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Use Employee Assistance to Manage Risk
MOST employers think of the services of an Employee Assistance Program (EAP) as a health benefit, focusing particularly on the free sessions available to an employee prior to using behavioral health insurance benefits. During the past 20 years, however, EAPs have evolved into much more than a health benefit. Today, the top EAPs offer employers a variety of services designed to improve health and productivity, reduce costs and risks, and serve the interests of both employees and management.
The Employee Assistance Professionals Association in 2003 offered a definition of employee assistance: "Employee assistance 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." This definition reflects the fact that EAPs were originally designed to address workplace productivity issues.
Many of the early EAPs were occupational alcoholism programs, often staffed by employees who were in recovery. EAPs soon expanded their services to employees struggling with substance abuse problems other than alcoholism. In the 1990s, with the rising popularity of managed care as a way to manage health care costs, large behavioral health care companies began to purchase local and regional EAPs. This again changed the types of services provided by the EAPs. By 2000, work-life services consisting of financial, legal, and child/eldercare services became products available through EAPs, along with a variety of wellness services. Some EAPs, particularly those with trained professional staff, also offer brief training programs for employees and various kinds of consultation to management.
With all of these different services falling under the umbrella of an EAP, employers may be unfamiliar with the ways they can use EAPs as risk management tools. A properly staffed EAP can provide a variety of services to assist knowledgeable employers in reducing exposure.
"Traditional" EAPs are staffed by master-level professionals (often licensed) who are trained in and knowledgeable about the workplace. They offer promotional and training programs and unlimited consultative services. The emphasis is on early identification of the troubled employee and early intervention to assist employees in coping with life's problems and to assist employers in managing workplace behaviors that affect productivity, morale, costs, and even risks of disruption or violence. Through early intervention and other prevention programs, such EAPs can help employers reduce the cost of doing business.
Four of the most common and costly problems facing employers can be ameliorated through appropriate reliance on a well-selected EAP:
• health care costs
• disability and worker's compensation costs
• legal and regulatory problems
• disruptive and violent behavior
It may surprise some employers to learn that EAP services could have an impact in these areas, particularly employers who have never used the full range of services provided by a traditional EAP. Anyone concerned for the health and safety of both the employees and the organization will want to become familiar with the types of services offered by their EAP and how they affect these areas. Because these issues are so important, professionals from occupational health and safety, risk management, security, loss prevention, legal, human resources, employee relations, and line management should all be consulted as an employer goes about selecting an EAP to meet its needs. An EAP that offers a workplace focus staffed by trained employee assistance professionals can affect an employer's bottom line and contribute to a productive workforce. We believe the services described below afford the greatest return on the dollar for the company.
Health Care Costs
These costs often are affected by behavioral and health problems that are highly identifiable and frequently treatable. Early intervention with problems such as substance abuse, depression, and anxiety can save health care dollars. Not only is the impaired employee typically a frequent user of significant healthcare benefits, but the family members affected by the employee's condition are also frequent users of health care services. Through early identification and appropriate referral, the EAP can make a significant impact on costs. This is accomplished through a promotional partnership with the employer.
Employees need to be continually reminded of the availability of the EAP as a resource, and support of the EAP must be made clear at the highest level of the company. Prevention activities sponsored by the EAP can include screening days, newsletters, and health fairs to improve employee awareness of the value of early intervention.
Employees often are unable to identify for themselves when their performance is slipping. It is the role of managers and supervisors, who should be familiar with the employee's baseline performance, to bring this to the attention of the employee. The EAP can provide training programs that aid supervisors in early identification of an employee who is experiencing problems. Most EAPs offer unlimited management consultation, affording supervisors, managers, human resources, and others an opportunity to discuss problematic employee behaviors. The earlier an employee receives care for a treatable condition, the less expensive that treatment is and the easier the recovery process. It is never the employer's role to diagnose an employee's behavior, but it is the employer's role to intervene when workplace behaviors are impeding productivity, including the productivity of a troubled employee's co-workers.
Disability and Comp Costs
These costs arise from a variety of diseases and injuries, from psychosocial factors affecting employees' responses to disease and injury, and, too often, from the purposeful exaggeration of symptoms and impairment. An EAP can contribute to early intervention with employees who are reckless or careless, and thus they play a part in reducing occupational injuries. An EAP can contribute to health promotion efforts to reduce the burden of disease and injury on the organization. An EAP can play a part in the rehabilitation of those for whom anxiety, depression, or substance abuse prolong time away from work. An EAP also can help improve the detection of malingering. Premiums for disability insurance often reflect the experience of the organization in prior contract years, and many large companies are self-insured for disability benefits. Thus, returning employees to productive work has a direct impact on the bottom line.
Legal and Regulatory Problems
Wrongful termination suits, Equal Employment Opportunity Commission complaints, discrimination suits, and sexual harassment complaints occur surprisingly often. They frequently are a result of failure to properly manage the early signs of employee misconduct, which then escalates to the point at which either the misbehaving employee is terminated--sometimes without adequate warning and without documentation of past misconduct--or others feel sufficiently aggrieved to bring action against the employer. Moreover, when managers and supervisors haven't received adequate training on how to approach employees who are not meeting job expectations, there is an increased risk for terminated employees to bring wrongful termination suits.
A policy setting forth the company's practices regarding hiring, promotion, and discipline is critical. Company policy should describe the progressive disciplinary process and delineate behaviors that are subject to discipline up to and including termination. The process of supervisory referral to the EAP should be outlined, identifying the EAP as a resource for employees to address issues that could be affecting workplace performance. The EAP should be able to provide sample policies that can form the basis for company policies. The EAP does not take the place of the employment lawyer but should be able to provide valuable recommendations and referrals regarding substance abuse, disciplinary issues, workplace violence, and catastrophic event planning.
Once the policy is in place, the EAP can provide training programs for supervisors, managers, HR, and others on how to approach an employee who is experiencing workplace performance problems. The EAP can provide guidance on how to make a referral without fear of having an Americans with Disabilities Act claim filed and how to document performance problems in an objective manner, with a concurrent action plan to ameliorate the identified workplace problems. Such training focuses on how to avoid labeling, diagnosing, or counseling the employee during the referral process.
A supervisory referral to the EAP occurs when a supervisor observes a pattern of behavior that is affecting the employee's performance. For example, frequent tardiness, unexcused absences, and repeated errors are observable behaviors that should be documented. The EAP is recommended as part of the corrective action plan. A referral to the EAP keeps the supervisor or HR professional from becoming involved in or learning about any personal problems that may be impeding the employee's ability to be successful at work. When a supervisory referral is made, the EAP may confirm that the employee kept the initial appointment but cannot share any other information without a signed release of information. At no time does the EAP specialist share intimate information regarding the employee. If the performance problem does not improve, the supervisor has documentation about the steps taken prior to termination. This documentation helps to deflate and defend against claims of wrongful termination.
Disruptive and Violent Behaviors
These have a dramatic effect on productivity and morale and may lead to injuries and deaths. In our experience, employees who engage in disruptive, bullying, intimidating, threatening, or violent behavior in the workplace have a history of performance problems and earlier misconduct long before the average supervisor considers calling security, HR, or the EAP for guidance. The earlier the employer can intervene, the less likelihood there is of further misconduct, including threats and violence toward self or others. Training is available for supervisors and managers about the observations that should lead them to call for guidance.
Early intervention in disruptive, bullying, intimidating, or threatening situations often can prevent escalation. Such situations should be discussed and reviewed with the EAP or specialists in workplace violence prevention. Employees who threaten self-harm or show other signs of suicide risk provide another opportunity to intervene before violence has occurred. These employees often have made statements indicating hopelessness, a wish to cease living, or even a plan of self-harm. These comments often are ignored because supervisors do not know what to do. This is a critical time to consult with on-site health care providers or the EAP.
There are times when the situation described is beyond the expertise of the EAP professional. Some of the situations that require consultation with specialists in threat assessment and workplace violence prevention include:
• references to weapons, violent incidents in the news, or thoughts or plans of attack that cause discomfort or seem inappropriate to the listener
• threatening actions or statements, regardless of whether the threat is direct ("I will hurt you."), indirect, veiled ("You better watch your back."), or contingent ("If they fire me, I'll be back with a gun.")
• persistent pursuit of an unwanted relationship, whether or not the victim has been followed or watched enough to feel that she or he is being stalked
• discovery that the pattern of misconduct leading up to the most recent incident is longstanding, undocumented, poorly managed, and worsening
• discovery that the person whose behavior threatens or frightens others has a history of violence, crime, a restraining order, substance abuse, mental illness, or stalking
• suspicions that the employee has engaged in product tampering, sabotage, poisoning, covert surveillance, or the construction of explosive devices
Valuable Opportunities Missed
A well-chosen EAP with the appropriate professional resources can be a valuable tool for management to contain costs and reduce risks, but only if those who need the services offered by the EAP know those resources exist and how to access them.
Employers vary in the extent to which they promote awareness of the services of their EAP or provide opportunities for the EAP to do so. Those employers who do too little to foster awareness of the EAP are missing valuable opportunities to improve productivity, reduce costs, and improve the safety of the workplace. Employers who take full advantage of the EAP experience a greater return on their investment and provide valuable resources to their employees and managers.
This article originally appeared in the July 2007 issue of Occupational Health & Safety.
Dale Kaplan, LCSW-C, MSWAC, is Vice President, Workplace Services, for First Advantage of Bethesda, Md. You can visit the company Web site at www.FADV.com
Park Dietz, MD, MPH, Ph.D., is President of the Threat Assessment Group, Newport Beach, Calif. You can visit the company Web site at www.TAGINC.com