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Employee Assistance Quarterly

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Employee Assistance Program Utilization

Rick Csiernika a School of Social Work, King's College, University of Western Ontario, Ontario, London, Canada

To cite this Article Csiernik, Rick(2003) 'Employee Assistance Program Utilization', Employee Assistance Quarterly, 18: 3,

45 — 60

To link to this Article: DOI: 10.1300/J022v18n03_04 URL: http://dx.doi.org/10.1300/J022v18n03_04

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Employee Assistance Program Utilization: Developing a Comprehensive Scorecard

Downloaded By: [Canadian Research Knowledge Network] At: 02:54 30 July 2010

Rick Csiernik

ABSTRACT. In the EAP field, utilization rates are an important concept routinely used as a descriptor of EAP success, yet there has been little formal research conducted in this area. In a study of 154 Canadian EAPs, 102 organizations reported their utilization rates along with how they defined both utilization and a case. Mean utilization rate was 9.2% with utilization being greater in organizations with a union where labor was involved in establishing the program, providing assistance in accessing the program and in managing the program through participation on a joint labor-management committee. Utilization rates were also found to be greater where there was an EAP policy in place and where ongoing program promotion occurred. However, what was also discovered was that most of these statistical conclusions were questionable as there was a lack of consistency in how utilization rates were calculated by various organizations, nor was there any agreement on what even constituted a case. This brings into question the utility of EAP utilization rates in any comparative program monitoring or evaluation. A comprehensive EAP Utilization Scorecard is offered as a response to this situation. The scorecard counts the actual number of employees, retirees and family members who use the EAP, either face-to-face, through telephone counselling or via e-counselling. Also presented is the idea of a new calculation, penetration rate. This value would include counselling offered by the EAP

Rick Csiernik, PhD, RSW, is Associate Professor, School of Social Work, King’s College, University of Western Ontario, London, Ontario, Canada. Address correspondence to: Rick Csiernik, 125 East 8th Street, Hamilton, Ontario, Canada, L9A 4Y7 (E-mail: [email protected]). Employee Assistance Quarterly, Vol. 18(3) 2003 http://www.haworthpress.com/store/product.asp?sku=J022  2003 by The Haworth Press, Inc. All rights reserved. 10.1300/J022v18n03_04

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EMPLOYEE ASSISTANCE QUARTERLY

along with the other services, including group counselling, critical incident debriefings, consultations and mediations, workshops and seminars, peer referral contacts and telephone inquiries. This approach would provide a more comprehensive understanding of what EAPs do and would also allow for longitudinal program comparison as well as comparisons between programs. [Article copies available for a fee from The


Haworth Document Delivery Service: 1-800-HAWORTH. E-mail address: Website: © 2003 by The Haworth Press, Inc. All rights reserved.]

KEYWORDS. EAP utilization, research

INTRODUCTION Employee Assistance Programs (EAPs) have become prominent across the United States and Canada as a means of providing counselling to employees and their family members. However, for such a significant enterprise this field remains relatively unexplored, empirically in certain areas. Hartwell et al. (1996) reviewed the prevalence, cost and characteristics of Employee Assistance Programs (EAP) from across the United States while Csiernik has written review articles on the evaluation of EAPs (1995) and their prevalence in the Canadian literature; (1998) while earlier, Macdonald and Dooley had surveyed Employee Assistance and health promotion programs across Ontario (1990). Of these, only Csiernik’s (1998) article on Canadian EAPs specifically examined the area of program utilization. Korr and Ruez (1986) were the first to examine EAP utilization in depth. They stated that to be able to evaluate a program and to compare outcomes of different programs properly one must know how many people actually use the service. In the 1980s as EAPs were rapidly expanding in size and scope, there was no uniform nor agreed upon manner in which to calculate utilization. In their sample of 20 randomly selected members of the Illinois Association of Labor and Management Administrators and Counselors on Alcoholism, Korr and Ruez found that four distinct formulas were used to determine utilization. At that time they recommended that EAP case studies and evaluations clearly articulate how utilization rates were determined and that more standardized methods be instituted to allow Employee Assistance Programs to provide more accurate and comparable outcomes.


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However, since Korr and Ruez’s article, little has appeared in the literature that directly relates to EAP utilization outside of dissertation research (Alexander, 1995; Burke, 1994; Crampton, 1993; Howard, 1992; Mazloff, 1996; Paries, 1997; Sweeney, 1995) or as one component of a larger examination of Employee Assistance Programming (Csiernik, 1998, 1999; Csiernik et al., 2001; French et al., 1995; and Rodriguez and Borgen, 1998). Poverny and Dodd (2000) did conduct a follow-up study of a university EAP to examine differences in how the program had evolved. They found that nine years after the initial examination of the EAP that differences in use by gender, ethnicity and employee status had occurred though the overall utilization pattern and problem profile had changed very little. Leong and Every (1997) investigated the relationship between utilization rate and how counselling services were delivered. They found that there were greater rates of EAP use when professionals internal to the organization and acculturated with the organization’s needs provided assistance rather than when counselling was provided by external third-party clinicians. As well, Zarkin et al. (2001) recently studied the impact of an enhanced model of workplace-based intervention on EAP utilization. They noted that their intervention increased not only overall program utilization but also utilization by women, minorities and white males. However, Korr and Ruez’s original concerns remain. Is there any consistency in how utilization is being defined and used, not only in the literature but also, more importantly, in the field itself? The Employee Assistance Program Association (EAPA), an international voluntary professional body based in the United States, has also recently become more concerned with this question. The EAPA measurements subcommittee offered two alternative utilization formulas each with three definitions to its membership in attempting to bring some clarity to this issue and uniformity in reporting (Blair, 1999). However, the core question remains unanswered. How is utilization currently being defined and used in the Employee Assistance Program field? METHODOLOGY A four-page survey was developed in conjunction with a national advisory committee of 21 persons representing labor, management and service providers as part of a larger study on Employee Assistance Programming in Canada. Along with basic demographic information the instrument asked about who initiated the EAP, who provided services,

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the program’s components along with how a case and how utilization were defined, and the EAP’s actual utilization rate. Four hundred English language surveys were distributed across Canada in 2000-2001 with the assistance of provincial and regional EAP associations. Of those, 154 were returned while 12 were undeliverable for a response rate of 39.7%. Of the 154 respondents, 102 (66.2%) provided information concerning their actual utilization rate and how it was calculated (see also Csiernik, 2002). RESULTS Utilization Rates Overall, the mean utilization for the 102 companies from across Canada with active Employee Assistance Programs was 9.2% with a median of 8.4%, and a mode of 10.0% (n = 13). Utilization ranged from 1.0% for an Alberta hospital and an Ontario forestry company to 30.0% at Dana Canada, an Ontario manufacturing company. The influence of a range of variables on utilization is highlighted in Table 1. There was slightly greater utilization among private sector companies than public sector organizations (1a) while utilization of EAP services was greater in unionized settings than in nonunion environments (1b). When unions were involved in establishing the programs either alone or in conjunction with management, utilization was greater than when management or the medical department alone initiated the program (1c). As well, utilization was also greater in organizations where representatives of labor continued to be involved in the program’s maintenance and development through involvement in a joint labor-management committee (1d). One of the most contentious and debated issues within the EAP field is how assistance should be delivered. There are three basic ways to provide EAP services, with volunteers who work for the organization, paid professional staff who work for the organization, or by professional counselors who work for a third-party private external provider. The results of this survey found that utilization rates were greater when volunteers were involved with virtually no difference between the mean utilization rates of internal and external professional counselors. However, when social workers employed by the organization were separated from occupational health nurses and human resources staff, counselling use increased from a mean of 9.1% to 9.7% (1e). This supported the findings of Leong and Every (1997) who had also reported that inter-

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TABLE 1. Utilization Rate n Total

Mean

Median

Mode

Range

102

9.2

8.4

10

1.0-30.0

Private Public

35 67

9.4 9.0

9.0 8.4

10 10

1.0-30.0 1.0-22.0

Yes No

90 12

9.4 7.5

8.4 8.6

10 10

1.0-30.0 1.0-12.5

Labour Joint Management Medical

8 53 33 6

12.1 9.8 7.8 7.7

10.0 9.0 8.2 8.1

1d: Joint Labor-Management Committee Yes 64 No 38

9.3 9.0

8.0 9.0


1a: Workplace Sector

1b: Union

1c: Program Initiator 10/12 10 7 multiple

4.0-30.0 3.5-22.0 1.0-14.0 4.0-10.0

10 10/12

1.0-30.0 1.0-22.0

1e: Service Provider Internal Volunteer Internal Professional External Professional

43 61 91

10.2 9.1 9.1

10.0 8.4 9.0

10 10 10

2.3-30.0 1.0-22.0 1.0-30.0

Internal Professional: Only Social Workers

27

9.7

10.0

7

1.0-30.0

Yes No

56 45

8.6 9.6

8.0 9.0

7 10

3.5-17.0 1.0-30.0

Yes No

82 20

9.4 8.3

8.4 7.6

10 12

2.3-30.0 1.0-17.0

Yes No

78 24

9.6 7.8

9.0 8.0

Western Canada Ontario Eastern Canada National

31 41 17 12

9.9 9.0 8.5 8.9

10.0 9.0 7.0 7.8

1f: Service Capped

1g: EAP Policy

1h: Promotion Campaign 10 multiple

1.0-30.0 1.5-17.0

1i: Location 10 10 7 7

1.0-21.0 1.0-30.0 3.5-19.0 4.0-17.0


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nal-based EAP assistance produces greater utilization than when a counselor or counselling agency outside the workplace provides the help. A second contentious issue along with who should provide services is how much service should be allowed to be provided. In this study 56 organizations capped the amount of counselling a client could receive while 45 allowed for unlimited access. Organizations that did not artificially limit the use of their EAP had a greater mean, median and mode than those with a formal limit on access to counselling (1f). It was observed that in organizations that have taken the time to create a distinct EAP policy to govern and monitor the program that utilization rates were, on average, greater than for those companies that did not have a policy (1g). Likewise, and not surprisingly, if there was some type of promotional campaign, held at least once a year, highlighting the existence of the EAP, these programs, on average, were more used than those that were not marketed to employees and/or their family members (1h). Finally, and perhaps most interestingly and least explainable, was the discovery that as one moved from east to west across Canada, EAP utilization increased (1i). While this is the first empirical comparative analysis of utilization rates in the literature there are few surprises in these findings. The greater the involvement of employees the more the EAP is used on average. As well, the more emphasis is placed on policy and promotion the more likely are employees to use the program. What is unfortunate is the lack of validity of the data because of a lack of comparability. Defining Utilization Organizations were asked not only what their utilization rate was but how the concept of utilization, itself, was defined. One hundred and fifty-four companies completed the original survey but only 102 (66.2%) responses regarding utilization were obtained. Of the non-respondents 19 (12.3%) organizations provided no answer. Another 15 (9.7%) had their third-party external service provider define utilization and thus were unsure how this was done and what it was, 10 (6.5%) simply did not calculate utilization while six (3.9%) stated they did not know how to determine utilization. Of the 102 companies that did report a utilization rate there were 19 different calculations used (Table 2). For those organizations that calculated utilization the most commonlyused formula was new files per year by the number of employees (n = 39). This was followed by family members plus employees using the EAP divided by the total number of employees (n = 21), and then total

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TABLE 2. How Utilization Rate Is Calculated (n = 154) 19 15 10 6

no response defined by service provider not calculated do not know

39 21 14 7 4 3 3 1 1 1 1 1 1 1 1 1 1

new files/employees (ongoing files not included) family ⫹ employees/total employees only employees using/employees (family can use) number of referrals/employees staff ⫹ families ⫹ retirees/employees employees only/employees (no family service offered) counselling sessions/employees number of calls/employees number of visits/employees new clients ⫹ carry overs ⫹ families/employees individual counselling ⫹ group sessions/employees new cases/household employee + families/employees + families families per year/employees employees ⫹ retirees/employees ⫹ retirees hours of service provided our utilization rate is actually a guess. I tend to focus more on costs. 2 calculations

2

employee use/employee population as well as employees ⫹ dependents/employee population

1

number of people/employees as well as number of contacts/employees

number of employees using the EAP divided by total number of employees in the work force, even though family members had access to the counselling and assistance offered by the program (n = 14). In this latter case, family members were not factored into either the numerator or the denominator. Only one organization that counted family members using the EAP also considered the number of family members in the denominator, while another organization calculated utilization rate by dividing new cases into the total number of households represented by the workforce. As well, four companies included not only family


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members and employees but also retirees, though they divided this total only by the actual number of employees (though again one company that counted retirees in the numerator also factored them into the denominator to obtain their utilization calculation). Seven organizations determined utilization by dividing the number of referrals by the number of employees while three used counselling sessions as the numerator. Other utilization calculations reported in the survey were based on individual and group counselling sessions, families per year, hours of counselling provided, number of visits, and new cases. Three organizations, recognizing the complications involved in determining an accurate utilization rate actually used two separate calculations. Of these three companies, two determined an employee only utilization rate along with a utilization rate, that considered use by family members. The third company was interested not only in use but also in the rate of contact. However, perhaps the most telling response was from the respondent who stated: Our utilization rate is actually a guess. I tend to focus more on costs. Further complicating this is that how a case is defined is as complicated, confused and unreliable as are the formulas used to calculate utilization. Defining a Case In the survey not only were organizations asked to report on utilization rates but also on the base determinant of this calculation, what is a case. As is illustrated in Table 3, the ambiguity of what a case is was as significant as that of defining utilization, further minimizing the empirical value of this measurement tool. There were fewer no responses (8), do not know (6) and do not calculate (2) than with utilization rate. However, 20 companies stated in their reply to how you define a case, that it was defined by their service provider while six stated that it varied. The most frequent reply (n = 32) to this open-ended question was that one new case was defined as either one new individual client or as one new family. For 31 organizations a phone intake was equivalent to a visit and would trigger the opening of a case, while for 18 organizations a case necessitated an actual face-to-face counselling session. As well, one food sector organization in Alberta only considered a meeting as a case if some type of treatment plan was developed. Different lengths of phone contact triggered a case for other organizations. For one company it had to be at least 45 minutes of phone con-

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TABLE 3. How a Case Is Defined (n = 154) 20 8 6 6 2

defined by service provider no response varies do not know do not calculate

32 31 18 7 5 5 3 2 2 1 1 1 1 1 1 1

one new family or one indivdual = 1 case phone call or visit actual face-to-face counselling session 2 individuals = 2 cases, 5 family members = 5 cases each new problem is a new case even if it is the same person 15-minute phone contact family member counted with employee as one case any contact that leads to referral if client file closed and then client returns in the same year = new case defined by area of service counselling versus group = 1 client can be 2 cases every 12 hours of counselling is a new case 45-minute phone contact 4 phone contacts or one visit only a case once treatment plan developed only new clients, any repeat client is not a new case couple together = 1, couple apart = 2

tact before it was considered a case, while, for a second, four phone calls was equivalent to one visit, while five companies responded that a minimum of 15 minutes of contact constituted a new case. Seven different organizations from various parts of Canada stated that they determined a case by the number of people that presented for counselling. For each of these companies two individuals from the same family would count as two cases, if five family members were seen it would constitute five distinct cases. Contrarily, three companies simply viewed family members as extensions of employees and did not count them independently while one company stated that if a couple comes together it is one case but if they are also seen apart it became two cases in determining the utilization rate. Five organizations stated that if they assisted the same client with two different problems in one year, that it would constitute two cases. It is hypothesized that this is one mechanism used to overcome the restrictions of service caps. Another organization reported that after every 12 hours of counselling they considered the situation a new case; that again


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could be a creative way to circumvent capping of services for clients still in need of counselling. A third scenario that two organizations employed may, too, have arisen as a response to the capping of services. In these organizations if a client’s case was closed but the client returned at some later time in the same year it was considered as a new case and the client became eligible for a new block of counselling sessions. This could be one response by counselors to employ who are no longer being paid by the counselling hour but by the head. Thus, if more heads are counted more counselling can be supplied to the client and the counselor can claim remuneration from the third-party provider who is coordinating the provision of clinical services. DISCUSSION In quantitative research knowing how to count is a rudimentary necessity. However, in the multimillion dollar, multidisciplinary, unregulated field of EAP, one that continues to grow globally, this fundamental concept is lacking. Utilization rates are regularly used to compare organizations’ ability to assist employees, they are used in assessing what model of assistance should be used in certain situations, if additional program promotion or development is required, and utilization is also used as a foundation evaluative tool. In the mid 1980s Korr and Ruez reported that EAP utilization was being calculated in a variety of different ways and advocated for uniformity in the field, something that at least one EAP body is also currently proposing (Blair, 1999). However, nearly two decades after their article appeared in the literature, the employee assistance field appears to be no closer to any type of agreement on how to measure utilization. This review appears to indicate that at the present time, for research purposes, the calculation and use of utilization rates has restricted value and may even be a futile exercise; for when how this statistic is derived is examined, it appears as if we are comparing apples with kumquats. Despite these limitations, utilization could still be used in some instances internally or in case study research to compare how a single program is progressing and developing, if the same method of calculation is used from year to year as was done in Poverny and Dodd’s (2000) research. Unfortunately, not even this is a certainty for a minority of companies reported that a third party establishes and calculates the utilization rate for their EAP and they have no idea how it is done, only that they receive the supposedly reliable and valid calculation regularly. One rea-


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son for the ambiguities in defining a case may arise from the cost-driven exercise of capping counselling services that employees are entitled to receive. Some counselors and perhaps even some organizations may be attempting to circumvent this artificial and irrelevant limit on access (Csiernik, 2002) to counselling through creative record keeping. While this act may constitute an attempt at moving to client-centered practice that meets the needs of the client and ultimately the company, it can play havoc with attempting to ascertain actual program use and need. What perhaps is most disturbing is that these numbers are actively used for a variety of vital industry functions. The numbers themselves are simply counts of the activities for a specific time period for a specific organization. However, they are important in that they serve to drive clinical and business goals pertaining to the EAP. Differences in how the information is collected may affect the quality of the service delivered to employees. Perhaps one reason that there is little literature on utilization is because researchers have realized it has little validity and reliability. Perhaps one reason third-party providers were reluctant to participate in this national Canadian study was because of questionable evaluative documentation on this and related topics. However, perhaps it is because there is so little research and formal reporting conducted in this area, and providing EAP services has become such a competitive field, that this lack of accountability has been allowed to occur. Utilization rates are used when third-party providers bid on contracts, and when public and government EAP contracts go to open tender bidding. They are used when the debate occurs regarding by whom and how EAP services should be provided, internally or externally. They are used in monitoring programs, justifying programs, in cost-benefit analysis, and in process evaluations and to request or demand better service provision. Yet as this study appears to indicate, what appears to be worse than lies and damn lies is the use of EAP utilization statistics in any type of empirically-based argument. THE EAP UTILIZATION SCORECARD What then can be done? The Employee Assistance Program Association has made recommendations for a new statistic but perhaps what is required rather than a single number is a scorecard so that utilization is viewed in the broadest possible context of EAP service provision. Table 4 outlines an example of such an elaborate chart that would better capture the range of programming activities offered to employees and their


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family members. While this recommendation is considerably more complicated than using one single number, it does provide an organization with a more comprehensive understanding of what is occurring within their EAP and, just as importantly, what is not. It could also be used as a beginning point of more thorough evaluations, though this is a discussion for another article. Rather than being concerned about what is a case or a file, total number of contacts are the focal point of the EAP Utilization Scorecard and are explicitly stated. Total number of employees is a key variable (Ne). However, it does need to be recognized that this, too, is a dynamic value and depending upon the flux of an organization, the number would change to some degree throughout the year. Thus, the recommendation is to use the total number of employees at the end of the year in which the report is being generated. However, the figure that would be even more accurate and thus more valuable would be the total number of persons eligible to use the EAP (Np). This would include not only employees, but also all persons eligible to access the EAP, particularly retirees and family members though employees who have been terminated or laid off could also be included. While this is a value to which few EAPs have ready access, it is possible to obtain as a few organizations are currently using this in their utilization calculation (see Table 2). As well, its presentation underscores a key weakness of current EAP utilization rates while making us more attuned to the entire population of persons eligible and actually using programs. The EAP Utilization Scorecard next requires the number of employees that contacted the EAP (E). This value is comprised of the number of employees who used the EAP through face-to-face (E1), telephone (E2) and e-counselling (E3) sessions. The average number of sessions per employee could then be easily derived by totaling the three and dividing by the total number of employees who contacted the EAP (Ea = (E1 + E2 + E3)/E). A similar process is repeated for retirees (RE) and family members (F). If an EAP does not provide services to the group, the calculation is simply omitted. However, the presence of these options on the scorecard serves as a question if these individuals should have access to the EAP if they currently do not. The scorecard also formally documents additional services provided by the EAP that are frequently omitted when considering program utilization. This includes group counselling (G), critical incident debriefings (D), manager and department consultations and mediations (CM), educational seminars and workshops (S), peer referral contacts (RA) and telephone inquiries

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TABLE 4. EAP Utilization Scorecard 1. Total number of employees = 2. Total number of persons eligible to use EAP =

Ne Np

3. 4. 5. 6. 7.

Total number of employees using EAP counselling services = Total number of face-to-face conselling sessions = Total number of telephone counselling sessions = Total number of e-counselling sessions = Average number of individual sessions/employee =

E E1 E2 E3 Ea = (E1 + E2 + E3)/E

8. 9. 10. 11. 12.

Total number of retirees using EAP counselling services = Total number of counselling sessions = Total number of telephone counselling sessions = Total number of e-counselling sessions = Average number of sessions/retired employees =

RE RE1 RE2 RE3 REa = (RE1 + RE2 + RE3)/RE

13. 14. 15. 16. 17.

Total number of family members using EAP counselling services = Total number of counselling sessions = Total number of telephone counselling sessions = Total number of e-counselling sessions = Average number of sessions/family member =

F F1 F2 F3 Fa = (F1 + F2 + F3)/F

18. Total number of persons participating in group sessions = 19. Total number of group counselling sessions = 20. Average number per group =

G Gs Ga = G/Gs

21. Total number of debriefing participants = 22. Total number of debriefing sessions = 23. Average number of participants per debriefing =

D Ds Da = D/Ds

24. Total number of employees involved in consultations/mediations = 25. Total number of consultation/mediation sessions = 26. Average number of employees per consultation/mediation =

CM CMs CMa = CM/CMs

27. Total number of participants in educational workshops/seminars = 28. Total number of educational workshops/seminars = 29. Average number of participants per educational workshop/seminar =

W Ws Wa = W/Ws

30. Total number of employees making referral agents contacts = 31. Total number of referral agent contacts = 32. Average contacts per referral agent =

RA Rac Raa = RA/Rac

33. Total number of telephone inquiries =

T

34. Total EAP Utilization Rate =

TUR = E+R+F/Ne

35. Employee EAP Utilization Rate =

EUR = E/Ne

36. EAP Penetration Rate =

PR = E+RE+F+G+D+CM+W+RA+T/Ne


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(T). Average number of contacts may be derived for each of these program components to indicate how much reach each service is having. Typically EAPs provide one utilization number while the EAP Utilization Scorecard has three. The first would be total utilization rate (TUR) that combines the total number of counselling contacts by employees (E), retirees (R) and family members (F) and divides them by the total number of employees (Ne). This is the value that is currently typically used when an organization states its utilization rate. Of course, this remains an inaccurate number, as the denominator should actually be total number of persons eligible to use the EAP (Np). Nonetheless, a basic utilization number can be calculated. To this is added the more precise employee EAP utilization rate (EUR = E/Ne). However, what is more telling is the new EAP penetration rate (PR). This variable combines primary, secondary and tertiary prevention indicating the depth of EAP involvement within the organization. It is a value that not only highlights crisis and counselling contacts but also the proactive and preventative efforts of the EAP by including consultations, mediations and educational and preventative workshops and seminars, plus peer and telephone contacts. The calculation would be (E + RE + F + G + D + CM + W + RA + T)/Ne, though again Np would be the more accurate denominator. Within this formula there would certainly be double counting for an employee could easily be involved in a critical incident debriefing, workplace seminar and individual counselling in one year. However, this is not viewed as a detractor for it indicates the multiple levels that an EAP can be used to maintain both employee and workplace wellness. As well, each facet of the EAP serves a different function and is no different than an employee using their extended health care program to access a dentist, chiropractor and x-ray service all in one year. The EAP Utilization Scorecard, while more complicated than current utilization rate calculations, provides a more comprehensive and holistic representation of what an EAP actually does. The scorecard allows for a more accurate comparison over time within a program, as well as allowing for better comparisons between programs and between what different service providers offer as part of their EAP service packages. While in general those associated with EAPs, and more so those not directly involved with programs, like simple numbers to illustrate what is occurring, as EAPs continue to become more complex, programs reporting also needs to become not only more sophisticated but also more consistent, valid and reliable.

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REFERENCES Alexander, P. (1993). Exploring the relationship between organizational structure, organizational climate and employee assistance program utilization. Unpublished dissertation. Blair, B. (1999). EAPA Measurement subcommittee requests member feedback on proposed utilization definitions. EAPA Exchange, May-June, 26-27. Burke, R. (1994). Utilization of employees’ assistance program in a public accounting firm: Some preliminary data. Unpublished dissertation. Crampton, S. (1993). Factors influencing EAP utilization: A control theory perspective. Unpublished dissertation. Csiernik, R. (2002). An overview of Employee and Family Assistance Programming in Canada. Employee Assistance Quarterly, 18(1). Csiernik, R. (1999). Internal versus external employee assistance programs: What the Canadian data adds to the debate. Employee Assistance Quarterly, 15(2), 1-12. Csiernik, R. (1998). A profile of Canadian Employee Assistance Programs. Employee Assistance Research Supplement, 2(1): 1-8. Csiernik, R. (1995). A review of research methods used to examine employee assistance program delivery options. Evaluation and Program Planning, 18(1), 25-36. Csiernik, R., Atkinson, B., Cooper, R., Devereux, J., and Young, M. (2001). An examination of a combined internal-external employee assistance program: The St. Joseph’s health centre employee counselling service. Employee Assistance Quarterly, 16(3), 37-48. French, M., Zarkin, G., Bray, J., and Hartwell, T. (1995). Costs of employee assistance programs: Comparison of national estimates from 1993 and 1995. Rockville: National Institute on Drug Abuse. Hartwell, T., Steele, P., French, M., Potter, F., Rodman, N., and Zarkin, G. (1996). Aiding troubled employees: The prevalence, cost and characteristics of Employee Assistance Programs in the United States. American Journal of Public Health, 86(6), 804-808. Howard, J. (1992). Employee assistance programs: Teachers’ perceptions about their utilization and principals’ perceptions of their utility. Unpublished dissertation. Korr, W. and Ruez, J. (1986). How employee assistance programs determine service utilization: A survey and recommendations. Evaluation and Program Planning, 9(4), 367-371. Leong, D. and Every, D. (1997). Internal and external EAPs: Is one better than the other? Employee Assistance Quarterly, 12(3), 47-62. Macdonald, S. and Dooley, S. (1990). A survey of Employee Assistance Programs and health promotion programs at Ontario worksites. Employee Assistance Quarterly, 6 (1), 1-15. Mazloff, D. (1996). Understanding employee assistance programs: A case study of communication strategies and utilization patterns. Unpublished dissertation. Paries, C. (1997). Middle managers’ attitudes toward employee assistance programs in the corporate setting. Unpublished dissertation.


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Poverny, L. and Dodd, S. (2000). Different patterns of EAP service utilization: A nine year follow-up study of faculty and staff. Employee Assistance Quarterly, 15(4), 29-42. Rodriguez, J. and Borgen, W. (1998). Needs assessment: Western Canada’s program administrators’ perspectives on the role of EAPs in the workplace. Employee Assistance Quarterly, 14(2), 11-29. Sweeney, N. (1995). Enhancing employee well-being: Evaluation of an employee assistance program. Unpublished dissertation. Zarkin, G., Bray, J., Karuntzos, G., and Demiralp, B. (2001). The effect of an enhanced employee assistance program (EAP) intervention on EAP utilization. Journal of Studies on Alcohol, 62(3), 351-358.

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