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• De Groot and Kiker (2003) observed that it is difficult to distinguish the distinct effects of EAP counselling programmes in comparison to other workplaces stress and health and wellbeing interventions. However, the review did highlight a number of factors that could have implications for EAP use. EAPs were most useful when there were specific outcomes to be focussed upon, and there were wide ranging and comprehensive interventions. To reduce an employee’s sickness absence better results were gained if EAPs were approached voluntarily. However, the programmes seemed to have little or no effect on job satisfaction or turnover levels.
• Kirk and Brown (2003) conducted a review of EAP literature with a country specific focus on Australia. Interestingly, they reported that counsellors used for EAPs in Australia were more qualified than their counterparts in the UK. The review suggested that employees who used the EAPs in general reported perceptions of improved mental and physical health and wellbeing, but there was little evidence that EAPs had a significant impact on organisational level data, e.g. improved job satisfaction and productivity.
• Csiernik (2004) reviewed published studies regarding EAP evaluation, and when reviewing those focussing on managers perceptions of the impact of counselling on employee performance, reported mixed outcomes (one study showing no perceived improvement, whereas others reporting between 43% and 73% of managers perceiving performance improvements).
• The British Occupational Health Research Foundation (BOHRF) (2005) found that workplace counselling for employee with mental health problems helps them to remain or return to the workplace, but there was little evidence that it could prevent mental health problems.
Additionally, the report concluded that Cognitive Behavioural Therapy (CBT) was the most effective method for workplace counselling.
• Mellor-Clark et al., (2013) analysed a national set of EAP data to assess the relative quality of EAP service provision when compared to CORE systems benchmarks for NHS primary care and UK higher education counselling services. The results indicated that EAP counselling can be a highly effective intervention, especially for employees who experience common mental health problems (which include, but are not limited to anxiety, stress and depression).
EAP providers in the study typically provided time limiting counselling services that usually lasted 4-6 sessions, and demonstrated efficiency and effectiveness when evaluated alongside comparators.
In summary, it seems justifiable to conclude that there is convincing evidence to suggest that workplace counselling can be an effective intervention for helping employees with psychological, emotional and behavioural problems, with some evidence suggesting that this can also reduce levels of sickness absence and enhance workplace functioning. The research to date is not however able to comment on what approaches are more effective, and what the critical amount of sessions are associated with optimal effectiveness. What is clear is that there are a range of methodological challenges in EAP research, which has led to difficulties in providing conclusive evidence.
Economic Evaluations of EAPs EAP literature has often commented that an organisation’s choice of which EAP they use and the method of EAP provision is more than just a technical matter based on organisational fit, but they will also be based upon economical reason (Berridge and Cooper, 1994). As the provision of EAPs and counselling services is not part of core business operandi, the availability of an EAP for employees becomes an added ‘cost’ for employers, and as a result any costs need to be balanced by HR in some way (McLeod, 2008). As a result, Cekiso and Terblanche (2015) argued that EAP customers rarely buy EAPs by prices alone, but through what an EAP can provide at the best value for money in terms of the benefits they can receive for the price they pay.
UK EAPA (2013) reported that the cost of EAPs has fallen, and the average benchmark cost of full EAP provision for an organisation of 100 employees represents value at £14/person (however, it is noted that prices will be lower for larger organisations). Masi (2011) calculated that some EAPs can now cost far less than one-half of 1% on an employer’s annual health benefit cost, and the EAPs objective to remain competitive whilst profitable can present a challenge in terms of ethical and quality problems (Masi and Sharar, 2006). However, EAPs need to show the efficacy of their services, and that they do provide an economic business case and relate this to both employee health and wellbeing and performance and productivity (Jacobson, Jones and Bowers, 2011).
Attempting to measure the economic benefits of EAPs has been a major study in EAP research, however care has to be given regarding what is being measured. For example, economic
benefits can be measured using:
• Cost-Benefit Analysis: these are the most common form of outcome evaluations reported in the EAP literature, and are conducted by comparing the money spent on providing services and the inputs, with the monetary values produced by the change, outputs (Csiernik, 1995).
Thompson and Fortress (1981), commented that if the costs are less than the benefits received then the programme can be deemed a success. It is thought however, that both tangible (e.g.
absence and performance) and intangible costs (e.g. self-reported measures that are difficult to translate into monetary values) should be included in a cost-benefit analysis
• Cost-effectiveness: this analysis looks at more unspecified outcomes (e.g. psychological wellbeing), and aims to establish which interventions that organisations have implemented achieves the best therapeutic results in relation to the cost of the implementation (Highley and Cooper, 1994).
• Return-on-Investment: As many organisations now may have to justify the costs of an EAP service, organisations could have to calculate what the return-on-investment for their EAP is (i.e. does the EAP provide enough business value to cover the cost of purchasing the service) (Attridge et al., 2009). Flanagan and Ots (2009, page 1) identified three types of potential financial benefits from EAPs to assess an employer’s financial return-on-investment: i) a healthcare value component, ii) the human capital value component (representing savings in reducing absenteeism and turnover (and presenteeism) and improving productivity and engagement), and iii) the organisational value component (comprising cost savings in regard to issues such as safety risks, employee grievances and legal claims and positive benefits in demonstrating employee concern and support). Leon (2012) reported that although 78% of organisations conduct return-on-investment calculations on HR functions, only 39% measured the return-on-investment of their EAP.
Houts (1991) undertook a piece of research on conducting economic analyses of EAPs in organisations. The survey results indicated that the majority of managers (83%) responded that cost-saving was an important criterion on which EAP performance could be evaluated on, with 98% of managers also reporting that the cost-saving potential of their EAP was high, or very high. However, only 40% actually collected any cost-saving data on which they could base any claims. As there is now an increasing demand for evidence that EAP services are effective and result in positive outcomes (Greenwood, Deweese and Inscoe, 2008), there are a growing number of publications discussing economic data with regards to EAPs.
• Highley and Cooper (1994) provide a description of the McDonnell Douglas study, who commissioned a cost-benefit analysis involving a longitudinal analysis of costs related to healthcare claims before and after the implementation of an EAP. The research did not attempt to calculate measures that could not be objectively measured, and the study found that the overall saving for the EAP population (compared with a control group) was $5.1 million, and there was a return-on-investment of $4:1. However, Masi (1997) reported that this study compared employees who used the EAP for alcohol treatment with those who used their own mental health programme, and thus determined the alcohol treatment was most cost-effective.
• Maiden (1988) described a study undertaken by the US Department of Health and Human Services Employee Counselling Service, with an emphasis in the cost-benefit of the EAP service provided to all employees. The employees who had not used the EAP were viewed as the control group. The cost-benefit analysis showed that the programme should realise a returnon-investment of $7:1 (predicted after 6 months of use).
• McClellan (1989) conducted a cost-benefit analysis of the Ohio state EAP, finding that the implementation of the EAP did not reduce health insurance costs or employee sickness absence, and there was no return-on-investment (the EAP did not offset its cost to the state government). However those who used the service did value the therapeutic services received, and rated the EAP highly.
• Blaze-Temple and Howat (1997) found that the EAP provided significant cost-savings, especially in terms of reducing sickness absence and employee turnover. When a cost-benefit ratio was calculated for those who had received counselling compared to those without, the EAP had paid for itself (1:1 ratio). However, the study also reported that those who had attended self-arranged counselling outside of the EAP also increased in organisational productivity, and the cost-benefit ratio was more beneficial than the EAP counselling.
• Dainas and Marks (2000) found an overall 2:1 cost saving was reported in favour of an organisational EAP, as those employees (and family members) who had used an EAP had lower general medical costs and overall healthcare costs (although their mental health costs were still higher than those who had not used the EAP). Similarly, Klarreich, DiGiuseppe and DiMattia (1997) calculated a cost-benefit ratio of 2.74:1 for organisational EAPs, in a study using the cost of supervisor times and absenteeism as factors measured.
However, with the increased interest in understanding whether organisations generate a returnon-investment from their EAP, providers are concerned about pricing (Cekiso and Terblanche, 2015), as purchasers may be quoted differently for the same service. As a result, providers may submit lower prices. Therefore organisations may not only have to consider the price of EAPs, but also the quality of the service provided (Sharar and Hertenstein, 2006). Sharar and Hertenstein (2006) argue that the issue of the pricing of EAPs need to be addressed, and what the cost should be for a quality service, otherwise price may become how organisations choose their EAP provider rather than service provision, thus losing sight of the original mission of EAPs (Cekiso and Terblanche, 2015). Developing a method through which EAP providers can demonstrate return-on-investment, will both aid an organisation’s decision to use EAPs, and to reduce the probability that EAPs may be removed from organisations when they experience financial problems.
In summary, although EAPs have the potential to improve the health and wellbeing of organisational employees, employers are increasing their attention and focus on how EAPs can provide services which also demonstrate economic effectiveness and a return-on-investment (Jacobson and Jones, 2010). However, currently there is a limited number of research studies looking at the economic costs and benefits of EAPs, and many of the studies conducted, because of the methodologies used to undertake the research, have led to tentative conclusions (McLeod, 2008). The studies that have been undertaken, in general, suggest that EAPs do cover their costs in terms of economic savings for organisations, but it is clear that many questions regarding an EAP’s return-on-investment (and whether this changes over time) are yet to be answered. Research into return-on-investment has been slow, but is becoming of greater importance as providers are now competing in price and may be compromising quality as a result.
Methodological barriers to EAP evaluations From the research discussed above, it could be concluded that EAP evaluations have not, as yet, produced the quality of evidence that is required to enable an unqualified endorsement and support of EAP interventions in the management of health, wellbeing and stress of employees or other personal and organisational issues that can affect an employee and the organisation (Kirk and Brown, 2003). The process of defining and collecting outcome measures is still important for EAP quality improvement, and data for verifying the differences that EAPs can make is crucial (Jacobson et al., 2011), but a very difficult part of EAP evaluations. Csiernik (2011) reported that there is a greater need to conduct more in-depth evaluations, using both quantitative and qualitative methods, including longitudinal designs. However, the EAP literature has also discussed a number of methodological barriers to undertaking evaluations, which could hamper the development of EAP and a full understanding as to whether EAPs do result in improved employee outcomes and organisational value for money.
Confidentiality One of the aspects that can assure the success of an EAP is the confidentiality of the service, with employees being able to seek help, at times without their managers knowing, and with the safety of knowing what is said would not be fed back to the organisation. As a result, releasing any information could destroy the reputation of a programme, if employees perceive the evaluation negatively (Highley and Cooper, 1994). Kirk and Brown (2003) and Csiernik (1995), also mentioned confidentiality as a barrier to evaluations, as once again, engaging in research could compromise the this position, with Csiernik (1995) commenting that any probing evaluative questions was a situation that most client organisations and providers would like to avoid so that anonymity remains. This consequently means that there may be difficulties in accessing records and reports regarding EAP use, or complications with participant selection. McLeod (2008) highlighted that confidentiality also leads to difficulty in obtaining organisational data around factors such as workplace performance, sickness absence and disciplinary procedures, and precludes the opportunity in undertaking any longitudinal data regarding employees who may have accessed the service.