Do Employee Assistance Program (EAP) Affiliate Providers Adhere to EAP Concepts? An Examination of Affiliate Fidelity to EAP Theory & Practice 

David A. ShararEAPA 2007 San DiegoOctober 27 Research Forumdsharar@chestnut.org

EAP affiliates

• Available "on demand" and paid fixed fee to see EAP clients on behalf of a vendor

• Most are based in private individual or group practices, or agency/hospital clinics

• Affiliates represent a mix of "helping" professionals

• EAP work likely represents a small portion of the affiliate's caseload

 

Statement of the problem

• EAP field has identified specific competencies unique to the delivery of "EAP"

• Most prevalent delivery system in EAP is the "Affiliate Network Model"

• Affiliates, as general mental health practitioners, may or may not deliver EAP as conceptualized

• Need to investigate whether affiliates believe they adhere to EAP concepts

Overall design & research questions

• Nation-wide (“one-time”) survey of EAP affiliates using random probability sample

• Goal is to provide a descriptive "portrait" of how affiliates apply EAP concepts in their practices

Two research questions:1.How are EAP concepts understood and

utilized among affiliates? 2.What are the commonalities & differences in

terms of how affiliates treat EAP versus other cases?

Comparison of EAP versus mental health benefits

EAP      Mental Health Benefits

Problems in living  Diagnosable disorders

Unrestricted access Usually some "gatekeeping"

Rapid resolution or referrals  Longer-term or specialized treatment

"Free" to

employees/dependents Co-payments/deductibles

Emphasis on follow-up Emphasis on case closure

Work performance model  Medical model 

Status of research on EAP affiliates

• Paucity of published scholarly research

• About 10 citations (mostly opinion, anecdotal observation, group consensus)

Status of research on EAP affiliates

These citations refer to 5 concerns

1.Overlapping EAP and MBHO networks

2.Duplicate purpose with mental health benefits

3.EAP affiliate shortcomings4.Lack of local workplace integration5.Affiliate dissatisfaction

Sampling frame & design

• No resource that covers the "universe" of EAP affiliates

• emindhealth (a provider of network services) appears to be a microcosm of the "universe"

• Random probability sample drawn from emindhealth list of affiliates (3,000)

• 222 completed questionnaires submitted (SE of 3.5)

Administration

• Self-administered over Internet as web-based survey ("Zoomerang" was hosting service)

• Listserv comprised of e-mail addresses of randomized affiliates ("respondents")

• Potential respondents received a pre-notification e-mail from emindhealth

• Pre-notification followed by an invitation with a link to the questionnaire, & up to 4 reminders

• Completed questionnaires submitted to secure server (under control of the investigator)  

Questionnaire Construction

• Core components of EAP used to provide conceptual basis (e.g. components "mapped" to questions)

• Uses mostly close-ended questions with scaled responses

• Two open-ended questions allows for some methodological mix

• Six subject matter experts (from Editorial Review Board of a Journal) reviewed the design and content

• Field pretest conducted with 15 actual respondents

Validity Threats

• Desirability: Respondents may want their answers to be perceived as "correct"

• Memory or unavailable info:  Recall of past events is subject to error

• No direct observation: Study measures "perceptions" that may not reflect actual behavior

Data Analysis Plan

• Data converted into Excel and dumped in SPSSx 14.0.2

• Descriptive statistics show characteristics of sample

• Chi-square used to compare "EAP" cases to "General" cases

• Findings presented with written narrative supported by tabular & graphic results

• Open-ended questions analyzed by content analysis/id of themes

42%

36%

18%

12% 11%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Per

cen

t of R

esp

on

den

ts

ProfessionalCounselor/MH

Counselor

Social Worker Marriage & FamilyTherapist

Psychologist Other

Licensed or certified disciplines (N = 222)

(81% masters level and 19% doctorate level)

General

practice

therapist or

counselor

76%

EAP

practitioner

9%

Specialty in

Marriage/Family

7%

Other specialty

8%

Professional identity

40%

27%

60%

73%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0-50% >50%

Approximate % Clients

General Practice Counseling Employee Assistance Program

% Assessing impact of client problem on job performance

14%11%

86%89%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0-50% >50%

Approximate % Clients

General Practice Counseling Employee Assistance Program

% Cases screened for substance abuse

57%

47%43%

53%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0-10% >10%

Approximate % Clients

General Practice Counseling Employee Assistance Program

% Referrals to outside practitioners

89% 89%

11% 11%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0-10% >10%

Approximate % Clients Referred

General Practice Counseling Employee Assistance Program

% Referrals to clinical programs

45%

53% 55%

47%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0-10% >10%

Approximate % Clients Referred

General Practice Counseling Employee Assistance Program

% Referrals to “non-clinical” community services

52% 53%48% 47%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0-10% >10%

Approximate % Clients Referred

General Practice Counseling Employee Assistance Program

% Referred to treatment that received follow-up

46%42%

12%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

<10% 11%-50% >50%

Approximate % of Clients Referred to Self

% Referrals beyond EAP to yourself

44%

17%

6%

25%

8%

38%

13%

29%

14%

6%

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%

Cognitive Behavioral

Eclectic/Integrative/generalist

Solution Focused

Some other Theory

No Particular Theory

General Practice Counseling Employee Assistance Program

% Primary theory or model

Chi-square (df=16)=387.68, p=.000

< 25% 27%

26% - 50% 32%

Greater than 50% 41%

Approximate % of EAP cases where assessed problem was improved or resolved within the EAP:

No way of assessing improvement with in the EAP 1%

Clinical impressions and judgment 57%

Review of the EAP action plan 29%

Formal outcome measurement tool 1%

Other 12%

How is improved/resolved determined for cases that only receive short-term EAP?

0% 22%

Less than 10% 45%

Between 11% and 25% 17%

> 26% 15%

Approximate percent of EAP cases that were formal management or supervisory referrals:

Not at all 37%

A little familiar 26%

Some knowledge 19%

Very familiar 18%

How familiar are you with EAP “core technology”?

Never 57%

Rarely (once/twice a year) 15%

Occasionally (3-5 times a year) 15%

Frequently (> 5 times a year) 13%

How often over past year did you provide a direct “ONSITE” service at an employer’s workplace:

Completely the same 28%

More or less the same 46%

Moderately different 25%

Very differently 2%

In terms of therapeutic approach and selection of interventions, are EAP clients generally treated the same as non-EAP clients:

Analysis of open-ended question(183 comments out of 222, or 82% response rate)

Representative themes include:  "Less sessions with EAP" "Little difference except EAP has fewer visits" "Only difference is some EAPs require

switching therapists for referrals" "EAP is mainly for 'here & now' issues, not

long-term" "EAP focus is on most pressing problem due to

short # visits" 

Describe how your approach to EAP is similar or different from your approach to general practice counseling?"