the role of employee assistance programs in supporting...

Institute for Behavioral Health

The Role of Employee Assistance Programs in Supporting

Workforce ResiliencyElizabeth L. Merrick, Ph.D., M.S.W.

Institute for Behavioral HealthHeller School for Social Policy and Management

Brandeis University

Institute of Medicine, Committee on Workforce Resiliency ProgramsOperational and Law Enforcement Resiliency Workshop

Washington, D.C. September 15, 2011

Institute for Behavioral Health2

Today’s Presentation• What do EAPs provide?

• What resiliency-related issues can EAP serviceshelp with?

• What is the evidence base for EAP effectiveness?

• What are facilitators and barriers to EAP utilization?

• How should EAP performance be measured?

• Conclusions


Employee Assistance Programs (EAPs)

“The work organization’s resource that utilizes specific core technologies to enhance employee and workplace effectiveness through prevention, identification and resolution of personal and productivity issue”

EAP assists:

(1)work organizations in addressing productivity issues, and

(2)“employee clients” in identifying and resolving personal concerns, including health, marital, family, financial, alcohol,drug, legal, emotional, stress, or other personal issues that may affect job performance

(From Employee Assistance Professional Association [EAPA])


EAP “Core Technology”(1) Consultation, training, and assistance to work organization leadership

seeking to manage the troubled employee, enhance the work environment, and improve employee job performance

(2) Active promotion of EA services(3) Confidential and timely problem identification/assessment services(4) Use of constructive confrontation, motivation, and short-term

intervention(5) Referral of employee clients for diagnosis, treatment, and assistance, plus

case monitoring and follow-up services(6) Assisting work organization in establishing and maintaining effective

relations with service providers and managing provider contracts(7) Consultation to organization to encourage availability of, and access to

health benefits (8) Identification of effects of EA services on organization and individual job

performance.

Abbreviated, from EAPA (2010), which built on and modified Roman & Blum Core Technology (1985)


Scope of EAPs• Today’s EAPs evolved from occupational alcohol programs

• Most contemporary EAPs are “broad-brush” programsaddressing wide range of issues for employees:

– Substance use problems– Mental health– Family/relationship issues, stress, other problems – Work-life including resource assistance, e.g.

referral/consultation on childcare, eldercare, legal, financial issues

• EAPs have important organizational component (e.g., consultation, training)


EAP and Workforce Resiliency

• A resilient workforce has the tools needed to successfully cope with stress of various kinds.

• EAP services include many relevant to helping employees to maximize “Resistance, Resiliency, Recovery” (Johns Hopkins Model*)

• EAP activities also focus on helping management understand how to support their workforce and address problem performance

• Organizationally, goal is better ability to carry out mission and respond successfully to change and pressure

* Kaminsky et al. (2006)


Typical EAP Services:Individual Employee-Focused

• Problem assessment • Short-term counseling• Referrals to additional

treatment• Specialized

consultation/ resource advice such as legal, financial, elder care, childcare

• Many EAPs also provide these services for family members

• Assistance with return to work (overlaps with disability management)

• Assistance negotiating treatment system, support for treatment (overlaps with disease management)

• Job performance referrals


Leadership/Organization-Focused Services

• Consultation to supervisors dealing with problem employees

• Helping to develop and/or implement workplace policies such as drug-free workplace

• Planning for and responding to workplace crises (e.g., providing response to critical incidents)

• Providing training and orientation to employees and managers (e.g., stress management, management skills)

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EAP Models & Benefits• Internal – original, less common• External – contracted out, network model, private office

location • Hybrid model

Models

• Often 3-8 visits for assessment +/or short-term counseling• Also 3-session or fewer model for information and referral • No copayment– so no financial barriers• Often includes family members of employee• Can be a separate benefit or integrated with behavioral

health benefits, wellness, +work/life • Face-to-face, telephonic, Web-based resources

Benefits/Features


EAP Intervention Level and OutcomesEAP

IndividualEmployee

Leadership/Organization

• Positive clinical outcomes

• Improved functioning• Coping/stress

management skills• Work success• Improved relationships• Maximize individual well-

being and performance under stress

• Effective policy development• Return on investment (ROI)• Productive workforce • Lower healthcare/disability

costs• Reduced liability• Lower turnover• Flexible, adaptive employees• Accomplish prevention/early

intervention• Maximize organizational

functioning in face of change/adversity

Resiliency


Overview of Evidence Base for EAPs

• Substantial body of research overall• Much on satisfaction, utilization, ROI• Also studies on clinical and work outcomes, but…• There are also studies of specific interventions delivered

within EAP• Notable limitations:

– Frequent lack of appropriate control or comparison groups and/or statistical methods to help address selection bias

– Many single case studies– Older studies based on EAP models that are now rare


Employee Assistance Research FoundationCommentary on Evidence Base*

• Although some studies suggest EAPs are generally effective, the EAP evidence base leaves many questions unanswered.

• In part, this is due to common methodological limitations; e.g. single case studies, program evaluations that do not always meet rigorous scientific standards.

• Many program evaluations undertaken by employers (and their EA providers or consultants), but most not widely disseminated or published in scholarly journals.

• Need additional research on: – contemporary EA service delivery models since this has

changed dramatically– examining the ‘active ingredients’ in EAP effectiveness– measuring outcomes of most relevance to employers and

workers* EARF- reference list


What the Evidence Indicates: Outcomes and Satisfaction

• Numerous reviews of EAP research have been conducted (see reference list)

• Most studies have found improved clinical and work outcomes including areas of: – Absenteeism– Job performance– Depression symptoms– Substance use

• Satisfaction or experience of care consistentlypositive (often 90%+)


Evidence of Effects on Costs• Many findings of positive return on investment (ROI)

(Savings from health costs, disability claims, absenteeism, etc. exceeded EAP cost; often $3-$10 ROI range)

• One reason why most large employers feel it is veryworthwhile to offer

• Cost effect complex: Utilization and direct health care costs may increase temporarily– especially for behavioral health (e.g. due to facilitation of needed services) (Zarkin et al. 2000)


Utilization Challenges

• Even when programs and practices may be effective, need to engage target population to derive benefit

• Reported EAP utilization varies widely, partly due to differing ways of calculating

• Typical EAP clinical case utilization rate has been characterized as 5-10%, but varies very widely


Barriers and Facilitators to Using EAP

• Positive perceptions of EAP accessibility, confidentiality, belief in efficacy, awareness of benefits are associated with greater EAP use +/or willingness to use EAP

• Important to pay attention to organizational culture and ramifications as perceived by employees

• Higher levels of program promotion, visibility and EAP worksite activities positively associated with service use

• May also be psychological barriers common in behavioral health services (e.g., denial of problem, feeling can handle oneself)

• Communication is critical- multiple and inclusive approaches


Measuring EAP Performance

• Evaluating EAP performance is critical to get the most out of program

• Major challenge in field to arrive at broad use of standardized measures

• Move towards adoption of performance measures is consistent with trends in health services

17


Employer’s Guide to Employee Assistance Programs(National Business Group on Health)*

Recommended Metrics:

• Utilization

– Participation rates among specific problem groups (e.g., substance abuse)

• Impact Assessment– Job performance– Retention– Work attendance– Clinical outcomes

• Financial Return– Effect on health care utilization – Rates of return-to-work for workers’ comp and short-term

disability– Increased productivity and work attendance

*Rothermel et al. (2008)


Framework for Value of EAP to Employers*

• Health care value (Direct Costs)– impact on medical, mental health, disability,

workers’ compensation costs

• Human capital value (Indirect Costs)– impact on absenteeism, presenteeism, turnover,

employee engagement

• Organizational value–costs associated with safety risk management, legal

liability, culture change, worker morale, other secondary impacts

* Attridge (2003)


Utilization Measures• EAPA recommend six possible

measures• More than one can and should be used• Measures differ by type of EAP activity

captured and population groupInformation Only Life Management Active EAP

Eligible Employees

Covered Lives


Outcome Measures• Existing administrative/clinical data • Supplemental questionnaires or other tools • When possible, use standardized, validated

instruments• For productivity/job performance, options include:

– Health and Productivity Questionnaire (Kessler et al. 2003)

– Work Limitations Questionnaire (Lerner et al. 2001)

– Chestnut Global Partners Workplace Outcomes Suite (Lennox et al. 2010)


Conclusions

• EAP services can support resiliency• Evidence points to positive outcomes in

resiliency-related areas, though need for additional research

• Communication strategies and program promotion are important in utilization

• Evaluating EAP performance is critical, and guidance/tools are available


Reference List: ReviewsAttridge M. Employee Assistance Programs: A Research-Based Primer. International Handbook of Work and Health Psychology, 3rd Edition. Edited by Cary L. Cooper, James C. Quick, and Mary Schalwacq. 2009, John Wiley & Sons, Ltd.

Attridge M et al. EAP Effectiveness and ROI. EASNA Research Notes 1(3):1-5, October 2009.

Blum TC, Roman PM. Cost-Effectiveness and Implications of Employee Assistance Programs DHHS pub no RP-0907. Rockville, MD, SAMHSA, Center for Substance Abuse Prevention, 1995.

Csiernik R. A Review of EAP Evaluation in the 1990s. Employee Assistance Quarterly 19(4):21-37, 2004.

Degroot T and Kiker DS. A Meta-Analysis of the Non-Monetary Effects of Employee Health Management Programs. Human Resource Management 42(1):53-69, 2003.

Kirk AK, Brown DF. EAPs: A Review of the Management of Stress and Well-Being Through Workplace Counseling and Consultation. Australian Psychologist 38:138-143, 2003.

McLeod J. The Effectiveness of Workplace Counselling: A Systematic Review. Counselling and Psychotherapy Research 10(4):238-248, 2010.

Roman PM, Blum TC. Alcohol: A Review of the Impact of Worksite Interventions on Health and Behavioral Outcomes. American Journal of Health Promotion 11:136-149, 1996.


Additional ReferencesEmployee Assistance Research Foundation, www.eapfoundation.org

Employee Assistance Professionals Association. Addendum to 2009 EAPA Standards and Professional Guidelines for Employee Assistance Programs.

Jacobson JM, Attridge M. Employee Assistance Programs (EAPs): An Allied Profession for Work/Life. In S. Sweet & J. Casey (Eds.), Work and Family Encyclopedia. Chestnut Hill, MA: Sloan Work and Family Research Network. Available from http://wfnetwork.bc.edu/encyclopedia_entry.php?id=17296&area+All2010 , August.

Kaminsky M, McCabe OL, Langlieb AM, Everly Jr GS. An Evience-Informed Model of Human Resistance, Resilience, and Recovery: The Johns Hopkins’ Outcome-Driven Paradigm for Disaster Mental Health Services. Brief Treatment and Crisis Intervention 7(1):1-11, 2007.

Masi DA. Employee Assistance Programs in the New Millennium. International Journal of Emergency Mental Health 7:157-168, 2005.

http://www.eapfoundation.org

http://wfnetwork.bc.edu/encyclopedia_entry.php?id=17296&area+All


Additional References (cont’d.)Merrrick ESL, Volpe-Vartanian J, Horgan CM, McCann B. Revisiting Employee Assistance Programs and Substance Use Problems in the Workplace: Key Issues and a Research Agenda. Psychiatric Services 58(10): 1262-1264, 2007.

Osilla KC, Zellmer SP , Larimer ME et al. A brief intervention for at-risk drinking in an employee assistance program. Journal of Studies on Alcohol and Drugs69(1):14-20, 2008.

Roman PM, Blum TC. The Workplace and Alcohol Problem Prevention. Alcohol Research and Health 26:49-57, 2002.

Roman PM, Blum TC. The Core Technology of Employee Assistance Programs. The ALMACAN 15(3):8-9, 16-19, 1985.

Rothermel S, Slavit W, Finch RA, et al. Center for Prevention and Health Services. An Employer’s Guide to Employee Assistance Programs: Recommendations for Strategically Defining, Integrating and Measuring Employee Assistance Programs. Washington, DC: National Business Group on Health;

Zarkin GA, Bray JW, Qi JF. The Effect of Employee Assistance Programs Use on Healthcare Utilization. Health Services Research 35:77-100, 2000.

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