module 3 - institute of behavioral...

Team Awareness Training For Workplace Substance Abuse Prevention

Module 3

Reducing Stigma and Tolerance and Increasing Responsiveness

Developed by

Joel B. Bennett, Ph.D. Norma G. Bartholomew, M.A.

G. Shawn Reynolds, M.S. Wayne E. K. Lehman, Ph.D.

Principal Investigator

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This manual was developed as part of a NIDA Grant (DA04390), Drug Use in the Workplace: A Prevention Training Program, to the Institute of Behavioral Research, Texas Christian University. The contents are solely the responsibility of the developers and do not necessarily represent the official views of NIDA. This Team Awareness training module and all related data collection forms may be used freely for personal, educational, research, and/or information purposes only. Permission is hereby granted to reproduce and distribute copies of content material (except reprinted passages from copyrighted sources) for nonprofit educational and nonprofit library purposes, provided that copies are distributed at or below costs and that credit for author, source, and copyright are included on each copy. No part of any material may be copied, downloaded, stored in a retrieval system, or redistributed for any commercial purpose without the express written permission of Texas Christian University. For more information, please contact: Institute of Behavioral Research Texas Christian University P.O. Box 298740 Fort Worth, TX, 76129 (817) 257-7226 (817) 257-7290 (FAX) Email: [email protected] Web site: www.ibr.tcu.edu © Copyright 2002 TCU Institute of Behavioral Research, Fort Worth, Texas. All rights reserved.

VISIT OUR WEB-SITE www.ibr.tcu.edu

The purpose of this 3-year project was to refine, implement, and evaluate a team-based substance abuse prevention program for work settings. The program is designed to increase employee awareness of issues relating to workplace alcohol and other drug use and its consequences. Because these issues and consequences occur within an organizational context, the training addresses specific factors that aggravate employee substance use and prevent effective policy implementation.

OVERVIEW OF THE TCU DRUGS IN THE WORKPLACE PROJECT

The Drugs in the Workplace Project at Texas Christian University has studied the prevalence, antecedents, and consequences of employee substance use for over 12 years. Results have emphasized the importance of work environments, policies, and employee characteristics in understanding the pervasiveness and impacts of substance use in the workplace.

In recognizing the changing social contexts in today’s workforce, Principal Investigator Dr. Wayne Lehman and researcher Dr. Joel Bennett spearheaded the development of two prevention programs. This manual contains material from the participatory "team-based" program and emphasizes the impact of substance use problems on all team members in a work group (in terms of lost productivity, having to cover for absent co-workers, and work-place safety). The approach promotes awareness of group dynamics that serve to condone or create tolerance for drinking or drug use in a workgroup. Issues such as stress management, communication, risk identification, and how to gently "nudge" a troubled co-worker to seek professional help are discussed. The second program is an enhanced "informational" training that primarily uses didactic presentations to familiarize employees with their workplace substance abuse policy, the effects of alcohol and various drugs of abuse, and Employee Assistance Programs (EAP).

Both programs have been evaluated in two municipal workforces -- a medium-sized suburban city in which work groups from all city departments (except uniform fire and police) were included, and departments that had previously been identified as "at-risk" for substance abuse problems from a larger urban city.

Work groups were randomly assigned to receive either the team-based or informational training, or were assigned to a no-training control group. Work groups were assessed two weeks before and after the trainings, and again at six months post-training. Overall, employees who attended either of the two training conditions showed improve-ments in important areas comparesults at 6-month follow-up fosupportive group climate, stress the EAP. Arrows from the trainingarrows indicate more substantial

The 6 components of Team oriented training are:

1) risk identification2) policy awareness

3) stress management4) understanding tolerance

5) communication6) peer referral skill training









red to employees in the control condition. Figure 1 summarizes the r both cities. Five domains of outcomes were examined, including a and coping, drinking norms, policy knowledge, and information about condition to the outcome domain indicate a positive change. The bold change.

http://www.ibr.tcu.edu/projects/workplac/prevention.html

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In its original form, the Team Awareness program was delivered as two 4-hour (half-day) sessions, each session delivered a week apart. Session I consisted of Modules 1 and 2. Session II consisted of Modules 3 through 6. We used slightly different steps in different work sites and so the length of the modules here are longer, if facilitators choose to use all the steps provided. These different options and an overview are explained in the manual titled “Introduction and Facilitator Overview.” Each module has (1) an accompanying manual in Acrobat/PDF format and, (2) overheads and speaker notes as separate PDF files.

Module Manual Overheads/Speaker Notes

Introduction & Facilitator Overview

Teamaware.pdf None

Session 1

(1) Relevance to you and your work group: Orientation and Risk Identification

Module1(Relevance).pdf Module1(Relevance)ho.pdf

Module1(Relevance)ho-notes.pdf

(2) Team Ownership of Policy: The Risks & Strengths Game

Module2(Policy).pdf

Module2(Policy-Part1)ho.pdf

Module2(Policy-Part1)ho-notes.pdf Module2(Policy-Part2)ho.pdf

Module2(Policy-Part2)ho-notes.pdf Module2(gameboard).pdf

Session 2

(3) Reducing Stigma & Tolerance and Increasing Responsiveness

Module3(Tolerance).pdf Module3(Tolerance)ho.pdf

Module3(Tolerance)ho-notes.pdf

(4) Work Stress, Problem Solving, and Substance Use

Module4(Stress).pdf Module4(Stress)ho.pdf

Module4(Stress)ho-notes.pdf

(5) Improving Workplace Communication

Module5(Communication).pdf

Module5

(Communication)ho.pdf Module5

(Communication)ho-notes.pdf

(6) Encouragement: The NUDGE Model Module6(NUDGE).pdf

Module6(nudge)ho.pdf

Module6(nudge)ho-notes.pdf Module6(casestudies)ho.pdf

Module6(casestudies)ho-notes.pdf

1

Module 3

Reducing Stigma and Tolerance and Increasing Responsiveness

Participants will: ObjectivesObjectives

Identify both personal and group attitudes toward coworkers with alcohol, drug, or other behavior problems.

Recognize and potentially reduce risky levels of

supervisor and coworker tolerance (stigma, enabling, codependence).

Increase responsiveness to problems

Facilitator Overview and Session Map:

• On the following page (Page 2), you will see a map of the different

steps in this module.

• We wanted to give you many different options or different tools for delivering this module.

• Take a moment to review the map and get familiar with the

SEQUENCE of STEPS. • Notice that there are 6 general steps • Notice that you can skip steps • Notice you have Options and Tools ( )

• Note that you can deliver a 20-minute, 45-minute, or a full hour

module.

Team Awareness: Tolerance Module

2

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Texas Christian University – Workplace Project at IBR (www.ibr.tcu.edu)

3

Module 3

Reducing Stigma and Tolerance and Increasing Responsiveness*

ObjectivesObjectivesParticipants will: Identify both personal and group attitudes toward

coworkers with alcohol, drug, or other behavior problems.

Recognize and potentially reduce risky levels of

supervisor and coworker tolerance (stigma, enabling, codependence).

Increase responsiveness to problems

Procedure Step

Segment Name

Time

1 Welcome 5 minutes

2 Topic Introduction: Define Tolerance 5 minutes

3 Discussion: What do you/don’t you tolerate? 10 minutes

4 Hand-Out/Exercise: Self Assess Tolerance 5 minutes

5 Hand-Out/Exercise: Group Decision-Making Tolerance 15 minutes

6 Increase Responsiveness: Faces of

Tolerance, Causes & Consequence, Stigma

15 minutes

Module Length 55 minutes

* You have the option of delivering a separate module for supervisors

only (see “Module 3 – For Supervisors”)


SessionStructureSessionStructure

4

Materials

• Flip Chart or chalkboard FacilitatorMaterials and

Preparation• Overhead or LCD projector and screen

• Markers or chalk

• Pencils for participants

• Slides or handout of slides for participants to follow

• A water soluble or erasable pen for overheads

• Handout materials (see below)

Prepare before class

• Review all overheads and/or flipchart statements. • Handouts-Make copies for each participant:

Be creative if you need to: 1 – “What Do You Tolerate?” (page 27; Overhead # 2, p. 18)

2a – “Individual Tolerance” – 6 –item survey [page 28]

[[NOTE. Please preview the six items on Overhead # 3 (p. 19) and determine if they are appropriate for your setting. You may choose to create your own set of “intolerable” situations.]]

3 – “Causes & Consequences” handout

• Make 3 to 5 copies for 3 to 5 groups:

2b-“Group Tolerance” – 6 –item survey (color copy)

• Two prepared Flip-Charts (you have the option of using slides—see Overhead # 2, page 18 and Overhead # 6, p. 22)

Use two sheets of flip chart paper to write out the words and format as shown below:

Stigma Stigma -- Tolerate Tolerate -- RespondRespondStigma Stigma -- Tolerate Tolerate -- RespondRespond

Te

Stigma Stigma -- Tolerate Tolerate -- RespondRespond

LabelLabelJudgeJudgeRejectReject

AvoidAvoidMinimizeMinimizeEnableEnable

CareCareApproachApproach

ActAct

Do NothingDo

Something





ActAct

Do NothingDo

Something

What do youWhat do youtolerate?tolerate?

What don’t youWhat don’t youtolerate?tolerate?

What do youWhat do youtolerate?tolerate?

What don’t youWhat don’t youtolerate?tolerate?

xas Christian University – Workplace Project at IBR (www.ibr.tcu.edu)

5

Participant and Classroom set-up Number of Participants: Minimum of 10-Maximum of 24

• This session involves participants working solo, working in pairs, and working in small groups.

• When possible, set up the room so that individuals can work around a table or easily move their chairs into small groups.

Slides/Overheads

There are a total of 9 slides. One slide is used to record participant (group) responses to the six-item “Group Tolerance” exercise (Step 5). NOTE. The PDF companion version of this module is available as "Module3(tolerance)ho.pdf." To viewthe speaker notes, open the "notes" file for Module 3,which is "Module3(tolerance)ho-notes.pdf."

For “Ideas Behind This Module” seethe Appendix


6

55

Ex

Sh

Step 1

Welcome and topic introduction

Welcome participants as they arrive

Introduce the session topic. (You may use your own

words, but cover the three main ideas below)

plain: ♦ “This session will focus on our attitudes toward real or imagined coworkers who have problems with alcohol or drug use. Specifically, the session examines the attitude of unhelpful or harmful tolerance.”

♦ “Sometimes we tolerate problems because there is

nothing we can do about them, we feel helpless about them, and decide that the best attitude is to just “put up with” or tolerate the situation.”

♦ “This session is designed to increase awareness of this

unhelpful attitude and to help participants generate alternative, more helpful, and more responsive attitudes.”

Write session purpose on flipchart or blackboard. [[ To save time, prepare purpose beforehand ]]

ow Purpose:

Purpose: To recognize and reduce risky levels of tolerance by identifying both personal and group levels of tolerance and generating alternative responses to problem coworkers.


7

Step 2 55

Define Tolerance

Prepare flipchart; record responses to following.

ASK participants what “tolerance” means or what

does it mean to “tolerate” a situation or a particular person.

LISTEN for and write down responses and examples that participants provide. Individuals might say “put up with” or “ignore” or “endure” or “stomach.”

SAY and CONVEY ACCEPTANCE:

“The ideas and definitions you give are all accurate and acceptable. This is because tolerance can be a very personal feeling or attitude. Very often we tolerate something because it is causing us pain or discomfort.”

“We also tolerate something because we believe that taking action to correct the situation would cause us pain, discomfort, and anxiety. Instead of taking action, we resign ourselves to the situation.” “In fact, the dictionary definition of tolerance reads:”

OVERHEAD or FLIPCHART: Definition of Tolerance: 1. capacity to endure pain or hardship: ENDURANCE, FORTITUDE, STAMINA

2. sympathy or indulgence for beliefs or practices differing from or conflicting with one’s own

SAY: “For today, we will focus more on the second definition. Human beings are each different and we all have likes and dislikes. Some of us indulge or tolerate things that others cannot tolerate”


Overhead 1

Definition

Explain:

8

Step 3 1010

What do you / don’t you tolerate?

Introduce this exercise by encouraging participants to think about all the different situations and people they tolerate and do not tolerate. Set the tone by encouraging a fun atmosphere and giving some examples. For example, in some sessions participants have come up with the following items they do or don’t tolerate:

• Toilet paper rolled under or over the toilet roll. Distribute

Handout 1

or Flipchart

• People who take more than 10 items on the “Quick Checkout” 10-item grocery line. • A certain style or genre of music (e.g., rap, opera, electronic, etc.).

Format the exercise by using any one of the following, or

starting out with individual/solo work, moving to paired exercises, and then to large group

• Individual: Ask people to complete on their own. • Paired or trio Exercise: Break the group into groups of two to three and provide them with one hand-out. • Large Group Participation: Work directly off the prepared flip-chart or blackboard or use the overhead.

Encourage Engagement & Interaction

To begin the exercise SAY: “Please list what you do and what you don’t tolerate”

Take 3 minutes for each list (maximum).


9

… Continued….”What do you / don’t you tolerate?”

Option: Half of the group completes the “do tolerate” list and the other generates the “don’t tolerate” list.

Facilitator Tip: This is a preparatory exercise. It lays thegroundwork for focusing more on tolerance of substanceabuse. The point of this exercise is to create a positiveexperience, attitude, or association with DOING SOMETHINGabout problems rather than tolerating, minimizing, avoiding orwithdrawing from them.

Fill in

Overhead 2

OVERHEAD or FLIPCHART:

“What Do you or Don’t you tolerate?”

• Ask participants to share from their lists. • Note that some participants may or may not have had some more serious items, e.g., political issues, beliefs about religion, morality, sexuality, violence, etc. • If there are any work-related or substance abuse items, recognize and elaborate. Some you might use, and ask the group:

Invite Response:

o “Do you or don’t you tolerate second hand smoke?” o “Do you or don’t you tolerate people who are dependent on alcohol?” o “Are there some people whose views and opinions you tolerate?”

• Use participant answers to segue into the next step.


10

Step 4

55

DH

D

P

Self-assess Tolerance at work

Randomly divide participants into groups of four to six people. Ask participants to number themselves out loud (“1” or “2” or “3”) as they go in sequence around the room. Indicate that all “1s” go to one area, all “2s” go to another area, etc.

istribute andout 2a

Distribute Handout “Individual Tolerance”

irections: • SAY: “Please complete the six items on this (hold it up) questionnaire on your own. Circle the number that shows your degree of tolerance. When you are done turn the survey over and look up. This should take no more than 5 minutes.”

NOTE. Facilitator Preparation:

• Familiarize yourself with Handout 2a and how you will be recording the average response for each group.

• In Step 5 (next page), you will be showing how the group changed (or did not change) [see diagram below: “2. Show change of individual responses”).

• Two examples are also shown in the Handouts section (see p. 31 of this manual).

repare:

2. Show change of individual 2. Show change of individual 1. Circle on Overhead1. Circle on Overhead

1 2 3 4 5 6 7 8 9 10

Highly tolerable

Highly intolerable

IndividualResponse

response (example)

Became less tolerantafter group discussion

1 2 3 4 5 6 7 8 9 10

Highly tolerable

Highly intolerable

IndividualResponse

response (example)

Became less tolerantafter group discussion

1 2 3 4 5 6 7 8 9 10

Highly tolerable

Highly intolerable

Group Average

1 2 3 4 5 6 7 8 9 10

Highly tolerable

Highly intolerable

Group Average


11

Step 5 1515

Group Decision-Making & Tolerance

Distribute Handout 2b (“Group tolerance”) – one to each of the newly formed groups, immediately following Step 4 without any pauses.

Distribute Handout 2b

SAY: “In this next exercise, we would like each of your small groups to discuss the six-items one at a time. Your objective is to reach consensus and come to total agreement about each item. Please circle the number that best fits the overall agreement or consensus for the group.”

Directions:

OVERHEAD

Prepare the overhead “Group tolerance” and have an erasable marker to write down (circle or mark) scores for a participating group. (See diagrams on previous page)

• After all groups are done, ask for one group to report its

final scores. • Circle or mark these scores on the overhead.

Ask participants in the group the following questions:

[Write responses on flipchart or blackboard]

• Who changed their original scores? • Did you become more or less tolerant? • What factors influenced you to change your scores?

As time permits, ask other groups the same questions.

Encourage Engagement &Interaction

Overhead 3

Group Tolerance

Facilitator Tip: Participants might say that the scenarios inthe six items are too vague and can be interpreted in manydifferent ways. In response, encourage them to use their ownexperiences and to be creative. They have permission toelaborate on the scenarios as much as they would like.


12


… Continued….” Group …Tolerance” Record responses; Show you are

LISTENING ASK: “There are several main points to get from this exercise, what do you think they are?”

[Record responses on flipchart or blackboard]

• After listening and writing, stress or re-emphasize two

additional points:

1. Sometimes tolerating other’s problems can put us at risk. (If this is not clear, review the six scenarios and ask “How do these scenarios involve risk?”] Explain:

2. Tolerance can occur at the group level. You may

believe or feel one way but—in order to conform with the group–you go along with the majority opinion.

OVERHEADS (for reviewing ideas if necessary) The following two overheads can be used to help emphasize two points: (1) that groups can sometimes tolerate problems and (2) the force of group opinion can cause individuals to ignore important signs of risk or danger.

Overhead 4

Levels

Overhead 5

Examples

• Overhead 4 “Levels of Tolerance”

Explain: “Just as individuals can tolerate problems that put them at risk, so can work groups and entire organizations. For example, a company could have a formal policy that says drinking alcohol is not permitted. In reality, there are some situations where employees drink during lunch and everyone knows about it but no one says anything. Informally, people tolerate problems that formal policy would not allow.”

• Overhead 5 “Examples of Tolerance” Link back to

Module 2

(relates to the “Risk & Strengths” game – see Module 2)

Using the overhead, SAY: “Recall the “Risks & Strengths” game. I am going to read the game spaces and ask you to identify the level of tolerance:

Individual, Group, or Organizational.

13

Step 6 1515

Increase Responsiveness NOTE TO FACILITATOR: In this last exercise you have several tools to use and options for using them. The main goal is to reinforce any awareness of unhealthy tolerance that was expressed in the session. You may SAY that:

Tool 1Tool 1

“Sometimes tolerance is appropriate as long as we don’t put ourselves or others at risk or in danger. The main purpose of this session is to increase your awareness of unhealthy levels of tolerance and increase responsiveness when appropriate” Overhead 6TOOL 1: Overhead 6 or Prepared FlipChart






ActAct

Do NothingDo

Something






ActAct

Do NothingDo

Something

NOTE TO FACILITATOR: This flipchart or overhead can be helpful in making participants aware of how their attitudes keep them from responding to problems before they become crises (molehills before mountains). In the case of alcohol and drug abuse, 12-Step programs for friends/family of people who are dependent on alcohol or drugs say:

“You didn’t cause it, you can’t control it, and you can’t cure it”

However, at work, YOU have benefits (EAP, counseling, mental health benefits) + you can use community resources (12-step, family services, local alcohol & drug councils). In addition, policy should encourage people to “GET HELP” before they “GET CAUGHT”.

Explain:

However, Policy is designed to help us

BE RESPONSIVE

SEQUENCE of FLIPCHART (or OVERHEAD 6):

1. Show the top portion only (Stigma > Tolerate > Respond), and ask: How do these differ?”

2. Show the circled text and ASK: “When you think about people with mental health problems: What is your typical response, Which of these three is most like you?” Are you likely to stigmatize some problems more than others?”

3. Show the bottom of the flipchart, and SAY; “The bottom line is whether we do nothing or do something”

ExamMentProb• D• Pe

Pr• O

or• Su

A


ples of al Health lems epression rsonality oblems verly Angry Anxious bstance

buse

14

Tool 2

TOOL 2: Overhead 7 (DRINKING CLIMATES) This introduces the concept of “Drinking Climates.” EXPLAIN THE FOLLOWING:

Explain: DEFINITION of Drinking Climate:

“A social situation, usually ongoing, where coworkers drink together for leisure purposes or stress relief; some may also develop tolerant attitudes toward drinking problems.” Drinking climates can serve helpful functions for workers:

• Express solidarity and bonding with the group • Excuse for relaxing together • Help shift task-defined relationships into expression-defined

relations; that is, fellow workers are more willing to share attitudes and personal interests as well as personal problems

By themselves, these things can be good for people. The problem is that over time or in certain situations, we can come to tolerate problems that can be a risk for the work group.

Overhead 7

SEQUENCE of OVERHEAD: Some Faces of ToleranceSome Faces of ToleranceSome Faces of ToleranceSome Faces of ToleranceSome Faces of ToleranceSome Faces of Tolerance

AcceptAcceptAccept

IgnoreIgnoreIgnore

MinimizeMinimizeMinimize

EnableEnableEnableStigmatize(Shun)StigmatizeStigmatize(Shun)(Shun)

AcceptAcceptAccept

IgnoreIgnoreIgnore

MinimizeMinimizeMinimize

EnableEnableEnableStigmatize(Shun)StigmatizeStigmatize(Shun)(Shun)

1. ASK: “What is going on in this situation? What are

the people thinking and feeling and doing? What about the person to the left?”

(Note. If there is no response, you can say “This looks like an office party because of the work desk…This may not happen in your work setting…but have fun with this)

2. ASK: “What are the different cartoon figures—Screen Beans—doing? (Ask participants to use their own words but you can help with information below). “Are these realistic?”

Encourage Engagement & Interaction

• Minimize: “It is no big deal…everyone does it…We have done it a long time.”

• Accept: “It’s OK.. It gives people a chance to have fun.” • Enable: “Sounds like a great idea…I’ll get the beer.” • Stigma: “You’re an ALCOHOLIC. What’s wrong with you?!” • Ignore: “I don’t want to have ANYTHING to do with it.”


15

TOOL 3: Overhead or Prepared FlipChart 8

Tool 3

NOTE TO FACILITATOR: This flipchart or overhead provides a more in depth look at why we tolerate problems. It is best to first place up the blank flipchart, shown to the right Prepare by reading through responses shown on Overhead 8 (see below) SEQUENCE of FLIPCHART:

1. ASK “Having discussed all these different aspects of tolerance, why do you think it occurs in the first place? What are some CAUSES of tolerance?”

2. Record Participant responses on the flipchart. 3. ASK “What are the CONSEQUENCES

“I am not my brother’s keeper”(apathy)

“Nothing is ever done about it anyway”

(learned helplessness)

“They are just under stress…”(excuses)

No one takes responsibility

Perception that policy isinconsistent (may be real)

Enhanced Risk

Potential harm

Teaches, models, or socializesothers (newcomers)

Undermines authority

of tolerance?” 4. Record Participant responses on the flipchart. 5. Put up Overhead 8 and explain. Lack of Group Lack of Group

ResponsivenessResponsivenessLack of Group Lack of Group ResponsivenessResponsiveness

“I am not my brother’s keeper”(apathy)

“Nothing is ever done about it anyway”

(learned helplessness)

“They are just under stress…”(excuses)

No one takes responsibility

Perception that policy isinconsistent (may be real)

Enhanced Risk

Potential harm

Teaches, models, or socializesothers (newcomers)

Undermines authority

CausesCauses ConsequencesConsequences

Stigma Stigma -- Tolerance Tolerance -- EnablingEnabling

CausesCauses ConsequencesConsequences

Stigma Stigma -- Tolerance Tolerance -- EnablingEnabling

Overhead 8

END SESSION TOOL 4: Overhead or Prepared FlipChart 9 NOTE TO FACILITATOR: This flipchart or overhead is a good way to end the session. Simply ask participants to generate a list of ways of responding when confronted with a coworker who has a behavioral or mental health problem. Tool 4 SEQUENCE of FLIPCHART:

Do Do Nothing?Nothing? Do something!Do something!Do Do Nothing?Nothing? Do something!Do something!

1. ASK “So..what are some ways that you or your work

group could be more responsive? 2. Record Participant responses.

OPTION: Ask participants to generate this list in pairs or small groups.


16

OVERHEADS AND HANDOUTS OVERHEADS

1. Definition of Tolerance

2. What do you tolerate? [[flipchart option]]

3. Group Tolerance (Use erasable overhead marker to

display group scores)

4. Levels of tolerance

5. Examples of tolerance

6. Stigma-Tolerate-Respond [[flipchart option]]

7. Faces of Tolerance / Drinking Climate

8. Causes & Consequences of Tolerance [[flipchart option]]

9. ADDITIONAL OVERHEAD

HANDOUTS

1. Paired/Small Group Exercise on Tolerance

2a. Self-assessment of tolerance

2b. Group decision making on tolerance

3. Causes & Consequences

Sample Showing Group Shift for Step 5 (See Bottom Page 10)


17

HANDOUTS


18

Te

Handout 1

Paired Exercise on Tolerance

In this exercise, work with a partner to generate two lists. In the first list, discuss those things that you, in your attitude and outlook, tolerate or consider to be tolerable. You can include anything you wish or feel comfortable discussing. For example, include personal tastes and preferences as well as things you tolerate in others or in culture, politics, and society. In the second list, list those things that you do not tolerate.

am Awareness: Tolerance Module

19
Handout 2a

TOLERANCE-SELF

To what degree are the following situations tolerable versus intolerable? Highly

Tolerable Highly

Intolerable 1 2 3 4 5 6 7 8 9 10

1. A co-worker comes to work late several days in a row in the past few weeks, and explains that he/she has problems at home.

1 2 3 4 5 6 7 8 9 10

2. A co-worker comes to work late

with a hangover on Monday mornings for the past month.

1 2 3 4 5 6 7 8 9 10

3. A co-worker has a drink or two

of alcohol at lunch while meeting with someone on city business.

1 2 3 4 5 6 7 8 9 10

4. A co-worker often smokes

marijuana away from work on the weekends. This person works with heavy machinery when at work.

1 2 3 4 5 6 7 8 9 10

5. A group of hard-working

employees get together for a few beers on a regular basis after work. Sometimes they drink so much they get drunk and have to get rides home.

1 2 3 4 5 6 7 8 9 10

6. A very efficient and productive

co-worker has recently become withdrawn and isolates him or herself. This person sometimes talks about trying to kick a cocaine habit.

1 2 3 4 5 6 7 8 9 10

Handout 2b 20

TOLERANCE

As a group, decide to what degree the following situations tolerable versus intolerable? PICK ONE NUMBER YOU ALL AGREE WITH

Highly

Tolerable Highly

Intolerable 1 2 3 4 5 6 7 8 9 10


1 2 3 4 5 6 7 8 9 10

2. A co-worker comes to work late with a hangover on Monday mornings for the past month.

1 2 3 4 5 6 7 8 9 10

3. A co-worker has a drink or two of alcohol at lunch while meeting with someone on city business.

1 2 3 4 5 6 7 8 9 10

4. A co-worker often smokes marijuana away from work on the weekends. This person works with heavy machinery when at work.

1 2 3 4 5 6 7 8 9 10

5. A group of hard-working employees get together for a few beers on a regular basis after work. Sometimes they drink so much they get drunk and have to get rides home.

1 2 3 4 5 6 7 8 9 10

6. A very efficient and productive co-worker has recently become withdrawn and isolates him or herself. This person sometimes talks about trying to kick a cocaine habit.

1 2 3 4 5 6 7 8 9 10


21 3
Handout

Causes & Consequences of Tolerance

In this exercise, work with a partner (or partners) to generate two lists. In the first list, discuss those things that you think cause employees to tolerate problem behaviors of co-workers. In the second list, describes the things that can happen – the consequences – of such tolerance.

22

EXAMPLES SHOWING GROUP SHIFTS IN TOLERANCE

When marking on the overhead you can use different symbols or colors to show how participants change their scores. Use a circle (• ) symbol to show individual responses from a group. Use an X symbol or circle the average number to show group average and how people changed after group discussion. For example, in item 1 below, prior to discussion a group of five (5) participants had different scores--2, 4, 8, 8, and 10. These were the ratings they made on Handout 2a from Step 4 of this module. Following discussion, however, the group moves to a 3 because Participant A (with original score of 3) is especially convincing and shifts the group to become more tolerant. You can draw arrows to show these shifts. NOTE. THE POINT OF THIS EXERCISE IS TO SHOW HOW GROUPS CAN INFLUENCE INDIVIDUAL ATTITUDES. YOU MAY ONLY NEED TO DEMONSTRATE THE FOLLOWING WITH ONE OR TWO ITEMS FOR ONE OR TWO GROUPS IN ORDER TO MAKE THE POINT.

Highly Tolerable

HighlyIntolerable

1 2 3 4 5 6 7 8 9 10

BEFORE DISCUSSION (Step 4)


1 2 3 4 5 6 7 8 9 10

• • • • • Individual Participant A B C& D E

AFTER DISCUSSION (Step 5) 1. A co-worker comes to work late

several days in a row in the past few weeks, and explains that he/she has problems at home.

1 2 4 5 6 7 8 9 10

Group Average (X): • X • • • •


APPENDIX -- THEORETICAL BACKGROUND ON TOLERANCE

The following material is excerpted from: Bennett, J.B., Lehman, W.E.K., Reynolds, G.S., (2000) Team awareness for workplace substance abuse prevention: The empirical and conceptual development of a training program. Prevention Science, 1 (3), 157-172. “Figure 2 (below) outlines the steps we took in deriving the goals, purpose, and objectives of training. Starting with our research framework (step 1 in Figure), we viewed the group as nexus for organizational and individual processes. We reasoned that group dynamics can occur in a negative cycle (step 2), where employees allow problems to continue. We focused on enabling/ neutralization in this negative cycle (step 3). The goals and five training objectives were designed to promote a positive cycle of supportive attitudes and the skills for addressing problems (step 4). The negative cycle. The negative cycle is sustained by the presence of more risk than protective factors, such as those reviewed above (e.g., drinking climate, alienation, safety risks). A representative sequence of behaviors describes this cycle.

1) Problem presentation: an employee presents with a deviant or problematic behavior (e.g., poor attendance) which is a direct or indirect result of alcohol or drug abuse;

2) Problem enabling or neutralization: coworkers and/or supervisors, through a set of self-reinforcing actions (tolerance, poor communication, withdrawal, inadequate coping), enable or neutralize the behavior;

3) Problem continuance: the problem remains unaddressed, re-appears, or is sustained over time; 4) Climate reinforcement: as a result, negative aspects of the environment endure.

Group Processes

Group Processes

Perceptions & Attitudes


WorkplaceEnvironmentWorkplace

EnvironmentProblem

Presentation

ProblemNeutralization

ProblemContinuance

ClimateReinforcement

SubstanceAbuse

SubstanceAbuse PolicyPolicy • Purpose

Enhance team communication for work groupsto help reduce any risks related to substance use

• Objective 1: RelevanceExplore how this training can help you andyour group and identify Risks and Strengths

• Objective 2: Team Ownership of PolicyUnderstand how substance use policy protects employees and requires shared responsibility

• Objective 3: Understanding StressUnderstand the relationship between stress,substance abuse, and communication. Identify resources for healthy (versus unhealthy) coping.

• Objective 4: Understanding ToleranceIdentify risky levels of tolerance at individualand group levels and adjust if necessary.

• Objective 5: Support, Encourage HelpImprove effective listening, nudge coworkersto get help, address resistance to change.

PoorCommunication

InadequateCoping

Tolerance &Resignation

Withdrawal/Antagonism

Disconnectedfrom Policy

(not meaningful)

ResearchResearchModelModel

Group ProcessGroup Processsurroundingsurrounding

ProblemsProblems NeutralizationNeutralizationGoals, Purpose & Objectives ofGoals, Purpose & Objectives of

Prevention TrainingPrevention Training

• Goals1 - Increase supportive group climate2 - Improve attitudes (policy, tolerance)3 - Increase help-seeking behavior/peer referral

[ negative cycle ]

1 2 3 4

Group Processes

Group Processes



WorkplaceEnvironmentWorkplace

EnvironmentProblem

Presentation

ProblemNeutralization

ProblemContinuance

ClimateReinforcement

SubstanceAbuse

SubstanceAbuse PolicyPolicy • Purpose

Enhance team communication for work groupsto help reduce any risks related to substance use

• Objective 1: RelevanceExplore how this training can help you andyour group and identify Risks and Strengths

• Objective 2: Team Ownership of PolicyUnderstand how substance use policy protects employees and requires shared responsibility

• Objective 3: Understanding StressUnderstand the relationship between stress,substance abuse, and communication. Identify resources for healthy (versus unhealthy) coping.

• Objective 4: Understanding ToleranceIdentify risky levels of tolerance at individualand group levels and adjust if necessary.

• Objective 5: Support, Encourage HelpImprove effective listening, nudge coworkersto get help, address resistance to change.

PoorCommunication

InadequateCoping




(not meaningful)

PoorCommunication

InadequateCoping




(not meaningful)

ResearchResearchModelModel

Group ProcessGroup Processsurroundingsurrounding

ProblemsProblems NeutralizationNeutralizationGoals, Purpose & Objectives ofGoals, Purpose & Objectives of

Prevention TrainingPrevention Training

• Goals1 - Increase supportive group climate2 - Improve attitudes (policy, tolerance)3 - Increase help-seeking behavior/peer referral

[ negative cycle ]

1 2 3 4

23

APPENDIX -- THEORETICAL BACKGROUND ON TOLERANCE We designed training objectives to address these four factors, focusing on attitudes and behaviors that – aggregated across employees in a group – constitute work climate. Enabling and neutralization. Attitudes and behaviors that support enabling include: 1) disconnection from policy – employees do not see policy as meaningful or their group’s informal norms run counter to policy as formally written; 2) poor communication – employees fail to speak up, avoid conflict, and otherwise stigmatize, minimize, or deny the problem; 3) inadequate coping – coworkers experience job strain and inability to cope with stress due to poor communication or employee withdrawal/ antagonism; 4) tolerance and resignation – tolerance of the problem (apathy) results from and contributes to other factors in this cycle; and 5) withdrawal and antagonism – employees in the work group act withdrawn or antagonistic. Because of withdrawal, resignation, and the belief that “nothing will change,” workers are unwilling to address issues – such as encourage a troubled employee or seek assistance from the EAP.” RESEARCH ON TOLERANCE “Just as norms reflect group variation in tolerance for deviance, individuals vary in tolerant attitudes for coworker substance abuse. To elicit these attitudes, Lehman, Rosenbaum, and Holcom (1994) created vignettes describing employee substance use. The vignettes varied by drug type (tobacco, alcohol, marijuana), location (at work, away from work), and job type (low versus high risk). For each vignette, employees responded by indicating if they would be willing to work with, cover for, and report the coworker. Employee tolerance was lowest when vignettes depicted coworkers who used marijuana, at work, in a high-risk job. Across vignettes, tolerance increased as a function of history of use. Illicit drug users reported more tolerance than problem/heavy drinkers (who did not use illicit drugs) who, in turn, reported more tolerance than non-users. Tolerant employees are also less willing to utilize EAP services (Reynolds, 1999). Among problem drinkers, those who are tolerant also seem the most reluctant to get help. Tolerant attitudes also reflect risk factors for substance abuse. Lehman (1994) classified employees into one of three groups based on their overall level of tolerance (low, medium, and high) and compared these groups on a profile of variables (e.g., personal background and job factors). The profile of variables that best described highly tolerant employees showed them to be younger males with higher levels of deviance (arrest record, peers with deviance, risk-taking behaviors) who also worked in safety-sensitive jobs. The demographic profile of highly tolerant attitudes matches very closely the one that describes marijuana users (Lehman, 1995). Most importantly, Lehman, Olson, and Rosenbaum (1996) simultaneously entered tolerance along with six personal background factors (e.g., religious attendance, arrest history, depression) and job risk in order to estimate substance use. The tolerance measure was the best predictor of recent illicit drug use and, following arrest history, the best predictor for use at work. Application. Both perceptions and tolerant attitudes provide windows into employee cognition and motivation. The training used participatory exercises where employees shared perceptions and attitudes about tolerance in small-group discussions. We reasoned that through communication, employees might dispel stereotypes and cognitive barriers (stigma) that prevent them from using the EAP or referring a troubled colleague.”

24

25

APPENDIX -- THEORETICAL BACKGROUND ON TOLERANCE The following material is excerpted from: Bennett, J.B., & Lehman, W.E.K., (2002). Supervisor tolerance-responsiveness to substance abuse and

workplace prevention training: Use of a cognitive mapping tool. Health Education Research, 17 (1), 27-42.

For the past twenty years, health education practices have been increasingly applied in work settings, typically through health promotion programs (HPPs, O’Donnell & Harris, 1994) or employee assistance programs (EAPs, Oher, 1999). EAPs typically include consultative support for supervisors, worksite training (e.g., stress management), and short-term counseling for employees. Supervisors can play a critical role in both HPPs and EAPs, especially when they become aware of substance abuse or mental health problems in employees. Supervisors can either respond to such problems or ignore them. Proactive responses range from seeking others’ input, informal discussions with the troubled employee, consultation with the EAP or HPP, or initiating a drug test. Supervisors can also tolerate problems; i.e., avoid issues or even enable the troubled employee (Ames & Delaney, 1992; Hall, 1990). The concept of tolerance-responsiveness is used here to represent supervisory decisions to ignore or take proactive steps with troubled employees. This concept may be of value to health educators who recognize that the success of their efforts can depend on workplace social environment or culture, specifically the role of supervisors in the culture (Heaney & van Ryn, 1996; Peterson & Wilson, 1998; Tessaro et al., 2000). The term “tolerance” is often associated with constructive responses among health educators, e.g., tolerance for diversity. However, in the context of others problem behaviors, tolerance can be dysfunctional—e.g., tolerating those who work with a hangover (or tolerance of coworker smoking, Stephens, 1989). Research has identified behaviors related to dysfunctional tolerance, including enabling (Roman, Blum & Martin, 1992), problem minimization (Ames & Delaney, 1992), and neutralization of deviance (Robinson & Kraatz, 1998). Borrowing from these studies, the current investigation introduces the concept of dysfunctional tolerance as a potentially useful teaching tool for workplace health educators. Many factors influence tolerance-responsiveness. EAPs can enhance responsiveness to alcohol problems (Beyer & Trice, 1978; Putnam & Stout, 1982), but supervisors who doubt EAP confidentiality will not refer workers. Supervisors may also be anxious about initiating discussion that encroaches on a coworker’s private problems (Donahoe et al., 1998) and such anxiety can be reinforced by a work climate that avoids communication (organizational codependency; McMillan & Northern, 1995). Generally, two factors appear to facilitate responsiveness: a climate that supports discussion of problems and a positive orientation to the EAP. Hopkins (1997) identified psychosocial factors that predict whether supervisors will intervene with a troubled employee, including psychological closeness with workers, managerial support for helping employees, and beliefs surrounding helping. Successful supervisory training programs are often integrated with an EAP, and include performance-based interventions and consultation with a counselor (Roman & Blum, 1996). Supervisors are more apt to talk with troubled workers when an ethos of helping exists (Sonnenstuhl, 1990) and a well-marketed EAP appears critical in building this ethos (Roman, 1990).

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