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EAP Outcomes Demonstrate Value EASNA 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. Presentation Abstract. Outcome Data from 60,000 EAP clients

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eap outcomes demonstrate value easna conference may 2004

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

presentation abstract
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
presentation issues
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
learning objectives
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
traditional eap value measures
Traditional EAP Value Measures
  • Utilization
  • Demographics
  • Presented and Assessed Problems
  • Client satisfaction
new eap value measures
New EAP Value Measures
  • Problem Improvement
  • Risk Management Results
  • Reduced Absenteeism
  • Productivity Improvement
u s dept of health and human services psc federal occupational health foh
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
the typical eap client 1
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
the typical eap client 2
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
health status questions
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
outcome measures used
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).
question productivity as affected by emotional problems
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
productivity as affected by emotional problems
Productivity – As Affected by Emotional Problems

Results show shift towards no or fewer productivity problems after EAP services.

question productivity as affected by physical health
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
productivity as affected by physical health
Productivity – As Affected by Physical Health

Results show shift towards no or fewer productivity problems after EAP services.

question improved work and social relationships
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
work and social relationships
Work and Social Relationships

Results show shift towards no or fewer relationship problems after EAP services.

question health status
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
health status
Health Status

Results show shift towards improved health status after EAP services.

question attendance tardiness
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
attendance tardiness
Attendance/Tardiness

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

question global assessment of functioning
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
global assessment of functioning
Global Assessment of Functioning

Results show change in average GAF scores at case closing.

how to present the results to the customer
How to Present the Results to the Customer
  • Charts
  • Percent Improvement
  • Quarterly Reports
  • Trends
outcomes for different types of clients
Outcomes for Different Types of Clients
  • By Assessed Problem Type
  • When Alcohol/Drug is the Primary Problem
  • By Gender
  • For Telephone Counseling Clients
slide34

Evaluation of

  • Telephone Counseling in an EAP
    • Criteria
    • Outcomes
telephone applications in behavioral health
Telephone Applications in Behavioral Health
  • Crisis counseling
  • Initial contact - information/education
  • Screening
  • Appointment scheduling
  • Management consultation
telephone applications in behavioral health1
Telephone Applications in Behavioral Health
  • Assessment
  • Counseling
  • Support between face-to-face
  • Case management
  • Supervision
  • Follow-up
  • Evaluation
other tc outcomes study results
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
foh guidelines for counseling by telephone
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
contraindications to counseling by telephone
Contraindications to Counseling by Telephone
  • Alcohol or other drug abuse
  • Management referrals
  • Risk of violence
  • Suicidal or homicidal
  • Marital, family, child
  • Serious psychopathology
foh tc evaluation components 1
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
foh tc evaluation components 2
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
comparison time frame analyses
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
outcomes s using telephone counseling
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.
telephone and face to face counseling groups
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
outcomes length of sessions
Outcomes – Length of Sessions
  • Average length of telephonic session – 32.2 minutes
  • Average length of face-to-face session – 59.8 minutes
outcomes affiliate assignment
Outcomes – Affiliate Assignment
  • Reduction of 5.6% in affiliate case assignment
outcomes client satisfaction access to care
Outcomes – Client Satisfaction: Access To Care
  • Same outcome results for telephonic and face-to-face cases on client satisfaction with access to care
outcomes client satisfaction quality of services received
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
outcomes absenteeism productivity
Outcomes – Absenteeism & Productivity
  • Similar outcomes for telephonic and face-to-face cases on:
    • Pre/post absenteeism/tardiness rates
    • Pre/post productivity measures
outcomes clinical functioning
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
outcomes counselor feedback
Outcomes – Counselor Feedback
  • 3.7 – level of counselor’s experience with telephone counseling
  • 4.0 – level of comfort providing TC with this case
  • 4.2 – perception of client’s TC comfort
  • 3.8 – perception of cnslr/client alliance

5 point scale – 1=low; 3=moderate; 5=high

outcomes counselor feedback 2
Outcomes – Counselor Feedback (2)
  • 3.7 – extent to which goals were met
    • 4.0 (5=not at all) – If goals not met, extent that counseling by telephone contributed
  • 4.5 (5=not at all) – Extent to which a TC session was interrupted
  • .93 (0=no and 1=yes) – If the client had privacy during the TC
outcomes counselor anecdotal information
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
telephone counseling summary
Telephone Counseling Summary
  • Appropriate clients; appropriate method
  • Use a multifaceted evaluation model for evaluating service delivery through technological modalities
client satisfaction dimensions
Client Satisfaction Dimensions
  • Service Satisfaction
    • Accessibility and Convenience
  • Productivity Improvement
    • Improve productivity at work
    • Improve work relationships
  • Client Improvement
    • EAP’s effect on problem resolution
    • Strengthening the client’s job effectiveness
    • Ability to cope with stress
how to use this data for client service delivery
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
how to use this data for the consultation to the organization
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
summary and discussion
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
thanks to
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; [email protected]; www.foh.dhhs.gov/outcomes.asp
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