This document summarizes research findings from a study of EAP behavioral health utilization. It provides an overview of 5 research questions examined including employee perspectives on EAP and how it helped with issues. It found the top issues were mental health, family concerns, and job stress. Employers chose various EAP benefit designs and worksite activities. Higher EAP promotion and activities were linked to greater utilization. Integrated EAP/MBHC plans had greater use than standalone MBHC. For enrollees with substance abuse, most used both EAP and MBHC or MBHC only. Greater EAP benefits and use were associated with reduced later MBHC use and costs.

1. 1
Understanding and Facilitating EAP
Behavioral Health Utilization:
Research Findings
Presenters:
Brandeis University: Elizabeth L. Merrick, Ph.D., MSW
Bernie McCann, M.S., CEAP
MHN: Arlene Darick, LCSW, CEAP
EAPA’s 2010 Annual World EAP Conference
Tampa, FL
October 8, 2010
Brandeis/Harvard Center on Managed Care and Drug Abuse Treatment
(Funded by the National Institute on Drug Abuse P50 DA010233)

2. Substance Abuse Treatment Pathways in
Employer-Sponsored Programs: Research Team
Brandeis/Harvard Center on Managed Care
2
and Drug Abuse Treatment
Brandeis University:
Elizabeth L. Merrick, Ph.D., M.S.W. (Project PI)
Constance M. Horgan, Sc.D. (Center PI)
Dominic Hodgkin, Ph.D.
Sharon Reif, Ph.D.
Bernard McCann, M.S., CEAP
Harvard University:
Thomas G. McGuire, Ph.D.
Vanessa Azzone, Ph.D.
MHN:
Deirdre Hiatt, Ph.D.
Arlene Darick, LCSW, CEAP
Brandeis/Harvard Center on Managed Care and Drug Abuse Treatment
(Funded by the National Institute on Drug Abuse P50 DA010233)

3. 3
Project Overview
 5+ year project within NIDA-funded
Brandeis/Harvard Research Center on Managed
Care and Drug Abuse Treatment
 Multi-faceted study of access and utilization in
stand-alone EAP, stand-alone managed
behavioral healthcare (MBHC), and integrated
EAP/MBHC products
 Focus especially on substance abuse but also
looking at behavioral health overall
 Multiple, complementary data sources– existing
administrative data and primary data collection

4. 4
An Overview of MHN, Inc.
 Subsidiary of HealthNet, Inc.
 Founded in 1974
 Affiliates: 1100 associates; 45,000 network providers;
1400 hospitals and care facilities
 850 clients (Employers, Unions, Insurers, etc.)
 Products: Employee Assistance Programs, Work Life
Services, Managed Behavioral Healthcare, Wellness
& Prevention programs – these products are offered
in various configurations; i.e., stand-alone or
integrated.

5. Research Questions on EAP Use
1. What do EAP clients say about what issues the EAP helped
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with, how they learned about the EAP benefit, and how
much it helped?
2. What choices in EAP design and worksite services do
employers make?
3. What effects do organizational and workplace factors have
on EAP utilization?
4. What differences in client utilization are seen in integrated
and stand-alone MBHC products? What role does the EAP
play within an integrated product?
5. Do EAP benefit limits or number of EAP visits used affect
the use of outpatient behavioral healthcare?

6. Q#1: What are employee/client
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perspectives on EAP?
 Study focused on: Facilitators, barriers and experiences
with EAP and behavioral health services use
 Sample: 361 employee EAP users of EAP-only product; had
EAP claim past year and self-reported as EAP user.
 Data Source: Telephone survey (stratified random sample
of MHN enrollees) conducted 2009-2010. Service users
queried regarding experience with EAPs and BH treatment
use over past 12 months; attitudes/knowledge about EAPs.
Among sample for whom current phone numbers were
available (about half), 57% participated in the survey
 Design/analysis: Cross-sectional; descriptive statistics

7. Q1: Respondents Reported Getting
Services from EAP for Varied Issues
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Family Issues/
Other Personal Concerns
3%
2%
34%
48%
82%
Mental Health/
Emotional Issues
Job Stress/
Workplace Issues
Issues with Alcohol/
Drug Use
None of Above
N = 361 with EAP claim and self-reported EAP use

8. Q1: Sources of Information About the EAP
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Posters/Flyers/HR
Communications
Employee Orientation/
Training Session/Workshop
13%
38%
33%
58%
77%
Company Website 71%
Supervisor
Coworker
Union
N = 361 with EAP claim and self-reported EAP use

9. Q1: Respondents’ View of EAP Services Received:
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How Much EAP Helped with Concerns
Not at all
4%
11%
A little
25%
60%
Some
A lot
N =228 with scheduled sessions and non-missing data

10. 10
Q1: Implications
 EAP assistance with family/personal and mental
health issues is most common, but EAP helped with
job stress/workplace issues for 1/3 of clients – EAP
retains workplace focus in eyes of many clients.
 Obtaining EAP help for drug/alcohol issues was not
frequently reported by enrollees; may be masked.
 Employer communications, including via its internal
website were a key source of information on EAP
benefits.
 Most employees who used clinical EAP services
reported they helped a lot and were a valued benefit.

11. Q#2 – What choices in EAP design and
worksite services do employers make?
 Study focused on: Employer size, industry, organizational
type, EAP benefit features, workplace substance abuse
policies, and level of health insurance benefits.
 Sample: 103 purchasers each with 1,000+ covered
employees, EAP-only product.
 Data sources: EAP administrative data, workplace activity
data, and results from Account Manager questionnaires.
 Design/analysis: Cross-sectional; bivariate tests of
association
11

12.  Account Manager Questionnaire – Distributed to
MHN Account Managers, this 25 item questionnaire
provided numerous details of workplace substance
abuse policies, drug testing practices, level of
unionization, nature/ extent of health coverage, EAP
program features, benefits eligibility of workforce,
workplace focus on health promotion, level of
worksite stress.
 Account Activities Database - Number and type of
EAP worksite activities; i.e., employee orientations,
mental health and wellness presentations, substance
abuse prevention and policy presentations,
supervisory training, and management consultations.
12
Q#2 - Data Sources

13. Q2: Employer Choices in EAP Limits
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34%
Percent of Employers
21%
45%
3-4 sessions
8+ sessions
5-7 sessions
N = 103 employers

14. Q2 - Employer Choices - Findings
 84% of employers chose EAP session limits per
issue/incident; 15% chose a per benefit year limit;
and 2% chose no limits to number of sessions.
 72% selected a flexible service delivery mode with
the option of either in-person EAP sessions or
telephone counseling for enrollees.
 Employers in the mining, manufacturing,
transportation and utilities industries were more
likely to provide enrollees with a more generous
EAP benefit (e.g., a higher number of sessions,
per concern/incident rather than annual limit).
14

15. Q2 - Employer Choices - Findings
15
EAP Worksite Activities:
 53% of employers received worksite mental health and
wellness educational presentations (Average annual hours
per worksite = 8.2)
 48% scheduled workplace substance abuse prevention
or policy training (Average annual hours per worksite = 6.9)
 37% received advanced training and/or organizational
consultation for management or supervisors (Average
annual hours per worksite = 8)
 Non-commercial and not-for-profit employers (i.e., those
in the healthcare, government, public education sectors)
had the highest user rate for any worksite activities.

16. 16
Q2: Implications
 Employer purchasers do have some similarities in
preferences when purchasing EAP products -- such
as number/allotment of “free” sessions and modes
of delivery. However, variations in demand for EAP
delivered worksite services are evident – e.g., by
industry and work organizational type.
 Understanding what each particular purchaser’s
preferences may be and its unique workforce needs
will be valuable in selecting the right menu of EA
program features and services, and thus contribute
to maximizing its benefit to the organization.

17. Q#3 – How do organizational and
workplace factors affect EAP utilization?
 Study focused on: Four factors - level of workplace
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stress; overall level of employer focus on
wellness/health; extent of employer EAP/MBHC
promotion; level of workplace EAP activities
 Sample = 742,937 enrollee (weighted) in EAP-only or
integrated product (26 employers), 2005
 Data sources: EAP administrative data: eligibility files
and claims data, results from Account Manager
questionnaires, and EAP workplace activity data.
 Design/analysis: Cross-sectional; generalized
estimating equations

18. Q3 - Organizational Factors and
18
EAP Utilization - Findings
When EAP Utilization is linked to Workplace Factors…
1
Higher EAP Promotion
Odds Ratio (98% CI) *p<.01; **p<.05
by Employer
EAP provided
Worksite Activities
Higher
Workplace Stress
Higher Employer
Focus on Wellness
0

19. 19
Q3: Implications
 Raising program visibility through employer
promotion and conducting EAP-provided
worksite activities may be key to increasing
client utilization.
 However, when experiencing major
stresses or critical incidents, our finding of
an association with lower rates of utilization
suggests in these situations, it may be
necessary to increase and/or better target
outreach efforts and worksite activities to
those in need.

20. Q#4 – What differences in service use occur
between integrated and stand-alone MBHC plans?
What is role of EAP within integrated product?
 Study focused on: a) Comparisons of service use
patterns between both products; b) utilization of EAP in
integrated product for enrollees with substance abuse
diagnosis
 Sample: 286,750 weighted for demographics, integrated
and MBHC users only in 2004; 1158 enrollee service
users in integrated product with a primary SA diagnosis
 Data source: Administrative benefits and enrollee claims
data files
 Design/analysis: Cross-sectional; logistic regression,
weighted for eligibility and demographics
20

21. Q4: Integrated vs. MBHC Products:
21
Any Claim
4.8%
0.21%* 0.17%
5.7%*
Integrated MBHC Only
Percent of Enrollees
Any behavioral
health claim
Any substance
abuse claim
Integrated results include clinical EAP claims.
N = 286,750 weighted/matched on demographics;
*Differences between products are significant at *p<.01

22. Q4: Integrated vs. MBHC Products: Any
22
MBHC Claim
4.6%** 4.8%
0.19%* 0.17%
Integrated MBHC Only
Percent of Enrollees
Any behavioral
MBHC health claim
Any MBHC
substance abuse
claim
N = 286,750 weighted; matched on demographics
*Differences between products are significant at *p<.01; ** p<.05

23. 23
Q4: Integrated vs. MBHC Products:
Outpatient Visits
4.6%
2.4%
0.0%
4.6%
4.4%*
5.5%*
Integrated MBHC
Percent of Enrollees
Used any regular outpatient - MBHC +/or EAP
Used any clinical EAP
Used any regular outpatient MBHC
N = 286,750 weighted, matched on demographics; *p<.01

24. Q4: Enrollees with Primary Substance Abuse Diagnosis:
Benefit Utilization Within Integrated Product
24
MBHC only
72%
Both EAP
and MBHC
20%
EAP
only
8%
N = 1,158 service users

25. Q4: Enrollees with Primary Substance Abuse Diagnosis:
25
Initial Service in Integrated Product
Any MBHC SA
Service
61%
Any MBHC
MH Service
EAP
23%
16%
N = 606 service users with “new episode” (no claims in prior quarter)

26. 26
Q4 - Implications
 A greater proportion of enrollees use any services in
the integrated product – which is consistent with
increasing access via EAP benefit.
 The greater proportion of service users in the
integrated product stems from EAP use; the
proportion using MBHC benefit is slightly lower in an
integrated product – which is consistent with the
concept that EAP may facilitate earlier interventions.
 Caveats: Some MBHC enrollees may have access
to an EAP outside of MHN. We were able to
observe and discuss only MHN plan services.

27. Q#5 – Do EAP benefit limits or EAP use
affect utilization of outpatient behavioral
health services?
 Study focused on: Whether amount of EAP visits
allowed or the number of EAP visits used affect
outpatient behavioral health care: i.e., number of
visits and total annual spending.
 Sample: 26,464 outpatient/EAP service users,
27
integrated product, 2005
 Data source: Administrative; Claims data
 Design/analysis: Cross-sectional, generalized
linear models with log link

28. 28
Q5 - Findings
 Per-incident EAP models had fewer outpatient
sessions than those with a per year EAP model.
 Having an EAP benefit of 4-5 sessions per
incident predicts a lower use of regular OP
sessions, compared with an EAP benefit of 3
sessions per year.
 Use of one additional EAP session was
associated with 11 percent fewer outpatient
sessions; and annual costs for MBHC outpatient
behavioral healthcare were reduced by 16 percent.

29. 29
Q5 - Implications
 Increased EAP benefit generosity (relative to a
3-session model) and actual use of EAP are
associated with some reduction in MBHC
outpatient use and costs.
 EAP and MBHC outpatient visits appear to be
partial substitutes.
 Investment in EAP within the integrated product
is not simply an addition to employer costs, and
clients appear to perceive some difference in
EAP and MBHC (not complete substitution).

30. Limitations of Research Findings
1. Cannot determine causality from data
(due to observational/non-experimental
design)
2. Generalizability (used data from only
one large MBHO)
3. Some limits to clinical data; i.e.,
unobserved variables including non-
MHN EAP use in MBHC product.
30

31. 31
Next Steps
 Analysis of non-service user responses: their
knowledge of, perception and inclination to
use an EAP
 Linkage of survey to claims data; e.g., how
factors service users told us about relate to
their utilization patterns
 Understanding the full range of services that
clients use, including those out of health plan
MORE INFO: merrick@brandeis.edu
bernard.mccann@rcn.com

32. For more on methods & findings cited:
Q1: Merrick EL, Hodgkin D, Hiatt D, McCann B, Horgan, CM. Manuscript
32
in preparation.
Q2: McCann B, Azzone V, Merrick EL, Hiatt D, Hodgkin D, Horgan CM.
Employer choices in EAP design and worksite services. Journal
of Workplace Behavioral Health 2010; 25(2):89-106.
Q3: Azzone V, McCann B, Merrick EL, Hiatt D, Hodgkin D, Horgan CM.
Workplace stress, organizational factors and EAP utilization.
Journal of Workplace Behavioral Health 2009; 24(3):344-356.
Q4: Merrick EL, Hodgkin D, Horgan CM, Hiatt D, McCann B, Azzone V,
Zolotusky G, Ritter G, Reif S, and McGuire TG. Integrated
employee assistance program/managed behavioral healthcare
benefits: Relationship with access and client characteristics.
Administration and Policy in Mental Health 2009; 36(6):416-423.
Merrick EL, Hodgkin D, Hiatt D, Horgan CM, Azzone V, McCann B,
Ritter G, Zolotusky G, McGuire TG and Reif S. Patterns of service
use in two types of managed behavioral healthcare plans.
Psychiatric Services 2010; 61(1):86-89.
Q5: Hodgkin D, Merrick EL, Hiatt D, Horgan CM, McGuire TG.
Manuscripts under review and in preparation.