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Management referrals vs. mandatory referrals: are they one and the same?

Journal of Employee Assistance, The, July, 2006

Historically, EAPs have dealt with self-referrals and management referrals. These days, we are also hearing much more about mandatory referrals. There are some crucial differences between these types of referrals, although the terms are sometimes not used with much precision. Each type of referral requires a different level of confidentiality, has a different relationship to the disciplinary process, and assumes a very different role for the EA professional.

Self-referrals are initiated by employees who are aware of a problem or are experiencing enough discomfort to seek resources. They may have been encouraged to use the EAP by co-workers, family members, or supervisors. They possess some level of insight or at least are motivated to obtain relief.

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Self-referrals contact the EAP at their own initiative and take advantage of the ease of access offered by the EAR Many of them would seek other resources if no EAP were available. No feedback is given to the employer or supervisor with this type of referral.

Arguably the most valuable service offered by EAPs is the management referral, which is directly related to job performance. A management referral and participation in the EAP does not constitute a formal step in the disciplinary procedure or a condition precedent to commencement of disciplinary action. A management referral to the EAP should not be viewed as a disciplinary action but rather as another tool or option for the employee to use in improving job performance. Communication with the referring manager is often limited to whether the employee followed through with the referral and a release is required.

Mandatory referrals, on the other hand, are controversial high-stakes and high-energy situations. These referrals are seldom proactive referrals based on patterns of declining performance; rather, they are reactive referrals based on triggering events. The triggering events are often very visible and routinely rise to a disciplinary level that could result in termination. Mandatory referrals give employees one last opportunity to turn things around.

We see mandatory referrals used in situations involving threats of violence, alcohol and drug abuse in safety-sensitive positions, citations for driving under the influence of alcohol in a company car, harassment, and even excessive absenteeism. Other mandatory referrals result from formal fitness-for-duty evaluations that require a specific course of treatment to return to the job.

Mandatory referrals are made in combination with progressive, corrective discipline and involve a formal personnel action. As part of a written agreement with the company, the employee signs a release of information so that the supervisor can be updated and informed of the employee's compliance with recommendations. Compliance with these mandatory referrals most often is a clear condition of employment. The EAP monitors compliance with the treatment recommendations and often monitors continuing care as well.

CHILLING EFFECT

Some EA professionals see mandatory referrals as counter to the basic EAP philosophy and worry that mandatory referrals will have a chilling effect on other areas of EAP work. These EA professionals feel that mandatory referrals produce a superficial, resentful compliance rather than a real commitment to change. They fear that mandatory referrals position the EAP to be seen as a tool of management rather than a neutral employee resource.

If an EAP reports noncompliance that can result in job loss, does that diminish the sense of protection that employees feel when seeking help through self-referral? EA professionals who work with mandatory referrals think that this concern can be managed through careful attention to policy, consultation, and education.

The written policy for mandatory referrals must clearly outline the intent for each referral, the process to be followed, the communication that is expected, and the levels of approval that are required at each step. Consequences for noncompliance with mandatory referrals need to be defined in advance--in policy, practice, and contract--and need to reflect the magnitude of the action/infraction warranting the mandate in the first place. A mandatory referral must be understood to be a last chance for the employee to make changes and demonstrate improvement.

The availability and coordination of care with appropriate providers presents an ongoing challenge for EA professionals and is particularly important in the case of mandatory referrals. Not all providers are equipped to handle such complex and high-profile cases. EA professionals and providers who are successful with mandatory referrals recognize that resistance and limited initial internal motivation are part of the assessment and counseling processes. Active care management of these cases is essential.

The EAP needs to take a very comprehensive approach with mandatory referrals, with an EA professional working with the employer, the treating professional, and the employee (as a performance coach). The ability to obtain the information needed from the provider about participation in treatment and readiness to return to work is critical to a successful mandatory referral.

Health Care Industry

Management referrals vs. mandatory referrals: are they one and the same?

Journal of Employee Assistance, The, July, 2006

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