March/April 2008

Working It Out — Social Workers in Employee Assistance
By Jodi M. Jacobson, PhD, LCSW-C, CEAP and Janet Hosford-Lamb, MSW, LCSW-C
Social Work Today
Vol. 8 No. 2 P. 18

Employee assistance programs are a perfect fit for social workers to support vulnerable employees in today’s sometimes unstable workplace.

As the only social worker responsible for a workforce of nearly 7,000 employees, Dave was undeniably busy. Using his social work background and training to help meet the needs of two clients—the employee and the employer—always made for an interesting day.

When talking with other social workers, Dave would often be asked, “How can you be a social worker and work for a company?” For Dave, the answer was simple: Social problems affecting employees, their families, and the surrounding community would probably have gone unnoticed had his company not employed a social worker.

Who else but Dave would consult with managers and supervisors to support workforce resiliency following a fatal workplace accident? Who would help alleviate the fears of an employee addicted to prescription drugs and concerned about speaking to his supervisor regarding time off to attend a 28-day treatment program? Who would patiently sit and talk with a single working mother of three young children, helping her to identify more affordable childcare options that could allow her to work the extra hours she needs to support her family? Who else if not a social worker employed in the world of work? Situations like these highlight only a fraction of the work issues that Dave and other social workers employed as employee assistance program (EAP) professionals contend with every day.

The social work profession has traditionally focused its services on vulnerable populations who are often disenfranchised. However, employed persons are also at risk and can be just as vulnerable considering the instability of today’s turbulent workplace. Social workers are trained to practice using an ecological perspective and systems theory that stress the importance of viewing the person in environment, or PIE (Karls & Wanderi, 1994). Using the PIE approach, it is a natural extension for social workers to offer supportive interventions where people often spend the majority of their time—the workplace. This approach to social work practice guides the EAP professional in working successfully with an employee to assess environmental life stressors that may be contributing to problems impacting the work/life balance.

Defining EAP
An EAP is the “work organization’s resource that utilizes specific core technologies to enhance employee and workplace effectiveness through prevention, identification, and resolution of personal and productivity issues. An EAP is a worksite-based program designed to assist organizations in addressing productivity issues and employee clients in identifying and resolving personal concerns, including health, marital, family, financial, alcohol, drug, legal, emotional, stress, or other personal issues that may affect job performance” (Employee Assistance Professionals Association [EAPA], 2003). EAPs are a field of practice comprised of multidisciplinary professionals including social workers, psychologists, professional counselors, substance abuse counselors, and nurses.

Social workers can provide the majority of EAP services within the United States (Jacobson, 2006). Social work has been referred to as the discipline of choice for EAP professionals due to their ability to see the whole picture and intervene at the micro, mezzo, and macro levels (Maiden, 2001).

Working for a for-profit company as a social worker is not without its challenges, as Dave’s experiences suggest. EAP professionals must remember that they are working for multiple clients—the employee, the employer, and sometimes the larger society when problems involve threats to public safety. EAPs provide myriad services aimed at preventing personal problems from becoming personnel problems.

EAP History
EAPs were originally established in the 1940s to address alcohol abuse and its impact on the workplace. These early EAPs, or occupational alcohol programs (OAPs) as they were then called, demonstrated moderate success in helping companies identify troubled employees and supporting them through the process of recovery and returning to work. E. I. DuPont de Nemours Company and Kodak Park of Eastman Kodak Company were two of the first major corporations to implement OAPs. The federal government further promoted OAPs through legislation such as the Hughes Act of 1970, which required all federal agencies and military installations to have an OAP. In 1972, this act was amended to include drug abuse.

While legislation resulted in an increased number of programs, OAPs quickly realized their services had to address more than alcohol and drug abuse, as addicted employees usually presented with multiple problems such as legal and financial difficulties, mental illness, family and workplace relationship issues, and other interpersonal and social challenges. The expansion of services shifted OAPs to the broader-based programs we refer to today as EAPs.

During the late 1980s and the 1990s, EAPs flourished in the United States and were established as a profession by forming two professional organizations, the Employee Assistance Society of North America (EASNA) and the EAPA.

With the adoption of drug-free workplace legislation, EAPs continued to grow in importance as they became vital to businesses by providing expertise and guidance to employers regarding the management of employees with addictions. The 1980s represented a time of significant transition in the workplace as more employers required their workforce to “do more with less.” Employees found it especially challenging to balance the increasing demands of work with the demands of their personal and home lives.

In the 1990s, EAPs further expanded their scope of service to provide more comprehensive interventions addressing issues such as violence and drug testing and supporting workplaces through significant changes such as mergers and downsizing. Today, EAPs continue to evolve with the rapidly changing American workplace.

One Size Does Not Fit All
Not all EAPs are structured in the same way nor do they all offer the same services. EAP services are meant to be customized to meet the clients’ needs, but there are some services and program tenets that are considered universal to all EAPs. The EAP core technology developed by Roman and Blum (1988) represents what has been accepted as the essential components of an EAP. In addition to the services described in the core technology, the majority of EAPs in the United States also provide short-term counseling services to employees/dependents that are paid for by the employer. Employers choose a predetermined number of face-to-face EAP sessions to offer employees/dependents. The most common model in the United States is six sessions.

Traditional EAPs were internal programs in which EAP professionals were employed by the company they supported. Internal EAPs are still common within large companies, universities, and sectors of the federal government. These programs are often recognized for their personalized service and high visibility at the workplace. Straussner (2001) reported that internal EAPs are more likely to engage in activities of employee advocacy. However, the more prevalent type of EAP today is the external program in which a workplace or customer contracts with an EAP company to provide services.

External EAPs, which may or may not have on-site offices, utilize EAP affiliates (mental health professionals within the community) to provide the majority of face-to-face services to employees/dependents within their private practices. External programs are more realistic and cost-effective for large companies that are spread out geographically. It is common for these programs to provide 24-hour assistance 365 days per year. To provide this type of service, EAPs have advanced the use of telephone counseling and triage as most employees initially access their EAP benefits by calling an EAP counselor.

Web-based services have played an important role in educating the workforce about the EAP. EAP Web sites are becoming more elaborate, offering access to provider lists, tip sheets, Webinars, and self-assessment tools. However, none of these services have replaced the importance of face-to-face counseling, which is still the preferred method for EAP service delivery.

While the services provided by internal and external EAPs are similar, employees sometimes report feeling more comfortable seeing an external EAP professional as it increases their sense of confidentiality. Arguably, the most essential function of a successful EAP is its ability to provide confidential services free of charge to employees and, oftentimes, their family members. Confidentiality is the cornerstone of EAPs, solidifying their credibility for employees. Additionally, EAP services are voluntary, and the majority of employees who use EAP services do so through self-referrals.

Sometimes, employees may be referred to the EAP for work-performance problems by their manager or supervisor; however, the decision to participate is still voluntary. Working with the EAP should be a support for employees, not a substitution for workplace disciplinary policies and procedures.

EAP services to individual employees/dependents represent only a fraction of the services offered by EAPs in the workplace. Looking back to the core technology, services provided to managers and supervisors are as important and critical as those for employees/dependents. These services may include consultation, training, coaching, crisis intervention, and follow-up. One of the most important services to managers and supervisors is consultation and support regarding the constructive confrontation and referral of a troubled employee to the EAP. These are among the most challenging tasks of a manager/supervisor (Harrison, 1982). When used as a proactive workplace tool, supervisory referrals of troubled employees to an EAP have resulted in positive outcomes and significant cost savings to the employer (Besenhofer & Gerstein, 1991; Keaton & Yamatani, 1993; Boone, 1995).

For the overall workplace, the EAP offers services including education, wellness programming, health and wellness fairs, crisis intervention, and reduction-in-workforce support. Modern EAPs are now recognized for their efforts in supporting workplaces after critical incidents, such as the terrorist acts on September 11, 2001. EAP professionals are often the first—and many times the only—behavioral health experts to have contact with employees during a crisis. Crisis intervention and strategic crisis management is seen as the primary benefit EAPs offer companies (Ottenstein & Jacobson, 2006).

Additional EAP services commonly provided to employees and their family members include work/life balance services, including child care, elder care, and legal and financial services; coaching; health promotion; and informational literature. Regardless of the different services, all EAPs offer their services and programs through a “world of work” lens. This means that the services offered are impartial in addressing the well-being of the employee and workplace productivity while working within the boundaries of workplace policies, procedures, and organizational culture.

EAP Services vs. Outpatient Mental Health Services
Throughout the 1980s and 1990s, numerous EAPs aligned with managed behavioral healthcare and were often purchased by larger mental health provider companies. This contributed to the blurring of boundaries between services offered by EAPs and those offered by traditional behavioral healthcare. Sometimes, even social workers confuse EAP services with mental health counseling; however, they are not the same. EAPs were not designed to be the gatekeepers to an employee’s health benefit system. In fact, many employees who seek individual counseling from their EAP do not need additional counseling sessions and can resolve their problems within a few sessions. The average number of counseling sessions used by an employee with access to a six-session model is 4.2. Other employees may not be in need of counseling at all, but just need someone to listen with an objective and unbiased ear. Others may be in need of community resources and/or education about a problem affecting their ability to be productive at work.

Some problems that EAPs can effectively handle include grief, parenting and interpersonal relationship problems, stress, work/life balance, workplace conflicts, and other psychosocial problems. When a problem is identified as appropriate for short-term counseling, EAP professionals utilize brief, solution-focused practice, which is thought to be best suited for this type of situation (Budman & Gurman, 1988; Sprang, 1992). Solution-focused counseling and problem solving work well with the ecological perspective and systems theory that inform the PIE approach. Using the PIE approach for assessment and problem solving, the EAP professional can help the employee identify the stressors contributing to challenges impacting work and determine how the person is coping with the stressor. The EAP professional will work to assess how an employee’s concern is affecting the workplace and his or her ability to function at work. This perspective is central for EAPs and is not always the theoretical framework utilized by community mental health providers.

An EAP is not a replacement for traditional behavioral healthcare services, as not all problems can be resolved in this context. When a problem transcends the scope of the EAP, the professional works with the employee to identify appropriate referral options using the employee’s health benefits or other method of payment. (Services that are offered through referrals out of the EAP are not paid for by the employer.)

If the employee does not have adequate insurance, the EAP professional will work with that employee to research alternatives within the community and advocate for appropriate levels of care. On a case-by-case basis, EAP professionals may self-refer to their personal practice when they are providing both EAP and mental health outpatient services. This practice is considered controversial as it can be viewed as a conflict of interest. When EAP professionals make a referral, they should always provide options for employees from their network of referral resources within and around the workplace. Social workers are trained to form working partnerships with the local community, and this process of building a referral network is a natural function for them.

The Future of EAPs
American culture encourages a fast-paced and constantly changing workplace, and EAP professionals have many challenges as they learn to adapt to new workplace problems and needs in order to remain vital. To be successful, these professionals must understand the workplace they support and its culture. It is impossible to predict what the EAP of tomorrow will look like.

As American businesses begin to view behavioral health and psychological disorders as workplace issues, they are seeking assistance from professionals to help minimize the costs from treating depression, substance abuse, and other mental health problems. The National Business Group on Health recently reported that mental illness and substance abuse disorders account for more than 217 million lost workdays per year at a cost to employers of approximately $17 billion annually. Indirect cost estimates, such as those resulting from poor morale, damage to public image, employee theft, workplace accidents, or diverted supervisory and management time, cost even more (Finch & Phillips, 2005). EAP professionals are working collaboratively with other business groups in the areas of health, disability management, work/life, and wellness to address the mental and physical needs of employees and develop prevention and early intervention programs that will improve their overall health and well-being.

The opportunities for social workers to be leaders in the EAP field are vast as it grows by leaps and bounds. More companies are seeking to provide EAP benefits to their employees. Nearly all the Fortune 100 and Fortune 500 companies currently provide EAP and work/life services to their employees. EAPs are in need of professionals to staff these programs and offer services to their corporate clients. Unfortunately, professional training in EAPs is limited, and new programs are desperately needed.

The first author of this article directs the only existing graduate educational program providing social workers a master’s degree with a subspecialization in EAPs. This program provides the training and experience that social workers need to excel in the fields of employee assistance and work/life programs. Approximately 25 to 30 social workers graduate from this program each year and go on to work for large EAPs in the private and public/government sectors, as well as in other related fields including work/life and human resources.

Additional opportunities for training and education are provided through continuing education. Dale A. Masi, PhD, a pioneer in the EAP field and the social worker responsible for establishing the University of Maryland-Baltimore School of Social Work subspecialization is currently directing an online graduate certificate program in employee assistance through Northeastern University’s School of Professional and Continuing Studies (www.spcs.neu.edu/employee_assist).

The EAPA and the EASNA also sponsor annual conferences providing attendees with the most up-to-date information and research from the EAP field. The EAPA has more than 90 chapters in the United States and worldwide. Many chapters hold monthly meetings and often sponsor local conferences. These meetings provide great networking opportunities to meet other EAP professionals and to learn about the field.

The EAPA also sponsors the certified employee assistance professional credential, which was created in 1986 “to identify to the public and the profession those individuals who have met established standards for competent, client-centered practice and who adhere to a professional code of conduct designed to ensure the highest standards in the delivery of employee assistance services.”

Whichever track you pursue to gain more knowledge about the EAP field, it is important to recognize that providing employee assistance services requires knowledge about human behavior, behavioral health including substance abuse, and organizational theory. This knowledge needs to be applied through services that impact personal and workplace productivity, as well as overall well-being for the employee and the employer.

If you are considering penetrating the EAP field, start by conducting a self-assessment. Areas to assess include your personal views on work and the workplace, with particular attention to how you view work and its importance to the individual, the family, and the larger society. Other assessment areas include your views on substance abuse and treatment, mental health, and using one’s job as a motivating factor to encourage help-seeking behavior. The EAP field is complex, but the future of the field is bright and provides a natural environment for social workers looking to impact change on micro, mezzo, and macro levels.

— Jodi M. Jacobson, PhD, LCSW-C, CEAP, is an assistant professor and the chair of the employee assistance program subspecialization at the University of Maryland-Baltimore School of Social Work.

— Janet Hosford-Lamb, MSW, LCSW-C, currently provides workplace training and affiliate services for multiple employee assistance program vendors.

Resources
Alliance for Work-Life Progress: www.awlp.org

Employee Assistance Professionals Association: www.eapassn.org

Employee Assistance Society of North America: http://easna.org

Society for Human Resource Management: www.shrm.org

University of Maryland-Baltimore, School of Social Work, Employee Assistance Program Subspecialization: www.ssw.umaryland.edu/academic_programs/specializations/eap.htm

References
Besenhofer, R. K. & Gerstein, L. H. (1991). Referrals to employee assistance programs (EAPs): Characteristics of hypothetical supervisors, EAPs, and substance abusing workers. Employee Assistance Quarterly, 7(2), 41-62.

Boone, C. M. (1995). The effectiveness of EAP supervisory training. Employee Assistance Quarterly, 11(1), 17-27.

Budman, S. H. & Gurman, A. S. (1988). Theory and Practice of Brief Therapy. New York: Guilford.

Employee Assistance Professionals Association (EAPA) (2003). EAPA Standards and Professional Guidelines for Employee Assistance Programs (2003 Edition). Available Online: http://www.eapassn.org/public/articles/EAPA_Standards_web0303.pdf

Finch, R. A. & Phillips, K. (2005). An employer’s guide to behavioral health services: A roadmap and recommendations for evaluating, designing, and implementing behavioral health services. Center for Prevention and Health Services. Washington, DC: National Business Group on Health.

Harrison, E. L. (1982). Training supervisors to discipline effectively. Training and Development Journal, November, 36(11)111-113.

Karls, J. M. & Wanderi, K. M. (Eds.) (1996). Pie Manual Person in Environment System. The PIE Classification System for Social Functioning Problems. Washington, DC: NASW Press.

Keaton, B. & Yamatani, H. (1993). Benefits of mandatory EAP participation: A study of employees with last chance contracts. Employee Assistance Quarterly, 9(11), 67-77.

Jacobson, J. M. (2006). Compassion fatigue, compassion satisfaction, and burnout: Reactions among employee assistance professionals providing workplace crisis intervention and disaster management services. Journal of Behavioral Health, 21(3/4), 133-152.

Maiden, R. P. (2001). The evolution and practice of occupational social work in the United States. Employee Assistance Quarterly, 17(1/2), 119-161.

Ottenstein, R. J., & Jacobson, J. M. (2006). Gaining a seat at the table. Journal of Employee Assistance, 36(2) 2nd Quarter, 13-15.

Roman, P. M., & Blum, T. C. (1988). The core technology of employee assistance programs: A reaffirmation. The ALMACAN, (8), 17-22.

Sprang, G. (1992). Utilizing a brief EAP-based intervention as an agent for change in the treatment of depression. Employee Assistance Quarterly, 8(2), 57-65.

Straussner, S. L. A. (2001). Comparison of in-house and contracted-out employee assistance programs. Social Work, 33(1), 53-55.