The Salvation of the EAP.

How does direct corporate service sound?

All corporate functions today are being challenged to justify their worth to the parent organization -- and the EAP function is no exception. In just two decades, employee assistance services grew from a novel and imaginative idea which aroused

corporate curiosities (and sometimes suspicions) to a highly professional system of service delivery that unmistakably improves the corporate climate. Today's challenges can be perceived as a major crisis threatening the survival of the EAP function, or as an opportunity to redefine this function.

EAPs can grow in size and importance by expanding their role and revamping the system of delivering EAP services. The same imagination and energy that conceptualized employee assistance programs--that took a small social movement and created a profession--can respond effectively to the current demands on EAP. The end result may well be the Corporate Assistance Program (CAP).

Most of the losses incurred by EAPs in recent years can be accounted for by the downsizing phenomenon, a weakening of the loyalties between companies and their employees, and the move toward behavioral health managed care carveouts.

Downsizing was, of course, a corporate response to economic challenges. "Lean and mean," "Just in time," "Outsourcing," "Do what we do best"--these became the mottos for companies scrambling to find ways to reduce deficits and recover profits. It meant reducing the labor force, first by having line personnel take on more responsibilities for the jobs of their laid-off counterparts and by using less expensive, part-time or contract labor. Next came the elimination of services, benefits and product lines that could not demonstrate profitability. Then came the increase in the managerial span of control by eliminating mid- and upper-level management positions. Finally, some companies resorted to replacing CEOs with individuals with no particular loyalty to the traditions of the company or its employees. These new CEOs often were given compensation packages that generally provided tremendous financial incentives for increasing stock values as quickly as possible -- but often without regard to long-term effects.

Meanwhile, behavioral health managed care carveouts were making a bid for business, especially from self-insured companies. The lure, as always, was the promise of cost savings using essentially three strategies: reducing benefits or at least the utilization of benefits; reducing the unit cost of service by capping provider fees; and eliminating EAPs. After all, the argument went, what role does an EAP have if managed care 1) promises to have case managers available at all times to help determine the need for services and monitor the adequacy of treatment; 2) restricts the provision of care only to providers and facilities enrolled in its network; and 3) agrees to distribute health education material, and periodically provide onsite educational experiences? What's left for EAPs?

Unfortunately, because the strategies companies used to respond to financial crises of the recent past have by now come to be seen as "standard operating procedures," EAPs have not seen a trend toward recovery. Recovery today for EAPs lies in growth and development of strategic alliances. Their basis of growth now is the preparation for and demonstration of the value of performing additional needed and valuable roles in corporations -- becoming CAPs--and the ability to perform these roles cost-effectively by being part of alliances that make it possible. This does not mean abandoning the traditional mission of the EAP, but expanding it. Let's look at the possibilities.

Due to their special training and experience in interpersonal and evaluative skills, EAPs are in a unique position to provide many corporate development services beyond those which now traditionally comprise the EAP portfolio. These additional skills generally can be mastered with minimal training and/or consultation support. A sample of the expanded services that evolve EAPs into CAPs would include:

* Developing critical organizational skills and facilitating organizational team learning by applying conflict management skills and positive reinforcement planning. Even the most functional organizations and teams periodically find themselves involved in internal conflicts that threaten their effectiveness. CAP staff can position themselves to facilitate conflict resolution. Basic supervisory training and role clarification facilitated by CAP staff also can serve to reduce the incidence of conflicts.

CAP staff can also be trained easily to provide the necessary consultation to all levels of management for implementing positive reinforcement planning, a frequently misunderstood but important contributor to employee morale and productivity.

* Building and managing teams. Every organization benefits from a consistent and dynamic team-building process. Teams can be composed of functional or of cross-functional teams--in either case, CAPs can be central to the development of managers' skills in such critical areas as: 1) developing team facilitation and management techniques, 2) team formation and associated problem-solving, and 3) team presentation skills.

* Involving the total family in the workplace. Integrating the family into the workplace has become a core value for many companies. CAPs can facilitate this by, among various steps:

* periodically organizing social functions

* sponsoring special events to introduce family members to the workplace

* acknowledging or celebrating personal moments and milestones in the workplace

* establishing and managing a corporate day care center

* developing family-oriented wellness, disease management and stress reduction programs.

* Building relationships with the broader corporate community. Corporations almost invariably acknowledge "responsible corporate citizenship" as an expressed (or implied) element of their mission. The CAP can be instrumental in the achievement of this by:

* developing and supervising an employee team of community volunteers

* identifying community projects for corporate participation and/or financial support

* helping the corporation identify job functions that can provide worksite opportunities for adults with disabilities, and outsourcing work to sheltered workshops

* recognizing scholarly, athletic and community service achievements among local elementary and high school students, and participating in "career day" activities.

* Serving as a consultant to the corporate benefits manager. Developing and managing benefits in today's corporate world has frequently (and unfortunately) become a case of searching for the least expensive insurance product. EAP professionals are in the nearly unique position of being able to help their companies decide on benefits from the standpoint of value, i.e., cost vs. benefit. EAP professionals can access the literature and interpret it for their companies concerning, for example, the relationship between efficacious mental health and substance abuse treatment and absenteeism, the medical cost offset, managing violence in the workplace and addressing turnover (e.g., see "Cui Bono et Quod Bono?: Health Care Benefits in a Cost-Conscious Corporate Environment," by Bruce A. Maloof in a forthcoming issue of Compensation and Benefits Management).

In short, EAP training and experience are outstanding basic preparation for becoming a CAP. In most cases, only a modest amount of additional training and consultation will be required. The benefits, though, may be considerable, including the enhancement of the EAP's professional role, career opportunities and security, and enhancement of the corporation's abilities in achieving its mission.

As mentioned, strategic alliances are a second important step toward recovery of the EAP. Traditionally, EAPs have been unduly self-contained. Whether embedded in medical departments or adjuncted to human resources, they have tended to do all employee evaluations, referrals, follow-up and training themselves -- and, in some instances have even provided ongoing therapeutic care. Whatever benefits this may have produced for the employee, the company or the EAP itself, it created limitations: 1) the volume of this work generally made it impossible for EAPs to do much of anything else, therefore there was little incentive to examine the value of taking on additional roles; 2) EAP staff were focused much more on examining improved strategies for delivering service to employees, rather than strategies for delivering services to the company in a wide variety of roles; 3) the alliances they formed with other individuals or systems, internal and external to the corporation, usually had to do only with sources of direct service provision to employees with socio-emotional problems, and not at all with what the company saw as its bread-and-butter issues; and 4) if the EAP developed any system at all for evaluating its worth, it was generally only in terms of the volume of employees seen, employees' satisfaction with the services received, and/or the impact of the services on the employees' quality of life; it was seldom if ever related to the company's costs and productivity. This easily (and incorrectly) leads corporate executives to conclude that EAPs have a highly specialized function that is expensive, does not clearly impact on the organization's financial mission and, if it has to be preserved, can be performed by an external EAP contractor or simply a managed care case manager staffing a 800-number.

Enter strategic alliances. Corporations of all kinds have been forced financially to consider the possible benefits of strategic alliances of one kind or another. The number of mergers and acquisitions in banking, hospital care, transportation, hospitality and entertainment, retail, and high technology illustrate how widespread this has become as an approach to survival. So, who can EAPs develop alliances with--and why should they?

Service networks of all kinds are among the fastest growing organizational models of the 1990s. They are emulating the widespread shift in the retail field to one-stop shopping vendors, and are reflections of the emergence or return of certain executive beliefs such as: "bigger is better," "bigger is cheaper," and "bigger is stronger." Service networks often consist of independent service providers who contract with a management and marketing organization that serves as a "parent." The network overall strives to be comprehensive in its niche, making itself attractive by virtue of its complete line of services.

Internal EAPs can expand their capabilities by associating with one or several of these networks in the health care field. The staff of the internal EAP--now CAP--can mobilize a vast array of services and expertise for its host company, and can be that internal source that helps the network interpret the corporate culture, improve its liaison with necessary company personnel, and by the same token evaluate the work of the network's services to the corporation. External EAPs, while they might not be as credible as interpreters of the corporate culture, can also increase their comprehensiveness, and hence attractiveness, by affiliating with health care service networks. They have an additional incentive to embed themselves in one or more networks, on grounds that "if you can't beat them, join them." Service networks in the health care field are marketing themselves very aggressively, and they have considerable resources. They are competing for EAP/CAP contracts and are likely to become the major competitor for external EAP/ CAP contractors.

In sum, EAPs can reach the millenium larger, stronger and more valuable to corporate America as CAPs. To do this they need to expand their roles to include benefits and corporate team development. Many EAP professionals already have a solid grounding in the social and behavioral sciences, and years of interpersonal training that will serve as cornerstones for the additional on-the-job training they might need to fill these expanded roles successfully. Furthermore, if they affiliate strategically with comprehensive service networks, they can offer an extraordinary array of supportive services to their host company largely by serving in liaison, interpretive, evaluative and contract management roles.

Realtors are often quoted as saying that there are three things that are important in considering real estate value: "location, location, location." We might paraphrase that, in the new era of corporate-based behavioral and human services, to urge EAPs to "diversify, diversify, diversify."

Bruce A. Maloof, PhD is President and CEO of The Practice Sentry, LLC, a management services organization and provider-owned behavioral health provider network at 83 cambridge Street, Suite 2D, Burlington, MA 01803; Phone: (617) 221-3180; Fax: (617) 221-3193. Nicholas Governale is President of Governale and Associates, a firm providing corporations in many sectors with consultation and training for total quality management, conflict resolution, and team building, located at 8 Rice Road, Maynard, MA 01754; Phone: (508) 897-4907; Fax: (508) 897-6383. Daniel Berman, PsyD, MHA, RN is President of Visionary Health Care Consultants, a firm providing consultation services for practice development, network development and the promotion of strategic alliances, at 32 Tanglewood Drive, Danbury, CT 06811; Phone: (203) 743-1202; Fax: (203) 743-1204.