EAP Outcomes Demonstrate Value EASNA Conference May 2004 Rick Selvik, LICSW, MBA, CEAP Diane Stephenson, Ph.D., CEAP Federal Occupational Health, Program Support Center, U.S. Department of Health and Human Services
Feb 02, 2016
EAP Outcomes Demonstrate Value
EASNA Conference May 2004
Rick Selvik, LICSW, MBA, CEAP
Diane Stephenson, Ph.D., CEAP
Federal Occupational Health, Program Support Center,
U.S. Department of Health and Human Services
Presentation Abstract
Outcome Data from 60,000 EAP clientsDuring a 3 Year PeriodWith Federal Occupational Health EAPDuring pre- and post- clinical processResults show client improvementLarge number and consistent findingsSupport productivity benefits of EAP
Presentation Issues
Cost-effective methods to document value
Demonstrate value by more than anecdotes
Outcome measures assure quality service and demonstrate value
Keep the customer informed of EAP services and impact on health and productivity
Learning Objectives
How to collect outcome measures
How to interpret the results
How to assess EAP impact on key workplace indicators
How to use results to evaluate program initiatives such as telephone counseling
Traditional EAP Value Measures
Utilization
Demographics
Presented and Assessed Problems
Client satisfaction
New EAP Value Measures
Problem Improvement
Risk Management Results
Reduced Absenteeism
Productivity Improvement
U.S. Dept. of Health and Human Services, PSC, Federal Occupational Health (FOH)
EAP for 1.4 million Federal employees
Serving over 400 Federal agencies
Have over 150 counselors onsite nationwide
Nationwide affiliate network
Heavy demand for information and quarterly reports of activity
The Typical EAP Client (1)
Between 45 and 54 years of age (35%)Married (50%)Caucasian (67%), African American (20%), and Hispanic (10%)Males (50%), Females (50%)Worked for Organization 6 to 15 Years
The Typical EAP Client (2)
Self-Referred to EAP (60%), Management Referred (15%), Union Referred (2%)Three to Four Sessions on AverageAddress Problem in EAP (80%)Others referred to community resourcesFollow-up for up to a yearFour of five clients resolve in EAP
Reported Work Problems
Other6%
Safety/Accident
2%
Work Relationship
15%
Misconduct5%
Absent/Tardy10%
Diminished Work
Performance10%
Disciplinary Action
3%
No Work Problem
49%
Assessed ProblemsAnxiety
25%Depression
20%Stress3%
Grief & Loss3%
Job 15%
Alcohol/Drug 10%
Family5% Marital/
Relationship 10%
Financial/Legal<1%
Other Emotional
8%
Health Status Questions
Health Outcomes Institute and InterStudy
John Ware of Johns Hopkins
Different versions: SF36 and HQ12
We selected four of the questions
Asked at case opening and case closing
Outcome Measures UsedProductivity impacted by emotional problems,
Productivity impacted by physical health,
Improved work and social relationships,
Health status,
Job attendance/tardiness, and
Global assessment of functioning (GAF).
Question: Productivity – As Affected by Emotional Problems
”During the past 4 weeks, to what extent have you accomplished less than you would like in your work or other daily activities as a result of emotional problems (such as feeling depressed or anxious)?”
The response options were: None at all (1), Slightly (2), Moderately (3), Quite a bit (4) and Extremely (5)
73% reduction in cases in lowest two categories
Productivity – As Affected by Emotional Problems
5%
25%26%19% 25%
1 None at All 2 Slightly 3 Moderately 4 Quite a Bit 5 ExtremelyProductivity Rating Level BEFORE use of the EAP
1%7%
37%42%13%
1 None at All 2 Slightly 3 Moderately 4 Quite a Bit 5 ExtremelyProductivity Rating Level AFTER use of the EAP
Results show shift towards no or fewer productivity problems after EAP services.
Question: Productivity – As Affected by Physical Health ”During the past 4 weeks, how much
difficulty did you have doing your work or other regular daily activities as a result of your physical health)?”
The response options were: None at all (1), A little bit (2), Moderately (3), Quite a bit (4) and Could not do daily work (5)
66% reduction in cases in lowest two categories
Productivity – As Affected by Physical Health
3%12%
20%48%17%
1 None at All 2 A little bit 3 Some 4 Quite a bit 5 Could not dodaily work
Productivity Rating Level BEFORE use of the EAP
1%4%23%
60% 11%
1 None at All 2 A little bit 3 Some 4 Quite a bit 5 Could not dodaily work
Productivity Rating Level AFTER use of the EAP
Results show shift towards no or fewer productivity problems after EAP services.
Question: Improved Work and Social Relationships ”During the past 4 weeks, to what extent
has your physical or emotional problems interfered with your normal social activities with family, friends, neighbors, or groups?”
The response options were: None at all (1), Slightly (2), Moderately (3), Quite a bit (4) and Extremely (5)
77% reduction in cases in lowest two categories
Work and Social Relationships
5%
26%25%18% 25%
1 None at All 2 Slightly 3 Moderately 4 Quite a Bit 5 Extremely
Work/Social Relationship Problems BEFORE use of the EAP
1%7%36%43%
13%
1 None at All 2 Slightly 3 Moderately 4 Quite a Bit 5 ExtremelyWork/Social Relationship Problems AFTER use of the EAP
Results show shift towards no or fewer relationship problems after EAP services.
Question: Health Status
”In general, would you say your health is:”
The response options were: Excellent (1), Very Good (2), Good (3), Fair (4) and Poor (5)
31% reduction in cases in lowest two categories
Health Status
3%13%
32%15%
37%
1 Excellent 2 Very good 3 Good 4 Fair 5 Poor
Health Status Level BEFORE use of the EAP
2%9%36%
19%34%
1 Excellent 2 Very good 3 Good 4 Fair 5 Poor
Health Status Level AFTER use of the EAP
Results show shift towards improved health status after EAP services.
Question: Attendance/Tardiness
“How many days have you been unexpectedly absent or tardy in the past 30 days?”
62% drop in average lost time away from work for clients after using the EAP
Attendance/Tardiness
0.91
2.37
0
0.5
1
1.5
2
2.5
30 Days Before EAP 30 Days After EAPResults show dramatic change in unscheduled attendance/tardiness occurrences after EAP services.
Question: Global Assessment of Functioning The counselors assessed a client’s level of
functioning using the Global Assessment of Functioning (GAF) Scale (American Psychiatric Association, 2000).
GAF scores can range from 1 to 100, with higher scores indicating better functioning.
10% average improvement for clients, moving from a range of mild symptoms and difficulty in functioning to transient, slight symptoms and impairment levels
Global Assessment of Functioning
70.3864.11
0
10
20
30
40
50
60
70
80
Case Opening Case Closing
Results show change in average GAF scores at case closing.
How to Present the Results to the Customer
Charts
Percent Improvement
Quarterly Reports
Trends
Outcome Area Percentage of Improvement in Lowest
Two Categories
Productivity impacted by emotional problems,
73%
Productivity impacted by physical health,
66%
Improved work and social relationships,
74%
Health status, 31%
EAP Impact In the Workplace
Outcome Area Percentage of Improvement for All
Clients
Job attendance/tardiness 62%
Global assessment of functioning (GAF) improvement
10%
EAP Impact In the Workplace
Outcomes for Different Types of Clients
By Assessed Problem Type
When Alcohol/Drug is the Primary Problem
By Gender
For Telephone Counseling Clients
Improved Outcomes by Assessed Problem
0%10%20%30%40%50%60%70%80%90%
Productivity -Mental Health
Productivity -Physical Health
Work and SocialRelationships
Health Status Attendance GlobalAssessment of
Functioning
Perc
ent o
f Im
prov
emen
t
Emotional Alcohol/Drug Family
Clients with Alcohol/Drug Problems
Improved Outcomes by Gender
75% 81%
0%
10%
20%
30%
40%
50%
60%
70%
80%
Per
cent
of
Impr
ovem
ent
Male Female
N=11,746
Evaluation of Telephone Counseling in an EAP
•Criteria•Outcomes
Telephone Applications in Behavioral Health
Crisis counselingInitial contact - information/educationScreeningAppointment schedulingManagement consultation
Telephone Applications in Behavioral Health
AssessmentCounselingSupport between face-to-faceCase managementSupervisionFollow-upEvaluation
Other TC Outcomes Study Results
Texas A&M Study (Reese, 2000)
Clients report same level of relationship with counselor (telephone & face-to-face)Convenience, cost, anonymity, control
U of IL Study (Schneider, 2000) Telephone, face-to-face, videoteleconference, no treatmentAudio (telephone) & video provide similar outcome levels to face-to-faceAny modality better than no treatmentComfort with audio & video increase over time
FOH Guidelines for Counseling by Telephone
Assessing Client AppropriatenessClient Request for Counseling by TelephoneEnvironmentConducting the Initial Assessment Conducting the CounselingDocumentationStatement of Understanding IssuesCounselor State Licensed
Contraindications to Counseling by Telephone
Alcohol or other drug abuseManagement referralsRisk of violenceSuicidal or homicidalMarital, family, childSerious psychopathology
FOH TC Evaluation Components (1)
Number of telephone casesLength of counseling sessionsRates of case assignment to affiliate counselorsClient satisfaction ratings on access to careClient satisfaction ratings on services received
FOH TC Evaluation Components (2)
Outcomes ratings on productivity and absenteeismClinical outcome (GAF score)Structured counselor feedback on their telephone casesAnecdotal case information from counselors
Comparison Time Frame Analyses
Implementation Period – 6 months immediately after issuance of the structured TC guidelinesComparison Period – the same 6 month period the year before
Outcomes – #s Using Telephone Counseling
Generally the same number of telephone cases and telephone sessions during the implementation period as compared with the comparison period.
Telephone and Face-to-Face Counseling Groups
Face-to-face counseling analysesTC sessions were fewer than 50% of the totalCases with no telephone sessions
Telephone counseling analysesTC session were 50% or more of the totalCases with any telephone sessions
Outcomes – Length of Sessions
Average length of telephonic session – 32.2 minutesAverage length of face-to-face session – 59.8 minutes
Outcomes – Affiliate Assignment
Reduction of 5.6% in affiliate case assignment
Outcomes – Client Satisfaction: Access To Care
Same outcome results for telephonic and face-to-face cases on client satisfaction with access to care
Outcomes – Client Satisfaction: Quality Of Services Received
Same outcome results for telephonic and face-to-face cases on client satisfaction with quality of services received
Outcomes – Absenteeism & Productivity
Similar outcomes for telephonic and face-to-face cases on:
Pre/post absenteeism/tardiness ratesPre/post productivity measures
Outcomes – Clinical Functioning
Cases with any telephonic sessions showed a greater average improvement in GAF scores from the opening to the closing of the case (p=.05) compared with the face-to-face cases
Outcomes – Counselor Feedback3.7 – level of counselor’s experience with telephone counseling4.0 – level of comfort providing TC with this case 4.2 – perception of client’s TC comfort 3.8 – perception of cnslr/client alliance
5 point scale – 1=low; 3=moderate; 5=high
Outcomes – Counselor Feedback (2)
3.7 – extent to which goals were met4.0 (5=not at all) – If goals not met, extent that counseling by telephone contributed
4.5 (5=not at all) – Extent to which a TC session was interrupted.93 (0=no and 1=yes) – If the client had privacy during the TC
Outcomes – Counselor Anecdotal Information
Categories where telephonic counseling may be appropriate and beneficial:StigmaMedical mobility problemsMental health mobility problemsScheduling problemsClients with multiple no shows
Telephone Counseling Summary
Appropriate clients; appropriate methodUse a multifaceted evaluation model for evaluating service delivery through technological modalities
Client Satisfaction Dimensions Service Satisfaction
Accessibility and Convenience Productivity Improvement
Improve productivity at workImprove work relationships
Client ImprovementEAP’s effect on problem resolutionStrengthening the client’s job effectivenessAbility to cope with stress
How to Use this DataFor Client Service Delivery
Improve Health and Productivity OutcomesDaily operational management
Continuous quality improvementActivity based managementEnable core processes
Monthly Supervisor/Counselor ReportDeveloping Internal Benchmarks
How to Use this DataFor the Consultation to the Organization
Show Health and Productivity OutcomesCustom reports for customersSenior management briefingsQuarterly reportsAnnual activity summary
EAP Value Dimensions
EAP Health & Productivity Role
EAP Commodity
Strategic Buisness Focus
Employee Service Delivery
New EAP Value Measures
Traditional EAP Value Measures
Client Service Delivery
Consultation to the Organization
Summary and Discussion
EAP services lead to improved outcomes in six areas of functioning
Results consistent over a 3 year period
Involved almost 60,000 EAP clients with a variety of presented problems
Include in clinical process
Supports health and productivity value and benefits of EAPs
Thanks to:Chris Plaza, MS, Brian Sugden, PhD, Dennis Derr, MA, Christopher Ross, PhD, David Bingaman, LCSW, Fran Wence, MAThe authors give special recognition to the counselors, counselor supervisors, clinical directors, and FOH EAP consultants for their work on the development/implementation of this initiative and their significant contributions to the health and productivity of the workforce.Questions: 312-886-4215; [email protected]; www.foh.dhhs.gov/outcomes.asp