What is the right EAP for the 21st century?

Employee Assistance Programs (EAPs) have an unusual history. They originated in the 1970s as a mechanism to assist workers with alcohol abuse, in ways that now seem chilling. Images of employees led to HR to contend with their “drinking problem” conjures an archaic workplace culture. Over the decades, however, EAPs have become the standard feature of most employers’ benefit offerings, emphasizing confidentiality and offering an array of benefits and services addressing issues such as substance use, child and/or elder care, relationship challenges, financial or legal problems, workplace aggressions, and mental health. They have come a long way, especially in the past five years, but where are they going?

Ubiquitous as they are, EAPs are terribly underutilized, with engagement rates generally hovering around 3% to 5%, and often lower. It’s no coincidence that many of the companies I speak with are looking for an “EAP replacement,” perhaps a euphemism for, “I want a program my employees will actually use.” I agree. Better adoption is desperately needed for a workforce that has been troubled by the COVID-19 pandemic, turbulent world events, and, currently, an uncertain economy.

While mental health concerns were on the rise prior to 2020, COVID-19 spotlighted the gap between benefit need and utilization, as well as other COVID consequences influenced by sheltering in place, such as the rise of substance abuse. Mental health has emerged as the dominant member demand. And employers understand the implications extend beyond health to productivity, absenteeism, retention, and overall job satisfaction.

The prevalence of EAP replacement requests indicates a pressing concern from benefits managers: What should a 21st century offering be for a workforce looking for something more than what they have? Is there a new choice of programs that are accessible, easy-to-use, relevant for their needs, and measurably effective?

It starts with access to care. The primary reason employers look for a new EAP is that their existing program doesn’t deliver good enough access to providers, whether for immediate support or a regular schedule to see a provider within a reasonable time. Access to care is a key benchmark for employer value, but achieving it requires investment. The question of ROI – essential to an employer’s EAP decisions – is intertwined with the need to build a business case to justify that investment.

At the crux of the business case is the need for evidence of positively impacting members and demonstrating the overall value brought to the employer’s benefit offering. Being able to measure and report on clinical outcomes experienced by the members as well as identify the impact to overall medical spend is critical. While benefits managers understand ROI, the reality is that employees do, too. If a person can only, at best, have a general sense of their progress or, at worst, not even that, why would they be expected to engage with an EAP for counseling services? Provable and measurable outcomes should define the ROI of EAPs for both stakeholders. Without that, move on.

EAPs have a greater chance of utilization when they go beyond traditional therapy support and provide ongoing access to a coach and self-care content such as mindfulness practices and other skill-building exercises. That sense of continuity is particularly important, as it addresses a common disappointment among users: “I did it for a while, but it felt like I reached a limit, that there was not much incentive to go on, so I stopped.” Regression often follows. Perhaps even more disappointing for benefits managers, 57% of adults with a mental illness receive no treatment at all. Surely, it’s harder to navigate care when experiencing stress or depression. To engage employees, benefits leaders should look for an EAP that offers:

• Multiple ways to access a clinical care team including phone contact and digital platforms;
• Searching for, vetting, and initiating connections to work/life services, including child and elder care, legal and financial services, and community-based organizations;
• Uncovering sensitive needs around social determinants of health and identifying community-based support or employer benefits from an extensive database of organizations that help with housing and food insecurity;
• Case management, including follow-up, to confirm the member made a connection with vetted providers offered, and staying in contact with members who engage with in-person care to ensure the provider match is right and needs are met.

The ultimate goal of any EAP should be long-term personal benefit through learned, practiced, enduring behavior, where employees have been provided unlimited access to tools and resources to maintain the healthiest versions of themselves. That’s even more difficult to achieve than initial utilization, and the combination of measurement and secondary interventions can help improve ROI.

Read more: EAPs: not just a therapist in the workplace

Ultimately, to be successful, the benefit team’s mission has to be larger than only communicating a new offering. The EAP should be seen as one aspect of a culture of caring in the workplace, encouraging feelings of safety and inclusion that employees will bring to the EAP discovery. Leadership training, and the adoption of policies and procedures that build a nurturing environment need to be at the forefront. It will free people emotionally to pursue mental health offerings in their EAP.

We’ve come a long way since EAPs were used as tools of enforcement. The desire exists among both employers and employees for EAPs to better satisfy changing needs. As mental health issues affecting the workplace continue to climb, EAPs can and should be the first stop for intervention. Giving employers and their members the tools to see what’s working is the key.

Sandra Kuhn, LCSW; Head of Commercial Enablement, Headspace.