Occupational Assistance: An Integrated Model

The Next Step

Introduction

A

s has been discussed and illustrated, the workplace is a salient venue through which to address personal difficulties and to assist family functioning and community health directly. Yet, what is the responsibility of counsellors to the workplace? Since the beginning of the industrial revolution in North America an antagonistic relationship has existed between labour and management. Responsibilities of occupational counsellors have ranged from ensuring that young single women were living in virtuous Christian environments to bringing widespread use of critical incident stress debriefing to Employee Assistance Programs. These initiatives by professional counsellors supplanted self-helpers in the workplace who had become active through groups such as Alcoholics Anonymous as early as the 1940s (Brandes, 1976; McGilly, 1985; Popple, 1981; Thomlinson, 1983).

Throughout the evolution of workplace-based counselling, clinicians have retained the aura of being agents of social control (Corneil, 1984; Csiernik, 1996; Pace, 1990; Roman, 1980). However, it is hypothesized that by applying an ecological orientation to occupational assistance, and thereby attempting to create both worker and workplace wellness, Employee Assistance can be moved from being a mechanism of social control to one of active social change in order to enhance workplace wellness. This process would entail integrating core practices, crisis and short term individual and family counselling, with mutual aid initiatives and organizational change based theories. Taking an ecological orientation is critical due to the reciprocal relationships that arise in workplace including including both life style issues and the social organization of the workplace.

Renewing Mutual Aid in the Workplace Environment

Self-help groups acted as a primary support in the development of the occupational assistance movement (Csiernik, 1993). The industrial revolution brought with it dramatic changes in the structures of business, industry, and the state leading to the depersonalization and dehumanization of social life, increased feelings of alienation and powerlessness and the decline of community (Robinson and Henry, 1977). With the changing pattern of industrialization and family and social relations, new forms of mutual aid emerged to replace weakened social connections, especially in North America. Self-help groups began to respond to the depersonalization in society and became an integral aspect of cooperation between people (Katz and Bender, 1976). As self-help evolved throughout the 20th century from having primarily a treatment and normalization orientation to taking on a greater social change direction, it has played a central role in transforming the focus of the occupational assistance movement from tertiary to primary prevention. The growth of mutual aid/self-help outside the workplace occurred as a response to the pervasiveness of technology, the unavailability and increasing unresponsiveness of human services, the complexity and size of institutions and the increasing dehumanizing and depersonalizing aspects of the work-place (Matzat, 1989).

Mutual aid has also been partially responsible for beginning to shift scrutiny from individual to organizational stressors that cause ill health and employee problems. Self-help has the capacity to assist and direct the evolution of occupational assistance programs to their next plane of maturation: wellness. It has an active role in preventing occupational assistance from slipping back to being predominantly a mechanism of social control through activities such as mandatory drug testing and managed care (Ansel and Yandrick, 1993; EAPA, 1992). Self-help groups can also be one mechanism for enhancing workplace participation and democracy. They can assist in modifying the emphasis of occupational assistance from being solely worker centered to focusing more upon problems created by the design of the workplace and the nature of the work, itself. Those influenced by mutual aid principles have the capability to act as catalysts for positive social change in the workplace and for enhancing employee wellness but whether that capacity will be utilized is still in question.

Workplace Participation

Formal employee participation in workplace decision making is not a new concept as it has existed in a variety of forms for decades. Different organizational methods of enhancing employee participation in the workplace have emerged throughout the world. Some of the better known initiatives include: Total Quality Management (Deming 1938; 1950; Ishikawa, 1985; Juran and Gryna, Jr., 1970), Quality Control Circles or simply QC Circles (Crocker, Chiu, and Charney, 1984; Dewar, 1980), Theory Z of Management (Ouchi, 1981), Quality of Working Life (QWL) enterprises (Ferman, 1985; Giordano, 1992; Ingle and Ingle, 1983; Kolodny and van Beinum, 1983) and the broader industrial democracy movement (Davies, 1979; Emery and Thorsrud, 1969; Obradovic and Dunn, 1978; Prasnikar, 1991). While the introduction of worker participation schemes implies and requires a change in the distribution of power within a work setting the primary, if not exclusive, theme of these exercises has been on production issues. The focus of the majority of participation plans has tended to highlight more rudimentary changes such as profit sharing schemes, job enlargement, job rotation and improving communication pathways, all of which involve minimal transfers of power between labourers and management. To date, participation plans that could change the nature of control over the actual decision making processes and the work environment itself have been much less evident.

As occurred during the Gomperism era of the American labour movement, labour groups have primarily focused upon economic factors. For example, many "enlightened" European Works' Councils have still targeted their efforts on enhancing the pay packet. While this is a valid use of their energies it has come at the cost of further enhancing the physical, psychological, social, intellectual and spiritual health needs of the workforce. Increases in democratic initiatives do not necessarily eliminate workplace let alone societal inequalities. Organizational methods of worker participation are still primarily examples of representative rather than direct democratic endeavours. Individual employees in most systems make little contribution beyond their immediate work environments with minimal attention heeded to anything beyond their basic needs. Worker participation has been espoused as the next great step forward but generally remains limited in its scope. The social and psychological elements of work have had some attention focused upon them but the other elements of wellness still remain largely neglected. Worker participation needs to be expanded so that it examines an employee's total life. This is a vacuum the Integrated Model of Occupational Assistance begins to address.

The Integrated Model of Occupational Assistance

The Integrated Model of Occupational Assistance draws upon the existing practice models of occupational assistance while placing a renewed importance on self-help. Worker participation is incorporated within an ecological framework to create an organizational plane to complement the historical emphasis upon the individual worker. The proposed model consists of two axis. The first focuses on the target. Individual wellness is balanced with organizational wellness, taking into account the needs of the range of stakeholders that exist in the immediate and extended workplace environment. The second axis is the method of intervention. It is divided into the categories of professional intervention and mutual aid/self-help. By combining both forms of assistance four quadrants are created allowing for a greater range of access points and prevention alternatives and moving EAP away from being only an agent of social control (Figure 22.1).

figure 22.1 - Model Quadrants

i. Professional - Individual Quadrant

The first quadrant of the Integrated Model Of Occupational Assistance is the individual-professional intersection. It consists of activities that are or should be currently provided by the majority of main stream programs and workplace health promotion programs. These activities include ongoing health promotion programming together with an increased emphasis on the provision of counselling and preventative services to family members of employees and retirees. This inclusion is an acknowledgement of the fact that workplace stresses are brought home and that home stresses brought to work by employees further intensify organizational stresses. This interrelationship manifests itself at the worksite through decreased performance and productivity. Highlighting the importance of the family within occupational assistance programming can be done in a variety of ways. Simple promotion activities such as sending information about the program to family members or sponsoring seminars and activities for families are standard mechanisms. Another option is actually changing the name of this component of occupational assistance. Organizations such as the Canadian Pacific Rail, the City of Saskatoon, MacMillan Bloedel and the Canadian Graphic Communications Workers Alliance have already changed the name of their EAPs to "Employee and Family Assistance Programs"(EFAPs). The specific individual components of this quadrant are:

1. provide one-to-one counselling by formally trained counselling professionals off site or on-site, depending upon organizational needs and preferences;
2. retain as the primary focus crisis intervention, brief solution-focused counselling and case management;
3. promote and extend assistance to family members so that the service becomes Employee and Family Assistance Programming;
4. provide proactive educational seminars and workshops to the workforce by social workers and other health and counselling professionals;
5. develop and promote activities that enhance wellness such as voluntary health screenings conducted by occupational health staff and voluntary worksite-based fitness appraisals and programs;
6. promote self-care activities for physical, psychological, intellectual, social and spiritual wellness;
7. respond to critical incidents with specially trained professional debriefers;
8. provide 24 hour crisis intervention and consultation accessible through a toll-free number if warranted; and,
9. incorporate a supportive care component so that employees absent from work for an extended period of time receive contact from the workplace to inquire if any additional, non-financial, assistance is required.

ii. Mutual Aid / Self-Help - Individual Quadrant

Mutual aid initiatives have a greater potential to span the gap between wellness and traditional one-to-one counselling than do professional, individually-focused counselling services. It has been stated by various EAP stakeholder groups that peer social support could be the best potential bridge between health promotion, prevention programming, and Employee Assistance Programming (Csiernik, 1995).

While the issue of confidentiality will always arise when discussing EAPs, this has not been a hindrance to many existing programs with very active self-help components (Bisgona, 1992; Csiernik, 2002; Eisman, 1991; Grant, 1992; Windsor, 1988). Self-help can be introduced through a variety of means. If there is uncertainty on how a mutual aid initiative will be received by a workforce, it would be judicious to initially begin with a physical health related or psycho-educational focused group. Treatment orientated groups could be considered if a specific request occurs from members of the workforce, or, of course, if a group arises spontaneously. For many organizations, on-site mutual aid/self-help groups will be much easier to support if they are focused upon wellness themes or upon issues of daily living such as child care or dealing with the demands of ageing parents. Components of this quadrant are:

1. use of peers, union counsellors, referral agents, peer resource teams and/or peer advisors, to aid employees access appropriate forms of assistance and to provide on-going social support;
2. use of community-based self-help groups as an adjunct to individual assistance and to further enhance social support;
3. develop on-site self-help groups that deal with traditional problem areas and with wellness-related topics if the employee population is large enough or distinct worksite-specific problems arise and requests emerge; and,
4. respond to any critical incident situation with trained peer debriefers who understand the culture of the organization and the nature of the routine stresses as well as the potential range of stress reactions produced by a critical incident.

iii. Professional - Organizational Quadrant

The third quadrant now moves occupational counselling into a new realm. It offers increased possibilities for organization-wide primary prevention and more proactive initiatives including acting as mediators between individuals and between work units in an alternative-dispute resolution process. The activities within this quadrant recognize that workplace health does not simply relate to employees' engaging in healthy behaviours but also includes making the work environment healthier. This would enhance the probability that both individual risk factors and broader environmental and structural issues would be integrated into program undertakings. This quadrant also introduces the idea that occupational assistance can and should enter into the broader context of policy change and advocacy beyond the workplace. There is a place for workplace wellness to be discussed and debated at societal and political levels. While the immediate impact of this aspect of the model may be minimal, in the long term it could be the most important dimension in creating not only well workplaces but also healthier communities. Advocacy efforts may come from researchers or professional associations as well as from groups with vested interests in the workplace. Examples of these are Chambers of Commerce, the Canadian Labour Congress and government mandated health and safety associations such as the Industrial Accident Prevention Association (IAPA) along with professional associations such as the Canadian Association of Social Workers. Aspects of the third quadrant are:

1. provide on-going worksite wide health promotion, safety and critical incident awareness and related wellness education programs;
2. provide consultation and training for ongoing organizational intervention, development and change including team-building initiatives;
3. enhance the health of work units through the provision of technical assistance including mediation or conflict-resolution services on both individual and organizational issues; and,
4. collaborate with individuals and groups external to the work-site in advocating for policy initiatives to increase the wellness and productivity of the workforce, to enhance the healthy functioning of workplaces, and to increase the profile of occupational assistance.

iv. Mutual Aid / Self-Help - Organizational Quadrant

The fourth segment of the model is the organization-mutual aid/self-help dimension. Programming arising from this quadrant reflects the needs of labour and management to work conjointly to define, identify and diagnose organizationally created problems. The two groups need to work together to find and implement solutions that can counter organizationally-produced reductions in both productivity and wellness. There are two primary options for these types of support groups; either broad organization wide groups open to all employees or groups organized along departmental or work unit lines. The organizational culture will be the predominant factor in determining whether either or both types of groups emerge. Training and education on what teams are, which is rarely done prior to implementation, how to use them, and their strengths and limits would be essential steps in properly developing the goals identified in this quadrant. Beginning the process by providing training would be much preferable to simply telling employees that they were being placed in teams and expecting them to know not only how to function in this new manner but also how to function more efficiently. The education process that precedes this dimension could be conducted by peers or by professionals internal or external to the workplace as previously discussed in the professional/organizational quadrant. The three components of this quadrant are:

1. engage in team building exercises and activities to acquaint the workforce with expectations, rights and responsibilities of being a team or group member;
2. develop mutual aid group(s) open to all employees that examine stressors both internal and external to the workplace which affect individual and group wellness;
3. develop work unit support groups to decrease work related stress and to act as problem solving and/or peer social support groups.

Conclusion

The Integrated Model of Occupational Assistance is premised upon the idea that to achieve wellness, physical, psychological, social, intellectual and spiritual, the workplace needs to address both production and personal issues. The various ideas all hinge, to varying degrees, on the assumption that participatory democracy is a valuable commodity toward which all workplaces should be evolving. Locke, Schweiger and Latham (1984) claimed that participation is not simply an ethical imperative but also a core managerial technique that is appropriate in any situation. However, in occupational programming participation should not only be deemed ethically correct, it should become a professional mandate. Employee Assistance counselling professionals and peer supports need to place greater value on self-determination and regard it as one of the core foundations for all human interaction and development not only outside the workplace but within as well. The delivery of the Integrated Model Of Occupational Assistance is intended to be flexible with a range of implementation options. An organization may begin by developing a physical health promotion component before adding other health promotion or treatment elements. An organization that has a traditional Employee Assistance Program in place could easily incorporate the mutual aid/self-help dimension. These options allow for mutual aid/self-help or organization intervention dimensions to be added to mature occupational assistance programs or to be a foundation for new programming. Implementation will of course be dependent upon the nature of the workplace and workforce. Presentation of the model to workplaces may be adequately vague and generic to allow each organization to take ownership of the program's evolution and adapt the different elements to its own needs.

The intent of this second-generation model of occupational assistance is to move away from the notion of intervention as social control. Its goal is not to isolate but rather to integrate physical, social and organizational aspects of the workplace with behavioural and lifestyle aspects of work. It is structured in a manner that when fully implemented, should improve the overall functioning of the workplace and health of employees and their families. Counsellors involved in occupational assistance, because of their knowledge, skills, entry points and positioning in organizations, have the opportunity to improve the quality of life for workers by becoming active change agents and encouraging participatory democratic action. However, occupational assistance is but a small subsystem of any organization. Programs and their champions cannot control all acts of employers and there are inherent limits on what can be realistically accomplished. Thus, to change workplace wellness also requires changes in our cultural norms, public and social policy, labour legislation and existing institutions. A noble goal for all involved in this enterprise.

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For more information on this topic please see Csiernik, R. (2005). Wellness and Work: Employee Assistance Programming in Canada. Toronto: Canadian Scholars Press

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