The Review Of Employee Assistance Programs
1. Up-to-date definition
Employee Assistance Programs (EAPs) are employer-sponsored programs designed to assist organizations in identifying and eliminating a variety of workplace issues (Attridge, 2009). Their main concern lies in resolving employee’s personal and/or professional concerns including, marital, financial, alcohol, substance abuse, mental health, and other counterproductive work behaviours that may be affecting their performance (Employee Assistance Professionals Association, 2003). The goal of EAPs is to provide employees with the proper intervention, helping them develop appropriate coping strategies which in turn, will make them less likely to take time off work and increase their productivity. EAPs typically provide assessment, interventions, and referrals to external counselling, provided by a variety of psychological and substance abuse professionals (Attridge, 2009).
2. Introduction/ Background Info on EAPs/ Outcomes
Employee Assistance Programs were first implemented in the late 1930s, their primary focus being on treating alcoholism in the workplace which at the time, was a norm (Kurzman, 2013). During WWII, organizations experienced a labour shortage, and to combat it, they implemented EAPs to identify and rehabilitate alcoholic employees back into the workforce (Attridge et al., 2009). By the late 1970s, EAPs were strictly tailored to benefit alcoholics and were originally called Occupational Alcohol Programs (Kurzman, 2013). During this time, more professional mental health providers had become involved in the employee assistance field, staffing programs in corporate, governmental and union settings (Kurzman, 2013). The next transformation in EAPs began in 1988, when the drug-free workplace legislation passed and EAPs grew exponentially across North America, with a broader focus on all mental health issues that may be affecting employees (Attridge et al., 2009).
Hobfoll’s (1989) conservation of resources theory of stress (COR) provided some of the first background research suggesting that intervention, to restore employee's psychological resources, did, in fact, increase productivity, improving the organization's overall outcomes. He posited that individuals seek to maintain psychological and physical resources, and a threat to this balance increases stress levels as well as employee disengagement (Hobfoll, 1989). In the 1990’s, as EAPs broadened their scope to include services that dealt with issues such as depression, anxiety, stress, work/life balance, marital problems, trauma, and other personal and emotional problems that could affect employees’ job performance, programs became a standard employee-benefit in large organizations (Attridge et al., 2009).
According to Merrick et al., as of 2002, 90% of Fortune 500 firms offered EAP services. During their establishment, EAPs were considered ‘internal programs’, meaning the professionals who administered the sessions worked for the same company that they supported (Attridge et al., 2009). However, currently ‘external programs’ are more common and are described as being those in which a external company staff’s a team of EAP professionals and supplies contracted services to companies (Attridge et al., 2009). As such, ‘external programs’ have proven to be more cost-effective and are the program of choice for small to mid-sized organizations (Attridge et al., 2009). As stated by the World Health Organization, an estimated one-in-four adults have a diagnosable mental disorder, one-in-five adults have an alcohol use problem, and one-in-eight adults have a drug or other addiction problem, all the majority of whom are under-treated or not treated at all (WHO; Hyman et al., 2006). Employees experiencing mental or physical crises can have negative implications for the organization in which they are employed. Some of these implications include: absenteeism, presenteeism, on-the-job accidents, diminished work quality, disability claim, decreased group morale and turnover (Attridge et al., 2009). Surveys of senior Human Resource executives determined that mental health is now considered one of the most significant sources of indirect business costs, amounting to more loss in revenue than the value of health-care and insurance claims (Employee Benefit News, 2007). The estimated economic strain of mental health placed on organizations is estimated to be at over 150 billion dollars annually, in both direct and indirect costs (Finch & Phillip, 2005).
Employee Assistance Programs currently offer employees the opportunity to access professional aid when seeking to communicate and work through personal and/or work-related issues. Through appropriate intervention techniques, EAPs provide confidential assistance through prevention, identification, assessment, referral, and follow-up services so that troubled employees and their families can develop coping strategies and improve their resilience in difficult situations. (Butler, 2018). These programs benefit the employer as employees are less likely to need time off work for personal reasons and they can quickly reinstate or improve employee work productivity. EAPs are staffed by mental health professionals in fields ranging from psychology to social work, and even extending to those specialized in substance abuse (Avis, 2016). These professionals use a variety of treatments and strategies during sessions such as motivational interviewing, stress management, cognitive behavioural therapy, and mindfulness to identify and link employee’s person or health concerns to their behaviour at work (Avis, 2016).
Some EAP benefits that can have the most substantial consequence on an organization include less absenteeism, fewer accidents, decreased use of medical and insurance benefits, savings in workers' compensation claims, fewer grievances and arbitrations, and fewer turnover costs (Butler, 2018). EAPs hold the assumption that employees are a valuable part of any organization, thus they will get a better return-on-investment when rehabilitating employees as compared to the cost of firing and replacing them. EAP professionals work one-on-one with troubled employees to create end goals that will lead to improved outcomes, satisfying both the employee and the organization. According to Attridge (2013), while an average of four to six treatment sessions is covered by the organization, employees have been found to average only 2.5 sessions, which may suggest that short-term counselling is sufficient for assisting troubled employees.
Research by Hargrave & Hiatt (2004) sought to calculate the return on investment, which many consider to be an integral part of the attractiveness of EAPs. They found that employees suffering from depression had close to four times the amount of lost productive time (LOT) in comparison to typical employees (Hargrave & Hiatt, 2004). When assessing the effectiveness of EAPs, Hargrave and colleagues (2008) found that most participants reported improvements in coping and productivity, resulting in an estimated return on investment between $5.17 and $6.47 for every dollar spent. In addition, a company-wide analysis at PricewaterhouseCoopers in 2014 found improvements in absenteeism, presenteeism, compensation claims and productivity post-EAP implementation (Walker et al., 2018). While several studies show similar findings, the overwhelming majority of organizations that implemented EAPs found enhanced employee and organizational outcomes, especially when considering absenteeism, presenteeism, healthcare costs and disability, overall functioning, and productivity (Walker et al., 2018; Greenwood et al., 2005).
Similar to EAPs, Corporate Wellness Programs (CWP) have been shown to produce positive outcomes at the employees and organizational levels. Rather than focusing on the psychological well-being of employees, CWP's look to improve physical health (Hubler, Larkin, & Pierce, 2018). The implementation of EAP's and CWP’s have effectively decreased both absenteeism and presenteeism. From the research previously discussed, there seems to be a connection between EAP services and the reduction of absenteeism and increased work productivity. Hubler and colleagues (2018) show similar results with the implementation of CWP, considering them to be essential when addressing overall employee wellbeing.
Existing research provides evidence in favour of EAPs, suggesting that their implementing not only helps employees, but also benefits the organization. By addressing mild to moderate psychological or health stressors and connecting these crises to work performance, EAPs can assist employees not only to remain productive, but to lead healthier and happier lives (Attridge, 2013; Nunes et al., 2018). As of 2011, over 75% of public sector and 40% of private sector U.S. employers offer counselling services through EAPs (Mayfield, 2011). With a growing response to the costs of mental health and addiction problems in the workplace, it is expected that the number of EAPs offered by employers will continue to rise.
Section 3: Specific Lit. review:
A prominent industry problem faced by employers today is the managing of employee absence behaviour, also known as absenteeism. As stated by Čikeš et al. (2018), absenteeism can be defined as a temporary absence from work for reasons related to illness, death in the family, among other personal issues. Alternatively, it could be interpreted as an employee's intentional or habitual absence from work. (Čikeš et al., 2018). For the purposes of this report, absenteeism will be defined as time away from work due to incidental or health problems (Nunes et al., 2017). By addressing core issues that decrease work performance, and by implementing EAPs, organizations can significantly change their productivity and reduce absenteeism.
Depression, anxiety, substance abuse, chronic illness, stress and work-related issues may have substantial costs to employers in the form of employee absenteeism (McTernan, Dollard, & LaMontagne, 2013). It is estimated that the economic burden of mental health constitutes over 150 billion dollars annually in both direct and indirect costs in US and Canadian organizations (Spetch et al., 2011). When unplanned absences occur, employers are forced to incur both direct (worker replacement, overtime costs) and indirect (loss of productive time for co-workers and supervisor) costs (Nunes et al., 2017). Lost productivity time due to absenteeism costs US employers an estimated 226 billion dollars (Stewart et al.,). Hertz and Baker (2002), noted that each year 217 million workdays are entirely or partially lost among workers aged 18 through 54 years due to psychological disorders, resulting in a loss amounting to over 5 billion dollars.
Employee Assistance Programs (EAPs) are a essential mechanism in assisting employees to restore depleted psychological resources, by providing employees with coping strategies and mental health services that if ignored, will reduce productivity, likely resulting in absenteeism (Nunes et al., 2017). Absenteeism has substantial negative consequences on organizations, such as compensation and replacement costs, and loss in productivity (Čikeš et al., 2018). In order to address the negative outcomes associated with absenteeism, one-on-one counselling services are offered by EAPs. These programs, being confidential and easy to access, benefit both employees and employers alike. According to a 2009 US Bureau of Labor Statistics report, the average employee takes an average of four sick days a year, while an employee suffering from depression or substance abuse will take nearly five days of sick leave within a three-month period (Nunes et al., 2017). Given the considerable costs that absenteeism imposes on an organization, employers have increased interest in programs such as EAPs to address behavioural issues and job-related stressors that result in increased absenteeism (Nunes et al., 2017). High rates of absenteeism has been shown to lower process quality and output, lower an organization's overall efficiency, and is highly correlated with withdrawal behaviours such as turnover (Morrow et al., 1999). On a more interpersonal level, absenteeism has been known to lower morale, increase stress levels, diminish communication, and decrease the relationship between management and employees (Čikeš et al., 2018).
In the studies reviewed, two metrics were used to measure absenteeism. The first being time lost, expressing absenteeism as a sum of units of time (e.g., hours or days) (Čikeš et al., 2018). The second metric used is absence frequency, measuring the number of absences in a specific period of time, regardless of duration (Čikeš et al., 2018). In a study conducted by Nunes et al., (2017), the impact of EAPs on reducing employee absenteeism was assessed. The sample included 145 subjects, all of whom were matched with control subjects in demographic, psychosocial and work-related areas. When measuring sick leave absences, a steeper decline for EAP than non-EAP employees was found, with estimates of 4.8% to 6.5% fewer hours lost per month to illness. Upon further analysis, the researchers found that EAP services reduce employee absenteeism at a faster pace than non-EAP users experiencing similar productivity challenges (Nunes et al., 2017). In a follow-up study by Richmond, Wood, Pampel & Nunes (2017), 156 employees receiving EAPs were once again matched to 188 non-EAP employees. The results showed that from 2 to 12 months post-baseline, employees who received interventions demonstrated significant reductions in work hours missed. These results demonstrate that EAP services may help employees overcome personal and work-related concerns affecting their job performance (Richmond et al., 2017). Consistent with these findings, Spetch, Howland, and Lowman (2011) found in their 3-year longitudinal study that rates of absenteeism increased for those utilizing EAP services (most likely due to attending EAP sessions), but thereafter significantly decreased. This suggests that EAP’s have long-term benefits for reducing absenteeism, despite a temporary increase during an intervention (Spetch et al., 2011).
A systematic review conducted by Beulah, Walker and Fuller-Tyszkiewicz (2018), revealed that of eight studies analyzed, five found improved absenteeism rates post-EAP assessment. Specifically, Anema & Sligar's (2010) study found a decrease in absenteeism from 28.1% in the first year to 7.1% in the second year (Beulah et al., 2018). A study conducted by Hargrave et al. (2008), defined the reduction of absenteeism to be reflected in the number of workdays that would have been missed had EAPs not been implemented. They found this estimate to be 2.6 days per individual, a $5.17 to $6.47 return on investment for every dollar spent on EAPs, yielding an estimated annual employer cost savings of $2,543,984 (Hargrave et al., 2008).
With the cooperation of 20 different EAP service providers, research by Sharar and Lennox (2014) observed a sample of 3,187 employees in EAP treatment programs. The researchers found an average of 5.79 fewer hours of missed work due to personal problems just 30 days post EAP use, a 43.6% reduction in work absenteeism hours. Thus, EAPs may have significant acute effects on absenteeism. The existing body of research on EAPs supports the idea of a relationship between absenteeism and several organizational and job characteristics (Čikeš et al., 2018). For example, larger firms seem to have higher absenteeism rates, self-employed workers have fewer absences that those employed by others, public workers are more absent that public workers, workers on temporary contract are less absent than workers who have a permanent contract, along with a few others (Čikeš et al., 2018).
Currently, there is limited evidence on the significance of EAPs in the workplace. While many studies have found positive effects on absenteeism (Čikeš et al., 2018; Sharar & Lennox, 2014; Hargrave et al., 2008; Beulah et al., 2018; Nunes et al., 2017), many of these claims lack consistent empirical evidence. The primary dilemma researchers face when looking at the effects of EAPs on employee performance is that of comparing employees who receive EAP counselling to those who do not. As EAPs are made available to all employees in an organization, it is difficult for researchers to isolate those of whom qualify and receive counselling, and employees who do not (Attridge, 2005). Another substantial limitation to studies assessing the effectiveness of EAP programs is that many rely on self-report measures, which average only a 15.5% response rate (Richmond et al., 2017; Hargrave et al., 2008).
Another concern is the limitation of current research designs used in studying EAP programs. While experimental designs, namely, random assignment of employees to intervention or non-intervention groups, while ideal, would raise legal concern. Withholding EAP treatment from an employee in crisis is highly unethical in research on human subjects (Richmond et al., 2017).
Another limitation lies in the fact that many employees seeking EAP services are reluctant to participate in this research (Richmond et al., 2017). For example, research by Richmond et al. (2017), had only a 22% participation rate, excluding the participation of employees in significant distress during the first phase of the study. While it is unlikely that these factors can be eliminated, it is important they be noted, as they are a recurring issue throughout the research on EAP services in relation to absenteeism.
Overall, research finds that EAP use enhances both employee and organizational outcomes, specifically when assessing the impact of EAPs on absenteeism. The vast majority of research suggests that absenteeism has several negative implications for employees and employers; lowering productivity, satisfaction, overall organizational health, and increasing turnover and its’ associated costs (Čikeš et al., 2018). EAPs facilitate access to professionals available to help employees overcome personal and work-related issues to improve overall productivity and behaviour, benefiting both the employee, and the employer.
