Assistance plans: Who’s using what and how

Study shows placing a cap on assistance plans serves no real purpose and doesn't save any money

As common as employee and family assistance programs (EFAPs) have become in Canadian workplaces, until now the programs themselves remain surprisingly unexplored.

The findings from a recent study I conducted of 154 Canadian EFAPs provides some revealing details on the structure and function of these programs and for the first time establishes empirical baselines where before there were only supposition and anecdote.

The study’s most important finding is that placing a cap on EFAP services serves no real purpose since this does not appear to save any money.

The fear that uncapped services lead to abuse or evolve into long-term psychotherapy was not seen in this study. In fact the opposite was true. Caps seem to drive up use because users seek to “get their money’s worth” and take advantage of all counselling sessions they are eligible for. In contrast, employees and family members belonging to programs without caps appear to be using the programs as they were intended, as short-term or crisis-orientated services.

Nearly one-half of all respondents (47 per cent) continue to cap EFAP access while just more than half allow for unrestricted counselling.

Excluding programs that provide a maximum of only four sessions — which are in essence assessment services and not EFAPs — it was discovered that with uncapped services an average of five sessions were taken, meanwhile with capped programs, the average was 5.1 sessions. Those with caps of eight, 10 or 12 sessions were actually used more on average than those that had no cap.

Nonetheless, there are situations when a long-term counselling relationship is appropriate and terminating prematurely is detrimental, not only to the employee but also to the family and the long-term interests of the workplace.

Program evaluation often lacking

What is disappointing but important to discover is the undeveloped nature of many of the programs in place. Every program should be based upon a formal, documented EFAP policy, but 20 per cent of organizations still lack such a policy. Two-thirds of respondents had not formally evaluated their programs and were thus unable to verify the cost savings achieved by the implementation of the EFAP.

No information was collected on why evaluations were not completed but complexity, confidentiality, cost and a lack of time have been typical reasons discussed in other studies. Furthermore, just 36 per cent did not have a formal committee overseeing the program, one-quarter did not provide new employee orientation, while nearly 30 per cent did not engage in ongoing promotion.

The study confirms EFAPs are a relatively new addition to the inventory of HR responsibilities, with about 10 per cent of programs introduced prior to 1980, nearly half added during the ’80s, while 40 per cent developed since 1990.

External versus internal services

Respondents were also asked how assistance is provided to plan members. While the large majority (86.4 per cent) use at least one external professional counsellor, a surprisingly large number (one-half) use them in conjunction with in-house counsellors. In-house counselling comes from either volunteers (referral agents, union counsellors or members of a 12-step fellowship) or professionals (social workers, HR professionals or occupational health nurses).

There has long been an open divide between internal and external service providers. Internal counsellors typically feel threatened by external experts who in turn tend to think in-house counsellors aren’t as qualified.

The training required of volunteers varied widely, with one organization only requiring volunteers take just a half day of training before allowing them to act as counsellors, while another organization required three weeks.

Meanwhile when it comes to professional counsellors, social workers are most often used and nearly 40 per cent of companies employed counsellors with specialized diplomas in either addiction or EFAP studies. More than three-quarters of all counsellors in the study were members of professional associations with specific practice guidelines and ethical codes of conduct.

The internal-external EFAP debate may never be resolved but this study further indicates that there are distinct differences that arise depending on how the program is delivered.

Prominent differences include the amount of service provided and the amount of program support offered. There tends to be less promotion, training and a greater likelihood to have a capped program when external professionals provide EFAP services than when the assistance is provided by internal staff or volunteers (see Table 1).

All organizations in the study promoted voluntary program use while three-quarters had an informal referral system in place and nearly half encouraged peers to refer their colleagues for assistance.

Forty per cent used a formal referral pathway to the EFAP. One-third still had a mandatory component whereby the employee had the choice of either seeing the EAP counsellor or being terminated. Only eight companies in the study conduct employee drug testing.

While some of the findings paint a picture of a young, underdeveloped industry, it was encouraging to see that employee and family assistance programming remains a growing enterprise in Canada.

Further analysis of the data will focus on the considerable discrepancies found in defining and calculating program utilization, an examination of EFAP outcome studies and the development of a best practices document for EFAP policies to assist in developing stronger, more useful and more comprehensive policy statements.

For more findings from Rick Csiernik’s EFAP study as they become available, watch for future issues of Canadian HR Reporter.

Rick Csiernik is currently on sabbatical completing his new book entitled “Responding to the Oppression of Addiction.” He will be speaking at the Institute on Addictions Study conference in Barrie, Ont., July 6-10. He may be reached at [email protected].

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