EAP Utilization Hack #15: Do Outreach with Post-Heart Attack Employees and Help Them Fight Depression to Prevent Premature Death

You have probably heard me encourage EAPs to look under every nook and cranny for real opportunities to identify unaddressed behavioral risk in organizations. New ways of applying the core technology can be spotted during the year if you pay attention and listen with the "3rd ear" while engaging with supervisors, counseling employee-clients, and participating in various work organization projects. Also, subscribe to a couple workplace wellness news feeds. Personally, I like Newswise.com -- it hits a lot of workplace related news that EAPs should pay attention to.
 
Today, I was scanning press releases on wellness, and spotted new research from Intermountain Medical Center in Colorado. Research conducted by this group shows that if you have a heart attack, your chances of dying over the next 10 years are higher if you suffer from depression after the heart attack, but rehabilitation can reduce this risk.

Can you guess what the opportunity might be for applying the core technology of EAPs to risk in this situation? The opportunity is encouraging employees and their family members to meet with the EAP after they leave the hospital following a heart attack. In your office, explain support services and screen for depression, encourage rehabilitation, follow up, and also refer them as needed to psychiatric help (med management) for clinical depression.

This is ripe territory for EAPs to make a difference, and the cost-benefit of this outreach can't be under-estimated in my view. So, I am declaring this an EAP Utilization Hack #15. (See prior posts for other EAP Utilization Hacks.)

In summary, the Intermountain Medical Center Heart research team (link shown below) compiled information from 7,550 patients who completed at least two depression questionnaires over the course of one to two years. These are patients who had heart attacks.

Patients were categorized based on the results of their survey as never depressed, no longer depressed, remained depressed, or became depressed. Following each patient’s completion of the last questionnaire, patients were followed to see if they had any major cardiovascular problems such as a stroke, heart failure, heart attack or death.

At the conclusion of the study, 4.6 percent of patients who were no longer depressed had a similar occurrence of major cardiovascular complications as those who had no depression at all (4.8 percent).

Those who remained depressed, however, and those who became depressed throughout the study, had increased occurrences of major cardiovascular problems — their rates were 6 and 6.4 percent, respectively. Treatment for depression resulted in a decreased risk of cardiovascular risk that was similar to someone who didn’t have depression.

So EAPs, the strategy is to talk more about depression, how's its treated, and educate people about this brain disease. Encourage self-referral, and follow up during the year. I suggest you read these heart-related research studies on depression and its impact on cardiovascular health. See if this avenue of EAP utilization improvement doesn't make your EAP one that has greater value, and hopefully one that is less easily contracted out to managed care. You may also save a few lives along the way.

Helping Employees Overcome Emotionally Challenging Workplace Incidents that Distract from Productivity and Contribute to a Deteriorated Workplace Climate

There is one topic that you should seek to include in your EAP newsletter to employees. These topics tackle "emotionally challenging workplace incidents and events.” For the most part, these are intra-psychic stress issues, but articles or content offered to help employees tackle them will be the most appreciated because they help relieve emotional distress and add resilience.

An example would be how to respond to a very disappointing performance review an employee did not anticipate. Another would be criticism from the boss that blind-sides an employee. A nasty interaction with a coworker in the staff kitchen can ruin the whole day, and others include difficulty accepting feedback from peers, struggling with triggers and angry feelings when ignored, and being ostracized, bullied, or passively "aggressed" against. Much of this is about incivility, but the scope of these events is much broader. They represent interactions with coworkers, for example, where their might be purposely withheld compliments about one's new dress. The silent treatment is another one. These actions and similar common emotional stress experiences in the workplace take a toll on productivity. Your EAP newsletter can masterfully target them.

Employees look for articles like these. They will anxiously await articles that help them conquer stressful undesirable emotional states. They are a life-ring that you throw to workers to help them find resiliency in the EAP's outreach. Consider the content of a recent article below, and you will get a very good feel for what I am referring to.

Although eagerly welcoming constructive feedback, employees who accomplish a lot on the job know their successes will sometimes rub others the wrong way. Not everyone will be quick to praise one's triumphs when they are cast into the limelight by supervisors or others who recognize your achievements. Sound familiar? Sometimes these achievements are met with criticism for whatever reason. Do you know how to cope with such experiences? Learning to detach from unhelpful criticism is a skill to help you stay motivated, adapt to change, and think more creatively about your job. Try these “inoculations” to beef up your immunity: 1) Remember that those who criticize don’t know the real you. 2) See negative criticism as possible validation that you are “on the right track.” 3) Accept criticism of your success as normal and part of life’s challenges. 4) Search for the truth in the criticism, if any. Something about it may be helpful despite the style of its delivery. 5) Let criticism inspire you to work with even more vigor toward accomplishing your dreams, rather than forcing you into retreat.

There are many issues employees face that create emotional distress. Targeting them with workshops, articles, handouts, and especially with your EAP newsletter will help employees in ways that they will appreciate most.

(Get copies of the last 2-3 issues of Frontline Employee or Work Life Excel by visit http://workexcel.com/frontline-employee-newsletter or for Work Life Excel, email me at publisher@workexcel.com. I will send you Jan, Feb, and Mar.

Can Your EAP Change Employee Attitudes and Create a More Positive Workforce?

There is one thing seldom discussed as a powerful purpose for having an EAP employee newsletter authored by an EAP peer. In fact, I seldom mention in it my own promotional literature about Frontline Employee.

This one thing can improve productivity, reduce the risk of violence, reduce complaints to HR, and produce a more positive workplace. The topic is changing and creating more positive attitudes among employees. There are thousand ways to go with this topic, but your employee newsletter is a powerful vehicle for delivering this sort of change to your organization.
 
Don't forget this topic in your newsletter. I can't think of a more cost-beneficial reason to have a workforce wellness or employee newsletter. So, I decided to blog about. And, frankly, this is why I attend to this topic regularly in our content throughout the year.

Insert purposeful articles on this topic about 7-8 times per year. Doing so will cause your organization to reap powerful benefits as people think about the content and seek to apply it.

A positive attitude controls our lives. It enhances our relationships. And it impacts our productivity, both in quantity and quality. I discovered this years ago, and it is why I decided to write about this subject in our employee newsletters about 3-4 times per year.

Did you know that Stanford researchers are making the case that attitude is more important than IQ. Yes, this in addition to the whole emotional IQ discussion. This is good news, and there are a lot of implications for workplace productivity in this declaration. The good news? Attitude is easier to change than I.Q. and it has significant financial payoffs.

Start with helping employees understand “mindset.” Either you have a mindset that is “fixed” or your mindset is “growth-oriented,” says researcher, Carol Dweck, Ph.D. A fixed mindset means you’re not very open to change or willing to adapt to it. You don’t view mistakes as opportunities or stepping-stones to your success. People with a growth mindset do. Hey, this is not genetic. This is a learned behavior. Sure, this is also a habit, but habits are changed to the degree new beliefs are acquired, and your employee newsletter should therefore target these concepts. (We do. Click here to get three free back issues of Frontline Employee so you can see what I am talking about.) I will send you Dartmouth College's newsletter. We started writing Dartmouth's newsletter about ten years ago. They love us. If you need, I will refer to the EAP Director there for a testimonial.

One powerful article (try this idea) is helping employees look at Thomas Edison's attitude—he kept trying hundreds of times (actually about 1000) before the bulb finally glowed.

Also, help employees look at the idea of embracing challenges. Also, what does it mean to persist in the face of setbacks--discuss this idea, too. Help employees plot a path to mastery of a skill or ability that will advance their career. Help them see criticism as gift. (There's a biggie.) Learning from criticism to achieve something more really requires an open mindset. I won't digress too far, but this whole positivism idea flows over into improved workplace communication -- both more civility in communication and more of it. That's right. When attitudes are poor, some people communicate less.

Pose the question in the beginning of your article of whether the reader  has an open or closed mindset. You can find a deeper discussion about this topic if you purchase the book  “Mindset: The New Psychology of Success,” by Carol Dweck, Ph.D. - I quick skim will give you a bunch of ideas for articles associated with this topic.

EAP Refresher Training for Supervisors Can Reduce Risk, Tragic Losses, and Perhaps Keep Your EAP from Getting "Farmed Out"

When was the last time your EAP conducted supervisor refresher training? Refresher training targets organization-specific questions and concerns supervisors have about using the EAP to manage troubled employees. It delves deeper into the work culture, examines nuances of the EAP policy, and allows discussion of "anecdotal issues" supervisors have faced (without any confidential disclosures) in their in use the EAP.

Although, you may complain about getting enough time to do first-time supervisor training, and the resistance management has in giving you face time, the following can help you paint an argument for getting the training time you need.

Here something that must be discussed: An impassioned argument does not guarantee that management will listen to your request to arrange supervisor training. And this is where you need understand the EAPs purpose. The degree to which your EAP "sells" its valuable purpose to the host organization a management tool instead of an "employee benefit" plays directly to the question of whether they will give you time to meet with supervisors. An EAP is communicated as an employee benefit to employees. But don't you look at an EAP this way. If you do, you will drift into an argument for losing your contract or program to a managed care 800#. You must market your EAP as a management tool (a pro-people, pro-organization program) and not a touchy-feely service. The latter will cause any organizational CFO to initiate discussion with the corporate board about having your program contracted out to a cheaper service delivery model.

If you can produce the results of a survey that demonstrates supervisors need what you have to offer, and with it show a direct connection to reduce risk to the organization, you increase the likelihood of getting stage time for supervisor training and re-orienting management's view of your program as something that can't be contracted out.

Consider constructing a survey of supervisors based upon the following questions and producing a report.

Please rate your knowledge in the following areas according to the scale below: 5 - I have a lot of expertise; 4 - I have a good grasp in this area; 3 - I feel adequate in this area; 2 - I feel rather weak in this area; 1 - I feel very inadequate in this area.

1. The policies, procedures and steps I would take to intervene with an employee who has

    alcohol on his breath. Comment: _______________________

2. The effects of alcohol and different types of drugs, prescription and illegal, and their effects of performance and behavior. Comment: _______________________

3. How to write an effective corrective letter to motivate an employee to improve performance or seek help for a personal problem. Comment: _______________________

4. How to make a supervisor referral to the employee assistance program. Comment: _______________________

5. How confront an employee with performance problems in such a way that might motivate them to seek help from the EAP. Comment: _______________________

6. How to write an effective performance improvement plan to resolve performance problems.

    Comment: _______________________

7. Managing interpersonal conflict between two or more employees.

   Comment:  _______________________

8. Feeling support from the organization for recommending and pursuing disciplinary action when

    necessary. Comment: _______________________

9. Writing effective and useful documentation that can support job actions or administrative

    recommendations in response to performance problems.

   Comment: _______________________

10. Giving clear, useful feedback on employees behavior. Comment: _______________________

11. Persuading and motivating employees to perform their best.

     Comment: _______________________

12. Feeling capable of responding properly to employees that may be potentially violent.  

     Comment: _______________________

13. How to monitor an employee who has been treated for a severe psychiatric condition or

     alcoholism/drug addiction. Comment: _______________________

14. The degree to which I feel an employee with an alcoholism problem has a disease, not a moral or psychiatric problem. Comment: _______________________

15. I am suspicious employees may be stealing, using drugs on the job, sleeping at work, or

stealing time, but I can't prove it. Comment: _______________________

Note that the comments section in a survey like this is critical. You will learn more this way. (Also, it will help you with questions and issues that you can send me to discuss in The Frontline Supervisor EAP Newsletter.

 

You may be able to think of more questions. These questions are only a starter. Once tallied, such questions argue on their own merits the need for training, but do not be afraid to analyze answers and make judgements yourself about what they mean. For example, if most supervisors think alcoholism is not a disease, but a psychiatric or moral issue, their attitudes are likely to interfere with their proactive use of the EAP.

Always consider the degree to which employee problems and supervisor attitudes increase the risk of lawsuits for employment practices liability. This area of discussion is a broad one and EAPs can play a significant role it educating supervisors about many issues and reducing this risk. For example, misapplication of discipline can create the grounds for a lawsuit that can cost an organization hundreds of thousands of dollars. Organizations pay close attention to such exposures, but only the truly insightful think about how to use their EAP as a prevention tool.

One last piece of advice. I know this sounds cynical, but let me say it anyway: Once you present a report to management that discusses risk and suggests what should be done about it, never let management return it to you. This is a technique used to later avoid knowledge of a risk issue if something the report predicted actually comes to pass.

EAP Integration Redefined By Mark Attridge in EAPA Journal: Now Let's Run With It

"EAP Integration" should never have meant an EAP mixed with Behavioral Health Care Insurance Benefits. (This was likely an insurance company lexicon concoction from day one.) But, finally, one EAP author has redefined the term, and with some solid discussion of research, unwittingly caused a crack in the wall that could lead to an EAP renaissance.

Certainly, you know that the Property Casualty (P-C) insurance is a world away from Health Insurance and their managed behavioral care partners, correct? P-C insurers are rich--health insurance markets pale in comparison--folks like Lloyds of London, AIG, and Hartford. These folks worry about a fire burning the building down where your EAP office is located. They also worry about things like lawsuits for wrong termination, automobile and truck wrecks, lawsuit payouts for harassment, racial discrimination, and endless workers' compensation payouts. Lawsuits for trips and falls, employment practices liability, and payments for theft of tools--yep, they insure against these types of losses too. And workplace violence, when it happens, and families sue over their grieved relatives...who pays? It's not United Healthcare. It's these big boys with P-C. They have deep pockets, but they need people like, well, EAPs. And they need everything from the Core Technology that you can throw at them. There is only one problem: They don't know you exist!

Now stick with me on this post.

While managed behavioral health care wants one thing from an EAP--assessment and help with avoidance of access to the employee's insurance afforded by the behavioral health plan, a property casualty insurance company would want everything it could possibly wring out of your EAP in order to target as many behavioral risk exposures as possible in an effort to prevent payouts for insurable and "compensable" losses. Human behavior in the workplace contributes to many liabilities and exposures, and all of these risks are born by insurance premiums. They also come with high deductibles--like $25-$50,000 for a lawsuit associated with sexual harassment that the employer must pay first.

Back injury and lengthy periods of time out of work, the P-C pays. Sexual harassment by a supervisor? Yes, the P-C pays the $5 million out of court settlement--and the large jury awards when they happen. A lawsuit for ruining a career with a wrongful disciplinary action? P-C forks over the cash. Insuring Lady GaGa's for being suspended from the sky-ceiling of the Super Bowl (if permitted) -- P-C Insurance!

Now imagine a well integrated EAP able to educate supervisors, detect emerging risks, and go anywhere within an organization (integrated EAP!) necessary to engage and discover, educate, and train, assess and consult, and all with the purpose of reducing losses. How much might this sort of "human factors exposures prevention" be worth? This is REAL EAP folks.

My guess is a lot, because the stakes are enormous. This is could also be a renaissance for EAPs. After all, about 800 members show up at a typical International EAPA Conference, while over 3000 were showing up in 1986 over 30 years ago. The field is not progressing by this definition. ("I'm just sayin'.")

It's time to engage this tremendous and financially liquid world of P-C. There are thousands of brokers nationwide. They know nothing about EAPs (other than the phone number on the back of their insurance card in the event the member has an alcohol or psychiatric issue.) There is a potentially wide open avenue for EAPs to grow and flourish in ways that have not been seen for quite awhile.

Write me at publisher@workexcel.com if you think I am off base about all this. I wouldn't have written this much except for one thing: In 1993, I went to one of the most competitive EAP markets in the U.S. (Denver) and I engaged with a property casualty insurance broker there. I trained insurance agents all about EAPs for about three hours. A week later, I returned and picked up three checks from three different companies averaging 100 employees who had never had a comprehensive EAP. Yes, two weeks later - three company contracts for comprehensive EAPs.

I then flew to Baltimore, MD to the corporate headquarters of billion dollar NSF&G (they closed down soon after) and within their boardroom made a presentation to begin an EAP division. They listened, but their staff turned over, and my funding ran out. But this opportunity is still sitting out there for the EAP field to consider. At least, that is my belief.

Mark Attridge's (hats off to him) awesome article in the Jan 2017 Journal of Employee Assistance discusses the obvious difference between a free EAPs and a for-fee EAPs, and the 400% improved utilization that one can expect from the latter. Mark in my humble opinion appears to shy away from calling these "managed-care driven EAPs." This is a disappointment and the elephant in the living room that is stepping (squashing) the EAP field. Marks research is solid content for EAPs seeking a new home in the risk world--one where they will be full appreciated, as well as traditional EAP marketing. See my 2002 article on this topic here that discusses these issues more directly entitled, EAPs Help Limit Behavioral Exposures from the NATIONAL UNDERWRITER INSURANCE MAGAZINE.

Reasonable Suspicion Training, Attendance Patterns, and Intervention

Alcohol and drug using employees who have substance abuse dependencies may in the later stages of their illness demonstrate erratic attendance patterns that lead to their termination. One common pattern that you should discuss in reasonable suspicion training is the problematic performance issues of being absent on Monday, absent on Friday, and absent the day after payday. Alcoholics or drug addicted employees aren’t the only ones who experience this attendance pattern, of course.

Depression affecting employees, for example, can easily contribute to an absenteeism pattern. In fact, oddly, once had an EAP client with attendance pattern caused by her inability to continue on any drive to work because of fear that she had accidentally run over someone when she turned the last corner while driving her car. This necessitated her turning the car around and driving back in the opposite direction to ensure no one was lying in the street injured or dead! This would happen a dozen times on her commute to work.

Despite other personal problems of employees that contribute to absenteeism, the classic pattern above is probably most common among addicts and frequently observed by managers and workforce management professionals with any significant time on the job. Typically when this symptom pattern is discussed in reasonable suspicion training, you will receive a odd chuckle from the crowd because they all know what you are talking about. (Continue to Read More on Reasonable Suspicion Training and Intervention and get the free e-book download PDF on Performance-based Intervention)

Preventing Caregiver Depression - There Are Employees You Haven't Reached

Caregivers suffer depression at three times the rate of other people. And if you do not think that this affects workplace productivity, you're missing the mark on this problem. When employees leave work at the end of the day, their "second" job begins, and like everyone else, the stress and strain of work, care-giving, and home life begin to form a box from which one feels that their is little escape. Some employees may take it a day at a time. And although few will admit it, some may secretly wish--and feel guilty for it--the natural death of their loved one. Combine this with any substance abuse issues, depression, financial problems, or the IRS bill that wasn't paid last year from a squeezed in part time job, and you risk for a seriously troubled employee. You can only reach these employees with what is an EAP newsletter for employees. I hope you have one, and I hope it is monthly. Because if it is not, you're putting on a nice show, but you're not penetrating what is known as "top of mind awareness." You've seen the stats on how many times we are bombarded by commercials and promotions on a daily basis. As I type this blog note, and glance to the right and left of me, I have count 31 such messages. I mean, it is insane! Your EAP is fighting this clutter, but you still have to figure out how to be not a pest, but a welcomed guest. The strategy is knowing the issues in the workforce, issues SHORT, INTENSE, NO FLUFF SOLUTION-ORIENTED CONTENT employees look forward to getting, and frankly, the rest is waiting for the phone to ring. I would like to add one more key. Add in writing, to the bottom of any newsletter, that the EAP is confidential. You are fighting perceptual erosion of confidentiality on a continual basis because fear of whether a program is confidential is a real energy force that is relentless. You can't fight this with a quarterly newsletter sheepishly and apologetically slipped into an employee's inbox once per month. Use this content in your next newsletter that I wrote - you may do so without attribution.

The following is copyrighted content that may be used by you the reader of this blog post. No attribution required, but you could put a copyright and link to http://workexcel.com, we would appreciate this very much because it allows us to improve rankings on search engines (and it harder now that ever!) So, you may also edit this article and add your professional expertise to it. However, for an editable, reproducible, web usable, and brand-able EAP Newsletter and articles of this type for your company, EAP, or wellness program, go here.
PREVENT CAREGIVER DEPRESSION
Since depression is a disease and not a moral or character failing, you must be on-guard for its signs and symptoms exactly like you would for the flu during the wintry months. In your case as a caregiver, this may be periods of time when you are under inordinate stress from sort of responsibility. There are many symptoms of depression, and the EAP is at your disposal for a full assessment, but here are five important rules regarding depression and personal awareness especially for caregivers: 1) Don’t dismiss stress you are experiencing and the symptoms you suspect may be depression by using positive "self-talks” and internal lectures to yourself about “handling it better” or “brushing it off.” Instead, get a quick and easy assessment at the EAP. 2) Understand the difference between “caring” and “doing.” This means being open to help from other people who love and care about you, and from services that can ease your burden or encourage independence by your loved one when appropriate. "Meals Without Wheels" may not be as wonderful as your home cooking, but it can help take the edge off of a bad day for a stressed caregiver. 3) Don’t wait to feel strained before asking for help. Learn to see the strain around the corner. If a tough assignment at work is coming soon and you anticipate conflict and added stress in care-giving, consider your options. The EAP can also help you trouble-shoot solutions. 4) Know what activities rejuvenate you and your spirit, so when you get respite care, (any extended break) you know what to choose that will best retool and re-energize your ability to carry forth. 5) Find another caregiver and develop a friend or buddy in that person, someone you can bond with socially, exercise with, or mutually find shared support.

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Learn more or see the tip sheet from WorkExcel.com associated with managing caregiver stress