Employers increasingly turn to employee assistance programs EAPs-- to help employees become more fit, healthy, and able to cope with personal problems. From a few employer-sponsored alcohol abuse programs in the 1940s, EAPs have expanded across the largest U.S. businesses. This box considers the current roles of EAPs in American businesses and what they may bring to ADA implementation, especially for people with psychiatric disabilities.
There are an estimated 12,000 EAPs in the U.S. A 1989 Employee Benefits Survey conducted by the Bureau of Labor Statistics found that 49 percent of full-time workers in private business establishments with more than 100 employees were offered EAPs. Fifteen percent of full-time workers in private business establishments with fewer than 100 employees were offered these programs.
EAPs are structured in a variety of ways and vary a great deal in the types of services they offer. Some firms -- usually large corporations -- have built on in-house programs that are likely to have originated as alcohol rehabilitation programs. Many retain a single problem focus on alcohol and drug abuse, tend to have strong links with labor unions, and are used most frequently by involuntarily referred male and minority employees. Some smaller firms form consortia to provide collectively owned EAPs. And some firms contract, individually or in multi-firm consortia, with outside providers for employee assistance services. Contractual EAPs offer employers a choice of a broad range of services on a fee for service basis. While some contractual EAPs undoubtedly offer professional, quality services, others have engendered a reputation for the "business card phenomenon" in which unqualified people print up business cards and announce that they are providing EAP services.
The professional make-up of EAP service providers reflects the variation among EAPs themselves. An EAP practitioner may be self-educated, be a graduate of a certificate program, or have an advanced degree in one of the health care professions. A 1986 survey of 182 EAP practitioners found that one-third had an advanced degree, most often in socialwork, psychology, or psychiatry. About 18 percent had a relevant undergraduate degree (but no graduate training), 21 percent were certified in alcohol and/or drug counseling and 5 percent had participated in other "certificate programs." Close to 22 percent of the practitioners received ongoing training by attending on-the-job and professional workshops. The survey analysts concluded that 17 percent of the EAPs that offered specialized services such as counseling and case management did not have the skilled staff legally required to provide the services. These data indicate that some EAP professionals are highly trained and have an extensive background in mental health; they are likely to be familiar with issues presented by psychiatric disabilities. However, many do not have training that would familiarize them with these conditions. Moreover, because employee assistance practitioners who are not licensed cannot classify client sessions as privileged, there is a danger that confidentiality could be breached in the event records were subpoenaed.
Thus, the history, types of services provided, and professionals involved suggest that some EAPs have the potential to assist in such critical areas as disclosure, devising accommodations, verifying disabilities, and educating the work force and supervisors. It is important to note, however, that although "pockets of activity" exist, EAP service providers have not yet recognized, much less defined in an organized way, their role as educators about the ADA or psychiatric disabilities. Furthermore, EAP experience is not with people with more serious psychiatric disabilities. And, most workers do no have access to EAPs.
S. Berger, Washington Employer Resource Consortium, Washington, DC, personal communication, April 1993; Bureau of National Affairs, Inc., Employee Assistance Programs: Benefits, Problems, and Prospects (Washington, DC: The Bureau of National Affairs, Inc., 1987); H.V. Hayghe, "Anti- Drug Programs in the Workplace: Are They Here to Stay?" Monthly Labor Review, April:26-29, 1989; S.L. Hyland, "Health Care Benefits Show Cost-Containment Strategies," Monthly Labor Review February:42-43, 1992; F. Luthans and R. Waldersee, "What Do We Really Know About EAPs?" Human Resource Management 28(3):385-401, 1989; D. Phillips, Center for Occupational Programs for Employees, Inc., Washington, DC, personal communication; April 1993; L.A. Straussner, "A Comparative Analysis of In-House and Contractual Employee Assistance Programs," Evaluation of Employee Assistance Programs, M.J. Holosko and M.D. Feit (eds.) (New York, NY: Haworth Press, 1988).