Addiction Intervention Consulting for EAPs

Should you offer intervention consulting to employees who have family members or close friends with alcoholism or drug addiction problems?

You may mistakenly believe that intervention consulting requires going to where the intervention is being held, and passively being available in case expert guidance is needed at the event. The intervention industry, which is fraught with rip-off artists has promulgated the belief that intervention requires highly skilled professionals who show up on a Sunday morning after a pancake breakfast to surprise the alcoholic with a loving and supportive surprise meeting.

Nothing could be further from the truth. Intervention guidance does not require "specialists". The evidence for such an observation is in plain site. Addicts are admitted to treatment programs every day with only the hip-shot pressure placed upon them by family members or employers who accidentally, on purpose, said the right thing for the right reasons to motivate an addict to accept help. No intervention expert was present. And, I would imagine 95% of admissions to addiction treatment programs happen just like this--influence and leverage of those in relationships with addicts effectively applied.

Most admissions to chemical dependency treatment programs occur without an interventionist guiding the process, which is usually very expensive. The call to "have an expert" present effectively eliminates many people from the opportunity to ever consider an intervention. This not fair. To say to a family that they can't be just as successful without an intervention is one of the greatest disservices ever to be levied on addicts and family members.

How do you help these people? Despite attempts by interventionists to claim a high levels of artistry and to promulage fear if an expert isn't present, the reality is that the basic principles of successful intervention can be easily taught.

And, my argument is that success rates are higher if this "empowerment model" is used. That's because family members can try again if the first intervention fails, and they can become determined engines of change until it happens.

Most interventions (althought not called that) are completed by insistent family members with no interventionist present. In other words, people do say the right thing, perhaps accidentally, that motivates an addict to enter treatment. Usually these are family members who have decided to make treatment “non-negotiable.” The result is admission.

So, how do you add this expertise to your EAP?

The logistics. Such a meeting to educate an employee should include at the most four or five persons who have significant influence or leverage. More than that, and too much cross talk emerges dragging out the training of these individuals. (From experience and having done as many as 11 trainings in one week, the two major tools of intervention are helping family members IDENTIFY and USE tools of "Influence" and "Leverage".

Influence is the value or weight assigned to the relationship one person has with the addict. Leverage is something that can be given or taken away, which the addict greatly fears. Each of these are crucial tools in interventions, and they are used differently, and at different times, as I will explain. My argument in this blog of course is to argue that addiction intervention training skills should (and I would like to argue must) be a part of your scope of service. It is perfectly within bounds of the EAP Core Technology.

The instructional meeting will last about two hours. (This is not treatment or group therapy, although I know many therapists who have illegally/unethically bill for it through 3rd party reimbursement.)

A person with addictive disease has a medical illness. You are providing common sense principles of constructive confrontation to help family/friends motivate the addict to accept help. This is not therapy.

Your first task is to get information about the addict. Get the family to tell you the whole story. Get a feel for the situation. Next, enter a discussion about addictive disease. You must determine each of the participant’s knowledge about the disease and ensure that each of them understands the biogenic nature of the illness. Educate as you go. Any participants with “psychologically oriented,” or “willpower” models about the disease will sabotage the intervention.

Ultimately exclude such persons if they can’t come around. Coach them out of the intervention. Next, you must deal with guilt. Each of the participants will feel guilty about the intervention to some degree. These persons will also sabotage the intervention if they can't get past it. Help them see that they are not going “behind the addict’s back”.

Most of this guilt is based upon an enabling dynamic fueled by the addict’s direct or implied demands for loyalty in order to avoid confrontation over a period of years. Explain this to erode their mistaken beliefs. My next blog note: The Intervention Training Meeting Part I.

I know this is a bit gutsy, and that I am going against about 30 years of convention, but people need to hear the message. By the way, the movie "I'll Quit Tomorrow" will get your company sued fast if you ever try to duplicate what promotes--bringing the family into the workplace and surprising the employee in the office of the company's president to be confronted about their alcoholism. Burn the film if it is in your midst.

Feel free to e-mail questions or rebuttals as I continue this blog. I would like to respond to your comments: publisher@workexcel.com.

EAPs and the Great Uncharted Territory of Cost-Benefit

(In this post, I am going to add a bit more to my previous post in November on EAPs and management liability. I see that I missed a couple points.)

The great uncharted territory of cost-benefit for EAPs is the positive impact they have on the bottom line in helping prevent lawsuits brought against companies by their employees for employment practice missteps and wrongdoings.

Did you know that the average out-of-court settlement for wrong discharge is over $100,000? The average jury award is over $500,000, and employers lose over 60% of the time. Health care dollar saved by EAPs do not compare with the size of the awards employers face in the lawsuit arena.

Discrimination, wrongful dismissal, constructive discharge, and dozens of other employment practices violations cost American employers billions in awards. Many of these awards are secretly agreed to by undisclosed out-of-court settlements.

So risky is the employment setting that a new insurance emerged in 1991 called EPL (Employment Practices Liability) insurance. Two companies existed then. Now over 80 insurance companies offer EPL. None of these insurers are using EAPs as cost-containment products like managed care is doing for their products. And, hardly any company is considering how an EAP can help reduce this liability in general.

EAPs are frequently first to learn of an employee's intention to sue. Indeed, how often have you had an employee in your EAP office say, "I think I want to sue?" "Hey, do you think I can sue!?" or a similar statement?

As an employee assistance professional, your task is to help the employee get their needs met in more effective ways. The buzz phrase for thwarting lawsuits and handling disgruntled employees is "alternative dispute resolution." (Yes, I know this is really a term used in labor disputes, but let's broaden this term for a second --- really, to be more precise, this term describes official channels established by management to deal with disputes employees bring, which if not managed effectively, could lead to litigation. Very frequently EAPs work things out and save management and litigation dollars. I see our ability to management conflict in organizations as a form of ADL.

Does the human resource department of the organization understand your ability to align constructively with employees and help them get their needs met without turning to lawyers? The biggest weapon you offer is an empathic listening ear and the most valuable benefit you offer employers is empathy for employees and redirection to constructive help. It’s called “putting out the fire.”

This impact of empathy toward employees that EAPs provide and that cannot be provided by other individuals in the organization who are closely aligned with management (human resources, occupational health, etc.) is under-researched and under-appreciated.

The employer who understands this empathy-redirection-protection paradigm will give you more time to educate managers. They will ask the EAP to be involved in providing management consultation. And your influence will expand as an EA professional beyond the limited role many HR managers mistakenly believe you only fill now.

You Gotta Get Out More

Sure, it can difficult because you are so busy, but few things will help keep your utilization up more than getting out of the office and traveling to the work sites to show your face to employees. In some organizations, factories, plants, or huge industrial work yards or similar settings, it's easier to simply go without a specific purpose. You go to the site, and with permission from a yard supervisor or other management official, walk in. Say "hello and greeting people as you go. NOTE: This strategy is very powerful and reinforcing, and will drive your utilization up faster if you go to the work site the DAY AFTER A TRAINING EVENT. The reason this is true, is because it is immediately reinforcing. You were just there. The memory of who you are is still present in the temporal lobes of these employees (to put it bluntly!) Do not be surprised if calls come to your EAP office afterwards or if employees walk up to you directly to chat about problems.

If you have a huge organization with multiple sites, consider assigning one of your EAP staff to that location for training, communication, and relationship-building.

Other work sites make it less appropriate to just show up and do a walk through. In such instances, you’ll need to consider a specific reason to show up. Perhaps your moving posters, dropping of cards someplace, or simply having a monthly meeting with the site manager on what needs might exist for the organization's work unit.

Why does this external rubbing of elbows work? Employees see you, consider their personal problem (remember 12-18% of the workforce has one right now) and think about calling. Then, some do. Visit again in three months and different employees will phone. The key low-dose frequency of contact with these potential clients.

Employees are also reminded about the company’s investment in them. This is appreciated and the reputation of the EAP as “being available” grows. Hint: 800#'s don't have legs.

1991-- the Pivotal Year for EAPs that Wasn't

What were you doing in 1991 when the U.S. Congress passed the 1991 Amendment to the U.S. Civil Rights Act? If you were like me, you were oblivious to its implications for the employee assistance field, but it was earth shattering and monstrous.

The only reason the EAP field didn't feel the 9.0 quake rumble under its feet was because all of us, or nearly so, were on the wrong side of the mountain mining what little gold there is in the Managed Care industry. We were trying to understand it, team with it, fight it, and for some surrender to it. Some really famous EAPs sold themselves completely--and vanished.

Where we should have been was digging for the mother lode was on the other side of the mountain. We should have been teaming up with the Property-Casualty insurance industry. That's because the property-casualty insurance industry is not interested in keeping employees from accessing their behavioral health insurance benefits and using EAPs as gate-keeping devices to save health insurance dollars--what little there is to be saved.

These big boys want everything an EAP can throw at a company to reduce behavioral risk exposures. They want--they need the core technology. Why? They pay for the lawsuits that were made possible by the 1991 Civil Rights Act. They are the insurers for damages caused by bad employee/manager/management behavior.

Are you beginning to see the picture?

So what happened in 1991? You will answer this question for yourself in just a minute.

Let me ask: Are you aware that a corporation like Denny's, Toyota, or any business entity can be sued for unlimited punitive damages for sexual harassment and racial discrimination?
Did you know that 10 years ago the average out-of-court settlement for a wrongful discharge claim was $100,000. Even better, did you know that the average jury award for wrongful termination/discharge is $500,000?

So how expensive, or better said, how cheap is an EAP that can help prevent these payouts using its tools and resources so problems never become problems? Call it "dollars recovered from loss."

Ask yourself: How many times have you, as an employee assistance professional sat in your office and had an employee grumble, "I'm going to sue this place." If your experience has been similar to mine, you will probably say, "quite a few times." Of course, if you're a pro, your approach is to help such an employee get their needs met in more effective ways than suing the employer. Unfortunately, these vital successes probably aren't statistics in your annual reports.

The 1991 Civil Rights Act relates to behavioral risk exposures of employees and managers--ones that EAPs deal with all the time. But here is the kicker: Insurance policies were developed in 1992 to protect these companies. But who is protecting the insurers? Enter EAPs.

EAPs, with their education, intervention, assessment, proactive program development, supervisor training, and effective follow up can reduce these exposures. Are you aware of the psychomedical aspects of worker injury and recovery? I would suggest you investigate it. It is rich territory for EAP application. The goal: reducing Workers Comp payouts.

EAPs haven't seen their best days yet. They're ahead. They lie in protecting companies against financial loss associated with human behavior. But these programs can't be watered down. They need to represent the robust approach that the core technology suggests.

Head for the other side of the mountain--and bring a shovel.

Cover Your W-2's and 1099s

So let's see how much of an EAP purest you are.

Depending on your orientation to employee assistance programs, it makes absolute perfect sense for the EAP cover only workers who are actually paid employees, who are full time or part time, and who receive access to the employer's benefits, especially health insurance plan.

But what about this? Should an EAP be made available to any employee who works for the organization regardless of pay status--volunteer, 1099, contract, or W-2s?

Any worker who touches the company is subject to personal problems and other forms of behavioral risk. This has nothing to do with pay status. EAPs were developed first and foremost as tools to manage trouble employee behavior, primarily substance abuse. The goal was not only to salvage employees and the proverbial secretary who costs $7000 to replace, but to protect the organization against financial loss--loss of all kinds from troubled employee behavior.

It makes sense to manage any paid worker's or unpaid worker's performance with the EAP. The rationale for doing so is based on the historical reasons EAPs emerged. I know many internal EAPs--especially older programs--that do precisely this. However, I know very few external provider EAPs that do. That's because employers don't want to pay for the extra lives and they have "met the need" by offering the EAP as a benefit only to their "insureds". They forget, or have never learned, that the EAP is a productivity tool. It is not a benefit or counseling service. It's there to protect the employer as well. Many would argue this is their first and most important purpose, and that this is perfectly consistent with the well-being of employees.

The view that an EAP is a benefit has brought us to the point where behavioral risk exposures are increasing for employers. Many don't get the number of supervisor referrals they believe they should be seeing. I have read where some HR managers are taking on the counselor role with employees. Look around the mainstream HR journals and you will find articles on the subject of "putting 'humane' back into human resources." In other words, some HR writers are calling for the HR role of pre-counseling, and then referral of employees to resources in the community. (Holy mackeral! This is what EAPs do!) This phenomenon is due to the loss of the EAP message in mainstream HR literature.

There is a need for education to help make a “cross over” to another way of thinking about EAPs, one that would renew and re-establish, what EAPs can do for organizations. We then need to market the EAP as a resource for all employees and workers, not just the "insureds". The EAP field will be better off, and so will its future. Employers may then begin to pay the necessary fees to have viable EAPs that keep their tushes out of the sling and understand why EAPs are such a good thing for them, not just their employees. Increase your EAP utilization with communication materials that actually keep the need for building utilization in mind with each article written.

EAPs: Teach this Strategy

No EA professional that I know of has ever helped a troubled employee learn this strategy, but it will go light years in helping employees with performance problems flip overnight to become outstanding employees if they aren't impeded by a severe personal problems like alcohol or drug addiction. To purchase this fact sheet go to http://www.workexcel.com/. It's reproducible and editable, and you put your name on it, etc. Search for fact sheet E076 after November 10, 2008. That is when I will have it posted.

Understanding Completed Staff Work

Maximizing your effectiveness in providing superiors with realistic and actionable solutions to problems is one of the quickest ways to enhance your value within an organization. Understanding the principles of Completed Staff Work will help you to develop a comprehensive and systematic approach to researching, documenting, and presenting your recommendations to your superiors.

Completed Staff Work is a doctrine originally developed in the U.S. military that describes the standard of responsibility, thoroughness, detail, professionalism, and accountability required when preparing material for a superior.

According to a document prepared by the Office of the Provost Marshall General of the U.S. Army, Completed Staff Work is “the study of a problem and presentation of a solution by a staff officer in such a form that all that remains to be done on the part of the head of the staff division, or the commander, is to indicate his approval or disapproval of the completed action.” (Harari)

Principles of Completed Staff Work

Independence
Creating Completed Staff Work is as much about process as result. When you are charged with finding solutions for your superior, your job is to work without further input or advice from your superior. Although certain matters may need clarification during this process, all details necessary to researching, documenting, analyzing, and providing a solution are your responsibility.

Thoroughness
Your research and analysis should be exhaustive, considering all possible scenarios,
alternatives, and repercussions in determining the best recommended course of action. This recommendation should include thoughtful and detailed steps for implementation, including contingencies for any foreseeable problems.

Clarity
Once your research and analysis are complete, you should prepare your final recommendations to your superior in a short, concise format. Your presentation should present a clear, unmistakable conclusion that leaves no question unanswered.

Ownership
Completed Staff Work requires the individual presenting the material to take a strong, clear position. Bureaucratic doublespeak and tepid conclusions are unacceptable. Your final recommendation should be one that you would be willing to stake your career upon.

Rising to the standard of Completed Staff Work requires the best that an employee has to offer. The default operating procedure in many bureaucracies is to limit personal risk, shift responsibility, and do the minimum required to “get by.”

Consistently presenting Completed Staff Work to your superiors will set you apart from peers and earn you notice as a serious and diligent professional.

Old Trick Pulls Utilization--Table Top Tents

Yes, it's simple. But, if you have a workplace with a large cafeteria, table-top tents (cardstock
paper folded in half with your EAP message on either side placed in the middle of
the table) can be effective at marketing the EAP. MS Publisher -- a common Microsoft Office software program can provide you with a quick do-it-yourself template for this marketing strategy.

Use 100# cover or card stock paper or this strategy to prevent drooping messages! It stays standing.

Consider placing five questions about your EAP that target myths and misconceptions about confidentiality, communication with management, what kind of problem EAPs tackle, and other interesting--tough but contraversial questions--on one side of the card and the answers to these questions on the other side of the card. This will stimulate conversation between employees at the table with one asking questions and the other trying to respond with the correct answer.

Everyone will be talking about the EAP by the early afternoon guaranteed.

Use questions that dispel myths and misconceptions about the EAP. Directly under the answers, consider providing additional information in smaller type that expounds on the answer given to the question on the other side of the card.

Consider these issues: Is the EAP is part of the disciplinary process? Is the EAP is therapy? Biographies about staff. Do supervisors find out what employees use the EAP? Can family members use the EAP? What confidentiality laws that govern EAP records, etc. Why EAPs formed. History of EAPs.

Don’t forget to put the phone number of the EAP on the card!