Canadian HR Reporter

CANADIAN HR REPORTER October 31, 2016 8 NEWS Drug and alcohol programs, policies rarely evaluated by employers: Study EFAP usage rates often used to determine effectiveness – but does that make sense? BY SARAH DOBSON DESPITE the costs — both tan- gible and intangible — of drug and alcohol use and abuse in the workplace, just one-third (32 per cent) of employers evaluate the effectiveness of programs and policies devoted to the issue, ac- cording to a Conference Board of Canada study. Employers in the natural re- sources, education, utilities and transportation and warehous- ing industries are more likely to gauge the effectiveness. And the private sector is much more likely to evaluate the programs and poli- cies than the public sector (42 per cent versus 18 per cent). But the point of a policy isn't to just have one and to tick a box, said Mary-Lou MacDonald, direc- tor of workplace health, wellness and safety research at the Confer- ence Board of Canada in Ottawa. "It's really about the people in your organization and making sure that you can recognize, first, if there is a problem and then you establish how you're going to deal with it, how you're going to sup- port that individual to be success- ful in the workplace. If you have a policy that you don't ever evalu- ate, you don't know if it's work- ing. So what would be the point of having one, other than being perhaps compliant?" ere's a cultural cost and a fi- nancial cost to substance abuse in the workplace, said MacDonald, citing absenteeism, productivity, performance, accidents and inju- ries, harassment, violence and the erosion of relationships. "So if you're not evaluating, you don't know if you're actually see- ing a change, an improvement, if you're on top of this or not," she said. "I guess there's an ROI but that's not the focus, it's really about the people and making sure if there are problems, they're able to identify there are problems and get people the appropriate sup- port they need to return them to work… to help them get back to a healthy, productive place." But many employers may not know how to measure the effec- tiveness, said Sean Slater, execu- tive vice-president of sales and marketing at Homewood Health in Toronto. "A lot of times, they have a poli- cy because their industry requires it or it feels like the right thing to do or they know they have a prob- lem so they put a policy in place. But, like a lot of other programs, they don't have the metrics to be able to adequately measure the impact or the outcomes from those programs." e horizon for these types of cases is also long, he said. "It can go for a couple of years and so at what point do you mea- sure the effectiveness and the outcome? Is it when they come back to work or is at a certain set point sometime in the future?" said Slater. "ere's not a cure for addiction — it's a lifelong, chronic disease that has to be managed ac- tively through the rest of one's life. So, as a result, it's hard for organi- zations to pick a point to measure that effectiveness." ese programs can be costly and there's a lot of investment of time and resources, especially upfront, said Nadine Wentzell, a workplace drug and alcohol con- sultant in Halifax. "e people that are making the financial decisions need to see the ROI, the bottom line. e prob- lem is so many of the benefits are intangible, they're indirect cost- related and they're not always easy to measure." e other problem is there's so much education that needs to be done around addiction, and many people have a very negative atti- tude. Many senior leaders, for ex- ample, question why they have to pay for four weeks of rehab, view- ing it as a vacation, she said. "(Evaluation is) important for the skeptics too, so people begin to see how much it improves morale and productivity, they really begin to turn around their thoughts. And sometimes the best advocate can be someone who's gone through the program and wants to serve as a peer support and/or educator for the organization. at adds a level of credibility." Top metrics used When it came to the most com- mon metrics used by employers to evaluate drug and alcohol policies and programs, "number of known cases identified" (26 per cent) came out on top. e number of workplace injuries or accidents (19) per cent and absenteeism rates (15 per cent) were also in the top five. But it's hard to know for sure which metrics are directly related to alcohol or substance use or abuse, said Wentzell. "e only time you're going to know is if someone self-identifies," she said. "ose are all things you can look at but unless you're ask- ing the questions and you know specifically that the individual has had a substance abuse problem, those are very general statements to make. And those questions are usually not asked." Because employers are starting to manage disability or have been managing disability better over the last few years, there's more data around presenting issues and accommodations, said Slater. "ere's all kinds of organiza- tions that are either required or choose to count or track their in- juries and accidents and the most extreme deaths in the workplace. If we can point to drug and alcohol abuse or use as a driver of those numbers, can we then look to see is your drug and alcohol policy and practice — and it's more than just a policy, it's the practice that follows the policy and the culture that an organization builds around that policy — is that having a posi- tive impact on injury, accident and death in the workplace?" Also popular as a measure of effectiveness are utilization rates for employee family assistance programs (EFAPs), at 24 per cent, found the Conference Board. It's a third party offering confi- dentiality, said MacDonald. "ere's professional support there, there's a program designed, custom, for the individuals to get appropriate help… and with sub- stance use, as with other issues, there's a stigma attached to it so moving through the EAP (em- ployee assistance program) sys- tem is not only easily accessible but it's private and anonymous." But the EAP's effectiveness also needs to be analyzed, she said. "ere's lots of information, a wealth of information that can be provided through an EAP to be able to determine if that's being effective… determining not only what the particular situation is but are people actually getting back to work, how many weeks… the shortage of time required, what kinds of treatments are needed and so on." Another issue is many people will only access an EFAP if they're very desperate, and many provid- ers will only report back the num- ber of calls related to a specific is- sue, not the details, said Wentzell. "It's better than nothing, abso- lutely, but I don't think it begins to really touch on what needs to happen with employees. I believe much more strongly that you need to have a self-identification com- ponent of your policy," she said. "Some EFAPs have greater depth in dealing with addictions than others, and some EFAPs will be very good and hire specialists or support paying for specialists in this area and others won't; it depends on what their model is and what their profit margin is… Some of the best addiction specialists, the EFAP companies won't hire them because they view their costs as too high and they'll hire (people) just out of school." Often, the EFAP only offers a few triage sessions and then noth- ing happens, said Wentzell. "Much of what they have in (the report) doesn't identify the whole problem or is not as all-encom- passing or as accurate as they're portraying it to be." EAP usage rates overall can serve as an indicator of the aware- ness and acceptance of the pro- gram by employees, said Slater. "If we really want to get into how the EAP program is being used, then we need to look at what are the problems an organization wants to solve and are they getting better today because of the EAP program or not? Versus whether it's 10 or 20 per cent utilization across the business," he said. "A 20 per cent utilization speaks more to the culture of an organi- zation and the promotion of the program, and how an organiza- tion has chosen to promote the program — it doesn't really tell you what problems are being solved or not." EAP usage related to addiction for people who self-disclose is a re- ally small number, said Slater, "so I'm not sure individuals in an or- ganization think of the EAP first." But an EAP provider can ar- range an assessment, clarify di- agnosis and help a person build a treatment plan through expert evaluation and recommenda- tions. ere might also be bridge counselling between diagnoses and treatment, "to keep them motivated and thinking about the recovery," he said, along with fol- lowup post-treatment. "It might be the entry point to treatment or the access point to treatment. So they know they have an issue so they reach out. e EAP was never designed to be that long-term, intensive treat- ment that someone suffering from addiction needs." Also among the top five metrics employers use to gauge effective- ness was "number of referrals to treatment" (17 per cent). But employers don't always know when someone is going to treatment, said Slater. "Like any other short-term dis- ability case, the employer is not entitled to know why the person's off, it's just a validated absence through the adjudication process of short-term disability." However, employers in the oil patch in Alberta, for example, have quite a good handle on what's happening with employees on the addiction front, he said. "Almost all of them have a policy in place, most all of them have pro- cess in place to manage it, they've got an understanding and a prac- tice in place around employees go- ing to treatment and coming back from treatment, what needs to be in place to bring folks back from their treatment, ongoing moni- toring when they do come back, relapse programs, approaches to what happens when there's a re- lapse. So there's probably some in- dustries that are more evolved out of a sense of necessity than others." And it's not just about metrics, said MacDonald. "ey're often lagging indica- tors so it's having management trained to really understand the signs of substance use, which is re- ally closely connected with men- tal health, of course... So having a workplace that reduces or elimi- nates the stigma around all of these things so you can more quickly identify when there's a problem." An effective program around drugs and alcohol involves a mul- titude of components including incentives for self-identification, addiction specialists, ongoing education and after-care support, said Wentzell. It's also about tak- ing a health and safety perspec- tive, as opposed to being punitive. "You put as much in place as possible to make sure it's as easy as possible for people to get help." "If we want to know how the EAP program is being used, we need to look at what problems the organization wants to solve."

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