An Examination of Clinical Outcomes from EAP and Work/Life Product Integration

1. An Examination of Clinical Outcomes from EAP and Work/Life Product Integration Melissa Back Tamburo, PhD, LCSW-C Chesapeake Chapter, EAPA September 1, 2011

2. EAP Background “Worksite based programs designed to assist: a) work organizations in addressing productivity issues, and b) employee clients in identifying and resolving personal concerns including, but not limited to, health, marital, family, financial, alcohol, drug, legal, emotional, stress or other personal issues that may affect job performance” (EAPA, 2011)

3. Work/Life Background W/L programs are “actions taken by employers and employees to help the workforce effectively handle the growing pressure and responsibilities of both work and personal lives, to live and work up to their full potential, and to achieve both life balance and increased productivity” (Boston College Center on Work and Family, 1999)

4. Integration Background • Customers of EAP and W/L services are driving program integration • Cost advantages to integration(Peck, 2001; Roberts, 2000; Stein, 2002; Swihart & Thompson, 2002; Turner & Davis, 2000; Willaman, 2001) • “One Stop Shopping” for employees reduces confusion about where to go for help(Stein, 2002; Turner & Davis, 2000; Willaman, 2001) • Professional associations (EAPA, EASNA & AWLP) have studied integration in three part study (Herlihy, Attridge & McCormick, 2003; Herlihy, Attridge & Turner, 2002)

5. Purpose of Study To introduce clinical outcomes in the discussion of impact of integration of EAP and Work/Life (W/L) services To examine whether there are differences between program models in treatment effectiveness

6. Political Economy Theory • Examination of interrelation between organization and an economy system (Wamsley & Zald, 1973) • Model to examine various pressures (market fluctuations, labor shortages, competition) influence on decision making

7. Analysis of Literature • Policy • Case Studies • Surveys • Trade Literature

8. Design & Data Sources • Secondary data analysis using information from EAP Case Closing Forms from a large Behavioral Health Company’s (BHC) regional office between April, 2002 and June, 2003 (N=5,792) • Quasi-experimental 2 group design • Proxy pretest design (Trochim, 2000)

9. Stand Alone Model W/L Intake W/L Program W/L Data W/L Client EAP Intake EAP Program EAP Data EAP Client Partnership Model W/L Case W/L Data W/L Client EAP Intake W/L Case with Clinical Features EAP Data EAP Client EAP Case

10. SampleN=5,792 • High tech company (N=3,976) • Stand Alone EAP • Communication conglomeration (N=1816) • Partnership ModelEAP & W/L

11. MeasuresIndependent Variables Independent Variable: Program Model • Stand Alone: up to 8 sessions of face-to-face EAP counseling, CISM, member and management training • Partnership: mean number of sessions of EAP counseling (between 2 operating units), CISM, member and management training; partnership with W/L vendor (dependent care issues, academic concerns, life management consultation and materials and financial consultation)

12. MeasuresDependent Variables • Level of functioning scale (LOF) • Single-item questions measuring • Overall functioning • 5-point Likert type scale with categories of • Excellent • Above average • Good • Below average • Poor • Proxy pretest measure • Post treatment measure

13. Measures Dependent Variables • Global Assessment of Functioning Scale (GAF) • One of the most widely used measures of impairment and functioning in clinical and research settings (Basco, Krebaou & Rush, 1997) • Single scoring scale for evaluating psychological, social & occupational functioning with rating on 0 to 100 point scale • Excellent inter-rater reliabilities (Startup, Jackson & Bendix, 2002) • Excellent reliability (ICC >.74) (Hilsenroth et. al, 2000)

14. MeasuresCovariates • Pre-test scores • Number of visits

15. Data Analysis • Examine characteristic differences in sample • Examine differences in proportions for penetration, traditional W/L presenting problems • ANCOVA for Overall LOF & GAF (separate) • DV = posttest score • IV = program model • CVs = pretest score & number of visits

16. Data AnalysisSpecific Presenting Problems • Select cases with problem • Alcohol/drug • Mental health • Relationship • Traditional W/L • ANCOVA for Overall LOF & GAF (separate) • DV = posttest score • IV = program model • CVs = pretest score & number of visits

17. Results!

18. Differences in SampleRace

19. Differences in SampleReferral Type Test of proportions statistically significant (z=420.00, p<.01) with Partnership model having larger proportion of Mandatory referrals

20. Research Question 1Do utilization rates increase with program integration? Test of proportions statistically significant (z=24.04, p<.01), with the Partnership model having larger proportion of employees using the program

21. Research Question 2 • Is there a significant difference between program models for the number of cases presenting with traditional W/L issues? • YES, but opposite of hypothesis • Partnership Model = 12% • Stand Alone Model = 10% • Test of proportions significant (z=2.177, p<.05)

22. Research Question 3Do scores forOverall Level of Functioningdiffer between program models? Stand Alone Overall LOF scores slightly higher than Partnership scores after adjusting for pretest scores & number of visits (F=90.414, p<.01)

23. Research Question 4DoGlobal Assessment of Functioningscores differ between program models? • 2550 cases with complete GSF pre & post scores • NO significant difference between program models on GAF scores after adjusting for pretest scores & number of visits F=3.397, p=.065

24. Research Questions Are there significant differences in outcomes between program models for those clients presenting with: 5.alcohol/drug involvement? 6.relationship issues? 7.mental health issues? • traditional W/L issues?

25. RQ5-8: Specific Presenting ProblemsSee Handout

26. Discussion • Statistical versus Practical differences • Non-significant findings • GAF • Alcohol/drug presenting problem • Sample size and results • Increased size, smaller effects found significant • Increased power, decreased false retention of null (Type II error)

27. Discussion • Sample differences • Race • Mandatory referrals • Utilization • Call flow • Role of intake assessment

28. Discussion • Increased marketing efforts of Partnership model • EAP role as gatekeeper • “turf issues”

29. Implications for Theory • Need organizational analysis to fully apply political economy theory • Proprietary/confidential information • Role of union in support of research • ROI • Cycle of innovation

30. Implications for Practice • Supports literature that integration increases accessibility and visibility of EAP • Supports proposal that EAP maintain lead role due to training and clinical credentials of staff (King, 2002)

31. Implications for Policy • Continued struggle for identity for EAP • Domain expertise in clinical assessment • Findings mixed on specific focus for EAP & W/L • Clinical differences not practically significant in all areas except alcohol/drug • More Traditional Work/Life cases in Partnership model • EAP clinical skills create distinction between other potential collaborators

32. Future Research • Data with demographic information • Include W/L data • Measures • Organizational analysis • Include more levels of integration & integration partners • Explore relationships between race and access • Explore assessment process

33. Limitations • Use of administrative data • Lack of organizational information • Outcome measures limitations

34. Strengths • Fills gap in literature, adding clinical outcomes to impact of EAP and W/L integration • Data from leading provider of EAP services in the country • Technical support and access to industry experts from BHC

35. Conclusions • Partnership Model had higher penetration rates • Outcomes did not substantially improve with access to increased resources; the SA model had slightly better outcomes than Partnership model • EAP retain clinical lead role • Vast research trajectory

36. 6 years later….. Data integration & benefits to programming Apples & Oranges, make fruit salad! Wellness…new player, new door to enter Domain expertise holds true

37. Resources • Boston College Center for Work & Family • http://www.bc.edu/centers/cwf.html • Global Assessment of Functioning Scale • http://en.wikipedia.org/wiki/Global_Assessment_of_Functioning

38. Question & Answer