VI. THE ROLE OF EMPLOYEE ASSISTANCE IN A CHANGING WORLD (Reprise)

It is no accident that the first and last chapters of this book bear the same title. Hopefully, this effort will serve as a navigational chart, guiding human resource practitioners through the murky, turbulent waters the employee assistance profession is now entering. To summarize, the turbulence now being experienced has micro and macro sources. Some of the macro issues impacting EAP functioning include:1) the rapid pace of change which has characterized the entire twentieth century, and which has accelerated as we near 2000; 2) the changing global landscape; 3) economic and demographic alterations experienced by the United States; and 4) resulting pressures from all of these factors on business in general. Sprouting from these larger issues are a host of more specific problems and pressures for the employee assistance field, including: 1) resistance by employee assistance professionals to alternatives and adjustments both in program focus and service delivery, because of the history and traditional orientation of the occupation; 2) the rising costs of health care, and the desire and commitment to manage these costs; 3) solutions posed in the effort to shrink health care expenditures, many of which appear negative; 4) resolutions and guidelines intended to create a drug-free work place; and 5) the need for program evaluation, clinical outcomes research, and accountability in order to avoid duplication of effort and ensure that stated goals are met with maximum efficiency and effectiveness.

One way of approaching specific recommendations for examining EAP alternatives is the continuum model discussed earlier in this book. This model suggests three basic possibilities open to those seeking to manage employee assistance problems:

• Abolishing employee assistance services and replacing them with alternatives like managed care and/or national health insurance, if that emerges as a possibility.

• maintaining employee assistance focus and service delivery basically as is; or

• Reconsidering employee assistance in terms of an expanded human resource function.

Each particular organization's individual needs and resources must obviously be central to selecting the most useful and viable option. This chapter, however, will discuss each of the points on the continuum in terms of material covered in the book, and finally, make basic recommendations concerning directions.

Abolishing and/or replacing employee assistance services does not, in the opinion of the authors, seem called for at this time. EAPs have made significant contributions both to the workplace and to individual employees. Additionally, the most frequently offered alternatives are not particularly attractive. When managed care firms, for example, have an employee assistance component, that component suffers from at least the appearance of a conflict of interest, because managed care practitioners have an obligation, as well as a profit motive, to limit treatment. Also, if incentives for managed care place emphasis on cost containment rather than "the appropriate level of care," managed care and employee assistance personnel can wind up at odds in their efforts to achieve conflicting program goals. On the other hand, if incentives place the emphasis on treatment, then the commitment to containing costs is likely to weaken. Achieving the balance, then, will be difficult, and struggles between employee assistance and managed care will probably occur, to some degree, no matter what the forum. It may be possible to mesh these fields, but not without bending both out of their original shape.

The concept of national health insurance, too, gives rise to a number of concerns. First, and most obviously, national health insurance does not exist at the moment. Second, government programs tend to bog down in bureaucratic regulations. Successful employee assistance generally requires creativity, imagination, and an entrepreneurial approach, all of which suffer when saddled with governmental restrictions.

Merely continuing the focus and service delivery of most employee assistance efforts in their present form, though, turns a blind eye to the changes in the business community. It is possible, for example, that some job assignments for employee assistance and other services purchased by human resources really do overlap. Also, with the advent of managed care, some clinical needs may indeed be better met by groups exclusively dedicated toward addressing those needs with costs in mind. At the same time, employee assistance personnel should retain some clinical functions, regardless of apparent redundancies, since overlap does not mean exact duplication, and simply discarding one or the other service will leave some requirements unmet. In this area, however, assessment and redefinition might prove beneficial to all.

The organizational functions presently provided by EAPs would probably be retained under this option, though they might be redirected or even expanded. As indicated earlier in this book, one of the employee assistance field's unique contributions has been its ability to balance the needs of the employee with the needs of the organization. If employee assistance services are already intimately connected to the organization, the possibilities for expansion certainly exist. If employee assistance services are primarily clinical, then exploring the organizational contributions a redesigned EAP could make should uncover new and fertile ground.

The third alternative mentioned, refocusing EAPs toward human resources functions, grows out of the previous option. In this case, employee assistance professionals would be fully integrated into the human resource service, providing special expertise in both managing employees with problems and managing problem employees. Organizational responsibilities would predominate, and would expand considerably. Clinical contributions would diminish, consisting primarily of ensuring that difficulties in this area are addressed with efficiency and effectiveness. Employee assistance personnel may need additional training in order to take on this expanded organizational role. However, information already assimilated through experience on the job may suffice, making shifts in specific areas relatively easy to accomplish in many cases. The authors believe this option holds the most promise for the future.

The alternative described would allow for the retention of some clinical responsibilities. Employee assistance personnel, for example, would probably remain the first contact point for people with personal problems. Assessment would likely be included in duties as well. However, individuals might then be referred to a contract service for actual diagnosis. The service would place individuals with capable providers at the appropriate level of care who charge reasonable rates. The contract service's job description would thus include developing and maintaining an up-to-date network of respected treatment providers. It might also consist of setting basic treatment plans, providing short-term counseling, and monitoring service delivery. Meanwhile, the employee assistance program might focus on furnishing all internal training for the organization with regard to clinical issues such as drug and alcohol abuse, work stress, AIDS, and other areas of particular interest. It would also secure and/or orchestrate delivery of any services necessitated by the advent of unexpected crises, such as violence in the workplace. Evaluation of the responsibilities of the contract service would be included in clinical responsibilities as well. Finally, employee assistance personnel would remain liaisons between individuals, treatment providers, and the organization.

As indicated, however, this approach would dramatically enlarge the organizational responsibilities for EAPS. For example, considering the global changes currently impacting the United States and given the specific alterations with which business must now cope, employee assistance personnel might be asked to educate people to the change process now affecting us all. The need for education mushrooms in times of downsizing, transitions, acquisitions, and/or mergers. However, education can also assist people on an every day basis in coping with our fluctuating and often difficult world. If people are informed about the impact of change, acquainted with its common elements, given strategies for management, and provided with a support network, they should be able to reduce stress and restore at least some of their own sense of balance. This accomplishment, in turn, will also reduce health care costs.

From this new foundation of increased responsibility, EAPS, could spread into other areas, such as work/family issues. Programs like child care and elder care present problems for employers and employees alike that rarely existed thirty to fifty years ago. These programs reflect the changing nature of our economy (i.e., two parents now often have to work to make ends meet); the change in our population's demographic composition (i.e., our population is aging); and alterations in our social values (i.e., more women choose to have careers whether they need to or not).

Dealing with diversity provides yet another new avenue of possible exploration and involvement for employee assistance practitioners. Again, the new diversity in the workplace mirrors the changes in the demographic makeup of our citizenry. EAPs are charged with handling "people problems." Historically, "people problems" has meant individual problems, but the phrase has also referred to broader group interests as well. Learning about different population groups, experimenting with educating employees about the values and cultures of various sub-groups, and assisting employee populations with devising strategies for creating a workplace everyone can work in will likely present fascinating challenges to many in the employee assistance field. Handling diversity in the workforce has become an ever-increasing concern for all businesses, and has created an intensifying need for effective management. A team, therefore, made up of those who work with equal employment opportunity issues and those who work in employee assistance could help individuals and organizations manage this transition more productively.

Career counseling might also create opportunities for both employee assistance personnel and the organization. Given the dizzying rate of change in contemporary life, most employees will likely face some shift in job choice at least once, and probably more than once, during their working lives. A resource capable of addressing possibilities and managing the tension such uncertainty produces would undoubtedly prove useful to all. This new, more versatile EAP could also examine other career-related issues, including the impact of dual careers on families, job burnout, the possibilities for flex time and/or job sharing, functional illiteracy in the workplace, and the transition to retirement.

Incorporating wellness efforts into an EAP provides still another area for possible expansion. As noted earlier, there are those who believe that wellness and EAPs should be staffed and administered independently. The authors of this book disagree. Wellness and "people problems" are inextricably linked. People devoted to exercise, for example, seem less inclined toward drug use, because substance abuse interferes with their fitness regimen. Exercise also diminishes the stress which so often contributes to both drug abuse and marital difficulties. While expanding into the prevention area might require the hiring of additional staff with particular skills, training and education should allow employee assistance professionals to accomplish some carefully defined wellness goals.

Employee assistance personnel have already made significant contributions to benefits management Many EAPs have begun assuming functions typically associated with managed care in the area of mental health, alcohol and drug abuse. Assigning personnel responsibility for "carve out" programs and empowering them to negotiate contracts for care can dramatically reduce costs for organizations, while still serving individuals. Owens Corning in Toledo, Ohio, for example, saved over 1.5 million dollars in three years (Bunn, 1992).

Educating people about requirements and consequences of drug-free workplace regulations and guidelines is an obvious responsibility for employee assistance professionals as well. Many programs already provide training in drug and alcohol abuse. Pairing the two programs might well increase the rate at which those engaged in substance abuse seek treatment. As demonstrated on numerous occasions, employees will often address issues they refused to examine at the request of either family or friends when they realize their jobs may be in jeopardy.

Employee assistance personnel will also find tremendous opportunities in program evaluation. Through program evaluation efforts, employee assistance services can provide a model of adaptability to other organization components by demonstrating a willingness to undergo examination and use data obtained to make necessary changes. Undertakings that examine employee assistance services specifically also offer possibilities for investigating organizational health overall. The presumed confidentiality of an employee assistance service may allow it to make inquiries into other sensitive organizational areas. Confidentiality encourages more honest responses than more typical organizational situations, in which consequences often accompany risks. Such investigations can provide a resource for examining broader organizational issues not easily addressed without the mantle of protection employee assistance typically offers. They might also prove useful for identifying emerging needs and trends.

Finally, employee assistance personnel should be able to contribute to organizational development. Organizational development is an education strategy adopted to bring about planned organizational adjustments. Organizational psychologists or development specialists have served as "change agents" aiding in the accomplishment of these types of objectives. According to noted development expert Warren Benis, strategies employed in these areas include "concentrating on the values, attitudes, relations, and organizational climate (i.e. , the I people variable I ) as a point of entry rather than the goals, structure, and technologies of the organization" (Benis, 1969). Specific problems organizational development specialists manage, then, include difficulties with communication, intergroup conflict, leadership, questions of "identity" and "destinations," concerns about satisfaction, the ability of the organization to generate appropriate reward systems, and questions of organizational effectiveness. While some of the complex skills required for addressing these issues are beyond the expertise of employee assistance professionals, others are not. Again, education, training, and exposure could at least equip employee assistance personnel to join an organizational development team, when such efforts are in progress.

If change is one of the hallmarks of the existing world, adaptability to change must be a key to success. This book has attempted to offer human resources and employee assistance professionals some possibilities for addressing changes specific to the field. Change, even when positive, causes stress, and so creates resistance. But resistance undermines progress, and the professional must progress to maintain his/her value and effectiveness. The authors believe the specific alternatives offered in this chapter might prove useful to those with responsibility for applying employee assistance in a changing world. More important than the particular recommendations, however, is the process of consideration. Remaining open to the exploration of new ideas fosters creativity and imagination, which in turn foster growth. Successful cultivation of new directions in response to change will reap the kinds of innovations essential to maintaining and expanding the employee assistance field's range and usefulness, as well as allowing the profession to act as a model for the organizations and communities it serves.

REFERENCES

Benis, Warren (1969), Organization Development: Its Nature, Origins, and Prospects, Reading, Massachusetts, Addison-Wesley Publishing Company.

Bunn, Jere, personal communication, October 1992.

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© CONSAD Research Corporation, 1999