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Summary: Leading experts explain how to establish and run an effective Employee Assistance Program.
Employee Assistance Programs (EAPs) offer counseling and services for a variety of personal problems that affect workers and the workplace.
This Handbook provides clinicians, administrators, and human resource professionals with a comprehensive review of EAP "best practices." Experts from the employee assistance field, behavioral health organizations, and ...show more corporate sectors illustrate the unique role EAPs play in maintaining a vibrant and productive workforce and explain the skills and resources needed to provide effective EAP services.
This reference features innovative and groundbreaking program and service initiatives, which incorporate expanded areas of EAP practice while retaining the core mission and technology. The best intervention, treatment, and prevention programs for all issues affecting employee productivity are fully described, including:
The book also covers services currently in place in such diverse settings as Champion International, Du Pont, Bank One, Wells Fargo Bank, the University of Michigan, Mobil, and L.L. Bean. In addition, it discusses two current issues that will affect EAP practice in the future: accreditation of professionals and programs and the academic and field training of EAP professionals.
The Employee Assistance Handbook is invaluable reading for any professional who wants to promote health and productivity by creating effective EAP services for his or her organization. ...show less
Oher, James M. :
James M. Oher, CSW, CEAP, is a nationally certified psychotherapist and employee assistance professional, and is president of a leading international human resources consulting firm. He has established and reviewed EAP and other services for a variety of organizations, including Pfizer, IBM, Sony Music International, College Board, New York Stock Exchange, JC Penney, Texaco, Veterans Administration, and Hilton International.
CHAPTER 1 : Clinical Practices and Procedures
The clinical practice and procedures an EAP clinician follows can help determine the type of intervention necessary for successful resolution of workplace or personal problems for both the individual client being treated and the employer. Both customers make up the dual-client relationships inherent in the EAP practice. In this chapter, clinical practice guidelines that incorporate procedures to ensure dual client satisfaction are discussed. The issues reflect EAP practice guidelines as developed by Magellan Behavioral Health Services. Magellan has a large EAP service center based in St. Louis, Missouri, as well as service centers in other areas of the USA and Canada, and a continuum of staff offices located throughout the United States. The St. Louis Service Center holds contracts with approximately 600 organizations to provide employee assistance services to over 3 1/2 million people.
The factors that make EAP services an integral part of any workplace setting are important to examine. Most companies are very interested in providing easy access to their EAP program both for employees wanting clinical services and for supervisors wanting to consult about the problems inherent in managing a workforce. Good EAP practice ensures easy access for both of these service requests. An internal EAP program is often located on company premises or at an off-site location nearby. An external vendor is usually off-site. Location of the program is important as easy access is necessary; how-ever, clients must feel that the setting maintains their confidentiality. An internal program or external EAP company can operate a 24-hour-a-day toll-free service line staffed by service representatives or clinicians to meet the needs of customer requests. Most internal EAP programs have contracted the 24-hours-a-day service delivery through answering services or larger external vendors. This allows clients calling to investigate EAP services or supervisors calling to request services for an employee with work-related problems flexibility in seeking assistance at any hour of the day or evening. Magellan has implemented a 24-hour call center to ensure this flexibility and access to the customers served. EAP internal program staff and external program consultants work closely with human resources personnel to ensure that information about access and flexibility is communicated to the employee and dependent population. In an external EAP model, which is the type of programming contracted for by the client companies of Magellan, customers who contact the company's EAP toll-free line are connected directly to an intake service representative, an administrative support assistant, or an intake clinician. Magellan's EAP product line allows a client company flexibility to choose a mode of access to the program that the client company desires to purchase for the employee population and dependents. Access to an external or internal program, however, must be simple, direct, and confidential, or EAP services will not be used.
At the St. Louis Service Center, Magellan uses highly trained intake representatives and clinicians who function as the initial contact for EAP services. Intake service representatives who are not clinicians receive initial and ongoing training in listening and empathy skills, call management, and client risk assessment. Intake service representatives also receive ongoing training in identifying and managing callers in crisis, as they may encounter callers who are potentially homicidal or suicidal. A set of questions designed to screen for risk is standard procedure for every call. After the intake representative has gathered the initial demographic information, explored the presenting problem, and completed a risk assessment, the clinical process begins.
Clinical EAP services can be provided to clients by utilizing resources through a comprehensive system. An EAP clinical delivery system might include a company's on-site counselors strategically located to serve a large population. Many EAP companies also have staff offices; employees can leave the work site and travel to an off-site location to see a counselor. Counselors are available to provide clinical diagnostic assessment, short-term counseling, and comprehensive follow-up services to clients. Many EAP companies have chosen to provide services over the phone without direct face-to-face client consultation. These programs have limitations in that a clinical assessment includes a client's appearance and body language, as well as eye contact, affect, and mood. These are hard to determine over the phone. Most EAP practitioners would agree that a comprehensive diagnostic assessment is always best performed in person. Magellan's large external EAP staff office and affiliate network continuum of care system allow clients throughout the country to be referred to EAP offices within a designated radius of their homes or offices. Where staff offices are not convenient, for the client customer calling in, the network of EAP affiliates is used to provide face-to-face service delivery for clients with in-person service.
THE DIAGNOSTIC ASSESSMENT PROCESS
When a client steps into a counselor's office for the first appointment, a series of events occurs that is the basis for developing an action plan designed to assist the client resolve the issue or concern that brought him or her into the EAP program. A first step in initial interviews is to assist clients to thoroughly understand their rights and responsibilities as EAP clients. This process is essential for both internally and externally based EAPs and should be standard practice to ensure that all clients using the program understand its capabilities. This process incorporates a Statement of Understanding form to educate clients of the terms under which EAP services are provided. Terms in the Statement of Understanding can include quantity of sessions, designated follow-up procedures, and confidentiality limitations. Counselors provide each client with a written and oral description of the terms under which services are provided, consistent with the particular client organization's policies and procedures. The Statement of Understanding, signed by the client, is filed in each client's case record. EAP firms adopt different versions of the Statement of Understanding for different client organizations and their employees because of the variances in corporate expectations. For example, one client company designates that if a client exhibits at-risk behavior for potential violence, the client company will be notified. This notification may be made to the referring supervisor or to the Human Resources department and may result in a fitness-for-duty examination for the employee who is a potential risk. Many companies have now established risk or threat assessment teams, and EAP clinicians are often a part of that team. Another client company may designate that a substance abuse situation be reported if an employee is in a safety-sensitive position. A report of this nature might be made to a medical review officer or a supervisor in charge of performance at the work site. When participation in the EAP is made a condition of keeping the employee's job, usually following a positive drug test, a mandatory Statement of Understanding allowing communication with the work site is used.
An EAP counselor or an affiliate acting on a company's behalf reviews the Statement of Understanding form orally at the beginning of the client's first session, giving examples of situations such as child abuse and threats to harm others that might require disclosing confidential information. The counselor also explores whether the client is involved in a lawsuit and, if so, advises the client that the case file could be subpoenaed. Although it is unlikely that these events will happen, it is important that the EAP counselor cover all aspects involving legal interaction. The EAP counselor also orally in-forms the client about service payment, including that the client is responsible for the fees of third-party providers that may be incurred following a referral. The counselor ensures that the Statement of Understanding and the EAP process is understood by the client and both then sign the form. If a client refuses to sign the initial Statement of Understanding, the counselor documents that the client reviewed the form with the counselor but refused to sign it. The counselor will then terminate the session. It is important for the client to understand the terms under which EAP services are provided and to agree to them at the onset of the process. The refusal to sign a Statement of Understanding is an indicator of the client's refusal to abide by the EAP procedures a company has arranged. This situation may occur when an employee is formally referred to an EAP program and does not believe it will provide real assistance for problems or the employee is experiencing anger and mistrust over the formal referral. This situation is particular to the EAP field and the dual-client relationship and is always present as a dynamic in EAP work. A clear understanding of program parameters sets the stage for the diagnostic assessment:
Assessment is an ongoing activity that dominates the treatment process. Each interaction with a client requires assimilating information, weighing it, responding to the meaning, and again assimilating information about the client's response. It is one of the most important clinical functions. Although data collection is a significant part of the assessment process, it is not synonymous with it. Data collection serves as the foundation, but the evaluation of the data is the linchpin. Reporting data without evaluating represents only partial completion of the assessment process. (Joint Commission on Accreditation of Healthcare Organizations, 1997, p. 23)
Assessment is one of the EAP's most important clinical functions. The assessment process can last up to several hours over the course of several sessions. The goal of this initial assessment is to identify the problem areas that the client and clinician believe are the cause of the client's emotional discomfort.
It is the experience of most clinicians, and informed practice demonstrates, that a client's presenting issue is typically only part of the underlying problem. The assessment stage is viewed as an opportunity to:
During the assessment process, the following areas are discussed:
In addition, as noted in the Practical Guide to Clinical Documentation of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO; 1997), completing a cultural and spiritual assessment with the client is useful as well. If the employee is formally referred, the goal is to gather key psychological information and, together with the client, develop a treatment plan tailored to the client's needs that will assist the employee to resolve personal and work-related issues. It is an additional goal in clinical assessment to screen for any underlying problems and not focus only on the client's presenting problem.
To assist in screening, standardized assessment tools may be used including:
An aspect of the diagnostic assessment process including the questions developed at the former Merit Behavioral Care Corporation, now Magellan, and used in the initial assessment phase is the WHY NOW? The WHY NOW? is a critical, clinically sophisticated process essential to determining the most effective way to deliver care to the client. The WHY NOW? was developed for use to assist clinicians to understand the cause of a client's request for assistance. By asking this question, the counselor is trying to determine why the client is seeking services. The WHY NOW? process consists of delineating the precipitating event, the proximal event, and the internal failure or inability to adapt to the proximal event. Each aspect of the process will be discussed. The precipitating events include birthdays, marriage, interpersonal conflict, death or significant loss, job change, change in health status, and so on. It is from this first event that a series of worsening events or stresses may follow. The proximal event is the event that prompts the client to access treatment. Like the proverbial ''last straw,'' this event triggers an inability to otherwise cope or adapt to the increasing stresses. For example, a client who has recently experienced the loss of a loved one may be expected to experience some level of abandonment. As additional stresses are experienced in this time of loss, the last straw may be the one that sends the client into a state of being overwhelmed with a fear of losing everything. Other examples of precipitating and proximal events follow:
The WHY NOW? process is essential to determine the most effective way to deliver care to the client because it analyzes specific strengths and weaknesses of the client at the moment the client decides to enter care. Questions clinicians can use in the WHY NOW? process include:
The clinical assessment should reflect the clinical case formulation, including the WHY NOW? Good care formulation creates treatment plans that are individualized and that optimize clinical outcomes.
The WHY NOW? process can give an EAP clinician insight into the client's problem area and the client's current ability to cope with the identified problem. Merit Behavioral Care's Utilization Management Guidelines for 1997-1998 state:
Not only does the ''WHY NOW?'' contain the patient's unique distress and motive for seeking help, it also contains the patient's expectations and attitudes toward changing. For these reasons, attempts to probe and understand the precise timing of the patient's decision to seek help have important implications for structuring treatment fostering alliance, developing a focus, and using time and resources efficiently. In constructing the roadmap of treatment (the treatment plan) the WHY NOW? is the point of departure for the therapeutic journey to be taken.
Using WHY NOW? for Supervisory Consultations
The WHY NOW? process is also effective to use with supervisors calling in to EAP service for a management consultation on a specific employee who may or may not be in treatment. The WHY NOW? questions that a clinician poses to a supervisor can help the clinician and supervisor further clarify the job performance issues or conduct-related issues that are the basis of the supervisory concern. A counselor can utilize the same questions with a supervisor to determine the precipitating event regarding job performance. Some questions that can be used with supervisors include:
Utilizing the entire WHY NOW? process with supervisors, managers, and union officials can enhance the understanding of the nature of the referral and assist the clinician to better determine appropriate steps for providing service to the referring party.
Release of Information
Another very important step in the process of the initial assessment is the explanation of the necessity for the release of information to be signed when a referral is made by a manager, supervisor, or union official. There is an implied warranty of confidentiality in every case that is opened by an EAP counselor. If the policies of the EAP require or permit disclosures other than by the consent of the client, except as the law requires, it becomes mandatory that the conditions of disclosure be made known to the client. Written confidentiality terms are highly recommended and consent is always required for disclosure of client information except as provided by law. A written consent form should include the following five items:
1. The person or agency to which the information will be disclosed.
2. The address of the person or agency.
3. The purpose for the disclosure of the information.
4. The date signed.
5. The length of time the consent to disclose is valid and a secondary disclosure clause that is a prohibition against redisclosure without client consent.
It is highly recommended that an EAP counselor take time during the initial assessment phase to thoroughly explain this process of confidentiality and to also explain the benefits of signing a release of information to the referring party to allow certain types of information to be shared. The type of information generally shared with a referring entity is attendance and compliance with the EAP process. Under some conditions, it is also recommended that the nature of the treatment and compliance with the treatment plan be made accessible to the referring entity. An EAP client should also be aware that a consent is revocable anytime at the client's will.
A client should also be made aware of the conditions under which confidentiality can be broken. As noted, EAP counselors may be required to disclose information without consent in the following two circumstances:
1. If a client poses a threat of harm to others or to him-or herself, an EAP counselor may need to breach confidentiality to get the client to a safe place or to keep others from harm.
2. Instances of child abuse require mandatory reporting in all states, as does abuse of elderly or handicapped individuals in many states.
At times, exceptions to confidentiality are presented to the client as part of the Statement of Understanding or as the basis on which the EAP and client will work together. An example of this exception is the disclosure often mandated under the United States Department of Transportation (DOT) regulations where various persons, including the supervisor and medical review officer can be informed of a client's test results. A thorough understanding of the confidentiality process is essential to the initial assessment phase of treatment. There is often a great deal of confusion in the EAP world regarding what information can be shared between an EAP professional and the employer. As previously stated, the dual-client relationship exists whether the program is externally or internally based. Generally, the supervisor making the referral or the employer can disclose any information about a referred employee to the EAP; however, the EAP can only provide information about a referred employer or supervisor in accordance with the policies and procedures of the program, the conditions of the Statement of Understanding, and the client's signed consent form. As a guide for good EAP practice, an EAP clinician can allow a supervisor to discuss concerns about or complaints against an employee; however, an EAP clinician should not confirm knowledge of an employee's attendance in EAP without the signed release of information or as a result of the aforementioned mandatory disclosure exceptions mentioned. At all times, the EAP should work in a consulting capacity with a referring supervisor or union official to assist with concerns regarding employees.
Following completion of a thorough diagnostic assessment is the formation of an action plan or plan of treatment to best address the client's needs. A treatment plan is a blueprint, a design, a projected strategy. It is not an edict, an order, or a mandate. A treatment plan in EAP practice can take several forms, however, the two most common ways to address the need identified in the diagnostic assessment process are (a) to continue to see the client for short-term problem resolution or (b) to refer the client for long-term assistance. This is a critical point in any EAP case because a clinician must gauge the severity of the presenting problem and decide where the client can get the best care for problem resolution. An EAP clinician must decide whether the client can be treated successfully using short-term problem-solving methodology, often within the EAP, or would be better served through a referral to a longer-term level of care covered by the client's insurance program or paid for by the client out of pocket. This decision point is often a difficult one for the EAP clinician and several questions must be asked. First, an EAP clinician must assess his or her ability to assist the client with short-term counseling care. A clinician who is unable to assist the client using short-term techniques must refer the client to the most appropriate resource. When a referral is made, a standard follow-up program must be instituted. In cases where short-term counseling is the agreed-on treatment, both the client and the therapist will decide on the desired outcome. Short-term counseling can be effective in many situations where employees have chosen to contact their EAP. At Magellan, St. Louis Service Center, approximately 70% of EAP client concerns can be resolved in a short-term counseling mode that includes up to eight sessions.
To be effective in an EAP setting, short-term counseling must be focused and must contain direct objectives for the EAP sessions. Problem areas must be identified and prioritized and objectives must be established for resolution of the concern. This is often accomplished by giving employees reading assignments or other ''homework'' to complete between sessions and by identifying the expectations and outcomes of every session. Short-term counseling can be effective in areas of job stress and job-related issues as well as myriad personal problems about which employees contact their EAP. When appropriate for problem resolution, short-term counseling can also result in cost savings both for the client company and the employee who may be involved in an insurance copay plan.
When short-term counseling is not sufficient to resolve the issues identified in the assessment, it becomes necessary to refer an employee to long-term care. Generally, these are cases where substance abuse or a more serious emotional concern or illness is present. It then becomes essential that the EAP clinician evaluate the employee's situation and refer the employee to the appropriate level of care. This referral process also includes a thorough discussion of the employee's benefit plans and an exploration of coverage that is available to the employee. Often it becomes necessary for an EAP clinician to become an advocate to appropriate levels of care (a process that often includes communication with a primary care physician).
An important aspect of EAP care is follow-up services to the employee who is referred for longer term treatment. Follow-up is also necessary for employees who remain in short-term counseling within the EAP. Follow-up takes many forms depending on the type of initial referral; however, at a minimum, an employee utilizing EAP services should receive follow-up by phone or in person at least monthly during the course of treatment to ensure that the program is effective and the employee is improving. Monthly follow-up with an employee is necessary if an employee is self-referred; however, for mandatory referrals, a more comprehensive follow-up becomes necessary. Supervisors who have referred an employee to an EAP have a need to know whether the employee has followed the supervisor's recommendation, as the supervisor must make decisions based on the work performance and conduct of the employee. In mandatory referrals where an employee's job may be in jeopardy, a supervisor should receive follow-up on a weekly basis for a specified time period, often a month, to ensure the supervisor that the employee is complying or to inform the supervisor the employee is not complying with the referral to the EAP program. This compliance follow-up can only be completed with a signed release of information from the employee allowing the EAP counselor to continue contact with the supervisor. Many employees will sign such a release to involve their supervisor and to show good faith that they are trying to rectify the work-related problem for which they were referred. A release to allow supervisory follow-up is usually limited to compliance with treatment recommendations and will generally not have information about the nature of the problem area. Supervisory follow-up with an appropriate release usually continues until the case is closed and the job-related issue is resolved. A specific and mandatory follow-up procedure is required for employees in organizations that are regulated by the Department of Transportation (DOT). It is essential for an EAP clinician to provide close monitoring and follow-up services to the employer and the employee in these cases.
Follow-up is an integral part of the therapy process and supports the gains made during therapy. Follow-up can be used to maintain a therapeutic relationship until the client feels strong enough to take the next treatment step. Follow-up can also ensure that the client does not need further treatment. Follow-up is done for the following four reasons:
1. It is the clinically appropriate procedure to follow to ensure that gains made during short-term counseling are sustained.
2. It is a core technology to EAP service and is an integral part of ensuring job performance gains at the work site.
3. It is a method of communication from the EAP to the work site allowing the work site to make decisions about the employee's status at work.
4. It is clinically appropriate to ascertain whether an employee who has received a referral to longer-term care has been able to access that treatment resource.
Standards for follow-up include prearranging contact in the last in-person session including selecting convenient times for contacting the client. The EAP clinician should confirm whether or not it is acceptable to contact the client at home or at work and whether or not the client can be contacted by mail.
An EAP clinician should make three attempts at follow-up. If the client does not return those calls, the clinician should send a brief letter (if the client has given permission to contact by mail) wishing the client well and offering the services of the EAP if the need should arise again for services. The case can then be closed. In cases of chemical dependency, follow-up is important to the recovery of the individual. There also needs to be close contact with referring supervisors and treatment facilities. Most cases are open a year for follow-up before being closed.
Case closure is an important juncture in EAP because after a case is closed, no further contact can be made with the client. It is very important from the standpoint of legal liability to close a case because an EAP clinician can remain liable for a client's well-being as long as the case remains active and open. At the point of case closure, these areas should be evaluated:
If the client decides to use EAP services again for a similar problem or if the same problem recurs, the information in the case closing can be very helpful to the clinician handling the reopened case. Case closure can be a time for evaluation and for measuring outcomes. EAP companies purchasing services expect a positive outcome at the work site for the money they spend to fund these services. The EAP must strive to show the positive impact at the work site and demonstrate a positive impact on absenteeism, safety, and productivity.
THE FUTURE OF EAP CLINICAL PRACTICE
In future years EAP will probably expand into areas that were more traditionally human-resource based. EAPs will need to show a positive impact with regard to disability, work-life concerns, threat management, and the issues facing productivity at the work site. The EAP field seems to be in a position to grow and expand as companies downsize and continue to emphasize increased productivity for the remaining workforce. Companies are also interested in additional services that will assist their employees to be more productive, such as benefits addressing dependent care issues and the provision of emotional support throughout the disability process. An EAP program, whether internal or external, will need to continue to be flexible to meet the needs of companies as an increase in employee productivity continues to be at the core of business today. According to the January 1998, issue of Open Minds, an expanded human resource consultation model is emerging in the EAP field with more services to managers. Some of these services include stress management related to organizational change, disability management, drug-free workplace compliance, critical incident debriefing, crisis management services, and dependent care. Workplace consultation for managers and full spectrum support services for employees will be the product of the next decade. An EAP program that continues to be flexible and to meet the needs of the dual customer base will grow and expand in importance in the organization it serves.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
Joint Commission on Accreditation of Healthcare Organizations. (1997). A practical guide to clinical documentation in behavioral health care (pp. 23-30). Oakbrook Terrace, IL.
J. Clary, & Oss, M. E. (1998, January). EAPS are evolving to meet changing employer needs. Open Minds.
Utilization Management Task Force, Merit Behavioral Care. (1997). 1997-1998 utilization management guidelines (pp. 13-14). St. Louis, MO.
DEVELOPING AND MANAGING EMPLOYEE ASSISTANCE SERVICES.
Clinical Practices and Procedures (A. Darick).
EAP Accreditation and Credentialing (J. Drotos).
Employee Assistance Programs in Higher Education (L. Stoer-Scaggs).
Occupational Psychiatry and the Employee Assistance Program (J. Kahn).
Benchmarks and Performance Measures for Employee Assistance Programs (T. Amaral).
Developing Clinical Tools for the Workplace: ORBIT (D. Oberg).
EAPs and the Future of Work (T. Elliott).
EAP PROGRAMS AND SERVICES.
The Evolving Role of EAPs in Managed Behavioral Healthcare: A Case Study of DuPont (P. Heck).
EAP and Wellness Collaboration (W. Derr & G. Lindsay).
Workplace Safety, Drug Testing, and the Role of the EAP Professional (K. Collins).
The EAP and the Work-Family Connection (B. Davidson & P. Herlihy).
From Management Consultation to Management Development (J. Zimmerman & J. Oher).
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