EAP Outcomes Demonstrate Value EASNA Conference May 2004

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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

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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

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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

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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

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Traditional EAP Value Measures

• Utilization
• Demographics
• Presented and Assessed Problems
• Client satisfaction

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New EAP Value Measures

• Problem Improvement
• Risk Management Results
• Reduced Absenteeism
• Productivity Improvement

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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

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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

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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

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Reported Work Problems
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Assessed Problems
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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

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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).

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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

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Productivity As Affected by Emotional Problems
Results show shift towards no or fewer
productivity problems after EAP services.
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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

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Productivity As Affected by Physical Health
Results show shift towards no or fewer
productivity problems after EAP services.
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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

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Work and Social Relationships
Results show shift towards no or fewer
relationship problems after EAP services.
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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

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Health Status
Results show shift towards improved health status
after EAP services.
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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

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Attendance/Tardiness
Results show dramatic change in unscheduled
attendance/tardiness occurrences after EAP
services.
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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

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Global Assessment of Functioning
Results show change in average GAF scores at case
closing.
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How to Present the Results to the Customer

• Charts
• Percent Improvement
• Quarterly Reports
• Trends

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EAP Impact In the Workplace
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EAP Impact In the Workplace
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Outcomes for Different Types of Clients

• By Assessed Problem Type
• When Alcohol/Drug is the Primary Problem
• By Gender
• For Telephone Counseling Clients

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

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Telephone Applications in Behavioral Health

• Crisis counseling
• Initial contact - information/education
• Screening
• Appointment scheduling
• Management consultation

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Telephone Applications in Behavioral Health

• Assessment
• Counseling
• Support between face-to-face
• Case management
• Supervision
• Follow-up
• Evaluation

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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

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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

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Contraindications to Counseling by Telephone

• Alcohol or other drug abuse
• Management referrals
• Risk of violence
• Suicidal or homicidal
• Marital, family, child
• Serious psychopathology

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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

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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

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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

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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.

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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

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Outcomes Length of Sessions

• Average length of telephonic session 32.2
  minutes
• Average length of face-to-face session 59.8
  minutes

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Outcomes Affiliate Assignment

• Reduction of 5.6 in affiliate case assignment

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Outcomes Client Satisfaction Access To Care

• Same outcome results for telephonic and
  face-to-face cases on client satisfaction with
  access to care

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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

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Outcomes Absenteeism Productivity

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

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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

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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

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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

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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

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Telephone Counseling Summary

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

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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

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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

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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

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EAP Value Dimensions
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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

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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