Chapter 16: Integration of Occupational Health Services in the Federal Sector

Abstract

Federal Occupational Health (FOH) is a federal sector model of the integration and collaboration of occupational health (OH) programs that includes on-site health clinics, and environmental health as well as EAP, work-life, and wellness/fitness programs. This article reviews several aspects of integration at various levels of this public health organization.

The broad objectives of occupational health programs are to promote, support, and provide a healthy and productive, highly functioning workforce to the employer. FOH staff has special expertise and knowledge related to federal procedures, regulations and agency culture, as well as the OH disciplines. With its mission to provide occupational health services to federal agencies and federal employees, FOH has the unique opportunity to provide integrated OH services, thereby providing a more comprehensive approach to the occupational health care of the individual employee, as well as a more comprehensive approach to the health and productivity efforts of the federal agencies.

Although we have made strides and engage in continuing efforts to promote integrated programs and care, a number of additional program enhancements are in discussion and/or in process. FOH is a unique entity and the largest provider of comprehensive OH services within the federal government. It has achieved some notable success with the integration of its services across various levels of the organization with different federal organizations. Efforts have been particularly successful in bringing a coordinated response to various crises and emergency situations. With increasing knowledge and data on the benefits of integration, FOH is working to reduce both internal and external organizational barriers to bring integration of services to their maximum potential.     

Workplace Problems and Needs for Lesbian and Gay Male Employees

Abstract

This article presents research findings pursuant to the problems and needs of lesbian and gay male employees, as perceived from a randomly selected national sample of employee assistance professionals. The research was based on a conceptual model for framing workplace interventions addressing issues of protection, inclusion and equity (PIE) for gay/lesbian employees. Findings indicate that heterosexual employees greatly underestimate the level of discrimination sexual minorities experience; women respondents were more sensitive to gay/ lesbian workplace issues than men; existing EAP and human resource services, programs and policies inadequately address gay/lesbian needs; significant differences exist between heterosexual and gay/lesbian employees' on perceptions of diversity training content and gay/lesbian EAP professionals feel the workplace is only somewhat “safe” for them as sexual minority employees.     

Chapter 9: Disaster Consequence Management

SUMMARY

The critical element in a workplace approach to consequence management for disaster, terrorism and other critical incidents is the integrated planning and response across numerous workplace functions including human resources, employee assistance, security and facilities, medical, occupational health, wellness and work-life. These corporate functions ensure the performance, health, safety and human continuity of the workplace. In this model, workplace professionals charged with the human capital and continuity of their organizations play new crucial roles that require an understanding of (1) the integration of mental health into a public health approach for managing the psychological and behavioral implications of terrorism; (2) the integration of operational continuity planning with human continuity resources; and (3) the integration of workplace preparedness into the larger sphere of population health interventions for the 21st century. This new role of workplace health and productivity professionals is necessary to the health and resiliency of our global community and its citizens in the workplace and at home.     

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.     

Implementing Disability Management

Summary

Disability management is a growing domain of practice and consultation for EAP professionals as organizations attempt to control escalating disability-related costs. It is defined as a systematic, cohesive, and goal-oriented approach that seeks to (a) minimize the impact that reduced functioning may have on an individual'S social and vocational roles and (b) maximize the health of employees in order to prevent disability or further deterioration when a disability is present. This paper reviews the essential components of disability management culled from the recent literature, highlighting how they should be implemented to achieve positive outcomes. Studies and data are presented that underscore the many benefits of implementing disability management for both organizations and disabled employees.     

The Utility of Personality Inventories in the Employee Assistance Process

Abstract

A study was conducted to assess the usefulness of objective measures of personality in (a) the identification of employees in need of an employee assistance program (EAP) and (b) the evaluation of employee mental health change as a result of EAP participation. In addition, comparisons of EAP referred and non-referred employees were made on race, sex, age, and performance variables. MMPI, CPI, and SRA-Verbal Form test data from all or part of a sample of 376 police officers referred for fitness-for-duty evaluations were used in various analyses. Many of the officers were reassessed following an EAP intervention, while others chose not to accept the intervention (forming a natural control group). It was found that the MMPI-2 has the potential utility in both the identification and evaluation stages of the EAP process. Males and black employees were found to more likely to be referees to an EAP. Finally, it was found that referred employee performance was more than a half a standard deviation lower than that of non-referred employees.     

A Systems Theory Analysis of Employee Assistance Programs

The systems theory principles of wholeness or nonsummativity, dynamic equilibration, nonlinear causality, feedback, equifinality, and permeable boundaries are described with conceptual and practical implications for employee assistance programs. Ten interfacing macrosystems relevant to EAP work are identified (e.g., employees; families; supervisors and management; unions; business community), and ways to account for and address the diverse agendas of these systems in EAP practice are discussed.     

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.     

Chapter 12: Wells Fargo's Employee Assistance Consulting Model

Abstract

Wells Fargo and Company's Employee Assistance Consulting (EAC) is an established and successful internal corporate-based EAP that delivers organizationally congruent services to a diversified financial services company with 80+ businesses and over 146,000 team members. While some elements of traditional EAPs are evident in the services provided by this entity, EAC also provides highly specialized and customized consultations to its corporate partners, business group customers and employees. Using a highly integrated service model that aligns closely with the specific strategy and operations of each Wells Fargo business, EAC is an invited guest at many of the company's most influential tables. EAC collaboratively partners with senior and line management, Human Resources, the Employment Law Department, Disability Management (called WorkAbility at Wells Fargo) and Risk Management, Corporate Benefits, Corporate Security, Learning and Development, and others to provide leadership and organizational influence on such wide ranging issues as threat assessment and management, business incident management, workplace trauma, health and productivity, and organizational and employee effectiveness. This article describes proven methods and strategies for maximizing organizational influence and positioning EAP consultants as effective business partners.     

Evaluating Organizations Through an Employee Assistance Program Using an Organization Development Model

This article describes one of the first accounts of an Employee Assistance Program (EAP) staffed by a social worker in industry in the United States. The author was the social worker employed in this EAP (called the Industrial Social Work Project) which was originally motivated by a vice president's concern over employee turnover. The article describes in detail how the EAP was operationalized and used to evaluate the organizational culture by using an organizational development model which involved five overlapping phases. These were: (1) orientation/information gathering; (2) individual treatment; (3) research on cultural change; (4) team building and O.D. projects; and (5) O.D. management training. The main contention of this article is that organizations do in fact contribute to the "professional suicide" of employees, and those who plan to evaluate ENS are remiss not considering the organization context of such programs and their possible impact on employees.     

A family systems-based model of organizational intervention

Employee assistance professionals are expected to be proficient at intervening in organizations and creating meaningful behavioral change in interpersonal functioning. Because of their training in family systems theories and concepts, marriage and family therapists (MFTs) are well suited to serve organizations as "systems consultants." Unfortunately, the authors were unable to identify any family systems-based models for organizational intervention that have been empirically tested and supported. In this article, the authors present a family systems-based model of intervention that they developed while working in an employee assistance program (EAP). They also present research that was used to refine the model and to provide initial support for its effectiveness.     

Enhancing Well-Being at the Workplace:

The workplace is a social environment and for many the opportunity for social interaction at work is a source of satisfaction. Yet, the quality of relations is variable and can be a source of anxiety, stress and work dissatisfaction. There is a need to enhance employee well-being and to improve social relations by increasing the opportunity for social support at the workplace. Two approaches are proposed: (a) as a health promotion strategy, to provide employees with training in interpersonal skills, and (b) as a component of aftercare, to foster the development of formal and informal support networks in order to reintegrate employees with emotional difficulties into the workplace. These strategies are discussed in the light of their applicability to EAP practice.     

The Role of Needs Assessment in the Design of Employee Assistance Programs:

This paper describes the value of a multimethod needs assessment in developing and tailoring an employee assistance program (EAP) to the particular characteristics, problems, and resources of an organization and then provides an illustration of an EAP needs assessment conducted for a city municipality. Unique concerns of city employees, and the specific EAP programs designed to address these concerns, are highlighted.     

Illuminating gendered organization assumptions

One key to why organizations have been less successful at integrating a work–family agenda into their organizational cultures is that workplaces have failed to consider how gender assumptions influence workplace practices, policies and cultures. This paper presents a theoretical framework for considering how gender role assumptions have prevented organizational attempts to become family friendly. Further, this paper uses an organizational case study to illustrate this point. Specifically, a theory of gendered organizations is used to frame an analysis of 30 employee interviews. Data suggest that gendered organizational assumptions inherent to several workplace policies and practices contribute to employee strain associated with negotiating the demands of life on and off the job. Further, the findings show that these gendered organizational assumptions prevent organizations from developing workplace cultures responsive to employees' work, family and personal needs. A brief review of the interdisciplinary work–family field is presented, followed by a discussion of gendered organizations. Then, using interview data collected from management and ‘front‐line’ female and male workers employed at a municipal government, this paper examines how workplace practices, presumably gender neutral, affect employees and the organizational culture in which they work.     

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.     

EAP Service Use in a Managed Behavioral Health Care Organization: From the Employee Perspective

Contemporary employee assistance program (EAP) services are typically provided in broad-brush programs delivered by large external vendors in a network model. Yet research has not kept pace with EAP evolution, including in terms of how EAP clients themselves view services. We surveyed a random sample of EAP service users from a national provider (361 respondents). About one-third of respondents reported getting help for workplace issues. Most learned about the EAP through employer communications such as the company website. The large majority reported that the EAP helped them "a lot" or "some," suggesting they valued this benefit.     

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.     

Technostress: Implications for Adults in the Workforce

The use of technology can enhance workplace efficiency, productivity, and flexibility; yet, technological tools can have negative effects on individuals’ cognitive, psychological, and physical health, as well as on organizations (e.g., lowered employee satisfaction, decreased employee commitment). The use of information and communications technologies (ICT) adds to existing work stress. The authors reviewed recent literature to identify ICT trends, define key terms, and gain insights to improve awareness of ICT issues related to career development, health and wellness, and job security. The potential for inquiry as it relates to career exploration, development, and advancement is relevant to counselors and clients in today's workplace. Research is needed to examine the effects of technostress across different industries, to identify workers at greatest risk of adverse effects, to explore the impact on career decision making, to help clients develop personal coping resources, and to determine strategies for career professionals to collaborate with workplace managers.     

Total Quality Management of EAP Vendors

Employers are increasingly turning to benefits consulting firms to help them plan the management of employee mental health care costs. With evolving employee assistance and managed care programs, employers need to be "informed consumers." Direct marketing by EAP vendors is no longer the most effective business strategy. Most employers want to get an impartial third party opinion on what their needs are, the type of program(s) best suited to their organization and which vendor can best meet those needs. Quality and cost are of primary concern. This article addresses the specific elements that are examined by a benefits consultant in review and selection of EAP vendors with a particular emphasis on total quality management.     

Resistant Employees

The goal of Employee Assistance Programs (EAP) is to assist employees with a host of emotional, behavior, and family problems which interfere with their ability to function optimally on the job (Sussal & Ojakian, 1988). EAP counselors work to quickly identify, assess and resolve employees' problems. Frequently, there are employees, who seek EAP assistance, but are resistant to changing their behavior. The purpose of this article is to propose the use of Brief Counseling (BC) intervention techniques with resistant employees.