Although once thought of as alcohol and substance abuse management programs, employee assistance programs have grown over recent years to incorporate a much larger range of offerings - including helping employees manage legal, financial, wellness and stress issues.

The EAP of the 21st century, when effectively implemented, is not merely the referral service of the past, but rather a start-to-finish case management and return-to-work program for employees suffering from critical issues like depression and disability.

And while benefit managers once struggled to show the return on investment for such programs, a collection of current research is giving pros the evidence they need to show that EAPs - long known as the right thing to do for workers - also is the right thing for business.

"Employers are finally beginning to tune in to the fact that [having an EAP as part of] an overall health and productivity strategy is very good for business," says Sandra Routledge, a consultant at Watson Wyatt.

EAPs and depression

Consider these facts:

• The Journal of American Medicine estimates that as many 8.4 hours are lost per employee per week as a result of major depression. That's 26 lost work days per year, versus 17 days for cancer.
• Mental illness, the same research shows, is the No. 1 illness causing disability in the United States.
• Over the past decade, there has been a 300% increase in mental-health Social Security disability claims, the Work Loss Data Institute estimates.
• JAM estimates that 9.4% of the U.S. workforce suffers from some type of depressive disorder, and that upward of 69% of people may not even realize they're depressed.

The cost of depression is estimated at $344 billion annually due to lost productivity and medical fees, shows research from Risk and Insurance magazine. Often the most difficult step in managing depression is actually getting in to see a doctor. "In today's psychiatric economy, it takes two months to see a psychiatrist, a month to see a therapist. [That's where] EAPs can be critical - quickly accessible service with a credentialed person," says Dr. Ken Hopper, chief medical officer of CorpHealth, whose company administers EAPs. Companies with EAPs in place have, on average, 21% lower rates of absenteeism and 14% higher productivity rates, shows research from the Department of Health and Human Resources.

EAPs and disability

In addition to yielding greater ROI in treating depression, employers using EAP services had shorter disability duration, new research from The Hartford Group shows. Its "Healthier, More Productive Employees" study shows that those with psychiatric concerns returned to work an average of 17 days sooner than those who did not use an EAP. The employees were also twice as likely to return to the workforce.

The same study showed significant cost savings associated with disability claims. Only 2% of employees using the EAP had a disability claim that converted to LTD benefits, whereas 9% of those who did not used LTD benefits. Organizations with 10% or greater EAP utilization rates had 23% to 47% fewer disability claims than those without an EAP.

The DMEC research also finds that companies with over a 12% utilization rate see strong decreases in disability claims. "We still have a lot more work to do in terms of coming up with documented cost savings," says Marcia Carruthers, the CEO of DMEC. "But, indirectly, we've seen a strong return on investment."

Part of realizing greater savings from disability plans is making sure claims adjusters screen for mental health issues. DMEC estimates that only 35% of STD claims adjusters review for possible psychological issues in physical claims. Less than half (45%) do so for LTD claims. Less than 40% of all disability management teams include a mental health professional or EAP representative.

Breaking down silos

For programs to truly be effective, EAPs and HR/benefits pros need to work together to move toward a common goal, says Mike Garfield, senior vice president of global business development for ComPsych. "Employers are starting to understand that EAPs are the perfect entrée for someone who is ready to make a behavior change or needs help or support in some area of life."

Garfield says he sees employers expanding on what might have started out as simply a counseling benefit and including areas like wellness, smoking-cessation and FMLA administration. "There's an understanding that 90% of people use FMLA to deal with an issue where an EAP might also be effective," says Garfield.

EAPs used to be "siloed in the behavioral health box," he adds, saying that now employers are considering the broader uses of EAPs because of tangible evidence linking utilization to decreased costs and faster return-to-work rates.

Other best practices

To get the most from your EAP, Routledge suggests looking at your provider's process from start to finish. If your program is particularly large or you're specifically interested the provider's ability to manage a specific condition, like depression, an audit may be necessary.

"There's a real disconnect between what employers are saying [their EAPs provide] and what employees are saying," Routledge says. Conducting an employee survey about how the EAP works can be a good way to find out if the program is functioning as it should.

Ask about what additional services your provider has regarding education. Communicating the value of an EAP in blanket educational sessions may encourage increased utilization. This can be done through a Web site, articles distributed to employees or employee training sessions. Managing confidentiality is always a concern, but with an appropriately run EAP, a generally unnecessary one. "Education is one way to eliminate fear," says Hopper. Encourage managers and supervisors to work with EAPs regarding return-to-work programs.

EAP shopping checklist

If you're searching for a new EAP, consider the following questions:

• What is the program's average utilization rate? Consider less than 6% ineffective.
• What is the EAP provider's core business? Look for a company that is specifically focused on this niche.
• Ask for a list of references.
• What kind of a track record does the EAP have in driving utilization into a program and then providing resolution within the program?
• What is the average session model? Best practice would be to have a five-to-six session model EAP, which is proven to resolve upward of 80% of all clinical issues.
• How often does a representative meet with the HR people in your client organizations?
• How often does the program participate in vendor summits?
• What are the qualifications of intake personnel? How are phones answered? How are transfers made to counselors, and how soon are appointments made?
• What strategies are in place to be visible to client organizations? How often is counseling conducted face to face?
• Are printed materials for employees also available via a Web portal?