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An EAP-Based Program to Identify and Manage At-Risk Employees

An EAP-Based Program to Identify and Manage At-Risk Employees. Michael A. Dvorak Paul R. Clavelle U.S. Department of Defense. Learning Objectives. Present details of one EAP’s program to identify and manage high-risk employees.

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An EAP-Based Program to Identify and Manage At-Risk Employees

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  1. An EAP-Based Program to Identify and Manage At-Risk Employees Michael A. Dvorak Paul R. Clavelle U.S. Department of Defense

  2. Learning Objectives • Present details of one EAP’s program to identify and manage high-risk employees. • Discuss practical issues that can improve the sustainability of the program. • Present outcome results from some Quality Improvement (QI) initiatives.

  3. Commercial Disclosures • Disclosure: In this presentation, we discuss three commercially-available products – SafeTALK, the OQ-45.2, and the CAMS. We have no affiliation with, or financial interest in, any of the products.

  4. Background (1) • We are an agency of the Department of Defense. Prevention of suicide and workplace violence are high priorities. • There is a great deal of support and involvement on the part of senior management. This is vital to the program’s credibility, sustainability, and success.

  5. Background (2) • Our EAP serves both civilians and military. • All of our clients hold security clearances. • All of our clients are voluntary. • All management-directed evaluations are performed by another branch.

  6. Goals of the Program • To identify as soon as possible employees who pose some risk of harm to themselves, others, or to the organization. • To collaborate with other stakeholders to minimize, and preferably eliminate, the identified risks. • To institute preventive measures that will reduce the likelihood of employees becoming a risk.

  7. Components of the Program • Training for employees and managers • Training for EAP staff • Collaboration with other offices and stakeholders • Protocols for handling emergencies 24/7 • Measuring instruments and data

  8. Training for Employees and Managers • SafeTALK: a 4-hour workshop on how to identify a suicidal individual, and what to do once you have identified him/her. • Geared to the layman. • Practical steps to take. Not a lot of theory. • Very popular. • Excellent course evaluations.

  9. Training for Employees and Managers • “Workplace Violence” This 2 hour workshop is intended primarily for managers. • What are the “red flags”? • What should you do if you have a concern? • What resources do you, as a manager, have at your disposal to help you manage this issue?

  10. Training for Managers • “Dealing with the Troubled Employee” • Day-long. Covers: • resources available to a manager, • identifying the troubled employee • steps to take (general), • specific issues, e.g., suicide and w/p violence. • Students say discussion of scenarios is the most helpful aspect of the workshop.

  11. Example of a Scenario for Discussion • One of your employees has a chronic, painful medical condition. She is very conscientious, but has taken several days of unscheduled leave recently. When you meet with her to discuss the matter, she looks discouraged, and says, “Everybody would be better off if I weren’t around.” You aren’t sure what she means by this. What do you do?

  12. Collaboration with Other Offices and Stakeholders • Our efforts often require collaboration with non-EAP offices, usually • Agency Security Operations Center (24/7) • Human Resources • Managers • Outside Care Providers • Psychological Services (formal evaluations)

  13. How we become aware of possiblyhigh-risk employees • 24/7 on-call • Other Agency offices: Security, HR, etc. • Management/coworker/family contacts. • Self referrals – telephone or walk-in • Intake form – Outcome Questionnaire-45.2. • Intake (or subsequent) interview

  14. Instruments we use to identify high-risk counseling clients • Outcome-Questionnaire-45.2 • Client self-report • Before each session • Brief – 45 items, to include: • I have thoughts of ending my life. • I feel angry enough to do something I might regret.

  15. More on the OQ-45.2 • Well-validated in EAP setting • Client answers 0 -4 for each item • 1-Never 2-Rarely 3-Sometimes 4-Frequently 5-Almost Always • Administered before each session to track client’s progress

  16. OQ-45.2 Sample Items • I have difficulty concentrating. • I feel that I am not doing well at work. • I have trouble falling asleep or staying asleep. • I feel angry enough at work to do something I might regret. • I have thoughts of ending my life.

  17. Instruments We Use To Identify and Manage High-Risk Clients • The Collaborative Assessment and Management of Suicidality (CAMS) • Counselor completes with client during session • Assessment of level of suicidality leads to a plan • We repeat it as often as appropriate in future sessions.

  18. Average Scores on the CAMS (1-5) • Psychological Pain (1-5) 3.5 • Stress (1-5) 3.7 • Agitation (1-5) 3.0 • Hopelessness (1-5) 3.3 • Self-Hate (1-5) 2.8 • Overall Risk (1-5) 1.7 • Wish to Live (1-10) 6.0 • Wish to Die (1-10) 2.0

  19. Reasons for Suicidal Ideation • Relationship problems 38% • Clinical Depression 31% • Problems at Work 27% • Alcohol 12% • Deployment-Related 12% • Combination of 2 or more 50%

  20. Age of Clients Who Take the CAMS (those at greatest risk) • 20s 38% • 30s 15% • 40s 23% • 50s 19% • 60+ 4%

  21. Clinical Procedures (Details are Covered in Policy and Procedures Manual) • Inquire about any score of 1 or more on an OQ-45.2 critical item. • If risk appears to be significant, develop an appropriately-detailed plan for addressing the risk. • Administer Collaborative Assessment and Management of Suicidality (CAMS), if suicide is a concern • If hospitalization is not necessary, develop and document a plan of action, to include steps client will take if urge becomes strong.

  22. Steps to Ensure Effective Management of High-Risk Situations • All possible high-risk clients receive immediate, top-priority attention 24/7. • Clinical Director (CD) and/or Chief (Ch) notified as soon as possible (and whenever a client endorses a 3 or a 4 on a high-risk OQ-45.2 item). • Clinician discusses plan of action with CD or Ch. asap.

  23. Additional Steps to Ensure Effective Management of the Situation • Client is added to the EAS At-Risk List, that is kept and monitored by CD. • Ongoing high-risk situations are discussed at the weekly clinical meeting. All staff are made aware of issues. • OQ-45.2 is administered before all subsequent sessions. • CAMS administered as needed in subsequent sessions.

  24. Results: % of clients endorsing “I have had thoughts of ending my life in the past week” (N = 1,040) At Intake At Termination • Not at all (0) 82.2% 97.3% • Rarely (1) 12.7% 1.8% • Sometimes (2) 4.0% 0.8% • Frequently (3) 0.8% 0.0% • Almost Always (4) 0.2% 0.1% (hosp) • Total 1+ 17.8% 2.7%

  25. Bottom-Line Results So Far • No suicides among our clients since program has been in effect (approx 3 years)

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