Evaluating Employee Assistance Programs

Many employers simply "check the box" when signing up for this benefit, figuring health insurance will cover the mental health needs of their employees; however, most employers really don't know what the EAP services entail or the value the services can bring to a workplace. With that said, we must remember that not all EAPs are created equal, and EAP services vary greatly. The following are some common features.

• Biopsychosocial assessments, including substance use assessments
• Individual and family counseling
• Financial and legal coaching and referrals for counseling
• Referrals for additional services, with follow-up
• Psychoeducation through workshops, newsletters, and other communication for personal and workplace concerns including but not limited to stress management, parenting, mental health literacy, relationships, and organizational change and individual crisis prevention, crisis response, and ongoing support
• Mediation and team development
• Leadership consultation, coaching, and development
• Fitness for duty evaluations
• Suicide risk assessment, treatment, and "postvention" (i.e., what to do after a suicide)
• Staff training on best practices on how to support someone in distress

Sometimes the services are very cursory, such as a brief telephone assessment and referral by a contracted outside provider. Other EAPs provide robust and high touch services like 24-hour support, online assessment and information, telephone and in-person assessment and counseling, on-demand crisis consultation, onsite workshops, incentivized mental wellness promotion, and much more. Just like with many things, you get what you pay for, so employers need to decide how much they are willing to invest in the mental well-being of their workers and conduct a cost-benefit analysis. However, EAPs, even more customized programs with on-site services, have been shown to be cost-effective to employers through the years.

Are EAPs Effective?

While the research on the effectiveness of EAPs is limited, studies have found that employees' use of EAPs enhanced outcomes, specifically significant improvement in presenteeism, life satisfaction, functioning, and often absenteeism.¹ In one longitudinal, controlled study, EAP participants were more likely than non-EAP participants to see a reduction in anxiety and depression.² Another matched control study found that users of EAP services often reduced their absenteeism more quickly than non-EAP users experiencing similar challenges.³ In another longitudinal study,⁴ 86 percent of people who were suicidal when they engaged with their EAP were no longer suicidal at the 2-year follow-up. Researchers have concluded that, while not all EAPs are created equal, they often provide accessible services that are effective at improving employee mental health and well-being.

Can EAPs Support Employers Facing Employee Suicide?

When it comes to the life-and-death issue of suicide, EAPs have the potential to provide evidence-based suicide prevention, intervention, and postvention services to employers. The EAPs' contribution to the comprehensive workplace suicide prevention strategy is essential, and many would benefit from annual state-of-the-art training in evidence-based methods of suicide risk formulation and treatment to help distressed employees get back on their feet.

Social workers, who provide the majority of EAP clinical services in the United States, often report having no formal training in suicide formulation, response, and recovery,⁵ so annual continuing education on suicide intervention and suicide grief support is often helpful to providers. Once trustworthy and credentialed providers have been identified, they should be highlighted in the "suicide crisis" protocol, so that companies are not trying to do this legwork in the midst of a crisis.

"[When it comes to supporting someone in a suicide crisis] Where do we find counselors who know what to do?" 

If one of the main messages in suicide prevention is "seek help," we need to make sure the providers are confident and competent with best practices approaches to alleviating suicidal despair and getting people back on track to a life worth living. Thus, dedicated employers will evaluate and even challenge their EAP providers to demonstrate continuing education in the areas of suicide prevention, intervention, and postvention skills. In fact, some states are mandating that all mental health professionals, including licensed providers of EAP services, have some sort of ongoing training in suicide risk formulation and recovery.

Do Employees Know about the EAP and Its Benefit?

In addition to making sure the providers have the needed skills, companies need to make sure that their employees know when and how to access the care. Recently, the American Heart Association CEO Roundtable worked with experts in the behavioral health field to develop a white paper for employers, Mental Health—A Workforce Crisis, which includes seven specific actions employers can take to improve the mental health of their employees.⁶

Dr. Jodi Frey, expert panelist for the report and internationally recognized expert in the EAP and broader behavioral health field, recommends that "employers need carefully consider their workplace's needs when selecting an EAP, and then should work with their EAP as a strategic partner to develop programs and communications that encourage utilization of the program and continued evaluation to improve services over time."

Employers who are mindful of their workers' well-being will continually promote well-vetted and employer-backed resources throughout the career of the workers. Leadership testimonials of the efficacy of the resources after the leaders have used them for their own mental health would bring credibility to the resources and model appropriate self-care to the employees. Bringing the resources on-site to the workers (and not waiting until the workers stumble upon the resources) is another way to break through the barriers to care. The Employee Assistance Society for North American (EASNA) developed a guide, Selecting and Strengthening Employee Assistance Programs: A Purchaser's Guide, to help employers evaluate EAPs and determine appropriate vendors. The guide also can be used to help employers evaluate their current EAP and decide if needs are being met or if more attention to what services should be offered needs to be addressed.

Are There Different Types of EAPs?

Much diversity exists in EAP structure and quality.⁷ Some companies use internal EAPs, where providers are also employees of the company. This arrangement often provides the benefit of having an immediate resource that has a clear knowledge of the company and industry culture. Evaluation of internal EAPs have found increased utilization, customization, and supervisor referrals;⁸ however, there are some drawbacks. Internal EAPs, because they are so closely connected to the company, run the risk of being perceived as having blurred lines of confidentiality and objectivity. By contrast, external EAPs are often more diverse and can respond 24/7 across a vast geography. Because of these benefits and consequences, many companies have moved to a hybrid model to get the best of both models.

Hybrid EAPs often have an internal employee to manage the EAP and to work with managers and employees on critical incident response, strategic planning, organizational change, and to provide on-site assessment and problem resolution. They can be an important ally for the employer to best understand the potential for an EAP and to help with an ongoing evaluation that EAP providers are effective in their response and offering high-quality services.⁹

EAPs are most effective when they understand the industry and organizational culture, have business acumen, and can adapt to changes in organizational structure.¹⁰ Thus, employers seeking to find a "best fit" for their employees will interview mental health providers about their knowledge of the unique stressors and strengths on the industry. Some industries (e.g., emergency responders and aviation) have gone so far as to credential mental health providers as being "specialists" in their industry to avoid a mismatch.