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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(No Transcript)
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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
Outcome Area Percentage of Improvement in Lowest Two Categories
Productivity impacted by emotional problems, 73
Productivity impacted by physical health, 66
Improved work and social relationships, 74
Health status, 31
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EAP Impact In the Workplace
Outcome Area Percentage of Improvement for All Clients
Job attendance/tardiness 62
Global assessment of functioning (GAF) improvement 10
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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