Big Blue surprised me. Managers at IBM told my organization (Masi Research Consultants) that they were not as interested in cost-benefit studies of their employee assistance programs as they were in clinical reviews of them. They believed that if employees were receiving good counseling, their productivity would increase. This surprised me because on my first day working for the U.S. Department of Health and Human Services, the assistant secretary said we needed to develop a cost-benefit methodology and study to show that its EAP was cost-effective. I thought it was ironic that HHS wanted cost-benefit reviews whereas IBM wanted clinical reviews.
Clinical reviews of EAPs are rare, as Thomas Amaral pointed out in his presentation at last year's Employee Assistance Society of North America annual conference. The Council on Accreditation (COA), however, performs reviews as part of its EAP accreditation process, and some consultants individually read records when evaluating a program.
IBM had another incentive for performing clinical reviews of EAP services. Its attorneys believed that clinical reviews by outstanding clinicians protected the company in any litigation around an EAP case. By hiring a bona fide evaluation team, IBM was ensuring that its employees received quality care. The reviews also ensured that all appropriate documentation, such as statements of understanding and release of information forms, were signed and that counselors were following applicable laws.
As we worked with IBM, we developed a protocol for clinical reviews of EAPs. If you are an EAP provider or customer considering a clinical review, look for the following elements in a review team.
The clinical review should be based on the fact that clinical work can be quantified. In our work with IBM, this meant that a rigorous instrument had to be devised, whereby reviewers numerically scored all aspects of clinical work. Through the years, this instrument was refined and registered with the U.S. Copyright Office. It uses 18 documentation questions and 34 clinical questions. Some of our clients use the resulting scores in their performance guarantees in their contracts with EAP providers.
A significant sample of records should be reviewed. The team should aim for reviewing 10% of the records.
Reviewers' experience and education should be superior to those of the counselors they are reviewing. The review team also should be interdisciplinary, perhaps including psychiatrists, psychologists, and social workers. We always include a psychiatrist on the panel for his/her knowledge of pharmaceuticals and general medical knowledge and experience. Psychiatric nurses often make excellent reviewers, but they are difficult to find.
Each case should be reviewed by each reviewer. A nonvoting member should coordinate the entire effort and work with the team to write the final report.
The reviewers should request that the EAP respond with an action plan to address areas needing improvement. If the reviewers believe a particular case needs immediate attention, the EAP's clinical supervisor should be notified on the day of the review.
When we started conducting clinical reviews, we found that EAPs were defensive, often trying to hide behind confidentiality regulations, but EAPs can be evaluated and monitored legally by third parties. However, chain-of-custody procedures regarding clinical case records should be followed, and providers should be allowed to obscure names and other relevant identifying information.
During the past 23 years, we have seen an increase in the seriousness of EAP cases, including incidences of violence and potential suicide, thereby increasing the importance of clinical reviews. Although the review process can be painful for EAPs, many realize that these reviews can help to improve their delivery of services.
Dale A. Masi, PhD, is a Professor Emeritus in the School of Social Work at the University of Maryland and the President/CEO of Masi Research Consultants, which has been providing clinical reviews for EAP customers since the mid-1980s.
For more information, contact Dr. Masi at firstname.lastname@example.org or (617) 536-1930.
- Masi DA.. Evaluating EAPs: Summary data from 20 clinical reviews, 1984-1994. EAP Digest 1995; Jan./Feb.:26-7.
- Masi DA, Jacobson JM, Cooper AR.. Quantifying quality: Findings from clinical reviews. Employee Assistance Quarterly 2000; 15(4):1-17.