Employee Assistance Programs in Managed Care

William Winston, Norman Winegar

• Publisher: Routledge
• Year: 2014
• eBook ISBN: 9781317720799
• Topic: Business
• Subtopic: Business General
• Index: Business

Make sense of the managed care systems that dominate the world of EAP professionals and programs today!Employee Assistance Programs in Managed Care gives you a valuable overview of modern employee assistance programs. It compares and contrasts EAPs with managed behavioral care products and examines how EAPs are often provided in conjunction with managed care services. This timely book, vital in today's ever-changing EAP climate, will familiarize you with essential managed behavioral technology such as the application of medical necessity criteria. This is especially important today in an environment dominated by employer- or insurer-sponsored managed care systems. You also get a helpful directory of EAP/managed care companiesEmployee Assistance Programs in Managed Care is your guidebook to today's EAPs, providing vital information about:

• the services modern EAPs offer to employers and employees
• participating in networks to provide both therapy and EAP services
• how EAPs interface with managed behavioral care organizations
• how EAPs are sold
• how EAPs are marketed and managed today
• professional issues--certification, credentials, ethics, and more
• ways that counseling professionals can participate in them to the advantage of their clients--and to their professional practices

EAP professionals, clinical social workers, professional counselors, psychologists, benefit consultants, insurance brokers, psychiatric nurses, and clinical nurse specialists can all improve their practices and stay current with Employee Assistance Programs in Managed Care.

Chapter 1

A Service for the Twenty-First-Century Workplace

This morning Teresa awoke to discover that a personal crisis is about to complicate her life—one that will test this single mother's substantial problem-solving skills and her resilient emotional resources. It involves all aspects of Teresa's life that are important to her—family, job, finances, and self-esteem. It's an all too familiar crisis, but one that seems to escalate with each reoccurrence.

This time the crisis is especially anxiety provoking, for she fears that it will cost her her job. Only two months ago, when the crisis last occurred, Teresa's supervisor called her into her office. The supervisor, Ms. Oliveras, said she really liked Teresa and wanted to help but didn't know how, and besides it wasn't her job. Her job was only to see that the office functions smoothly, the work gets done, and customers get served. She said that Teresa wasn't helping and was in fact becoming a problem and a hindrance. Reliable attendance was what the company demanded first and foremost. She warned Teresa not to let this problem cause her to miss work again. She even wrote the warning down and handed a copy of the note to Teresa.

Teresa's mind races. If she loses her job and misses even a single paycheck, she will fail to meet her mortgage payment. She will surely lose her newly purchased home for which she has worked so hard and which means so much. Her ex-husband's hateful prediction that she'd fall on her face if left on her own would come true. And then what will happen to her two small children?

Teresa's crisis is a common one in America, for Teresa is a member of the sizable, ever-growing minority of employed parents, about one in five, who is single and experiencing a child care crisis (Bond et al., 1998, p. 30). Her child care arrangements have failed again, and she is not sure how to find other responsible caregivers for her two preschool-age children on such short notice. Without child care she cannot go to work. Her only option may be to miss part or all of the workday to resolve the problem, at least temporarily. For Teresa, as with other American parents, disruption in child care services is a common problem, happening, on average, about once every three months (Bond et al., 1998, p. 51). For a single, working mother with limited resources, however, this seemingly small crisis may well escalate into a major, destructive, life-changing event.

Dennis is leaving his primary care physician's (PCP) office again. This time his complaint was about his headaches, which are becoming increasingly worse. His doctor ordered some tests this time, and Dennis is thinking about having to explain to his boss that he'll need to take another morning off this Friday. He is not looking forward to that conversation.

This office visit with Dr. Jefferson was different from the others Dennis has had recently. The doctor seemed to take more time with him. He asked a lot of what Dennis thought were personal, not medical, questions. Dr. Jefferson seemed especially interested in how Dennis was taking the medications prescribed for him about six months ago for depression. He emphasized to Dennis that these medications had to be taken exactly as prescribed. Dennis told him that he'd never been very good at taking medicine, while wondering to himself what any of this had to do with his headaches.

Though he doesn't feel well enough, as his headache has returned, Dennis returns to work. He is a technician for a cable television company and, when he's feeling well, spends most of his time in the field installing new cable service and repairing problem equipment. Although he dreads it, he knows he needs to see his supervisor to turn in the excuse he received from Dr. Jefferson, and to tell him he'll need another morning off for the tests the doctor ordered. His relationship with his supervisor, Mr. Hardy, has not been good lately. He even thinks Mr. Hardy is a little afraid of him now, after the big argument they had two weeks ago. He believes Mr. Hardy is assigning too many of the difficult assignments to him instead of the newcomers, as it used to be. In fact, Dennis feels a lot of people at work who used to be his friends are now acting strangely toward him.

When Dennis finally arrives at Mr. Hardy's office, his boss seems particularly ill at ease. His supervisor tells Dennis that he's been dreading this discussion for months. He makes a quick call, and in from an adjacent office step the company's security guard and Mr. Jensen, the human resource manager who hired Dennis seven years ago. Mr. Hardy explains to Dennis that his employment is being terminated, effective immediately. He and Mr. Jensen explain that Dennis's attendance has faltered, the quality of his work has declined, and his temper and irritability have disrupted his co-workers and managers. They point out that he's been warned before about the need to change but has not done so. Everyone feels badly about this, but since the merger, the company can no longer tolerate people not functioning efficiently. They tell Dennis that he's had his chance, and the company cannot be responsible for resolving whatever problem he's having. After he signs some forms, the guard will escort him off the property. His belongings from his locker are already in a box in the adjoining office.

Dennis is stunned and bewildered. He does not seem to have the energy to get angry. He remembers some talks with the supervisor about his work, but he never thought he was in danger of losing his job. Then again, Dennis has felt unhappy a lot in the past couple of years and many things have seemed a little unreal.

Though often unrecognized by family, friends, co-workers, and professionals, Dennis's situation is common. One in five Americans experiences a substance abuse or mental health disorder over the course of a lifetime (Von Korff and Simon, 1996, p. 162). Dennis suffers from clinical depression, one of the nation's most common behavioral disorders, with an affliction rate of 6 to 8 percent of all primary care outpatients (U.S. Department of Health and Human Services [DHHS], 1993, p. 2).

About half of those who experience a behavioral disorder impacting their social and occupational functioning never seek any treatment (Narrow et al., 1993, p. 95), and Dennis receives care through his PCP, not a behavioral care specialist. Studies have shown that of the half who seek care for diagnosable behavioral conditions, about half receive treatment only from a general physician, and that as much as 70 percent of all psychotropic medications and 80 percent of antide-pressants are prescribed by general physicians (Strosahl, 1994, p. 177). Unfortunately for Dennis, his depression has not responded to the particular treatment prescribed by his physician. His work has evidenced a pattern of deterioration for months, but workplace efforts to intervene have been unsuccessful. Now, in addition to his depressive disorder and somatic complaints, Dennis is confronted with numerous psychosocial stressors associated with his newfound status as unemployed. His tenuous relationship with his treatment provider, Dr. Jefferson, will be disrupted by his loss of employment. Dennis will join America's ranks of the uninsured. Untreated, his behavioral disorder will worsen, exacerbated by financial and family problems that develop as a consequence of losing his job.

Teresa and Dennis have something in common—both of their dilemmas could have been effectively addressed by an employee assistance program (EAP). An EAP could have assisted Teresa in finding reliable child care and helped Dennis to identify his depressive condition early in its progression and to obtain effective treatment before his job performance resulted in termination. Neither of their employers offered such a service, making them part of the estimated 58 percent of American businesses employing fifty or more workers who do not offer such a benefit to their workforces (Oss and Clary, 1998). Yet thousands of American employers do offer such services (see Table 1.1), and their numbers are growing, representing one of the few expanding markets for early intervention counseling and consultation services.

TABLE 1.1. National Prevalence of EAPs by Size of Work Site

Number of Employees	Number of Work Sites	Percent of Work Sites Offering EAPs	Percent of Employees with Access to EAPs
All work sites	162,800	32.9	55.3
Under 100	61,600	20.9	21.0
100–249	66,000	33.2	34.0
250–999	29,000	48.4	51.8
1,000 or more	6,200	76.1	82.3

Source:Adapted from Oss, M.E. and Clary, J. (1998). EAPs Are Evolving to Meet Changing Employer Needs. Open Minds12(1), p. 5.

Businesses offer EAPs, not for purely humanitarian reasons, but instead out of a recognition of the prevalence of psychosocial problems in society, as well as an awareness of their negative impact on employee productivity and employer health care costs. In the face of fierce competition in the global marketplace, many businesses have embraced EAPs as a tool to extend their competitive ability. The awareness that a counseling-oriented tool can help employers' bottom line by assisting workers to remain healthy and productive has been one of the least publicized changes in American business in the past decade. To thousands of workers aided by EAPs and those professionals and students in counseling fields, it may be one of the most significant changes.

Employers need to ensure early identification and effective treatment intervention for workers experiencing behavioral disorders for three reasons. First, behavioral disorders are very common, affecting about one in five Americans. Second, behavioral disorders create functional disabilities that impact both social and occupational functioning; this reduces worker productivity and indirectly creates higher social costs that are borne by employers in the form of taxes. Third, behavioral disorders can escalate, thereby increasing health care costs if left undetected and untreated in their earlier stages. Adopted from Von Korff and Simon (1996, p. 162), the three most prevalent psychological disorders among presenting primary care patients most likely to be members of the workforce are

•alcohol abuse,

•major depression, and

•generalized anxiety disorder.

BACKGROUND

It is useful to think of EAPs as products. They may be sold and delivered by a range of entities, from solo practitioners offering relatively modest counseling services to international behavioral care companies offering an entire EAP product line. In sharp contrast to managed behavioral care products, health maintenance organizations (HMOs), and other health care systems, EAPs are largely unregulated. Though their goals remain consistent, their functions, features, and forms continue to change according to the forces of the marketplace. No one standard model exists. In fact, EAP suppliers compete fiercely for the millions of dollars in EAP contracts awarded annually by private businesses an...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Acknowledgments
• About the Author
• Chapter 1. A Service for the Twenty-First-Century Workplace
• Chapter 2. A Managed Care Primer
• Chapter 3. Professional Roles in EAPs
• Chapter 4. Legal and Ethical Considerations for EA Professionals
• Chapter 5. Marketing and Selling EAPs
• Chapter 6. Innovations in Managed Care
• Appendix A. 2001 Directory of Major North American MBHO and EAP Companies
• Appendix B. Sample EAP Sales Proposal for a New Customer
• Appendix C. Magellan Behavioral Health Medical Necessity Criteria, 2000
• Bibliography
• Index