A WIDER ROLE FOR EAPs

The past five years have provided a number of opportunities for change in the EAP field: the events of 9/11, extreme natural disasters, biologic attacks, and the looming threat of a global avian flu pandemic. The convergence of these events along with increased awareness of their impact on organizations and human capital have provided a great opportunity for EAP and workplace behavioral health experts to be in leadership positions around risk and response.

One such expert is Robert Ursano, MD, the director of the Center for the Study of Traumatic Stress and professor and chairman of the Department of Psychiatry at the Uniformed Services University of the Health Sciences. Speaking at a conference of government, research, and private-sector leaders on crisis response, he stated, “Only by sustaining the social and emotional health of employees can organizations and the nation sustain continual operational effectiveness in light of today's new threat environment.”

Historically, EAPs' role has been to respond only “on request” or postevent with psychological debriefings designed to alleviate individual symptoms in response to a traumatic experience. For many organizations, however, EAPs’ postevent response is no longer enough. EAPs’ skills as behavioral experts can be reclaimed as a key consultative value to organizations.

The traditional behavioral health and EAP therapeutic approach of leading with a clinical first model does not serve organizational crisis management or response very well. This became evident following last year's devastating hurricanes, when traditional resources and responses were overwhelmed or nonexistent and continue to be in short supply. Many EAPs found themselves operating in a new environment, providing aid and comfort directly related to necessities of daily living, assisting overwhelmed HR managers in locating evacuated employees and separated family members, and supporting community responses through religious organizations. These tasks were critical to creating organizational continuity of operations.

In a recent conversation with EAP counselors working for Gulf Coast governmental agencies, one counselor pointed out that although the daily living struggle a year later is difficult, the worst thing EAPs can do is to pathologize the situation based on expectations of normal living. For Gulf Coast residents, “normal” has become different from what other Americans consider normal.

Experts on Human Behavior

In current risk-management process thinking, the term “convergence” to manage risk describes bringing together internal and external experts who have key contributions to the success of influencing and protecting employee behavior before, during, and after a crisis. This convergence of experts often includes organization and/or community leaders in medicine, security, safety, human resources, employee assistance, and operations. Each plays a key role in behavior management, preparing the workplace for operational risk management and employees’ families for crisis behavior.

Many risk-management experts speak of the three Rs of continuity:

• redundancy, in which “people knowledge” is spread and shared across a working population;

• reliability, in which people have the knowledge and ability to back up or take over for the equipment that does most of the work; and

• resiliency, in which the human factor has the learned flexibility to function under new or difficult conditions.

Together with other organizational professionals, EAPs can play an active role in improving the three Rs and planning to ensure they function well after crises. In fact, in some larger organizations EAPs actively are joining the risk-management process. Many of the larger behavioral health/EAP provider organizations, however, have yet to be able to successfully provide this level of value because of their operational and structural distance from the organizations they serve.

Behavioral health experts' new role is to link both individual and organizational preparedness with psychological and social well-being. To be successful in the linkage, behavioral health professionals and EAPs need to become active participants in the convergence conversation. Behavioral health and EAP experts can help to create critical organizational thinking around crisis preparedness and planning that puts the plans and thinking into everyday situational behaviors.

When organizations create plans, they often rely on people doing things according to the written plan and don't account for the fact that people react differently during crises. In addition, many external EAPs operate under a set plan that is expected to be applied repeatedly for all events without a clear understanding of organizational differences. Therefore, the goal of being a part of the convergence team is to incorporate a level of flexibility and relationship building within the organization that can respond to a variety of events in light of the variability of human behavior. For EAPs and behavioral health experts, not knowing or seeking to actively participate in the development of their client organizations’ disaster planning is like intentionally climbing a ladder to nowhere when it comes time to deliver support.

Psychological First Aid

After 9/11, controversy surrounded the validity of applying the traditional clinical debriefing model to the masses. Individuals' needs following the December 2004 Asian tsunami and last year's hurricanes demonstrated the inappropriate use of clinical debriefing.

One expert in this area is Carol S. North, MD, chair of crisis psychiatry at the University of Texas Southwestern Medical School and author of “The course of PTSD, major depression, substance abuse, and somatization after a natural disaster” in the Journal of Nervous and Mental Disease.1 Dr. North has been clear in her research findings that traditional clinical debriefing methodologies are not effective in crisis response. This concern also has been raised in a number of distinguished publications, including Preparing for the Psychological Consequences of Terrorism: A Public Health Strategy.2

The research across cultures and disasters tends to show that few people experiencing a critical event eventually will show the clinical symptoms of PTSD and meet the criteria for appropriate diagnosis. Most will be distressed and challenged by their exposure and require an approach that creates calm. Critical to understanding the difference in reactions is the importance of understanding that reactions follow perceptions and that perceptions are not based on exposure.

On the other hand, psychological first aid provides for the organization and its employees what has been termed by some as “operational solace.” The key principles of the psychological first aid model are to provide a sense of safety, calm, efficacy, connectedness, hope, and optimism in a manner that is nonintrusive, supportive, and educational rather than clinical in focus. David Benedek, MD, associate professor of psychiatry at the Uniformed Services University of the Health Sciences, says the psychological first aid model is best suited for the convergence of behavioral crisis preparedness and response (Dr. Benedek was speaking at a recent conference to an audience of government officials, researchers, and private-sector risk managers).

A converged team of key leaders—including EAPs—makes up what Dr. Benedek describes as the critical incident needs assessment team (CINAT). Working together pre- and postincident, this team applies the principles of psychological first aid and is responsible for the following:

• Identifying high-risk groups

• Targeting behaviors related to mental health, distress, and risk

• Identifying barriers to services, care and physical, psychological, and community recovery

• Providing education for prevention, assessment, and resource utilization

• Coaching leaders on communication and information-building and -briefing techniques

• Providing leadership consultation and guidance

• Integrating with family support systems

Moving Forward

People often speak of “lessons learned” after crises, but they seldom result in individual or organizational behavioral change. The past five years’ events are challenging the EAP and behavioral health world to rethink both individual and operational processes. The warning signals are clear, and it is up to those of us who call ourselves experts in behavioral health to begin to respond and plan for what may be some of our greatest challenges yet.

We now are aware that large-scale disasters will overwhelm the ability of any government (including our own) to respond effectively. The Department of Homeland Security has made clear that it is unreasonable to expect the government to be able to care for everyone affected by catastrophic events. Individuals and organizations are expected to prepare for self-sustaining operational effectiveness for an extended period following a critical event. There is psychological comfort in being prepared, and it moves both individuals and organizations from a sense of learned helplessness (i.e., “Someone else will take care of me”) to one of learned helpfulness or positive self-control.

A lot of work needs to be done quickly. How are we preparing to respond to a potential pandemic that would overwhelm the world's healthcare system and governments? How will we respond to the next category five hurricane or major earthquake? How will we respond to future terrorist attacks? Now is the time for EAPs to take advantage of the opportunity to redefine their risk-management roles in organizations. As a Chinese proverb so aptly reminds us, “You are a fool if you wait to start digging a well until you are thirsty.”

W. Dennis Derr, EdD, SPHR, a Senior Consultant with Signature Resources, has more than 30 years of experience with EAP and behavioral healthcare, having directed internal programs in both Fortune 500 companies and the government. Dr. Derr provides consultation to organizations throughout the world. He currently oversees the delivery of EAP services for the United States Postal Service. Dr. Derr also is a member of Behavioral Healthcare's Editorial Board.

References

1. North CS, Kawasaki A, Spitznagel EL, Hong BA. The course of PTSD, major depression, substance abuse, and somatization after a natural disaster. J Nerv Ment Dis 2004; 192:823-9.
2. Butler AS, Panzer AM, Goldfrank LR, eds. Committee on Responding to the Psychological Consequences of Terrorism. Board on Neuroscience and Behavioral Health. Institute of Medicine. Preparing for the Psychological Consequences of Terrorism: A Public Health Strategy. Washington D.C.:National Academies Press; 2003.