JEA Q. 2 2019

Going Digital: A Roadmap for EAPs
By Navya Singh, PsyD; Tom Shjerven, CEBS

Recent innovations in technology and predictive analytics are profoundly changing the world around us.  Smart phones and mobile apps, big data, and artificial intelligence are all affecting how we live and work. These developments are changing how EAPs are providing services and will have significant impact on how workplace behavioral health is practiced and delivered in the coming years. 
Some EAPs are beginning to incorporate evidence-based mobile apps into their practice: self-management tools to help employees track and manage chronic health conditions such as depression, anxiety, substance abuse, and/or diabetes; apps to add support to the care provided by a counselor or doctor to help build the skills and confidence needed to sustain healthy habits; and as an early intervention for employees not yet meeting the criteria for a formal diagnosis, but who can benefit from education on risk factors and appropriate prevention strategies. 
Still, most EAPs have barely scratched the surface in leveraging these technologies to fundamentally change and improve service delivery (the ability to effectively scale their expertise), user engagement and outcomes (lower stress, depression; better sleep, more productivity, etc.).
To differentiate themselves in today’s cost-conscious health landscape, EAPs need to know what to look for in an “enabling” technology that allows them to extend their expertise and deliver better results to more people…and for less money.
Equally important, they need to have a clear and realistic understanding of the challenges and know what to look for in a technology partner to drive the process – from needs assessment, to planning, through implementation and follow-up. 

The Central Challenges
Many digital health products fall short because they apply a strategy to healthcare that was developed and refined in the tech sector, versus taking a “need-driven” approach that starts by deeply understanding an important problem in workplace behavioral health and then designing a technology that is uniquely suited to solve it.
For instance, CRM (customer relationship management) and ERP (enterprise resource planning) technology are often sold on the breadth of features that looked good during the presentation, but are seldom used when actually implemented. You see this in mHealth apps, where the “fun” component – say, a leaderboard for health-related achievements (more miles run, etc.) – loses its novelty and the app is abandoned. 
New technology takes time to integrate into practice. The section below shows how this can be done with online exercises based on CBT (Cognitive Behavioral Therapy) and/or mindfulness techniques. It’s also important that the technology offer users an easy way to reach and engage a counselor when needed.
Mobile health apps and games may be user-friendly and fun, but many are flawed in that they’re entirely self-administered and produce numbers – heart rate, number of steps, etc. - without having the appropriate expertise available to interpret these numbers and provide support for real, lasting change. For instance, many focus on tracking stress without providing any clue as to how to develop resilience strategies.   

Toward a Hybrid “High-Tech, High-Touch” Solution
Digital technology supports connection and collaboration by giving both the patient and population the ability to share information needed to make better decisions. The digital “migration path” can be as long and winding – or as short and brief – as you make it, and no two EAPs will necessarily follow the same route.
That said, here are several core elements that all EAPs ought to consider as they evaluate technologies that improve service delivery, access, engagement and, ultimately outcomes. The platform or app should:

* Provide EAP clients with the ability to navigate the platform or application on their own. They should have easy access to customized interventions, with psycho educational content that people can work through actively. 
* Be aligned with core principles and approaches. For instance, EAPs that focus on CBT, Mindfulness and Positive Psychology should use technology that facilitates interventions that are based on these techniques and methodologies.   
* Connect users back to the EAP for more personal counseling. The platform or app should make it easy for employees to seek out clinical experts for personal guidance, and to augment and guide additional interventions and solutions. 
* Offer Artificial Intelligence based assistance to clinicians (it’s not a bot trying to replace experts; it’s AI to enable experts to reach more people faster).
* Provide analytics that enable clinicians to assess the success of the program from start to finish. For instance, has completion of the sleep module resulted in users self-reporting heighted alertness, less irritability, etc.
* Generate ongoing promotional messages to promote EAP engagement and utilization. These messages ought to be measured based on how they resonate with platform users and should help create steps to action. 
* Integrate with other programs through screenings, tools and content to guide the right level of access to care at the right time for employees.

How it Works
Here are several concrete examples of how EAPs can move their core programs to a digital platform. Each component or module includes an online assessment and a guided, user-driven program, each with a specified number of sessions.
The assessments can screen and identify employees struggling with anxiety, depression, anger, relationship concerns, post-traumatic stress, substance use, work engagement and sleep issues and others, in order to provide appropriate referral to clinical care, self-use programs or coaching (as determined by the EAP partner). 
The self-assessment programs outlined below are based on Cognitive Behavioral Therapy (CBT), mindfulness and positive psychology. These programs can include animated videos and interactive sessions that are delivered via an app and the web. The program teaches coping skills and uses science-based techniques to manage emotional problems, foster resilience and positive thinking, as well as mindfulness based relaxation exercises – and at all times, a counselor is always a mouse click away. . 
 
a. Work-Life Balance 
Goal Description: Life can throw a lot of stressful scenarios our way – from work stressors, to managing relationships and handling finances – as well as the pressure we put on ourselves to perform or achieve goals. These stressors can impact our productivity and work engagement; in turn, lowered productivity can lead to even more stress and feelings of sadness. This track is designed to help your employees on a path to a happier, more productive life.
# of sessions: 30
Estimated time per session: 6 min each
Skills: Mind-body connection; identifying stress patterns; challenging negative thoughts; positive thinking, and activity planning

b. Work Stress 
Goal Description: Taking time out for self-care while managing a busy work schedule, can be very difficult. Stress and burnout can negatively impact your mind and body, leaving you sad and affecting your productivity. This track is designed to help your employees on their path towards lower-stress and a happier life.
# of sessions: 30
Estimated time per session: 6 -8 mins
Skills: Identifying triggers, patterns and thoughts; challenging and replacing negative thoughts with positive thoughts; coping skills like progressive muscle relaxation and mindfulness-based exercises.

c. Sleep 
Goal Description: Different people naturally have distinct patterns for basic needs-- how much we eat, sleep, and even work varies from person to person. Sleep is one area in which complications may arise if you do not get the amount required for your unique body and its unique demands. The impact of sleep deprivation can be seen on work performance, interpersonal relationships, mood, concentration, decision-making or problem-solving abilities. This track is designed to help employees foster behaviors that will help them sleep better. 
# of sessions: 8
Estimated time per session: 25-40 min, 1x/weekly
Skills: Basic principles of CBT; daily tracking using sleep diary; basic sleep hygiene skills and checklist; stimulus control and sleep restriction; relaxation techniques and mindfulness

d. Relationship Conflict
Goal Description: Managing interpersonal relationships can be stressful at times. Despite being rewarding, it takes time and commitment to make them work. The stress of a difficult relationship can leave you sad and impact your productivity. This track is designed to help your employees manage their relationships better and guide them toward a happier life.
# of sessions: 30
Estimated time per session: 6 min
Skills: Perspective-taking; role-play; cognitive distortions and assertive communication skills vs. passive/aggressive communication. 
The following screen shots take you through the process: it begins by setting a goal (for instance, stress reduction), which moves the user to concise videos that provide context pertinent to the goal (understanding stress), interactive sessions to get a better handle on how it affects them, and tools to manage stress and build resilience. 

At any point the user can seek out a counselor and schedule a live session. The EAP and employer can monitor progress via a reporting screen (below) that shows the number of people using the system, the goals set, the number of sessions completed, and the number of people accessing coaches or counselors.  

Practical Steps in a Successful Rollout 
In order for EAPs to successfully implement a given technology they need to find partners who will shoulder most of the implementation – from a needs analysis, to customization, promotion, deployment, to testing, training and follow-up.
The reality is that most EAPs don’t have the extra “hands on deck,” let alone the specific expertise, to take this on. In evaluating a new technology solution, EAPs need to assess the solution itself (functionality, ease-of-use, etc.), but also how their partner is going to help them launch and sustain it over time:  Together, the EAP and technology partner must establish the implementation team and set project goals. This includes:

* Customizing the platform or app, planning integration; and establishing the account interface over the length of the project;
* Training the EAP’s internal staff on the solution – not only how it operates and the features, but also how to market/sell it to the clients;
* Training/orienting end user clients, whether that is the employer purchaser or the actual individual users.
* Developing communication plans and materials for sales promotion, program launch and ongoing engagement of users. The technology partner ought to control and handle most of this so it’s not up to time-constrained EAP partners and employers to drive the success of the program.  
* Providing analytics related to user engagement and helping partners understand the significance of that data so they can convey that to their clients.
As with any technology partnership, careful project planning – and management – is key to a successful implementation. An implementation schedule begins with a clear articulation of all stakeholders and their roles, and defines time frames and targets, from customization to workflow to training, testing official launch, and follow-up.
When the technology partner supports the EAP in planning, execution and promotion, the implementation and roll-out will go more smoothly, the EAP will be ready to provide the necessary support to stakeholders, the communications plan will maximize reach and engagement, and the technology partner will be in optimal position to evolve with the EAP to make continual improvements and enhancements to the program. 

Summary: The Digital Future
Since their inception, EAPs have been grappling with the same challenge: making mental and behavioral healthcare more accessible by bridging the barriers to access, awareness, and affordability in screening and treatment. As this article illustrates, the challenges today are even steeper as increasing price pressure forces EAPs to make hard decisions in their business models in order to remain competitive.  
Digital health solutions can help shift purchasing focus from costs to return on investment by supporting collaboration between clinicians and patients, providing efficient resource allocation, making patient data available at the point of care, and leveraging AI and “prescriptive” analytics to turn information into insights that inform decisions for patients, providers, and organizations. 
As EAPs contemplate a digital future – their digital future – the age-old cautionary advice applies: look before you leap. The EAP needs a clear grasp of the challenges (and typical pitfalls), a rigorous evaluation of the technology and how it advances work and goals, and, perhaps most importantly, a technology partner that will support you on your journey, and assure a smooth and successful transition. 


Navya Singh, PsyD, is a psychologist and founder of PsyInnovations Inc. She may be contacted at navya@wayforward.io. Tom Shjerven, CEBS, joined wayForward (PsyInnovations, Inc) in 2018 as Director, EAP Business, to lead the organization’s sales and business development efforts with EAP and wellness company partners. Tom may be reached at tom.s@wayforward.io.


Digital EAP by the Numbers

A national EAP that provides holistic, evidence based, “high-touch, high-tech” services, wanted to use technology to improve their ability to serve more organizations and their employees more efficiently and deliver improved health outcomes. 
The EAP worked with a leading technology vendor to roll out a self-use app that would enable employees to take structured assessments on how to self-identify problem areas such as stress, generalized anxiety, depression, relationship conflicts, work engagement, anger, substance abuse, and quality of sleep.
Employees who wished to use the app were provided with information on how to access and use the app. If users needed help in navigating the app, coaching was provided by the technology vendor and/or EAP staff.
Working with the technology vendor, the EAP established when to schedule email reminders to keep users motivated or otherwise on track. Thirty-seven percent of employees registered to use the app within the first three months of its roll-out. Results after three months break out as follows:

* Over 30% of employees completed the full screening process.
* 15% of population utilized the self-use app versus 4.5% average EAP utilization.
* Over 59% saw a symptom reduction in depression.
* Over 48% saw a symptom reduction in anxiety.
* Over 32% saw a symptom reduction in avoidance.
* Over 27% saw a symptom reduction in fear