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Vol. 45, No. 10
Every manager has had to deal with problem employees who resist help: the welder whose heavy drinking has gotten out of control, the emotionally fragile secretary who sabotages projects, the computer technician who fails to show up for three or four days at a time.
Chances are, they have been counseled, been given sub-par performance evaluations and even had their pay docked—everything short of being fired. Still, their behaviors continue to give managers their biggest headaches and pose great risks to the company.
To deal with such behavioral health problems and intervene with them earlier, some employers and occupational groups are turning to peer-to-peer programs.
“Time and again I’ve seen situations where an impaired worker will listen less defensively to a colleague than to a supervisor, from whom he is more likely to be hiding the problem. It’s a matter of being approached about their problem by a co-worker, with whom they share much in common, instead of an authority figure,” says E. Paul Hoover, a Kansas City, Mo.-based health and productivity consultant. “Employers will always use tools like progressive discipline and management confrontation to deal with employee personal problems, but often they can be addressed earlier and more effectively with the involvement of a trained peer.”
Two That Lead the Way
One company that has produced convincing results using a peer-to-peer program is Weyerhaeuser Corp. Since 1997, the Seattle-based forest products company has been using trained peer referral agents, or “helpers,” at its work sites. According to Dr. Jeffery N. Thompson, the company’s medical director, the Peer Helping program was designed to prevent or intervene early in issues including work stress, alcohol and drug abuse problems, and other disabilities when impairment becomes noticeable on the shop floor.
“Weyerhaeuser has found that peer helpers can become adjuncts to its team-based management, where peer helpers act as listeners, mentors and coaches, freeing up the time of managers and supervisors,” says Thompson. “Their primary role is to identify and intervene with troubled co-workers and, in some cases, refer employees to the corporate employee assistance program (EAP).”
Peer helpers are trained in basic listening skills, peer-to-peer counseling, work stress, return-to-work issues and substance abuse. “While the skills are basic, they are powerful tools to assist employees in both simple and complex problem solving,” Thompson adds. Local EAPs assist the helpers by augmenting their training and serving as mentors and referral resources for more difficult problems.
As often happens with successful workplace initiatives, Weyerhaeuser’s Peer Helping program has evolved beyond its founding mission. Today, it also functions informally as an organizational development tool and talent mine. Many peer helpers develop a knack for spotting problems that cause work stress. When stress is high due to situational problems like layoffs, work system changes or return-to-work issues following a disability or turmoil at the mills, they help employees to cope. In short, they manage crises.
Peer helpers usually are selected by the workers. (See “Setting up a Program,” p. 106). “As the helpers gain self-assurance,” Thompson adds, “they become more assertive in seeking out people for active intervention. Over time, many of them use their skills in new roles in the company. They become effective and mature team leaders.”
Weyerhaeuser’s Peer Helping program is being studied under the Workplace Managed Care grant program of the Substance Abuse and Mental Health Services Administration (SAMHSA) of the U.S. Department of Health and Human Services. Outcomes data from SAMHSA suggest the program is cost-effective, especially when used in conjunction with a managed care program. Early results from an in-house study at Weyerhaeuser show that as mental health utilization goes up at Peer Helping sites, costs remain stable. “The findings tell us that we are intervening with employees earlier and more successfully,” Thompson notes.
Another peer-to-peer program, called PeerCare, is producing similarly impressive results at a major U.S. transportation company (which requested anonymity for this article) in conjunction with its labor unions. The program is one of four “pillars” in place at the company to identify troubled employees. The other three are managed care preauthorization, EAP services and mandatory alcohol and drug testing. Only the peer program is free of management oversight.
“We’re learning that PeerCare is the only one of the options that many employees will voluntarily use,” says Ted Miller, a research scientist for Landover, Md.-based Pacific Institute for Research and Evaluation, which is studying the program. PeerCare has been evolving for more than a decade. It began as a union-based program that provided drug- or alcohol-impaired employees with an opportunity to leave the company’s premises without facing discipline.
Today, PeerCare trains peers—about 10 percent of the workforce—to identify impaired co-workers, get them off the property and conduct a follow-up intervention. A peer talks to the impaired employee at the beginning of the next shift. “The PeerCare team member determines whether the impairment was an unusual circumstance, such as from not quite being sober yet after a daughter’s wedding the day before. If there’s a more serious problem, the peer works to convince the employee to seek help,” Miller explains.
Buoyed by the program’s success, a new component has been added: a group of highly trained peer counselors who act as paraprofessionals and smooth entry into treatment. They also provide confidential monitoring after treatment to reduce problems of relapse for employees with addictions.
“Since the late 1980s, when the initial training was done, the culture of the company has changed from one where substance abuse was tolerated and even covered up by fellow employees to one where it is no longer considered acceptable,” says Miller.
Would the program work as well without the threat of punitive action? “Having the heavy hand of disciplinary action and drug testing available appears to help induce some employees to recognize their at-risk behavior before delusional thinking sets in,” says Miller. “The program could exist without drug testing, but it would be more difficult.”
The program has produced financial benefits, too. Since 1987 total medical and work-loss costs of employee injuries have been cut nearly in half, and workplace substance use discipline reports per 1,000 workers are only about a fourth as common for workers with access to PeerCare than for workers lacking access.
Programs for Occupations and Professions
Other peer-to-peer programs are used among occupational or professional groups whose members represent different employers or are self-employed. These programs are common among airline pilots, lawyers and physicians.
In the aviation industry, the “HIMS” program relies upon three legs to identify and rehabilitate pilots who abuse alcohol: the airlines, the Air Line Pilots Association (ALPA), and the Federal Aviation Administration (FAA). HIMS stands for “Human Intervention and Motivation Study.” The name is no longer relevant, but the acronym has stuck.
While the Weyerhaeuser program is an intra-company approach generally for non-management and non-professional employees, the HIMS program is multi-employer and has primary focus on the occupation.
The HIMS program oversees interventions in the quasi-militaristic and often stressful life airline pilots lead. There are two pathways to help: One during the early stages of problems, when pilots are exhibiting poor or erratic behavior, and another when problems develop into genuine medical conditions that could threaten public safety and pilot health.
To help pilots at both stages, HIMS uses paid staff, pilots who volunteer to refer peers for help and representatives of the above-mentioned aviation groups. The HIMS staff provides training to pilots on substance abuse and related aviation topics. The pilots help identify impaired pilots and refer them to the carriers’ EAPs or, in cases where there is no EAP, to the HIMS medical staff. The aviation group representatives serve on a HIMS review panel that puts alcoholic pilots into a rehabilitation program and monitors their progress so they can regain their medical certification from the FAA.
Those involved with HIMS at the airlines, ALPA and the FAA consistently sing from the same hymnal: alcoholism is a disease and medical problem; education is the key to understanding addictive illnesses; rehabilitated pilots can return to the cockpit; the “Anonymous” programs are important for sustaining sobriety; and so forth. So important is the Alcoholics Anonymous philosophy among the pilots that they have their own AA-modeled program called Birds of a Feather.
“When you have an occupational group like airline pilots, who usually identify more with their profession than their employer and who work in a para-military environment subject to public scrutiny, a specialized support group becomes very important,” says Hoover. “The pilots enjoy the shop talk and know that the person across the table from them understands what it’s like to be a recovering [alcoholic who is also a pilot]. They become a tight fraternity that is always there for each other, even if they are from different airlines.”
That bond, says Hoover, is one reason why alcoholic pilots have a long-term recovery rate of 90 percent, compared with 60 percent among the general public, and why more than 3,000 impaired pilots have returned to the cockpit since HIMS was founded 26 years ago.
The field of law also has a number of longstanding peer-to-peer programs. One of the most established is Fort Lauderdale-based Florida Lawyers Assistance (FLA), which has helped an estimated 2,500 attorneys recover their law licenses in the state.
“Lawyers are mostly ‘independent operators,’ ” says FLA executive director Michael Cohen. “That makes it difficult to use a pure conduct and work-performance model of intervention.”
The program, which receives about two-thirds of its funds from the Florida Bar, provides two hours of training to lawyers, judges and others interested on an ongoing basis around the state. It also sponsors over 20 support groups for chemically dependent legal professionals and facilitates five groups for those who are psychologically impaired through depression or other mental illness. FLA estimates that more than 90 percent of the attorneys with whom it intervenes sustain their recoveries.
FLA’s roles are to promote awareness, educate attorneys and judges about substance abuse and psychological impairment and how to intervene in it, conduct assessment and referral to support groups, and do follow-up monitoring.
The regulating agencies for both lawyers and pilots use a weighty “stick” to enforce professional conduct—license revocation for attorneys and medical decertification or license revocation for airline pilots. That stick is also leverage for the impaired person to participate in their peer-to-peer programs for behavioral problems. So once an impaired attorney has been identified—whether through self-referral or a call to the FLA from the Florida Bar, by a trained peer, judge, judge’s bailiff, opposing counsel or family member—program staff can usually motivate them to accept help.
More Employers, Occupations Could Benefit
In addition to the programs mentioned in this article, others around the country exist in different workplaces, but most lack any rigorous research on their effectiveness.
Experts say that peer intervention programs could work in many more occupations and work settings without a strong union presence—both multi-employer and single-employer. For example, regional and statewide professional associations could sponsor such programs for their members. So could any employer utilizing team-based management.
While many employers talk a good game about “partnering with employees,” peer-to-peer programs are one way of backing up their claim.
Rudy M. Yandrick is a Mechanicsburg, Pa., freelance writer specializing in human resource and employee assistance issues, and vice president of York, Pa.-based NewMode Workforce Solutions, an employee assistance firm.
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