1. 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

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 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

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. 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% EAP Impact In the Workplace

29. Outcome Area Percentage of Improvement for All Clients Job attendance/tardiness62% Global assessment of functioning (GAF) improvement 10% 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

51. 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 – 1=low; 3=moderate; 5=high

52. 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

53. 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

54. Telephone Counseling Summary Appropriate clients; appropriate method Use a multifaceted evaluation model for evaluating service delivery through technological modalities

55. 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

56. How to Use this Data For 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

57. How to Use this Data For the Consultation to the Organization Show Health and Productivity Outcomes Custom reports for customers Senior management briefings Quarterly reports Annual activity summary

58. EAP Value Dimensions

59. 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

60. 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@psc.gov; www.foh.dhhs.gov/outcomes.aspRselvik@psc.gov