The On-Liner

June 2008 Edition


In this issue:

Read the latest President's Message

Welcome New NC EAPA Members

We have had 6 new members join since the Februrary. A warm welcome goes out to Jessica Kasinoff, Lissette Torres, Rachel Kauffman, Elizabeth Danielian, Robert Hinshaw, and Virginia Rumschik. We are thrilled that you have joined us and look forward to getting to know you better!!!

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May Training Report/September Training Announcement

We had great conference on May 22 in Greensboro at the Doubletree Hotel. This was our special Members Only training in which we had Jordan Goldrich speak on Rapid Conflict Resolution. Jordan provided a didactic and interactive training experience in which attendees were able to learn and practice skills that would be helpful in consulting with client companies.

Our next training will be in Research Triangle Park (RTP), NC on September 18 at the Comfort Suites on Page Rd. We have part of the agenda set up for that day, but not the entire agenda. For half of the day, we will have Jeff Christie, the current District 2 representative, discussing Ethics in EAP. This will give you 3 hours of training in Ethics, which is required for many licenses. The other part of the agenda is to be announced. I will send an e-mail via the listserv once that is confirmed and will post the registration on the website. In the meantime, you may go ahead and reserve a room at the Comfort Suites by calling 919/314-1200. The room rates are $105/night, but they will give State employees the Federal rate of $97/night, with ID. Please call the Comfort Suites by August 21, in order to get the conference rate. Tell them you are with the North Carolina Chapter of EAPA or NCEAPA to get the discounted rate.

See you in RTP!

— Submitted by Jay Hale, NC EAPA Vice President

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2009 NC EAPA March Conference Update

As the Chairperson for the March 2009 Annual Conference, I am pleased to announce that the conference committee (aka the Dream Team) has already begun work on developing the 2009 Conference. The conference dates are set for Wed March 11- Friday March 13, 2009. Also, you may be pleased to know that just as in the past couple of years, the conference will be held at the Embassy Suites in Concord, NC.

This year's Conference Committee:

Andy Silberman, Conference Chairperson
John Waller, Conference Vice-Chair
Jay Hale, NC EAPA President
David Hamby, Secretary
Dawn Klug, Treasurer
Martha Ausman
Eileen Hodiak
Jessica Kasinoff
Margaret Larrea
Karen Molli
Terry Newsom

I want to thank everyone on the committee for volunteering their time, talents, and energy. If you are not on the committee, but have ideas for potential speakers, or exhibitors, we welcome your input. Contact me or any of the committee members with your suggestions. Our primary goal is to create another terrific conference!

BE THINKING ABOUT and WATCHING FOR the CONFERENCE CALL FOR PAPERS. This will be sent via the listserve and posted on the website. Clearly, we have an enormous wealth of talent and experience within our chapter, and we encourage you to consider presenting on a topic with which you have expertise. Year in and year out, our members' presentations receive very high marks on the evaluations!

Andy Silberman, LCSW, CEAP
March 2009 Conference Chairperson
Work Phone: (919) 416-1727
Work Email:
June 27, 2008

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ICARE Project Article

Please read this informative article from Sally Smith with the ICARE project (Integrating behavioral health services into primary care practices) that describes who they are and what they are doing:

ICARE collaborative pilot bridging the gap for Quadrant IV patients

Nearly three-quarters of people with severe mental illness also have at least one chronic physical health condition, and experts say provider collaboration is vital for individual with concurrent, persistent physical and mental health conditions - known as Quadrant IV patients.

"Neither physical nor mental health can improve until all of a patient's concerns are addressed by primary care professionals and mental health specialists working in concert," said Dr. Dan Gerber, a psychologist and consultant with the Western Highlands Network local management entity (LME).

Propelled by that principle, The ICARE Partnership ( has established a program in Buncombe and Henderson counties aiming to integrate Quadrant IV patients into primary care practices. Through sponsorship from ICARE, a provider-led effort working to increase collaborative care throughout North Carolina, the pilot targets Medicaid, Medicare and uninsured patients.

Communication is the key

ICARE pilot leaders say the key to integration is seamless communication between primary care (PCP) and behavioral health professionals - accomplished, in part, through coordinated case management like that provided by ICARE case manager April Conner. Working with Access II Care of Western North Carolina, Mountain Area Health Education Center and Western Highlands, Conner serves as an advocate for both patients and providers, helping clients obtain referrals and comply with treatment plans while liaising with providers and making psychiatric consultation available to PCPs in a timely fashion.

According to Conner, pilot results thus far have been very encouraging. When the program launched in July 2006, fewer than two percent of Conner's clients received integrated care. As of December 2007, nearly half of Conner's clients benefit from provider collaboration.

Individual stories help highlight ICARE's success, said Conner. After six months of coordinated case management, a bipolar client with a history of crack cocaine use is now clean and sober, medically stable and linked with primary care, mental health and substance abuse services. Conner was able to help another client stop overusing emergency room services after she was alerted to the situation by the client's community support worker.

"Two years ago, there would have been no contact and this problem would have gone unaddressed," said Conner.

The right tools for the job

In addition to providing case management, the ICARE pilot also enables primary care providers to offer behavioral health services and helps behavioral health providers screen and refer for physical illness.

With input from participating practices and partners - including Western Highlands, Access II Care, MAHEC and four local medical practices - the pilot is developing a bipolar tool kit: guidelines that will help physicians assess a patient's presenting problems and diagnosis and prescribe medications when appropriate. The kit will also indicate when psychiatric consultation or referral should be considered.

The pilot committee is also developing similar notes and additional provider training for metabolic syndrome - a combination of four medial conditions that increase the likelihood of stroke, heart disease and diabetes. Quadrant IV patients may be susceptible to these conditions because of genetics, lifestyle issues and the use of prescribed atypical anti-psychotic medications, which often cause weight gain and decrease insulin sensitivity.

'Not just a demonstration'

Pilot members say their ultimate goal is to shape a health system that functions collaboratively even after the pilot ends.

"We're working to create communication protocols and tools that are simple and intuitive to use so that collaboration will happen naturally," said Conner. "We want to see integrated care thrive here - even without outside support."

To help build a self-sufficient integrated system, pilot participants are calling for a new mental health funding structure - one that would reimburse care coordination and case management activities that link primary care providers and community support agencies. The model set forth by ICARE is working and could easily be adopted by all LMEs, said Dr. Louis Stein, medical director at Western Highlands.

Currently, the pilot is funded through The Duke Endowment, the Kate B. Reynolds Charitable Trust, AstraZeneca, North Carolina Area Health Education Centers, the North Carolina Department of Health and Human Services and the North Carolina Foundation for Advanced Health Programs. Pilot participants are thankful for the generous support but hope to find a permanent source of funding in the future.

"We need to continue the pilot's work beyond sheer grant funding if we are to maintain our credibility with primary care providers," Stein said, noting that ICARE has applied for additional charitable funding to maintain the pilot through 2009. Pilot participants hope that by that time, a state-backed plan for sustainable funding will be in place.

"Primary care providers placed a lot of faith in this new system and have taken on more Quadrant IV patients - with the understanding that they will get support from the behavioral health care community," said Stein. "We need to provide that support. We need to show that this pilot is not just a demonstration that will disappear."

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Ray Robbins forwaded this article about ADHD in the workplace

EA Friends - Please Note:


"Dr. Kessler says the next step will be to get some large employers to offer treatment - probably a combination of medication and coaching - to people with ADHD, then compare the treatment group with a control group. My guess is that [treatment] is going to be a smart thing for employers to do," he said, comparing it with workplaces offering free flu shots to employees each winter."


"Bill Wilkerson, president and co-founder of the Global Business and Economic Roundtable on Addiction and Mental Health, spends his days explaining to business leaders why they should be concerned with mental disorders. Employers shouldn't play psychiatrist, he says, but it makes financial sense for Corporate Canada to strengthen employee-assistance programs and help people with ADHD obtain treatment."


ADHD cuts workplace productivity


From Monday's Globe and Mail

June 23, 2008 at 9:05 AM EDT

People who have attention deficit hyperactivity disorder work 22 fewer days each year than their colleagues who don't have ADHD, according to a new World Health Organization study.

Some of those are sick days, but most are days of lost productivity as a result of the symptoms of inattention and hyperactivity that characterize ADHD.

"It's a surprisingly serious disorder," says study co-author Ronald Kessler, a professor of health-care policy at Harvard Medical School, who said ADHD has a more significant impact on work performance than he expected. "There's an enormous societal cost."

Dr. Kessler says he hopes his research, based on a WHO survey of 7,075 people in 10 countries, will prompt employers to offer more support to workers with ADHD.

But people with the disorder received the study skeptically, saying it will only make their life in the workplace harder.

"I understand research is needed, but you begin to wonder, what were they thinking?" says Steven, a contracts administrator who asked that his full name be withheld because he doesn't want people to know he has ADHD. Although about 4 per cent of the adult population has ADHD, it carries a stigma - one that Steven fears will worsen as a result of the recent findings.

"Mental disorders as a rule do not have a good face in public," Steven says. "ADHD is a very misunderstood disorder. A lot of people think you just give someone medication and they're cured."

Now 47, Steven discovered he had ADHD when he was 31, after his son was diagnosed. He'd spent years bouncing through a series of unfulfilling jobs: driving a bus, working in restaurants, performing customer service. "I was a smart person, yet I couldn't seem to figure out a job," he explains.

His diagnosis forced him to become more self-aware and to take stock of what he liked to do, what he was good at and what his weaknesses were. That sort of self-inventory would help anyone, but Steven says it's crucial for people with ADHD.

"I finally got a job that suits my likes, my personality and my mental aptitude," he says of his current position. He writes lists to keep himself on track, he's careful not to take on more responsibilities than he can handle, and at the end of the day he's usually exhausted - but the important point to him is that his ADHD doesn't stop him from doing a good job.

Nor does it stop Denise Difede, an office administrator who works for a supportive employer - the Canadian Centre for ADHD/ADD Advocacy in Toronto. Sometimes she feels that her flickering attention span is an asset.

"I have an uncanny ability to multitask," Ms. Difede says.

But she has to work hard to stay organized, writing down everything in the day-planner her children call "the bible." Like Steven, she says learning about her ADHD helped her figure out how to stay on track.

"I don't allow myself to let anything go," she says. "If I don't write it down in my date book immediately it will not get done."

The WHO survey asked people to report how often they did not work, cut back their hours or cut back on the quality of their work; the results were compared with data from the survey that included diagnostic interviews for ADHD.

Dr. Kessler says the next step will be to get some large employers to offer treatment - probably a combination of medication and coaching - to people with ADHD, then compare the treatment group with a control group.

"My guess is that [treatment] is going to be a smart thing for employers to do," he said, comparing it with workplaces offering free flu shots to employees each winter.

Some advocates for people with ADHD applaud Dr. Kessler's goals, but question the idea of employee screening and treatment. "My concern is that it not be used to discriminate when hiring," says Heidi Bernhardt, national director of the Centre for ADHD/ADD Advocacy. "We have to be careful because there's a double-edged sword here."

Screening isn't as easy as just handing out a questionnaire, Ms. Bernhardt says. Only a trained psychologist or psychiatrist can diagnose ADHD. Ms. Difede notes that she fields dozens of calls a week from adults desperately seeking a psychiatrist who can assess them.

"There are only two in the [Greater Toronto Area] accepting new adult patients, and that's two more than I had last month," she says.

Still, Ms. Bernhardt says she welcomes any effort to educate employers and the public.

"Most people think of ADHD as little boys running around being hyper, and that's probably one-100th of it," she says. Adults often don't show the same obvious signs of ADHD, she says, but suffer instead from internal feelings of restlessness. In terms of public understanding, she says, ADHD is now where depression was 20 years ago - many people don't understand it and think that people with the disorder should just snap out of it.

Bill Wilkerson, president and co-founder of the Global Business and Economic Roundtable on Addiction and Mental Health, spends his days explaining to business leaders why they should be concerned with mental disorders. Employers shouldn't play psychiatrist, he says, but it makes financial sense for Corporate Canada to strengthen employee-assistance programs and help people with ADHD obtain treatment.

"It's really about prognosis, not diagnosis," says Mr. Wilkerson, a former insurance industry executive. "Whether an employee has ADHD, depression or diabetes is immaterial. ... You don't need to know what's wrong with someone in order to facilitate their getting care and getting back to work."

Signs in the workplace

About 4 per cent of the adult population has attention deficit hyperactivity disorder. The three major facets of ADHD are inattention, hyperactivity and impulsivity; in adults, the outer symptoms of hyperactivity often become internalized - instead of the person physically racing around a room, their mind is racing. Here are some symptoms of adult ADHD that may surface at work:

Chronic lateness.
Inability to track details, prone to careless mistakes.
Forgetting to complete tasks, even when they are daily activities.
Frequently losing necessary things.
Talking at inappropriate times, interrupting.
Struggling to pay attention in meetings.
Spending hours at work, but getting little done.

Sources: Centre for ADHD/ADD Advocacy,;

Rebecca Dube

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Listserve Reminder

If you are a member of NC EAPA and are not yet on the listserve, or you have changed your e-mail address recently, send your e-mail address to Andy Silberman at:

If you are a chapter member and wish to send a message to the listserve, just address the message to: (that's a small "L" after the hyphen).

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You can be a part of the On-Liner!!

Just a friendly reminder that anyone can submit updates, articles, book reviews, pictures, etc. for the On-Liner. You can send information anytime and I'll make sure that it gets in the next edition!!

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Jordan Goldrich demonstrated his technique in a 1:1 meeting with Renee...

...and then by meeting with the others involved in the conflict

Small groups helped us practice the technique

Michelle and John are new CEAPs!

Jordan helps Paul with the Box of Generosity...

...and the winners are Eva and Sandy!

Eileen, Karen and Dawn: a TRUE dream team

Andy and Lib having fun

Time to talk to friends

More socializing

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Please see our Businesses & Services page for Supporting Companies found in the OnLiner!

For information about our CONFERENCES available, visit the Conferences & Events page.