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Standard of practice: a field-based evaluation study of state bar responses to the attorney substance abuse, mental health, and attrition epidemic

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Standard of practice: a field-based evaluation study of state bar responses to the attorney substance abuse, mental health, and attrition epidemic

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Content Running head: STANDARD OF PRACTICE

STANDARD OF PRACTICE: A FIELD-BASED EVALUATION STUDY OF STATE BAR
RESPONSES TO THE ATTORNEY SUBSTANCE ABUSE, MENTAL HEALTH, AND
ATTRITION EPIDEMIC

by

Evan Michael Hess, Esq.

A Dissertation Presented to the
FACULTY OF THE USC ROSSIER SCHOOL OF EDUCATION
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF EDUCATION

December 2018

Copyright 2018 Evan Michael Hess, Esq.
STANDARD OF PRACTICE i
Abstract
There is a quality of life epidemic in the legal profession. Attorneys have substance abuse issues
at nearly twice the rate of the average American, experience mental health issues at 3.6 times the
US population’s average, and 7-10 times the turnover of other professions. However, this issue is
not just centered on quality of life, but what is being done to address it. This dissertation asked
“what is impeding the recognition and treatment of attorney quality of life issues, and what can
be done to positively impact the delivery and efficacy of services provided by the State Bar and
its Lawyer Assistance Program (LAP)?” Specifically, a gap analysis was conducted to examine
the knowledge, motivation and organizational influences that interfere with the State Bar LAP
fulfilling its core values. The evaluative study included over 7,500 participants in its Phase One
quantitative survey, 10 Phase Two qualitative interviews and 410 people took part in the
narrative follow-up survey. Four key themes emerged: 1) practical issues of economics in
practice demand systematic reform; 2) education programming is required to fulfill the mission
of the State Bar and LAP; 3) the State Bar and LAPs need to be assessed for structural
realignment; and 4) gaps in knowledge, motivation, and organization exist. Specifically,
attorneys are well aware that quality of life problems plague members of the profession. The
problem is not unknown, nor is the rate at which quality of life issues are present. As a result,
greater insight into the form, function, and administration of LAPs and similar programs is
provided. Based on these findings, I discuss recommendations for the future including reforms
for state bar associations, and topical discussions regarding attorney conduct, culture, sociology,
and professionalism.

STANDARD OF PRACTICE ii
Dedication
To the three greatest women I know: S, C, and K.

and

David Mann, whose story and service to the profession offered me inspiration.

STANDARD OF PRACTICE iii
Acknowledgments
I am so very grateful for the time, dedication, and mentorship offered by Link Christin, David Mann, and
Richard Carlton (among others). Your experience, expertise, and service gave life to this study and
direction to this researcher.

My Cohort 5 classmates deserve much of the credit. Their support and sunny disposition, sprinkled with
disdain and sass kept me trudging along. Specifically, I have an incredible amount of gratitude for Denis
Ortega and Matthew Virtue, who were my ballasts in the last three years of stormy seas. I have so much
respect and appreciation for Jonathan Townsend and Bharadwaj Hegde who ceaselessly checked-in with
me to make sure I was keeping my head up and feet moving, even when I did not want them to do so.

I am astounded by the altruistic fervor of the faculty at Rossier. An impact was made on me in every
course, but it behooves me to recognize the following faculty by name:

Dr. Holly Ferguson for, quite literally, influencing the educator I am and the student I was (and
will continue to be). Her tireless dedication to the learning process and student success is simply
incredible.

Dr. Jenifer Crawford who welcomed me to the program, shepherded me through the initial
development of this dissertation, and was ultimately responsible for helping me realize a passion
for a subject I did not know I had.

Finally, my mentor, guide, and Kitchkinet: Dr. Seli. I am still perplexed at how much she
accomplished as a professor, dissertation chair, researcher, and course lead. I never felt pressed
for her time, as she always made herself available.

I could not have accomplished what I did without the brilliance and support of Dr. Alexandra Ycaza
Herrera, who lent me her time, feedback, and crafty riposte as my friend, a model academic, and
committee member; she deserves a great deal of credit for pushing me to do my level best at all times.
Moreover, Alejandro Herrera, who not only allowed me to slough-off a great deal of work on him but for
being, perhaps, the most understanding and supportive law partner for which I could have dreamed. And,
the voice and videographer, Evan Chaffee, for understanding my vision and making the topic come alive.

Finally, the real heroes: my family:

Edward Newman and Kendall Newman, who consistently gave me confidence by removing any
doubt that I could do this given all I had scheduled in my life (and for building my ego up past
healthy levels at times).

“TBD”, Winifred “Wonderbread” Newman, who was just the perfect little bundle of stress-
relieving giggles I needed since her birth.

Joshua Hess, who knew exactly what not to say to me at all the right times, and consistently
sharing his feelings about my commitment to myself and my education to fill the void my mother
left behind.

And, most importantly, the ultimate acknowledgment is for Cristina Herrera, who put up with all
my deadlines, research, time away, and stress. Your encouragement was empowering, your
support motivating, and your understanding of this endeavor was inspiring.
STANDARD OF PRACTICE iv
Note From the Researcher
We won't do better until we realize we deserve better.
We won't do better for each other until we realize we deserve better from each other.
I originally endeavored to research attorney professionalism and the resultant issues associated
with it. However, I became immersed in the world of quality of life overall.

More than ever, I believe that we need to change the obstreperous and outdated systems that
force upon us a “win at all costs” mentality. Lawyers should think like a human—a human
lawyer. This does not mean that attorneys should not be disciplined, it does not mean that they
should not be analytical, and certainly does not mean they should be focused on something other
than providing results for their clients. However, attorneys should concentrate on stellar
advocacy, not arguments. They should look at their peers as warriors fighting for an intersecting
cause. Our profession must begin to view the other side as fellow counsel, not as an adversary.

Law school does a great many things well. It takes individuals who have somewhat unfocused
and unsharpened minds and shapes them into individuals with laser focus and technical skills
perfect for looking at legal issues, researching the law, and making cogent arguments to support
their given position. What it does not do is instruct future lawyers about how to work together to
ensure the best outcome for their clients. Law schools generally do not drive home the need to be
a human first and an attorney second. If our entire identity is wrapped-up in being a member of
the profession, our image becomes everything. If this research taught me anything, is that the
most healthy attorneys are those who have lives and identities outside the practice of law.

To this end, attorneys need to know that they can accomplish (with great skill) the outcome they
seek for their clients without necessarily ensuring the other side walks away battered and
bruised. Our system of legal education, professional culture and organizational environment has
created attorneys who seek wins above all else. When attorneys are taught to win at all costs, to
value their bottom line, and the seek accolades in the form of wins and profits, they forget that
the law is a zero-sum game. At some point, every attorney is going to lose, and when we lose, we
feel crushed; it bruises the ego. Moreover, in order to continue to mount wins and gain success in
the field of legal battle, attorneys must work long, hard hours, sacrificing their personal lives,
and more importantly their mental health. Quality of life issues creep in, and well-being becomes
neglected.

Instead of aiming to crush the other party, let’s all win together. Perhaps it is naïvely optimistic
and overly idealistic, but I think our profession is better than we currently act; I believe we can
be an example to other professionals. I hope that respect, honesty, and civility will once again
become the hallmarks of a stellar lawyer. It is at least a discussion worth having, and a topic
worth exploring.

We can do better.

STANDARD OF PRACTICE v
Table of Contents
ABSTRACT.................................................................................................................................................. I
DEDICATION ............................................................................................................................................. II
ACKNOWLEDGMENTS .............................................................................................................................. III
NOTE FROM THE RESEARCHER ................................................................................................................ IV
TABLE OF CONTENTS ................................................................................................................................ V
LIST OF TABLES .................................................................................................................................... VIII
LIST OF FIGURES ...................................................................................................................................... IX
CHAPTER ONE: INTRODUCTION ....................................................................................................... 1
INTRODUCTION TO THE PROBLEM OF PRACTICE ...................................................................................... 1
ORGANIZATIONAL CONTEXT AND MISSION ............................................................................................. 2
ORGANIZATIONAL PERFORMANCE STATUS .............................................................................................. 3
RELATED LITERATURE ............................................................................................................................. 4
IMPORTANCE OF ADDRESSING THE PROBLEM .......................................................................................... 8
ORGANIZATIONAL PERFORMANCE GOAL ................................................................................................. 9
DESCRIPTION OF STAKEHOLDER GROUPS .............................................................................................. 10
STAKEHOLDER GROUPS’ PERFORMANCE GOALS ................................................................................... 11
STAKEHOLDER GROUP FOR THE STUDY ................................................................................................. 12
PURPOSE OF THE PROJECT AND QUESTIONS ........................................................................................... 12
METHODOLOGICAL FRAMEWORK .......................................................................................................... 13
DEFINITIONS ........................................................................................................................................... 14
ORGANIZATION OF THE PROJECT ............................................................................................................ 14
CHAPTER TWO: REVIEW OF THE LITERATURE ........................................................................ 16
IDENTIFYING THE PROBLEM AND POPULATION OF FOCUS ..................................................................... 16
Lack of Current Research .................................................................................................................. 17
Attorney Demographics and Population ............................................................................................ 17
Attorney Quality of Life Problems: Statistical Overview ................................................................... 19
UNDERSTANDING THE PROBLEM, ITS ORIGINS, AND TREATMENT ......................................................... 23
Risk Factors for Addiction and Mental Health Problems .................................................................. 24
Approaches to Intervention and Treatment ........................................................................................ 31
LAWYER ASSISTANCE PROGRAMS IN THE UNITED STATES ................................................................... 33
Comparative Models of Current Quality of Life Programs ............................................................... 36
QUALITY OF LIFE IN CONTEXT ............................................................................................................... 37
Reprogramming the Profession .......................................................................................................... 37
Workplace Dissatisfaction .................................................................................................................. 38
Burnout ............................................................................................................................................... 39
Servant Leadership ............................................................................................................................. 40
ATTORNEY KNOWLEDGE AND MOTIVATION INFLUENCES ..................................................................... 41
Knowledge and Skills ......................................................................................................................... 41
Attorney Motivation, Expectations, and Values ................................................................................. 48
STATE BAR LAP ORGANIZATIONAL INFLUENCES ON LAWYER UTILIZATION OF THE LAP .................. 57
State Bar LAP Specific Factors .......................................................................................................... 58
Cultural Model and Setting Influences ............................................................................................... 59
CONCEPTUAL FRAMEWORK: THE INTERACTION OF ATTORNEY MEMBERS’ KNOWLEDGE, MOTIVATION,
AND THE ORGANIZATIONAL CONTEXT ................................................................................................... 63
CONCLUSION ........................................................................................................................................... 67
CHAPTER THREE: METHODS ........................................................................................................... 68
PARTICIPATING STAKEHOLDERS ............................................................................................................ 68
STANDARD OF PRACTICE vi
Survey Sampling Criteria and Rationale ............................................................................................ 69
Survey Sampling (Recruitment) Strategy and Rationale .................................................................... 70
Interview and/or Focus Group Sampling Criteria and Rationale ...................................................... 72
INTERVIEW AND/OR FOCUS GROUP SAMPLING (RECRUITMENT) STRATEGY AND RATIONALE ............. 73
Explanation of Choices ...................................................................................................................... 74
DATA COLLECTION AND INSTRUMENTATION ......................................................................................... 74
Surveys ............................................................................................................................................... 75
Interviews ........................................................................................................................................... 76
Documents and Artifacts .................................................................................................................... 77
CREDIBILITY AND TRUSTWORTHINESS ................................................................................................... 78
VALIDITY AND RELIABILITY................................................................................................................... 80
DATA ANALYSIS ..................................................................................................................................... 81
ETHICS .................................................................................................................................................... 82
LIMITATIONS AND DELIMITATIONS ........................................................................................................ 84
RESEARCH DESIGN UPDATES ................................................................................................................. 85
CHAPTER FOUR: RESULTS, FINDINGS, AND DISCUSSION ....................................................... 87
DESCRIPTIVE STATISTICS ....................................................................................................................... 88
RESULTS AND FINDINGS ......................................................................................................................... 90
Knowledge Findings and Results ....................................................................................................... 90
Motivation Findings and Results ........................................................................................................ 98
Organizational Findings and Results ............................................................................................... 109
CONCLUSION ......................................................................................................................................... 115
CHAPTER FIVE: RECOMMENDATIONS ....................................................................................... 116
STRENGTHS AND WEAKNESSES OF THE APPROACH ............................................................................. 116
RECOMMENDATIONS FOR PRACTICE TO ADDRESS KMO INFLUENCES ................................................ 117
Knowledge Recommendations .......................................................................................................... 117
Motivation Recommendations .......................................................................................................... 123
Organization Recommendations ...................................................................................................... 126
ECONOMIC EVALUATION OF LAWYER ASSISTANCE PROGRAMMING AND ITS ALTERNATIVES ........... 131
Program Alternatives – A Cost/Benefit Analysis ............................................................................. 134
Best Economic Choice for the State Bar .......................................................................................... 142
Conclusion ........................................................................................................................................ 143
EDUCATION TO FULFILL THE MISSION OF THE STATE BAR .................................................................. 144
Mandated Annual Counseling .......................................................................................................... 145
Stress-Hardiness Training ................................................................................................................ 147
Marketing and Public Outreach ....................................................................................................... 148
RESTRUCTURING STATE BARS AND THEIR LAPS TO HEIGHTEN EFFICACY AND ATTORNEY RELATIONS
.............................................................................................................................................................. 149
Realigning the State Bar Lawyer Assistance Program .................................................................... 149
INTEGRATED IMPLEMENTATION AND EVALUATION PLAN ................................................................... 153
Implementation and Evaluation Framework .................................................................................... 153
Organizational Purpose, Need, and Expectations ........................................................................... 154
Level 4: Results and Leading Indicators .......................................................................................... 155
Level 3: Behavior ............................................................................................................................. 156
Level 2: Learning ............................................................................................................................. 159
Level 1: Reaction .............................................................................................................................. 161
Evaluation Tools .............................................................................................................................. 162
Summary ........................................................................................................................................... 163
FUTURE RESEARCH ............................................................................................................................... 164
CONCLUSION ......................................................................................................................................... 165
STANDARD OF PRACTICE vii
REFERENCES ........................................................................................................................................ 168
APPENDIX A .......................................................................................................................................... 185
PHASE ONE - QUANTITATIVE SURVEY ................................................................................................. 185
APPENDIX B .......................................................................................................................................... 207
INTERVIEW PROTOCOL ......................................................................................................................... 207
APPENDIX C .......................................................................................................................................... 213
PHASE TWO – QUALITATIVE, NARRATIVE SURVEY ............................................................................. 213
APPENDIX D .......................................................................................................................................... 227
DOCUMENT REQUESTS ......................................................................................................................... 227
APPENDIX E .......................................................................................................................................... 228
SAMPLE ASSESSMENT OF PROGRAM IMPLEMENTATION ...................................................................... 228

STANDARD OF PRACTICE viii
List of Tables
Table 1: Organizational Mission, Global Goal, and Stakeholder Performance Goals .............. 11

Table 2: Knowledge Influence, Knowledge Types, and Knowledge Assessment ........................ 48

Table 3: Motivational Influence, Motivation Types, and Motivation Assessment ...................... 56

Table 4: Assumed Organizational Influences and Organization Assessment ............................. 62

Table 5: Study Demographics by Phase ..................................................................................... 89

Table 6: Phase 1 Survey, Question 34 ........................................................................................ 98

Table 7: Summary of Knowledge Influences and Recommendations ....................................... 118

Table 8: Summary of Motivation Influences and Recommendations ........................................ 123

Table 9: Summary of Organization Influences and Recommendations .................................... 127

Table 10: Cost – Benefit Analysis Summary ............................................................................... 135

Table 11: Cost Effectiveness of Three Programs ........................................................................ 141

Table 12: Outcomes, Metrics, and Methods for External and Internal Outcomes ..................... 156

Table 13: Critical Behaviors, Metrics, Methods, and Timing for Evaluation ............................ 157

Table 14: Required Drivers to Support Critical Behaviors ........................................................ 158

Table 15: Evaluation of the Components of Learning for the Program. .................................... 161

Table 16: Components to Measure Reactions to the Program. .................................................. 162

STANDARD OF PRACTICE ix
List of Figures
Figure 1. Conceptual Framework for the Study............................................................................ 65
Figure 2. Phase 1 Survey, Question 26. ........................................................................................ 91
Figure 3. Phase 1 Survey, Question 33. ........................................................................................ 97
Figure 4. Phase 1 Survey, Question 21. ...................................................................................... 102
Figure 5. Phase 1 Survey, Question 25. ...................................................................................... 112
Figure 6. Phase 1 Survey, Question 41. ...................................................................................... 115
Figure 7. Mission Statements of the CA State Bar and the California Attorney Association. ... 151

STANDARD OF PRACTICE 1
CHAPTER ONE: INTRODUCTION
Introduction to the Problem of Practice
Attorneys suffer from mental health issues at 3.6 times the average American and are
nearly twice as likely to fall victim to substance abuse (Scott, 2011). Moreover, the legal
profession has a turnover rate at as much as seven to 10 times companies in Fortune’s 100 Best
Companies to Work For (Shanker, 2013). State Bar Associations (hereinafter the State Bar)
serves as a legislative, judicial and support organization tasked not only with policing its
membership but also providing over-arching support to its licensees. Improving the programs
employed by the State Bar can be a useful tool in combating the epidemic rates of attrition,
substance abuse, and mental health problems. The statistics are clear: the current programs
utilized by the State are not successfully or proactively staving-off future issues faced by the
state’s attorneys, and the Bar not providing plausible programs to help those who have already
found themselves a victim of this quality-of-life epidemic (Cooper, 2003; Jones, 2001; Krill,
Johnson, & Albert, 2016; Scott, 2011).
Stress is the common thread of the legal profession’s mental health and substance abuse
concerns, and all stakeholders suffer when a lawyer becomes addicted to alcohol and drugs
(Silver, 2004). Thirty-three percent of lawyers have a mental health issue, and 19% have
elevated levels of depression, which is more than twice the national average in the US (Silver,
2004; Scott, 2011; South Carolina Bar Association HELP Task Force “SCBA,” n.d.), and the
number of lawyers abusing alcohol and drugs is twice that of the rest of the general populace
(Silver, 2004; SCBA, n.d.). Law Professor Lawrence Krieger has conducted research showing
that practicing lawyers exhibit clinical anxiety, hostility, and depression at rates that range from
eight to 15 times those of the general population (The National Law Journal; SCBA, n.d.). The
STANDARD OF PRACTICE 2
evidence highlights that work quality expectations and demands are not fulfilled in the practice
of law, and attorneys experience burnout because of emotional, physical, and mental exhaustion
(Johnson 2008; Shanker, 2013).
Organizational Context and Mission
This field study focused on State Bar Lawyer Assistance Programs (“LAP”), in six states
across the Country: California, Florida, Michigan, New York, South Carolina, and Washington
State. Each of these states was selected to reflect varying geographic regions, populations, active
attorney membership levels, and length of tenure of the state’s LAP. In South Carolina, the LAP
is called the “Lawyers Helping Lawyers” program under the purview of its Attorney Wellness
Committee (formerly taskforce), which also includes a “Living Above the Bar” initiative and
program. Washington State’s program, known as the “Member Assistance Program” provides
member services related to quality of life issues and collateral services. In New York State, these
services are provided by the New York City Bar (Lawyer Assistance Program) and the New
York State Bar Association (Lawyer and Judges Assistance Program), both of which are
voluntary associations. The New York State Unified Court System, which licenses attorneys, has
no programming available. In Florida, at the time of drafting, its Lawyer Assistance Program’s
website and any associated materials were unavailable and inaccessible. However, Florida was
the only state of the six studied whose program was independent of their state bar association.
Michigan offers programming and resources through its Lawyers and Judges Assistance
Programs. Of all six states, California offers the greatest amount of information on the Internet to
the public regarding its Lawyer Assistance program. As a result, while the facts and figures of
each LAP may vary, the statistics and reports of the State of California’s Bar Association and
LAP will be utilized in a majority of this study for illustrative purposes. For the purpose of this
STANDARD OF PRACTICE 3
study, all programs are referred to jointly and severally as “LAP” or “Lawyer Assistance
Programs.”
Like California’s, which was implemented through state legislation in January 2002,
LAPs are in large part tasked with aiding lawyers and non-attorney applicants who are dealing
with mental health and substance abuse issues (S. Bill 479; 2001; The State Bar, LAP, n.d.). As
outlined in the Attorney Diversion and Assistance Act (ADAA), participants in the LAP are
provided confidential services aimed at combating these epidemic-level issues while helping
legal professionals achieve their optimal quality of practice in service to the overall mission of
the State Bar.
Organizational Performance Status
The organizational performance problem at the root of this study was the rise of attorney
quality of life issues despite the attempts of State Bars to address these problems through their
LAPs. Whether mandated by a lawyer’s employer, the State Bar, or another entity or entered into
voluntarily, the LAP strives to offer structure and support to its participants (Lawyer Assistance
Program, 2016). In addition to out-patient services, such as group meetings and counseling, the
LAP provides continuing legal education (CLE) programs as a part of the ADAA and enjoys a
budget in California of around $1.5 million annually (down from $2.5 million in 2011) (LAP,
2016). In 2015, the California LAP staff conducted 127 intake interviews, and turned away just
13 individuals because the candidates did not meet the LAPs acceptance criteria; the LAP
terminated the participation of two attorneys and discharged 14 attorneys from the LAP after
their three-year regimen of monitored participation was completed (LAP, 2016). The number of
intakes rose by seven in 2016 to 134, with the program maintaining 127 participants (LAP,
2017). The primary role of the eight staff professionals and 12 members of the LAP Oversight
STANDARD OF PRACTICE 4
Committee is to fulfill the LAPs mission to “support recovering attorneys in their rehabilitation
and competent practice of law, enhance public protection, and maintain the integrity of the legal
profession” (LAP, 2016). Failure to address these issues puts attorneys, the clients they serve,
the judicial institution, and the general public at risk of distrust and lack of fulfillment of the
mission of the State Bar, the LAP, and the judiciary.
Related Literature
Stress and depression are leading attorneys to abuse drugs and alcohol, leading to
statistically epidemic levels of chemical dependency. The culture of law firms and their bottom
line - longer hours and more ‘billables’ - is a significant factor in professionals becoming
dependent on alcohol and substances (Pregenzer, 2014). To this end, greater stresses and mental
health decline supports the formation of self-destructive habits and the seeking of chemical
substances (Pregenzer, 2014). Pregenzer theorizes that lawyers are facing increasingly negative
work cultures, which include long hours and fierce competition. To cope with these stress levels
attorneys are turning to chemical substances, resulting in high levels of addiction, which, in turn,
lead to a damaged reputation and a shortened career that “wreaks havoc on [lawyers’’] personal
lives (Pregenzer, 2014, p. 307; Brady & Sinha, 2005; Sinha, 2001).
The fact that lawyers are expected to internalize their feelings not only to act
“professionally” but, as the Legal Profession Assistance Conference (“LPAC”) asserted, to keep
their clients calm and trusting of their lawyer’s judgment impacts attorneys’ mental health, which
in turn, leads lawyers to seek alcohol as a metaphorical crutch. Consequently, lawyers who have
alcohol abuse problems also suffer from a diminished potential to perform (LPAC). Their peak
abilities will fade over time, and, untreated, alcohol will control their actions, which will, in turn,
harm their reputation. According to the LPAC, “at the worst, alcoholic lawyers will lie, cheat
STANDARD OF PRACTICE 5
and steal and thereby damage their clients, downgrade the profession, and destroy their careers
and reputations. The same holds true for drug addicts” (Baer, 2014; LPAC, p. 7).
New research by Pierson, Hamilton, Pepper, and Root (2017) asserts that not only are
some lawyers more “stress hardy” than others, but that stress hardiness assists lawyers with their
own self-control and a sense of purpose, and the ability to maintain cognitive flexibility. The
research suggests that all of these abilities are interdependent and that factors improved by one
stress-hardiness factor strengthen the others. In other words, not all lawyers are created equal,
and the profession must find a way to support attorneys and law students by teaching them how
to become more stress hardy; this type of training will lead to an improved quality of life for
members of the profession.
Chemical dependency can commence before an individual obtains a license to practice
law. While many had issues with drinking begin in law school, “a far greater number – 44
percent” had these problems arise during their formative years of professional practice (Olson,
2016). Moreover, stress is a common factor in the abuse of alcohol. When measured together,
based upon levels of consumption, 28 percent of lawyers exhibit depression and 19 percent
report anxiety (Olson, 2016). These studies all reach the same conclusion: the culture of law
firms is partly to blame (LPAC, n.d.; Olson, 2016; Pregenzer, 2014). If the culture of legal
practice, stress levels, and character traits of attorneys were not enough, lawyers are encouraged
to socialize not only with each other but also with clients; socialization often includes alcohol
(Olson, 2016).
It is clear that attorneys are suffering at the hands of the work they perform, and the
levels are epidemic (Krill, 2016; Pregenzer 2014; Scott, 2011; Silver 2004). The creation of
effective programs for the proactive treatment and prevention of mental health and chemical
STANDARD OF PRACTICE 6
dependency issues need to become a priority for the bar associations who regulate and advocate
for lawyers. However, those programs may not be helping to address these problems.
Current lawyer assistance programs are not helping to solve chemical dependency
problems and mental health issues. Bar associations across the United States have implemented
both continuing legal education programs (CLE’s) and Lawyer Assistance Programs, which
endeavor to address the problem of chemical dependency and the epidemic rates of mental health
concerns. However, there exists no empirical data to affirm the belief that any current legal
programs, such as CLE’s or LAPs work (Supreme Court of New Jersey “SCNJ,” 2008). Almost
every jurisdiction with these programs has agreed that the programs offered may not solve any of
the problems experienced by attorneys (SCNJ, 2008). While the Supreme Court of New Jersey
is supportive of CLE programs, their report very clearly found that it has no facts to support the
notion that mandatory CLE’s are a viable way to find a way to address the problems haunting the
profession (SCNJ, 2008). The State of California has a requirement for a continuing education
course in substance abuse and mental health, while it is an option to fulfill a requirement in
Florida; New York, South Carolina, and Washington have no mandate for a course in these
fields, and Michigan does not require its attorneys undertake any CLE’s.
Further impacting this issue is the fact that there exists no data on the efficacy of CLE’s.
As a result, there is no foundation for CLE’s being an effective way to thwart mental health and
chemical dependency issues. This is the very result reached by the California Supreme Court
(“CSC”) in a landmark case on the topic, People v. Ngo, 14 Cal.4
th
30 (1996). In the case, the
Court held that CLE’s have no actual proof of affecting an attorney’s ability to practice or
general competence, though the mission of the program is to educate lawyers. As a result, there
STANDARD OF PRACTICE 7
are many obstacles to treatment for lawyers, including the belief that they did not need help and
could do it on their own.
Other issues hindering attorneys seeking self-help include the impact admission could
have on their respect and reputation in the legal community; when coupled with lawyer’s
sophisticated level of denial and highly developed sense of being right, the barriers to self-help
and treatment come into focus (Scott, 2011). Scott (2011) asserted that more must be undertaken
proactively to help change the profession’s mindset to stop the chemical dependency and
depression from occurring, instead of treating it after it already has manifested. Classes simply
are not enough.
Programs that focus on education only instead of treatment, programming, and outreach,
like DARE, the most famous and highly funded of its kind, do not produce the results intended
(Reaves, 2001). In fact, there is a statistical number of higher usage among students who go
through the program (Reaves, 2001). Not only is the need for programs to be more proactive,
but they also need to commence earlier in an attorney’s career (Pregenzer, 2014). Law schools
teach students the interrelationship between the law and academic pursuits but fail to address the
practical aspect of being a lawyer. (Pregenzer, 2014). This narrow approach to the education of
prospective attorneys leaves a void between the idealizing of the practice of law, and the
struggles practitioners will face after they graduate from law school, including firm structure,
culture, or client interaction. Accordingly, law students are unprepared for practice and
vulnerable to chemical dependency and mental health issues. Without exposure to the reality of
law practice today, law students are ill prepared to meet their future.
The current programs and processes available to attorneys to address the mental health
and chemical dependency problems, which are rampant in the profession, are not sufficient. The
STANDARD OF PRACTICE 8
profession must be proactive and creative when solving these critical issues, as they not only
affect the attorneys within the profession but the general public whom they serve. Instead of
waiting for the problem to occur or the attorney to either seek help or be forced by the Bar to
obtain it, the State Bar and its LAP must employ tactics to preempt these important problems.
Importance of Addressing the Problem
This problem is important to address because of three factors. First, the rates of attrition
in the profession stem, in part, from of a lack of attorney professionalism (Rhode, 1998;
Rizzardi, 2005). Next, the profession is experiencing a recession of public confidence in legal
practitioners and the justice system (Rizzardi, 2005). For example, a study by Fisk and Dupree
(2014) confirmed that while rated highly competent, lawyers are nearly on par with prostitutes
when it comes to “warmth.” Finally, attrition and burnout are inapposite to the goals of the
American Bar Association and other licensing organizations (Davis-Lack, 2014; Patton, 2003;
Wright, n.d.).
The negative factors associated with unhealthy work demands have resulted in attorneys
increasingly suffering from chemical dependency and mental health issues. While epidemic
rates of mental health (Krill, 2016) and chemical abuse (Pregenzer, 2014; Scott, 2011; Silver
2004) issues within the legal profession are staggering, the inability of these advocates to serve
to the best of their ability presents institutional problems as well. Consequently, the State Bar’s
mission to achieve high-quality standards of advocacy and maintain the public trust and
confidence in legal practitioners continues to suffer (Krill 2016; SCBA, n.d.; State Bar, 2012;
State Bar Act). The organizational performance evaluated is the larger problem of attorney
quality of life and the work-life culture engendered in a country with changing economic and
social standards.
STANDARD OF PRACTICE 9
Some attorney licensing entities, such as New York, operates as a branch of the judiciary
through the court system itself. Others, like California, are pseudo-governmental agencies which
derive their powers from all three branches of government but operate under the auspices of the
state’s Supreme Court. The California State Bar has a duty to serve the public and ensure that its
members adhere to its six core values and the law (State Bar, 2012; State Bar Act). Chemical
dependency and mental health issues, which are derivatives of reduced job satisfaction, are
antithetical to five of those values (State Bar, 2012). As such, it is incumbent upon the State Bar
to solve this problem immediately to stave-off an epidemic and treat its members and serve its
mission to protect the public. Failure to act swiftly will allow these issues to continue to spiral
out of control and leave the public without protection in the derivation of the State Bar Act, and
thus, the highest priority delegated to the State Bar by the government (State Bar Act).
Organizational Performance Goal
To further each State Bar’s mission, commencing in December 2020, the organizational
performance goal of this study was that State Bars would experience a decrease in attorney
mental health and substance abuse problems relative to the previous year’s statistics. In
California, for example, as of 2016, the LAP had a caseload of approximately 134. When
extrapolating from the statistics of the Krill (2016) study and Allan (1997), approximately 53,000
attorneys in that State have a mental health issue, and no less than 34,000 have a substance abuse
problem. The organizational performance goal would require a meager 5% increase from the 134
intakes in 2016 to nearly 141, as set forth in Table 1. While this goal suggests that an increased
caseload would reflect increased rates of quality of life issues, services must increase and
attorneys must receive help before the incidence of quality of life can decrease overall.
STANDARD OF PRACTICE 10
This goal also increases both attorney satisfaction and the public’s confidence in the
profession. This goal is set by and underlies the mission of the LAP and the State Bar in
minimizing attorney attrition, maintaining attorney performance standards, and supporting the
general well-being of the profession. This standard will be measured utilizing both the State
Bar’s investigation results from its membership and the American Bar Association’s studies on
mental health and substance abuse (See Krill, 2016; State Bar, 2012).
Description of Stakeholder Groups
State Bars have three distinct stakeholder groups: attorneys, the State Bar itself, and the
public. The stakeholder group upon which this study will focus is attorneys, with consideration
of the role of other groups as well. Lawyers fund the State Bar, follow licensing and regulatory
standards, and perform professional services as allowed by the organization. Attorneys are the
subject of the epidemic issues of negative quality of life (Krill, 2016; Pregenzer 2014; Scott,
2011; Silver 2004) and are directly impacted by the programs utilized by the State Bar.
Attorneys are granted licenses under the auspices of each state’s judicial branch. As a
result, each attorney is an officer of the court. Without the government of the State, the State
Bar’s ability to operate, regulate, and support attorneys would be non-existent. The State Bar
requires resources and support from the State government to raise the standards of practice for
attorneys, which directly affects quality of life issues including attrition, mental health problems,
and substance abuse. For example, one of the major budgetary items the California State
government helps to fund is the Lawyer Assistance Program. The State Bar is charged with
providing education and protection to the public. The public relies upon the Bar to not only
regulate lawyers and discipline individuals in the profession for misconduct but depends on the
organization to act as a consumer protection agency in the complicated state judicial system.
STANDARD OF PRACTICE 11
Finally, the public is the third stakeholder. The public is directly affected when attorneys
have an adverse quality of life (Davis-Lack, 2015, Pregenzer, 2014). More specifically, when
attorney attrition is high, or their attorneys are suffering from mental health conditions or
substance abuse issues, their clients—the public—are directly harmed (Davis-Lack, 2015,
Pregenzer, 2014).
Stakeholder Groups’ Performance Goals
Table 1.
Organizational Mission, Global Goal, and Stakeholder Performance Goals
Organizational Mission
The State Bar’s Lawyer Assistance Program is charged with the mission to “support legal
professionals in achieving their optimum level of practice while enhancing public protection and
helping to maintain the integrity of the profession.”
Organizational Performance Goal
Two years following implementation of recommendations, the State Bar will have experienced a
statistical decrease in the rates of attorney quality of life issues compared to the date of
implementation.
Attorneys State Bar Public
One year following
implementation of
recommendations, attorney
members of the State Bar will
have utilized the Lawyer
Assistance Programs services
at a 5% greater rate when
compared to the previous
calendar year as measured
through State Bar assessments
and released statistics.
One year following
implementation of
recommendations, the State
Bar will undertake critical
assessments of its current
policies and procedures about
programming, education and
intervention techniques.
Eighteen months following
implementation of
recommendations, public
awareness of the quality of life
issues facing attorneys will be
heightened through a series of
public relations and marketing
programs aimed at educating
the public, and providing
resources and outreach to
clients to ensure the public is
protected and attorneys feel
empowered to seek assistance
without worrying about public
perception.
STANDARD OF PRACTICE 12
Stakeholder Group for the Study
Though a complete analysis of all stakeholder groups would provide of the successes and
failures of the current State Bar programs, for the scope of this study, the focus is on attorneys.
The attorney stakeholder goal of 5% higher useage of LAP services was selected as a benchmark
for this study because the outcome would signal the effectiveness of the Lawyer Assistance
Program, and the need for more effective outreach and treatment for attorneys. Alternatively, the
higher enrollment may also signify better recruitment or increasing knowledge of the programs’
existence. The attorney stakeholder goal should identify both the strengths and weaknesses of the
program by targeting known quality of life issue interventions that are underutilized, not utilized
or are currently being used by the LAP. Upon conducting a summative evaluation of the
program, this study will then identify the future needs of attorneys in these areas, and develop
strategic tools for the future. Should this goal not be achieved, the State Bar is risking a lack of
fulfillment of its mission to protect the public, the Lawyer Assistance Program failing to realize
its full potential.
Purpose of the Project and Questions
The purpose of this project was to conduct a gap analysis to examine the knowledge,
motivation and organizational influences that interfere with the State Bar fulfilling its core
values. The study began by generating a list of possible or assumed interfering influences that
inhibit the efficacy of LAPs that will be examined systematically to focus on actual or validated
interfering influences. While a complete gap analysis would focus on all stakeholders, for
practical purposes the stakeholder to be focused on in this analysis is the State Bar’s attorney
members.

STANDARD OF PRACTICE 13
The questions that guided this study were as follows:
1. What are the attorney members’ knowledge and motivation related to utilizing the
Lawyer Assistance Programs services that are designed to address issues related to
mental health, chemical dependency and attrition?
2. What is the interaction between the State Bar organizational culture and context and
attorney members’ knowledge and motivation?
3. What are the recommended knowledge and skills, motivation, and organizational
solutions?
Methodological Framework
This field study employed a mixed-methods approach to gain the most insight into the
issues examined. The approach was based on the guidelines derived from Creswell (2014), and
Salkind (2014). A mixed methods approach allowed for data-based results to be explained via
participants’ insight. This method provided rich insight into both the problems and the study
results. Utilizing an explanatory sequential method, this descriptive and process-based research
first sought out quantitative evidence as to the utilization and efficacy of the LAP and its attorney
stakeholders. This was followed by qualitative field-based interviews and surveys (McEwan &
McEwan, 2003; Creswell, 2014). Finally, the study concluded with pre-selected members of the
qualitative study being interviewed as a member-checking technique to ensure the veracity of the
results (Creswell, 2014).
According to Creswell (2014) and Merriam and Tisdell (2016), this approach to research
will allow the qualitative inquiry to be based on actual data and objective evidence underlying
the efficacy of the LAP and the cultural and related foundations of the issues surrounding
attorney quality of life issues. The information rendered from the quantitative inquiry informed
STANDARD OF PRACTICE 14
the focus of qualitative surveys and interviews. The research undertaken built upon the 2016
study conducted by Krill, Johnson, and Albert (2016), which was the most comprehensive
research report on quality life issues of attorneys in the United States upon its release. As
discussed in subsequent chapters, there are two types of threats to validity: internal threats, and
external threats. This mixed-method designed study identified these threats, responded to their
potential to invalidate the outcome and minimized or eliminated their effect on the results
(Creswell, 2014; Merriam & Tisdell, 2016).
Definitions
Lawyer Assistance Program (LAP or LAPs): Programs organized and run under the auspices of a
state or local bar association aimed at providing confidential mental health and substance abuse
assistance to lawyers and their families.
Quality of Life Issue: As used in this research study, any issue associated with or arising out of
mental health, substance use/abuse, and attrition.
State Bar Association (State Bar or State Bars): A professional licensing organization within a
particular jurisdiction that operates under the authority of the highest court in the jurisdiction,
most often a State Supreme Court. For purposes of this study, State Bar Association includes all
licensing entities including, for example, the New York State Unified Court System.
Organization of the Project
This research study is organized into five chapters. In Chapter One, the organization’s
mission, goals, and stakeholders as well as the initial concepts of gap analysis were introduced.
Chapter Two provides a review of the current literature surrounding the scope of the study.
Topics of quality of life issues, its origins, those who deal with them, and the creation of LAPs,
and a statistical overview will be addressed. Chapter Three details the assumed interfering
STANDARD OF PRACTICE 15
elements as well as the methodology when it comes to the choice of participants, data collection,
and analysis. In Chapter Four, the data and results are assessed and analyzed. Finally, Chapter
Five provides solutions, based on data and literature, for closing the perceived gaps as well as
recommendations for an implementation and evaluation plan for the solutions
1
.

1
Adopted from USC Rossier exemplar.
STANDARD OF PRACTICE 16
CHAPTER TWO: REVIEW OF THE LITERATURE
Identifying the Problem and Population of Focus
The legal profession is in the middle of a quality of life epidemic, and stakeholders must
take action to deal with the overwhelming tide of evidence that the issue is not going away (Krill,
2016). The statistics on the field are startling; 18% of lawyers who have practiced between two
and 20 years have developed problematic drinking habits. That number rises to 25% when
lawyers hit their 20
th
anniversary of practicing law. The propensity for use, even if not
problematic, is higher for attorneys, as well. In a dated, but still insightful Washington State
study, while 12 percent of the general population had tried cocaine at some point in their life,
that figure was 26% for attorneys (Allan, 1997).
Substance abuse has a crippling effect on the legal profession, placing nearly every
stakeholder at the peril of competency problems. The outcomes are so widespread that the
majority of professional conduct violations involve substance abuse. Therefore, the key to
combatting alcoholism and substance abuse is early detection and intervention.
The authors of Authentic Happiness & Meaning at Law Firms, Huang & Swedloff (2007)
noted that lawyer depression and alcoholism are palpably higher than the rest of the US
population. In fact, most employers, especially at law firms believe that the solution to attorney
discontent is to raise wages or utilize money as a solution to any problem (Weiss, 2007).
However, money solves nothing when it comes to dealing with mental health, substance abuse,
and attrition. Financial incentives do not alleviate or even address the issues underlying the
discontent; sometimes it even adds to it.
Schiltz (1999) synthesized a number of market studies which yielded devastating news
for the legal profession: attorneys are more depressed, more likely to commit suicide, abuse
STANDARD OF PRACTICE 17
alcohol and drugs, suffer a greater number of divorces, have anxiety, hostility, and paranoia and
are in poorer health than the rest of society. Schlitz asserted that, overall, lawyers are not happy,
and the profession is to blame. While the State Bar and its LAP may help address the symptoms
of quality of life issues, to ensure the best chance at recovery lawyers must look to the cause of
the problems: their work and workplace (Jones, 2001). Attorneys must self-audit and be trained
to recognize both the issues themselves and the development of the issues.
Lack of Current Research
There has been only one comprehensive, generalizable study undertaken regarding
attorney quality of life issues (Krill, Johnson, & Albert, 2016). This sole landmark study, which
was funded jointly by the Hazelden Betty Ford Foundation and the American Bar Association
Commission on Lawyer Assistance Programs, opens the door for further research into the issue.
The survey-style study utilized a sample of 12,825 licensed, employed attorneys to assess quality
of life issues (alcohol use, drug use, and mental health). The study found that 20.6% of study
participants had hazardous levels of alcohol use, with depression, anxiety, and stress among
attorneys as statistically significant (28%, 19%, and 23% respectively). These statistics are the
most reliable and qualify as the most extensive piece of research undertaken on the topic. This
study picks up where the Krill Study left off: now that we know that there is a problem, what can
be done to address it?
Attorney Demographics and Population
The legal profession is growing in size, and the incidence of quality of life issues is
increasing accordingly. As of 2016, there were approximately 1,315,561 lawyers in the United
States. Compared to the population of the United States, there is roughly one lawyer for every
244 people (American Bar Association, 2016). Lawyer Assistance Program funding in the
STANDARD OF PRACTICE 18
United States varies widely from jurisdiction to jurisdiction, with the greatest number of
programs falling within the $0-$50,000.00 and $100,001.00-$150,000.00 ranges (American Bar
Association, 2014). The most highly funded program boasts a budget of $1,350,000.00. The
most common issues addressed by LAPs in the US are substance abuse and mental health issues,
which accounted for almost 85% of the total.
In March 2017, the California State Bar’s LAP submitted its statutorily required report
for the year 2016 (State Bar LAP, 2017). Over the course of the year, the LAP conducted 134
intakes, representing a slight increase from the previous year of seven intakes, with 127 active
program participants. Of those 134 intakes, half came from applicants to and students preparing
to apply for admission to the Bar. Twenty-three percent of those individuals referred to the LAP
came from the State Bar’s discipline system (either the Alternative Discipline Program, “ADP,”
or the State Bar Court, “SBC”). Forty-seven percent of those participating in the LAP were
seeking aid for chemical dependency issue, and 24% sought treatment for an issue related to
mental health. The 36% remaining were seeking aid for a dual-diagnosis. Of all cases closed,
43% (137) were as a result of the participant meeting program goals, a slight decrease from the
previous year (143). Setting aside two individuals who passed-away while enrolled in the LAP,
21% involuntarily exited the program, and 15% were not admitted. Even when compared to
other professionals, attorney quality of life problems are exceedingly high.
In 2004, results of a study regarding the treatment of attorneys with substance abuse and
psychiatric disorders were released (Sweeny, Myers, & Molea, 2004). The retrospective study
looked at treatment statistics of attorneys, utilizing, for comparison purposes, health care
professionals. While 46% of healthcare professionals present for substance abuse treatment,
60% of attorneys reported the same co-occurrence (Morris, 2017). More concerning was that
STANDARD OF PRACTICE 19
while 86% of healthcare professionals completed treatment, only 64% of attorneys reported the
same. When compared to the non-professional treatment population suffering from a co-
occurring psychiatric disorder (dual diagnosis) only 28% of the time, the 60% figure is starker.
Attorney Quality of Life Problems: Statistical Overview
The statistics on lawyer quality of life issues are sobering and reach across numerous
attorney demographics (Scott, 2011). The issue of alcohol dependency is ignored by most
practitioners, and no industry standard exists for helping lawyers seek recovery. In 1991, the
ABA reported a drug and alcohol abuse rate of 18% for lawyers, whereas the average in all other
professions is 8-10 percent. Another report found drug use for attorneys at a rate at twice as
much as the general public (Benjamin et al., 1990).
As discussed previously, the numbers for mental health issues play right into these
figures: 33 percent of lawyers have a mental health issue, and 19 percent have elevated levels of
depression, which is more than twice the national average in the US (Silver, 2004; Scott, 2011;
South Carolina Bar Association HELP Task Force “SCBA,” n.d.). In 1990, a study at Johns
Hopkins University revealed that attorneys are 3.6 times more likely to suffer depression than all
other professions” (Eaton, Anthony, Mandel, & Garrison, 1990). And, when spoken about in
terms of suicide, lawyers claim the title for the highest rate, whereby the National Institute for
Safety and Health found that cross sections of the lawyer community are twice as likely to die
from suicide as the same cross sections in other communities such as male lawyers between the
ages of 20 and 64 (Weiss, 2009).
There are many obstacles to treatment for lawyers, including the belief that they did not
need help and could do it on their own. Other issues include the impact admitting to needing
treatment could have on their respect and reputation in the legal community, and a sophisticated
STANDARD OF PRACTICE 20
level of denial and highly developed sense of being right (Scott, 2011). The symptoms and
warning signs of quality of life issues are the same within and without the profession (Silver,
2004). However, within the profession, denial features prominently as a warning sign. Attorneys
tend to be more defensive about any perspective issues others may raise. In a study of 2,600
lawyers in the State of South Carolina, 17% admitted to consuming three to five alcoholic
beverages per day. Unlike other individuals struggling with attrition, substance abuse, or mental
health problems, lawyers are increasingly at risk for these quality of life issues because these
professionals quickly become disenchanted with their work and, according to Bloom and
Wallinger (as cited in Silver, 2004) are “terrible resources” for their peers when it comes to
seeking and obtaining help (p. 7). Lawyers operate in a high-stress world where the benefits of
practice are counterbalanced by equal pressures to achieve. When a lawyer falls victim to
substance abuse, other lawyers and the public become victims as well.
Even if, arguendo, the rates of mental illness and substance abuse were no higher for
attorneys than the rest of the US population, the consequences of these issues are far greater
(Rothstein, 2007). Quality of life issues, while different from each other, are similar in the
profound effects they have on the profession’s stakeholders and individual attorneys’ conduct.
While quality of life issues may be viewed as a disability according to the government (through
the ADA and other pieces of legislation) and the general public, attorney conduct, not their
disability, is strictly scrutinized. Therefore, the attorney’s ability to competently practice law,
though impeded by a disability, is what matters, not the disability or cause of the impediment
itself.
The culture of law firms is partly to blame (Olson, 2016). Lawyers are encouraged to
socialize not only with each other but with clients; these interactions often include alcohol.
STANDARD OF PRACTICE 21
Though two decades old, that while many had issues with drinking commence in law school, “a
far greater number – 44 percent” had these issues arise during their formative years of
professional practice (Schools, 1994). Substance abuse is involved in 50-75 percent of attorney
discipline cases. The problem has not become better since (Krill et al., 2016). For many lawyers,
substance abuse and related quality of life issues develop in law school.
The problem was so widespread that the American Association of Law Schools (AALS)
established a Special Committee on Problems of Substance Abuse in the Law Schools from
1990-1993. That committee’s charge was to explore substance abuse in law schools and
recommend substantive outreach solutions to them. The AALS undertook two major surveys
during this period and found that every law school in the US has students and faculty who have
developed or are developing major substance abuse issues. While state bar associations and law
schools have improved their assessment of quality of life issues and the methods by which they
address them, the efficacy of the programs utilized is questionable and largely without results-
based study.
While estimates of general alcoholism in the United States is roughly 10-13% of the
population, the same measure for attorneys is no less than three times that average depending on
the study (Bloom & Wallinger, 1988; Krill 2016). It is extremely rare for an attorney disciplined
for their failure to report fellow practitioners’ misconduct. This phenomenon is referred to as the
“conspiracy of silence” and certainly contributes and enables practitioners to engage in conduct
that is detrimental to the rule of law and the protection of the public. Thus, denial is only further
compounded because of the legal community’s failure to hold its members internally liable for
failure to meet practice standards. Moreover, practical questions arise as to this self-reporting
issue; should practitioners be reporting each other for every shortcoming such as health issues,
STANDARD OF PRACTICE 22
suspected cognitive impairments, or even every time a medical issue arises (such as a stroke,
traumatic brain injury, or heart attack)? The questions are, therefore, how is a practitioner to
measure the competency of a peer, and when must that peer be reported?
The current system of misconduct proceedings often fails to take into account that
alcoholism—and the other quality of life problems discussed herein—is not a voluntary action
(Bloom & Wallinger, 1988). Most misconduct proceedings treat the actions of substance use and
abuse, and mental health problems as voluntary in the discipline prescribed. This is often a non-
mitigating factor approach. However, alcoholism is sometimes treated as a mitigating factor.
These two systems are wildly inconsistent, and the general public sees the two as serving
two different stakeholders (Bloom & Wallinger, 1988). When it comes to a non-mitigating
approach, the swift justice of the bar is seen as serving the public’s protection. Compared thereto
is the system of viewing substance abuse as a mitigating factor, which the public likely views as
the State Bar protecting its own members. The mitigating factor approach supports the societal
shift in its view of addiction and mental health: that the problems need to be addressed and
rehabilitation serves the greater public good than does punishment.
As before stated, the culture of law firms is partly to blame (Olson, 2016). Lawyers are
encouraged to socialize not only with each other but with clients; socialization often includes
alcohol. While many had issues with drinking commence in law school, a great many had these
issues arise during their formative years of professional practice when stress may start to mount.
And, stress is a common factor in the abuse of alcohol and other substances (Sinha, 2008; Sinha,
2001).

STANDARD OF PRACTICE 23
Understanding the Problem, its Origins, and Treatment
Attorney quality of life issues are far-ranging and include substance abuse, mental health
issues, and attrition. Lawyers suffer elevated symptoms of substance abuse and mental health
issues in comparison to their peers in other professions and the general public (Benjamin, Sales,
& Darling, 1990). Based upon the progeny of articles and studies published since Benjamin,
Sales, and Darling (1990) brought the issue to prominence, it is clear that bar associations must
make an effort to reach their membership before issues are elevated to a level where their clients
are at risk, and prior to the commission of malpractice.
Addiction is based on a theoretical model where an individual makes a choice to engage
in an activity based on an internalized cost-benefit analysis (West & Brown, 2013). When one
has a compulsion to repeat the activity without rationale, the activity becomes an addiction. A
1997 study of 12,000 individuals found that lawyers were members of the most depressed
profession (Sweeney, 1997). The study revealed that the Bar must address the issues of
substance abuse, mental health issues, and burnout. Learning how to manage stresses, identify
the symptoms of these issues, and educating the bar membership on programs offered can greatly
address the issues discussed.
The cause of quality of life problems is varied. For example, suicide among lawyers is
all-too-common as a result of the stresses and requirements associated with the practice of law.
Lawyers are twice as likely to commit suicide than the general population (Jones & Crowley,
1998). Given the substance abuse statistics for the legal profession, suicide needs to be
addressed in a major way; “substance abusers are ten times more likely to commit suicide than
the general population” (Jones & Crowley, 1998).
STANDARD OF PRACTICE 24
Given the issues from which lawyers suffer, it is no surprise only half of the lawyers in
California who took part in a RAND Institute for Civil Justice study which revealed that “if they
had to do it over again, they would not become lawyers” (McCarthy 1994, 1). Long hours, the
promise of wealth, the obsession with money and making it, statutory requirements and
pressures, as well as the culture of practice, all contribute to poor mental health and habits which
may weigh heavily upon the attorney (including substance abuse and other related behaviors and
addictions) (Schiltz, 1999).
Risk Factors for Addiction and Mental Health Problems
Quality of life issues tend to arise during a lawyer’s formative years, either during law
school or early in their professional career. The issues that were pre-existing become more
pronounced in law school. When substance use and abuse are part of the law school experience,
those practices will not stop upon graduation.
Law school culture. Law students are surrounded by a mixture of stress, anxiety,
depression, and substances. At nearly every social event, alcohol is on display; drugs,
prescription or illicit, are readily available. In 2003, Cooper declared the mantra for law students
and lawyers in his article Under the Influence: “Celebrate your victories, drown your defeats.”
Law school culture is intertwined with alcohol, and the biggest issue is avoidance by students
and staff (Cooper, 2003). Denial that there is a problem or that there should be greater regulation
and responsibility fuels the abundance of substance use.
There is a distinct absence of substance abuse regulations and guidelines at law schools in
the US, much less action on the part of administrators and law students to address developing
issues with alcohol and drugs (Cooper, 2003). Even if students self-identify as having a
problem, they are unlikely to seek school assistance. Students see how professors treat students
STANDARD OF PRACTICE 25
who are merely late to class and do not see the administration as having a soft, helpful approach
to any problem from which they may be suffering.
The statistics on law student substance abuse and use habits are just as staggering as that
of their lawyer counterparts. One-quarter to one-third of law students report frequent binge-
drinking, drug abuse and mental health issues (Organ, Jaffe, & Bender, 2016). The researchers
proffered that law school has stress and anxiety in abundance. Ten deaths were reported at
American law schools between July 2014 and February 2015, including eight suicides and two
homicides by a law student. This 2016 research study was conducted utilizing surveys of law
students at 15 ABA-accredited law schools in the US. In the study, 90% of respondents reported
that they had an alcoholic drink in the past 30 days, up 8% from a similar study (AALS, 1991) .
More than half of those who took part in the study reported that they drank enough to
become inebriated in the prior 30 days, and 22% of the respondents reported binge drinking
twice in the prior two weeks. In the same study, 25% of respondents reported using marijuana in
the prior year, with 14% using the drug in the previous 30 days. The participants also reported
cocaine use at 6% and 2% in the prior year and 30 days, respectively. Of the 15 schools
reporting, marijuana use overall ranged from 14.3% over the last 12 months to 36.9%.
Prescription drugs (with a prescription) were utilized by participants, with between 9% and 15%
reporting usage of at least one of five categories of prescription drugs. Additionally, 14% of
reporting participants admitted using prescription drugs without a prescription, with stimulants
being the most widely utilized drug.
The study also screened law students for mental health issues with 42% self-identifying
as having needed some assistance with a mental health issue over the past 12 months. Using the
Patient Health Questionnaire-2 (PHQ-2), the survey yielded 17% of participants screened
STANDARD OF PRACTICE 26
positive for depression. Utilizing the Kessler 6, 37% of participants screened positive for anxiety.
Using the SCOFF questionnaire, the research shows that a surprising 27% of respondents had an
eating disorder.
The results of the survey likely suffer from underreporting issues, skewing the statistics
to what is likely lower usage than what may be. Some schools refused to allow the authors to
survey students because they were worried about what the results may yield. Most impactful to
the problem of practice in this study is that the greatest factors which discouraged participants
from seeking outside help for their issues was the potential of those issues to impede or threaten
their admission to the bar (63%) or their ability to obtain a job or succeed academically (62%).
Organ, Jaffe, and Bender’s research was not limited to the law school survey in 2016.
Previously, in 2015, the authors undertook an analysis of data regarding law students’ reluctance
to seek help for these immense problems. They found that law students may be reluctant to seek
help or even identify the need to get help for themselves or their peers (Organ, Jaffe, & Bender,
2015). Law students and attorneys have an adversarial mindset. They may find ways to hide or
otherwise make it difficult for third-parties, such as the Bar or their law school, to discover
outright that they have a quality of life issue that needs to be addressed. To this point, the
authors asserted that clear and unambiguous disclosure is not a part of the lawyer mindset.
Furthermore, the competitive atmosphere of law school pits peers against each other (as lawyers
are in the courtroom). Others can exploit any vulnerability, and seeking help is certainly
classified as a vulnerability. Law students believe they are better off keeping their issues to
themselves than exposing a weakness. If a law student seeks help in law school, they would
necessarily need to expose the issue when they apply for admission to the bar. This exposure
may limit or impede any admission.
STANDARD OF PRACTICE 27
Help-seeking behavior is thwarted by this type of thinking. There exist two distinct types
of the stigma attached to mental illness: perceived public stigma and anticipated self-stigma
(Bilbelhausen, Bender, & Barrett, 2015). According to Pattyn, Verhaeghe, Sercu & Bracke
(2014) “perceived public stigma refers to discrimination and devaluation by others and
anticipated self-stigma refers to internalization of negative stereotypes about people who seek
help” (p. 232-238). There have been no effective methods developed to reduce self-stigma such
as education, facilitated discussions, and activism (Pattyn et al., 2014). The law presents many
opportunities for a practitioner to take the problems and stress of their client and adopt it as their
own. The culture of law school not only prepares a law student for professional practice but
instills both positive and negative realities into the student’s everyday life (Pattyn et al., 2014).
Though research by Dutton (2012) suggests that the legal profession ranks second in
professions which attract individuals that can be classified as psychopaths, having characteristics
that can be classified as psychopathic may be sought-after by employers and clients alike. In his
book “The Wisdom of Psychopaths,” Dutton asserts that there are “Seven Deadly Wins,”
character traits that actually help individuals achieve success: charm, ruthlessness, focus, mental
toughness, fearlessness, mindfulness, and action. However, having psychopathic tendencies or
traits may also be a burden on a lawyer’s ability to overcome the obstacles and issues associated
with the practice of law even though these traits are engrained during law school and sometimes
earlier.
Law students must adopt a mentality to deal with rule-based morality that forces a
practitioner to see the world as being a particular way, and like a puzzle, every piece must fit in
with exacting precision, removing much of the humanity or empathy that society expects (Pattyn
et al., 2014). The lack of emotional processing in exchange for analytical thinking further
STANDARD OF PRACTICE 28
impacts the mental health of lawyers and is not only taught to but demanded of law students
while in school. Perfectionism and pessimism drive their practice. Finding faults and being
without faults has been shown to yield greater levels of success, but instills within the law
student and lawyer negativity and may drive them to see the world as either winning or losing.
The authors describe vicarious trauma as what may be the biggest threat to a lawyer’s
mental health. The impact of continued exposure to clients who may have suffered trauma and
traumatic stress may be transferred to their lawyer who spends a great amount of time with them
and advocating for their needs (Pattyn et al., 2014). Finally, legal professionals and law students
feel increased isolation as walls constantly surround them as they stare at desks filled with
computers and phones. These individuals may feel pressure not to interact or socialize with the
people around them for fear of not attaining enough billable hours, missing a deadline, and
cutting into study time. The adversarial system of law in the US discourages sharing personally
because of the fear of exposing weakness.
While law schools train law students to deal with the realities of being a lawyer, however
harsh they may be, law school conditions may involve excessive workloads and the inability to
manage their time (Benjamin, Kaszniak, Sales, & Shanfield, 1986). This sets in motion an
unfortunate cycle for the students; psychological distress may arise as a coping mechanism,
which leads a downward cycle of the stress causing more stress (Organ, Jaffe, & Bender, 2016).
High faculty to student ratios lead to less student interaction and higher levels of distress. In the
1981 study, 84 percent of law students believed that no faculty member had shown interest in
their progress (Benjamin et al., 1986). The feeling of a divide between students and faculty leads
to poor relations and a general feeling of student dissatisfaction
STANDARD OF PRACTICE 29
Law schools also fail to train students on intrapersonal skills, instead concentrating solely
on skills that are decidedly analytical instead (Benjamin et al., 1986). The lack of intrapersonal
skills not only impedes the effective practice of law but leads to elevated distress levels as it
correlates to intrapersonal concerns. Because law students and attorneys are engaged in a process
that emphasizes emotionally isolating analytical processes, they are “less skillful in dealing with
the emotional tensions which are so much a part of the lawyer-client relationship” (Watson,
1979).
Professional culture and demands. The demands of the legal profession require
perfection and unwavering strength in adversarial interactions. Whether dependency occurs as a
result of social pressures or performance requirements, substance abuse and mental health issues
are regular occurrences. An intensive study of both law students and lawyers undertaken by
Krieger and Sheldon (2015) revealed that the value of money, grades and prestige is fairly
limited for the well-being of the lawyer. Not surprising, the data yielded evidence that a happy
life as an attorney has little to do with prestige, grades, or affluence, but based upon how
engaging, and meaningful the work the lawyer is doing rates to that particular attorney.
Further, Krieger and Sheldon (2015) asserted that a law student’s tendency to place
greater value on making money than being engaged with their work would have a negative
correlation with their future happiness. Well-being did not vary with the number of hours an
attorney works. However, the more billable hours in which the attorney engaged or was expected
to engage correlated directly with increased alcohol use. Participants in the study experienced
less life satisfaction as billable hours increased. Choices of an attorney to engage in activities
that promoted autonomy, relatedness, competence or internal motivation were correlated with
greater happiness and well-being. The profession must attempt to redefine success in both law
STANDARD OF PRACTICE 30
school and the profession systematically. Placing less emphasis on income and more on
professional attitudes and identity will strengthen attorney well-being considerably (Krieger &
Sheldon, 2015).
Put more bluntly, American lawyers are unhappy (Seligman, Verkuil, & Kang, 2001).
Lawyers are naturally and nurtured pessimists. Their pessimism drives the search for truth and
distrust of one-sided evidence. The search for truth is the cornerstone of the justice system, and
the practitioner who embraces pessimism will likely yield the greatest results for their client.
Pessimism is an unhealthy attitude to embrace and drives their mentality in all other areas of life
(Seligman, Verkuil, & Kang, 2001). Younger attorneys are placed in high-pressure scenarios,
with little decision-making ability. This type of atmosphere promotes poor health, poor morale,
and pressure to succeed (sometimes against all the odds), which contribute to the fact that
lawyers are not happy. As a result, the authors describe the law as a “zero-sum game”
(Seligman, Verkuil, & Kang, 2001). Never advancing or succeeding sets up an environment from
which negative emotions flow. With one side a winner and the other a loser, the results are not
satisfying for practitioners who are continually running in place.
Lawyer unhappiness and discontent has been studied and documented well over the past
decades (Heinz, Hull, & Harter, 1998; Schlitz, 1999). Even Supreme Court Justice Cardozo
recognized the misery inherent in the practice of law, stating: “Happiness may not be in a
successful lawyer’s life.” Experts and practitioners agree that the legal profession is
experiencing crises related to the generalizable disenchantment of the most successful lawyer
and the average lawyer alike (Horn, 1999; Kurson, 2000). The problem certainly is not financial
in most cases, as attorneys have claimed the title of highest-paid professionals, passing doctors in
the 1990s. Aside from substance abuse, the mental and physical health of attorneys is
STANDARD OF PRACTICE 31
remarkably poor. (Schiltz, 1999; Kurson, 2000; Quinn, 2000; Sweeney, 1997). In a Johns
Hopkins University study of occupations and mental health, when adjusted for socio-
demographic factors, lawyers topped the list, suffering major depressive disorder at a rate 3.6
times that of the general employed population (Eaton, Anthony, Mandel, & Garrison, 1990).
Approaches to Intervention and Treatment
There is no one-size-fits-all approach to treating quality of life issues for legal
professionals. Careful attention must be made to underlying issues which lead attorneys to use
and abuse substances. Mental health and professional demands are regularly underlying issues
and co-occurring in substance abuse diagnoses. The National Institute on Drug Abuse has
estimated that between 40% and 60% of individuals who enter treatment for addiction will
relapse or experience a setback (Rosenberg, 2016). Rosenberg asserts that the old models of
addiction treatment must be substituted with new, evidence-based treatment. The old model of
addiction treatment centers around a one-month in-patient treatment program (referred to as
residential treatment), with little follow-up and support once the individual leaves treatment.
Addiction is a chronic condition, which, like diabetes, cannot expect a cure to occur in a one-
month period. The services following residential or other treatment plans must be
comprehensive and long-term to effectuate success better.
Denial and projection are the most common psychodynamics of addiction in a social
context (el-Guebaly, Carra, & Galanter (eds.), 2015). An addicted person either denies that they
have a problem, or they project blame onto others (like their work, friends, family, etc.) for their
problem. There may exist some truth to the person’s blame on other individuals or groups for
their addiction. Others may pass on a gene, fail to intervene, produce a sense of vulnerability, or
even fail to educate on the perils of the subject of their addiction. However, to address the
STANDARD OF PRACTICE 32
addiction, the addicted person must take responsibility for their actions and self-actualize the
need for change (el-Guebaly et al., 2015). The clinician treating the addiction must take a
holistic view of the treatment of the individual. Social factors and interpersonal relations are at
the center of the addiction treatment process, as environmental factors are key to treatment
success.
Prevention can be successful in effecting change in substance use and negative behaviors
and is complementary to the treatment of addiction and harm reduction (el-Guebaly et al., 2015).
Evidence-based prevention is taking the place of good-will prevention (goodwill for goodwill’s
sake). Prevention strategies must target the environment of those most likely to use and abuse
substances and engage in the behavior. By targeting solely young people, there will necessarily
be a large gap between the prevention measure and the behavior. By targeting a range of
different environments and groups of vulnerable individuals—such as school, night-life,
families, and societal normative values—the prevention takes deeper root, and there is evidence
of a greater effect on the target population (el-Guebaly et al., 2015). Universal prevention has
the greatest level of public attention but is not likely to be effective in preventing substance
abuse.
A systems-based approach is likely to yield positive results for long-term addiction
treatment (el-Guebaly et al., 2015). Systems-based approaches look to bring together
community services for a comprehensive treatment plan over a long-term plan of treatment.
These networks of treatment services provide a more comprehensive treatment system that treats
all aspects of addiction, instead of a fragmented approach to single-system treatment.
Mood disorders are the most likely to co-occur with substance abuse in the general
population (el-Guebaly et al., 2015). Treatment of these co-occurring mental health issues has
STANDARD OF PRACTICE 33
been shown to improve treatment of substance abuse disorders. For example, the authors assert
that stress is a causal risk for both mood disorders and substance abuse. Therefore, treating both
the substance use disorder and the mental illness raises the prospect of successful treatment
overall (el-Guebaly et al., 2015).
Substance abuse issues are proven to be co-indicative of other issues including mental
health problems (Miller & Miller, 2009). Treatment must include more than just addressing the
substances being abused; treating the whole person includes addressing their mental health and
other inter-related issues. The fact that addiction itself is usually born out of the want or need to
divorce ones-self from unhappiness or the individual is trying to obtain happiness demand that
the addiction address the baseline causing the person to feel this way. Quality of life is,
therefore, a major consideration when diagnosing and treating substance abuse, and should be
targeted as a cause of the addiction (American Psychological Association, 2013). “To attract,
engage and retain people more successfully with addiction-related problems, addiction services,
and the interventions they use need to be more welcoming, attractive and focused broadly
towards their clients’ actual needs” (Miller & Miller, 2009, p. 685-86).
Lawyer Assistance Programs in the United States
LAPs were developed in the 1980s to respond to alcohol abuse by legal professionals.
Since that time, nearly every state bar has adopted a version of the LAP, with the ABA endorsing
and supporting these programs nationally. Presently, most LAPs address more than alcohol use;
LAPs handle numerous types of addiction, substance abuse, mental health issues, and family
problems. Due to the rising dissatisfaction with professional practice, rising incidence of mental
illness, and the increased reliance and abuse of chemical substances, LAPs have been developed
to intervene before the negative effects of these issues impair an attorney’s ability to function
STANDARD OF PRACTICE 34
competently (Benjamin, Sales, & Darling, 1992). The authors assert that LAPs must be
comprehensive in the services they offer while providing an atmosphere of confidentiality and
separation from the disciplinary authority. LAPs must also engage in proactive educational and
prevention programs aimed to stop issues before they require treatment. Finally, the LAP should
aid lawyers and the State Bar to identify and reach out to distressed lawyers to offer services and
intervention.
There is an ongoing tension, as discussed previously, between the State Bar and its LAP
providing confidential services to lawyers in need and the Bar’s mission to protect the public
from these very lawyers (Zacharias, 2004). LAPs need to carefully assess the needs of the
members of the State Bar, and the public whom they serve to ensure that the right model is
adapted for use by the State Bar. There is one major tension for the LAP: lawyer assistance
versus client protection. The State Bar must balance these competing interests to ensure the
effects of this tension is stabilized and meets the charge of the State Bar and its membership. As
a result, the Bar must decide whether it is going to concentrate on its lawyer members, the
public, or a balance of the two when formulating the needs and systems of the LAP itself
(Zacharias, 2004). Indeed, the tensions cannot be resolved in isolation of the LAP because of the
other functions of the bar.
In the 1950s, it was the practice of professional licensing organizations to merely suspend
or revoke the license of individuals who had substance abuse issues, as they were considered
moral, ethical, and legal problems (Weiss, 2016). As a result, attorneys would hide or deny they
had these issues for fear of losing their ability to practice or be publicly humiliated in a
profession built on respect. The key to the development of LAPs and individual responsibility
STANDARD OF PRACTICE 35
was the recognition of substance abuse and addiction as a chronic disease that requires treatment
over time.
The establishment of the first LAPs can be traced to the mid-1980s, where the programs
focused on assisting lawyers struggling with substance abuse and dependence (Albert, 2015).
Over time, LAPs were expanded to provide a multitude of assistance beyond substance abuse
issues, foremost among them: mental health. The ABA took note of the various state bar
programs, and in 1988 created the Commission on Impaired Attorneys, which was later renamed
the Commission on Lawyer Assistance Programs (CoLAP). The CoLAPs charge is “to educate
the legal profession concerning alcoholism, chemical dependencies, stress, depression and other
emotional health issues, and assist and support all bar associations and lawyer assistance
programs in developing and maintaining methods of providing effective solutions for recovery”
(Albert, 2015). The CoLAP ensures that every member of the bench and bar has access to
support services and assistance so they can be a productive member of the Bar and the public is
protected. These LAPs obtain referrals from multiple sources, including the lawyer, law schools,
the public, families, and mental health or medical professionals.
Clark (2004) described the purpose of a LAP as “like a friendly fireman” (p. 18). The
LAP is not designed to judge individual attorneys; they seek to provide assistance. The trend
among bar associations has been to address quality of life issues by committing more resources.
One of the ways these bar associations have shown this commitment is the widespread adoption
of LAPs. The original LAPs were based loosely on the 12-step program utilized by Alcoholics
Anonymous. However, no two LAPs operate in precisely the same way, but each is designed to
aid practitioners with both substance abuse and mental health issues. In 1995, the ABA House of
Delegates approved a model LAP which has since been used by different bar associations for the
STANDARD OF PRACTICE 36
creation of their programs. Worth noting is that the adaptation of the model by states varies;
some LAPs report directly to and are under the purview of the State Bar, while others are
independent or pseudo-independent (receive their funding from and file yearly reports with the
State Bar).
Comparative Models of Current Quality of Life Programs
The LAP is not the only professional assistance program in existence. Successful
programs for physicians have sprouted in numerous Western nations. Addiction is not thought of
as being like a disease when, in fact, it is one (Jurd, 2004). The New South Wales (Australia)
Medical Board developed a cutting-edge, first-of-its-kind program in their jurisdiction called the
Impaired Registrants Program (IRP), whose mission it was to assist physicians who breached
laws or regulations voluntarily seek help (Jurd, 2004). Other programs have been developed for
physicians, such as the Doctors Health Programs (DHP) in Victoria and other locations which
are involved in monitoring and aiding physicians in need of assistance, separate and apart from
any disciplinary boards.
The LAP is also not the only professional program that aims to help its practitioners deal
with quality of life issues. The Federal Aviation Administration utilizes a program similar to the
LAP for its licensed population (Weiss, 2014). The program is designed to treat pilots with
substance abuse issues and return them to their normal course of duties. There, the program
utilizes testing, monitoring, accountability, and consequences if the undesired behavior returns.
The State of Washington utilizes a program for its physicians that resembles the LAP, which
yielded positive results, with 80-95% of individuals in the program maintaining sobriety for at
least one year after treatment, and 85% with ten years continuous sobriety with monitoring
(Weiss, 2014).
STANDARD OF PRACTICE 37
Quality of Life in Context
This study will focus on four conceptual areas that are specific to the attorney context of
practice. These areas (professionalism, workplace dissatisfaction, burnout, and servant
leadership) are useful to understand as they form the foundation for the study design. Indeed, the
recommendations require a deep understanding of quality of life both within and without the
workplace, and how workplace managers and Bar administrators can serve the people they lead.
Moreover, these areas provide the landscape backdrop upon which attorneys of all ages enter the
workforce, face disillusionment, experience quality of life issues, and end of leaving practice or
suffering through it. Those in positions of authority wield a great deal of influence that can
change the prospect of practice for all members of the profession.
Reprogramming the Profession
Prior to outlining recommendations about professionalism and the practice of law, it is
important to have a basic understanding of the history of the industry. My father was once fond
of protesting the fact that “there is no longer any professionalism in the profession.” This study
shed some light on his unwittingly profound lamentation. A lack of professionalism not only
affects the public, but it has a deleteriously profound effect on practitioners. In 2005, Keith
Rizzardi took on the issue of the Florida Bar Association’s failure to regulate professionalism in
a meaningful way in his article “Defining Professionalism: I Know It When I See It.” Rizzardi
(2005) proffered that the only thing current education programs accomplish is what has been
termed “procedural professionalism,” and not actual professionalism in practice. He concluded
that it is not possible to simply teach away decades of unprofessionalism; there must be follow-
up or enforcement (Rizzardi 2005). Without it, it is like playing a game that has rules but no
officials. Rizzardi’s thesis was one supported by a litany of legal scholars, like Law Professor
STANDARD OF PRACTICE 38
Deborah Rhode in her 1998 Law Review Article, “The Professionalism Problem.” She asserted
that practicing in a profession where the public generally distrusts lawyers is not advantageous in
lowering the stunningly high levels of burnout, dissatisfaction, and attrition (Rizzardi, 2005;
Rhode, 1998). As the Florida Supreme Court held in 5-H Corp. v. Padocano, 708 So.2d 244,
247 (Fla. 1997), attorneys should report unprofessional attorney actions to “maintain and
promote attorney professionalism, high standards of conduct, decorum in Florida courtrooms and
pleadings, and the general integrity of the legal profession.” This notion supports an American
Bar Association study which found that only one-fifth of the public believes lawyers to be
“honest and ethical” (Hengstelr, 1993).
Attorney feelings of dissatisfaction drive them out of the profession (Rhode, 1998).
Accordingly, Rhode (1998) explained that it is becoming increasingly clear that the profession is
transforming into a business. To put this problem into perspective, in a professional paradigm,
lawyers subscribe to an altruistic set of standards that places their client and the community
before themselves, whereas, in a business paradigm, financial interests dominate the legal
landscape (Cooper & Humphreys, 1995). As a result, work dissatisfaction when coupled with a
complete lack of enforceable standards of professionalism is resulting in the high attrition rates
experienced by law firms (Cooper & Humphreys, 2005; Lee, Schneunemann, Hall, & Payne,
2012).
Workplace Dissatisfaction
A lack of civility can have a more significant impact than merely burdening the
profession with a negative image, it makes working within the profession a far-less rewarding
experience, and can affect a lawyer’s sense of self, willingness to collaborate, and image, which
ultimately lead to attrition (Cooper, 2005; Lee, et al., 2012). Setting the standards of practice
STANDARD OF PRACTICE 39
within individual firms are its partners and leaders, who, according to a study conducted by
Ramarajan and Barsade (2006), increase attrition and accelerate the burnout process in human
and social service jobs (see also Defoe, 2013; Shanker, 2013; Lee, et al., 2012). The National
Association of Legal Professionals (“NALP”) found attrition rates as high as 19% for large firms
(NALP, 2003; NALP, 2010). When interviewed, a plurality of lawyers who found a new job
stated that they left their previous job because of “work standards not being met” (NALP, 2003;
NALP, 2010).
In an article discussing this tension, Leary et al. (2013) explained that three-quarters of
adults blame their dysfunctional leader for being the most stressful aspect of their job and believe
them to be responsible for their burnout. Attorneys new to the profession no longer place
emphasis on wages (Johnson, 2008), but instead seek a life outside of the firm, and a rewarding
career inside a firm (Fortney, 2000). For this reason, legal professionals and organization leaders
need to work to find a way to measure success in terms that do not emphasize billable hours or
utilize quantitative measures (Fortney 2000). When combining these issues to a lack of
professionalism and civility, workplace dissatisfaction, burnout, and attrition often follow
(Fortney, 2000; Cooper & Humphreys, 2005; Lee et al., 2012). The recommendation is that
legal employers (both public and private), with the help of the State Bar, and in conjunction with
the LAP introduce and embrace workplace initiatives and programs aimed at equalizing the
work/life imbalance inherent in the practice of law, enhance leave policies and time-off, and
change workplace culture and attitudes to bring about more positivity in the work setting.
Burnout
Dan Defoe (2013) argues that dysfunctional leadership is the root cause of bad morale
and burnout. Defoe is not alone, and studies prove this assertion true. Workplace issues for a
STANDARD OF PRACTICE 40
great many associates include the attitudes of decision-makers and leaders in the way they
approach their staff (Shanker, 2013). The NALP studies (NALP, 2003; NALP, 2010) reveal that
almost 60% of associates who left firms stated that the long work hours caused their departure,
and over 50% reasoned that “work load pressures” were to blame (Johnson, 2008). A recent
lawsuit detailed that some firms have a practice or culture that promotes negativity and abusive
conduct, where all that matters is the bottom line: billable hours or similar benchmarks.
A senior partner of Michigan’s oldest law firm filed a complaint in 2012 against seven
firm shareholders, alleging that a “culture of fear and intimidation” existed among the managers
at the firm (Altobelli v. Hartman, 2016 WL 3247615 (2016)). In a great many cases, other
lawyers have also increasingly engaged in abusive and frivolous conduct that has adverse effects
on both their employees and the profession (e.g. Hayes v. Rodgers, 573 S.E.2d 775 (2002); In Re
Bourbeau - 94G0393; In Re Drake - 02G1602 (2004); NCSB v. Barrett - 10 DHC 18 (2011); In
Re Leigh - 04CRS4162 (2004)). Even the best-intentioned bosses can make their employees
lives miserable, as associates are tired of dealing with abuse, regardless of management
intentions (Shanker 2013). Law firms and public law employers need to undergo regular training
and attitudinal check-ins with administrators and employees to ensure open lines of
communication, issues are addressed, and that manager demeanor enhances employee positivity.
Servant Leadership
The topic of numerous studies, servant leadership is the belief that a leader puts others
(staff and community or organization) before themselves (Spears, 2004). Servant leadership can
increase staff morale and significantly ease attrition (Greenleaf, 1996; Senge, 2006). Dye and
Garman (2006) relate that “increasing accessibility and authenticity, fostering openness, and role
modeling” can address staff morale and burnout. These guidelines are a simple way to reduce
STANDARD OF PRACTICE 41
attrition, combat burnout, and enhance professionalism at a law firm level (Shanker, 2013).
Therefore, law firms need to adopt and model servant leadership ideals to ensure the work
environment supports a healthy quality of life for all employees.
Attorney Knowledge and Motivation Influences
Knowledge and Skills
The purpose of this section is to review key literature that provides a focus on
knowledge-related influences that are paramount to understanding the stakeholder goal studied
herein and how it will be achieved. The following literature review provides the foundation for
this gap analysis of the knowledge and skills lacking for both the State Bar’s Lawyer Assistance
Program (“LAP”) and attorney utilization of it, which has led to empirically significant shortfalls
in attorney quality of life. Attorneys need to know and understand the most prevalent quality of
life issues plaguing the profession, the resources available to those afflicted with issues, how to
take advantage of the resources available, and how to self-assess their quality of life.
While the quality of life issues discussed herein have been studied at length, the
knowledge and skills necessary to bridge the gap between the availability of resources and
attorneys’ usage of them must be addressed. This gap analysis is key in determining the steps
that must be taken to improve the delivery of services from the LAP, and the usage and treatment
of quality of life issues by attorneys (Clark & Estes, 2008). The Clark and Estes gap analysis
was the framework utilized to study these issues and provide a model upon which both this study
and the following literature review was based. A gap analysis, according to Clark and Estes
studies shortcomings in an organizational outcome or goal based upon reviewing knowledge,
motivation, and organizational influences underlying achievement or the lack thereof. This
review focused on literature that detailed the knowledge influences of attorney stakeholders and
STANDARD OF PRACTICE 42
the stakeholder goal that one year following implementation of recommendations, attorney
members of the State Bar will have utilized the Lawyer Assistance Programs services at a 5%
greater rate when compared to the date of implementation.
Knowledge influences. Krathwohl (2002) proposed the existence of four knowledge
dimensions to classify and map instructional gaps in learning outcomes. A revision of Bloom’s
Taxonomy, Krathwohl’s work expanded the theory into a new knowledge dimension, adding a
fourth knowledge dimension—metacognitive—to the pre-existing dimensions: factual,
conceptual and procedural. This chapter will explore three of the four distinct knowledge types:
conceptual (declarative), procedural, and metacognitive.
First, conceptual knowledge influence represents an individual’s understanding of the
key, underlying interrelationships between and among larger structures. This includes the
knowledge of principles, theories, models, and structures (Krathwohl, 2002). Conceptualization
is the comprehension of how a system or structure functions (Anderson, 2006; Krathwohl, 2002).
Second, procedural knowledge incorporates an individual’s understanding of how
something is done, subject-specific skills, techniques, and methods, as well as an understanding
of how to determine when to utilize proper procedures to accomplish a task or undertaking
(Krathwohl, 2002). Specifically, procedural knowledge influences revolve around a person’s
ability to understand the proper steps to take to inquire into a problem or solution, and how to
utilize the required techniques and methods to accomplish the task. Knowledge influences
provide the foundation for recognizing process and procedure.
Finally, metacognitive knowledge influences focus on one’s strengths and challenges,
necessarily involving self-assessment and reflection (Baker, 2006). Metacognition influences a
learner’s self-regulation and strategic knowledge (Mayer, 2011). The ability to self-reflect in
STANDARD OF PRACTICE 43
regards to one’s abilities, shortcomings and knowledge enable the individual to properly give
context to cognitive tasks and plan strategically for the task with which they face.
The following literature review will take each of the three knowledge influences
described and frame them regarding the gap analysis this paper studies. By understanding these
knowledge influences in terms of attorney quality of life, the following research will not only be
better understood but will be framed regarding how this study can better utilize knowledge and
skills to yield the desired outcome of lowering the rates of attorney quality of life issues currently
realized.
Conceptual knowledge influence. This section explores two declarative conceptual
knowledge influences: knowledge of the quality of life issues for which members of the
profession are most likely to be afflicted, and methods of coping attorneys can utilize to
minimize these issues. There exist multiple shortcomings for the members of the legal
profession that are directly based on these two conceptual-based knowledge influences
(Benjamin et al., 1992). First, when attorneys are not aware or educated about quality of life
issues, they not only fail to recognize the warning signs of these issues, but they are not aware
that their experiences are abnormal. Second, while LAP resources and services could be meeting
the needs of members of the bar, the services may not be implemented or utilized because of a
lack of knowledge regarding lawyer impairment (Benjamin et al., 1992, p. 134). Concerted
education efforts likely yield lower rates of at-risk behavior and increase the use of the LAP
among attorneys, which points to this knowledge influence as having great impact.
Quality of life issues manifest in all age groups; research which studied conceptual
knowledge influences of young or early career professionals show that young people are more
likely to seek self-help for mental health issues if they know what resources are available to them
STANDARD OF PRACTICE 44
and if they have some education regarding these issues (Rickwood, Dean, & Wilson, 2007, p.
S35). Therefore, literacy about quality of life problems is a key indicator of an individual’s
likelihood to seek assistance for problems they may be facing. The knowledge, skills, and
encouragement to seek help make an individual more prone to addressing the issues (Rickwood
et al., 2007, p. S36). Citing Sheehan, Oppenheimer, & Taylor (1988), Hartnoll (1992) posits that
individuals who have quality of life issues are not well-informed about the resources available to
them, and are thus less likely to seek help (p. 434). Education regarding the availability of
treatment programs helps individuals assess their need for those programs and shapes their
perceptions regarding the usefulness of those programs (Hartnoll, 1992). Moreover, the public’s
understanding that there exists a problem is the reason for rising support of LAP programs,
making education an even more potent model for the improvement of attorney quality of life
issues (Zacharias, 2004).
The earlier the education takes place, the more likely prevention and treatment can treat
or even thwart the problems before they become insurmountable and negative consequences
arise (Benjamin et al., 1992). The belief or knowledge that a problem exists and is influencing
the afflicted individual’s life indicates a higher likelihood that the individual will seek and utilize
resources for treatment or aid (Finney & Moon, 1995). The same ideals follow for the
conceptual knowledge regarding the methods of both practice and coping they can utilize to
minimize these issues (Finney & Moon, 1995; Benjamin et al., 1992). Conceptual knowledge is
the beginning of narrowing the gap between resource offering and resource utilization to combat
quality of life issues. The conceptual knowledge regarding access to appropriate services must
be coupled with the procedural knowledge of both how to seek help and how encouragement for
help-seeking issues is offered (Rickwood et al., 2007, p. S35).
STANDARD OF PRACTICE 45
Procedural knowledge influence. Attorneys must obtain procedural knowledge in two
“how-to” areas: (1) how to utilize available services and resources provided by the State Bar
through its LAP, and (2) how to recognize the warning signs of quality of life issues. As
explained by Benjamin et al. (1992), a comprehensive LAP that improves stakeholder knowledge
and motivation must include all the following: confidentiality, separation from disciplinary
authority, prevention and education service identification and evaluation of distressed lawyers,
referral to treatment resources, the right for the LAP to advocate in front of disciplinary
authority, and promotion of therapeutic outcomes. Thus, a fully-formed and successful State Bar
LAP utilizes education to at-risk individuals not only on how to seek help but the likelihood of
success in treatment (Rickwood et al., 2007).
Processes in the providing of resources create standards of practice that not only make it
easier to access resources but promotes the usage of those resources (Benjamin et al., 1992).
Lawyers contacted by a LAP are likely to initially deny issues—having multiple witnesses may
assist the attorney in confronting the problems; use of peer counselors who have dealt with the
same issues has proved successful. LAP staffers should be trained on how to persuade, not
coerce, lawyers to take advantage of resources available (Benjamin et al., 1992).
Finally, lawyers who can trust the procedural steps involved in seeking resources—such
as knowledge that the process if confidential—promotes honesty and self-help among lawyers
(Benjamin et al., 1992). As described above, a comprehensive LAP program includes elements
that allow an attorney to help self-identify as having a quality of life issue and produces attorney
stakeholders with a greater level of knowledge. People are unlikely to seek help if they are not
able to assess and process their habits and day-to-day experiences (Hartnoll, 1992). These
elements include confidentiality to promote honesty and self-help, prevention and education
STANDARD OF PRACTICE 46
services to aid in identification and evaluation of distressed lawyers, and the promotion of
therapeutic outcomes (Benjamin et al., 1992; Rickwood et al., 2007).
The last step in enhancing knowledge and skills is to study the metacognitive knowledge
influences underlying self-help and self-reflection for attorneys who suffer from a quality of life
issue. A bridge between procedural knowledge influences and metacognitive knowledge
influences is bridged because people are more likely to seek self-help (i.e., enter treatment) once
they perceive their symptoms to be severe (Finney & Moos, 1995).
Metacognitive knowledge influence. Metacognition as a knowledge influencer plays the
greatest role in attorneys seeking the help or resources of the State Bar’s LAP, and self-
identification as being at-risk of suffering from a quality of life issue or in-need of treatment for
the same. Three metacognitive factors aid in the seeking of treatment: hardship or psychological
distress; stressors; and social pressure (Finney & Moos, 1995). The authors asserted that self-
perception of the manifestation of these factors had been shown to be a predictor of treatment
entry in studies undertaken. Furthermore, if an individual has sought help before the instant
occurrence, they are more likely to seek help again. A referral to a treatment facility also
facilitates this self-help process as it aids the individual in identifying resources and providing
community support in seeking help.
Even if an individual self-identifies as in-need, if the program offered is perceived to be
ineffective by the individual, or there is a lack of support from their social network, an individual
will be less likely to seek assistance (Finney & Moos, 1995). Negative attitudes and stigmas
regarding mental health issues and the treatment of them are likely to act as a barrier to an
individual seeking help (Rickwood et al., 2007). Incentivizing help-seeking behaviors provides
the impetus for individuals to want to seek help, lessen the impact of negative community
STANDARD OF PRACTICE 47
stigma, and encourages self-assessment and participation in LAPs (Zacharias, 2004). To enable
attorneys to self-help, the attorneys must utilize a metacognitive self-empowerment that forced
participation programs are unlikely to achieve. As a knowledge influence, lawyers should be
influenced by their self-perception and must learn how to self-assess their quality of life. As
metacognition helps identify when an individual should use the designated processes to obtain
help for quality of life problems, the next section on motivation outlines why individuals are
driven to use the resources available (Mayer, 2011).
Table 2 outlines the organizational mission, global goal, stakeholder goal, as well as three
knowledge influences discussed in the preceding literature review.

STANDARD OF PRACTICE 48
Table 2
Knowledge Influence, Knowledge Types, and Knowledge Assessment

Attorney Motivation, Expectations, and Values
The following literature review sets forth prevailing motivational factors underlying the
achievement of this study’s stakeholder goal, which is to increase the usage of the LAP at a rate
of no less than 5% when compared to the previous year. Motivation is the manifestation of an
Organizational Mission

The State Bar’s Lawyer Assistance Program is charged with the mission to “support legal
professionals in achieving their optimum level of practice while enhancing public protection and
helping to maintain the integrity of the profession.”
Organizational Global Goal

Two years after implementation of recommendations, the State Bar will have experienced a
statistically significant decrease in the rates of attorney quality of life issues (including attrition,
chemical abuse, and mental health issues) compared to the rates on the date of implementation.

Stakeholder Goal

One year following implementation of recommendations, attorney members of the State Bar will
have utilized the Lawyer Assistance Programs services at a 5% greater rate when compared to
the date of implementation.

Assumed Knowledge Influence Knowledge Type Knowledge Influence Assessment
Attorneys need to know the quality
of life issues by which members of
the profession are most likely to be
afflicted.
Declarative
(Conceptual)
Surveys
Interviews
Attorneys need to know methods of
coping they can utilize to minimize
these issues.
Declarative
(Conceptual)
Surveys
Interviews
Quizzes

Attorneys need to know how to
utilize available services and
resources provided by the State Bar
Procedural
Interviews
Surveys
Attorneys need to know how to
self-assess their own quality of life
status
Metacognitive
Statistical analysis
Interviews
STANDARD OF PRACTICE 49
internal state or beliefs that both initiates and maintains goal-based behaviors (Mayer, 2011). In
the context of the stakeholder goal outlined in this literature review, motivation is the basis upon
which an individual self-helps, self-assesses, and seeks outside assistance from the LAP. Self-
efficacy plays a significant role in identifying individuals who will take advantage of the
opportunities and resources they are presented (Borgogni, Russo & Latham, 2011; Bandura,
2000).
The two theories of motivation that will be discussed in this literature review are utility
value and attribution theory. Utility value is the relationship between a task or undertaking and
an individual’s goals and plans (Eccles, 2006; Eccles, Wigfield, & Schiefele, 1998). A task,
therefore, has utility value if it fulfills an individual’s basic psychological needs. Attribution
theory posits that motivation is enriched when an individual places emphasis on their effort
rather than their abilities when measuring success or failure (Anderman & Anderman, 2009;
Pintrich, 2003). The section that follows will combine motivational theories as they relate to this
paper’s stakeholder goal.
Utility value theory. Utility value is a part of the expectancy value theory in which task
values are measured according to a person’s interests, needs or perceptions (Pintrich, 2003).
Expectancy value theory places emphasis on four measures: (1) intrinsic interest, which
measures a person’s interest in the task; (2) importance, which places emphasis on an
individual’s drive to do well and the relatedness between the task and the individual’s self-
identity; (3) cost, which deals with perceptions of the negative consequences resulting from
engaging in the conduct; and (4) utility, which deals with an individual’s perceptions of the
usefulness of the task (Pintrich, 2003). This literature review deals with utility expectancy value,
which posits that an individual’s goals and psychological needs gives value to a task or
STANDARD OF PRACTICE 50
undertaking, and is, therefore, more likely to be undertaken and completed by that person
(Eccles, 2006). As a result, the more aligned a task is with an individual’s goals and
psychological needs, the higher value that individual will assign to it.
Expectancy value can be reduced to two critical queries: first, “Can the individual
accomplish the task?” and “Does the individual wish to accomplish the task?” (Eccles, 2006).
These two fundamental questions underlie the basis of utility theory by explaining an
individual’s perceptions of what the task can do for the individual. Utility value is the answer an
individual gives when asked “Why did you do it?” or “What was in it for you?” The basis of
utility value is attainment value, or the evaluation of who an individual is, what their goals are,
and how they self-identify (Eccles, 2006). The worth a person assigns to themselves in
conjunction with the task’s benefits in the undertaking is, therefore, the driving factor in utility
value. Eccles (2006) weaves together the idea of the conceptualization of image with how well a
task interconnects with an individual’s goals and belief system. The way an individual sees
themselves directly affects the value that a person assigns to a task (Eccles, 2006).
Attorney utility value theory. Motivation to address, identify, and treat a quality of life
issue for a lawyer starts with their values and belief system. The goals of an attorney play an
essential role in decision-making processes; self-help is no different. As the journey to
becoming a lawyer is long and tedious (a four-year degree, followed by three years of law
school, and culminating with a 18-hour exam in which roughly 45% of first-time test takers
fail—the figure is even worse for repeat test-takers) a lawyer has two significant and somewhat
fused assets: their law license and reputation. Thus, an attorney’s identity is interwoven with
their will to maintain their ability to practice law. As a result, coercion can be beneficial to an
individual’s motivation to seek help and intervention by preying on an attorney’s self-image (as a
STANDARD OF PRACTICE 51
practicing attorney), and their valuation that achievement of completion of an intervention is
highly regarded (Wolf, Kay-Lambkin, Bowman, & Childs, 2013). If an attorney knows they
must complete treatment to practice law, they are likely to complete the treatment; if completion
is not mandatory, they will likely not seek or complete treatment.
Wolf et al. (2013) found coercion plays a significant role in treatment commencement,
but not treatment outcomes. While treatment commencement is important and addresses self-
help motivations, treatment is also equally significant. To this end, the study asserted that both
enforcement and engagement of individuals in drug and alcohol treatment is an essential factor in
both treatment initiation and successful intervention (Wolf et al., 2013).
Motivation plays an integral role in treatment engagement and outcomes (Wolf et al.,
2013). An attorney’s engagement in treatment signifies that the individual has placed a high
utility value on the treatment and addressing of their quality of life issue(s). Studies reveal that
individuals who are engaged in their treatment have a more favorable outcome from the
treatment (Wolf et al., 2013). In measuring the motivational factors of individuals who are
seeking or are in need of treatment, there are two elements to consider: internal motivational
factors and external motivational factors. Internal factors are represented by an individual’s self-
image, psychological needs and goals, whereas external factors arise from considerations of
consequences of continuing the behavior and other outside pressures. Thus, the assertions of
Wolf et al. (2013) align directly with the utility value of the expectancy value theory. Attorneys
must see the value in utilizing the resources offered by the LAP for the program to realize its
potential and to lower the incidence of attorney quality of life issues.
The value in seeking treatment or utilizing resources can also come from societal norms
and beliefs, further driving attorney motivation. People who have mental illnesses tend to either
STANDARD OF PRACTICE 52
fail to seek out treatment or fully engage in treatment (Corrigan, Druss, & Perlick, 2014).
Societal stigma plays a significant role in impeding an individual’s self-help and care seeking
mentalities. Care seeking behaviors and motivators can be aided by increasing mental health
literacy, cultural competence, and family engagement. The utility value placed on treatment or
self-help can arise from attitudes and behaviors that affect care decisions. The stigma that may be
felt by the individual in need can lead to treatment avoidance, lack of a support system, and a
belief that treatment is ineffective, thereby lowering the utility value (Corrigan et al., 2014).
According to Corrigan et al. (2014) stigma is particularly of concern because it undermines self-
help behaviors and reduces treatment effectiveness. This theory posits that people who suffer
from quality of life issues must maintain choice as a way to enhance self-help and goal setting
behaviors to raise the utility value of treatment.
Attribution theory. Attribution theory studies an individual’s beliefs about the
occurrence of events and how those events affect subsequent motivation (Anderman &
Anderman, 2006). Put more simply, an individual is affected by both their environment and
personal factors; this changes the way they understand the environment and the occurrence of
events. In this way, motivation is heightened when an individual places emphasis on the effort
and other self-controllable efforts they expend on a task instead of their ability to accomplish
what it is they set out to accomplish (Anderman & Anderman, 2006; Mayer, 2011). Pintrich
(2003) asserts that the opportunity to exercise some levels of choice and control over decision-
making enhances an individual’s motivation. As a result, individuals will work harder when they
attribute their successes and failures to their effort instead of their abilities (Mayer, 2011).
People attempt to append a meaning to an action or behavior to shape their response to that
STANDARD OF PRACTICE 53
occurrence (Harvey & Martinko, 2009; Weiner, 2006). These meanings—or attributions—have
numerous elements that can be classified according to three dimensions (Weiner, 2006).
First, attributions can be classified according to their stability or lack thereof.
Consistency over time or across differing situations modifies perceptions (Weiner, 2006). The
stability of an occurrence tends to temper the future expectations an individual will have. The
more unstable the event, the more likely the occurrence is expected to be different or changed in
the future; likewise, the more stable the occurrence, the higher the expectation will be that the
individual will act the same in the future.
Second, attribution theory looks to the locus of causality, which is defined as the
internality or externality that is attributed to the occurrence (Harvey & Martinko, 2009). An
internal locus is one in which an individual proscribes the occurrence as resulting from
something within their control, whereas an externality arises from something outside their
control.
Finally, attributions look at the dimension of control. This dimension assesses the degree
to which the behavior’s cause can be altered or controlled (Weiner, 2006). While locus of
causality discusses internal and external factors, controllability examines whether the individual
can alter the locus, regardless of their internalized nature or externality (Seel, 2012). An
individual may be able to control an externality, thus making the locus of causality and
controllability distinct factors in attribution theory.
The sum of attribution theory can be explained as follows: it is the rationalization of an
individual’s causal explanation for their performance (Seel, 2012). In other words, how an
individual ascribes their failures or successes influences their motivation for future related
undertakings (Seel, 2012; Weiner, 2006). By explaining and identifying the causes of an
STANDARD OF PRACTICE 54
individual’s present behavior, their motivation in the future can be influenced in the future, even
if the task is not the same, but merely related in some manner.
Attorney attribution. An attorney must understand that they are in control of their
successes and failures, and must recognize that they must assert personal effort and be
accountable for their self-care. While this study has made the case that quality of life issues are
far more prevalent in the legal profession than other professional endeavors, the motivation for
attorneys to seek help from the State Bar or LAP is low (Baron, 2015). On their path to licensing
and beginning a life-long identity as lawyers, law students are taught that the “good citizen
lawyer” self-manages their stresses to avoid quality of life issues (Baron, 2015, p. 158). The
motivation for self-assessment and treatment comes from an attorney’s duty to themselves. If a
lawyer does not seek to self-manage, does not care to self-manage, or does not place value on
their reputation, self-management is a losing proposition. The programmatic resources provided
by the LAP are useless if they are not utilized or requested by those in need.
As a part of this self-management, a lawyer must emphasize two phases: (1) recognition
and acknowledgment that they have an issue; and (2) the adoption of methods and strategies to
regulate their distress. While Baron (2015) challenges the notion that quality of life issues are to
be assumed by the lawyer as their responsibility, interpellation is proffered as an overarching
theme in response. Interpellation is the process by which an individual encounters and
internalizes their culture’s values. Baron reviews three studies regarding an attorney’s
responsibility in quality of life issues and reveals one significant implication based upon the
issue caused by interpellation. Here, interpellation in the legal field has normalized quality of
life issues (such as alcohol abuse); not only has it legitimized self-denial, but other attorneys fail
to recognize the warning signs of quality of life issues in their peers. Normative professional
STANDARD OF PRACTICE 55
culture places the burden of self-assessment and treatment upon the individual attorney. Baron
suggests that while self-management may help with the issues, the structural issues and cultural
norms are a barrier to the eradication of the problem profession-wide (Baron, 2016).
Indeed, mindfulness and self-perception can motivate an attorney to seek actions
regarding their quality of life issues (George, 2015). More simply: mindfulness aids motivation
(Jha, Krompinger, & Baime, 2007; Ortner, Kilner, & Zelazo, 2007). Insight meditation, the
looking into one’s self, can lead to heightened self-perception and can help people not only feel
better but perform better. Mindfulness and self-regulation enhance and empowers lawyers to
better address their mental health issues (George, 2015) This idea of mindfulness not only
enhances the mental well-being of attorneys but helps the attorney understand their goals and
belief systems. The clarity gained from mindfulness is not only self-help for quality of life
issues itself but enhances the personal image required to heighten an at-risk attorney’s
motivation to seek resources and treatment (George, 2015).
Mindfulness can directly lead to the regulation of emotional affect (George, 2015).
When a lawyer self-regulates and practices mindfulness, they have mental health benefits, which
includes a release of stress and tension. To this end, mindfulness would enable lawyers to self-
regulate, which has motivational advantages: the lawyer who can self-regulate can recognize the
symptoms of stress and anxiety and can act to help themselves treat the underlying causes
(George, 2015, p. 24). Attorneys who understand that they have an internal locus of control over
their successes or failures, assert personal effort, and are accountable for their self-care will
realize success in addressing quality of life issues. Table 3 outlines the organizational mission,
global goal, stakeholder goal, motivational indicators, as well as the two motivational influences
discussed in the preceding literature review.
STANDARD OF PRACTICE 56
Table 3
Motivational Influence, Motivation Types, and Motivation Assessment

Organizational Mission
The State Bar’s Lawyer Assistance Program is charged with the mission to “support legal
professionals in achieving their optimum level of practice while enhancing public protection and
helping to maintain the integrity of the profession.”

Organizational Global Goal
Two years after implementation of recommendations, the State Bar will have experienced a
statistically significant decrease in the rates of attorney quality of life issues (including attrition,
chemical abuse, and mental health issues) compared to the rates on the date of implementation.

Stakeholder Goal
One year following implementation of recommendations, attorney members of the State Bar will
have utilized the Lawyer Assistance Programs services at a 5% greater rate when compared to the
date of implementation.

Motivational Indicator(s)

Persistence: Attorneys begin to inquire and utilize Lawyer Assistance Program resources in a
meaningful manner.

Active Choice: Attorneys are invested in their quality of life and believe that utilization of the
Lawyer Assistance Program enhances their ability to competently practice law and lead a
fulfilling career.
Assumed Motivation Influences Motivational Influence Assessment

Utility Value – Attorneys need to see the value in
utilizing the Lawyer Assistance Program
resources.
Written Survey Item: “It is important for me
to take advantage of the resources offered by
the Lawyer Assistance Program.” (Strongly
Agree-Strongly Disagree)
Attribution Theory – Attorneys need to
understand that they have an internal locus of
control over their successes or failures, must
assert personal effort, and be accountable for their
self-care.

Written Survey Item: “I believe that I am
accountable for addressing my own
conduct.” (Strongly Agree-Strongly
Disagree)

Written Survey Item: “I believe that the State
Bar is responsible for notifying me when I
fall below the standard of self-care.”
(Strongly Agree-Strongly Disagree)
STANDARD OF PRACTICE 57
State Bar LAP Organizational Influences On Lawyer Utilization of the LAP
The achievement of stakeholder performance goals of the LAP and attorneys themselves
requires alignment of the organizational influences with the motivation and knowledge
influences discussed in previous sections (Clark & Estes, 2008; Rueda, 2011). This section
focuses on the literature related to the organizational influences that enable a deeper
understanding of this gap analysis and furthers the foundations upon which this study will be
developed and solutions formulated. Moreover, this review concentrates on the organizational
gaps and cultural factors lacking in both the State Bar's Lawyer Assistance Program and attorney
utilization of it. The organizational stakeholders need to improve their methods of practice to
change the cultural norms and attorney attitudes concerning the fundamental issues associated
with the attorney quality of life epidemic. Acknowledgment, perception, and acceptance by the
State Bar, its attorney members, and the public are necessary to meet the stakeholder and
organizational goals upon which this study is based.
To this end, this element of the gap analysis helps us understand how the organization
operates, the cultural norms that drive this issue, both positive and negative, and the processes
needed to achieve the LAPs goals (Clark & Estes, 2008). This continuation of the Clark and
Estes (2008) gap analysis is, perhaps, the most significant identifier of the LAPs ability to
manage for its mission, and enable attorneys to self-actualize and self-help. This review will
focus on literature which details the organizational influences of the State Bar and LAP
stakeholders and the organizational global goal that two years after implementation of the
study’s recommendations, the State Bar will have experienced a statistically significant decrease
in the rates of attorney quality of life issues (including attrition, chemical abuse, and mental
health issues) compared to the rates on the date of implementation..
STANDARD OF PRACTICE 58
Factors underlying organizational influences include how people interact with their
environment, the organization's resources, and each other (Clark & Estes, 2008). Not only do
insufficient systems, processes, and resources prevent the realization of performance goals but
organizational culture influences can also affect stakeholder performance. In this study, culture
is understood to be the identity of the State Bar and its stakeholders, and events and interactions
that may be occurring as a matter of practice (Schein, 2004).
Rueda (2011) asserts that both cultural settings and cultural models must be discussed to
understand and identify the organizational influences that affect performance. Among a large
number of factors, cultural settings research focuses on the incentives, goals, and communication
of the organization (Gallimore & Goldenberg, 2001). Cultural settings are usually open, clear or
evident, and tangible markers of cultural models that are formed by individuals or groups.
Cultural models, on the other hand, are the norms, covert values, beliefs, and attitudes that are
typically systematic within an organization (Rueda, 2011; Gallimore & Goldenberg, 2001).
More specifically, cultural models influence trust, feelings towards change, and accountability
where the cultural setting focuses on the presence of goals, incentives, feedback, and
communication (Rueda, 2011; Gallimore & Goldenberg, 2001).
State Bar LAP Specific Factors
Previous influence sections suggested that the organization must put in place procedural
and related systems of operation to ensure the LAP meets its goals and carries out its vision.
Thus, a comprehensive LAP must include all of the following: confidentiality, separation from
disciplinary authority, prevention and education service identification and evaluation of
distressed lawyers, referral to treatment resources, the right for the LAP to advocate in front of
disciplinary authority, and promotion of therapeutic outcomes (Benjamin et al., 1992). These
STANDARD OF PRACTICE 59
programmatic features should include confidentiality to promote honesty and self-help,
prevention and education services to aid in identification and evaluation of distressed lawyers,
and, as stated previously, the promotion of therapeutic outcomes (Benjamin et al., 1992;
Rickwood et al., 2007). To realize success in moving towards this end, the State Bar should
enact education programs to inform at-risk attorneys not only on how to seek help, and the
likelihood of success in treatment (Rickwood et al., 2007).
Benjamin et al. (1992) also found that the creation of standards of practice, in turn,
produce cultural norms that not only make it easier to access resources but provides the
foundation upon which more individuals will avail themselves of the resources. Cultural norms
are also responsible for how people self-assess and process their habits and experiences (Schein,
2004). To this end, help seeking behaviors are likely to be thwarted if people are either not able
or not knowledgeable on self-assessment and processing (Hartnoll, 1992).
Cultural Model and Setting Influences
This study revolved around two assumed cultural model influences for the State Bar's
LAP derived from Gallimore and Goldenberg's (2001) article which addresses this influencer
model. First, there is a cultural norm in the legal profession to deny that an attorney is not
performing their duties entirely and that they are in need of assistance from a third party. The
second assumed cultural model influence is that attorneys generally resist self-reflection and
diagnosis pertaining to quality of life issues that affect their daily lives. In addition to the
cultural model influences, there are two assumed cultural setting influences adopted from the
Gallimore and Goldenberg (2001) model, which act as barriers to the State Bar and LAPs
mission and goals. First, the demand to produce results and perform in high-stress environments
regardless of outside influences interferes with attorneys investing time to address their
STANDARD OF PRACTICE 60
problems. Second, attorneys are responsible for maintaining a flawless reputation to gain respect
and professional advantage from their peers and clients. Negative attitudes and stigmas
regarding mental health issues and the treatment of them are likely to act as a barrier to an
individual seeking help (Rickwood et al., 2007). Incentivizing help-seeking behaviors provides
the impetus for individuals to want to seek help, lessen the impact of negative community
stigma, and encourages self-assessment and participation in LAPs (Zacharias, 2004). Zacharias
asserts that to enable attorneys to self-help, the programs must utilize a metacognitive self-
empowerment that forced participation programs are unlikely to achieve.
Studies have made even more evident the result of both institutional and cultural
shortcomings which significantly impact the identification and treatment of quality of life issues
(Christin, 2017; Krill et al., 2016). A dysfunctional culture is at the center of this complex issue,
and these patterns of normalized assumptions need to be addressed and overcome (Schein,
2004). There exists a pervasive stigma in the legal field revolving around both addiction and
mental health issues that have caused any acknowledgment of the suffering of a quality of life
issue to be hidden and untreated (Christin, 2017). This cultural norm has caused attorneys to
either deny they have a problem or hide it from their peers and the State Bar if they even believe
one exists. The 2016 Betty Ford Hazeldon study noted, in perhaps its most profound finding,
that there are two main obstacles to self-reporting (Krill et al., 2017). The first is that attorneys
do not want others to know that they have a problem; the second is that attorneys are worried
about their privacy and have concerns about confidentiality (Christin, 2017).
This cultural problem often commences long before an attorney passes the bar exam and
starts work as a practitioner. On their path to licensing and beginning a life-long identity as
lawyers, law students learn that the "good citizen lawyer" self-manages their stresses to avoid
STANDARD OF PRACTICE 61
quality of life issues (Baron, 2015). In fact, a recent exposé in the New York Times
(Zimmerman, 2017) discussed the fact that recent studies revealed that going into law school,
law students are healthier than the general population both mentally and physically. However,
the formal structure of law school turns that promising statistic on its head (Benjamin et al.,
1986; Organ et al., 2015; Rothstein, 2007). The study by Professors Krieger and Sheldon (2015)
details the troubling erosion of quality of life starting in a lawyer's infancy, commencing in law
school. Krieger and Sheldon posit that the values emphasized in law school have no impact on
an attorney's well-being. This normative value system continues beyond law school and into
professional practice (Benjamin et al., 1986; Organ et al., 2015; Rothstein, 2007).
Interpellation in the legal field—as discussed in the knowledge and motivation literature
review—has normalized quality of life issues (such as alcohol abuse); not only has it legitimized
self-denial, but other attorneys fail to recognize the warning signs of quality of life issues in their
peers. Normative professional culture places the burden of self-assessment and treatment upon
the individual attorney. Baron (2016) suggests that while self-management may help with the
issues, the structural problems and cultural norms are a barrier to eradication of the problem
profession-wide.
Christin (2017) offers tips to manage this epidemic by implementing organizational
processes and programs. Christin further asserts that educational programs are a starting point to
recognize and evaluate quality of life issues, but by creating an atmosphere of acceptance by
implementing policies and programs that change the culture of practice and acceptance of those
who suffer from any these concerns practitioners. These actions can "crack the stigma that
prevents [lawyers] from asking for help while at the same time building a business that sustains
productivity and personal satisfaction" (Christin, 2017, p. 30).
STANDARD OF PRACTICE 62
Table 4
Assumed Organizational Influences and Organization Assessment

Organizational Mission

The State Bar’s Lawyer Assistance Program is charged with the mission to “support legal
professionals in achieving their optimum level of practice, while enhancing public protection
and helping to maintain the integrity of the profession.”
Organizational Global Goal

Two years after implementation of recommendations, the State Bar will have experienced a
statistically significant decrease in the rates of attorney quality of life issues (including
attrition, chemical abuse, and mental health issues) compared to the rates on the date of
implementation.
Stakeholder Goal

One year following implementation of recommendations, attorney members of the State Bar
will have utilized the Lawyer Assistance Programs services at a 5% greater rate when
compared to the date of implementation.

Assumed Organizational Influences

Organization Influence Assessment
Cultural Model Influence 1: There is a
cultural norm in the legal profession to deny
that an attorney is not performing their duties
fully and that they are in need of assistance
from a third party.

Survey or interview questions about whether
the profession has informal standards or
requirements that interfere with an attorney’s
ability to self-realize; review of previous
State Bar surveys and statistics.
Cultural Model Influence 2: Attorneys
generally resist self-reflection and diagnosis
pertaining to quality of life issues that affect
their daily lives.

Survey or interview questions about the
cultural motivation for attorneys to address
quality of life issues.
Cultural Setting Influence 1: Demand to
produce results and perform in high-stress
environments regardless of outside
influences interferes with attorneys investing
time to address their own problems.

Survey or interview questions about the
professional demands on attorneys to
complete a designated goal without regard to
personal factors.
STANDARD OF PRACTICE 63
Conceptual Framework: The Interaction of Attorney Members’ Knowledge, Motivation,
and the Organizational Context
The basis of this study’s conceptual framework was adapted from the work of Maxwell
(2013) and Merriam and Tisdell (2016). Maxwell described the conceptual framework as a
system of assumptions, beliefs, expectations, theories, and concepts that support and inform
research. Maxwell posited that the conceptual framework is a crucial element of research, and is
defined as a visual or written product that, graphically and/or in a narrative, explains the subject
that is to be studied (Maxwell, 2013; Miles & Huberman, 1994). The framework will not only
direct the inquiry process, but it is the foundation of both the field study to be conducted and the
development of the research questions (Yin, 2014). Finally, the conceptual framework provides
the boundaries within which the literature review has been undertaken while enabling the study
to be analytically generalized (Merriam & Tisdell, 2016).
In previous sections, knowledge, motivation, and organizational influences have been
presented independently. However, in this gap analysis research study, it was understood that
these influences are not necessarily independent of each other. As the literature suggests,
influences interact and operate in tandem with each other. For example, the motivation influence
which exists as the utility value of the LAP—seeing the value of utilizing the program’s
resources—depends upon the knowledge influences of both recognition that a problem exists and
the knowledge of the services provided by each State Bar. Additionally, these knowledge and
motivation influences depend upon the organizational influence of the culture of the State Bar
being such that attorneys in need of assistance feel safe in their decision to seek assistance.
The universe of research on addiction and mental health suggests that motivation to seek
help begins with the knowledge that a problem exists (see Weiss, 2016). In fact, Alcoholics
STANDARD OF PRACTICE 64
Anonymous, the most well known sobriety program in the world, utilizes the Serenity Prayer that
makes a note of this connection: “… grant me the Serenity, to accept the things I cannot change,
Courage to change the things I can, and Wisdom to know the difference” (Niebuhr, 1986, p.
251). The recognition that being motivated to seek change is bound to knowledge is a basic
understanding according to the literature.
Figure 1 demonstrates the interplay between the influences described in the previous
sections. At the center of this conceptual framework is the organization: the State Bar LAP. The
organizational influences of the LAP—specifically the culture of the State Bar—is at the center
of motivating (Baron, 2015) and educating the State Bar’s membership and the public; this ideal
provides the most significant influence not only on attorneys but the knowledge and motivation
influences as well (Corrigan et al., 2014). Figure 1 also illustrates the way three motivation
influences and two knowledge influences interact with the organizational influences to achieve
the stakeholder goal of this research.
It is important to note that while this study addressed multiple knowledge, motivation,
and organization influences, for purposes of this conceptual framework, only three motivation
influences, two knowledge influences, and the overarching organization influences of cultural
norms and resistance to self-reflection were utilized. This decision was made strategically to
draw attention to the interplay between all of the influences by illustrating the interaction
between a representative sample of those discussed in this study. The sampling that was utilized
streamlined the complex interplay of influences underlying the theories and framework of this
study in a more simplified manner.

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Figure 1. Conceptual framework for the study.

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As explained in Figure 1, the directional arrows show the impact one influence—shown
in circles—has on another influence. The box at the bottom of the table represents the goal of the
study, which is represented by a bi-directional arrow. Here, it is believed that the goal of
expanding the usage of services provided by the State Bar will have a positive effect on the
influencers; success begets success. This conceptual framework shows the hypothesis that the
organizational influences affect all knowledge and motivation influences; the reverse is true as
well.
The organizational influence of State Bar cultural norms and values has a direct impact
on attorney knowledge that a problem exists (Benjamin et al., 1992) and motivation to both seek
help and take responsibility for those problems. In turn, the more attorneys that are equipped
with knowledge and are motivated to take action, the greater likelihood the normative values of
the State Bar will change in a positive manner to enable more of the Bar’s membership to (want
to) get help. Another example of this interplay between the different influences in this gap
analysis is the bilateral impact the motivation influence of personal effort and accountability
(George, 2015), and the knowledge influence that provides attorneys with the understanding of
how to utilize self-help and LAP services (Finney & Moon, 1995). When individuals understand
how to help themselves, they are more likely to seek the help they need (Hartnoll, 1992;
Rickwood, Deane, & Wilson, 2007; Sheehan, Oppenheimer, & Taylor, 1988); when they are
motivated to seek help, they become more likely to educate themselves on the services that are
available to them (George, 2015). Based on this conceptualization, the three different types of
influences discussed in this gap analysis and research are interconnected to each other.

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Conclusion
The purpose of this study was to explore and evaluate the impediments to the recognition
and treatment of attorney quality of life issues, and what can be done to positively impact the
delivery and efficacy of services provided by the State Bar to address these issues. The quality
of life issues (attrition, mental health problems, and substance abuse issues) discussed in this
literature review showed that the number of attorneys experiencing quality of life issues had
reached epidemic levels. These quality of life issues are the foundation of the problem of practice
explored in this study. With the foundation provided by the literature, the study’s focus on the
problem of practice became more understandable and manageable.
Chapter Two presented a description of the fundamental stakeholder group of this study
(attorney members of the State Bar), their knowledge, motivation, and the State Bar’s
organizational influences, as well as the study’s conceptual framework. Clark and Estes’ (2008)
model for gap analysis, when coupled with the problems of practice and State Bar influences,
formed the scope of the research that follows. In Chapter Three, an explanation and exploration
of the methodological approach of the study, including a description of the stakeholders, the
strategy for sampling and recruitment, and the rationale for these factors are undertaken.

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CHAPTER THREE: METHODS
The purpose of this study was to evaluate the efficacy of the State Bars and their LAPs
outreach, resources, and services in response to the lawyer quality of life epidemic. Chapter
Three presents the research design and methods for data collection and data analysis that was
employed to respond to the study’s research questions, based upon the problems of practice set
forth in Chapters One and Two. The chapter describes not only the stakeholders who participated
in the study, but the method of selection and analysis, and ethical implications of the study itself.
Participating Stakeholders
The stakeholder group upon which this research study focused was the active attorney
membership of the six states involved in the field study. This study commenced with a
quantitative-style survey of each state’s attorney membership who have electronic mail addresses
available to the public. The only criteria to be selected for the survey phase of the study was
membership in the State Bar. Inactive members (hereinafter “recently active” attorneys)
participated to widen the pool of responses and account for those individuals who may have
suffered from a quality of life issue. All responses gathered necessarily engaged the participants
from the view as an active attorney; any inactive attorneys were asked to answer from their
active experience. For purposes of this research report, this sample population, which includes
active and inactive attorneys, will be referred to as “members.” Online surveys were transmitted
to every member of the six State Bars via their publicly available electronic mail addresses.
Finally, individuals were randomly selected for the second phase, the qualitative portion
of the study from the responses received from the quantitative survey phase. The random
selection was purposeful in order to ensure a representative sample of participants from each of
the six study states has an opportunity to participate. After taking the quantitative survey,
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participants were asked if they are open to further inquiry. Participants who agreed to take part
in the study further were then asked for contact information (telephone and email), as well as
their state of residence in a separate, independent survey not connected to the original survey
they completed.
An explanatory sequential mixed methods design was used in this gap analysis. This
method required the gathering of quantitative data in the first phase—in this case, through a
survey—followed by a qualitative phase to help explain the results of the quantitative phase
more thoroughly (Creswell, 2014). Member-checking was utilized throughout both phases to
identify outlier and dishonest information obtained through both phases of study, and was based
upon the input of known experts on the topic, including treatment experts and psychologists,
State Bar and LAP administrators, and attorney stakeholders who are known to have suffered
quality of life issues and utilized the State Bar’s LAP.
Survey Sampling Criteria and Rationale
Criterion 1. All active attorneys registered with the State Bar at the commencement of
this study who have an electronic mail address available to the public. As described at length
throughout Chapter 2, every attorney member of the State Bar is part of the stakeholder group at
the center of this study. This criterion was based on the fact that every attorney—regardless of
the existence of a quality of life issue—gives insight into the baseline utilization of the LAP and
the resources the State Bar is allocating to combat the subject issues.
Criterion 2. All inactive attorneys who were active at the date of commencement of the
study. This group of “inactive” attorneys were included in this study to account for attorneys
with recent experience with the State Bar who can share insights into quality of life issues and
the State Bar’s handling of them. Further, attorneys who may have suffered quality of life issues
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but have either chosen to become or were forced into inactivity by the State Bar can provide,
perhaps, the most significant amount of insight into the quality of life epidemic from a personal
and systematic/procedural standpoint.
Survey Sampling (Recruitment) Strategy and Rationale
The rationale for choosing the survey sample was based on the gap analysis influences of
knowledge and skills, motivation, and the organization. Sampling with a large population was
necessary in order to make the results of the study more generalizable (Maxwell, 2013).
Therefore, the nature of this study required a large sample size for the quantitative survey phase
(Fink, 2013; Johnson & Christensen, 2015). In California, as of July 31, 2017, there was a total
of 189,680 attorneys in the State; according to the American Bar Association National Lawyer
Population Survey, there were 77,008 attorneys active in Florida, 35,236 in Michigan, 177,035 in
New York, 10,316 in South Carolina, and 25,786 attorneys active in Washington State. The goal
participation in this study was 2% of this total population, adjusted for the ability to obtain
contact information (403,359), or 8,067. Given the issues discussed in Chapter 2, it was unlikely
that widespread participation would be achieved; attorneys not only belong to a culture of silence
and denial that quality of life problems exist, but the reasons underlying many of these quality of
life issues stand as a barrier to participation (lack of time, outside stressors, caseload, etc.).
Further, distrust regarding confidentiality and perceived connection to a State Bar would—and
did—cause many individuals to refuse participation. Therefore, it was likely and satisfactory
that 1% of attorneys solicited for participation (~4,033) would complete a survey. These figures
were confounded by the lack of publicly available electronic mail addresses for all 515,061
attorneys in these six states.
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While a random sample population would usually be sought, obtaining a truly
representative sample of the State Bar membership was not possible with such method as there
was no way to control the response rate of the sample population (Johnson & Christensen, 2015).
The State Bar LAP services are rendered, by statute, confidentially. As such, there is no way of
identifying those who have utilized the LAP, along with difficulty in identifying and sampling
attorneys who have quality of life problems, and attorneys who do not. Therefore, because of the
ease of gaining access to all electronic mail addresses is a matter of automated collection or
cooperation of the State Bar, all members of the State Bar were solicited for participation.
Moreover, participation rates skyrocketed (sometimes by hundreds or thousands) with every
reminder email solicitation sent. Only two reminders were sent to participants after the initial
email, with reminders being sent every two weeks after initial contact.
Mixed methods approach. Using this mixed methods approach allowed for both
quantitative data and qualitative insight to be obtained sequentially as a result of the design of the
study (Creswell, 2014). Beginning the research in phase one with a survey enabled the
interviewer in phase two—this researcher—to not only prepare more completely for the
interviews but also enables deeper insight and inquiry into issues that were otherwise unknown
previously (Creswell, 2014). The survey also allowed for the relationship between the
knowledge and skills, motivation, and organizational influences to be developed in a more
comprehensive manner than merely conducting interviews or focus groups.
The first phase of this research study required initial contact be made via email at the
commencement of the study. Attorneys registered with each State Bar, in large part, had a public
email address displayed as a matter of public record online. Since the State Bar of California
refused assistance, email addresses from each of the six states were obtained from each State
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Bar’s public website. Upon collection of all email addresses available, an initial solicitation
email that contained a link to an online survey will be distributed to all available participants.
As discussed previously, two follow-up emails were disseminated at regular, two-week
intervals to remind participants about the request for participation. Phase One continued until
three weeks after the final reminder email was disseminated. While the continued collection of
data and overlap of Phase One and Phase Two would not have had an impact on the interview
phase of the study and would have allowed, hypothetically, for increased insight into the subject
matter during the analysis of the study, participation rates plummeted to zero within three weeks
of the final reminder. As a result, the Phase One survey was closed. As Creswell (2014)
emphasized, the survey was based upon the need to examine the relationship between the gap
analysis variables. Furthermore, the survey allowed for the collection of data in a rapid fashion,
which was essential in this two-phase study to meet time requirements to proceed with the
qualitative interviews.
Interview and/or Focus Group Sampling Criteria and Rationale
Criterion. Phase One participating attorneys who volunteered for further inquiry. Those
who answered positively to a question regarding further participation and openness to follow-up
inquiry were purposefully selected for Phase Two, with a proportionate sampling based upon
their state of practice. The purpose for selection of these individuals was, first, to gauge why
these individuals utilized (or chose not to utilize) the LAP, their knowledge of the program, and
their general views regarding the State Bar and the LAP. The qualitative interview sought to
inquire the basis for the use or non-use of, and referral to the State Bar LAP. Finally, the
individual’s feedback regarding the efficacy and features of the LAP was sought. The
individuals selected were interviewed regarding both their knowledge about the services offered,
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their view of lawyer culture that affects both quality of life issues and LAP utilization, and any
insight they may have regarding other attorneys who have or have had quality of life issues.
These participants’ beliefs and knowledge regarding the LAP and its offerings, and their
likelihood of participating in those service offerings in the future should they develop quality of
life issues were examined. The interview included inquiry into those factors which would drive
the individuals to take part in the LAP services offered, and the socio-cultural issues revolving
around their future use and/or historical refusal or failure to utilize the services.
Interview and/or Focus Group Sampling (Recruitment) Strategy and Rationale
While the quantitative portion of the study commenced at the outset of the study and
ceased prior to the commencement of the interviews, the qualitative phase (Phase Two) ended
following the final interview. The second phase of the research utilized a purposeful approach
maximum variation sampling (Merriam & Tisdell, 2016). Responses from the first phase
surveys received underwent initial review and sorting based on volunteerism and state of
practice. Eleven individuals were randomly selected based on this sorting of survey responses,
with ten participating. This number was selected to ensure a representative subset of the
surveyed population who fits the group identity set forth. The goal was to identify the effect of
the State Bar’s culture on motivation and knowledge. The Phase Two inquiry focused on the
conceptual framework ideals.
Where a survey participant declined the invitation to be interviewed, another survey
participant was randomly selected and contacted until the interview group had a population of at
least six. This purposeful method of study was utilized to ensure the most exceptional level of
discovery, understanding, and insight into the topic (Merriam & Tisdell, 2016). Therefore, this
STANDARD OF PRACTICE 74
method was useful to attain a sample from which the greatest amount can be learned (Merriam &
Tisdell, 2016).
Explanation of Choices
The mixed-method research design utilized in this study was aimed at gaining the most
significant insight into the research questions posed. The surveys in Phase One were aimed at
gaining general information about the State Bar, its LAP, and their cultural norms and values.
Both surveys and interviews were selected to allow for the initial inquiry via survey to be
followed by in-depth interviews to target the representative sample’s beliefs and experiences as
they relate to the research question and conceptual framework. Focus groups were not utilized
due to the confidential and sensitive topics. A group setting would not likely yield honest
answers and open communication about the topics of the study. The process of recruitment for a
focus group would have been the same, with different groupings of individuals identified for the
interviews.
Data Collection and Instrumentation
As discussed in the prior section, this study utilized a mixed-methods approach to data
collection commencing with a general survey (quantitative) and ending with in-depth interviews
(qualitative). The purpose underlying this selection was to recover detailed information that
could be generalized to respond to the problem of practice. The survey, as discussed in the
previous section, provided data points that were used for the interviews. The interview process
focused on obtaining generalizable anecdotal information and featured follow-up lines of
questioning to provide context and rich foundational support for the survey responses that were
collected.

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Surveys
The surveys were administered to attorneys who were or are members of the State Bar.
Publicly available electronic mail addresses were harvested and utilized to request responses to
the web-based surveys. The surveys were designed to take fifteen minutes to complete to
account for the already demanding schedules attorneys experience. The surveys were
administered in English, which reflects the general practice of attorneys in the six States.
The survey allowed for specialized sets of questions using a branching method to reflect
specific responses about quality of life issues to gain more in-depth information from attorneys
who have different insights or experienced regarding these issues. For example, if an attorney
had referred a peer to the State Bar’s LAP, a special question set was given to the respondent; if
an attorney had not, a question set branched to obtain further information. To ensure validity and
reliability pre-set answer choices were arranged to reveal if a respondent was merely clicking
boxes randomly, and a question was repeated for comparison purposes. Suspect responses were
flagged for individual review. For example, if boxes directly down one column were selected
throughout the survey, or if two questions which were identical in substance but different in
wording yielded different answers, those surveys were reviewed individually.
Before the surveys were edited for time or content, they were drafted in full to ensure that
the substantive elements of the surveys were included before editing to account for limitation
(Fink, 2013). Once the substance of the Phase One survey was set, other factors were reviewed
and considered. While the number of questions was an important measure, because legal
professionals’ time is already at a premium, the surveys were designed to ensure consistency
within a small time frame for completion. Finding the best mix of time required to complete the
surveys and comprehensive but efficacious results was of the highest importance. As a result, the
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survey designs took these limitations into account; the surveys underwent pilot testing twice with
both legal professionals (who will not be part of the study population) and non-legal
professionals. Times were averaged so that study participants could be given an estimated
completion time. The aim was to keep the estimated time as low as possible to ensure a more
significant number of the survey population not only undertake but fully complete the surveys.
Please see Appendix A for the survey questions.
Interviews
The primary purpose of the interview process was to obtain a particular kind of
informational need: anecdotal background to explain the survey results, and a more in-depth
explanation into personal thoughts, feelings, experiences, and outcomes associated with the
results of the Phase 1 surveys (Merriam & Tisdell, 2016; Weiss, 1994). Through the interviews,
I hoped to uncover what is “in and on someone else’s mind” (Patton, 2015, p. 426). Interview
participants were selected from survey respondents; the survey had a set of questions that asked
participants if they were willing to take part in an interview. This question set included a brief
explanation of the parameters of the interview, including the approximate time required for the
interview, confidentiality, and other information. The semi-structured interview was one-on-one
and took place on the telephone (Merriam & Tisdell, 2016; Patton, 2002).
The goal of the interview was to obtain as much information on these highly sensitive
subjects as possible. As a result, the format aimed to have an informal feel to relax the
participant and made them feel comfortable with disclosing information that they may otherwise
resist sharing. Therefore, it was important for the interviewer to follow the information and be
flexible in the approach utilized. While there were specific lines of questioning outlined for the
interview, the interviewer necessarily paid close attention to the interviewee’s statements and
STANDARD OF PRACTICE 77
narratives and let the participant guide the discussion to other topics of disclosure. However, the
focus of the interviews was to answer the research questions and gain insight into the LAP from
the lawyer perspective.
The specific areas of emphasis were developed both prior to the study portion of the
research project and edited after obtaining the results of the survey. The purpose of taking this
tactic was to ensure the problems of practice and research questions were addressed, but also to
allow for the data set to guide the interviews to ensure the information obtained was provided
proper context and illustration.
There were two types of questions: “soft” leading foundational questions (where the
answer was not forced upon the participant but was merely inherently a non-narrative response)
and open-ended follow-up questions. The leading foundational questions solicited a “yes,” “no”
or “I do not know” response from participations. Open-ended follow-up questions sought the
“why,” “how,” and “please explain” type narrative responses from participants. The semi-
structured format featured pre-written foundational questions, most of which utilized Patton’s
(2002) six categories of questions, but the open-ended follow-up questions were left to the
interviewer’s discretion after asking the leading-style questions. There were a total of 24
questions, each seeking different insights from the participants, and was aimed at utilizing no
more than one hour of the participant’s time per interview. Please see Appendix B for the
Interview Protocol.
Documents and Artifacts
Merriam and Tisdell (2016) described the use of six different types of artifacts and
documents. Of these six, this research study utilized one: public records. The State Bar is a
public organization with duties to protect the public. As such, the State Bar and its LAP generate
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a wealth of information in publicly available documentary form. This study utilized minimal
documents and artifacts to shed light on the research questions set forth herein. First, self-studies
of the State Bars’ LAP, as well as annual reports, were obtained and reviewed. Next, budget
reports of the State Bar with regard to allocations to the LAP provided financial insights were
obtained to evaluate Bar priorities and habits pertaining to lawyer well-being. Finally, any other
public documents, statements, reports, articles, and other publications available and applicable to
this study were gathered. Specifically, the following documents were requested or obtained:
1) Public Reports from the LAP;
2) Public Reports re: Attorney Misconduct Facts, Figures, and Yearly Report;
3) Public Attorney Misconduct Outcome Reports based on Quality of life, and
4) Third Party Quality of Life Organization Documents (i. e., The Other Bar).
Credibility and Trustworthiness
Credibility is a clear and understandable way to describe the correctness or
trustworthiness of a description, conclusion, explanation, interpretation, or another account
(Maxwell, 2013). As a result, validity and reliability helped to visualize threats to research data
prior to the realization of those issues. It was incumbent upon this researcher to design the study
with an eye towards threats to validity by using pro-active measures that limit or eliminate them
(Maxwell, 2013).
One threat to credibility was researcher bias. According to Maxwell (2013), this could
occur when data is selected to fit the study’s hypothesis in a self-serving or preconceived
manner. While this threat to validity is impossible to remove entirely, it was essential that this
researcher was aware of this threat’s existence and designed measures to stay cognizant of the
effects this danger of bias may have had on the results of the study.
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The other main threat to credibility was reflexivity (also called reactivity). The effect an
individual researcher has on the design of the study and the analysis of the results has
consequences for the study’s generalizability. In both phases of the study, the wording of
questions in both the survey and the interviews (for example: not using hard leading questions
where an answer was asserted, such as “Isn’t it true that…” or “You agree that…”) helped limit
the influence reactivity had on the data collected.
While guaranteeing that all answers are valid and reliable was not possible, steps were
taken to aid in providing greater trustworthiness in the interview responses. Prior to
commencing data collection, with the help of experts in the field of study, individuals within the
survey demographic were identified who provided insight through pilot testing. These diverse
individuals aided in the identification of outliers and invalid or unreliable responses for both the
survey and interview phases. Further enhancing the likelihood of honesty during the interview
process provided assurance that there were confidentiality and security for the participants. Any
specific reference to a participant was immediately assigned a pseudonym; at no time was any
identifying information transferred from the survey or interview responses to any other
document. To this end, aliases were even utilized as soon as any notes were taken or written
responses obtained during the interview phase. The promise of confidentiality and storage
methods used were intended to achieve a higher level of honesty from the participants and
trustworthiness of the information gathered.
To ensure credibility and trustworthiness, I took copious, low-inference notes that were
written in verbatim whenever possible and took notes without judgment so as to limit or avoid
biases. These notes acted as data points in what was a triangulation method of this study; the
interview when coupled with documents and the survey served to make the results more
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trustworthy and credible (Merriam & Tisdell, 2016). I also recorded audio of the interview,
which I had transcribed. Finally, to lower the threat of both reflexivity and researcher bias, I
utilized the aforementioned method of member-checking, and any qualitative data obtained
during the interview process was checked against and based-upon the quantitative data from
Phase One.
Validity and Reliability
Validity is a clear and understandable way to describe the correctness or credibility of a
description, conclusion, explanation, interpretation, or another account (Fink, 2013; Salkind,
2017). Validity is the ability of an instrument to accomplish or measure what it is intended to
measure. As a result, validity and reliability help to visualize threats to research data before the
realization of that issue (Salkind, 2017). Reliability is the degree to which a test measures a
benchmark with consistency; in other words, it is the degree to which the results can be
consistently reproduced (Salkind, 2017). It is incumbent upon a researcher to design their study
with an eye towards threats to validity by using pro-active measures that limit or eliminate them
(Salkind, 2017; Fink, 2013).
The survey utilized questions that revolved around the same subject matter but was
worded in different terms to aid in the identification of unreliable responses. This seemingly
redundant style of questioning helped with the automation of validity-checking that enabled the
significant data set to be quickly reviewed for authenticity; survey responses that did not align or
were counter-indicative were flagged for review. The nature of the survey did not require any
participant to have their identity utilized for any purpose; Phase Two volunteers completed a
second, independent survey to supply information.
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The survey utilized basic language subject only to common usage. The goal of this
method was to ensure that there were no “terms of art” subject to individual interpretation. To
ensure the content of the survey was uniformly asked and universally answered in a
generalizable manner, it was important to either define the attitude, belief, or value being
measured or ensure the concept was a universal normative value (Fink, 2013).
Finally, not only did I address inherent bias by participants in the study design, but the
study itself also focused on self-identity bias. The survey was carefully worded so that
participant behavior, rather than opinion, was documented unless it was explicitly the purpose of
the survey or interview question. In other words, the numerical data collected was based on an
educated guess or experience, rather than opinion. From these responses, I was not only able to
identify participant bias, but I had the opportunity to utilize it as a statistical benchmark in my
study.
Data Analysis
A statistical descriptive analysis of the Phase One interviews took place using coding
processes to obtain a numerical breakdown. After the survey results were assessed, participants
who had volunteered for the Phase Two interviews were contacted and interviews organized. The
interviews followed the Interview Protocol in Appendix B and were revised based upon the
statistical analysis from the surveys.
I wrote analytic memos and kept a study journal at all times during the study. I
documented my thoughts, concerns, and initial conclusions about the data in relation to my
conceptual framework and research questions. Once I left “the field,” interviews were
transcribed and coded. In the first phase of the analysis, I used open coding, looking for
empirical codes and applied priori codes from the conceptual framework. The second phase of
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analysis was conducted where empirical and “a priori” codes were aggregated into analytic/axial
codes. In the third phase of data analysis, I identified pattern codes and themes that emerged in
relation to the conceptual framework and study questions. I then analyzed documents and
artifacts for evidence consistent with the concepts in the conceptual framework.
Ethics
The study was submitted to and approved by the University of Southern California
Institutional Review Board (IRB) after review by my dissertation committee and approval by its
chair prior to study commencement. This study followed the guidelines set forth by Glesne
(2011), whereby informed consent was not only necessary but expected to assure the study’s
participants that their participation was knowing, voluntary, confidential and that they could have
withdrawn at any point without fear of repercussions. As a researcher, it was also vital that I
follow Rubin and Rubin’s (2012) guidelines to both ensure no harm came to any participating
attorneys because of their participation, and that I behaved ethically at all times according to the
standards of practice in both legal and research settings. While legal ethics did not strictly apply,
the expectations participants had of a legal researcher who is a licensed legal professional
necessarily were that I maintain the standards of the legal profession at all times. As a result, the
IRB approved and participation came both as a result of oral informed consent for the interviews
and written informed consent for the surveys and was entirely voluntary. Furthermore, I stored
all data and interview information on a password protected, secure sockets layer (SSL) server to
safeguard the participants and their information from data breaches.
Each participant was given or read a statement of information in each phase of the study.
For the first phase survey participants, I outlined the information underlying the principles of this
study’s informed consent and obtained a waiver at that time electronically. This informed
STANDARD OF PRACTICE 83
consent was included on the initial page for participation on the survey, which could not be
commenced unless a participant agreed to continue. Those participants selected for and who
took part in the interview phase were read another informed consent to ensure voluntary
participation and the understanding that their responses were held in confidence during this
second, separate phase of research. The interview was only commenced after receiving verbal
confirmation that the interview could be recorded after the informed consent was read.
Due to the strict standards of the practice of law and the requirements to hold a license,
confidentiality was paramount for participants. Not only do I respect the participants’
expectations of privacy and confidentiality, I believed it the highest priority of the study, as
participants must have felt free to be open and honest to give the study the greatest chance at
obtaining measurable outcomes. If these tenets were ignored, participants would have been
unlikely to provide information which could be potentially damaging to their professional
standing; the idea that their license could have been in peril would have driven volunteers away
from participation, causing a lack of data to be obtained from attorneys whose conduct who
could be judged as less-than-ethical, and a higher percentage of attorneys who have had no
interaction with the LAP at all.
During the second phase, the interviews featured a semi-structured, conversational format
(Merriam & Tisdell, 2016), which necessarily precluded the interviewer from taking copious,
verbatim notes. Format aside, note taking during an interview could have put the interviewee on
edge and caused them to disengage from the informal feel of a conversation. Therefore, it was a
necessity to record the conversation. Thus, the interview utilized recording technology to record
the interview and transmit the interview to the transcriptionist. Beyond the ethical requirements
to inform the participant that the interview is or may be recorded, California law required two-
STANDARD OF PRACTICE 84
party consent to legally record a conversation (Cal. Penal Code § 632). A transcript was
produced from the audio recording, and for the sake of posterity and to show that I had not
changed anything they may have said, an opportunity to request a copy of that transcript was
offered to each participant to allow them to review any such transcript for errors. Only one such
request was made, and that request withdrawn by the participant at the conclusion of the
interview.
Finally, I reminded participants that I would not incentivize their participation. At no
time was a participant coerced to provide answers, and their participation was given freely and
without any outside influence from the researcher. It was my hope that participants realized the
true potential for positive impact this study can have on the profession and its outside
stakeholders, and were driven to donate their time as a result.
Limitations and Delimitations
As discussed in previous sections, some aspects of the study could not be controlled.
Chief among these anticipated limitations was the truthfulness of the study’s respondents,
completeness of responses, the number of individuals who volunteer for the Phase Two
interviews, and outside influence on participation or responses submitted.
Anticipated delimitations of the study included the self-imposed requirement to ensure
the survey requires no more than fifteen minutes to complete. Given the already overwhelming
demands on an attorney’s time, it was essential to ensure that the survey does not require a
significant dedication of time to complete. This delimitation was aimed to obtain a greater
number of respondents, but severely limited the number of questions that could be asked. The
time required to complete the survey varied depending on the participant, with some taking ten
minutes or less, and some over 25 minutes.
STANDARD OF PRACTICE 85
Whereas these limitations and delimitation were identified prior to the study’s
commencement, the research methods were designed to address these issues and minimize their
overall impact on the reliability of the study results. For example, the design and purposeful
redundancy of the survey, as well as the member checking of both the survey and interview
phases were intended to add levels of assurance that the data collected was reliable.
A limitation identified after the Phase One survey was completed was the fact that most
attorneys have trouble hypothesizing or “speculating” as that practice is strictly forbidden in a
court of law and which attorneys are trained to distrust. Asking attorneys to leave their comfort
zone proved difficult, and many noted that they didn’t believe their conjecture would help, even
though conjecture was exactly what was needed. The study design removed for many questions
the ability to answer “Not Applicable” or “Unknown.” The purpose behind this decision was to
force attorney participants to take a position and commit to a response, knowing that they may
not have actual experience but could apply their self-awareness regarding their own actions, their
attitudes, understandings, and life experiences to make a highly educated decision in response to
an inquiry. Beliefs and conjecture as to personal actions are not scientifically without merit and
were insightful in this study. However, the results where attorneys expressed frustration were
mostly not included in the reporting, analysis, or recommendations of this study to ensure higher
levels of trust and validity in the study.
Research Design Updates
The research design was updated after the Phase One surveys were completed. Namely,
while this researcher was initially worried about attorney volunteerism for the Phase Two
follow-up study, these issues were not realized. A total of 829 participants volunteered to be
contacted for follow-up purposes, exceeding the expected volunteer responses by over 100 times
STANDARD OF PRACTICE 86
(and representing an 11.3% volunteer rate from Phase One participants). After discussion with
committee members, it was agreed that Phase Two would be expanded to include a narrative-
style survey that reflected most of the interview questions. Invitations to participate in the Phase
Two narrative surveys were sent to every volunteer who was not selected to participate in the
Phase Two interviews. The Phase 2 narrative survey featured a participation rate of 54.8% (or
410 of 748 attorney volunteers from Phase 1). The narrative survey, which contained a
verbalized informed consent, 12 demographic questions, 15 open-ended, narrative-style
substantive questions (some were “yes” or “no,” with a follow-up narrative question requesting
explanation), and nine optional questions provided in-depth, open-ended discussions that mirror
the interviews. This survey and new research amendment were first sent for approval to my
Dissertation Chair; upon her authorization, it was submitted to the University of Southern
California IRB, who approved the revised study design inclusive of the new, narrative survey.
The Phase Two qualitative (narrative) surveys were coded in the same method as the qualitative
interviews where the information sought was slated to be utilized, and quantitative information
included as needed in Chapter Four.
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CHAPTER FOUR: RESULTS, FINDINGS, AND DISCUSSION
The purpose of this study was to look at the gap between resource availability, resource
usage and the socio-cultural issues acting as barriers to positive quality of life outcomes in the
legal profession. In short, the legal profession is aware that there exists an epidemic related to
attrition (burnout), mental health issues, and substance abuse; the question remaining is “what
are we going to do about it?” The study addressed perceived knowledge about the existence of
problems, actions attorneys take to address them, and the socio-cultural, organizational, and
motivation of legal professionals and bar associations.
The research followed the gap analysis outline, splitting information into the three Clark
and Estes (2008) influences: knowledge, motivation, and organization. The guiding research
questions were as follows:
1. What are the attorney members’ knowledge and motivation related to utilizing the
Lawyer Assistance Programs services that are designed to address issues related to
mental health, chemical dependency, and attrition?
2. What is the interaction between the State Bar organizational culture and context and
attorney members’ knowledge and motivation?
3. What are the recommended knowledge and skills, motivation, and organizational
solutions?

STANDARD OF PRACTICE 88
Descriptive Statistics
This mixed-methods research included participants from six states
2
selected for their
geographic location, size of State Bar membership, administration of the state’s LAP, and
availability of information to the public. Those six states were California, Florida, South
Carolina, Michigan, New York, and Washington State. For the initial survey, a total of 403,359
individuals were invited to participate via electronic mail. The study enjoyed a response rate of
1.95% with 7883 participants. During the study, those completing the survey were solicited to
volunteer for further inquiry. An astounding 892 volunteers responded in the affirmative,
representing an 11.3% volunteer rate for the study’s second phase. Because of the considerable
amount of volunteers, the scope of the study was expanded, and a narrative survey added as a
study component. Thirteen individuals were asked to participate in the second phase qualitative
interviews, with 11 accepting the invitation and 10 completing an interview. All remaining
volunteers were sent a follow-up narrative-style survey asking the same or similar questions as
those who participated in the interviews. A total of 410 participants responded to the narrative-
style survey.
Table 5, which follows, summarizes the demographics of the multi-phase study, focusing
on date of birth, race, sex, marital status, and year and state of licensure.

2
Participants also represented other states in which they were either licensed to practice in
addition to one of the six states that were the focus of the study, or to which they had moved
since becoming licensed in a focus state.
STANDARD OF PRACTICE 89
Table 5
Study Demographics by Phase
Study
Phase
DOB Race (%) Sex (%) Marital Status (%) Year
Licensed
State of Licensure
(%)
Initial
Survey

n=7,883
Mean:
1966.5
White: 77.38
Black: 3.33
Latino/Hispanic:
6.34
Asian: 5.74
Other/DTS: 5.74

Male: 56.65
Female: 42.17

Single - NM: 13.6
Single: Div: 8.21
Cohab/Life Partner: 6.1
Married: 67.28

Mean:
1995.61
CA: 41.62
FL: 8.32
MI: 5
NY: 17.62
SC: 2.37
WA: 6.73
Other: 18.34

Interviews

n=10
Mean:
1970.5
White: 90
Black: 10

Male: 60
Female: 40

Single - NM: 40
Single: Div: 10
DP: 20
Married: 30

Mean:
1999.9
CA: 40
FL: 10
MI: 10
NY: 20
SC: 10
WA: 10

Narrative
Survey

n=410

Mean:
1964.8
White: 79.76
Black: 2.38
Latino/Hispanic: 6.43
Asian: 3.10
Other/DTS: 8.33

Male: 51.17
Female: 48.57
Decline to
State: .26

Single - NM: 15.80
Single: Div: 7.77
Cohab/Life Partner: 7
Married: 65.03

Mean:
1994.73
CA: 36.97
FL: 12.25
MI: 3.95
NY: 16.01
SC: 2.37
WA: 9.68
Other: 19.76

STANDARD OF PRACTICE 90
Results and Findings
Knowledge Findings and Results
The results of the study were clear: attorneys are well-aware that quality of life problems
plague members of the profession. One participant noted that the biggest personal issues facing
attorneys include “[p]ressure, leading to risk of health issues (mental and physical) and to risk of
substance abuse.” Even though the surveys and interview did not ask any direct questions
revolving around personal experiences regarding quality of life issues—only whether they had
utilized a lawyer assistance program (LAP)—an ultra-minority of individuals voluntarily self-
identified as experiencing quality of life issues. The mean percentage of attorneys that believe
other members of the profession suffered from a mental health issue was 34.39%, with substance
abuse believed to affect 36.02% of all attorneys, and attrition/burnout yielding a mean of
53.47%. In other words, attorneys believe over one-third of the members of the profession suffer
from mental health issues and substance abuse, and more than half are experiencing
attrition/burnout. Obviously, the problem is not unknown, nor is the rate at which quality of life
issues are present. In fact, participants overestimated the actual figures by notable amounts. The
knowledge that quality of life issues exist must be reconciled with attorney ignorance that peers
they know are, in actuality, suffering from these issues. When inquiry was made about how an
attorney can identify if one of their peers is suffering from a quality of life issue, participants
commented that “Mostly, I don't,” and that “You don’t. Lawyers can typically perform well
under stress and appear confident and capable regardless of what is going on inside.” These
feelings were widespread; “It is hard to tell unless the associate is open about it,” mentioned one
participant. “[L]awyers can also put on a mask and hide it all. I know I did,” stated another.
STANDARD OF PRACTICE 91
Figure 2. Phase 1 Survey, Question 26.
(“Actual” data from Krill, 2016; Shanker, 2013; Scott, 2011; Johnson, 2008).

Neighbor syndrome. Attorneys exhibit willful ignorance (or blindness) that shows signs
of what this researcher has named “neighbor syndrome.” Neighbor syndrome is a construct that
builds upon attribution theory and fundamental error attribution. Attribution theory represents the
belief that individuals attach a personal meaning to explain or classify the actions of others
(Heider, 1944). We do not know the basis or reason for why that person may have acted a certain
way, instead ascribing our personal experience or understanding of the situation to explain the
conduct. Neighbor syndrome is the idea that because we do not understand what others are going
through, we attach our own narrative to the way that person is behaving. While we may be aware
that roughly one-third of the people may be suffering from a quality of life issue, we believe that
none of those individuals are somebody we know; we believe the issues to be manifesting in
34%
36%
53%
33%
21%
20%
0%
10%
20%
30%
40%
50%
60%
a mental health issue? a substance abuse issue? attrition or burnout?
Q26 - What percentage of attorneys nationwide do you
believe suffer from:
Estimate (Mean) Actual
STANDARD OF PRACTICE 92
people we don’t know. For example, when asked whether they had referred a peer to any lawyer
assistance program, 87.27% of participants responded that they had not. When respondents who
answered in the negative were asked why they had not referred any peer, over 95% of those
respondents stated that they did not know anybody with those issues or gave an answer that
could be categorized as such. One survey participant stated they “[d]id not know of someone
who I thought needed it,” while another mentioned that they “[n]ever encountered a lawyer that
needed the program.” These categorical comments were repeated constantly, and included: “I do
not know of an attorney needing it,” or “[n]one of my peers need such assistance, as far as I am
aware,” and “I never felt that one of my peers was in need of that assistance.”
This same phenomenon presents itself when neighbors of serial killers are interviewed;
most state that they had no idea such a person lived next to them; they assert that their serial
killer neighbor was kind and a good neighbor. In recent news, neighbors of the Grim Sleeper
described him as a “nice, funny, ‘fix-it’ man” (Simon, 2010). Neighbor syndrome is not limited
to residences; it seems to find its way into all facets of life, and indeed our culture. In essence,
neighbors need to focus on the neighborhood beyond their own property. The fact that people, in
general, dislike Congress but love their Congressperson clearly illustrates that while individuals
believe there to be a problem in general, that problem does not (and could not) be close to home.
Even though Congressional approval ratings are dismal (16% approval rating as of 2017),
incumbents are reelected to Congress at overwhelming rates (~95%) (Gallup, 2017; Friedman &
Holden, 2009). In the vein of attribution error, attorneys overwhelmingly understand (and
overestimate) the rates of quality of life issues faced by their peers, but believe that nobody they
know suffers from the issue.
STANDARD OF PRACTICE 93
This occurrence defines professional practice: cold, distant, and calculating. There seems
to be a disconnect between colleagues in the workplace and the human beings they are outside of
it. Moreover, the culture of attorneys denying their problems and failing to check in with their
own well-being contributes to both the quality of life epidemic and the lack of treatment
received. The study revealed that, from the cultural standpoint, attorneys need to be open with
each other and more cognizant that they need to take more responsibility for intervening and
discussing quality of life problems with their peers in an open, constructive, and accepting
manner. To do so, researcher Holly Ferguson describes the need to “check-in with our own
story” (Ferguson, 2018). What she described to this researcher was the need to look at our own
situation before we can look at the status of others. In doing so, attorneys can utilize
metacognition to approach the situation more seamlessly. Culture change begins with ourselves;
we must engage in reflective inquiry and ask ourselves questions such as:
 How would I feel if a colleague said something to me;
 How does it feel for me to self-disclose?
 Would I be more open to being my colleagues’ “keeper” if I felt ok with someone
being that for me?
 How can I present myself to my peers to make them feel comfortable confiding-in
and trusting me to be there when they need help both professionally and
personally?
 How can I play an active role in ensuring both professionals and the profession
are being best served?
To this end, Ferguson (2018) asserted, “… the key is to stress culture change via
individuals discussing their own mental health and wellbeing.” She urges the need for members
STANDARD OF PRACTICE 94
of the profession to publish their own stories to their peers. Attorneys need to create an
environment in which not only are they empowered to be heard, but they listen to each other. In
doing so, the profession can create “an open space where mental health issues can and will be
discussed [… where] resources are readily available,” and confidentiality and transparency are a
part of the process. In other word, attorneys need to get to know their neighbors and
neighborhood and listen to them. Instead of “[I have] not had a peer who appeared to need this
assistance,” attorneys need to be taught to recognize the signs and intervene to ensure their peers
have the support and resources they need. The focus of this cultural change will not just need to
be on the neighbor, but the neighborhood itself.
Willful blindness. Related to neighbor syndrome is the legal Doctrine of Willful
Blindness. In the 2011 case Global-Tech Appliances, Inc. v. SEB S.A., the US Supreme Court
affirmed the legal doctrine of willful blindness, adding to a canon of legal theory that asserted
that requirements of mens rea, a guilty mind (or required level of knowledge), can be satisfied
either by possessing actual knowledge or being willfully blind to facts. The Court asserted, in its
8-1 decision, that the definition of willful blindness, as set forth in the 1962 Proposed Official
Draft of the Model Penal Code, §2.02(7) (which later was adopted) is where “a person is aware
of a high probability of [the fact’s] existence, unless he actually believes that it does not exist”
(Code, 1962). Where a person is willfully blind to a fact, they are deemed to have knowledge of
that fact.
The difference between neighbor syndrome and the Doctrine of Willful Blindness (and
the other sociological theories discussed in this dissertation) is two-fold. First, attorneys do not
believe that there is a high probability that the attorneys they know experience quality of life
issues; they simply believe everybody else is suffering from these issues and that they surround
STANDARD OF PRACTICE 95
themselves with other people who are not affected. Second, they have no reason to know that
their peers have an issue. As discussed at length in this study, attorney culture demands silence
and denial about these issues. “[I have only] known one person in trouble and he was in
DENIAL,” stated one participant. “Denial. Denial. Denial,” another participant added in
response to inquiry as to why people do not seek help. Therefore, as applicable as the Supreme
Court’s assertions may be to specific findings in this study, when it comes to simple knowledge
of or ability to recognize issues in their peers, they are just as unaware as the Grim Sleeper’s
neighbors when it comes to who around them may be experiencing problems.
Self-identity. The next finding revealed that attorneys suffer from self-identity issues that
not only affect their motivation to seek help (which will be discussed in the next section) but
their recognition of issues in themselves and their peers. Participants were clear that being a
lawyer is more than just a job: it is their identity. Much of the attitudes and actions of attorneys
arise because of training in law school and identity. Attorneys are part of a profession where
they believe stress, anxiety, lack of a personal life, and a disconnect from things other than the
practice of law are all a “part of a lawyer’s identity.” “I think that many of these issues are
closely tied... Attrition/burnout may lead to depression and/or substance abuse. Attorneys with
mental health issues may self-medicate with substances. Substance abuse may lead to mental
health issues. Mental health and/or substance abuse issues and lack of coping skills may lead to
burnout. “I also believe that all of these issues are hugely stigmatized in the legal profession,”
stated one participant. “Attorneys are often perfectionists and high-achievers, who often are
unwilling to admit they have a problem, or seek help for it, because of their own feelings about
failure and fear of the perception of peers in the profession.”
STANDARD OF PRACTICE 96
In fact, 100% of those interviewed discussed mental health, substance abuse, and/or
attrition as being part of the attorney identity. Participants in the study noted that “[e]veryone
accepts you’re going to be stressed, your life is going to be terrible, and then you’re going to
burn out…” While some participants described the profession as a vicious circle where
depression, anxiety, and stress beget even more of the same, others discussed the fact that once
on the road to quality of life issues, all paths lead to the same end: either discontent with ones
life, or more drastic outcomes such as suicide, psychological disorders, or burnout. As one
participant stated, “[t]he profession’s full of good attorneys, but [full of] idiots when it comes to
personal life […] and business…”
Education. Surprisingly, though CLE’s have not been proven empirically successful in
fulfilling their purpose attorneys overwhelmingly believe in the potential CLE’s have. “I have
been impressed by the MCLE programs offered on burnout, substance abuse, etc. I would not
have taken them except for the MCLE requirement,” noted a study participant. The Phase One
survey specifically asked participants to opine on the topic of CLE’s, and the results show that
attorneys believe they have an impact. Of note, 65.3% of respondents believe that CLE’s (if
efficacious) have the potential to help attorneys be more likely to recognize their own mental
health or substance abuse problems. Additionally, 72.21% stated that they would be more likely
to recognize these issues in their peers through a required CLE course.
STANDARD OF PRACTICE 97
Figure 3. Phase 1 Survey, Question 33.

Participants were further asked to choose what type and delivery method of the CLE
program would be most impactful. Of 14 multiple choice, multiple answer options available
(including “Other”), participants chose “Discussions with members who have dealt with these
issues themselves” 57.39% of the time, which represents the top choice. Rounding out the top-
three CLE programs were “in-person seminar / training” (45.33%) and “online education videos”
(42.45%). Surprising was the fourth place vote-getter, “Mandatory Continuing Legal Education
Program,” which garnered 38.86%. The very fact that attorneys are not only open to CLE’s but
that more than one-third were open to mandated programming shows the potential of education
to make an impact on attorneys and their knowledge of quality of life issues. The least selected
choice beyond “Other” (which obtained 5.46%) was “Brochures” which participants only
selected 9.09% of the time.

STANDARD OF PRACTICE 98
Table 6
Phase 1 Survey, Question 34
In thinking about yourself, what type of
education programs would make you more likely
to seek assistance for a substance abuse or
mental health problem? (Select all that apply) -
Selected Choice
Percent
Selected
Discussions with members who have dealt with
these issues themselves 57.39%
In-person seminar / training 45.33%
Online education videos 42.45%
Mandatory Continuing Legal Education Program 38.86%
Workplace seminar / training 32.55%
Articles in legal publications 27.86%
Bar association programs 26.50%
Discussions with prominent attorneys 18.24%
Book-based learning 16.90%
Discussions with members of the judiciary 13.42%
Discussions with Bar Association leaders 9.42%
Social media live question & answer session 9.33%
Brochures 9.09%
Other (please specify) 5.46%

Motivation Findings and Results
This study resulted in six different areas of motivation findings, each of which will be
discussed in turn. The motivation factors are those assisting in or acting as a barrier for attorneys
seeking self-help or intervention for their peers, engaging in metacognitive practices, and
admitting the quality of life problems they may have. Each of these factors is necessarily related
to the knowledge and organization influences as discussed in the conceptual framework set forth
in Figure 1. Therefore, some of these findings may necessarily overlap into other influence
findings or may repeat in other sections.
Denial. Attorneys do not necessarily lack any knowledge related to quality life issues in
the profession or themselves. A majority of interviewees (90%) responded in the affirmative
STANDARD OF PRACTICE 99
when asked about lawyers’ penchant for denying that they may be suffering from a mental health
or substance abuse issue. Noting that attorneys pressure themselves to be perfect and fulfill
expectations, an interviewee remarked, “you’re supposed to be self-sufficient.” The sole
dissenter noted that while they did not believe attorneys deny they have a problem, they feel
stigmatized by letting anybody know. In other words, they do not deny they have an issue to
themselves, but they do when it comes to anybody else.
However, denial does not begin and end with self-awareness, it continues into whether
attorneys believe they need help from a third party. Again, the percentages were telling; 9 of the
10 interviewees agreed that attorneys deny they need help from a third party, with one stating “I
think inevitably substance abuse and certain mental health issues can have an impact on your
practice but we have this machismo that we're all so self sufficient.” Another participant agreed,
alleging that, “there's a tremendous amount of denial.” The lone dissenter noted that it was not
about denial; instead, it was more about reputation and public perception whereby they know
they have a problem or are not meeting standards, but do not say anything about it. Indeed, the
participant explained that it was not about self-denial, but instead about the afflicted attorney
denying their issues to everybody else. When asked about denial regarding the work product of
an attorney falling below the standard of practice in the legal community, 80% of interviewees
agreed that most attorneys deny it has happened. “They don’t want anybody to see the
weakness,” commented one interviewee; the other interviewee who disagreed noted that
attorneys are hard on themselves and always questioning their work product. Moreover, there
was a general worry by participants that their professional standing will come into question if an
attorney admits to having a quality of life issue, falling below the standard of practice, or
acknowledging that they need help and cannot solve the problem(s) on their own.
STANDARD OF PRACTICE 100
Further compounding the issue is the fact that young attorneys (and professionals in
general), who are hit hardest by quality of life issues (el-Guebaly et al., 2015; Rickwood et al.,
2007), worry about admitting that they have an issue and need help when they are already
experiencing imposter syndrome (Aronowitz, 2016; Kolligan & Sternberg, 1991). The fact that
young attorneys may be questioning their efficacy as attorneys or their place in the profession
further minimizes their propensity to admit they have problems, need help, and that they will
actually seek that help.
Stigma. “You’re supposed to be self-sufficient,” stated one participant. “[Lawyers]
worry about not being seen as fit to go represent other people.” The issues surrounding stigma
are both motivation and organizational influences that deal with the culture of the profession. As
a motivational influence, stigma plays largely into the serial denial of the members of the
profession that they are experiencing a quality of life issue or need help from others to address
those issues. The motivation to seek help from others, or even admit that they have a problem is
made more difficult by the profession that their image will be tarnished or their peers will either
not understand or use the flaw against them. There is “a big stigma around mental health
issues,” noted one participant. That Second Phase participant was not alone; “[attorneys] either
just deal with it and spend their whole lives pretty apparently unhappy or at least faking
happiness, or they burn out and switch jobs.”
When asked what would make them less likely to utilize a lawyer assistance program,
peers finding out overwhelmingly ranked as the top reason, earning 82.74% of a perfect
weighted score, which represented 11.82% of the overall total sum weight of all 13 options.
Ranking second was fear of loss of license (78.45% of a perfect weighted score). The finding
was bolstered by the third-place ranked option of “professional culture” which was given 68.68%
STANDARD OF PRACTICE 101
of a perfect weighted score. Stigma, therefore, is one of the single greatest reasons attorneys both
fail to seek help from a LAP, but also do not admit they are experiencing a quality of life issue.
In fact, when asked to opine on this very issue, 27.38% of respondents answered that stigma
surrounding the issue itself or treatment of it were the single greatest reasons attorneys who
suffer from mental health issues do not seek help. Moreover, participants agreed that attorneys
who are suffering from quality of life issues do not seek help because of stigma (related to
issues/treatment) for surrounding mental health (41.35%/42.48%) and substance abuse
(38.48%/40.69%). Professional standing and reputation (how others evaluate their worth) are
aligned with an attorney’s own perceived worth and drive their ability to meet both professional
and bottom-line demands of the occupation. Stigma forces attorneys hide their flaws and
promote their image in order to succeed. Narratives supported these quantitative findings, where,
for example, one participant stated: “Everyone accepts you’re going to be stressed, your life is
going to be terrible, and then you’re going to burn out…” It was clear that attorneys believe you
need to just accept the quality of life issues as a part of the norm or quit the profession altogether.
Finally, the worries surrounding issues of stigmatization of treatment or help-seeking (or
even admission that an attorney has a quality of life issue) are plainly illustrated by the study
participant’s overwhelming agreement that “confidentiality” is a predominant factor driving
behavior and motivation to seek help. When asked to rank the “program features [that] would
make you MORE likely to use the Lawyer Assistance Program,” 55.44% of respondents ranked
“confidentiality” as the number one choice. Indeed, “confidentiality” garnered 90.12% of a
perfect weighted score overall, more than 10 points more than the second highest-ranked choice
“receiving treatment,” which itself received 78.91% of a perfect overall weighted score (and just
22.93% of first place rankings). The fact that confidentiality is more important than actually
STANDARD OF PRACTICE 102
receiving treatment when it comes to decision-making is a real statement about the priorities that
the profession demands. Therefore, not only is stigma a factor in motivation influences but is a
prominent study finding regarding attorney’s reticence to utilize the LAP.
Figure 4. Phase 1 Survey, Question 21.

Social Exchange Theory. Building upon other sociological theories (all the other
citations), social exchange theory describes the phenomenon where people are only apt to act in
aid of another individual if they were rewarded by the transaction (Emerson, 1976). When a
person’s motivations and resulting actions are premised upon what they will receive from the
exchange, social exchange theory is the conception underlying the interaction. The legal
profession is not divorced from what Cropanzano and Mitchell (2005) describe as “among the
STANDARD OF PRACTICE 103
most influential conceptual paradigms” in organizational behavior (p. 874). Understanding why
attorneys will not involve themselves without receiving something in exchange for their
actions—good feelings, sense of accomplishment, or actual tangible measures—not only
provides clarity for those who believe that it is not their problem, is none of their business, too
personal, or even that they are worried about negative outcomes such as being terminated,
ostracized by their peers for “snitching” or “outing” somebody, or severing a relationship they
may have. One participant remarked that were they to intervene, their peer “would be highly
offended.” This participant was not an outlier; many noted situations where they “haven't known
someone well enough … to feel comfortable recommending it,” or that it “[s]eems quite
"personal" to [refer a colleague to an LAP].” Moreover, there was a pervasive belief that it is not
a lawyer’s “… business to tell a colleague how to handle their life.”
Compounding the issue is the fact that most attorneys in the study perceived that their
peers might take advantage of their less-than-perfect standing. As a result, individuals with close
business and personal relationships may perceive negative outcomes for the person they want to
help by addressing the issues that need help. Naturally, people do not want to hurt those with
whom they are close, and in a profession where perfection is demanded, pushing those we care
for to admit they are not operating at the highest levels may negatively effect their reputation;
this is not a positive benefit under social exchange theory, and the motivation to get help or help
somebody else is undermined as a result.
Study participants described the reasons they did not broach the topic of quality of life
with their peers whom they believed experienced these issues; participants’ comments on the
topic typically were divisible into three categories: the issue is “too personal,” the “timing is not
right,” or they were worried about “backlash” from the individual they sought to assist.
STANDARD OF PRACTICE 104
Therefore, it is clear that attorneys do not take action without a benefit to themselves, their
business, or their clients. This type of analytical thinking and strategy is taught in law school and
engrained in the psyche of attorneys across the nation; social exchange theory plays a distinct
role in helping attorneys make assessments on how they will act and whether they will intervene
when they see a problem arise for themselves or their peers.
Lack of social responsibility. Beyond social exchange theory, attorneys do not want to
get involved in what they see as somebody else’s issue, especially when they are already dealing
with their own problems and that of their clients. The study rendered that attorneys have a
lacking surprise of empathy towards their peers, and most are constantly on the prowl to push
themselves up, even at the expense of others. Both phases of the study revealed that many
attorneys believed that the quality of life issues experienced by others is the other attorney’s
problem (not theirs), or that they think if attorneys “are not happy: quit.” “I would never seek
help, I would quit the profession,” said one participant. “Most lawyers just need to quit
practicing law. The law is an avocation not a job,” noted another. Participants mentioned, for
example, that they did not refer people to a LAP because it “[s]eems quite "personal" to do that,”
it was “[n]ot my business to tell a colleague how to handle their life,” and attorneys who are not
happy should “quit and go somewhere happy.” In fact, some participants went as far as blaming
the profession for doing too much to help lawyers. When asked “What do you believe can or
should be done to address the issues lawyers are facing,” a respondent noted that the profession
should “[q]uit coddling lawyers…” As a result, lawyers may feel a lack of responsibility for
ensuring their peers are addressing their quality of life issues, which further compounds
profession-based cultural norms and values that are the basis of the cycle of acceptance of these
problems. Blaming, shaming, or otherwise exercising an ideology that one lawyer’s quality of
STANDARD OF PRACTICE 105
life issues is the responsibility of that lawyer alone, and that they are to blame for their failure to
take action minimizes the ability of those experiencing these issues to seek help (and further
stigmatizes help-seeking behavior).
This paradigm is illustrated in the rape culture of male dominated organizations, such as
sports teams, fraternities, and social clubs. In their book, Buchwald, Fletcher and Roth (2005)
assert that the prevalence of rape is so engrained in our culture that “sexual violence is a fact of
life, inevitable as death or taxes” (p. xi). In rape culture, survivors of rape are often not believed,
or themselves blamed and re-victimized through the reporting and justice systems. As a result,
occurrences of rape are unreported or concealed from others, and those affected most by rape
culture are muted, and may even contribute to what Burnett et al. (2009) describes as “the
creation and perpetuation of […] rape culture” (p. 465).
Attorneys and quality of life, though categorically different from rape (and not at all
comparable as experiences), eschew much of the same socio-cultural issues that act as a
demotivating factor for not only admitting or requesting help, but for individuals to offer help or
step in when they notice the signs of quality of life issues in another person. The fact that over
95% of respondents, in overwhelming fashion, noted that they did not offer a referral to their
peers because they did not know anybody in need of the LAP shows just how engrained in the
profession the signs and symptoms of attrition, mental health issues, and substance abuse
problems are currently. In other words, attorneys do not recognize the signs of these quality of
life issues because they are believed to be normal or just a fact of attorney life. Attorneys are
around others who have these issues (roughly one in three in actuality per the Krill et. al (2016)
study, and more than 50% are perceived to have a quality of life issue per this study), but they do
not actually see the suffering or experience of others as requiring intervention or help. As noted
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by one participant as a part of a pattern of responses, it is “just part of being a lawyer.”
However, the survey also revealed that participants consistently agreed that they would be more
likely to actually seek help if they were referred to the LAP by their manager or boss (72.15%),
their employer (70.65%), a member of their family (62.77%), or a peer (59.36%). The results
confirm that while some individuals hold a greater level of sway over the likelihood that an
attorney in need will seek assistance from a LAP, referral to a LAP is itself a notable motivating
factor overall.
As discussed in the next section (Abilene Paradox), those who are experiencing quality of
life issues do not feel confident or comfortable letting others know they have an issue, need help,
or are not performing to the standard of practice. The silence of those experiencing these
problems may very well perpetuate the same issues experienced by their peers who will feel the
need to suffer in silence as well.
The Abilene Paradox. The Abilene Paradox is the idea that everybody maintains the
status quo or makes decisions based upon what everybody believes others want when, in reality,
if the group discussed the issues, a different outcome would have been reached (Harvey, 1988).
Often, groupthink mentality renders each member of a team making a decision based on what
they think the group wants instead of what members of the group actually want. If the issues are
discussed, the team would realize that they all want something different. As explained by Jane
Daniel (2001), even though all members may agree on how to handle a situation or make a
decision, communication does not occur, and the outcome is actually contrary to what the group
actually wanted (but never expressed).
As applied to this study, attorneys are worried about seeking help, admitting they have a
problem or discussing their issues because there is a perception both within the profession and
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from the public, that attorneys are and must be perfect. More than one in three attorneys is
suffering from a quality of life issue. In fact, attorneys believe that over half of their peers
(53.47%) are suffering from attrition or burnout, and over one-third have a mental health or
substance abuse problem (34.39% and 36.02%, respectively) (Krill et. al, 2016). However, in
practicality, attorneys are not discussing these problems because they feel it will harm them
professionally (or their business), that they will be less effective, worry about their reputation, or
that nobody will understand what he or she are experiencing. Additionally, research shows and
attorneys perceive that they are not alone and that these issues are endemic of the profession
(Krill et. al, 2016). Attorneys are just not discussing these issues in the open and are afraid that
they are the only ones experiencing quality of life issues when, in reality, in a group of attorneys
more than one are likely suffering apart, together.
Mandated annual counseling. Following the Phase 1 Survey, it became apparent that
because stigma, social responsibility, and lack of knowledge were significant factors forestalling
help-seeking behaviors, a solution to address these issues was necessary. Therefore, in Phase 2,
inquiry was made after speaking with various industry experts in the field of mental health
regarding the benefits of mental health counseling and check-up as it relates to attorney quality
of life issues and the Phase 1 Survey results. In both the Phase 2 interviews and narrative survey
participants were asked about whether they believed mandated annual counseling as a
requirement to become licensed would result in positive outcomes for attorneys. Specifically,
Narrative Survey Question 31 asked: “Do you think that yearly mandated private counseling
sessions would assist attorneys with not only learning about mental health and substance abuse
issues but how to recognize them and the resources available?” A branched follow-up question
was then displayed to ask the respondent why they gave their specified “Yes,” “Maybe,” or “No”
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response. Answering “Yes” and “Maybe” were 33.7% and 36.21% of participants, respectively;
“No” responses accounted for 30.08% of participant selections. Thus, surprisingly, most
attorneys are open to mandated annual counseling. Most “No” respondents cited the fact that
forcing anybody to do anything may not result in positive outcomes.
However, the same has been said about mandated mediation, where, for example, Quek
(2009) noted that critics believe that “the principal objection is that mandatory mediation
impinges upon the parties’ self-determination and voluntariness, thus undermining the very
essence of mediation” (Quek, 2009, p. 484). However, the results of mandated mediation
programs have proven so successful that enhanced programs have been adopted at all levels of
litigation, and that even though there may have been reticence from participants in entering the
mediation when they were compelled to be there, studies have revealed that those participants
still benefited from the process (Quek, 2009; McEwen & Milburn, 1993; Pearson & Thoennes,
1985). The point is this: The two camps of participants understood that the same issues were
present, but those that responded “Yes” or “Maybe” saw the potential that mandated self-
reflection may have for some people, and that any positive outcomes that could result from
mandating mediation were worth all the negatives that could result from people who either did
not take the mandated session seriously, or may be entirely resistant to the process. As one
participant noted, “It would make attorneys get help without a stigma attached to particular
attorneys for doing so.” This category of comment was widespread throughout the response of
those who explained their affirmative belief that mandated counseling could help. Besides,
attorneys “probably wouldn't do it unless it was mandatory.”
Finally, 80% of those who participated in the Phase 2 Interviews agreed that yearly
mandated counseling sessions would offer a considerable benefit to individual attorneys and the
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profession. One of the two negative responding interviewees noted that they would answer in
the affirmative if the mandatory counseling session was required in place of mandatory
continuing legal education (MCLE or CLE) classes, yielding, for purposes of the question, a
90% agreement to the substance of the question, and an 80% agreement as to form. While some
pointed out that “it ain’t gonna happen…” these respondents also stated, “it probably would
help.” The political and administrative changes necessary to make this type of requirement come
to fruition are overwhelming but are not insurmountable. The State Bar of California has shown
willingness and the ability to require its entire membership to adhere to new requirements for
continued licensing. In 2018, the State Bar recommended and the Supreme Court approved a
new rule requiring every attorney to become re-fingerprinted to maintain his or her license to
practice (CRC 9.9.5, 2018).
Organizational Findings and Results
Perhaps the most clear-cut results from this study were the ones surrounding
organizational influences. It became quite clear in both phases of the study that attorneys were
highly distrustful of State Bar Associations. In fact, the negative feelings so strongly outweighed
the positives, that this research may be the most persuasive argument to-date for the restructuring
of State Bars, or, at the very least, the need for deep introspection for these organizations. As
discussed in Chapter Five, a gap analysis study of State Bar operations is undoubtedly needed to
address these overwhelming issues.
LAP form and function. The survey concentrated on many factors dealing with the
form and function of existing LAPs, much of the time asking general questions related to what
attorneys believe the model of a LAP should be instead of focusing on what was wrong with any
particular existing LAP. It became clear that the management and structure of the organization
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are not only important to the members of the Bar but impact motivation. The organizational
influences, like most others, interconnected with both knowledge and motivation influences.
State Bar operations and the seemingly tenuous relationship it has with attorneys is a paramount
organizational influence, especially as it relates to overall management and function.
While many entities value experience and management abilities when seeking an
executive, survey respondents seemed to deviate from this norm. Over half of respondents
(58.39%) rated “previous management experience” as an unimportant qualification of an
individual chosen to run a LAP, with 95.74% noting that it is important that the manager be a
licensed substance abuse/mental health counselor. Further, 89.59% of respondents also rated
“addiction medicine / psychotherapy professional” as an important qualification. However,
participant beliefs about the efficacy of the program’s manager aside, qualifications do impact
motivation. When asked what would make them less likely to utilize the lawyer assistance
program, 81.59% of respondents answered: “[if] the management was the same as the regulation
and discipline committee.” On the contrary, 72.45% of respondents stated that were the
program’s manager to have “expertise in substance abuse and mental health treatment, they
would make them more likely to utilize the program.
Furthermore, the location of the LAP also showed a likelihood to influence the program’s
utilization. Attorneys overwhelmingly agreed that they would be less likely to utilize the lawyer
assistance program if the program offices were in the same building as the State Bar (74.62%),
and they also generally agreed that they would be more likely to utilize the LAP if the program’s
offices were in a different building than the State Bar (63.44%).
LAP participant cost. Survey respondents were resistant to the idea of paying the State
Bar or a LAP to access services regardless of income level. If the program were cost free,
STANDARD OF PRACTICE 111
42.47% responded that they would likely participate, and another 49.27% said they would
participate (a total of 8.26% stated that they would either likely not participate or would not
participate if the program were free). More to the point, 16.73% noted that they would not pay
anything to participate in a LAP program unless they were forced to do so, with less than half
willing to pay anything over $100.00 per month.
Moreover, interviewees detailed, in a surprising narrative, the general willingness of
attorneys to pay increased State Bar dues to ensure their peers had low-or-no cost services
available to address quality of life issues. One interviewee noted that “I think I would pay more.
It would just be a question of how much it was that had to come out of my pocket, because I
think as far as people, if they have some sort of mental health or substance abuse issue, I think
it's good for them to have access to help.” Another participant added, “for an identifiable
program like that that I think has real results and helps not just me but my friends, yes, that is
something that, if it weren't already free, I would be willing to see my money go towards.” All
interviewees (100%) stated that they would be willing to pay more bar dues, with some noting
that “it depends how much.” However, a modest raise of $20.00 to each member’s dues could
yield millions of dollars in funding not previously enjoyed by the program, expanding
geographical service areas, the types of services and resources offered, staffing, marketing, and
LAP participant contact hours.
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Figure 5. Phase 1 Survey, Question 25.

Public relations. The study revealed that not only do LAPs lack any effective public
relations or marketing success but that attorneys feel that the Bar is their adversary. As such,
attorneys not only do not know about all the services and programming the LAP offers, but even
when they do, they cite worries about confidentiality and professional standing as reasons that
they may think twice about using any State Bar services. The survey revealed that the single
issue that would make an attorney more likely to utilize a LAP is guarantees of confidentiality.
Participants ranked “confidentiality” as their top choice 55.44% of the time, which represents
more than twice the next highest ranked item “receiving treatment.” In fact, more people ranked
“confidentiality” second than participants ranked any other choice as number one. When asked
what would keep them from utilizing services, the top two answers “peers finding out” and “fear
of loss of license” received 30.94% and 26.92% of the number one choice, respectively. One
interviewee summed-up this negative feeling where, in response to being asked why they would
STANDARD OF PRACTICE 113
utilize all other resources before a LAP, they responded, “Nothing more than the word “Bar”
[being] in the name. I don’t like to put any of my personal [issues] next to anything that could
[…] end my career.” State Bar LAPs across the nation offer safeguards for confidentiality but
must do better to publicize these guarantees.
The second finding is that attorneys are not aware of the low intake into LAPs that occur
yearly. The survey revealed that across all six states, participants on average believe that
roughly 2.11% of attorneys (10,896.38 attorneys) go through intake every year, where the total
attorney population in those six states is roughly 515,381. In California alone, documents reveal
that only 135 attorneys went through intake in the previous calendar year, which accounts for
.07% of attorneys. Participants in California believed that 1.63% of attorneys (3091.25) on
average went through intake. These beliefs represent a difference of almost 23 times the actual
intake in California alone. When asked for percentages of intake, participants estimated roughly
7.06% of attorneys go through a LAP intake every year, which for California, is 100.85 times off
the actual intake percentage. These figures show that attorneys are completely unaware of the
level of utilization of LAP services, that they believe more individuals should be using the
program, and that attorneys expect more is being done with their yearly dues that fund these
services. Of all six states, attorneys in California believed the least number of attorneys went
through intake with the LAP with estimates of 1.63%; ranking the highest were South Carolina
attorneys who estimated intake numbers to be 3.17% of the State’s attorney population.
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Figure 6. Phase 1 Survey, Question 41.
Participants were further asked about what they believe to be the “most effective way to
notify [them] about State Bar programs and lawyer assistance program resources and offerings?”
Participants agreed that electronic mail (email) was the top choice, with 57.82% of participants
ranking the option as the top choice. Email received 89.49% of a perfect weighted score overall,
with brochures receiving the lowest ranking (besides “Other”), receiving just 6.7% of a perfect
score overall. Interviews yielded a slightly different outcome, where participants responded to
inquiries into best marketing practices for the State Bar’s LAPs are to utilize methods of face-to-
face interaction or education programs where presenters were individuals who utilized the
services and could share their story with others. Interviewees noted that “[the Bar] needs to reach
STANDARD OF PRACTICE 115
members, but [they] need to do it privately. In order for [marketing the LAP] to be open, there’d
have to be a change in the culture.” Participants noted that email does just that: it notifies
attorneys of programs available to them in a private manner that may achieve a higher level of
inquiry into the resources offered. In addition, many participants offered that direct mailings
should include information on LAPs, such as Bar journals, license renewal notices, and other
targeted mailers.
Conclusion
Chapter Four presented the evaluative study’s findings, highlighting the specific areas of
emphasis in this gap analysis: knowledge, motivation, and organization. The results in this
chapter provide the foundations for the recommendations that follow in Chapter Five. The final
chapter will present those recommendations under the gap analysis areas as set forth in previous
chapters. More specifically, Chapter Five revolves around an economic evaluation of State Bar
programming, education resources, and the structure of the LAP and State Bar Associations.
Furthermore, Chapter Five outlines a potential method for implementation and evaluation of
recommendations utilizing the Kirkpatrick Model. These recommendations are by no means a
comprehensive list, but those that have not only been validated by the findings, but will provide
the greatest level of impact.

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CHAPTER FIVE: RECOMMENDATIONS
What follows in Chapter Five are specific recommendations for future practice based on
this evaluative study. Utilizing the results of the study, as set forth in Chapter Four, this section
first deals with recommendations based on both the Clark and Estes (2008) gap analysis model,
splitting the gap analysis-based recommendations into the KMO (knowledge, motivation, and
organization) influences, as well as a synthesis of general themes that emerged from the research.
Next, specific recommendations will be presented in three distinct areas that address institutional
change: economics, education, and a new LAP model for the future. Finally, after discussing the
KMO influences and the more specific recommendations, this Chapter will conclude with
guidelines which adhere to the Kirkpatrick New World Model to present a plan for future
analysis and change evaluation (Kirkpatrick & Kirkpatrick, 2016b). The Kirkpatrick Model will
focus on more of the generalities as far as the recommendations are concerned, leaving
evaluation of movement toward and successful implementation of the institutional changes for a
broader, unstructured format of review not outlined in this study.
Strengths and Weaknesses of the Approach
As Clark and Estes would themselves admit, all methodological approaches have
strengths and weaknesses. The Clark and Estes (2008) model helped to identify the three major
influences in both creating and closing gaps for any organization or stakeholder goal. This
framework made possible a research design that took into account the significant themes and
gaps that were being experienced. However, the Clark and Estes (2008) framework was not itself
singularly appropriate for the study as it did not address industry specific issues that existed, and
it indeed forced this researcher to utilize sometimes independent research to design the study
itself. In other words, the study utilized the Clark and Estes framework as a foundation for the
STANDARD OF PRACTICE 117
study’s design, but previous studies and research were used to ensure a proper fit for this specific
undertaking because attorneys are not the average citizen and experience quality of life issues for
different reasons than most others in society. The profession has its own culture, its own
normative values, and a socio-culture standard different from other professions. While there
may be some intersection in previous studies and literature, such information only informs so
much before losing relevancy. As a result, many findings and recommendations were entirely
unexpected.
Recommendations for Practice to Address KMO Influences
Knowledge Recommendations
Introduction. Table 7 represents a list of knowledge influences that have been validated as
gaps from the results of the study; these influences have a high probability of influencing
stakeholder actions to achieve the organizational goals of the LAP and, therefore,
recommendations are needed. Provided as support for these assumed knowledge influences are
the principles from the literature that support the influences as well as a context-specific
recommendation for the future. Following the table is a narrative explanation of these knowledge
influences explaining both Table 7 and its specific application to this study.

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Table 7
Summary of Knowledge Influences and Recommendations
Assumed Knowledge Influence

Principle and Citation Context-Specific
Recommendation
Attorneys need to know the
quality of life issues by which
members of the profession are
most likely to be afflicted. (D)
Learning tasks that are similar to those that
are common to the individual’s familiar
cultural settings will promote learning and
transfer (Gallimore & Goldenberg, 2001).
Provide information on attorney
quality of life issues.
Attorneys need to know methods
of coping they can utilize to
minimize these issues. (D)
Self-regulatory strategies, including goal
setting, enhance learning and performance
(APA, 2015: Dembo & Eaton, 2000;
Denler et al., 2009).
Engage attorneys
through proactive job aids by each
LAP.
Attorneys need to know how to
utilize available services and
resources provided by the State
Bar. (P)
Increasing germane cognitive load by
engaging the learner in meaningful
learning and schema construction
facilitates effective learning (Kirshner et
al., 2006).
Engage attorneys through job aids
on the utilization of lawyer
assistance programs.
Attorneys need to know how to
self-assess their own quality of
life status. (P)
Facilitating transfer promotes learning
(Mayer, 2011).

Engage attorneys through job aids
regarding self-assessment.
Attorneys need to know and
understand why these issues are
important for them to assess and
recognize. (M)
Activating and building upon personal
interest can increase learning and
motivation (Schraw & Lehman, 2009).
Utilize job aids to guide attorneys
in self-assessing the problems
they and their peers may be
facing.

Declarative knowledge solutions. Attorneys need to know the quality of life issues by
which members of the profession are most likely to be afflicted. This study’s findings indicated
that while attorneys are aware that the profession is suffering from a quality of life epidemic, the
depth of knowledge is facial at best (Krill et. al, 2016). Knowing that a problem exists is
different from knowing what the problem is. As Gallimore and Goldenberg (2001) stated, in
order to promote the transfer of information, it is first necessary to utilize learning tasks that
mirror those with which attorneys have become familiar. In order to fully realize this principle as
it applies to this declarative knowledge influence, the recommendation is that LAPs and state
bars should provide information on attorney quality of life issues through proactive attorney
outreach, interactive discussions, and education through talks, presentations, and continuing legal
education programs.
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Prevention strategies must target the environment of those most likely to use and abuse
substances and engage in the less-than-positive behavior described throughout this study (el-
Guebaly et al., 2015). While most agencies market a one-size-fits-all problem and program
because of its universal appeal and positive public perception, to truly be effective, the method of
education for quality of life issues must be targeted and tailored to fit the audience that needs
treatment the most (Miller & Miller, 2009). The information offered to legal practitioners must
be appealing to those faced with quality of life issues by customizing the presentation of the
information conveyed to members of the profession to ensure that those in need (and those who
know those in need) recognize that these problems exist even when they do not present
outwardly.
Next, attorneys need to know methods of coping they can utilize to minimize quality of
life issues. While knowing about the quality of life issues is a start, more important to seeing
success in the abatement of these issues is the ability to know what kind of coping methods and
resources attorneys can utilize. Strategies that include both self-regulation and goal setting
enhance learning and performance overall (APA, 2015: Dembo & Eaton, 2000; Denler et al.,
2009). This principle transcends learning and empowers learners to use knowledge to undertake
action in response to the issues they face. Therefore, the recommendation is to engage attorneys
through proactive job aids by each LAP and required annual counseling sessions, continuing
legal education programs, email and social media advertising efforts.
Scott (2011) asserts that more must be undertaken proactively to help change the
profession’s mindset to stop the chemical dependency and depression from occurring, instead of
treating it after it already has manifested. While this may innately demand a cultural shift in the
profession, giving attorneys the skills to take action is just as important as the opportunity to take
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action. As such, LAPs must engage in programs supported by proactive job aids and prevention
aimed to stop issues before they require treatment (Benjamin, Sales, & Darling, 1992). If
attorneys have outlets and coping mechanisms before the problems grow unmanageable, these
quality of life issues might not be as significant.
Procedural knowledge solutions. Attorneys need to know how to utilize available
services and resources provided by the State Bar. The next step to informing attorneys about the
resources available to them is to provide them with the skills and ability to feel confident in
utilizing them. The data revealed in this study illustrated that this is generally not the practice in
the profession and that there exists a gap between presentation of the issue and knowledge of and
ability to address its existence and treatment. Kirshner et al. (2006) posited that in order to
facilitate effective learning, the learner’s germane cognitive load needs to be increased by
employing both meaningful learning and schema constructions. Therefore, the recommendation
for attorneys is to engage them with job aids on the utilization of lawyer assistance programs
through email newsletters, social media, and online literature, and by training and education
through proactive outreach by each LAP through a step-by-step process that emphasizes access
of services and programs.
Utilization of resources starts with the knowledge that they exist, and become actionable
when an individual has the knowledge necessary to access them; this includes providing
attorneys with a step-by-step guide on how to approach these issues, and resources that guide
them throughout the process. Krathwohl (2002) emphasized the need not only to determine how
something is done, but what procedures must be undertaken to accomplish the task. This
knowledge influence requires that attorneys have operative knowledge of the resources available
to attorneys and how to access those resources such that they are comfortable enough to utilize
STANDARD OF PRACTICE 121
the opportunities themselves and make recommendations to their peers. Part of this knowledge is
the minutiae of what happens when these resources are accessed, and the outcomes that may
occur as a result. Thus, a fully-formed and successful State Bar LAP utilizes education
programming (job aids) to at-risk individuals not only on how to seek help but the likelihood of
success in treatment (Rickwood et al., 2007).
Before they can engage in metacognitive reflection, attorneys also need to know how to
self-assess their own quality of life status. To accomplish this goal, methods must be utilized to
facilitate knowledge transfer to promote learning (Mayer, 2011). More specifically, by giving
attorneys the knowledge to self-advocate for solutions to the issues they face, they will be more
likely to avail themselves of the available resources and be motivated to seek help. The complex
procedures included in these processes must be broken down, and these individuals should be
encouraged to think about the information in strategic ways (Schraw & McCrudden, 2006). As
such, the recommendation is that state bar associations engage attorneys through job aids
regarding self-assessment through email newsletters and online literature, and by training and
education through proactive outreach by each LAP and annual mandatory counseling sessions.
This knowledge solution deals with the procedural influences on a learner’s self-
regulation and strategic knowledge (Mayer, 2011). The ability to self-reflect in regards to one’s
abilities, shortcomings and knowledge enables the individual to properly give context to
cognitive tasks and plan strategically for the task with which they are faced. Finney and Moos
(1995) explain that self-perception of the manifestation of these factors of self-assessment and
metacognition have been shown to be a predictor of treatment entry in studies undertaken. The
more an individual understands about their problem and how to recognize it for themselves, the
more likely they are to act on that knowledge.
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Metacognitive knowledge solutions. Whereas the study demonstrated the absence of
deep, metacognitive practice, attorneys need to know and understand why this practice is
important for them to assess and recognize. Underlying all the quality of life issues attorneys
have and the low utilization of programs and resources that address them is the fact that most do
not believe they or their peers have a problem to begin-with. Heightening and building upon the
personal understanding attorneys have of these issues can increase their willingness to learn and
motivation to act (Schraw & Lehman, 2009). The recommendation is that the state bars utilize
job aids to guide attorneys in self-assessing the problems they and their peers may be facing
through continuing legal education programs, online literature, email outreach, and personalized
one-on-one counseling sessions.
In 2015, El-Guably et al. (eds.) asserted that in order to self-actualize and understand that
a person has a problem, that person must take responsibility for their actions and embrace the
need for change. Thus, perhaps the most important knowledge factor is relating and “owning”
these problems on an individual level. This can only occur once an attorney has knowledge
regarding quality of life issues, how they may be impacting that attorney’s life, and what they
can do to help themselves. The legal profession is positioned quite differently when it comes to
knowledge to help oneself and to help others than the public at large. While the general public
may also grapple with attrition, substance abuse, or mental health problems, lawyers are
increasingly at risk for these quality of life issues because these professionals quickly become
disenchanted with their work and, according to Bloom and Wallinger (as cited in Silver, 2004)
they are “terrible resources” for their peers when it comes to seeking and obtaining help (p. 7).
Self-reflection and increasing the knowledge of attorneys will provide greater opportunity for
self-help seeking, and peer outreach and intervention. As a result of the reluctance of even law
STANDARD OF PRACTICE 123
students to seek help (Organ, Jaffe, & Bender, 2015), attorneys and aspiring members of the
legal profession need to be reached through job aids, both dynamic and static, early in their
careers and regularly throughout.

Motivation Recommendations
Introduction. Table 8 represents a list of motivation influences that have been validated
as challenges from the results of the study, and have a high probability of influencing stakeholder
actions to achieve the organizational goals of the LAP. Provided as support to address these
assumed motivation influences are the principles from the literature as well as a context-specific
recommendation for the future. Following the table is a narrative explanation of these assumed
motivation influences explaining both the information in Table 8 and its specific application to
this study.
Table 8
Summary of Motivation Influences and Recommendations
Assumed Motivation Influence

Principle and Citation Context-Specific Recommendation
Utility Value – Attorneys need to see
the value in utilizing the Lawyer
Assistance Program resources.
Rationales that include a
discussion of the importance and
utility value of the work or
learning can help learners develop
positive values (Eccles, 2006;
Pintrich, 2003).
Utilize job aids that emphasize
rationales about the importance and
utility value of the LAP resources
and its usage.
Attribution Theory – Attorneys need
to understand that they have an
internal locus of control over their
successes or failures, and must assert
personal effort and be accountable for
their self-care.
Provide feedback that stresses the
process of learning, including the
importance of effort, strategies,
and potential self-control of
learning. (Anderman &
Anderman, 2009)

Utilize job aids that provide feedback
that stresses the nature of learning,
including importance of effort,
strategies, and potential self-control
of learning as it relates to personal
effort and self-care of quality of life
problems.

Utility value. The study revealed the need to educate and empower lawyers and change
the normative practices of seeking help outside the Bar. As such, attorneys need to see the value
STANDARD OF PRACTICE 124
in utilizing the Lawyer Assistance Program resources (utility value). Eccles (2006) and Pintrich
(2003) posited that rationales that include a discussion of the importance and utility value of the
work or learning could help learners develop positive values. Attorneys need to understand that
there is a benefit in the LAP and that their own values align with the goals of the programming
and resources the organization provides. Therefore, the recommendation is that that the State Bar
should both employ job aids that emphasize rationales about the importance and utility value of
the LAP resources and its usage, and utilize personal testimonials from those who have
experienced positive outcomes from program utilization.
As discussed in Chapter 2, motivation plays an integral role in treatment engagement and
outcomes (Wolf et al., 2013). An attorney’s engagement in treatment signifies that the
individual has placed a high utility value on the treatment and addressing of their quality of life
issue(s). Studies reveal that individuals who are engaged in their treatment have a more
favorable outcome from the treatment (Wolf et al., 2013). In measuring the motivational factors
of individuals who are seeking or are in need of treatment, there are two elements to consider:
internal motivational factors and external motivational factors. Internal factors are represented
by an individual’s self-image, psychological needs and goals, whereas external factors arise from
considerations of consequences of continuing the behavior and other outside pressures. Thus, the
assertions of Wolf et al. (2013) align directly with the utility value of expectancy value theory
where attorneys see as useful anything that prolongs their careers, makes them more potent
practitioners, and helpful to achieving their professional goals. As a result, the LAP must seek to
increase the utility value of the services they provide while emphasizing that the goals and values
of the program align with that of attorneys in need.
STANDARD OF PRACTICE 125
Attribution theory. A gap was identified in the study that evidenced that attorneys find
reasons to shirk responsibility for their actions. As a result, attorneys need to understand that
they have an internal locus of control over their successes or failures, and must assert personal
effort and be accountable for their self-care. According to Anderman and Anderman (2009),
learners must be provided feedback that stresses the process of learning, including the
importance of effort, strategies, and potential self-control of learning. Attorneys may feel the
only source of control over the issues they face is to either self-medicate or hide the issues they
have; the LAP must target attorneys who may be suffering from quality of life issues by
emphasizing constructive self help and resources available to them so that they can become
responsible for addressing their own conduct and issues. The recommendation is, therefore, that
the State Bar should utilize job aids that provide feedback that stresses the nature of learning,
including the importance of effort, strategies, and potential self-control of learning as it relates to
personal effort and self-care of quality of life problems.
Pintrich (2003) asserts that the opportunity to exercise some levels of choice and control
over decision-making enhances an individual’s motivation. As a result, individuals will work
harder when they attribute their successes and failures to their activity and effort instead of their
abilities (Mayer, 2011). Accordingly, people attempt to append a meaning to an action or
behavior to shape their response to that occurrence (Harvey & Martinko, 2009; Weiner, 2006).
As a result, attorneys must understand that they are in control of their successes and failures, and
must recognize that they must assert personal effort and be accountable for their self-care. This
begins with the LAP helping attorneys take responsibility for their actions by removing barriers
to outreach and self-help for their target population. In essence, attorneys have to want to
STANDARD OF PRACTICE 126
promote their own self-care and actively seek assistance when those resources are available to
them.
Organization Recommendations
Introduction. Table 9 represents a list of four organization influences, which have been
validated from the results of the study and identified as gaps in practice. These factors have a
high probability of influencing stakeholder actions to achieve the organizational goals of the
LAP. Provided as support for these assumed organizational influences are the principles from
the literature that support the influences as well as context-specific recommendations for the
future. The principles underlying the assumed organization influence are derived from Clark and
Estes (2008) and utilize Gallimore and Goldenberg’s (2001) two cultural constructs as described
in Chapter Two: cultural model influences and cultural setting influences. Following the table is
a narrative explanation of these assumed organization influences explaining both the information
in Table 9 and its specific application to this study.

STANDARD OF PRACTICE 127
Table 9
Summary of Organization Influences and Recommendations
Assumed Organization
Influence

Principle and Citation

Context-Specific Recommendation
Cultural Model Influence 1:
There is a cultural norm in the
legal profession to deny that an
attorney is not performing their
duties fully and that they are in
need of assistance from a third
party.
Organizational effectiveness
increases when leaders are
trustworthy and, in turn, trust their
team. The most visible demonstration
of trust by a leader is accountable
autonomy (Clark & Estes,
2008).
The State Bar will utilize job aids
aimed at empowering attorneys to not
only self-help but empower their peers
to be accountable for taking
responsibility for their quality of life
issues.
Cultural Model Influence 2:
Attorneys generally resist self-
reflection and diagnosis
pertaining to quality of life
issues that affect their daily
lives.
Effective change begins by
addressing motivation influencers; it
ensures the group knows why it
needs to change. It then addresses
organizational barriers and then
knowledge and skills needs (Clark &
Estes, 2008).
The State Bar will employ education
measures aimed at instructing all
stakeholders--the profession and public
included--about the quality of life
epidemic and the importance of self-
care.
Cultural Setting Influence 1:
Demand to produce results and
perform in high-stress
environments regardless of
outside influences interferes with
attorneys investing time to
address their own problems.
Effective change efforts ensure that
everyone has the resources
(equipment, personnel, time, etc.)
needed to do their job and that if
there are resource shortages, then
resources are aligned with
organizational priorities (Clark &
Estes, 2008).
The State Bar will train managers of
the legal profession on the
consequences of poor work-life
balance and workplace demands and
educate members of the profession on
quality of life issues and the need to
address them.
Cultural Setting Influence 2:
Attorneys are responsible for
maintaining a flawless reputation
in order to gain respect and
professional advantage from
their peers and clients.
Effective organizations insure that
organizational messages, rewards,
policies, and procedures that govern
the work of the organization are
aligned with or are supportive of
organizational goals and values
(Clark & Estes, 2008).
The State Bar will utilize job aids that
combine education and action plans for
members of the profession with the aim
of transforming the normative socio-
cultural values that discourage help-
seeking behaviors.

Denial. The study findings and general experience support the notion that there is a
cultural norm in the legal profession to deny that an attorney is not performing their duties fully
and that they are in need of assistance from a third party. Organizational effectiveness increases
when leaders are trustworthy and, in turn, trust their team. The most visible demonstration of
trust by a leader is accountable autonomy (Clark & Estes, 2008). Attorneys need to take
responsibility for their health and wellbeing, and their peers must emphasize this quality as
paramount to achieving professional success and the organizational goals of the State Bar. The
State Bar, therefore, will utilize job aids and testimonial outreach aimed at empowering attorneys
STANDARD OF PRACTICE 128
to not only self-help but enable their peers to be accountable for taking responsibility for their
quality of life issues (See, e.g., Prilleltensky, I, 2015).
There exists a pervasive stigma in the legal field revolving around both addiction and
mental health issues that have caused any acknowledgment of the suffering of a quality of life
issue to be hidden and untreated (Christin, 2017). As discussed in Chapter 2, this cultural norm
has caused attorneys to either deny they have a problem or hide it from their peers and the State
Bar if they even believe one exists. Attorneys not only want to protect themselves because they
do not want others to know that they have a problem and are worried about their privacy and
have concerns about confidentiality from service providers (Christin, 2017). The State Bar must
give attorneys the tools they need to be able to take responsibility for the issues they face.
Resistance to self-reflection and diagnosis. Next, the study revealed that attorneys
generally resist self-reflection and diagnosis pertaining to quality of life issues that affect their
daily lives. Clark and Estes (2008) assert that effective change begins by addressing motivation
influences; it ensures the group knows why it needs to change; it then addresses organizational
barriers and then knowledge and skills needs. The State Bar should ensure that attorneys not only
self-assess the quality of life issues they may be facing, but they must be empowered to do so by
their peers and socio-cultural normalization of help seeking behavior. Therefore, the State Bar
must employ education measures aimed at instructing all stakeholders--the profession and public
included--about the quality of life epidemic and the importance of self-care.
Zacharias (2004) asserts that to empower attorneys to self-help, the programs must utilize
a program of metacognitive self-empowerment. Supporting this idea of a lack of self-
empowerment is Christin’s (2017) assertion that there exists a pervasive stigma in the legal field
revolving around both addiction and mental health issues that have caused any acknowledgment
STANDARD OF PRACTICE 129
of the suffering of a quality of life issue to be hidden and untreated. Baron (2016) suggests that
while self-management may help with the issues, the structural problems and cultural norms are
a barrier to eradication of the problem profession-wide. Therefore, it is necessary to roll out
strong education and public relations-based programming aimed at empowering attorneys to self-
help.
Cultural demand to produce results and perform flawlessly. According to the results
of the research, the legal profession places a demand on attorneys to produce results and perform
in high-stress environments regardless of outside influences which interfere with attorneys
investing time to address their own problems. Effective change efforts ensure that everyone has
the resources (equipment, personnel, time, etc.) needed to do their job and that if there are
resource shortages, then resources are aligned with organizational priorities (Clark & Estes,
2008). Facilitating self-help is as crucial as providing self-help programming and resources. To
achieve positive outcomes, the State Bar will train managers of the legal profession on the
consequences of poor work-life balance and workplace demands and educate members of the
profession on quality of life issues and the needs to address them.
As discussed previously, recent studies emphasize the result of both institutional and
cultural shortcomings which significantly impact identification and treatment of quality of life
issues (Christin, 2017; Krill et. al, 2016). A dysfunctional culture is at the center of this
complex issue, and these patterns of normalized assumptions need to be addressed and overcome
(Schein, 2004). This cultural norm has caused attorneys to either deny they have a problem or
hide it from their peers and the State Bar if they even believe one exists. The training of
managers and education of the members of the profession can "crack the stigma that prevents
[lawyers] from asking for help while at the same time building a business that sustains
STANDARD OF PRACTICE 130
productivity and personal satisfaction" (Christin, 2017, p. 30). Therefore, the State Bar must train
workplace managers and decision-makers (as well as its own staff) the importance of self-help,
understanding quality of life issues, and the positive effects of an employee-centric work-life
balance.
Reputation maintenance and competition. Further, according to the study findings,
attorneys are responsible for maintaining a flawless reputation in order to gain respect and
professional advantage from their peers and clients. According to Clark and Estes (2008),
effective organizations ensure that organizational messages, rewards, policies, and procedures
that govern the work of the organization are aligned with or are supportive of organizational
goals and values. The organizational culture must reflect an environment supportive of self-help
practices and help-seeking behaviors in order to assure that the public is protected and the
standard of practice maintained. Therefore, the State Bar must utilize job aids that combine
education and action plans for members of the profession with the aim of transforming the
normative socio-cultural values that discourage help-seeking behaviors.
The State Bar must feature a program that emphasizes confidentiality to promote honesty
and self-help, prevention and education services to aid in identification and evaluation of
distressed lawyers, and, as stated previously, the promotion of therapeutic outcomes (Benjamin
et al., 1992; Rickwood et al., 2007). As a result, the State Bar should enact education programs
to both identify at-risk attorneys and inform them not on how to seek help and the likelihood of
success in treatment (Rickwood et al., 2007). This enactment must normalize quality of life
issues and enact programming that makes attorneys feel comfortable to seek help not only from
the State Bar but from their peers and personal resources. Because negative attitudes and stigmas
regarding mental health issues and the treatment of them are likely to act as a barrier to an
STANDARD OF PRACTICE 131
individual seeking help (Rickwood et al., 2007), changing the standard of practice inclusive of
these points will produce cultural norms that not only make it easier to access resources but
provides the foundation upon which more individuals will avail themselves of the resources
(Benjamin et al., 1992).
Economic Evaluation of Lawyer Assistance Programming and its Alternatives
In addition to the Florida State Bar, as with much of this study, the focus will be on the
California State Bar, whose facts and figures were easily accessible. These states are used to
illustrate the points being made. In 2017, the California State Bar budgeted $1,200,600 to the
Lawyer Assistance Program; in 2018, that number increased to $1,707,404. Revenues for the
Lawyer Assistance Program Fund, a separate line item from the Lawyer Assistance Program
itself, were roughly $2,084,800 in 2017, and $2,107,000 in 2018.
There are significant questions regarding where these funds are going, especially because
the State Bar budget does not show interest accumulations for the funds in excess of that which
they have set aside for the LAP funding. This begs the question: where are the LAP Fund
revenues going? The answer may be found in the State Bar’s “Projected Reserve Balance by
Fund” table, which shows a projected reserve balance of $3,557,000 for the LAP Fund as of
12/31/2017, and $3,447,000 by 12/31/2018.
The most significant allocation in the State Bar’s LAP budget is $919,000 (2017) and
$1,260,100 (2018)
3
, which have been delineated for personnel expenses, with only $184,600 and
$340,000 going to the Program’s services in each of these two years. In its 2017 Annual Report,
the LAP stated that its expenditures equaled nearly $1.5 million, with salaries and benefits, plus

3
Under the consolidated listing for the State Bar’s LAP, the State Bar lists the budget figures for
personnel as $828,200 for 2017, and $1,242,000 for 2018.
STANDARD OF PRACTICE 132
administrative overhead reaching nearly 89 percent of that total. While the LAP provides
services to its participants, it does not explicitly state what these employees do beyond
administrative work and intake. The State Bar lists a services line item, designating $184,600 in
2017 and $340,000 in 2018 to “services.”
Taking the Bar’s allocations at face value, of the $1,200,600 budgeted in 2017, 15
percent is delineated for services, and 76.5% is designated for personnel and administrative
overhead. In 2018, the figures get a little better; of the $1,707,404 forecasted for the LAPs
budget, 19 percent is for services, and about 74% is for personnel and administration. Charity
Watch, an independent charity watchdog, gave the charity “Comic Relief” an A+; Comic Relief
spends 90% of its budget on its programing, and 10 percent on overhead (Charity Watch, 2018).
Well-known for its television and radio jingles, Kars4Kids utilizes 37% of its budgetary
resources for programming and 63% for overhead; it has received a D rating from Charity Watch
as a result. Where the LAP utilizes less than half the percentage of Kars4Kids, it is safe to say
that it can do better. The other issue that seems to be misleading is the actual number of
individuals in the program, and the cost-benefit analysis of the LAPs efficacy as a result.
While 2018 numbers are not available, there were roughly 277 open cases during the
course of the 2018 calendar year. More specifically, looking at 2017, the LAP conducted 143
intakes and discharged 147 cases for either completing the program or not meeting qualifications
to enter the program
4
. Where intakes and discharges have maintained relative equality over the
last six years, when translated to a per-case cost, the 277 open cases cost $4,334 per person, per
year. There is a lot of vagueness in the term “open case” because it can refer to any case that was

4
This means that not all of those cases that proceed through intake were accepted it into
treatment with the program.
STANDARD OF PRACTICE 133
open at any given time during 2017. For example, if there were 143 cases accepted into the
program, but 100 were closed within a one month period, the State Bar could still be accounting
for 143 intakes, and adding 143 open cases to its measure. Even when coupled with the “cases
closed” statistic, “open cases” does not become any easier to understand. Therefore, the best
number to review is “open cases” – “discharged cases.” Therefore, if the carrying costs of new
and discharged cases are equal, there is a carry-over of just 130 cases at any time in a given year
(277 open cases – 147 discharged cases), the cost per case is roughly $9,235 per case.
Furthermore, in its budget, the State Bar seemingly does not account for any income from
its participants, who, by law, must pay a fee to be part of the program. Rule III of the Rules and
Regulations Governing the Lawyer Assistance Program states:
Attorneys will be responsible for payment of all expenses relating to treatment and
recovery, including but not limited to the costs of hospitalization, drug testing, group
meetings, individual therapy, etc.
(Rules and Regulations, 2018).
Each participant is charged a flat fee of $250 per month, plus all associated lab and medical
expenses accrued. Patrick Krill makes a note of the issues fees present to the efficacy of the
program in his consultant’s report on behalf of Krill Strategies, which was included in the LAPs
2017 Annual Report. He notes:
The fee structure for the LAP should be evaluated for both value and competitiveness.
($250 month, plus lab fees, all medical fees). Participants complain about the fees, and a
determination should be made as to the fee structure’s necessity and appropriateness.
Furthermore, the LAP should attempt to better understand the extent to which fees
have been or are a barrier to greater participant enrollment.
(State Bar LAP, 2017, p. A-9).
None of the foregoing comes as a surprise. In 2015, the California State Auditor
conducted an investigation of the State Bar as a part of its normal scope of practice. The auditor,
in her cover letter, made clear that the State Bar “lacks accountability related to its expenditures”
(California State Auditor, 2015, p. 2).
STANDARD OF PRACTICE 134
Program Alternatives – A Cost/Benefit Analysis
While the State Bar has taken a continuing position on the continuation of the Lawyer
Assistance Program as it stands (adopting tradition over change), there are numerous options
available that will aid the State Bar in meeting the goals the LAP was formed to address. The
following are four options that can be taken to address the issues as set forth above. A complete
summary of this cost-benefit analysis is included in Table 10, below.
STANDARD OF PRACTICE
Table 10 Cost – Benefit Analysis Summary
COST/BENEFIT OF LAWYER ASSISTANCE PROGRAM ALTERNATIVES
OPTION BENEFITS DRAWBACKS COSTS
5
DISCOUNT RATE
6
ESTIMATED
COST-
EFFECTIVENESS
A – STATUS
QUO
Maintaining programs, processes,
traditions, relationship with other bar
systems/programs, and current clientele.

No/low political costs.
Continue to have an
extraordinarily high cost
effectiveness ratio compared to
other programs, less
opportunity for change and new
programs; nothing changes.
$1,200,600

Actual Costs (+)

Opportunity Costs (++)

Participant Costs (++)
$3,557,000 Reserves –
7% discount =
$3,450,290

Losses: $248,990 per
year
$4,334 per
participant
B - EXPAND
SERVICES AND
MARKETING
OUTREACH
Expand accessibility, social acceptance,
outreach, and services offered. Do more
with the same amount of money.

No change for current participants.
Spend more money without a
guarantee of higher usage.
>$1,200,600 (Status Quo +
Extra Expenses)

Actual Costs (+++)

Opportunity Costs (+)

Political Costs (+)

Participant Costs (+)
$3,557,000 Reserves –
7% discount =
$3,450,290

Losses: $248,990 per
year
>$4,334 per
participant
C – LOWER
OVERHEAD,
RAISE BUDGET
Do more with more money and less
overhead. Utilize the funds earmarked for
LAP use (and collect the interest
accruing).

Greater delivery of funds direct to
participants.

No change for current participants.
Spend more money without a
guarantee of higher usage.
>$1,200,600 (Status Quo +
Reserves)

Actual Costs (++)

Opportunity Costs (+)

Political Costs (+)

Participant Costs (+)
If reserves decrease to
auditor max:

<$248,990 per year
>$4,334 per
participant
D -
OUTSOURCE
Use systems and models that work,
accessibility, lower barriers to lawyer
entry into the program, expand and
reward organizations that have successful
programs.

Lower participant costs.
High political costs.

Changing-out of “old guard”
and old way of doing things.

Hard to make drastic changes.
$1,200,600 (budgeted as
grants and awards)

Actual Costs (+)

Political Costs (+++)

Participant Costs (+)
If reserves decrease to
auditor max:

<$248,990 per year
<$350 - $2,000 per
participant

5
“+” refers to the degree of costs, high (+++), medium (++), low (+)
6
“The 2017 real discount rate for public investment and regulatory analyses remains at 7%. However, in Circular A-4, released September 2003, OMB
recommends that two estimates be submitted, one calculated with a real discount rate of 7% and one calculated with a real discount rate of 3%” (Department of
Energy, 2017)
STANDARD OF PRACTICE

Change nothing, maintain the status quo. The State Bar may continue to operate the
Lawyer Assistance Program in the same manner as they have since the Attorney Diversion and
Assistance Act was passed in 2001 (California SB 479, 2001; Amended by California AB 1708,
2003). The program as it currently stands is afflicted with a great many flaws, but it continues to
serve hundreds of attorneys who are dealing with mental health and substance abuse issues.
When an individual does muster the strength to enter the program voluntarily or is mandated to
attend as an Alternative Discipline Program (ADP) requirement and completes the program,
there is a distinct value to all State Bar stakeholders. However, as one of the largest State Bars in
the nation, the low intake numbers and high expenses are not desirable.
The cost effectiveness of the services offered by the state bar is roughly $9,235 per
participant per year (plus fees and costs attributed to the participant) or $4,334 per person, per
year plus fees, depending on the method of calculation as described previously. Given that costs
borne by a participant are no less than $250 per month, these numbers are relatively high for the
minimal services provided (between $7,334 and $12,235 per year). Cost effectiveness for other
programs ranges from no less than roughly $342.70 per person, per year for non-profit The Other
Bar (California based), and $1,966 per person, per year for not-for-profit Florida Lawyers
Assistance, Inc. the official treatment organization for the Florida State Bar, though it operates
independently from the Florida Bar.
Expand services and marketing outreach. To heighten its efficacy, the State Bar must
reach more individuals. This necessarily requires aggressive marketing, comprehensive outreach
programs, and increased accessibility for program participants. As society evolves, the LAP
must follow suit by taking a determined approach to how they sell their product: confidential
treatment and support. Through marketing campaigns, the LAP needs to reach it chosen
STANDARD OF PRACTICE 137
demographic. However, these actions necessarily implicate higher budgetary needs. Marketing,
program planning and administration, and technology come with a hefty price tag.
Marketing must take place in the form most likely to reach the LAPs intended demographics.
More than ever, younger attorneys are at risk for mental health and substance abuse issues (el-
Guebaly et al., 2015; Rickwood et al., 2007); more to the point, younger attorneys will dominate
the profession for decades to come. Impressing upon the younger generations about the
accessibility, confidentiality, and general benefits of the LAP will aid those attorneys throughout
their long careers and hopefully reap benefits for decades to come. Generally, marketing to this
demographic—or, really, any demographic of the modern lawyer—requires the use of electronic
and social media platforms. Electronic mail, Facebook, LinkedIn, text message blasts, and other
online publications (including websites) are the best means to market the LAP.
At the December 2017 LAP Oversight Committee meeting, members were discussing,
with general excitement, the reformation of a paper brochure for the LAP. The general issue with
a paper brochure is that it is easily discarded, quickly out-of-date, and requires hand-to-hand or
U.S. Mail distribution. As if it were not complicated enough to get members of the Bar to seek
help, having to ask in-person for information on services in a likely public venue is even more
unlikely. Instead, providing marketing materials privately to attorneys where they can view them
without worrying about others finding out is precisely the method required to grow and expand
the program. Electronic marketing comes with a price-tag, however. The antiquated paper
brochure must be discarded, and resources dedicated to electronic marketing instead.
The second prong, outreach programming, needs to incentivize peer, judicial, and
organization referrals of attorneys dealing with mental health and substance abuse issues. The
first step to outreach is educating the membership not only in regards to how to identify the signs
STANDARD OF PRACTICE 138
of these struggles, but how to intervene to enable attorneys to feel free to get help. While there
are some meaningful and educational continuing legal education (CLE) programs available, not
all substance abuse prevention programs are created equal. Further to the point, attorneys may
not value the time spent in a seminar on the topic, or that they are required to take a course on the
subject as a result of Mandatory Continuing Legal Education Requirements (MCLE). When the
goal is to “get it done” instead of help yourself and your peers deal with a problem of epidemic
proportions, the point of the MCLE is lost.
Finally, increased accessibility requires the State Bar to undertake new means of delivering
its services. Namely, busy attorneys do not stop being busy when they have a mental health or
addiction issue. Instead, they grapple with another hurdle to success. Adding in-person meetings,
a long intake process, onerous ongoing commitments to the LAP as required, and a $250/month
fee makes the program as inaccessible as the circumstances allow. While the law may require
attorneys to pay for all or part of their treatment, laws can be reformed or fees lowered to a
negligible amount. There are also new advances in technology that allow for treatment to be
delivered through the internet or a mobile phone in a measurably successful way. The time and
pride barriers to treatment can be lowered, if not removed altogether, if treatment is delivered
privately, at the time and place of the participant’s choosing. However, like all else, deploying
these measures will require significant personnel and monetary resources the State Bar does not
seem to have currently.
Lower overhead, raise budget allocations and utilize reserve funding. Lowering
overhead, raising budget allocations, and utilizing reserve funding is the goal of every single
organization that operates with finite resources. However, was this always possible,
organizations would always do it. This option is more of an exercise in theory than it is practical.
STANDARD OF PRACTICE 139
Given the State Bar currently holds over $3.5 million in funds earmarked for the LAP (a
historic high for this program), and that rates of participation by attorneys are historically low,
budgeting issues may require scrutiny. Perhaps the most astounding figure is the amount of
personnel and administrative overhead spent by the State Bar on delivering the LAP. While the
program spending is low, the overhead spending is overwhelmingly high. In its 2018 Annual
Report and its accompanying consultant report by Krill Strategies, the State Bar recognizes that
many of its administrative processes need to be reformed. For example, during intake, counselors
are expected to cover over 21 pages of the intake form, with over 100 questions requiring
discussion. The sheer length and time consumption necessitated by this kind of procedure equate
to increased time and expense.
The State Bar LAP already struggles with funding and understaffing. Expanding services is
not an option. An LA Case manager position was eliminated and moved to San Francisco to
address “delays in serving clients in the Northern Part of the state” (see State Bar LAP Annual
Report, 2018, p. B-2). This issue presents in tandem with already extraordinarily high overhead
costs compared to expenses associated with the delivery of actual programming. In reality, the
LAP seems to be doing the best it can with the resources the State Bar has allocated. For
example, in 2016, the State Bar terminated the LAPs Director and assigned the LAP to the
Director of the State Bar’s Probation Department. Instead of paying two individuals to lead two
separate programs, the Bar cut costs by having one individual lead both
7
. This highly debated
decision certainly cut costs, but the impact of doing so remains in question as the current
director’s qualifications pale in comparison with the previous and raises questions discussed in

7
It should be noted that the Former LAP Director, Douglass Hull, was also the director of the
Mandatory Fee Arbitration Program.
STANDARD OF PRACTICE 140
other sections related to acting as a determent for attorneys to want to seek aid from the LAP.
Richard Carlton, the former Director of the LAP, came with over 25 years’ experience with
mental health in the legal profession, held a master’s degree in public health with a concentration
in treatment interventions and behavioral science research, and was a prolific speaker and
consultant dealing with lawyers, judges, and the courts. The now former director, Douglass Hull,
did not share these credentials, though he came with impressive leadership and management
experience within the organization, serving the State Bar since 1986 (with less than one year
away from June 1998 to April 1999 due to funding constraints). His replacement and current
director of the program, Michelle Harmon, served as Interim Director prior to Mr. Hull’s
departure and is a Licensed Clinical Social Worker (LCSW). The California State Bar has the
funding (both budgeted and reserve) to engage in loftier spending goals, especially with the
downsizing of what the organization has seen as redundancy in its management. Therefore, this
option would merely see the State Bar spending more to accomplish more widespread positive
outcomes on a larger scale.
Outsource the program to an independent agency, organization, or non-profit. There
are numerous options for outsourcing to both established and highly successful non-profits, and
private organizations. California is home to an independent non-profit organization which
provides support services for attorneys; the organization “The Other Bar,” has been in operation
since 1986. While The Other Bar historically received funding from the State Bar, it is now
entirely self-funded. Statistics on open cases, intakes and discharges are not available from the
organization, except for estimates of attorneys served being in excess of 600. The organization
reported income in the amount of $218,353 in 2016 (the earliest year in which figures are
available), and expenses totaling roughly $205,625 that same year.
STANDARD OF PRACTICE 141
The State of Florida’s official lawyer assistance program is provided independent from
the Florida State Bar. The Florida Lawyers Assistance, Inc. (“FLA”) is a not for profit
organization that claimed income totaling $735,469 and expenses of $743,803 as of June 30,
2017. In its latest published annual report, in 2015 FLA did intakes for over 500 inquiries,
resulting in 184 new cases; the organization also reported an active caseload of 364. FLA
claimed expenses of $715,621, and an income of $724,364.
The best way to measure the benefit of this alternative is to outline a cost-effectiveness
model on a per-participant basis. Unlike cost-benefit analysis, cost-effectiveness is comparative
and will enable an evaluation across multiple different options (Levin et al., 2018). Here, the
comparison will be between the California Bar’s LAP, The Other Bar, and Florida Lawyers
Assistance, Inc.
Table 11
Cost Effectiveness of Three Programs
COST EFFECTIVENESS OF LAWYER ASSISTANCE PROGRAMS
NAME RELATION TO
STATE BAR
STATUS EXPENSES OPEN
CASES
COST-
EFFECTIVENESS
(PER PERSON)
California Bar –
LAP
Associated Government $1,200,600 277 $4,334
The Other Bar
(CA)
Not Associated Non-Profit $205,625 600+ <$343
Florida Lawyers
Assistance, Inc.
Independent Not-For-Profit $715,621 364 $1,966

As illustrated in Table 11, the least desirable cost effectiveness value was clearly the
California Bar’s LAP, with a cost effectiveness of $4,334. This figure is the best-case-scenario,
as the CE is likely higher given the vagueness of California’s statistical reporting, which could
render the CE as high as $9,325, or between $7,334 and $12,235 per year if participant borne
costs are added. The best cost effectiveness is The Other Bar with a CE of <$343. It is of note
STANDARD OF PRACTICE 142
that the closest program of the same type as the California LAP is Florida Lawyers Assistance,
Inc., which has a CE of $1,966, which is less than half that of California; FLA also charges its
participants fees, but those fees were unavailable at the time of publication.
It is worth noting that this option comes with a high political cost. Changing the current
practices of the State Bar is not only difficult but may not be possible, especially if the change
was adopted without a transition period. There would be pushback from the State Bar, the LAP,
and “old guard” members who are accustomed to doing things “the way they have always been
done.” This option is riddled with issues regarding how to handle removing one long-standing
administrative bureaucracy to replace it with another that would develop and administer the
program that provides oversight. Option D would also require that most (if not all) current
employees be terminated from their current position, which may, itself, turn into a political
problem for the adoption of this alternative. This option also impacts current program
participants who have gone through intake, processing, and have adhered to program policies
and procedures. Changing the treatment provider in the middle of treatment may not yield
beneficial outcomes for this group of individuals.
Best Economic Choice for the State Bar
There is a clear choice that will render the best results for the LAP, though it is the most
drastic. Option D calls for the disbanding of the State Bar’s LAP and instead opts for either the
formation of an independent pseudo-governmental non-profit (or not-for-profit, like the FLA) or
the full funding and support of a non-associated non-profit, like The Other Bar (or an Attorney
Association). The choice reflects the need for change as clearly set forth by the California State
Auditor, the lack of institutional controls to manage the budget and the program, and the
complete lack of efficacy of the LAP and its programming including marketing, outreach,
STANDARD OF PRACTICE 143
service, and administration. Table 10, supra, provides clarity to this decision by outlining each of
the four choices, summarizing a complete cost-benefit analysis.
There are considerable opportunity costs that would occur if Option D were not chosen.
Foremost is the budgetary issue; the State Bar continues to reap considerable benefit from the
LAP Reserve Fund, which certainly bears interest. The ability to use those Reserve Funds, not
only in part but to reap the benefit of the interest accruing would enable the delivery of more
resources directly to participants (for whom the program is intended to benefit) through grant
money to service providers.
As discussed, Option D is not without substantial drawbacks, but most of those issues are
short-term problems that will dissipate over time. With low actual costs, a measurably greater
direct delivery of services to participants, and a far-lower cost-effectiveness rating in comparison
to the other options, Option D would likely deliver the most significant benefit not only to
lawyer participants in the LAP but to the organization itself. Option D advocates for the position
that the State Bar should focus on regulating lawyers, and mental health professionals and
substance abuse counselors should take the reins from the LAP to provide treatment in the fields
of their specialties.
Conclusion
This problem can be addressed, but only if the State Bar and its LAP are willing to look
inward at their flaws and become prepared to manage them adequately. Attorneys and the State
Bar are attracted to tradition and historical underpinnings. To adopt any of the changes
recommended, it will need new visionaries who can redevelop this program; the LAP is a
genuinely altruistic organization that needs to do better for itself in order to maximize its
potential. Models certainly exist both locally and nationally that the LAP should be striving to
STANDARD OF PRACTICE 144
duplicate. Should the State Bar deem severance of the LAP not a viable option, it should look to
take steps to streamline its systems and processes, reform its service offerings, market the
program vociferously and efficaciously, heighten accessibility, and take control of their budget
and spending.
Education to Fulfill the Mission of the State Bar
This dissertation revolved around the issue of education. As is the case with most
substance abuse or mental health issues, those who present with either heightened risk or
diagnosis of these quality of life issues face a two-fold educational issue: lack of personal
acceptance, and lack of public acceptance. The research presented reflected that societal and
professional influences drive attorneys to hide or deny their quality of life issues which further
compounds any problems they may present. Further to the point, given the wealth of literature on
addiction and mental health issues, it is suspected that the State Bar, its Lawyer Assistance
Program, attorneys, and the general public lack useful knowledge of the epidemic levels of
pervasiveness that these quality of life issues present to their attorney membership and the public
the State Bar aims to protect. This study was an in-depth inquiry into the knowledge, perception,
and motivation of the legal profession’s stakeholders, and what can be done to educate the
profession and public to overcome or normalize quality of life issues so they can be addressed in
a meaningful manner by the State Bar and its attorney membership. The takeaways in the field of
education were as follows:
1. Continuing Legal Education courses can be an impactful and cognitively opportune
program if appropriately structured;
2. Attorneys require education regarding how to identify (both in themselves and their
peers) the signs and symptoms of quality of life issues;
STANDARD OF PRACTICE 145
3. Attorneys should be trained on proper intervention techniques to promote self-help
for both themselves and their peers;
4. Stress hardiness training must be delivered starting in law school and regularly
throughout an attorney’s career;
5. The culture of denial and the symptoms underlying many of these quality of life
issues can be prevented, or those in need of help feel culturally confident in admitting
they have an issue or need and want treatment if the public and profession are
targeted with health promotion marketing; and
6. As will be discussed in the next section, mandating annual lawyer counseling, while
not politically popular would present cultural, educational, and barrier-breaking
education that could change the outlook of the profession and the quality of life
epidemic from which it suffers.
Mandated Annual Counseling
The profession would resist with every ounce of passion possible the idea of forcing
members to receive one therapy session every year. Obviously, there is a political problem not
only in forcing attorneys to possibly “go through the motions” of attending counseling when they
do not wish to do so on their own, but there exists a problem in forcing anybody to do anything.
Seatbelts save lives, but people are resistant to being told to do so. But, therein lies the problem:
attorneys are so resistant to being ordered to do anything as a normative practice of the
profession—appellate courts, motions for reconsideration, counter-offers, and adversarial
practice—that the mere thought of one hour of therapy every year seems overly burdensome.
However, the yield of that one hour of therapy may be immeasurable. If just one percent of
attorneys nationally felt less stigmatized because “everybody is (has to) do it,” and continues to
STANDARD OF PRACTICE 146
see a therapist, or at least realizes something may not be right, then the profession can help no
less than 13,386 attorneys every year (ABA, 2018). Eradicating the overwhelming stigma
associated with help seeking attitudes and admissions that all is not perfect as it relates to quality
of life can only be achieved by shocking the cultural attitudes and actions of the members of the
profession. When children respond to the anger of their parents about a misstep with “everybody
is doing it,” the fact that everybody else is doing it makes it easier to do and more acceptable in
the minds of the person doing it.
Alternatives to mandatory counseling.
One alternative for State Bars is to incentivize and monetize healthy behaviors as far as
quality of life is concerned. State Bars can offer rewards or incentives for attorneys who engage
in mental health counseling instead of requiring it. These incentives can incorporate reductions in
State Bar dues, access to CLE materials to satisfy licensing requirements, waiver of the
substance abuse and mental health CLE, or other such rewarding of self-help behaviors that help
ensure a positive quality of life in the profession.
Another alternative is to change the structure or format of the already mandatory (in most
states) CLE on quality of life issues like substance abuse and mental health. These sessions
should be in-person and require self-reflection and metacognition as part of these learning
experiences. Furthermore, requiring these classes take place in person may result in a more
impactful educational opportunities than those who place an online class on “play” and walk
away or pay no attention to the lecture in order to merely fulfill their CLE requirements. As one
participant stated: “making it an in-person requirement is really the only way to actually get us to
listen and consider [quality of life issues] in large numbers.” Furthermore, these environments
STANDARD OF PRACTICE 147
would allow for a more acutely personal connection to a presenter to occur. This study evidenced
that personal connections are likely to lead to self-awareness and help-seeking behaviors.
Finally, local and state bar associations should engage in open discussions regarding the
quality of life issues outlined in this study. Where bar association leaders discuss mental health,
substance abuse and attrition issues openly, the rest of the bar may follow. Cultural change must
begin with bar association leaders who are comfortable enough to share their personal
experiences, willingness to entertain treatment options, and admit that those who feel the same
way are not alone. To ensure the Abilene Paradox does not persist, letting attorneys know that
they can admit they may be in danger of unhealthy practices because a full one-third of their
peers are in the same scenario. If the profession engages in open discussion and admission that
those who suffer from a quality of life issue are not alone, the culture will have a greater
propensity to shift from silence and denial, to metacognition and acceptance.
Stress-Hardiness Training
The fact that some people are built psychologically to handle the extraordinary
constitution necessary to be a lawyer plays into not only the need to seek assistance from a third-
party but also self-awareness generally when quality of life issues affect a member of the
profession. Recent research by Pierson, Hamilton, Pepper, and Root (2017) found that while
stress hardiness is undoubtedly teachable, there is only hope for the future instead of action in the
present when it comes to law schools and the profession teaching skills necessary to become
more stress hardy. Respondents in both phases of the study noted that stress and anxiety
contributed to quality of life issues, and needed to be addressed by the profession and its
practitioners. While, as some respondents noted, it may be a “fact of life” that attorneys will
experience stress triggering events throughout their careers, lawyers should be trained to manage
STANDARD OF PRACTICE 148
and form approaches and responses to these stressors enabling them to have “a combination of
attitudes that enhance performance, health, and mood despite stressful circumstances” (Pierson et
al., 2017, p. 22; Maddi et al., 2006).
Marketing and Public Outreach
The State Bar and its LAP must not only target attorneys with information and training
regarding quality of life issues, their treatment, and LAP resources available, but the general
public needs to become aware of these problems and assist in ushering in change and acceptance.
Not only were most attorneys in the study woefully unaware of the services and offerings of the
State Bar and its LAP, but they are unaware who among them are experiencing quality of life
issues. One of the most effective ways to ensure program utilization is to receive a referral to the
program by a peer. This means that attorneys need to receive information, training, and job aids
to help them attack this important issue face-on, and recognize the signs and symptoms of an
issue surrounding quality of life. This will take dramatic marketing efforts through a number of
traditional (CLE’s, mailings, bar journals/publications) and non-traditional (email, social media,
etc.) mediums to ensure effective and ongoing learning takes place.
Finally, the public needs to become aware of the issue in order to remove the barriers to
self-reporting, self-help seeking attitudes, and the cultural norms within and without the practice
of law. Society needs to demand the profession address these quality of life issues in order for
the leadership at both the State Bar and the government of the state to take action. These issues
may be more prevalent in the legal profession than elsewhere, but the problems still exist
throughout all cross-sections of society. Education through marketing and outreach will bring the
profession closer to acceptance of the problem, addressing the symptoms and causes, and
enabling self-help.
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Restructuring State Bars and their LAPs to Heighten Efficacy and Attorney Relations
The study showed the need to address issues surrounding attorney professionalism, and
the relationships professionals have with each other and the State Bar. The conduct of attorneys
in the legal forum cannot support quality of life without rigorous educational endeavors (as
described in previous sections) aimed at reforming and redefining professional culture and the
practice of law. As one study participant defiantly stated, “…it’s pathetic because we’ve known
about this for years and nothing has changed.” That change must commence immediately. The
State Bar must employ job aids aimed at retraining and reforming current practitioners, and
ensure that law students are programmed to maintain high levels of professionalism, even in the
face of the current standard of practice. However, education is not enough on its own; regular
reinforcement and regulation of these expectations must take place to ensure that lawyers put
into practice the training and are held accountable for their conduct. Unless the profession
subjects itself to this arduous undertaking, then much of the underlying symptoms of quality of
life issues not only can but should be expected to continue unchecked. One of the more
surprising results from this study supports this recommendation.
Realigning the State Bar Lawyer Assistance Program
This section discusses two different issues regarding the form and function of the State
Bar and its LAP. Not only do lawyers have an overly adversarial relationship with each other,
but this study also revealed that there is an adversarial relationship between the State Bar and its
members. The structure of LAPs needs to be assessed on a state-by-state basis to ensure both
management and function of the program provide a more efficacious suite of services and adhere
to lawyer needs and expectations. These recommendations will be discussed in turn.
STANDARD OF PRACTICE 150
Attrition and burnout services and resources. If not already present, LAPs need to
add services to address the widespread attrition and burnout being experienced by more than half
of the attorneys nationwide. Study participants responded that attrition and burnout were, by far,
the most experienced phenomenon associated with the legal profession; attorneys seem generally
discontent with their choice of profession. While most LAPs generally offer services associated
with mental health and substance abuse, more must be done to address the third major quality of
life issue, and this change needs to occur immediately. This recommendation will take an effort
on the part of both the State Bar and their LAPs to ensure proper services and resources are made
available to deal with both the underlying problems that give rise to attrition and the symptoms
they create that drive attorneys into substance abuse or the experiencing of mental health
problems and an exodus from the profession itself.
Aligning mission and message. State Bars focus, as they should, on attorney regulation
and consumer protection. However, the mission to regulate and protect presents a grand problem
for the organization’s members: who is protecting attorney interests? It has been lamented that
attorneys “pay dues to sanction themselves.” Indeed, the California State Bar’s mission is “to
protect the public and includes the primary functions of licensing, regulation and discipline of
attorneys; the advancement of the ethical and competent practice of law; and support of efforts
for greater access to, and inclusion in, the legal system” (Cal. Bar, 2018). Missing from that
mission is any mention of what lawyers receive as a benefit, beyond the right to practice law in
the State. Indeed, California is not alone, as each of the other five states promotes a similar
mission statement, albeit some with a more favorable disposition to attorneys, like Washington
State, who mention service to attorneys.
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However, California has engaged in admirable organizational change and innovation with
the severance of its “practice sections” and formation of the California Lawyer’s Association
(CLA). The CLA provides what should become the model for mandatory bar associations across
the country. Formed in January 2018, the CLA boasts a mission statement that seems to present
an opportunity for addressing the relationship of distrust between attorneys and State Bar. The
CLA’s mission is to “Promoting excellence, diversity, and inclusion in the legal profession and
fairness in the administration of justice and the rule of law” (CLA, 2018). The CLA, goes
further, by clarifying that it “is a member-driven, mission-focused organization dedicated to the
professional advancement of attorneys practicing in the state of California.” The juxtaposition of
these two organizations offers a fresh perspective on delivering to all stakeholders meaningful
services and programming. It is in this light that the recommendation is, therefore, that the CLA
Figure 7. Mission Statements of the California State Bar and the California Attorney
Association.

STANDARD OF PRACTICE 152
assume operation of the State’s LAP. The CLA can and should be able to operate independently,
under the auspices of the State Bar, fulfilling statutory and regulatory requirements set forth by
the State’s government. The cost of operations would mirror that of the State Bar and would
address many of the requirements suggested for the form and management of the LAP. Given
the results of this study, any increase in program administration costs would be offset by both
attorney willingness to pay more bar dues to ensure the LAP can serve its purpose, and fulfill the
demands of legal professionals to have suitably qualified staff, with suitable service offerings.
The recommendation is that State Bars need to follow the lead of California and adopt separate
but interdependent associations like the CLA. State Lawyers Associations are a simple solution
with immense benefits that reconcile the shortcomings currently of the economic and
administrative models currently in use.
Managing a proper program. As discussed in Chapter Four, attorneys overwhelmingly
agreed that they would be less likely to utilize the lawyer assistance program if:
- the management was the same as the regulation and discipline committee
(81.59%); and
- the program offices were in the same building as the State Bar (74.62%).
Participants also generally agreed that they would be more likely to utilize the LAP if:
- The program’s manager had expertise in substance abuse and mental health
treatment (72.45%); and
- If the program’s offices were in a different building than the State Bar
(63.44%).
Thus, the recommendations for management and location of the State Bar is clear: the program
must, AT the least, be located in a building separate and distinct from the State Bar, and
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managed by a mental health and substance abuse treatment professional who has no connection
to the regulatory and discipline arms of the State Bar.
Young attorney representation on LAP committees. Finally, because quality of life
issues are experienced by the more youthful attorney demographic (el-Guebaly et al., 2015;
Rickwood et al., 2007), it is essential that any administrative, oversight, or organizational
committee that deal with the LAP feature younger attorney representation. It is important to have
the ideas and insight of, and connection to young attorneys who understand how to reach
younger attorneys more efficaciously and on their peers’ terms. As technology advances and
society changes, the needs and methods of outreach must mirror the younger generation’s
cultural expectations. Representation on boards and committees that oversee these issues must
reflect the demographic experiencing the problems the organization seeks to address.
Integrated Implementation and Evaluation Plan
Implementation and Evaluation Framework
The New World Kirkpatrick Model will serve as the organizational outline for the
recommendations that follow. The Kirkpatrick Model focuses on defining results in a way that
can be measured (Kirkpatrick & Kirkpatrick, 2016b). Moreover, change managers are better
served by developing a model before the creation of a program because it offers a more
streamlined and clear route to success for the organization (Kirkpatrick & Kirkpatrick, 2016a).
This increased efficacy will enable the organization to change with greater ease, present a clear
plan for success, and a reference for every step of the change process. For these reasons, the
recommendations in this Chapter will adhere to the Kirkpatrick Model.
The system requires an inversion of the Model’s pyramid and starting with Level 4
results, and working towards Level 1 Reaction (Kirkpatrick & Kirkpatrick, 2016b). The top
STANDARD OF PRACTICE 154
level, “Results” defines targeted program outcomes and how those outcomes impact the highest
level results for the change program. Level 3 “Behavior” studies the way members of the
organization apply the principles they need to learn and apply to make the initiative a success.
Levels 2 and 1 “Learning,” and “Reaction” outline the extent to which the members of the
organization obtain “knowledge, skills, attitude, confidence, and commitment” (Kirkpatrick,
2016a, p. 39) based upon training initiatives and the buy-in from those employees to the training
itself.
Organizational Purpose, Need, and Expectations
State Bar Associations are tasked, nearly unanimously, with attorney licensing and
regulation, as well as consumer protection. In contrast, the mission of Lawyer Assistance
Programs is to provide support and resources for lawyers who are experiencing substance abuse
and mental health issues. While these two entities seemingly have different charges, the
outcomes can be the same: protect the public and ensure high standards of practice by addressing
problem-causing quality of life issues. As a result, the stakeholder goal of this study is threefold:

1. Attorney members of the State Bar will have utilized the Lawyer Assistance
Programs services at a 5% greater rate when compared to the previous calendar
year as measured through State Bar assessments and released statistics;

2. The State Bar will undertake critical assessments of its current policies and
procedures about programming, education and intervention techniques; and

3. Public awareness of the quality of life issues facing attorneys will be heightened
through a series of public relations and marketing programs aimed not only at
educating the public but providing resources and outreach to clients to ensure the
public is protected, and attorneys feel empowered to seek assistance without
worrying about public perception.

These goals were selected because they are simple, achievable, and allow for
generalization across all jurisdictions in this field-based study. In accordance with Kirkpatrick
and Kirkpatrick’s New World Model, the organization will need more than quantitative data; it is
STANDARD OF PRACTICE 155
necessary to look to qualitative information and metrics to evaluate programs critical to the
mission and goal of the organization (Kirkpatrick & Kirkpatrick, 2016a). Using this data to
measure progress enables the organization to adapt to changing circumstances and ensure more
significant opportunities for success. Thus, to build a meaningful mission, the Kirkpatrick model
requires starting at the end: Level 4 Results.
Level 4: Results and Leading Indicators
Where the goals and outcomes for the study stakeholders were created in an effort to be
simple and measurable, the metrics and methods for both the external and internal outcomes
adhere to the purpose underlying their creation. The three outcomes listed in Table 12 track the
three stakeholder goals of the study, keeping in mind the fact that the recommendations resulting
from this study may exceed those set forth in this section. As such, these outcomes, metrics, and
methods are this study’s minimum baseline recommendations. Further recommendations will be
addressed following the discussion of the Kirkpatrick New World Model’s four levels.
The sole external outcome--to increase public awareness and perception of the quality of
life issues from which attorneys may suffer aids to increase not only the recognition of these
problems in furtherance of consumer protection aims but decreases stigma within the profession
itself. The State Bar will need to utilize a multi-medium marketing strategy, utilizing pre-existing
avenues such as social media, mailings, public disclosures, and its website, as well as looking
into commercial advertisement and public notices.
The first of two internal outcomes, increasing attorney utilization of LAP and State Bar
quality of life services is at the heart of this study. Where the quality of life epidemic is raging,
the underlying issues to self-help, need to be addressed in order to achieve this goal. Lowering
stigma, increasing self-efficacy, changing the form and function of LAPs, enabling access, and
STANDARD OF PRACTICE 156
ameliorating attorney-State Bar relations are all issues that need to be addressed to achieve
increased service utilization. This outcome can be measured through detailed statistic-keeping
practices and reporting.
The final internal outcome of State Bar introspection requires critical analysis of program
and resource offerings by the State Bar and service providers to achieve a higher level of
program-based efficacy and lawyer utilization. The metric by which this outcome can be
measured is self-reporting and strategic self-study by the organization itself. It is crucial that the
organization continually review its practices and procedures, ensuring they are constantly
evolving to serve its target demographic: attorneys. By undertaking either an internal audit or
utilizing external consultant services, the State Bar and its LAP can achieve its goals and evolve
with a changing culture of professional practice. Both of these practices must necessarily occur
simultaneously; attorneys must want to access resources and the resources must be available.
Table 12
Outcomes, Metrics, and Methods for External and Internal Outcomes
Outcome Metric(s) Method(s)
External Outcomes
Increase public awareness and
community perception of
attorney quality of life issues.
Marketing materials are distributed to the public
through multiple mediums, with some seeking
interaction and feedback from the target
constituency.
Marketing and public
relations outreach by the
State Bar.
Internal Outcomes
Increase attorney utilization of
LAP resources and services.
Number of attorneys both inquiring about
services and enrolling.
Data-keeping programs and
statistical analysis of attorney
utilization of the LAP.
State Bar and LAP managers
engage in metacognitive
practice in regular intervals.
Self-reporting and official discussion of the
self-assessment.
Either internal auditing or
consultant-based external
auditing occurs.

Level 3: Behavior
Critical behaviors. In order to achieve the Level 4 Results, there are numerous
behaviors that must be adopted by the three stakeholder demographics (Kirkpatrick &
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Kirkpatrick, 2016b). Five critical behaviors, as defined in Table 13, will enable the organization
to measure its movement towards achieving the stakeholder goals. These five critical behaviors
are measurable and address stakeholder buy-in and self-efficacy. Three of the critical behaviors
address not only information-seeking conduct but attorney action, all of which are self-help (or
self-help enabling) practices. The remaining two critical behaviors reflect, yet again,
metacognition and cultural acceptance of program features and attorney quality of life.
Table 13
Critical Behaviors, Metrics, Methods, and Timing for Evaluation
Critical Behavior Metric(s)
Method(s)
Timing
1. Attorneys request more information on
LAP services and resources (information
seeking).
Increased statistical figures
year-over-year.
State Bar and LAP
reporting of
statistics.
Annually
2. Attorneys seek to utilize resources related
to quality of life from the State Bar and its
LAP (action-taking).
Increased statistical figures
year-over-year.
State Bar and LAP
reporting of
statistics.
Annually
3. The public becomes more knowledgeable
about attorney quality of life issues and
their causes, leading to enhanced
understanding and acceptance of them.
Viewership statistics and
interaction data.
Statistical
reporting and
metrics.
Quarterly
4. State Bar undertakes a critical self-study
of the efficacy of services and
programming.

Repetitive engagement and
reporting practices that
illustrate self-analysis and
metacognition.
State Bar and LAP
internal reporting.
Monthly
5. Attorneys initiate increased referrals of
their peers to the LAP.
Increased statistical figures
year-over-year.
State Bar and LAP
reporting of
statistics.
Annually

Required drivers. The critical behaviors recommended to accomplish the stakeholder
goals required specific systems and drivers to ensure success. As described in Table 14, there are
four types of required drivers that support and enhance critical behaviors: reinforcing,
encouraging, rewarding, and monitoring (Kirkpatrick & Kirkpatrick, 2016b). The timing of the
individual methods vary but must be maintained continuously until the stakeholder goals, and
Level 4 results are achieved. Each of the four methodological areas is intended to further the
potential for adaptation of stakeholders’ critical behaviors. In essence, each driver is intended to
STANDARD OF PRACTICE 158
support the intended critical behaviors, which further the Level 3 Behaviors as set forth by
Kirkpatrick and Kirkpatrick (2016b).
Table 14
Required Drivers to Support Critical Behaviors

Method(s) Timing
Critical
Behaviors
Supported
Reinforcing

The State Bar and/or LAP offer greater ease of access to
resources for attorneys.
Ongoing 1, 2, 5
The State Bar LAP streamlines contact and intake procedures
emphasizing confidentiality.
Ongoing 2
The State Bar conducts regular outreach to attorneys through
information blasts and communication efforts regarding
resources and programming.
Ongoing 1, 2, 5
The State Bar markets the LAP to the public through
comprehensive media campaigns.
Ongoing 3
Culture-changing focused educational opportunities for
members of the bar and public regarding quality of life
issues.
Ongoing 1, 2, 3, 4, 5
Encouraging

The State Bar LAP staff and volunteers meet monthly to
assess organizational efficacy and goals.
Monthly 4
The LAP must utilize marketing campaigns (targeting both
the public and the profession) about quality of life issues.
Ongoing 1, 2, 3, 4, 5
The LAP must coach attorneys to recognize and take action
to encourage self-help practices.
Ongoing 1, 2, 5
Rewarding

The State Bar offers private thank you’s for referrals to its
LAP from attorneys.
As needed -
Ongoing
1, 2, 4, 5
The State Bar includes the public in service and marketing
planning and promotions.
Ongoing 1, 2, 3, 4, 5
The State Bar LAP acknowledges program and goal
successes and movements toward overcoming barriers.
Quarterly 1, 2, 3, 4, 5
Monitoring

The LAP and State Bar enhance public reporting policies
with an emphasis on LAP statistics and metrics.
Quarterly 3, 4
The State Bar is more transparent with their budget and
ensures greater public and member access to records.
Ongoing 1, 2, 3, 4, 5
The LAP engages in self-assessment and monitoring systems
including internal meetings and work review.
Ongoing 4
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Organizational support. The State Bar and LAP are at the center of this change
initiative and gap analysis. As such, the organization must necessarily support the stakeholders’
critical behaviors. To do this, the organization needs to be self-critical in its analysis of progress
and shortcomings, offer transparency to all stakeholders by reporting statistics, metrics, actions
taken, and self-studies as described in Levels 4 and 3. The purpose of the organizational support
should be to ensure the greatest level of buy-in and application of skills and behaviors necessary
to achieve the organizational change goals. As emphasized by Kirkpatrick and Kirkpatrick
(2016a), “Level 3 is the most important level to not only evaluate but also invest in [sic] for any
important program” (Kirkpatrick & Kirkpatrick, 2016a, p. 39). Thus, each step of Level 3
requires the State Bar pay particular attention to ensuring the necessary behaviors are supported
and enabled.
Level 2: Learning
The Level 2 learning goals recommended to bridge the gap identified in Chapter Four are
important to ensure that the stakeholders are not only given the opportunity to gain the
knowledge and motivation necessary, but that they actually acquire these items based upon their
participation in training and outreach undertakings by the organization (Kirkpatrick &
Kirkpatrick, 2016b; Clark & Estes, 2002). Here, learning skills, practicing those skills, and
having the confidence to apply this knowledge are given equal weight in any program
introduced. Confidence and commitment to the change program are enhanced as a result of
introducing a comprehensive plan for skill utilization and education. A well-rounded program
takes these elements into account and helps ensure a greater level of success for the given change
initiative.
STANDARD OF PRACTICE 160
Learning goals. The three stakeholder groups must necessarily work in tandem to
achieve positive movement towards narrowing the gaps asserted in this study. The learning goals
of the public revolve around learning that a problem exists and moving towards acceptance of
attorneys who may be experiencing them. The organization must remove barriers to attorneys
seeking treatment, conduct outreach programs, and address administrative issues including cost,
confidentiality, service offerings, and association with the State Bar. Finally, attorneys need to be
able to identify quality of life problems in themselves and their peers, feel empowered to seek
the assistance of third parties (including LAPs), and engage in metacognitive reflection.
Program. Given the multiple angles from which the issues revealed in this study must
be addressed and the differences between all stakeholders, the program must be delivered
continuously over an extended period of time. The program will be multifaceted, and feature
education through marketing programs, job aids and training of attorneys not only to recognize
quality of life issues in themselves and others, but how to intervene and support themselves and
their peers, and reorganization of the program administration. It is important to note that the aim
of much of this program is not only the re-education and reprogramming of attorneys, but to shift
lawyer culture; as a result, any program employed must necessarily be consistent, ongoing, and
long-term. Furthermore, the program must be delivered in a method that protects confidentiality,
is delivered on mediums best positioned to reach the target stakeholder groups, and can affect the
most significant level of impact given economic constraints and needs.
Evaluation of the components of learning. Table 15, below, presents evaluative
milestones and concepts to enable the stakeholder organization to understand the successes and
failures of any programming it utilizes to narrow the gap identified in this study. These methods
and activities are outlined with the purpose of being adaptable by any number of different types
STANDARD OF PRACTICE 161
of Lawyer Assistance Programs, and keep in mind different levels of funding and sizes of
programs. The timing at which evaluation takes place reflects not only standards of practice but
takes into account the organizational needs of the State Bar and manpower required for the
undertaking.
Table 15
Evaluation of the Components of Learning for the Program.
Method(s) or Activity(ies) Timing
Declarative Knowledge “I know it.”

Regular surveys and assessments about specific program offerings Yearly with Attorney
Licensing Renewal
Procedural Skills “I can do it right now.”

Attorneys know how to engage with their LAP and State Bar
regarding quality of life issues.
Yearly (or with Attorney
CLE Reporting)
Attitude “I believe this is worthwhile.”

Attorneys utilize the LAP at greater levels. Quarterly
Attorneys engage with the resources available to them and their
peers through inquiry, attendance at CLE’s and conversation with
other legal professionals.
Yearly Reporting with
License Renewal and CLE
Reporting
Confidence “I think I can do it on the job.”

Attorneys refer their peers to the LAP for treatment of suspected
quality of life issues.
Quarterly
Attorneys self-reflect and self-diagnose themselves with quality of
life issues.
Yearly Reporting with
License Renewal
Commitment “I will do it on the job.”

Law firms and other legal employers provide greater opportunities
for lawyer metacognition including time-off, mental health days,
and training revolving around quality of life.
Yearly Reporting with
License Renewal
Attorneys demand greater levels of support and programming or
resources from their employers to deal with quality of life issues.
Yearly Reporting with
License Renewal

Level 1: Reaction
Level 1 Reaction refers specifically to what the organization’s stakeholders believe with
respect to the change initiative. The program must be meaningful and valuable to participants.
The other need is stakeholder engagement to ensure the learning that takes place in Level 2 is
maximized. The Kirkpatrick Model emphasizes three categorical methods or tools: engagement,
STANDARD OF PRACTICE 162
relevance, and customer satisfaction. Table 16 contains an outline of these three categories, with
an emphasis on measuring reaction to the program, and contains the suggested timing for
undertaking these measures.
Table 16
Components to Measure Reactions to the Program.
Methods or Tools Timing
Engagement

Engagement Metrics (Web Analytics) with Online Marketing Monthly
Attorney Enrollment Statistics in a LAP Quarterly
Attorney Peer Referrals to a LAP (Statistics) Quarterly
Relevance

Law firms and other legal employers ask for resources from the LAP
and/or utilize job aids aimed at addressing quality of life issues in their
organization.
Biannually
Survey regarding attorney/professional culture. Annually (with
license renewal)
Customer Satisfaction

Attorney Enrollment and Retention in a LAP Quarterly
Survey of attorney attitudes towards the State Bar and its programs. Annually (with
license renewal)
Cost-Effectiveness Analysis of Programming Annually
Attorney workplace meetings and check-ins regarding the current status of
attorney quality of life, needs, and general well-being
Monthly

Evaluation Tools
The evaluation should be delayed for a period after the program implementation initially
occurs to allow organizational change and policies to take effect. Following at least six months
after implementation of the four Kirkpatrick levels, evaluation must be undertaken to not only
ensure the efficacy of the recommendations but that their introduction is well-received and
embraced. Appendix E reflects an evaluation instrument for the State Bar and its LAP for both
Level 1 (engagement, relevance, customer satisfaction) and Level 2 (declarative knowledge,
procedural skills, attitude, confidence, commitment) that was outlined above. All of the
STANDARD OF PRACTICE 163
recommendations are mostly binary and quantitative in nature. These programs can be measured
in either “it has been done (or not done)” or “utilization or reach of the programming has risen
according to reported statistics.”
Data Analysis and Reporting
After assessment is done, it is important that the State Bar (or whatever organization is
administering the LAP) make a yearly report of the efficacy of the program. Public awareness
and attorney access to these reports are important to not only normalize quality of life
experiences but to ensure the management and resources of the program meet the needs of its
target population. Therefore, State Bars should follow the lead of the California State Bar and
publish reports on the successes, and, perhaps more importantly, its shortcomings. Public
reporting and prominent posting of self-assessments and reports ensure the program is
continually improving itself and evolving with its attorney members. Problems can be addressed,
and attorneys will benefit from the knowledge that not only do these resources exist, but that
their membership and licensing fees are being utilized for a valuable purpose.
Summary
The New World Kirkpatrick Model assisted in the planning, implementation, and
evaluation of the preliminary recommendations for the State Bar and its LAP to optimize their
ability to achieve the identified stakeholder goal and the organizational goal. This framework is
not a one-size-fits-all solution to many of the shortcomings the results reveal, but it provides a
framework upon which each State Bar and its LAP should look to provide a skeletal model for
their unique programming needs. The sections that follow this framework build upon the
Kirkpatrick Model, and provide specific recommendations for the future based upon the results
in Chapter Four.
STANDARD OF PRACTICE 164
Future Research
This research study yielded many areas that necessitate further research and generally
provoked research questions and previously unstudied areas of interest for this researcher.
1. The most needed area of future research pertains to the relationship between the State Bar
and attorneys. Namely, inquiry should be undertaken to identify the gap between the
relationship of distrust between the organization and its members.
2. Though very much related to the first area, the second topic of future research revolves
around how to align the purpose of the State Bar and its identity. State Bar Associations
seem to have a mission to protect the public and regulate members of the profession
while trying to promote itself as an organization that cares for and supports its attorney
members. This study and the recommendations rendered therefrom tackled this subject,
but further research may be of assistance in expanding into further best practices.
3. While the instant research was designed to be generalizable, a nationwide study
supported by an organization with national reach, such as the American Bar Association
(ABA) or its Committee on Lawyer Assistance Programs (CoLAP), supported with
funding to promote participation and marketing efforts would further develop many of
the issues described in Chapters Four and Five. Further to the point, the ABA or similar
organization would garner the support and facilitation of mandatory State Bar
Associations across the country; the support may render a higher level of access to
association and program leaders, documentation, and membership lists.
4. Since the commencement of this study, the California Bar Association created the
California Lawyers Association, as described in this Chapter. Further study of the
potential of this new voluntary bar association may render more significant benefits to
STANDARD OF PRACTICE 165
both lawyers and the profession by assuming roles more fit for its mission than
mandatory bar associations.
5. Further study should be conducted regarding the efficacy of Mandatory Continuing Legal
Education requirements and courses, and how to formulate meaningful, education and job
aides for attorneys on an ongoing basis.
6. The gap between personal versus colleague identification of quality of life issues,
including an in-depth ethnographic study about neighbor syndrome.
7. Finally, research should be undertaken to evaluate the efficacy and implementation of
any solutions recommended in this study.
It should be noted that the profession, generally, has a practice of excluding speculation in court,
but welcoming it in opinion regarding practice. Thus, the future research offered herein is
related to this research study, though there are countless areas that would yield compelling
results to instruct progress in the future. To this end, the profession should adopt a more
research-based model for making suggestions for change. Much of the literature available in bar
journals, blogs, and industry publications offer statements—parading as fact—about where the
profession must proceed. Indeed, while many of these articles may well offer positive
suggestions and calls for change, there may be no data or support for the stated conclusions. The
legal profession must operate out of court the same way it does within. Evidence-based practice
should become the standard; attorneys are trained to expect no less.
Conclusion
Attorneys are the gatekeepers to the justice system and voices for those who are
oppressed. When the protectors of our constitution cannot protect themselves, the public and our
system of justice are in peril. To this point, substance abuse and mental health issues have a
STANDARD OF PRACTICE 166
crippling effect on the legal profession, placing nearly every stakeholder in danger of
competency problems. Because the quality of life epidemic is raging out of control, new,
creative measures must be employed. While the legal profession is based on tradition and highly
procedural practice, the status quo must be challenged. Organizational change initiatives need to
sweep through each State Bar, with a focus on either separating attorney-centric programs and
resources from the licensing entity or reforming the way attorneys think and feel about the
institution. This undertaking will require a constant evaluation of the knowledge, motivation, and
organization influences that drive stakeholder behavior, with an emphasis on the fulfillment of
the organizational goals.
The purpose of this study was to conduct a gap analysis to examine the knowledge,
motivation and organizational influences that interfere with the State Bar fulfilling its core values
and acts as a hindrance to Lawyer Assistance Programs achieving high levels of efficacy in the
delivering of services and enabling or attorney outreach. Failure to act swiftly will allow quality
of life issues to continue to spiral out of control and leave the public without protection in the
derivation of the mission of State Bar Associations, and, the highest priority delegated to these
entities by the government and its citizens. While there is no guarantee that any state, practice
area, or national state bar will take notice of this study, it is the hope that the importance of this
subject and the results are, on their own, a generally important subject that must be addressed.
Furthermore, education and intervention must begin early in a lawyer’s career and
continue regularly throughout. Law schools utilize tried-and-true methods of education aimed at
preparing students to think like lawyers, but students leave unprepared to deal with the realities
of professional practice, which includes work-life imbalances, high stress and anxiety, client
demands, and socio-cultural norms associated with being a legal practitioner. To this end,
STANDARD OF PRACTICE 167
attorneys, licensing organizations, and professional associations must be proactive and creative
when solving these critical issues, as they not only affect the attorneys within the profession but
the general public whom they serve. Mandating counseling, studying program administration and
delivery, and training attorneys through yearly job aids and programs to recognize, intervene,
and self-help is a positive start to addressing the issues inherent to the practice of law.
Reprogramming normative values and practices of the profession are weighty undertakings, but
necessary to ensure attorneys are happy and have fulfilling careers. In the Phase 2 narrative
survey, only 58.94% of respondents answered that they would, indeed, choose to be a lawyer if
they were given the opportunity to start over again. This statistic was telling about the general
discontent felt by practitioners.
The profession must give attorneys the tools to better themselves. This starts with
turning towards Prilleltensky’s (2015) SPEC model (strengths, prevention, empowerment, and
community conditions) to ensure all types of quality of life issues and causes are identified, and
both the symptoms and causes of them addressed. We must change our culture of shaming those
with these issues by enabling self-help and professional support services. State Bar Associations
must help attorneys help themselves, and, in exchange, provide the public with the advocates
they deserve and the professionals the justice system demands. Hopefully, this study is the start
of the attorney well-being revolution, and a positive step towards addressing the profession’s
quality of life epidemic.

STANDARD OF PRACTICE 168
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STANDARD OF PRACTICE 185
APPENDIX A
Phase One - Quantitative Survey

Start of Block: Informed Consent

Q1 The purpose of this study is to identify the knowledge, motivation, and organizational
barriers to utilization of State Bar and independent Lawyer Assistance Programs. All answers
you submit are confidential. You will not be required to identify yourself in any way, nor will
any information be collected about your name, specific location, or other data that would enable
individual survey responses to implicate any individual participant. You will not be compensated
for your participation in this survey. As such, you are giving responses freely and
voluntarily. You may ask that the principal investigator remove your responses from the study
at any time without fear of reprisal or retribution. However, because responses are confidential,
your individual responses may not be identifiable once a survey is submitted.
By clicking the button below, you acknowledge that your participation in the study is voluntary,
you are 18 years of age, and that you are aware that you may choose to terminate your
participation in the study at any time and for any reason.

This survey should take anywhere from 10-15 minutes or less. Please note that this survey will
be best displayed on a laptop or desktop computer. Some features may be less compatible for
use on a mobile device.
1) I consent, begin the study (1)
2) I do not consent, I do not wish to participate (2)

Skip To: End of Survey If Q1 = I do not consent, I do not wish to participate
End of Block: Informed Consent

Start of Block: Demographic Information

Q2 What is your year of birth?
1900 2000

Year of Birth ()

STANDARD OF PRACTICE 186
Q3 Choose one or more races that you consider yourself to be:
1) White (1)
2) Black or African American (2)
3) American Indian or Alaska Native (3)
4) Asian (4)
5) Native Hawaiian or Pacific Islander (5)
6) Latino/Hispanic (6)
7) Other (7) ________________________________________________
8) Decline to state (8)

Q4 What is your sex?
3) Male (1)
4) Female (2)
5) Decline to state (3)

Q5 Please indicate the answer that includes your entire household income in (previous year)
before taxes.
6) Less than $10,000 (1)
7) $10,000 to $19,999 (2)
8) $20,000 to $29,999 (3)
9) $30,000 to $39,999 (4)
10) $40,000 to $49,999 (5)
11) $50,000 to $59,999 (6)
12) $60,000 to $69,999 (7)
13) $70,000 to $79,999 (8)
14) $80,000 to $89,999 (9)
15) $90,000 to $99,999 (10)
16) $100,000 to $149,999 (11)
17) $150,000 or more (12)
18) Decline to state (13)

STANDARD OF PRACTICE 187
Q6 What is your current marital/relationship status?
19) Single/Never Married (8)
20) Married (1)
21) Widowed (2)
22) Divorced (3)
23) Separated (4)
24) Cohabitating (6)
25) Life Partner (7)
26) Decline to state (5)

Q7 In what year did you first commence practicing law?
________________________________________________________________

Q8 Your current status with your State Bar is as follows:
27) Active (1)
28) Inactive (2)
29) Suspended (3)
30) Member of the Judiciary (4)
31) Other (5) ________________________________________________

Display This Question:
If Q8 = Inactive
Or Q8 = Suspended

Q9 When was the last year you were an active member of your State's Bar?
________________________________________________________________

STANDARD OF PRACTICE 188
Q10 In which of the following states are you licensed to practice law?
9) California (1)
10) Florida (2)
11) Michigan (3)
12) New York (4)
13) South Carolina (5)
14) Washington State (6)
15) Other (7) ________________________________________________

Q11 Which statement(s) best describes your current employment status?
16) Working (paid employee) (1)
17) Working (self-employed) (2)
18) Not working (temporary layoff from a job) (3)
19) Not working (looking for work) (4)
20) Not working (retired) (5)
21) Not working (disabled) (6)
22) Not working (other) (7) ________________________________________________
23) Prefer not to answer (8)

Q12 Where are you employed?
24) Private Large Firm (1)
25) Private Medium Firm (2)
26) Private Small Firm (3)
27) Sole Practitioner (4)
28) In-house: corporation or for-profit institution (5)
29) In-house government, public, or nonprofit (6)
30) Judicial Chambers (7)
31) Other Law Practice Setting (8) ________________________________________________
32) College or Law School (9)
33) Other Setting (Not Law Practice) (10)
________________________________________________
34) Bar Administration or Lawyer Assistance Program (11)
35) Unemployed (12)
36) Decline to state (13)

STANDARD OF PRACTICE 189
Q13 What best describes your work position?
37) Manager / Managing Partner (1)
38) Partner (2)
39) Employee / Associate (3)
40) Academic (4)
41) Clerical (5)
42) Non-Legal (6)
43) Decline to state (7)

End of Block: Demographic Information

Start of Block: LAP Information

Q14
A lawyer assistance program is a program organized and run under the auspices of a state or
local bar association or independently, and is aimed at providing mental health and substance
abuse assistance resources to lawyers and their families.

Have you heard of the State Bar or other lawyer assistance program or related official treatment
program?
32) Yes (1)
33) No (2)

Display This Question:
If Q14 = Yes

Q15 How did you learn about the LAPs services? (Select all that apply.)
44) Your own research (1)
45) Continuing Legal Education Programming (2)
46) State Bar Association (3)
47) Lawyer Assistance Program Materials (4)
48) Local / County Bar Association (5)
49) Law Firm (6)
50) Colleague (7)
51) Law School (8)
52) Other (Please specify) (9) ________________________________________________

Display This Question:
If Q14 = Yes

STANDARD OF PRACTICE 190
Q16 When you first heard of the Lawyer Assistance Program, what did you believe to be its
purpose and/or mission? (Select all that apply.)
53) Assist lawyers with cases (1)
54) Provide legal research aid (2)
55) Provide mental health services (3)
56) Provide substance abuse services (4)
57) Oversee lawyer misconduct programs (5)
58) Career services / Career Counseling (6)
59) Other (Please specify) (7) ________________________________________________

Display This Question:
If Q14 = Yes

Q17 Have you ever utilized the lawyer assistance program?
34) Yes (28)
35) No (29)

Display This Question:
If Q14 = Yes

Q18 Have you ever recommended that a peer utilize the services provided by a lawyer assistance
program?
36) Yes (23)
37) No (24)

Display This Question:
If Q18 = No

Q19 What are some reasons you have not recommended that a peer utilize the services provided
by a lawyer assistance program?
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________

STANDARD OF PRACTICE 191
Display This Question:
If Q18 = Yes

Q20 What are some reasons you have recommended that a peer utilize the services provided by a
lawyer assistance program?
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________

End of Block: LAP Information

Start of Block: Program Features

Q21 If you had a mental health or substance abuse issue, what program features would make you
MORE likely to use the Lawyer Assistance Program? (Rank all that apply. 1= Most Important.
SELECT, DRAG & DROP)
______ Receiving Treatment (1)
______ Confidentiality (2)
______ Resources and Support (3)
______ Detailed Information on Treatment (4)
______ Physical and/or Bureaucratic Separation from the State Bar (5)
______ No or Low Cost (6)
______ Other (Please specify) (7)
⊗______ Nothing (8)

STANDARD OF PRACTICE 192
Q22 If you had a mental health or substance abuse issue, what would make you LESS likely to
use the Lawyer Assistance Program? (Rank all that apply. 1=Most Impactful, 13=Least
Impactful. SELECT, DRAG & DROP)
______ Peers finding out (1)
______ Professional culture (2)
______ Societal culture (3)
______ Fear of reprisal (4)
______ Fear of loss of license (5)
______ Fear of misconduct report (6)
______ Fear of loss of employment (7)
______ Cost (8)
______ Impact on family (9)
______ Dignity/Pride issues (10)
______ Self-Denial (11)
______ Other (12)
⊗______ Nothing would make you less likely to utilize services (13)

Q23 What would make you personally likely to seek help for an attrition (burnout), substance
abuse, or mental health problem? (Please rank the following from 1-Most Likely to 10-Least
Likely. SELECT, DRAG & DROP)
______ I would have to hit rock-bottom (1)
______ Referral by a peer (2)
______ Possible or actual instance of malpractice (3)
______ Formal diagnosis by a professional (4)
______ Employer takes notice of the problem (5)
______ Employer referring me to seek help (6)
______ Employer requires me to seek help (10)
______ I realize that I have a problem (7)
______ A family member asks me if I have a problem / to seek help (8)
______ Other (Please specify) (9)

STANDARD OF PRACTICE 193
Q24 How would the following impact the likelihood that you would participate in a lawyer
assistance program?

Would Not
Participate (1)
Would Likely
Not Participate
(2)
Would Likely
Participate (3)
Would
Participate (4)
The program
charged me a fee
to participate.
(17)
38) 39) 40) 41)
The program was
cost-free. (18)
42) 43) 44) 45)
The program
cost $125.00 per
month. (19)
46) 47) 48) 49)
The program
cost $1,000.00
per year. (20)
50) 51) 52) 53)

Q25 If you had a mental health or substance abuse issue, what is the most you would pay
monthly to receive assistance from a lawyer assistance program?
54) $1-$50 (1)
55) $51-$100 (2)
56) $101-$150 (3)
57) $151-$200 (4)
58) $201-$250 (5)
59) $251+ (6)
60) I would not pay anything to participate unless I was forced to do so. (7)

End of Block: Program Features

Start of Block: Branched States Estimates - K

Q26 What percentage of attorneys nationwide do you believe suffer from:
0 10 20 30 40 50 60 70 80 90 100

STANDARD OF PRACTICE 194
a mental health issue? ()

a substance abuse issue? ()

attrition or burnout? ()

Display This Question:
If Q10 = California

Q27 Of the nearly 190,000 active attorneys in California, how many attorneys do you estimate
go through intake with the lawyer assistance program for Substance Abuse and/or Mental Health
issues every year? (Please enter a number.)
________________________________________________________________

Display This Question:
If Q10 = Florida

Q28 Of the nearly 77,008 active attorneys in Florida, how many attorneys do you estimate go
through intake with the lawyer assistance program for Substance Abuse and/or Mental Health
issues every year? (Please enter a number.)
________________________________________________________________

Display This Question:
If Q10 = Michigan

Q29 Of the nearly 35,236 active attorneys in Michigan, how many attorneys do you estimate go
through intake with the lawyer assistance program for Substance Abuse and/or Mental Health
issues every year? (Please enter a number.)
________________________________________________________________

STANDARD OF PRACTICE 195
Display This Question:
If Q10 = New York

Q30 Of the nearly 177,035 active attorneys in New York, how many attorneys do you estimate
go through intake with the lawyer assistance program for Substance Abuse and/or Mental Health
issues every year? (Please enter a number.)
________________________________________________________________

Display This Question:
If Q10 = South Carolina

Q31 Of the nearly 10,316 active attorneys in South Carolina, how many attorneys do you
estimate go through intake with the lawyer assistance program for Substance Abuse and/or
Mental Health issues every year? (Please enter a number.)
________________________________________________________________

Display This Question:
If Q10 = Washington State

Q32 Of the roughly 25,786 active attorneys in the state of Washington, how many attorneys do
you estimate go through intake with the lawyer assistance program for Substance Abuse and/or
Mental Health issues every year? (Please enter a number.)
________________________________________________________________

End of Block: Branched States Estimates - K

Start of Block: Bar Education / Programming

STANDARD OF PRACTICE 196
Q33 Do you believe taking a required CLE in mental health or substance abuse issues makes
you more, less, or equally as likely to...
More Likely (1) Equally Likely (2) Less Likely (3)
have a mental health
or substance abuse
problem in the future?
(1)
61) 62) 63)
recognize your own
mental health or
substance abuse
problems? (2)
64) 65) 66)
recognize a
colleague's mental
health or substance
abuse problems? (3)
67) 68) 69)
seek assistance for
any mental health or
substance abuse
problem you may
suffer? (4)
70) 71) 72)
intervene with or help
a colleague who may
have a mental health
or substance abuse
problem? (5)
73) 74) 75)

STANDARD OF PRACTICE 197
Q34 In thinking about yourself, what type of education programs would make you more likely to
seek assistance for a substance abuse or mental health problem? (Select all that apply.)
60) Online education videos (1)
61) In-person seminar / training (2)
62) Workplace seminar / training (3)
63) Social media live question & answer session (4)
64) Book-based learning (5)
65) Mandatory Continuing Legal Education Program (6)
66) Bar association programs (7)
67) Articles in legal publications (8)
68) Discussions with members of the judiciary (9)
69) Discussions with Bar Association leaders (10)
70) Discussions with prominent attorneys (11)
71) Discussions with members who have dealt with these issues themselves (12)
72) Brochures (13)
73) Other (please specify) (14) ________________________________________________

Q35 In your opinion, how prevalent are the following issues among attorneys?
Not at all prevalent Extremely Prevalent

0 1 2 3 4 5 6 7 8 9 10

Substance Abuse ()

Mental Health ()

Attrition / Burnout ()

Q36 In your opinion, how well is the State Bar and the lawyer assistance program doing in the
following areas?
Not at all Extremely Well

0 1 2 3 4 5 6 7 8 9 10

STANDARD OF PRACTICE 198
Handling substance abuse issues ()

Handling mental health issues ()

Helping attorneys who suffer from substance
abuse issues ()
Helping attorneys who suffer from mental
health issues ()

End of Block: Bar Education / Programming

Start of Block: Opinions on KMO

Q37 A recent study shows that as many as 28% of attorneys suffer from mental health issues,
20.6% have a substance abuse problem, and that attorneys are 7-10 times as likely as other
professionals to experience attrition.

In your opinion, why don’t attorneys who suffer from the following
issues seek help? (For each issue, select all that apply.)
Mental Health (1) Substance Abuse (2) Attrition / Burnout (3)
STANDARD OF PRACTICE 199
Loss of sense of
control (1)
74) 75) 76)
Belief that they don't
have a problem / self-
denial (2)
77) 78) 79)
Belief that they can
help themselves / do
not need outside help
(3)
80) 81) 82)
The issues is
associated with a
stigma (4)
83) 84) 85)
The treatment is
associated with a
stigma (5)
86) 87) 88)
Belief that they are
able to be high-
functioning (6)
89) 90) 91)
Worry that it will be
used against the
attorney or client (7)
92) 93) 94)
Work responsibilities
(8)
95) 96) 97)
Family
responsibilities (9)
98) 99) 100)
Other responsibilities
(please specify) (10)
101) 102) 103)
Lack of incentive (11) 104) 105) 106)
Issues revolving
around confidentiality
(12)
107) 108) 109)
Time commitment
associated with
treatment / the
program (13)
110) 111) 112)
Lack of
empowerment (14)
113) 114) 115)
Lack of peer support 116) 117) 118)
STANDARD OF PRACTICE 200
(15)
Lack of family
support (16)
119) 120) 121)
Other (please specify)
(17)
122) 123) 124)

Q38 In your opinion, what is the single greatest reason attorneys who suffer from substance
abuse issues don't seek help?
76) Loss of sense of control (1)
77) Belief that they don't have a problem / self-denial (2)
78) Belief that they can help themselves / do not need outside help (3)
79) The issues is associated with a stigma (4)
80) The treatment is associated with a stigma (5)
81) Belief that they are able to be high-functioning (6)
82) Worry that it will be used against the attorney or client (7)
83) Work responsibilities (8)
84) Family responsibilities (9)
85) Other responsibilities (please specify) (10)
________________________________________________
86) Lack of incentive (11)
87) Issues revolving around confidentiality (12)
88) Time commitment associated with treatment / the program (13)
89) Lack of empowerment (14)
90) Lack of peer support (15)
91) Lack of family support (16)
92) Other (please specify) (17) ________________________________________________

STANDARD OF PRACTICE 201
Q39 In your opinion, what is the single greatest reason attorneys who suffer from mental health
issues don't seek help?
93) Loss of sense of control (1)
94) Belief that they don't have a problem / self-denial (2)
95) Belief that they can help themselves / do not need outside help (3)
96) The issues is associated with a stigma (4)
97) The treatment is associated with a stigma (5)
98) Belief that they are able to be high-functioning (6)
99) Worry that it will be used against the attorney or client (7)
100) Work responsibilities (8)
101) Family responsibilities (9)
102) Other responsibilities (please specify) (10)
________________________________________________
103) Lack of incentive (11)
104) Issues revolving around confidentiality (12)
105) Time commitment associated with treatment / the program (13)
106) Lack of empowerment (14)
107) Lack of peer support (15)
108) Lack of family support (16)
109) Other (please specify) (17) ________________________________________________

Q40 Of all the active attorneys in the state, what percentage do you estimate go through intake
with a lawyer assistance program for Substance Abuse and/or Mental Health issues every year?
________________________________________________________________

Q41 What do you believe to be the most effective way to notify you about State Bar programs
and lawyer assistance program resources and offerings? Please rank the following from most
effective (1) to least effective (11). SELECT, DRAG & DROP
______ Email (1)
______ U.S. Mail (2)
______ Telephone (3)
______ Text Message (4)
______ Social Media (LinkedIn, Facebook, Twitter, etc.) (5)
______ Direct Referral - Attorney (Peer) (6)
______ Direct Referral - Judiciary/Court (7)
______ Local/City/County Bar Events (8)
______ State Bar Website (9)
______ Brochure (10)
______ Other (please specify) (11)

STANDARD OF PRACTICE 202
End of Block: Opinions on KMO

Start of Block: Management Qualifications

STANDARD OF PRACTICE 203
Q42 Would you be more, less or equally as likely to utilize a lawyer assistance program if...
Less Likely (1) Equally Likely (3) More Likely (5)
the management of
the program was the
same as the
Regulation and
Discipline
Committee? (1)
110) 111) 112)
the program offices
were in the same
building as the State
Bar? (2)
113) 114) 115)
the program offices
were in a different
building as the State
Bar? (3)
116) 117) 118)
a peer referred you?
(4)
119) 120) 121)
your employer
referred you? (5)
122) 123) 124)
if your manager/boss
referred you? (6)
125) 126) 127)
a member of your
family referred you?
(7)
128) 129) 130)
the program's
manager had expertise
in substance abuse
and mental health
treatment? (8)
131) 132) 133)
the program manager
also managed the
Bar’s lawyer
discipline program?
(9)
134) 135) 136)
Other (please specify)
(10)
137) 138) 139)

STANDARD OF PRACTICE 204

Q43 In your opinion, how important are the following qualifications for the manager(s) of a
lawyer assistance program?

Very Important
(1)
Somewhat
Important (2)
Somewhat
Unimportant (3)
Unimportant (4)
Licensed
Attorney (1)
140) 141) 142) 143)
Licensed
Substance
Abuse/Mental
Health
Counselor (2)
144) 145) 146) 147)
Attorney (Active
or Inactive)
Recovering from
a Substance
Abuse and/or
Mental Health
Issue (3)
148) 149) 150) 151)
Miscellaneous
Management
Experience (4)
152) 153) 154) 155)
Addiction
Medicine /
Psychotherapy
Professional (5)
156) 157) 158) 159)
Other (please
specify (6)
160) 161) 162) 163)

End of Block: Management Qualifications

Start of Block: General Understanding

STANDARD OF PRACTICE 205
Q44 Do you agree or disagree with the following statements?

Strongly
Disagree (1)
Disagree (2) Agree (3)
Strongly
agree (15)
No Opinion
(16)
The services
provided by
lawyer
assistance
programs are
effective. (1)
164) 165) 166) 167) 168)
It is important
for me to take
advantage of
the resources
offered by the
Lawyer
Assistance
Program. (2)
169) 170) 171) 172) 173)
I believe that
I am
accountable
for
addressing
my own
conduct. (3)
174) 175) 176) 177) 178)
I believe that
the State Bar
is responsible
for
addressing
my actions.
(4)
179) 180) 181) 182) 183)

End of Block: General Understanding

Start of Block: Closing

Q45 Is there anything else that you were not asked that you feel help explain your thoughts about
this subject? Please explain.
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
STANDARD OF PRACTICE 206
________________________________________________________________

Q46 Would you be willing to participate in a confidential interview regarding the topics of this
study in the future?
184) Yes (1)
185) Maybe (2)
186) No (3)

Skip To: End of Survey If Q46 = No
End of Block: Closing

Start of Block: Interview Information

Q47 Your feedback and help will make a difference! If you are willing to participate in an
interview or discussion on the topic of this study, please enter the requested information at the
following link.

https://usceducation.az1.qualtrics.com/jfe/form/SV_3OiEoT1lHBYaXQh

Note: This information will not be tied to your survey response in any way. Your survey will
remain confidential, and the information provided in this separate questionnaire will not appear
in the same answer fields as this survey. You may change your mind at any time. Providing this
information does not guarantee nor require your participation in the interview.

https://usceducation.az1.qualtrics.com/jfe/form/SV_3OiEoT1lHBYaXQh

Skip To: End of Survey If Q47() Is Displayed
End of Block: Interview Information

STANDARD OF PRACTICE 207
APPENDIX B
Interview Protocol
The questions which follow will guide the interviewer throughout the one-on-one
interview. The questions listed are merely meant to cover all issues required to gain insight into
the research questions (as set forth below) and problems of practice. The interviewer will be
empowered to detour from the set questions to explore a participant’s answer further, or elicit
further information that were not foreseen prior to the interview. Thus, the questions are a road-
map, not the directions. In other words, this interview process will be highly flexible.
Research Questions
The questions that will guide this study are as follows:
1. What is the stakeholder knowledge and motivation related to the State Bar’s goal of
protecting the public and supporting legal professionals handling a wide range of attorney
quality of life issues, including mental health, chemical dependency and attrition?
2. What is the interaction between organizational culture and context and stakeholder
knowledge and motivation?
3. What are the recommended knowledge and skills, motivation, and organizational
solutions?
In other words, what is impeding the recognition and treatment of attorney quality of life
issues, and what can be done to positively impact the delivery and efficacy of services provided
by the State Bar to address these issues?

STANDARD OF PRACTICE 208
Interview
Interview Opening Remarks
Thank you very much for agreeing to participate in my study. I am conducting research
as part of my EdD program in Organizational Change and Leadership with Rossier School of
Education at USC. The interview will take around 45 minutes, and consists of 24 questions, with
follow-up questions if needed. There are no right or wrong answers. You can skip any question
you don’t want to answer, and you can stop the interview at any time.
Your responses will be kept confidential, and will only be shared in summary form, with
no identifying information and in a manner to ensure that no individual participant can be
identified. I may utilize specific quotations from time-to-time that will not be attributable to any
individual, nor will such quotation contain any identifying information. I also plan to make
specific recommendations to bar association leadership related to improving lawyer utilization of
assistance program services and resources as a result of this study.
I would like to record the interview to help me remember your responses. Immediately
following this session, I will upload the recording to a secure server and delete it from my
device. I will transcribe the session at some time following upload to the secure server and I may
delete the recording after transcription is complete. The transcription will be stored under a
pseudonym so your responses cannot be connected back to you.
 Do I have your permission to record the interview?
 Do you mind if I also jot down a few notes to jog my memory?
 Do you have any questions for me before we get started?
Knowledge
1. What are the greatest (personal) issues practicing attorneys face because of their career?
STANDARD OF PRACTICE 209

2. What do attorneys do to deal with these issues?
- Describe a specific instance in which you have witnessed this—or—Describe the
circumstances where you have seen this occur.
3. What services are available to attorneys who suffer from these issues?
4. How do you know if you are suffering from an issue associated with or arising from the
practice of law?
5. How do you know if one of your peers is suffering from an issue associated with or
arising from the practice of law?
6. Have you ever heard of the State Bar’s [Lawyer Assistance Program]? How?
a. [READ THE FOLLOWING]: “The Lawyer Assistance Program (LAP) is a
confidential program that provides a supportive structure for building a personal
program of recovery from chemical dependency and/or mental health disorders.
The program also monitors a participant's progress, not only for the public safety,
but also as documentation of recovery for the professional participant.”
8

b. [AFTER READING ASK]: Did you know the State Bar offered services like this?
Please explain.
Motivation
7. What is the value for attorneys in utilizing the Lawyer Assistance Program?
8. In what way do you believe yourself in control of any issues you may be experiencing?
9. What can you do to:

8
Taken from State Bar’s LAP FAQ #1. The State Bar LAP statement will reflect the state in
which the participant is licensed to practice law.
STANDARD OF PRACTICE 210
a. hold yourself accountable for your own self-care?
i. Describe an experience in which this has occurred.
b. hold your attorney peers accountable for their own self-care?
i. Describe an experience in which this has occurred.
Organization
10. Do you think attorneys deny that they or their peers are not performing their duties as it
relates to the standard of practice in the community? Why or why not?
11. Do you believe that attorneys deny that they need help to address their issues from a third
party? Why or why not?
12. Do you believe attorneys do not self-reflect or self-diagnose themselves for the issues
they may be experiencing? Why or why not?
General
13. Would you utilize the Lawyer Assistance Program if you had a mental health or
substance abuse issue? Why or why not?
14. What could the State Bar do to make you more likely to utilize the Lawyer Assistance
Program?
15. What could the State Bar do to make you less likely to utilize the Lawyer Assistance
Program?
16. What do you think is the best way to market the program to lawyers?
17. Would you pay more bar dues to make the program free to all lawyers?
18. Would you participate in the Lawyer Assistance Program if you had to pay a monthly
fee?
a. What is the most you would pay every month for services?
STANDARD OF PRACTICE 211
b. What would you expect to get in return for the monthly fee?
19. If you were told the monthly fee for services is currently more than $100, would that
surprise you? Why or why not?
a. If you were told the monthly fee for services is currently more than $200, would
that surprise you? Why or why not?
b. If you were told the monthly fee for services is currently $250, would that
surprise you? Why or why not?
20. In your opinion, what is the greatest single problem that leads to attorney mental health
issues and/or substance abuse?
21. What other problems lead attorneys to suffer from mental health issues and/or substance
abuse?
22. Would mandatory counseling assist attorneys in gaining knowledge or insight into theses
issues?
Would it help attorneys identify problems they may have?
Would it serve any purpose in assisting to alleviate quality of life problems?
23. Is there anything else you wish to discuss that you were not asked or did not already
explain?
24. If we have any further questions, would you be amenable to receiving further contact
from us regarding the study? What is the best method to get ahold of you? (Collect
contact information.)
Thank you for your time and participation in this study.
Demographics:
STANDARD OF PRACTICE 212
YOB:
State:
Race:
Sex:
Relationship Status:
Year started practice:

STANDARD OF PRACTICE 213
APPENDIX C
Phase Two – Qualitative, Narrative Survey

Start of Block: Informed Consent

Q1 The purpose of this study is to identify the knowledge, motivation, and organizational
barriers to utilization of State Bar and independent Lawyer Assistance Programs. All answers
you submit are confidential. You will not be required to identify yourself in any way, nor will
any information be collected about your name, specific location, or other data that would enable
individual survey responses to implicate any individual participant. You will not be compensated
for your participation in this survey. As such, you are giving responses freely and
voluntarily. You may ask that the principal investigator remove your responses from the study
at any time without fear of reprisal or retribution. However, because responses are confidential,
your individual responses may not be identifiable once a survey is submitted.
By clicking the button below, you acknowledge that your participation in the study is voluntary,
you are 18 years of age, and that you are aware that you may choose to terminate your
participation in the study at any time and for any reason.

This survey should take anywhere from 10-15 minutes or less. Please note that this survey will
be best displayed on a laptop or desktop computer. Some features may be less compatible for
use on a mobile device.
o I consent, begin the study (1)
o I do not consent, I do not wish to participate (2)

Skip To: End of Survey If The purpose of this study is to identify the knowledge, motivation, and
organizational barriers t... = I do not consent, I do not wish to participate
End of Block: Informed Consent

Start of Block: Demographic Information

Q2 The first part of this survey asks for demographic information. Much of this
information was asked on the first survey you submitted. However, because the previous
survey has no identifying information and is not connected or linked to this survey,
demographic information must be collected again to help better understand your
responses.

Q3 What is your year of birth?
1900 2000
STANDARD OF PRACTICE 214

Year of Birth ()

Q4 Choose one or more races that you consider yourself to be:
▢ White (1)
▢ Black or African American (2)
▢ American Indian or Alaska Native (3)
▢ Asian (4)
▢ Native Hawaiian or Pacific Islander (5)
▢ Latino/Hispanic (6)
▢ Other (7) ________________________________________________
▢ Decline to state (8)

Q5 What is your sex?
o Male (1)
o Female (2)
o Decline to state (3)

STANDARD OF PRACTICE 215
Q6 Please indicate the answer that includes your entire household income in (previous year)
before taxes.
o Less than $10,000 (1)
o $10,000 to $19,999 (2)
o $20,000 to $29,999 (3)
o $30,000 to $39,999 (4)
o $40,000 to $49,999 (5)
o $50,000 to $59,999 (6)
o $60,000 to $69,999 (7)
o $70,000 to $79,999 (8)
o $80,000 to $89,999 (9)
o $90,000 to $99,999 (10)
o $100,000 to $149,999 (11)
o $150,000 or more (12)
o Decline to state (13)

STANDARD OF PRACTICE 216
Q7 What is your current marital/relationship status?
o Single/Never Married (8)
o Married (1)
o Widowed (2)
o Divorced (3)
o Separated (4)
o Cohabitating (6)
o Life Partner (7)
o Decline to state (5)

Q8 In what year did you first commence practicing law?
________________________________________________________________

Q9 Your current status with your State Bar is as follows:
o Active (1)
o Inactive (2)
o Suspended (3)
o Member of the Judiciary (4)
o Other (5) ________________________________________________

STANDARD OF PRACTICE 217
Display This Question:
If Your current status with your State Bar is as follows: = Inactive
Or Your current status with your State Bar is as follows: = Suspended

Q10 When was the last year you were an active member of your State's Bar?
________________________________________________________________

Q11 In which of the following states are you licensed to practice law?
▢ California (1)
▢ Florida (2)
▢ Michigan (3)
▢ New York (4)
▢ South Carolina (5)
▢ Washington State (6)
▢ Other (7) ________________________________________________

STANDARD OF PRACTICE 218
Q12 Which statement(s) best describes your current employment status?
▢ Working (paid employee) (1)
▢ Working (self-employed) (2)
▢ Not working (temporary layoff from a job) (3)
▢ Not working (looking for work) (4)
▢ Not working (retired) (5)
▢ Not working (disabled) (6)
▢ Not working (other) (7) ________________________________________________
▢ Prefer not to answer (8)

STANDARD OF PRACTICE 219
Q13 Where are you employed?
▢ Private Large Firm (1)
▢ Private Medium Firm (2)
▢ Private Small Firm (3)
▢ Sole Practitioner (4)
▢ In-house: corporation or for-profit institution (5)
▢ In-house government, public, or nonprofit (6)
▢ Judicial Chambers (7)
▢ Other Law Practice Setting (8) ________________________________________________
▢ College or Law School (9)
▢ Other Setting (Not Law Practice) (10)
________________________________________________
▢ Bar Administration or Lawyer Assistance Program (11)
▢ Unemployed (12)
▢ Decline to state (13)

STANDARD OF PRACTICE 220
Q14 What best describes your work position?
▢ Manager / Managing Partner (1)
▢ Partner (2)
▢ Employee / Associate (3)
▢ Academic (4)
▢ Clerical (5)
▢ Non-Legal (6)
▢ Decline to state (7)

End of Block: Demographic Information

Start of Block: General Questions

Q15 Prior to this participating in this study, had you heard of the State Bar’s Lawyer Assistance
or other Treatment Program?
o Yes (1)
o No (2)

Page Break

STANDARD OF PRACTICE 221

Q16 What follows are 10 open-ended questions; one question is multiple choice with an
opportunity to explain your selection. You may be as thorough or concise as you wish. There
are no right or wrong answers, and you can skip any question you do not want to answer.

Q17 What are the greatest (personal) issues practicing attorneys face because of their
career? Please explain.
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________

Q18 What do attorneys do to deal with these issues?
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________

Q19 How do you know if you are suffering from an issue associated with or arising from the
practice of law?
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________

Q20 How do you know if one of your peers is suffering from an issue associated with or arising
from the practice of law?
________________________________________________________________

Q21 What is the value (if any) for attorneys in utilizing a Lawyer Assistance Program?
________________________________________________________________
STANDARD OF PRACTICE 222
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________

Q22 In what way do you believe yourself in control of any issues you may be experiencing?
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________

Q23 Do attorneys self-reflect or self-diagnose themselves for the issues they may be
experiencing? Why or why not?
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________

Q24 In your opinion, what is the single greatest problem that leads attorney to suffer mental
health issues and/or substance abuse? Why?
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________

Q25 What do you believe can or should be done to address the issues lawyers are facing? Why?
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________

STANDARD OF PRACTICE 223

Q26 If you were given the opportunity to choose your career again, would you still choose to be
a lawyer? Why or why not?
o Yes (1)
o Maybe (2)
o No (3)

Display This Question:
If If you were given the opportunity to choose your career again, would you still choose to be
a law... = Yes

Q27 Why would you choose this career again?
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________

Display This Question:
If If you were given the opportunity to choose your career again, would you still choose to be
a law... = Maybe

Q28 Please explain your answer of "maybe?" What would need to change to make you decide
"Yes" or "No?"
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________

Display This Question:
If If you were given the opportunity to choose your career again, would you still choose to be
a law... = No

Q29 Why wouldn't you choose this career again?
________________________________________________________________
STANDARD OF PRACTICE 224
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________

End of Block: General Questions

Start of Block: Closing

Q30 Thank you for participating. There are three optional closing questions left in this follow-up
questionnaire.

Q31 Do you think that yearly mandated private counseling sessions would assist attorneys with
not only learning about mental health and substance abuse issues but how to recognize them and
the resources available?
o Yes (1)
o Maybe (2)
o No (3)

Display This Question:
If Do you think that yearly mandated private counseling sessions would assist attorneys with
not onl... = Yes

Q32 Please explain why you believe it would help.
________________________________________________________________

Display This Question:
If Do you think that yearly mandated private counseling sessions would assist attorneys with
not onl... = Maybe

Q33 Please explain why your response of "maybe."
________________________________________________________________

STANDARD OF PRACTICE 225
Display This Question:
If Do you think that yearly mandated private counseling sessions would assist attorneys with
not onl... = No

Q34 Please explain why you do not believe yearly counseling would help.
________________________________________________________________

Q35 Is there anything else that you were not asked that you feel help explain your thoughts about
this subject? Please explain.
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________

Q36 If we have any further questions, would you be amenable to receiving further contact from
us regarding the study? What is the best method and contact information to get ahold of you?
(Answering this question is optional).
▢ Phone (1)
▢ Email (2)
▢ Other (3)

Display This Question:
If If we have any further questions, would you be amenable to receiving further contact from
us rega... = Phone

Q37 Phone Number xxx-xxx-xxxx:
________________________________________________________________

STANDARD OF PRACTICE 226
Display This Question:
If If we have any further questions, would you be amenable to receiving further contact from
us rega... = Email

Q38 Email:
________________________________________________________________

Display This Question:
If If we have any further questions, would you be amenable to receiving further contact from
us rega... = Other

Q39 Other:
________________________________________________________________

End of Block: Closing

STANDARD OF PRACTICE 227
APPENDIX D
Document Requests
1. Public Reports from the LAP (and State Bar Regarding the LAP)
a. Oversight Committee Meeting Notes
b. Internal Reports
2. Public Reports re: Attorney Misconduct Facts & Figures and Yearly Report
a. LAP Yearly Report
b. Intakes
c. Participation
d. Closed Cases
e. Incoming Cold-Call Data
f. Discharges
g. ADP Successes
h. ADP Failures
3. Public Attorney Misconduct Outcome Reports based on Quality of Life
a. Alternative Discipline Program Public Records
4. Third Party Quality of Life Organization Documents (ie: The Other Bar)
5. LAP Oversight Committee Membership Records
6. LAP Budget Records
7. LAP Consultant Reports and Records

STANDARD OF PRACTICE 228
APPENDIX E
Sample Assessment of Program Implementation
Assessment Item Assessment
What is the net gain (loss) of engagement or interaction with online marketing and
outreach?

What is the net intake of attorneys into the LAP compared to the previous year?

What is the net referral of attorneys from a peer to the LAP compared to the
previous year?

Is there growth in attorney retention in the LAP compared to the previous year?

What is the cost-effectiveness of the LAP per attorney participant?

How many employer visits has the LAP made compared to the previous year?
How many days-off have attorneys taken for “mental health” purposes?
How many days of vacation have attorneys utilized compared to the previous
year?

How often did the LAP meet in the previous calendar year to assess program
delivery and efficacy?

How many contacts and/or inquiries were made by attorneys this year compared to
the previous year?

Did the LAP issue a yearly report assessing its efficacy and outreach in the
previous calendar year?
- Did that report include critical elements and suggestions for change?

Abstract (if available)

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Asset Metadata

Creator Hess, Evan Michael (author)

Core Title Standard of practice: a field-based evaluation study of state bar responses to the attorney substance abuse, mental health, and attrition epidemic

School Rossier School of Education

Degree Doctor of Education

Degree Program Organizational Change and Leadership (On Line)

Publication Date 10/17/2018

Defense Date 09/18/2018

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag attorneys,attrition,LAP,Law,lawyer assistance program,Lawyers,legal,Mental Health,OAI-PMH Harvest,Quality of life,state bar association,substance abuse

Format application/pdf (imt)

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Seli, Helena (committee chair), Crawford, Jenifer (committee member), Ycaza Herrera, Alexandra (committee member)

Creator Email evan@evanhess.com,evanhess@gmail.com

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c89-82106

Unique identifier UC11671732

Identifier etd-HessEvanMi-6856.pdf (filename),usctheses-c89-82106 (legacy record id)

Legacy Identifier etd-HessEvanMi-6856.pdf

Dmrecord 82106

Document Type Dissertation

Format application/pdf (imt)

Rights Hess, Evan Michael

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA