A PLACE FOR MARRIGE AND FAMILY SERVICES IN EMPLOYEE ASSISTANCE PROGRAMS (EAPs): A SURVEY OF EAP CLIENT PROBLEMS AND NEEDS

Journal of Marital and Family Therapy, Jan 2004 by Shumway, Sterling T, Wampler, Richard S, Dersch, Charette, Arredondo, Rudy

Marriage and family services have not been widely recognized as part of employee assistance programs (EAP), although family and relational problems are widely cited as sources of problems on the job. EAP clients (N = 800, 97% self-referred) indicated how much family, psychological/emotional, drug, alcohol, employment-related, legal, and medical problems troubled them and the need for services in each area. Psychological/emotional (66%) and family (65%) problem areas frequently were rated "considerable" or "extreme." Both areas were rated as "considerable" or "extreme" by 48.6% of participants. In view of the evidence that marriage and family services can be effective with both family and psychological/emotional problems, professionals who are competent to provide such services have much to offer EAP programs.

Despite evidence of the value of marriage and family therapy (MFT) in treating a wide array of mental health problems (Sprenkle, 2002), Employee Assistance Programs (EAPs) have been slow to recognize the potential contributions of professionals whose training in marriage and family services prepares them to address both the employee's individual problems and the larger system issues that are contributing to the problem, Although MFT has not always been recognized as a legitimate mental health service, there have been some notable successes in terms of certification, licensure, and eligibility for third-party reimbursement for MFT services in the last decade. Marriage and family therapists have equal status with psychiatrists, psychologists, social workers, and/or professional counselors for third-party reimbursement in a growing number of states. However, challenges to MFT practice remain. Insurance companies and health management organizations (HMOs) largely continue to limit reimbursement to services for individuals with a DSM-IV diagnosis (American Psychiatric Association, 2000). Further, MFT services involving the individual's partner or family members are often excluded from coverage (e.g., couple therapy for depression). The growing body of MFT efficacy and effectiveness research challenges the reluctance of insurance companies and HMOs to reimburse couple or family therapy for psychological problems.

Employee Assistance Programs began as a service to identify and rehabilitate alcohol-addicted employees. These programs have grown rapidly, with an estimated 20,000 EAPs providing coverage for an estimated 55% of the U.S. workforce (Van Den Bergh, 2000), including 80% of Fortune 500 companies (Employee Assistance Professionals Association [EAPA], 1996). The initial rationale for offering EAP services was that it is more efficient to rehabilitate trained and experienced employees with substance abuse problems than to terminate and replace them. To provide this rehabilitation, EAPs relied on a set of "core technologies" in which "treatment" was largely limited to assessment and referral (Cagney, 1999). Over time, a number of EAPs have moved outside of this set of core technologies, providing in-house services and, in some cases, extending those services to other family members as well. Thus, the initial focus of EAPs on the addicted employee has expanded to an approach that recognizes the role of mental health and/or family and marital issues as potentially interfering with work performance (Chima, 1995). Such a "full service" approach offers the increased potential for higher rates of utilization of a variety of prevention and intervention services by employees and their family members (Metcalf, 1993).

Employees' work may suffer because of psychological, marital and family, substance abuse, medical, financial, and legal problems (Dubreuil & Krause, 1983). In a survey of EA professionals (EAPA, 1996), the most prevalent problems identified were family issues (25%), stress (23%), depression (21%), substance abuse (16%), and workplace/job conflict (9%). Of course, problems in one area may lead to problems in other areas. Emotional and personal problems are associated with increases in absenteeism, tardiness, sick leave use, injuries on the job, property damage, medical claims, and employee turnover (Carr & Hellan, 1980; Johnson & O'Neil, 1989; Roman, Blum, & Bennett, 1987). Chima (1997) estimated that 85% of industrial accidents are stress-induced, accounting for losses estimated at $32 billion in work-related accidents and heart attacks each year. Supporting Chima's estimate, Leiter and Wahlen (1996) found personal problems are implicated in 80%-90% of industrial accidents. Further, emotional illnesses are estimated to account for 61% of absences and 65% of job terminations (Chima, 1995, 1997). Employers subscribing to full-service EAPs recognize the negative impact of these problems on worker morale, productivity, and relationships with coworkers. Although limited, available data suggest that the establishment of an EAP is followed by a reduction in employee turnover, a reduction in absenteeism, and a reduction in reprimands (Gam, Sauser, Evans, & Lair, 1983).