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

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 client’s 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 N=11,746

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 A&M 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