Demand for Trauma Support Service and Employee Assistance Programmes

Helping hand

The demand for trauma support services and Employee Assistance Programmes is rising. Rebecca Ellinor explains what buyers need to know

Staff at a flooring shop in central London witnessed the natural deaths of two customers within a fortnight last year. In the third week, a child died in the store, and workers needed extra support to cope with the shock.

Distressing ordeals experienced by employees in and out of work can range from verbal abuse to terrorist attacks. And an increasing number of employers are providing assistance to help staff cope with the effects of trauma. As well as crises, help and support covers longer-term personal problems that cause emotional upset, such as debt, relationship and health worries.

Most of these services are referred to as employee assistance programmes (EAPs). Post-trauma support can also be included as part of the package, or offered separately. According to suppliers, one in five UK organisations now uses EAPs, compared with virtually nil 25 years ago. And the rate of take-upis accelerating.

And procurement is getting involved more frequently in negotiating the deals. But, providers say, it's a risky business. Since little is known about EAPs, and the market is unregulated, it is easy to make mistakes and it can be difficult for buyers to assess suppliers.

So what exactly are EAPs and what do buyers need to know?

EAPs explained
EAPs originated in the US. They were introduced following the end of prohibition in the 1930s to help people cope with drug and alcohol problems. Entrepreneur Mike Megranahan is credited with bringing the concept to the UK in the 1980s and setting up a company called Employee Advisory Resource (EAR). While the market is unregulated, the UK Employee Assistance Professionals Association (EAPA) does set national standards of practice and professional guidelines. About 20 providers are registered with the association.

Services range from the basic to the complex. Help and advice can cover child and elder care, tax problems, gambling, drugs, alcohol, illness, relationship breakdowns, arranged marriages, stress, suicide, abuse and more. Some also provide help for staff dealing with changes at work including adjusting to new shift patterns, retirement and coping with mergers. Some EAPs also include critical incident cover.

"There are different models," says Mandy Rutter, clinical manager at supplier Independent Counselling and Advisory Services (ICAS). "You can have an EAP with one provider and a trauma response with another, or you can have them together."

Where EAPs are in place they are usually offered to all staff in a company and often their families, too.

Tim Cuthell, consultancy and sales director at EAR and past president of the EAPA, says: "Access is usually on a 24-hour basis and is free to the user. They get telephone advice, information services and short-term face-to-face counselling. If someone needs longer-term help, with a problem they've had since childhood for instance, then that's beyond the scope of EAPs."

Some programmes also offer telephone advice to managers handling delicate situations with staff, says Cuthell: "If I'm a manager and a member of my staff has a problem I can call this service to talk through the difficulties and try to understand what I can do to help."

But employees don't need to wait for tragedy to strike before seeking confidential help: "It can be preventative, but only if people pick up the phone," says Paul Roberts, an intermediary at health insurance company IHC, that helps organisations find suitable services.

It is generally larger firms, particularly those where the work is perceived to be of higher risk, that have EAPs in place, especially trauma support services.

"Oil companies, banks, travel and transport firms and some retail organisations have these services," says Rutter.

Ralph Holtom, business director at supplier CiC, adds: "The press, aid organisations and frontline staff who deal with the public all day and are going to be exposed to tricky situations also tend to be covered."

But the term EAP is now used quite loosely, which can pose a problem for those buying services.

"EAP terminology is now used for anything and everything, from a legal helpline service to a comprehensive programme," says Roberts. "There's no legal comeback [if someone uses the term inaccurately], which is why it's become such a mess. Buying an EAP is like buying a car - some have different numbers of seats, doors and wheels. It's used as a generic term which lacks detail."

Why have an EAP?
There are several strong reasons for firms to have an EAP - all of which can result in financial savings, provided the service is set up and used correctly.

EAPA describes these services as "unique within the occupational health field" because they address the "twin focus of employee wellbeing and organisational performance". Their primary purpose is to reduce staff absence and turnover and improve efficiency. And research published by the University of Sheffield last month found evidence they do just that.

Researchers at the university's Institute of Work Psychology discovered the very existence of effective trauma management in the workplace can reduce staff absence and lead to better health among employees. Those in the study who felt supported immediately after suffering a trauma had lower absence 12 months later.

Jo Rick, who led the research, says: "There has been much debate about the appropriate response to psychological trauma. The lack of evidence left employers with little or no guidance. Our research provides information about different approaches that work."

The study, which can be downloaded at www.bohrf.org.uk, was conducted with the Institute for Employment Studies and Atos Origin, an IT company and EAP provider.

It tracked, over a 13-month period, 815 Royal Mail Group (RMG) workers who had been exposed to traumatic incidents such as dog attacks, armed raids, hostage situations or verbal abuse. The university said the RMG was chosen because of its established trauma management programme. The range of jobs also means it has staff who have suffered a variety of distressing experiences.

The RMG trauma programme consists of three phases: practical support on the day of the incident in the form of crisis management; a support post-trauma protocol designed by Atos Origin to ensure managers provide appropriate practical, emotional and social support; and further ongoing support from a professional trauma counselling service also provided by Atos Origin.

"Most of The Sunday Times 100 Best companies to work for have EAPs because they are a good value, low-cost solution," says Roberts. He helped bone marrow transplant charity the Anthony Nolan Trust put an EAP in place to reduce high staff turnover rates. The charity's HR officer, Sarah Woodruff, explains: "Stress and absence can be an issue for us, particularly given the highly emotional nature of the work we do. This really makes a difference to both existing and potential employees and demonstrates we genuinely support staff where we can."

Other benefits
Another motivation for having an EAP is to guard against stress-related injury claims from staff, while also fulfilling duty of care as an employer.

Claims against employers for stress-related injury have risen steeply in recent years. In 2000, TUC figures show 516 stress-related claims were made. In 2006 claims increased 12-fold to 6,428.

Guidelines following a Court of Appeal ruling in 2002 acknowledged the benefit of EAPs, saying: "An employer who offers a confidential advice service, with referral to appropriate counselling or treatment services, is unlikely to be in breach of duty of care."

According to Roberts, by putting an EAP in place, which meets the Court of Appeal's criteria on confidentiality and access to appropriate treatment, employers will be able to protect themselves from workplace stress-related claims. It can also improve performance by reducing stress and distractions caused by outside influences.

"Organisations cannot ignore the whole range of people issues if they want to improve performance," says Roberts.
Cuthell points out that management information obtained from having an EAP can also be useful to an organisation. "We capture data that tells companies what people are using, the take-up of the services and what sort of problems they raise. We don't tell them who used which service but we can provide the client with some kind of profile. Over a longer period we can provide a baseline, so when firms introduce big changes we can track the impact."

Holtom adds that EAPs are an important part of business continuity planning.

Rutter agrees. It is important for staff to feel valued, she says, and for them to know who to call in the event of a tragedy.

"In a crisis, while you're likely to lose some people, you will lose less if you show some compassionate management before, during and after the disaster."

What's the cost?
Most companies pay a fixed price per head for an EAP, but some have a pay-as-you-go arrangement. For crisis intervention services, a retainer fee is usually paid to ensure a certain level of response if disaster strikes.

"The EAP market is very soft at the moment," says Roberts. "Two years ago it cost about £25 a year per head for EAPs, now it is £13-£14 per person. More providers means more competition."

But Holtom and Payne warn against the "commoditisation" of EAPs and highlight the risks associated with negotiating too low a price.

"If a supplier is offering an EAP for £5-£6 per head, they're not going to be doing very much for it. You get what you pay for," says Holtom.

Payne points out that counsellors have three to five years' training and once they are qualified they can demand fees in the region of £35 to £60 per session. "So for a supplier to provide that level of counselling expertise and to be charging companies under £10 a head... you can see it doesn't stick," she says.

Rutter advises purchasers to delve into the detail of what will be provided for the price they're quoted: "It's about reading the small print."

"We provided trauma support services to one client, then procurement got involved and decided it could get a better deal by adding trauma support to a contract it had in place elsewhere. When operations staff did a simulation to see how the company would cope in a crisis, they realised they weren't really getting anything from the provider so they switched back to us."

Payne says if a buyer just needs to put a programme in place, and they're not worried about usage, they should pay around £10-£14 a head.

But, she adds: "If you want people using the programme and staff phoning for help sooner rather than later, then you shouldn't consider buying services for under £25 a head."

Advice for procurement
"EAP is relatively low-cost to purchase, so the task tends to fall to the most junior person in the procurement department - but the role played by EAPs is worth far more than the importance attached to it," says Holtom.
Providers agree the crucial thing for buyers to ascertain is why their organisation wants an EAP. They should ask "What is it trying to achieve?" and then put in place services which best meet that need.

Robbie Morrow purchases HR benefits at financial services company Zurich. He is researching an EAP supplier who provides specialist relocation services and agrees it is not just about cost: "It comes down to having a service that meets your requirements for the best value. It's about establishing a service that meets your business needs."

Bertil Mukkulainen is global strategic sourcing manager for Air Products, a supplier of industrial gases and equipment. He was part of a team that set up an EAP covering Europe with ICAS, which went live last month.

He says: "Every company should look to get value from the price but we didn't buy the cheapest service. We wanted a supplier with a multilingual capability and a service that was easy for employees to use."

His only regret is that there are currently no global EAP providers: "It seems there is no-one with global reach yet, although some have started partnering with one another. The best thing would be for a provider with a global reach so we could have one supplier and one contract."

He advises asking for references and contact details for existing clients of similar size and scope in the request for proposal document.

Payne suggests: "Compare facts such as cost and box ticking, then decide who you want to have a working relationship with over the period of the contract."

Most important of all, says Roberts: "The value is in encouraging people to use the service so that they remain at work and focused. The value is not just in getting a cheap deal."

Features, 15 February 2007

http://www.supplymanagement.co.uk/EDIT/Featured_articles_item.asp?id=15719