Improving the Intake Process: Customer Service, Motivational Interviewing are Crucial
By Michael Laird, LCSW, CEAP


Imagine that “Joe” is about to make a big purchase that will have implications for years to come. Or perhaps “Ron” finally decides to try skydiving after thinking about it for a long time. After summoning the courage to go through with their decisions, Joe and Ron discover that the sales professional and skydiving instructor seem to be dismissing their concerns as being irrelevant.
How would you describe your feelings if an important, emotional decision like this was met with such a ho-hum reaction? Some people would not have any difficulty in still going through with the transaction. But for others, like Joe and Ron, lack of interest in their feelings could mean they won’t go through with the purchase, or step out of the airplane. 
Let’s say that Joe is calling his EAP for the first time after thinking about it for days. If Joe feels the exchange is nothing more than a transaction and that the intake professional has little or no interest in his individuality or feelings, the implications could mean the difference between Joe getting the help he needs, or falling through the cracks. 

The Importance of Intake in EA Services
The vast majority of clients first come into direct contact with their EAP by calling an intake telephone number. For employees looking for counseling services, the decision to make that first call could easily feel like a free-fall. It may seem like a tacit admission of a problem that has long been denied.
Or it could reveal feelings of insecurity as a result of placing themselves in what is perceived to be a vulnerable position – unsure about whether or not the person on the other end of the phone can be trusted or will understand how they are feeling.  
While client interaction during the first contact call is usually limited, the intake professional is ideally positioned to not only ease these concerns and facilitate a warm transition to other EA services, but is also in the position to create a positive first impression that will resonate throughout the remainder of a client’s experience with their EAP. 
EAPs can also assist managers, supervisors, and union officials calling with a request for consultations, workshops, group interventions, or other EA services. While it is arguably less daunting for one of these professionals to call, it is equally important to be aware that there may still be feelings of uncertainty.

Customer Service Standards
At this point, a reader may be thinking, “How is customer service related to employee assistance?” Or, “Isn’t customer service for businesses only?” It is true that many of us don’t usually think of EA services in relation to a business model; however, it is important to remember that much like a business selling products or services, we are offering services that can either be accepted or declined. Additionally, while intake professionals are not incentivized to sell services, we definitely want them to interact in a manner that allows a client to trust the intake professional and trust that the services being offered will be helpful. 
According to a report by the Disney Institute, “All organizations are driving toward the same goal – serving the people who purchase their products and services. Whether they are called clients, customers, constituents, or in Disney-speak, guests – organizations must satisfy them or risk losing them” (Disney Institute & Kinni, T., 2011, p. 10).
The Disney brand is one of the most well-known, respected, and successful businesses in the world. Part of this success is a result of their dedication to customer service. Dick Nunis, an early consultant for Walt Disney, defined quality standards that would set Disney apart from the competition: safety, courtesy, show, and efficiency.
Safety extends the notion that guests were to feel safe and have peace of mind while participating in the Disney attractions. Each guest was to be treated with courtesy, which meant that every guest was to be treated like a VIP and with respect and recognition of their emotions, abilities, and cultures.
Each guest was to be given a show – that is, seamless and exceptional entertainment. And finally, the parks were to run efficiently in order to maximize the guest’s usage of the properties (Disney Institute & Kinni, T., 2011). These standards continue to exemplify the Disney experience today. 
These standards should also apply to EAPs. When clients are going through the intake process, we want them to feel safe. Our clinical backgrounds and dedication to confidentiality should help to ensure this. 
Clients should also be treated with courtesy. A client-centered approach to each intake call will make the client feel as if he or she is the only thing that matters at that time.
While EAPs are not in the business of entertaining others, we are able to provide short-term problem resolution services. That is our show. Lastly, we want to make sure that our clients are able to efficiently access EA services. One way to do this is through good communication.  

Communication
A breakdown in efficiency leads to many problems in communication. This usually reveals itself in guest perceptions of wait time. According to University of Chicago Hospitals (UCH) officials, most patients commented less on the length of the wait than how the wait was handled.
In trying to better understand guest perceptions, it’s important to point out three vital factors relating to patient care:

* Access – Patients want access to care and are frustrated by voice mail, scheduling difficulties, and restrictions.
* Respect – Patients describe a strong need to be recognized and treated with dignity.
* Communication – Patients express fear that they are not being completely informed.

Upon closer examination, communication is at the center of the Disney World quality standards and the University of Chicago Hospitals factors of patient care. Disney World and the UCH understand that they have exceptional products and services. It is just as important to make the customer feel as if they are able to access those products and services with accurate information and respect.
Congruently, communication is also at the center of EAPs. We know that the services we offer help our clients manage challenges they face and in turn help organizations function at an optimal level. It is the intake professional’s role to communicate this message to clients.  

Motivational Interviewing
Since EAPs have a strong clinical foundation, it is also essential to view the intake process through a clinical lens. Many of the clients that call the intake line do so in a state of ambivalence. Ambivalence is defined as, “The state of having mixed feelings or contradictory ideas about something or someone” (Oxford Dictionary, 2016). The intake professional’s goal should be to help callers who are in this state to overcome those mixed feelings. Motivational interviewing is an approach that can help achieve this goal. 
Motivational interviewing has been defined as a, “client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence” (Hohman, 2012, p.3). According to Hohman, the three aspects of motivational interviewing (MI) are collaboration, evocation, and autonomy support. 

Collaboration
Within the framework of MI and the intake process, collaboration means that the intake professional and caller work together to determine what the main problem is and then discuss options and services that may help resolve the problem 

Evocation
After establishing a collaborative effort, it is important to evoke the client’s own thoughts and feelings over their concerns, and elicit their own goals and ideas in order to resolve those concerns. 

Autonomy Support
Clients always have the right to self-determination. It is crucial to allow clients to make their own decisions. Most EA services are voluntary. As soon as the EA intake process seems mandatory, it is more likely that the client will remain in a state of ambivalence (e.g. uncertainty about which course of action to follow). Therefore, it is important to provide autonomy support when the client is determining whether to utilize EA services.
Motivational interviewing assumes that the client knows how to make the best decision – in this case deciding to use EA services. It is the role of the EA intake professional to accurately inform clients about the services and to allow the client to feel comfortable enough to make the decision to access those services. 

Summary
In my experience, the intake process is much more than an interaction between the client and intake professional. It is important to see the intake process as the beginning of a larger and more interconnected process. The EAP’s policies and procedures lie at the foundation of this process. Each EAP will have their own distinct methods that have been designed to best serve their clients. An understanding of this foundation is essential in order for an intake professional to conceptualize his or her role as their EAP’s front-line professional. 
Building on this foundation is the intake professional’s ability to develop effective communication with co-workers. Communication is not one-sided. It needs to come from each staff member: clerical staff, clinical professionals, management, providers, etc. An EAP is in the business of connecting people to people. The ability to communicate effectively is vital to build the network necessary to deliver services to clients. 
I have also found that it is important to understand who may be calling. A good starting point is to actively engage in cultural competency opportunities and develop your own cultural competency. Clients have their own unique socio-economic and cultural backgrounds. It is a best practice to have an awareness of how those different backgrounds can affect client trust, communication, and the decision on whether or not to access EA services. 
In addition, it is important to have an idea about the kind of work that clients perform. This can be more difficult in larger EAPs due to the number clients served. However, having at least a broad understanding can help intake professionals establish rapport, and better understand some of the issues that revolve around their areas of concern.   
Lastly, I have found that the best way to gain the trust of a caller is to use empathic responses during the conversation. Empathy may be defined as the ability, “to perceive the internal frame of reference of another with accuracy, and with the emotional components and meanings which pertain thereto...Thus empathy involves understanding the world or problem as the client sees it without identifying with or taking on the problem” (Homan, 2012). 
We want clients to know that we are interested in how they feel and what they are going through. Most clients want to be understood. They are reaching out in the hopes of being understood. We want to be able to convey that we do in fact understand, during that first, important call. 

Michael Laird, LCSW, CEAP, is the program coordinator for the Personal Support Program (PSP), AFSCME IL. He is responsible for the intake department. He may be contacted at mw_laird@yahoo.com.

References
Disney Institute, & Kinni, T. (2011). Be our guest: Perfecting the art of customer service. Los Angeles, CA: Disney Editions. 
Hohman, M. (2012). Motivational interviewing in social work practice. New York, NY: Guilford. 
Oxford Dictionary (2016). Definition of ambivalence. Oxford University Press: Author. Retrieved from https://en.oxforddictionaries.com/definition/ambivalence.