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Developing an Employee Assistance Program

Developing an Employee Assistance ProgramEmployee Assistance Programs (EAPs) are the primary means for employers to identify and address workers’ concerns regarding job stress, family strain, alcohol and substance use problems, and mental health and well-being.
Access to EAPs improves workers’ well-being and mental health:

  • Using EAP services has been shown to effectively reduce depressive symptoms, particularly thoughts about suicide. a
  • Using EAP services increases the likelihood that workers will receive appropriate treatment for depression and alcohol or substance abuse conditions. b
  • Receiving EAP services reduces the likelihood that workers will be late or absent due to alcohol use or a hangover by over 60%. c

Several factors affect whether workers will utilize their EAP:

  • Greater perceived social support from fellow workers and encouragement from supervisors increases the likelihood workers will use an EAP. d
  • Awareness and visibility of EAP services is key to their effective use.  Up to 40% of workers are unaware if their workplace has an EAP or the services it provides. e
Employees' attitudes towards addression depression in the workplace

Charbonneau et al. The Community Initiative on Depression: Report from a multiphase work site depression intervention. J Occup Environ Med 2005; 47:60-67.

EAPs

  • An Employee Assistance Program (EAP) is “a work-site based program designed to assist (1) work organizations in addressing productivity issues; and (2) employee clients in identifying and resolving personal concerns, including, but not limited to health, marital, family, financial, alcohol, drug, legal, emotional, stress or other personal issues that may affect job performance,” according to the Employee Assistance Professionals Association (EAPA). f
  • The EAPA also provides a list of core guidelines and components: g
    • Consultation with, training of, and assistance to work organization leadership (managers, supervisors, and union officials) seeking to manage troubled employees, enhance the work environment, and improve employee job performance.
    • Active promotion of the availability of employee assistance services to employees, their family members, and the work organization.
    • Confidential and timely problem identification/assessment services for employee clients with personal concerns that may affect job performance.
    • Referral of employee clients for diagnosis, treatment, and assistance, as well as case monitoring and follow-up services.
    • Assisting work organizations in establishing and maintaining effective relations with treatment and other service providers, and in managing provider contracts.
    • Consultation to work organizations to encourage availability of health benefits covering medical and behavioral problems including, but not limited to, alcoholism, drug abuse, and mental and emotional disorders.
    • Evaluation of the effects of employee assistance services on work organizations and individual job performance.
  • EAPs are different from, though inclusive of, workplace depression awareness campaigns or screening services. An EAP is a comprehensive entity meant to facilitate workers’ connection to health services, which in the case of workplace depression often involves addressing reluctance to seek help due to stigma through awareness campaigns and conducting screenings for symptoms.
  • Additionally, a comprehensive, integrated management program that incorporates internet tools, education for health care providers, and coordination between health care providers and employers has been shown to be feasible and capable of reducing health care costs. h

Design

  • “Internal” EAP counselors work for the company they serve.  An internal EAP may include an on-site office or department.
    • Internal EAPs can offer closer observation of employees and quicker access to EAP services.
    • On-site services may also trigger more consultations than external programs. i
  • On the other hand, in “external” EAPs, an outside provider (e.g., a hospital or mental health service) contracts with a company in order to provide support to employees.
    • External EAPs have the added benefit of delivering confidential counseling services off-site, discreetly separate from co-workers and supervisors.
  • Strict rules of confidentiality apply to both internal and external models, in accordance with ethical standards and privacy laws.
  • Research indicates that a majority of EAP clients are self-referred, and that a relationship exists between self-referrals and positive attitudes about EAPs. j

Effectiveness

  • Screening for depression alone is not enough—a coordinated system of care that includes physicians and employers must be in place to effectively combat the workplace effects of depression. k, l
  • According to the 2009 Society for Human Resource Management Employee Benefits Survey, 75% of all employers who responded offer EAPs (n=522). m
    • It is estimated that 88% of Fortune 500 companies offer some type of EAP services to their employees. n
  • Recent evidence suggests that these programs are cost effective for employers. For example: o
    • General Motors Corporations estimated that its EAP saves the company $37 million per year--$3,700 per employee enrolled in the program.
    • United Airlines estimated a $16.95 return on investment for every dollar spent on its EAP.
    • Recent simulations have demonstrated that the costs of enhancing depression screening and care programs (which often involve referrals to EAPs) are more than offset by savings from reduced absenteeism, presenteeism, and employee turnover. p
    • Collaborative depression care has been associated with longer number of days employed. q
Impact of a workplace-based screenining

Wang et al. Telephone screening, outreach, and care management for depressed workers and impact on clinical and work productivity outcomes: A randomized controlled trial. JAMA 2007; 298:1401-1411.

Measuring success

  • EAPs often use standardized tests to measure outcomes of EAP services, like the example below measuring presenteeism, which used a 5-point Likert-type scale for responses, including “strongly agree,” “agree,” “neutral,” “disagree,” and “strongly disagree”: r
    • I had a hard time doing my work because of my personal problems.
    • My personal problems kept me from concentrating on my work.
    • Because of my personal problems I was not able to enjoy my work.
    • My personal problems made me worry about completing my tasks.
    • I could not do my job well because of my personal problems.

 

a. Nakeo, Nishikitani, Shuma and Yano (2007) “A 2-year cohort study on the impact of an Employee Assistance Programme (EAP) on depression and suicidal thoughts in male Japanese workers.” International Archive of Occupational and Environmental Health, 81:151-157.
b. Zarkin, Bray and Qi (2000). “The effect of Employee Assistance Programs Use on Healthcare Utilizations.” Health Services Research, 35:77-100.
c. Bennett, Patterson, Reynolds, Wiitala and Lehman (2004). “Team awareness, problem drinking, and drinking climate: workplace social health promotion in a policy context.” American Journal of Health Promotion, 19:103-113
d. Delaney, Grube and Ames (1998). “Predicting likelihood of seeking help through the employee assistance program among salary and union hourly employees.” Addiction, 93:399-410.
e. Charbonneau A, Bruning W, Titus-Howard T, et al. The community initiative on depression: report from a multiphase work site depression intervention. Journal of occupational and environmental medicine / AmericanCollege of Occupational and Environmental Medicine. Jan 2005;47(1):60-67.

f. Prochaska, S. (2003). Employee assistance programs: what does HR need to know?. Society For Human Resource Management, retrieved March 9, 2010 from http://www.shrm.org/Research/Articles/Pages/default.aspx
g. EAPA Standards and Professional Guidelines for Employee Assistance Programs, January 2010 ed., retrieved March 19, 2010 from http://www.eapassn.org/i4a/pages/index.cfm?pageid=804
h. Colombi, A. M. (2005). "Depression management in the workplace: a case study." Journal of Managed Care Pharmacy 11 (3 Supplement): S16-20.
i. Collins, K.R. (2001). Buying an employee assistance program with your eyes open. SHRM White Paper. Retrieved March 9, 2010 from http://www.shrm.org/Research/Articles/Pages/default.aspx
j. Sturmer, P., & Gerstein, L. (1999). Message source characteristics and Employee Assistance Program advertising: Beliefs in program effectiveness and intentions to self-refer. Employee Assistance Quarterly, 15(1), 77-105. doi:10.1300/J022v15n01.
k. US Preventive Services Task Force. Screening for depression: recommendations and rationale. Ann Intern Med. 2002;136:760-64
l. Pignone MP, Gayles BN, Rushton JL, et al. Screening for depression in adults: a summary of the evidence for the US Preventive Services Task Force. Ann Intern Med. 2002;136:765-76.
m. SHRM Employee Benefits Survey. Retrieved March 19, 2010 from http://www.shrm.org/Research/SurveyFindings/Articles/Pages/2009EmployeeBenefits
SurveyReport.aspx
n. Janette Bennett “Helping Staff Deal with the Pressures of Life”, Sunday Times: Business Times, (1999)
o. Prochaska, S. (2003). Employee assistance programs: what does hr need to know?. Society For Human Resource Management, Retrieved from
p. Wang, P., Patrick, A., Avorn, J., Azocar, F., Ludman, E., McCulloch, J., et al. (2006). The Costs and Benefits of Enhanced Depression Care to Employers. Archives of General Psychiatry, 63(12), 1345-1353. doi:10.1001/archpsyc.63.12.1345.
q. Schoenbaum M, Unutzer J, Sherbourne C, et al. Cost- effectiveness of practice-initiated quality improvement for depression: results of a randomized controlled trial. JAMA. 2001;286(11):1325-1330.
r. Sharar, D, & Lennox, R. (2009). A New measure of EAP success. Society For Human Resource Management, Retrieved from http://www.shrm.org/hrdisciplines/benefits/Articles/Pages/EAPmetrics.aspx