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Measures of utilisation Amaral (1999) reported that there can be issues associated with the validity of utilisation indices that are reported by organisations. In fact Csiernik (2003) undertook a survey of utilisation in 154 organisations, not just about the level of utilisation in organisations but how it was measured and calculated. The survey highlighted that organisations used 19 different formulae for collating EAP utilisation reports, thus on occasions researchers may not be measuring like for like. Utilisation measurements differed through what could be detailed as a recordable case: a referral, a new case, a face-to-face meeting, a telephone contact, a return visit or a situation where a treatment plan has been agreed. The difficulties in measuring utilisation is also an issue for providers, as they have the objective of remaining competitive, while trying to remain profitable, but this is difficult as Masi (2011) concludes because there have never been common measures or measuring tools to gauge and compare aspects of performance.
Missing data Jacobson et al., (2011) noted that EAP evaluations could be challenging for EAPs of any size, but the situation is not aided as a result of EAP databases not often designed for formal evaluation processes, and often contain missing data. McLeod (2008) highlighted that the more missing data there is, the more likely it is that study findings can be mis-interpreted, and Jacobson et al., (2011) also reported that a lack of complete data also meant that researchers have a limited opportunity to conduct more complex statistical analyses, and have a limited ability to make broader generalisations regarding the effectiveness of EAP services. In their research, Compton and McManus (2015) found that 24% of their respondents did not keep relevant and up to date records of EAP use, thus hindering any attempts of an evaluation.
Research design Berridge and Cooper (1994b) reported that built into any EAP there must be its objectives, a subjective data collection process, a regular and systematic evaluation and then a re-evaluation of the evaluation process. However, differences in research methodologies and research design when evaluating EAPs have led to difficulties in gauging their true effectiveness. Kirk and Brown (2003) discussed that many studies pertaining to calculate cost-benefit analyses of EAPs usually did not include valid control groups for comparisons, and also did not collect longitudinal data to provide any long-standing evidence of EAP effectiveness, with Colantonio (1989), adding that there were few studies using designs where subjects were randomised into treatment and control groups. Arthur (2000) also claimed that there is a lack of properly controlled and methodically sound studies, and as many claims for the benefits of EAP use come from studies from the USA about alcohol intake and work outcomes, he questioned the generalisability of the results to other organisational contexts. Csiernik (1995) cautioned that consideration needs to be made when drawing conclusions from research studies highlighting cost-benefit analyses of EAPs as a result of a lack of consistency in selecting criteria for evaluation and the inability to quantify some pertinent types of data.
Providers Highley and Cooper (1994) commented that in both the US and the UK, EAP providers have resisted attempts of any form of evaluation, usually claiming that EAP benefits cannot be easily quantified, and this could be strengthened as a result of provider fears that any cost-benefit calculations may not be favourable. If results are not favourable, then this reflects upon their programmes, and their businesses. McLeod (2008) also acknowledged that providers of EAP services are in commercial competition with each other, and are fearful that information about their programmes will be passed on, and so can create barriers to research evaluations, which has prevented the EAP field from developing as a profession (Jacobson et al., 2011).
In summary, although research has been undertaken in an attempt to establish how beneficial EAPs can be for organisations, a number of methodological challenges have been noted which could hamper their development. Issues such as problems with methodological rigour (control groups, RCTs, lack of longitudinal data) add to the complications of mixed definitions of concepts such as ‘utilisation’. However, data confidentiality from EAP purchasers and providers also add to the limited opportunities for effectively evaluating the services provided. In fact, Csiernik (2011) concludes that there is a great need to conduct more in-depth evaluations, using qualitative and quantitative designs, to approach the basic questions that still remain in the field.
Conclusion Recent research has indicated that employee health is good for business and improving workplace health could generate organisational savings as well as benefiting productivity.
EAPs, a relatively new form of workplace counselling (for both work and non-work issues), are increasingly being used in the UK, with the perception that they have an important role in operating at a high level of efficiency, quality and competitiveness. However, although there is some evidence to suggest workplace counselling can be effective for helping employees with psychological and emotional problems, current research does not yet provide clarity on what counselling approach is most effective, and what the critical number of sessions (or mode of sessions) was associated with reaching optimal effectiveness. Although the costs of EAPs have fallen, they are still not a core part of business, and so organisations have to consider whether EAP costs are covered by improvements in organisational outcomes. Current EAP research however has a paucity of evidence focussing on economic cost-benefits of EAPs, and many questions regarding whether EAPs provide a return-on-investment are yet to be answered. A review of the EAP literature has also indicated that there are many methodological challenges when undertaking EAP evaluations, indicating the need for further research in this area.
Study Objectives andMethods
The main objectives of the research included undertaking background, state of the market research into EAP provision and use for organisations in the UK, with an aim to understand the size, shape and trends within the UK EAP market. As the literature review highlighted there has been considerable data on the coverage and take-up of EAP and research on their organisational impact, however comprehensive research on their economic utility has remained relatively sparse. Therefore, a second objective for this research was to study and examine the present evidence of return-on-investments for EAPs, to allow for an independent and objective appraisal to be made of their pros and cons as well as an assessment of the economic returns that could be accrued from their use.
The methods that were used to meet these objectives included:
• Conducting an online survey of HR Managers/Professionals to determine the use, utility and value of EAPs (or the barriers to take-up among those who do not use them). The survey investigated the services provided by EAPs, why organisations invested in them (and in a particular provider), and the most common reasons for EAP use. The online survey also asked questions regarding EAP promotion within organisations, how and if the quality of EAP services are measured by an organisation, and whether any financial calculations of costeffectiveness or return-on-investment are undertaken.
• In-depth interviews with a number of stakeholders on user perspectives of EAPs, to collect their views on the current utilisation and value of EAPs, how/if they measure their EAP (both in terms of employee wellbeing and financial return-on-investments), and how they think that the use of EAPs and the services that EAPs provide can be improved.
• An online survey for EAP providers, to understand the number of clients EAPs providers offer services to, the products that EAPs offer (e.g. telephone services, face-to-face counselling etc.), utilisation rates, gross revenue, gross profit and organisational surplus, and the quality standards that their EAP staff have.
Results: HR Managers The survey for HR Managers/Professionals was answered by 78 respondents having been advertised through both UK EAPA and The Work Foundation websites and contacts, and through an article in HR Magazine. In-depth interviews were conducted with 10 HR Managers who were either involved in the procurement of the EAP for their organisation, or who were the EAP contract manager. All interviews were conducted over the telephone and thematically analysed. This chapter will report the results of both the online survey, and the in-depth qualitative interviews with HR Managers/EAP contract managers.
Organisational use of EAPs In total, 88% (69 organisations) of the respondents reported that their organisation used an EAP.
When asked why they decided to invest in an EAP, the most common response was that having an EAP was part of the organisation’s health and wellbeing plan (67%), followed by an EAP was implemented as a way to reduce organisational sickness absence (49%), closely followed by the response that an EAP was a method through which an organisation could provide staff with support for particular issues (48%). Investing in an EAP to improve organisational productivity was only reported by 33% of HR Managers.
Does your organisation use an EAP?
88% When answering a similar question in the qualitative interviews, the most common response provided by the HR Managers was that implementing an EAP was seen as ‘good employment practice’ as employees may have concerns, worries or questions that employers may not be able to answer (or that they do not want to disclose to their employers) and consequently an EAP is a service that is on-hand and able to provide support that employees require.
“It is also about us being a caring organisation, we do care about our staff in the organisation, we care about their wellbeing and we want to be able to support them with the issues that they may be facing in their day to day lives.” (Participant 4) “As a good employer it is important to provide such a service.” (Participant 5) As with the quantitative survey, many of the interviewees highlighted that an EAP was part of a wellbeing strategy that organisations were implementing in their organisation, as wellbeing at work was a stream that was being viewed as a having increasing importance. However, it is important to note that EAPs were often one component of the organisation’s health and wellbeing strategies, being implemented alongside other schemes such as the Virgin Pulse Global Challenge1, healthy eating initiatives, resilience training, and equality, diversity and inclusion practices, and as a result, when later discussing EAP outcomes, difficulties were voiced in highlighting the role of EAPs for overall employee wellbeing changes or improvements.
“We are playing a part in advocating employee wellbeing and acknowledging that we think that is important…I couldn’t think about why we wouldn’t have it. It is very much part of our health and wellbeing package that we have for stuff.” (Participant 8) “We are putting staff health and wellbeing at the forefront of everything that we do, and the EAP is an example of that.” (Participant 10) Another organisational service that was often discussed to help organisations improve wellbeing was Occupational Health (OH). In both the online survey and the interviews, there was a mixed reaction about the relationship between OH services and EAP in organisations. For some there was a good relationship, where both EAP and OH services would refer clients to the respective sources of help, if they believed the other service would be beneficial. In some organisations, (1) Formerly the Global Corporate Challenge (https://globalchallenge.virginpulse.com/) all the different services that have been implemented to promote wellbeing meet to discuss how their profile could be improved – showing a proactive approach to service delivery. Managers were often key to highlight that EAPs offer something more distinct than OH, which is why they could justify having both. EAPs provided the confidential help for both work and nonwork issues, and the service was instant, whereas OH was often cited as a managerial referral service to help those who had been on long-term sickness absence to discuss issues in relation to returning to work, workplace adjustments and fitness for work tests. However, for others, there was very little or no link between the OH and the EAP services, especially if there was competition for the services. For example, one survey respondent mentioned that the OH wanted to try and introduce counselling to improve their income. Some managers discussed wanting to develop improved communication between the services to find something more cost-effective.
The role that EAPs could play in sickness absence prevention or reduction was also discussed by a majority of interviewees. Managers explained that they had concerns about the level of sickness absence rates at their organisations, and referred to evidence from literature or other examples of good practice they had become aware of, where EAPs had been implemented to help reduce long-term sickness absence. This was described very clearly by one participant
“At the time we had a lot of sickness absence, and the sickness absence rates were very high, in-particular around stress, mental health, anxiety and depression…and therefore the business case (for implementing the EAP) was to try and reduce sickness absence, and this was one of the methods to really try to assist with that.” (Participant 7).
Other reasons for the why organisations invested in and implemented EAPs that were mentioned in the qualitative interviews included: as a result of the level of structural changes occurring in the organisation, implementing an EAP provided employees with an external service through which any concerns that could have an impact on their health and wellbeing could be discussed, and help could be offered; two organisation discussed that previous interventions similar to EAPs (such as in-house counselling services, or referrals to NHS programmes) were not very successful and often resulted in long waiting lists, and consequently the EAP with the instant access to a counsellor was considered to be more preferable.