Problem Addressed

• A common, growing problem: Three-fourths of employees believe that workers face more on-the-job stressors now than a generation ago.¹ A 2007 American Psychological Association survey found that half of all Americans report that stress negatively affects their personal and professional lives and about one-third of adults report experiencing stress as a result of managing work and family responsibilities.²
• Many negative effects, including mental health problems and substance abuse: The cumulative effects of daily stress often lead to psychological problems such as depression, anxiety, and somatic complaints. Stress also commonly causes an increase in problem drinking and substance abuse.³ Co-occurring mental health and substance use disorders (including those caused by stress) constitute a significant public health concern and a leading cause of disability worldwide.⁴
• Unrealized potential of worksite interventions: Although the worksite can be an effective place to identify and support stressed individuals at risk of such problems, relatively few employers offer such support.

Description of the Innovative Activity

• Weekly worksite-based sessions led by trained facilitator: The program consists of 16 weekly, 90-minute sessions taught around regular work hours. Sessions are led by a certified, trained facilitator who has attended an intensive 2- to 3-day session sponsored by the Consultation Center at the Yale University School of Medicine. Each session typically includes 15 to 20 individuals.
• Customized to specific audiences: The program can be customized to meet the unique needs of individual worksites and therefore has broad applicability. The program has been implemented with employees at all levels of the organization, at all ages, and across a broad spectrum of ethnic, racial, and socioeconomic backgrounds. It has been used with employees working in private for-profit companies and private and public nonprofit organizations and with clients served by nonprofit organizations. Several research and adaptation efforts are currently under way, including the following: (1) testing the effectiveness of the program with medical residents in university settings (information provided in December 2012 indicates that an initial study involving anesthesiology residents has been completed and results have been published⁵); (2) evaluating the impact of a modified 12-week version of the original intervention with minority women at risk for HIV/AIDS; (3) development of a related intervention specifically for managers and supervisors (which complements the original program for employees) to undertake multilevel interventions within an organization; and (4) development of a modified program specifically for employees who are caregivers of older family members and therefore confront work, family, work–family, and caregiver stressors.
• Curriculum focused on preventing co-occurring disorders: The program teaches participants how to reduce stressors and improve coping skills and social supports in two key areas of life: work and family. Throughout the course, instructors emphasize the role of stress, coping, and social support in relation to substance use and psychological symptoms. The goal is to reduce risk factors, such as sources of stress and use of "avoidance coping" (maladaptive coping designed to avoid dealing with a stressor), and to enhance protective factors such as use of active (positive) coping and social support. Key elements of the curriculum are outlined below:
  • Broad array of topics: The program covers a broad array of topics, including problem-solving, deep breathing, muscle relaxation and other stress management approaches, communication skills, cognitive coping strategies (such as cognitive restructuring and reframing), lifestyle change (including eating and exercise), expanding and using social support, and goal setting.
  • Group support: The group format encourages participants to share successful coping strategies, use social networks, and practice stress management and problem-solving skills with other members of the group.
  • Focus on practical skills: Participants learn an array of problem-solving and effective communication skills to better deal with stressful situations and events that occur at work, home, or the interface between work and family.
  • Homework focused on specific stressors and strategies: Homework, given after each session, involves exercises related to the session focus and gives participants the opportunity to practice skill development in real-life situations during the week.
  • Personal stress management plan: At the last session, participants review the costs and benefits of applying the coping strategies learned throughout the course to their specific family and work problems and then create a personal stress management plan to follow after the program ends.

References/Related Articles

Snow DL, Kline ML. A worksite coping skills intervention: effects on women’s psychological symptomatology and substance use. The Community Psychologist. 1991;24:14-7.

Kline ML, Snow DL. Effects of a worksite coping skills intervention on the stress, social support, and health outcomes of working mothers. J Prim Prev. 1994;15(2):105-21.

U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services. Prevention of co-occurring mental illness and substance abuse report. Rockville, MD. March 19, 2010.

U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Prevention. SAMHSA National Registry of Evidence-based Programs and Practices: Coping With Work and Family Stress. Rockville, MD. Available at: http://nrepp.samhsa.gov/ViewIntervention.aspx?id=103.

Contact the Innovator

David L. Snow, PhD
Professor Emeritus and Senior Research Scientist in Psychiatry and Epidemiology and Public Health
Yale University School of Medicine
Phone: (203) 789-7645, ext. 104
Fax: (203) 562-6355
E-mail: david.snow@yale.edu

Susan Ottenheimer, LCSW
Assistant Clinical Professor in Department of Psychiatry
Yale University School of Medicine
Phone: (203) 789-7645, ext. 152
Fax: (203) 562-6355

E-mail: susan.ottenheimer@yale.edu

Innovator Disclosures

Results

• Greater use of active coping strategies and increased social support: Results from Study 1, a randomized, controlled trial of 239 female clerical workers, indicated a 16-percent increase in use of active behavioral coping strategies for dealing with work, family, and work-family stressors at a 6-month followup, while the control group showed a 4-percent decrease in the use of behavioral coping. At the 6-month followup, program participants reported a 10-percent increase in social support from supervisors and coworkers, while the control group showed a 4-percent decrease in this area. In Study 2 (a randomized, controlled trial of 468 male and female employees), results indicated a 15-percent increase in social support coping (active coping strategy) at 4-month posttest, and no change in the two control groups. A third randomized, controlled trial examined the effectiveness of the program with a sample of anesthesiology residents; residents in the intervention group reported increased social support at work and greater problem-solving coping as compared with one or both of the control groups (a no-treatment control with release time and another no-treatment control with routine duties) (updated December 2012).^5,6,7,8,9
• Less avoidance coping: Program participants in Study 1 reported a 39-percent decline in use of avoidance coping at the 6-month followup, compared with no change in the control group. Study 2 reported a 17-percent decline in the use of social withdrawal as an avoidance coping strategy at posttest, while the two control groups showed only minor reductions of 4 and 2 percent, respectively. Both studies showed reductions in participants' tendencies to use avoidance when confronted with stressful situations and events at work and home. Study 3 findings related to reducing avoidance coping were suggestive of positive intervention effects (updated December 2012).^5,6,7,8,9 Program developers believe this decrease resulted from an improved ability to handle work and family stressors and the interface between work and family life. Program developers credit this improved ability to greater use of active coping strategies and increased use of support from social networks.
• Fewer psychological symptoms and less problem drinking: Study 1 participants reported an 18-percent decline in psychological symptoms such as depression, anxiety, and somatic complaints at 6-month followup, while the control group reported a decline of only 4 percent. In Study 2, participants reported an 11-percent decline in psychological symptoms, while control groups showed no change. In Study 1, program participants reported a 31-percent decrease in the number of drinks per month (compared with a 12-percent decrease in the control group) and a 52-percent decrease in this tendency to drink to reduce tension (compared with a 9-percent increase in this tendency in the control group). Study 2 participants showed a 27-percent decline in problem drinking (compared with 18- and 20-percent increases in the two control groups) and a 23-percent decline in the tendency to use alcohol to reduce tension (compared with 13- and 10-percent increases in this tendency among the two control groups). In Study 3, residents in the intervention group reported significantly fewer stressors in their roles as parents and less anxiety as compared with one or both of the control groups; Study 3 findings related to alcohol consumption suggested positive intervention effects (updated December 2012). Heavy alcohol users (98 people from Study 2) showed declines at posttest in both problem drinking (34 percent) and number of drinks per month (26 percent). ^5,6,7,8,9

Evidence Rating (What is this?)

Context of the Innovation

Planning and Development Process

• Obtaining funding: In 1987, the program developer sought and successfully obtained funding from the National Institute on Drug Abuse (NIDA) to develop and test the program in four worksites (a large manufacturing company and three utility and telecommunication companies).
• Developing curriculum based on conceptual framework: Program leaders developed the curriculum based on a three-part model of adaptive coping behavior, which focuses on attacking the problem, rethinking the problem, and managing the stress. They designed the curriculum to emphasize the role of stress, coping, and social support in relation to substance abuse and psychological problems.
• Testing program in multiple settings with diverse populations: The success of the initial test of the program funded by NIDA led to securing additional funding from the National Institute on Alcohol Abuse and Alcoholism (NIAAA). This funding allowed developers to further evaluate the program’s effectiveness in reducing substance use and psychological symptoms. Program leaders tested the approach in a number of additional worksites, including another large manufacturing company and two water authority companies. Participants included men and women of diverse ages; ethnic, racial, socioeconomic, and educational backgrounds; and levels in the organization, including supervisors and managers, administrative and support personnel, and frontline workers.
• Creating dissemination plan: Based on the successful results from the two randomized, controlled trials and subsequent research, program developers created a national dissemination plan. The plan includes intensive 2- and 3-day programs to train professional facilitators across the United States and abroad to implement the Coping With Work and Family Stress intervention. Program developers have given more than 32 facilitator trainings across the United States since the program's inception.

Resources Used and Skills Needed

• Staffing: As noted, one trained facilitator runs each 16-week session. Facilitators typically have master’s-level degrees and experience in group dynamics and have completed the intensive training session (see Planning and Development section). Facilitators come from a wide variety of specialties, including human resource and employee assistance program professionals, behavioral health and prevention specialists, and other mental health professionals. Organizations can choose whether to train internal staff to facilitate the program or to hire a trained professional on a contract basis. To date, 500 individuals in 42 states have become certified facilitators.
• Costs: Program costs vary based on several factors, including whether the program uses an internal or external facilitator, whether the program requires the release of employees during regular work hours, and overhead costs (e.g., physical space). External facilitators generally cost $3,200 for the entire program (with costs averaging $100 per hour), while an internal facilitator generally costs less. Program materials cost approximately $400 for a group of 20 participants, which covers hard copy of the full curriculum, a CD-ROM, and weekly handouts. Technical assistance can be made available to program facilitators for $150 per hour, plus travel costs (if provided onsite). The costs of facilitator training will vary depending on availability of a training space (offsite or onsite) and the length of the session (2 or 3 days).

Funding Sources

Tools and Other Resources

More information about the program is available on the Yale Consultation Center Web site: http://www.theconsultationcenter.org/index.php?/coping-with-work-a-family-stress-a-workplace-preventive-intervention-for-employees.html.

Getting Started with This Innovation

• Obtain organizational buy-in: To win the support of organizational leaders, explain how the program can improve the bottom line of the company by helping workers remain as productive as possible and by reducing costs related to substance abuse and mental health treatment. To ensure broad-based support, discuss the program with people from different levels of the organization.
• Negotiate release time: To ensure high participation, workers should be allowed to participate around normal working hours. Work with senior leaders to find times that employees can take part with as little disruption to work as possible (e.g., by having sessions at lunch time or in the early morning or at the end of the day), and communicate to employees that taking part in the program will be viewed positively by management.
• Identify and customize to target group as necessary: Determine what group of individuals within the organization will participate in the program (e.g., supervisors, middle management, senior management, professional employees, administrative and support staff, frontline workers), and then orient the program to their needs in terms of the types of work and family stressors they are likely to encounter. Facilitators should pay attention not only to issues related to occupation but also to ethnicity, race, socioeconomic status, education, and religious background.

Sustaining This Innovation

• Monitor and share data on program benefits: Continue to make the case for the program to leaders by tracking and sharing data on the program's ability to improve employee health and productivity and reduce absenteeism and use of medical services.
• Regularly emphasize confidentiality of information: To facilitate continued participation and honest communication, discuss the importance of confidentiality in the first group session and reinforce this concept regularly throughout the program.
• Tap into technical assistance as necessary: The program developers offer consultation and technical assistance to troubleshoot program implementation issues as needed and to provide advice on program evaluation.

Additional Considerations and Lessons

Use By Other Organizations