**[Joint Industry Alliance: Employee Assistance and Work/Life Lessons
Learned and Future Opportunities]{.smallcaps}**

**[Current Trends in the Workplace: Impact of EAP and Work/Life Programs
on Human Capital]{.smallcaps}**

This paper provides a description of Employee Assistance Programs (EAPs)
and Work/Life programs as perceived by human resource professionals and
the "purchasers" or employers that offer their workforce this benefit.
This description unveils the purchasers' needs, preferences and concerns
regarding such programs. Finally, efforts that the Society for Human
Resource Management (SHRM) has been involved with that directly affects
the EAP and Work/Life industry are highlighted.

***EAP Effectiveness Defined***

***[Need intro./background defining EAP's.]{.mark}*** The human capital
management strategies of many organizations reflect the on-going efforts
of human resource managers to recognize the needs of the business,
strengthen functional relationships, and deliver support services to its
operational units. Despite these efforts, employers continue to suffer
from the operational and financial consequences of disruptive and costly
human capital challenges, such as recruitment and turnover, absenteeism,
misuse of health benefits, disability management, low employee morale,
and other related issues.[^1] Regardless of how EAP's are defined,
whether as a prevention program or part of a benefit plan, there is an
opportunity for EAP's to be linked to benefit management and serve as
one resource in decreasing these costly human capital challenges. EAP's
are in a unique position to champion behavioral health benefit structure
and program design. Employee Assistance Programs (EAPs) have become a
part of the basic benefits packages for over 90% of all Fortune 500
employers. To remain competitive, employers must, at minimum, offer
comparable benefits to those offered by their competitors. Employees and
job candidates are more "negotiation-savvy" than they were even a few
years ago, due in part from being better equipped with on-the-spot
information, especially from the Internet. Job candidates are expecting
more from employers and employers are expecting more from employees. In
what can be regarded as a reasonable effort to remain competitive, to
thrive and to maximize the utilization of the human capital within the
organization, employers large and small include EAP services among their
health and welfare benefits.

# *Organizational Support for EAP Effectiveness*

Employees faced with financial difficulties, marital problems,
depression, stress, drug and other substance abuses addictions or
dependencies are less productive for their employers. In the chief
interest of improving the bottom line, many employers (67%), offer EAP
services. To do so, most contract with an outside firm.

As with other types of benefits, the consumer or "purchaser" of EAP
service(s) has particular needs, concerns, and preferences. Employers
want the benefits they offer to give them optimal "bang for the buck"
and want to know the return on investment from offering an EAP. Human
Resource (HR) professionals with responsibility for "shopping" for the
benefits to offer employees are consumers just as much as we are. They
want the best quality product with the most durability and breadth of
features for as little cost as is reasonable. Furthermore, they have
taken the lead on how EA programs fit into the overall organizational
benefit structure. The managers of these organizations are less
concerned with providing health care benefits beyond the traditional
prescription drug coverage, life insurance, dental, and vision, than
they are with the actual price of the benefit. HR professionals are more
inclined than managers to provide EAPs as a benefit, but are constricted
by the authority of management which typically sees no direct
relationship between offering EAP services and the dominating "bottom
line." As a result, HR professionals -- consultant or in-house staff --
will be more likely to accept an inexpensive, downscaled version of an
EAP, void of the most helpful features of good EAPs, than to go without
one. Obviously, many employers simply opt not to use an EAP as an
employee benefit.

Employers want to contain health care costs and, therefore, need an
inexpensive EAP with useful options. Employers will look for excellent
customer service and account management from the EAP provider. If the
employer is contracting to an outside firm for this service, the
employer will be dependent on the EAP for all the (timely) communication
it needs. It will be necessary for the EAP to have efficient, thorough
communication and recordkeeping, as the employer will not have the time
to manage the administration of yet another benefit.

Employers have concerns with respect to EAPs. Employers will be
concerned about employer liability for EAP negligence and matters
related to the Americans with Disabilities Act (ADA). With the advent of
recent HIPAA regulations, employers will want to depend on the EAP's
expertise in current and pending legislative matters related to health
care and medical information. Employers will expect EAPs to be aware of
and to consider the confidentiality requirements under Federal and state
laws.

Incidentally, there were dozens of bills presented before congress over
the past few years. Only a few that have been watched by SHRM, though,
relate directly to the EAP industry. The Genetic Nondiscrimination Act
of 2003 deals with discrimination in health care on the basis of
genetics. This legislation would impact wellness programs and others
that may have occasion to access "genetic" information. Senator Paul
Wellstone Mental Health Equitable Treatment Act of 2003 would expand the
Mental Health Parity Act to prohibit health care plans from imposing
treatment or financial requirements on mental health benefits if it does
not maintain similar limits on medical and surgical benefits. Also, Paul
and Sheila Wellstone Domestic Violence Protection Act would create new
leave entitlements (resembling the FMLA) for domestic violence for
certain organizations.

***Work/Life Effectiveness Defined***

It is imperative to frame this discussion by defining the multifaceted
concept of work-life effectiveness and to clarify its increasingly
well-documented contribution to increased productivity, employee
engagement, retention and attraction. The recognition of people for who
they are as well as what they do is a necessary response to the new
realities of the twenty-first century marketplace. In our
twenty-four-by-seven boundary-less world, where the economic laws of
scarcity dictate that time is literally becoming as valuable as money,
work-life effectiveness is coming into its own as a vital component of
such proactive people strategies as total rewards and employer of
choice.

The phrase "work-life" has become ubiquitous, sometimes standing
awkwardly alone, but is most often used as an adjective followed by the
noun "balance." It does beg for a qualifier (work-life *what?)*, since
"work-life" is an invented term that inevitably raises more questions
than it addresses. However, the notion of work-life *balance* simply
doesn't reflect current workplace reality. As defined on wordspy.com,
the term connotes "a state of equilibrium in which the demands of both a
person's job and personal life are equal." Ever since Harvard economist
Juliet Schorr pointed out that Americans are working an average of one
month more each year than two decades ago, any illusion of achieving
equilibrium went up in smoke. Any lingering doubts are dispelled by
extensive research that shows that the spillover of job demands to home
far outweigh the reverse cycle. Ours is fundamentally an unbalanced
world, which now is becoming more prevalent around the globe.

As the professional association that represents the burgeoning work-life
field, Alliance for Work-Life Progress prefers the notion of work-life
*effectiveness*, which refers to a specific set of organizational
practices, policies, programs and a philosophy that recommends
aggressive support for the efforts of everyone in the workforce to
achieve success both at work and at home. This concept makes no
judgments, and leaves it up to each worker to define what success means,
however unbalanced by the dictates of conventional wisdom. This is no
mere repackaging of benefit offerings, but a major restructuring of the
employment "deal" in alignment with new realities in the workplace that
are contributing to the rise of the dual-focused worker (Burud and
Tumulo, *Leveraging the New Human Capital*, 2004). Strategies of
proactive support for work-life effectiveness are taking root in
response to the growing body of evidence across corporate America that
suggests it literally pays to treat employees with the levels of respect
and solicitude normally reserved for external customers.

Many employers are becoming more creative and offering a broader variety
of benefits, particularly where work life balance is concerned. Besides
the traditional benefits of sick leave, vacation leave, holidays, group
health insurance coverage, and a company picnic or annual party, the
SHRM 2003 Benefits Survey reveals that employers are also offering a
variety of "Family-Friendly" benefits. For example, 71% of the survey's
respondents indicate that they provide dependent care flexible saving
plans, thirty four percent of respondents allow telecommuting on a part
time basis and 55% provide flextime for employees. In the same survey,
about two thirds of the respondents offer EAPs. Further, employers are
beginning to see the fruitfulness of providing such creative benefits to
employees.

The Commerce Clearing House (CCH) indicates...*"A study of employers
revealed that the increasing presence of work and family benefit
programs has a positive effect for employers, particularly those
employers with a majority of female employees.*

*Employer reasons for initiating work-family programs and benefits*

-   *Remain competitive \--69%*

-   *Raise morale \--66%*

-   *Enhance recruitment \--61%*

-   *Corporate philosophy \--53%*

-   *Response to employee requests \--52%*

-   *Lower turnover \--44%*

-   *Increase productivity \--44%*

-   *Lower absenteeism \--43%*

-   *Reduce tardiness \--26%*

-   *Enhance community image \--25%*

-   *Result of bargaining agreement \--12%*

-   *Media recognition \--10%*

-   *Other \--5%*

*Work-family programs impact on bottom line*

-   *44% of companies report a favorable impact.*

-   *33% of companies report that the impact is unknown.*

-   *22% of companies report that there is no noticeable impact.*

-   *1% of companies report an unfavorable impact.*

# 

# *Organizational Support for Work-life Effectiveness*

So what does this new type of collaboration between employers and
employees to optimize business outcomes look like organizationally? In
its most robust form, there are seven categories of support for
work-life effectiveness, all of which address the most important
intersections between the worker, his/her family, the community and the
workplace:

-   **Workplace flexibility** -- Refers to the collaborative efforts
    between employers and employees to achieve optimal individual and/or
    team control over how, when and where work gets done. This is
    consistently ranked as the single most valued human resource
    practice today by virtually everyone who works, but it is also the
    hardest to implement in many organizational cultures, because it
    demands high levels of trust and open dialogue between employees and
    the managers who give them direction. This vital category of support
    for work-life effectiveness includes, but is not limited to, the
    provision of a variety of flexible work options that enhance the
    perception of job autonomy, a workplace optimization practice that
    has been shown to increase productivity, engagement and the
    intention to stay, especially among top performers. The three most
    common full-time options are flextime, telecommuting (working
    remotely, usually, but not always, from home; the rising corporate
    practice of hoteling also applies) and compressed work week. The
    three most common less-than-full-time options include job-sharing,
    phased return from (maternity or other) leave and regular part-time
    work.

-   **Paid and unpaid time off --** Time to spend with family and in
    one's community is the most fundamental work-life support of all.
    Some of the newer policies in this category include paid family
    leave for new fathers as well as mothers, and paid or release time
    for community service.

-   **Health and well being (self and family) --** Reduction of stress
    is the central premise of work-life effectiveness. Since the
    negative impact of stress-related illness has been shown to eclipse
    the combined annual profits of the Fortune 100 companies, a focus on
    this category of work-life support holds the most promise of
    contributing to the reduction in the escalating cost of health care.
    Employee assistance programs, fitness center affiliations, workplace
    convenience services, on-site stress reduction seminars, and
    proactive wellness strategies all fit here.

-   **Caring for dependents (children and aging parents)** -- Work-life
    began in most organizations as a response to the growing need of
    dual-income parents for childcare resource and referral services.
    This has greatly expanded over the past decade to such services as
    eldercare support; long-term care insurance and emergency backup
    dependent care for both children and elderly relatives.

-   **Financial support (self and family) --** Providing financially for
    oneself and family from now through retirement is basic to work-life
    effectiveness. This is the primarily the province of compensation
    and benefits specialists.

-   **Community involvement --** This is one domain where employers' and
    employees' interests are spontaneously in close alignment, since
    both the workforce and customers come from the community in which
    the organization operates. Corporate responsibility is expanding to
    include not only new types of external community outreach, but also
    a renewed internal focus on building a strong internal sense of
    community. Formal ethics programs, shared (or catastrophic) leave
    banks, and disaster relief funds are some of the creative new ways
    of taking care of each other.

-   **Management/leadership of culture change --** Creating genuine
    support for work-life effectiveness at all levels of an organization
    is generally so difficult as to require strong leadership in the
    areas of culture change management, new types of management training
    to create an optimally collegial, flexible work environment, and
    work redesign. Additionally, in order to eliminate any residual
    barriers to the full engagement and productivity of every
    contributor, it is sometimes necessary to launch specific
    interventions to eliminate gender (and/or other) inequity, Thus,
    there is a growing link between work-life effectiveness, diversity
    initiatives, women's advancement, mentoring and networking.

As those of us in the EAP, work-life, HR, benefits, compensation and
total rewards professions know so well, not all of these programs,
policies and practices typically reside in one neatly organized and
appropriately resourced department or function. Nor does the work-life
professional independently "own" much of the terrain in which s(he)
operates. The work-life function is, therefore, a highly collaborative
endeavor that helps connect the dots between many other human resources
efforts. At its best, it serves as a catalyst that drives the
organization to measurably superior outcomes.

***The Stages of Work-life Evolution***

Organizations progress through definable stages once they catch on to
the now irrefutable connection between strong leadership support for
widespread work-life effectiveness and above average business
performance.

*Pre-Stage One* describes the vanishing breed of organizations that
still fundamentally believe that people are a cost, not an asset. There
is no discernible activity to support or promote work-life
effectiveness, since nurturing employees is not a core value.

*Stage One* is programmatic. There is usually one program, one target
population or one area of focus that launches a firm on a path towards
building what eventually becomes a healthy portfolio of work-life
programs, policies and practices. A decade or two ago, in work-life's
infancy, the first programs to appear often centered on childcare, since
women were entering the workforce in record numbers and employers needed
to help them figure out who was going to take care of their children.
The business objective was to reduce productivity loss caused by
childcare problems. Today, it is equally likely to be the escalating
need for eldercare support or a program of community involvement that
becomes the first formal manifestation of an employer's support for the
work-life effectiveness of its workforce. A stage one company may use
the term "work-family" if the focus is entirely on working parents or
families with children.

*Stage Two* is integrative. There is a broad range of integrated
programs that meet the needs of multiple segments of the workforce, not
just parents. The vocabulary often changes to "work-life", in
recognition of the fact that everyone who works has a life. Flexible
work arrangements are often implemented at this juncture. The business
objective shifts to realizing productivity gains through addressing
multiple causes of work-life conflict.

*Stage Three* is characterized by deliberate culture change management.
There is increasing emphasis and outreach to community organizations as
resources in new, creative collaborative ways to help solve employees'
work-life issues. Deeper cultural issues that might be hindering gender
(or other) equity might be identified and need to be dealt with. The
business objective becomes the improvement of employee commitment and
discretionary effort by creating a more effective organization, even if
that means reinventing itself.

*Stage Four* focuses on the workplace, the creation and sustenance of
high performance work teams and the efficiency of work processes.
Workplace flexibility matures beyond individual one-off accommodations
to a team sport that is appropriately shared and practiced, so that the
team takes care of its own work-life needs, not the manager. Where
necessary to reduce work overload and unacceptable levels of stress,
work gets redesigned and new ways of working are experimented with.
There may be a shift to a global concern for work-life effectiveness in
large, multi-national corporations. The business objective is to improve
the individual and collective sense of well being and engagement as the
key to achieving better business outcomes.

Given the broad charter of the work-life professional, and the critical
tasks to be accomplished at each stage, the trends and challenges in the
work-life field tend to stay relatively constant:

-   Debunking the myth that work-life effectiveness is of primary
    interest only to women. Now that single fathers are one of the
    fastest growing demographic groups, men are showing more interest in
    using the work-life programs available to them. However, many
    organizational cultures make access much more difficult for men than
    women, so this represents a new frontier.

-   Proving the business case. Again. Work-life professionals have been
    asked to prove that their interventions have measurable impact so
    often over the past twenty years that the entire field has become
    much more adept at calculating ROI than any other function within
    HR. There is now so much compelling evidence for the positive
    relationship between support for work-life effectiveness and higher
    shareholder value (and just about any other measure of positive
    business outcome) that FORTUNE magazine has approached the Alliance
    for Work-Life Progress (the professional association for the field)
    to partner on a multi-year national educational campaign called the
    National Work-Life Initiative to make sure that everyone in the
    business world realizes that the Golden Rule is alive and well --
    treating people with the utmost respect for who they are, not just
    what they do, is simply good business.

**[Missed Opportunities within the EA and Work/Life
Industry]{.smallcaps}**

There are numerous examples of how the EAP field as a whole has missed
several opportunities to advance the needs and interests of the EA
industry. Perhaps this is most evident as it relates to various
legislation passed over the last several decades. The lack of a known or
recognized lobbying entity has resulted in the passing of legislation
that does not take into account recognition of the benefits or interest
of the EA industry.

Linkages with other HR organizations/associations with mutual interests:
The Employee Assistance industry has worked in a vacuum, rarely
connecting with organizations that may have similar/mutual interests,
organizations such as SHRM, AWLP, World at Work. Resources for any
association/organization are limited and when joint interests could have
been served and resources more wisely spent by collaboration, the
relationships didn\'t exist for the collaboration. Whether the issue was
potential legislation, areas of common/shared training and education, or
educating benefits consultants and employers regarding how EAPs fit into
an organizations vision and objectives, the EAP industry tackled the
issue from a narrower, industry-specific perspective, often losing sight
of the bigger human resources picture.

Although integration is relatively run of the mill in 2004, it was a
long time before EA organizations recognized the need for
integration-and many still do not acknowledge the broader arenas in
which an EAP can partner with the workplace. EAPs can remain true to the
core technology while integrating effectively with worklife, health and
wellness, absence management, and other areas impacting workplace health
and productivity. Most large EAP vendors now routinely offer worklife
support as a significant part of the EAP and many more are now moving
into the health and wellness arena.

Benefits consultants now play a key role in the bidding of EAP work,
particularly for the larger vendors. An area of missed opportunity for
EAPs was partnering with benefits consultants to help educate them about
EAPs, how they differ from MBHC organizations, the core technology,
appropriate utilization and other metrics, etc., so that as they assist
buyers, they can help the buyer focus on the important components and
uniqueness of EAPs.

Several examples can illustrate missed opportunities as it relates to
legislation impacting the employer and the EA industry.

***[Need to add this section]{.mark}***

California's Knox Keene Act:

Employee Retirement Income Security Act ("ERISA"):

Health Insurance Portability and Accountability Act of 1996:

[HSA's??]{.mark}

The work-life field has been pre-empted by the media as the "keepers of
the lists", the authorities that define what excellence is in the domain
of work-life effectiveness. Working Mother Media, FORTUNE magazine, and,
once upon a time, Business Week run the most nationally visible public
contests that determine who the 100 best companies are, largely
determined by the content of the seven categories of work-life support.
Although this situation can be frustrating for the work-life
professional, it does have the advantage of making work-life the most
vetted, scrutinized, measured, lauded set of people practices in modern
history. There is literally nowhere to hide.

**[Future Opportunities for EA]{.smallcaps}**

Leading organizations are forced to continually look for ways to
increase productivity and reduce costs. Advances in technology have led
the way in the pursuit of higher returns but as the U.S. economy
struggles and margins shrink, additional avenues are needed to sustain
or gain competitive advantage in a global market. A key area of focus is
on the human side of the business. Some organizations have shifted sales
support, accounting, billing and other office jobs offshore in search of
lower labor costs. How does EA fit in this environment? How can EA
programs bring measurable solutions to the table? One hurdle is EA
programs still have the tag of being a "nice to have" program but the
value is not seen, as evidenced by the earlier mentioned Commerce
Clearing House (CCH) study where 55% of respondents reported the impact
of work-family programs on the bottom line is either unknown or has no
noticeable impact. This survey is even more troubling given the fact
that many EA programs were spotlighted following September 11, 2001 and
many EA professionals used the opportunity to increase visibility at the
executive levels in their organizations and with many human resource
professionals.

***Partnerships***

There is tremendous opportunity for EA professionals in larger
organizations to partner with various functions within the organization
to increase the value of the EA program. In smaller organizations, EA
professionals may only need to partner with a couple of key individuals,
and in fact, many small, regional EA programs have been very successful
in developing relationships with these organizations and the value of
the program is often measured more on the personalized service that
comes from having a close geographical relationship.

In large organizational systems there is potential for the EA program to
get lost among the many competing functions looking for the decreasing
pieces of the resource pie. One strategy to assist organizations with
the continued drive for productivity improvements is in specifically
looking at ways to leverage their people resources. Yearly surveys are
conducted and mined to develop strategies to increase employee
productivity. The Gallup organization has long been aware of the link
between employee engagement and productivity and has identified 12 key
areas that consistently related to retention, profitability,
productivity and customer satisfaction. (Coffman & Harter, 1999)
Identifying specific questions within the organizational survey process
can help identify important metrics that EA professionals can align
themselves and program goals around.

Another partnership role for the internal and hopefully external EA
programs is with consumer directed health plans (CDHP's). CDHP's, are a
relatively new health plan that was rolled out in a few organizations in
2004, and is expected to be very common in 2005. There are variations on
the how the plan is built, including if fund dollars are available to
members before moving into higher deductibles, percentage of co-pays and
maximum out of pockets. How do these plans affect EAP and or mental
health / substance abuse benefits (MHSA)? There are many, often
confusing variables in getting mental health and substance abuse issues
addressed. In plans where the MHSA benefits are carved out there
essentially two plans the members to be aware of and be able to access.
For example, if a member sees a MD for depression and is prescribed
medications, the MD would be covered under the MHSA plan while the
medications would be covered under the CDHP. EAP's are in a great
position to help employees understand the nuances of the particular
benefit plans. There is some discussion and attention to the issue of
employees and their dependents picking and choosing what medications
they will take based solely on how much benefit coverage is available in
the plan. These decisions may reduce expenditures in the short run be
could be devastating to the employee / family and the organization in
the long run. Other opportunities to educate the consumer-employees and
dependents include types of MHSA treatment, and best practices. EA
professionals are also in the unique position to educate benefit
consultants & purchasers of service on the relationship between mental
health problems and medical utilization and the impact CDHP may have on
health care. Within this framework of educating the consumer hopefully
added benefits will be gained by reducing the stigma and receiving care.

The global EAP industry and professional associations have been
supporting the development of complex tools to measure ROI or program
value as pricing power has eroded and services are being viewed more as
a commodity. Human capital measurements include; worker productivity,
absenteeism, presenteeism, turnover rate, replacement costs, avoided
legal / health costs, stress, physical health, motivation, behavioral
health. These measurements are assigned a value, usually salary rate and
total cost (or resources lost) to the organization and then the impact
is computed. Program cost is divided by the total computed cost for the
projected ROI. Problems with this method include: establishing a
baseline and/or difficulty in tracking improvement as a result of
organization's poor or imprecise data. In 1974, Myers and Flowers
presented a framework to measure human capital.[^2] They viewed job
performance as the end product of a five-part flow process: knowledge,
skills, health, availability and attitudes. The five components add up
to job performance and any one missing piece would negate the effects of
the others.[^3]

The EAP industry is not the only industry or professional association
looking for measurements to demonstrate value and ROI. Companies and
associations that specialize in Wellness, Disease Management,
Organizational Development, Occupational Health, Benefits, Human
Resource Management, Communications and Healthcare all project cost
savings or ROI based on one or more of the above human capital
measurements. A presentation titled: 2008 Future Vision -- A Wellness
Perspective anticipates the marketplace will demand vendor
consolidation, high service quality and cost effectiveness and a greater
variety of benefit partners will be integrated: EAP, wellness,
work/life, worker's compensation, medical and disease management.[^4]
Companies currently are highly fragmented in their approach to measuring
health care costs. Benefits managers may focus on medical claims,
whereas other managers' look at workers' compensation, and a different
group zeros in on absenteeism and short- and long-term disability costs.
Increasingly, a number of companies are taking an integrated approach to
evaluating costs.[^5]

As the different HR & benefit related external service providers seem to
be bumping heads with each other trying to demonstrate value, there has
been little discussion of integration other than, EAP with Work-life and
Wellness programs. This situation presents an opportunity to integrate
the different functions both within an organization and externally and
develop pilot projects. Strategies-projects that leverage the resources
of the different disciplines directed toward one or more of the
organizational goals. This integration, has the potential to, 1)
integrate health-related costs, 2) analyze employee
demographics/costs/risks --targeting interventions for best returns, and
3) measuring the impact on workplace performance and total
health-related costs.

Example of this collaboration from the EAP perspective:

Background

The top problems identified by an EAP over the past 2 years listed in
order of prevalence are depression, family, marital, and child-teen
issues and substance abuse. All of these problem areas impact
productivity, safety and employee engagement.

-   Articles by Burton et al and by Lerner et al in the July 2004 issue
    of the Journal of Occupational and Environmental Medicine reconfirm
    the finding that Employee depression is associated with reduced
    productivity. Burton also noted that the major effects were on time
    management, interpersonal skills, and overall productivity.[^6]
    Lerner noted that the depression effects were most pronounced in
    jobs that required either proficiency in decision making or frequent
    customer contact.[^7]

-   An untreated depressed worker is functioning at 67%
    productivity[^8].

-   Depressed individuals utilize five times as many disability days vs.
    a non-depressed person.[^9]

-   Twenty plus years of research links social support & healthy
    relationships to better physical and mental health.[^10]

-   A study conducted by the National Institute on Drug Abuse (NIDA) and
    the National Institute on Alcohol Abuse and Alcoholism (NIAAA) found
    that in 1992 alcohol and drug abuse cost the economy an estimated
    \$245.7 billion. In particular, alcohol and drug abuse had a
    profoundly negative effect on the workplace in terms of decreased
    productivity, increased accidents, job turnover, and medical
    costs.[^11]

-   Alienating work seems to increase problem drinking indirectly
    through contribution to job dissatisfaction, and then only when
    workers believe that alcohol is "an important and efficacious coping
    mechanism".[^12]

-   According to a 1993 study, substance abuse drives up health care
    costs:

> Between 25% and 40% of all general hospital patients have been
> admitted for complications related to alcoholism.
>
> Between 17% and 53% of falls are alcohol related, and falls are the
> second leading cause of fatal injuries.
>
> When heavy smokers are hospitalized, they stay 25% longer than do
> non-smokers.
>
> About 28% of all ICU admissions and nearly 40% of all ICU costs at one
> major hospital were due to substance abuse[^13]

-   Substance abuse is expensive to business in several different ways:

> Workplace accident rates are two or three times higher than normal.
>
> Substance abusers are five times more likely to file a worker's
> compensation claim.
>
> Substance abusers are 2.5 times more likely to have absences of eight
> days or more.[^14]

-   Government statistics indicate that 80% of heavy drinkers are
    employed full or part time. Their supervisors and co-workers are
    likely to notice the signs of problem drinking such as frequent or
    unexcused absences and hangovers, both of which can seriously
    interfere with job performance. Employers have another strong
    incentive to be concerned about alcohol problems in the workplace:
    in addition to their impact on productivity, they drive up
    company-borne medical costs through more frequent use of emergency
    room services and through longer hospital stays for a variety of
    alcohol-related injury and health conditions. Alcohol problems add
    19 billion to the nation's health care bill.[^15]

Identified Plan of Action:

The collaborating team would review possible strategies to address the
identified problem and develop pilot projects. For example the team may
select a program that has the ability to influence help seeking
behaviors, and communication within a work group. Lehman and Bennett at
the Institute of Behavioral Research at Texas Christian University have
conducted studies around a Team-Based Approach for Substance Abuse
Prevention: A workplace Training. Results of this study funded by the
National Institute of Drug Abuse and the Center for Substance Abuse
Prevention (SAMHSA) found that employees who participated in *Team
Awareness* training were:

-   Significantly less likely to come to work under the influence of
    drug or alcohol

-   Two times as likely to decrease problem drinking behaviors

-   Nearly three times less likely to work with, or miss work due to a
    hangover

-   Likely to double their help-seeking behaviors

-   Significantly more likely to work in groups that encourage coworkers
    to stop a drinking or drug habit

This study establishes the effectiveness of classroom training in
several areas: stress reduction; work-life balance; enhanced emotional
health; work group communication and supervisory responsiveness. The
program has been designated "effective" or a "model program" by the
National Registry of Effective Programs and the Substance Abuse and
Mental Health Services Administration.[^16]

[Need closing statement]{.mark}

***Six Sigma***

Service operations now comprise more than 80% of the GDP in the United
States and are rapidly growing around the world. Even within
manufacturing companies, its common to have only 20% of product prices
driven by direct manufacturing labor-the other 80% comes from costs that
are designed into the product or costs associated with support and
design functions (finance, human resources, product development,
purchasing, engineering, etc.). Moreover, in service applications, the
costs related to work that adds no value in your customers' eyes
("non-value-added") is higher than in manufacturing, in both percentage
and absolute dollars. The revenue growth potential of improving the
speed and quality of service often overshadows the cost reduction
opportunities. For example,....work that adds no value in your
customers' eyes typically comprises 50% of total service costs. This
represents enormous, "white collar" potential for achieving significant
speed, quality, and cost improvements, all of which can give
organizations a major strategic advantage over their competition. [^17]

What does this have to do with EAP? EA programs provide a valuable
service and like most service organizations there are opportunities to
improve both the process and speed at which services are delivered.
Organizations have begun to use six sigma tools to evaluate how services
are delivered and how to increase successful outcomes. For example, six
sigma tools can be used to gain valuable insight in how depression
impacts the organization through data collection and then develop
strategies and control process to help improve outcomes of those who are
treated.

EAPs have become commoditized and need to move into the future by
focusing on their contribution to an organization\'s human capital
management. Assuring that all appropriate products and services are
offered to support the ever changing workplace will be a key element to
the industry\'s growth. EAPs cannot afford to stagnate; they must look
for new opportunities to expand their value to
organizations/corporations to demonstrate a more significant ROI.

The opportunity for the greatest contribution from the work-life field
is the potential for slowing down the upward trajectory of corporate
health care costs. The central premise of work-life effectiveness is the
reduction of stress. Stress literally kills. It certainly disables. It
is conservatively estimated to cost American business over \$300 billion
each year, more than the combined profits of all FORTUNE 500 companies.

In collaboration with other specialists in the workplace, such as EAPs
and benefits professionals, it is urgent that we move quickly to bring
to bear all the collective expertise and resources we own in order to
accelerate the creation of healthier workplace environments -- places
that are good for people and good for business.

***International***

It is surprising at first sight that the large US Employee Assistance
Program providers have shown so little interest or initiative in
expanding their services outside the US. Given that the growth of EAP
services overseas will continue to accelerate faster than in the US one
might expect that market leaders would have seen this as a
mouth-watering invitation. Without radical innovation the relatively
saturated US market is now unlikely to keep pace with rapid EAP growth
globally.

A handful of American providers may wish to dispute that they have shown
too little interest in overseas development but in all honesty their
efforts to portray themselves as "global" are generally more optimistic
than accurate and occasionally unhelpful in a naïve marketplace.

It isn\'t only the case that opportunities have been lost with formal
Employee Assistance Programs. There are three million US citizens abroad
at any one time these days and many of whom are employees of corporate
America, often in pressured and vulnerable circumstances, to say nothing
of their family members. This sort of "one off" requirement of the
frequent traveler has overtaken the needs of the traditional ex-Pat in
many parts of the world as well as being beyond the outreach of the
typical Employee Assistance Program provider, yet little seems to be
being done in a consistent or systematic manner. To those who see the
"EA" as equally important as the "P" this is a very obvious employee
need.

EAP provision outside the US is taking many forms and innovation has
been its hallmark, if for no other reason than that overseas providers
are obliged to be creative to meet the circumstances of their own
cultures. It is paradoxical that in an era of globalization, cultural
divides become more evident and acute and the need for EAP providers to
be adaptive is even more pressing. Although it may sound harsh, Core
Technology is hardy more relevant to life as it is lived in many parts
of the world outside the US than the sacred cows of India are relevant
elsewhere.

Some historical data: by mere quirks of history the EAP formula has been
known for decades outside the US, particularly in South Africa and
Australia. In South Africa the mining industry adopted it as a support
mechanism for tens of thousands of mine-workers -- a desperately poor
segment of the population, mostly drawn from neighboring Africa states.
In Australia, socialist governments in the 1970's supported the growth
of Employee Assistance Programs through subsidies to employers who
adopted them. In both these continents local providers have since moved
on to more contemporary versions but the tradition is well rooted.

Meanwhile, in the UK, another example where EAPs have made good headway,
the legislative background has not been and probably never will be as
supportive of EAP-led alcohol and drug services as in the US. On the
other hand, a strong welfare tradition stretching back more than a
century has made it easier for a new generation of EAP providers to find
fertile soil. In retrospect it is somewhat surprising that EAPs have had
such success in the UK, given that that there is little genuine
awareness of the systems and structure of the Managed Care EAP, and that
the work-life/EAP divide in the US has no mirror image in the UK. It
might be said that if the American "alcohol" EAP evolved into the
broad-brush "mental health" EAP, the UK version was re-designed, almost
unwittingly, as the "stress" EAP.

Whichever way one considers these two types of Employee Assistance
Program -- US and UK - they may appear similar on the surface but
reflect radically different cultures and times, a phenomenon which is
mirrored and magnified further in the kind of EAP services which are
growing in other European countries, and even more in Asia Pacific
regions.

Is this a missed opportunity? Perhaps so and perhaps this is a blessing
in disguise. Early tentative ventures to integrate the traditional EAP
formula into some Asian countries have highlighted the possibilities for
mismatch of expectations among local providers (fees and income) against
a background of different legislative, healthcare and professional
structures. Local providers have been bemused and flattered on occasion
by approaches telling them that multinational X is establishing itself
in their country ("we have 100,000 employees worldwide") only to find
that in the end a single 400-strong plant falls within their area --
under managed care procedures -- and that they have few referrals with
lower than their usual fee income. Meanwhile the provider has been
coaxed into 24-hour coverage where the telephone is neither a typical
nor functional means of communication, nor where managed care is a
contradiction in terms within that culture. Such mismatches fortunately
are not common but they need to be quickly understood if we are not to
trip up more frequently.

Elsewhere and in a variety of settings, and in the absence of a clearly
defined and viable universal EAP model, local practitioners have taken
up the slack, with the ability to match their services to compatible
employment law and practice, with provision based simply on their broad
understanding of the ethos of the Employee Assistance Program, on their
existing experience of responding immediately and professionally to
local conditions and on their own service capability. They may belong to
different professions (such as industrial social workers) rather than
the counselors and psychologists with whom (in Europe at least) we are
more familiar, and they are more likely (in Asia generally) to be based
in hospitals and educational institutions than to practice from private
premises.

There are still opportunities for US providers to expand overseas,
especially for those willing to contemplate a sensitive adaptation to
and partnership with local professionals. This is by no means a second
best. The number of well-educated and ambitious local providers is
increasing and the choice of locations for such partnerships is endless
and exciting. The creativity involved in such enterprise may well
generate greater program flexibility, if we look backwards, and perhaps
new options for our own environment.

***[Conclusion/Summary Statement]{.mark}***

[^1]: Placeholder

[^2]: Myers, M. S., Flowers, V.S. (1974). A framework for measuring
    human assets. *California management Review*16(4), 5-16.

[^3]: Cascio, W. F. (2000) Costing Human Resources: The financial impact
    of behavior in organizations (4^th^ ed.). Cincinnati, Ohio.
    South-Western College Publishing.

[^4]: Mulvihill.. Presentation from the Employee Assistance Professional
    Association conference. 2003

[^5]: Cohen, K.; Vogt, E.; Naughton, D.; and Sullivan, S. (1997).
    Equating health and productivity. *Business and Health* 15(9):23-26

[^6]: Burton, et al. JOEM 2004; 46 (6)

[^7]: Lerner, et al. JOEM 2004; 46 (6)

[^8]: Burton, et al. JOEM 1999; 41 (10): 863-877

[^9]: Mercur, S. Disease management, Fall 1999

[^10]: Chemiss, 1980; Pines 1983; Taylor, et al. 1989; Eriksen 1994

[^11]: Harwood, Fountain, Livermore et al., 1998

[^12]: Greenberg, E.S.; and Gunberg, L. (1995). Work alienation and
    problem alcohol behavior. *Journal of Health and Social Behavior*
    36(1):83-102

[^13]: Institute for Health Policy, ed. Workplace burden. In; Substance
    abuse: *The Nation's number one health problem-Key indicators for
    policy.* Princeton. NJ: The Robert Wood Johnson Foundation, 1993,
    44-45.

[^14]: "Drug abuse in the workplace: An employer's guide for
    prevention." *EAP Digest*

[^15]: Hon, Jeffery; Ensuring Solutions to Alcohol Problems, 2003, The
    George Washington University Medical Center

[^16]: Bennett, J. B., (2003) and SAMHSA presentation at Employee
    Assistance Professional Association, 2003

[^17]: George, Michael L., *Lean Six Sigma For Service.* New York:
    McGraw-Hill 2003