Subject Matter Expert Section

Written By: Christina Thompson, Magellan Health Services

Steven Haught, AFSCME

Charlie Williams, Center of Substance Abuse Prevention, SAMHSA

The EAP Joint Industry Alliance addresses a range of behavioral health
topics and issues that are important to the employee assistance field.
To aid in that mission, subject matter experts are often invited to
attend the meetings and asked to give presentations on issues of
interest to the employee assistance community. Outlined below are some
of the subject matter experts that attended Alliance meetings, along
with the topics they presented on.

Ron Mandershied, Ph.D., Chief for the Survey and Analysis Branch of
SAMHSA's Center for Mental Health Services and member of the Alliance

[September 1999]{.underline}

Dr. Mandershied convened the first EAP Joint Alliance meeting. His
presentation focused on the responsibility of employers to make sure
their EAPs effectively coordinate quality mental health and substance
abuse services for employees and families in need. The Alliance was
convened to improve collaboration and communication between SAMHSA and
the private sector organizations linked to behavioral healthcare choices
available to employers to assist their employees. No external guest
speakers attended this meeting.

[December 2000]{.underline}

Dr. Mandershied provided updates on the mental health system, Decision
Support 2000+, core data sets, transformational software and clinical
and system guidelines. He also raised the issue of HIPAA and its impact
on the delivery of EAP services. Majeela Uzan, President of World
Strategic Partners, spoke about the following year's Mental Health Forum
in Geneva.

Majella Uzan, CREDENTIALS, President of World Strategic Partners

[June 2001]{.underline}

Ms. Uzan presented on the Global Conference and Club of Geneva. The
conference's intent was to bring together prominent members of the
European, North American and South American EAP industries to . develop
a global framework for addressing mental health in the workplace and to
identify international EAP standards, definitions and practices.

Melvin Haas, CREDS, TITLE of SAMHSA's Center for Mental Health Services
(CMHS)

[June 2002]{.underline}

Through his work with CMHS, Dr. Haas has explored mental health issues
and how the September 11 terrorist attacks have changed perceptions
about employee assistance programs.

On April 23, 2002, CMHS met with the American Psychiatric Association
(APA) to answer the following question: What are we doing in corporate
America to promote mental health? Are employers developing trauma
programs? Are companies working together to address the issue of
disasters in the workplace? As a result of that meeting (?), the APA
formed partnerships with 14 different large- and medium-sized companies
to work together on addressing what corporate America can and will do to
respond to trauma in the workplace.

Four people were represented at the plenary session -- each with
experience in dealing with terrorism:

1.  Ambassador Bushnell, CREDS - former? U.S. ambassador to Guatemala.
    Bushnell was stationed at the American embassy in Guatemala when it
    was bombed.

2.  Neil Cohen, M.D. or Ph.D. -- former Health Director for the State of
    New York. Dr. Cohen was in charge of responding to 9/11.

3.  Carol North, CREDS -- TITLE or ROLE of Department of Psychiatry in
    St. Louis. North responded to the Oklahoma bombing. HOW?

4.  Cory Thompson, CREDS -- Chief Safety Officer for the Postal Union.
    DID HE HAVE A ROLE IN THE ANTRAX ATTACKS?

Three groups were formed to explore the following issues:

1.  Early intervention in the wake of a disaster

2.  Bioterrorism

3.  How to build organizational capacity to deal with terrorist attacks

The outcomes of the sessions were two-fold:

1.  Preparation of a manual for the corporate sector to us in developing
    a response to terrorist attacks

2.  Preparation of a manual for psychiatrists to use in addressing
    terrorism at the at the local, state and federal levels

Dr. Haas presented 22 key points:

> \- Disaster planning is crucial.
>
> \- The CEO must be involved in disaster planning.
>
> \- One person must be in charge of coordinating the company's
> response.
>
> \- A corporation has a responsibility to do something for its
> employees and a disaster plan must address the human side. \[what do
> you mean by this?.
>
> \- Families must be given time to plan.
>
> \- CEOs must buy into the issue of human capital management and work
> to employees back to production as quickly as possible.
>
> \- Data must be provided that demonstrate how well a response works
> when you plan. (Also, how poorly it works when you don't plan.)
>
> \- A protocol must be developed that addresses the issue of continuing
> operations; one person must be in charge of this.
>
> \- Disaster planning just as important for small businesses as it is
> for big businesses.
>
> \- Corporate officers must realize that an employee reacting to a
> terrorist attack can continue to do their job. Officers also must
> understand the difference between acute stress disorder and post
> traumatic stress disorder
>
> \- Behavioral health is essential to public health and public health
> is essential to homeland security
>
> \- Dual diagnosis should be addressed. \[is that what you're trying to
> say with the following?\] Overlap between mental health disorder and
> substance abuse disorder
>
> \- Because of its stabilizing influence, the workplace can play an
> important role in the larger societal response to terror. People need
> structure when their normal response is to "flee")
>
> \- Accurate information is crucial. What do we know *and* what must we
> learn
>
> \- EAP professionals must attend refresher training courses \[is that
> what you're trying to say with the following?\] Frequent and realistic
> training.
>
> \- Primary care physicians are the primary line of defense and must be
> trained in disaster response.
>
> \- Confidentiality must always be a priority,.
>
> \- Stressors may trigger a genetic predisposition.
>
> \- a well-prepared and *structured* response follows a plan
>
> \- An employer's contradictory messages: "Take your time" and "Go back
> to work" must be addressed.
>
> \- Use the ties people feel to the workplace.
>
> \- Focus on the resiliency and workers will return to productivity
> rather than to the disorder

To summarize:, early identification, early intervention and a focus on
getting back to work are key to effective disaster planning.

The proceedings of the meetings are currently being written up.\[what do
you mean by this?\]

Frank Cavenaugh, CREDS, TITLE of the Office of Personnel Management
(OPM)

[June 2002]{.underline}

Mr. Cavenaugh's presentation, "Data Collection for Government Programs,"
discussed the following:

-   OPM collects data for federal programs and congress.

-   In 1970, a law was passed that required the federal government to
    provide services to address alcohol problems \[was this law passed
    by the NIAA?\]

-   In 1972, the issue of drug abuse was added to the law described
    above. Occupational health representatives worked hard to get these
    programs up and running.

-   In the mid-1970s, OPM spoke to other agencies about problems other
    than alcohol/drugs. EAPs were formed and OPM developed a nationwide
    data collection and reporting system.

-   During the 1980s, 80% of the cases that went to EAP were not
    substance abuse-related. All services were voluntary. The data used
    in Capital Hill hearings provided a reasonable snapshot of what was
    happening in federal programs.

-   In 1986, Congress passed a law that required all Federal programs to
    report data to Congress. Federal agencies resent the reporting
    requirement.

-   In 1997, the Office of Work/Life Programs was formed and
    "teleworking" became a hot issue.

-   Program managers need to be able to read a report and understand how
    the program is funded, whether or not it is supported by government
    and whether or not the program is accountable.

Marilyn Henderson, CREDS, TITLE of the ORG

[March 2003]{.underline}

Marilyn Henderson presented on Decision support 2000+ and discussed the
following:

-   Establishment of Core Data Sets

    -   Performance indicators and consumer oriented report cards to
        address access, quality, appropriateness, outcomes, program/plan
        management and early intervention/prevention.

-   Population Based

    -   Patient/client; human resources; ????? and the organizations.
        This would be a revision of the 1989 Data Standards.

-   Consumer outcome measures that address consumer perception of
    outcomes, functioning, symptom relief, recovery, health status and
    adverse events.

-   Accountability to improve quality of care and managing mental health
    systems.

Allen Daniels, CREDS, TITLE of the ORG

[December 2003]{.underline}

The Institute of Medicine's (IOM's) Quality Chasm Report discussed "Six
Aims for the 21^st^ Century Health Care System and the Ten Rules for
Redesigning the Health Care System. Dr. Daniels presented "Crossing the
Quality Chasm: a New Health System for the 21^st^ Century -- What is the
Role for EAPs?" which focused on challenging EAPs to look at the
following issues within the context of the "quality chasm":

-   Is there an existing policy framework on quality for EAPs? (e.g. the
    relationship to existing standards?)

-   Does the IOM framework have utility for EAPs?

-   Should a health policy framework be used for EAPs?

-   Should EAPs be considered in the health care discussion?

-   Can the "quality chasm" framework be a useful tool for employers to
    consider their employee wellness and health benefits?

Dr. Daniels recommended that the Alliance familiarize itself with the
Quality Chasm Series at [www.iom.edu](http://www.iom.edu/). He also
provided a review of the five reports in the series, along with specific
questions for the EAP field related to each report's focus:

-   ***To Err is Human: Building a Safer Health System*** -- Do EAPs
    have a definition of errors and mechanisms to track them?

-   ***Crossing the Quality Chasm: A New Health System for the 21^st^
    Century*** -- Are the EAP standards for quality consistent with
    behavioral and general healthcare?

In addition, Dr. Daniels provided a list of the IOM's "six aims" for
improving health care:

-   safe;

-   effective;

-   patient/person-centered;

-   timely;

-   efficient;

-   equitable.

He also presented the IOM's "ten rules" for the redesign of 21^st^
century healthcare systems and suggested an examination of them in the
context of their relation to or implications for EAPs:

-   care based upon continuous healing relationships;

-   care customized to patient need and value;

-   patient is the source of control;

-   knowledge is shared and information flows freely;

-   decisions making is evidence based;

-   safety is a system priority;

-   transparency is necessary;

-   needs are anticipated;

-   waste is continuously decreased;

-   cooperation among clinicians is a priority.

He then reviewed the six "challenges" for the redesign of the healthcare
system and their relevance to EAPs :

-   redesigning care processes;

-   effective use of information technology;

-   knowledge and skills management;

-   development of effective treatment teams;

-   coordination of care across patient conditions, services and
    settings over time;

-   use of performance measures/outcomes for continuous quality
    improvement and accountability.

He concluded with a presentation on a few of the IOM tools for "crossing
the quality chasm:"

-   ***Unequal Treatment: Confronting Racial and Ethnic Disparities in
    Health Care*** -- How are racial and ethnic disparities manifested
    in EAPs?

-   ***Leadership by Example: Coordinating Government Roles in Improving
    Health Care Quality*** -- Should EAP performance measures be
    consistent with other areas of behavioral health? Can we develop
    common systems of performance measurements across these spectrums?
    What is the difference between common and core outcomes measures.

-   ***Priority Areas for National Action: Transforming Health care
    Quality*** -- What are the crosscutting roles for EAPs in the health
    status of their beneficiaries?

Dr. Daniels wrapped up his presentation by challenging EAPs to answer
the following questions: Are EAPs healthcare-based entities or
performance management entities? Do EAPs function primarily as portals
to the healthcare system? Does this IOM framework (and its "six aims"
and "ten rules") have at least some relevance as EAPs bridge to and
interface with the broader healthcare system?

The Alliance members engaged in a discussion of the implications and
relevance of the IOM's framework to the EAP field, focusing specifically
on the "six aims" (safe; effective; patient/person centered; timely;
efficient; equitable) and the "ten rules" and whether there were any
other measures of relevance to the EAP field. It was concluded that
these six aims and ten rules do have relevance to the EAP field and
provide an initial framework for the EAP field to use in considering the
existence and/or development of related performance measures that may
bring consistency to the EAP field.

Pam Greenberg, CREDS, TITLE of the American Managed Behavioral
Healthcare Association (AMBHA)

[December 2003]{.underline}

Ms. Greenberg presentation "Update on EAP Exception Request" was
submitted by AMBHA to the Department of HHS \[OR SAMHSA?\]. It provided
an overview of the exception request recently submitted by AMBHA based
upon the premise that, "if EAPs are supposed to comply with HIPAA, then
the standard transactions do not adequately address most EAP workflow
and business processes." AMBHA specifically requests "an exception from
the transaction requirements to allow us to develop, test, and introduce
standards in the form of modifiers, or EAP specific codes, as
appropriate for EAP business needs." After further discussion and some
expressed concerns about the description of EAPs as healthcare entities,
EAPA and EASNA representatives in the Alliance agreed to take this
exception request to their respective organizations for further review.

Jeffrey Mitchell, CREDS, TITLE of the ORG

[April 2004]{.underline}

Mr. Mitchell presented on "The State of Critical Incident Stress
Management (CISM)." He was assisted by Don Howell, President of the
International Critical Stress Foundation, Inc. (ICISF). Mitchell's
presentation contained an overview of the International Critical
Incident Stress Foundation, formed in November 1989, and the Critical
Incident Stress Management Program (CISM) -- both of which have provided
crisis intervention/stress management training to 30,000 to 50,000
people a year in 28 countries. He stressed the need for standardization
in training approaches for managing traumatic stress and discussed
prioritizing services in relation to the degree of trauma experienced.

He then recommended two articles located on the following website -
[www.icif.org](http://www.icif.org/) - that address the confusion that
exists around the use of the terms Critical Incident Stress Management
(CISM) and Critical Incident Stress Debriefing (CISD), along with the
concerns with PTSD. Briefly put, CISM is now the more generic and
inclusive term used to describe intervention efforts within four weeks
of a crisis event. A variety of techniques may be utilized. CISD is used
to describe a specific, formal, seven-phase group discussion process to
assist a homogeneous group in their response to a critical event. CISDs
were never intended to treat PTSD and should only be conducted with
those who have been trained in critical incidents.

The Alliance will continue to invite subject matter experts to their
meetings and ask them to raise current, relevant interests that impact
the EAP industry as a whole.