Global Employee Assistance Programs: 10 Employer Tips to Increase EAP Utilization and Effectiveness

January 09, 2020

As companies become increasingly global, employers are searching for ways to improve the health and productivity of their employees around the world by implementing employee assistance programs (EAPs) globally.

While employee assistance programs (EAPs) are gaining popularity around the world, a number of Global Institute members report low utilization rates--or even no utilization-- in many of their global locations. Since EAPs come with financial and human resource costs, this often leads companies to wonder whether EAPs are worth providing outside the United States. On the other hand, some global employers report widely effective and highly utilized programs that have increased retention rates and productivity. This part of the Global EAP guide outlines 10 ways that employers increase the effectiveness and utilization rates of their EAP using insights from global employers with highly utilized and valued (but different) programs, in their own words.

Local Engagement

Involving key local leaders as stakeholders in the selection, program development and goal-setting processes will often lead to greater investment in the program on their part as well as increased cooperation and partnership down the road. Conversely, when business or local leaders do not see the value of an EAP, they are more likely to consciously or unconsciously put up roadblocks to EAP success.

We take some of our internal staff from the U.S. and assign them to different parts of the world to work with our medical departments, HR and HES health and safety advisors to pick a local vendor that makes sense within the culture, country and nationality where we’re operating as a business.


A big part of [getting local leaders on board] was just a lot of communication- speaking to them on a regular basis and addressing issues that they had, and just gentle persuasion, convincing them of the benefits of having an EAP


We worked a lot with our local business leaders, HR leaders and regional medical directors, and engaged them in creating the goals for the EAP in their locations. This allowed us to develop a broad global strategy and we also created a standard scope of work that everyone agreed to, so we are able to say that for the most part, everywhere you go in the world, the EAP provides the same level of care, scope of work and mix of services, no matter where you are--with some local adaptations that I mentioned earlier. Those are necessary to get the support you need from your business leaders and local employees.


We needed to tell a story to the business leaders, to the country leaders, on why we wanted EAP, and why they needed to give us the money to implement this benefit. We started to work on the justification, the story of why we wanted EAP


We needed to do some internal education. Even within some of our C&B partners, even within HR, we needed to have a lot of education and explain what it was all about, why you’d want EAP, why should we invest in that. We needed to bring some more familiarity to the plan.


Education & Ease of Use

Familiarize employees with the program and make sure it is easy to access. In many countries, an EAP is a new concept that may be viewed with suspicion. Helping employees to understand what an EAP is and does, putting a face to the EAP provider’s name, and ensuring that it is easy to use may help encourage employees to use the program.

“We needed to tell a story to the business leaders, to the country leaders, on why we wanted EAP, and why they needed to give us the money to implement this benefit. We started to work on the justification, the story of why we wanted EAP.”

Life events are happening all the time; it could be an elder parent, in every culture. It could be a parent, it could be a son who got in trouble at school, and it could be a number of things that are happening in a marriage. All of these things need attention and resources that need to be close, easily accessible and available. That’s what local EAP resources ultimately can provide and we should demand they provide them so that our employees can take advantage of them.


I’ve been trying to organize and encourage informational sessions and promotional events with the EAP provider, whether that’s a webinar or an on-site activity like a talk on a specific topic, or just generally promoting the EAP and its services. Feedback is always very positive, so I’ve been trying to target the countries with low utilization or where there’s a lot of sensitivity around EAP. We want to share all the services the EAP has to offer -- it doesn’t always just have to be about counseling.


We have an EAP provider in 30 countries globally and it’s proved to work well with on-site trainings and information sessions. We tend to see an increase in utilization and certainly word of mouth from folks who have used the service in the past helps and even family members.


We have different education sessions for managers so they know not only how they can use the EAP as employees but also, as managers, what the tool can provide them. We’re also doing education session for the employees themselves… There wasn’t a lot of knowledge about EAP and what it delivers. We found out very early on that we need to emphasize [privacy] heavily. That even if we’re getting reports, it’s completely unidentified; it’s aggregate information. We needed to clarify that very strongly to the sites. Even in the communication materials…every guideline that we’re posting, every communication, every e-mail that is being sent out, even the brochures and pamphlets that people are getting physically – it’s stated very clearly that it’s completely confidential and we don’t have any way to know who’s using the EAP. That’s something we put a lot of emphasis on proactively so it would be known to the employees that it’s a completely confidential benefit.


We needed to tell a story to the business leaders, to the country leaders, on why we wanted EAP, and why they needed to give us the money to implement this benefit. We started to work on the justification, the story of why we wanted EAP.


Local Relevance

Ensure that services are geared toward local and business needs. Even if an organization has a global or regional EAP provider, all programs should be viewed as local and be personalized to the needs of a specific location or business. Needs can be identified through focus groups, employee surveys or informal conversations; regardless, it is crucial that an EAP provider understand these needs and provide services, as well as employ locally-based counselors who understand the culture (when possible), accordingly.

A psychological resource for someone in Thailand with their particular background, religion and cultural orientation is going to look very, very different than one that is operating in Houston, Texas or San Francisco.


All effective EAPs are local, no matter how many countries you are in or how large the company is. Really no matter where your company is located, whether it’s a Mexican, Brazilian, Canadian or American company, you need to be building an EAP that fits the local needs to the employees you’re serving, rather than trying to transmit your EAP to fit those locations. When I say EAP, I mean we are able to see people in their local communities and serve them in their local languages with locally available mental health professionals and other resources, depending upon the location of the plant site or office.


[When developing the program in the beginning], “ would always hold employee focus groups because I needed to understand what the local concerns were that an EAP could approach and attempt to address. I could hear what employees felt was important. That didn’t just give me information; employees would also share attitudes about EAP use. Many of our older and more experienced country managers believed that people would never step outside of their own families to use a program like this, and that it wasn’t worth doing. Then I would invite those managers to these employee focus groups, which were populated mostly by younger employees in their 20s and 30s, starting out with careers and families. Many of them were challenged with child care issues, elder care issues and worrying about how to commute to work and get used to being a new family. I would explain the idea behind an employee assistance program. Then I would say, “If this program existed today in this location, how many of you would use it?” Invariably, almost all the hands would go up, and these older managers would be completely surprised. It helped me establish the need for and interest in an EAP that would help me to develop the program.


You also, in my opinion, need to work with the cultural norms that are appropriate for that country even if they may not be seen as appropriate in the U.S. This was an early learning for me and I think it was very helpful and important to build the program in a way that was acceptable in other countries. In my opinion, it is not the job of the employee assistance program to advance American values. Therefore, we have to focus on providing assistance within the local cultural context.


Brand the Program in an Appealing and Culturally Adapted Way

Don’t forget to communicate where and how it can be used broadly. “Employee Assistance Program” may not resonate widely, and terms like counseling and mental health may alienate some people. It is also important to ensure that program descriptions are translated not only for language but also for cultural suitability. Make sure that employees are aware of all the services available that they may not think of from a traditional EAP model. Everyone needs a referral some time for a legal service or a child care need – those types of services can be the best way to engage with employees and redefine the perception of the EAP.

I definitely feel that we have a number of challenges and our main barrier in terms of improving our utilization is proving that EAP is just not about counseling. It can be used proactively before reaching the crisis point and that really means a change in perception and a shift in our cultural values around EAP.


When we do webinars and on-site visits we try to talk about managing your family and things like that that people don’t immediately associate with their EAP. We schedule webinars with our EAP provider over the lunch hour at least once a month, if not more than that. They’re on very different topics: eldercare, stress, bullying on the playground, retirement. If employees understand they can use this resource not just for mental health, they feel more comfortable reaching out to them at the point that they do need that kind of interaction. We really keep it out there in their faces and our wellness committees really support the communications as well.


You need to change “the title if necessary so that it’s culturally relevant. You may not refer to an EAP as an employee assistance program in many locations because that can have a negative connotation, and it’s not about what you call it, it’s about what you do and how you add value that matters, so you need to be flexible in selecting the wording that will be used to announce and build the brand of the program around the world. You also have to be careful about the terminology used to describe the service. For example, in many countries, I’ve found the term counseling could have a negative connotation. In certain translations, it could be perceived as a negative approach that would imply a government intervention or in some cases were communist parties were very active, counseling was what would happen when a party official would help you to “adjust your attitude” in some way that was being enforced by party rule. So we learned quickly that cultural translations were extremely important -- not just language translations, but cultural translations.


We had to recognize that you have to approach the values within local culture and find a way to use them in a positive context, so personal improvement, personal education, professional development, career development…those terms were usually more positive in many parts of the world than the more clinical, problem-oriented terminology that you might find common in a U.S.-based program. So while we did the same things in terms of providing counseling and support services to employees and family members who had conflicts in their marriage or families, or who had anxiety or depression disorders, or who were addicted to a substance or who were involved in a domestic violence situation or who were concerned about caring for elderly parents, or any number of other problems -- the key was to view the solutions as personal development instead of counseling or clinical intervention.


We’re going country by country and specifically going through their needs, how implementation would work, and whether they would prefer an educational webinar or seminar… [In some countries we’ve] put a little bit less emphasis on the emotional stuff. So we wouldn’t say, ‘we’re coming to give you emotional support.’ We’d say, ‘we’re coming to give you holistic support.’ [We come at it from] a little bit of a different angle because we did all this prep work at the beginning.


Dedicate Company Resources to the EAP

Several Global Institute members credit their company’s investment in internal EAP resources, and the resulting time spent on promotion, oversight and quality assurance, to the success of their program. Having a physical presence from the corporate level on-site, either occasionally or frequently, may also lead to increased investment on the part of local or business leaders. This also formalizes accountability.

What we want to do is maintain quality and control. One way to think about this is you have a legal department, you have a finance department. Those departments have expertise within your organization. You probably wouldn’t outsource that to a third-party vendor.


When you have a psychological service, there is always a cross-cultural attitude of, “Is this something I really need?” It’s enhanced depending on the particular nationality or culture from which a person comes. When you have a vendor close by or when you have an internal resource in the company, there’s the opportunity to de-mystify the service and make it more user-friendly, so there’s more opportunity for employees to take advantage of it.


I would suggest that at a corporate level, you have some subject matter experts who understand quality services and the kinds of resources that can be deployed under an EAP banner. Those particular SMEs have cultural sensitivity to the various places you’re operating and engage with the stakeholders in the region or in the country to understand better the best resources that can be found in those places, and the way those resources can best be deployed to the employee team in those areas.” “What we want to do is maintain quality and control. One way to think about this is you have a legal department, you have a finance department. Those departments have expertise within your organization. You probably wouldn’t outsource that to a third-party vendor.


Outcomes will be enhanced when you have an internal EAP manager. We’ve seen around the world that if you’re a large company, and you’re trying to build sophisticated services in many locations, utilizing multiple vendors and multiple cultures, the idea that you don’t have a resource available that is knowledgeable about how to do that, to me is kind of akin to asking your dentist to do open-heart surgery. EAP is a specialty, just like other corporate functions (Finance, Medical, HR, and Purchasing) and I do believe it’s appropriate and necessary for a large corporation to have someone to build the strategy, manage the resources, get the right people in place and understand how to build the most value for the program.


My experience was that traveling to the sites in the early days of development was a key aspect of building ownership and value at the local and regional level. I felt like it was very important to represent the leadership at the local level around the world, so people felt that they had been heard when telling us what their challenges were and what they needed from a program like this in order for it to deliver the value for the company that we all wanted to see. So I did a lot of travel to local locations and participated in meetings that we refer to as country manager meetings-- every business I know is organized differently, but we had country managers who at that time were responsible for individual country operations. They would meet on a regional basis several times a year so I would get myself invited to those meetings, do my presentations, and then answer their questions and hear their concerns and comment.


A dedicated [EAP] team, in my mind, is a huge advantage. We kicked off a process together and we knew the goal we wanted to have. We looked together at the end goal, and we didn’t break down in the middle. I think that was a huge advantage for us getting where we are.


Put EAP Advocates and Champions in Place

One of the best examples of using dedicated resources (as outlined above) is the use of champions. Peer promotion and review -- and a trusted voice -- can go further toward increasing utilization than even the best formal communications campaign. Advocates and champions can also help the corporate staff and the EAP provider understand local needs and tailor services accordingly.

We encourage our EAP champions to visit their local supplier office and have the supplier team come into our office. You can see that there’s much more engagement in the EAP and in particular, in communication and on-site visits once an exchange and meeting has taken place


Each country has at least one EAP champion. Their role is to ensure that there is a high level of EAP awareness and that employees know how to access the service. They come from a number of departments, not just EHS and benefits. This year we’re going to focus on providing them with tools, particularly communications, that they can adapt for their market and also staying in touch with them much more about what they think about the EAP every couple of months. As part of this bi-monthly update, I’ve included a spotlight on one of our champions so they can share best practice about what has worked well in specific countries. This focus is definitely paying off and I’m seeing champions in countries that haven’t reached out to us before. With this two-way communication there’s much more sharing about the activities they’re doing at the local level. I can already see this translating into increased utilization on a country-by-country basis.


You need local advocates that can keep their thumb on the pulse of the employee group that you’re serving and help you understand word of mouth, perception and in the event that it’s going negative, how to change it into positive. Every location has their informal leaders as well as their formal leaders and we try to get a handle on who those folks are. We invite them to have lunch, or coffee or tea, and ask them what they hear about the EAP service. We want to know all those attitudes so we can understand, on a regional basis, how people perceive the program and if they’re looking at it positively, neutrally or negatively. We ask our champions, in the event of a negative reading, what we can do to try to help that out.


Word of mouth is ultimately your best friend or your worst enemy, and word of mouth does occur in any organization that offers an EAP, because it’s an unusual offering and people are worried about their confidentiality. They want to know if they take the risk of calling, they’re going to get something good out of it. So if anyone uses the program and mentions it, very quickly people are interested in their opinion about how good or bad it was, how it helped them or did not help them. So word of mouth has to be something that we figure out how to manage or monitor.


We do a lot of partnering with our wellness programs and there is a lot of cross-pollination. A lot of wellness champions also serve as EAP champions.


Promote, Promote, Promote

We provided our own webinars for each region on a range of topics to help raise awareness about the depth and scope of the EAP, and we built it into our existing programs. For example, our Energy and Resilience course would now reference the EAP as a resource for employees, and also our Benefits team embedded the EAP into any relevant communications.


We’re also focused on integrating the EAP across the business. For example, in EHS, we have a number of business leads who consult outside of our department on the full range of what EHS offers, not just the EAP. There’s a little bit of training and the business leads become advocates for the EAP. So we’re seeing awareness-raising and promotion taking place not only at the country level, but at the business unit level as well.


I hear from champions, ‘Oh yes, we’ve already communicated about the EAP six months ago. We don’t need to do it again.’ So we’re trying to change that perception because where we see an impact is where we have regular communications about the EAP. I also try to encourage them to contextualize the EAP and embed it in other communications. It doesn’t have to be a stand-alone about the EAP. It can be linked to an article on the website or embedded into something else that’s already going out. Overall, at the end of this year, I want to have reached out to, and spoken with, a majority of the champions on a one-on-one basis so I know they’re all on board and are raising awareness as much as possible with regards to the EAP.


I believe a key element is that it’s our responsibility to promote the program, not the vendors. So we own it, we develop the strategy for it, we build the value creation for it, and then we are the ones who must promote it.


We participate in all of our HR training programs—we get anywhere from an hour to half a day to explain the program and how it serves as a resource to our HR managers and supervisors. We have a structured supervisor training module that we refer to as diminished capacity training that we lead every two years for every supervisor who has a high-hazard operation in his or her organization that includes a majority of the information about EAP. We have our intranet websites, we have local health fairs, we use posters, desk drops, home mailings (although we don’t do that as much as we used to), emails, on-site presentations by vendors. All of that to build the program, get it publicized and promote it so we get the most value out of our service.


Ensure Clinicians are Qualified and Develop Robust Quality Assurance Processes

It’s important to ensure that employees who do use the EAP have a good experience, and that the company is getting the expertise and services they are paying for (especially when performance guarantees are in place). Initial and ongoing vendor training can help counselors get up to speed with business needs and clinical standards, and periodic audits where feasible will provide regular information about the quality of the program.

Outside the country, the credentials are similar…for example, we have a licensed psychologist in Nigeria that operates the services, and it’s a Nigerian certification and licensure system. Same in Angola. So there are no paraprofessionals. Some of our folks have strength in certain areas, some in others, some specialize in critical incident debriefing… but all of them have a range of services that are geared not only to workers but also to workplace organizations.


We included performance “guarantees…based on things like access to clinicians, how far employees would have to travel to get to appointments, website availability, making sure the clinicians met a minimum standard, timely reporting, and demonstrating that clinical improvement took place and the clinical interventions were effective through use of a patient questionnaire – the PHQ-9.


I do think it’s important for everyone to understand the minimum level of training and competency that you’re willing to accept -- and if you’re not willing or able to do the training, you need to have a vendor that’s willing to do that, so that you’re comfortable with the basic level of EAP services that are available. If you want to focus on a solution-based therapy or some other type of model you want to see, you need to be able to get that kind of service ramped up and in place, so that you’re confident that when people do utilize your service they will have a positive experience.


Measurement & Evaluation

Ensure the program is having the desired effect. Showing good utilization, positive clinical outcomes or satisfaction measures to corporate, local and business leaders will continue to provide a business case for the program; when clinical outcome measures do not show improvement or satisfaction scores are poor, this highlights a need for more training or a potential change in provider.

Regular meetings (for example, quarterly) with the EAP vendor allows the you to review metrics together and discuss what is working well or needs improvement.


We agreed to implement the Patient Health Questionnaire with 9 questions (PHQ-9) before they commence counseling and it’s based on how they felt in the previous week physically, emotionally and mentally, and then after their clinical intervention they do the questionnaire again, and the results are analyzed. It has been shown to be very effective and the outcomes are incredible. In 2013, 85% of clinical interventions showed improvement of at least 1 point and 69% of those showed significant improvement. It really has been very effective and is one of our most impactful measures in terms of demonstrating the EAP’s effectiveness.


We had to come up with outcomes that would be valued and understood locally. We do that by having our local vendors work with our site managers, HR leaders and employee advocates to identify what people are most concerned about in every location where we serve our people. We try to have some specialized programming to address those concerns through health fairs, brown bags, online resources, mailings, whatever we need to do. Ultimately, I think the value of the program [depends on] how it’s perceived by local and regional managers and communicated up through the organization. It’s those folks, and the day to day managers and operations at our sites, who are going to tell the senior level executives that this program is either a good thing or not.


We’re involved in testing the Workplace Outcomes Suite. It’s five questions; we ask them before somebody starts using the EAP and we ask them again after the EAP. We’re hoping that will give us a feel for a self-reported benefit in the experience of having an EAP service available that will be something we can point to later as evidence of further value. We also make sure that we get a local report at least once a year from the employee advocate groups into our system so we can give some informal word-of-mouth reports up through the line, to show that generally speaking, people are perceiving the EAP as a positive service.


Re-group and Stay Fresh

Business and employee needs will change over time. It is important for a company to stay close to those needs and what people are saying about the program so that continuous improvement can take place.

We use quarterly or semi-annual meetings to gauge program effectiveness with the leaders of the site, to understand what they see coming and what we need to do to help them from a business perspective, again using our provider perspective. We try to look for those appropriate emotional and social themes that may be common in that area, such as elder care, child care, school issues, financial problems; of course, when it comes to local value and perception, an EAP is always going to have the most impact during critical times.


As you consider program development, you have to get enough information from your employees and your managers -- in other words, your key stakeholders -- to be able to craft a service and a scope of work that will meet the current needs of that employee population you’re going to serve, and do it in a way that gives you some adaptability year-over-year to make sure you’re fresh, relevant, and meeting those emotional concerns that are potential derailers for people if they’re not met.


Conclusion

Developing an effective EAP is not easy. It isn’t a matter of just choosing a good provider who can promote and manage the program. It takes support and buy-in from key corporate, local and business leaders, and regular promotion and oversight on the ground. With company investment in a program, employers can provide high-quality, highly valued and highly utilized programs around the world that may help to address the growing challenges employees face in today’s busy world.

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TABLE OF CONTENTS

  1. Local Engagement
  2. Education & Ease of Use
  3. Local Relevance
  4. Brand the Program in an Appealing and Culturally Adapted Way
  5. Dedicate Company Resources to the EAP
  6. Put EAP Advocates and Champions in Place
  7. Promote, Promote, Promote
  8. Ensure Clinicians are Qualified and Develop Robust Quality Assurance Processes
  9. Measurement & Evaluation
  10. Re-group and Stay Fresh
  11. Conclusion