The King Has No Clothes: Managed Care's Utter Failure to Harness the Power of EAPs

One of the things I have attempted to do over the past 25 years is help EAPs see themselves as part of the organization's larger risk management strategy. This is no way conflicts with the touchy-feel (aka, program of attraction) model EAPs depend upon. On the contrary it enhances it.

Things like employee newsletters and other utilization and promotion devices are risk management tools and part of the critical continuum of best practices organizations must embrace to reduce loss.

And wow are these tools inexpensive. I would like to see more organizations phoning the EAP and saying, "Hey, make sure your renew the employee newsletter, it is probably saving us thousands or millions by increasing your referrals." 

There are many other tools EAPs can assemble, but this is just one of them. These things are not "nice to haves" as they are often portrayed by uninformed (or misinformed.) Nay, they are essential risk management, and potentially, "going postal" prevention tools.

Until recently, I really could not determine why the value-added argument everyone well-understood in the early 1980's was not working better for EAPs, and why instead EAPs  service vendors and internal programs were closing faster than a creeping forest fire in Gatlinburg.

The idea the EAPs can grow and grow to capture more unmitigated risks associated with human workplace behavior should have overwhelming acceptance by now. I have theory: "The King has No Clothes" . Managed care wants nothing to do with the property-casualty risk market, (which is what we are discussing here), its issues, and the work and integration required to penetrate it. It simple does not meet its business goals of reducing health insurance costs and increasing profits. But EAPs did not start out this way. In yesteryear, they targeted the whole ball of wax of risk in business organizations. If you are retired from the EAP field by now, but as you read this, you know something dramatically degrading has happened to the EAP field.

If a better linkage between EAPs and their powerful risk management reduction capacity where ever truly codified, managed care would risk losing control of EAPs and the simplistic model they depend upon for their uni-polar purpose. Managed care depends on the large majority of EAPs thinking and behaving as they do, and they spend millions on publicity, educational forays, and press releases at every turn to educate the human resources continuum and public at large to buy into their understanding of EAPs as they wish them to be seen. That is, more or less counseling and assessment services with a predominant self-referral path. When the time comes, as  it seems to do almost every day, traditional EAPs bite the dust. Actually, a better way to put it would be that they are more easily assimilated like the Borg in Star Trek. ("resistance is futile.")

I helped secure Arlington County Government's EAP and the School System's EAP against
managed care contagion 15 years ago by capturing the high ground and allowing the EAP core technology to work its magic by reaching out into any area of the organization where human behavior and trouble employees became exposures that threatened the financial well-being of the organization. Arlington County/Public Schools now has a six person staff for 7,500 employees and a very healthy budget. No vendor or managed care organization can touch it (many have tried) with the large swath of EAP services it provides.

Below is an amazing Web site which contains many arguments and appropriate phraseology for EAPs to use in arguing for their larger purpose, value, and ability to manage more behavioral risks within the confines of the EAP core technology. If you face the ever-present jeopardy of closure and takeover by managed care, you may find help here. Delve deep into it, and start identifying unmitigated risks and exposures during the year. Present an annual "risk mapping report" and recommend additional growth for your EAP, not budget cuts.

The successful end result, of course, is more lives saved and more organizational costs contained. Be aggressive with risk management and program growth to help your EAP and the EAP profession itself. It has shrunk 60% in 25 years despite growth in what are called "EAPs."

The real story of successful EAPs is still be written, or re-discovered, but it is not one that will sit well with managed care. When it comes to the "lead, follow or get out of the way" approach to the EAP field (as I heard at a recent EAPA conference), be sure the one you are following has clothes.

https://erm.ncsu.edu/library/article/current-state-erm-2015

Increasing EAP Utilization Hack #16: Use a Good Health Supply Line

I want to share with you an employee assistance program utilization improvement hack I created that will help boost your EAP utilization nearly overnight. It is called the "Good Health Supply Line®". I created this service as part of the EAP program I owned in the early 90's, but since I have never seen it duplicated, I thought I would share it and let you consider it for your EAP. You are welcome to use this idea by changing the name of the service to one you find suitable, but different than mine. The following background and rationale for this utilization hack is obvious. Many employees will never phone the EAP, and so you need to make every reasonable attempt to reach them. This does the trick. Create an order form with a large menu of wellness topics that include handout titles, tip sheet titles, or booklets on workplace wellness topics, such as those distributed by Abbey Press using their product called "CareNotes." Or, you can use the workplace wellness tip sheets from WorkExcel.com (purchase the entirely library here). On the order form, allow employees to confidentially choose five topics/titles. The form should be mailed via U.S. Postal mail to the EAP office. The EAP then fills the order and mails it back to the employee or family member. Distribute a postpaid envelope with it the order form for best results. Emphasize confidentiality. Only the EAP will receive the order from the employee. Postal mail is confidential of course. The beauty of this outreach technique is the opportunity to promote your EAP with a cover letter designed to encourage the employee or family member to visit the EAP for the issues or problems that concern them, identified in the titles they chose. Do this once per year. Have the employer to reimburse the EAP directly or make it a part of your service. The titles of the booklets distributed to employees are not shared with the employer. This is also an important part of the service and key to its effectiveness.

Can Mindfulness Help to Intervene with Our National Opioid Epidemic?

A new federally funded research project will attempt over a five-year period to demonstrate that mindfulness  will reduce a person’s craving for opioid painkillers and improve the ability to cope with the intense pain for which these drugs are most often prescribed. There is evidence already that mindfulness can have some impact on managing pain. (Mindfulness is the psychological process of bringing one's attention to the internal and external experiences occurring in the present moment, which can be developed through the practice of meditation and other training.) Here is the essence: The research will attempt to restore restoring brain levels of endorphins in patients with chronic back pain who are being treated with prescription opioids. This, in turn, will make it potentially possible to reduce addiction occurrence rates. The subjects will be military veterans who suffer with more pain, trauma, and serious problems with opioid addiction. The advantage of the research will be to extend its benefits and approach to opioid addiction treatment to other people in the general population. Here's what to do: 1) Check out this news article here. 2) Follow the research 3) Find and find out what they are doing and whether you can apply these techniques to supplement recovery and follow-up work if you are currently working with recovering addicts. This is a non-medical, non-invasive approach, and I would not hesitate to consider whether these approaches might help addicts, frankly, because prior research from the same researcher shows that mindfulness has an impact on some of this stuff. This researcher should be posting a twitter account or updates that can be tracked by the general public. Consider: "Prolonged opioid use changes the way the brain functions, leading to heightened pain sensitivity, insensitivity to natural pleasure, and vulnerability to addiction—factors that may result in opioid dose escalation, which can end in overdose and death. Based on the results of previous research, Eric Garland, Associate Dean at the University of Utah hopes that with this grant he will find evidence that mindfulness meditation training through this research will restore proper function to the brain’s opioid receptors.

Don't Keep Parents in the Dark about Club Drugs

If you are an EAP, be sure to offer parents information about Club drugs in addition to more common drugs of abuse like marijuana. Parents want to be informed and armed with information about substance abuse, but the one area of drug abuse that they will have the least knowledge about are "club drugs." Club drugs is a moniker assigned to psychotropic, elicit substances that are commonly used on dance floors, at raves, and in other party locations that are often hidden or otherwise protected from police raids. (Raves are wild, often drug-fueled parties.) Club drugs tend to be used by teenagers and young adults. Club drugs include GHB, Rohypnol®, ketamine, MDMA (Ecstasy), Methamphetamine (Meth), and LSD (Acid). Any of these substances can be used as date rape drugs. Help parents know where to go to find more information about these substances. https://www.drugabuse.gov/drugs-abuse/club-drugs is the go-to source of information sponsored by the National Institute on Drug Abuse. Did you know that in the past year 2.3 percent of 8th graders used Meth? Addiction can occur with one dose. What you do think the long-term prognosis for a great future might be for an 8th grade Meth user? Not good. You'll find a lot of information on the Web site above. Consider this resource on teen drug abuse at WorkExcel.com

Increasing EAP Utilization Hack #17: Distribute an EAP Supervisor Newsletter

Create your own supervisor tips newsletter, or use ours, or someone's to build relationships with supervisors so they will naturally refer more often. You'll get more more EAP referrals, more at-risk employees, and you will see more alcoholic workers. Make it short. Make it sweet. Make it easy to read and relevant to supervisory issues, especially relationships, conflict, leadership, morale, productivity, team building, attitude issues, communication, and improving employee engagement. Send it monthly for maximum top-of-mind-awareness, not because I think you should, but because that is what is needed. Every marketer will tell you this--frequency is king, not quantity. A two page newsletter sent monthly is 50% more content per year than a four-page sent quarterly. And a 2-pager is more likely to be completely read. This is how you boost your EAP utilization. You also deepen your integration within the organization. Supervisors "sit" on troubled employees and often do not refer them until a crisis hits. It takes some nudging to get them to loosen their grip. This requires them trusting you, and then thinking of you first when a incident (or crisis) occurs. So also regularly educate supervisors about the EAP, how to refer to it, all the nuances associated with communicating effectively with you, how to avoid armchair diagnosis, how to follow up, how to help the EAP maintain and nurture the perception and reality of confidentiality, and remember to put yourself out there as a consultant regarding documentation, coaching, referral to the EAP, motivating of employees, engagement, conflict resolution, morale improvement, and making performance improvement plans more effective. You will grow your influence. Here is a sample supervisor newsletter and information.

Increase EAP Utilization Hack #19: Encourage DUI/DWI Court Programs to Refer to Your EAP

Employees of your company, or the companies you serve with your EAP, may get arrested for drunk driving. Establish relationships with the local courts, and specifically their municipal alcohol safety action DUI/DWI diversion programs to boost your EAP utilization rate. I've done it.
 
We're talking meeting with these professionals and discovering how you can help them with specific case management issues associated with clients who have eligibility to use your EAP. This could include family members.

ASAP or court-run alcohol-DUI/DWI intervention programs improve highway safety by reducing alcohol-related accidents and arrests. They are court-mandated programs for DUI and first-time drug offenders. ASAP evaluates those entering the program and recommends one or more of the following: driver education, alcohol/drug education, combination of education and counseling. All education is designed to prevent relapse and repeat offenses. By monitoring program participants, ASAP acts as a probation facility or diversion program for the courts. After completing the program, defendants either receive a certification of compliance or an order to return to court for noncompliance.

ASAP offices or similar services managing court referred DUI/DWI cases can use your services for assessment, follow-up, treatment referral, post-treatment monitoring, etc. And they have the power to make these referrals. Your EAP is voluntary, so the one caveat here is that the court can't force the offender to use your EAP, but a firm request will rarely be turned down by an anxious and cooperative client who would like to avoid going to jail. DUI staff counselors are swamped with cases. Many are difficult to follow up, and they experience frustrating communication with these court appointed clients, many of whom are alcoholic.

Some ASAP offices will accept the EAP's assessment, recommendations, and with the client's permission, allow the EAP to do the follow-up. As stated, most employees will readily accept a referral to the EAP when the ASAP counselor says, "You have an EAP with your company. We would like you to take advantage of its confidential services."

The chances are high that employees arrested for DUI are alcoholics, and this can further boost your alcohol-related EAP stats. There is nothing more valuable to an EAP than improving alcohol-related stats.

As you know, DUI and ASAP clients don't usually end up in treatment. And if they do, it is often poorly followed up--the most important aspect of treatment is follow up and aggressive participation in a program of recovery that does not dwindle. Many serious addicts get overlooked in DUI intervention programs, and your involvement may save lives on the highway if the alcoholic is motivated into treatment and properly followed up.

Call your court-run DUI/DWI intervention program. Meet to set up a cooperative relationship, and discuss how you might help them, help you. Synergy your efforts and boost your EAP utilization. Email me, and let me know how it goes.

EAP Utilization Hack #20: Make and Rotate New EAP Posters Every Six Weeks

Increasing EAP utilization is about visibility, promotion, and efforts you take to keep your program "top of mind." This means employees develop reflexes for thinking about the EAP as a "fix" for their problems. When people are in pain, they think of resolving that pain. If your EAP offers solutions  that employees can connect to their problems, they will phone. This is why you should be specific about the solutions you offer and link them to specific problems in promotion in your promotional efforts. Also, the magic is to never to underplay the importance of mentioning confidentiality in every communication. You are always marketing confidentiality because there are always forces real and imaginary that are marketing against confidentiality. One promotional technique that doesn't get enough appreciation is EAP posters. This is why I distribute a free EAP poster periodically. Three things make EAP posters work: 1) Relevance to the work culture (that means you must create them with a relevant message. Fun and easy.; 2) Rotate them or post new ones every six weeks. Six weeks is the magic number I came up with where I believe things like posters and flyers of any sort become invisible to those who have seen them 11-12 times; And 3) Problem specific. This means creating a poster that focuses on something like "Seasonal Affective Disorder" or "Teens and Drug Abuse" rather than the general as in this bad example: "When Times are Tough, the Tough Get Going to the EAP" (gag me). Okay, now you know about EAP Poster Technology.