Chapter 21: A Commentary on the Integration of EAPs

Abstract

This article addresses the notion of integration-past and present. The author discusses his earlier experiences and research in the field when the dominant model of service delivery was occupational alcoholism programs and counselors of the day sought to integrate these programs into the personnel management function as a means of more effectively serving the employee and the employer. This article also reviews the evolution of this earlier model into employee assistance programs and points out the success and continued growth of these programs was the direct result of empirical research that demonstrated the cost-effectiveness of EAPs. The author reminds the reader to be mindful of the need to maintain the core technology ascribed to EAPs as the range of workplace human service programs continues to expand. Lastly, the author reiterates the necessity of empirical research to demonstrate the value of adding of work-life and wellness services to the broadening scope of programs aimed at maximizing human capital.     

A Comparative Analysis of In-House and Contractual Employee Assistance Program

This paper aims to expand the present state of knowledge regarding employee assistance programs (EAPs) through the presentation of the findings of a study which explored the existence and the nature of such programs in the New York Metropolitan Area. The identification of all EAPs in this area allowed for the development of a typology encompassing the identified programs, and for a comparative analysis of in-house and contractual EAPs in the finance/insurance, manufacturing, and service industries.     

EAP Benefit and Cost Structure Analysis:

This presentation is a review of basic estimation methods geared for assessment of service benefit and cost structure of employee assistance programs (EAPs). The methodologies specify how various benefit and cost items can be organized and measured in dollar figures in order to translate effects of the EAP and operating cost distribution patterns. Based on the calculations, EAPs may assess cost saving patterns and avoid becoming a financial liability to the company. The estimation of benefit/cost ratios can be utilized for establishing program accountability and planning purposes. The methodologies presented in this chapter are at an introductory level. They are geared for EAP personnel and social work students interested in EAPs who have minimal familiarity with cost and benefit structure analysis.     

Promises to keep. An evaluator's perspective on employee assistance programs.

This paper presents a critical review of the rapidly expanding literature concerning employee assistance programs (EAPs). Several essential features of EAPs are identified and the assumptions underlying these components are examined. The latter section of this report offers some tentative suggestions for correcting this situation so that the EAP movement will no longer suffer from the lack of a firm database upon which to build more coherent and defensible theories and programs.     

Chapter 20: A Social Partnership Approach to Work-Life Balance in the European Union—

Abstract

Over the past number of years there has been considerable focus on the integration of employee assistance and work-life programmes in the United States. A national survey conducted by EAPA, EASNA, and AWLP found there is a trend towards the integration of employee assistance and work-life. Many US providers and multinational companies will seek to extend their EAPs and work-life programmes globally. It is sometimes assumed that the EAPs and work-life models that operate in the US will transfer but this is often not the case. There is a cultural dimension to EAPs and work-life programmes that is often overlooked. The European Union (EU) is involved in the greatest example of integration in recent history and an understanding of the EU and its legal system will assist those providing their services. In the EU, EAPs did not follow the same growth pattern as in the US. Professionals in European countries working with business such as psychologists, social workers, and counsellors did not recognise the need for EAPs as, in their view, programmes to deal with personal problems in the workplace already existed. The concept of work-life is widely known and accepted in many European countries; however, there is little evidence of research specifically on the integration of EAPs and work-life programmes. This article will look at one EU country, Ireland, and outline the history and development of EAPs and work-life and present case studies of Irish companies who have developed work-life programmes.     

Evaluating employee assistance policy in an HMO-based alcoholism project.

One aspect of successful employee assistance program (EAP) implementation is the adoption of a formal, written policy, reflecting company commitment to EAP guidelines and goals. This study of criteria predictive of such policy adoption was conducted at the occupational alcoholism project of a New England health maintenance organization (HMO). Data on nearly 400 organizations contacted by occupational program consultants (OPCs) over a 20-month period were collected by questionnaire and interview. One third of these organizations adopted employee assistance policies and set about establishing formal programs. Stepwise multiple regression is the principal method used to pinpoint the correlates of policy adoption. Two of the most important of these are the attitudes of contact persons within the organization toward alcoholism and employee assistance programs, particularly their admission of alcohol problems within their social networks; and the consultants' persistence and marketing skills. The adopting organizations also had reputations for being progressive, and actively concerned about employee welfare; they tended to be large, their executives autonomous, and their union membership rates high. Inhibiting policy acceptance were fears that a written policy would jeopardize the reputation and image of the organization, and that an employee assistance program would remove internal control of personal procedures. The adequacy of the evaluative data and methods are discussed, and recommendations are offered in the interests of streamlining the efforts of OPCs and of achieving greater penetration of targeted organizations.     

Training of Social Workers in Work Settings:

This paper describes results from a survey of Schools of Social Work regarding their role in the preparation of social workers to assume professional responsibilities within work settings. The results clearly indicate that although social workers are increasingly entering the work settings including employee assistance programs, there does not appear to be a dramatic increase in the number of full fledged specialized occupational social work programs. Despite this small number of schools with specialized occupational social work concentration, an overwhelming number of them do incorporate this content in their curriculum.     

Evaluating the Development of Employee Assistance Programs in Rural Communities

The development of Employee Assistance Programs (EAPs) has accelerated during the last decade. However, the impact of EAPs is slowly reaching small rural communities. A telephone survey of companies in North Central Louisiana was conducted to evaluate the development of programs there. Only 40% of the sample had EAPs and 13% were in the process of developing programs. Companies without EAPs generally assumed no responsibility in assisting with employee problems. This paper focuses on salient factors contributing to the limited development of rural EAPs.     

Impaired Job Performance and Worksite Trigger Incidents:

Relatively little empirical research has been done on the supervisory referral of employees to employee assistance programs (EAPs). Inclusion of constructive confrontation (supervisory referral) into program standards and its continued promotion as "central strategy" of program theory and operation calls for critical investigation of supervisors' referral behavior, factors affecting their use of the strategy, and its effectiveness with the referred employees. This study examined two factors found to influence referral action-job performance and occurrence of an incident at the worksite which serves as a "trigger event" for the supervisor. Supervisors (N = 415) at 25 sites from seven organizations responded to a survey regarding their referral behavior. Both impaired job performance and worksite incidents were found to have significant relationship to the EAP referral handling of a specific "job problems" employee. Reported occurrence of a dramatic worksite incident accounted for about eight times as much of the observed referral index variance as a job performance (impairment) rating scale. An interesting, but statistically nonsignificant, trend was also found - the more "public" the incident, the greater the referral action taken. About half of the respondent supervisors were found to have taken no referral action whatever with their "job problems" subordinate. These findings raise questions about supervisors' perceptions of EAPs and their motivations in referral. More research into referral dynamics is needed if EAPs are to achieve their potential to help impaired workers and maximize cost savings for their host organizations.     

Principles of Total Quality Management and Their Application to Employee Assistance Programs:

Total quality management (TQM) has been thrust into the psyche of corporate America. TQM is not a new phenomena. Introduced in the early fifties to Japanese managers by an American management expert, it served to make Japan an international economic leader. U.S. companies have generally had little international competition. They now recognize he formidable challenge that quality based companies represent and are striving to replicate these successes. To do so will be to remain competitive. To discount the impact of TQM initiatives could spell economic disaster. Employee assistance program (EAP) management is modeled after American management principles. EAPs are also now having to compete for market share in ways for which they were never prepared. The TQM initiatives currently being implemented in many companies may be applied equally well to EAPs. This article presents an overview of the TQM principles formulated by W. Edwards Derning. The article also attempts to critically analyze some of the areas that have been problematic in EAP management. Further, it examines how TQM initiatives could serve to ameliorate some of these problems and lend additional impetus to the competitiveness of employee assistance programs with other behavioral health care service delivery and cost management programs.     

The Role of Supervisory Referral in Employee Assistance Programs

Abstract

A growing number of organizations offer Employee Assistance Programs (EAPs) to help employees with their personal problems. Many organizations rely on their supervisors to help identify and refer troubled employees to the EAP for assistance, yet very little conclusive evidence exists regarding the factors that influence whether or not supervisors identify and intervene with troubled employees. A previous review of the literature (Nord & Littrell, 1989) found that the following variables were consistently related to referral: (a) degree of management support for the EAP, (b) gender of supervisor, (c) gender of subordinate, (d) existence of a supervisor network, (e) occupational category of the employees supervised, (f) social distance between supervisor and troubled employee, (g) supervisors' attitude toward their role in referral, and (h) supervisor knowledge of the EAP. However, results of some of the studies reviewed for the current paper were inconsistent with Nord and Littrell's (1989) findings. Additional research is needed in this area, including research on the effectiveness of EAP supervisory training, in order to provide guidelines for the administration of effective EAP programs.     

Employee Drug and Alcohol Use Estimates: Assessment Styles and Issues

Estimates of employee drug and alcohol abuse levels are increasingly used by employers to evaluate Employee Assistance Programs (EAPs). It is important to understand what goes into an estimate and the issues surrounding the utilization of such estimates. When estimates suggest that employee drug and alcohol abuse has not diminshed while Employee Assistance Program costs have been consistently high or increasing, these programs may be cut back or cancelled. Employees who are in need of these programs may lose them.     

Health promotion and disease prevention: a look at demand management programs

This Issue Brief describes employers' efforts to contain health expenditures through demand management programs. These programs are designed to reduce utilization by focusing on disease prevention and health promotion. Demand management includes work site health promotion, wellness programs, and access management. Work site health promotion is a comprehensive approach to improving health and includes awareness, health education, behavioral change, and organizational health initiatives. Wellness programs usually include stress management, smoking cessation, weight management, back care, health screenings, nutrition education, work place safety, prenatal and well baby care, CPR and first aid classes, and employee assistance programs (EAPs). These programs are often viewed positively by workers and can have long-term benefits for employers above and beyond health care cost containment. Demand management can benefit employers by increasing productivity, employee retention, and employee morale and by reducing turnover, absenteeism, future medical claims, and ultimately expenditures on health care. Even though a growing number of employers are offering wellness programs, only 37 percent of full-time workers employed in medium and large private establishments were eligible for wellness programs by 1993. However, a recent survey found that 88 percent of major employers have introduced some form of health promotion, disease prevention, or early intervention initiative to encourage healthy lifestyles among their salaried employees. Distinctions must be drawn between short- and long-term strategies. Demand management can be thought of as a short-term strategy when the focus of the program is on creating more appropriate and efficient health care utilization. Disease prevention is characterized by longer-term health improvement objectives. Whether the purpose is to reduce utilization in the short term or in the long term, the ultimate goal remains the same: to reduce health care expenditures while improving overall health. This goal can be achieved through the use of health risk appraisals, organizational health risk appraisals, high risk programs, awareness programs, medical call centers, return to work programs, EAPs, and smoking cessation programs. Studies of a health program's cost effectiveness must disentangle the effects of many competing factors on cost effectiveness. For example, a health risk appraisal program may identify health problems of which the patient and the health care provider were unaware, resulting in the treatment of these health problems. At the same time, the employer may have switched from a nonmanaged pharmaceutical program to a managed program with incentives for participants to utilize generic and/or mail order drugs. As a result, when evaluating a health promotion program, the long-run impact on the program's cost effectiveness is most important.     

Selling EAPs Using Total Quality Management Initiatives

Qualify Management is striving to perform to standard work processes that will achieve the results customers are seeking. EAPs do just that by focusing their performance early in the healthcare delivery process to help insure a healthy and productive workforce. Selling Quality is educating employers, who are wrestling to maintain employee benefits at reasonable costs, to the fact that Quality Management of behavioral healthcare works. Promoting health and wellness at the workplace, intervening early and professionally, and managing care to healthy outcomes is what EAPs and managed care programs are doing today, and convincing employers through their performance that Quality Management works.     

EAPs in Transition:

This paper is a survey report of EAP purpose and practices. One hundred and eighty-two (n = 182) randomly selected EAP practitioners responded to a questionnaire designed to measure purposes, services, staff specialties and characteristics, service users, and related background information. The findings provide an empirical evaluation of the "state of the art" of the growth, development and trends in the employee assistance field. Also, while the findings indicate that EAPs are in transition several basic functions common to all are identified.     

Chapter 5: Perspectives on the Integration of Employee Assistance and Work-Life Programs

SUMMARY

A recent qualitative study explored perceptions of critical issues and challenges from the point of view of experts and key informants working in diverse roles in the Employee Assistance Program (EAP) field (Sharar & Hertenstein, 2005). One of the central themes that came out of the study is that EAPs have become a type of platform for the expansion of integrated collateral services, chiefly work-life (WL) programs. This paper presents a variety of perceptions and opinions from experts in the EAP field, both pro and con, on the growing convergence of EA and WL programs, including the rationale to integrate, segregate, and concerns regarding the diffusion of traditional and core EAPs. The paper concludes with the authors? perspectives on implications for the EA field, along with the need to find ways to measure if and when integration leads to employee and organizational improvement.     

Using Critical Incident Stress Debriefing to Mediate Organizational Crisis,Change and Loss

This article provides an overview of the development of critical incident stress debriefing and suggests its utility for both traditional and nontraditional purposes, by employee assistance practitioners. Both crises and traumas are defined and a brief history of the development of CISD is offered. The critical incident stress debriefing process is explicated and examples of how CISD's has been used by EAPs is shared. Case studies are then offered of both traditional and nontraditional situations where a CISD process was used by an internal EM, including a homicide, an operating room fire, an organizational change and multiple losses of employees by a work unit.     

One Organization's Experience in a Case Management/EAP Program:

Historically, Employee Assistance Programs (EAPs) have been viewed as an employee benefit even though there is documented evidence of their cost-effectiveness for the company. This article presents an integration of the Employee Assistance Program and Case Management as a way of providing a proactive method of containing health care costs. Such an integration will expand the focus of the Employee Assistance Program, strengthen our role as an employee advocate, and provide a method of demonstrating to corporations that EAPs do contribute to the "bottom line" profit margin of the company. This article outlines the components of an effective, comprehensive Employee Assistance Program and discusses the process of integrating a Case Management system that emphasizes local demographic control within the EAP.     

Cost-containment,computers and confidentiality

The profession of social work has clear standards to follow in protecting confidentiality when a client discloses information in a psychotherapy session. These standards are examined in relation to an ever-increasing diresrefard for privacy as staff of managed care for mental health services and employee assistance programs gather and store information in computer databases, with the overall objective of cost-containment. Ethical principles are discussed and suggestions are made for safeguarding, the client's right to privacy.     

Case Studies of Federal Occupational Health's EAP Responses to Natural Disasters

Summary

Employee assistance professionals have increasingly been called upon to address the emotional and mental health needs of customer organizations and their employees in response to large-scale natural or man-made disasters. In doing so, employee assistance program (EAP) professionals must use a repertoire of responses that encompasses a broad range of interventions, generally anchored in an understanding of and focus on the organization and its culture, mission, management and labor concerns, and other critical characteristics. The EAP's fallback response to a crisis affecting the workplace is often a critical incident stress debriefing or close variant of it. However, EAPs can best serve their customers at all levels with interventions attuned to an understanding of the workplace culture gained through a consultative relationship with management, while factoring in the nature of the disaster, the length of time and characteristics of the disaster's aftermath, and the nuances of the employees' physical and emotional needs throughout the entire disaster response and recovery process.

This article highlights these issues through the presentation of two case studies, gained from the hurricane response activities of the Federal Occupational Health (FOH) EAP. FOH, a service unit within the U.S. Department of Health and Human Services' Program Support Center, has 60 years of experience working in partnership with its federal agency customers to deliver comprehensive occupational health services to improve the health, safety, and productivity of the federal workforce. FOH's EAP contracts with vendor organizations to provide direct employee assistance, work/life, and related services to more than 1.3 million federal employees. The first case study describes (from the first person perspective) an on-site, multi-focused EAP intervention at a federal facility. The second case study describes management consultation with the U.S. Postal Service in response to major hurricane activity.