Employee Counseling and Wellness Services

Chapter 11

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The Need for Employee Counseling

Have you ever seen people: Struggling due to high levels of anxiety? Refusing treatment for a treatable condition? Experiencing job burnout? Involved in efforts to promote good health?
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The Need for Employee Counseling 2

Personal problems are a part of life Personal problems affect job performance Healthcare costs continue to rise Reducing tardiness, absenteeism, lost time and workers compensation saves money Reducing turnover can improve productivity and the bottom line
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Addressing Employee WellBeing

Promotes employee morale Reduces the impact of external factors on work Promotes productivity

Cheaper to train, treat, and retain existing workers than to hire new ones

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Employee Counseling as an HRD Function

Counseling serves the same goal as other HRD activities

Improving/maintaining worker performance

Same techniques are used, especially coaching Same kinds of analysis and planning needed
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Overview of Counseling Programs

Problem Identification Education Counseling Referral Treatment Follow-up

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Problem Identification
Screening device Absenteeism records Supervisors observations Referral Voluntary participation

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Education
Pamphlets Videos Lectures Unsolicited

Television Radio Other media

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Counseling
Needs a non-threatening person with whom the worker can discuss problems and seek help. Options include:

Supervisor/coach Ombudsman HRD Counselor Professional Counselor

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Referral
Directing employee to appropriate resources for assistance e.g.,

Physician Substance abuse treatment center Marriage counselor Alcoholics Anonymous (AA) Other options (clergy)

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Treatment
The actual intervention to solve the problem e.g.,

Group therapy Medications Individual therapy Psychological therapy

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Follow-up
Needed to:

Ensure the employee is indeed carrying out the treatment Obtain information on employee progress Ensure that referrals and treatment are effective

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A Caution About Employee Counseling

All six approaches are not always needed The following issues drive which approach is taken:

Type of problem identified Appropriate response Available resources

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Who Provides Employee Counseling?

Depends on the organization and organizational culture Can be done using:

Corporate resources (In-house) Outside resources (Out-of-house)

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In-House Efforts
Advantages: Internal control Familiarity with organization Better coordination of efforts Sense of ownership Greater internal credibility Disadvantages: Confidentiality Lack of needed resources Employee reluctance to use services Limitations in staff skill and expertise
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Contracting Externally (Out-ofHouse)

Advantages: Subject matter experts Confidentiality easier to maintain Lower cost Better identification and use of resources Disadvantages: Lack of on-site services Possible communications problems Lack of organizational knowledge
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Characteristics of Effective Programs

Top management support Clear policies and procedures Cooperation with unions and employee groups A range of care:

Referral to community resources Follow-up

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Characteristics of Effective Programs 2

Policy of guaranteed confidentiality Maintenance of records for program evaluation Health insurance benefit coverage for services Family education

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Employee Assistance Programs (EAPs)

Job-based programs operating within an organization that:

Identify troubled employees Motivate them to resolve their problems Provide access to counseling and treatment, as appropriate

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General Topics that EAPs Might Address

Alcoholism Drug abuse Anxiety Depression Eating disorders Compulsive gambling Marital problems Financial problems Personal problems

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Issues/Outcomes Affected by EAPs

Productivity Absenteeism Turnover Unemployment costs Substance abuse treatment Accidents Training Replacement costs Insurance benefits Etc.

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Who Offers EAPs?

62% of medium- and large-sized companies 33% of companies with 50+ employees Estimated 82% of large firm employees have access to an employee assistance program
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Items of Importance
Extent of substance abuse and mental health problems faced by companies Approaches to employee assistance Effectiveness of EAPs in treating substance abuse and mental health problems
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Substance Abuse
Over 19 million Americans abuse alcohol or drugs Alcohol is involved in 47% of industrial injuries Substance abuse costs U.S. businesses over $100 billion per year

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Substance Abuse 2
6.5% of workers reported going to work while under the influence of drugs or alcohol 5%8% reported being under the influence of marijuana at work Companies lose over $7,000/year for each abuser of alcohol or drugs
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Reasons for Immediate Concern

Drug and alcohol users are more prone to accidents, injuries, disciplinary problems, and involuntary turnover Would you want to fly in a plane with a drunken pilot? Do you want to drive a car put together by someone abusing marijuana or cocaine?

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Drug-Free Workplace Act of 1988

Promotes drug-free awareness among federal contractors and grant recipients Tells employees about:

Availability of drug counseling Availability of rehabilitation programs Employee assistance programs

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Mental Health
It is estimated that: 18.8 million Americans suffer from a depressive illness every year 23% of the American population has some sort of mental disorder 5.4 % have a serious mental illness

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Results of Serious Mental Health Problems

Mental health problems can interfere with major life functions such as:

Eating Managing money Functioning in family groups Functioning at work Functioning in society Functioning in educational settings
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Common Mental and Emotional Health Problems

Individual adjustment Victim of external factors (rape, incest, battering, crime) Sexual problems, including impotence Divorce and marital problems

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Common Mental and Emotional Health Problems 2

Depression and suicide attempts Difficulties with family and children Sexual harassment in workplace Legal and financial problems Gambling addiction

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Why Care About Mental and Emotional Problems?

Problems can cause:

Absenteeism Poor performance and work habits Low job satisfaction Indecisiveness Interpersonal conflicts Violence and aggressive behaviors at work

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Three Federal Regulatory Actions

American Disabilities Act of 1990 Mental Health Parity Act of 1996 Executive Directive by President Clinton (effective January 1, 2001)

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American Disabilities Act (ADA) of 1990

Who is covered by the ADA? An employee who:

Has a physical or mental impairment that substantially limits one or more major life activities, Has a record of such impairment, or Is regarded as having such an impairment, i.e., an employers perception of a disability would be covered.

Guarantees equal access to jobs for those with disabilities Includes mental and emotional disabilities, along with physical disabilities How to deal with individuals with such disabilities (EEOC Guidelines, May, 1997)
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Mental Health Parity Act of 1996

Employers with 50+ employees must provide mental health coverage equal to physical coverage Does NOT include coverage for substance abuse or chemical dependency Note: This law has been extended on a year-by-year basis since September 2001.

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Executive Directive by President Clinton

Requires equal coverage (parity) for mental health benefits for those covered by the Federal Employees Health Benefits Program:

Federal employees Their dependents Federal retirees

Also covers substance abuse treatment Took effect on January 1, 2001

Source: http://www.opm.gov/insure/health/consumers/parity/faq.asp

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Why These Three Federal Actions?

To require employers to pay attention to mental health issues To urge/force employers to carefully manage and address such problems

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EAP Approach to Resolving Employee Personal Problems

Basis of the EAP approach: Work is very important to people Work performance can help identify an employees personal problems Employees can be motivated to seek help

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Characteristics of the EAP Approach

Problem is defined in terms of job performance, rather than in clinical terms Supervisors monitor employees to identify changes in workplace behavior that indicate potential problems
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Behavior Problems Indicating Possible Substance Abuse

Absenteeism On-the-job absences High accident rate Poor job performance Poor relationships with co-workers

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Constructive Confrontation
In this approach, a supervisor:

monitors performance confronts employee on poor performance coaches to improve performance urges use of EAPs counseling service emphasizes the consequences of continued poor performance

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The Typical EAP

Clear policies, procedures, and responsibilities concerning health and personal problems on the job Employee education campaigns Supervisory training program Clinical services (In- or out-of-house) Follow-up monitoring
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Effectiveness of EAPs
Effectiveness is generally accepted Estimated 50% to 85% effectiveness rate Estimated savings of $2 to $20 per dollar invested in EAP However, much EAP evaluation is subjective, and strongly criticized
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EAPs and the HRD Professional

EAPs are often housed within the HRD area of the organization HRD must determine:

Costs vs. benefits of the program in dollars Whether its cheaper to replace an individual than to successfully treat that person

Healthcare organizations are increasingly involved in EAPs (behavioral healthcare management)

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Stress Management Interventions

Any activity, program, or opportunity initiated by an organization, which focuses on reducing work-related stressors.

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What is Stress?
Some environmental force affecting the individual (a stressor) Individuals response to the stressor Interaction between individual and the stressor Individuals react in different ways to stress
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Organizational Stressors
Factors intrinsic to the job Organizational structure and control Rewards systems Human resource systems Leadership

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Stress Management Interventions

Educationally-Oriented Interventions

Sources or stress, how it feels, how to avoid it, how to cope with it Provides new ways to manage stress such as:
Time management training Assertiveness training
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Skill-Acquisition Interventions

Stress Management Intervention Model

By Permission: Ivancevich (1990)

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A Model of SMIs
Focuses on the individual Helps the individual cope Perhaps more focus should be placed on stressors from the work environment

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Effectiveness of SMIs
Research hasnt been rigorous enough to measure effectiveness accurately Well-conducted research demonstrates some success More research is needed

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Guidance for SMIs

Look for specific issues Assess and analyze apparent problems Look for specific and focused solutions Look at strategic intervention:

Is problem throughout the organization, or is it localized?

Ensure evaluation and timely feedback

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Employee Wellness and Health Promotion

Wellness is more than the absence of disease Promotes physical fitness and other nonstress issues:

Obesity Smoking

Helps control healthcare costs

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Three Levels of Fitness and Wellness Programs

Level 1 primarily educational without interventions Level 2 seeks to bring about direct change:

Supervised exercise, fitness centers, etc.

Level 3 institutionalized wellness

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Ten Dimensions of Work Site Wellness

Constructive wellness policy Wellness screening Working with community resources Employee referrals to professionals Menu-approach to health improvement

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Ten Dimensions of Work Site Wellness 2

Outreach and follow-up counseling Plant-wide wellness events Worksite policies and systems Ongoing evaluation of wellness process Periodic evaluation of cost-benefits of wellness programs
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Exercise and Fitness Interventions

Most popular interventions Even modest exercise helps prevent disease Research shows effectiveness Problem: Getting those who would benefit the most to exercise

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Smoking Cessation Programs

Smoking: most publicized health risk Cost per smoking employee: $2,853 per year more than nonsmokers Measuring effectiveness:

Quit rate Percentage of smokers in program

Cost Benefit: $8 saved for $1 spent

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Nutrition and Weight Control

Obesity: 30% or more over ones ideal weight 30% of Americans are obese; another 34% are overweight Obesity causes hypertension, musculoskeletal problems, high blood sugar, and cholesterol levels Competition helps program effectiveness
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Control of Hypertension
Hypertension blood pressure greater than 140/90 repeatedly over time Greater incidence of heart disease and stroke

Control through, exercise, weight loss, medication, stress reduction and low salt diet

Benefit: $1.89 to $2.72 reduction in health claims per dollar spent on program

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Issues in Employee Counseling

Effectiveness of programs Legal issues Who is responsible for counseling? Ethical issues Unintended negative outcomes

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Effectiveness of Counseling
Determine organizational demographics Determine expected participation rates Estimate start-up and maintenance costs Implement test and tracking system Measure pre- and postprogram Analyze results for users and non-users Do present and future cost-benefit analyses
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Legal Issues
Using counseling programs to comply with legislation may increase liability to lawsuits:

Must be equally available to all Erroneous assessments are made

Injuries in wellness/fitness programs can lead to lawsuits

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Responsibility for Employee Counseling

HRD Professionals? Supervisors? Unions? Management? Individuals? What are your thoughts?

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Ethical Issues
Confidentiality:

Records should be held in strictest confidence, and kept separate from the employees regular personnel file Release only with specific employee permission Mandatory versus voluntary
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Nature of Participation:

Question
Should participation be mandatory or voluntary? Why?

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Potential Unintended Negative Outcomes

Increased workers compensation costs Employee scheduling problems, increased fatigue, lower performance Conflicts at work over smoking bans

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Closing Thoughts
EAPs show that companies care HRD professionals have the skills and expertise to provide EAP information Promoting employee health and well-being can contributes positively to an organizations bottom line.
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Summary
Employee well-being affects ability, availability, and readiness to perform a job Employee counseling encompasses a lot of areas It is an HRD function that:

Ensures that employees are now effective contributors to the organization, and that they will continue to be in the future Needs professionals who are qualified to deal with the difficult issues involved with this topic
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