The document compares different EAP models based on whether counselors are staff or affiliates, and whether services are provided on-site or off-site. It discusses the advantages and disadvantages of internal vs external models, and on-site vs off-site services. Various session models are outlined including those providing 1-3, 1-5, or 1-8 in-person sessions as well as telephonic consultations and counseling. Factors like cost, utilization rates, employee satisfaction, and regulatory considerations are examined for each approach.

1. Comparison of EAP Models
Staff vs. Affiliate; On-Site vs. Off-Site
Internal vs. External; Session Models
Gary DeFraia, Ph.D.
April 23, 2010

2. Staff vs. Affiliate Models
 Staff Model
 EAP counselors as employees of either an employer or an external EAP
 Unrelated to whether the counselors work on or off-site
 Affiliate Model
 External EAP contracts with private practitioners, groups or agencies
 Unrelated to whether the counselors work on or off-site
 Blended-External Model
 External EAP establishes off-site staff offices to serve concentrations of
employer populations; Sets up an affiliate network to serve dispersed
populations
 Direct Employer-Contractor Arrangement
 By-passing external EAPs, employer hires a counselor as a private
practitioner working as an independent contractor
 Counselor typically works on-site
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3. Internal vs. External; On-Site vs. Off-Site
 Internal / On-Site
 Employer hires counselors who are housed on-site
 Staff model
 External / On-site
 External staff and/or affiliate counselors housed on-site
 Staff and/or Affiliate model
 External / Off-site
 External staff offices and/or affiliate counselors housed off-site
 Internal-External Blended Model
 Employer hires on-site counselors to serve a concentration of
employees at an employer site
 External EAP provides affiliate or staff counselors serving rest
of population off-site
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4. Internal & On-Site: Advantages
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 On-site staff develop strong connections to the employer, more
so for staff employed by the employer vs. on-site external EAPs
 Enhanced knowledge of the organization: Culture, morale,
stressors, trends, processes, communications, etc.
 Better awareness drives innovation and creative approaches
 Well integrated into organization teams, projects, committees
 Convenient on-site offices; Readily available to see urgent cases
and quick response to management

5. Internal & On-Site: Advantages, cont.
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 Internal: As employees of the employer, new tasks or projects can
be added to job functions of counselors as needed
 Internal programs generally viewed more favorably by unions than
externals
 Greater number of management referrals and better identification of
substance abuse
 Higher utilization by minorities
 Multiple services are integrated via the on-site staff
 Communications, seminars, consultations, counseling, critical incident
support, reporting, etc.

6. Internal & On-site: Disadvantages
 Dual Client System: Counselors working for the employer have added
challenges balancing needs of employees and management
 Confidentiality can be more difficult to insure
 Potentially employees have less trust in confidentiality, with internal EAPs
viewed somewhat less confidential than external on-sites
 Maintaining boundaries: Internal managers may bring pressure for
information – viewing the counselor as a subordinate
 User concerns about physical visibility of seeking assistance
 Security of record keeping needs to be assured
 Utilization:
 Fewer employee self referrals
 Higher level managers may be less likely to be referred for assistance or to
seek assistance voluntarily
 Families do not have access to on-site facilities
 Costs: Internal EAP employees are costly; External, on-sites less so,
with both significantly more costly than external, off-site EAPs
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7. External & Off-Site: Advantages
 Flexibility for changing EAPs - Vendor/contractor vs.
employee:
 If poor performance, external contracts can be canceled at
renewal or terminated for cause
 Internal termination of employees involves human resource
issues
 Better Population Coverage:
 Due to expansive resources, fewer service gaps in areas
covered
 Availability less impacted by vacation or illness
 Off-site offices ensure better confidentiality
 Externals and off-site counselors experience less pressure
to take sides between management and employees
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8. External & Off-Site: Advantages, cont.
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 Cost-effectiveness:
 Relieves employer of overhead costs
 Reduces administrative responsibilities: Consistent with trends to
outsource functions, allowing employers to focus on core tasks
 Utilization:
 With counselor independence from the employer, more levels of the
organization may be comfortable using EAP
 Better utilization from self referrals
 Better utilization by high-level workers
 Availability to family members
 Liability: Counselor independence from employer lessens risk
 Fewer conflict of interest situations

9. External & Off-site: Disadvantages
 External EAPs are more challenged in maintaining familiarity with
organizational philosophy, culture, internal issues, job pressures,
activities and needs
 Contractual limitations
 New projects or additional duties require renegotiation of the contract
and may result in increased costs
 Reduced informal accessibility
 Employees cannot “drop in” during breaks, etc.
 Utilization: Fewer management referrals
 Greater emphasis on individual change than organizational
support or change
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10. Additional Considerations: Externals
 Where internal programs generally rely on a small group of staff to
provide a limited number of services, external EAPs provide
multiple personnel to deliver a broad range of comprehensive
services
 24-hour emergency coverage, wellness programs, dependent
care, and managed behavioral healthcare, disability
management, etc.
 External EAPs allow a smaller employer to take advantage of an
array of services without incurring the cost of full-time in-house staff
 Utilization: Studies indicate external programs show higher rates of
employee self referrals and increased perception of confidentiality
(Strausser, 1988; Hartwell, 1996; Blair 1987)
 Diversity: Large external affiliate network afford better cultural
competence than small staffs
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11. Additional Considerations: Internals
 Performance Management: Internal programs provide better
interventions for making timely interventions at the point of
performance decline
 Internal programs offer greater accessibility
 Internal programs have higher visibility, better outreach, better
coordinated substance abuse services
 Organizational Support: Internal programs provide more rapid
feedback to the organization when systemic issues emerge
 Utilization: Internal programs have three times more management
referrals of employees with performance problems
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12. Models: 1 - 8 In-Person Sessions
Allows for full engagement of the employee with short-term
treatment techniques
Average range of cases resolved in the EAP, avoiding benefit-
covered services: 60% - 80%
Cost off-set to either preserved self-insured health care
payments or in lower premiums in a fully insured plan
Employee satisfaction is usually higher than with other models
Potentially regulated under Knox Keene in CA
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13. Models: 1 - 3 In-Person Sessions
Assessment and referral model
 Diagnosis and motivational counseling to pursue recommend a treatment
plan; Limited opportunity for treatment
Average range of cases resolved in the EAP, avoiding benefit-covered
services: 50% to 60%
 Self insured funds or benefit plan pays for higher portion of cases that could
have been resolved in a higher session model
Lower utilization
 Employees may view three sessions as inadequate for their problem
 Anticipating need to transfer to a benefit-covered provider, they may by-pass
EAP and go directly to benefit-covered treatment
 Number of employees by-passing the EAP generally higher than 1- 8 model
Typically lower user satisfaction levels than 1-8 model
Generally not regulated under Knox Keene in CA
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14. Models: 1 - 5 In-Person Sessions
Compromise between 1-8 and 1-3 session models
 Increasingly popular option among employers
Some short-term treatment can be accomplished
Average range of cases resolved in the EAP, avoiding benefit-
covered services: 50% to 70%
Number of EAP by-passes, cost off set and member satisfaction
will fall somewhere in between those predicted for 1-8 and 1-3
session models
Potentially regulated under Knox Keene in CA
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15. Models: Telephonic Sessions
Telephonic Consultations vs. Telephonic Counseling
Telephonic Consultations
 Single session assistance from a call center
 No limit on number of calls
 No continuity of counselor; Unscheduled calls answered from a queue
 Permissible across state lines regardless of counselor’s state licensure
Telephonic Counseling
 Multiple sessions with the same counselor; Scheduled in advance
 No limit on number of sessions
 Permissible only by a counselor licensed in the same state in which the
caller resides
Neither is generally regulated under Knox Keene in CA
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16. Contact Information
Gary S. DeFraia, Ph.D.
gdefraia@hvc.rr.com
845-216-1392
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