EAPs as risk managers: to regain their identity and value as risk managers, EAPs must distill information about organizational problems into broad concepts, then use this knowledge to help managers act strategically.

The ongoing search for the EAP identity is directly related to the search for EAP value. The value of an EAP is never static--it is always changing.

In my 30 years as an EA professional, I have watched the struggle for identity and value generate a variety of new terms, program designs, and labels. Risk management as part of a distinct EAP identity was put forth by former EAPA Exchange editor Rudy Yandrick in his book, Behavioral Risk Management: How to Avoid Preventable Losses from Mental Health Problems in the Workplace. Rudy made the case that identifying potential mental health and behavioral problems on the job, along with providing distract intervention and prevention strategies, were key roles for EA professionals and of value to employers.

For a brief period, the concept of providing value through risk management generated some excitement within the EAP field. Some EA professionals even chose to add the term "risk management" to the list of services they provided. Over time, however, this concept became part of the fog surrounding the search for EAP identity and value and lost its initial luster.

To answer the question of whether EAPs are risk managers, the obvious and simple answer is yes. The more difficult questions are whether EA professionals are actually providing risk management and, if so, whose risk are we managing? If we are managing risk, is anyone noticing? Are we conducting risk management for the individual client seeking EAP services or the customer that purchased an EAP with business expectations?

To answer these questions, we need to ask a tar more important question: What is the value of EAP risk management as practiced in today's business environment? We also need to ask whether the EAP of today focuses on the client or the customer and whether we understand the difference.

EAP VALUE IN MANAGING RISK

In the early days of the EAP field, the workplace was in the midst of the post-Vietnam societal war on drugs. Employers found themselves "at risk" with returning veterans who had been traumatized by their war experiences and were returning to a society that too often rejected them as willing instruments of a failed government policy The easy access of drugs and alcohol in Southeast Asia and growing drug culture at home provided a convenient escape.

Employers valued people and programs that could assist them in addressing the growing substance abuse culture in the workplace. EA professionals were seen as drug and alcohol abuse experts who could get someone admitted into treatment with a simple phone call. The EAP's value in risk management was the ability to assess and refer employees and support them through the recovery process.

In the 1980s, through the help of researchers like Paul Roman, John Erfurt, and Andrea Foote, the EAP field was able to show a valid relationship between its work and subsequent reductions in benefit costs and absences and improved productivity In addition to managing the workplace risk of employees with alcohol and drug problems, EA professionals could now show a financial impact on the bottom line. EA professionals were seen as part of the business culture, called upon by managers, executives, and union leaders to assist in dealing with a broad variety of behavior-related risks. EA professionals were "connecting the dots" for employers regarding the impact of behavioral health and the workplace.

DISRUPTIVE BUSINESS DRIVERS

What has changed since the early 1980s that we are again trying to redefine risk management value and our identity? A key aspect of business operations is that the value proposition changes if a product or service can be produced on a scale that captures cost and scale efficiencies. In business research jargon, this value change as a result of a new method or innovation is called "disruptive innovation."

The advent of managed behavioral care and the growth of technology tools took what initially had been an internally provided value--most early EAPs were internal programs--and turned it into a commodity product. These factors, combined with rising benefits costs and economic recession, made the outsourcing of EAP services a better value than insourcing. (For more information on how disruptive innovation is affecting the EAP and behavioral health field, read "Shaking Up The Behavioral Health/EAP Field" in the September/October 2003 issue of Behavioral Health Management.)

What was once considered an individual EA professional's skill set of having a network of providers, facilities, negotiated rates, information, and services was, in the 1980s, bundled into large managed behavioral health organizations that were able to "transact" EAP services faster and cheaper. This "factory design" of service delivery could crank out EAP services 24 hours a day, seven days a week with good results. Employers' costs for employees' mental health care was reduced, individuals received appropriate treatment through a discounted network of providers, reasonable follow-up and case management services were provided, and the risk of harm to self or others was addressed. Managed behavioral health account executives provided quarterly reports and information on utilization and delivered special briefings to their multiple company accounts as risk issues arose.

In sum, the value of the EAP field changed to a "transactional" service. This change can be seen as the forerunner of the outsourcing of a number of internal business functions, such as payroll, accounting, human resources and information technology. Today, virtually all EAP services are provided through a transactional behavioral health/EAP firm directly or indirectly through a subcontract with a management group that also handles other outsourced transactional services. The number of remaining internal EAPs probably can be counted on two hands.

This "disruptive innovation" in our business is not a negative. Tremendous improvements in service delivery, technology, and cost have resulted from the change, and thousands of new jobs have been created (with little likelihood they will be moved offshore soon). What has gotten lost in this disruptive change is the translational value of EAPs.

TRANSLATIONAL SERVICE VALUE

When deciding which functions of business operations to outsource, a key consideration is whether a service is transactional, i.e., whether it can be provided more cheaply by capturing efficiencies of scale and scope. Higher-valued business operations, in turn, are known as "translational" services. Translational opera lions are those that make sense of avail able data and incorporate them into the strategic big picture for purposes of business planning and operation.

Translational services require a great deal of specific information about the business and its strategy and competitors, industry trends, and environmental influencers. Translational value delivers the best EAP risk management value to the customer, but it is hard to find in today's EAP environment. The cost-efficient EAP model preferred today involves large service centers that gather hundreds if not thousands of contacts regarding a business and systematically put them into reports that contain little translational value.

Achieving translational value requires asking several questions. Are EA professionals willing to ask their service center teams for themes, concepts, or the "temperature" of a particular customer? Are they able to translate these themes and concepts into useful information for EAP customers in a timely manner? Would this information be welcomed by their customers?

These questions will answer whether or not EA professionals are helping to manage an organization's risk. To deliver risk management in today's competitive business environment, however, our field needs to consider making a number of changes

First, we must recognize that risk management is a consultative service to managers; it is distinctly different from clinical tools or surveys or utilization reports. Consultation to management requires a higher-level skill and knowledge that few EA professionals today are delivering. Translational value derives from a discussion or dialogue wherein an EA professional leads a manager or executive to act strategically by identifying previously unknown organizational problems or concerns.

The concept of improving the consultative relationship with business customers is just starting to capture interest in the EAP field. One good resource is Peter Block's classic book, Flawless Consulting. This easy-to follow text teaches the reader how to create successful value-driven consultative engagements between two parties. So applicable is this text to the higher level of translational work that Federal Occupational Health's U.S. Postal Service EAP national consultants and the Magellan supervisors of the Postal Service contract used it in a customized training on consultative account leadership to improve the business-oriented service value for one of the largest EAP accounts in the world.

In addition to mastering the basics of consulting, it is critical that EA professionals learn to see the big picture front the eyes of business so they can translate risk management concerns for executives. Are EA professionals using business language and making associations that ring true with the organizational bottom line? Too often, EA professionals' comfort with clinical terms and associations prevent them from effectively communicating with business customers.

REBUILDING INTIMACY 

EA professionals need to determine whether there are "walls" that prevent them from being seen as effective risk managers to organizational customers. Is the wall of confidentiality so high that it prevents effective translation of themes and issues that provide insight into possible risks? Has HIPAA (the Health Insurance Portability and Accountability Act of 1996) really made that wall thicker and higher? I continue to be astounded at the number of my colleagues who limit their interaction with organizational customers out of tear (unrealistic tear, in my opinion) of somehow violating individual confidentiality or HIPAA.

To translate EAP services into risk management value, the EA professional will need to be conversant about the customer's business strategy, competition, and partners as well as future business trends and value propositions. For example, how will an aging workforce affect workplace behavior, risks, and liabilities in additional to organizational design? How do the growing number and unique needs of female employees affect the organization, its benefit structure, and its future? How is the technology-driven, 24/7 work schedule affecting human performance, and is it contributing to the risk of burnout or other conditions? How will the growing healthcare cost crisis affect the ability to address workplace well-being issues? How does increased tear of terrorism affect a global workforce? These are current and future trends that affect workplace behavioral health.

From the very beginning, the EAP field has been offering risk management services as they relate to human behavior in the workplace. What we have lost is the ability to effectively translate risk data from the current commodity style transactional program design. As a result, the intimacy that we used to have with our customer organizations--intimacy that is needed to be an effective consultative translator has been diminished. If EA professionals are to be effective risk managers, they need to rebuild this intimacy with organizational customers and learn how to be effective consultants who can bring value to bottom-line business concerns.

Finally, for those who may be asking how to do this, I recommend you read Peter Block's latest book, The Answer to How is Yes. When we spend so much time worrying about how, we never get to yes. If you want to call yourself an EA professional, you must be a risk manager for your organizational customer. Don't re label yourself--just realign your program with the EAP Core Technology The essence of risk management is in there.

References

Block, Peter. 2002. The Answer Ill How is Yes: Acting on What Matters. San Francisco, Calif.: Berrett-Koehler

Block, Peter. 2001. Flawless Consulting: A Guide to Getting You, Expertise Used. San Francisco. Calif.: Jossey-Bass.

Derr, W. Dennis. 2003. "Shaking Up the Behavioral Health/EAP Field." Behavioral Health Management, 23 (3): 14-19

Yandrick, Rudy 1996 Behavioral Risk Management: How to Avoid Preventable Losses from Mental Health Problems in the Workplace. San Francisco, Calif.: Jossey-Bass.

Dennis Doff is president of Integrated Human Solutions and senior consulting partner with Signature Resources. He provides employee assistance and organizational consulting to government and business, He can be reached at dennisderr@integrated-human-solutions, corn or at [phone].