Employee and Family Assistance Programs (EFAP)

by Dr. Noel Kerin - May 25, 2014

Over the past 25 years there have been widespread improvements to both the design and delivery of Employee and Family Assistance Programs (EFAP). There does however, remain, significant concern among occupational medical personnel as to the measured effectiveness of these programs in helping to identify and manage, in particular, mental health issues.

Scenario One

  • A 32-year-old woman, struggling with work-life balance, trying to maintain a household with two young children, a demanding job, and a husband who travels with his job.

  • Final diagnosis in this case was uni-polar depression, for which she did not receive appropriate therapy for approximately 13 weeks. By the time she received therapy she had been disciplined at work for absenteeism and poor quality of work produced while at work.

  • Appropriate management in her case would have been delivery of a recognized diagnostic questionnaire for depression at an intake clinic, to be followed by prompt referral to a treating professional with the capability of prescribing anti-depressants as indicated.

  • Financial cost to the company – 14 lost days and probably twice as many when her performance at work was poor (presenteeism).

Scenario Two

  • A 33-year-old male, accounts manager, received a written warning from management as to his work performance and chronic lateness

  • Intake clinic did not administer a substance abuse questionnaire

  • Two months after first contact with EFAP this employee was found to have uni-polar depression with a co-morbid condition (alcohol dependency)

  • Proper treatment consisted of 28-day in-patient program to address his alcohol dependency issues and an anti-depressant with cognitive behavioural therapy to address his depression issues

  • Cost to company – approximately 38 working days

  • Cost to individual – near loss of employment and lost promotional opportunities

Both of the above cases are from my files and illustrate the serious nature of these illnesses and the impact on both employee and employer when critical mental health and addiction issues are not addressed promptly.

By being able to administer a bonded, confidential clinical audit system, one could hold the EFAP provider to a standard of enquiry and disposition of cases, which would be appropriate and in the best interest of the employee and the company. Performance incentives could be written into contracts so that, should the EFAP provider meet the agreed-upon standard in 95% of cases, a bonus would be paid. Likewise, if the EFAP provider did not meet the standard in 95% of cases, then a financial penalty would be applied against the EFAP carrier, along with a review of their contract.

As we can see, both in attendance management and disability management, the EFAP Program is central and essential to the useful and smooth functioning of modern workplace employee support programs.

EFAP providers, to date, have been reluctant to allow their confidential medical files to be reviewed. However, I would counter that hospital patient medical files (which include as much confidential personal information as one would find in an EFAP file), are regularly audited by independent, external, bonded, confidential reviewer(s); therefore, there is clear precedent to have auditing measures applied against any clinical program. I believe it is past time that this take place with EFAP programs in general.