Impact of Employee Assistance Services on Depression, Anxiety, and Risky Alcohol Use: A Quasi-Experimental Study

The Evolution of Employee Assistance Programs to Best Support Healthcare Organizations

GOAL

Employee assistance programs (EAPs) have been evolving since they first became prevalent in the 1970s. The important counseling component of EAPs is sometimes lost in discussions about what they do, with many EAPs marketing a broad portfolio of services such as childcare, elder care, legal referral, and other concierge services rather than counseling. The objective of this study was to examine outcomes for the EAP of one organization (Mayo Clinic), compare them to outcomes reported in the literature, and gain insights to help all healthcare organizations best support their employees.

METHODS

Consistent with customary EAP practice, data for this study was collected through an anonymous survey link distributed by e-mail to users of individual counseling as well as users of organizational consulting services such as advising leaders and supervisors and leading educational sessions.

PRINCIPAL FINDINGS

All (n = 82) individual counseling respondents indicated they would recommend the EAP, none reported worse symptoms, 90% decreased their stress levels, 92% reduced their feelings of anxiety, 88% enjoyed an overall improvement in mood, and 95% developed new skills. If their concern was work-related, 96% agreed the counselor understood the work culture and was able to provide helpful guidance; of the clients who were feeling burned out, 86% agreed they gained strategies to reduce its symptoms. Thematic analysis of individual counseling services indicated that participants highly valued their counselors. Regarding organizational consulting services, respondents (n = 50) indicated EAP services increased their confidence as leaders, supported their work, and provided tangible guidance. They appreciated having an internal EAP counselor. Thematic analysis of organizational consulting services indicated that EAP supported leaders by listening, coaching, and empowering them to normalize issues.

PRACTICAL APPLICATIONS

EAPs have evolved into distinct internal, external, and hybrid internal-external models. Internal model counselors are company employees with inside knowledge of company culture, external EAP model counselors are contracted outside of the company, and hybrid models combine a small cadre of internal counselors with the support of outside contractors. Regardless of the model, EAP counselors must collaborate with internal stakeholders, notably the human resources department, to efficiently identify and troubleshoot employee relational issues and allow for customized initiatives to improve mental health. Based upon these findings and the authors' direct experiences with EAP providers, components of an ideal EAP are outlined to show how EAPs can best support employees. Healthcare leaders seeking to add EAP services are advised to focus on offerings that are custom fit to the organization.

Workplace Social Support and Work Engagement Among Japanese Workers: A Nationwide Cross-sectional Study

OBJECTIVES

We investigated the relationship between employees' perceptions of the number of sources of workplace social support and work engagement and whether each type of workplace social support is independently related to work engagement.

METHODS

A cross-sectional study was conducted using a questionnaire survey in Japan. In total, 12,017 participants were analyzed. Participants were asked about 4 sources of workplace social support: supervisors, colleagues/subordinates, occupational health staff, and external counselors contracted by the workplace. Work engagement was measured using the 9-item Utrecht Work Engagement Scale. Coefficients were estimated using multiple regression analyses.

RESULTS

The coefficient of work engagement increased as the number of sources of perceived workplace social support increased. Each support was also positively related to work engagement.

CONCLUSIONS

Organizations should develop systems comprising various sources of workplace social support to increase employee work engagement.

A systematic review of the efficacy, effectiveness and cost-effectiveness of workplace-based interventions for the prevention and treatment of problematic substance use

Employee alcohol and other drug use can negatively impact the workplace, resulting in absenteeism, reduced productivity, high turnover, and worksite safety issues. As the workplace can influence employee substance use through environmental and cultural factors, it also presents a key opportunity to deliver interventions, particularly to employees who may not otherwise seek help. This is a systematic review of workplace-based interventions for the prevention and treatment of problematic substance use. Five databases were searched for efficacy, effectiveness and/or cost-effectiveness studies and reviews published since 2010 that measured use of psychoactive substances (i.e., alcohol, cannabis, hallucinogens, inhalants, opioids, sedatives, hypnotics, anxiolytics, and stimulants) as a primary or secondary outcome, in employees aged over 18. Thirty-nine articles were identified, 28 describing primary research and 11 reviews, most of which focused solely on alcohol use. Heterogeneity between studies with respect to intervention and evaluation design limited the degree to which findings could be synthesized, however, there is some promising evidence for workplace-based universal health promotion interventions, targeted brief interventions, and universal substance use screening. The few studies that examined implementation in the workplace revealed specific barriers including lack of engagement with e-health interventions, heavy use and reluctance to seek help amongst male employees, and confidentiality concerns. Tailoring interventions to each workplace, and ease of implementation and employee engagement emerged as facilitators. Further high-quality research is needed to examine the effectiveness of workplace substance use testing, Employee Assistance Programs, and strategies targeting the use of substances other than alcohol in the workplace.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=227598, PROSPERO [CRD42021227598].

Advancing the field of employee assistance programs research and practice: A systematic review of quantitative studies and future research agenda

The COVID-19 pandemic has accentuated the critical role of organizational support for the workforce. An employee assistance program (EAP) represents an inclusive strategy which organizations adopt to provide supportive and empathic care to help employees overcome undesirable situations. To date, we have limited knowledge of what EAP issues have been researched from the human resource management (HRM) perspective and what theoretical underpinning these studies have used. This article systematically reviews quantitative empirical studies on EAPs. Drawing upon 115 articles from 72 journals across 40 years (1981–2020), we trace the evolutionary trend of the construct of EAP and shed light on the internal link of EAP with HRM. After summarizing research themes, methods, theories, and approaches to the evaluation of EAPs, we identify pitfalls in the current research and contribute to extending the field by proposing several research agendas for future investigation.

Effectiveness of Workplace Interventions for Improving Working Conditions on the Health and Wellbeing of Fathers or Parents: A Systematic Review

Evidence on the effectiveness of workplace interventions for improving working conditions on the health and wellbeing of fathers is scarce. We reviewed studies on the effectiveness of various workplace interventions designed to improve working conditions for the health and wellbeing of employed fathers and their families. Randomized controlled trials (RCTs) and quasi-randomized controlled trials of workplace interventions applied to employees with the aim of improving working conditions of employed parents, compared with no intervention, other active arms, placebo, wait list, or usual practice were included. Studies involving only women were excluded. An electronic search of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, ERIC and SSCI was done for eligible studies. Studies were screened against predetermined criteria and assessment of risk of bias done using the Cochrane Handbook for Systematic Reviews of Interventions for RCTs and the Risk of Bias Assessment tool for Non-randomized Studies for non-RCTs. Of the 8229 records identified, 19 reports were included in this review: 14 reports from five RCTs and five reports from two quasi-RCT studies. The studies were conducted in four different countries among working populations from various sectors. Studies addressing issues related to improving working conditions of fathers alone were lacking. All included studies assessed intervention effects on various health-related outcomes, the most common being sleep disturbances and mental health outcomes. Interventions administered yielded positive effects on various health outcomes across all seven studies. All included studies had methodological limitations, while study designs and methodologies lacked comparability. Consequently, a narrative synthesis of evidence is provided. Based on our findings, providing workplace interventions for improving working conditions may improve some aspects of the health and wellbeing of employed parents, including fathers.

Best practices of highly infectious decedent management: Consensus recommendations from an international expert workshop

With the increasing number of highly infectious disease incidents, outbreaks, and pandemics in our society (e.g., Ebola virus disease, Lassa fever, coronavirus diseases), the need for consensus and best practices on highly infectious decedent management is critical. In January 2020, a workshop of subject matter experts from across the world convened to discuss highly infectious live patient transport and highly infectious decedent management best practices. This commentary focuses on the highly infectious decedent management component of the workshop. The absence of guidance or disparate guidance on highly infectious decedent management can increase occupational safety and health risks for death care sector workers. To address this issue, the authorship presents these consensus recommendations on best practices in highly infectious decedent management, including discussion of what is considered a highly infectious decedent; scalability and storage for casualty events; integration of key stakeholders; infection control and facility considerations; transport; care and autopsy; psychological, ethical, and cultural considerations as well as multi-national care perspectives. These consensus recommendations are not intended to be exhaustive but rather to underscore this overlooked area and serve as a starting point for much-needed conversations.

A systematic review and meta-analysis uncovering the relationship between alcohol consumption and sickness absence. When type of design, data, and sickness absence make a difference

AIM

Earlier research has revealed a strong relationship between alcohol use and sickness absence. The aim of this review was to explore and uncover this relationship by looking at differences in type of design (cross-sectional vs. longitudinal), type of data (self-reported vs. registered data), and type of sickness absence (long-term vs. short term).

METHOD

Six databases were searched through June 2020. Observational and experimental studies from 1980 to 2020, in English or Scandinavian languages reporting the results of the association between alcohol consumption and sickness absence among working population were included. Quality assessment, and statistical analysis focusing on differences in the likelihood of sickness absence on subgroup levels were performed on each association, not on each study. Differences in the likelihood of sickness absence were analyzed by means of meta-analysis. PROSPERO registration number: CRD42018112078.

RESULTS

Fifty-nine studies (58% longitudinal) including 439,209 employees (min. 43, max. 77,746) from 15 countries were included. Most associations indicating positive and statistically significant results were based on longitudinal data (70%) and confirmed the strong/causal relationship between alcohol use and sickness absence. The meta-analysis included eight studies (ten samples). The increased risk for sickness absence was likely to be found in cross-sectional studies (OR: 8.28, 95% CI: 6.33-10.81), studies using self-reported absence data (OR: 5.16, 95% CI: 3.16-8.45), and those reporting short-term sickness absence (OR: 4.84, 95% CI: 2.73-8.60).

CONCLUSION

This review supports, but also challenges earlier evidence on the association between alcohol use and sickness absence. Certain types of design, data, and types of sickness absence may produce large effects. Hence, to investigate the actual association between alcohol and sickness absence, research should produce and review longitudinal designed studies using registry data and do subgroup analyses that cover and explain variability of this association.

Organizational Best Practices Supporting Mental Health in the Workplace

OBJECTIVE

To provide a narrative review of best and promising practices for achieving exemplary mental health in the workplace as the foundation for the inaugural Carolyn C. Mattingly Award for Mental Health in the Workplace.

METHODS

Research was drawn from peer-reviewed articles using the search terms associated with workplace mental health.

RESULTS

Eight categories of best practices were identified: (1) culture, (2) robust mental health benefits, (3) mental health resources, (4) workplace policies and practices, (5) healthy work environment, (6) leadership support, (7) outcomes measurement, and (8) innovation.

CONCLUSION

The review provided the scientific backing to support criteria developed for the Carolyn C. Mattingly Award for Mental Health in the Workplace. By recognizing organizations that apply evidence-based practices in their health and well-being programs, the Mattingly Award may inspire employers to adopt best practices.

Identifying Strategies for Decreasing Work-Related Stress Among Working Men: An International Delphi Consensus Study

OBJECTIVE

The objective was to identify helpful, feasible strategies that can be implemented by working men to decrease work-related stress.

METHODS

An international Delphi consensus study was conducted with four panels of stakeholders. Three rounds of surveys were sent to panellists who rated the helpfulness and feasibility of strategies. Strategies were considered to have reached consensus if 80+% of at least three panels "agreed" or "strongly agreed" that the strategies were helpful or feasible.

RESULTS

Eighty-one strategies reached consensus out of a total 127 for helpfulness in decreasing work-related stress. Eleven strategies did not reach consensus in any of the vignettes. Only two strategies reached consensus for feasibility.

CONCLUSION

While many strategies are perceived as helpful for decreasing workplace stress, the feasibility of the strategies likely depends on an individual's particular needs and context.

Association between alcohol consumption and impaired work performance (presenteeism): a systematic review

OBJECTIVES

The aim of this review was to explore the notion of alcohol-related presenteeism; that is, whether evidence in the research literature supports an association between employee alcohol consumption and impaired work performance.

DESIGN

Systematic review of observational studies.

DATA SOURCES

MEDLINE, Web of Science, PsycINFO, CINAHL, AMED, Embase and Swemed+ were searched through October 2018. Reference lists in included studies were hand searched for potential relevant studies.

ELIGIBILITY CRITERIA

We included observational studies, published 1990 or later as full-text empirical articles in peer-reviewed journals in English or a Scandinavian language, containing one or more statistical tests regarding a relationship between a measure of alcohol consumption and a measure of work performance.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers extracted data. Tested associations between alcohol consumption and work performance within the included studies were quality assessed and analysed with frequency tables, cross-tabulations and χ² tests of independence.

RESULTS

Twenty-six studies were included, containing 132 tested associations. The vast majority of associations (77%) indicated that higher levels of alcohol consumption were associated with higher levels of impaired work performance, and these positive associations were considerably more likely than negative associations to be statistically significant (OR=14.00, phi=0.37, p<0.001). Alcohol exposure measured by hangover episodes and composite instruments were over-represented among significant positive associations of moderate and high quality (15 of 17 associations). Overall, 61% of the associations were characterised by low quality.

CONCLUSIONS

Evidence does provide some support for the notion of alcohol-related presenteeism. However, due to low research quality and lack of longitudinal designs, evidence should be characterised as somewhat inconclusive. More robust and less heterogeneous research is warranted. This review, however, does provide support for targeting alcohol consumption within the frame of workplace interventions aimed at improving employee health and productivity.

PROSPERO REGISTRATION NUMBER

CRD42017059620.

Evaluation of a workshop to address drugs and alcohol in the workplace

Purpose

Risky alcohol and other drug (AOD) use is ubiquitous in some workplace cultures, and is associated with considerable risks to health, safety and productivity. A workplace drug and alcohol first aid program was developed to support supervisors and managers to recognize and respond appropriately to AOD problems, increase knowledge of AOD and reduce the stigma associated with AOD. The purpose of this paper is to undertake an evaluation to assess the program’s efficacy.

Design/methodology/approach

A self-report survey was administered to program participants before (T1), immediately after (T2) and three months following program completion (T3). Changes in alcohol/drug-related knowledge, role adequacy, motivation and personal views were examined using repeated measures ANOVA.

Findings

A total of 109 participants took part in the program, with only 26 completing scores at all three time points. Mean scores increased significantly (p<0.05) between T1 and T2 for knowledge (12.7–16.0), role adequacy (11.8–17.4), motivation (9.7–10.4) and personal views (9.0–9.6). Significant improvements were maintained at T3 for knowledge (15.1) and role adequacy (17.3).

Practical implications

Drug and alcohol first aid programs offer a potentially valuable initiative to improve the knowledge, skills and understanding of managers and supervisors in tackling workplace AOD risks, associated stigma and improving help seeking.

Originality/value

Workplace programs for managers can facilitate organization-wide responses to the reduction of AOD-related problems, increase implementation of appropriate policy and interventions, minimize associated harms and stigma and reduce negative imposts on productivity and profit.

Role and Value of the Corporate Medical Director

: The role of the corporate medical director (CMD) has evolved over the last 300 years since Ramazzini first identified diseases of Italian workers in the early 1700s. Since then, there has been a gradual blurring of the boundaries between private and workplace health concerns. Today's CMD must have intimate knowledge of their corporation's industry and the businesses that they support, particularly the occupational and environmental programs that comply with all local, state, and/or national standards and regulations. Leading companies not only measure compliance with such standards but also may hold programs to their own internal corporate global standards even if these go beyond local government requirements. This document will explore in greater depth the strength and importance that the CMD brings to the business operations to support a healthy, engaged, and high performing workforce. Part 1 describes the role and value of the CMD, while Part 2 provides collective wisdom for the new CMD from current and past highly experienced CMDs.

A Substance Use Cost Calculator for US Employers With an Emphasis on Prescription Pain Medication Misuse

OBJECTIVE

Substance use disorders are among the most common and costly health conditions affecting Americans. Despite estimates of national costs exceeding $400 billion annually, individual companies may not see how substance use impacts their bottom lines through lost productivity and absenteeism, turnover, health care expenses, disability, and workers' compensation.

METHODS

Data on employed adults (18 years and older) from 3 years (2012 to 2014) of the National Survey on Drug Use and Health Public Use Data Files were analyzed.

RESULTS

The results offer employers an authoritative, free, epidemiologically grounded, and easy-to-use tool that gives specific information about how alcohol, prescription pain medication misuse, and illicit drug use is likely impacting workplaces like theirs.

CONCLUSION

Employers have detailed reports of the cost of substance use that can be used to improve workplace policies and health benefits.