As soon as you notice signs of a personal problem such as:

• Absenteeism
• Chronic lateness
• Personality change
• Decline in work quality
• Unusual behavior or appearance
• When someone reports having personal problems

Don’t avoid approaching the employee about your concerns. Early intervention may prevent the employee’s personal problem from getting worse and may minimize impacts on work performance. If you need some guidance about how to discuss your concerns, the EAP is available for consultation.

An informal referral is a suggestion that the EAP is an available, helpful resource. This type of referral is appropriate when:

• An employee or staff member with a good performance record may be having problems outside of work or may be experiencing significant distress
• When you observe early job performance issues

Key Things to Convey when Making an Informal Referral to the EAP

• You have noticed that the employee seems stressed or not like their usual self
• Mass General Brigham provides a free, confidential resource (the EAP) which offers consultation to help employees get “unstuck” when extraordinary problems interrupt their successful ways of coping with everyday life
• The EAP offers in-person, virtual or telephone appointments
• The referral is intended to be a recommendation to a potentially helpful resource, not a requirement or a mandate
• You are willing to assist with making the appointment but only if the employee is receptive to this
• Information about visits with the EAP is not shared with anyone without written permission, except in legally mandated instances of risk of harm to self or others
• EAP records are kept in a separate system and are not part of the Mass General Brigham medical or Human Resources record
• Everyone needs some help once in a while

A formal management referral may be used in cases when there is a pattern of deteriorating job performance, attendance, or behavior. Before making a referral it is advisable to contact the EAP first. An EAP consultant can:

• Ensure that a referral to the EAP is the most appropriate resource
• Answer questions about the formal referral process
• Clarify available assistance options

The EAP consultant may make a few notes in the EAP’s confidential Case Management System, to document the background. This information is not shared with the employee.

Key Things to Convey when Making a Formal Referral to the EAP

• Concern about performance and clear/specific details about areas needing improvement
• Mass General Brigham offers a free, confidential resource (the EAP) which can provide helpful assistance with addressing issues which may be contributing to performance problems
• The EAP offers in-person, virtual or telephone appointments
• The referral is intended to be a recommendation to a potentially helpful resource, not a requirement or a mandate
• You are willing to assist with making the appointment but only if the employee is receptive to this
• Information about visits with the EAP is not shared with anyone without written permission, except in instances of risk of harm to self or others
• EAP records are kept in a separate system and are not part of the Mass General Brigham medical or Human Resources record
• Everyone needs some help once in a while

Regardless of the type of referral or employee need, it’s helpful to convey that:

• Use of the EAP is always voluntary
• The program is a free resource but referrals outside the EAP may require benefit use or other cost
• The EAP provides short-term counseling and referrals to mental health providers in the MGB system or the community
• The EAP offers resources for a variety of areas, such as childcare, eldercare, housing, legal and financial. It is the responsibility of the employee to use these resources to meet their respective needs. For example, the EAP may provide housing search resources, but the EAP clinicians do not find housing for the employee
• The EAP provides distinct services from the other divisions of Human Resources, such as Occupational Health, Benefits or HR Business Partners. For example, the EAP cannot provide information on the status of a leave of absence request or a job transfer

While a lack of appropriate skills or failure to abide by department policies or work expectations may contribute to poor performance, most employees with problems at work are also experiencing personal or family difficulties. Both the EAP and HR are available to managers, as well as to employees, to consult on performance issues when the causes are unclear.

The EAP provides a confidential space to help the employee identify the source(s) of the problem and targeted solutions. One solution may be the suggestion that the employee voluntarily seek assistance from Human Resources when the source of the stress is a misunderstanding about job expectations or staff relationships. With the employee’s permission the EAP can consult with Human Resources to help determine how to help the employee.

Contact us at 866-724-4327, or complete and submit the Mass General Brigham Request for Service Form – Managers to request a consultation or to make a referral.

EAP Orientation

An EAP orientation provides employees with general information about the EAP’s scope of services and components for assistance. Employee Orientation is most often presented to work groups during a regularly scheduled staff meeting and takes approximately 5-10 minutes. This module can be expanded/tailored to accommodate group needs, such as incorporating basic information about the causes of stress and stress management techniques. Providing an orientation should strongly be considered when a manager knows a workgroup, or some individual staff, may be experiencing workplace stress, changes or some other concern for which EAP can assist.

Employee Group Trainings

The EAP can provide trainings (in-person or virtually) to workgroups in response to manager requests. The EAP can present training from a selection of topics.  Some examples of our other most popular trainings include:

• Choosing Childcare
• Debt Management
• Effective Communication
• Moving from Stress to Resilience
• Success with Stress Series

Click here for a full list of EAP Webinars.

The EAP offers a number of training opportunities for managers. Some offerings are part of a formal series of planned seminars or webinars and some are tailored to adapt to system or individual work group needs. Our EAP Manager Training is designed especially for managers, and is an important contributor to the success and high level of utilization in our programs.

When an employee is experiencing  personal problems his/her performance may be affected. Managers have the difficult task of meeting organizational goals as well as being sensitive to the needs of their employees. To support this role the EAP offers: What Every Manager Needs to Know at Mass General Brigham EAP: How to Make Referrals. In addition to this training, the EAP is available to help if you are concerned about an employee or routine corrective actions do not result in improved performance.

Some other examples of our other most popular training topics include:

• Domestic Violence Awareness for Managers
• Managing the Impact of Critical Incidents: Helping Build Workplace Resilience
• Substance Use Disorders and the Impaired Employee: What Leaders Need to Know

Click here for a list of EAP Manager Trainings or if you wish to have an EAP Consultant offer a training to your work group call, 866-724-4327.

• Manager Consultation following Adverse Events
  The first step with any adverse event is a leadership consultation with an EAP expert. The EAP can assist managers in determining the needs and timing of intervention and connect managers and employees with support and resources. Contact the EAP at 866-724-4327.
• Assistance to Individual Employees Impacted by an Adverse Event
  The EAP can be reached 24/7 for routine or urgent needs. Appointments are available in person, by phone and by video. Click here for guidance on making a referral to the EAP.
• Intervention to Assist Workgroups Impacted by an Adverse Event
  Group requests begin with a manager call to EAP to assess the most effective response to the situation. EAP will provide assistance in determining when to provide the group based upon best practices and the needs of the impacted staff. EAP also offers consultation around how to communicate the group offering to staff members and encourage participation. Individual support is always available as needed. Below you will find some key concepts about EAP group assistance following adverse events and critical incidents.
  • The EAP uses a Psychological First Aid model of intervention designed to reduce the initial distress caused by traumatic events, and to support adaptive functioning and coping. This intervention supports recovery.
  • Groups can be provided both in person and virtually.
  • Groups provided immediately after an incident are not recommended. Resilience builds from a place of safety. Interventions provided within 24 to 72 hours provide the most impact in restoring resilience and mitigation of sustained impacts of stress.
  • Participation is voluntary and confidential. The EAP does not recommend ever making participation mandatory.
  • These meetings are not operational debriefings about a medical event and don’t serve a root cause analysis function.

Reactions could Include

• Vigilance and jumpiness
• Concentration problems
• Fatigue
• Need to re-establish control
• Irritability
• Recounting experiences many times over
• Avoidance of “dreaded areas” (reminders of the event)

Avoiding Secondary Reactions
Employees exposed to traumatic events are less vulnerable to secondary reactions when there is positive support and/or acceptance by co-workers, management, friends, family and community agencies.

How to Respond to Employees who have Experienced a Critical Incident

• Seek consultation from EAP
• Acknowledge that stress-related symptoms may surface immediately or may not surface for employees for many weeks following a critical incident
• Expect a wide range of individual responses among employees and each other
• Encourage acceptance and sensitivity among individual members of workgroups
• Be visible and available to employees
• Encourage employees to communicate about their feelings and what’s been helpful for them. Support expressions of emotion such as sadness, anger or expressions of guilt
• Create/support activities that re-establish a sense of control
  – Allow people to set goals and determine priorities that do not negatively impact operations
  – Allow people flexibility to pace themselves in returning to work
• EAP handout – Personal Coping after a Traumatic Event

In the aftermath of traumatic events, employees want and need to hear guidance from leadership. During this acute phase, leaders must communicate effectively with people who have questions, seek reassurance, and want to take action.  Leaders play critical roles in the recovery of the workplace and are in a position to help their employees move forward and identify when outside support may be helpful.

Understanding Traumatic Grief    

People vary in their reactions to experiencing or learning about traumatic events. Most will recover well over time, while for some the immediate reactions can last longer than normal and interfere with their return to their usual work routines. In the short term, many people experience transient, but powerful symptoms. They can include:

• Waves of sadness and stress
• Intrusive images of the traumatic event and memories of previous losses
• Withdrawal from co-workers, and close relationships with family and friends
• Avoidance of activities that are reminders of the event
• For some people, their reaction can be delayed. For others, grief or stress may not ever be evident.

Leaders are positioned to be important role models by acknowledging their feelings or reactions, communicating hope, identifying facts, managing rumors and providing support to others as needs change over time.

Immediate Responses

• Be visible — make public announcements and appearances. By providing useful and accurate information, leaders can re-establish a sense of safety and enhance the workplace’s trust in leadership.
• Provide accurate, timely information on what is known, what is not known, and when more information will be communicated. Press briefings, use of social media, and workplace meetings can reassure employees and dispel rumors. Always say when more information will be available.
• Understand that people process information differently in high stress situations – keep messages as simple as possible, repeat frequently, and emphasize positive messages (people tend to focus on negative information when stressed).
• Use multiple channels of communication – people seek information from multiple sources (intranets, all-user emails, staff meetings, and walk arounds) depending on the culture and history of a workplace.
• Speak calmly and encourage working together – leaders promote calmness, empathy, optimism, a can-do attitude, and collective healing and recovery.
• Don’t worry alone. Use the resources available to you. The EAP is here to help you and your workgroup heal and recover.
  Don’t hesitate to contact the EAP at 1-866-724-4327.

Moving Ahead

• Know the status of existing and available resources – monitor emerging needs, and support fellow workplace leaders.
• Organize memorial services and sites recognizing the diversity within the workplace – respect the desires and needs for families who have sustained losses and tragedies. The timing of services is important.
• Attending memorials is important – tears and grieving in public by leaders gives “permission” to others to express grief and humanizes unthinkable tragedies.

Recovery

• Provide common goals for future direction – redirect energy into needed recovery projects and respectful remembering and rebuilding efforts.
• Avoid blaming – blame directed towards groups or individuals leads to stigma, anger, and desire for retribution. Redirect energy to providing support and future needs.

Growing

• Encourage resuming normal workplace activities, but understand and be supportive if the recovery is slow.
• Recovery takes time, is not linear, and is influenced by unpredictable future events.
• Workplace rituals provide an opportunity for individuals to heal and reflect on their experience in their own style. These create cohesiveness and can cross racial, cultural, and socioeconomic divides.
• Beware of identifying a “we” and “they.”
• Focus on future goals – reorient the workplace to future objectives, enhanced preparedness, and “we can do it.”
• Acknowledge those from within and outside the workplace who want to and do help; establish a climate of healing and workplace support.
• Expect workplace disappointment and anger after the initial sense of togetherness. Help the workplace understand the changing trajectory of recovery.
• Take care of yourself. You need supporting staff, friends, family who remind you to rest and can objectively advise you about things you do not see or do not recognize the importance of. Keep your advisors informed and listen to their perspectives.

Adapted from  The Center for the Study of Traumatic Stress – Grief Leadership

Although trauma affects people differently, there are some common reactions that you may experience. These signs may begin immediately or you may feel fine for a couple days or even weeks, then suddenly be hit with a reaction. The important thing to remember is that these reactions are quite normal; although you may feel some distress, you’re probably experiencing a normal reaction to an abnormal situation.

Some common responses to traumatic events are listed below.

Physical Reactions

• Insomnia/nightmares
• Fatigue
• Hyperactivity or “nervous energy”
• Appetite changes
• Neck or back pain
• Headaches
• Heart palpitations (flutters) or pains in the chest*
• Dizzy spells*

Emotional Reactions

• Flashbacks or re-living the event
• Excessive jumpiness or tendency to be startled
• Irritability
• Anger
• Feelings of anxiety or helplessness

Effect on Productivity

• Inability to concentrate
• Increased errors
• Lapses of memory
• Tendency to overwork

*  If you experience these symptoms, see a physician.

Usually, the signs and symptoms of trauma will lessen with time.  If you are concerned about your reaction, note the specific symptoms that worry you.

For Each Symptom, Note the Following:

Duration
Normally, trauma reactions will grow less intense and disappear within a few weeks.

Intensity
If the reaction interferes with your ability to carry on your life normally, you may wish to seek help.

Tips to Help you Keep Your Life in Order while you Experience the Trauma Response

• Maintain as normal a schedule as possible, but don’t overdo it. Cut out unnecessary busyness and don’t take on new projects
• Acknowledge that you’ll be operating below your normal level for a while
• Structure your time even more carefully than usual. It’s normal to forget things when you’re under stress.  Keep lists and double-check any important work
• Maintain control where you can. Make small decisions, even if you feel that it’s unimportant or you don’t care.  It’s important to maintain control in some areas of your life
• Spend time with others, even though it may be difficult at first. It’s easy to withdraw when you’re hurt, but it might be helpful to be in the company of others
• Give yourself time. You may feel better for a while, then have a “relapse.”  This is normal.  Allow plenty of time to adjust

When an Employee is Ill

In our adult lives, we spend at least one-third of our weekday time at work.  Some of us spend more time with our work families than we do with our biological families.  So, for many of us, when a co-worker is ill, the sense of loss can be significant.

Sometimes it is hard to know how to support an employee who has a serious illness or how to help staff who are impacted by an ill co-worker.  It is always best to listen to both the ill employee and his/her peers to hear what their needs are.  Some suggestions are as follows:

• Respect the ill person’s privacy
  Either the ill co-worker or their close family members should determine how much and what medical information is shared. With the co-worker’s permission, a manager should provide regular updates
• Explore with both the ill person and co-workers ways to support the ill employee.  Some workgroups can donate time, organize fund raisers, take up a collection, and send cards
• Allow staff time for private discussion
  Staff may need time to discuss what they can do.  Some staff may be experiencing personal losses and this makes their co-worker’s illness more difficult.  Additionally, co-workers may feel the impact of the added job responsibility and need to share this.  Discussion may be helpful to some employees

When an Employee Dies

When a co-worker dies, grief is a painful and normal experience.  How we grieve is very personal.  Some factors contributing to the manner and length of our grief include, but are not limited to: culture, relationship to the deceased, the manner in which he or she died, other recent personal losses, and our personality.   When a death is unexpected (from violence, suicide or an accident) and when a close relationship exists, grief can be particularly painful.

When an employee dies let employees know as soon as possible.  Ideally all employees wishing to attend a funeral will be able to do so. Some things that workgroups do to help in the grieving process are:

• Create a memorial board or memory book
• Memorial Service
  Most hospitals have a chaplaincy staff that can be contacted to coordinate a memorial service for the employee that includes both staff and family members in the planning
• Scholarships/Fund in memory of the employee, or to donate funds to assist the family in either their current or future needs. A hospital credit union is often involved in planning such a fund

The EAP is available to meet with staff to discuss their thoughts and concerns, either individually or as a group.  Managers are encouraged to contact the EAP at 1-866-724-4327 to consult with an EAP counselor about the needs of their staff.

R U OK? is a suicide-prevention initiative that promotes peer support and a safe culture to share personal struggles. The EAP hopes managers can encourage staff to check in with co-workers who might be struggling.

EAP Manager Handout – How Managers Can Help Employees Cope with Stress and COVID Fatigue

Mental health and substance misuse issues can impact quality of life inside and outside of work. Left untreated, they can have a negative effect on job satisfaction and job performance. Below is some information on some common conditions and how they may impact the workplace. The Mass General Brigham EAP is available to help with assessment and referral as needed at 866-724-4327.

• Depression
  Mental Health America – Depression and the Workplace

• Bipolar Disorder
  American Psychiatric Association – Bipolar Disorder and the Workplace

• Anxiety Disorders
  American Psychiatric Association – Anxiety Disorders and the Workplace

• Eating Disorders
  American Psychiatric Association – Eating Disorders and the Workplace

• Autism Spectrum Disorders
  American Psychiatric Association – Autism Spectrum Disorders and the Workplace

• Full Mass General Brigham EAP Mental Health Resources
  Information on Mental Health

• Alcohol Use Disorders
  American Psychiatric Association – Alcohol Use Disorders and the Workplace

• Full Mass General Brigham EAP Substance Misuse
  Information on Substance Misuse and Addiction 

• Helping Employees who are Experiencing Intimate Partner Violence 

• Workplace Safety

• Job Transition Resources

Employee Assistance Program (EAP)
866-724-4327

The EAP is a free and confidential Work and Life Resource

Who can use the EAP?

Employees, professional staff, and household family members.
Access is easy and there is no cost to you.

 Schedule a confidential in-person, video, or phone appointment.

What can EAP help with?   

Anxiety • Childcare • Depression • Elder care • Emotional well-being • Family
and parenting issues • Financial concerns • Grief, loss• Intimate partner abuse
• Legal issues • Marital and relationship problems • Physical illness
• Physical, emotional and sexual abuse • Stress • Substance use problems
• Workplace issues