EAP Outcomes Demonstrate Value

EASNA Conference May 2004

Rick Selvik, LICSW, MBA, CEAP

Diane Stephenson, Ph.D., CEAP

Federal Occupational Health, Program Support Center,

U.S. Department of Health and Human Services

Presentation Abstract

Outcome Data from 60,000 EAP clientsDuring a 3 Year PeriodWith Federal Occupational Health EAPDuring pre- and post- clinical processResults show client improvementLarge number and consistent findingsSupport productivity benefits of EAP

Presentation Issues

Cost-effective methods to document value

Demonstrate value by more than anecdotes

Outcome measures assure quality service and demonstrate value

Keep the customer informed of EAP services and impact on health and productivity

Learning Objectives

How to collect outcome measures

How to interpret the results

How to assess EAP impact on key workplace indicators

How to use results to evaluate program initiatives such as telephone counseling

Traditional EAP Value Measures

Utilization

Demographics

Presented and Assessed Problems

Client satisfaction

New EAP Value Measures

Problem Improvement

Risk Management Results

Reduced Absenteeism

Productivity Improvement

U.S. Dept. of Health and Human Services, PSC, Federal Occupational Health (FOH)

EAP for 1.4 million Federal employees

Serving over 400 Federal agencies

Have over 150 counselors onsite nationwide

Nationwide affiliate network

Heavy demand for information and quarterly reports of activity

The Typical EAP Client (1)

Between 45 and 54 years of age (35%)Married (50%)Caucasian (67%), African American (20%), and Hispanic (10%)Males (50%), Females (50%)Worked for Organization 6 to 15 Years

The Typical EAP Client (2)

Self-Referred to EAP (60%), Management Referred (15%), Union Referred (2%)Three to Four Sessions on AverageAddress Problem in EAP (80%)Others referred to community resourcesFollow-up for up to a yearFour of five clients resolve in EAP

Reported Work Problems

Other6%

Safety/Accident

2%

Work Relationship

15%

Misconduct5%

Absent/Tardy10%

Diminished Work

Performance10%

Disciplinary Action

3%

No Work Problem

49%

Assessed ProblemsAnxiety

25%Depression

20%Stress3%

Grief & Loss3%

Job 15%

Alcohol/Drug 10%

Family5% Marital/

Relationship 10%

Financial/Legal<1%

Other Emotional

8%

Health Status Questions

Health Outcomes Institute and InterStudy

John Ware of Johns Hopkins

Different versions: SF36 and HQ12

We selected four of the questions

Asked at case opening and case closing

Outcome Measures UsedProductivity impacted by emotional problems,

Productivity impacted by physical health,

Improved work and social relationships,

Health status,

Job attendance/tardiness, and

Global assessment of functioning (GAF).

Question: Productivity – As Affected by Emotional Problems

”During the past 4 weeks, to what extent have you accomplished less than you would like in your work or other daily activities as a result of emotional problems (such as feeling depressed or anxious)?”

The response options were: None at all (1), Slightly (2), Moderately (3), Quite a bit (4) and Extremely (5)

73% reduction in cases in lowest two categories

Productivity – As Affected by Emotional Problems

5%

25%26%19% 25%

1 None at All 2 Slightly 3 Moderately 4 Quite a Bit 5 ExtremelyProductivity Rating Level BEFORE use of the EAP

1%7%

37%42%13%

1 None at All 2 Slightly 3 Moderately 4 Quite a Bit 5 ExtremelyProductivity Rating Level AFTER use of the EAP

Results show shift towards no or fewer productivity problems after EAP services.

Question: Productivity – As Affected by Physical Health ”During the past 4 weeks, how much

difficulty did you have doing your work or other regular daily activities as a result of your physical health)?”

The response options were: None at all (1), A little bit (2), Moderately (3), Quite a bit (4) and Could not do daily work (5)

66% reduction in cases in lowest two categories

Productivity – As Affected by Physical Health

3%12%

20%48%17%

1 None at All 2 A little bit 3 Some 4 Quite a bit 5 Could not dodaily work

Productivity Rating Level BEFORE use of the EAP

1%4%23%

60% 11%

1 None at All 2 A little bit 3 Some 4 Quite a bit 5 Could not dodaily work

Productivity Rating Level AFTER use of the EAP

Results show shift towards no or fewer productivity problems after EAP services.

Question: Improved Work and Social Relationships ”During the past 4 weeks, to what extent

has your physical or emotional problems interfered with your normal social activities with family, friends, neighbors, or groups?”

The response options were: None at all (1), Slightly (2), Moderately (3), Quite a bit (4) and Extremely (5)

77% reduction in cases in lowest two categories

Work and Social Relationships

5%

26%25%18% 25%

1 None at All 2 Slightly 3 Moderately 4 Quite a Bit 5 Extremely

Work/Social Relationship Problems BEFORE use of the EAP

1%7%36%43%

13%

1 None at All 2 Slightly 3 Moderately 4 Quite a Bit 5 ExtremelyWork/Social Relationship Problems AFTER use of the EAP

Results show shift towards no or fewer relationship problems after EAP services.

Question: Health Status

”In general, would you say your health is:”

The response options were: Excellent (1), Very Good (2), Good (3), Fair (4) and Poor (5)

31% reduction in cases in lowest two categories

Health Status

3%13%

32%15%

37%

1 Excellent 2 Very good 3 Good 4 Fair 5 Poor

Health Status Level BEFORE use of the EAP

2%9%36%

19%34%

1 Excellent 2 Very good 3 Good 4 Fair 5 Poor

Health Status Level AFTER use of the EAP

Results show shift towards improved health status after EAP services.

Question: Attendance/Tardiness

“How many days have you been unexpectedly absent or tardy in the past 30 days?”

62% drop in average lost time away from work for clients after using the EAP

Attendance/Tardiness

0.91

2.37

0

0.5

1

1.5

2

2.5

30 Days Before EAP 30 Days After EAPResults show dramatic change in unscheduled attendance/tardiness occurrences after EAP services.

Question: Global Assessment of Functioning The counselors assessed a client’s level of

functioning using the Global Assessment of Functioning (GAF) Scale (American Psychiatric Association, 2000).

GAF scores can range from 1 to 100, with higher scores indicating better functioning.

10% average improvement for clients, moving from a range of mild symptoms and difficulty in functioning to transient, slight symptoms and impairment levels

Global Assessment of Functioning

70.3864.11

0

10

20

30

40

50

60

70

80

Case Opening Case Closing

Results show change in average GAF scores at case closing.

How to Present the Results to the Customer

Charts

Percent Improvement

Quarterly Reports

Trends

Outcome Area Percentage of Improvement in Lowest

Two Categories

Productivity impacted by emotional problems,

73%

Productivity impacted by physical health,

66%

Improved work and social relationships,

74%

Health status, 31%

EAP Impact In the Workplace

Outcome Area Percentage of Improvement for All

Clients

Job attendance/tardiness 62%

Global assessment of functioning (GAF) improvement

10%

EAP Impact In the Workplace

Outcomes for Different Types of Clients

By Assessed Problem Type

When Alcohol/Drug is the Primary Problem

By Gender

For Telephone Counseling Clients

Improved Outcomes by Assessed Problem

0%10%20%30%40%50%60%70%80%90%

Productivity -Mental Health

Productivity -Physical Health

Work and SocialRelationships

Health Status Attendance GlobalAssessment of

Functioning

Perc

ent o

f Im

prov

emen

t

Emotional Alcohol/Drug Family

Clients with Alcohol/Drug Problems

Improved Outcomes by Gender

75% 81%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Per

cent

of

Impr

ovem

ent

Male Female

N=11,746

Evaluation of Telephone Counseling in an EAP

•Criteria•Outcomes

Telephone Applications in Behavioral Health

Crisis counselingInitial contact - information/educationScreeningAppointment schedulingManagement consultation

Telephone Applications in Behavioral Health

AssessmentCounselingSupport between face-to-faceCase managementSupervisionFollow-upEvaluation

Other TC Outcomes Study Results

Texas A&M Study (Reese, 2000)

Clients report same level of relationship with counselor (telephone & face-to-face)Convenience, cost, anonymity, control

U of IL Study (Schneider, 2000) Telephone, face-to-face, videoteleconference, no treatmentAudio (telephone) & video provide similar outcome levels to face-to-faceAny modality better than no treatmentComfort with audio & video increase over time

FOH Guidelines for Counseling by Telephone

Assessing Client AppropriatenessClient Request for Counseling by TelephoneEnvironmentConducting the Initial Assessment Conducting the CounselingDocumentationStatement of Understanding IssuesCounselor State Licensed

Contraindications to Counseling by Telephone

Alcohol or other drug abuseManagement referralsRisk of violenceSuicidal or homicidalMarital, family, childSerious psychopathology

FOH TC Evaluation Components (1)

Number of telephone casesLength of counseling sessionsRates of case assignment to affiliate counselorsClient satisfaction ratings on access to careClient satisfaction ratings on services received

FOH TC Evaluation Components (2)

Outcomes ratings on productivity and absenteeismClinical outcome (GAF score)Structured counselor feedback on their telephone casesAnecdotal case information from counselors

Comparison Time Frame Analyses

Implementation Period – 6 months immediately after issuance of the structured TC guidelinesComparison Period – the same 6 month period the year before

Outcomes – #s Using Telephone Counseling

Generally the same number of telephone cases and telephone sessions during the implementation period as compared with the comparison period.

Telephone and Face-to-Face Counseling Groups

Face-to-face counseling analysesTC sessions were fewer than 50% of the totalCases with no telephone sessions

Telephone counseling analysesTC session were 50% or more of the totalCases with any telephone sessions

Outcomes – Length of Sessions

Average length of telephonic session – 32.2 minutesAverage length of face-to-face session – 59.8 minutes

Outcomes – Affiliate Assignment

Reduction of 5.6% in affiliate case assignment

Outcomes – Client Satisfaction: Access To Care

Same outcome results for telephonic and face-to-face cases on client satisfaction with access to care

Outcomes – Client Satisfaction: Quality Of Services Received

Same outcome results for telephonic and face-to-face cases on client satisfaction with quality of services received

Outcomes – Absenteeism & Productivity

Similar outcomes for telephonic and face-to-face cases on:

Pre/post absenteeism/tardiness ratesPre/post productivity measures

Outcomes – Clinical Functioning

Cases with any telephonic sessions showed a greater average improvement in GAF scores from the opening to the closing of the case (p=.05) compared with the face-to-face cases

Outcomes – Counselor Feedback3.7 – level of counselor’s experience with telephone counseling4.0 – level of comfort providing TC with this case 4.2 – perception of client’s TC comfort 3.8 – perception of cnslr/client alliance

5 point scale – 1=low; 3=moderate; 5=high

Outcomes – Counselor Feedback (2)

3.7 – extent to which goals were met4.0 (5=not at all) – If goals not met, extent that counseling by telephone contributed

4.5 (5=not at all) – Extent to which a TC session was interrupted.93 (0=no and 1=yes) – If the client had privacy during the TC

Outcomes – Counselor Anecdotal Information

Categories where telephonic counseling may be appropriate and beneficial:StigmaMedical mobility problemsMental health mobility problemsScheduling problemsClients with multiple no shows

Telephone Counseling Summary

Appropriate clients; appropriate methodUse a multifaceted evaluation model for evaluating service delivery through technological modalities

Client Satisfaction Dimensions Service Satisfaction

Accessibility and Convenience Productivity Improvement

Improve productivity at workImprove work relationships

Client ImprovementEAP’s effect on problem resolutionStrengthening the client’s job effectivenessAbility to cope with stress

How to Use this DataFor Client Service Delivery

Improve Health and Productivity OutcomesDaily operational management

Continuous quality improvementActivity based managementEnable core processes

Monthly Supervisor/Counselor ReportDeveloping Internal Benchmarks

How to Use this DataFor the Consultation to the Organization

Show Health and Productivity OutcomesCustom reports for customersSenior management briefingsQuarterly reportsAnnual activity summary

EAP Value Dimensions

EAP Health & Productivity Role

EAP Commodity

Strategic Buisness Focus

Employee Service Delivery

New EAP Value Measures

Traditional EAP Value Measures

Client Service Delivery

Consultation to the Organization

Summary and Discussion

EAP services lead to improved outcomes in six areas of functioning

Results consistent over a 3 year period

Involved almost 60,000 EAP clients with a variety of presented problems

Include in clinical process

Supports health and productivity value and benefits of EAPs

Thanks to:Chris Plaza, MS, Brian Sugden, PhD, Dennis Derr, MA, Christopher Ross, PhD, David Bingaman, LCSW, Fran Wence, MAThe authors give special recognition to the counselors, counselor supervisors, clinical directors, and FOH EAP consultants for their work on the development/implementation of this initiative and their significant contributions to the health and productivity of the workforce.Questions: 312-886-4215; Rselvik@psc.gov; www.foh.dhhs.gov/outcomes.asp