The Relationship Between Program Developers and ...

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The Relationshi Between Program Developers and Delivery of Occupation Assistance Rick Csiernik PhD, CSW

a

b c a

Canadian Employee Assistance Program Association,


b

EAP Studies Program at McMaster University in Hamilton, Ontario c

Ryerson Polytechnic University School of Social Work, Version of record first published: 15 Oct 2008

To cite this article: Rick Csiernik PhD, CSW (1997): The Relationship Between Program Developers and Delivery of Occupational Assistance, Employee Assistance Quarterly, 13:2, 31-53


To link to this article: http:// dx.doi.org/10.1300/J022v13n02_03

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The Relationship Between Program Developers and Delivery of Occupational Assistance Rick Csiemik

ABSTRACT. Articles concerning the dcvelopmcnt of occupational assistance have become less prominent in the literature with much more emphasis being placed upon clinical issues than upon ongoing program formation and evolution. This article reviews 42 Occupational Alcoholism Program (OAP) case studies and 43 Employee Assistance Program (EAP) case shidies that appeared in the literdture between 1970 and 1990 to explore thc rclarionship bctween the initiator of a program and the model of service provision implemented. While there was inadequate data to demonstrate a casual rclationship the manncr in which assistance was provided to employees and their families does appcar to depend upon which stakeholder group initiated a program, parricularly around h e utilization of self-help rcsowces. DiKerenccs WCIC also noted betweeii O M S and EAPs, and between American and Canadian based programs. (Ariiclr copies ovduble/,otri The Howorll, Docu,i?enl Deliwry Service. 1-800-342-9678. E-mail address: g e ~ i i ~ o ~ ~ a ~ v o ~ r I ~ . c n i i i ]

INTROD UCTIOR' The majority of occupational assistance research has focused upon clinical questions. These have included such issues as the


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value of a constructive confrontation model, the effectiveness of third party counsellors versus internal counsellors, which treatment alternatives work best with problem employees and continuing debates about what types of assistance are appropriate to he undenaken within occupational assistance programs (Anthony et al., 1992; Bayer, 1995; Chapman et al., 1992; Ellis-Sankari, 1992; Googins and Casey, 1992; Kikoski and Kikoski, 1993; Wright and Beach, 1992). Much less attention bas centered on developmental issues such as who initiates the program, what motivates this initiation and how those motives influence the delivery model chosen. An examination of the relationship between program developers and the type of occupational assistance delivery system chosen has gone basically unexamined in the literature to this time.

METHODOLOGY From the formal emergence of Occupational Alcoholism Programs (OAPs) through the growth of broadbrush Employec Assisonly a few select program initiators have tance Programs (EMS), written to describe the developmental process of their programs. Case study' has been far and away the most popular method of examining both O M S and EAPs to this time. A review of the litcrature from 1970 until 1990 found 42 OAP case studies, 28 American and 14 Canadian (Table 2), and 43 EAP case studies, 38 American and five Canadian (Table 5). In analyzing the data the criterion of program initiator was divided into seven categories: i. ii. ...

management labour 111. medical iv. labour-management v. management-medical vi. chaplain vii. counsellors.

The model of service delivery used by the workplace was distinguished using the following table (Table 1):


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As expected, a variety of differences between the case studies for the two eras of occupational assistance were discovered. CHARACTERISTICS OF OCCUPATIONAL ALCOHOLISM PROGRAMS

Management was the primary hitiator of documented OAPs, implcmenting 16 (38.1%) pmgrams while medical personnel were responsible for 11 (26.2%), labour for seven (16.7%) joint labourmanagement committees for five (1 1.9%) and other groups for three (7.1%). The preferred delivery model involved profcssionals internal to the workplace, accounting for 612% of the total followed by volunteers intcmal to the workplace with 29.9%, professionals extcmal to the workplace accounting for 7.5% and one (1.5%) external self-help group. Management and medical initiators both relied primarily upon internal professionals to provide assistance while labour initiators preferred internal volunteers. OAP initiation spanned 36 years with the majority of programs discussed in the literature having been started in the 1970’s (66.7%) regardless of initiator. However, medical initiators accounted for more prc-1970’s program initiation than did any other group. There were no professionals external to the workplace utilized to deliver services to employees prior to the 1970’s (Table 1). Half of managemenr-initiated programs discussed the use of self-help in assisting troubled cm-


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ployees while all but one labour initiatcd program referred to selfhelp. Sixty per cent ofjoint labour-management initiated programs indicated the use of self-help resources to assist employees with personal problems while five of eleven (45.4%) medical programs did so. All references to self-help programming within Occupational Alcoholism Program case studies cited Alcoholics Anonymous (Tablc 4). Twenty-eight of the Occupational Alcoholism Program case studies reported workforce size. Size ranged from 120 to 185,000 employees with a mean of 40,598. There were as many organizations with over 20,000 cmployees as there were with under 10,000 (n = 11) but only two case studies discussed companies with less than 500 employees. OAP case studies thus greatly over represented largcr employers. All articles discussed the history of the program, its initiation and information on the policies and procedures of the delivery option utilizcd. There was no uniformity with regard to presentation of demographic data. The most frequently reported qualitative information was number of clients (n = 19), referral sources (n = 9), outcome measures (n = 9), and caw histories (n = 7) highlighting employees who had successfully used the program (Table 2). The major consideration and limitation in comparing American OAPs with Canadian O M Sis that only three authors were responsible for all 14 Canadian case studies while 19 authors wrote about the 28 American O M S .The representativeness of the Canadian programs should be carelidly appraised prior to drawing any broad conclusions. With this in mind, the comparison of reported American O M case studies with their Canadian counterpa- produced several differences. There was no Canadian OAP solely initiated by labour though three of the five joint labour-management initiatives were Canadian in origin. While medical staff were the primary providers of service delively for both nations, these providers were much more prominent in Canada (50.0%) than in the United States (30.2%)with Americans utilizing human resources staff almost as frequently (25.6%) as occupational physicians and nurses. Within the volunteers internal to the workplace category there was more use of union counselling in Canada (12.5% versus 9.3%) while reference to recovering individuals was more common in American


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than in Canadian studies (16.3% versus 8.3%).There was no reference to staff social workers being used within Canadian programs while there were two references to external counselling staff in both American and Canadian program. Average year of program initiation was 1967 in the United States and 1970 in Canada (Table 4). Five of 14 (35.7%) Canadian OAPs discussed using self-help within their programs while only slightly more. American programs did so (40.4%)(Tables 3 and 4). CHAM CTERISTICS OF EMPLOYEE ASSISTANCE PROGRAMS The EAP case studies were much more representative of all three major categories of delivery options, though not of initiators, than were OAP case studies. Volunteers internal to the workplace were used by 16.4%of worksites, professionals internal lo the workplace by 47.2% with professionals exkrnal to the workplace accounting for 36.4%. Sulprisingly, management was even more predominant in iniliating EAPs than OAPs, being responsible for 27(67.5%) programs. Medical personnel werc responsible for only two (5.0%), as were unions while joint labour-management committees were credited with initiating eight (20.0%)programs (Table 5). Management used both professionals internal (58.3%) and external to the workplace (38.9%) to deliver clinical services while labour initiators used only internal volunteers (Table 6). Thc choice of joint labour-management committees was evenly split between internal volunteers, internal professionals and external professionals. As expected, EAP initiation spanned a shorter time frame, 29 years, though the majority of programs discussed in thc literature were also initiated during the 1970s (62.5%). Management and medical initiated programs were predominant during the 1970s while labour and joint labour-managemenl committees were most active in initiating programs during the 1980s. Thus as would be expected, the use of internal volunteers was also higher in programs begun during the 1980s. Reported new programs commenced in the 1970s tended to utilize internal and external professionals most often (Table 7). Less than one third (29.6%) of management initiated EAPs discussed referred to self-help. Contrarily, all medical and labour initi-

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TABLE 2. Occupational Alcoholism Program Case Studies


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Rick Csiemik

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Ulliie A A member~esproqram~bnleerr, orwile AA meebngr held Use A A lor aftercare

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TABLE 4. Occupational Alcoholism Programs Case Studies Summaries


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TABLE 6. Self-Help Activities Oiscussed In Employee Assistance Program Case Studies

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TABLE 7 Employee Assistance Programs Case Studies Summaries


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I 1975

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I 1979 I

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ated programs (lOO%) made some reference to the use of self-help resources while half of the programs initiated by joint labour-managcment groups did likewise. Of the I R referenccs to self-help, I I mentioned Alcoholics Anonymous while the remaining discussed either peer support groups or non-A.A. affiliated forms of mutual aid (Table 6). Thirty-three o f t h e studies reported workforce size. Size ranged from 700 to 80,000 employees with a mean of 18,796. Again larger organizations were overrepresented among EAP case studies as they were among OAP case studies. However, in these reviews there werc no organizations with less than 500 cmployees discussed and only one case study examined a company with less than 1,000 employees. Thirty-eight articles discussed the history of the program and its initiation and all but eight2 case studies provided information on the policies and procedures of the E M delivery option employcd. Again, thcrc was no uniformity with regard to presentation of demographic data. The most frequently reported qualitative information was clients (n = 29), problem categories (n = 23), referral sources (n = 17), gender (n = 15) and measures used to determine succcssful outcome of intervention (n = 10) (Table 5). With only five published Canadian EAP care studies it is difficult to draw any significant comparisons with the American studies. A major distinction is that four ofthe five (80.0%) Canadian programs were initiated by joint labour-management committees while four of 35 (11.4%) American programs had this initiator. Management initiated programs dominated the American studies. Canadian pmgrams again had a later initiation time frame (1979 versus 1975) and had a greater proportion of program references to self-help (60.0% versus 40.0%). While this data has significant limitations, as does the OAP case study literature, both allude to differenccs in motivation for occupational assistance program initiation and delivery in Canada compared to the United States.

CONCLUSION While there are at least 10,000 I3APs in North America (Kohn, 1990), relatively little research has focused on the relationship between initiators in developing programs or on how they select a


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specific service delivery model. In the existing literature disproportionate emphasis exists on documenting programs initiated by large employers with a majority of the reported studies discussing workforces of 10,000or more employees. While references to mutual aid were limiled, health promotion initiatives were not evident in any of the case studies examined. Negligible discussion focused on the role of the program initiator or the source of service provision with some case studics not cven directly reporting who initiated the program. The concept of discovering what the most suitable delivery option is for a specific organization is only an underlying theme in the literature. The majority of authors present their articles without attcnding to the idea that their research could also indicate the approprialeness of the delivery modcl tit so as to maximize thc benefit realized by employees. Thus, there is much opportunity for exploration and discovery in the area of occupational assistance programming to improve the delivery option selection by initiators regardless of their motivation for progrnm development.

NOTES I . Case studies are methods of exploratory, empincal inquiry that in attempring to comprehend meaning investigate a contemporary phenomenon within their real-life context. Case studies arc cmplnyed when the boundaries between phcnomenon and context arc not clearly evident and when multiple sources of ewdence areavailabie(Yin, 1989). 2. Of the eight case studies that did not discuss policy and procedures half were conkortia. In the consortia model, thew is a ccntral service provider for xvera1 member organizations with each organization retaining responsibility for its own internal policy and procedures.

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ALMACA (1975a) “A Good Thing In A Small Package,” Lobour-Managernesl Alcolioiirm Joumnoi, 4(5), 1-8.


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