Program Coordinators Retreat Mary Yarbrough, MD, MPHJim Kendall, LCSWFaculty and Physician Wellness Program

Your Role(s)GuideNurtureDirectLeadCoordinateMediate

Knowing the Resources Mission: Helping Others Find Their Way

SUPPORT | HEALTH & PRODUCTIVITY | FACULTY & STAFF

SUPPORT | HEALTH & PRODUCTIVITY | FACULTY & STAFF

Why Have an EAP? Personal problems can have an impact on the workplaceWell, its a delicate situation sir Sophisticated firing system, hair-trigger mechanisms, and Bobs wife just left him last night, so you know his minds not into this.The Far Side.Gary Larson

The Faculty and Physician Wellness Program Began May 1999

Concerns during TrainingStress, depression, and grief.Career decisionsRelationships, pregnancy, and familiesTime, money, and lifestyle (lack of sleep, personal time, etc)

Work/Life Connections-EAPContinuum of Services

Skill Development Training: Encouraging stress resilience and life balance

Goal: Improve abilities through development of skills.

Common themesStress ResilienceSeeking Work/Life BalanceTime managementPreventing Compassion FatigueHandling ChangeFatigue and Energy Level Management

Desired outcomes: Improve the capacity to perform given certain environmental stimuli and situationsOrient Residents about other available services

Skill Development

Goal Learn to spot issues and triage situations

First, lets look at some hypotheticals

LifeOne of the Residents just broke up with her fianc. She appears upset-like she has been crying but it could also be that she is fatigued. She and the fianc moved here from Iowa.You have heard rumors that he was having an affair and broke off their engagement.This Resident stops by your desk having just completed night call and looks exhausted.

What Should You Do?Ask her if she is depressed?

Validate that she will be better off without him?

Tell her to forgive him?

Should you contact anyone about your observations?

Work/Life Connections-EAP

Easy Access: 936-1327

Confidentiality

ConfidentialityRecords separate from other systems

Releases required exceptConcern for the safety of other specific personsConcern for public welfare

A Good Assessment is KeyStruck from behind all rightand from my first examination of the wound, Id say this was done by some kind of heavy, blunt object.

The Far Side.. Gary Larson

Solutions-Focused CounselingAddressing personal, relationship , and workplace

Referrals for Psychotherapy or MedicationMaking the connection of the past to unresolved problems in the present. (FPWP provides assessment, stabilization and referral.)

Overwhelmed Resident A Resident confides in you in a moment of vulnerability that he is behind on his charting, feels in over his head most of the time, and fears that he is about to fail his Boards.

He says that if things dont improve, he might as well leave the Program.

What Should You Tell Him?What are the issues?

Are there any resources that can help?

Does he need Counseling? Coaching? Career Mentoring?

Performance CoachingEnhancing an individuals performance to be more effective and productive at work.Developing Skills

Performance CoachingGoal: Help achieve personal goals, overcome barriers, and remain motivated.

Common themes:Good physician but with patient complaintsTest taking anxiety Trouble getting organized Feeling socially isolated Lacking communication skills

Desired outcome: Maximize personal and professional potential. Biswas- Diener, J Clin Psychol. 2009 May;65(5):544-53

The Concerned SpouseA spouse calls you to tell you that her husband ("your resident") has had a problem with drug abuse in the past. She says he completed a drug treatment program and has been "clean" for a number of years. The spouse feels that her husband may be relapsing and feels that you should know. She suggests that you be particularly observant at work and asks you to report any "unusual behavior" back to the her.She wants you to keep this in confidence since she doesnt want it to hurt his career.

What Should You Do?What are the issues?

Should you contact anyone since she told you in confidence?

What are the resources?

Recovery Support Services Promoting addiction recovery and supporting a safe workplace

AddictionsAlcoholDrug: illegal and prescriptionSex

Others: Gambling, Shopping, Food, Smoking, Video games, Internet, Work

The Impaired PhysicianIncludes substance abuse, alcoholism, depression or any medical condition (mental or physical).

The Faculty and Physician Wellness Program of Work/Life Connections-EAP (Vanderbilts Employee Assistance Program) can be of assistance.

Dont make promises you cant keep no off the record discussions.

Ignoring a problem never works.

Best Practice ElementsBest Chance for Recovery SuccessCompetent assessmentQuality treatment (life-saving not punishment) Participation in professional advocacy TMF-PHPAccountability: Formal Plans for Aftercare12-Step Program ParticipationRandom UDS MonitoringConsistent MessagesSupportive Workplace

Linking with More Intense Treatment and Rehabilitation

Treatment and RehabilitationGoal: Assessment, treatment, and rehabilitation based upon the stage and type of each individual's disorder

Common themes:Cycling of distress, denial, and anger: mood swingsMinimal acknowledgement of work impact until the eventUnexplained absences and erratic performanceColleagues opinions vary: compassion to coldness to indifferencePast attempts to control behaviorDUIMarital discord

Desired Goal: Achieve and maintain the best possible functioning and quality of life.

like a travel agent for psychological support servicesBrief CounselingAssessmentReferrals to Community Resources

StressDepressionWorkplace IssuesAddictionsFinancial ProblemsRelationship ConcernsEldercareParenting

Performance Coaching

If You Need Help Get It Sooner Rather than Later936-1327

MissionSupporting the health and productivity of the Vanderbilt community.

Regularly Express Appreciation

You play a variety of roles with the Residents and Fellows that you serve. Some are formal and some informal. *One of the key things that you provide is information- where to go and who to see. ***Certain for the sake of Bobs performance, I hope the employer has an EAP that he can work with. *Our physician and faculty wellness program has been a source of pride for Work/Life Connections-EAP this year.*Not everyone needs to meet with a counselor one on one for counseling. In addition to our solutions focused counseling we also provide a continuum of care services. It begins with an assessment of the problems and forming a plan for the best interventions. **While we provide counseling services to individuals who are facing existing life challenges, we also want to provide training to strengthen our stress resilience.

BackgroundA skill is the learned capacity to carry out pre-determined results often with the minimum outlay of time, energy, or both. Skills can often be divided into domain-general and domain-specific skills. For example, in the domain of work, some general skills would include time management, teamwork and leadership, self motivation and others, whereas domain-specific skills would be useful only for a certain job. Skill usually requires certain environmental stimuli and situations to assess the level of skill being shown and used.

The skills used by a personto properly interactwith others. In the business domain, the term generally refers to an employee's ability to get along with others while getting the job done. Interpersonal skills include everything from communication and listening skills to attitude and deportment. Good interpersonal skills are a prerequisite for many positions in an organization

Coping skills are those skills that we use to offset disadvantages in day to day life. Coping skills can be seen as a sort of adaptation, such as the finely tuned hearing that many visually impaired people develop.Coping skills can be positive or negative. Positive coping skills help us get through situations at nearly the same level as those who do not have the disadvantage. Negative coping skills, however, may provide short-term relief or distraction, but ultimately worsen our disadvantage. A common example of a negative coping skill is the abuse of alcohol or drugs.Coping SkillsBy Lisa Fritscher, About.com GuideUpdated: October 01, 2008About.com Health's Disease and Condition content is reviewed by the Medical Review Board

*What is your role here? As a concerned person? As a representative of the program? How are you doing? *Work/Life Connections-EAP how may I help you?Client: I am an employee at Vanderbilt and I'd like to talk to someone about a problem that I am having. . Narrator: Help begins with a call

*Confidentiality is critical in the success of the counseling relationship. Information concerning your use of Work/Life Connections-EAP is not part of your personnel record or recorded in StarPanel medical record. *Informed consent: discussion of the following elements: -the nature of the decision/procedure -reasonable alternatives to the proposed intervention -the relevant risks, benefits, and uncertainties related to each alternative -assessment of patient understanding -the acceptance of the intervention by the patient

**Assessments are helpful; Diagnosis is critical Most people know WLC-EAP for the individual solutions focused counseling services we offer. Work/Life Connections-EAP provides short-term counseling and resource information to assist those who are dealing with acute life stressors. This service is the heart of the Work/Life Connections Program. **Another service is performance coaching aimed at enhancing an individuals performance, effectiveness, and productivity at work. This intervention helps a motivated employee develop skills to perform their jobs even better.*

*You have not seen any evidence of problems in your role. Would it change your actions if you knew they were in the beginning stages of divorce and things were getting bitter?Do you tell the Resident that the spouse called and expressed concern?Do you notify the chief Resident. The Program Director; or GME office?

*If the nature of your problem involves an addiction, Work/Life Connections-EAP provides specialty services to help address these concerns. Addictions can impact safety in the work environment. Safety is a paramount concern for all of our customers (patients, students, parents, families, faculty and staff).It is estimated that one out of every ten employees in the workplace has a substance abuse problem at some time in their lives.It is important to get help early before family, workplace or career relationships are jeopardized.*Should this physician be taken off work and required to get treatment if no mistakes or complaints have been reported?

Do you feel that an Impaired Physician in recovery should be able to return to practice medicine after successful treatment? *

BackgroundIntegration of Care: Integrating Treatment With Rehabilitation for Persons With Major Mental Illnesses Alex Kopelowicz, M.D. and Robert Paul Liberman, M.D. Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Email this article to a Colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Articles & Searches Download to citation manager Citing Articles via HighWire Citing Articles via Google Scholar Articles by Kopelowicz, A. Articles by Liberman, R. P. Search for Related Content PubMed Citation Articles by Kopelowicz, A. Articles by Liberman, R. P. Chronically Mentally Ill Patients Patient Satisfaction, Quality of Life Skills Training Atypical Neuroleptics Psychiatr Serv 54:1491-1498, November 2003 2003 American Psychiatric Association Integration of Care: Integrating Treatment With Rehabilitation for Persons With Major Mental Illnesses Alex Kopelowicz, M.D. and Robert Paul Liberman, M.D. Psychiatric treatment and rehabilitation are integrated, seamless approaches aimed at restoring persons with major mental disorders to their best possible level of functioning and quality of life. Driven by a thorough assessment, treatment and rehabilitation are keyed to the stage and type of each individual's disorder. Examples of coordinated treatment and rehabilitation are pharmacotherapy, supported employment, social skills training, family psychoeducation, assertive community treatment, and integrated programs for persons with dual diagnoses. The authors conclude by proposing seven principles to guide mental health practitioners in their integration of pharmacologic and psychosocial interventions.

comprehensive, coordinated, compassionate, and consumer-oriented integration of treatment with rehabilitation requires organizational mandates and supports. Unless the top managers and program administrators of serviceswithin a given catchment area or systemwidelend credence to the complexities of and requirements for high-fidelity use of an integrated approach and allocate the necessary resources, clinicians will not go the extra yard to adopt evidence-based innovations (23).

To facilitate optimal improvement, comprehensive treatment programs for persons with serious mental disorders should integrate evidence-based pharmacologic, psychosocial, and learning-based interventions. The following principles, distilled from the results of many studies and practice guidelines, summarize current clinical wisdom about the integration of pharmacologic and psychosocial interventions (25). First, pharmacologic treatment almost exclusively improves symptoms and reduces the risk of relapse. The ability of antipsychotic and other customary psychotropic drugs to improve neurocognition is still controversial, because any effects may be due to the presence or absence of concomitant anticholinergic drugs. Cholinergic drugsfor example, donepezilappear to slow down the rate of dementia-related memory loss. Second, the only way that pharmacologic treatment of major mental disorders leads to improvements in psychosocial functioning is when the individual has acquired the relevant psychosocial skills before developing the mental disorder and the removal or reduction of symptoms unmasks the person's preexisting functional abilities. Medications can never teach a person new functional skills; rather, they may remove the obstacles to the person's learning those skills through psychotherapeutic or educational procedures. Third, psychosocial treatments affect primarily psychosocial functioningsocial, vocational, educational, family, recreational, and self-care skills. Such improvements are likely to occur only when the psychosocial treatment directly targets the particular area of skill or functioning and is capable of providing training or compensatory support for that area of functional participation. Psychosocial treatments may reduce symptoms or risk of relapse to the extent that they are effective in ameliorating stressors that may induce exacerbations, promoting adherence to drug treatments and enhancing the individual's resilience and coping skills. Fourth, both pharmacologic and psychosocial treatment have dosage-related therapeutic effects and side effects. Although it is well known that antipsychotic and antidepressant drugs may take days to weeks to have a therapeutic impact, it is less well known that psychosocial treatments have dose-response relationships as well. If the psychosocial treatmentfor example, skills trainingis well structured and incremental in its design and if it is provided for a sufficient number of sessions and for an appropriate duration, it may be significantly effective. On the other hand, if the psychosocial treatment is unstructured and overstimulating, aversive arousal and exacerbation of symptoms may ensue. Just as medications can exert prophylactic effects only for as long as they are administered, psychosocial treatments must also be delivered for lengthy periods and be offered as "booster" sessions to maintain their therapeutic and rehabilitative benefits. Fifth, psychosocial treatment is most helpful for clients who are symptomatically stable or in reasonably good states of partial or full remission from florid symptoms, when they are able to absorb rehabilitation and need assistance in surmounting the problems and stresses of readjusting to the community. Stable levels of medication also favor positive responses to psychosocial treatments. Psychosocial treatment during acute flare-ups of symptoms should be aimed at calming the client, reducing levels of social and physical stimulation, and helping the client to integrate and understand the symptoms as part of an illness process. Sixth, the most effective psychosocial treatmentwhether provided by individual therapy, group or family therapy, day hospital, or inpatient milieu therapycontains elements of practicality, concrete problem solving for everyday challenges, incremental shaping of social and independent living skills, and specific and attainable goals. Finally, a continuing positive and collaborative relationship infused with hope, optimism, and mutual respect is central for treating clients with major mental disorders with pharmacologic or psychosocial treatments

**Work/Life Connections-EAP counselors serve as "travel agents for psychological support services." We match the needs of the employee and link you with resources when life is challenging. And face it, we all have challenges in our life. *