An introduction to employee assistance and counselling services

Linda Hoskinson describes the essential functions of EAPs and workplace counselling services, and considers different routes of referral to such services and how line managers can become involved.

Employee assistance programmes (EAPs) have tended to be introduced in response to different concerns in different countries. In the UK, for example, work-related stress and problems with work-life balance are cited as principal precursors to the introduction of EAP services. In other parts of the world, different health-related problems have driven their growth - addiction and substance abuse in the US and HIV/AIDS in Africa, in particular. EAPs in Spain have recorded a rising domestic violence problem, while in Australia finance and debt is reported to have been a significant issue leading employees to seek assistance.

The function of an EAP thus tends to reflect the needs of the workforce it serves and a tailor-made service will be based on some form of "needs analysis"¹. For example, an EAP in the education sector needs to offer support for teachers who are themselves facing classroom indiscipline, or harassment, and who also need to advise pupils about their own problems (which may include such issues as bullying, online gambling debts and inappropriate internet relationships).

EAP definition

There is still lively discussion among practitioners about the primary function of EAPs and when a service may, or may not, legitimately be referred to by that title.

One definition of EAP widely used in the UK is: "An EAP is a worksite-focused programme to assist in the identification and resolution of employee concerns, which affect, or may affect, performance."

Another definition - used by the Employee Assistance Professionals Association (EAPA) internationally, and which has evolved over the past 70 years - is as follows: "Employee assistance is the work organisation's resource that utilises specific core technologies to enhance employee and workplace effectiveness through prevention, identification and resolution of personal and productivity issues."

Some EAPA member countries have adjusted this wording but one underlying characteristic is clear: EAP services both support employees (and usually also their families) and help to improve the productivity of their employing organisation.

A productive EAP is therefore one that supports on a day-to-day basis employees with personal or occupational concerns, aiming, so far as possible, to re-direct their constructive energy towards their work. Those responsible for delivering an active EAP will be constantly assessing needs, making the case for appropriate resources to be available, and feeding back non-confidential information to the sponsoring organisation about the kinds of pressures and problems affecting the workforce.

Occupational health specialists may have a different opinion from that of their colleagues in human resources management, personnel or welfare on the type of employee support service that is appropriate for an organisation. Some of those selling services in the external EAP market differentiate between the "occupational health-driven" EAP specification and an "HR" version, and they may include different services in their proposals depending on who they think will be taking the lead in awarding the contract.

The counselling component

It is unfortunate that EAPs are sometimes limited to a counselling-only service. Certainly, EAPs include counselling as an important component but, as we shall see, the function of an EAP is to anticipate and prevent employees becoming impaired rather than retrospectively dealing with the consequences of longstanding pressures or crises that have already occurred.

A 2001 report by professor John McLeod of Dundee University provided an evidence base for the proposition that counselling "works" in terms of resolving problems of individual employees. It is also increasingly accepted that EAP services "pay for themselves".

McLeod's report concluded: "A substantial number of studies have provided plausible and convergent evidence of the significant contribution that counselling can make to the alleviation of work-related psychological problems."²

The EAP provider's feedback to a client organisation usually includes both an overall activity report and a report on how the service's problem-solving and information-giving function has operated. This typically covers discussions that have taken place about return to work, indications about formal grievances avoided and anonymised data about employees who have been helped to maintain work performance despite having difficult personal problems to deal with at home.

Emerging components

The broad EAP function may also include provision of services by professionals other than counsellors; these might include legal specialists, finance and debt counsellors, childcare experts or specialists on housing or social security benefits.

Such services, whether provided internally or externally to an organisation - and whether delivered by telephone, face-to-face or online - are designed to reflect the diversity of the workforce, including its age profile, the languages spoken and shift patterns.

The EAP can conduct stress audits, offer training on such matters as work-life balance and depression and also be available to provide support following emergencies such as fires, explosions, floods or epidemics.

Buyers of EAPs, with an eye to the future, develop their selection criteria so as to ensure that the EAP provider can grow alongside their own requirements. An EAP "steering group" that includes people from different parts of the organisation may help to ensure the EAP adapts to the changing needs of both the employer and the workforce and provide ideas on how the EAP can be promoted so as to ensure a high level of utilisation.

IRS survey

Public sector organisations are far less likely than private sector organisations to offer an EAP service, according to a survey of the practices in 127 organisations recently reported by IRS.³ One explanation given for this by respondents was that internal occupational health advisers, providing a similar service to an EAP, were more commonly provided in the public sector, negating the need to purchase an additional product.

The vast majority of the EAP services operating in the private sector are supplied under contract by external providers, according to the IRS survey. The most commonly supplied services cited by respondents were telephone helplines and telephone counselling. Next most common EAP elements were face-to-face counselling, referral to specialist advisers for tax and legal issues and support for line managers. Surprisingly, not all employers making use of external services are aware they can ask for reports from the provider on the usage of the service.

Formal vs informal referral

Individuals need a great deal of self-awareness to refer themselves to an EAP and the tendency is to leave it until it is too late. The particular function of an EAP, as distinct from a counselling service, is to act proactively and provide help and advice at an early stage.

A recent study of outcome statistics for a reputable counselling service found that, of those self-referring, nearly 30% were already on medication, nearly 20% were at risk of self-harm, 20% were assessed as a suicide risk and 4% as a risk to others⁴. More than half were already off sick and only 4% were assessed as functioning normally at work. Such figures are not untypical and underline the case for reaching people earlier in their problem-solving journey.

The Hatton ruling⁵ in 2002 suggested that employers gain some protection from liability if they offer an EAP service, or even a counselling service, to employees. However, the subsequent Barber case emphasised that the availability of a service must be actively promoted to employees⁶.

Colleagues and managers often notice when individuals "are not their normal selves" and can intervene sensitively, "nudging" them to get assistance and address issues promptly. This is called an "informal referral".

Line manager involvement

Line managers can justifiably intervene proactively, making "formal referrals" to an EAP, for example on the grounds that an individual's work performance has declined, that pressure is being put on others in the same department, or that their behaviour creates a safety risk. This is generally known as a "formal referral". While it will always remain voluntary for an individual to access an EAP, some organisations have policies that in certain circumstances require managers to make formal referrals to an EAP to ensure that all possible steps have been taken to encourage the employee to access assistance. This would apply, for example, when performance is seriously affected, in cases of violent behaviour, or where a hazard is being created.

The EAP agrees boundaries for confidentiality with line managers, protecting the privacy of the individual and rarely making limited disclosures, and then only with the employee's consent, or with their awareness in predefined situations that could affect the employer's duty of care to others. Typically, the manager would make the referral sensitively, provide space for the EAP professionals to assist the employee with personal or work-related issues, and would return to managing day-to-day performance. A recent Chartered Institute of Personnel and Development (CIPD) survey confirmed that line managers have a key role to play in preventing and dealing with interpersonal issues in the workplace, such as harassment and bullying.⁷

Training line managers to handle formal referrals will have a significant impact on the cost-effectiveness of an EAP service. Without managers' active involvement in referrals, EAP services typically report modest returns on investment (such as a 3:1 return, namely £3 return for every £1 invested in the service). In a landmark study carried out at Chevron⁸, however, a 14:1 return was achieved, with 75% of the savings being the result of intervention by trained line managers. There have been more recent studies of cost-effectiveness, some showing higher cost-benefits, but none has so clearly highlighted the potential of proactive involvement of line managers.

Managers generally respond well to training designed to help them manage the referral process and the training of line managers is a suitable component for inclusion in EAP service contracts.

OH and welfare involvement

If a number of support services are available to an employer then professional collaboration and boundaries will be made explicit to all employees at the point of entry. A successful return to work, for example, may require an occupational health assessment, input from the EAP - for example providing financial information and relationship counselling - and an HR specialist working with the line manager on the contractual consequences of "reasonable adjustments" in the workplace.

EAP standards

To assist employers that are thinking of redesigning their counselling, welfare or EAP services, there are a number of resources available. The EAPA has set standards for the provision of all aspects of EAPs, including how the initial "needs assessment" is conducted, how the service can be delivered, how managers are trained and by whom, and how the service can be integrated with the strategic goals of the organisation and evaluated. The EAPA also publishes a purchasers' guide that covers evaluation and auditing of EAP services.¹

Employers can effectively design their own EAPs, combining internal and external components for example, thus helping to retain the knowledge acquired by an experienced in-house welfare department while cost-effectively outsourcing a helpline that needs to operate on a 24-hour basis.

EAPs also have a role to play in vocational rehabilitation and in facilitating return-to-work following either physical or mental illness. The Department of Health, for example, acknowledges the value of such services and requires that NHS staff have access to a "counselling service". It remains the case, however, that UK government departments, unlike those in the US, have not yet clearly distinguished between a reactive, remedial counselling service and a more proactive EAP, with its greater emphasis on reaching employees earlier in their problem-solving and including a wider range of referral sources.

In summary, proactive EAPs are gaining in popularity because of their cost-effectiveness and the way in which they complement the work of occupational health services, welfare and HR/personnel and support their goals. Those that are well designed and well run are understandably able to claim the greater benefits - to the individual employee, their families and to the effectiveness of the organisation.

1. Standards of practice and professional guidelines for EAPs, EAPA, www.eapa.org.uk .

2. Counselling in the workplace: the facts, Professor John McLeod, School of Social and Health Sciences, University of Abertay, Dundee, British Association for Counselling and Psychotherapy (BACP).

3. Employment Review 874, 4 June 2007, www.xperthr.co.uk.

4. "When self-referrals can be 'too little, too late'?", Linda Hoskinson, Counselling at Work (Summer 2005), BACP.

5. Hatton v Sutherland [2002] 2 All ER I.

6. Barber v Somerset County Council [2004] UKHL 13.

7. Managing conflict at work, Chartered Institute of Personnel and Development, www.cipd.co.uk/surveys/.

8. Cost/benefit analysis shows EAP's value to employers, Ken Collins, EAPA, November 1998, ISBN 1085 0856.

Linda Hoskinson CEAP is managing director of People Resolutions Group, grievance prevention and resolution specialists. She is a member of BACP, the Vocational Rehabilitation Association and a former chair of the UK Employee Assistance Professionals Association. She re-qualifies regularly as CEAP-I, the international Certified Employee Assistance Professional, linda@people-resolutions-gp.com.