This literature review will critically discuss Employee Assistance Programs abbreviated as EAP. In the discussion, the review will endeavor to show the importance of EAP in an organization and the benefits accrued to the clients who use them. This will be accomplished by reviewing different case studies and research works which have been carried out in this area. The review will highlight some of the arguments concerning the necessary changes which should be implemented to EAPs.
What is an EAP?
According to CCOH (2009), EAP can be defined as a private short term counseling service provided to employees of an organization; this is specifically aimed at helping employees overcome some personal problems, which may affect their performance at work. CCOH (2009) reports that EAPs ideas were triggered by industrial alcoholism programs back in the 1940’s. In most cases, EAPs forms part of organization plan to support the wellness of both the employer and employees in the organization. EAP may either involve written policies which may touch on employee and supervisor personnel offering training programs or services, and, in some cases, it engulfs an approved drug testing program (CCOH, 2009). In most cases, large organizations or which have a greater number of workforce or organizational labor force, have EAP department with qualified personnel; usually psychologists from whom employees seek to be assisted (). CCOH (2009) argues that the private sector is the source of external Employee Assistance Programs.
The Purpose of EAPs
EAPs are designed to offer help and solution to the various problems and crises which affect the employee performance at the work place. The crisis or the problem at hand might not necessarily be related to the work place but the effect they have on the performance of the employees is the basis of these programs. EAPs offer a wide range of services but at times they rely on other professional agencies in cases where more professional touch is required (CCOH, 2009).
The Development of EAP
According to Shannon (2006), the crudest form of EAP was started by Henry Ford in the 1900s through the efforts which he aimed at, “maintaining sobriety and good health and embodying positive family values” (Shannon, 2006, para. 3). Shannon (2006) argues that Ford viewed his employees as the greatest asset he has and thus embarked on investing substantially in them, and eventually organizational performance sustainability. He strongly believed that all the funds he was spending on his employees would pay, as Shannon (2009) puts it, good dividends. Ford believed that employee performance was highly dependent on their well being. The author continues to argue that that Henry Ford’s tactic/approaches worked out well and increased the performance of the organizational employees to augmented levels. The author continues to argue that about 40 to 50 years after Henry Ford’s efforts, EAPs were to be formalized (Shannon, 2009).
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Shannon (2006) continues to report that by the early 1960s, the popularity of EAP was spreading quickly in the U.S. He argues that this widespread growth led to the maturation of the EAP and thus growth slowed down. According his research, when a product matures in the market the solution to it is either replacing it or expanding its scope by refining it further. The EAPs were not replaced but their scopes were refined and expanded. This mostly took place in the later half of the 20th century. The EAP services were expanded and refined to include services in the behavioral health care. This meant that the EAP partly directed their focus to health care cost containment. The circumstances that led to the increase in costs of health care at those times led to its rapid growth (Shannon 2006).
The late 1990s presented yet another opportunity to the EAPs. The workers lives were growing more complex and there was a need for approaching a new approach whereby duties would have to be balanced between family affairs and workplace duties. This saw the emergence of work life programs which were integrated with the traditional employee assistance services. This has formed the present status of employee assistance services which have integrated EAP/MBH (managed behavioral health) and EAP/work life products. Shannon argues that these have reached the mature stage and need to be expanded. He believes that the time is mature for the next generation productivity service to be formulated. He sees the age old problem as an opportunity which these programs can now focus on (Shannon 2006).
According to Shannon (2006), in the past two decades, two programs which have gathered a considerable growth are disease management service and health and wellness programs. The products, Shannon (2006) argues, aims at increasing employee productivity by enabling the employees better their health management through prevention measures, that is, the health and wellness initiatives. There however, are other ways through which this may be accomplished, that is, through the control of chronic illness where disease management programs are incorporated in the systems (Shannon, 2006).
The two initiatives have shown a great achievement in increasing employee productivity. Shannon gives an illustration of a survey carried out in June by the Deloitte centre for health solutions. The survey involved 365 companies and revealed that 62 percent of the employers involved in the survey had made implementations for the health and wellness programs. A continued data analysis revealed that 33 percent of the employers were making considerations to implement these programs. From this survey finding, Shannon (2006) reports that there exist a growing understanding of the employers; that is, when the employees are healthy, it costs less money and increases the potential of making the employees more productive in their place of work; this in other words is to mean that organizational performance increases due to employees job satisfaction (Shannon, 2006).
Shannon quotes another research showing the popularity of disease management programs. The Forester research 2005 showed that 45 percent of the employers at present time offer some form of disease management benefit. By then another 22 percent were planning to implement some form of this service. Shannon (2006) believes that because the benefits are aimed at reducing chronic diseases and their associated complications; the programs would also help organizational employees in the management of the same. The benefits which are likely to accrue from this initiative will eventually increase the productivity of the employees (Shannon 2006).
As Shannon (2006) claims above, the EAP workgroup (2008) is in agreement that the healthy care has come to the fore front of the employers’ concern as far as organizational productivity is concern. The workgroup claims that the absenteeism associated with short and long term disability are becoming too frequent and as such are causing an alarm to the employers. The family medical leaves have also being implicated to cause these numbers of absenteeism. The group implicates mental health to a leading cause of illness for employees and as such, the leading cause of performance reduction. Equally disturbing to the employers are employees stresses as well as substance abuse because of the negative effects they have on employee wellbeing and subsequently their performance. The workgroup claims that most of the factors affecting the performance of employees are modifiable or can even be prevented (EAP workgroup 2008).
Today’s workforce is faced with so many challenges that many of the employees are often weighed down by chronic stresses. These stresses in most cases do not originate from the workplace but come from families and friends. Depression apart from causing poor performance at workplace can be life threatening (EAP workgroup, 2008).
Shannon (2006) writes that the health and wellness programs come in a wide variety of forms but with one aim of increasing the employee productivity at the work place. Shannon (2006) associates the following services with the health and wellness programs:
Proactive health assessments which are aimed at identifying health risks
Onsite fitness centers which encourages physical activity
Studies on weight management, pre-and postnatal care, smoking cessation and stress management
Employee Assistance Programs considering venturing into the health and productivity management sector may be effective by offering services that help the employers to track the factors that reduce performance levels. As an example, Shannon (2006) gives the case of employee absenteeism of which few organization are effective at tracking. He goes ahead to give an example of one such organization which gives an integrated service with an ability to track down employees service. The service released by Ceridian is designed to track absence of employees. The organization does this by managing, coordinating and tracking all kinds of employee absences. The absences covered include FMLA, state leave laws, vacation/paid time off and employer authorized policies. These services also helps to identify absence drivers and give services such as disease management and health and wellness programs to aid in resolving them (Shannon, 2006).
Through the incorporation of such ideas into the contents of EAP it is possible for an organization to come up with a strong EAP. Such EAP should have the ability to facilitate a strong growth in an organization. This is possible because; the number of organizations planning to use leave administration has kept on increasing from 25 percent in 1996 to around 51 percent in 2001. This rate has been on the rise since then (Shannon, 2006).
The Future of EAPs
From the stand point of employees, there is a need for organizations to come up with strategies that will facilitate and guarantee a growth in these programs. This in other words is to mean that employee assistance programs should be furthered and at the same time, the top management in such organizations should incorporate disease management and health and wellness service with the EAP services. Shannon claims that the numerous wellness services which are being offered to the employees are just white noise whose benefits cancel each other out. Shannon (2006) believes that unlike these services which are offered by other organizations, EAPs can form the best in the sense of their combination of various aspects of the employee’s life. The employee assistance, health and wellness, disease management and work life programs integrated into a single course that will enable the employees in an organization to be connected to the productivity services. Shannon (2006) argues that the wellness and disease management coaches and psychological all put together will be in a position to provide a holistic approach which will maximally benefit the employees as well as the employers (Shannon, 2006).
Shannon gives an example of Ceridian which has a product which provides a continuum of incorporated services which are designed to reduce employee absences, improve employee health and increase productivity. The program is designed to include the following components:
The tracking and administration of employee absences; this includes FMLA, casual absences and paid time off. There is also an absence analysis tool meant to help the employers understand absence drivers and consequently garner interventions aiming them.
There is a toll-free life enhancement line. This is designed for accessing wellness, psychosocial, disease and disability management services.
There is a health risk assessment which aims at identifying employees who can benefit from the services provided. There is also a provision of numerous intervention options from which the employers can pick the ones that best meet their interests and needs.
There is provision of more services such as employee group interventions which include health screenings, health fairs and healthy lifestyle lessons.
There is a provision of organizational effectiveness interventions which are designed with an aim of creating an environment that fosters health and wellness. Examples of such service include the assessment of organizational culture and the job specifications.
There is an employee intervention which includes life enhancement disability coaching and disease management coaching. There is also a 24/7 nurse hotline purposely for employees identified through health risk analyses.
Lastly, the program aims at helping the employees understand the productivity services.
To make these programs effective, there are incentives which are attached to them. Shannon (2006) writes that they range from reduced insurance co-pays to prize & cash give away. He also claims that the incentives can also be attached to the employees’ achieving progress.
An Opportunity to Upsell
Shannon (2006), in his study argues that EAPs should be designed in such a way that they ultimately broaden their services to include health, disease and the productivity management services. To develop these programs, it’s therefore important to consider these two options: either they should develop their services internally or they should join hands and partner with other organizations. Shannon (2006) claims that the partnering process is advantages in that it will enable interaction with various personnel leading to improvement of the service offered. For instance, some vendors are more specialized and well established in the health and productivity areas. It should be noted that traditionally the field of health and productivity is outside the EAP scope.
The Scope of EAPs
The areas in which EAPs cover are wide. These areas have expanded as opportunities have increased. From the above discussion it is evident that traditionally, EAPs covered only the financially areas of employees but as time went opportunities for expansion of EAPs arose which has widened the scope of EAPs. At present the range of areas which are managed by EAP providers are as follows:
separation and loss
parenting issues such as child care, elder care
balancing work and family
financial or legal
There are EAPs which go beyond this scope. Such programs facilitate the provision of other services such as retirement or lay-off assistance. Others have gone to the extent of health promotion and fitness for instance weight control, exercise, nutrition, or smoking. Still others offer services on long term illness and advice for managers on how to deal with difficult situations. Services that help solve crisis or difficult situations such as death at the workplace are also provided (CCOH, 2009).
MODELS OF EAPs
According to Fauria (2009), the field of employee assistance is at a situational crisis. The author claims that that the EAPs are faced with complex dilemmas with multiple causes. One of such dilemmas facing Employee Assistance Programs is that the employers, who are also purchasers of such programs, do not have sufficient information needed to guide choose the best and most appropriate EAP model for their organization; or the best model that suits the employee needs of the organization. Because of such ignorance, the employers are compelled to make their decisions based on such factors as price. Another dilemma which Fauria (2009) highlights is the lack of Employee Assistance professionals that would help the employers choose the best option for the employee or for the organizational needs. Fauria (2009) explains the following models of EAP which are available for application by purchasers.
Staff versus Network Models
EA services have got two delivery system models: the network model and the staff model. The models have both the advantages and disadvantages. Fauria (2009) reports employers should have the knowledge to identify both the advantages and disadvantages of the models before making a decision to buy one the models. This is important for it helps the purchasers pick the relevant services which can fill the unmet service needs of their organizations (Fauria 2009).
Fauria (2009) describes a network model as a model which consists of a number of network providing EAP services. The independent contractors may be serving in various health plan networks or EAPs. This model is based on volume and as such serves employers from a large geographic region. Apart from the provision of counseling, other services offered by the Employee Assistance Programs include finance/legal services, concierge services, augmented web based resources, elder child care and others. These services are provided through economies of scale revenues from a big number of purchasers. The models are best for employers whose employees are spread out on a wide geographical area; this may include multiple states or an entire nation (Fauria, 2009).
The network models have professionals from the general mental health community and as they lack the specific knowledge and expertise required for resolution of workplace complications. The network members may take the view that EAPs are just but another additional channels of additional revenues and as a result, such members may eventually become reluctant to embrace such assessment plans. Fauria (2009) argues that many of these networks do not have the basic understanding of what may entail an employer’s policies and culture (Fauria, 2009).
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The network providers are independent contractors under the IRS rules. They therefore use their own assessment tools and clinical procedures in service acquisition. Due to their spread over large geographical areas, it makes it hard for them to generalize or to use set guidelines in their training practice and procedure. This is has been considered as a loopholes that helps to compromise the treatment plan consistency; this is especially when the clients are from the same employer. Network providers make use of call centers through which employers are able to reach them from wherever point the employers may be located. This in other words is to imply that they are able to reach nationwide clientele as well as multiple states clientele. At the call centers, there are established procedures of processing the calls. The call centers help the callers to make a selection from local network members whom can quickly reach the employer and provide the required service (Fauria, 2009).
These are based on a small group of Employee Assistance experts who only serve selected few employers. Their services are tailored to suit specific and selected employers. This model lays emphasis on a close interaction with the employees such that individuals are able to understand the culture of the employees at the work place. The experts also get to understand the employers’ goals. This model has a characteristic flexibility as it is readily available in case of an emergency. The counselors are readily available for service provision through their established offices. The flexibility of the services offered by this model renders this model to be more expensive than the network model. The counselors offering the service have to be paid heavily; this is especially for their easy accessibility (Fauria 2009).
Local receptionists are used in the staff model EAPs. The receptionists work closely with counselors and as such are aware of their schedules. This makes it possible for receptionist to make a quick allocation of time in form of booking when an employees wishes to have some counseling sessions with the counselor (Fauria 2009).
THE EMPLOYER PERCEPTION OF EAPs
The EAP workgroup carried out a research to enable them understand the views of employers on the EAPs. In the research the employers were required to give their on view on what they thought were the roles of EAPs at the present and in the future.
The research was administered online with all 200 corporate members from the National Business Group on Health. There was a 21% response. The methodology used had one limitation in that the individuals solicited to participate in the research findings may not have been responsible for the company’s EAP.
It was found that majority of the employers use external organizations in the provisions of EAPs. This is as shown in the pie chart below.
Responsibility of EAP
It was found that 66% of the employers designated the EAP responsibility to the benefits departments. Those who left it to the hands of the human resource department were 36%. The medical department was only 6% while the occupational health department was 2%. The findings are in the figure below.
Employer Perception of EAPs
The survey used the following questions to gather the perception of the employers on their current EAPs. They were required to choose the answer which best described what they thought an EAP was.
Workplace performance program
Employing counseling service
The findings showed that 90% of the surveyed employers viewed EAP as an employee counseling service. The analysis also showed that 43% of the employers viewed it as healthcare benefit while 21% viewed EAP as a workplace performance program. A number of employers chose more than one option with 33% viewing EAPs as both health care benefit and a counseling service. The findings also reveal that 17% viewed it as both an employee counseling service and workforce performance program and 14% viewed EAPs as both workforce performance program and healthcare benefit.
Core Services Provided
When the employers were required to list the core EAP services they provided to their employees, the following findings came out. Some employers had 85% cited intake, identity, refer and provide care to employees, 80% cited self help material and web based education, 68% cited referring to HR management while 66% cited training employees and provision of leadership. The findings also show that 34% viewed it a core service providing data on the effect of EAP on the company.
Additional EAP Services Offered
When the employers were asked of the additional services they gave to their employees, 95% cited critical incident stress management, 80% cited workplace violence consultation, 76% cited work support and life support and 76% financial ands legal counseling.
The definition of and scope of work of EAPs has been given. Then attention can now be turned to the effectiveness of EAP. In this chapter the scope of effective EAPs will be discussed.
Lenox, Sharar and Burk (2009) argue that in deciding whether an EAP is effective, the end results of the program should be looked at. The aim of an EAP is to obtain a positive outcome at the workplace. There should be for instance absentees if the aim of an EAP was to reduce the absentees in a work place. It should be appreciated that this might not necessary be the definition of effectiveness for the case of an EAP provider or owner. Being a business, the owner of an EAP provider might be bent more on money making in the definition of effectiveness (Lenox, Sharar & Burk, 2009).
Lenox, Sharar and Burk (2009) continues to argue that the concept of using the end results to measure EAP effectiveness is still at its infancy stages though it is coming up. One way in which an employer can determine the effectiveness of an EAP is by looking at the approach to be used in measuring outcome and return on investment (Lenox, Sharar & Burk, 2009).
Our Historic Approach
The traditional methods which have been in use to determine whether an EAP has been effective are as follows:
Measuring the satisfaction of the user
Dependency on anecdotal reports of positive outcomes
Published academic work on EAP carried out
These three measures are quite weak and can really not be depended upon to give a true measure of effectiveness. Lenox, Sharar and Burk (2009), claim that only a small fraction of the EAP providers are able to give a demonstration of a workplace specific outcome without the review of charts and making of subjective determination (Lenox, Sharar & Burk, 2009).
Outcomes as a Value Proposition
Lenox, Sharar and Burk (2009) in their research find that the core of EAP is to recognize the employee needs and at the same time seek to reduce the spilling of the employee’s personal issues to their performance at the workplace. They continue to argue that there should be a realization of the significance of work to good health. They claim that those employees who have struggles with their jobs often have problems which are related to their health. They however lament that the employee assistance field has greatly diverted from this course and instead operates as though it were a business. They feel that the EA field should improve productivity at the workplace through behavioral health expertise. The EAP providers however operate on a different view and instead keeps on coming up with new innovative products and hence increasing the market (Lenox, Sharar & Burk, 2009).
Lenox, Sharar and Burk (2009) continue to argue that the employers are not very much concerned on how the EAP help their employees to change but are interested in whether there are changes in the productivity of the employees. It is expected that all the employers will not be willing to pay for Employee Assistance services if they do not see any outcome. But again, because of the absence of good indicators of measuring the performance outcome there lacks a link between the price paid by the employers and the expected outcome. This according to Lenox, Sharar and Burk (2009), should not be an end result determining the effectiveness of these programs. They believe that for maturity to be developed in the field a method for determining the effectiveness should be developed. Again these methods should be standardized across the EAP providers and practitioners (Lenox, Sharar & Burk, 2009).
Outcomes as a Reform
Lenox, Sharar and Burk (2009) claim that a good method of measuring effectiveness should meet the following: validity, reliability, and demonstrate psychometric properties. They also add that the measure should detect change over time with an administrative and a manageable burden. They believe that such a measure will truly reform the field of EA and rebuild its credibility. It will liberate the field from the mechanical way of measuring effectiveness where for instance, recording the number of times a phone rings before it is picked up (Lenox, Sharar & Burk, 2009).
Lenox, Sharar and Burk (2009) claim that the EA field should no longer spend more resources in measuring the process but divert the same resources to the measurement of the outcome and in demonstrating results. In most cases, the employers will look unto the EAP providers to start the outcome evaluation. Unfortunately the vendors or providers often struggle to come up with the correct measures to be used, relevant in measuring the outcome expected. For the measure to be relevant it should be appropriate to the EAP setting and workplace focused (Lenox, Sharar & Burk, 2009).
One such method which can be used to determine the effectiveness of an EAP has been developed by Dr. Richard Lennox. The measure is short and well suited for both the pre and post EAP use. It designed to use the self report scale examining the effect of personal issues on work place performance as influenced by absenteeism, work engagement, work distress and life satisfaction (Lenox, Sharar & Burk 2009). Check figure 1 in the appendix below.
EAPs AND JOB LOSSES
According to the National Association of Social Worker (NASW, 2001), job losses is becoming a major problem to most of the employers especially at this time of economic crisis whereby the employers seems to continuously reduce the number of employees on the payroll. NASW (2001) believes that lay offs not only affects those employees who are fired but also those who remain behind. Equally affected are the employers who see their staff go. The social workers have an ability to provide comprehensive programs with a potential of reducing possibilities of workplace violence and ensuring that there is smooth transition for the employees who remain (NASW, 2001).
Such programs will include training which are directed at the supervisors educating them on how to handle employees in the course of downsizing. The programs among other things are meant to enable the supervisors spot those employees who are troubled and consequently offer counseling services to them. These trainings are also meant to help the managers and employees regroup in an appropriate manner so that despite the increased work load, the productivity of the employees is not lost. This is achieved by helping everyone to maintain a positive morale and attitude (NASW, 2001).
Social workers in the field of EAP have a great potential in helping employees in a variety of ways thus help in uplifting the performance of employees at the workplace. The provision of direct services to individuals and families has a great deal in stabilizing the employees. These services can be provided in marriage and relationship counseling and even in child bearing concerns. By settling individuals on such issues, the social workers help to empty the employees of possible worries and as a result they can focus their efforts in production (NASW, 2001).
THE CHANGING NATURE AND FUTURE OF EAPs
The Biggest Fundamental Change in the Past 15-20 years
Sharar (2009) in describing the changing nature of EAPs quotes John Burke in explaining the major change in the EAPs in the past 15-20 years. Burke is quoted saying that the major change that has been witnessed is the maturity of EAPs. He explains that the industry has been able to focus on profit and loss. He explains that in the early days the EAPs services were offered by public agencies and professional within companies. However in the late 1970 and at the beginning of 1980s external EAPs emerged. These were focused on the profit motive. The external EAPs grew to dominate the field by the early 1990s. Burke explains that this uplifted the level of the competition forcing companies to engage in the service distinction in the production of growth and profitability (Sharar 2009).
Sharar (2009) continues to write about Burke and his concern on how some companies have continued to lower their prices as the competition heightened. This brought about the cycle of commoditization. This was an opportunity for growth because many businesses reinvented their business. Sharer (2009) quotes Darick who had a different opinion on the same question. Darick is implicated believing that the biggest change which has ever occurred to the EAPs being the change in the scope of coverage of the EAPs. Initially the EAPs were designed to help employees who had issues with substance abuse. The scope at the present time has expanded to include health, wellness, prevention and the treatment of the whole person.
The EAPs have also integrated life management services in the EAPs packages. The EAPs are focused on ways they can help employees become more effective and balanced aiming at the improvement of the workplace productivity. Still another big change which can be noted down is shift in the EAPs providers. Sharar (2009) writes about Darick claiming that initially it was the small regional companies which were responsible for EAPs services unlike at the present whereby the s
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