II. HISTORICAL OVERVIEW AND EVOLUTION OF EMPLOYEE ASSISTANCE PROGRAMS
An appreciation of EAPs past and present helps lay a foundation for future planning. Historical study illustrates what has been effective in the employee assistance field by highlighting elements germane across circumstances and time. It also speaks to specifics of program operation by documenting a range of program models utilized for service delivery to date. In times of change, historical study becomes particularly useful, offering access to a wide range of possible options and reducing the possibility of repeating previous mistakes. A well-defined point of departure makes the charting of new territory easier and less intimidating.
A. Definition and Employee Assistance Program Rationale
Employee assistance programs have become a familiar facet of the American industrial landscape, but even today, there is no consensus as to what actually constitutes these efforts. Some practitioners still debate which elements give an EAP legitimacy. The research work of Paul Roman and Terry Blum, however, has yielded a core technology that comes closest to capturing the experience of long-term employee assistance professionals. Roman and Blum (1988; Roman, 1991) assert that for such programs to reflect their history, they must:
1. Provide effective liaison with supervisory management. This linkage includes:
a. Identification of problem employees through the vehicle of inadequate job performance;
b. Consultation with supervisors on how to refer to and utilize EAPS; and
c. Instruction in how to practice constructive confrontation that motivates employees to improve their job performance if they desire continued employment.
2. Provide effective liaison with benefits management. This linkage includes:
a. Creating a network between employee assistance and appropriate community resources;
b. Creating a working relationship between service providers and employee assistance practitioners;
c. Fostering acceptance of the fact that the workplace can be an appropriate setting for dealing with personal problems that might impact job performance, especially when those problems are alcohol and drug abuse;
d. Combining alcohol and drug abuse benefits with other forms of treatment; and
e. Insuring managed health care through cost containment and other gatekeeping efforts.
3. Provide effective assessment and referral for a number of human problems, among which addiction problems are clearly the most important.
The Employee Assistance Program Association (EAPA) also offers guidelines with regard to definition. The Association defines EAPs in their Standards as:
10 ... a worksite-based program designed to assist in the identification and resolution of productivity problems associated with employees impaired by personal concerns including, but not limited to: health, marital, family, financial, alcohol, drug, legal, emotional, stress, or other personal concerns which may adversely affect employee job performance" (EAPA, 1990).
These two resources capture mainstream current thinking within the field. Although various aspects of the definition of employee assistance remains contested, the reasons companies, governments, and other organizations have established such programs for their workforce have become obvious. Primary rationales for these efforts fall into three major areas: humanitarian commitments, safety issues, and economic concerns. Managers in most organizations realize that employees are their most important asset. Even with the advent of computers and robotics, people still make organizations function. Workers, however, are human beings, and therefore face human problems. In these stressful times, the frequency and magnitude of human problems has, predictably, increased. Assisting employees through their difficulties is humanitarian and moral act, and has often been cited by administrators as a justification for employee assistance efforts. Safety issues also motivate organizations to establish EAPS. A number of federal and state government regulations specify that organizations must provide a safe working environment for their personnel (Occupational Safety and Health Act of 1970). Failure to address human problems may therefore subject an organization to legal liability. This is especially true if suspicions about safety hazards have been reported, and the organization takes no action to address the situation. Any of the wide range of human problems including depression, anxiety, stress, and certainly drug and alcohol abuse, can conceivably cause or accelerate safety-related problems. Costs for negligence in this area can be considerable in both human and financial terms.
The primary impetus for the establishment of EAPS, though, has been and remains economic. While estimated costs of human problems vary widely, no one disputes that their impact is substantial. The Health Insurance Association of America (HIAA, 1991) estimated the treatment costs for mental illness and drug abuse in the United States at $105 billion in 1989. Recent estimates of the economic cost of substance abuse alone range between $70 and $75 billion annually (Hoffman La Roche, 1988), representing annual productivity losses of $30.1 billion for United States businesses (Farkas, 1989). To reduce such costs, businesses and governments have looked to dramatically expanded EAPS. Small businesses, too, have begun contracting for employee assistance services.
B. Evolution of Employee Assistance Programs
There are many different EAP alternatives available in today's market, with numerous organizations and individuals claiming program expertise. Part of the reason for the existence of such myriad options is that employee assistance has become a profitable, market-driven business. To make intelligent choices between options, human resources (HR) managers need to understand underlying philosophies with regard to what different programs seek to accomplish. The sophisticated businesses on the current scene often emerged out of humble origins. As mentioned, occupational alcohol programs (OAPs) 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. By the late 1940s, a number of organizations had begun to recognize that employees with alcohol problems could be treated and subsequently returned to work. Profound changes in both work productivity and general life functioning occurred when drinking ceased. EAPs at Eastman Kodak and du Pont in the early 1940s as well as later programs at North American Aviation, Consolidated Edison, New England Electric, and Caterpillar, all possessed similar characteristics. They focused primarily on alcoholism and alcohol related problems, and their initial efforts remained mostly informal. The dedicated efforts of industrial or company physicians proved instrumental in gaining management acceptance and approval for these undertakings.
Employers aided the recovering individual initially by assuming the risk of returning that person to work. When such gambles proved successful, efforts began to identify employees with alcohol problems before termination due to poor job performance became necessary. Supervisors and certain union representatives assumed these new duties. These individuals received minimal training in the signs and symptoms of alcohol abuse and addiction so they could recognize such problems among their colleagues.
Between the mid-1940s and the end of the 1950s, the Labor Management Committee of the National Council on Alcoholism (NCA) worked with many companies, unions, and governmental agencies on establishing alcoholism programs. Relentless trial and error produced major refinements in the creation of meaningful and successful efforts. These refinements resulted in the formalization of alcoholism programs, increasing acceptance in the business environment, and growth in jointly supported union management ventures. However, repeated applications of the original occupational alcohol/supervisory approach revealed some obvious shortcomings. Charging first line supervisors, for example, with the responsibility for identifying and referring employees with alcohol problems left people above first line management largely undiagnosed. This pattern of referral persisted despite overwhelming evidence that alcoholism affects every occupational and professional level equally. Worse, it often created the impression among employees that these initial programs were "witch hunts." Such an attitude obviously made constructive, cooperative efforts increasingly difficult to achieve.
In addition, supervisors tended to base diagnoses on their own knowledge of alcohol problems and drinking habits. Thus, if the supervisor had a drinking problem, he or she would not likely diagnose others with similar difficulties. Moreover, since early training sessions were typically brief, elementary, and not repeated, the tendency to return to personal biases and assumptions about drinking over time remained strong.
Finally, first line supervisors proved no match for practicing alcoholics with years of experience in manufacturing excuses for failures in responsibility. Lacking understanding of the disease process, supervisors often unintentionally aided the practicing alcoholic by covering up his or her mistakes. Because of the considerable stigma attached to alcoholism, supervisors also leaned toward postponing referral until they could completely verify the presumed problem. Most individuals referred for help, therefore, had already reached the end stages of the disease process, where the chances for recovery are more remote.
By the 1960s, a shift in focus had occurred in the workplace from the attempts to identify the symptoms of alcoholism to that of impaired job performance. Several factors eased this transition. First, problems with job performance carried less of a blemish with them than alcoholism. Second, the use of concrete behavioral descriptions (poor turnaround time, difficulty getting along with others, excessive absenteeism) allowed supervisors to avoid arguments over alcohol use and abuse, and, thus, sidestep the alcoholic's denial system. Third, most supervisors recognized the rudimentary nature of their training in diagnosing alcohol abuse, and so hesitated to act on it, but gauging job performance was something with which these same supervisors were comfortable and familiar. When asked to assume responsibility along these redefined boundaries, they accepted the task.
This shift in supervisor focus to job performance, however, uncovered one of the biggest limitations of employee assistance efforts to date: assistance only existed for alcohol problems. When employees presented other problems contributing to or impairing their job performance, management had no resource available to impact them. Out of this need, the concept of employee assistance, as we know it today, was born.
Contemporary employee assistance efforts have expanded well beyond the scope of the original alcohol approach. EAPs have generated widespread acceptance of the fact that many personal problems beside alcoholism affect (or potentially affect) an employee on the job, and have overcome some of the stigma attached to previous efforts by broadening the spectrum of care. Because a wider range of services exists, utilization often takes place earlier, and problems get addressed before they reach a chronic and less manageable stage. Interestingly, this approach seems to have expanded the identification of alcohol abuse, and has exposed drug abuse as well. These difficulties often surface during treatment an employee has sought for an apparently unrelated problem.
Current employee assistance efforts still deal with substance abuse, but also typically address: individual psychological problems; marriage, family and child difficulties; work stress; and financial and legal concerns. Adding problem areas to the program palette has generated what is commonly known as the "broad brush" or comprehensive approach to human problems. The Comprehensive Alcohol Abuse, and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (also known as the Hughes Act) helped speed the evolution described. The Act identified alcoholism as a physical and psychological disease, effectively decriminalizing alcoholism and setting the stage for more systematic and thorough efforts to mobilize treatment resources for the employed alcoholic. A separate federal agency, the National Institute of Alcohol Abuse and Alcoholism (NIAAA), was established in 1971. The NIAAA began providing, through its occupational branch, considerable attention to the development of alcohol related programs in both private and public organizations. In 1972, the NIAAA trained occupational program consultants and published a position paper supporting the comprehensive approach to EAPS. The comprehensive concept had become the norm in industrial counseling by the end of the decade.
In 1974, the organization of the Association of Labor and Management Administrators and Consultants on Alcoholism, or ALMACA (renamed the Employee Assistance Professionals Association, or EAPA, in 1989), provided another major boost to the EAP movement. AL14ACA contributed to the dissemination and enhancement of EAP knowledge. Publication of a directory of EAP specialists has increased community and individual awareness of the EAP concept. Since the mid-1980s, credentialing of employee assistance professionals has fallen within the jurisdiction of the Employee Assistance Certification Commission of ALMACA/EAPA (Bickerton, 1990). As mentioned earlier in this chapter, EAPA has also published program standards to serve as guidelines for establishing EAPS. However, program standards and particularly certification remain controversial issues. (See Chapter III for further discussion.)
One of the more important events in the 1980s contributing to the rapid growth of EAPs was the increasing involvement of public treatment centers and private practitioners in EAP services. Government cutbacks had left a void in treatment through typical employee assistance programs. 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. Some managed mental health care firms now offer services to employees that are often mistaken for EAPS. These arrangements typically involve a provider organization with a staff skilled in both diagnosis/referral and counseling/treatment, and offer at least some proportion of these at low rates or even no charge. They claim more efficient and effective use of benefits dollars as a result, with an accompanying better access to treatment. Frequently marketed as EAPS, these services often include little of the core technology of actual employee assistance efforts. Though similar in appearance, their present structure does not provide full and comprehensive EAP services (Roman and Blum, no date). For a detailed discussion of the EAP/managed mental health care controversy, see Chapter V.
C. Continuum of Responsibilities
As mentioned earlier, the EAP concept can be viewed as a continuum of different models, each with a set of responsibilities. Adapting EAP responsibilities to the unique needs of a particular organization or worksite typically produces both the greatest program success and organizational satisfaction. This section outlines the continuum of responsibilities from which an HR or EAP manager might choose when matching EAP efforts to organizational needs and goals.
EAP responsibilities fall into two fundamental categories: clinical and organizational. Handling clinical problems facing employees requires EAP practitioners to engage in assessment, diagnosis and referral. Evaluations may apply to alcohol and/or drug abuse programs only, or to comprehensive, full service efforts. In the latter case, clinical programs typically deal with individual psychological problems, marital and family problems, work stress, and legal and financial concerns as well as substance abuse. An EAP professional's duties might also include short-term counseling (i.e., three to six sessions) for any of the clinical components of the program.
Other clinical duties may involve developing a network of high quality treatment resources, monitoring service delivery, participating in treatment planning as appropriate, maintaining a support system for the employee in the workplace even after clinical placement, and remaining as a liaison between the treatment provider, the individual, and management as necessary.
Clinical contributions alone, however, do not define the uniqueness of the employee assistance concept. Organizational responsibilities have historically had at least equal importance. Changes in the workplace make this aspect of EAPs even more important today. As indicated by the core technology described, one organizational responsibility for employee assistance is to assist supervisors. Assistance can include consultations with supervisors regarding employee problems, developing strategies for handling problem individuals whether or not employee assistance formally intervenes, and supervisory training in employee assistance and other areas of human development as needed.
Effective employee assistance practitioners have also acted as expert consultants to other staff members of the organization utilizing them. They have often been asked to advise and lead in times of crisis, layoff and retirement. Management development and/or labor relations have enlisted employee assistance professionals to help reconcile organizational problems that require the application of discipline with the personal needs of employees who need attention and compassion. Qualified personnel have also been requested to provide interventions when an analysis of EAP records reveals that many referrals come from the same area in an organization, and that the problems appear to stem from the same work-related source. Further, by maintaining accurate statistics on their programs, professionals in the employee assistance field have sometimes foreseen emerging needs for health care, education, and/or training and development.
Employee assistance personnel also help manage health care, especially where benefits analysis, cost containment, and development of effective service for alcohol, drug abuse, and mental health are concerned. The organizational component of such programs is at least as important as the clinical. Insuring the involvement of employee assistance providers in the organizations they serve maximizes the chances for program success. In the mid-1980s, EAP experts began debating the merits of "mega-brush" programs (Erfurt, Foote and Heirich, 1991). "Mega-brush" programs refer to the combination of EAPs and worksite wellness efforts. Where EAPs typically treat substance abuse and mental health problems already affecting job performance, wellness programs deal with prevention and control of physiological and behavioral health risks before such risks develop into disabilities. The combination of EAPs and wellness programs has some observers concerned about the possible dilution of EAP core technology (Roman and Blum, no date) . However, employers' concerns about health care cost containment encourages consideration of all avenues of health improvement, including adoption of both wellness programs and EAPS. If run cooperatively, wellness and employee assistance efforts have shown potential for complementing each other quite well (Erfurt, Foote and Heirich, 1991).
Claims for the success of employee assistance have sometimes reached surprising heights. Unfortunately, much of the data in this area is not the product of rigorous research investigation. Nevertheless EAPs have succeeded, and, in fact, have had an impact on cases where traditional managerial intervention and treatment programs have not. The reason for this is that individuals will sometimes face personal problems when their job is at stake that they would not face when confronted by family, friends, and clinical treatment providers. According to EAPA estimates, an organization sponsoring an EAP can expect up to a five-to-one return on investment through savings made possible by employee response to counseling and subsequent job performance improvement (Nordheimer, 1990). As a result of their contributions to organizations, the number of EAPs has swelled dramatically. EAPs have a marked presence amongst the companies listed in the Fortune 500. As early as 1973, 25 percent of Fortune 500 companies already had an EAP. By 1979, 59 percent of the Fortune 500 companies had established EAPS, and today, estimates of program operations in these organizations have reached 80 percent.
D. Influence of Government Regulations
Several federal laws have had an important influence on how organizations deal with alcoholics, drug abusers, and other impaired workers. For example, the Comprehensive Alcohol Abuse, and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 referred to earlier, directed the federal government to aid federal civilian employees (and, due to a later amendment, their families) in alcoholism prevention, treatment, and rehabilitation (42 U.S.C. paragraph 4561). Subsequently, the Vocational Rehabilitation Act, passed in 1973, prohibited employment discrimination by federal contractors or subcontractors against employable, qualified, handicapped workers. Amendments in 1977 to this Act ensured that employees with a history of alcohol and drug abuse receive the same rights as other handicapped workers. These amendments also directed federal contractors to take affirmative action and hire individuals with a history of drug and alcohol addiction if they are qualified and able to perform their duties (Banta, 1989). As a result of these federal laws, alcoholism is now viewed as a legal disability, and the Vocational Rehabilitation Act has been reenforced, in a variety of contexts, to ensure the workplace rights of alcohol and drug abusers (Geidt, 1985). In 1978, however, the Rehabilitation, Comprehensive Services, and Developmental Disabilities Amendments drastically altered laws prohibiting discrimination on account of a physical handicap, as well as redefining the term, "handicapped individual." According to these amendments, an employee "who is an alcoholic or drug abuser whose current use of alcohol or drugs prevents such an individual from performing the duties of the job in question, by reason of such current alcohol or drug abuse" is not considered physically handicapped (Paragraph 122). Thus, in most jurisdictions, an employer may terminate an employee for alcohol abuse or drug addiction, except where a contract modifies the right to discharge employees, such as in a collective bargaining agreement. Even if the employer has the right, though, to discharge an employee, the employee has the right, in a number of states, to receive unemployment and disability benefits. Furthermore, if the disease is demonstratively job-related--due to work-stress, for example--the employer might have additional liability for damages for such a disability (Swanson, 1984).
Moreover, according to the Equal Employment Opportunity Commission's (EEOC) guidelines, an employer aware of an employee's alcoholism or drug abuse must make "reasonable accommodation" to known physical and mental limitations of a qualified handicapped applicant or employee unless the employer can demonstrate that the accommodation would impose undue hardship upon the operation of the organization (EEOFG, 1982). Arbitrators have interpreted this to mean that the employer has the duty to try to assist the troubled employee and to direct and encourage the employee to seek treatment. For this purpose, the employer must allow the employee to take sick leave, if necessary, for treatment, before initiating termination for continued poor job performance (Luthans and Waldersee, 1989). Although current United States law does not require employers to provide employee assistance services, some experts believe that most organizations could not meet the "reasonable accommodation" requirement without an EAP (Scanlon, 1986; Farkas, 1989). Instituting EAPS, therefore, can establish a first line of defense for organizations against unreasonable accommodation laws and wrongful termination suits (Good, 1986). Another piece of legislation with the potential for substantial impact on EAPs is the Drug Free Workplace (DFW) Act of 1988. This legislation requires the federal government, as well as its contractors and grantees, to have a drug-free workplace policy. All executive branch offices must develop drug-free workplace programs that provide for supervisory training, employee education, an EAP, drug testing, and a written policy statement. Private sector employers have also been encouraged to adopt these types of programs with the same components recommended in the federal arena (NIDA, 1990).
In response to the DFW Act, many organizations have adopted comprehensive programs, including drug testing. Some employee assistance professionals have expressed concern that the DFW Act might encourage the application of consequences" such as termination, without providing the opportunity, through the EAP process, for drug rehabilitation. The Act does not require organizations to establish EAPS, and only suggests making EAP services available as part of an alternative to disciplinary action. For a comprehensive interpretation of the DFW Act, see the Complete Handbook for Combating Substance Abuse in the Workplace (Banta and Tennant, 1989).
The most recent piece of legislation impacting employee assistance programs is The Americans With Disabilities Act (Public Law 101-336), signed into law in 1990 and enacted in July 1992. The Act includes various time lines stipulating when objectives defined must be accomplished. Provisions build on the Vocational Rehabilitation Act already discussed and further prohibit discrimination in employment against those with recognized disabilities. Under this new law, employers must reasonably accommodate those who can otherwise perform stated job functions, unless, once more, the employer can demonstrate undue hardship such accommodations would cause. Additionally, the Act establishes that: 1) employees can be tested for illegal drugs; 2) the use and/or abuse of illegal drugs can be prohibited in the workplace; 3) employers may require that employees be free from the influence of drugs in the workplace; and 4) the workplace must conform to the Drug Free Workplace Act of 1988.
E. Summary of Objectives of EAPs
Employee assistance efforts typically assist employees with personal problems that might impact job performance. Currently, most EAPs utilize a broad brush approach to human problems. For maximum employee assistance functioning, programs need both clinical and organizational responsibilities. The amount of additional responsibility an EAP decides to assume in a particular organization depends on the specific needs of the organization's workforce, as well as the organization's structure, philosophy, and resources. Whatever role the EAP plays within a given organization, its basic objectives, beyond its clinical role, are to retain valued employees with skills and experience and to make contributions to various aspects of the organization, including:
F. Unresolved and Emerging Issues of Controversy
Over the last ten years, EAPs have received considerable recognition for both clinical and organizational accomplishments. Larger organizations now typically regard employee assistance as an essential component of the human resources (HR) function. EAPs (internal or external) have largely moved out of the fringe relationship with organizations that characterized their early stages of development. Most standard HR texts used in today's business programs identify EAPs as part of the human resource (or personnel) function. As a consequence, employee assistance professionals feel qualified and comfortable contributing to the overall HR mission, and HR managers generally appreciate what EAPs can bring to an organization. Despite this recognition and acceptance, however, the function of employee assistance efforts still varies from setting to setting. The role EAPs should play in the present and future persists as a subject of discussion within the employee assistance profession. The remaining chapters of this book delineate some of these controversies and consider some roles HR managers might want to examine for EAPs in their own organizations. Some of the issues further explored include:
REFERENCES
Banta, William F., and Forest Tennant (1989) , Complete Handbook for Combating Substance Abuse in the Workplace, D.C. Heath and Company, Lexington.
Bickerton, Richard L. (1990), "Employee Assistance: A History in Progress," EAP Digest, November/December, p. 34.
Employee Assistance Professional Association, Inc. (EAPA, 1990), EA Program Standards, Arlington, Virginia.
Equal Employment Opportunity in the Federal Government (EEOFG, 1982), 29 U.S.C. 1613.
Erfurt, John C., Andrea Foote, and Max A. Heirich (1991), "The Core Technology of 'Megabrush' -- Employee Assistance and Wellness Programs Combined," Worker Health Program, Institute of Labor and Industrial Relations, The University of Michigan, Ann Arbor, Michigan.
Farkas, Gary M. (1989), "The Impact of Federal Rehabilitation Laws on the Expanding Role of Employee Assistance Programs in Business and Industry," American Psychologist, December, Vol. 44, No. 12, pp. 1482-1490.
Geidt, T.E. (1985), "Drug and Alcohol Abuse in the Work Place: Balancing Employer and Employee Rights," Employee Relations Law Journal, Vol. 11, pp. 181-205.
Good, R.K. (1986), "Employee Assistance," Personnel Journal, Vol. 65, pp. 96-101.
Health Insurance Association of America (HIAA, 1991), Source Book of Health Insurance Data, Washington, DC.
Hoffmann-La Roche, Inc. (1988), Corporate Initiatives for a Drug-Free Workplace, Nutley, New Jersey.
Luthans, Fred, and Robert Waldersee (1989), "What Do We Really Know About EAPs," Human Resources Management, Fall, Vol. 28, No. 3, pp. 385-401.
National Institute on Drug Abuse (NIDA, 1990), "A Plan of Action: President Bush Gives Momentum to War on Drugs," Employee Assistance, p. 18.
Nordheimer, Jon (1990), "Psychological Counseling from the Company Store," The New York Times, August 19.
Roman, Paul M. (1991), "Core Technology Clarification," Employee Assistance, July, pp. 8-9.
Roman, Paul M., and Terry C. Blum (1988), "The Core Technology of Employee Assistance Programs," The ALMACAN, August, pp. 17-22.
Roman, Paul M., and Terry C. Blum (no date), "Educating Organizational Consumers About Employee Assistance Programs," Tulane University, New Orleans, Louisiana.
Scanlon, W.E. (1986), Alcoholism and Drug Abuse in the Workplace, Praeger, New York.
Swanson, Robert C. (1984), "Legal Issues Affecting Employee Assistance Programs," presented at the National ALMACA Conference, Denver, Colorado.
Continue to: EAP Handbook - Chapter 3 - DESCRIPTION, SELECTION, ESTABLISHMENT, AND MAINTENANCE OF EMPLOYEE ASSISTANCE PROGRAMS
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