Small Business EAPs: Last Frontier for Employee Assistance?

One of the anomalies characterizing employee assistance services to small business is that, in comparison with large businesses, the small ones may well use those services less frequently. However, the services may nonetheless be immensely more crucial to small business survival. Within this truism is a decades old marketing dilemma for EAPs. Marketing EAPs to small business is not an easy task.

How do you convince a small business of say 40 employees to pay a reasonable fee for a proactive, high-touch EAP when the EAPs success will be likely be unable to demonstrate that disaster X or crisis Y never occurred? It is easier to intuitively convince a company with 5,000 employees that the EAP probably had an impact on X and Y, especially if records of the past can be compared with those going forward. This eap cost-benefit proof is a tougher challenge.

The answer to this problem must lie in a presentation that includes cost-benefits, reduction in financial risks, and removal of stress experienced by the business owner/decision maker all of which are included in a presentation tailored to small businesses. I will begin discussing these factors in this blog and also discuss other "influencers" in the decision-making process toward the goal of motivating the decision maker to invest in effective employee assistance services.

EAPs & Liability Prevention: Someone Please Rebut This...

If you think I am nuts for talking about this, please say so, or I just might continue. Seriously. I think there is a room here for a breakthrough on EAPs getting more attention from stakeholders in the risk management arena. But listen, if you disagree, please tell me to stop kicking this horse and give me a good reason. I might be too close to my own brain to see the opposite argument. So, here it goes.

Although virtually unheard of in the EAP literature (including recent writings on behavioral risk), EAPs may prove their highest value in EPL intervention and loss prevention far exceeding health insurance cost containment. Indeed the average jury award for wrongful termination is over $500,000. Out of court settlements average $100,000. I believe this is a powerful EAP role and one EAPA can use to claim the high ground in the EPL loss prevention frenzy currently being spearheaded by big P-C underwriters.


Here's what I recommend the profession consider:

1. Establish and fund a committee on Employment Practices Liability and Loss Control to study the EAP role in preventing lawsuits related to employment practices. Survey EA professionals and the like. Survey literature to spot unaddressed opportunities and evidence that potentially new constituencies for EAPs are not aware EAPs as a solution to their loss prevention goals.

2. Contact major underwriters to learn of their knowledge current state of knowledge and the deficiencies in that knowledge associated with EAPs.

3. Create a multi-part strategy to educate these underwriters using their economic self-interest to consider effective, core tech-driven, and high-touch EAPs as solutions to problems they face.
3. Seek to establish a national dialogue with P-C insurers and insurance agencies selling EPL products. A labor-management-insurer sponsored joint benchmarking project to demonstrate interface and impact would be ideal.
4. Promote and encourage conferences, papers, and partnering opportunities along with aggressive press coverage for this linkage and by so doing, penetrate the P-C literature base.

5. Encourage the establishment of CT-EAP products offered by property casualty insurance companies as part of their programmatic approach to EPL risk reduction.

Okay, am I crazy?

OSHA Safety and Health Checklist (and No EAP)

You would have to be from another planet to not know that EAPs are cost-beneficial and that when fully implemented have a positive impact on helping reduce accident rates and injury related costs. The research has already been done 30 years ago. And EAPs reduce other behavioral losses in the workplace as well. Somehow however the recommendation to have an EAP is still not listed on OSHA's Safety and Health Management Systems Checklist. This list is no small thing. This is the front line handout OSHA distributes nationwide. It covers many recommended steps that companies should take to reduce accidents and injuries. I think "Establish a Employee Assistance Program" should be on this list. I know probably agree. Think about the lives saved, reduced accidents, and reduced injuries associated with helping troubled employees, particularly alcoholic employees, not to mention reduced property damage and lost time results having an EAP in place. How much pull to you have with OSHA? Do you know anyone there? Are you reading this post from  your desk at OSHA because you work there? (Hi!) The above PDF was last printed in March 2008! The clock is ticking. QUICK! Before this gets re-written without an EAP mention, let's get OSHA to include EAPs as an important part of a Workplace Safety and Health Management System. Right now, I see this as an overlooked and critical component that needs to be on this list. Do you agree? Phone right now while you are thinking about it. This is the office of communications phone number:  202-693-1999. If enough people phone, they will consider adding EAPs. It's the little things folks that promote this profession. Look for more of these gems--things EA professionals can do to promote their craft. Email me and I will post suggestions on this blog. Health and wellness in the workplace is dramatically enhanced when EAPs are in place.

Alcohol in the Workplace: Tinkering with the Employee's Denial

As you become an expert on alcohol in the workplace, you will need to become an expert with assessment and helping an employee-client, who may be diagnosable as alcoholic. Invariably you will bump into your employee-client's "model of denial". This is a critical juncture in your assessment interview. All alcoholics have a model of denial. This is a construct that assists the alcoholic in preventing self-diagnosis. 

It is a myth that denial is absolute in alcoholics. Denial is a defense mechanism and it is therefore employed to do battle against self-diagnosis. Non-alcoholic drinkers deny alcoholism of course, but they do not use denial in the classic psychodynamic sense of the term. It is logical and realistic to view all alcoholics as having--if not the ability to self-diagnose their illness--at a minimum, a fuzzy idea about the nature of their problems and whether drinking is in some way linked to them or associated with them. This is all that is needed to help alcoholic employees examine their "denial construct". 

So where to begin? At an appropriate point in your assessment interview, you should define denial in the following way to make an impact and help the employee move toward self-diagnosis--your goal.

Here is the definition that I finally arrived at using after testing a few other presentations to help employees move past denial. I don't simply rattle this off the tip of my tongue, however.  I piece it out in  my discussion with the employee until he or she finally gets it all. I like this definition because it seriously erodes or creates useful anxiety in the employee-client, enough at least to further the interview to the next step. That next step might be a MAST (Michigan Alcoholism Screening Test) done verbally, or some other next step in the interview and assessment process.

So alcohol and workplace intervention is enabled by the following presentation by the EA professional:

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Are you familiar with the term denial and how it works with regard to alcoholism? Here's what I have observed in many people over the years. When considering the definition of alcoholism above, many people focus on the symptoms that they do not have more than the ones they do have. Unlike cancer, where any symptom would cause alarm, symptoms of alcoholism often get ignored if other symptoms can be shown to not exist. This process is called “comparing out” of the definition, and it is a natural part of denial.

Here’s a better way to understand denial. Alcoholics usually maintain a definition of alcoholism that serves to exclude them. Alcoholics usually focus on symptoms of addiction that they do not have and use this information to avoid their self-diagnosis. Alcoholics then change their definition over time to exclude symptoms that they begin to experience.

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You can hear this definition discussed in the following video. (FYI: This video is available for purchase in several different formats as a useful tool.) It "stirs the juices" in employees, family members, and of course alcoholic employees in denial. It is also embedded in the WorkExcel.com Reasonable Suspicion Training Course for (DOT and non-DOT) Training of Supervisors.

EAPs Can Help Alcoholic Employees on Disability and Others

If you work for a company of any appreciable size, there is probably a disability insurance policy in case employees get sick or injured to the extent they can’t work for an extended period of time. Some organizations are progressive with their disability insurance, while some still live in the dark ages. 

The most progressive insurance plans cover physical injuries and illness, emotional disabilities, and yes, acute chronic alcoholism. The state of South Carolina, for example, covers alcoholism or any condition caused by alcoholism or alcohol abuse for a maximum of 24 months. 

By the way, did you know that prior to the ADA, the federal government recognized acute alcoholism as a disease without restrictions on alcoholism, but after the ADA and its language covering alcoholism, many changes were made that were actually detrimental to the acceptance of alcoholism as a disease? 

Go to the American Society of Addiction Medication, ASAM.org, website and read the policy statement and response to the language of the ADA and how adamantly opposed this organization is to the EEOC interpretation of the law, which increased discrimination against alcoholism in its belief. 

The ADA did not help alcoholics, they claim. It made discrimination worse in many ways. You will stunned at the insight afforded by this statement.  

For example, did you know that the Federal government, Office of Personnel Management issued regulations that "required" use of the EAP for employees suspected of having alcohol problems prior to the institution of any disciplinary action. If the EAP was not used, the disciplinary action would be considered illegal and void. That changed after the ADA.

Sorry for the digression --- Many physically ill patients retire on disability with acute illnesses associated with acute chronic alcoholism. The smartest organizations with disability insurance that cover alcoholism and mental disorders seek to aggressively document that the patient is participating in required treatment to arrest the illness and manage it successfully. You EAP can play this role and possibly save the employer a fortune. You'll have to feel your way into the benefits policies and administration to see if there is a role for you to play in this regard, but it can boost utilization and make your program more valuable. 

The EAP can play a key role in helping these employees who get sick or are injured, and qualify for disability insurance. Only an EA professional is proactive enough to assist employees in dealing with the psychosocial aspects of illness or injury effectively. This could conceivably assist these employees in getting back to work or in having meaningful lives. If you make headway in this area, let me know! I will make a post about it and it could encourage other EAPs to do the same and be more valuable.

I was afraid this would happen.

Depressed employees drive up costs for EAPs. Huh? An official document issued by the American Psychiatric Association states that depression in the workplace takes a financial toll on the work organization. Specifically, "in addition to claims for behavioral health care, costs due to behavioral health problems significantly impact other costs such as productivity, employee assistance programs (EAPs), disability, general medical, and other pharmaceutical claims. While most employers have developed strategies to reduce behavioral health costs, few employers make use of strategies to manage behavioral health treatment quality.

In other words, the EAP is a cost-center and behavioral health problems burden it. This statement is tantamount to saying the fires drive up the costs of fire departments, so we should find a way to put out fires better to save the costs to fire departments.

Let's be more illustrative. If you view an EAP as simply an employee benefit like a gym membership, this statement is completely consistent with how EAPs are more and more being viewed by the business world thanks to a continuing stream of published literature that has redefined them from their original intent. No longer, it appears, are EAPs viewed as management tools to address behavioral risk issues and improve productivity via supervisory and self-referral.

This view of EAPs should change or a different model for the delivery of the Core Technology (which ain't going away) should be created, and then THAT--whatever it is called--should be sold to rescue workers and management and employers from the burden costs associated with troubled employees.

The Report, from the 4th Quarter document "Mental at Work" published by the Partnership for Workplace Mental Health has, in my opinion, a worrisome view in its context of what the benefits industry sees as an EAP. Tell me I am wrong, and I will love you forever.

http://www.workplacementalhealth.org/mhwfourthqtr2010

Value Proposition or Value of Customer Expectations?

There is a lot of talk these days in marketing circles about clarifying the "value proposition" of what we sell. Simply put, this means selling the message of what we believe the value of our wares to be. We want the customer to listen. And if they 'finally' hear what we are saying, they will wake up and sign on to an EAP.

But wait. 80% at least of America's employers have EAPs the research says. So where is the market we are trying to coax into the value proposition?

EAPs have long sought to sell the "value proposition". But there is another side of the coin. The customer's needs. Managed care won this sale. To be more specific, the other side of the coin is selling to the value of the customer's expectations, and not the value proposition we possess necessarily. Mark Hunter, a marketing guru talks about this in an article entitled "Value of Customers Expectations" that he sent me.

If you are still with me on this post, let me ask, should EAPs be doing this more? If so would this cause us to shift our focus to different customers who are not using EAPs now? I think yes.

And these customers happen to be in the property casualty insurance industry spectrum. These big boys don't know about EAPs. But my belief is that they could use whatever they could possibly squeeze out of an EAP that would help them reduce risk and exposures associated with the things they insure against. This is not health insurance. It's everything else -- from employment practices liability lawsuits, suits for wrongful termination, discrimination, workers comp, property damage, the works. Imagine full-bore EAPs reducing these payouts. Hey, the average wrongful termination lawsuit is $150K out of court. It's over $500K in court and companies lose 70% of the time. Imagine an employee who didn't sue the company because his behavior or that of the supervisor was mitigated by EAP involvement. That's sounds like the beginnings of a new profession to me.

Mark Hunter is a sales pro. He speaks to thousands of sales people per year. Here's what he says, "We've all heard the rule of listening to what the customer has to say, and there's not a salesperson who thinks they don't listen to the customer.  Reality, however, is quite the opposite.  I find time after time when I'm working with salespeople across any number of industries that the failure to listen is a huge issue."

Hunter adds, "Too many salespeople believe because they know the products they represent much better than the client, they know exactly what the customer will see as real value.  Yes, you as the agent are going to have a general indication of what a typical customer wants. However, when it comes to interacting with a specific customer, you can't rely on a "general indication" of value."

Here's the thing. Businesses wanted lower costs on health insurance. Managed care sold them their solution. EAPs, unfortunately, got in the way without the ability to collectively say "halt".

And, EAPs still aren't doing much to collectively and "officially" point out diminished models of quasi-EAP products that insist on the full title to the word "EAP". I don't see this changing in the new EAP Strategic Plan. I may have read it wrong. If so, I will post my correction if someone lets me know.

Unless this becomes a targeted goal--rejecting products that do not adhere to the spirit and intent of the core technology, along with an ongoing survey and confrontation of freelance writers posting misguided articles about EAPs in over 30 HR and Benefits periodicals, I believe problems will continue. That translates to more suppression of life-saving, risk reducing, fully functioning, loss preventing EAPs in the world of work.
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I referenced Mark Hunter above. You learn more about him here: "The Sales Hunter," is a sales expert who speaks to thousands each year on how to increase their sales profitability.  For more information, to receive a free weekly email sales tip, or to read his Sales Motivation Blog, visit www.TheSalesHunter.com. You can also follow him on www.Twitter.com (TheSalesHunter), on www.LinkedIn.com (Mark Hunter), and on his Facebook Fan Page, www.facebook.com/TheSalesHunter.