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The State Of EAPs In Canada

By: Karen Seward

Like the customers they serve, EAP providers have evolved over the last decade in response to economic, technological, and demographic challenges. However, Karen Seward, of The WarrenShepell Research Group, suggests that as organizations embrace wellness as a strategic value and acknowledge the intrinsic link between individual and organizational health, EAPs are poised to help their customers develop measurable, preventive organizational health programs.

Employee Assistance Programs have ‘come of age’ over the last decade as Canadian employers have embraced the EAP business case. While market penetration is hard to gauge, the majority (57 per cent) of mid- to large-size Canadian employers provide EAPs (Buffett Taylor’s National Wellness Survey Report, 2003). Employee acceptance of EAPs is demonstrated through increased utilization. The Canadian Employee Assistance Program Association’s annual survey noted that 80 per cent of respondents reported that the number of individuals using EAPs had grown during 2003.

However, to paint a clear picture of the current Canadian EAP industry, we need to look at the economic and demographic factors that have changed the EAP landscape over the last decade. Like their customers, Canadian EAPs have been affected by changing demographics (aging Baby Boomers, GenXers, multicultural diversity), new technology, as well as mergers and acquisitions. While local or regional EAP providers continue to concentrate on traditional counselling services, Canada’s national EAP providers have expanded and enhanced their service offerings to suit their customers’ changing employee needs.

They have embraced new technologies to provide information, prevention, and support services through multiple service delivery options such as:

Another trend that has grown over recent years is the development of partnerships between group insurers and EAP providers. In the past, many insurance companies maintained one or several preferred providers to whom they referred their EAP business. Over the past two years, the top Canadian insurance benefits providers have forged partnerships with national EAP providers to offer EAPs as an integrated component of their group insurance product suite. This strategy reflects a growing awareness among insurers and their clients of the link between disability and health benefits usage and the important preventative function offered by EAPs.

Perhaps the most telling shift in the EAP landscape is the move toward measuring program effectiveness and in assisting customers in developing healthy workplace programs that address both physical and mental health prevention, intervention, and recovery. There are two key issues driving this trend. One is management’s ability to quantify the costs associated with mental health issues and the second is recognition of the intrinsic link between physical and mental health.

Mental Health Costs
While organizations across Canada continue to struggle with absenteeism and ‘presenteeism’ as well as growing STD/LTD and drug claim costs, research now demonstrates the role that mental health problems play across all of these cost categories. The Global Business and Economic Roundtable on Addictions and Mental Health in the Workplace estimates that “mental health problems alone are costing Canadian organizations $11 billion per year in lost productivity, absenteeism, short-term disability, and related direct and indirect costs.”

HR professionals understand the impact of work-life imbalance and job stress on employees. An Ipsos-Reid/WarrenShepell Research Group survey of Human Resources professionals in 2004 found that 60 per cent of respondents reported stress as the most serious contributor to their organization’s absenteeism and/or health benefits costs. Not surprisingly, theWork-Life Conflict in Canada in the New Millennium – A Status Report released in 2003 found that high job stress and absenteeism due to ill health had increased over the past decade. This data illustrates the “negative impact” that increased demands and work-life conflict have on employee mental health, with “almost three times as many respondents report[ing] high job stress in 2001 (35 per cent) than in 1991 (13 per cent)” and 28 per cent (up from 24 per cent) of respondents missing three or more days of work due to ill health.”

Without effective strategies in place to identify, prevent, and treat stress and other mental health issues, the World Health Organization predicts that by the year 2020, depression will be the second-leading cause of disability in the world, up from fourth place in 1996.

The ‘Mind-Body Connection’
While many cultures have understood and honoured the mind-body connection for thousands of years, North Americans have only recently begun to acknowledge the link between physical and mental health. With organizations such as the American Centre for Disease Control and Prevention (CDC) reporting that “perceived mental distress… is believed to be an important determinant of health behaviours related to chronic disease and disability prevention” (CDC Report, May 1998), business leaders are now beginning to accept the mind-body correlation and its impact on behaviour in the workplace.

We know that depression can be manifested through physical symptoms and, alternatively, that physical conditions can affect a patient’s mental health. However, research is now demonstrating that four of the top five illness categories driving shortterm disability (heart disease/stroke; cancer; gastro-intestinal; musculoskeletal) can all be affected and/or triggered by mental illness. Harvard’s Mind/Body Medical Institute confirms “stress is directly linked to numerous medical conditions such as hypertension, asthma, chronic pain, allergies, and others, which can account for significant job absenteeism.” Statistics Canada’s Work Stress and Health report suggests that workers in high-strain jobs have higher rates of a wide variety of diseases than their counterparts in low-strain jobs. In fact, job stress has been found to double the risk of heart attack and has also been linked to infectious diseases and higher incidences of back pain, repetitive strain injuries (RSIs), and colorectal cancer.

Preventive Strategies
The move toward measuring program effectiveness, combined with new demands to develop workplace programs that address the fundamental relationship between physical and mental health, has led to a healthy embrace of workplace initiatives and resulted in some substantial cost savings, in particular High Performance Work Systems (HPWSs). In High Performance Work Systems and Firm Performance (1998), Brian Becker and Mark Huselid report that large organizations with High Performance Work Systems (comprised of healthy workplace factors such as role clarity, work-life balance programs, training, effort-reward balance), gained a 12 per cent higher share price and produced $200 million in additional revenue per year.

As EAPs move forward in Canada, continuing to expand their role in overall organizational health, they will take the next logical step – developing and implementing customized healthy workplace prevention programs that can be accurately tracked and measured.

The first imperative to build a prevention- based EAP is a methodology to identify the unique and specific mental health cost drivers in an organization. Only by doing so can the EAP expand its impact from early intervention to an earlier point on the continuum, where prevention goals must begin.

A prevention-based EAP will include communications, awareness raising, and employee education strategies that focus on the issues that drive healthcare costs in the organization. Having said that, it is essential to have a methodology for analyzing and understanding exactly what the health cost drivers are and what types of behavioural health interventions are necessary to prevent or reduce these costs from occurring. A prevention-based EAP provider can do much to facilitate the collection and analysis of data and help the organization know what types of activities can be undertaken to contain the rising cost of disability and other extended health costs, especially those with a mental health component.

The first step is to identify and analyze sources of data that are indicators of employee health. These include health benefits usage, drug plans, absenteeism and turnover data, short- and long-term disability claims data, EAP statistics, and information from employee surveys, especially regarding employee satisfaction or engagement. There are typically two challenges in collecting these data. First, many organizations do not collect information in some or all of these areas, or the information that is available is not available in a format that allows for proper analysis or between- and within-group comparisons. Second, the data may need to be retrieved from benefits consultants, carriers, or providers who must be prepared to work together in good faith in a process that might be quite new to them. It is here that the EAP provider can play a co-ordinating role and support the organization in gaining consensus and buyin. An EAP with strong relationships with group insurers is in an even stronger position to co-ordinate and assist in the analysis of data, untangling the role of mental health issues in disability claims rates and costs.

Once these issues have been sorted out, it’s possible to determine from these indicators of employee health what the main employee health cost drivers are and, from there, develop a plan of action to counter them. Again, it is highly desirable to involve as many of the organization’s healthcare and benefits consultants, carriers, and providers as possible, as each will have a contribution to make to the tactics and activities incorporated into the prevention plan.

Finally, the very data collected and analyzed provides the baseline for measuring the success of the prevention program(s) put in place. It’s important to be realistic about the size of the effect that can be achieved – as with any multi-variable model, it will be difficult to isolate true ‘cause-and-effect.’ Also, given the many reasons why healthcare costs are climbing – among them, more effective methods of diagnosis, an aging population, increased stress, and other environmental factors that contribute to disease and disability – cost containment is a more likely result, rather than cost reduction. Nonetheless, an integrated approach to health promotion planning has the greatest likelihood to achieve the desired ‘return on investment’ – and progressive EAP providers are in an ideal position to support and contribute to this goal.

The Future Of EAPs In Canada
Over the next decade, Canadian EAPs will continue to move away from a static, short-term counselling model and towards an organizational approach that encompasses prevention, intervention, and recovery components. EAPs are wellpositioned to play a central role in implementing this new preventive model and in demonstrating the value to be achieved through promoting the healthy workplace/ healthy employee/healthy bottom line continuum.

Karen Seward is vice-president of the WarrenShepell Research Group

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