to instill and reinforce those positive 2015. Prior to that, he was President of SPIRE Health attributes, while identifying those individuals who Consultants, Inc., a global consulting firm specializing in EA needed additional help. training, strategic planning, program design, and quality improveJust as individual worksites, with EA help, supment. In both roles, he had the opportunity to meet and exchange ideas with EA professionals in countries around the world. He ported their employees, so too did EAPA support its currently accepts consulting projects and speaking engagements own network of EA professionals. Through its conwhere he believes he can make a positive difference. He can be ferences, chapters, publications, and peer networks, reached at EAPA provided needed networking, information, and camaraderie to all of us. References Maynard, J. (2001). Pulling Together, EAP Association Exchange, 31(September/October), p.2.

The EA profession rose to the occasion after 9/11, just as it has done in so many other critical situations, large and small. We will continue to do so, if we also

Sturdivant, L. (2001). An Opportunity to Come Together, EAP Association Exchange, 31(November/December), p.4.

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specialreport Work Outcomes and EAP Use During the COVID-19 Pandemic | By Mark Attridge, PhD, MA, & Ivan Steenstra, PhD, MS


Zealand and 5% from 37 other countries. The gender mix of cases was 68% women and 32% men. Cases also ranged in age, with an average of 38 years. Most cases were self-referrals into the EAP (84%), with 10% being referred by a supervisor at work or 6% by family. The reason for seeking counseling from the EAP was most often for a mental health (28%) or personal stress (27%) problem. Another 22% used the EAP for help with a work problem or work-related stress. Marital or family issues accounted for 20% of cases. Support for alcohol and substance abuse was only 3% of cases using the EAP. The number of counseling sessions used ranged from 1 to 6 or more, with an average of 3.3 sessions per case. The period of EAP treatment averaged about 7 weeks.

he following are key findings from the forth© coming Workplace Outcome Suite (WOS) 2021 Annual Report by LifeWorks and endorsed by EAPA. For the full report, see the LifeWorks website: What is the WOS? Created in 2010, the WOS examines four key aspects of workplace functioning and overall life satisfaction. Originally 25 items, the brief 5-item version has one question per outcome area. It is a measure of longitudinal change that requires collecting self-report data at before and after the use of counseling services. The WOS is the only publicly available, free instrument that has been psychometrically validated and tested for use in employee assistance program (EAP) settings. It has been extensively studied in over 40 peer-review and applied research reports.

Employee Outcomes Improve After EAP Counseling The WOS scores were collected longitudinally at the first session and again at a follow-up about 45 days after the last session of counseling. The sample sizes for paired WOS data at both before and after EAP use ranged from 38,302 to 39,135, depending on the measure. The data from the earlier 25- and 9-item versions was adapted to match the more popular 5-item brief version of the WOS.

Industry-wide Profile of EAP Counseling Service Use The new annual report has data from 45,726 users of EAP counseling services over the span of 2010 to early 2021 from: • 27 external vendors; • 11 internal staff programs; and • 11 hybrid programs at specific employers. Not all of these EAPs provided data on each of the profile factors or WOS measures at both pre and post EAP use. This aggregate dataset offers a valuable profile of EAP counseling across a wide range of contexts. A range of industries are represented, with 28% of employees working in government, 16% in health care, 11% in colleges, 18% in manufacturing, 14% in technology, and 13% in other industries.

Work Absenteeism (hours missed from work during the past month due to a personal concern) was reduced from an average of 6.8 hours missed per employee before counseling to only 2.9 hours missed at follow-up. By comparison, other research shows the typical employee misses less than half a day of work a month. When defined as missing 4 or more hours of work as a “problem level” of this outcome, the percentage of all EAP cases with an absenteeism problem was reduced from 43% before to 15% of cases after counseling.

Most of the cases were living in the United States (77%), but 12% are from China, 6% from New 30

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Work Presenteeism (not being able to concentrate on work because of personal problems) was reduced from 56% of cases at a problem level before use to 30% at follow-up.

Although the usage rates increased during the pandemic, the effectiveness of EAP counseling remained strong when based on examining the profile of WOS outcomes. The pandemic period cases (n = 4,505) tended to have a very similar profile, in general, on the five WOS outcomes at Pre and Post use compared to cases in the year 2019 (n = 4,289). There were no differences on work engagement or life satisfaction and just slightly higher levels of workplace distress, work presenteeism, and work absenteeism in the pandemic year. However, these differences were all very small statistical effect sizes. Improvement on all WOS outcomes also occurred to a similar extent when comparing cases who used traditional in-person office visits and cases who used technology-based modalities to virtually access EAP counseling (telephone or internet video/text). v

Workplace Distress (dreading going into work) was reduced from 23% of cases at problem level before use to 15% at follow-up. Work Engagement (being eager to get to work the start the day) was improved from 31% of cases at problem level (lack of engagement) before use to 23% at follow-up. Life Satisfaction (feeling that life overall was going very well) was improved from 37% of cases at problem level (not being satisfied) before use to 16% at follow-up.

Dr. Mark Attridge is an independent research scholar as President of Attridge Consulting, Inc., based in Minneapolis. He can be reached at

The number of total WOS outcomes experienced at a problem level was reduced from 2.42 per person (out of five possible) when first seeking assistance to 1.07 problems after counseling. The simple conclusion is that brief counseling from EAPs improved multiple aspects of work functioning. All five WOS outcomes showed statistically significant results, although there were different degrees of impact and improvement. Of the five measures, work presenteeism is the most defining outcome for EAP users, in terms of both severity of initial adverse impact before use and the extent of improvement after use. Also important was that the extent of improvement on all WOS measures was generally consistent across different countries, EAP delivery models, client demographics, and other clinical factors.

Dr. Ivan Steenstra is the Director Research & Analytics at LifeWorks. He is a human movement scientist and epidemiologist with a PhD in Public and Occupational Health. He has over 40 peer reviewed and indexed publications and presented his work at numerous peer reviewed conferences. He is based in Toronto and can be reached at

Maximize exposure of your EAP! Advertise in

COVID-19 Pandemic and WOS Other data from a survey study of industry trends (N = 110 vendors, internal programs, purchasers) found a higher utilization rate for counseling during the recent pandemic period than in the prior year: 10.6 vs. 7.5 EAP cases per every 100 covered employees, respectively. There also an increase in the average number of sessions of counseling per case: 5.5 during the pandemic vs. 4.0 in the year before. About half of EAPs also reported increases since the pandemic in the use of work/life kinds of services and increases in workplace/organizational services too. 31

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featurearticle History of EAPs in the United States – Part III | By Dale Masi, PhD Editor’s note: The following is an excerpt from the book, The History of Employee Assistance Programs in the United States. For a complete paperback version check out For a .pdf version, see Portals/11/Docs/EAP%20History/The_History_of_ EAPs_in_the_US.pdf. The first two excerpts appeared in the fourth quarter 2020 and third quarter 2021 JEAs. This article picks up from there with more on Occupational Program Consultants (OPCs), and NIAAA funding.

substantial independent documentation of their recovery from alcoholism. The rationale for establishing a confidential pilotcentered program included the lack of a traditional on-the-job supervisory program, and a belief that a pilot’s ability to function effectively was best observed by fellow pilots. Accordingly, given the safety-sensitive nature of a pilot’s responsibilities, a peer identification and referral system were developed for the HIMS program.


By the close of the initial NIAAA-funded demonstration phase, most major U.S. airlines had endorsed the model, and had HIMS trained management and union personnel on their property. The 800 participating pilots had achieved an 85 percent long-term abstinence rate. In 1992, the FAA began funding ALPA to administer and provide training for the HIMS. The programs’ continued success is a result of a cooperative and mutually supportive relationship between pilots, airline management, and the FAA’s Office of Aviation Medicine. Since its inception, over 4,500 professional pilots have been successfully rehabilitated and returned to their careers (Cuddihy, 2014; ALPA, 2016). Another category of funding by NIAAA was an award in the early 1970s for a singular training grant to Dr. Masi. As a professor at Boston College’s School of Social Work Community Organization and Planning Program, she recalls her first experience learning how the occupational alcoholism concept was impacting the workplace

he Occupational Program Consultants (OPCs) were not in a position to conduct systematic research about their work, therefore, additional demonstration research projects were established through funding from NIAAA (Masi, 1982; Roman, 1981a). These included a number of projects designed to service smaller employment settings in locations such as Reading, PA and Lincoln, NE, a faculty and staff assistance program at the University of Missouri, the 10 Cities Project with NCA to implement jointly administered labor- management programs in ten significantly unionized cities (Blum, 1988). NIAAA grants were also forthcoming to support additional OPCs in states where activities and service demands had grown rapidly. Examples of these expansion grant states were New York, Florida, South Carolina, New Hampshire and Michigan. Beginning in 1974, the Air Line Pilots Association (ALPA) received an NIAAA grant to fund the Human Intervention Motivation Study (HIMS). HIMS is a peer recovery program for dealing with alcoholism and recovery among commercial airline pilots. Building on cooperation from the federal Aeronautics Administration which altered its long-standing rules to allow continued licensing of pilots who could provide

I went to an all-day conference at Harvard University on Occupational Alcoholism. It really ignited me. I knew that something exciting was happening. At that time, most of the speakers were recovering from alcoholism. They were eloquent, and it was clear to me that in the future, then dug a little more 32

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Manual outlining requirements for federal agency employee alcoholism programs. The recommended program model mirrored that developing among the NIAAA planners, namely that employees with alcohol problems, would be identified by patterns of deteriorating performance or conduct and not by focusing on the signs and symptoms of alcoholism (Phillips, 2003).

into the field of Occupational Alcoholism and realized that the National Institute of Alcohol Abuse and Alcoholism was just starting to do a great deal in this area. I contacted them and said, ‘I’m in a school of social work chairing the Master’s in Social Planning. I think that there might be something here for our graduate students.’ I applied for a training grant from NIAAA to train master’s students in Occupational Alcoholism. I set up five different centers using my social planning students to manage each program, with two clinical students and one social planning student performing in each area. These five centers became quite successful, and we ended up having lots of clients. I learned the importance of staffing the programs with trained workers.” (Dale Masi EARF History Project interview:

Research studies on workplace alcoholism programs, which had begun during the 1950s and 1960s through the support of the Smithers Foundation, NCA and the Yale Center for Alcohol Studies, increased in the early 1970s with NIAAA support and continued to grow up until the early 1990s. Researchers supported by this funding initially included Harrison Trice and Paul Roman, each of whom was funded in 1972 for research on the diffusion and implementation of the federal employee policy described earlier. They both later focused on studies of program implementation in New York State and throughout the U.S. Soon, other NIAAA funded researchers in Michigan (Andrea Foote and Jack Erfurt) produced insights into the integration of these programs into other human resources and employee health initiatives.

The Boston College Occupational Alcoholism and Drug Training Program was the sole NIAAA-funded training effort that would go on to produce social work graduate students in occupational alcoholism and employee assistance programming. At its full development, this program provided a full range of services to 51 companies in 5 locations. Under faculty supervision, students engaged in policy development, organizing of advisory committees, employee education and supervisory training, creation of information and referral services, employee counseling for declining job performance, alcoholism, drug addiction, mental health and emotional concerns, periodic reporting and other administrative functions. Additional funding for the program came from Boston College as well as participant companies including Polaroid Corporation, New England Telephone, Hanscom Air Force Base, the Taunton and Brockton Chambers of Commerce, and the John F. Kennedy Federal Center (Masi, 1979; Maiden, 2003).

Further studies include Norman Kurtz and Bradley Googins who initiated a stream of new research building on older studies by Trice related to the behavior of supervisors relative to alcoholic and other problem employees. Walter Reichman teamed with Marguerite Levy on studies of the identification of employed women with drinking problems. Janice Beyer and Terry Blum, both business school-based organizational research specialists, joined Trice and Roman respectively in broadening both the focus and depth of diffusion and implementation in varying workplaces, as well as adding in- depth data collection on women employees. Later additions to this cohort of NIAAA supported researchers in the 1980s included Diana Chapman Walsh and Douglas Parker. v

Another milestone was the inception of occupational programming for federal civilian non-security employees. The 1970 Hughes Act, which established NIAAA, also mandated appropriate prevention, treatment, and rehabilitation programs and services for alcoholism and alcohol abuse among federal employees. In 1971, the U.S. Civil Service Commission (CSC) issued a directive to the Federal Personnel

Dale A. Masi, PhD, CEAP is Professor Emeritus of the University of Maryland (UMD), and president and CEO of MASI Research Consultants, Inc. Dr. Masi is a recipient of the Employee Professional Association (EAPA) Lifetime Achievement Award, a Fulbright scholar, and author of 15 books and 70 articles. She may be reached at

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EAPA Names New CEO

developing a health care workforce capable of meeting the critical needs of underserved populations,” said Acting HRSA Administrator Diana Espinosa.

The Employee Assistance Professionals Association (EAPA) has announced that Julie FabsikSwarts, MS, CFRE, CAP, has been named CEO, effective September 15, 2021. As CEO, Ms. Fabsik-Swarts will be charged with growing the EAPA membership and revenue base, increasing member services, expanding professional development opportunities, and advocating for the Employee Assistance role in helping drive positive workplace outcomes. Ms. Fabsik-Swarts has over 35 years of executive experience leading several prominent non-profit associations and brings a proven track record in growing organizations, building teams, implementing growth strategies, expanding member services, and other accomplishments. “Julie is the right leader for EAPA at a time when the EAP industry is rapidly evolving to meet the needs of the ever-changing business landscape,” said Kristin Rantala, EAPA President. Greg DeLapp, who is retiring in October 2021, concurred she “is the right person at the right time for EAPA.” “I look forward to working with the outstanding volunteers and the excellent staff of this organization in moving the association to the next level,” said Ms. Fabsik-Swarts.

Questions to Ask about Return-to-Work Policies For employees and employers eager to leave remote work behind and reclaim a sense of normalcy that has gone missing in their professional lives, September 2021 has long been the light at the end of the tunnel. Now, the Delta variant threatens to delay even that return. To be clear, there is no one-size-fits-all approach. Each company is different with a unique talent base and distinctive value. Edelman’s Brian Roy and Elizabeth Swiker shared some parameters that can help frame the issue with Human Resource Executive.  Masks, vaccines or both? While Tyson Foods and Microsoft are among the latest to require vaccinations, the three major U.S. automakers are returning to a mask mandate in factories rather than issuing a vaccination mandate prior to full FDA authorization. Some are requiring that employees both be vaccinated for on-site work and mask while on-site. Decisions should reflect the input of employees and the guidance of state, local and industry leaders. Remember there are options: u Mandate example: An employee cannot stay on the job without wearing a mask and/or being vaccinated. It is a condition of employment. u Conditional requirement example: All on-site employees must be vaccinated. But if an employee is not vaccinated, they may stay on the job if they get tested regularly or work entirely from home.  Will you use carrots or sticks? Encouraging and requiring are two different things, but in most cases, companies will need to do both. Firms need to strike the right balance between incentivizing vaccinations with positive reinforcement (e.g., an extra day off, cash payments), negative reinforcement (e.g., restricting attendance for in-person events or at the job site, reserving the night shift for non-vaccinated), and diligence around the health of workers once the policy is set. Learn more at

HHS $103 Million Rescue Plan to Address Burnout The U.S. Department of Health and Human Services (HHS) recently announced the availability of an estimated $103 million in American Rescue Plan funding over a three-year period to reduce burnout and promote mental health among the health workforce. These investments, which take into particular consideration the needs of rural and medically underserved communities, will help health care organizations establish a culture of wellness among the health and public safety workforce and will support training efforts that build resiliency for those at the beginning of their health careers. “This funding will help advance HRSA’s mission of

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areas can be identified, corrective plans developed and then monitored for their effectiveness at addressing the identified issue. While some of these metrics may not necessarily demonstrate organizational value or cost savings, they can be useful in providing directional insights. For example, increased behavioral health-related utilization rates for EAP may portend enhanced employee well-being, recognition of employer interest in workforce well-being, and employee retention. It can be helpful to ‘connect the dots’ to show the relationship over time of improved workforce well-being to favorable business outcomes.

employee and family member support. Collaboration with the EAP in data analysis can help to ensure that available EAP-linked initiatives are meaningfully addressing the needs of the entire KSU population. Alignment with organizational culture: To be successful, employer-EAP collaborative initiatives such as Right Direction must be mutually reinforced within the broader organizational culture. If not, such programs may not achieve the desired effect. Especially today, EAPs are in a unique position to help employers better understand unmet population health needs – and particularly members of historically underserved sub-populations, including lowwage workers, minorities, or specific employment categories, such as food or janitorial service workers. A proactive approach can help employers identify opportunities to support a broader range of employees, thereby enhancing a collective sense of well-being and fostering a healthy organizational culture.

Approach to communications: One of the important lessons learned was that early during implementation, the hope was that a single communication regarding the Right Direction offering would generate a meaningful increase in EAP utilization. As noted in the data, there was only a nominal increase in EAP use during the first six months following program implementation. In light of these results, a change in messaging, using multiple communications tactics and channels as previously described in an established frequency appeared to enhance effectiveness, as evidenced by data at the end of the first year after the initiative began. Importantly, the behavioral health program also appeared to generate more interest and utilization from employees when it was incorporated as a component of a broader well-being initiative that addressed physical health (diet, activity, weight management), financial well-being (budgeting, savings for retirement), emotional health (managing stress, resilience, mindfulness), and social health (building a better living space and community). One of the most critical factors for program effectiveness is the development of not only a robust communication plan but also regular messages with scheduled frequency. These messages included: weekly email wellness updates, postings on the Kent State intranet, and dissemination by internal “wellness ambassadors” or champions. In the future, KSU plans are to include race, ethnicity and gender data in analyses to ensure that the needs of all population subgroups are effectively met. With growing awareness of the extent of the racial, ethnic and cultural diversity of employees, one-size-fits-all approaches may risk contributing to disparities in

Summary In conclusion, the Kent State and EAP collaboration provided a basis to optimize use of each organization’s capabilities and strengths to improve awareness and reduce the stigma of depression and increase employee help-seeking as part of a broader, ongoing well-being initiative. This partnership – including strategy development, implementation and outcomes analysis – yielded clear and measurable evidence supporting the active role that EAPs can play in working toward targeted solutions for employer clients. v Bruce Sherman, MD, FCCP, FACOEM, is a medical director at Triad HealthCare Network/Cone Health in Greensboro, NC, where he provides clinical and strategic support for the employee health plan and broader organizational strategic planning. Dr. Sherman also serves as medical director for the North Carolina Business Group on Health, where he has ongoing research interests in the areas of equitable employer health benefits strategies, disparities in care, and the business value of investments in workforce health. He may be reached at Kimberly Hauge is Executive Director for Employee Benefits, Wellness and Health Promotion at Kent State University, which has 41,000 students enrolled in an eight-campus system, and more than 214,000 alumni worldwide. She has worked at Kent State for the past 20 years in benefits administration, communication and project management, and employee wellness and health promotion. Kim may be reached at

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exigency related to the covered active duty or call to covered active duty of an employee’s spouse, domestic partner, child or parent in the Armed Forces.

work to receive a COVID-19 vaccine. The ordinance also prohibits employers from requiring that a worker get a COVID-19 vaccine outside of work hours.

Illinois has also been busy addressing employee health and safety issues. The Employee Sick Leave Act was expanded to include personal care as of April 27, 2021. Leave for personal care now includes activities to ensure that the family member’s basic medical, hygiene, nutritional and safety needs are met, and to provide transportation to medical appointment, for a member who is unable to meet their own needs. Personal care also means being physically present to provision emotional support to a family member with a serious health condition who is receiving inpatient or home care. “Personal care” can also mean being physically present to provide emotional support to a family member with a serious health condition. On April 21, 2021, the Chicago City Council passed an ordinance prohibiting adverse action against all Chicago workers—including independent contractors—who take time off from

Summary EA professionals are urged to become familiar with the employment laws applicable to their clients, and their clients’ employers, to ensure a clear understanding of potential legal landmines, identify risks, understand what issues may need to be addressed and identify appropriate next steps. v


Legal Lines articles are provided for informational purposes only. For legal advice regarding how the issues in this article relate to your circumstances, Hall Render recommends that EAPs seek out their regular counsel who can provide appropriate context and advice for a particular situation. Robin Sheridan is an attorney with Hall, Render, Killian, Heath & Lyman, P.C., the largest health care-focused law firm in the country. Special thanks to Jon Rabin, Jon Bumgarner, Todd Selby, Sean Fahey, Brian Jent, and Abby Kaericher for their contributions to this article. Please visit the Hall Render Blog at for more information on topics related to health care law.

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Ageism Emerging as Persistent Problem

• Job requirements have gone up, and those from underrepresented communities work much harder to get a job offer.

Older, mid-career workers bring both experience and an established track record to the workplace. However, they also make up the majority of the longterm unemployed in many countries and face growing barriers to finding good jobs, according to the nonprofit Generation, which recently conducted a global survey of the challenges facing older workers. (The countries surveyed were Brazil, Italy, India, Singapore, Spain, the United Kingdom, and the United States.) Among the key findings: • Age 45-plus individuals make up a high share of the long-term unemployed. • Hiring managers have a negative view of 45-plus jobseekers, even though employers highly rate the job performance of those they do hire. • Age 45-plus individuals with the greatest need for training are the most hesitant to pursue it.

Despite national differences, the challenges and experience of age 45-plus individuals are global, displaying striking consistency around the world. However, Benefits Pro reports that one key insight is positive. Yes, hiring managers express bias against 45-plus individuals. But those very same employers also acknowledge that, once they hire people over 45, those workers perform on the job just as well as or even better than their peers who are a decade younger. “In a world in which decisions are made on the basis of fact, the employment prospects of 45-plus individuals should be much better than they are today,” the report said. “Critically, these core insights are universal across all seven countries in our survey, despite their very different circumstances.” v 36

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