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“In general, an EAP is a set of professional services specifically designed to improve and/ or maintain the productivity and healthy functioning of the workplace, and to address a work organisation’s particular business needs through the application of specialised knowledge and expertise about human behaviour and mental health. More specifically, as EAP is a workplace programme designed to assist: (1) work organisations in addressing productivity issues, and (2) ‘employee clients’ in identifying and resolving personal concerns, including health, marital, family, financial, alcohol, drug, legal, emotional stress, or other personal issues that may affect job performance” (EAPA, 2012).
Berridge and Cooper (1994) explained that EAPs are seen by organisational managers as playing a capable role in keeping organisations operating at a high level of efficiency, quality and competiveness, by helping employees tackle complex work and out of work issues. As a result, an EAP can be seen to help organisations attain and retain high performance through supporting employees who are experiencing problems leading to stress or feelings of being unable to cope with their current situation. At any given time, 20% of employees have personal problems that can have an impact on their organisational role (Carchietta, 2015), and if employees (and other eligible dependents that some EAPs may cover) are encouraged, or chose to, access an EAP at the earliest opportunity and before the problem worsens, an organisation may be able to mitigate or avoid financial and human capital costs (Sharar and Hertenstein, 2006). As such, Compton and McManus (2015) commented that EAPs can be seen as an organisational risk management tool, as through providing an early counselling intervention to employees, there is a greater opportunity that problems experienced by employees such as substance abuse and mental illness can be avoided, reducing the risks (and costs) of both short-term and long-term sickness absence. EAPs are now frequently included as an employee benefit, and are increasingly regarded as evidence of duty of care by organisations (Kirk and Brown, 2003;
Berridge and Cooper, 1994).
A review of the literature shows that a standardised model of an EAP does not exist (Berridge and Cooper, 1994; Arthur, 2000; Jacobson, Jones and Bowers, 2011), as variations appear as a result of individual needs, organisational characteristics, and the capability of EAP providers among others. However, there do appear to be elements of commonalities, or core components
of effective EAPs, which include:
• A commitment and support from top management
• A clear, written set of policies and procedures that outline the purpose of the EAP and how it functions in the organisation
• Close co-operation with local unions
• Training of supervisors on their role in problem identification
• Education of employees and promotion of EAP services to foster widespread utilisation throughout the company
• A continuum of care, including referral to community agencies and follow-up of each case
• An explicit policy on confidentiality of employee information
• Maintenance of records for programme evaluation purposes (Arthur, 2000, page 550) EAPs can vary in the scope they cover, for example, some will cover employee’s families and a broad range of issues, including those extrinsic to work, while others may be limited solely to those issues that have an impact on work performance, such as: mental/physical ill-health, the inability to cope with their work or the experience of unacceptable behaviour at work (Berridge and Cooper, 1994). As such, EAPs are intended to tackle stress in organisations in the wider-sense, with the underlying notion that stress is a normal part of life, and should not be categorised, especially as different stressors can inter-react and affect all aspects of an individual’s life. Berridge and Cooper (1994) also highlighted the wide range of issues that can come under an EAP’s scope, arguing that the range of issues handled is really only limited by the problems that are encountered by individual employees or by the training/competence of the counsellors. Counselling issues can include: alcohol abuse, bereavement, career development, disabilities, family problems, financial advice, legal issues, retirement, physical fitness and violence, among others.
EAPs may also vary in terms of whether an organisation decides to implement internal or external provision. Advantages of having an internal EAP include: it is perceived that it would be more likely to fit with an organisation’s needs, it can be easily monitored to ensure maximum service provision, and if problems with the service did occur, then finding solutions would be easier (IDS, 2002). However, staff may not see an internal service as independent or confidential, and there may also be problems with trying to deliver services to employees if they are situated in different organisational sites (Newton, Hayday and Barkworth, 2005).
External EAPs can provide many benefits for organisations: confidentiality and independence of the service is perceived, however, service benefits are considered to be the priority with external EAPs, including having specialist structures in place to serve customers, as well as having access to high level support from different geographical locations on a 24-hour basis (Newton, Hayday and Barkworth, 2005). As Cekiso and Terblanche (2015) highlighted, as EAPs are operating in complex climates, any product offered must be refined to meet a customer’s demand and services should be tailored to best match their needs.
There are a range of external models of EAPs that organisations can choose. The ‘Full Service Model’ (EAPA, 2012) is the most comprehensive, usually including a 24-hour/365 day a year helpline, offering a range of practical and clinical support. Therapeutic support is usually short-term (lasting between 3-8 sessions and time limited), provided by qualified and trained clinicians. Some EAPs also offer internet-based online counselling, which can include livemessaging if required. Practical support (e.g. legal help, debt management, medical help and support for managers) can also be provided over the telephone or online. In all cases, those using EAP services will be initially assessed to see what the most suitable services for their needs are, and then are helped by the appropriate professionals. The model also includes the provision of utilisation reports, EAP promotional materials and online resources. Some organisations opt for a more embedded EAP service, where the EAP is included ‘free’ with other insurance or healthcare products (EAPA, 2012). As a result, this model may be more limited in the services offered in comparison to full EAPs (e.g. telephone services only, or limited face-to-face counselling provision). EAPs may also be purchased as a ‘telephone and online’ model, removing all face-to-face services, and counselling takes the form of structured, shortterm sessions either over the phone or online (EAPA, 2012). Other services in this model can include self-assessment and factsheets available online. One caveat to this model is to ensure that security and confidentiality measures are agreed by both the provider and the purchaser.
The Employee Assistance Society of North America (EASNA) (2009) describes that effective implementation of EAPs is based on a number of factors; however leadership support of an EAP is crucial. Senior leaders can help define the reasons for implementing the EAP, to bring it into the organisation’s culture and promote its use. Trades unions and other employee organisations may also have to be included in discussions to reduce any suspicions that employees may have re: the introduction of an EAP (Berridge and Cooper, 1994). It is also important that an organisation ensures that metrics are collected and reported, so that improvements and changes can occur to the programme (EASNA, 2009).
Employees can encounter EAP services through a number of modes (Berridge and Cooper, 1994):
• Self-referral: the employee refers through their own volition (often on the advice of a colleague with experience of EAPs)
• Organisational specialist referral: when an employee is referred through occupational health or HR. The referral can be made as a result of a meeting, request for advice or an accident.
• Managerial referral: a manager could refer an employee as a result of problem identification either through one-to-one management meetings or informal conversations and can be concerned about the wellbeing of their employees, or through more formal performance management where unsatisfactory job performance has been recorded. An employee may then contact an EAP voluntarily, or in some cases, using an EAP could be attached to disciplinary action.
Since their introduction in the UK, the EAP market is growing rapidly, with recent statistics suggesting that more than 13.79 million employees are covered by an EAP, which represents about 47% if the working population (EAPA, 2013). In terms of EAP utilisation, McLeod (2001) reported that utilisation rates for organisations with EAPs averaged between 4-8% of eligible employees, with women more likely to use the services then men. Compton and McManus (2015) indicated that there was a wide age distribution of EAP users with the highest percentages between 40-49 years (14%) and 50-59 years (10%). Other research has indicated that one in five employees seeking help from EAPs sought advice directly about work issues, and EAPs were more commonly used to discuss personal problems (Newton, Hayday and Barkworth, 2005). Compton and McManus (2015) undertook research into why organisations introduced EAPs. The main reasons included to support the health and wellbeing of their employees, to implement best practice and for perceived organisational duty of care. Importantly, a minority of the respondents (6%) noted that effective counselling led to an improved business strategy.
Organisational perceived benefits of EAPs included: improving employee relations, improved employee morale, and reduced stress in the workplace, with increased productivity reported as being inconsequential (Compton and McManus, 2015).
Do EAPs work?
Although EAP provision within organisations have almost trebled over the last decade (MellorClark et al., 2013), and EAP services have been ranked as one of the most popular core employee benefits that organisations can provide, the growth of EAPs has occurred without having a substantive level of research evidence (McLeod, 2001, 2010). Mellor-Clark et al., (2013) also reported that there has been very little research specifically focussing on UK EAP effectiveness.
Additionally, where research has been undertaken, it has predominantly occurred in the private sector which has been described as primarily promotional or prescriptive, and lacked methodological rigour or evaluative design (Cayer and Perry, 1988).
As EAPs can be introduced into organisations with the belief that counselling or other assistant services will improve employee productivity, it has been argued that more aspects of EAPs should be explored more fully (Colantonio, 1989; Csiernik, 1995), especially focussing on whether the health and wellbeing of the workforce has been enhanced (Csiernik, 1995). Sharar and Hertenstein (2006) argued that EAPs have not been studied or evaluated with the same level of intensity as other employer sponsored health and wellbeing work programmes. Thus, what evidence do we have that EAPs are effective for improving employee wellbeing and productivity?
McLeod (2001) conducted a literature review of the impact of EAPs on workplace behaviour and client satisfaction. The review concluded that EAPs were not seen as less effective than other workplace wellbeing interventions, with the finding that 90% of clients in EAP studies indicated satisfaction with the services they received. The review of the literature was updated by McLeod in 2008, which also reported that clients would use the service again, and that they would recommend EAPs to their colleagues. However, McLeod (2008) mentioned client satisfaction reflects how professionally a service was delivered, rather than the quality of the services, and the overall implications for an individual’s health and wellbeing or organisational productivity.
The updated review also studied the effects of workplace counselling on employee psychological functioning, reporting that those who had attended counselling experienced an amelioration of their symptoms of stress and wellbeing, and there was also a positive effect on depression.
However, the author also stressed that review of the literature could not claim that EAPs had an enduring impact on psychological difficulties, or whether the service merely helped the client deal with their current symptoms. Additionally, those who used the workplace counselling services reported higher levels of psychological distress and clients with a more complicated or severe health issue required long-term counselling, or referral to other specialist services. With regards to job attitudes such a job satisfaction, motivation, organisational work commitment and workplace relationships with other work colleagues, EAPs did appear to lead to positive changes in work attitudes, but the data also suggested that for many clients there was not a sufficient level of current ‘work dysfunction’ for there to be a clear measurable outcome, and consequently results for job attitudes still remain uncertain.
A range of other studies have also provided mixed results regarding the effectiveness of EAPs:
• Van der Klink et al (2001) conducted a systematic review on workplace counselling interventions to help with occupational stress, concluding that individual interventions were more effective than organisational level interventions. However, CBT style methods were most effective (in comparison to other counselling interventions).