“Advancing the EAP Field by Applying Innovations in Technology and Predictive Analytics” Presented at

Employee Assistance Society of North America 2013 Annual Institute Chicago, IL May 2, 2013 Presented by

Tom Amaral, Ph.D., President & CEO EAP Technology Systems Inc. Dave Sharar, Ph.D., Managing Director Chestnut Global Partners Mark Attridge, Ph.D., President Attridge Consulting, Inc. About the Presenters

Dr. Tom Amaral is President & CEO of EAP Technology Systems. He is a research psychologist who has been researching and evaluating EAPs for more than 30 years, and a recognized expert on ROI, workplace outcomes, benchmarking, and demonstrating business value. He has implemented these types of projects for many Fortune 500 corporations and other organizations. Tom is also chief architect of the company's computer software systems, and he conducts training seminars on a variety of advanced topics, including how to make the business case for EAPs, how to calculate ROI, and how to conduct benchmarking. He has authored and presented

many papers and articles on research, evaluation, cost-benefits, performance metrics, and software topics. He is also on the editorial board of the Journal of Workplace Behavioral Health.

Dr. Dave Sharar is Managing Director of Chestnut Global Partners, a provider of international employee assistance, expatriate support, and crisis intervention abroad. Dave is also a Research Scientist with Chestnut's Division of Commercial Science where he deploys scientific methodologies to help EAP firms and other workplace health programs evaluate their effectiveness.

Dave has published over 70 articles in peer reviewed journals and trade magazines. In partnership with Dr. Richard Lennox, he co-developed the Workplace Outcome Suite, a tool being used by over 400 EAPs to measure effectiveness. He is on the editorial board of the Journal of

Workplace Behavioral Health and on the Board of Directors of the Employee Assistance Research Foundation.

Dr. Mark Attridge is a social psychologist and research consultant in independent practice as President of Attridge Consulting. He has experience with a range of employee health management services but has been most active in the field of workplace mental health and with EAPs in particular. He was the co-recipient of the "2009 EASNA Member of the Year" award for writing and editing the EASNA report "Selecting and Strengthening Employee Assistance Programs: A Purchasers Guide."

Mark is a prolific writer, scholar and teacher. He has authored more than 100 articles and conference papers on topics in health care, psychology

and communication. Previously, Mark was a National Director at Watson Wyatt Worldwide and a Principal at Optum.

All three speakers are active members of EASNA’s Knowledge Transfer and Research Committee – KTR.

Advancing the EAP Field by Applying Innovations in Technology and Predictive AnalyticsTom Amaral, Ph.D., President & CEOEAP Technology Systems Inc.

Dave Sharar, Ph.D., Managing DirectorChestnut Global Partners

Mark Attridge, Ph.D., PresidentAttridge Consulting, Inc.

2013 EASNA 25th Annual InstituteChicago, ILMay 2, 2013

Top Six Needs of the EAP Industry

• Higher utilization rates

• Actionable and measurable outcomes

• Better coordination among partners

• Greater perceived value among purchasers

• Innovative services for future generations

• Continuous succession of EAP professionals

High Prevalence of Behavioral Health Problems in the Workplace

9%8%

9%

11%

Alcohol Drugs Depression Anxiety

Percent of All Employees

Low Utilization of Benefits for Mental Health and Addictions

10% Unmet Need

30%

0% 10% 20% 30%

Those WhoReceive Help

Those WhoNeed Help

Percent of All Employees

EAP Utilization Rates from the EAP Data Warehouse™

Employee Cases Utilization Rate 3.0%

Alcohol Cases Opened 1.4/1000

Drug Cases Opened 0.7/1000

Cases Opened with Depression 6.5/1000

Cases Opened with Anxiety 8.1/1000

Technology Solutions

• Easy access to the EAPfor employees throughmobile devices

• Easy access to self-directed help-seeking information through apps

• Easy access to the EAP for managers and HR professionals through direct portals

• Next generation counseling solutions, such as e-counseling, v-counseling, gaming apps

EAP Data Warehouse™

EAPData

EAPBenchmarks

EAP DataWarehouse

EAPData

EAPData EAP

Data

EAPData

Buckets of EAP Outcomes

Gathering Consistent Data

• The role of “portals” and mobile devices in standardized data collection processes

• Integration of standardized data collection tools, such as the WOS

• Automated gathering ofworkplace outcomes

• Standardized performancemetrics

Open Audience Dialogue On:

• Higher utilization rates

• Actionable and measureable outcomes

What is “Coordinated Care?” (No Agreed Upon Definition)• Linkage Coordination Integration

• “Right care, Right place, Right time”

• Ensuring info sharing across people, functions, sites

• Smooth transitions from one service to another

4 Key Functions of “Care Coordination”1. Communication & info sharing

2. Education & motivation

3. Self-management support

4. Monitoring of adherence

Why Monitoring is Critical? Hypothetical but Common Example

Stage of intervention

Sym

ptom

sev

erity

0

1

2

3

4

5

6

7

8

9

Pre-tx During During During Post-tx

During

Care Coordination in EAP is More Than:• Handing a referred client a provider phone #

• A warm phone transfer to a service partner

• Co-location of EAP, WL, & Wellness

• Sending the client a web-link or PDF

18% 15%

82% 85%

NBC Study (2013) Sharar (2008)

Referred Resolved

EAP Referral Out vs. Resolved

Coordinating Care in EAP: How Are We Doing (In General)?• About 25% of EAP vendors incorporate

validated screening or SBIRT as a part of intake*

• Most vendors rely on a 3-10 minute intake call*

• Of the 18% referred on, how many do you think received “post-referral” follow-up?

• Less coordination with workplace as management referrals decline

* Mahieu & Taranowski (2013). A study of RFI data from Aon Hewitt. EASNA Research Notes.

Barriers to Care Coordination in EAP• Mainly viewed by purchasers/consultants as “free”

(pre-benefit) counseling (not care coordination)*

• Care coordination seen more as a Managed Behavioral Health or Disease Management than EAP role

• Affiliates are more “therapists” than care coordinators

• Are we being paid to provide care coordination?

• We are largely separated from primary care

* National Business Group on Health (2008) Employer’s Guide to EAP

Use of Technology CanConnect Every EAP Constituent

PrimaryCare

WorkLife and

WellnessPartners

Management ReferralLiaisons

Treatment or Community Resources

EAPAffiliates

EAP Provider

Common EAP Value Propositions

• Total “well-being”

• Integration with allied products

• Easy access, Highly responsive

• Readily available resources

• Engaging communications

• “Preferential” relationships

• Low price

• Savings via “problem resolution”

• Claims of impact & outcomes

Historical Indices of EAP Value

1. High utilization

2. User satisfaction

3. Positive testimonials

4. References to studies/reports

5. Perceived “responsiveness”

6. Some effort to “quantify” impact

National Behavioral Consortium Benchmark Survey (2012)

On your follow-up surveys, did you incorporate items from a standardized and research-validated tool to measure outcomes after use of the EAP?

No, 58%Yes, 42%Less than half of

EAPs used validated survey tools

(n=62)

Validated Survey Measurement ToolsOf the 25 companies that used Validated Tools:

36% Internally developed tools

28% Workplace Outcome Suite (WOS)

20% Stanford Presenteeism Scale

20% Health and Productivity Questionnaire (HPQ)

16% Work Limitations Questionnaire

4% Employer Measures of Productivity, Absenceand Quality or EMPAQ

Product Expansion of “EAP”

Assess/Refer

Short-term Counseling

Legal/Financial

Critical Incident

Response

Work-Life

OnlineResources

LifestyleCoaching

1988 Last 25 Years 2013

PEPY Past 20 YearsN=29 Convenience Sample of EAPs

$25 $22

$0

$5

$10

$15

$20

$25

$30

1993 2013

“Free” $5

Fee-based (not embedded) full-service, 5 visit EAP and WorkLife AVERAGE book-of-business PEPY.

Free (embedded) “sleeping” EAPs

PE

PY

RA

TE

Cross-cutting Themes

• Product load / Price

• Turnover / Vendor loyalty

• Commodity-based purchasing / Value-based

• Wide variation in quality

• Little correlation between price and quality

Potential Technology Solutions

• Produce and use improved analytics

• Align price and performance/outcomes

• See the future as obtaining rigorous evidence re: effectiveness

• Use technology to capture relevant, transparent, reliable metrics

The “Holy Grail”

IF we use technology to enhance access, build stronger connections, and make data more transparent, WILL this result in fair rates based on quality and effectiveness?

Open Audience Dialogue On:

• Better coordination among service partners

• Greater perceived value among purchasers

Innovative Services for Future Generations• Who are the Future Generations?

• Generation Y– Also known as the “Millennials”– Born in late 1970s to 2000 range– Teenagers to young adults now in 2013

• Generation Z– Youngest cohort– Born since 2000– Children today

Innovative Services for Future Generations: ToolsTechnology-enabled tools create more opportunities for access to traditional EAP services and to develop new services:

– Internet webpages– Internet therapy (e-mail & video)– Internet social media– Smartphone text messaging– Mobile applications (iPad…) mHealth

Review article Attridge 2011

Journal of Employee Assistance

Innovative Services for Future Generations: ExamplesNew EAP Tech-Tools:

• FirstChat – Shepell-fgi (Canada)

• e-AP – Homewood Human Solutions (Canada)

• Beating the Blues – from the UK and adapted by Employee & Family Assistance Program (BC, Canada)

• MoodHacker – ORCAS (USA)

• ExecuPrev – OWLS (USA)

FirstChat Users Study: Age

22%

33%

31%

14%

10%

33%

41%

16%

50 + years

40-49

30-39

18-29

FirstChat Company EAP Norm

See EASNA Notes by Veder et al. (2012)

Innovative Services for Future GenerationsNeed Skills Training for Existing and Future EAP Counselors in Tech-Therapy e-Tools to Deliver:

– Clinical and Risk Assessments

– Primary Clinical Services

– Recovery and Monitoring Support

– Self-Care Educational Resources

– Prevention and Culture Change

Aging of the EAP Field

This Annual Institute celebrates 25 Years of EASNA.

This is very good; but it also means…

“As EAPA enters its fifth decade, many of its original proponents, innovators and practitioners have retired, moved on or passed away. Could their legacy be lost and forgotten?”

Dr. Daniel Hughes, Journal of Employee Assistance, Spring, 2013 (p. 26).

“As EAPA enters its fifth decade, many of its original proponents, innovators and practitioners have retired, moved on or passed away. Could their legacy be lost and forgotten?”

Dr. Daniel Hughes, Journal of Employee Assistance, Spring, 2013 (p. 26).

AGE of EAP Professionals

32%

45%

16%

3%

2%

60 + years

50-59

40-49

30-39

18-29KEY FACT: 77% are50 or older

Future Trends Research Study - Attridge & Burke (2011)

AGE of EAP Professionals

27%

37%

20%

14%

2%

60 + years

50-59

40-49

30-39

18-29KEY FACT: 64% are50 or older

EASNA’s COHP Marketing Survey Study March 2013

Continuous Succession of EAP ProfessionalsTHE CHALLENGES

– EAP professionals are aging

– Few university-based programs focus on EAP

– No government funding dedicated to EAP

– Global growth of the field = more demand

– Is level of pay enough to attract new people?

Continuous Succession of EAP ProfessionalsTHE ANSWERS

– Mentoring opportunities/business succession

– Encourage industry and corporate sources of sponsorship for training (CEU/PHD/certifications)

– Cross-training of EAP partners and network affiliates

– Advanced online training (websites & webinars)

– Technology tools can connect EAP staff globally

– e-therapy channels attract new people to EAP work

– e-business entrepreneurs as new partners for EAP

Open Audience Dialogue On:

• Innovative services for future generations

• Continuous succession of EAP professionals

Open Q&A Period

References

Amaral, T. M., & Attridge, M. (2003, November). Making the business case for EAPs: A review of

research and methods. Workshop presented at the National Conference of the Employee Assistance

Professionals Association, New Orleans, LA.

Anthony, K., Nagel, D.M., & Goss, S. (Eds.). (2010). The Use of Technology in Mental Health:

Applications, Ethics and Practice. Springfield, IL: Charles C Thomas.

Attridge, M. (2012). Employee Assistance Programs: Evidence and Current Trends. In R.J. Gatchel & I.Z.

Schultz (Eds.), The Handbook of Occupational Health and Wellness (pp. 441-467). New York:

Springer. Available from: http://rd.springer.com/chapter/10.1007/978-1-4614-4839-6_21

Attridge, M. (2011). The Emerging Role of E-therapy: Online Services Proving to be Effective. Journal

of Employee Assistance, 41(4), 10-13.

Attridge, M., & Burke, J. (2011, November). Trends in EAP Services and Strategies: An Industry Survey.

EASNA Research Notes, Vol. 2, No. 3. Available from: http://www.easna.org/publications

Attridge, M., Cahill, T., Granberry, S. W., & Herlihy, P. A. (in-press). The National Behavioral

Consortium Industry Profile of External EAP Vendors. Journal of Workplace Behavioral Health:

Employee Assistance Practice and Research.

Blum, T., & Roman, P. (1995). Cost-effectiveness and preventive implications of employee assistance

programs. Rockville, MD: U.S. Department of Health and Human Services.

Conlin, P., Amaral, T. M., & Harlow, K. (1996). The value of EAP case management. (Health care

claims cost-offset study conducted at Southern California Edison Co.). EAP Association Exchange,

26(3), 12-15.

Dainas, C., & Marks, D. (2000). Evidence of an EAP cost offset. Behavioral Health Management, 20(4),

34-41.

Dentzer, S. (2009). Mental health care in America: Not yet good enough. Health Affairs, 28(3), 635-

636.

Frone, M. R. (2006a). Prevalence and distribution of alcohol use and impairment in the workplace: A

U.S. national survey. Journal of Studies on Alcohol, 67, 147-156.

Frone, M. R. (2006b). Prevalence and distribution of illicit drug use in the workforce and in the

workplace: Findings and implications from a U.S. national survey. Journal of Applied Psychology,

91, 856–869.

Hughes, D. (2013). Professional Memory Loss. Journal of Employee Assistance, 2nd Qtr., 26-27.

Kessler, R. C., Chiu, W. T., Demler, O., Merikangas, K. R., & Walters, E. E. (2005). Prevalence,

severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey

Replication. Archives of General Psychiatry, 62, 617-627.

National Institute of Mental Health. (2008). The numbers count: Mental disorders in America.

Available from http://www.nimh.nih.gov/health/

publications/the-numbers-count-mental-disorders-in-america/index.shtml.

Smith, D. C., & Mahoney, J. J. (1990). McDonnell Douglas Corporation employee assistance program

financial offset study 1985-1989. Westport, CT: Alexander & Alexander Consulting Group.

U. S. Department of Health and Human Services. (1999). Mental health: A report of the Surgeon

General. Rockville, MD: Substance Abuse and Mental Health Services Administration, Center for

Mental Health Services, National Institutes of Health, National Institute of Mental Health. Available

from http://www.surgeongeneral.gov/ library/mentalhealth/home.html.

Veder, Torino, Beaudoin & Zhoa (2012). Attracting New EAP Users Through Online text-based Chat

Services. EASNA Research Notes, Vol. 3, No. 2. Available from: http://www.easna.org/publications

Yandrick, R. M. (1992, July). Taking inventory: Process and outcome studies. EAP Association

Exchange, 22(7), 22-29.