Employee counseling and wellness services

CH-11 Copyright 2008 Werner et al 1

Employee Counseling and Wellness Services

Chapter 11


Learning Objectives

• Explain the need for employee counseling in organizations and why counseling is an HRD activity

• Describe the typical activities included in employee counseling programs

• Describe the focus and effectiveness of three types of employee counseling programs: – employee assistance programs – stress management interventions– employee wellness/health promotion programs


Learning Objectives

• Describe the role of supervisors in the various types of employee counseling programs

• Explain the legal and ethical issues raised by employee counseling, assistance, and health and wellness programs


Questions

• Have you ever witnessed any of the following from someone in a work setting?• Showing up for work under the influence of alcohol or drugs• Struggling to maintain satisfactory job performance because of severe anxiety or depression• Refusing medical or other assistance for a treatable condition • Burnout or fatigue as a response to ongoing work pressures and stress• Involvement (or noninvolvement) in organizational efforts to promote good health (e.g., fitness, nutrition, weight control, or control of high blood pressure)


Personal Problems

• Personal problems are a part of life– They can affect behavior at work as well as

does one’s personal life

• Such problems contribute to accidents, absenteeism and turnover, poor decisions, decreases in productivity, and increased costs


Reasons for Promoting Well-Being

• Rising healthcare costs

• Reduce workers' compensation costs, tardiness, absenteeism, turnover, lost time from work because of illness and injury, and accidents

• Shortage of skilled workers


Employee Counseling Services

• A relationship established between a trained counselor and the employee

• Thoughtful and candid discussion of personal problems experienced by the employee

• An appropriate referral that secures the necessary assistance

• The provision of short-term counseling, when a referral is not necessary


Employee Counseling as an HRD Activity

• Employee counseling is an HRD activity

• Coaching and counseling are often intertwined

• Supervisors are generally encouraged to provide early identification and referral to a trained professional or counseling service– They should not try to solve or resolve the

employee’s problem themselves


A Typical Counseling Program

• Problem Identification

• Education

• Referral

• Counseling

• Treatment

• Follow-up


Health Risk Appraisal Concerning Alcohol Use

Table 11-1

• Questions– On average, how often do you drink beer, wine,

liquor, or other beverages containing alcohol?– On days when you drink, how many drinks do you

usually have? (One drink equals a twelve-ounce beer, a four-ounce glass of wine, or a shot of liquor)

– During the past thirty days, on how many days did you have five or more drinks on the same occasion?

– In the next six months, do you want to reduce the amount of alcohol that you drink?

SOURCE: From Lapham, S. C., Chang, I., & Gregory, C. (2000). Substance abuse intervention for health care workers: A preliminary report. Journal of Behavioral Health Services & Research, 27(2), 131–143.



Table 11-1

• Feedback– Low-risk drinking is using alcohol in a way that does

not harm your health– Research suggests that

• on any one day, more than four drinks for men and more than three for women can cause problems

• having more than twelve drinks a week can cause problems over time

• drinking alcohol every day may cause problems. Unless you limit your intake to one drink each day, you are advised to drink no more than four to five days a week




Table 11-1

• Risk assessment categories:– a. Low risk—drink less than seven days a

week and no more than one to two drinks per occasion

– b. Moderate risk—drink up to three to four drinks per occasion or drink every day

– c. High risk—usually or occasionally drink five or more drinks per occasion



Who Provides the Service?

• A counseling program in-house

• A contracted-out independent service


Advantages of In-House Service

• Advantages attributed to in-house programs include – internal control of the program– familiarity with the organization – better coordination of treatment and follow-up– a sense of ownership of the program greater

awareness and credibility with supervisors


Disadvantages of In-House Service

• Disadvantages of in-house programs can include – real or perceived problems with confidentiality– lack of resources needed– reluctance of some employees to use the

service (e.g., a vice president of finance may be reluctant to go to a lower-level employee to admit a drinking or marital problem)

– possible limitations in staff skills and expertise


Advantage of Contracting Out

• Advantages can include– can rely on the services of trained

professionals– confidentiality may be easier to maintain– cost may be lower, and– better identification and use of community

resources


Disadvantages of Contracting Out

• Disadvantages include– lack of on-site counseling– possible communication problems– lack of knowledge of the organization and its

employees by contractor


Effective Employee Counseling Programs

• Must Have– Top management commitment and support– A clearly written set of policies and procedures – Cooperation with local union(s), if they are present in

the organization– A range of care (e.g., referral to community

resources, follow-up)– A clear and well-enforced policy concerning employee

confidentiality– Maintenance of records for program evaluation– Health insurance benefit coverage for services– Family education


Employee Assistance Programs (EAP)

• Employee Assistance Programs (EAPs) are defined as – Job-based programs operating within a work

organization for the purposes of • identifying troubled employees• motivating them to resolve their troubles• providing access to counseling or treatment for

those employees who need these services


EAP Discussion

• This section will discuss– the extent of the problem organizations face

with respect to substance abuse and mental health

– describe the approach taken by EAPs, and – discuss the effectiveness of EAPs in dealing

with these problems


Substance Abuse

• Alcohol and drug abuse– Estimated that companies lose over $7,000

per year for every employee who abuses alcohol or drugs

– greater risk for accidents, injuries, disciplinary problems, and involuntary turnover


Mental Health

• About 21 million adults in the United States experience a depressive illness in any given year

• Up to 25 percent of medical claims filed can be tied to mental and emotional illnesses

• 5.4 percent of American adults have a serious mental illness that substantially interferes with one or more major life activities


Emotional and Mental Health Issues Commonly Seen

• Individual adjustment problems (neurosis to psychosis)

• External factors such as battering, incest, rape, or crime

• Sexual problems, including impotence

• Divorce and marital problems


Emotional and Mental Health Issues Commonly Seen

• Depression and suicide attempts

• Difficulties with family or children

• Legal and financial problems

• Pathological or problem gambling


The EAP Approach

• Employee problem is operationally defined in terms of job performance, rather than clinically defined in terms of addiction or psychiatric disorder


Constructive Confrontation – 1

• Calls for supervisors to – monitor their employees’ job performance– confront them with evidence of their

unsatisfactory performance – coach them on improving it – urge them to use the EAP’s counseling

service if they have personal problems – emphasize the consequences of continued

poor performance


Constructive Confrontation – 2

• Constructive confrontation proceeds in progressive stages– at each stage, employees must choose

• whether to seek help from the EAP• manage their problems themselves• suffer the consequences of their actions


Conceptual Framework for EAPTable 11-2

• EAPs are based on the premise that work is very important to people; the work itself is not the cause of the employee’s problem– The workplace can be a means to get people help.

• The supervisor plays a key role in getting help for the employee.– The supervisor is critical in the confrontational

process with the troubled employee. – Therefore, education is necessary to eliminate the

supervisor’s tendency to enable the employee by denying the problem.

SOURCE: AMA handbook for developing employee assistance and counseling programs by Masi, Dale A. © 1992 by AM MGMT ASSN/AMACOM (B). Reproduced with permission of AM MGMT ASSN/AMACOM (B) in the format Textbook via Copyright Clearance Center.



• Information about job performance is extremely important in diagnosis and treatment

• Workplace peers and union stewards are very important – however, they too can deny the problem and enable

the employee to continue the behavior – teaching them to confront and consequently break the

denial barrier is an important element




• Job leverage is the key ingredient in helping an employee – the counselor must be able to use this in

conjunction with the supervisor

• EAPs concentrate on job performance issues – they are not intended to be medical programs




• Cost-effectiveness is an important consideration and must be addressed with upper management

• The EAP professional’s knowledge about addiction is paramount – Every EAP should be staffed by licensed

professionals who are familiar with addictions and other employee personal problems



Behavioral Problem IndicatorsTable 11-3

• Absenteeism– Taking many absences without authorization– Using vacation days to cover frequent

absences

• On-the-Job Absences– Often away from one’s work area– Frequent tardiness after lunch or breaks

SOURCE: Adapted from Campbell, D., & Graham, M. (1988). Drugs and Alcohol in the Workplace: A Guide for Managers. NY: Facts on File, pp. 100–101.



• High Accident Rates– Accidents off the job that affect work

performance– Accidents on the job due to carelessness,

inattentiveness, etc




• Job Performance Issues– Complaints from coworkers or clients– Missing deadlines– Frequent shifts between high and low

performance– Difficulty understanding instructions or new

information




• Poor Relationships with Coworkers– Extreme reactions to real or implied criticism– Large mood swings– Avoiding coworkers and friends– Increasing irritability or argumentativeness



Typical EAP Content

• Includes– a policy and procedures statement– employee education campaigns– a supervisory training program– clinical services– follow-up monitoring


Determining EAP Worth

• HRD professionals who are considering adopting an EAP for their organization should – determine whether it is likely to be a cost-effective

solution for their organization– determine the types of programs needed

• They can make these decisions by– calculating the per-person cost of treating problems to

obtain the desired outcomes– comparing those costs to the cost of replacing the

person rather than offering treatment


Stress Management

• Stress is a common aspect of the work experience

• Expressed as – job dissatisfaction– anger– frustration– hostility– irritation


Categories of Stress Response

• Five categories of behavioral responses to stress: – degradation/disruption of the work role itself

(e.g., accidents and errors) – aggressive behavior at work (e.g., stealing) – flight from the job (e.g., absenteeism)– degradation/disruption of other life roles (e.g.,

spouse abuse)– self-damaging behaviors (e.g., smoking or

alcohol or drug use)


Stress Management Programs or Interventions (SMIs)

• Any activity, program, or opportunity initiated by an organization, which focuses on reducing the presence of work-related stressors or on assisting individuals to minimize the negative outcomes of exposure to these stressors


Two Considerations

• Stress management interventions SMI) are popular

• Two important issues have yet to be completely addressed: – the definition of stress – the effectiveness of SMIs


Stress

• Includes three main components:• some environmental force affecting the individual, which is called a stressor• the individual’s psychological or physical response to the stressor• in some cases, an interaction between the stressor and the individual’s response


Organizational StressorsTable 11-2

• Factors intrinsic to the job– role conflict or ambiguity– workload– insufficient control

• Organizational structure and control– red tape politics – rigid policies

SOURCE: From Ivancevich, J.M. (1990). Worksite stress management interventions. American Psychologist, 45, 254. Copyright 1990 by J.M. Ivancevich. Reprinted by permission.



• Reward systems– faulty and infrequent feedback– inequitable rewards

• Human resource systems– inadequate career opportunities– lack of training




• Leadership– poor relationships– lack of respect



Categories of SMIs

• Educational Interventions are designed to inform the employee about – the sources of stress,– what stress feels like – how stressors can be avoided, and – how the individual can better cope with stress


Categories of SMIs

• Skill-acquisition interventions, such as time management or assertiveness training, are designed to– provide employees with new ways to cope

with stressors affecting their lives and performance

– help keep the effects of stress in check


A Model of Stress Management Interventions

Fig 11-1

SOURCE: From Ivancevich, J.M. (1990). Worksite stress management interventions. American Psychologist, 45, figure 2, 254. Copyright 1990 by American Psychological Association. Reprinted by permission.

Targets ofStress Management

Interventions

Types ofInterventions

Outcomes

SituationalStressors

(1)

Cognitive Appraisalof Stressors

(2)

Coping Strategies(3)

IndividualMeditationExerciseRelaxation techniquesCognitive approachesGoal-settingTime management

OrganizationalOrganizational structureJob designSelection and placement programsWorking conditionsTraining and development

Individual/OrganizationalInterface

Job demands—person style fitParticipation preferences-practicesAutonomy preferences-practicesCoworker relationships

IndividualBlood pressure, heart rate,

cathecholaminesQuality of lifeAnxiety, depressionPsychosomatic complaints

OrganizationalProductivity, quantity, and qualityTurnoverAbsenteeismHealth care costsAccidents

Individual/OrganizationalInterface

Job performanceJob satisfactionBurnoutHealth care utilization


Issues Guiding SMIs

• Look for specific issues with employees—– instead of talking generally about “stress,”

determine what specifically is going on with employees

• Assessment—what evidence is there of a problem, and how widespread is it?


Issues Guiding SMIs

• Specific and focused solutions– what will work in a particular organization?– where should the intervention be targeted?

• Strategic intervention– how does this intervention relate to other HR and

organizational practices? – do other things in the organization need to change

first?

• Evaluation and feedback– what will be evaluated?– how will this guide future actions?


Employee Wellness Programs (EWPs) or Health Promotion Programs (HPPs)

• Activities that promote employee behavior• Organizational practices that ensure employee

health and fitness• Activities that promote employee behavior• Organizational practices that ensure employee

health and fitness


Premise of EWPs and HPPs

• Based on the premise that wellness is more than the mere absence of disease

• Encourage individuals to adopt lifestyles that maximize overall well-being

• Deal with stress and non-stress issues– obesity– nutrition– smoking cessation


Three Levels

• Level I programs – primarily cover educational activities and may

not attempt to directly change employee behavior

– newsletters, posters, classes, and health screening


Three Levels

• Level II programs– attempt to bring about direct behavioral

change – may include supervised exercise classes,

memberships in fitness centers, and classes on how to properly perform physical work tasks, such as lifting


Three Levels

• Level III programs – try to create an organizational environment

that helps employees maintain healthy lifestyles


Ten Dimensions of Worksite Wellness Programs (WWPs)

• Establishing a constructive policy for wellness• Conducting wellness screening—health risk

appraisals• Establishing working relationships with

community resources• Referral of employees to treatment and health-

improvement interventions• Providing health-improvement interventions

using a menu approach


Ten Dimensions of Worksite Wellness Programs (WWPs)

• Outreach and follow-up counseling, done on a regular and ongoing basis

• Wellness events done for the entire organization• Consultation on worksite policies and systems,

and organizational-level changes• Ongoing evaluation of the process used to carry

out the wellness program, as well as any reductions in employees’ health risks

• Periodic evaluation based on work performance and benefit use


Four Common Components of HPPs

• Exercise and fitness

• Smoking cessation

• Nutrition and weight control

• Control of hypertension (high blood pressure)


Exercise and Fitness

• Corporate exercise and fitness programs are among the most popular employee well-being interventions

• The major obstacle to the effectiveness of fitness and exercise programs may be persuading the employees who would most benefit from them to participate


Activities that May be IncludedTable 11-6

• Screening Programs

– Annual Medical Exam

– Blood Analysis

– Cervical Cancer

– Colon Cancer

– Diabetes

SOURCE: From Davis, M.F., Rosenberg, K., Iverson, D.C., Vernon, T.M., & Bauer, J. (1984). Worksite health promotionin Colorado. Public Health Reports, 99, 2.


Activities that May Be IncludedTable 11-6

• Screening Programs– Fitness Assessment– Health Fairs– Health-risk Appraisal– Height and Weight– High Blood Pressure

SOURCE: From Davis, M.F., Rosenberg, K., Iverson, D.C., Vernon, T.M., & Bauer, J. (1984). Worksite health promotion in Colorado. Public Health Reports, 99, 2.



• Screening Programs– Pre-employment Medical Exams– Pulmonary Function Tests– Screening for Job-specific Health




• Educational Programs– Alcohol and Drug Use– Breast Self-Exam– Cancer Prevention– Coronary Disease Risk Factors– Cardiopulmonary Resuscitation




• Educational Programs– Weight Control– Health and Fitness– First Aid– Cancer Detection– Low Back Pain




• Educational Programs– Nutrition– Seat-Belt Use– Smoking Cessation– Stress




• Behavioral Change Programs– Exercise and Fitness

• Aerobics• Calisthenics• Recreational Sports• Competitive Sports• Weight Training• Exercise Instruction




• Behavioral Change Programs– EAPs– Healthy Back– Self Defense– Smoking Cessation




• Behavioral Change Programs– Stress Management– Weight Loss– Cooking Classes



Smoking Cessation

• Smoking is one of the most publicized health risks in society and the workplace

• It has been amply demonstrated that smoking is linked to greater incidence of – Coronary heart disease– Stroke– Cancer– Emphysema


Smoking Costs

• 20.9 percent of U.S. adults smoke– Down from 42.4% in 1965

• The additional annual cost of employing smokers and allowing smoking in the workplace has been estimated to be $2,853 per smoker

• 35 percent of private companies have a smoking cessation program


Cost-Benefit of Smoking Cessation

• Worksite smoking cessation programs can yield a cost-benefit ratio of 8.75 – over eight dollars gained for every one dollar

spent on the program

• Reduced health costs– Reduced secondary effects on non-smokers

• Reduced facility & cleaning costs


Nutrition and Weight Control Interventions

• 64 percent of U.S. adults can be considered either overweight or obese

• Overweight is defined as being 25 to 29.9 percent or more over one’s “ideal” body weight (based on height and gender)

• Obesity is defined by a body mass index (BMI) of thirty or more– Approx Weight/7.37 for Males– Approx Weight/6.96 for Females


Obesity

• Obesity has been causally associated with musculoskeletal problems, hypertension, high levels of blood sugar and cholesterol, and some forms of cancer


Obesity Programs

• Include educational activities – newsletters, leaflets, cooking demonstrations, weigh-

ins, and advice on developing weight-loss programs

• Organizations may also stock cafeterias and vending machines with healthy, low-fat foods

• Post nutritional information concerning food sold in cafeteria

• Provide a “health coach” to assist employees with issues such as obesity and smoking


A Cautionary Note

• Negative attitudes toward overweightindividuals are widespread in our society– psychological and economic implications here for

overweight individuals– potential legal implications for employers

• Organizations must ensure that – interventions are kept free of negative stereotypes

and negative job outcomes for participants unless the participant’s weight is truly related to their ability to perform a given job


Control of Hypertension (High Blood Pressure)

• Approximately 29 percent of U.S. adults suffer from hypertension– with an additional 31 percent classified as

pre-hypertensive (i.e., at risk for hypertension)

• Hypertension causes a significantly greater incidence of heart disease and stroke


Controlling Hypertension

• It can often be controlled through – Exercise– Weight reduction– Medication– Stress reduction– A low-salt diet


Typical Hypertension Program

• Typical screening and control program may include:– provision of educational materials– blood pressure screenings to identify hypertensive

employees– referral of such employees for treatment– installation of blood pressure screening equipment for

employees to use to monitor their own blood pressure– low-salt foods available in both cafeteria and vending

machines– periodic monitoring of employee progress


Cost Benefit of Reducing Hypertension

• Effectiveness of workplace hypertension programs in reducing blood pressureand increasing participant knowledge appears to be well established

• Benefit of $1.89 to $2.72 in reduced healthcare claims per dollar spent on running a hypertension control program


Six Steps for Better Health1. Provide nutritious options in cafeterias and vending machines

and, if possible, subsidize the purchase of them2. Make the workplace smoke free and help employees kick the

habit outside of work3. Encourage exercise by offering employees free use of a fitness

center or subsidizing employees ’memberships to offsite facilities4. Offer on-site health education and screening for conditions like

high blood pressure and cholesterol5. Share with employees who take care of themselves some of the

savings they generate6. Design healthcare programs with a component that extends to

employees’ families


Issues in Employee Counseling

• Modest number of scientifically sound studies demonstrating effectiveness

• Defining success and effectiveness for many of these problems is a difficult task

• Reasons an organization has begun an intervention in the first place may affect whether research is done and how effectiveness is defined


Strategy for Evaluating Effectiveness

• Determine the demographics of the organization (age, sex, etc.)

• Determine expected participation rates• Estimate program start-up and maintenance costs • Implement a testing and tracking system to quantify

program outcomes• Measure pre- and post-program changes for relevant

outcomes• Analyze program variables separately by relevant

demographic groups and by measuring participation versus nonparticipation in the program

• Perform cost-benefit analyses of present and future benefits, expressed in current-dollar value


Legal Issues in Employee Counseling Programs

• Drug-Free Workplace Act requires federal contract and grant recipients of more than $100,000 to have a written policy regarding drug use in the workplace and to notify employees of the availability of related counseling, rehabilitation, and employee assistance programs


Legal Issues

• State laws and federal agency rules require drug testing programs to be accompanied by EAPs or some other form of rehabilitation counseling

• Equal Employment Opportunity has listed having an EAP in place as a “best practice” for employers to ensure that employees are treated fairly


Legal Issues

• Rehabilitation Act of 1973 • Americans with Disabilities Act of 1990 (ADA)

– prohibit employers from discriminating against individuals with disabilities

– require that employers make “reasonable accommodations” to help such employees perform their job functions

• Both of these laws cover employees with alcohol and drug problems


Legal Issues

• Rehabilitation Act • Applies to federal contractors and government

supported organizations• Specifies that employees with disabilities may be

discharged only for job-performance reasons– An alcoholic employee may not be fired because of

his or her alcoholism– only for the negative effects the alcoholism has had

on work performance• Employer must make reasonable

accommodations that help the employee resolve the problem and improve performance


Legal Issues

• ADA applies to all employers of fifteen or more employees

• ADA broadly defines reasonable accommodation to include modification of facilities, materials, procedures, and jobs

• Employers must take such action provided these modifications do not create an “undue hardship” on the organization (e.g., significant difficulty or expense)


A Caution

• The potential legal advantage of using counseling programs to comply with existing laws may be offset to the extent that the counseling program exposes employers to lawsuits charging erroneous assessment for failure to refer either to appropriate treatment or to any treatment


Whose Responsibility Is Employee Counseling?

• Employees, the organization, supervisors, and unions all have a role to play in employee well-being

• The individual bears primary responsibility for his or her own well-being


Ethical Issues in Employee Counseling

• Two ethical issues relating to employee counseling– Confidentiality

• all records of program utilization should be held in the strictest confidence, maintained separately released only with the express permission of the employee

– Voluntary or mandatory


Supervisory Counseling Training Program

Table 11-7

• Identification of the supervisor‘s initial reactions to the prospect of counseling e.g., using comfort reaction questionnaire

SOURCE: From Ramsey, K.B. (1985). Counseling employees. In W.R. Tracey (Ed.), Handbook of human resource management and development (pp. 829, 832). New York: AMACOM.



Table 11-7

• Lecture and discussion of various counseling topics, which may include:

1. emotional needs of individuals2. potential signs of employee problems3. signs of over-involvement in counseling (e.g., loss

of objectivity, focusing beyond job performance, guidelines for giving advice)

4. structure of a counseling session, including decisions to be made therein

5. counseling terminology to facilitate discussion of feelings, reactions, and behaviors

6. nonverbal communicationSOURCE: From Ramsey, K.B. (1985). Counseling employees. In W.R. Tracey (Ed.), Handbook of human resource management and development (pp. 829, 832). New York: AMACOM.



Table 11-7

• Training in counseling skills, perhaps using case studies and behavior modeling

• Role play of counseling sessions• Discussion of the relationship between

counseling and coaching/performance management

• Evaluation of counseling options and resources available

SOURCE: From Ramsey, K.B. (1985). Counseling employees. In W.R. Tracey (Ed.), Handbook of human resource management and development (pp. 829, 832). New York: AMACOM.


Unintended Negative Outcomes

• Workers’ compensation cost increases

• Employees participating in fitness programs may experience schedulingproblems, increased fatigue and accidents, and lower performance

• Smoking bans may lead to conflicts between smokers and nonsmokers


Closing Comments

• Both organizations and employees have much to gain from workplace counseling and wellness interventions

• Healthy work environments cannot be expected to occur without healthy employees