CHAPTER 26: Employee Assistance
In any large group of people, a large fraction have personal problems that interfere with their work, attitude, and enjoyment of life. These problems did not develop overnight and are deeply rooted in the individual's psychology and past experience. By identifying such problems early, before they bring the employee to a crisis or to dismissal from work, an enlightened employer can help such people and in so doing save a good and valuable employee with productive hears ahead.
Employee assistance programs (EAPs) identify employees with personal problems, refer them for treatment, support and motivate them to complete treatment, and assist in their rehabilitation. Most EAPs are focused on alcohol and drug abuse and mental illness but many also concern themselves with family and adjustment problems, financial mismanagement (particularly credit card overruns), and stress. Employee assistance is often categorized with health promotion as an approach based on "wellness" of individual workers. There is often overlap in the programs and activities undertaken when both exist in the same organization. Even so, the emphasis in EAPs is on resolution of problems.
If an employee-patient presents signs of personal problems, anxiety, or substance abuse, that patient may be helped by self-referral to an employer's EAP, if one is available. Many employers will be cooperative and may assume costs for key or long-term employees if reimbursement under the health plan is not complete. Maintaining absolute confidentiality is essential, however, as the problems dealt with by an EAP are of the most sensitive nature.
The description that follows is only an introduction to the operation of an EAP. Entire books are available detailing the appropriate procedures to be followed and the best approaches. Help in developing an EAP with an emphasis on controlling alcohol abuse may be obtained from the Association of Labor-Management Administrators and Consultants on Alcoholism in Arlington, Virginia. The optimal design of an EAP depends on many factors, among them the characteristics of the community, the size of the plant, and the availability of local agencies to receive referrals.
Programs designed to help employees who have personal problems that interfere with their work performance and enjoyment of life have been around since the 1940's when alcohol abuse began to be recognized as a treatable illness. Back then a few corporations such as Eastman Kodak, E.I. Dupont de Nemours and Consolidated Edison set up medically oriented programs run by their medical departments. But it really was not until the 1950's, when the American Medical Association sanctioned the concept that alcohol abuse was a treatable medical condition, that the foundation for modern EAP's was established. Since then EAP's have emerged in various forms and been called by various names, although they are still by no means universally available or accepted. EAP's commonly focus on alcohol and drug abuse and behavioural disturbances due to stress. Some, called "broad brush" programs, have also addressed family, financial and legal problems as frequent sources of stress and provide additional special services in these areas.
The design and implementation of an EAP in any given workplace depends upon the perception and attitudes of the various stakeholders, the nature of the industry, the characteristics of the community and the availability of professional consultants and treating agencies to receive referrals. The stakeholders who must all participate in the design and implementation of an EAP are management, the union or other employee representation, occupational health, and human resources. Outside consultants in the design of EAPs may also be involved.
The program itself may be administered or delivered by the occupational health team, by the human resources department or by an EAP counsellor, working as an employee of the company or as a consultant. Each of these arrangements have their strengths and weaknesses. Regardless of the situation there are underlying principles that must be in place if the program is to succeed. These principles must be articulated in a company policy which must be known and understood by all employees.
A complete EAP policy must be written which outlines not only the underlying principles, but also describes the program content, identifies the key players and describes their roles and responsibilities. It will also specify the program's relationship to other employment policies. A sample EAP policy follows this chapter.
The full EAP program will provide for an education and training component, as well as for counselling, treatment and rehabilitation. Employees receive information in the training sessions on how to avoid or to cope with alcohol, drugs and stress, and how the overall program works. Supervisor training focuses not on how to identify signs and symptoms of severe alcohol or drug abuse or to speculate on the meaning of a person's behavioural problem, but rather on how to watch for and react to early signs of trouble. These include irritability, tardiness, absenteeism, sloppy work habits, and unusual or changed behaviour that is out of character for the individual. Supervisors are taught that these are important, early signs of failing job performance.
An EAP operates primarily by the voluntary action of employees who seek help and who are then referred to local health care or counselling facilities. The well-established questionnaire in Table 26.1 was used successfully by Rohr Industries, an aerospace corporation based in Chula Vista, California, to assist employees with problems related to alcohol abuse. It was distributed widely, with an invitation to call the firms EAP if the worker answered yes to any question. Some employees are referred into an EAP by their supervisors as a condition of retaining employment. The employer monitors the progress of the employee and guarantees return to the same or similar work. EAPs usually do not provide direct treatment except for initial counselling. The program usually relies on existing community services.
Table 26.1. Questionnaire Used by Workers to Evaluate their Own Drinking Habits
(Courtesy of the Rohr Corporation)
"Drinking.... 20 Important Questions"
The most frustrating aspect of alcohol use, abuse, and alcoholism is the inability of the
drinker to accept the fact that alcohol can, and often does, result in serious problems for the drinker. The primary characteristic of alcoholism itself is denial that problems exist in spite of evidence to the contrary. The 20 questions below are designed to assist drinkers to objectively examine their own use of alcohol.
1. Has anyone suggested you quit or cut back on drinking? ___ ___
2. Has drinking affected your reputation? ___ ___
4. Have you ever changed your drink or drinking pattern in an effort to ___ ___
reduce your alcohol consumption?
5. Have you ever gotten into financial, legal, or marital difficulties ___ ___
because of drinking?
6. Have you lost time from work because of drinking? ___ ___
7. Have you ever "sneaked" or "gulped" drinks? ___ ___
8. On occasion, do you feel uncomfortable if alcohol is not available? ___ ___
you did while drinking?
11. Has your efficiency decreased as a result of drinking? ___ ___
12. When drinking, do you neglect to eat properly? ___ ___
13. Do you drink alone? ___ ___
14. Do you drink more than usual when under pressure, angry, ___ ___
to when you first began to drink regularly?
16. Have you lost interest in other activities or noticed a decrease in your ___ ___
ambition as a result of drinking?
17. Have you had "shakes" or tremors following heavy drinking, or ___ ___
after not drinking for a period of time?
18. Do you want a drink at a particular time each day? ___ ___
19. Do you go on and off "the wagon"? ___ ___
20. Is drinking jeopardising your job? ___ ___
Answering yes to one or more of the above questions does not necessarily imply a drinking problem. However, three or more yes answers suggest that you should more closely evaluate your use of alcohol.
Employees may enter the program through a self-referral or by being directed to get help by the supervisor. In the former situation, the employee, for whatever reason, has decided to seek help before the work situation has deteriorated to the point where a supervisor has become involved, while in the directed situation job performance has deteriorated to the point that if improvement does not occur discipline up to and including dismissal is possible.
For the EAP to work effectively, the underlying principle of confidentiality must be in place. In the case of the voluntary referral not only must the details of the problem be kept in confidence, but also the fact of the referral itself.
In the case of a directed referral, the fitness-to-work procedure described in Chapter 18 should be followed. This procedure provides a method that ensures confidentiality for the employee while at the same time gives the supervisor and others the necessary information to manage the employment situation. The fitness-to-work procedure should be followed whether the case is being handled by an occupational health physician or nurse, or an EAP counsellor.
Most EAP's do not attempt to provide ongoing in-house counselling, treatment or rehabilitation. Rather, they provide the necessary framework for case identification, management and follow-up, and provide liaison with community treatment and resources for rehabilitation. Other underlying principles include recognizing that alcohol and drug abuse and stress related behavioural disturbances are legitimate, treatable illnesses, and that the program is not to be used as a substitute for usual disciplinary procedures or to compromise rules, regulations or binding agreements.
EAPs should be heavily advertised, but in a nonthreatening way. The employee falling deeply into alcohol abuse has considerable denial and will usually resist an accusatory tone. Appeals to one's responsibility to one's family and references to "troubles" with a picture of an empty bottle seem to be more effective than the direct approach. In all publicity regarding the EAP, strict confidentiality and professionalism must be emphasized and an outside phone number provided so that the employee can call from a private phone.
The location of the EAP offices is also important. The entrance should be discreet, so that a visit is not obvious, but not inconvenient. Often EAP offices are placed so that a visitor must walk through the length of the clinic area to reach it (out of sight of the waiting room) or in an office building a few block away.
The key to an effective EAP is the counsellor. Alcohol rehabilitation counsellors have a special rapport with alcohol abusers and many have had drinking problems themselves that they have overcome. Increasingly, psychologists and counsellors specially trained in EAP services and management are becoming available. Whatever the credentials of the counsellor, an employee must feel at ease and confident in his or her presence. For this reason the demeanor and attitude of the counsellor is critical, as is the ability to relate to persons of different ages and social classes.
For programs based on referral to community agencies, the counsellor should know what resources are available in the local area, their suitability for different people and situations, their fees, criteria for enrollment, and the treatment approaches used. Not every treatment centre works for every employee. Some people respond to intensive residential programs away from home and work and others do better in a visiting setting, such as Alcoholics Anonymous. Sometimes referral to a special counsellor is required and the EAP counsellor should have a roster of practicing professionals in the area and extensive knowledge about the ones used.
By closely monitoring the progress of the employee through treatment and after return to work if an absence is required, the EAP reinforces the treatment and increases the likelihood of success. By providing assistance before an employee's work or absenteeism deteriorates to the point of dismissal, the EAP preserves an important part of the employee's life and helps the employee to build on that and to have a better chance at recovery. In many cases the destruction of the affected family as a result of the problem is so far along that the worker's job is the only point of stability left in a chaotic life. As the employee's job performance returns to normal both employer and employee gain.
EAP services do not have to be very costly, particularly when health insurance covers the treatment programs. Essential to its effectiveness, however, is sufficient staffing so that a counsellor can spend sufficient time with the employee, manage the caseload without difficulty, and stay abreast of new developments in treatment and community resources.
In the future, it is likely that EAP programs will combine with health programs as an integrated wellness program that seeks to provide a full range of lifestyle guidance and support.
The following is an example of a corporate policy on employee assistance that may serve as a model for enlightened management.
Policy on Employee Assistance Program
To outline the company's approach for assisting employees with alcohol, drug or stress related problems.
1. The company recognizes that inappropriate alcohol and drug use, and stress induced emotional disturbances can result in treatable health problems.
2. As these particular health problems may affect a significant portion of a workforce, a special program that includes education, treatment and rehabilitation is established.
3. Alcohol, drug and stress related health problems will be considered and handled as would any illness which may affect job performance.
This policy applies to all company operations, subsidiary and affiliate companies.
2.2 Following a confidential evaluation by the company occupational health service, the employee may be required to obtain rehabilitative counselling, treatment or other outside services to resolve the problem.
2.3 Employees who refuse to accept a confidential evaluation or to follow recommended treatment will be referred back to their supervisor to follow normal procedures for dealing with deteriorating work performance.
2.4 Employees should not be disciplined for refusing a referral to the company occupational health service, nor should acceptance of a referral necessarily replace disciplinary action.
2.5. The terms of the company short-term disability plan apply.
1.1 The immediate supervisor will set work performance standards and identify unsatisfactory or deteriorating work performance.
1.3 If work performance is unacceptable and health reasons are given or suspected to be the cause, the supervisor will direct the employee to seek assistance from the company occupational health service. The directed referral immediately precedes any formal disciplinary process.
Departures from this policy must be approved in advance by the senior corporate officer responsible for occupational health and safety or the company medical director.
Dickerson OB, Kaminer AJ, eds. The Troubled Employee. Occupational Medicine: State of the Art Reviews 1986; 1(4):541-682.
Gaeta E, Lynn R, Grey L. AT7T looks at program evaluation. EAP Digest, May 1 - June 1982;2(4):22-31.
McClellan K. The consortium approach to EAP services. EAP Digest, January/February 1982;(2):33-35.