Additional Services

Career Assessments

Duke offers career assessment and counseling services to assist individuals with career planning and decision making. Interviews, structured questionnaires, exercises, career inventories, and personality testing are employed to enable the individual to compile a picture of his/her interests, values, strengths, and styles of interaction. Based on this feedback, we can collaborate with the individual to create an action plan, and provide support and guidance to the individual as he/she implements the plan.

Psychological Evaluations

Psychological evaluations are useful for gaining insight regarding an individual's interaction and work styles in order to plan for better utilization of their strengths and improvement of their weaknesses. A comprehensive testing battery typically consists of a psychological interview, personality assessment, cognitive assessment, collateral information collection, and interview of significant parties involved. A formal write-up with recommendations is used to synthesize this information and provide an analysis of the information.

Psychological evaluations are also performed for Fitness for Duty (FFD) evaluations, which assess the feasibility of an employee to perform his/her stated job duties given some recent negative appraisal (e.g., violence on the job, inadequate job performance, inability to interact appropriately with co-workers).

Program and Policy Development

Duke OMHP and the Division of Occupational and Environmental Medicine have helped organizations evaluate their programs and policies as well as establish cutting edge programs and policies for complying with existing legislation (e.g., ADA and OSHA). We have the vision, expertise, and experience to help you integrate your policies and programs with your organization's overall mission. We work best with organizations who truly value their human resources.

Case Management

Organizations may request Clinical Case Management as part of their benefit design. For these companies, Duke OMHP clinical staff will manage services provided when individuals are admitted to an intensive outpatient program, partial program, inpatient facility, or residential treatment program. To assure appropriate and quality care, a Duke OMHP Clinical Case Manager reviews all clinical information provided by the facility to determine medical necessity. Subsequently, the case manager will review the case on a regular basis. Such periodic reviews will examine the following criteria as they apply to the case:

• Diagnosis
• Treatment plan
• Medication
• Estimated length of stay
• Patient/family psycho-education
• Discharge plan
• Continuing outpatient therapy and support from available community resources

Duke EAP Quality and Outcomes Management

Duke EAP recognizes that an employee's emotional state and personal concerns can affect multiple components of the work environment: productivity, absenteeism, retention and turnover, worker's compensation and disability claims, and use of insurance benefits. These factors certainly impact a company's "bottom line" as well as an employee's perception that the company is supportive of his/her emotional well-being/personal concerns. Evidence suggests that EAP's are successful in helping employees and their families resolve challenging issues. Moreover, the utility of prevention and early intervention efforts for thwarting the development of more severe or chronic problems has been well documented. Duke EAP is committed to demonstrating our value by measuring our tangible and intangible benefits to companies and clients.

Return on Investment

Duke EAP has been developing a return on investment model that will demonstrate the potential financial benefit of EAP services. Part of this effort has entailed an extensive review of industry standards for estimating cost savings. Since most models of this nature include some assumptions, our goal has been to identify benchmarks that might most accurately apply to a particular company and to use this information in conjunction with company-specific data. Returns on investment in EAPs have fluctuated from $2 to $20 returned for every $1 invested (Cascio, 1991, Costing Human Resources: The financial impact of behavior in organizations). Duke EAP recently estimated the return on investment for one company as $16 saved for every $1 invested in comprehensive EAP services. Our return on investment model was calculated based on potential savings in three areas: increased productivity, reduced absenteeism, and reduced use of insurance benefits.

Utilization Review

As a managed care company, Duke EAP provides case management and authorization for higher levels of psychiatric care (e.g., inpatient hospitalization). We have also developed the capability to track utilization rates. By systematically collecting data on diagnosis, length of hospitalization, and client group (e.g., employee, spouse, dependent), we are able to:

• Target areas for prevention efforts and intervention
• Track client progress and guide treatment decisions

In addition, by adding cost information, we will be able to identify the most cost-effective treatments and treatment facilities.

Outcomes Measurement

Duke EAP is involved in a continual process of improving the quality of services and the measurement of outcomes. Toward this end, we are developing and implementing an instrument uniquely tailored to our services, clients, and companies. Using this instrument will enable us to:

• Assess, both quantitatively and qualitatively , the degree of work impairment related to employee problems
• Assess the severity of psychological symptoms
• Gauge client satisfaction with EAP services and the therapist/client interaction
• Track the therapist's ratings of client's symptoms, impairment, and progress (improvement)
• Compare ratings pre and post counseling, as well as during counseling, to track client progress and guide treatment decisions

These three components, return on investment, utilization review, and outcome measurement, provide a comprehensive way to meet multiple needs:

• The needs of the company purchasing EAP benefits by addressing "bottom line" cost and work related variables
• The needs of the employee, spouse, or dependent utilizing the EAP by addressing client satisfaction and response to counseling or other interventions
• The needs of Duke EAP itself by assessing the therapeutic benefits of services and therapist effectiveness

Critical Incident Debriefing

Duke EAP has a critical incident stress debriefing (CISD) team with Cognitive Behavioral Therapy (CBT) and Eye Movement Desensitization and Reprocessing (EMDR) training and experience available to provide on-site CISD services within 24-48 hours of a critical incident.

Duke EAP clinicians are prepared to assist the workforce in managing traumatic incidents that might occur at work. We tailor critical incident stress debriefings (CISD) to the circumstances of a particular incident. Generally they include crisis intervention and an educational component designed to mitigate the psychological distress associated with a traumatic event and facilitate resolution in employees experiencing normal stress reactions to abnormal traumatic events. The structure of a debriefing allows employees to discuss the event in a controlled manner. A debriefing is not counseling or a substitute for psychotherapy. The debriefing team usually consists of two Duke EAP clinicians.

Disability Management Services

Executive Coaching and Consultation

We provide highly customized and confidential services for executives covering a broad spectrum of issues, including:

• Assessment of leadership and personality style, abilities, career interests, and values
• Problem solving communication, emotional communication, time management, negotiation, active listening, and assertiveness training
• Supportive personal empowerment focused psychotherapy
• Team building
• 360 communication process facilitation

Stress Management Programming

Numerous aspects of the contemporary work scene and its performance standards/requirements can contribute to significant job stress. Demands for increasing technological sophistication, high efficiency and productivity, as well as the juggling of multiple tasks, can lead workers to experience severe stress and burnout. Duke EAP has created programs designed to assist workers to examine the sources of their stress and to provide them with concrete strategies for managing their stress level, improving their focus, enhancing their well-being, and promoting better job performance.

Benefit Design Consultation

Duke has experience in creating mental health/substance abuse benefit designs that incentivize employees to utilize their Employee Assistance Program services rather than seek external services on their own. Such programs “reward” the employee who uses the Employee Assistance Program by allowing the employee or dependent to receive the highest insurance reimbursement rate. Individuals who choose to seek services independently will receive a lower insurance reimbursement rate.

Duke can also assist your organization in determining covered services, establishing provider qualifications, defining benefit coverage, explaining level of care coverage, and creating usual and customary fee schedules. Please contact our office (1-800-336-3853) if you are interested in Duke providing benefit design consultation.

VIP Psychological Services

Sometimes key personnel have work related problems such as interpersonal conflicts or personal problems which impair their ability to perform at the highest levels. Through a dedicated multi-disciplinary team of professionals, we offer highly confidential, "state-of-the art" evaluations including medical, psychological, organizational, and familial dimensions of these difficulties. We formulate customized and creative solution focused interventional plans and deliver these services using only the most senior, experienced clinicians at Duke. If required, we facilitate referrals to appropriate specialists, as needed, worldwide.

Cost Containment

Organizations lose substantial amounts of money as a result of under treatment, inappropriate treatment and over treatment of individual's interpersonal, marital, and family problems. At Duke, we have developed a system to analyze the cost/benefit of your organization's employment policies and your compensation and benefit system to improve employee performance and employee well being. Cost wise management begins with well-designed programs and well-trained employees (and/or vendors) implementing and maintaining them. Our team of professionals provides you with expertise in simultaneously becoming even more cost wise and constructively employee focused.

Fitness-for-Duty Evaluations

A mental health Fitness for Duty (FFD) evaluation is a mandatory evaluation referral used by the employer to assist in determining whether an employee is psychologically capable of performing his/her assigned job duties and/or whether an employee poses a significant risk to the safety of him/herself or others in the workplace. This referral is different than the voluntary, supervisory, or mandatory supervisory referral. Generally, a FFD referral arises when an employee exhibits some behavior that raises questions about his or her ability to appropriately perform their assigned duties or about his or her risk of harm to self or others in the workplace. When an employee has been referred for a FFD evaluation, it is a requirement for continued employment.

The FFD evaluation is performed by an independent clinician. The FFD evaluator is not part of the Employee Assistance Program staff that works for the Duke Occupational Mental Health Programs or the providers that are contracted with Duke as part of the Extended Provider Network. However, Duke EAP may assist the company in locating a FFD evaluator in your area.

Workplace Violence Prevention Programming

We have considerable expertise and experience helping organizations establish workplace violence prevention programming. Our multi-disciplinary team offers a broad range of services including organizational risk assessment, individual risk assessment, fitness to be at work evaluations, work place violence prevention education and training for management and employees, threat assessment team creation and maintenance, critical incident stress management, and critical incident stress debriefing.