Underdeveloped Workplace Opportunities for

Employee Assistance ProgramsPaul M. Roman

Distinguished Research Professor of Sociology Center Director, Institute for Behavioral Research

University of Georgia Presentation at 2007 Conference of the Employee Assistance Society of North America, Atlanta,

GAMay 10, 2007

Topics of Today’s Talk

Historical backgroundUse of EAP as a platformTwo groups of EAP specialists

Topics (cont’d)

EAPs are missing a their potential for providing constructive assistance to employees with depression and ADHD as well as alcohol or drug problemsEvidence based practices are critical to gaining a prosperous foothold in the American workplace as health specialists and rejuvenating the employee assistance profession

Historical Background: The First Innovations

Spinning off the Post-Prohibition paradigm of the disease concept of alcoholism, industrial alcoholism programs are established in 8-10 major companiesIt proves to be an innovation with minimal diffusion potential A new innovation is created in the EAPIt has unlimited diffusion potential

Historical Background of EAPs

NIAAA used the EAP for its own endsBeginning in 1970s, NIAAA created a potentially strong combination of EAPs, health insurance coverage, and private treatment was established.NIAAA continued to provide substantial support to the overall movement through 1970s and 1980sCore technology of 6 elements necessary to define an EAP and make it effective in dealing with substance abuse issues were established in mid 1980s

Core Technology of EAPs (Similar for MAPs)

1. Presence of expertise to distinguish work problems from personal problems2. Available of consultation to managers, supervisors, and union reps3. Use of constructive confrontation when necessary4. Appropriate linkage with treatment at the individual level5. Linking workplace with helping agencies in the community6. Provide ongoing constructive support that eventually will change organizational culture to accept behavioral health problems as legitimate

History (cont’d)

The EAP model slowly drifts away from the intentions of its original formExternally based programs are touted as equal in quality to internal programsExternal programs vary widely, down to those costing pennies per capitaSelf referral is emphasized as the desired referral route, eventually forcing many programs into a reactive modeThe behavioral health emphasis widens to include “everything” The program without boundaries

Historical Background of EAPs (cont’d)

NIAAA, NIDA, and NIMH lose their authority and role to promote specific interventions in 1981; “subsidies”Disappearance of this core of the constituency demonstrates the softness of other support for core techniques“Carryover” to new SAMHSA agency has almost exclusive focus on drug testing

Major Changes Begin

The emphasis on alcohol and drug problems begins to deteriorateEA work finds many new avenues for service provision in the 1980s and 1990sRequired investment by employers in EAP service continues to dropEAPs become commodified and are competitively sold in the open marketplaceEmployers determine the program emphasis rather than conforming to guidelines emanating from a professionEmployers have no vision of EAP potential

Suitors and Potential Partners Come and Go

Occupational medicineOccupational psychiatryOccupational social workNIDA and the Trojan HorseThe work-family movementDisability managementThe health promotion/wellness movementCurrent talk within EAP about “integration”

Missing Elements of Professionalism

Formal EA training is rarely unavailable.There is no EAP textbook, or set of competing textbooks. Thus EA work is decreasingly a “vocation” and is thus difficult to call a “profession”EAP work is made up of organizational positions occupied by people trained in other occupations, and who have opportunities to be mobile within those occupations

Two Groups of EAP Specialists

The “professional” subgroup of the EAP community is of unknown size, but is oriented toward perfecting a bounded technologyThose who use EAP as a salable commodity. Market driven and reactive to new and unmet interests of workplace managersThese two groups are in many ways incompatible and have very different shared goals within their groups

A Professional Core Value

EA professionals need to prioritize those employee problems:Which are known to exist in the workplaceFor which there are strategies for intervention that flow from EA core technologyWhere the effectiveness of these strategies have been establishedWhere there is no alternative work-based strategy which offers a more efficient or effective solution

A Commodified Core Value

The product must satisfy the customerThe customer may participate in product design, adding innovationsThere must be a return on investment for the customerThere must be a profit margin for the supplier

EAP Prevalence

The data in the following tables are generated from 3 national randomly selected samples of employed persons in the United States, interviewed by telephone by the Survey Research Center of the Institute for Behavioral Research, University of GeorgiaStudy N = 3100 (1993); 2940 (1997), 6003 (2001-2002)

47.4%

57.8%60.1%

1993 1997 2001

0%

10%

20%

30%

40%

50%

60%

70%

EAP Prevalence

22.4%

46.2%

73.9%

32%

57.1%

86.1%

28%

62.3%

86.3%

1-24 employees 25-499 employees 500+ employees0%

20%

40%

60%

80%

100%

1993 1997 2001

EAP Prevalence by Organizational Size

19.7%

15.7%

12.8%

12.8% 12.7%13.9%

8.6%7.8% 7.7%

1993 1997 2001

0%

5%

10%

15%

20%

Subordinate's Problem

Own Problem

Family Member's Problem

EAP Use by Problem Type

Prominence of EAPs

Harvard Business Review, most prominent US management journal, has published monthly case studies in 2005, 2006 and 2007 that show evidence of employee personal problems, but neither the story writers or the responders show cognizance of concepts of EAP to provide professional assistance

Dimensions of the “Problem”

Formal EA training is largely unavailable, with no textbooks and no degreesEAP “profession” is made up of multiple occupational groups, minimal unity among persons with diverse backgrounds and loyalties, often business competitors

Dimensions of the “Problem”

Disappearance in the US of industrial and occupational physicians who were the original departmental “patrons” and the constituency of workplace leaders, both recovered and not, promoting constructive alcohol and drug interventions

EAPs: Current Barriers to Substance Abuse Attention

EAP standards for staffing do not require alcohol and drug problem skillsMany program designs are completely reactive; no case-finding or supervisory trainingWorkplace leaders accept EAPs as normative and as a minor and inexpensive benefit; have little knowledge of the potential of EAPs for alcohol and drug intervention

Alcohol and Drug Problems Can’t Compete

Even if EAP skills are available, employees with alcohol problems are time consuming and not necessarily rewarding; compare these with outcomes where clients really want assistanceEmployees with alcohol problems may be recalcitrant, resistant and just plain nasty; given the choice, they will be avoided.

Alcohol and Drug Problems Require Explicit Attention

Employees with alcohol and drug problems will rarely initiate self referrals; prefer to be left alone and continue self-medicationReferrals may be problematic with very frustrating treatment options But the dominance of drug testing as an observed “solution” to workplace drug problems leads to a false confidence that the issue is being dealt with adequately

Sound scientific research on EAPs that stems from

significant research grants is dormant

Federal Agencies and Private Foundations

NIAAA never re-establishes research interestNIDA never re-establishes research interestVery small support program in SAMHSANIMH never pursues EAP as platformRobert Wood Johnson Foundation does not support grant requestsNational Institute of Child Health and Human Development shows unclear interest in program platform

There have been no U.S. studies of the role of

substance abuse problems in EAP caseloads since the early

1990s

There is no evidence of proactive efforts from the practitioner community to promote research support

Research Imperatives

“Best practices” need to go beyond benchmarking where it is decided what we “know” will workThe model of a clinical trial with elements of randomization, control groups and intervention fidelity need to be developed, with outcome measures focused on turnover, job performance and clinical indicators

Establishing an Evidence Base

Major new research studies have not been launched for a decadeData exist, but they are proprietary and outside the realm of objective scientific evidenceDisassembling our interventions into their component parts and establishing what works.Testing established practicesTesting new practices

Key EAP Practices

Trials are needed to test the well-established practice of short-term counseling linked to EAPsTrials are needed to establish the viability of “primary” identification, both linked and not linked to short-term counselingTrials are needed to assess the system linkages associated with community referrals

Conclusions (1)

EAPs are world-wide platforms of opportunity and have potential for dealing with many employee problems, including alcohol which is emerging in great importance globally.EAPs are the sole constructive mechanism for dealing with employee substance abuse problemsEAPs have great potential for outreach and early assistance to substance abuse problems in employees’ dependentsParity legislation may very rapidly escalate the demands for mental health and substance abuse services

Conclusions (2)

EAPs need appropriate expertise to deal with employee alcohol and drug problemsTraining, skills and strategy are needed to deal with employee depressionTraining, skills and strategy are needed to deal with employee Attention Deficit Disorder

Conclusions (3)

The EAP field should split into its entrepreneurial and professional segmentsThese have the potential for becoming mutually supportive, but without growth on the professional side, the entrepreneurial side will remain reactive and competitive. The consumer will continue to evaluate on cost rather than potential quality of the services offered.