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EAPage.com has long supported the mission of EAPs.
Competition for your business is fierce. There are many
products, methods of delivering services, pricing structures, and
sizes. This section is designed to help you get through the
bells and whistles and finding the right services for your
business objectives.
What you should first know:
- There are National and International
Associations with governing boards, members and ethical
standards. The two main organizations are: Employee
Assistance Professional Association (EAPA),
Employee Assistance Services of North America (EASNA).
Each have local and/or international chapters.
- EAP counselors have various credentials,
licensing, training and relative experience. EAPA offers a
credentialing certification- Certified Employee Assistance
Professional (CEAP). For more information review the
CEAP handbook.
- EASNA offers an Accreditation for EAP
programs that must meet certain criteria. To review this
criteria go to
Accreditation.
Types of EAPs
Internal EAP
Internal EAP services generally provide full and
comprehensive service. Staff consists of trained professionals
with strong clinical backgrounds, including social workers,
psychologists, and certified alcoholism counselors. Organizations
with large employee populations are more likely to provide
internal service.
A strong argument for internal practitioners is that they have
greater access to and more effectively understanding of the
workings and culture of their organization. Outside contractors
with limited organizational contact simply cannot duplicate the
amount of information available to the internal EAP provider.
The loss of organizational input through employment of outside
contracting deprives an EAP of one of its essential components.
Further, internal EAP services provide easy access to employees
during working hours. Availability encourages utilization. Having
the program so readily accessible, however, creates one serious
problem: employees sometimes fear that such close proximity to the
organization might jeopardize confidentiality of services, and
render the EAP more susceptible to management discovery and
manipulation. This is a perception problem that is inherent with
internal programs and must be routinely addressed.
External EAP
EAP services can also be obtained through
contracts with external for-profit or nonprofit organizations.
Organizations often view contract services as a quick and
efficient way to establish and maintain an EAP. Managers also
apparently believe that utilizing outside contracting shifts EAP
liability away from the organization (Sonnenstuhl, 1990). The
truth of this assumption remains unclear. Some contend that
organizations remain just as liable for the agents they select to
assist them as they are for the actions of their employees.
As discussed previously, one major drawback of external EAP
services is their more limited workplace knowledge and experience.
Regardless of a provider's clinical experience, the lack of a
regular, extended on-site presence prevents an intimate
understanding of the organization. Outside contractors, therefore,
frequently emphasize counseling and de-emphasize the
organizational opportunities and interactions displayed by their
internal counterparts (Sonnenstuhl and Trice, 1990). There is a
greater perception of confidentiality with external EAPs by virtue
of employees going "outside" the company for services and less
likely being seen. There is also a greater expectation that
appointments be done outside of the work schedule.
Combined Programs
Use of in-house services and external
contractors or community resources constitutes yet another
strategy for delivering an EAP service. An organization desiring
this type of effort would employ EAP personnel to deliver certain
services themselves, and then contract with external vendors for
other services as needed. The in-house EAP coordinator might
assess employee difficulties and educate the workforce in general,
but then assign placement for treatment and surveys of community
resources to contractors outside the organization. The EAP's
internal component might also provide training to supervisors and
union officials regarding program utilization, policies, and
procedures.
For more information see the
EAP Handbook
Before meeting with prospective EAPs, determine what your needs
are. Have a clear understanding what you want of your EAP. What
do you want to see different next year when you review the
effectiveness of your EAP? Avoid letting sales
presentations tell you what your needs are. In an article from EAP
Exchange (magazine published by EAPA) an article in February 2003
relates to encouraging EAPs to create their own identity about who
they are, what they can do, and who they can serve.
"...the issue of meeting customer needs is all a bunch
of horse manure in lots of ways. Because if you don’t know what
their needs are, how are you going to meet them? Sometimes we
think we ought to be able to sell something new to our customers
because they don’t know what their needs are. So I think we have a
real struggle in terms of determining what a customer’s real needs
are." (EAP Exchange, 2003)
EAPs are being called to the task of ethical marketing, sales
practices and accountability for their services. It was not
uncommon for an EAP to report that they have a network of
providers local to your employees. Then after the contract is
secured to go out and create one.
If an EAP cannot demonstrate they have the resources and
know-how to meet your objectives, move on.
Delivery of EAP Services- EAP Counseling
The primary role of the EAP counselor is to make an accurate
assessment of the employee's reported issues and offer a plan to
address and improve upon the assessed problem. Part of the
assessment should include whether or not the problem is affecting
work performance and if so, included in the plan. How the
assessment is conducted may vary depending on the EAP. Not all
methods are can provide the same service.
Face to Face Meetings- Clearly the
preferred manner to conduct EAP sessions from a clinical
standpoint. Employees will meet with a counselor on-site or away
from the workplace. Meeting with an local EAP
counselor offers advantages to the assessment process as the
provider is aware of local customs, resources, and relevant
geographical implications (commuting for instance). Face to face
meetings offers the EAP counselor visible information which is
important in making an accurate assessment. There may be times
that the body language may conflict with the oral presentation. If
a Counselor picks up on this (and they should) it will generate
more assessment questions and likely lead to a truer reflection of
the problem areas. A local counselor will likely have
greater knowledge of the potential referral options. This is
a key function of the EAP counselor.
Telephonic Meetings- Assessments over the
phone have grown in popularity. It has been seen as a more cost
effective manner to implement the counseling services. Being able
to provide a 24-hour, 800 number coverage at a reduced cost of
having a face to face program is enticing. However, telephonic EAP
has its limitations. The obvious absence is the visible
information gained in face to face meetings. Phone counselors will
argue that other skills are utilized to improve the accuracy of
the assessments. There is some truth in this. Other
considerations, however, are the location of the counselor in
relation to the employee. An employee in South Carolina speaking
with a counselor in Chicago can create some gaps in the services.
These gaps are magnified when the services reach across
internationally.
Telephonic sessions are not, by any means,
invaluable. Offered to employee when face to face is not
realistic, by counselors knowledgeable of, or local to, of certain
areas. After-hours coverage and emergency response are also
excellent ways to utilize telephonic interventions. Employees may
prefer to "meet" over the phone. It may feel safer and more
convenient to their schedules.
Online Counseling- Also comes with
limitations as the primary means to offer EAP counseling services.
Online counseling cannot spontaneously convey emotional content
accurately or as it is intended to be expressed. Crying in-person,
or over the phone is a different experience then telling the
online counselor you are crying or indicating this by a symbol.
The process of using a key board requires a cognitive translation
from thought or affect to the skill of typing. This may come
naturally for some, but not for most and spontaneity is lost.
Online services not done in real time also offer a break in the
exchange of dialogue. The role of the EAP counselor is to
accurately assess. If an employee sends in a request for a
resource to gain help for their presenting problem, of
course a resource can be returned via an online format. But is it
the correct resource? If someone writes in they are looking for a
support group because they are having difficulty getting over the
sadness related to their divorce they also may be drinking
excessively, may have gone into a depression and need medication
or something else that is complicating their recovery. Online
counseling is a format that makes the exploratory process more
difficult and thereby potentially less accurate.
All of these methods offer something. Making sure you
have the right match based on your needs is crucial. They
are not the same service delivered in a different format.
What makes up an EAP Counselor?
First an abbreviated history lesson.
In the early days of EAP, most EAP
services where offered in-house (internal) by self identified
employees who were recovering alcoholics. Occupational
alcohol programs (OAPs) as they were called, were the earliest
form of employee assistance. These efforts were founded by
recovering alcoholics who, with the help of Alcoholics Anonymous
(AA), had overcome drinking problems that had significantly
affected their personal and working lives. What was learned that
by rehabilitating, rather then firing, the company was able to
retain employees and avert the cost associated with retraining and
productively loss. "Counselors" in recovery, however, could only
offer assistance in alcohol related problems. Some companies still
have employees in recovery as part of their overall EAP services
but by an large, they are fewer and fewer.
By the 1960's the OAP service which had gained popularity,
transitioned from an alcohol based problem intervention to a work
performance intervention. Employees presented other problems than
alcohol related problems which contributed to or impaired their
job performance, and management had no resource available to
impact them. Out of this need, the concept of employee assistance,
as we know it today, was born.
EAPs began employing counselors with training in a multitude of
problem areas. In the 1980's the Public and mental health
agencies, alcohol and drug treatment centers, and private
consulting firms eagerly entered the EAP field, seeing potential
for future economic survival in partnership with industry. New
concepts also emerged with purportedly preventative capabilities
focusing on stress management and health or wellness and
"addiction" problems (smoking, overeating, overworking, etc.).
Innovative, controversial programs proposed that controlling
stress and encouraging healthier lifestyles among employees could
reduce or prevent many problems dealt with in occupational
alcoholism programs and EAPs.
A new breed of EAP counselors entered into occupational health.
Psychologists, social workers, addiction specialists and other
mental health providers began offering and were hired by business
to provide an EAP service.
In 1985 a certification for counselors was developed by
Association of Labor and Management Administrators and Consultants
on Alcoholism, or ALMACA (renamed the Employee Assistance
Professionals Association, or EAPA, in 1989). In 1987 the
Certified Employee Assistance Professional (CEAP) credential began
to mark a process of evaluation of EAP counselors through
experience, advisement and examination. Its' goals are to identify
to the public and profession those individuals who have met
established standards for competent client-centered practice and
adhere to an enforceable professional code of ethical conduct.
With the onset of Managed Care in 90's, EAP counselors began to
show up everywhere. Although managed care began in the late
1960's/early 1970's, the impact upon treatment providers began to
considerably impact treatment options for clients and the ability
to make a living in the private sector of behavioral health care
in the 90's. Focused on cost containment, managed care
agencies developed provider lists which soon became one of the few
ways private practitioners could receive referrals from employees
who desired to use their insurance plans. In the interest of
saving their practice, practitioners despite their resistance,
signed up but did not necessary ascribe to, or have the training
in short-term models manage care required. Many signed up on
EAP lists to do EAP assessments for large external EAP providers
who needed counselors in areas throughout the country. Was this
unethical? Yes. Was it regulated? Poorly. Does it still exist
today? Yes.
Well wouldn't a psychologist be able to do an EAP assessment
even if they weren't trained in EAP?
A psychologist can provide a clinical assessment and make
treatment recommendations. Most however, do not understand or have
experience in serving dual clients, that is, the client and
the organization. This is a neutral position. Treating
providers unfamiliar with EAP will likely align with the client in
front of them. Newly signed up "EAP providers" are unlikely to
understand the job performance referral process and the
organizational flavor to their roles. In short, untrained EAP
counselors can provide some of the EAP role, but generally not the
full spectrum of services nor have the skill set an EAP Counselor
must have possess to provide effective EAP work.
EAPage.com's EAP Counselor Guidelines:
Has at least a masters level degree.
Has training in substance abuse.
Has worked in both inpatient settings and
outpatient settings.
Has had or has a private practice.
Meets all licensing requirements.
Has been in their own psychotherapy or recovery.
Has training in Critical Incident Stress
Management.
Is an association member.
Technological proficient.
Professional speaking skills.
Local to employees.
Short-term treatment training. Long-term
developmental conceptualization.
Has a CEAP.
Diversity Training.
Culturally sensitive.
Organizational training.
EAPs and Diversity.
Diversity is not just a Human Resource Department concern.
We think that because EAP programs and counselors have some level
of clinical training, therefore, they are sensitive and
knowledgeable to issues of diversity, ethnicity, minority and
culture. Sensitive likely, trained possibly, but integrated
into their business approach requires checking beyond what the
brochure reads. When reviewing the services of an EAP consider the
following:
- Are their outreach materials, seminars, worksite trainings
gender specific and culturally sensitive?
- Do referral networks include treatment providers who
specialize or are culturally sensitive to the needs of women and
racial/ethnic minorities?
- Have counselors been trained in issues of racial bias,
discrimination and stereotyping?
- Are their screening tools culturally sensitive and adaptive
for gender and unique populations?
- Is there diversity among the EAP staff? Their existing
Corporate clients?
- Are marketing and sales presentations all-inclusive? Or do
you have to ask?
- Is their list of training programs reflective of your
organizational culture?
- Are there services or access to interpreters, and handicap
needs, i.e. deaf.?
If issues of diversity are not openly presented on initial
presentations, it was because it was not thought of. This is a
warning sign. If it has been presented, then probe deeper by using
the guide above to determine if there is substance beyond the
presentation.
More to come...
EAP and Managed Care Related Terms
EAP services and Managed Care services are often combined when
considering a plan to reduce health care costs. Here are some of
the terminology likely to be heard.
Accreditation: Acceptance by a nongovernmental state of
national peer body as meeting prescribed or desirable standards
set by the body.
Capitation: A method for payment of
providers. Usually this is a prepaid amount per month to the
provider per covered member. In risk arrangements, the provider is
then responsible for providing all behavioral health services
required by members of that group during that month for the fixed
fee, regardless of the amount of charges incurred.
Carve-Out: A health care plan in which the employer
separates the funding for, and requirements to receive, certain
medical benefits (for example, mental health care) from the
general medical benefits plan.
Case management: The monitoring, planning and coordination
of treatment rendered to patients with conditions requiring high
cost or extensive services. Case management is intended to ensure
an appropriate and cost-effective course of treatment in an
appropriate setting.
Cost Containment: Strategies to control
or reduce inefficiencies in the consumption, allocation, or
production of health care services that contribute to higher than
necessary costs.
Fee-for-Service: In the traditional fee-for-service model,
the health service provider bills the patient for a specified
amount, typically on the basis of the amount of time spent
delivering the service.
Gatekeeper: The role of the gatekeeper is to establish the
patient's diagnosis, formulate a treatment plan, and refer the
individual to the appropriate medical provider. The gatekeeper
might also monitor care, reassess periodically the patient's
status to determine necessary changes in care, as well as maintain
a watchful eye over the provider to ensure quality care.
MCOs: Managed care organizations are alternative health
care delivery systems that use mechanisms to reduce utilization
and/or control prices. MCOs provide financial incentives or
constraints to encourage the use of efficient providers of medical
care.
Point-of-Service: A type of managed care plan that offers
members a choice of using a doctor within or outside an approved
network each time they need health services. If network doctors
are used, a patient pays a low fee and no deductible. If
out-of-network doctors are used, the deductible and reimbursement
rates are similar to the more traditional group indemnity plans.
PPOs: Preferred Provider Organizations generally consist of
a network of independent health care providers who usually offer
first dollar coverage of 80 percent or more. Consumers may decide
whether to opt for a preferred provider on a case-by-case basis.
Approximately 80 percent of charges are covered when a non-PPO
provider is chosen.
Preadmission Certification: A health care professional
evaluates an attending physician's request for a patient's
admission to a hospital by using established medical criteria.
Problem Focused Therapy: A type of outpatient
psychotherapy, generally short term (average of six to eight
sessions) with the emphasis focused on the problem the client
brings to the therapy session. When this problem has been
resolved, therapy is terminated.
Reasonable and Customary Charge: The
going rate or charge for health care in a certain geographical
area for identical or similar services.
Utilization Review: Evaluation of the necessity,
appropriateness, and efficiency of the use of medical services,
procedures, and facilities based on pre-set criteria. A
comprehensive utilization review system includes admission review,
concurrent review, and discharge review.
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