I. THE ROLE OF EMPLOYEE ASSISTANCE IN A CHANGING WORLD

From its roots as an attempt to help employees with alcohol problems that impacted job performance, the employee assistance profession has blossomed into a full-fledged professional service that fulfills numerous personal and organizational needs. Like the business and popular culture within which they exist, employee assistance programs (EAPs) now find themselves in a period of significant transition.

The characteristics of societal transitions and the process of change in general have been studied and written about extensively. Because this book deals primarily with changing and emerging new roles for employee assistance practitioners, a review of some of this material is useful, as it speaks to the issues the book addresses. Considering the larger picture will provide insights into techniques for managing the shifts facing the employee assistance field.

The changes in perspective and accompanying transitions now affecting large portions of global society have been underway for some time. Numerous journals, books, and forums have focused on this process. The consensus among those who deal with such issues is that substantial adjustment has dominated the last 70 to 75 years. Peter Drucker, in his 1989 book The New Realities, suggests that somewhere between 1965 and 1973 we moved away from the fundamental beliefs and social attitudes that have anchored us for the last century or two. One of those beliefs, Drucker claims, was that society was a savior, and that good social policies and programs would lead, if not to Eden, then at least to a vastly improved world. He contends that this belief has been replaced by a new mindset in which people question whether societal efforts can even function in a leadership role for establishing new directions, let alone accomplish "the greater good." While we may not be fully aware of the new paradigms that will emerge to guide us, we are increasingly disillusioned with society's ability to manage change effectively. We also have a heightened awareness of the impact dramatic changes have had.

Interestingly, a large portion of the transition and change in which we are all engaged has occurred since World War II. The last decade, by itself, has produced astounding surprises (the dissolution of the Soviet Union and subsequent collapse of Communism in Eastern Europe, for example) which indicate substantial shifts all across the globe. The emergence of the global economy and the increasing impact of technology have also fostered profound change.

As soon as change begins, transition, by definition, begins as well. This process seems comprised of three components: endings, a neutral zone, and new beginnings. As a society, we have been in the endings phase--the dissolving of the familiar--for quite some time. Endings are accompanied by a series of predictable characteristics. These include a sense of impermanence that leads to disengagement, a disidentification with what is happening around us, a disenchantment with what we have known, and a disorientation in our more global setting. We find ourselves employing labels like "disrupted," "distressed," "disconnected," and "anxious" to describe the experience.

In the United States, too, our awareness of change has intensified as the nation's two hundred year-old wellspring of good fortune has begun to show signs of drying out. Perhaps the most dramatic change we have experienced lies in the shift in our economic position on the world stage. For the first time in half a century, our country must now compete for dominance of the economic landscape. While the United States remains a major force, other competent industrialized nations have emerged to challenge it. The shifting ethnic composition of our citizenry has also caused significant change. Our population now reflects a degree of diversity never before anticipated. Emergence of the changing economic and demographic face of our society has alerted us, at last, that we are not particularly well equipped to manage the adjustments necessary for our continuing success.

These more macro changes have, of course, impacted the world of employee assistance. Establishment of the original employee assistance efforts was undoubtedly prompted, at least in part, by the stress resulting from both the pace of societal change and the changes themselves. The expansion of program parameters beyond their initial scope has also been dictated by some of the emerging features of our new world.

As mentioned, employee assistance efforts began as grassroots movements influenced by the founding of Alcoholics Anonymous in 1935. These efforts have taken on professional status in the last 15-20 years. Today, a variety of practitioners, each with his or her own areas of expertise and credentials, offer a variety of services. The majority of practitioners now represent educators, psychologists, social workers, and those I#recovering" from substance abuse. These professionals help people cope with the full range of personal difficulties, including individual psychological problems; marital, parental, and familial difficulties; work stress; financial and legal concerns; and substance abuse, which still comprises a significant portion of EAP caseloads. Current EAPs often serve dependents and retirees as well. The problems these people present may or may not directly impact an employee's workplace performance.

The level of support enjoyed by employee assistance endeavors has swelled in recent times. Initial undertakings, for example, had no benefits coverage to provide financial support for those attempting to solve alcohol problems, let alone all of the impairments now covered. As the advantages of rehabilitating previously impaired workers became obvious, however, businesses became more willing to commit company dollars to EAP efforts. This led to insurance coverage for people suffering from alcohol and other forms of substance abuse, as well as benefits for additional difficulties already described.

While appreciation of EAPs remains high at present, the changes that have taken place in the business world have given rise to new questions that demand attention. These questions have been stimulated, in part, by shifts that mirror some of the national and global changes already described. Primary among them are the skyrocketing costs to business of employee benefits, the emergence of managed care, legislation and regulations related to a drug-free workplace, and the shrinking pool of business dollars available to address job-related and personal problems employees might face. Employers and employees, like people everywhere, seem to have less faith that societal institutions are the best hope for resolving human difficulties. Since business, corporations, and the EAPs which serve them all represent social institutions, it is hardly surprising that the concept of assigning them the level of responsibility they have traditionally shouldered for solving "people problems" is now under review.

Turning to specifics, the dramatic rise in medical and benefits costs in this country has caused companies to question whether they can still afford to allocate their dwindling resources to cover the range and types of problems EAPs now typically handle. The increase in substance abuse across the United States has made the provision of treatment to those in need more costly. With its component of relapse as part of the disease process, substance abuse has come under particular scrutiny since a relatively small number of people generally consume most of the available benefit dollars by requiring repeated treatments (Broskowski, 1991).

The advent of managed care has also led to a reassessment of employee assistance efforts. Conceived to combat spiraling medical costs, managed care was charged with reducing spending while insuring that an "appropriate level of care" continued. Managed care efforts often contain components that appear to overlap with employee assistance functions. The most obvious example is utilization review. Managed care personnel, usually nurses, are assigned the responsibility for making assessments and diagnoses, and then matching patients with the appropriate level of care and treatment provider. This has been an employee assistance job function for some time where mental health and drug and alcohol abuse are concerned. Some managed care efforts also claim to provide a full range of employee assistance services as part of their health care delivery system. Given this perceived redundancy in a time of scarce resources, businesses have, not surprisingly, begun to consider whether EAPs are necessary.

The establishment of the drug-free workplace as a standard for American industry presents a third factor stimulating review of EAPS. While articulating basic guidelines for achieving a drug-free workplace, management has often contributed neither desire nor appropriate funding to support the accomplishment of stated goals. While almost all guidance on EAPs recommends a combination of assistance and consequences, criteria that spell out recommended components of such efforts are neither uniform nor specific. This has generally left direction of drug-free workplace efforts in the hands of individual organizations, many of which have begun with a comparatively punitive approach, instead of one that incorporates education and rehabilitation in conjunction with the more traditional disciplinary actions associated with unacceptable job performance. Increasingly, organizations realize that their economic interests are better served by rehabilitating employees instead of firing them, some enterprises remain wedded to punitive measures to the exclusion of all other options for handling mental health, drug, and alcohol abuse problems. The economic argument, for whatever reason, has not convinced them. These organizations also seem to believe that negative measures more accurately reflect the tone of the legislation or regulations that have been passed than alternatives that educate or provide assistance for managing difficulties.

Increased global competition has also impacted the status of EAPS. To compete, businesses must operate more efficiently with fewer resources than ever before. Employees, therefore, may be asked to shoulder more of the burden for assistance themselves, and will find relapses tolerated and supported to a much more limited degree. Accountability requirements will likely increase for EAPS, with funding dependent to some extent on demonstratively positive results. Programs will need to illustrate in measurable ways that they are accomplishing the goals that guide them.

EAP professionals have exhibited many of the same characteristics common to other groups when confronted with transition and change and the questions and concerns that accompany them. While many view the challenges as new opportunities, others have resisted any alterations. These people see the changes taking place as undermining and dismantling what has been a positive and effective calling. As a consequence, they have had difficulty generating alternatives that would encourage the most productive adaptations for the changing world.

Where does this leave employee assistance efforts today? The answers to that question are myriad. Some argue that EAPS, as we now know them, should be absorbed into managed care or even national health insurance efforts, should that option emerge.

Others take a more central position, arguing that the need for EAPs is greater than ever, and that the efforts should continue more or less as they are now. Finally, others believe that EAPs should remain an integral part of the business arena, but that their role should be substantially redefined. many in this position suggest that the focus of employee assistance needs to shift from strong clinical involvement to a broader organizational outlook. Gatekeeping, education, and program evaluation of the clinical aspects of service delivery might become primary responsibilities of employee assistance professionals with this point of view. Practitioners might also assume a broader range of human resource activities, such as crisis management, wellness programs, and training and development as directions for EAPs to become better defined.

The purpose of this employee assistance handbook is to provide a guide for those interested in examining what the profession might offer with regard to managing our changing business environment. It gives those charged with the responsibility for such endeavors an opportunity to explore multiple approaches and emerging strategies. It discusses alternatives and directions organizations might consider, depending on their particular circumstances and concerns.

The book is primarily geared to human resource professionals and those fulfilling that role, who will be asked, increasingly, to make difficult decisions about how dollars allocated to the people dimension of the business world will be spent. However, it may also prove useful to employee assistance professionals. While

Focusing partially on the assessment of EAPs already in place, the book is also geared to defining new possibilities. Given the number of new factors now facing EAP operation, the appearance of such a book seems particularly timely. These new factors, and the profession's response to them, will play critical roles in determining the shape, size, and direction of EAPs in the future.

REFERENCES

Broskowski, Anthony (1991), "Current Mental Health Care Environments: Why Managed Care is Necessary," Professional Psychology: Research and Practice, Vol. 22, No. 1, pp. 6-14.

Drucker, Peter (1989), The New Realities, Harper & Row Publishers, New York, New York.

Continue to: EAP Handbook - Chapter 1 - HISTORICAL OVERVIEW AND EVOLUTION OF EMPLOYEE ASSISTANCE PROGRAMS

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© CONSAD Research Corporation, 1999