New developments in employee assistance programs

New Developments in Employee Assistance Programs M.A. M.D. P. Schwartz, M.D.

Robert

K. White,

David

R.

McDuff,

Robert Stuart

A. Tiegel,

LC.S.W.-C.

Chelsea

P. Judge,

Employee

assistance

and sive

referral employee

programs

of problems

pervisors, treatment

constructive providers,

added

based

as enhancements

field

ployee

assistance

developed

assessment Comprehencomponents:

on job

to the

through

program

(Psychiatric

performance,

consultation referral, Other

basic

include

model

and

assistance and executives.

examples

at the

Services

from

evaluation and abuse expertise.

and professional professionals

are illustrated

Baltimore.

alcoholism

behavioral health programs. are defined by six major

confrontation, and substance

haviorah health activities vide services for impaired in the

have

centers to specialized assistance programs

identification

been

M.S.

from

University

the

progranis

with have be-

scribe at

prograrn

memits

Medical

System

in

1996)

Svstemis

how

they

issues

that

ale, care

are concerned

are

ployee

worker

productivity,

expenditures.

problenis

Many strongly

abimse.

cc assistamsce these through

misor-

not

linked and

resources

subthere-

terpersonal

comiflict,

depression,

related

problems

The ployee traced

exckmsive

ftx,us

to

l)e al)atidOmsedi

msianage

resemsts

el” for ensployee

assistamsce

stress-

which

effective

of ens-

ployees

was

tiire

orgamsizatiotss

programiss can be 1800s (2,3). They

abuse early

suggested

abuse,

efforts the

productivity. successes, most

range

80 percent

Despite early oc-

O)ti

of workforce

substance

of al-

abuse with

comistssocl-

programsis,

assistimsg

emis-

prOl)letsss

health

By 1991,

etssphoyers, nsore

than

amid about

that 250

tiots o)fabout

is director System, 419

McDuff

Di: Schwartz,

try at the Unicersity program

of the employee West Redwood and

PSYCHIATRIC SERWUS

Mr Tiegel

ofMaryland

counselorfor

Select,

.

April

assistance program at the Street, Suite 540, Baltimore,

School Inc., 1996

arefaculty

Virginia.

in Glfton, Vol.

members

ofMedicine.

47

No.

4

Unirersity Maryland

in the department

Ms. Judge

is an employee

care

sys-

is, cmii-

of Maryland 21201. Di of psychiaassistance

Professioti-

7,000

mssenih)ers

professiotiahs

that

rep-

ensphoved

1)51

assistamsce

programsss,

has

recognized

six mnajor comsspomsemsts

that

defimse ami emisphovee assistamsce program. These comnpomsents are also referred

to as the core

technologies

amid

are present its all co)mssprehensive )loyee assistance programsss (7). are

emssThe

identifIcatioms

of

1)rOl)lenis based on job perfornsamsce, comisultation with supervisors, cotsstructive and

,

co)msfrontatioms

referral, amid

eval

with

liaisomi

providers,

uatiois

treatissent

substamsce

abuse

cx-

l)ertise.

JOh)

Medical

iSro-

health

emssphoyee

sure Mr. White

or-

a msatiomsal orgamsiza-

Associatioms,

six consponemsts

Existing proto address a

nsental issues.

of large

organizatioiss

shsouhd

perspec-

persomsal

to imslprove productivity gramsss were reorganized

by mssan-

effects

that the

its reaching

of

goals

to resolve

this linkages

assistance

memstal

Major components The Emisployee Assistance als

substance

other

that

the cosorate a “broad-brush

for discuss

etss)loyee

nsamsagers. howevem; Organiz-

and

beginnings

the earliest

focus

for a broader

emshsamsce-

amid we dis-

not

adopted

ons alcolsohismss

tive (3). Evemstuall tssittiity accepted

(1).

to address

otiie 1950s,

This

temii.

were

were

evamsgehical

for ensploy-

assistance to the late

represent

others

programs

conceptual

agement

Sortie

and

ers o)fsuch

programs

programsis

(4,5).

a strong

they alienated Its the early

issues ansong misost workers the early identificatioms of iii-

anxiety,

effective

such

to ens-

have

alcohsohismss

cost-effective,

workplace

Employers

fore consmssitted

cupational

amid health

psychopathology

stance

cohol souse

affect

about

sonic

issodel,

also

amid the

deIro-

Baltinsore.

developed

We

an

and

of \luyhand

its

l)asic

gamsization.

misajor

assistance

includes

cuss

as-

of

prograns

University

ofthe

the model

etsil)lo)vee

the

Medical

granis

nsployers

discuss

a basic

assistance

l)etWeen

E

we

of the

gram

emssployee

(6).

paper

emss)lo)yee

of the

em-

established

cotsiponents

which prodevelopments

experience

of Maryland

47:387-391,

su-

managed

committees, Recent

had

sistamsce Its this

with

liaison services

)lo)yees,

pem-formance

that

is the

key

inca-

must

use

to re-

a supervisor

fer an emssphoyee to the ensplo)yee assistance prograns Supervisors are discouraged frons attensptimsg to diag.

nose involved

personal in

problemsss an

ensployee’s

or becoming personal 387

life.

The

gram

employee

becomes

assistance

the

propriate handling nsay be experiencing ed to mental

pro-

nsechanismss

healths

for ap-

problems. ployees,

of employees problems

who relat-

times

or substance

use.

misany

as

Compared with substance abusers

as many misany

other have

accidents,

three

absences,

health

emfour

three

clainis,

five

times

ical staff.

Five

professional

exist on the towms canspus

tinses

as

a separate

times

as

ty of Maryland

state

agency. Medical nonprofit fromsi the

Constructive confrontation is an intervemition that uses the leverage of disciplinary action to influence an

many workers’ comsipensation clainss, and only two-thirds the productivity

canse a private aisd separated

of fellow

employee to comply with needed treatment. For exansple, an employee with a chemical dependency may be

the reverse that utilize

in the nsid-1980s. vehoped its own

confronted

workplace cost savings

in person

by an employee

assistance prograns counselor, perhaps accompanied by the employee’s supervisor. The ed with evidence

employee is presentof the problemis and

the mseed for ongoing offered a reprieve action

or

treatment and is from disciplinary

temsination

complies

with

the

if he

or

she

recommssendation.

Employee assistance programs provide employees and family members with

access

sehing, basic

to free,

evaluation, services,

confidential

coun-

and referral. These though simple and

straightforward,

are

crucial

to the

fectiveness of the program. through open and easy access vices that ensployees are able ate

appropriate

treatnsent

personal problems. ization ofthis process benefits

for

the

is to serto initi-

to resolve

Successful has many

employer,

reduced absenteeisns fewer accidents, and

ef-

It

realdirect

employees

progratsi

to help

and turnover, increased pro-

Fortunately, Conspanies assistaisce

promisote

a drug-free

can achieve and retain

significant valuable cmii-

ployees. Other services are considered hancensents of the basic tsio)del comprehensive prograns

employee

and

are based

enof the

assistance on the

individual

listing aged

ofother services includes manbehavioral healths activities,

stress

rnanagememst

tation wellness

ensployer.

oms workers’ programs,

comsspemssation, professional assis-

volved

in

planning

or

treatment ensployee

for their assistance

as a liaison

between

behavioral health ployee assistance serve

as the

providers. program

Employee

assistance

that is rooted

enormous

388

by

assistance prograns of of Maryland Medical

which

includes

of the

important to note that cats be offered

l)ecause

cost

of

and

somsse

en-

model.

It is

that all the services by employee assis-

progranis on suba develop-

work

alcohol

ah-

reasons include

for the

organiza-

and

may

The University

not be iseeded

drug

l)egams

The staffofthe

ensphoyce

assistaisce

prograns has expanded tinse coumiselor to three staff,

a program

intakes

and

to-face

miseetings

visits

director,

or

1994

1995

or

contacts

Medical

with

as face-

fansily

the

sanse

sible

by the

increase

tion

of a nsanaged

service,

greater

of the

programss,

reach

cffirts

stress,

and

234

per

made

pos-

were in staff,

an

awareness

as

its

year

1 shows,

in the

Medical

System’s

1990

to

1995).

the

ensploycc

percent

ots

nurnl)er

by the program

fiscal

year

in out-

scmssimsars its the

covered

addi-

health

increase

an increase

imscrcascd

the

I)chavioral

such

Table

period,

to 1,633

employee

in fiscal

grans

employ-

six-year

frons increases

for the

mcmii-

traimsing value arc

although

These

rate

Incots-

scssiomss, large-group and lcctimres arc not.)

increased

As

sys5,500 mcd-

paper,

telephone

intakes,

During visits

to

1990

are defined

miot include

considered

5,500

of the fiscal

University

years

utilization

assistamice

fromss 4 percent sanse

proto 12

six-year

period.

of Maryland

cnsployce

assistance

1990-1995

Fiscal

1990 1991 1992 1993

a

1

Utilization

year

and

withs emssployees.

do

of ensphoyees (fromss 4,000

System is a large urban hospital tens with nsore than 700 l)eds, employees, and 900 attemsdimsg

on

frons one fullfull-tinse chits-

.

year.

of Maryland

Medical System’s program The University of Maryland

prograns,

in occupational

to the

progranis

basic

as-

officially

cc orientation presentations,

System,

emssployee

emsiployce

the the

Table

others.

cohohisns programs. Other this continued emphasis tion

advocate

is in treatment to selfor

historically focused abuse treatnsent,

nsent

ensalso

by the employee assistance helps assure the employer a danger

have stance

The can

ongoing compliance At the same time, the

that the employee is not

and

The

sistamsce prograns July 1, 1989.

tacts

O)f

The serves

employer

employee’s

documenting with treatment. oversight program

monitoring

employees. prograns the

in-

its own

l)crs Intetssive small-group scssmo)mss thsat have climsical

desired iw all ensphoyers aisd that the developnsent of a particular service should be driven by the specific needs the organization.

1)e directly

later

debriefing. In the following program description, we outline the development of

Because mental health amid sul)stance abuse treatment is confidemscannot

prograns.

timise, it deof humssais

takes

tance

ensployers

and

be-

corporation state system

creased fromss 145 in fiscal year 649 in fiscal year 1995. (In this

consul-

ductivity.

tial,

resources

Universi-

Systens

tance consmssittees, fimsancial assistamice programs, and critical incidemit stress

employee University

co-

part-timise psychiatrist, as well as clerical staff. As Table 1 shows, the msuns1)cr of imstakes to the programis hsas in-

A partial

seminars,

The

At that departmssent

assistance

ical

needs

of the

hancetsients

including

(6).

is also) true. an employee

schools

hospital systens’s downand are admisinistered by

N imstakes

N visits

N covered lives

Utilization rate

145

234

4,()00

164

552

4,500

4

251 299 439 649

753 956 1,311 1,633

5,000

5

5,500 5,5(X) 5,500

5

PSYCHIATRIC SERVICES . April

(%)

4

8 12

1996

Vol.

47

No.

4

The

utilization

rate

is the percentage

of covered employees l)y the program during

who are a given

seen year.

This nseasure

is a reflection

ees’ awareness the employee

of and attitudes toward assistance progians.

Several to the

services six core

services

versity of Matyland employee assistance the

most

nianaged the tee,

beets

services

behavioral

health

tors

and

managing

a behavioral

such term

as evaluation counseling,

sessment

amid follow-up,

tion with lion,

treatnsent

employee

provide

Many

providers.

that

In addi-

services.

tered

health

work

ure

aligned

to

high

also

use

of in-

University

satisfied In fiscal

counselors

workers

or pro-

of Maryland

System’s

prograns

employee

has

responsibility

all aspects

behavioral

mnay choose

ofthe

health

ensploycc

hospital

plan.

assistamsce

plan

from

nscdical

plan

and

The

cmssployee

patient

institution.

an in-network

that covers imspatient percent and outpatient

.

April

are

1996

that

47

arc

in the

nsan-

direct

ways.

not

affiliated

were

No.

4

were

access

Two group

than

for

because

the

as in-net-

achieving

in-network

a high and

proproviders

level

of paticist

controlling

costs

by

the average number of visits case. It has beets evident that

cases,

outside the network arc to practice in a cost-effi-

although

assistatscc prohandle substance without

ofserviccs

through

have a misams-

that perissits prograns to by the

organizatioms and Such agreemsscnts

negotiated

the

nsams-

authorize mssust l)e ensployer’s

department.

The professional assistance committee Like

process for is msiorc

in-network

denial

aged care treatment.

spe-

other

professionals,

can suffer pendence, chiatric ical

review providers

Souse with

to prac-

with

added

cases.

aged care organization the ensployce assistance

benefits

In addition, the core which is affiliated system, opened an

cient manner. Most employee grams can easily abuse

steps

abuse

to) take on all ad-

an agrecmemst

override

location.

providers less likely

at 100 at 80

hospital

patients’

services.

system

reducing for each

Mcdplan

Vol.

Several

ensure

satisfaction

benefit

services services

to

stringent

satis-

the

its less

do not need

negotiated

a

to use with

viders,

The suc-

fig-

in fiscal has l)een

Initiall)

The utilization out-of-network

does all precertificareview, claims authoprovider management

of both

confidentiality

a

ensployees would be reluctant mssental health services affiliated

off-site

assis-

that

administrators

hospital

is adminis-

project

to 80 percent

work providers. provider group, with the hospital

hospital

1995

for

that

tices

is a self-

the

We

Programs

feared

the

because the for a manplan that coy-

year

opted

process

How-

programsis

to participate

care

Mcd-

assistamscc

assunsed

for nsanaging ever,

fromss in-net-

In fiscal

priority.

system’s

the University of Systens’s employ-

This

PSYCHIATRIC SERVICES

programis social

counselors).

The ical

institution

services

rise

year 1996. Patients’

and misensployee

separately.

developed

l)y

systcnss

services.

could

is

plan

faction and cost containmssent. The University of Maryland ical System’s behavioral health has

mssanagcd

cases amid routine health cases arc

the substance

prograns gatekeeper health

its tcrnss

abuse nscntal

mssan-

ill patients.

the

(8,9).

for the behavioral health plan. plan has been judged to be quite cessful

Substance outpatient

fessional

Mcd-

seriously

in-net-

“carve-out”

tance program tion, utilization rization, and

all

imspaticmst

case

providers.

confidemitial

system’s

prostaff

all

and

of 50 pcrcemst

is closely

people.

for

(nsaster’s-heycl

in-net-

the role of The psy-

supervises

adnsissions

staff

total

taken

9,000

aver-

expanded psychiatrist.

now

agcmssent

pro-

review

work

In July Maryland

funded

among

crnployees’

received

the way the plan is administered.

ers

differ-

to a lower

utilizatioms

psychiatric

an avthat of

This

the

chiatrist

hospital

actually redundant provided by cm-

as much as cost containvalues will be reflected in

cc assistance manager and aged behavioral

have is half

added

the assistance

rnimsistration and mamsagensent of a l)chavioral health plams to play a sigimificant role. Sonse choose to) nsanagc only

the employer’s philosophy sion. If the employer values

1992 Medical

by the showed

of Maryland

Thus

oms

service,

employee

plan

oms a capitated

of managed

behavioral

satisfaction memst, these

University

network

health

care

progranis

programs

the prograns

data

Patients have l)ccn quite with the in-network services.

A major advantage ofhaving an ciiiployee assistance prograns manage the employer’s

due

frons

havioral

nsanaged

aged

services

assistamscc

of

providers. The its-network arc primssarily faculty and System.

be-

gratis

design.

years

of visits

benefits

pa-

the

year 1992 oishy 30 percent of cnsphoyecs who used the behavioral health

activities

organizations are in light of services phoyee

and coordina-

assistaisce

these

basis.

ical

plan,

ill psychiatric

To develop

amid considerably the progratis’s

is primarily

of the

and referral, shortsubstance abuse as-

plan

for seriously

tiemits.

to this

providers.

number

work viders

perfor

health

the

review

systens’s

three

out-of-network age

assistamsce programsss of the services needed

a $250

staff they nsay not be capable management amid utilization

an incentive to use benefit. Several fac-

that its-network pro)viders erage cost-per-case that

behavioral

Employee many

with

Consequently,

of

ciahized of case

80

and 52 per-

care,

contributed

ence

form

care

at

claims authorized for payment cnsployce assistance program

professional assistance commssitwhich arc described below.

The managed health plan

Out-of-

covered

for inpatient for outpatient

Analysis

the

plan

arc

offers employees the in-network

Uni-

arc

no dedrmctiblc.

deductible.

Medical System’s program. Two of

pronsinent

services

cent

added

for the

with

network

percent

of employ-

have

percent,

disorders

societies

progress grams

to

ing

(10-12).

have

State

mssade

mcd-

substantial

its developing effective proidentify amid treat inspaired

physicians, generally programsss.

phsysiciamss

frons alcohohismis, drug dedepressioms, amid other psy-

l)ut

hospitals

have

msot

been imstegratcd into these However, hospitals are fac-

increased

deissands

to

provide

reasonable and adequate nscasures to identify and nsonitor physicians who may

have

had

alcohsol,

chiatric problemsis (13). nsany hospitals provide prograns physicians, all’

for

all of their as phvsiciaiss

drug,

or

psy-

It is ironic that an assistance staff are

except not

usu-

emssployecs. 389

Figure

providing

1

Litskages

with

prevemsting

employers

and

psychiatric

employee

assistance

patiomsal

in of

programiss,

misental

healths

the tssemstal health

and

roles

problems occu-

consultants,

care

systetss

Emnplovee

health

A

Secondary

taisce diction

prograns treatment,

fessional

prevemstiomi

V

thirds

prevemstiomm

and

primary reporting.

routes

of contact,

The ensployee assistamsce prograns is a well-established mssodel for providing free, comifidential counsclimsg to employees

and

their

fansihics.

The

assistance

ployee

assistamsce

prograns

for physi-

ciamss (14,15). The comssnsittcc referrals frotss a variety of arratsgcs

rals

for evaluations,

for treatnsent,

amid misonitors

impaired

ing boards,

supervisors

partnsemsts,

amid malpractice

long with

on behalf

de-

insuramscc

of the

consnsittee

hospital

systens’s

zation

with

ployce

was

physician

assistance

director

as

mnittee

in

physiciams’s tests,

the

nsonitoring

utine

or

tests,

compliance

prograns

ofthe

professiomsal

physician

staff

emits

is an advisomy assistance

1989.

assis-

inspairment

assistamsce

successful with

and

its assisting

affect

policy.

programsss

a variety

currently

al)out stress amid consult orgamsizational

Emssploycc

of or

are

employ-

problcmsss

might

that

affect

jo1)

M imsor or umsconsphicat-

perfornsance.

with

Serious ferred

the profesreceived problems drug depsychiatric

in 20 cases.

In

msscdical staff rcasomss.

ter-

stage

because

their

materials

included

cvi-

of these

commit-

ondary

goals

care

and

its

the

of The

hospital

assistance

its primary

assistitsg

of treatnscnt. ognizes

cases

professional

Ensployers invested program l)cncfits,

sec-

as a l)road

flexibly

used

The

individuals

in need

sistamsce

systcmss rcca

for

amsd prevctit amsd occuprogramsss

cost-effectiveness

with siml)stancc illness (16,17).

poo)l that healths

prevention treatmisent.

distinctions

and

to mssake

at an

thse msecd for

tssay view the total dollars in the cnsploycc assistance and ensployee nsental health imscludimsg utilization mssan-

agcmssent,

patient

hospital

their

of cmssployees or psychiatric

protecting

responsibility

the workplace

imstcrvcmstioms interpersonal

showis

and illness tal health

corn-

and

health

by rcducimsg abscmstceismss amid tssedical claimsss thsrough aggressive nsamsagc-

applyimsg

cornnsittee

iii

misay reduce

pational dysfunctioms. E nsployee assistamsce

dcncc of past imnpairmssent. The rensaining 21 cases involved physicians who are in stal)lc recovery. all

re-

nsemstal

programsss

ment al)use

In

or

usually

specialty

early

specialty unisecessamy

for rnedical staff privileges and who were referred by the medical staff’s

system’s

emisotiomsal are

tance

volved

Who) were

to

consplcx

probhenss

providers for ongoimsg mssanagemsseist. However, idcntificatioms of misental health problemsss l)y ensployee assis-

have

physicians

or

behavioral

a nsedica-

and

comssultatioms with a psychiatrist its the emssployee assistance

prograns.

In 20 cases, no further actioms was required after the investigation was completed. Many of these cases in-

achieved

by

al)Out

fimmsctioning,

ces

recovering

with

problemiss

mittec

consmssittce

executives

structure, quite

Brcathalyzcr

its 12 cases,

member

comssnsittec enhances the the state nsedical society’s

withs

involve

43 referrals. The primssamy were alcoholism in 1 1 cases,

applicatioms

organi-

emsiployce

assistance

credentials

by the

ofstaffofthc

of the

programis

tee. The work of

formed

medical

the help

tancc

390

ofmsscdical

as he or she is in compliance the trcatnsemst agrcemssemst.

The

The

In addition, with hicens-

toward

cmssployee

l)crvisOrs and executives amid mssental health issues,

with

physicians

omsly two cases were nsinatcd for mscgativc

co)rn-

issoved

assistamscc programsss pronsote worker health amid vell-hcing, educate su-

for specific evaluation or services amid assist the comsi-

or behavioral

refer-

have

by hsavimsg their

brief based

link

experts treatment

pemsdemsce

accepts sources,

nsakes

pliance with trcatnsemst. time comssnsittee advocates

carriers

comsscmii-

ensploycrs

help

consnsittec

only withs physicians. The serves as a “volumsteer”

to)

to fulfill

ed prol)lenss can usually be mssanagcd in a few visits with prograiss staff or a

and 1995

deals mittee

provems

substance abuse problenss.) Staff of the emsiployce assistance program also)

sional

but

has

mssechamsismis

rcspomssibility

Many

in adthe pro-

cormsnsittce

tee

samssc way

effective

prevention

by the profes-

tion reginsen. Between 1990

in the

collab-

the ensphoyec assisamid the professiomsal

comsstssittee

au

that

The

insThe

assis-

comssmssittce

University of Maryland Medical Systens’s professional assistance consissitfunctions

problems

Linkages with the mental health care system

office

expertise assist

handled

addiction

to inspairmsseist.

save

hocatioms

etsiployce they

l)e this

need

can

program

have

lead

assistaisce a

for imispaired colleagues abuse problems. (Two-

of cases

sional

desigtsate

I Arrows referral,

steps

an actively identified.

assistance

intcr’entions with substance

Memstal health care systemsi

Tertiary

what

staffofthc

or

co)uhd

oratioms behvccms tamsce programss

are apply-

by whomis,

assistance

Because

A

V

and

health

privileges.

also serves as a comsfidential for case records.

comssuhtamsts

program

who staff

time whets physician is

emssploycc

ental

assistance

reasonable effort to identify amid nsonito)r physiciamss who mssay hsave nscmstal

for dealing

inspaired physician physiciamss with

in advance taken,

precious paired

V

for

program’s

policies

nsedical

Knowing

A

Primiiar,’

-

for

to) he

A

assistance

of inspaimsent

imsg Executives

support

staff have provided both and chimsical expertise, drafting

history

departmisemmt

-

cnsploycc

with ams actively and fur evaluating

Humssamm

preventioms

The

professioisah admssinistrativc including

Employer

resources

hospital-level

its activities.

responsibilities progranss,

can

be

pro)mssotion

as well

as msscms-

l)et’#{188}Vccms the

roles

of employee occupatiomsah

asmisen-

tal healths consultants, amid msscntal health providers mseed to be clarified.

PSYCHIATRIC SEIWICES

. April

1996

Vol.

47

No.

4

The

role

of the

program

employee

be

can

Conclusions

assistance

distinguished

from

Defining

the parameters

4. Masi DA: Programs.

of employee

ment

those of the mental health care systern and other mental health consul-

assistance programs and the services they provide has been consphicated by

tants by considering the vention activity in which

the continued

engages and the type has with the employer. As Figure 1 shows,

type of preeach party

oflinkages

each

focus, the

role

of the

belief

prevention

the

grams

are

(18).

oriented

prevention,

Such

toward

or reducing

sues

pro-

primary

the base

a wide have

emssergcd.

that

rate

ployees’

health

nv’s

vention,

grams (19). Significant

or

shortening

the

ists

clinical

course ofa problem. Primary prevention is achieved through employee education,

stress

ing, and health

management promotion.

aware

Secondary

The mental

health toward

oriented

vention-reducing mental havioral

the

tance

elected

assistance

gatekeeper

and

program

the effectiveness

The can

employee greatly

assis-

health

health

Employee

ser-

will

ees’ needs

boundaries between mental health care

propriate

with

system.

the ap-

skills.

Tertiary

prevention-reducing

within

health

tal

care

assistance greatly

the domain system.

facilitate

by supporting

take

employee

however, tertiary

a mentally

serves

the

as the employer

prevention

hensive

ill employ-

gram,

mental

health

added.

ment

1.

#{149} April

1996

47

programs the

healths

care

exterAl-

health optiotss under health. Feb 1988, pp

The impaired physician four I)rol)ttiOIi. JAMA 248:3127-

Prevalence prol)leIils

JAMA

255:1913-1920, 1986 Ull:

iaired

physician

Journal

of Addictive

assistance six major

continue

procorn-

to represent

responsil)ility Review

15. Schwartz RF \Vhite RK, McDuff DR. Four years experience of a hospital’s

the

It is also likely, howmodel of the consprc-

alcohol and physicians.

for Bul-

14. White RK, Schwartz R lcDtiff DR, et al: I lospital-based professional assistance comnsittees: literature review and guidelines. Marvlaisd Medical Journal 41:305309, 1992

in the system contracts

dfliOfl

Coiporate

of

providers

of

dnig

emstities delivery

capitated

by the

JM:

other

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American 14(2):13-21,

1995 16.

Sperry

Workplace. Psvchiatric 17. Smith tion’s

Aug

U: Psychiatric Consultation Washington, DC, Press, 1993

D: EAP

McDonnell prmxluces

Douglas hard data.

in the American

CorporaAlniacan,

1989, PP 18-26

18. Kaplan H, Sadock B: Comprehensive Text1)00k of Psvchiatr; 4th ed. Baltimore, Williams & Wilkins, 1985 19. Spicer Trends Mints,

J (ed): The and

Hazelden

Future

EAP Solution: Current Issues. Center City,

1987

+

Dixon primer

K: Ensployee for buyer

No.

assistance and seller.

Psychiatry

programs: a Hospital and

39:623-627,

1988

2.

Poppel P: Social work practice in business and industr’ 1875-1930. Social Science Review, June 1981, pp 257-269

3.

Bickerton RL: Employee torv in progress. EAP 1990, pp 34-42,82-84

are

to addevelop-

Vol.

abuse

foundation on which other and enhancemisents nsay I)c

Consnsunitv

needs.

PSYCHIATRIC SERVICES

technology Alnsacan,

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typically hired by executives dress specific organizational

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7. Roman P\l, Bluni TC: The core of employee assistance progranis. Aug 1988, Isp 17-22

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cxpro-

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with

compa-

have

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Center

8. Bernstein \l, Dolan JJ: Internal and isal EAPs in the MMIIC environment. niacan, Ma 1988, PP 22-25

cm-

of emssployec assistance in an effort to control ris-

health

mental

the

counseling, have bccomssc

sponsibilities programs

compliance

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only

have

progranss

have

improved

also

capabilities

employers

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iscore

Assistance 1980s.

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ad-

the

not

but

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tervention

duration

that

appropriate

as emssploycrs ofthe

Short-term and referral

ing

RS,

line, misuch variation employee assistance

assistance

care systens is secondary pre-

6. W7right

that

trends

however,

train-

prevention is achieved through early identification, brief workplace interventions, and ongoing monitoring. also

bottons among

diversifica-

Frons beginabuse was the

problcmsss

and benefits

ofemotional and behavioral problemsss in the workplace, and secondary pre-

Employee for the 1980

Beyond

persomsal

workplace

intervention

JT: The

Updated Hazelden,

of emsiployce

Assistance Manage-

1984

gratis: Minis,

mssodels

variety

Association,

5. Vrich

and

broad-l)rush

dress

employee assistance program can be conceptualized by using a psychiatric model

growth

tion of such programns. nings in which alcohol

Designitig Employee New York, American

4

assistance: a hisDigest, Nov-Dec

391