Transcript Do Employee Assistance Program (EAP) Affiliate Providers

Do Employee Assistance
Program (EAP) Affiliate
Providers Adhere to EAP
Concepts? An
Examination of Affiliate
Fidelity to EAP Theory &
Practice
David A. Sharar
EAPA 2007 San Diego
October 27 Research Forum
[email protected]
EAP affiliates
• Available "on demand" and paid fixed fee
to see EAP clients on behalf of a vendor
• Most are based in private individual or
group practices, or agency/hospital clinics
• Affiliates represent a mix of "helping"
professionals
• EAP work likely represents a small
portion of the affiliate's caseload
Statement of the problem
• EAP field has identified specific
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competencies unique to the delivery of
"EAP"
Most prevalent delivery system in EAP
is the "Affiliate Network Model"
Affiliates, as general mental health
practitioners, may or may not deliver
EAP as conceptualized
Need to investigate whether affiliates
believe they adhere to EAP concepts
Overall design & research questions
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Nation-wide (“one-time”) survey of EAP affiliates using
random probability sample
Goal is to provide a descriptive "portrait" of how
affiliates apply EAP concepts in their practices
Two research questions:
1. How are EAP concepts understood and utilized
among affiliates?
2. What are the commonalities & differences in terms
of how affiliates treat EAP versus other cases?
Comparison of EAP versus mental health
benefits
EAP
Mental Health Benefits
Problems in living
Diagnosable disorders
Unrestricted access
Usually some "gatekeeping"
Rapid resolution or referrals
Longer-term or specialized treatment
"Free" to employees/dependents
Co-payments/deductibles
Emphasis on follow-up
Emphasis on case closure
Work performance model
Medical model
Status of research on EAP affiliates
• Paucity of published scholarly research
• About 10 citations (mostly opinion,
anecdotal observation, group consensus)
Status of research on EAP affiliates
These citations refer to 5 concerns
1. Overlapping EAP and MBHO networks
2. Duplicate purpose with mental health
3.
4.
5.
benefits
EAP affiliate shortcomings
Lack of local workplace integration
Affiliate dissatisfaction
Sampling frame & design
• No resource that covers the "universe" of
EAP affiliates
• emindhealth (a provider of network
services) appears to be a microcosm of the
"universe"
• Random probability sample drawn
from emindhealth list of affiliates (3,000)
• 222 completed questionnaires submitted
(SE of 3.5)
Administration
• Self-administered over Internet as web-based
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survey ("Zoomerang" was hosting service)
Listserv comprised of e-mail addresses of
randomized affiliates ("respondents")
Potential respondents received a pre-notification
e-mail from emindhealth
Pre-notification followed by an invitation with a
link to the questionnaire, & up to 4 reminders
Completed questionnaires submitted to secure
server (under control of the investigator)
Questionnaire Construction
• Core components of EAP used to provide
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conceptual basis (e.g. components "mapped" to
questions)
Uses mostly close-ended questions with scaled
responses
Two open-ended questions allows for some
methodological mix
Six subject matter experts (from Editorial Review
Board of a Journal) reviewed the design and
content
Field pretest conducted with 15 actual respondents
Validity Threats
• Desirability: Respondents may want their
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answers to be perceived as "correct"
Memory or unavailable info: Recall of past
events is subject to error
No direct observation: Study measures
"perceptions" that may not reflect actual
behavior
Data Analysis Plan
• Data converted into Excel and dumped in
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SPSSx 14.0.2
Descriptive statistics show characteristics of
sample
Chi-square used to compare "EAP" cases to
"General" cases
Findings presented with written narrative
supported by tabular & graphic results
Open-ended questions analyzed by content
analysis/id of themes
Licensed or certified disciplines (N = 222)
(81% masters level and 19% doctorate level)
50%
45%
42%
36%
Percent of Respondents
40%
35%
30%
25%
18%
20%
12%
15%
11%
10%
5%
0%
Professional
Counselor/MH
Counselor
Social Worker
Marriage & Family
Therapist
Psychologist
Other
Professional identity
Specialty in
EAP
practitioner
Marriage/Family
Other specialty
7%
8%
9%
General
practice
therapist or
counselor
76%
% Assessing impact of client problem on job
performance
100%
90%
73%
80%
60%
70%
60%
40%
50%
27%
40%
30%
20%
10%
0%
0-50%
>50%
Approximate % Clients
General Practice Counseling
Employee Assistance Program
% Cases screened for substance abuse
86%
100%
89%
90%
80%
70%
60%
50%
40%
30%
14%
11%
20%
10%
0%
0-50%
>50%
Approximate % Clients
General Practice Counseling
Employee Assistance Program
% Referrals to outside practitioners
100%
90%
80%
70%
57%
53%
47%
60%
43%
50%
40%
30%
20%
10%
0%
0-10%
>10%
Approximate % Clients
General Practice Counseling
Employee Assistance Program
% Referrals to clinical programs
100%
89% 89%
90%
80%
70%
60%
50%
40%
30%
11% 11%
20%
10%
0%
0-10%
>10%
Approximate % Clients Referred
General Practice Counseling
Employee Assistance Program
% Referrals to “non-clinical” community services
100%
90%
80%
70%
60%
53%
55%
47%
45%
50%
40%
30%
20%
10%
0%
0-10%
>10%
Approximate % Clients Referred
General Practice Counseling
Employee Assistance Program
% Referred to treatment that received follow-up
100%
90%
80%
70%
52% 53%
60%
48% 47%
50%
40%
30%
20%
10%
0%
0-10%
>10%
Approximate % Clients Referred
General Practice Counseling
Employee Assistance Program
% Referrals beyond EAP to yourself
100%
90%
80%
70%
60%
46%
42%
50%
40%
30%
12%
20%
10%
0%
<10%
11%-50%
>50%
Approximate % of Clients Referred to Self
% Primary theory or model
6%
No Particular Theory
8%
14%
Some other Theory
25%
29%
Solution Focused
6%
13%
Eclectic/Integrative/generalist
17%
38%
Cognitive Behavioral
44%
0%
Chi-square (df=16)=387.68, p=.000
5%
10%
15%
20%
General Practice Counseling
25%
30%
35%
40%
45%
Employee Assistance Program
50%
Approximate % of EAP cases where assessed problem
was improved or resolved within the EAP:
< 25%
27%
26% - 50%
Greater than 50%
32%
41%
How is improved/resolved determined for cases that
only receive short-term EAP?
No way of assessing improvement with
in the EAP
1%
Clinical impressions and judgment
57%
Review of the EAP action plan
29%
Formal outcome measurement tool
1%
Other
12%
Approximate percent of EAP cases that were formal
management or supervisory referrals:
0%
22%
Less than 10%
45%
Between 11% and 25%
17%
> 26%
15%
How familiar are you with EAP “core technology”?
Not at all
37%
A little familiar
26%
Some knowledge
19%
Very familiar
18%
How often over past year did you provide a direct
“ONSITE” service at an employer’s workplace:
Never
57%
Rarely (once/twice a year)
15%
Occasionally (3-5 times a year)
15%
Frequently (> 5 times a year)
13%
In terms of therapeutic approach and selection of
interventions, are EAP clients generally treated the
same as non-EAP clients:
Completely the same
28%
More or less the same
46%
Moderately different
25%
Very differently
2%
Analysis of open-ended question
(183 comments out of 222, or 82% response rate)
Describe how your approach to EAP is similar or
different from your approach to general practice
counseling?"
Representative themes include:
 "Less sessions with EAP"
 "Little difference except EAP has fewer visits"
 "Only difference is some EAPs require switching
therapists for referrals"
 "EAP is mainly for 'here & now' issues, not longterm"
 "EAP focus is on most pressing problem due to
short # visits"