Article

The impact of a Canadian external Employee Assistance Program on mental health and workplace functioning: Findings from a prospective quasi-experimental study

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Abstract

In this investigation, a quasi-experimental prospective evaluation employing a pretest–posttest control group design with propensity score matching estimated the causal impacts of a Canadian Employee Assistance Program (EAP) on mental health, workplace functioning, and life satisfaction. Participants (N = 304) were employees working at different organizations across Canada. EAP users had access to up to 12 counseling hours per year. Outcomes were compared between groups of EAP (n = 152) and non-EAP (n = 152) users matched on numerous baseline variables including demographic, occupational, mental health, workplace functioning, and other characteristics and measures. At 6 month follow-up, EAP users had significantly reduced psychological distress, including reduced symptoms of depression and anxiety compared to non-EAP users. EAP users also had significantly reduced work presenteeism and work distress, and increased work engagement. Finally, they reported greater life satisfaction at follow-up relative to non-EAP users. The largest effect sizes of EAP counseling were observed on mental health outcomes. Mediation analyses revealed that EAP treatment effects on workplace functioning were mediated by changes in (their positive impacts on) mental health. This is the first known quasi-experimental study conducted with an external EAP, with evidence supporting a causal link between use of a Canadian assistance program and a number of positive clinical and workplace outcomes.

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... Colantonio, 1989;Csiernik, 2005Csiernik, , 2011Joseph et al., 2018). The studies by Richmond et al. (2016Richmond et al. ( , 2017, Nunes et al. (2018), and Milot (2019) are the exceptions. Most other studies on EAP did not employ a control group but only reported within-group changes (cf. ...
... We also contribute to the current literature by explaining the mechanism of EAPs in the context of the allostatic load theory and how workplace counseling can benefit employees' health by diminishing allostatic load processes. Finally, this study adds to the body of quasi-experimental EAP studies, solidifying and confirming past findings (Milot, 2019;Nunes et al., 2018;Richmond et al., 2016Richmond et al., , 2017. ...
... Employees undergoing counseling can be expected to experience fewer instances of allostasis (i.e., primary processes) and, therefore, also lowered indicators of secondary processes. In fact, past studies found EAP to have an effect on symptoms of depressiveness and anxiety (Milot, 2019;Richmond et al., 2016), which can be considered to be subclinical perturbations and, for that reason, indicators of secondary AL processes. EAP usage also reduced risky alcohol use (Richmond et al., 2016), thus, a maladaptive coping mechanism that would increase AL. ...
Article
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Employee Assistance Programs (EAPs) have been shown to effectively reduce absenteeism, workplace injury rates, and health-related productivity impairments. However, established measures for determining its impact on employee-level productivity have rarely been used, nor have studies employed biological measures of well-being. Drawing on the allostatic load theory, we examine the effects of an EAP on biological measures (heart rate, heart rate variability), established measures of health-related productivity (Workability Index, Health and Work Performance Questionnaire, Workplace Limitations Questionnaire), and absenteeism 4 weeks and 6 months after clients started to receive counseling. We conducted a quasi-experimental study comparing an EAP (n = 73) with a matched control group (n = 134) using propensity score matching. We found that an EAP improves health-related productivity 4 weeks and 6 months after enrolling in counseling, above and beyond changes in the control group. Biological measures changed in the hypothesized directions, but differences between the groups did not reach significance. Absenteeism did not change in the EAP group 6 months after enrolling in counseling. In an exploratory analysis, we found that individuals requiring many sessions in the first 4 weeks showed worse productivity outcomes, demonstrating a negative dose–response relationship. Our study provides an example of how to include biological measures in EAP research. It adds to the scientific evidence of the usefulness of EAP services in restoring employee-level productivity. We calculate that the marginal productivity improvements per employee using the EAP are as much as $15,600 per annum.
... Several other EAPs have collected data on their clients with the GAD measure, but the key finding of what percentage of the total clients had started use of the service at risk for clinical anxiety was missing from the reports. This omission was because either the authors did not analyze the data to find this statistic [43][44][45] or they did not include the full sample of clients in their study and instead focused only on the subset of users who had started EAP use at risk for anxiety and/or depression disorders [46][47][48][49][50]. ...
... A second prospective quasi-experimental study was conducted in Canada with data from an external national EAP vendor [44]. Outcomes were compared between a group of 152 EAP clients and a comparison group of 152 non-EAP users that had been matched to the counseling group profile on numerous baseline variables (i.e., demographic, occupational, mental health risks, workplace functioning and other characteristics). ...
... Work Absenteeism. Developed by Chestnut Global Partners [58], the Workplace Outcome Suite (WOS) is a validated questionnaire with five outcomes that has been used in over 40 EAP studies [39,43,44,[58][59][60][61]. One of the five outcomes on the WOS is work absenteeism. ...
Article
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This project provided real-world conditions with a national sample that allowed us to empirically investigate the role of anxiety among employee assistance program (EAP) users. This study is based on 20,725 clients who used a national EAP service during parts of 2022 and 2023 for mental health counseling (96%) or coaching (4%). All clients had completed a standardized measure for anxiety risk (GAD-2), depression disorder (PHQ-2), the extent of hazardous alcohol use (AUDIT-C), and two aspects of employee work performance (WOS absenteeism and presenteeism). The primary finding was 42% of EAP clients had a clinical level of anxiety symptoms at the start of use. This is about four times higher than the typical working adult in the United States. In addition, 30% had a clinical level of depression, and there was substantial comorbidity between anxiety and depression (r = .54). Only 13% of clients had alcohol misuse as a clinical problem and it had little overlap with anxiety (r = .10). Thus, anxiety is one of the most common psychiatric disorders among users of counseling and coaching services. Only 14% of clients contacted the EAP specifically for assistance with an anxiety related issue. Thus, three times as many clients were at risk for clinical anxiety than were interested in anxiety as their primary treatment goal. The background profile analyses revealed few meaningful associations between anxiety severity and factors of client age or gender, employer factors or aspects of EAP service use. Greater anxiety, however, was associated with greater work absenteeism (r = .16) and work presenteeism (r = .25). Clients at risk for anxiety had about three times the number of hours of lost work productivity in the past month before starting EAP use than the typical employee non-user of EAP (72 hours vs. 27 hours, respectively). Longitudinal results (n = 772) determined that EAP use was significantly associated with a 64% reduction in the severity of anxiety symptoms for the average client (r = .56). A reduction in anxiety symptoms was significantly correlated with a reduction in hours of lost work productivity (r = .40). Among the subsample of longitudinal clients who started out at clinical risk for anxiety (n = 287), the average case reduced their level of anxiety severity by 69% (r = .83). Also, a reliable change index analysis indicated that 88% of the clients initially at risk for anxiety had a clinically meaningful improvement in their symptoms and that 82% recovered to no longer be at risk after EAP use. The study findings replicate other research and provide a descriptive profile of anxiety in workers based on a large national sample.
... More specifically, some studies evaluating the effectiveness of EAP counseling have inappropriately tested for changes in depression or alcohol outcomes among all cases using the EAP for any reason. A logical consequence of having test samples with the majority of cases being irrelevant to clinical depression or to alcohol disorders is finding only modest improvement in depression symptoms and weak or no improvement in levels of alcohol misuse [40][41][42]. ...
... Each of these studies found significant and substantial improvement in the severity level of depression symptom after counseling. The statistical effect sizes for the improvement in these five studies that tested only the EAP cases starting treatment at a clinical level of depression (d = 1.08 to 1.62) were more than double what was found in the two studies noted earlier that used general samples of EAP users with a range of issues and relevance to depression (d = 0.45 [41] and 0.59 [42]). Matching the clinical condition of the user to the outcome is also standard practice for most research studies assessing the effectiveness of computer and phone App machine-based interventions designed for self-support of specific mental health conditions [47][48][49]. ...
... In contrast to work absence, the majority of employees who use EAP counseling do typically experience reduced on-the-job productivity (i.e., presenteeism) during the period of acute distress during the month just before seeking counseling [37][38][39][40]42,46,[55][56][57][58]. The same studies all find that work productivity tend to rebound to a more normal level after counseling is completed. ...
Article
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This paper presents empirical findings from a multi-year applied naturalistic study that focused on changes in clinical and work outcomes after using an employee assistance program in the United States. Self-report outcomes assessed with standardized measures were collected at the start of counseling from 33,683 employees during the normal course of business at CuraLinc Healthcare during 2017 to June 2022. A total of 5,159 employees had valid Pre and 30-day Post use data on one or more of the outcomes. Tests within each outcome sample found significant improvement after counseling (most had a 5 or 6 session model). Among the 487 cases using the EAP for a depression issue, the average severity level of depression symptoms (PHQ-9) was reduced by 59%. Among the subset of these cases at-risk for clinical depression disorder (n = 292), 89% had a reliable clinical improvement in severity. Among the 440 cases using the EAP for an alcohol issue, the average severity level of alcohol misuse (AUDIT-10) was reduced by 67%. Among subset of these cases at-risk for alcohol misuse disorder (n = 288), 73% had a reliable clinical improvement in severity. Across all cases with absence data (n = 3,732), the average hours of work absence in the past month per employee (Workplace Outcome Suite) was reduced by 80%, changing from 8.9 hours at Pre to 1.8 hours at Post. At the start of counseling, 35% of these cases were classified as having an absence problem (i.e., missing more work than a typical healthy employee), but at Post only 7% had a work absence problem. Across all cases with productivity data (n = 3,845), the level of work productivity (Stanford Presenteeism Scale) improved by 35%. At the start of counseling, 34% of cases were initially classified as having a problem with work productivity (i.e., low performance and lack of focus), but at Post this rate was reduced to just 5% of cases. All primary results for each outcome were large size statistical effects. Moderator tests indicated the improvement in each outcome was generally consistent across different subgroups of employees based on client age, sex, clinical use characteristics and other study context factors. Some moderator findings were identified for clinical issue, referral type (self or manager) and client sex having slightly different profiles on certain outcomes. Comparisons with past research, study design limitations, and best practices in conducting applied research on workplace mental health are discussed.
... In a systematic review of 17 studies evaluating the effectiveness of EAPs, Joseph et al. found that utilising EAPs lead to enhanced employee outcomes, specifically improving levels of employee presenteeism, productivity and psychosocial functioning [12]. The use of EAPs have also been shown to improve employee mental health, with a number of studies worldwide reporting reduced levels of employee depression, anxiety, and stress following EAP service utilisation by employees [13][14][15][16][17][18][19][20]. Additionally, several studies have further demonstrated that merely providing employees access to an effective EAP can significantly reduce turnover intention, whilst promoting employee retention and organisational commitment [21,22]. ...
Article
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Background The average person spends 1/3 of their lives working. However, approximately 15% of working adults worldwide are struggling with a mental disorder at any given time. The COVID-19 pandemic has spearheaded the importance of employee mental health, highlighting the role that employers can play in preserving employee wellbeing. Although Employee Assistance Programs (EAPs) are slowly becoming an established practice, it is still a relatively new phenomenon in most of Asia. This study therefore aims to investigate the prevalence of employees in the Southeast Asian region who have access to EAPs and understand the relationship between EAP access and employee wellbeing. Methods This cross-sectional, online survey-based study involved 15,302 employees from Malaysia, Singapore, Philippines, Thailand, Indonesia, and Vietnam who completed the Depression, Anxiety, Stress Scales (DASS-21), Thriving from Work Questionnaire (TfWQ), and sociodemographic measures. Employee productivity and turnover intention was also measured as a secondary outcome. Hierarchical regression models were conducted to determine the influence of EAP access on employee wellbeing. Subgroup analyses were conducted on employees with access to EAPs to explore how different forms of EAP services contribute to employee wellbeing. Results Only 29.04% of employees in the region reported being aware of having access to any forms of EAP services provided by their employers. After controlling for sociodemographic variables, access to EAP was significantly associated with improved mental health, thriving, and productivity, and reduced turnover intention (p < 0.001) among employees in the region. Subgroup analyses revealed that employees had access to well-being and mental health webinars, talks, or workshops (12.64%), followed by sponsored counselling, therapy or carelines (11.16%). Access to regular mental health risk assessment and screening was the form of EAP service significantly associated with the highest number of outcomes. Conclusion Having access to EAP services alone is associated with improved employee wellbeing outcomes. However, different forms of EAP services can vary in their impact on employee wellbeing. Our findings suggest a need to improve accessibility and diversity of EAP offerings for employees in Southeast Asia post-pandemic.
... Richmond et al., 2017;Milot, 2019). One of these studies actually found that hours of absenteeism increased over time for the matched group of non-users of the EAP, whereas absence decreased for the EAP users (Richmond et al., 2017). ...
Technical Report
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This report is the sixth in a series of employee assistance program (EAP) industry global benchmarks on the Workplace Outcome Suite©. The WOS measures work absenteeism, work presenteeism, workplace distress, work engagement and life satisfaction. This is one of the largest and most comprehensive applied studies ever done to profile EAP use and the effectiveness of EAP counseling. The project features data contributed by 61 different EAPs operating in 15 countries. The study profiles 141,297 users of counseling across a wide range of demographic, employer and EAP use contexts during 13 years (2010 to 2022). Longitudinal tests conducted on over 62,000 cases with paired data at both before and after EAP use reveal that each WOS measure had significant improvement. When controlling for other factors, only 2 of 18 factors moderated the improvement results to a meaningful extent (specific EAP provider companies and internal programs and depression symptom severity). The conclusion is that brief counseling from EAPs improved multiple aspects of work functioning and life satisfaction. A $5:1 ROI is estimated based on avoided further loss of combined hours of productive work time from the WOS absenteeism and presenteeism outcomes and industry standards for use and cost inputs. Psychometric tests supported the reliability and validity of the WOS measures. Revised best practices for data collection and scoring are presented. Benchmarking norms for scores at before and after EAP use are provided for all WOS measures for counseling cases in six global regions and also for external vendors and staff model kinds of providers. For the first time results for a new 0-10 rating of job performance are included. The 98-page report includes 10 chapters, 9 appendices and 58 references.
... As this was not a prospective study, we did not use other stronger kinds of designs such as the quasi-experimental type (with a comparison group matched on key characteristics) or the experimental randomized control trial type. However, we know of only seven other quasi-experimental studies involving both treatment and comparison groups in the literature on EAPs [four studies cited in 58, [146][147][148]. All of these studies found that the EAP treatment group had superior improvements over time on clinical and work outcomes compared to the other employees who did not use EAP counseling. ...
Article
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This applied study examined client characteristics and outcome data for users of brief counseling treatment delivered by licensed counselors in-person at clinic office settings. A sample of 33,228 clients was obtained from archival records of the normal course of business at CuraLinc Healthcare, which is a national employee assistance program (EAP) service provider in the United States. Based on a 7-year naturalistic study design, we profiled who the users are, how and why the counseling was used and what impact it had on their health and work. Almost all of the clients were employees (98%; 2% family) and voluntarily used the EAP (97% self-referrals; 3% formal management referrals from work). There was a wide range between users for age (range 16-86 years; average 40) and gender (females 61%, males 39%). Many different industries were also represented (10+ types). The reasons why the EAP was used had substantial variation across mental health (63%), personal stress (20%), relationships and family life (20%), work (7%) and substance use (2%) issues. The duration of the counseling treatment per case spanned from 1 week to over 10 months, but most clients found relief after about two months of time engaging in talk therapy with their EAP counselor. Self-report outcomes were assessed with standardized measures. Prevalence rates for clinical status when starting counseling were: 39% at-risk for anxiety; 29% at-risk for depression; 14% at-risk for alcohol misuse; 39% at-risk for a work presenteeism problem; and 22% at-risk for a work absenteeism problem. At 30-days after completing counseling, improvements in the severity of symptoms and clinical recovery (i.e., changing from at-risk/unhealthy to no risk/healthy) were documented for each outcome. Longitudinal tests conducted within each clinically at-risk subsample of clients found significant improvement after counseling (all p < .001) with large size statistical effects: Anxiety severity (GAD-2) was reduced by 65% for the average at-risk case (d = 1.71) and 80% of the 124 at-risk cases recovered; Depression severity (PHQ-2) was reduced by 50% (d = 1.91) and 78% of the 281 at-risk cases recovered; Alcohol misuse (AUDIT-3) was reduced by 53% (d = 1.48) and 76% of the 307 at-risk cases recovered; Work absenteeism per past 30 days (Workplace Outcome Suite) was reduced by 88% from 25 hours at Pre to 4 hours at Post (d = 1.63) and 88% of the 1,101 at-risk cases recovered; and severity of work presenteeism (i.e., lack of focus and performance while working; WOS or Stanford Presenteeism Scale) was reduced by 47% for the average case (d = 1.71) and 88% of the 1,217 at-risk cases recovered. Overall, the broad appeal and high level of effectiveness of in-person delivered counseling for health and work outcome areas confirms this kind of delivery context is an important option for EAPs and other workplace mental health support services. Comparisons with past research, study limitations, and implications are also discussed.
... Some of these programs provide training and resources to help PSP cope with the stress and psychological trauma of their work [9]. Additionally, many public safety agencies have employee assistance programs that provide confidential counseling and support to employees struggling with mental health concerns [10]. ...
Article
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Background: Public safety personnel (PSP) are exposed to traumatic events due to their work environments, which increases the risk of mental health challenges. Providing effective and evidence-based interventions, such as SMS text messaging programs, can improve PSP's overall mental well-being with high user satisfaction rates. Objective: This study aims to evaluate users' satisfaction, receptiveness, and perceptions of a cognitive behavioral therapy (CBT)-based supportive SMS text messaging intervention (Text4PTSI). Methods: Participants self-subscribed to Text4PTSI and received unidirectional cognitive behavioral-based supportive text messages for 6 months. Participants completed a web-based survey delivered via SMS text message at enrollment, and 6 weeks, 3 months, and 6 months post enrollment. Respondents' perception and receptivity of the program were assessed using a questionnaire measured on a 5-point Likert scale. Data were collected as categorical variables, and overall satisfaction with the Text4PTSI program was measured on a scale from 0 to 100. Results: There were 131 subscribers to the Text4PTSI program; however, only 81 subscribers responded to the survey, producing 100 survey responses across the 3 follow-up time points. The overall mean score of satisfaction was 85.12 (SD 13.35). More than half of the survey responses agreed or strongly agreed that Text4PTSI helped participants cope with anxiety (79/100 responses, 79%), depressive symptoms (72/100 responses, 72%), and loneliness (54/100 responses, 54%). Similarly, most of the survey responses agreed or strongly agreed that the Text4PTSI program made respondents feel connected to a support system, improved their overall mental well-being (84/100 responses, 84%), felt more hopeful about managing concerns about their mental health or substance use (82 out of responses, 82%), and helped enhance their overall quality of life (77/100 responses, 77%). The available survey responses suggest that the majority always read the supportive text messages (84/100 responses, 84%), took time to reflect on each message (75/100 responses, 75%), and returned to read the text messages more than once (76/100 responses, 76%). Conclusions: PSP who responded to the follow-up surveys reported high user satisfaction and appreciation for receiving the Text4PTSI intervention during the 6-month program. The reported satisfaction with the service provided could pave the way to ensuring a better uptake of the service with potential effectiveness to end users.
... The expansion to drug abuse came about in the 1960s in the aftermath of President Lyndon Johnson's Great Society program and when drug abuse became a dominant social problem (Archer, 1977;Mio and Goishi, 1988;Sonnenstuhl and Tice, 1986). The purpose of EAPs was to increase productivity of workers by eliminating these debilitating substance abuse issues, and studies examining this issue have verified the efficacy of EAPs (Milot, 2019;Nunes et al., 2018;Roche et al., 2018). In a meta-analysis from 2010 through 2019, Csiernik et al. (2021) affirmed the efficacy of EAPs both in saving organizations money and in employee well-being. ...
Chapter
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Employee Assistance Programs (EAPs) are services offered to a company's employees to address life problems that may interfere with their productivity at work. These programs initially focused on alcoholism, which was a major problem in the aftermath of the repeal of Prohibition in 1933. However, as the years passed, EAPs expanded to cover other kinds of substance abuse as well, then mental and behavioral problems in general. These expanded services are referred to as “broad brush” EAPs. In more recent years, there has been a trend to outsource EAP services, which places service providers into ethical dilemmas regarding issues of confidentiality. In the last two years, the COVID-19 pandemic has also created challenges to both workers and to EAP service providers.
... However-to be fair-applied research conducted on EAPs businesses have never (to our knowledge) used a true experimental prospective study design to test outcomes because employers who provide the EAP as a benefit available to all employees will not allow some employees (for purposes of a research study) to be denied or delayed access to the EAP when requesting such assistance (Attridge, 2001). Some insight, however, is provided by the two quasi-experimental prospective studies on EAP counseling that included a non-randomized comparison group of employees who did not use EAP counseling but who were matched with the profile of the EAP cases for the level of clinical distress and demographic factors (Milot, 2019;Richmond et al., 2015Richmond et al., , 2016. Both of these research projects found superior improvement over time for the users of EAP counseling compared to the matched nonusers, in outcomes in both mental health and work domains. ...
Article
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The purpose of this applied naturalistic study was to determine the effectiveness of brief counseling, estimate the potential cost savings associated with select outcomes, and explore the client ratings and comments evaluating their experience. Follow-up survey data from 830 employee users of counseling services from a statewide employee assistance program (EAP) were analyzed. Paired tests examined changes in anxiety, depression, health status, life satisfaction, and work productivity. At the start, more of the EAP cases were above the threshold for at-risk status on each outcome than healthy employees in normative data. Significant reductions in risk were achieved for all outcomes after counseling. Improvements in health were correlated with improvements in work productivity. Most of the cases (82%) considered their experience to be positive and helpful. Results were used to estimate an ROI of 4.26:1 for the EAP from avoided overall health care treatment costs for depression (611/case)andavoidedlostworkproductivity(611/case) and avoided lost work productivity (1,433/case).
... Those with higher levels, while less reactive to the news they consume, still reported elevated uncertainty in general. This calls attention to the importance of employee assistance programs that provide counseling services to help those with chronic or potentially unhealthy anxieties (including death anxiety) or mental illnesses (Menzies et al., 2018;Milot, 2019); such programs may be particularly critical during a crisis such as the COVID-19 pandemic (Couser et al., 2020). Organizations could also provide resources such as resilience training or mindfulness strategies (Park & Pyszczynski, 2019)-indeed, mindfulness may also help employees experiencing uncertainty to mitigate its deleterious downstream consequences (Good et al., 2016). ...
Article
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Uncertainty is a defining feature of the COVID-19 pandemic. However, because uncertainty is an aversive state, uncertainty reduction theory (URT) holds that employees try to manage it by obtaining information. To date, most evidence for the effectiveness of obtaining information to reduce uncertainty stems from research conducted in relatively stable contexts wherein employees can acquire consistent information. Yet, research on crises and news consumption provides reasons to believe that the potential for information to mitigate uncertainty as specified by URT may break down during crises such as the COVID-19 pandemic. Integrating URT with research on crises and news consumption, we predict that consuming news information during crises—which tends to be distressing, constantly evolving, and inconsistent—will be positively related to uncertainty. This in turn may have negative implications for employee goal progress and creativity; two work outcomes that take on substantial significance in times of uncertainty and the pandemic. We further predict that death anxiety will moderate this relationship, such that the link between employees’ news consumption and uncertainty is stronger for those with lower levels of death anxiety, compared to those with higher levels. We test our theorizing via an experience-sampling study with 180 full-time employees, with results providing support for our conceptual model. Our study reveals important theoretical and practical implications regarding information consumption during crises such as the COVID-19 pandemic.
... The expansion to drug abuse came about in the 1960s in the aftermath of President Lyndon Johnson's Great Society program and when drug abuse became a dominant social problem (Archer, 1977;Mio and Goishi, 1988;Sonnenstuhl and Tice, 1986). The purpose of EAPs was to increase productivity of workers by eliminating these debilitating substance abuse issues, and studies examining this issue have verified the efficacy of EAPs (Milot, 2019;Nunes et al., 2018;Roche et al., 2018). In a meta-analysis from 2010 through 2019, Csiernik et al. (2021) affirmed the efficacy of EAPs both in saving organizations money and in employee well-being. ...
Article
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The employee assistance program (EAP) movement has been of interest to businesses at least since the 1940s. In the 1940s, programs to treat alcoholic workers were put into place in the United States in order to address the problem of alcoholism affecting worker productivity in the workplace. This was included but not limited to absenteeism, decreased productivity while intoxicated, and workplace accidents caused by alcoholism. As causes of worker impairment were expanded to include illegal drug abuse and other family problems that could affect worker performance, EAPs expanded from a narrow focus on alcohol to a ‘broad brush’ approach that included these other kinds of impairments. Estimated costs were in the billions or even hundreds of billions of dollars to businesses. However, outcome evaluations of these programs have generally not proven savings in the billions of dollars. Moreover, while the assumption is that such problems have penetrated into the white collar or upper management domain of businesses, research in this area is lacking. Future research of EAPs should address these issues and also the implications of the increasing disparity of treatment that high-income workers in upper management may receive in comparison with frontline workers.
Article
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A recent study published in the Industrial Relations Journal entitled Employee well-being outcomes from individual-level mental health interventions: Cross-sectional evidence from the United Kingdom (Fleming, 2024) has been widely covered in the mainstream and business press, such as the New York Times and Forbes magazine. Data for this study was composed of self-reports from two waves of a survey between 2014 and 2018 completed by 46,336 employees at 223 different employers in Britain. The author’s conclusion was “the results show that those who participated in individual-level interventions have the same levels of mental well-being as those who did not” (p. 176). The finding is the direct opposite of decades of other more rigorous research, and unfortunately, this adverse conclusion was noted and publicized by many journalists. This study is flawed in both its design and analytical methods. Thus, it cannot make any legitimate judgments concerning the effectiveness of individual-level mental health interventions in the workplace. It simply does not have the essential data to properly answer this question. Having personally conducted numerous empirical evaluations of the use and effectiveness of workplace mental health services since the 1990s, this study is not how you do it. There are better examples from the USA, Canada, and the UK of high-quality longitudinal research studies demonstrating the effectiveness of workplace mental health counseling when rigorously evaluated (see References).
Article
Goal Employee assistance programs (EAPs) have been evolving since they first became prevalent in the 1970s. The important counseling component of EAPs is sometimes lost in discussions about what they do, with many EAPs marketing a broad portfolio of services such as childcare, elder care, legal referral, and other concierge services rather than counseling. The objective of this study was to examine outcomes for the EAP of one organization (Mayo Clinic), compare them to outcomes reported in the literature, and gain insights to help all healthcare organizations best support their employees. Methods Consistent with customary EAP practice, data for this study was collected through an anonymous survey link distributed by e-mail to users of individual counseling as well as users of organizational consulting services such as advising leaders and supervisors and leading educational sessions. Principal Findings All ( n = 82) individual counseling respondents indicated they would recommend the EAP, none reported worse symptoms, 90% decreased their stress levels, 92% reduced their feelings of anxiety, 88% enjoyed an overall improvement in mood, and 95% developed new skills. If their concern was work-related, 96% agreed the counselor understood the work culture and was able to provide helpful guidance; of the clients who were feeling burned out, 86% agreed they gained strategies to reduce its symptoms. Thematic analysis of individual counseling services indicated that participants highly valued their counselors. Regarding organizational consulting services, respondents ( n = 50) indicated EAP services increased their confidence as leaders, supported their work, and provided tangible guidance. They appreciated having an internal EAP counselor. Thematic analysis of organizational consulting services indicated that EAP supported leaders by listening, coaching, and empowering them to normalize issues. Practical Applications EAPs have evolved into distinct internal, external, and hybrid internal–external models. Internal model counselors are company employees with inside knowledge of company culture, external EAP model counselors are contracted outside of the company, and hybrid models combine a small cadre of internal counselors with the support of outside contractors. Regardless of the model, EAP counselors must collaborate with internal stakeholders, notably the human resources department, to efficiently identify and troubleshoot employee relational issues and allow for customized initiatives to improve mental health. Based upon these findings and the authors' direct experiences with EAP providers, components of an ideal EAP are outlined to show how EAPs can best support employees. Healthcare leaders seeking to add EAP services are advised to focus on offerings that are custom fit to the organization.
Article
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The negative effect of workplace ostracism on employees has attracted increasing attention. This research, drawing on the perspective of negative reciprocity belief, in combination with the self-regulation theory and the person-environment theory, proposes and tests the positive effect of workplace ostracism on interpersonal deviance, which is negatively moderated by self-control (two-way) and further negatively moderated by negative affect (three-way). Based on a three-wave survey of 233 employees in China, we find that workplace ostracism is positively related to interpersonal deviance. This positive relationship is stronger when employees are low in self-control. Furthermore, this moderating effect exits only when employees’ negative affect is high. Therefore, this research theoretically explicates the positive relationship between workplace ostracism and interpersonal deviance and the boundary conditions of this relationship, and also proposes a practical way to help managers reduce the occurrence of employees’ interpersonal deviation. The theoretical contributions and practical implication have also been discussed.
Article
An implementation fidelity study evaluated the quality of the therapeutic alliance (TA) in the counseling services of a Canadian Employee Assistance Program (EAP). The aims were to evaluate the level of TA experienced by EAP users during counseling, to assess the influence of client gender, and to determine the associations between the level of TA and mental health and work functioning outcomes. The TA was assessed with the Brief Therapeutic Alliance Scale (BTAS-5), a self-report quantitative measure developed to rapidly assess multiple elements of the client-therapist alliance from the perspective of the client. The majority of the EAP users (N = 1277) reported experiencing a high level of TA during counseling and men and women reported equal levels. Pretest and posttest analysis with ANCOVA showed that EAP users (N = 505) reporting higher levels of TA had greater mental well-being, lower depression symptoms (Patient Health Questionnaire-2), lower work presenteeism (Workplace Outcome Suite-5; WOS-5), and greater life satisfaction (WOS-5) at follow-up after end of counseling. The TA from the perspective of EAP users can serve as an indicator of well-implemented employee counseling services and its assessment can provide additional evidence of counseling quality and effectiveness, supplementing the findings of traditional outcomes-based EAP studies.
Article
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Mitarbeiterberatung, intern oder auch extern als Employee Assistance Program (EAP) angeboten, gilt als niedrigschwelliges Präventionsangebot im Rahmen der Betrieblichen Gesundheitsförderung. Seine Wirksamkeit zur Vorbeugung psychischer Erkrankungen wurde im deutschsprachigen Raum bisher nicht überprüft. Vorgestellt werden Ergebnisse einer nicht kontrollierten Begleitstudie mit N=40 Beschäftigten, die sich in einer betrieblichen Beratungsstelle einfanden. Psychische Symptome gingen innerhalb von 3-4 Monaten signifikant, Stresssymptome und krankheitsbedingte Fehlzeiten statistisch nicht bedeutsam zurück. Zur Bestätigung dieser positiven Gesundheitseffekte sind größer angelegte Studien mit randomisiertem Kontrollgruppendesign erforderlich.
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Employee Assistance Programs (EAPs) originated as workplace-focused programs delivered largely by peer employees. Over the past 25 years, the once standard internal EAP has largely been replaced by internal/external hybrid programs or outsourced EAP vendors. Many long-standing internal programs have been downsized or eliminated, along with their internal program manager positions. This qualitative study examined the organizational, leadership, and programmatic characteristics associated with the internal and internal/hybrid EAPs from the perspectives of EAP managers working in programs that have thrived and those that have depreciated. Twenty-four current and former internal or internal/hybrid EAP managers were interviewed using a semistructured interview schedule. Qualitative methods were used to identify patterns and themes within the data to describe the experience of internal and internal/hybrid EAP managers and the critical success and risk factors associated with their positions and programs. Five final themes, with 15 subthemes emerged from the data, suggesting that both individual and organizational characteristics of EAP internal and hybrid programs are important to the program’s sustainability. These findings offer insights regarding best practices and critical success factors to EAP professionals, EAP purchasers, and the EAP industry.
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This review summarizes the current meta-analysis literature on treatment outcomes of CBT for a wide range of psychiatric disorders. A search of the literature resulted in a total of 16 methodologically rigorous meta-analyses. Our review focuses on effect sizes that contrast outcomes for CBT with outcomes for various control groups for each disorder, which provides an overview of the effectiveness of cognitive therapy as quantified by meta-analysis. Large effect sizes were found for CBT for unipolar depression, generalized anxiety disorder, panic disorder with or without agoraphobia, social phobia, posttraumatic stress disorder, and childhood depressive and anxiety disorders. Effect sizes for CBT of marital distress, anger, childhood somatic disorders, and chronic pain were in the moderate range. CBT was somewhat superior to antidepressants in the treatment of adult depression. CBT was equally effective as behavior therapy in the treatment of adult depression and obsessive-compulsive disorder. Large uncontrolled effect sizes were found for bulimia nervosa and schizophrenia. The 16 meta-analyses we reviewed support the efficacy of CBT for many disorders. While limitations of the meta-analytic approach need to be considered in interpreting the results of this review, our findings are consistent with other review methodologies that also provide support for the efficacy CBT.
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Rehabilitation professionals often serve persons with disabilities in Employee Assistance Programs (EAP). There is scant research regarding companies with an EAP that employ persons with disabilities. This paper reports a 2 year summative evaluation of a grant funded, pilot, internal EAR The company served by the EAP employs 218 workers, about 88% of whom have a disability. Data collection included reviews of internal reports, employee surveys and a focus group with administrative stakeholders. The findings indicate that the EAP met or exceeded the original start-up goals and that employees and first line supervisors were satisfied with the services, administrative stakeholders perceived the EAP as effective, and the EAP compared favorably to a benchmark organization. Implications for potential implementation of EAPs in other companies that employ a high percentage of persons with disabilities are discussed.
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Employee Assistance Programs (EAPs) are widely used to help employees experiencing personal or work-related difficulties that impact work productivity. However, rigorous research on the effectiveness of programs to improve work-related outcomes is lacking. The current study represents a major advance in EAP research by using a prospective, quasi-experimental design with a large and diverse employee base. Using propensity scores calculated from demographic, social, work-related, and psychological variables collected on baseline surveys, we matched 156 employees receiving EAP to 188 non-EAP employees. Follow-up surveys were collected from 2 to 12 months post-baseline (M = 6.0). At follow-up, EAP employees had significantly greater reductions in absenteeism (b = -.596, p = .001) and presenteeism (b = -.217, p = .038), but not workplace distress (b = -.079, p = .448), than did non-EAP employees. Tests of moderation of baseline alcohol use, depression, anxiety, and productivity indicate that for the most part, the program works equally well for all groups. However, EAP did more to reduce absenteeism for those who began with lower severity of depression and anxiety at baseline. Results provide the scientific rigor needed to demonstrate EAP impact on improved work outcomes. In the first study of its kind, findings confirm the value of EAPs to help employees address personal and work-related concerns that are affecting job performance. (PsycINFO Database Record
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A secondary analysis of data provided the initial examination of comparative metrics pertaining to Canadian employee assistance program (EAP) vendors. Contracts held by the 12 participating organizations ranged from 10 to 6,500 with lives covered ranging from 300,000 to 6.3 million, underscoring not only the diverse nature of EAP vendors in Canada but issues with comparing data among such vastly different providers. The most prominent model of service provision was capped EAP counseling which led to an average of 3.1 counseling sessions per client with only one vendor having a mean of greater than four. The majority of counseling offered through Canadian EAP vendors is provided by fee for service affiliate counselors. All client satisfaction scores were positive; however, the vast majority of clients did not complete any type of evaluation leaving both EAP vendors and client organizations with no substantive knowledge of the impact of the service. In the comparatively small EAP market that Canada represents, it was not surprising to learn that the greatest business concern of the vendors was product pricing, especially as ten percent of EAP services were being provided as part of larger bundled benefits plans and thus there was no actual direct cost for the EAP.
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The objective of this study was to estimate the health and economic impact of major mental illnesses in Canada, beginning in 2011 and annually over the next three decades. For the purposes of this study the major mental illnesses included: mood disorders, anxiety disorders, schizophrenia, substance use disorders, ADHD, conduct disorders, ODD and cognitive impairment including dementia. Using RiskAnalytica’s Life at Risk simulation platform, measures of incidence, prevalence and mortality were simulated for the total Canadian population (ages 9 and over) to project the impact of major mental illnesses over a 30-year time horizon. The outcomes, assuming a steady-state prevalence were then linked to estimates of health service use and workplace productivity to forecast the economic impact of mental illness now and into the future.
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Since the emergence of external Employee Assistance Programs (EAPs) in the 1970's to challenge the ensconced internal model, there has been an ongoing debate over which method of service delivery is superior. Numerous assumptions have arisen about the various strengths and limitations of the two models though the empirical support for these beliefs remains relatively limited. In this article, 36 Canadian EAP studies are used as the basis to assess the suppositions surrounding internal and external EAPs.
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Demonstrating outcomes and highlighting the value of employee assistance (EA) services are critical, especially in today's difficult economic climate. This study reports findings from an exploratory study of Employee Assistance Program (EAP) outcomes using existing EAP case files from 20 different U.S. employers. Research questions examined the effects of EAP services as measured by three commonly used indices: the Level of Functioning Scales at Home and at Work, and the Global Assessment of Functioning. Significant changes in scores on all three measures were found at posttest, suggesting an overall positive affect from employee participation in EAP services. Recommendations for EAPs with little to no resources for research and limited experience with research are discussed.
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Despite the increasing need for employee assistance program (EAP) providers and human resources (HR) departments to demonstrate outcomes resulting from the availability and use of EAP services, few empirical studies have examined the relationship between EAP utilization and objective organizational outcome measures. This study made use of a unique longitudinal archival data set to examine EAP utilization, the problems for which help was sought, and the relationship of EAP utilization to absenteeism over 3 consecutive years among all EAP-eligible (N = 3,448) employees in all locations of a large national Canadian retail store. Patterns of usage were examined by gender and age with a clearly defined EAP utilization statistic. Most frequently, the reasons for help seeking were personal issues, marital/family problems, and (a distant third) work-related issues. Longitudinal hierarchical linear modeling (HLM) was used to examine the differences in yearly absentee hours between EAP users versus non-EAP users. The results showed that EAP users generally had higher rates of absenteeism than nonusers during the year in which EAP was used but (with some exceptions) did not differ from the non-EAP user groups in the year(s) before and after treatment. Implications for consulting psychology are suggested. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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To date, few studies have been published on the dose-response relationship, but there is general consensus that between 13 and 18 sessions of therapy are required for 50% of patients to improve. Reviewing the clinical trials literature reveals that in carefully controlled and implemented treatments, between 57.6% and 67.2% of patients improve within an average of 12.7 sessions. Using naturalistic data, however, revealed that the average number of sessions received in a national database of over 6,000 patients was less than five. The rate of improvement in this sample was only about 20%. These results suggest that patients, on average, do not get adequate exposure to psychotherapy, nor do they recover from illness at rates observed in clinical trials research.
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The propensity score is the probability of treatment assignment conditional on observed baseline characteristics. The propensity score allows one to design and analyze an observational (nonrandomized) study so that it mimics some of the particular characteristics of a randomized controlled trial. In particular, the propensity score is a balancing score: conditional on the propensity score, the distribution of observed baseline covariates will be similar between treated and untreated subjects. I describe 4 different propensity score methods: matching on the propensity score, stratification on the propensity score, inverse probability of treatment weighting using the propensity score, and covariate adjustment using the propensity score. I describe balance diagnostics for examining whether the propensity score model has been adequately specified. Furthermore, I discuss differences between regression-based methods and propensity score-based methods for the analysis of observational data. I describe different causal average treatment effects and their relationship with propensity score analyses.
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The most common mental disorders in both outpatient settings and the general population are depression and anxiety, which frequently coexist. Both of these disorders are associated with considerable disability. When the disorders co-occur, the disability is even greater. Authors sought to test an ultra-brief screening tool for both. Validated two-item ultra-brief screeners for depression and anxiety were combined to constitute the Patient Health Questionnaire for Depression and Anxiety (the PHQ-4). Data were analyzed from 2,149 patients drawn from 15 primary-care clinics in the United States. Factor analysis confirmed two discrete factors (Depression and Anxiety) that explained 84% of the total variance. Increasing PHQ-4 scores were strongly associated with functional impairment, disability days, and healthcare use. Anxiety had a substantial effect on functional status that was independent of depression. The PHQ-4 is a valid ultra-brief tool for detecting both anxiety and depressive disorders.
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This paper considers causal inference and sample selection bias in nonexperimental settings in which (i) few units in the nonexperimental comparison group are comparable to the treatment units, and (ii) selecting a subset of comparison units similar to the treatment units is difficult because units must be compared across a high-dimensional set of pretreatment characteristics. We discuss the use of propensity score-matching methods, and implement them using data from the National Supported Work experiment. Following LaLonde (1986), we pair the experimental treated units with nonexperimental comparison units from the CPS and PSID, and compare the estimates of the treatment effect obtained using our methods to the benchmark results from the experiment. For both comparison groups, we show that the methods succeed in focusing attention on the small subset of the comparison units comparable to the treated units and, hence, in alleviating the bias due to systematic differences between the treated and comparison units. © 2001 by the President and Fellows of Harvard College and the Massachusetts Institute of Technolog
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Applied probit analysis to 15 sets of data to specify the relationship between length of treatment and patient benefit. Data were based on more than 2,400 patients, covering a period of over 30 yrs of research. The probit model resulted in a good fit to these data, and the results were consistent across the studies, allowing for a meta-analytic pooling that provided estimates of the expected benefits of specific "doses" of psychotherapy. Analysis indicated that by 8 sessions approximately 50% of patients were measurably improved, and approximately 75% were improved by 26 sessions. Further analyses showed differential responsiveness for different diagnostic groups and for different outcome criteria. Findings hold promise for establishing empirical guidelines for peer review and 3rd-party financial support of psychotherapy. (30 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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This report describes the World Health Organization Health and Work Performance Questionnaire (HPQ), a self-report instrument designed to estimate the workplace costs of health problems in terms of reduced job performance, sickness absence, and work-related accidents-injuries. Calibration data are presented on the relationship between individual-level HPQ reports and archival measures of work performance and absenteeism obtained from employer archives in four groups: airline reservation agents (n = 441), customer service representatives (n = 505), automobile company executives (n = 554), and railroad engineers (n = 850). Good concordance is found between the HPQ and the archival measures in all four occupations. The paper closes with a brief discussion of the calibration methodology used to monetize HPQ reports and of future directions in substantive research based on the HPQ.
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This article reports the development and validation of a scale to measure global life satisfaction, the Satisfaction With Life Scale (SWLS). Among the various components of subjective well-being, the SWLS is narrowly focused to assess global life satisfaction and does not tap related constructs such as positive affect or loneliness. The SWLS is shown to have favorable psychometric properties, including high internal consistency and high temporal reliability. Scores on the SWLS correlate moderately to highly with other measures of subjective well-being, and correlate predictably with specific personality characteristics. It is noted that the SWLS is Suited for use with different age groups, and other potential uses of the scale are discussed.
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Despite the growing popularity of propensity score (PS) methods in epidemiology, relatively little has been written in the epidemiologic literature about the problem of variable selection for PS models. The authors present the results of two simulation studies designed to help epidemiologists gain insight into the variable selection problem in a PS analysis. The simulation studies illustrate how the choice of variables that are included in a PS model can affect the bias, variance, and mean squared error of an estimated exposure effect. The results suggest that variables that are unrelated to the exposure but related to the outcome should always be included in a PS model. The inclusion of these variables will decrease the variance of an estimated exposure effect without increasing bias. In contrast, including variables that are related to the exposure but not to the outcome will increase the variance of the estimated exposure effect without decreasing bias. In very small studies, the inclusion of variables that are strongly related to the exposure but only weakly related to the outcome can be detrimental to an estimate in a mean squared error sense. The addition of these variables removes only a small amount of bias but can increase the variance of the estimated exposure effect. These simulation studies and other analytical results suggest that standard model-building tools designed to create good predictive models of the exposure will not always lead to optimal PS models, particularly in small studies.
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Heightened stress levels and compromised well-being are common among college students. Current trends on college campuses include an increase in the number of students experiencing mental health issues and an increase in students seeking help, illustrating a need for evidence-based brief interventions that improve student wellness. This research study used a randomized controlled study design to examine the effects of a short-term (seven-week), solution-focused wellness intervention on perceived stress and wellness of college students. Repeated measures analysis of variance results demonstrated that the effect of group membership across time was significant for both perceived wellness and stress (p < .01). Effect sizes using partial eta² statistics were large for both outcome variables. Findings indicate that a brief solution-focused wellness intervention can significantly improve perceptions of wellness and reduce stress among college students and is more effective than treatment as usual. Intervention replicability allows for dissemination across varied academic groups and locations, and potential generalization across populations.
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The rapid growth of employee assistance Programmes (EAPs) has not been matched by the accompanying research base of their efficacy. Given the inconsistent information relating to the effectiveness of EAPs in enhancing employee and organizational outcomes, the present review systematically appraised available evidence from organizational psychology and business databases and grey literature sources. A total of 17 studies examining the impact of EAPs, met the inclusion criteria. These were mostly from North America and utilized quantitative methodology and pre- and post-intervention designs. The majority of studies focused on EAPs offered by external providers and the counselling service, with the most common limitations being discrepancies in variable definitions and an absent comparable control group. Overall, this review found that utilizing EAPs enhanced employee outcomes, specifically improving levels of presenteeism and functioning. Absenteeism was most commonly investigated but produced mixed results. Presenteeism demonstrated a stronger effect size and greater improvement than absenteeism, suggesting presenteeism as a better variable for assessing EAP effectiveness. This review clarified parameters of existing evidence and highlighted the narrow range of measures used to date, omitting important constructs such as health and well-being and productivity. A broader evaluation capturing a wider range of variables is urgently needed.
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Objective: To test the impact of Employee Assistance Programs (EAPs) on reducing employee depression, anxiety, and risky alcohol use, and whether improvements in clinical symptoms lead to improved work outcomes. Methods: The study used a prospective, quasi-experimental design with propensity score matching. Participants (n = 344) came from 20 areas of state government. EAP (n = 156) and non-EAP (n = 188) employees were matched on baseline demographic, psychosocial, and work-related characteristics that differentiate EAP from non-EAP users. Follow-up surveys were collected 2 to 12 months later (M = 6.0). Results: EAP significantly reduced symptoms of depression and anxiety, but not at-risk alcohol use. EAP reductions in depression and anxiety mediated EAP-based reductions in absenteeism and presenteeism. Conclusions: EAPs provide easy-to-access work-based services that are effective at improving employee mental health.
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This study examines if and to what degree an Employee Assistance Program (EAP) intervention improves Chinese employees’ workplace functioning. The sample included 670 employees from 26 local and multinational companies in China who received EAP counseling. The Chinese translation of the Workplace Outcome Suite-Short Version, a five-item outcome assessment instrument, was used as a pre/post measure. Four of the five items showed significant improvements from the pre- to posttest. The effect sizes on the items varied, indicating that EAP produced different levels of impact on dimensions of workplace functioning. Future research should examine the influences of different EAP models, client organizations, and dimensions of workplace functioning.
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One hundred employee assistance clients completed self assessments during intake and again at the end of counseling. They rated their overall level of psychosocial functioning and their level of functioning at work. Counselors rated the clients on the Global Assessment of Functioning Scale at the beginning and at the end of counseling. In the termination summary, counselors also rated the amount of perceived improvement by each client on the major goals established at the beginning of counseling. The majority of clients showed improvement in overall functioning. Clients who had presented for counseling because of work-related problems reported improvement in their work adjustment, and so did clients who had presented with problems that were not related to work. Clients with work-related problems reported a somewhat-lower level of overall functioning before and at the end of counseling.
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This study examined associations between behavioral health and workplace outcomes for 1,989 state employees served by a large Employee Assistance Program (EAP) over 19 months. Screening and brief intervention was used to identify and intervene for risky substance use and depression at intake. Employees completed psychometrically sound self-report measures of workplace functioning. About 80% of EAP clients screened positive for depression. There was a strong association between depression and impaired workplace productivity. About 90 days after intake, 438 employees (22.0%) participated in a follow-up interview. Analyses of intake to follow-up indicated significant improvements in depression and workplace productivity, translating to substantial cost savings.
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Objective: We review all available controlled outcome studies of solution-focused brief therapy (SFBT) to evaluate evidence of its effectiveness. Method: Forty-three studies were located and key data abstracted on problem, setting, SFBT intervention, design characteristics, and outcomes. Results: Thirty-two (74%) of the studies reported significant positive benefit from SFBT; 10 (23%) reported positive trends. The strongest evidence of effectiveness came in the treatment of depression in adults where four separate studies found SFBT to be comparable to well-established alternative treatments. Three studies examined length of treatment and all found SFBT used fewer sessions than alternative therapies. Conclusion: The studies reviewed provide strong evidence that SFBT is an effective treatment for a wide variety of behavioral and psychological outcomes and, in addition, it may be briefer and therefore less costly than alternative approaches.
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Objective: A meta-analysis was conducted to evaluate the effectiveness of solution-focused brief therapy (SFBT). Method: Hierarchical linear modeling software was used to synthesize the primary studies to calculate an overall effect size estimate and test for between-study variability. Results: Solution-focused brief therapy demonstrated small but positive treatment effects favoring SFBT group on the outcome measures (d = 0.13 to 0.26). Only the magnitude of the effect for internalizing behavior problems was statistically significant at the p < .05 level, thereby indicating that the treatment effect for SFBT group is different than the control group. Conclusions: This study allows social workers interested in solution-focused brief therapy to examine the empirical evidence quickly and with more definitive information.
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Background: Levels of psychological distress appear to be increasing in the workplace, in parallel with the growth of employee assistance programme (EAP) provision offering a range of talking treatments. However, such growth takes place in the absence of a substantive body of supporting research evidence despite a quarter of a decade of research activity. Aims: To analyse a national sample of EAP data and profile relative service quality on a set of key service indicators. Method: CORE System data profiles of over 28,000 clients were voluntarily donated by six EAP service providers. An established benchmarking methodology was used to assess the relative quality of EAP service provision compared with published CORE System benchmarks for NHS primary care and UK higher education student counselling services. Results: High quality data profiled an EAP service clientele who were quantifiably distressed, accessed treatment quickly, with the majority completing treatment and demonstrating high rates of recovery and/or improvement relative to published benchmarks from the NHS and HE comparative sectors. Limitations of the study and implications for practice and further investigation are considered.
Article
This article reports data on increased work productivity resulting from the employee assistance program (EAP) treatment of employees. Participants (N = 155) had various psychiatric diagnoses and were seen in individual counseling by network clinicians. Measures of “presenteeism,” absenteeism, and degree of problem resolution were obtained from members' ratings. The results indicated that 80% of costs associated with lost productivity was associated with presenteeism, with absenteeism accounting for the remainder. Characteristics associated with lost productivity were energy level, concentration, and work quantity/quality. A return on investment (ROI) calculated using these data in a typical EAP indicated that for every dollar spent for the program, there is an expected return of between 5.17and5.17 and 6.47.
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Cognitive behavioral therapy (CBT) refers to a popular therapeutic approach that has been applied to a variety of problems. The goal of this review was to provide a comprehensive survey of meta-analyses examining the efficacy of CBT. We identified 269 meta-analytic studies and reviewed of those a representative sample of 106 meta-analyses examining CBT for the following problems: substance use disorder, schizophrenia and other psychotic disorders, depression and dysthymia, bipolar disorder, anxiety disorders, somatoform disorders, eating disorders, insomnia, personality disorders, anger and aggression, criminal behaviors, general stress, distress due to general medical conditions, chronic pain and fatigue, distress related to pregnancy complications and female hormonal conditions. Additional meta-analytic reviews examined the efficacy of CBT for various problems in children and elderly adults. The strongest support exists for CBT of anxiety disorders, somatoform disorders, bulimia, anger control problems, and general stress. Eleven studies compared response rates between CBT and other treatments or control conditions. CBT showed higher response rates than the comparison conditions in 7 of these reviews and only one review reported that CBT had lower response rates than comparison treatments. In general, the evidence-base of CBT is very strong. However, additional research is needed to examine the efficacy of CBT for randomized-controlled studies. Moreover, except for children and elderly populations, no meta-analytic studies of CBT have been reported on specific subgroups, such as ethnic minorities and low income samples.
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The primary purpose of this study was to determine the impact of counselling through an Employee Assistance Program (EAP) on selected work performance indicators. Employee records on absenteeism and other performance criteria were collected for EAP clients and matched controls over a five year time period. Employee records on performance outcomes indicated that EAP clients had higher rates of sick days before, during and after treatment, compared to a matched control group. Additionally, rates of sick days had not significantly changed from before to after treatment among EAP clients. Supplementary data were obtained from EAP counsellors and EAP clients. Counsellor reports revealed that the most common problem addressed by the EAP was personal mental health (46.9%) followed by family problems (30.4%). A survey of EAP clients suggested that the majority of clients were satisfied with the overall quality of services, confidentiality, helpfulness of counsellors, and effectiveness of treatment.
Article
This article describes the development and validation of a five-item scale Workplace Outcome Suite designed as an open access instrument aimed at facilitating empirical research on Employee Assistance Program (EAP) interventions. The suite contains five-item measures of absenteeism, presenteeism, work engagement, life satisfaction, and workplace distress. All but the absenteeism measures are effect-indicator structures derived from classical psychometric theory. The absenteeism measure used a formative model that captures the individual components of being away from the job site because of personal problems. These components are not thought to be internally consistent with one another but rather represent distinct manners that force time off. Two separate validation studies of the suite, one with a paper-and-pencil modality (N = 220) and another with a telephone interview modality (N = 228) tested the reliability of the scales, the structural validity of the items, and the construct validity of the unit-weighted scale scores. The effect-indicator scales were found to have moderate (in the range of .75) to excellent levels (in the range of .90) of internal consistency. Only two items in the Work Engagement scale produced low factor loading for the telephone interview study, but the low loading did not replicate in the paper-and-pencil study and thus was considered spuriously low for the time being. None of the items produced factor loading below .30 in the paper-and-pencil study. Correlations of the scale scores with self-reported measures of relevant behavior and emotions provided limited evidence of construct validity for all five scales. The results suggest support for the use of the Workplace Outcome Suite to evaluate EAP services and interventions.
Article
Brief intervention (BI) research has traditionally examined alcohol and drug use outcomes; however it is unknown whether BIs can also impact on-the-job productivity. This exploratory study examines changes in workplace productivity and related costs for clients receiving a BI for at-risk drinking in the employee assistance program (EAP). Participants were 44 clients attending the EAP for behavioral health concerns, screened for at-risk drinking, assigned to BI+Usual Care (n=25) or UC alone (n=19), and who completed 3-month follow-up. Absenteeism, presenteeism, and productivity costs were derived as outcomes. At follow-up, participants in the BI+UC group had improved productivity when at work (presenteeism) compared to the UC group. The estimated cost savings from improved productivity for the BI+UC group was $1200 per client over the UC group. Groups did not differ by absenteeism (missed days of work). Preliminary evidence suggests the broad impact BIs may have. Implications for future BI research are discussed.
Article
The employee assistance program (EAP) field has identified the skills and knowledge needed to provide EAP as unique from other helping professions. The most prevalent model in the delivery of EAPs is the affiliate network, where EAP vendors contract with a network of independent behavioral health clinicians, or “affiliates,” to provide EAP services in a private office to employees and family members. What has not been systematically examined until this study is how affiliates enrolled in EAP networks deliver short-term counseling in the context of EAP. This study examines how affiliates utilize short-term counseling with EAP-specific cases referred to affiliates, as well as how short-term counseling in EAP duplicates or overlaps with “general practice” counseling. A “one-time” survey was created using subject matter experts and deployed over the Internet as a Web-based survey. A “working population” of 3,000 EAP affiliates was used as the sampling frame and a random sample of 400 was drawn, with 222 surveys completed (55% response rate). Findings indicate that there has been significant “leakage” from general practice counseling into EAP, or the degree to which EAP clients receive general practice counseling, in the form of short-term intervention as opposed to traditional EAP-specific services. There is currently not much contrast between EAP work and general practice counseling, and the marginal differences reflect the nuances of benefit design (e.g., number of allowed sessions) and a shift among a segment of respondents toward using solution-focused counseling with EAP clients. Implications of these findings are discussed.
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Programs for alcoholic employees have shifted their emphases from prevention and constructive confrontation to self-referrals, through 'employee assistance programs', for counseling and treatment.
Article
To estimate the effect of Employee Assistance Program (EAP) use on healthcare utilization as measured by health claims. A unique data set that combines individual-level information on EAP utilization, demographic information, and health insurance claims from 1991 to 1995 for all employees of a large midwestern employer. Using "fixed-effect" econometric models that control for unobserved differences between individuals' propensities to use healthcare resources and the EAP, we perform our analyses in two steps. First, for those employees who visited the EAP, we test whether post-EAP claims differ from pre-EAP claims. Second, we combine claims data of individuals who went to an EAP with those of individuals who did not use an EAP to test whether differences in utilization exist between EAP users and nonusers. From the EAP we obtained the date of first EAP contact for all employees who used the service, and from the company's human resources department we obtained limited demographic data on all employees. We obtained healthcare utilization claims data on all employees and their dependents from the company's two healthcare plans: a fee-for-service (FFS) plan and a health maintenance organization (HMO) plan. We found that going to an EAP substantially increases both the probability of an alcohol, drug abuse, or mental health (ADM) claim and the number of ADM claims in the same quarter as EAP contact. The increased probability of an ADM claim persists for approximately 11 quarters after the initial contact, while the increased ADM charges persist for approximately six quarters after the initial EAP contact. Our results strongly suggest that the EAP is able to identify behavioral and other health problems that may affect workplace performance and prompt EAP users to access ADM and other healthcare. Consistent with the stated goals of many EAPs, including the one examined in this study, this process should improve individuals' health, family functioning, and workplace performance.
Article
A number of self-administered questionnaires are available for assessing depression severity, including the 9-item Patient Health Questionnaire depression module (PHQ-9). Because even briefer measures might be desirable for use in busy clinical settings or as part of comprehensive health questionnaires, we evaluated a 2-item version of the PHQ depression module, the PHQ-2. The PHQ-2 inquires about the frequency of depressed mood and anhedonia over the past 2 weeks, scoring each as 0 ("not at all") to 3 ("nearly every day"). The PHQ-2 was completed by 6000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. As PHQ-2 depression severity increased from 0 to 6, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and healthcare utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-2 score > or =3 had a sensitivity of 83% and a specificity of 92% for major depression. Likelihood ratio and receiver operator characteristic analysis identified a PHQ-2 score of 3 as the optimal cutpoint for screening purposes. Results were similar in the primary care and obstetrics-gynecology samples. The construct and criterion validity of the PHQ-2 make it an attractive measure for depression screening.
Article
In this study, a stress management program based on cognitive behavioural therapy principles was compared with a Kundaliniyoga program. A study sample of 26 women and 7 men from a large Swedish company were divided randomly into 2 groups for each of the different forms of intervention; a total of 4 groups. The groups were instructed by trained group leaders and 10 sessions were held with each of groups, over a period of 4 months. Psychological (self-rated stress and stress behaviour, anger, exhaustion, quality of life) and physiological (blood pressure, heart rate, urinary catecholamines, salivary cortisol) measurements obtained before and after treatment showed significant improvements on most of the variables in both groups as well as medium-to-high effect sizes. However, no significant difference was found between the 2 programs. The results indicate that both cognitive behaviour therapy and yoga are promising stress management techniques.
Article
The Alcohol Use Disorders Identification Test Consumption (AUDIT-C) questions have been previously validated as a 3-item screen for alcohol misuse and implemented nationwide in Veterans Affairs (VA) outpatient clinics. However, the AUDIT-C's validity and optimal screening threshold(s) in other clinical populations are unknown. This cross-sectional validation study compared screening questionnaires with standardized interviews in 392 male and 927 female adult outpatients at an academic family practice clinic from 1993 to 1994. The AUDIT-C, full AUDIT, self-reported risky drinking, AUDIT question #3, and an augmented CAGE questionnaire were compared with an interview primary reference standard of alcohol misuse, defined as a Diagnostic and Statistical Manual, 4th ed. alcohol use disorder and/or drinking above recommended limits in the past year. Based on interviews with 92% of eligible patients, 128 (33%) men and 177 (19%) women met the criteria for alcohol misuse. Areas under the receiver operating characteristic curves (AUROCs) for the AUDIT-C were 0.94 (0.91, 0.96) and 0.90 (0.87, 0.93) in men and women, respectively (p=0.04). Based on AUROC curves, the AUDIT-C performed as well as the full AUDIT and significantly better than self-reported risky drinking, AUDIT question #3, or the augmented CAGE questionnaire (p-values <0.001). The AUDIT-C screening thresholds that simultaneously maximized sensitivity and specificity were > or =4 in men (sensitivity 0.86, specificity 0.89) and > or =3 in women (sensitivity 0.73, specificity 0.91). The AUDIT-C was an effective screening test for alcohol misuse in this primary care sample. Optimal screening thresholds for alcohol misuse among men (> or =4) and women (> or =3) were the same as in previously published VA studies.
Article
Depression and suicide-related behaviours are important issues for workers, and the number of Japanese companies contracting with the Employee Assistance Programme (EAP) to promote employees' mental health has recently increased. However, no longitudinal studies have reported that the EAP maintains or improves the overall level of depression among employees qualitatively. Thus, we attempted to assess the impact of the EAP on depression and suicide-related behaviours in the workplace. A cohort study was conducted on 283 male Japanese employees aged 22-38 years at a Japanese information-technology company introducing the EAP. Because the privacy policy of the EAP service made it difficult to perform a randomised design in the workplace, 22 men working at an affiliated company without the EAP were used as a reference group. All the subjects completed the 17-item Hamilton Depression Scale (HAM-D) and Job Content Questionnaire (JCQ) consisting of job demands, control, and social support before the EAP was introduced to establish a baseline and after 2 years. In the EAP group, the total HAM-D scores significantly decreased after the 2-year study period (P=0.0011); the changes in the scores of the five HAM-D items (i.e., suicidal thoughts, agitation, psychomotor retardation, guilt, and depressed mood) were significant. Specifically, 19 (86%) of the 22 workers with a positive response to the suicidal thoughts item (i.e., score >or= 1) at baseline reported that they no longer had suicidal thoughts (i.e., score=0) after the 2 year study period. No significant changes were observed in the reference group. The three JCQ scores were not significantly different between the baseline and after the 2 year study period in both groups. Although further studies are needed, EAPs may be a promising strategy for maintaining the good mental health of workers.
Article
Propensity score matching (PSM) has become a popular approach to estimate causal treatment effects. It is widely applied when evaluating labour market policies, but empirical examples can be found in very diverse fields of study. Once the researcher has decided to use PSM, he is confronted with a lot of questions regarding its implementation. To begin with, a first decision has to be made concerning the estimation of the propensity score. Following that one has to decide which matching algorithm to choose and determine the region of common support. Subsequently, the matching quality has to be assessed and treatment effects and their standard errors have to be estimated. Furthermore, questions like 'what to do if there is choice-based sampling?' or 'when to measure effects?' can be important in empirical studies. Finally, one might also want to test the sensitivity of estimated treatment effects with respect to unobserved heterogeneity or failure of the common support condition. Each implementation step involves a lot of decisions and different approaches can be thought of. The aim of this paper is to discuss these implementation issues and give some guidance to researchers who want to use PSM for evaluation purposes. Copyright 2008 The Authors Journal compilation © 2008 Blackwell Publishing Ltd.
Article
The purpose of this study was to determine the effectiveness of an Employee Assistance Program (EAP) in terms of selected work performance indicators and treatment outcomes. Three primary data sources were utilized: a questionnaire administered to EAP users, reports from EAP counsellors on treatment diagnoses and outcomes, and employee records on absenteeism and other performance criteria over a five year time period. On the whole, EAP clients reported very favourable outcomes regarding the quality of services and improved well being, and the counsellors reported successful treatment outcomes. However, employee records on performance outcomes indicated that EAP clients had higher rates of problems before, during and after treatment, compared to a matched control group. Additionally, rates of sick days significantly increased from before to after treatment among EAP users.
Employee Assistance Program Impact: One local program's effectiveness. MS thesis
  • G L Matrone
EAP works: Global results from 24,363 counseling cases with pre-post data on the Workplace Outcome Suite© (WOS)
  • M Attridge
  • D A Sharar
  • G Delapp
  • B Veder
Validation of the 5-item short form version of the workplace outcome suite
  • R D Lennox
  • D Sharar
  • E Schmitz
  • D B Goehner
Can propensity score analysis approximate randomized experiments using pretest and demographic information in pre-K intervention research? Evaluation Review
  • N Dong
  • M W Lipsey
The workplace effects of EAP use: “Pooled” results from 20 different EAPs with before and after WOS 5-item data
  • D A Sharar
  • R Lennox
Anxiety disorders in primary care: Prevalence, impairment, comorbidity, and detection
  • K Kroenke
  • R L Spitzer
  • J B Williams
  • P O Monahan
  • B Löwe
Innovation in the workplace: Evaluation of a pilot employee assistance program serving persons with disabilities
  • J C Anema
  • S R Sligar