Secrecy of EAPs makes measurement tough

Employee assistance programs come with a lot of gray areas. They have to. The privacy and confidentiality of the service must be unconditional. But that secrecy often poses a problem to some employers.

“It can be very difficult to evaluate the effectiveness of an EAP,” said Drew Sousa, a senior consultant with Aon Consulting’s health strategies team, and a member of the board of the EAP Association of Toronto.

Many employers still don’t appreciate the kind of information being revealed by employees using the EAP and are surprised to find out that they aren’t allowed access.

Conversely many others go to the opposite extreme and think they aren’t entitled to any information about the program. But as the payer of the bills, the employer has a right to a certain level and service and information about utilization, so long as there is no risk of compromising the confidentiality.

Indeed, information about utilization should be used to highlight possible problems in the organization that could explain the reason for EAP utilization in the first place.

Providers should be conducting their own user surveys first to evaluate the process of the service itself. For example, did the EAP respond in a timely manner? Other providers go beyond that in an attempt to measure the outcome: Did we improve the way you felt?

Providers will also often survey the entire company to get a larger picture of their performance.

However the provider can only survey the client if they are willing to be surveyed and response rates aren’t good, she said.

Providers will share information and many will be very open about how they do on their survey, often committing to improving services if they don’t rate well, said Sousa.

There is also the option of auditing, and some client companies will reserve the right for a third-party audit in the service contract. Audits can be done on the outcomes, but more often it focuses on the process: have the financials been met, have they done everything they were supposed to, were calls responded to and appointments made in a timely manner?

It is difficult to determine the value of an EAP, agreed Rick Csiernik, associate professor in the School of Social Work at the University of Western Ontario in London.

Csiernik is part of a team creating a national database on EAPs in order to establish some national benchmarks. About 150 companies have responded to the survey. By the end of this year, data accumulation will be completed and the team will begin analysing the feedback.

When it comes to gauging the effectiveness, the best approach may be to look at it as one part of a bigger picture, and include health and wellness as part of the business scorecard, said Sousa.

That is when the benefits are realized in the form of higher morale or reduced short-term disability claims, for example.

While it is tough to measure the impact, it is likely EAPs aren’t as effective as they could be if for no other reason that people who need them aren’t using the service. Some people simply aren’t aware assistance is available, while for others fears about confidentiality persist. Utilization rates typically run at around eight to 10 per cent, but some people think they should be as much as three times that, said Sousa. Utilization rates usually skyrocket after employers do a promotional campaign, added Csiernik.

While measuring the effectiveness of EAPs may be one issue in the industry, it isn’t the only one.

Traditionally EAPs have been strictly counselling, said Sousa. But recently other services have been tacked on.

Shakeups in the insurance industry are partly to blame. As a result of demutualization in the insurance sectors, some employers feel they aren’t getting the service they once were.

In the past, a company would have gone to an insurance company to manage a disability. But now the company might look at an EAP to help it be more proactive and preventive about the problem.

Though it is an interesting development, Sousa added a cautionary note about EAPs straying from their strength and becoming committed to more than they can deliver.

Employers are also interested in containing costs, but they should be careful not to make some ill-advised decisions. “There are some companies where family members aren’t eligible and that is a huge mistake,” said Csiernik.

While some employers consider introducing caps as a means to control costs, Sousa said caps aren’t always a good idea. “I would prefer to cut down the number of different services,” she said. Smoking cessation programs and some of the nutritional and financial programs, for example, may be a little too generous. Counselling, on the other hand, is a service that should never be cut, she said. And neither should elder-care or child-care assistance.

Employers should also monitor what is going on outside the workplace to determine what should be offered. The Telehealth program being offered by the government in Ontario easily replaces most of the health lines operated by EAPs, she said. Several other provinces are also considering similar programs.

However, any decisions about what should be offered should reflect the needs of employees, she added. Unfortunately a lot of employers don’t do enough research to figure out what those needs are.

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