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EAP Outcomes Demonstrate Value EASNA Conference May 2004

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Outcome Data from 60,000 EAP clients. During a 3 Year Period ... Serious psychopathology. FOH TC Evaluation Components (1) Number of telephone cases ... – PowerPoint PPT presentation

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Title: EAP Outcomes Demonstrate Value EASNA Conference May 2004


1
EAP Outcomes Demonstrate ValueEASNA
Conference May 2004
  • Rick Selvik, LICSW, MBA, CEAP
  • Diane Stephenson, Ph.D., CEAP
  • Federal Occupational Health, Program Support
    Center,
  • U.S. Department of Health and Human Services

2
Presentation Abstract
  • Outcome Data from 60,000 EAP clients
  • During a 3 Year Period
  • With Federal Occupational Health EAP
  • During pre- and post- clinical process
  • Results show client improvement
  • Large number and consistent findings
  • Support productivity benefits of EAP

3
Presentation Issues
  • Cost-effective methods to document value
  • Demonstrate value by more than anecdotes
  • Outcome measures assure quality service and
    demonstrate value
  • Keep the customer informed of EAP services and
    impact on health and productivity

4
Learning Objectives
  • How to collect outcome measures
  • How to interpret the results
  • How to assess EAP impact on key workplace
    indicators
  • How to use results to evaluate program
    initiatives such as telephone counseling

5
Traditional EAP Value Measures
  • Utilization
  • Demographics
  • Presented and Assessed Problems
  • Client satisfaction

6
New EAP Value Measures
  • Problem Improvement
  • Risk Management Results
  • Reduced Absenteeism
  • Productivity Improvement

7
U.S. Dept. of Health and Human Services, PSC,
Federal Occupational Health (FOH)
  • EAP for 1.4 million Federal employees
  • Serving over 400 Federal agencies
  • Have over 150 counselors onsite nationwide
  • Nationwide affiliate network
  • Heavy demand for information and quarterly
    reports of activity

8
The Typical EAP Client (1)
  • Between 45 and 54 years of age (35)
  • Married (50)
  • Caucasian (67), African American (20), and
    Hispanic (10)
  • Males (50), Females (50)
  • Worked for Organization 6 to 15 Years

9
The Typical EAP Client (2)
  • Self-Referred to EAP (60), Management Referred
    (15), Union Referred (2)
  • Three to Four Sessions on Average
  • Address Problem in EAP (80)
  • Others referred to community resources
  • Follow-up for up to a year
  • Four of five clients resolve in EAP

10
Reported Work Problems
11
Assessed Problems
12
(No Transcript)
13
Health Status Questions
  • Health Outcomes Institute and InterStudy
  • John Ware of Johns Hopkins
  • Different versions SF36 and HQ12
  • We selected four of the questions
  • Asked at case opening and case closing

14
Outcome Measures Used
  • Productivity impacted by emotional problems,
  • Productivity impacted by physical health,
  • Improved work and social relationships,
  • Health status,
  • Job attendance/tardiness, and
  • Global assessment of functioning (GAF).

15
Question Productivity As Affected by
Emotional Problems
  • During the past 4 weeks, to what extent have you
    accomplished less than you would like in your
    work or other daily activities as a result of
    emotional problems (such as feeling depressed or
    anxious)?
  • The response options were None at all (1),
    Slightly (2), Moderately (3), Quite a bit (4) and
    Extremely (5)
  • 73 reduction in cases in lowest two categories

16
Productivity As Affected by Emotional Problems
Results show shift towards no or fewer
productivity problems after EAP services.
17
Question Productivity As Affected by Physical
Health
  • During the past 4 weeks, how much difficulty did
    you have doing your work or other regular daily
    activities as a result of your physical
    health)?
  • The response options were None at all (1), A
    little bit (2), Moderately (3), Quite a bit (4)
    and Could not do daily work (5)
  • 66 reduction in cases in lowest two categories

18
Productivity As Affected by Physical Health
Results show shift towards no or fewer
productivity problems after EAP services.
19
Question Improved Work and Social Relationships
  • During the past 4 weeks, to what extent has your
    physical or emotional problems interfered with
    your normal social activities with family,
    friends, neighbors, or groups?
  • The response options were None at all (1),
    Slightly (2), Moderately (3), Quite a bit (4) and
    Extremely (5)
  • 77 reduction in cases in lowest two categories

20
Work and Social Relationships
Results show shift towards no or fewer
relationship problems after EAP services.
21
Question Health Status
  • In general, would you say your health is
  • The response options were Excellent (1), Very
    Good (2), Good (3), Fair (4) and Poor (5)
  • 31 reduction in cases in lowest two categories

22
Health Status
Results show shift towards improved health status
after EAP services.
23
Question Attendance/Tardiness
  • How many days have you been unexpectedly absent
    or tardy in the past 30 days?
  • 62 drop in average lost time away from work for
    clients after using the EAP

24
Attendance/Tardiness
Results show dramatic change in unscheduled
attendance/tardiness occurrences after EAP
services.
25
Question Global Assessment of Functioning
  • The counselors assessed a clients level of
    functioning using the Global Assessment of
    Functioning (GAF) Scale (American Psychiatric
    Association, 2000).
  • GAF scores can range from 1 to 100, with higher
    scores indicating better functioning.
  • 10 average improvement for clients, moving from
    a range of mild symptoms and difficulty in
    functioning to transient, slight symptoms and
    impairment levels

26
Global Assessment of Functioning
Results show change in average GAF scores at case
closing.
27
How to Present the Results to the Customer
  • Charts
  • Percent Improvement
  • Quarterly Reports
  • Trends

28
EAP Impact In the Workplace
29
EAP Impact In the Workplace
30
Outcomes for Different Types of Clients
  • By Assessed Problem Type
  • When Alcohol/Drug is the Primary Problem
  • By Gender
  • For Telephone Counseling Clients

31
Improved Outcomes by Assessed Problem
32
Clients with Alcohol/Drug Problems
33
Improved Outcomes by Gender
N11,746
34
  • Evaluation of
  • Telephone Counseling in an EAP
  • Criteria
  • Outcomes

35
Telephone Applications in Behavioral Health
  • Crisis counseling
  • Initial contact - information/education
  • Screening
  • Appointment scheduling
  • Management consultation

36
Telephone Applications in Behavioral Health
  • Assessment
  • Counseling
  • Support between face-to-face
  • Case management
  • Supervision
  • Follow-up
  • Evaluation

37
Other TC Outcomes Study Results
  • Texas AM Study (Reese, 2000)
  • Clients report same level of relationship with
    counselor (telephone face-to-face)
  • Convenience, cost, anonymity, control
  • U of IL Study (Schneider, 2000)
  • Telephone, face-to-face, videoteleconference, no
    treatment
  • Audio (telephone) video provide similar outcome
    levels to face-to-face
  • Any modality better than no treatment
  • Comfort with audio video increase over time

38
FOH Guidelines for Counseling by Telephone
  • Assessing Client Appropriateness
  • Client Request for Counseling by Telephone
  • Environment
  • Conducting the Initial Assessment
  • Conducting the Counseling
  • Documentation
  • Statement of Understanding Issues
  • Counselor State Licensed

39
Contraindications to Counseling by Telephone
  • Alcohol or other drug abuse
  • Management referrals
  • Risk of violence
  • Suicidal or homicidal
  • Marital, family, child
  • Serious psychopathology

40
FOH TC Evaluation Components (1)
  • Number of telephone cases
  • Length of counseling sessions
  • Rates of case assignment to affiliate counselors
  • Client satisfaction ratings on access to care
  • Client satisfaction ratings on services received

41
FOH TC Evaluation Components (2)
  • Outcomes ratings on productivity and absenteeism
  • Clinical outcome (GAF score)
  • Structured counselor feedback on their telephone
    cases
  • Anecdotal case information from counselors

42
Comparison Time Frame Analyses
  • Implementation Period 6 months immediately
    after issuance of the structured TC guidelines
  • Comparison Period the same 6 month period the
    year before

43
Outcomes s Using Telephone Counseling
  • Generally the same number of telephone cases and
    telephone sessions during the implementation
    period as compared with the comparison period.

44
Telephone and Face-to-Face Counseling Groups
  • Face-to-face counseling analyses
  • TC sessions were fewer than 50 of the total
  • Cases with no telephone sessions
  • Telephone counseling analyses
  • TC session were 50 or more of the total
  • Cases with any telephone sessions

45
Outcomes Length of Sessions
  • Average length of telephonic session 32.2
    minutes
  • Average length of face-to-face session 59.8
    minutes

46
Outcomes Affiliate Assignment
  • Reduction of 5.6 in affiliate case assignment

47
Outcomes Client Satisfaction Access To Care
  • Same outcome results for telephonic and
    face-to-face cases on client satisfaction with
    access to care

48
Outcomes Client Satisfaction Quality Of
Services Received
  • Same outcome results for telephonic and
    face-to-face cases on client satisfaction with
    quality of services received

49
Outcomes Absenteeism Productivity
  • Similar outcomes for telephonic and face-to-face
    cases on
  • Pre/post absenteeism/tardiness rates
  • Pre/post productivity measures

50
Outcomes Clinical Functioning
  • Cases with any telephonic sessions showed a
    greater average improvement in GAF scores from
    the opening to the closing of the case (p.05)
    compared with the face-to-face cases

51
Outcomes Counselor Feedback
  • 3.7 level of counselors experience with
    telephone counseling
  • 4.0 level of comfort providing TC with this
    case
  • 4.2 perception of clients TC comfort
  • 3.8 perception of cnslr/client alliance
  • 5 point scale 1low 3moderate 5high

52
Outcomes Counselor Feedback (2)
  • 3.7 extent to which goals were met
  • 4.0 (5not at all) If goals not met, extent
    that counseling by telephone contributed
  • 4.5 (5not at all) Extent to which a TC session
    was interrupted
  • .93 (0no and 1yes) If the client had privacy
    during the TC

53
Outcomes Counselor Anecdotal Information
  • Categories where telephonic counseling may be
    appropriate and beneficial
  • Stigma
  • Medical mobility problems
  • Mental health mobility problems
  • Scheduling problems
  • Clients with multiple no shows

54
Telephone Counseling Summary
  • Appropriate clients appropriate method
  • Use a multifaceted evaluation model for
    evaluating service delivery through technological
    modalities

55
Client Satisfaction Dimensions
  • Service Satisfaction
  • Accessibility and Convenience
  • Productivity Improvement
  • Improve productivity at work
  • Improve work relationships
  • Client Improvement
  • EAPs effect on problem resolution
  • Strengthening the clients job effectiveness
  • Ability to cope with stress

56
How to Use this DataFor Client Service Delivery
  • Improve Health and Productivity Outcomes
  • Daily operational management
  • Continuous quality improvement
  • Activity based management
  • Enable core processes
  • Monthly Supervisor/Counselor Report
  • Developing Internal Benchmarks

57
How to Use this DataFor the Consultation to the
Organization
  • Show Health and Productivity Outcomes
  • Custom reports for customers
  • Senior management briefings
  • Quarterly reports
  • Annual activity summary

58
EAP Value Dimensions
59
Summary and Discussion
  • EAP services lead to improved outcomes in six
    areas of functioning
  • Results consistent over a 3 year period
  • Involved almost 60,000 EAP clients with a variety
    of presented problems
  • Include in clinical process
  • Supports health and productivity value and
    benefits of EAPs

60
Thanks to
  • Chris Plaza, MS, Brian Sugden, PhD, Dennis Derr,
    MA, Christopher Ross, PhD, David Bingaman, LCSW,
    Fran Wence, MA
  • The authors give special recognition to the
    counselors, counselor supervisors, clinical
    directors, and FOH EAP consultants for their work
    on the development/implementation of this
    initiative and their significant contributions to
    the health and productivity of the workforce.
  • Questions 312-886-4215 Rselvik_at_psc.gov
    www.foh.dhhs.gov/outcomes.asp
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