employee attitudes toward an internal employee assistance program

Employee Attitudes Toward an Internal Employee Assistance Program KIRK C. HARLOW

To assess attitudes toward the effectiveness of an employee assistance program (EAP), a survey was sent to a random sample of 16,603 employees and adult dependents of a large. multinational company. Four groups were surveyed: employees who had used the EAP, adult dependents who had used the EAP. employees who had not used the EAP, and adult dependents who had not used the EAP. The findings indicated that both employee and adult dependent EAP users viewed the EAP more positively than did employee and adult dependent nonusers. Regression analyses indicated that factors including perception of EAP confidentiality. perceived support by other employees, and belief that the EAP would not negatively affect the career were related to positive views of the E M among both EAP users and nonusers.

The use of client satisfaction surveys is common practice for employee assistance programs (Ems). There is, however, a lack of published literature presenting the results of those surveys, and there are few studies that compare the perceptions of the EAP across different groups, especially those who have not used the EAP.

Available published research indicates that useful insights for EAP development can be garnered from studies of attitudes toward and use of EAPs. Park (1992), in a study of university employees, found less awareness of the EAP among men, faculty, and employees over age 50. Several studies have suggested a link between knowledge or awareness of the EAP and use. Hall, Vacc, and Kissling (1991), in an investigation of telephone company employees, found that knowledge of services was related to the use of the EAP. A survey of police officers revealed that those who had seen the EAP policy and had EAP training rated the need for the EAP higher than did those who had not (Asen & Colon, 1995). Knowledge of the EAP also was identified as contributing to decisions to use the EAP in a

Kirk C . Harlow is an associate professor in the School of Business and Public Ad- ministration at the University of Houston-Clear Lake. and president of Decision Support Associates. Correspondence regarding this article should be sent to Kirk C. Harlow, University of Houston-Clear Luke, 2700 Bay Area Blvd., Houston, TX 77058.

JOURNALOF EMPLOYMENT COUNSELlNGlSEPTEMBER 1998/VOL. 35 141

survey of EAP directors (Braun & Novak, 1986). Evidence also suggests different perceptions of the need and success for the EAP between users and nonusers. Park found that respondents who did not perceive a need for the EAP had not used the EAP. The success of the EAP was rated significantly higher among police officers who had used the EAP (Asen & Colon, 1995).

Other factors associated with positive views of the EAP include supervisory support for use of the EAP (Braun & Novak, 1986; Hall et al., 1991) and perceived confidentiality (Frost, 1990; Hall et al., 1991). Concern that use of the EAP may negatively affect the career has been found related to reduced likelihood to use the EAP (Braun & Novak, 1986; Hall et al., 1991). Although higher use of the EAP among women has been reported, Gerstein, Moore, Duffey, and Dainas (1993) found no difference between men and women, and no difference between ethnic groups.

The purpose of this study was to examine the attitudes of adult employees and dependents toward an internal EAP in a large, multinational company. Several research questions were considered. First, the attitudes about the value and qualities of the EAP were compared between employee and dependent EAP users and nonusers. Among the items examined were perceptions of the effect of EAP use on the career, confidentiality of the EAP, support among employees and su- pervisors, and the E W s overall effectiveness. Then, using multiple regression analyses, factors that may influence attitudes toward the use and effectiveness of the EAP were investigated.

THE EAP

The EAP in this study was an internal program with all employee assistance counselors employed directly by the organization. Approxi- mately 65,000 employees and their dependents were eligible for the EAP's services. Approxhately 45 EAP counselors were located at work sites throughout the United States. A full range of EAP services was provided, including assessment and referral, supervisory consulta- tion, and training. A 24-hour emergency number was available for contact with the EAP during nonworking hours. In addition, the EAP administered a managed care network, and authorization for treatment through the EAP resulted in lower copayments.

METHOD

Data for the study were gathered through the use of a client satisfaction survey distributed to a sample comprising four groups: employees who had not used the EAP, adult dependents who had

142 JOURNALOF EMPLOYMENTCOUNSELlNG/SEPTEMBER 1998/VOL.35

not used the EAP, employees who had used the EAP, and adult dependents who had used the EAP. The sample population was cre- ated by drawing random samples of 6,400 employees and 6,400 dependents. This group was then linked with the 4,380 individuals who had used the EAP in 1994 and duplicate names were re- moved, resulting in a total sample population of 16,603. This sample included 3,012 employees and 1,368 spouses who had used the EAP. The remaining 12,223 individuals were an equal number of employees and dependents who had not had contact with the EAP in 1994. This procedure was used to ensure that no one outside the EAP could discern whether an individual in the sample had used the EAP.

The survey consisted of a single mailing. Respondents were asked to return it to an independent organization for tallying. This further ensured confidentiality. A total of 3,768 surveys were returned, an overall response rate of 22.7%. Estimated response rates for each of the four subgroups were 48% for employees who used the EAP, 29% for dependents who used the EAP, 19% percent for employees who did not use the EM, and 9% for dependents who did not use the EAP.

RESULTS

A summary of the proportion of individuals in each rating category for 13 items concerning perceptions of the EAP is presented in Table 1. I t was posited, as the literature suggests, that EAP users would have more favorable attitudes than nonusers. Those who used the EAP gave markedly more favorable ratings than did those who had not. The differences are particularly large on several items, including "Convenience of location," "No negative career effect," and "Overall EAP effectiveness."

I t is important to note, however, that the difference between the two groups occurred primarily because the nonuser group contained a proportionately higher number of people who were neutral toward the EAP. Because a "No opinion" option was included in the scale, this suggests that those who have not used the EAP tended to have neither a positive nor a negative perception of the EAP.

A comparison of the user and nonuser groups broken down by relationship to the organization is presented in Table 2. The proportionately more favorable perception of the E M S effectiveness among users is consistent, even when controlled for employees and spouses.

These findings reveal the extent to which use of the EAP was related to favorable perceptions of the EAP. A key question, however, is the extent to which other factors shaped perceptions of the

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TABLE 1

Comparison of Item Ratings by Use of EAP

I tem Item Ratinas

Easily make contact with the

EAP protects confidentiality Recommend EAP to other employees

Location is convenient Would contact EAP if needed Having EAP is worthwhile Using EAP does not negatively affect career

Staff acts professionally EAP is helpful Important to have an EAP

EAP

How effective is EAP?

How supportive of employees? How supportive of management?

Easily make contact with the

EAP protects confidentiality Recommend EAP to other

Location is convenient Would contact EAP if needed Having EAP is worthwhile Using EAP does not negatively affect career

Staff acts professionally EAP is helpful Important to have an EAP

EAP

employees

Used EAP Strongly Disagree Neither Agree Strongly Disagree Agree nor Agree

Disagree

4.10 8.10 3.10 28.40 56.30 2.70 3.50 10.30 18.00 65.50

2.20 1.70 2.90 11.50 81.70 5.1 0 5.80 13.00 22.70 53.40 3.00 2.60 2.70 16.90 74.80 2.20 1.60 3.90 8.80 83.50

5.30 7.70 17.70 23.50 45.80 2.00 3.50 4.70 16.10 73.70 1.70 2.60 4.50 15.00 76.20 1.60 1.30 3.90 8.00 85.20

Very Ineffective Neither Effective Very Ineffective Effective Effective

nor Ineffective

2.70 2.90 7.40 48.00 39.00

Very Unsuppor- Neither Supportive Very Unsuppor tive Supportive Supportive

tive nor Unsuppor-

tive 4.20 4.20 19.60 46.90 25.20

4.60 3.40 14.00 41.20 36.80

Did not use EAP

Strongly Disagree Neither Agree Strongly Disagree Agree nor Agree

Disagree

6.70 8.20 21.30 35.70 28.00 4.1 0 6.90 31.80 21.90 35.30

4.1 0 3.50 17.20 31.70 43.40 5.90 6.70 38.10 23.90 25.40 7.90 7.50 18.70 36.50 29.30 5.1 0 5.50 21.40 29.50 38.60

8.70 15.90 31.60 23.20 20.50 2.00 2.50 42.50 20.10 33.00 2.00 2.60 33.30 31.80 30.40 5.1 0 5.00 19.00 28.90 41.90

(Table continues on next page)

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TABLE 1 (continued)

Comparison of Item Ratings by Use of EAP

Item Item Ratings

Did Not Use EAP (continued)

How effective is EAP?

Very Ineffective Neither Effective Very ineffective Effective Effective

Nor Ineffective

2.20 4.30 59.30 30.80 3.40 Very Unsuppor- Neither Supportive Very

Unsuppor- tive Supportive Supportive tive nor

Unsuppor- tive

How supportive of employees? 5.30 7.10 35.50 42.40 9.70 How supportive of management? 4.40 3.60 24.60 43.10 24.30

Note. EAP = employee assistance program. Item ratings given in percentages. Statisti- cally significant chi-squares, p < .05, for all items when EAP use and nonuse groups compared.

EAP. To gain a better understanding of the factors related to perceptions of the EAP, two stepwise regressions were calculated, as shown in Table 3.

In Equation 1, the dependent variable was the respondent's level of agreement (1 = strongly disagree, 5 = strongly agree) with the statement, "I would contact the EAP if1 had a problem or concern for which I needed assistance." Six of the 10 variables were included in the equation, all of which were quite consistent with previous research. I t is not surprising

TABLE 2

Effectiveness of the EAP by Use and Relationship to Organization

Did Not Use EAP Used EAP

Employee Employee Rating Employee Spouse Employee Spouse

Very ineffective 2.5 1.4 2.5 2.3 Ineffective 4.5 3.7 3.3 1.5 Neither 53.4 72.5 6.8 10.7 Effective 35.2 21.1 48.7 45.4 Very effective 4.4 1.2 38.8 40.1

Note. See Table 1 Note. Ratings given in percentages.


TABLE 3

Stepwise Regression Coefficients for DependentVariables: Would Use EAP and EAP Effectiveness

Equation 1 Equation 2 Would Use EAP EAP Effectiveness

Variable B P B P

Past use of EAP .30 .ooo .24 .ooo Confidentiality .24 .ooo .18 .ooo No negative career effect .18 .ooo .06 .ooo Employee support .17 .ooo .14 Satisfaction with EAP .16 .ooo .26 .ooo Convenient location .11 .ooo .06 .ooo Familiarity with EAP" .02 .344 .12

Employee or dependent", .oo .940 -. 02

.ooo treatment authorization

.ooo Gender" -.03 .093 -.09 .004

-.01 .628 Management supporta, -.03 .142 .219

Note. See Table 1 Note. Adjusted f f for Equation 1 = 49; for Equation 2 = .51. "Not included in Equation 1. bNot included in Equation 2

that past use of the EAP, perception of confidentiality, and no negative career effect would be related to indicating willingness to use the EAP.

The three other variables, however, provide additional insight into influences on employee attitudes. The first is a perception that other employees are supportive of the EAP. This might be interpreted as a perception of peer support. The second is satisfaction with treatment authorization, which was the level of a respondent's satisfaction with the EAP authorizing treatment before a higher level of benefits coverage could be obtained. This suggests that respondents who are less satisfied with the EAP playing this role are also less likely to use the EN. Although, one might expect the convenience of location factor to be tied to willingness to use the EAP, the fact that the EAP was internal and generally available at the work site suggests that perception of convenience of location may be more complex than the EAP's proximity to work.

The factors not included in the equation were also revealing. Gender did not emerge as a significant contributor to the equation, although it approached significance, which suggests that other factors are more influential than gender in an individual's attitude toward contacting the EAP. Furthermore, management support also was not included in the equation, a result somewhat inconsis- tent with other research (Braun & Novak, 1986; Hall et al., 1991). I t

146 JOURNALOF EMPLOYMENT COUNSELING /SEPTEMBER 1998/VOL.35

is important to note, however, that the exclusion of this variable was because of its relationship to other variables in the equation (e.g., employee support), not because it is unrelated to the dependent variable. Similarly, the level of familiarity with the EAP did not emerge as a significant contributor to the equation, probably partially because of its relationship to whether or not a respondent has used the EAP. Finally, the relationship of the respondent to the organization (i.e., employee or dependent) also was not included in the regression equation.

A second dependent variable considered in Equation 2 was the respondent's rating of the overall effectiveness of the EM'S assistance to employees and families. Although the two dependent variables were highly correlated (Spearman's r = .62, p < .OOO), the difference between a perception of EAP effectiveness and willingness to contact the EAP seemed meaningful enough to include the second equation.

As Table 3 indicates, there is little difference in the results of the two equations. The second equation includes the same variables as the first. I t does, however, also include two additional variables. The first is the familiarity with the EAP. In this case, the inclusion of this variable is indicative of the relationship between familiarity with the EAP and a willingness to rate it favorably. As noted previously, ratings tended to be either favorable or neutral, rather than negative. The inclusion of the familiarity variable in this equation suggests that a perception of effectiveness is tied to familiarity, irrespective of other variables.

Gender also was included in the second equation. The results indicate that men tended to rate the EAP's effectiveness slightly less favorably than did women. Although these results contrast those in Equation 1, the contrast is only slight because both pa- rameters have negative signs, and the parameter in Equation l nearly reached the .05 significance level required for inclusion in the equation.

Both variables, employee or dependent and management support, were excluded from Equation 2 as well as Equation 1. As noted, this suggests that these variables are not very influential when compared with the other variables in the equation.

CONCLUSION

Because the results of the study were specific to one EAP organization, any generalization of the findings must be made with cau- tion. The findings do, however, suggest some important considerations for EMS. First, EAPs should examine the strength


of support for their services beyond the client population. The results clearly show that those who had used the EAP in the past tended to have more favorable attitudes than those who had not used the EAP. Although this finding is certainly to be expected, its implications are noteworthy. Employees and dependents who have not used the EAP usually represent about 80% to 90% of the total employee-dependent population. Because most of this group were neutral toward the EAP, there was only a moderate base of support for the EAP in the overall organization. Although the quality of EAPs is often judged by client satisfaction (past users), these findings elucidate the need for EAPs to strengthen support in the general employee-dependent population.

The importance of this issue is further supported when the findings of the regression analyses are considered. Among the statistically significant factors associated with both willingness to use the EAP and a perception of its effectiveness was a perception of employee support. In other words, if an employee or dependent perceived that other employees were in favor of the EAP, they were more likely to be willing to use the EAP. This suggests that an important contributor to effective early case finding may be efforts to shift employees and dependents from their neutral view of the EAP to a more positive view.

The other factors identified in the regression analyses offer additional insight into contributors to both a willingness to use the EAP and a perception of effectiveness. Among the strongest was a perception of confidentiality. Confidentiality of the EAP is doubt- lessly one of the most important features of the EM. There are, however, aspects of EAP practice that may contribute to a perception that the EAP is not fully confidential, such as when the EAP client is a substance abuser who works in a safety-sensitive posi- tion. If those who have sought help from the EAP are unsuccess- fully treated, they may lose their jobs. Research has suggested (Kanouse & Hanson, 1972) that one negative perception, such as an employee’s job loss attributed to the EAP, may markedly out- weigh other positive perceptions. Unfortunately, absolute confidentiality in the EAP may be a practical impossibility, but the EAP can take steps to make clear what the limits of confidentiality are and the rationale for those limits.

Not surprisingly, a perception that using the EAP would not have a negative career effect was also a statistically significant variable in both regression equations. As with the perception of confidentiality, mitigating perceptions that use of the EAP may negatively affect the career can be difficult. These concerns may relate to the social stigma that is attached to mental health and substance

148 JOURNALOF EMPLOYMENTCOUNSELlNGlSEPTEMBER 1998NOL. 35

abuse problems. Thus, the EAP may have to respond not only to perceptions specific to it, but also to general societal perceptions of mental health and substance abuse problems.

Two other statistically significant variables, satisfaction with EAP treatment authorization and convenient location, merit some com- ment. The first suggests that attitudes toward the EAP's role as a gatekeeper may be related to its use and perceived effectiveness. Perceptions of EAP effectiveness are associated with satisfaction with more extensive involvement of the EAP in access to treatment.

The second variable, convenient location, is somewhat difficult to interpret. As noted, the EAP in this study was an internal one with EAP counselors at most work sites. Consequently, the extent to which convenience of location was not perceived by over half of the respondents who had not used the EAP (see Table 1) was somewhat unexpected. One possibility is that the perception of convenient location may involve more than proximity to work site. For example, it is possible that the rating of convenient location is also tied to a view that the location protects anonymity. The diffi- culty of interpretation indicates a need to better define this survey item in the future.

In summary, the results of this study offer some important considerations for EAPs that wish to improve employees' perceptions of their effectiveness, and the willingness of employees and dependents to use the EAP. As suggested by other research, perception of confidentiality and of no negative career effect influence attitudes toward the EAP. Furthermore, creating a sense of employee support for the EAP is also of consequence.

I t is axiomatic in EAPs that the organization will benefit if troubled employees receive assistance as soon as possible after the onset of the problem. The results of this study bring to the forefront questions about the attitudes of employees and dependents toward the EAP and its use, especially the majority who have not used it.

Further research is needed across multiple organizations with EAPs of different structures to better identify other factors that may influence attitudes. For example, research has suggested different patterns of use among internal and contracted EAPs (Harlow, 1987; Straussner, 1985). Also, different managed care arrange- ments such as higher reimbursement when the EAP is used may affect attitudes. Globalization has resulted in the emergence of more international EAPs, resulting in the need for more examina- tion of cross-cultural variations in attitude. Finally, additional research should examine the effect of different EAP activities such as training, newsletters, and other types of communication on attitudes.

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REFERENCES

Asen. J., & Colon, I. (1995). Acceptance and use of police department employee assistance programs. Employee Assistance Quarterly. 1 1, 45-54.

Braun, A. L., & Novak, D. E,. (1986). A study of EAP non-utilization. EAP Digest, 7, 52-55.

Frost, A. K. (1990). Assessing employees’ awareness: A first step to utilization. Employee Assistance Quarterly, 6, 45-55.

Gerstein. L.. Moore, D.. Duffey, K., & Dainas, C. (1993). The effects of bio- logical sex and ethnicity on EAP utilization and referrals. Consulting Psy- chology Journal, 45, 23-27.

Hall, L., Vacc, N. A.. & Kissling, G . (1991). Likelihood to use Employee Assis- tance Programs: The effects of sociodemographic, social-psychological. socio- cultural, organizational, and community factors. Journal of Employment Coun- seling, 28. 63-73.

Harlow, K. (1987). A comparison of internal and external employee assistance programs. New England Journal of Human Seruices, 7, 16-2 1.

Kanouse. D. E., & Hanson, L. R. (1972). Negativity in evaluations. In E. E. Jones, D. E. Kanouse, H. H. Kelley. R. E. Nisbett, S. Valins, & B. Weiner (Eds.]. Attribution: Perceiuing fhe causes of behauior (pp. 47-62). Morristown. N J : General Learning Press.

Park, D. A. (1992). Client satisfaction evaluation: University Employee As- sistance Program. Employee Assistance Quarterly. 8. 15-34.

Straussner. L. A. (1985). The nature and growth of contractual EAPs. The Almacan, 15, 20-23.

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