Employee Assistance Programs — Social Work's Influence
By Mike Laird, LCSW, CEAP
Social workers have a long history of advocating for employees in the workplace. While social workers in a variety of settings provide services to vulnerable and marginalized clients in the face of increasing political turmoil and budget restraints, occupational social workers in employee assistance programs (EAPs) continue to offer services to a broad intersection of vulnerable workers and their families.
Although occupational social work and EAPs share many common characteristics, they have distinctive origins. Occupational social work began with a much broader focus on the social challenges of working people, whereas EAPs began with a more narrow focus on the productivity of employees in the workplace.
In the early 20th century, occupational social workers, also known as industrial social workers, were dealing with "problems of illness, economic insufficiency, family breakdown, and the cultural assimilation of new immigrants" (Cunningham, 1994). The work of Bertha Capen Reynolds is a classic exemplar of occupational social work. In the 1940s, Reynolds (1963) was discovering the unique social challenges of maritime workers and their families and applied her social work experience in an attempt to alleviate these problems.
Tens of thousands of seamen were recruited in the 1940s for the war effort. Although employed, they were not eligible for USO benefits, nor were they provided the protections given to enlisted men and their families. Many of the men died while out to sea, or suffered from war-related injuries, which resulted in high rates of drinking and family stress.
Along with the National Maritime union, Reynolds and a team of social workers touted multiple successes, which included organizing members to create a credit union, and improving a Personal Service program that offered medical and other social support for union members and their families.
In contrast with occupational social work, EAPs emerged in the 1940s out of the recognition that alcohol use was hindering workplace productivity (Cunningham). Early staff did not necessarily consist of social workers, but as the profession matured and services expanded, social workers with an interest in occupational functioning and advocating for the working poor found themselves in EAPs.
The Association of Labor and Management Administrators and Consultants on Alcoholism was formed in 1971, and later became the Employee Assistance Professionals Association. Other associations include the Employee Assistance Trade Association and the Labor Assistance Professionals.
Current Trends in Employee Assistance
According to the Employee Assistance Trade Association (2015), about one in four adults in the United States and Canada have symptoms of a mental health disorder, a substance use disorder, or both; in addition, more than 75% of the people with these behavioral health disorders are employed. The monetary costs associated with these disorders have forced employers to seek the support of employee assistance programs. According to the American Psychiatric Association (2016), 97% of companies with more than 5,000 employees have an EAP; 80% of companies with 1,001 to 5000 employees have an EAP; and 75% of companies with 251 to 1,000 employees have one. Yet, no more than 5% of people with access to EAPs use them. More concerning, up to 40% of workers are unaware that they have access to an EAP, or even know what EAP services are. For those that do access EAP services, Chestnut Global Health Partners (2016) reports that the top five presenting concerns include stress, relationships, child behavior, anxiety, and depression.
EAPs target three segments of the workplace: Employees and eligible family/household members, organization leadership, and the organization as a whole (EAPA Standards and Professional Guidelines for Employee Assistance Programs, 2010). While consulting with organization leadership and the organization as a whole continue to be core EAP services, working with employees and eligible family/household members remains the primary service. These services include problem identification/assessment and referral, short-term problem resolution, and monitoring and follow-up services (2010).
Many problems go unnoticed until an employee's work begins to suffer. It is often at the workplace where addiction, mental health, family/relationship stress, and other stressors present themselves through behavioral changes or performance issues. Many employees are referred to their EAP after an observed change in behavior or a decline in performance.
Referrals can come from human resources, management, and union representatives; employees can self-refer as well. Once an employee has contacted the EAP intake department, an appointment is scheduled with employee assistance professional, who is often a social worker. During the first appointment, an assessment is conducted to determine the problem.
Short-Term Problem Resolution/Referral
Once an assessment is completed and a problem is identified, there are usually two modes of intervention. If a problem can be resolved in a limited number of sessions (the number of sessions available is determined by each respective EAP), then the client can be seen for short-term problem resolution counseling. However, if the assessment reveals that the problem cannot be resolved within the limited number of sessions, or can be better resolved with a higher level of care, the client is referred to an outside resource. Examples of short-term problem resolution counseling or referral include the following:
• "A supervisor has difficulty handling conflict among his work group. The EA professional meets with the supervisor for several sessions to provide management coaching.
• An employee who is having difficulty with child-rearing issues receives support and education during several sessions with an EA peer counselor.
• When the EA professional determines that referral is appropriate, he or she must provide motivational counseling and support to encourage the client's acceptance and follow through with referral recommendations.
• An employee describes a long history of participation in dysfunctional family systems. The EAP protocol suggests that short-term problem resolution will not be appropriate. The employee is referred to an outside clinician" (2010).
Monitoring and Follow-Up Services
Monitoring and follow-up services are crucial for successful client outcomes. EAPs generally have proprietary follow-up and monitoring policies tailored to meeting the needs of their respective client populations. The purpose of following up with a client after either short-term problem resolution or a referral to an outside source is to maximize well-being and ensure continuity of care. A follow-up service could be as simple as a brief outreach call to determine a client's current anxiety level, whereas monitoring services would include case management for a client that recently returned to work after being discharged from a treatment program.
In addition to counseling, EAPs offer a variety of other services. These services include critical incident responses, organizational training and consultation, support of a drug-free workplace, work/life initiatives, and integration into external community organizations.
The NASW Code of Ethics (2008) states, "The primary mission of the social work profession is to enhance human well-being and help meet the basic human needs of all people, with particular attention to the needs and empowerment of people who are vulnerable, oppressed, and living in poverty." For social workers interested in occupational functioning and the plight of the working poor, EAPs continue to offer services to a broad intersection of vulnerable workers and families.
— Mike Laird, LCSW, CEAP, is program coordinator for a union-based employee assistance programs serving public service employees in Illinois.
American Psychiatric Association. (2016). Employee assistance programs: an often overlooked resource. Retrieved from https://www.psychiatry.org/news-room/apa-blogs/apa-blog/2016/07/employee-assistance-programs-an-often-overlooked-resource.
Chestnut Global Partners. (2016). Trends report 2016. Retrieved from http://chestnutglobalpartners.org/Portals/cgp/Publications/Chestnut-Global-Partners-EAP-Trends-Report-2016.pdf.
Cunningham, G. (1994). Effective employee assistance programs: A guide for EAP counselors and managers. Thousand Oaks, CA: SAGE.
Employee Assistance Professional Association. (2010). EAPA standards and professional guidelines for employee assistance programs. Retrieved from http://www.eapassn.org/Portals/11/Docs/EAPAStandards10.pdf.
Employee Assistance Trade Association. (2015). EAP best practices: The value of employee assistance programs. Retrieved from https://www.easna.org/wp-content/uploads/2016/02/Value-of-EAP-2015.pdf.
National Association of Social Workers. (2008). NASW code of ethics. Washington, DC: NASW Press.
Reynolds, B.C. (1963). An uncharted journey. New York, NY: The Citadel Press.