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CHAPTER 17
Employee Assistance
Programs: A Research-Based
Primer
Mark Attridge
Attridge Consulting, Inc., Minneapolis, USA
17.1 INTRODUCTION
Employee Assistance Programs (EAPs) are an important part of many or-
ganizations. This chapter features a review of the literature to provide a
research-based overview of EAPs and their role in supporting the mental
health and work performance of employees. Many aspects of EAPs are pre-
sented in this chapter, including what defines an EAP, the history of the field,
the scope of EAP services, what makes EAPs unique, the market prevalence
of EAPs, utilization, outcomes, the return on investment (ROI) for EAPs,
and future trends. But first the business need for EAPs is examined to under-
stand why these programs were initially developed and why they continue to
flourish.
17.2 WORKPLACE MENTAL HEALTH AND ADDICTIONS
17.2.1 Why are EAPs Needed?
Comprehensive reviews of the research literature on workplace mental health
abound, including reports by researchers (Brun et al., 2003; Kahn & Langlieb,
2003), business groups and consultants (American Psychiatric Association,
2006; National Business Group on Health/Finch & Phillips, 2005; Watson
Wyatt Worldwide, 2007), the Canadian government (Larson et al., 2007), the
Work and Health Psychology: The Handbook 3rd Edition Edited by Cary L. Cooper, James C. Quick, and Marc Schabracq
C
!2009 John Wiley & Sons, Ltd
381
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382 SUPPORTING INDIVIDUALS AT WORK
United States government (DHSS, 1999; Masi et al., 2004), the European
Union (McDaid, 2008), and the World Health Organization (WHO; Hyman
et al., 2006). There are a number of conclusions from these reviews that
support the need for more employer attention to workplace mental health
and addiction issues and thus also to the need for EAP services:
!Mental health disorders and addictions are widely experienced among
working-age populations. An estimated one in four adults have a diagnos-
able mental disorder, one in five adults have an alcohol use problem, and
one in eight adults have a drug or other kind of addiction.
!Many people with mental health disorders and addictions suffer from
chronic medical conditions (such as heart disease, asthma, diabetes and
hypertension).
!Over a third of people with alcohol and drug addictions have a high rate
of also having another kind of addiction or mental disorder.
!Untreated mental health disorders and addictions can damage the individ-
ual in many ways, such as an increased risk of illness, personal problems,
incidents at work or school and even family breakdown.
!Employees with untreated mental health and substance abuse disorders
can lead to problems for their employers, such as poor customer rela-
tions, absenteeism, diminished work quality and performance, on-the-job
accidents and disability claims, work-group morale issues and turnover.
!Society also bears the burden of consequences related to mental health,
alcohol and drugs, all of which add up to hundreds of billions of dollars
in economic costs in terms of lost work productivity, health care services
use, law enforcement and other areas.
!Many kinds of treatments have been proven to be both clinically effective
and cost-effective, but sadly most people with mental health or addiction
disorders never see a professional care provider for treatment.
The majority of adults with mental health disorders and addictions in the United
States and Canada are under-diagnosed, under-treated or get no treatment at all
(Green-Hennessy, 2002; Statistics Canada, 2003).
The implications of this alarming evidence are not lost on some employ-
ers. Savvy business leaders recognize the critical role that mental health
factors play in the overall success of their company. This understanding has
guided the development of a new approach to the design of employee health
benefits called Health and Productivity Management (Kramer & Rickert,
2006; Loeppke et al., 2007). For example, a recent survey of senior human
resources (HR) executives found that mental health is now considered the
number one driver of indirect business costs, such as lost productivity and
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EMPLOYEE ASSISTANCE PROGRAMS 383
absence (Employee Benefit News, 2007). This is important because these
indirect kinds of costs are typically far greater than the direct costs that
most employers are naively so concerned about, like health care costs and
insurance claims (Goetzel, 2007; Kessler et al., 2003, 2004).
17.3 PROFILE OF EMPLOYEE ASSISTANCE PROGRAMS
Many employers have responded to mental health and addictions in the
workplace by implementing Employee Assistance Programs. Let us now
examine the nature of EAPs.
17.3.1 Definition: What are EAPs?
EAPs are employer-sponsored programs designed to alleviate and assist in
eliminating a variety of workplace problems. Employee Assistance Programs
typically provide screening, assessments, brief interventions and outpatient
counselling for mental health and addictions problems as part of their basic
services offered to client organizations. The source of these employee prob-
lems can be either personal (legal, financial, marital or family-related, mental
health problems and illnesses, including addiction) or work-related (conflict
on the job, harassment, violence, stress, etc.). EAPs are a field of practice
composed of multidisciplinary professionals including social workers, psy-
chologists, professional counsellors, substance abuse counsellors and nurses.
An EAP is a worksite-based program designed to assist organizations in ad-
dressing productivity issues and 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
(Employee Assistance Professionals Association, 2003).
17.3.2 History: Where Did EAPs Come From?
EAPs were originally established in the 1940s to address alcohol abuse
and its impact on the workplace. These early EAPs, or Occupational Alcohol
Programs (OAPs) as they were originally called, helped companies to identify
troubled employees and support them through the process of recovery and
return to work (Trice & Schonbrunn, 2003). The US federal government
promoted OAPs through legislation such as the Hughes Act of 1970, which
required all federal agencies and military installations to have an OAP and its
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384 SUPPORTING INDIVIDUALS AT WORK
amendment in 1972 to include drug abuse (Jacobson & Kominoth, 2009). In
the 1970s, OAPs realized their services had to address more than just alcohol
and drug abuse. During this period many OAP professionals belonged to
the Association of Labor/Management Administrators and Consultants on
Alcoholism (ALMACA).
During the 1980s, EAPs became more popular in the United States and
Canada. At this point the mix of services offered expanded to build on
the focus of OAPs to feature more comprehensive elements. The field also
grew through the activity of two major professional organizations: the Em-
ployee Assistance Professionals Association (EAPA; which evolved from
ALMACA) and the Employee Assistance Society of North America (EASNA;
which has a strong Canadian influence). When the drug-free workplace legis-
lation was passed in 1988 in the United States, EAPs continued to grow in im-
portance as they became vital to businesses by providing expertise and guid-
ance to employers regarding the management of employees with addictions.
In the 1990s, EAPs became a standard component of employee benefits at
the majority of large companies. EAPs responded to this growth in market
penetration and the greater demands of new clients by broadening their menu
of services to address issues such as work/life balance, elder care, workplace
violence, drug testing and supporting company-wide changes such as mergers
and downsizing. In the 2000s, EAPs continue to evolve with the rapidly
changing American workplace (see final section of this chapter on trends
for EAPs). Today, the number of members in the two major professional
associations exceeds 5000 and is growing worldwide.
17.3.3 Scope of Services: What do EAPs do?
The primary job of an EAP professional is to meet privately with employees
or their family members to identify and resolve workplace, mental health,
physical health, marital, family, personal addictions or alcohol, or emotional
issues that affect a worker’s job performance. These kinds of cases typically
comprise about two-thirds of all cases at an EAP. The most common initial
reason for seeking help from an EAP is for personal relationships/marital
issues. Most EAPs also offer consultative and educational services around
legal and financial issues that affect employees (Wilburn, 2007). Other as-
pects of an EAP include services that support individual supervisors with
their management and work team problems – these are called ‘management
consultations’ – as well as more strategic consulting around organizational
change and workforce development issues (Hyde, 2008). EAPs offer pre-
ventative and immediate response services for crisis and workplace critical
incidents (Everly & Mitchell, 2008).
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EMPLOYEE ASSISTANCE PROGRAMS 385
Program type
In the beginning, almost all EAPs were ‘internal programs’, in which EAP
professionals worked for the same company that they supported. These kinds
of EAPs are still common within large companies, universities and the pub-
lic sector. However, the more prevalent type of EAP today is the ‘external
program’, which has a staff of EAP professionals who are employed by an
independent company and supply contracted EAP services to other compa-
nies. External EAPs hire counsellor affiliates (part-time or full-time licensed
mental health professionals within the community) to provide the majority
of telephonic or face-to-face clinical services. External types of EAPs are
cost-effective for companies with employees at worksites in different geo-
graphical areas. There is a third type, called Blended EAPs, in which the
company has a few key EAP managerial staff and this group works with an
external EAP vendor to provide the counsellors and other services (Turner,
Weiner & Keegan, 2005).
17.3.4 The Core Technology: What makes EAPs Unique?
There are several aspects of EAPs that contribute to their unique role in
employee benefits and the larger health care system. Such attributes include
how the EAP is accessed, the focus of the EAP on restoring employee
work performance, specialization in alcohol and drug addiction problems
and being responsive to difficult issues or incidents that affect the workplace.
Confidential, free, and immediate access
Arguably, the most essential function of a successful EAP is its ability to
provide confidential services, free of charge, when needed to employees and,
oftentimes, their family members. Additionally, EAP services are voluntary,
and most employees who use EAP services do so through self-referrals.
Virtually all EAPs feature some form of 24-hour assistance every day of
the year. This is accomplished through advanced telephone and web-based
technologies. Knowing that this help is always available can be reassuring to
employees and supervisors.
Core technology
The EAP core technology, developed by Paul Roman and Terry Blum over
20 years ago, represents the essential components of employee assistance
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386 SUPPORTING INDIVIDUALS AT WORK
Table 17.1 EAP core technology components
Core technology component
1 The identification of employees’ behavioural problems includes assessment of
job performance issues (tardiness, absence, productivity, work relationships,
safety, etc.)
2 The evaluation of employees’ success with use of EAP service is judged
primarily on the basis of improvement in job performance issues
3 Provision of expert consultation to supervisors, managers and union stewards
on how to use EAP policy and procedures for both employee problems and
for management issues
4 Availability and appropriate use of constructive confrontation techniques by
EAP for employees with alcohol or substance abuse problems
5 The creation and maintenance of micro-linkages with counselling, treatment
and other community resources (for successful referral of individual EAP cases)
6 The creation and maintenance of macro-linkages between the work
organization and counselling, treatment and other community resources (for
appropriate role and use of EAP)
7 A focus on employees’ alcohol and other substance abuse problems
(Roman & Blum, 1985, 1988; Roman, 1990). There are seven components
(See Table 17.1). The key is for the EAP counsellor to assess how an em-
ployee’s concern – or presenting problem – is affecting the workplace and his
or her ability to function at work. The EAP counsellor is trained to help the
employee to identify the stressors that impact work and determine how the
person can better cope with the situation. This ‘work-function’ perspective,
while central for EAPs, may or may not be shared by other mental health
providers in the community or outpatient network who may elect not to focus
on work issues when treating a client. Another core component is to have
the EAP staff work closely with the company in order to train managers and
supervisors on how to successfully engage the EAP and to understand the
larger issues of importance to the organization. It is critical for the EAP staff
to know the range of resources available to assist employees from within the
company and from the surrounding local community. Even though it was first
introduced more than 20 years ago, a recent survey conducted this year found
that the vast majority of professionals active in the EA field today (85%) were
familiar with the EAP core technology (Bennett & Attridge, 2008).
Alcohol and drug issues
In 1990, the seventh component of the EAP core technology was added
(Roman, 1990). This component harkens back to the days of OAPs and
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EMPLOYEE ASSISTANCE PROGRAMS 387
places a strong emphasis on screening and assessments for alcohol and drug
issues. The workplace offers a useful context for the identification and refer-
ral for individuals with drinking and drug abuse problems (Roman & Blum,
2002). The EAP can provide confidential services to management and staff
workers with substance use disorders and associated mental health disorders.
This typically means being directly involved in providing screening, refer-
ring employees for treatment and offering follow-up care and support during
recovery. In such cases, sometimes the political leverage that comes from the
EAP counsellor being affiliated with the employer can help employees with
substance troubles to get into treatment in order to keep their job. This process
can also use what has been called ‘constructive confrontation’, in which the
EAP professional leads others at the company in a coordinated intervention
with the person in trouble from alcohol or drug abuse. Thus, by offering ac-
cess to an EAP, an employer can be more successful in reducing harm from the
misuse of alcohol and other drugs by having a dedicated and experienced re-
source available and ready to support the company’s alcohol and drug policy.
Crisis
EAPs can also deliver unique value in their ability to increase awareness of,
and preparedness for, traumatic incidents and the kinds of serious workplace
problems to which managers are not comfortable in responding on their own,
such as natural disasters, workplace bullying and violence, domestic abuse,
fatal on-the-job accidents and suicide (Paul & Thompson, 2006). Avoiding
a lawsuit from a critical incident or effectively dealing with sensitive human
resources issues can be a value trump card for an EAP.
17.3.5 Market Penetration: How Many Companies
have an EAP?
Due in part to this unique mission and their relatively low cost, EAPs are
now widely adopted across North America. EAPs have become the primary
channel for many workers to get their first access to mental health care
and addiction treatment services, particularly in unionized environments and
medium to larger size organizations (Csiernik, 2002). For example, in the
regional province of Ontario, Canada during the period of 1989 to 2003, the
number of employer organizations with an EAP doubled – going from 28%
to 67% (Macdonald et al., 2007). A more recent 2006 national survey of
Canadians found that half of workers (50%) had access to an EAP where
they worked (Desjardins Financial Security, 2006).
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388 SUPPORTING INDIVIDUALS AT WORK
The figures on EAP market penetration are similar in the United States.
In 1985, about 31% of companies in the United States had an EAP and this
had risen to 33% in 1995 (Hartwell et al., 1996). In the next seven years,
this figure had almost doubled. A 2002–3 national survey in the United
States revealed that 60% of full-time workers were employed in settings
with an EAP (Roman & Blum, 2004). In 2007, about three-quarters of all
businesses in the United States had an EAP (Employee Benefit News, 2007).
Similar findings come from the most recent Society for Human Resources
Management Survey of Employer Benefits [SHRM] (2008). It found that in
2008 three- quarters of businesses in the United States (75%) offered EAP
services to their employees. This figure is up slightly from five years earlier,
when it was 70% in the 2004 SHRM survey. However, in 2008 as in past years,
having an EAP varied substantially based on company size, ranging from
52% for small employers (1–99 staff), 76% for medium employers (100–499
staff), and 89% for large employers (500+staff)(SHRM, 2008). Today, well
over 100 million American workers have access to an EAP (Masi et al., 2004).
17.3.6 Utilization: How often are EAPs used?
Utilization rates for an EAP are commonly measured by a metric that com-
pares the total number of people who use the EAP for a clinical issue (which
is primarily employees but also includes some spouses and dependents) to
the total number of employees active at the company the EAP supports. For
many years the typical EAP clinical case utilization rate has been between
5% and 10% of the number of total employees at the company (Amaral,
2005). The amount of contact with the EAP service is actually much higher
that the clinical case utilization rate would suggest, as each individual case
can have multiple sessions (or calls) with an EAP counsellor. The average
number of counselling sessions used by an employee with access to a six-
session maximum model is about four sessions (Jacobson & Hosford-Lamb,
2008). EAPs with a telephonic-based external program model tend to have
an average number of contacts per case that is even lower.
Although 5% use among all employees may not seem that significant,
keep in the mind that the relevant group for clinical use of an EAP is really
not the entire employee population, but rather it is more appropriately the
10 to 20% or so with mental health disorders, addictions or personal life
events in a given 12-month period that merit clinical assistance and direction
into community services or professional treatment. Indeed, one would hope
that the vast majority of employees at a given company should be healthy
and functioning well enough not to need the EAP. Depending on the rate of
turnover at a company, the cumulative use rate for an EAP over a number
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EMPLOYEE ASSISTANCE PROGRAMS 389
of years is even higher, as an employee may use it one year and not need to
do so again for several years. For example, a 2006 survey found that about
one in 10 workers (11%) with access to an EAP had used ever it (Desjardins
Financial Security, 2006).
In addition, about 10 to 20% of the total caseload of all EAP users is of a
much different nature than those who need assistance for their own personal
or family issues. These other kinds of EAP users are supervisors who need
help to better manage a worksite issue or other staff needing support after a
workplace critical incident. Some EAPs also can have a large slice of their
total mix of EAP services devoted to supporting organizational development
and more strategic issues at the company (Hyde, 2008). Still others use the
EAP in a more preventative mode and seek information and educational
materials from the EAP office or website or onsite training workshops. This
kind of non-clinical contact can double or triple the total contact use rate for
an EAP over just the clinical case rate.
17.4 EAP OUTCOMES AND BUSINESS VALUE
17.4.1 Effectiveness and Outcomes: Do EAPs Help?
All EAPs measure the level of client satisfaction with program services
and most find it to be very high (Dersch et al., 2002; Phillips, 2004). For
example, one study used an independent survey firm and random sampling
techniques to conduct follow-up interviews with over 1,300 cases nationally
from an external model EAP. The results revealed that 95% of users reported
being satisfied with the EAP service (Attridge, 2003c). But having high
levels of client satisfaction is not enough to show the full value of an EAP.
Also needed is evidence of clinical symptom relief and work performance
improvement among EAP clients (Csiernik, 2004; Roman, 2007). These
outcome areas produce immediate returns to the company as well as create
additional long-term cost savings in related areas later on (reduced health
care claims, disability insurance claims, less turnover, etc.).
EAP outcomes
Studies show that, when appropriately administered to emphasize the core
technology components, EAP services produce positive clinical change, im-
provements in employee absenteeism, productivity and turnover, and savings
in medical, disability or workers’ compensation claims (Attridge & Amaral,
2002; Kirk, 2006; McLeod & McLeod, 2001; Yandrick, 1992).
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390 SUPPORTING INDIVIDUALS AT WORK
Table 17.2 EAP impact on employee work performance: results from six studies
Improved work performance Sample size EAP model Source
61% of all cases had improved
work performance
1,190 cases Internal programs at
many universities
with mostly
in-person model
Phillips
(2004)
50% of all cases had improved
absence and productivity at
work
882 cases Internal program
with in-person
model
Kirk
(2006)
64% of cases with work issues
as primary problem had
improvement after EAP use;
Average of 46% improved
productivity rating on 1–10
scale for EAP cases
Not
specified –
10,000+
National data
warehouse with
dozens of EAPs;
mostly internal
programs with
in-person model
Amaral
(2008a)
Reduction from 15% to 5% of
all clients who ‘could not’ do
their daily work or who
experienced ‘quite a bit’ of
difficulty doing their daily
work in past four weeks
59,685 cases Blended program
with mostly
in-person model
Selvik
et al.
(2004)
57% of cases had improvement
in ability to work productivity,
with average gain in
productivity of 43% on 1–10
scale
11,909 cases National EAP
provider –
external program
with mostly
telephonic model
Attridge
(2003a)
Number of work cut-back in
past 30 days was reduced
from 8.0 days to 3.4 days
(58% gain in productivity)
3353 cases National EAP
provider –
external program
with mostly
telephonic model
Baker
(2007)
Examples of results from six major contemporary studies illustrate the
kinds of improvements obtained after EAP use in the primary outcome area
of work productivity for individual employees. These findings consistently
show improvement of presenteeism problems, both from EAPs with a tradi-
tional in-person model or from those with an external model with telephonic
contact between employee and counsellor (see Table 17.2).
EAP referrals
A necessary part of the EAP service is to appropriately refer some of the clin-
ical cases – particularly those cases requiring more extensive psychotherapy,
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EMPLOYEE ASSISTANCE PROGRAMS 391
pharmacological treatment or alcohol/drug treatment – to providers of men-
tal health care outside of the EAP. Such referrals are usually to outpatient
clinical settings staffed by licensed psychologists, psychiatrists, social work-
ers or other professionals. At this point the referral client must pay for these
services however the benefit is arranged. In these cases, the effectiveness of
the EAP thus ultimately rests with these other providers.
Fortunately, the success rates for the treatment for some of the most com-
mon mental health disorders are quite high. According to a landmark study
that examined over 300 meta-analysis papers (each paper itself a review of
other many original studies), outpatient mental health treatment is largely ef-
fective at improving patient functioning (Lipsey & Wilson, 1993). A recent
randomized control experimental design study demonstrated the effective-
ness of mental health treatments on reducing clinical symptoms for depres-
sion and improving work absence and presenteeism outcomes (Wang et al.,
2007). Consumer opinion research has also found generally positive results
from the perspective of clients who used mental health services (Seligman,
1995). Thus, the evidence strongly indicates that once people with mental
health disorders can get to a treatment provider – perhaps after referral from
the EAP – the treatments are generally effective at restoring better mental
health and work functioning.
Some studies indicate that EAPs are particularly effective at helping em-
ployees with substance abuse issues to navigate successfully through the
many treatment options available and with providing follow-up support and
case-management assistance after treatment to reduce relapse issues and im-
prove the return-to-work process (Blum & Roman, 1995; Cook & Schlenger,
2002). A survey of over 800 EA professionals experienced in this area found
that almost nine in 10 referral cases from the EAP were believed to be suc-
cessful in completing their recommended specialized treatment for alcohol
or drug issues (Attridge, 2003b). As with mental health, literature reviews of
the hundreds of outcome studies on alcohol and drug abuse treatment have
agreed upon the general effectiveness that professional treatment can provide
to those suffering from alcohol and drug abuse problems (Canadian Centre
on Substance Abuse, 2005; Miller et al., 2003; NIDA, 1999). In particular,
the combination of cognitive behavioural therapy, pharmacological therapy
and self-help peer support groups has been the most helpful in getting addicts
to reduce and better manage their alcohol or drug use for long periods of time.
17.4.2 EAP and ROI: Dollars and (Business) Sense
Employers purchase EAPs to provide services to the individual employees,
members of their family, and the organization as a whole. A fundamental
management question then becomes whether or not their EAP is providing
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392 SUPPORTING INDIVIDUALS AT WORK
enough value to cover the cost of sponsoring the service. In other words, is
the financial return on investment (ROI) a positive ratio? For perspective, fees
for EAPs in the last decade have been in the range of $15 to $25 dollars per
employee per year (Hartwell et al., 1996; Sharar & Hertenstein, 2006). The
average annual cost to employers for single coverage in the United States in
2007 was $4,479 (Kaiser, 2007). Thus, this level of cost for an EAP represents
about one-half of 1% of total health care costs at most companies. Thus, EAPs
are one of the least costly of all benefits services for most companies.
To help answer the ROI question, the ‘EAP Business Value Model’ was
created to better conceptualize the components of total business value that
mental health workplace services can offer employers (Attridge & Amaral,
2002; Attridge, Amaral & Hyde, 2003; Amaral & Attridge 2004, 2005;
Attridge, 2005). This model organizes the business value that results from
positive employee mental health into three classes of outcomes that are
important to employers: health care outcomes; human capital outcomes; and
organizational outcomes.
!The health care value component includes the impact of the program
on medical, mental health, disability and workers’ compensation claims.
These are the direct costs paid by most employers that can be routinely
measured and tracked.
!The human capital value component comprises indirect costs. It represents
the savings that an employer can expect when effective prevention and
intervention services result in avoided employee absenteeism, reduced
presenteeism and turnover and enhanced employee engagement, retention
and recruitment.
!The organizational value component includes costs associated with work-
place safety risk management, legal liability risk prevention, organizational
culture change, improved worker morale, and secondary impacts on health
costs and human capital costs. Ultimately, these costs affect the bottom
line of company net profitability.
This triadic model is a useful heuristic for understanding what an EAP
can do for a company. Most researchers and industry experts now believe
that there is enough solid evidence in each of these value component areas
to ‘make the business case’ for providing greater access to mental health
services in general and to workplace-based services in particular (American
Psychiatric Association, 2006; Attridge, 2005, 2008a; Finch & Phillips, 2005;
Goetzel et al., 2002; Kessler & Stang, 2006a; Langlieb & Kahn, 2005). This
conclusion is supported by many case studies of EAP outcome value at
companies such as Abbott Laboratories, America On Line (AOL), Camp-
bell Soup, Chevron, Crestar Bank, Detroit Edison, DuPont, Los Angeles
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EMPLOYEE ASSISTANCE PROGRAMS 393
City Department of Water & Power, Marsh & McLennan, McDonnell Dou-
glas, NCR Corp, New York Telephone, Orange County (Florida), Southern
California Edison, the U.S. Postal Service, and the U.S. Federal Government
(Blum & Roman, 1995; Yandrick, 1992).
The typical analysis produces an ROI between $5 and $10 in return for
every $1 invested in the EA program (Attridge, 2007; Hargrave et al., 2008;
Jorgensen, 2007). In fact, as in most other cost-benefit studies of health
care services, the financial benefits from the area of improved employee
productivity (presenteeism) comprises the largest and most immediate part
of the overall cost savings to the employer from employees’ use of EAP
services (Goetzel, 2007; Hargrave et al., 2008). Several ROI calculator tools
are available that offer rough estimates of illness burden costs and poten-
tial savings from prevention and intervention programs for mental health
and alcohol problems in the workplace (Attridge, 2008b; see the follow-
ing websites: www.alcoholcostcalculator.org, www.bipolarsolutions.com,
www.depressioncalculator.com, and www.intelliprev.com).
17.5 FUTURE TRENDS IN EAP
Before closing this chapter, a number of advances in the field must be ac-
knowledged. These trends include integration of EAP with other areas of
employee benefits, Internet-based EAP, measurement and interventions for
employee engagement and presenteeism, research on EAP and expansion of
EAP around the world.
17.5.1 EAP Trend 1: Integration with Other Employee Benefits
In the last decade, EA professionals have begun to collaborate with other
business groups in the areas of work/life, health and wellness, and disability
management to address the mental and physical needs of employees and de-
velop prevention and early intervention programs that try to improve overall
health and well-being. The number of EAPs with integration activity has in-
creased from about one in four in 1994 to over one in three in 2002 and is now
expected to be the majority of EAPs (Herlihy & Attridge, 2005). Part of the
reason for this growth is a natural business development response to the rise in
the popularity of work/life (W/L) programs and the benefits of collaboration
between EAP and W/L. Another reason is that EAPs are well suited to offer
prevention services that target employee behavioural risks and workplace
culture issues (Caggianelli & Carruthers, 2007; Goetzel & Ozminkowski,
2006). There are many examples of how EAPs are increasingly delivering
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394 SUPPORTING INDIVIDUALS AT WORK
their services in greater integration and collaboration with work/life and well-
ness kinds of services (Attridge, Herlihy & Maiden, 2005; Csiernik, 2005).
There is also a conceptual and empirical rational for greater collaboration
among health and workplace service providers towards delivery of compre-
hensive organizational wellness (Bennett, Cook & Pelletier, 2003; Grawitch,
Gottschalk & Munz, 2006). In addition, there is now a strong scientific ev-
idence base for the effectiveness of potential EAP partners in the areas of
worksite wellness and stress management intervention programs that have
been shown to improve employee health and work performance (see meta-
analysis by Parks & Steelman, 2008).
Also important are the findings from a new survey that the majority of
EAP professionals consider prevention to be a core component of their pro-
fessional identity and that about a third of EAPs already deliver prevention-
oriented services to employees and organizations (Bennett & Attridge, 2008).
The prevention services provided most often by EAPs to their client organi-
zations (on at least a quarterly basis) were alcohol or other drug screening/
training (40%), team building (32%) and depression screening (25%). Given
the increasing prevalence of delivering prevention services and the positive
attitudes towards them among providers, some have even argued that pre-
ventive services should be added to the core technology of EAP (Bennett &
Attridge, 2008).
17.5.2 EAP Trend 2: Internet Services and e-Counselling
Related to the greater integration of EAP with other health and wellness
services is an increasing use of the Internet in the promotion and delivery of
EAP (Richard, 2003, 2009). Web-based services have allowed many employ-
ees to become more familiar with the purpose of EAPs. Websites for EAPs
are becoming more elaborate, offering access to provider lists, tip sheets,
Webinars and self-assessment tools. Many of these sites are even embedded
within the larger company intranet or human resources website. One advan-
tage of this common portal approach is a lessening of the reluctance some
people have to seek out counselling. At Ernst & Young, when they combined
the EAP, work-life and HR/benefits website functions, the result was a big
increase in the use of the EAP and of the work-life services – from 8% and
12%, respectively to a combined 25% annually (Turner, Weiner & Keegan,
2005). There is less stigma associated with addressing addictions and deliv-
ering prevention programs through the Internet, where it can be accessed at
anytime, with relative anonymity. Although still a small fraction of all client
contact, the use of online or web-based counselling between EAP clinicians
and employees is advancing as a new practice model (Parnass et al., 2008).
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17.5.3 EAP Trend 3: Measuring Employee Work Performance
Given that one of the unique features of employee assistance is a focus on the
work productivity of employee clients, it has been surprisingly difficult for
EAPs to accurately measure productivity in order to assess clinical symptom
severity and to gauge improvement. This scenario has dramatically changed
in the last decade due to recent advances in the validity and reliability of self-
report tools for measuring employee productivity, absence and health factors
(Attridge et al., 2009). There are now several brief assessment tools that
can reliably and validly measure employee productivity/presenteeism and
absence. One of most widely tested tools is the Health and Work Performance
Questionnaire (HPQ), developed by the World Health Organization and
Harvard University (Kessler et al., 2003, 2004). The HPQ has subscales of a
seven-item Presenteeism Scale and a four-item Absenteeism Scale and norms
from more than 200,000 workers worldwide. A short form of the HPQ is
being adopted by leading employers in the United States for use as an annual
all-company benchmarking practice (see website for the Integrated Benefits
Institute). This HPQ measure has also been incorporated into standard use
among dozens of EAP providers who combine their operational experiences
in a large international reporting database (Amaral, 2008b).
The opportunities that better measurement of worker performance pro-
vides for EAPs (and other health service providers) is enormous as it allows
the comparison of EAP cases over time before and after use of the EAP
and the comparison of the EAP cases to the rest of the employees on work
absence and productivity metrics (Attridge, 2004). Even more significant
is the trend among leading companies to switch their focus from reducing
‘negative’ outcomes (such as absence and presenteeism) to encouraging the
development and maintenance of ‘positive’ outcomes such as employee en-
gagement. Indeed, major studies by the Gallup organization, Watson Wyatt
and others on employee engagement have linked it to overall company prof-
itability and customer loyalty (Grawitch et al., 2006; Harter et al., 2003;
Watson Wyatt Worldwide, 2002).
17.5.4 EAP Trend 4: Revitalizing Research
Although there are several key research-based books and texts on EAP (Oher,
1999; Attridge, Herlihy & Maiden, 2005; Richard, Emener & Hutchinson,
2009), the empirical research on EAPs is a relatively small literature. For
example, one review found almost 200 reports on the business value of
EAPs, but few works were from peer-reviewed research journals and almost
all of these EAP studies use non-experimental research methods (Attridge &
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396 SUPPORTING INDIVIDUALS AT WORK
Fletcher, 2000). Instead, most of the reports in this review were conference
presentations, trade journal articles or industry white papers. However, these
weaknesses in research rigour are largely due to the applied nature of the
service delivery context and are not unique to EAPs as they are common
to much of the research conducted on workplace health issues (Attridge,
2001; Kasl & Jones, 2003; Kessler & Stang, 2006b). Nonetheless, much has
already been learned from this past research and operational practices have
been established well enough to allow for EAP industry accreditation of
provider companies and certification of individual professionals. Yet, more
basic research is needed on the factors that determine just which kinds of
operational practices drive service quality, user satisfaction and important
outcomes (Roman, 2007; Sharar, Amaral & Chalk, 2007). Higher quality
research on the effectiveness and value of EAPs can also be used to argue for
general fee increases, which have tended to stagnate or even go down in the
past decade due to pressures of ‘commoditization’ of the industry (Sharar &
Hertenstein, 2006).
The good news is that there is robust political support for research and op-
portunities for disseminating it through the two major industry organizations.
Each association has research committees and work groups, conferences and
publication outlets for research work (the peer-reviewed Journal of Work-
place Behavioral Health: EAP Practice and Research, published by Haworth
Press and affiliated with EASNA; and the Journal of Employee Assistance,
published by EAPA).
A practical limitation to more and better research on EAPs is that there
are so few people trained in how to do quality research who specialize
in the area of EAP and only a handful of university-level programs that
focus on EAP exist to produce new scholars (Pompe & Sharar, 2008). In
addition, compared to the heyday era of abundant government funding for
alcohol-related services, hardly any financial support exists today for EAP
research from the industry or from government (Roman, 2007). Most of
the research that is done is paid for by larger EAP providers, conducted by
external consultants, or contributed by university students and professors.
A promising new development, however, is the creation of a foundation
dedicated exclusively to funding basic and applied research in the employee
assistance field (Tisone, 2008).
17.5.5 EAP Trend 5: Going Global
The employee assistance concept began in the United States and remains
very popular with over 75 local chapters of EAPA. However, there has also
been significant expansion and adaptation of employee assistance services
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EMPLOYEE ASSISTANCE PROGRAMS 397
more recently in other countries. For example, there are EAPA member
chapters located in Australia, Canada, Greece, Ireland, Japan, South Africa
and the United Kingdom as well as some start-up activity in Chile and China.
The EASNA organization hosts its annual institute on an alternating basis
between cities in Canada and the United States. There also has been some
qualitative research on the progress of EAP development in Australia (Kirk
& Brown, 2005; Smith, 2006), Europe (Hoskinson & Beer, 2005; Nowlan,
2006; Malhomme, 2008), Germany (Barth, 2006; Gehlenborg, 2001), India
(Siddiqui & Sukhramani, 2001), Ireland (Powell, 2001; Quinlan, 2005), Israel
(Katan, 2001) and South Africa (Maiden, 1992, 2001). With all of this global
interest in EAP, the profession has a strong future and many opportunities
for positive change and evolution (Burke, 2008).
17.6 CONCLUSION
Employee Assistance Programs have a long history of supporting employees
and organizations in a variety of ways. They bring a unique focus on how
to maintain or restore employee work performance through troubles with
mental health, addiction and workplace events. The role of employee assis-
tance in supporting worker mental health and job performance is already a
key component to the overall success of thousands of organizations. This
chapter has used a research literature review to provide an overview of why
companies need an EAP, what defines EAP, what are its roots, what services
are commonly provided, what makes EAPs unique, how many employers
have an EAP, how often employees use the EAP, outcomes from EAP use,
and their business value to employers. Also examined were five trends in
the EAP field, focusing on service integration, the Internet, measurement,
research and globalization.
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