Leveraging Technology to Improve Services
By Claudia Ryan, LCSW, CEAP; Cheri Anthony, LCP, PhD; and Karen Landrum, LCSW, CEA
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How does a small EAP remain relevant in the 21st century? The answer lies in adapting with the times while staying true to EAP Core Technology. Bon Secours Richmond Employee Assistance Program is an internal EAP. Creativity and the use of technology have been essential to our evolution and expansion of employee assistance programing. We continue to emphasize retaining the essential components of the EA profession, while expanding our sphere of influence in a client’s organization by maximizing the high-tech resources already at our fingertips.

History
Like all organizations, Bon Secours has seen its share of changes over the years. Like many external EAPs, we have expanded geographically. Our EAP clients are no longer housed in one hospital, but spread across the region in multiple facilities, clinics, and physician practices. Our corporate strategic goals have changed to emphasize the need to improve employee well-being.
Leadership in our organization recognizes that quality care, patient satisfaction, and ultimately, health care reimbursements, are impacted by employee stress and well-being. Integrating with Employee Wellness to address these strategic goals has pushed us to broad-brush health interventions.
Bon Secours Richmond EAP has only one full-time and five part-time clinicians, who cover about 14,000 lives. Organizational changes have necessitated that we reach outside our comfort zone to utilize technological platforms and demonstrate the value of the organization’s investment in EAP.  
Bon Secours Richmond EAP’s evolution from only offering traditional, individual, short-term counseling (which we still do) to a population health strategy is the result of constant evaluation and measures. The movement to “whole person well-being” and the leveraging of EAP’s expertise is in alignment with our strategic quality goal of building healthy communities.
Employee surveys, health risk assessment data, EAP utilization, and data from employee hardship grant applications led us to our key areas of program development:

* stress management;
* financial well-being; and
* depression.

As programs are created, outcome measures are built in, with each category requiring unique instrumentation. Technology allows us to collect and analyze data, which helps us demonstrate our value.

Stress Management on Demand
Once population needs were assessed, we used electronic surveys to identify barriers in our organizational culture and increase engagement by adapting our interventions. For example, sometimes health care professionals can be resistant to “self-care.” Bon Secours had already partnered with Cleveland Clinic to offer a six-week stress management program, but employee feedback told us that staff did not have time to attend group classes, and it was not feasible to offer classes at distant locations or smaller clinics. 
Cleveland Clinic listened to our concerns and helped us progress to an online program. Employees now access experiential stress management programing via computer or smartphone. This online format increased employee engagement in our six-week program by 86%. However, participation made its greatest strides when the program was tailored to the unique stressors of bedside caregivers and offered participants continuing education credits (CEs). The program is making self-care accessible and acceptable to our staff. To date, this program has engaged nearly 3,000 employees, and it remains in demand. 
One drawback was that post surveys told us that a six-week class was not appealing to all employees interested in stress management. We then began supplementing our own unique programing by offering 30-minute stress resiliency webinars and videotaping one-minute mindfulness exercises, all of which are available to staff via our website. We also designed a leader toolkit to guide managers who want to bring mindfulness into their unit activities. All programs are widely marketed throughout the organization via electronic newsletters, system-wide screen savers, and emails to reach employees in every location, on every shift.

Wallet Wellness Webinars
As EAP practitioners, we have a fundamental understanding of the relationship between financial stressors and employee productivity, health, and well-being. An electronic survey of internal wellness program participants revealed that roughly 25% of our employees had experienced a financial crisis within the last six months, and 34% worry about finances daily. 
For years we partnered with our credit union to offer “brown bag lunch seminars,” but our attendance was dismal. Bon Secours Richmond EAP responded with the “Wallet Wellness Challenge,” which offered a series of webinars with the credit union’s financial experts. The series addressed how fundamental money management skills can improve financial literacy.
This completely online, self-paced program engaged 776 employees. We incentivized participation by providing regular communications via email, hyperlinks to videos, archived webinars, worksheets, and small prizes, such as lunch bags. Prize eligibility required participants to complete a brief email survey, assessing changes in both knowledge and behavior.  
The ongoing survey data identified two major behaviors that place employees at high risk for financial crises: lack of an emergency savings account and lack of a household budget. A total of 105, or 13.5% of participants reported that they “never” or “rarely” had either savings or a budget. Survey results from Wallet Wellness showed significant improvement in both areas, as participants utilized the skills they learned and moved out of these high-risk categories for financial crisis.
In fact, 31% of participants went from having no emergency savings fund to starting an emergency savings fund, and 65% progressed from never using a budget to using a budget. We follow up with clients after six months to measure the sustainability of these results, and to encourage building on their success by signing up for the next round of Wallet Wellness classes.

Depression Screening and Awareness
American society often fails to regard behavioral health problems as “real illnesses.” However, an expanded view of well-being enables us to fully embrace behavioral health concerns. Clinical depression is a common diagnosis, and the leading cause of disability, according to the World Health Organization (WHO, 2016). Because depression is also linked with diabetes (Ciechanowski, 2000), cardiopulmonary disease, and hypertension, addressing depression impacts multiple risks (Ford, 1998).
In 2013, Bon Secours Richmond EAP added a simple, clinically validated screening to our annual health risk assessment (HRA); the Personal Health Questionnaire-2 (PHQ2), a two-question, psychologically validated tool indicating risk for depression and need for professional follow up (Maurer, 2012). Those identified at-risk for depression receive immediate referral for assistance and follow-up psychoeducational materials.
Utilizing our employee wellness software allowed us to electronically screen and email psychoeducational and referral information without risking confidentiality. Not surprisingly, our HRA data verified that those at risk for depression are more likely to suffer from high-risk medical conditions. In fact, 55% of these employees were in the highest health risk category when we first assessed them in 2013.
After following this group for several years, the effects of EAP interventions on overall health have been striking. By 2015, the portion of this group in the highest overall health risk category dropped to 35%, while the portion in the lowest overall health risk category increased from 9% to 29%. Annual aggregate data generated by the wellness software demonstrated outcomes that validated EAP contribution to corporate strategic goals to improve employee well-being.

Summary
No employee assistance strategy in the 21st century can be executed without using, adapting, and applying technological resources. EAPs can retain the essence of EAP Core EAP Technology while continuing to evolve and expand the boundaries of a successful EAP. In so doing, EAP educational programing can move from face-to-face “brown bag lunches” to web-based, online webinars to reach a broader audience, and do so 24/7.
Perhaps the greatest technological change comes from our ability, as EA providers, to assess, target psychoeducational messages, improve interventions, and demonstrate value to organizations. More than ever before, we have the ability to employ electronic surveys and use data to adapt interventions, making programs easier to access, more efficient, and more impactful. Technology is proving that our expanded vision of wellness is effective, and it will make our future programs even better.

Acknowledgements
Bon Secours Richmond EAP gratefully acknowledges the contributions of its community partners to the success of its population health programing: Cleveland Clinic Wellness, clevelandclinicwellness.com and Virginia Credit Union, vacu.org. 

Editor’s note: Bon Secours received the “Best Use of Technology in EA Award” at EAPA’s 2016 World EAP Conference in Chicago.

Claudia Ryan, LCSW, CEAP, is the Senior Counselor for Bon Secours Richmond EAP. She has 25 years’ experience in behavioral health care and has been a CEAP for ten years. In addition to her clinical credentials, she holds human resource certifications: the PHR and SHRM-CP. Contact her at Claudia_Ryan@bshsi.org.

Dr. Cheri Harrell Anthony is an experienced trainer and educator in the Employee Assistance Program at Bon Secours Richmond and has been a Licensed Professional Counselor for 12 years. She is the current President of EAPA’s Virginia Chapter. Readers may reach her at Cheri_Anthony@bshsi.org.

Karen Landrum, LCSW, CEAP, brings 20+ years of knowledge on addiction and mental health to Bon Secours Richmond EAP.  In her current role she works closely with Virginia Credit Union and Fidelity to present financial webinar challenges to employees, with the goal of improving financial literacy and preventing future financial crises. Karen may be contacted at Karen_Landrum@bshsi.org.


References

Ciechanowski, P., Katon, W., & Russo, J. (2000). . Depression and diabetes: Impact of depressive symptoms on adherence, function, and costs. Arch Intern Med, 160(21), 3278-3285. 

Ford, D., Mead, L., & Chang, P. (1998). Depression is a risk for coronary artery disease in men. Arch Intern Med, 158(13), 1422-1426. 

Maurer, D. M., DO, MPH. (2012). Depression Screening. American Family Physician, 85(2), 139-144. 

World Health Organization. (n.d.). Retrieved September 6, 2016, from http://www.who.int/topics/depression/en/ Regional Office for the Americas of the World Health Organization, 525 Twenty-third Street, N.W., Washington, D.C. 20037, United States of America.