Journal of Employee Assistance 4th Quarter 2018 v2

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4th Quarter 2018 | VOL. 48 NO. 4

The magazine of the Employee Assistance Professionals Association

EAP in South Africa:

HIV/AIDS Pandemic Drives Development |Page 12

Union Buildings in Pretoria, South Africa


Top 10 Well-Being Apps

Significant WOS Study

Page 18

Page 22

Internal EAPs in China Page 28

Plan to Attend EAPA 2019 St. Louis Conference & EXPO

St. Louis Union Station Hotel, Curio Collection by Hilton St. Louis, Missouri, USA

Main Conference

Wednesday, September 25 – Friday, September 27 Pre-Conference Sept 23-24 | EXPO Dates Sept 24-26

contents EAPA Mission Statement

4TH Quarter 2018 | VOL. 48 NO. 4

cover story


EAP in South Africa: HIV/AIDS Pandemic Drives Development

| By Thiloshni Govender, MA; Radhi Vandayar, BS

In South Africa, the HIV/AIDS pandemic has been key in the emergence and development of public and private sector EAPs, but there are many other ways in which EAP/ Employee Health and Wellness Programs (EHWP) services differ. Another unique aspect of South African EAP is that it has set up a national qualification structure for EA professionals.



Top 10 Well-Being Apps for 2018

| By Kathleen Greer A total of 250 apps were selected for consideration from a variety of sources. Preference was given to apps that were evidence-based and were either free or had a free version for new users. The apps that made this year’s top 10 list aim to make life easier and healthier for users. Many of them serve as an additional counseling tool.


Significant WOS Study: Internal EAP Results

| By Mark Attridge, PhD, MA; Henrietta Menco, MSW, LICSW, CEAP; & Andrea Stidsen, MSW, LICSW, CEAP

This article presents significant WOS data from more than 500 cases over a five-year span. Their results are noteworthy for numerous reasons – among them, the results are from an internal EAP and work-life program.



Developing Internal EA Experts in China

| By Peizhong Li, PhD

An important challenge in developing internal EA expertise in China is the lack of a contingent of experts who command both theoretical thinking and practical experiences from the daily operation of the profession. There needs to be an organic development of knowledge… and experiences for future robust development of internal EAPs in China.


Assessing Suicide Risk for Problem Gamblers

| By Michael Goldman, LPC, CEAP

No other addiction has as high a suicide rate as gambling. This article examines the factors contributing to this exceptionally high rate, along with ways of addressing this risk and suggested treatments.

departments 4 FRONT DESK



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 James B. Printup at Send requests for reprints to Debbie Mori at ©2018 by The Employee Assistance Professionals Association, Inc. Reproduction without written permission is expressly prohibited. Publication of signed articles does not constitute endorsement of personal views of authors. Editor: Mike Jacquart Development & Donor Relations: Jim Printup Designer: Laura J. Miller, Write it Right LLC

Index of Advertisers ASAP....................................................7 EAPA Plan to Attend.........................IFC EAPA Best Value Package...............IBC Harting EAP.......................................BC KGA, Inc.............................................19, 23 Workplace Options...............................5 IFC: Inside Front Cover IBC: Inside Back Cover BC: Back Cover

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frontdesk Glimpses of EA Practice from Around the World |By Maria Lund, LEAP, CEAP


ith hundreds of attendees from dozens of countries, the annual EAPA Conference & Expo brings ideas and lessons about the unique challenges and opportunities EA professionals face from around the world. This spectrum of knowledge about cultures, markets, services, employers, and employees enhances all of our practices, regardless of where they are located. This issue of the Journal of Employee Assistance taps into some of this knowledge with articles that share intriguing glimpses of EAP work from South Africa, China, and India. In this issue’s cover story, Thiloshni Govender, MA; and Radhi Vandayar, BS, discuss the state of our profession in South Africa, where EAPs are developing rapidly. In South Africa, the HIV/AIDS pandemic has been key in the emergence and development of public and private sector EAPs. The EA profession enjoys strong support here with universities offering EAP as a subject of study for graduate level candidates. Peizhong Li, PhD, talks about the need for more internal EAPs in China, a need that includes greater educational and professional development for practitioners in internal programs. In response to this scarcity of resources, Peizhong and other EA professionals in China and the US have

been working together to establish an EA professional training institute. In this month’s World of EAP column by John Maynard, PhD, CEAP, John explains that mental health services are severely lacking in India, a nation of 1.4 billion people that has only one psychiatrist for every 333,000 people. While India lacks training standards and quality regulations for counseling services, the flip side is that EAPs are frequently the most reliable and accessible source of counseling and mental health care available. The Workplace Outcome Suite (WOS) has emerged as the EAPAendorsed, industry standard for outcomes measurement in the EAP field. In an important study, Mark Attridge, Henrietta Menco, and Andrea Stidsen, present results, which confirm those of other studies showing positive effects with EAP services, especially for short-term outcomes for work absence and work presenteeism. The study is also noteworthy for using data from an internal EAP and work-life program at Partners Health Care System. ***** After many decades in print with various titles, the EAPA Journal of Employee Assistance (JEA) will adopt an all-digital format with the 1st Quarter 2019 issue (January-March 2019). As part of

this transition, the last print edition is the one you are reading now: the 4th Quarter 2018 issue. A variety of factors led us to the electroniconly decision. The percentage of users who access magazine content online is increasing and constitutes the majority of our audience. As we further embrace our digital future, we are poised to expand and further improve the valued JEA. Watch for further details in the next issue. v

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

Mark Attridge – Minneapolis, MN

Nancy R. Board – Seattle, WA

Daniel Boissonneault – Hamden, CT

Mark Cohen – New York, NY

Donald Jorgensen – Tucson, AZ

Eduardo Lambardi – Buenos Aires, ARG

Peizhong Li – Beijing, China

John Maynard – Boulder, CO

Bernie McCann – Waltham, MA

Igor Moll – Al Den Haag, the Netherlands

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techtrends Developing a Webside Manner | By Marina London, LCSW, CEAP


ver since video counseling became a modality for EAP services delivery, I have urged employee assistance professionals to add it to their book of business. I have also strongly recommended they get the specialized training necessary to become certified online counselors. Just as short-term counseling isn’t long-term counseling delivered in fewer sessions, online counseling isn’t the same as faceto-face work. So how do you become web counseling literate? The Online Therapy Institute collaborated with EAPA to create an “Ethical Framework for the Use of Technology in EAPs”. A mandatory first step is reading that document. The Online Therapy Institute is actually one of a handful of organizations that offer a Certified Cyber Therapist training. Here are some of the unique topics covered by their program: • The Online Disinhibition Effect • Assessment and Intake Online • Maintaining a Responsible Online Presence • Working with Email • Working with Chat and Instant Messaging • Working with Audio Tools • Working with Video Tools

• Closure and Discharge Online • Virtual Reality and Avatars • Marketing and Taking Your Services Online The Center for Credentialing and Education offers board certification as a telemental health provider. Their certification process is similar to the CEAP® in that it requires a specific set of courses before culminating in an exam. If you aren’t interested in devoting the time or money necessary for certification, consider taking a few courses on the topic. The American Telemedicine Association (ATA) offers Delivering Online Video Based Mental Health Services: (3 Clock Hours) ($199.00) The course covers a multitude of areas such as the history, evolution, models of care, and benefits of telemedicine. In addition, the course provides a detailed overview of telemental health and online service delivery models and instructs participants in how to develop an online mental health service or practice by outlining essential infrastructure and technology components for getting started. Legal, regulatory, and ethical considerations when delivering mental health services online are also included.

Another option is: offers Counseling Issues Online (3 clock hours) ($49): Richard K. Nongard. This course explores and explains the evolving ethics concerning online and electronic therapy, which is more common than many in the field would imagine. It provides interesting information about the counseling and social work industry, even if you don’t practice therapy in these ways. An October 2017 Wired magazine article, “Telemedicine is forcing doctors to learn ‘webside’ manner” urged physicians to develop a webside manner – the 21st century version of the old-fashioned bedside manner. Every recommendation in the article is directly applicable to employee assistance. For example, the article quotes experimental psychologist Elizabeth Krupinski, associate director of evaluation for the telemedicine program at the University of Arizona. (The University of Arizona is one of the first schools in the country to incorporate telemedicine instruction into its medical school curricula.) Krupinski’s suggestions include:

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 Master the technology you are going to be using. Is your webcam resolution properly set? Do you have a fast and reliable Internet connection? Do you know how to use your equipment? Is your backdrop appropriate? Is your lighting on target so that you are clearly visible? Are you dressed in colors that enhance your on-camera appearance?

The American Telemedicine Association (ATA) – http://learn.american Ethical Framework for the Use of Technology in EAPs – http://www. Web Secret 512: Webside manner – web-secret-512-webside-manner.html?m=1 Online Therapy Institute – Telemedicine is forcing doctors to learn “webside” manner. Wired. October 26, 2017. Robbie Gonzalez –

 Self-examine your on-camera behavior. Krupinski explains: “It sounds strange, but when you’re on camera all your actions are magnified,” Krupinski explains. “Sitting six feet away from your doctor, in person, you might not mind or notice her slouching, fidgeting, or gesticulating. But a webcam’s intimate vantage point augments these actions in ways that patients can find distracting or off-putting. ‘You take a sip of coffee and your mug takes up the whole screen, and all they hear is the sound of you slurping,’” she says. “Or you turn away to make a note, and now all your patient sees is your shoulder. Maybe you disappear from the frame entirely.” –

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while contributing to the EAP profession —

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 Disable your video chat’s picture-in-picture feature. “Turn it off and look at the patient,” Krupinski says. That can be tricky: To appear as though you’re making eye contact, she suggests not looking at the patient on your screen, but directly into your device’s webcam.

The article notes that in the United States, physicians are no longer required to see a person in person before seeing them virtually. Most EA professionals are reluctant adopters of technology. However, video counseling is here to stay. It behooves us to develop our core competencies in this modality of service delivery. v Marina London is Director of Communications for EAPA and author of iWebU, (http:///, a weekly blog for mental health and EA professionals who are challenged by social media and Internet technologies. She previously served as an executive for several national EAP and managed mental health care firms. She can be reached at


The Center for Credentialing and Education Board CertifiedTeleMental Health Provider – Credentialing/BCTMH/Training

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effectivemanagementconsulting Appreciating Change with Appreciative Inquiry |By Jeffrey Harris, MA, PCC, CEAP


uch of the consulting that EA professionals provide is focused upon a single manager and his/her request for help with one troubled employee. But it is also possible that a supervisor or manager might approach the EAP for help managing an entire team or workgroup. A large percentage of those scenarios have to do with coping or adjusting to change. I’d like to discuss a consulting process that is ideally suited to helping groups navigate through change. This method, known as Appreciative Inquiry, is commonly attributed to author David Cooperrider. The Relentless Drumbeat of Change Occasional change in a company or work organization can be useful… to maintain competitiveness in the marketplace, keep pace with trends, benefit from the fresh perspective of a new leader, or most frequently, adopting newer forms of technology. However, organizations are frequently invoking change, resulting in “change fatigue” for employees, both individually and as a group. So how can the EAP help a supervisor looking for help scripting a message to the team about the need to embrace upcoming change? This is where Appreciative Inquiry comes in. The assumption contained in this process

offers a template for the manager or supervisor to park useful and inspirational conversations about moving ahead.

“I’d like to discuss a consulting process that is ideally suited to helping groups navigate through change. This method, known as Appreciative Inquiry, is commonly attributed to author David Cooperrider.” The Eight Assumptions of Appreciative Inquiry • In every society, organization, or group, something works. • Reality is created in the moment, and there are multiple realities.

• What we focus on becomes our reality. • The language we use creates our reality. • The act of asking questions of an organization or group influences the group in some way. • People have more confidence and comfort to journey to the future (the unknown) when they carry forward parts of the past (the known). • If we carry parts of the past forward, they should be what is best about the past. • It is important to value differences.  In every society, organization, or group, something works. This is a great philosophy for a manager to share as an opener. When change presents itself, it is usually assumed that something was broken and needs to be fixed; this then leads the group into problem solving and a negative perspective. An early agreement among the team that “something always works” may help free up doubts and kick start creative thinking. The team can be prompted to build upon what has been working.  Reality is created in the moment, and there are multiple realities. This assumption helps a team realize that we are not locked into our collective past, and there are many

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story lines about what works and how to move forward successfully.  What we focus on becomes our reality. This assumption is both simple and empowering. The supervisor or manager can help his/her team embrace the new normal by engaging members to focus upon what they want instead of what they do not want.  The language we use creates our reality. Consultants can offer feedback to the supervisor or manager about helpful reframes, or prompt the manager to search for newer, more useful vocabulary. Language that expresses doubt or defeatism often leads to an undesirable result. Vocabulary that is positive, forward thinking, and inquisitive is ideal for carrying a team forward constructively.  The act of asking questions of an organization or group influences the group in some way. When a manager asks his/ her team questions that are meant to invoke a creative process, then employees start to move away from being static or stuck and can move towards creating answers that focus on possibilities.  People have more confidence and comfort to journey to the future (the unknown) when they carry forward parts of the past (the known). A consultant can create a rehearsal for a supervisor, to help prepare him/her to engage the team in identifying what parts of the past they would like to bring forward into an unknown future. I remind managers that their team’s best tools will move forward with them through

space and time, and the team usually carries a useful knowledgebase even into new scenarios.  If we carry parts of the past forward, they should be what is best about the past. This is my favorite assumption. Help the manager develop some questions for their team about what is best about the past, and how they can make those strengths and accomplishments part of the DNA of the team’s success during forthcoming changes.  It is important to value differences. This serves as a reminder for the manager to create conversations acknowledging that bringing everyone on the team forward successfully into the new normal is not only compassionate, but effective because the most successful teams embrace diversity of thinking and problem-solving.

and union member assistance programs. The author also has extensive experience as a manager and executive coach, from which he draws insight for his consulting. Jeff recently retired from the University of Southern California, but continues to provide consulting through his private practice, Uplevel Coaching + Consulting.

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To Learn More To explore this model in greater detail, check out “Appreciative Inquiry: A Positive Revolution in Change” by David L. Cooperrider at Appreciative-Inquiry-PositiveRevolution-Change/dp/1576753565/ Stay in Touch The author invites readers to network around all topics of effective management consulting through his LinkedIn profile at JeffHarrisPCC, and Twitter at v Jeffrey Harris, MA, PCC, CEAP has provided management consulting to a wide variety of work organizations throughout his 24-year career in employee assistance, including such sectors as medicine, finance, higher education, government

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legallines The Americans with Disabilities Act

Important Considerations for EA Professionals | By Robin Sheridan, JD, MILR


he Americans with Disabilities Act (ADA) is a federal civil rights law that prohibits discrimination against individuals with disabilities in employment and in public accommodations, which includes an EA professional’s office. (State and local laws against discrimination based on disability may also apply.) This article will address the definition of a disability under the ADA, focusing on substance abuse and mental health. Is my client disabled under the law? A disability under the ADA is: (1) a physical or mental impairment that substantially limits at least one of the individual’s major life activities; (2) having a record of such an impairment; or (3) being regarded as having such an impairment. “Major life activities” include, but are not limited to: learning, reading, thinking, communicating, and working. An impairment need limit only one major life activity to be considered a disability. Episodic impairments can also be considered to be substantially limiting if a major life activity is affected. Current illegal drug use is not a disability. An individual who is currently engaging in the illegal

use of drugs is not an “individual with a disability” and is not protected by the ADA. The Equal Employment Opportunity Commission (EEOC) has defined “current” to mean that the illegal drug use occurred recently enough to justify the reasonable belief that drug use is an ongoing problem. Therefore, if a client tests positive on a drug test, he/ she will be considered a current drug user. Courts have also held that a person can still be considered a current user when he/she has not used drugs for a number of weeks or months. See e.g. Scott v. Harrah’s LLC, (D. Nev. 2017), marijuana use weeks prior is current use; Zenor v. El Paso Healthcare Systems, Ltd., (5th Cir. 1999), employee who used cocaine 5 weeks earlier was current user; and Salley v. Circuit City Stores, Inc., (3rd Cir. 1998), after 3-week period of abstinence still a current user). However, former addicts may be protected under the ADA. As long as enough time has passed so that their use is not “current” (see above), individuals who are no longer using illegal drugs and who are receiving treatment for drug addiction or who have been rehabilitated

successfully for drug addiction, may receive protection under the ADA. However, employees who only casually used illegal drugs in the past, but were not addicted, are not considered disabled. See EEOC ADA Enforcement Guidance: Pre-Employment DisabilityRelated Questions and Medical Examinations, 2005 WL 4899269; and Almond v. Westchester Cnty. Dept. of Corrections, (S.D.N.Y. 2006), no ADA protection where employer thought employee had been a casual drug user, rather than an addict. Alcoholics may be considered disabled. Unlike current illegal drug use, alcoholism qualifies as an impairment under the ADA. But whether or not it is a disability affording the client protection by the law, depends on the facts and circumstances. See Johnson v. N.Y. State Office of Alcoholism & Substance Abuse Servs., (RJS) (S.D.N.Y., 2018), alcoholism not disability when addiction did not substantially limit a major life activity; and Office of the Senate Sergeant at Arms v. Office of Senate Fair Employment Practices, (Fed. Cir. 1996), alcoholic police dispatcher substantially limited in the major life activity of working when not

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able to report to work regularly nor to comply with the call-off rule, was considered disabled. When is a mental impairment a disability? According to the EEOC, a mental impairment is “[a]ny mental or psychological disorder, such as emotional or mental illness.” Examples include: major depression, bipolar disorder, anxiety disorders (including panic, obsessive compulsive, and post-traumatic stress disorders), schizophrenia, and personality disorders. In determining whether a mental impairment is a disability, courts will consider the severity, duration, nature, and impact of the impairment. To be a disability under the ADA, the mental impairment must be substantially limiting. If the impairment lasts for “more than several months” and impacts a major life activity, it is a disability. If, however, it is temporary or does not significantly impact a major life activity, it is not a disability under the law. The EEOC Enforcement Guidance on the Americans with Disabilities Act and Psychiatric Disabilities offers these examples: An employee has had major depression for almost a year. He has been intensely sad and socially withdrawn (except for going to work), has developed serious insomnia, and has had severe problems concentrating. This employee has an impairment (major depression) that significantly restricts his ability to interact with others, sleep, and concentrate. The

effects of this impairment are severe and have lasted long enough to be substantially limiting. An employee was distressed by the end of a romantic relationship. Although he continued his daily routine, he sometimes became agitated at work. He was most distressed for about a month during and immediately after the breakup. He sought counseling and his mood improved within weeks. His counselor gave him a diagnosis of “adjustment disorder” and stated that he was not expected to experience any long-term problems associated with this event. While he has an impairment (adjustment disorder), his impairment was short-term, did not significantly restrict major life activities during that time, and was not expected to have permanent or long-term effects. This employee does not have a disability for purposes of the ADA.

see also Moss v. England, (9th Cir. 2005), hostile or aggressive personality not impairment under ADA; Lanman v. Johnson County, (10th Cir. 2014), personality conflicts with co-workers did not show mental impairment; and Brunke v. Goodyear Tire and Rubber, (8th Cir. 2003), quick temper not an impairment.

Personality traits and behaviors are not mental impairments:

Summary This article is an overview about some of the important ADA considerations for EA professionals. However, no single article can address all of the legal aspects of the ADA. Readers with additional questions about the ADA should contact me at (414) 721-0469 or v

Traits or behaviors are not, in themselves, mental impairments. For example, stress, in itself, is not automatically a mental impairment. Stress, however, may be shown to be related to a mental or physical impairment. Similarly, traits like irritability, chronic lateness, and poor judgment are not, in themselves, mental impairments, although they may be linked to mental impairments. EEOC Enforcement Guidance, 2005 WL 4899269;

Are other addictions covered by the ADA? The ADA explicitly excludes certain conditions from the definition of disability including compulsive gambling, kleptomania, pyromania, sexual behavior disorders, and Substance Use Disorder resulting from current illegal drug use (42 U.S.C.S. § 12111). Although not explicitly addressed by the ADA, courts have historically ruled that ADA protections do not extend to tobacco or nicotine addicts. See e.g., Brashear v. Simms, (D. Md. 2001).

Editor’s note: The recommendations provided in this article are for educational purposes only and are not to be construed as actual legal advice. Always consult with a local attorney. Robin M. Sheridan is an attorney with Hall, Render, Killian, Heath & Lyman, PC, the largest health care-focused law firm in the country.

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coverstory EAP in South Africa

HIV/AIDS Pandemic Drives Development |By Thiloshni Govender, MA; and Radhi Vandayar, BS


outh Africa is known globally as the nation that instituted apartheid – legal racial separation – in the 1940s. There were sanctions on our society for many years as the rest of the world would not support a government that perpetuated such injustices on its citizens. Nelson Mandela was imprisoned for 27 years for fighting against this oppressive system. Apartheid legislation was repealed in 1991, pending fully democratic, multiracial elections in 1994. When Nelson Mandela was finally released from prison and elected as our first black president, it made worldwide news and marked a drastic revolution for South Africans. “Since the apartheid system officially ended, both blacks and whites have shared equal rights under the laws. However, the economic disparity that existed during apartheid has persisted. The South African census in 2012 found that the average black family earned just one-sixth as much as the average white family,” said former EAPA CEO Dr. John Maynard in his “World of EAP” column in the 1st Quarter 2017 JEA. History of EAP in South Africa Our turbulent history has impacted every part of South African society, and the development

of EAPs is no exception. The mining industry, in particular, was notorious for migrant labour as men had to leave their homes and families in rural areas to live in urban hostels. More than any other industry, EAPs developed out of the need for resources for these employees. The movement of black people was severely regulated and prohibited in most areas. Families could not travel to see their family members. This created a breakdown in the family unit and increased informal settlements as well as the transmission of HIV/AIDS. These factors catapulted the growth of EAPs in the mining sector. While there were programs that centered on mental health and substance abuse issues, the major focus of most programs was around HIV/AIDs, which has since become a pandemic. “A United Nations report in 2016 estimated that 19.2% of South Africa’s black population was HIV-positive,” Dr. Maynard noted. The South African government has developed HIV policies and legislation into labour laws and duty of care guidelines, and many EAP practitioners have used HIV/AIDS laws to gain access to employers to educate employees on other issues. This has enabled EAPs to grow into a more holisticcentered approach for employees.

Today, nearly all industries in South Africa ranging from mining, manufacturing, technology, customer services, and finances, all have an EAP in one form or another. (The South African Department of Public Service and Administration mandated the establishment of EAPs in all government departments in 2001.) Overview of Internal EAPs in SA The development of EAPs in South Africa has been complex. EAPs have evolved from Social Welfare and Occupational Social Work, to Human Resource Management, Occupational Health and the Mental and Medical health fields. Social workers appear to be the preferred profession in staffing EAPs – but they are certainly not the only ones as nurses, psychologists, and human resource personnel all play a role. As such, EAPs have become fairly sophisticated within a short period of time. The EAP field is developing rapidly in South Africa, where EAPA-SA is celebrating its 20th anniversary. “EAPA-South Africa is one of EAPA’s most successful international branches with eight local chapters and an annual conference that typically draws close to 400 delegates,” Dr. Maynard stated. Many workplaces have long since bought into the concept of EAP, and in fact are expanding

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by incorporating issues of Health Risk Management, Occupational Health and Safety, Organizational Development and other relevant issues. EAPs or Employee Health and Wellness Programs (a different title but still maintaining EAP Core Technology) are prevalent among government departments and most medium to large private sector work organizations in South Africa. Internal EAPs remain the preference for more organizations although they may not be pure 100% internal models. Many

“The South African government has developed HIV policies and legislation into labour laws and duty of care guidelines, and many EAP practitioners have used HIV/AIDS laws to gain access to employers to educate employees on other issues.” South African internal EAPs are actually hybrids combining elements of internal and external models, depending on access to professional resources and funding. There are various external service providers that partner with internal EAPs to extend their services. The most popular EAP-SA providers are ICAS-SA, Life: Careways, Workforce, Life Assist, Metropolitan Health, Healthichoices, Kealo, and Proactive Health Solutions.

The few international service providers in South Africa include Universal Health, Chestnut Global Partners, and Workplace Options. Moreover, South African broad-based black economic empowerment (BBBEE) laws made it hard for companies to operate without empowering the local populations that were previously disadvantaged. This created an environment that has helped realize the potential of EAP potential within our country. The well-regulated labour environment creates external pressure for employers to take care of employee health and wellness needs and mitigate workplace risks. In the public sector EAPs have been compulsory for all tiers of government departments since a directive – as noted earlier – was issued in 1996. HIV/AIDS Drives Public, Private EAPs The HIV/AIDS pandemic in South Africa has been a key driver for the emergence and development of EAPs in both public and private sectors. Stigma and discrimination relating to HIV and AIDS resulted in adoption of the broadbrush approach of EAPs. Many newly created EAPs, traditionally underfinanced, have used peer education and peer counselling models to deliver low-cost EAP services, some of which still do today. Most EAPs feature a proactive approach to employee wellness through wellness education; health screening and testing, as well as a reactive risk-mitigating approach of employee counselling and support. Internal EAPs are typically organisationally situated in Human

Resource and Occupational Health departments and have varying degrees of access to executive management. Depending on the size and complexity of the organization, EAP staff may be found at different levels but come mainly from Health, Social Science, and Business backgrounds. However, in the public sector it is not unusual to find an EAP manager from other occupational groups since the directive to establish EAP came without specifics on staffing requirements. Providers have extended EAP services to include counselling, and legal, financial, and health advice. There has also been growth and other supporting services like occupational health, ergonomics, absenteeism, and disability management. In other words, employee services in SA have been evolving from EAPs to Employee Health and Wellness Programs (EHWPs). The following provides an overview to EHWP services in South Africa.  Do EHWPs perform assessments? Yes, based on presenting problems. Assessments may include psychometric tests, selfassessments, organisation-wide behavioural risk questionnaires; and health risk assessments. Occupational health assessments might include environmental hygiene, disability audits, and health and safety determinations. For example, when a EHWP service provider has a new client, they tend to start with a behavioural risk assessment and then a health risk assessment (HIV, blood pressure, cholesterol, etc.) as a measure of identifying health and wellness issues. The next step

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coverstory would involve devising a wellness strategy around the findings, targeting interventions based on the outcomes. Quarterly reports are then used as a measure to indicate progress. Such assessments allow for measurement and tracking toward program goals, but also as an integration point since services might be offered by different providers. (The data can be integrated for a more holistic picture.)  What kind of services are typically included in EHWPs? Services vary from program to program, however most consider the Department of Public Services and Administration (DPHS) fourpillar framework formed in 2001:

• HIV/AIDS and TB management; • Health and productivity management (absence, incapacity, injury on duty, and disability); • Safety and health (occupational health and safety, and environmental and risk management); and • Wellness management (physical, psychosocial, spiritual, and organisational wellness).  How are services delivered? It varies as sometimes it occurs internally with a multi-disciplinary team or a combination model consisting of internal and external providers. For example, with an HIV awareness drive, the internal EAP manager would outsource HIV testing to a nursing firm that would perform physical testing at a workplace wellness day. The internal EAP would do an awareness session about HIV and AIDS, the nurses would test, and EAP counsellors would offer those services.

If the employee tests positive, they would be referred to medical insurance to begin treatment and access disease management services. If the employee is not coping with the disease or needs support in breaking the news to a partner or family, they are referred back to the counsellor to assist with additional counselling. Legal and financial issues re also common secondary problems. Essentially, there are a lot of cross referrals within a multidisciplinary team. The EAP standards of managing confidentiality and solid case management is key. Most services ensure that they operate with consent forms for referrals and track referrals and repeat users.  What is the most unique, interesting aspect of EAP and EHWP in your country, which might differ from other nations? Historically speaking, prioritizing the HIV pandemic mentioned earlier is a main difference from many countries. The SA government has included it as a separate pillar in their wellness framework to ensure that all organizations address this issue in their population. It initially was the entry point of the employee to EHWP services – but they realize they can access so much more – particularly in blue-collar environments. In fact, for the past 10 years psychosocial issues has been a dominant EAP service. These issues range from dealing with relationship issues (partner/ spouse), organisational issues (conflict or changes) and stress management.

Other Ways in Which South African EAP/EHWP Services Differ  Cultural or spiritual diversity. Some EAP practitioners face dilemmas in dealing with “African spiritual calling.” Most companies and practitioners are trained from a Western philosophy and theories. As a result, an employee who seems to be having delusions (her ancestors are calling her) feels she needs time off work to become a spiritual healer. Culturally, the manager understands but according to company policies and business practices, he is not sure what to do. The employee is talented, and the manager does not what to lose her. If relying solely on the DSM5, the EAP would say clinically that this person needs medication and therapy. However, if culture is taken into account, the employee and manager cannot simply succumb to a Western way of handling this situation. EAPs have begun reaching out to the Spiritual Healers Association as an extra resource for dealing with an issue like this. This has also forced EAP managers to work with HR to reexamine leave policies.  Racism and empowerment. The history of oppression, racism, and broad-based black economic empowerment (BBBEE) creates workplace conflicts where the EAP is called in to either mediate the issue or to counsel the victim or aggressor. (In BBBEE, African recruits receive the initial option for a position based on reparation for previously disadvantaged populations.)  Heavy unionism. South Africa is also notorious for being

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Professional Development Environment in South Africa The Skills Development Act, SAQA, and the National Qualifications Framework (NQF) regulate and support employee skills development in South Africa. This framework stratifies and accredits formal learning as well as learning providers. As mentioned earlier, SAQA has recognised EAPA-SA as a professional body. This provides a mandate to register professional designations for EAP on the National Learner Records Database (NLRD); create a formal system for both Continuous Professional Development (CPD) and Recognition of Prior Learning (RPL).This recognition has provided EAPA-SA with an opportunity to institutionalise and structure EAP learning and to forge a clear path to develop formal accreditation, certification, and ultimately qualifications in EAP.

heavily unionized. EAPs work closely with unions to gain access for employees for awareness drives and stakeholder referrals. However, since there are so many strike-related activities, EAP support is required for both management and employees. In addition, trauma debriefing is sometimes necessary after a violent or threatening situation. Conflict management by the EAP ensures a peaceful return to work. EAPA-SA’s Role in Professional Development Another unique aspect of South African EAP is that it has set up a national qualification structure for EA professionals. In 2015 EAPA-SA was recognised by the South African Qualifications Authority (SAQA). The professional designations provide a framework to stratify EAP roles and provide requirements for effective functioning within those roles. The four professional designations are:

EAP Skills Development There are currently no EAP-specific qualifications in South Africa, but EAP is included in certain

• Employee assistance coordinator (general, non-clinical administrative support to clients and colleagues); • Employee assistance practitioner (mainly nonclinical EAP services at implementation level); • Employee assistance professional (licensed, autonomous clinical services in addition to program implementation); and • Employee assistance specialist (design, implementation, and strategic management of EAPs).

Continued on page 21

The four designations are progressive in complexity and create a clear skills development path. EAPA-SA’s Recognition of Prior Learning Policy and Procedure forms a bridge between the designations and involves a process of assessment by a trained advisor and moderated by a SAQA accredited assessor. Moreover, EAPA-SA’s Continuous Professional Development Policy ensures that practising members regularly update their knowledge and skills to deliver effective EAP services. Earning a minimum number of CPD points per year is requirement to renew membership. CPD is also a requirement for renewing licences of clinical professionals with their respective Statutory Councils.

Upcoming features include:  How to Run a Digital EAP  EAPs in Australia  Newcomers to EAP

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earoundup Q4 2018 Last Print Issue of JEA After many decades in print with various titles, the EAPA Journal of Employee Assistance (JEA) will adopt an all-digital format with the 1st Quarter 2019 issue (January-March 2019). As part of this transition, 4th Quarter 2018 is the final print edition. As has always been the case, the Journal will continue to be a member benefit; and now, highly accessible on smartphones, tablets, and on the Web. It is important that we underscore what this digital transition means and, as importantly, what it does not. We are transitioning the JEA, not saying goodbye to it. We remain committed to the magazine and what it represents. This decision is about the challenging economics of print publishing and distribution. As we further embrace our digital future, we are poised to expand and further improve the valued JEA.

Making the Case for EAP Return on Investment EAPA has published the 2018 update of its comprehensive Annotated Bibliography of EAP Statistics and Research Articles. The bibliography, which includes hundreds of EAP-related research articles published in the U.S. and other countries from 2000 through June 2018, is a unique EAPA members-only benefit (requires login). Articles in the bibliography address EAP return-

on-investment studies, program effectiveness research, and other important topics. A brief summary of each article is included in the bibliography, along with the publication reference. EA professionals, HR decision-makers, benefits brokers, PhD students, and others will find the bibliography to be a valuable resource in making evidence-based decisions affecting the future of individual programs and even the profession. The bibliography is available at http://www.eapassn. org/EAPresearch.

Evolution of EAP Results Available Thanks to the 155 professionals who completed the recent survey on The Evolution of EAP in North America, the results are available at the EAP Digital Archive at the University of Maryland Baltimore. The “Evolution of EAP” study examined changes over the past 30 years. In that time, the EAP market has become more mature, with most large and medium-size employers now having an EAP, a shift from the internal staff model to mostly external vendors, consolidation of providers into fewer but larger companies, and use of technology. In general, employers today purchase EAPs for three reasons: 1) to support employee work and behavioral health (rated as important by 84% of sample); 2) to support the employee’s work/life and family (65%); and 3) to support the work organization (57%). Other results focus on how much certain factors contribute to why a

particular EAP vendor is selected over another. Findings were largely similar for sub-groups of sample representing EAP purchasers and EAP providers, for US and Canada, and for demographic factors of age, sex and years of EAP experience. The 20-page written report includes slides with many charts of the survey’s major findings. Go to http://archive.hshsl.umaryland. edu/handle/10713/8061. - Submitted by Mark Attridge

Technology: The Good and the Bad Technology has a lot of positive impacts on our lives, but do we need to be plugged in ALL of the time? Being constantly connected contributes to depression and anxiety, according to the “2018 Global Wellness Trends” report from the Global Wellness Summit. According to the report, human connection is a strong driver of happiness and people are finally acknowledging the ways in which technology is making them feel ill as they are striving to reclaim peace of mind. As disconnecting becomes increasingly attractive to people, “tech-fighting tech” has been trending in the workplace, the “2018 Global Wellness Trends” report also stated. This includes apps like Off the Grid, which allows users to block their phone for any amount of time, and The Moment, which lets people set daily time limits on devices.

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Such tech tools are already being used in the workplace, said Autumn Krauss, principal scientist, human capital management research at SAP SuccessFactors. However, solutions like these aren’t all positive, Krauss told Workforce. She stressed that employees’ responsibilities remain, so a stretching reminder may come in the middle of conducting a webinar. Or, an employee may leave early to pick up their child from school and find that not being able to send emails at night makes work-life balance more difficult. “If we really want companies to think about how they can help employees disconnect, that comes from a cultural perspective, and that’s where I’ve seen a lot of this work done,” Krauss said.

Suicide is the tenth-leading cause of death in the United States, and one of three that is increasing. The other two are Alzheimer’s disease and drug overdose, in part because of the spike in opioid deaths, said Dr. Anne Schuchat, principal deputy director of the CDC. Prevention has been elusive, in part because doctors have not had programs that reliably reduce suicide rates. Crisis hotlines can save lives; so can psychiatric treatment. But suicide is such an unpredictable, often impulsive act that no single intervention has proved sufficient. Research has shown that nearly 80 percent of people who die by suicide explicitly deny suicidal thoughts or intentions.

US Suicide Rates Reach Alarming Levels

Depression Big Problem, But Improvements Occur

Suicide rates rose in the US steadily in nearly every state from 1999 to 2016, increasing 25 percent nationally, according to the Centers for Disease Control and Prevention (CDC). In 2016, there were more than twice as many suicides as homicides. The increase varied widely by state, from a low of 6 percent in Delaware to more than 57 percent in North Dakota. The rate declined in just one state, Nevada, where it has historically been higher than average. Social isolation, lack of mental health treatment, drug and alcohol abuse, and gun ownership are among the factors that contribute to suicide.

According to the World Health Organization (WHO), depression is a monumental problem. In fact, it’s the leading cause of disability worldwide – ahead of more widely publicized health conditions such as cancer, heart disease, and diabetes. A quick glance of news headlines would lead many to think that depression invariably leads to suicides, school shootings, and run-ins with police. Even scientific findings often state that depression is a recurring, chronic condition that is difficult to treat. While depression can be a lifelong problem, Psychology Today reports that almost 10 percent of individuals who were

clinically depressed when they joined a Midlife in the United States (MIDUS) study, were thriving 10 years later. Why? The truth is that mental health professionals don’t know. For some individuals, healing may simply take time. Others may attain it following formal treatment. Still others may discover a new purpose in life or a routine that works for them. Some people may achieve this state after the first time they were depressed; others may get there only after several instances of depression. The article states: “The most exciting thing about illuminating these pathways is that some pathways undoubtedly will provide new points of leverage for containing the depression epidemic.”

EAPA Town Hall Meetings Set EAPA Chapter/Branch Leader Town Hall meetings will be held in person during the EAPA 2018 Conference & Expo in Minneapolis. Meetings are hosted by the EAPA Board of Directors and include updates from the Board committees, task forces, and EAPA staff. There will be plenty of time for discussion on topics of interest. Forward any questions or suggestions for agenda topics to All meetings will be held in the EAPA online meeting room. Detailed agendas and log-in instructions with dial-in numbers will be sent out prior to each meeting. v

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featurearticle Top 10 Well-Being Apps for 2018 | By Kathleen Greer


or the past four years, KGA has vetted well-being apps in order to recommend its top 10 choices for EA professionals. This project is more difficult today than when it first began because the market has been flooded with options. New apps appear every day, and the number of mental health ones has increased significantly. For example, in May 2016, the following number of apps were introduced: 805 medical, 1,206 health and fitness, and 2,225 lifestyle. In contrast, it is estimated that five million apps will be available to consumers by 2020 (Perez, 2016). Can Well-Being Apps Help with the Mental Health Crisis? One in six U.S. adults, or 48.3 million adults, live with a mental illness, which represents a national epidemic that EAPs are uniquely positioned to help address (Marshall, 2018). People with mood disorders such as depression and bipolar have a life expectancy that is 25 years less than those without these conditions. (Nichols, 2018). Although face-to-face counseling is still a treatment choice for many, others are turning to e-mental health options, such as well-being apps, to get the assistance they need. Study of EAP and Behavioral Health Executives In a recent 2018 National Behavioral Consortium (NBC)

survey on apps and e-health platforms, 60 percent of EAPs and managed behavioral health care organizations (MBHOs) agreed that apps were “very important” or “extremely important” in making interventions more available, helping members with specialty programs, and addressing generational differences. As part of the survey, NBC member organizations covering more than 22 million lives identified the app categories of greatest interest: • Stress, 73%; • Cognitive Behavioral Therapy (CBT), 68%; • Depression, 64%; • Anxiety, 59%; and • Addiction: 55% The apps most familiar to EAPs were Moodhacker, Headspace, and Happify, which focus on improving a person’s mood and outlook. But while the number of mental health and well-being apps available is staggering, engagement has not kept pace. Health experts recognize that apps can play a key role in both mental and physical health, but note that consumer interest may be lagging behind. EAPs Can Narrow Options in a Crowded, Confusing Field EAPs are in a unique position to recommend trusted apps to clients who may otherwise bounce

around a disjointed mental health system. Critical in this process is narrowing a list so that it isn’t overwhelming. “If we’re overwhelmed [by apps] as clinicians,” says Alison Magee, Senior VP of Clinical Services at KGA, “just imagine what it’s like for someone suffering from a mental condition.” Apps Form a Bridge in EAP Counseling Apps can be helpful in employee assistance work for a variety of reasons. Since EAP counseling is typically short-term, recommending an app to a client can help fill a waiting period while the practitioner searches for a good referral. Collaborating with a client on an app can also deepen a relationship that otherwise would be more superficial. For example, reviewing progress on an app with a short-term client may make three counseling sessions seem like more than that. There are also times when a client may be waiting for a session opening. Apps can also address this gap. The Relevancy of Well-Being Apps Apps are more specialized than ever, which makes them even more relevant and helpful. For instance, some clients prefer a private digital-based program over a face-to-face or video interaction. Apps can also assist in treating serious mental health issues. A

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recent study of men with depression showed that high-risk men were more likely to endorse accessing resources on the Internet than low-risk men (Wang, et al, 2016). For these men, the top three reasons to access e-mental health included: getting help with sleep hygiene, improving stress and depression, and having quality information about work-related stress issues. Given that middle-aged men are at the highest risk of committing suicide, this is important data. KGA’s Selection Process Each year, KGA counselors and work-life specialists are asked to recommend mental health apps based on their experience in using them as an adjunct to counseling. They indicated that they are 30 percent more likely to recommend an app this year than last year at the same time. Ninety percent of KGA staff “agrees” or “strongly agrees” that it’s easier to recommend KGA’s Top 10 Apps because they have already been vetted by people they trust. When asked if they have any concerns about employees using apps, 100 percent said “no.” Comments from KGA staff included:  A client struggling with anxiety and depression that was affecting his work started using Headspace for mindfulness exercises and found it helpful for his concentration and focus at work.  I often will use Headspace with a client face-to-face or at least show it to them.  Apps are often a great option to help empower clients to engage in self-care.

 It’s been helpful to mention free mindfulness apps to help people with acute stress or anxiety until they can get to an affiliate provider.  Apps are helpful to clients with insomnia and anxiety.

A total of 250 apps were selected for consideration from a variety of sources. KGA evaluated the popularity, reliability, and ease of use of each of the apps. Preference was given to apps that were evidence-based and were either free or had a free version for new users. (Counselors and specialists are more comfortable recommending free apps to employees who may see cost as a barrier.) Other criteria included the requirement that apps had versions for both IOS and Android, and fell into one of the following categories: • Anxiety/depression; • Finances; • Suicide prevention; • Self-awareness; • Happiness; • Sleep; • Stress management; • Mindfulness/meditation; • Personal organization; • Habit management; • Parenting; • Relationships; • Retirement; • Eldercare; and • Childcare. KGA counselors reviewed and ultimately rejected apps that would create frustration for clients or didn’t add sufficient value. One app, for example, had too many push notifications. “For someone with stress or anxiety, this could be overwhelming or frustrating,” a counselor explained.

Another app geared towards suicide prevention and mood disorder monitoring required users to input mood data three times a day for 14 days before providing any feedback — much too long, the counselor thought. Counselors also rejected apps that called for a lot of effort syncing the app with other devices, as well as apps that didn’t have a clear purpose or connected users with non-digital resources. A Closer Look at KGA’s Top 10 The apps that made KGA’s top 10 list this year aim to make life easier and healthier for users — whether by streamlining tasks, improving sleep, supporting sobriety, increasing physical fitness, or quelling anxiety.

KGA 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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featurearticle The top picks also met KGA’s criteria for ease of use. They are well designed, with clear prompts and thoughtful organization. Counselors felt strongly that the tops apps shouldn’t be frustrating to use or unnecessarily distracting. Many of the apps KGA selected serve as an additional

counseling tool. The apps SAM: Self-Help for Anxiety Management, Daylio, Sober Grid, HabitBull, Grateful: A Gratitude Journal, and SuperBetter offer opportunities to record information that can be used for selfassessment. The recorded data, patterns and observations stemming from the apps can then be

shared with a counselor during a face-to-face or phone session. The top apps also provide support once a client has received a counselor referral and is waiting for an appointment. They have resources for coping and also connect the user to a digital support network. For someone experiencing isolation, SAM: Self-Help

Here are the Top 10 Apps of 2018: Sleep Cycle Alarm Clock The Sleep Cycle Alarm Clock listens in on movements while you’re asleep and wakes you up during a lighter sleep phase, leaving you more refreshed than if you were jolted out of a deep sleep. Users can set a time by which they must wake up, and the app will wake them up within a 30-minute range of that time. HabitBull HabitBull assists users in maintaining good habits or breaking bad ones by encouraging them to track progress on a calendar that they customize. App features like graphs, a forum, reminders, and motivational words provide additional habit-building help. Sober Grid Sober Grid creates a virtual, online sober community where users can communicate, encourage each other, and instantly reach out for help when struggling to stay sober. Users can remain anonymous or use the geotagging feature to meet up in real life. Wunderlist This is a list-making app that allows users to share lists with

family, friends, and colleagues. Wunderlist aims to help users tackle “to-dos”. Along with the ability to collaborate on lists, Wunderlist also includes reminders, due dates, and room for notes. 10% Happier 10% Happier bills itself as “meditation for fidgety skeptics” and combines guided audio meditations and video lessons to build a lasting and compelling meditation practice. SuperBetter SuperBetter turns everyday emotional, physical, and mental challenges into a “game”, with the user as the “hero” of the story. In time, players develop resiliency and decrease symptoms of depression and anxiety. Daylio With this private micro-diary, users track their moods and habits throughout the day by using simple icons and quick notes. Daylio then converts this data into a chart to show patterns over time and provide other insights.

Grateful: A Gratitude Journal As opposed to starting at a blank screen, Grateful users are given prompts like, “What made you smile today?” to get their gratitude juices flowing. They can also create their own recurring prompts. The reminders are pleasant and easy to use. Sworkit Sworkit refutes the “no-time-toexercise” excuse with its library of more than 50 videos ranging in length from 5 minutes to an hour. Users can customize workouts and workout plans based on impact level, difficulty, exercise type, and focus area. SAM: Self-Help for Anxiety Management Created in the U.K., SAM guides users through small steps they can take to manage anxiety. The anxiety-management toolkit includes breathing exercises, and prompts to acknowledge the source of anxiety and rate and record anxiety levels. Through a closed in-app social network, users can connect with others coping with anxiety. v

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for Anxiety Management offers a useful social cloud feature. Apps like Grateful, HabitBull, and SuperBetter make keeping healthy resolutions less of a chore. Summary Apps are here to stay. EA counselors are advised to embrace this trend and recognize how apps make a positive difference in the lives of employees and their families. This includes a meaningful improvement in the user’s immediate day-to-day existence and in the long run. v

coverstory curricula, such as Social Work, Industrial Psychology, Occupational Health, and Human Resource and Management. Many members have used EAPA -SA as an informal method of “upskilling” through discussions and mentorship by more experienced EAPA-SA members. At the graduate level of study there are many universities where Health, Social and Business Science Doctoral and PhD candidates choose EAP as a subject of study. EAPA-SA is positioning itself to offer EAP mentoring and coaching to its network of EA professionals and specialists; influencing the development of an EAP undergraduate qualification. Summary EAP practitioners have come a long way in “professionalising” the EAP field and getting business leaders to understand their role in

Kathleen Greer is founder and chairman of the Framingham-Mass.-based KGA, Inc., which provides EAP services to over 100 organizations. KGA is a member of the National Behavioral Consortium (NBC). Kathy can be reached at greer@

Perez, S. (2016, August 10). App Store to reach 5 million apps by 2020, with games leading the way. TechCrunch. Retrieved from https://techcrunch. com/2016/08/10/app-store-to-reach5-million-apps-by-2020-with-gamesleading-the-way/.


Wang, J., Lam, R., Ho, K., Attridge, M., Lashewicz, BM., Patten, SB., Marchand, A., Aiken, A., Schmitz, N., Gundu, S., Rewari, N., Hodgins, D., Bulloch, A., & Merali, Z. (2016). Preferred features of E-mental health programs for prevention of major depression male workers: Results from a Canadian national survey. Journal of Medical Internet Research. Retrieved from

Marshall, J., & Meiners, A. (2018). Integrating mental health into the workplace. Journal of Employee Assistance, 48(2): 28-31. Nichols, H. (2018, January 8). The top 10 mental health apps. Medical News Today. Retrieved from

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relation to business and performance. They have come a long way and have accomplished much. However there are still many issues that require additional work:  The current counselling environment curtails professional development. With life coaching, and peer, lay, pastoral, debt, and other forms of counselling, work organizations content with compliance do not feel the need to invest in EAP professional development as long as they have someone coordinating an EAP. This is an area that needs to be studied and remedied to protect employees and organizations.  Internal EAPs – especially those in government – remain extremely focussed on compliance. We need to get away from bureaucratic red tape and work towards outcomes and ROI. We still struggle

with the link between investment and internal EAP expertise. Training needs to broaden expertise from basic clinical practice to demonstrate the business case for EAP return on investment (ROI).  Finally, we need to finalise our RPL and other professional development processes. This will give EAP practitioners the accreditation they deserve. v Thiloshni Govender and Radhi Vandayar are fourth-generation Indians living in South Africa. Thiloshni has been actively involved in the employee assistance field since 1996. She is President-Elect of EAPA-SA and has been actively involved in the revision of EAPA-SA Standards adopted in 2010. Radhi is currently an MBA mentor at Henley Business School for the SA16 MBA class. She has been a member of the EAPA-SA board for the last 12 years. They may be reached at and respectively. Editor’s note: For further information about EAP in South Africa, see Dr. John Maynard’s “World of EAP” column in the 1st Quarter 2017 JEA.

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featurearticle Significant WOS Study

Internal EAP Results | By Mark Attridge, PhD, MA; Henrietta Menco, MSW, LICSW, CEAP; and Andrea Stidsen, MSW, LICSW, CEAP


ntroduced in 2010 by Chestnut Global Partners, the Workplace Outcome Suite (WOS) has emerged as the EAPA-endorsed, industry standard self-report tool for outcomes measurement in the EAP field (Lennox, Sharar, Schmitz, & Goehner, 2010). The WOS measures five employee outcomes: absenteeism, presenteeism, workplace distress, work engagement, and life satisfaction. Other than absenteeism, which is answered by filling in a specific number of hours, the items are rated on a 1 to 5 Likert-type scale. Reasons Results are Important This article presents significant WOS data from more than 500 cases over a five-year span. The retrospective data analysis is noteworthy for a number of reasons.  Most of the results in WOS literature have been taken from external vendors of EAP services; the data presented in this article is from an internal EAP and worklife program at Partners Health Care System.  The data compares results against a matched group of over 700 cases from similar internal programs in the United States. The findings for internal programs are also compared with those of external EAP vendors in the US.

 This is also one of the first reports to feature WOS results based on the reduction in problem status approach, which was introduced in 2017 as an alternative method for analyzing WOS data over time. This approach asks, for each problem area, how many employees are having problems, and then, how many of these same cases have improved enough at the postor follow-up stage to no longer be at the problem level?

More on Measuring Workplace Outcomes In 2017, Chestnut Global Partners released a comprehensive report of normative WOS scores based on over 16,000 EAP counseling cases worldwide. At the EAPA 2017 Conference & Expo – Los Angeles, EAPA CEO Greg DeLapp, WOS co-creator Dave Sharar, and researcher Attridge introduced a new analytic approach, as noted in the preceding paragraph. This method coded WOS scores into two basic conditions: either having a problem within the particular outcome area or not having a problem – and then testing for a reduction from before, to after EAP counseling in the percentage of problem-level cases on each WOS measure.

For example, agreement with the statement “I dread going into work” is considered having a “problem” within the outcome area of work distress. Thus the percentage of the total EAP caseload who dread going to work in the past month is calculated both at the start of EAP intervention and 60 days’ post-EAP intervention. A positive result overall for the EAP is to then see a reduction in the percentage of cases with work distress. About Partners EAP The EAP at Partners HealthCare System is an internal program with 20 clinical and support staff located at nine offices in the Boston area. The EAP supports more than 76,000 employees who work at the two largest academic medical centers in Boston – Brigham and Women’s Hospital and Massachusetts General Hospital – and is also affiliated with Harvard Medical School. Since 2009, Partners has been one of the few providers (including internal programs and vendors) in the US that is accredited in EAP by the Council on Accreditation (COA). External program accreditation demonstrates a commitment to continuous quality improvement and ensures the delivery of services that follow EAP industry best practices.

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Why a Retrospective Data Analysis? As part of a long-term quality improvement initiative, Partners EAP began collecting data on outcomes in 2012. The intent was to demonstrate to stakeholders that Partners EAP could produce positive changes in workplace-related outcomes for employee clients. By systematically measuring a set of valid and reliable outcomes relevant to EAP services, we hoped to show that the EAP has business value to the larger work organization. Finding favorable results on these types of workplace metrics has strengthened the commitment of business leaders to continue sponsoring and collaborating with the EAP. It also has motivated our counselors and staff who can see the fruits of their labors when clients have improvements in multiple outcome areas. Collecting Outcome Data  Our data. Workplace outcome data was obtained at the start of each counseling case and then again at a follow-up conducted approximately 60-days after the case was opened. The pre and post data for each case was aggregated over a multi-year period into a dataset with a total of 510 employee cases. The reference period for all five of the WOS questions was, “For the period of the past 7 days.” Note that this period was shorter than the 30-day period often used with the WOS, and results for absenteeism hours were adjusted accordingly.  Comparison data samples. Chestnut Global Partners graciously shared their cumulative

dataset of WOS responses collected from January 2010 to April 2017, which enabled us to make a customized comparison group of WOS cases with pre and post data. A total of 718 cases came from four different EAPs, each one an internal program in the US in the health care industry. Thus the comparison group was very similar to Partners EAP on the key attributes of program delivery model, geographic location, and industry type. We did not expect the outcomes at Partners EAP to be different from other similar EAPs. We also included a third group that consisted of cases from external vendors and large employers with EAP hybrid programs involving vendors that were all located in the US – but from many different industries. The vendor sample had 6,635 cases. All cases in each study group had complete data on all five WOS-5 single-item measures at both pre and post time intervals. None of these groups had an overlap of the same cases.

Partners EAP had significant reductions over time for the four outcomes of work absence, work presenteeism, work engagement, and life satisfaction but had no change in the outcome of work distress. The group of matched EAPs had reductions of in all five outcomes, as did the external vendor group. Of note, fewer Partners employees presented with work distress than employees in the matched comparison group. Total Number of Workplace Outcome Problems. The five problem-status outcomes were also totaled to create a new single composite score (ranging from 0 to 5 total “problems” per case at pre and again summarized at post).

 Statistical testing. A series of repeated-measures ANOVA (analysis of variance) procedures were conducted within each group to test if the change over time in each outcome was significant at beyond chance levels (p < .05, indicated with * in Table). A statistical effect size metric (eta2) was calculated to fairly compare the results between groups of different sample sizes.

Results WOS-5 Outcomes at “Problem Levels.” Each WOS outcome was tested separately for both Partners EAP and the matched internal EAPs. These tests indicated that 23

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featurearticle The results showed that the total number of problems per case was reduced over time and to a similar degree with medium size effects for both the Partners EAP and Matched EAP groups (see Table). This change was also found in the External Vendor group (with a “large” size effect). Best Possible Workplace Outcome. Exploring this combined score of WOS problem status outcomes another way revealed that the best possible outcome of having zero problems had increased over time from 31% to 53% of all cases from pre to post-EAP use at Partners. This same outcome also increased from 20% to 45% at the matched EAP group. In the external vendor group this zero-problem outcome changed from 20% to 49% of all cases. These results reveal that the number of cases from the total without a problem on any of the five WOS outcomes roughly doubled after the EAP intervention. Beyond Workplace Outcomes. In examining the data, this same result also tells us that there is a sizeable sub-portion of the EAP case mix (about 1 in every 5 cases on average) who did not have a problem with any of these five outcomes when first seeking assistance from the EAP. As a result, although assessing work-related outcomes is important, it is not the full story for how EAPs offer business value. For example, more clinical aspects of the EAP user client experience should also be measured when examining the effectiveness of employee assistance services. We suggest using validated instruments such as the

PHQ-4 (for depression and anxiety) and the AUDIT (for alcohol). Summary – Comparing Partners EAP to Other Internals. The employee clients at Partners EAP were similar on three of the five WOS outcomes at the outset before the EAP intervention compared to the employee clients in the matched group of other internal EAPs. However, fewer employees at Partners EAP presented with problems related to work distress and presenteeism than the employees in the matched comparison group. Employees at Partners EAP also had fewer total combined workplace problems, on average per case, compared to the matched sample as well. One explanation for these differences is that on-site EAP services (at Partners) create easy access and allow employees to seek help sooner and therefore their problems are less severe. In comparing the extent of change over time, we found that most of the effect sizes in both groups were of similar magnitude and were all in the range of “small” to “medium”. This confirmed our initial expectation of not finding much difference between Partners EAP and the experience at other internal EAPs in the health care industry. Summary -- Comparing Internal Programs to External Vendors. Overall, these findings revealed a workplace outcome profile at the two internal program groups that was similar to that for external EAP vendors. Significant reductions in the proportion of cases suffering from various kinds of workplace problems after the

use of EAP counseling services were found for both kinds of delivery models. The data revealed that the matched internal EAP group was more similar to the external vendor group than to Partners EAP. However, readers should keep in mind that other important aspects of EAP services were not represented in this study because we focused only on the WOS measures collected from individual cases. The more comprehensive and workplace-based service set that is characteristic of highquality internal programs with on-site staff, and which are well integrated into an organization, no doubt offer additional unique components of value to the corporate client that are fundamentally different from what most external vendor programs provide. A comparison of program models that uses a wider range of services and outcomes awaits further study. Conclusions This data comparison adds to a growing literature of evaluation studies that have presented data from WOS measures to determine the impact of EAP counseling. The findings reinforce what has been found in other studies that have examined pre- to post changes in workplace outcomes. As in past studies and data comparisons, only small changes were found for long-term outcomes of work distress and work engagement, but larger changes were found for short-term outcomes of work absence and work presenteeism. This pattern is consistent with the nature of the brief treatment model of EAPs that supports

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employees who are dealing with acute issues in only a few clinical sessions. Lastly, life satisfaction is not specifically a workplace outcome but rather represents how the employee’s overall well-being is restored after counseling. This retrospective data analysis was based on large numbers of employee cases collected over multiple years at our own internal program and also from other similar EAPs operating as internal programs with EAP staff who are employees of the organization. The results clearly demonstrate the positive impact that internal programs can deliver on a variety of workplace outcomes – outcomes that are of great interest to the corporate stakeholders and purchasers of employee assistance services. End note: Interested readers are also directed to a related report that chronicles the larger quality improvement, clinical risk screening and outcomes project at Partners EAP (Menco, Stidsen, & McPherson, 2018). v

Workplace Outcome Suite, Journal of Workplace Behavioral Health, 25(2), 107-131. Menco, H., Stidsen, A., & McPherson, T. (2018, June). Implementing behavioral health screening and outcome measures at an Internal EAP: A quality improvement initiative at Partners HealthCare System. EASNA Research Notes, Vol. 7, No. 2. Available from

Sharar, D., & Lennox, R.D. (2014). The workplace effects of EAP services: “Pooled” results from 20 different EAPs with before and after WOS 5- item data. EASNA Research Notes, 4(1). Available from

Tips for Increasing Use of EAP Most organizations are not reaping the full financial benefits of having an EAP. Business Management Daily offers the following suggestions for boosting use of the EAP:  Make it convenient. Employees are more likely to use the EAP if counselors are a short drive from work, or they can access them 24/7 by phone or online.  Emphasize confidentiality. Employees are more likely to use EAP services if they are not concerned about co-workers knowing about it.  Host wellness seminars. For instance, free lunchtime “brown bag” sessions on topics like stress management or time management.  Inform families. Let employees’ families know they can contact you. Offer information about your services, hours, and phone numbers.  Publicize, publicize, publicize. Promote your EAP regularly through emails, website updates, and free posters and refrigerator magnets that list hours and phone numbers.  Remind employees there’s more to EAP than they might think. Stress that the EAP is available for personal reasons such as financial concerns, relationship counseling, and others.  Encourage staff to bookmark the EAP. Add a link on a company intranet to the EAP site.  Train supervisors. Teach them how to recognize work problems and to recommend using the EAP as an option for improving work performance. v

Dr. Mark Attridge is an independent research scholar as President of Attridge Consulting, Inc., based in Minneapolis. He is past Chair of the EAPA Research Committee. Mark has authored over 200 papers and presentations on workplace behavioral health. He can be reached at Henrietta Menco is the Quality Improvement Manager of the EAP and Work/Life Resources at Partners HealthCare. Henri provides national expertise in program and policy development, accreditation and quality measurement, as well as best practices and ethics. She can be contacted at Andrea Stidsen is the Founder and Director of the EAP and Work/ Life Resources at Partners HealthCare. Andrea has been a leader in the areas of program development, management and consultation with expertise in healthcare, employee assistance, and work/ life. Contact her at


Chestnut Global Partners. (2017). Workplace Outcome Suite (WOS) annual report: Comparing improvement after EAP counseling for different outcomes. Bloomington, IL: Author. Available from Portals/11/Docs/WOS/WOS_AnnualReportFinal2017. pdf?ver=2017-09-15-173501-900 DeLapp, G., Sharar, D., & Attridge, M. (2017, October). Workplace impact of EAP: WOS-5 benchmark results from 16,000+ cases & tests of moderator factors. Presented at the annual world conference of the Employee Assistance Professionals Association, Los Angeles, CA. Lennox, R.D., Sharar, D, Schmitz, E., & Goehner, D.B. (2010). Development and validation of the Chestnut Global Partners

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theworldofeap EAPs in India Evolve to Fit the Market | By John Maynard, PhD, CEAP


n 1986, a large Indian-owned conglomerate in Mumbai reached out to a former employee who had lost his job due to drinking. Mr. Stany Sequeira, who by that time was in recovery, was invited to return to the company to help set up an in-house AA program to assist other employees with drinking problems. Management was concerned that these employees represented safety risks to the company and their co-workers. Unfortunately, the program lasted only a short time. However, it inspired Sequeira to invest his own funds to order learning materials from Hazelden and to start exploring how the EAP concept could be adapted for India. Now, over thirty years later, his daughter still applies what he learned to her role as a leading EA professional in India. Rapid Social and Cultural Change Awakens Need For EAP Despite Sequeira’s efforts, counseling services and EAPs remained essentially unknown in India until the early 2000s. By then, the rapid influx of Western multinational high-technology companies was beginning to create a huge demand for workers, especially in the major cities. Suddenly, thousands of new highpaying jobs were available. But they came at a cost: night-shift

hours, high workloads, stress, mandatory language and accent training, culture shock, and major lifestyle changes. Still, young people migrated from around the country to join these organizations, often uprooting long-standing traditions, social stability, and extended family support systems. Parents were anxious about the safety and health of both their migrating children and the family who remained at home. Female employees struggled with managing family and work responsibilities. Workers found themselves in an unfamiliar environment without the traditional supports for developing relationships or coping with stress. The effects of this unprecedented social and cultural upheaval were compounded by the demographics of India. India is the world’s youngest country, with a median age of 27.6 years (Statista, 2018), compared, for example, with China at 37 years and the United States at 42 years (BLS, 2017). Moreover, the suicide rate among younger Indians (15-29 years old) is among the highest in the world (Patel et al., 2012). Yet, mental health services in India were and remain severely lacking. India has only one psychiatrist for every 333,000 people.

There is just one psychologist and one social worker for every 143,000 people (WHO, 2018). Until very recently, counseling as a profession hasn’t existed, and even today there is no regulatory structure covering counseling services, and most of those who call themselves counselors are not adequately trained. Together, these conditions set the stage in the early 2000s for the real birth of the EAP field in India. And in a country with a population approaching 1.4 billion and a rapidly emerging economy, they continue to provide an environment for EAP to flourish. EAPs Evolve to Fit the Market The first EA firm in India was, founded in Bengaluru in 2001 to serve the rapidly growing IT industry there. 1to1’s initial clients were multinational corporations who were already familiar with EAPs in their other locations. Over the next ten years, as Bengaluru became the hub for high-tech companies in India (known as the “Silicon Valley” of India), other international EA firms also set up offices in the city. Even today, Bengaluru remains the center of the EAP field in India. From their central EAP offices there, EA firms typically serve corporate customers and coordinate client services throughout India and in

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Sri Lanka, Bangladesh, and other neighboring areas. An interesting aspect of Indian EAPs is how the predominance of multinational corporate clients, most with large employee populations working nights in 24/7 call centers, have affected the functioning of the EAPs. For example, one EA firm noted that their lowest client call volume is daytime Monday. Volume of calls begins building Monday evening (when it’s Monday morning in the U.S.), as the Indian call center employees are starting their Monday evening/ night shifts. Saturday and Sunday in India appear to be among the busiest time for calls. India has 23 constitutionally recognized official languages and many more that are spoken by well over a million people each. This means that EA help centers have to be able to handle calls in multiple languages, and that all EAP staff be multiculturally sensitive and knowledgeable. The predominance of Millennials among both employee clients and EA professionals requires that EAPs in India be technologically sophisticated in order to compete. In addition to providing typical face-to-face and telephonic access and service options, EAPs also have introduced Internet-based options, including email and chat. Even these services are labor intensive, however, and some EAPs are now exploring chatbots, which can conduct initial intakes and, based on the presenting issues, advance to screening

assessments, providing resource links, offering referrals when needed to staff or network providers, and other services. Challenges and Opportunities India has a long cultural tradition in its marketplaces of customers bargaining for the lowest possible price. This tradition carries over into the Indian business community, including the corporate marketplace for purchasing EA services. The result is even greater downward pressure on EAP prices than that experienced in most countries. Fortunately, the exploding demand for mental health services in general, and EAP services in particular, may help mitigate that pricing pressure. India has no training standards or quality regulations for counseling services or outpatient therapy, nor are these services typically covered by insurance. This means that EAPs are frequently the most reliable and accessible source of counseling and mental health care available in a given community. With high demand and growing awareness in the business community, EAPs have begun to expand beyond their original multinational corporate base to serve more indigenous Indian companies. This trend is expected to accelerate as India’s economy continues to grow and diversify. v Let’s Continue the Discussion My thanks to the following individuals for taking the time to meet with me in India as I was preparing this column: Isabel Paul, CEAP, of People Wellness;

Amber Alam of Optum India; Archana Bisht & Ellen Shinde of 1to1 Help; Karuna Baskar of ResilienceWorks; Lynette Nasareth of CGP India; and Maullika Sharma, CEAP, of WPO . Let’s continue the discussion of EAP in India and elsewhere around the world! If you have comments about this article or ideas for other countries we should explore in future issues, please email them to me or post them online, where you’re welcome to contact me anytime or to post questions or suggestions on EAPA’s LinkedIn group. Dr. John Maynard served as CEO of EAPA from 2004 through 2015. Prior to that, he was President of SPIRE Health Consultants, Inc., a global consulting firm specializing in EA strategic planning, program design, and quality improvement. In both roles, he had the opportunity to observe, meet, and exchange ideas with EA professionals in countries around the world. He currently accepts consulting projects and speaking engagements where he can make a positive difference. He can be reached at


Bureau of Labor Statistics (BLS). (2017). Retrieved from https:// Patel, V., Ramasundarahettige, C., Vijayakumar, L., Thakur, J., Gajalakshmi, V., Gururaj, G., Suraweera, W., Jha, P. (2012). Suicide mortality in India: a nationally representative survey. The Lancet, Jun 23, 379(9834):2343-51. Statista. (2018). Retrieved from World Health Organization (WHO). (2018). Retrieved from http://www. health/about_mentalhealth/en/.

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featurearticle Developing Internal EA Experts in China | By Peizhong Li, PhD


his article discusses internal EAPs at work organizations in China, focusing on the people who manage and work in those programs. I will explain the roles, characteristics, and expertise of internal EA workers, as well as their needs, challenges, and gaps in training and professional development. One difficulty in studying EAPs in China (and elsewhere) is the lack of systematic data collection and reporting. There are no statistics on how many internal EAPs exist in China or their prevalence among various types of work organizations. Professional associations are weak and have negligible influence. This article is based on information released to the public by employers, vendors, educational institutions, as well as the author’s experience in working with corporate clients and colleagues. The concept of EAP is less well-defined in China than in the United States. My discussions include both self-identified internal EAPs and EA-like programs with a mental-wellness focus housed within an organization. Sometimes the EA-like programs are referred to as Employee Care or Mental WellBeing programs.

An Overview of Internal EAPs in China In the United States, EAPs started from within the work organization in the form of peerto-peer self-help movements such as the Occupational Alcoholism Programs. Third-party vendors came on the scene later, following the development of the broadbrush approach. In China, EA development proceeded in the reverse order; international vendors brought the basic idea and rudimentary practice of EA to China in the early 2000s, when they followed global expansion of their clients, especially multinational companies. Internal EA-like programs are a late comer and generally regarded as more limited in depth than external EAPs, which are considered to be specialists, if not experts or “pros”. Internal programs are seen as more exploratory and experience-based, while the larger external vendors are believed to follow more or less established protocols and models. Broadly speaking, there are two categories of EA-like internal programs, which are (1) what I call the “hire a shrink” approach and (2) in-house support programs. The “Hire a Shrink” Approach The “hire a shrink” programs hardly qualify as EAPs as defined

by the standards of the Employee Assistance Professionals Association (EAPA); their existence demonstrates the need for employee mental health services, instead of a form of mature EA practice. In these programs, the employers simply hire a number of counselors who are either on the company payroll or on contract to provide consultation for employees. These programs are most prevalent among private manufacturing companies with large numbers of workers. The practice arose around 2010 in response to the harsh working and living conditions at those facilities, part of the human cost for China to become the “Factory of the World”. A series of employee suicides at an electronics manufacturing company resulted in the expansion of this practice. Between January and May 2010, 12 young workers at one company killed themselves by jumping off buildings at their factories. These incidents created a media storm, bringing attention to the plight of the manufacturing workers, most of whom are migrants from rural areas. In the midst of a public relations crisis, the company installed safety nets to the exterior of worker dorm buildings to catch potential jumpers. Others noted

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that since the company hired about half a million workers in China, a certain percentage of them would be expected to suffer from mental health issues that could lead to suicide. In response, the company then hired counselors for employees in distress. The approach quickly spread to other manufacturing companies. Counseling usually takes place in a space offering some worksite privacy, e.g., the clinic, although some companies pay counselors to see employees at their offices. With little professional supervision or evaluation, the utilization and effectiveness of these programs are unknown. It is unclear how much employees trust the employer-hired counselors. This rudimentary practice is designed for employers who hire a large number of workers with lower levels of skills and have high turnover. Most employees work at the company for only a short period of time with little concern for career development, since what they have are mostly deadend jobs. From the employer’s perspective, it is a necessary way to control the legal, PR, and medical risks of mental illness. The government, healthcare professionals, employers, and society at large are all grappling with the difficult issue of finding more effective ways for improving and maintaining the mental well-being of this segment of the population who face a significant amount of stress. It is difficult to forecast where this EA-like practice is going in the future, as the manufacturing sector in China has been chang-

ing rapidly due to declining labor supply. Some factories with resources are replacing many workers with robots, letting go many production line workers but retaining employees with higher levels of skills. In-House Support Programs In-house support programs are primarily adopted by large state-owned companies. These companies have a tradition of providing longer-term employment as well as benefits and welfare to employees. The internal EAPs are managed by the Health, Safety and Environment Department, or Trade Union, who provide employee care ancillary to HR’s benefits functions or the HR Department. At some large state-owned companies, these programs are operated by the political apparatus, which is part of the state economy. When that is the case the programs emphasize employee morale and dedication as well as corporate culture issues. Examples of these types of activities include assessment and educational programs on employees’ identification with corporate values, communication programs on organizational change to building happy enterprises. In terms of infrastructure and organization, a small proportion of these programs are equipped with a dedicated EAP Center at the corporate level, with a director leading a team that could range from a couple to dozens of people. Some airlines with branches all over the country have EAP teams of nearly 100 members at various locations. However, most programs do not have a dedicated EAP Center, and

are operated by staff as part of their overall job functions. The internal EA staff plays the role of mental health advocates, educators and occasionally “counselors” with various levels of professionalism and skills. They organize health education, stress-management and lifeadjustment (e.g. family and marriage issues) activities, such as lectures and workshops, and provide some forms of consultation and referral to employees who seek them out. Some organizations call the staff EAP ambassadors, care ambassadors, or health ambassadors. The makeup of the staff of inhouse support programs belong to two categories. The leading member(s) or key administrator may have master’s level education in psychology or counseling, while the majority of the team consists of employees who are interested in volunteering, psychology, counseling and mental health, and express a willingness to help their peers. Most of the programs also contract mental health experts from hospitals, universities and external EA vendors as consultants and trainers. The “hire a shrink” programs provide little supervision and no training to the counselors or administrators in the EAP, while the in-house support programs usually do. Some companies paid their in-house EAP staff to study for the country’s short-lived counseling licenses program, as part of their professional development. Sometimes Internal EAPs at large state companies are embedded in a hybrid program. The services provided by the external

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featurearticle vendor include training, mentoring and supervising internal EA staff. The training focuses on the systems and functions of EA, basic knowledge of psychology and mental health such as identifying and coping with mental health problems, communication about and promotion of EA services. More advanced classes teach the basics of short-termsolution-focused therapy and EA program design. Education and Professional Development Resources In terms of education and professional development in EA in general and Internal EA in particular, three themes stand out. First, there is not much in existence. Second, what is available is inadequate in terms of utility and quality. Third, not many practitioners are investing the time and money to use the available resources. Overall, education and training in the field is under-developed. Resources fall into two broad categories, i.e. systematic education programs and short courses. There is no doubt that greater development of educational resources will help promote more internal EAPs. Systematic Education Programs It is worth noting that in China, counseling has only been an occupation since 2003, when the Ministry of Labor and Social Security created this new category of work and started giving licenses through various occupational training outfits, which were usually small and newly set up. It would take someone with a college degree less than six months to

complete a course and pass a written exam to be licensed. The system had produced between one and two million licensed “counselors” before it was abolished at the end of 2017. The system was abandoned because healthcare communities and most of the bureaucratic apparatus agreed that it could not possibly produce professionals capable of working with clients in competent and ethical ways. Unfortunately, a new system is nowhere in sight. The vast majority of counselors in EAP affiliate networks trained under the old defunct system. The future of China’s counseling profession is unknown from the standpoint of regulation and supervision. The global EA profession has yet to achieve a level of knowledge development to support graduate or undergraduate programs in this specialty. In China, there are attempts and experiments in establishing formal programs in this area at institutions of higher learning. The Institute of Psychology, Chinese Academy of Sciences offers a curriculum in EAP as part of its continuing education programs. According to the school’s catalog, this is a two-year, nondegree program which can be completed either online or on the weekend in face-to-face classes. The curriculum includes most of the core courses one would take to get a BA in psychology at a US university, in addition to management-related courses such as Organizational Behavior, Behavioral Economics and Leadership, as well as EA knowledge and skills.

The EA-related topics would sound unconventional to a practitioner from North America. For example, under the heading “Operational EA Skills”, the curriculum lists courses entitled “Career Planning”, “Managing Interpersonal Relations and Communications in the Workplace”, “Building a Harmonious Family”; whereas mental health assessment, referral, constructive confrontation, and brief interventions are not mentioned. Presumably these cultural differences have resulted from the Chinese academia’s understanding of employee needs as well as the specialties in their own skill set. The instructors listed in the catalog are almost exclusively university teachers and researchers, with little experience from the frontline of EA work. Another top-tier university in Beijing had a Master of Applied Psychology Program specializing in EAP between 2014 and 2016. When the program existed, it was accredited by the education authorities of China. Since 2017, it is no longer listed in the school’s catalog. Short Courses in EAP EAPA’s China Chapter offers training for the Certified Employee Assistance Professional (CEAP) credential. This line of training provides the most authoritative and robust information on the basics of EAP from the US perspective. However, only a small number of individuals have received the CEAP credential in China so far. The usefulness of this training to Chinese practitioners is an

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important question for discussion. Some of the best practices from the US and elsewhere are applicable or practical in China’s workplace, while many services in demand in China are not covered in the curriculum. For example, many Chinese companies want systematic, multiple-intervention programs designed for new hire integration and adaptation, time-limited (e.g., three-month) but comprehensive programs for improving mental well-being and job performance at particular work locations, e.g., bank branch offices or outlets of telecom companies. Chinese companies also take a strong interest in large-sample, systematic, and longitudinal assessments of employee mental health and work attitude to build corporate norms and gain management insights in those areas. Larger EA vendors offer short courses about EAP to the public. In most cases, anyone with an interest can take them. However, the consumers of these courses are mostly counselors who want to join EA affiliate networks or set up EA programs. These courses run from several days to an entire week. They usually cover short-term solution-focused counseling, program design, account management, mental health training in the EAP framework, account management, etc. Many of the counselor training outfits have also rushed to offer EAP training since the termination of the counselor licensing program took away most of their original business. The quality and credibility of those programs has not been firmly established.

Summary and Conclusions Mental health in the workplace has become an increasingly prominent issue in the Chinese workplace. Private and state employers are more and more aware of the legal, health and management risks associated with these issues. They actively seek solutions for these issues. One approach is to put in place an internal employee mental health management system, borrowing methods and practices from internal EAPs, as known in the US, to work out their principles, mandate, scope of practice, and core technologies. The evolution of this line of business creates opportunities for systematic training and education. An important challenge in developing internal EA expertise in China is the lack of a contingent of experts who command both theoretical thinking and practical experiences from the daily operation of the profession. International experts may help, but only to a limited extent, since China EAP has taken a divergent road from North America. There needs to be an organic development of knowledge, skills, insights and experiences for future robust development of internal EAPs in China. Very few vendors have survived long enough to acquire the perspective necessary to undertake these tasks. In response to this scarcity of resources, a group of EA professionals in China and the US, including this author, have worked together to establish an EA professional training institute. The institute provides

online and face-to-face instructions on EAP counseling, administration and internal EAPs. The curriculum combines instruction with opportunities for internships and supervision. The institute’s Founding Advisory Committee and core faculty include US and global industry leaders, pioneers of China’s EA industry on both the provider and client side who have worked in the field since the early 2000s, as well as business and management professors from the prestigious Peking University. The students came from internal EAPs, vendors, clients and HR professionals and corporate managers. In addition to gaining a global and historical perspective on EA, the students were deeply impressed with the uniqueness of the EA concept and its close link with the American culture and life-style. They are also prompted to think about the elements of EA which that are universal and applicable across different cultures. This effort was designed as a first step towards systematically accumulating and summarizing the knowledge, skills and experiences of EA in China, in order to create a body of expertise that can be critiqued, developed and transmitted. v After receiving a doctoral degree in psychology in the United States, Peizhong Li spent seven years in the US and China teaching at the university level and acquiring research experience. Since 2012, he has worked as the Research and Development Director and then Vice President for Strategy and Research for Chestnut Global Partners, China. He has been a co-founder and core faculty of the Shengxin International EAP Coaching Institute since 2018. He can be reached at

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featurearticle Assessing Suicide Risk for Problem Gamblers | By Michael Goldman, LPC, CEAP


uicide in the US is a serious problem, and the statistics are dire. There are 45,000 suicides in the US each year; for every completed suicide there are 25 attempts (American Foundation for Suicide Prevention). No other addiction has as high a suicide rate as gambling. The National Council on Problem Gambling (NCPG) estimates that one in five gambling addicts will attempt to kill themselves, about twice the rate of other addictions. This article will examine the factors contributing to the exceptionally high rates of attempts and suicides among persons with gambling disorder (PWGD), ways to address this risk and suggested treatments. Overview of Gambling Disorder Most studies estimate that 1.5-3% of the adult population are PWGD. Moreover, 2.6% or 10 million people have gambling problems (North American Foundation for Gambling Addiction Help). These estimates have remained stable for many years. PWGD tend to fall into two types, action and escape. Action types are predominantly male and play games of high energy such as blackjack and craps. The “hook” for them is not the money but the

excitement of being in action. Escape gamblers are predominantly female and tend to only play slots. When an escape player no longer falls within the limits of what they can afford, they become a PWGD. Loss aversion is an important difference between people with and without a gambling disorder (GD). A person without a GD is not motivated to continue to play after they have lost money, but a PWGD will gamble despite losing because gambling is in and of itself the reward. According to the DSM V, the nine criteria for having a gambling disorder include: 1) Increased tolerance (gambling more and more over a given period of time); 2) “Chasing” losses (increasing bets in order to recoup losses); and 3) Lies to cover up gambling. A minimum of 4 criteria must be met to have a diagnosis of GD. Mild=4-5, moderate =6-7, and severe =8-9. This diagnosis cannot be made if the behavior is the result of a manic episode or Bipolar Disorder. Formalized treatment for PWGD is essential for long-term success. Unfortunately, very few affected individuals will commit to treatment unless they are forced by an external party, e.g. the courts, employer or family.

Unlike chemical dependency, the signs of a GD can remain hidden for a much longer period of time. Suicide Risk  Finances. Because it can take so long to be detected, by the time the disorder is diagnosed, the financial losses and the family impact is already devastating. It is not uncommon for decades of life savings to vanish before the family finds out. This in part contributes to the high suicide rates of this population.  Lack of physical effect. Another reason for the high suicide rate is that, unlike addictions such as drugs and alcohol, the body is not affected physically by gambling.  Co-occurring disorders. Problem gamblers also often suffer from associated disorders that exacerbate their struggles. Substance abuse issues or problems with depression and anxiety are common among those with gambling addictions. Best Practices for an EA Counselor Suspecting a Gambling Disorder The first step if the EA professional suspects an employee client might have a gambling problem is to refer to one of the many reliable screening tools for assessing gambling disorder (GD).

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One is the Gamblers Anonymous (GA) 20-question test at Sample questions include: Did gambling affect your reputation (yes/no); and after a win, did you have a strong urge to return and win more? Seven or more affirmative responses probably indicates a gambling disorder. Another tool is the South Oaks Gambling Screen at www.ncrg. org/sites/default/files/uploads/docs/ monographs/sogs.pdf. This resource reveals areas such as how often the individual gambles, how much money does he gamble? How does he gamble? (e.g. lottery, casino, etc.); and where does he get the money from? (A scoring system is indicated with 5 or more indicating a probable pathological gambler.) If GD is a possible diagnosis, it is important to also screen for suicidality. The Columbia Suicide Severity Rating Scale is considered a good screening tool. Check out Additional Best Practices Below are additional best practices for an EAP practitioner to consider.  Be on the lookout for other impulsive behaviors. A person whose impulsivity leads to a gambling problem might well exhibit other impulsive behaviors. Moreover, it’s important to note that many suicides occur on the spur of the moment. Mindful approaches like meditation are very useful in curbing impulsive behavior. Another helpful tool is

to create a list of “triggers” the client can refer to when tempted to gamble.  Talk to the family. Ask the individual if their family knows about their gambling, and how they reacted when they found out. This point is crucial because if the gambler lacks family support to deal with the problem, the more likely it is that the individual’s gambling will escalate. If there is no support, Gamblers Anonymous and therapy is even more critical.  Probe for impact of on the client’s career. Some PWGD will resort to illegal activity to continue

“If GD is a possible diagnosis, it is important to also screen for suicidality.” paying for their gambling. This might include on-the-job embezzling and other forms of theft. Loss of employment and possible incarceration are huge risk factors for a PWGD. Talking to a manager or supervisor to get to know the individual is important because a good work record alone is more common for a PWGD than a performance issue.  Consider the individual’s background. Other risk factors may include being a middle-aged male, lower socio-economic status and early onset of gambling behaviors.  Be aware of potential protective factors. As opposed to an

individual with little to no family support for gambling behavior, an intact social support system, as well as economic stability and resiliency may make it easier for PWGB to hide their problematic behavior. The EAP practitioner should not assume that an apparently solid family man with a good income couldn’t still have a gambling problem.  Discuss the various forms of recovery. Successful modalities include individual and/or group therapy and Gamblers Anonymous (GA). Therapy may include Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), emotional regulation techniques, and trigger management. When the EAP is not familiar with problematic gambling, it is imperative to ask about gambling behavior regardless of the presenting problem, just like many practitioners already do for drug/alcohol use.

Case Study: ‘Arthur’ The following steps illustrate how a specific case might proceed.  Why is the client seeking help? At our first session, *Arthur, a 64-year-old attorney, told me that he had been in alcohol recovery for the past year after going to A.A. at the encouragement of his wife. (* Not his real name.) He went to one meeting per week, and had a sponsor he spoke to occasionally. He made very few fellowship contacts outside of the meetings. When asked why he sought treatment, Arthur stated that his wife was concerned about his gambling. He was quick to add that his wife struggled with

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featurearticle anxiety and was prone to exaggeration. When asked if he thought he had a gambling problem, he said he thought he might but wasn’t positive. He said he had a history of depression in the past with some suicidal ideation but no attempts and no current desire to kill himself. It’s important to note that if there was a previous suicide attempt, the EA professional should probe for the method, how many attempts, did they receive treatment, what is their current ideation, do they have a plan, do they own a weapon, etc.  What does the client like about gambling? How did it escalate? Arthur had been playing fantasy sports online for very low stakes and really enjoyed it. He felt he was very good at it and it made him feel like a real general manager of a sports team. He said that after he started going to A.A., one of the men from the meetings spoke to him about sports betting. The man told him of his favorite website and that he had done well with it. Arthur thought it sounded fun so he decided to explore it. He did very well at first, making a lot of money. As he gambled more, he lost all of his winnings and then some. Arthur’s wife found out and told him he needed help.  Work through the individual’s denial and/or anything else that is stopping the individual from quitting gambling. The crux of our work together involved breaking down Arthur’s denial about his gambling problem. We went through his loss of control and its negative consequences. We discussed DSM-V criteria and

determined that he had a moderate gambling disorder. Arthur agreed to go to G.A., in addition to his A.A. meetings. He got a sponsor and made more fellowship calls to connect with other problem gamblers. He learned that his “hook” for gambling was the winning that improved his feelings of self-worth.  Understand the triggers that make the person gamble. We discovered that part of the problem was that Arthur also gambled to alleviate his depression. Arthur eventually gave up the fantasy leagues realizing it wasn’t about the money but how it made him feel better. Arthur gave up gambling almost immediately.  Discuss how addictions can interrelate. We talked about transfer addictions – how one addiction can lead to another one. Since Arthur had been in alcohol recovery, we determined that he needed to remain abstinent from drinking as well as gambling.

in DBT groups. These charts are like diaries in which the individual records moods as they occur, triggering events, how long it lasted, what they did about it, and what options are available when the triggers reoccur. Summary When treating a problematic gambler, it is essential to screen for suicidality throughout treatment, not just at assessment. Understanding the risk factors, especially for PWGD, and addressing them quickly can reduce the number of tragic deaths. v Michael Goldman has been a trainer and certified addictions counselor (CRADC), for the past 33 years and a Certified Employee Assistance Professional (CEAP) for the past 28 years. He is also a Licensed Professional Counselor (LPC), and a certified Problem and Compulsive Gambling Counselor (PCGC). As a trainer, Michael has developed and implemented over 4,500 hours of wellness programs. He may be reached at


 Explain the elevated risk of suicide. This discussion may vary depending on the individual, but stress that the suicide rate for PWGD is twenty times greater than the general population. Moreover, an EA counselor should always recognize that, just as an individual can hide gambling behavior, it’s also possible to mask thoughts of suicide. It is not uncommon for people to hide their intent to kill themselves and many do so spontaneously.

Addressing Suicide Risk Among Compulsive Gamblers (2013). Northstar Problem Gambling Alliance. Retrieved from http:// northstarproblemgambling. org/2013/12/2166/.

 Develop tools to help regulate mood and manage cravings to gamble. One great method is a feelings chart like the ones used

Suicide Statistics, American Foundation for Suicide Prevention (2016). Retrieved from https://afsp. org/about-suicide/suicide-statistics/.

National Council on Problem Gambling (n.d.) FAQ. Retrieved from help-treatment/faq/. Statistics of Gambling Addiction (2016). North American Foundation for Gambling Addiction Help. Retrieved from statistics-gambling-addiction-2016/.

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