#76253: An Introduction to Employee Assistance Programs

EAP consultation is specifically directed toward organizational leadership (e.g., managers, supervisors, union stewards) seeking to manage troubled employees, enhance the work environment, and/or improve employee job performance [1].

The promotion of EAP services in an organization involves providing education and outreach to an organization's employees and dependents to facilitate awareness and encourage the use of these services when needed. Newsletters, health fairs, onsite workshops, and webinars are examples of effective promotion techniques [1].

EAPs provide confidential assessment services for employee clients regarding personal issues that may affect their job performance.

Constructive confrontation is a tool used to facilitate referral of employees to EAP to address problems affecting their work. Constructive confrontation involves a meeting between an employee and a manager/supervisor to discuss work performance concerns and initiate referral to the EAP.

EAPs offer employee client referrals for diagnosis, treatment, and assistance.

EAPs establish and maintain effective relationships between work organizations and treatment providers.

EAPs provide assistance to work organizations to support employee health benefits covering medical/behavioral problems including, but not limited to, alcoholism, drug abuse, and mental/emotional disorders.

EAPs monitor and evaluate the effects of their services on the work organization and on individual employee job performance. The EAP also works with the company to evaluate if the EAP has reduced absenteeism, workplace accidents, disability claims, and health insurance claims.

Employee assistance is a workplace-based program. As discussed, its mission is to improve workplace productivity through the resolution of employees' personal problems and consultation with the work organization. EAP services include assessment, referral, and short-term counseling (i.e., advice or guidance given by a specially trained individual to a person having emotional problems). EAP services do not include treatment or therapy [5]. EAP core technologies specifically state that employee clients are referred from the EAP to treatment and outline that the primary role of an EAP counselor is to complete an assessment and connect employees to appropriate treatment resources.

The first sessions with an EAP client should include a comprehensive psychosocial assessment. After the assessment, the EAP counselor should determine whether the client should be referred to a therapist, physician, or other specialist, or whether the client's problem can be resolved through short-term EAP counseling. An EAP counselor can offer supportive, skills-building services to individual clients if the assessment shows that such services could help improve the client's work performance. Common services provided by EAP counselors include: counseling for work-related problems, such as stress, that do not require treatment or therapy; teaching communication skills to help the client improve relationships with colleagues and/or supervisors; improving the client's time-management habits; helping the client to establish a better work-life balance; or helping the client adjust to a new work role or environment.

EAP counselors provide supportive and skills-building services to employee clients, but because they do not provide treatment or therapy, no diagnosis following assessment is required. Supportive services may include short-term counseling for personal relationship problems, occupational problems, bereavement, or phase-of-life problems [5].

Counselors are sometimes asked to supply an EAP network with information about the primary focus of the counselor's work with a client. This information is gathered to improve EAP monitoring and follow-up and to ensure that an organization's workplace needs are met. It is not gathered to be recorded as an "official diagnosis" in the client's employment record.

All assessments performed by an EAP counselor should include an assessment of employee work performance. This is essential because EAPs are work-based programs focused on improving productivity; a therapist or counselor who is not conducting an EAP assessment may not ask questions about work. It is important for an EAP counselor to ask about workplace performance, satisfaction, and attendance. It is also important to include workplace improvement goals in the employee's counseling plan and to ask about work performance during follow-up sessions and telephone calls.

An EAP counselor might want to ask the following questions during an assessment:

Follow-up should include contact with a client to monitor progress and/or the impact of EAP recommendations (including referrals to treatment resources) and to determine the need for additional services. Follow-up may include telephone calls, face-to-face meetings, written surveys or questionnaires, or a review of job performance and attendance records. This type of follow-up is different from the therapeutic process of aftercare in that it is a monitoring process. Some EAP networks ask the EAP counselor to make follow-up calls to ensure a successful connection with the referrals provided and to assess additional referral or EAP needs. Other EAPs assign a staff counselor (often located at an EAP call center) to follow up with clients, while still others use a questionnaire or survey as the follow-up method.

The source of payment for services is another difference between EAPs and traditional therapy. In the majority of circumstances, an organization pays for EAP services for its employees (typically included as part of the organization's benefits package). Businesses who outsource EAP services typically pay a fixed price (i.e., a monthly, predetermined, per employee rate) to an EAP vendor. The EAP vendor then performs all EAP functions requested or required during the contract period. The EAP vendor pays the EAP counselor, per the terms of its agreement with the counselor. EAP clients pay nothing, including no co-pay.

One benefit of this structure is that it removes financial concerns as a barrier preventing an employee from using counseling resources. One potential problem is that the employee who does use the resources may not fully value or commit to the counseling process because it requires no personal investment.

EAP stakeholders include such entities as individual employees, supervisors and managers, executives, union officials, family members, medical staff, and human resources.

Each of these stakeholders influences the EAP regardless of whether the EAP is aware of the stakeholders and their programs or resources. Supervisors and executives create the culture in which EAP clients work, so it serves these clients well when the EAP is fully informed about employees' perceptions of their work environment. Human resources, union officials, EEO, and medical staff all develop policy and implement organizational change that impacts EAP clients. It is important, therefore, for EAP counselors to be familiar with organizational resources. Counselors in private practice also may benefit from a general understanding of the typical resources available in many organizations. Helping employee clients explore internally available resources may help them to avoid the use of other more expensive or time-consuming community resources. Building awareness of workplace resources also helps to empower employee clients to re-establish a sense of control and/or influence over their work and personal lives.

Self-referral is the most common type of EAP referral. It occurs when an employee or family member recognizes a need for counseling help and initiates contact with the EAP. Management and/or the company is not involved.

An informal management referral occurs when a manager becomes aware of an employee's personal problem, has a private discussion with the employee about the problem, informs the employee about the availability of the EAP, and encourages the employee to call EAP for an appointment. Management and/or the company are not involved beyond educating the employee about the EAP.

This type of referral typically requires that an employee's manager follow a formal process. The process starts with the manager observing and documenting work performance problems and then reporting these observations to the EAP and human resources. The EAP coaches the manager in how to confront the employee regarding the work performance problems and how to talk to the employee about the EAP. Human resources typically assists the manager with adhering to company policy and employment law and with writing a formal letter of referral to the EAP. The manager then confronts the employee about the work performance problems and formally refers the employee (through the letter) to the EAP. With this type of referral, it is common for the EAP counselor to request that the employee sign a release of information authorizing the EAP to confirm the employee's attendance at the EAP (but not to release clinical details).

Most companies have a drug-free workplace policy that outlines the role of the EAP to include assessment and referral for employees who self-identify as having a problem with drugs and for employees who have tested positive during a drug test. In addition, the EAP is responsible for monitoring employee progress through treatment and rehabilitation. With this type of referral, the employee is typically asked to sign a release of information authorizing the EAP to confirm EAP attendance and report compliance with EAP recommendations, but not to release other clinical details. It is important to remember that the EAP is a neutral workplace entity and should be separate from the drug testing and disciplinary processes. While compliance with EAP recommendations is often a requirement to maintain employment following a positive drug test, it is not the only requirement, and alone, it does not guarantee that an employee retains employment.

A medical referral occurs when an employee's personal physician recommends counseling and the employee decides either to begin with an EAP assessment or seek EAP help in identifying a therapist. This type of referral may also come from a nurse or physician who works for the company's occupational health unit. The referral may be a result of the employee presenting with physical symptoms of stress, anxiety, or depression, or it may be following a physical examination (as is required for many law enforcement agents). In this situation, it is sometimes useful to request that the employee sign a release of information allowing the EAP counselor to consult with medical staff.

This type of referral may be initiated by an employee in crisis or by a family member, manager, or other staff member. It generally involves an employee who is suicidal or homicidal or occurs following a crisis at the worksite (e.g., death of an employee, worksite accident, robbery).

A client contacts the EAP following his supervisor's retirement and recent problems with his new supervisor. The client reports that his new supervisor is unresponsive to emails containing questions about draft work products, but then expects him to work evenings and weekends to make last-minute corrections. The client reports a disruption to his work-life balance. No current symptoms are assessed—no problems with sleep, appetite, mood, or concentration and no risk of substance abuse. The EAP counselor employs short-term counseling to help the client develop alternate communication strategies to use when talking to his new supervisor about concerns and needs; learn stress management skills such as deep breathing and journaling; and develop assertiveness skills to set limits with his new supervisor.

A different approach would be needed if, for example, the assessment had revealed that the client has a history of clinical depression; averages only four hours of sleep each night; has gained weight in the past two weeks; or is drinking four glasses of wine each work night. In this case, due to the client's history of depression and current symptoms, he would be referred to a therapist with experience working with depression and substance abuse. He would also be encouraged to abstain from alcohol use and attend AA for additional support regarding his use of alcohol. The EAP counselor may provide SAMHSA literature about unhealthy drinking behaviors and alcohol abuse and encourage the client to consider the consequences and problems associated with using alcohol as a stress management tool.

If the counselor's assessment indicates that a client's problem requires more sessions than allotted by the EAP for resolution, or if a specialist is needed for diagnosis and treatment of a mental health disorder, a referral to treatment resources is included in the action plan. Referrals to treatment resources should be made after the first or second session, before the client gets too connected or goes too deeply into the problem with the EAP counselor.

Referrals are a fundamental part of EAPs, however, case monitoring and follow-up are also included in the EAP service model. This differentiates EAP from the traditional therapy model in which the client is responsible for initiating any desired follow-up. EAP follow-up is typically achieved by telephoning the employee, but it may also be achieved with either a face-to-face session or via a survey in the mail. Typically, follow-up assesses whether the client accessed referral resources and whether the referral was a good fit. Follow-up may also assess current work performance and any other additional needs. If the client is complying with the agreed-upon plan, finding the plan to be helpful, and has no new work performance problems, the case is normally closed. If the client is not complying with the plan and/or has not contacted the referrals, then the counselor engages in additional motivational work to help the client break down barriers that are preventing compliance and follow through. If the client cannot be reached, the EAP counselor often documents three attempts to contact for follow-up before closing the case.

Employees report to management that they often smell alcohol on their supervisor's breath and that sometimes the supervisor disappears after lunch. Management talks with the supervisor who assures them that she is not drinking. She says that she often has meetings in the afternoon and that she will do a better job of communicating her schedule to her team and to other departments who may need her. Later the same month, the cleaning crew supervisor reports finding several empty single-serving wine bottles in the supervisor's trash can. (This is a mandatory reporting as outlined in the company's drug-free workplace manual.) Management discusses the matter and decides to formally refer the supervisor to the EAP but to take no additional disciplinary action. Management reports to EAP that the supervisor has been with the company for more than 30 years and that she is close to retirement, so they do not want to tarnish the supervisor's employment record or jeopardize her retirement. The EAP coaches management on how to confront and refer the supervisor. The supervisor comes to the EAP, which assesses her problems as depression and alcohol dependence. The EAP strongly recommends an outpatient substance abuse treatment program as well as therapy with a local provider who has experience with addiction and depression. The supervisor rejects the recommendations and instead prefers to attend Self-Management and Recovery Training (SMART) meetings and see her former therapist. The EAP continues to follow up with the supervisor to ensure compliance with the two-prong plan. About one month later, the supervisor is found passed out in the office building lobby and is taken to a hospital for treatment. Management then gives the supervisor three choices: resign from the company; work with the EAP and comply with all EAP recommendations; or do nothing and be fired for violation of several company policies. The employee chooses the second option and begins outpatient treatment and therapy. The EAP will continue to monitor her compliance and will report results to management.

Consultation with work organization leadership (e.g., managers, supervisors, union officials) seeking to manage the troubled employee, enhance the work environment, and improve employee job performance is a part of the EAP core technology component 1 [1]. This service is typically initiated by a supervisor who contacts an EAP counselor to discuss concerns about an employee. The EAP counselor's responsibilities are to listen, build rapport with the manager, validate the manager's experience, and begin to assess the problem. It is common for a manager to telephone, give the EAP counselor a brief description of the area(s) of concern, and then ask: "So what do I do?" Often, an EAP counselor's next step is to slow the manager down and gather additional information so the counselor has a comprehensive understanding of the problem and the history. The skills required for a successful management consultation are transferable and similar (if not the same) to the skills used when working with an individual employee client.

One of the most fundamental and important tasks of the EAP counselor is to keep the supervisor focused on work performance problems, as these are within the supervisor's realm of expertise and responsibility. Supervisors should not diagnose employees (as they are not trained mental health professionals and diagnosis of employees falls out of their scope of responsibility). The EAP counselor should coach managers about staying away from words such as depression, anxiety, alcoholic, or bipolar and redirect them to focus on attendance, conflicts in the workplace, missed deadlines, quality or quantity of work product, complaints from customers or colleagues, attitude, and other work performance criteria.

As part of the management consultation, the EAP counselor should educate the manager about available resources and encourage the manager to access additional support (EAP core technology component 2). For example, if a supervisor has observed work performance problems, the supervisor should consult with human resources to ensure that he or she is documenting the problem in accordance with company policy. Human resources can also provide the supervisor with guidance to ensure that any actions taken are compliant with employment laws and union agreements.

Assisting the manager in making a referral of the employee to EAP is also part of the consultation. This may include outlining the steps involved in the referral process, providing the manager with key phrases to use, and discussing how to handle potential reactions from the employee. Some managers may also want to role play the conversation; this is especially useful if it is the first time a supervisor is referring an employee to the EAP. This meeting and referral is termed "constructive confrontation."

Constructive confrontation (EAP core technology component 4) is a meeting between the employee and the supervisor to discuss performance concerns; in some cases, a union representative and/or human resources may be present. The purpose of the meeting is to motivate the employee to make changes and improve job performance. The meeting also identifies the EAP as a resource for the employee and outlines possible future consequences if improvements are not made. During constructive confrontation, the supervisor will review the documented and specific performance problems with no focus on any suspected personal problems. The supervisor should avoid criticizing and instead focus on the documented and unacceptable behavior. The supervisor may ask for reasons for the performance problem and should listen to the employee's answer. The supervisor should then express a desire to help the employee resolve the problem and encourage the employee to contact the EAP.

The EAP counselor should coach the manager about how to talk about the EAP. A manager may say, "I'm concerned that something is happening to you that is affecting your performance in a negative way. The EAP is a free and confidential resource that can assist you in identifying obstacles and resolving problems that may negatively impact your performance. I highly encourage you to schedule an appointment." It is best if the employee is given a letter of referral to the EAP. These meetings should be held in private locations, free of interruptions, and should allow for sufficient time to cover all concerns.

Many managers enable their employees and then problems worsen. It is not uncommon for a manager to make excuses or cut the employee slack when problems start. Managers often believe that they are protecting and/or helping employees by not holding them accountable. The EAP should help managers learn the importance of holding employees accountable. This in turn helps prevent problem escalation and encourages problem resolution. Educating managers about enabling behaviors is a key part of the management consultation process.

Training of managers and supervisors seeking to manage the troubled employee and outreach to employees and dependents about the availability of EA services are key components of the EAP. EAPs typically provide three types of training: employee orientations, supervisory training, and health and wellness seminars.

Orientations are typically offered either when a new EAP is contracted to provide services to an organization or at new employee orientations sponsored by the organization. However, employee orientations may be included in town hall meetings held by executives, in staff meetings, or during other events, and are good ways of reminding employees about the availability of EAP services. Typical orientations educate employees about the services offered by the EAP, the number of counseling sessions available to them, the confidentiality for employees who meet with the EAP, and contact information and the location of the EAP.

Supervisory training is a formal training session for supervisors and managers to orient them to EAP activities and benefits and to educate them about their role in the identification of work performance problems and EAP referral. Trainings will typically include an overview of EAP services, a thorough review of confidentiality policies, indicators of a problem employee (e.g., performance, attendance, conduct), types of EAP referrals (informal vs. formal), and how to discuss and refer an employee to the EAP (constructive confrontation). Trainings also provide supervisors with education about how to document work performance deficiencies, and they differentiate the roles played by the supervisor, union, human resources, and EAP.

The number of counseling sessions an employee can receive varies based upon the contract the company establishes with the EAP vendor. Most EAPs allow for 3 to 8 sessions. It is important to verify the number of authorized sessions before working with a client.

Most EAPs offer a toll-free number that is available 24 hours per day. This can be an important resource to incorporate into a plan with an employee. If an employee is in danger of relapsing or is in need of immediate emotional support, the EAP may be able to serve as an additional resource.

Some companies have an EAP counselor onsite. This counselor is typically familiar with human resource policies, corporate culture, and internal company resources that may be useful to an employee client. Even if the employee client chooses to be seen offsite by an affiliate EAP provider, the client may want to call the onsite counselor to inquire about resources and options. An onsite counselor can make it easier for a client to find time to make and keep appointments. An onsite counselor also increases the overall visibility of the EAP. Onsite EAP counselors should take special precautions with information stored on a computer; ensure that all files are locked; and select a discrete location that protects client confidentiality. Onsite counselors should also be cognizant of who they socialize with in order to maintain confidentiality and the perception of trustworthiness. Most EAPs offer offsite counseling even when a counselor is available onsite.

An internal EAP is a "company" EAP, meaning the EAP and its services are part of the company's structure, not provided by an outside vendor. Internal EAP counselors are employees of the company.

There are fewer internal EAPs now than in the past. One advantage of an internal EAP is that the counselor is often best situated to understand corporate culture and company resources. A potential disadvantage is that other employees often question the confidentiality of the EAP (more so than with the external model). The company must also know how to build, regulate, staff, and run an EAP. Internal EAPs are most commonly found among local, state, or federal governments or in other public agencies (e.g., a large school system).

An external EAP is not a company EAP; rather, the EAP and its services are provided by an outside vendor. The external EAP is the most used model in the private sector. One advantage of an external EAP is that it can streamline processes, combine resources (e.g., an account manager or quality auditor can manage more than one company contractor), and write one set of policy statements that apply to several companies. The disadvantage of the external EAP is that it creates distance and obstacles that prevent the EAP from understanding the company culture and its needs.

Internal and external models should not be confused with onsite and offsite counselors. These are separate nuances. It is possible to have an internal EAP that sits offsite. For example, a large school system may have an internal EAP with an offsite counselor. The school system has placed the EAP counselor offsite to centralize the location for all staff members and to further ensure confidentiality for EAP clients. Alternatively, a large manufacturing plant may have an external EAP with an onsite counselor. The plant's contract with the EAP vendor requires that a counselor sit onsite several days every week to allow greater accessibility for employees.

Most EAPs extend benefits to significant others, children, and/or family members living in the employee's home. If an employee has a family member who is dealing with a personal problem, the employee is more likely to be distracted at work and take more leave. Therefore, resolution of the problems of family members increases the overall work productivity of the employee.

The Code of Federal Regulations (CFR) refers to administrative laws that spell out details about how the executive branch interprets laws. The CFR is considered legally binding by courts. Title 42 of the CFR covers public health laws. Chapter 1, Part 2, addresses the Confidentiality of Substance Use Disorder Patient Records and states [11]:

Records of the identity, diagnosis, prognosis, or treatment of any patient which are maintained in connection with the performance of any program or activity relating to substance use disorder education, prevention, training, treatment, rehabilitation, or research, which is conducted, regulated, or directly or indirectly assisted by any department or agency of the United States shall, except as provided in subsection (e), be confidential and be disclosed only for the purposes and under the circumstances expressly authorized under subsection (b).

Disclosures of information that may be made if the patient provides written consent include: in cases of medical emergency; for scientific research, audits, or program evaluation; to satisfy a court order; or to report child abuse.

Also known as the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment, and Rehabilitation Act Amendments or the Hughes Act, this law protects the confidentiality of patients seeking treatment for alcoholism or alcohol abuse education, training, treatment, rehabilitation, or research. Protected records include the identity, diagnosis, prognosis, and treatment of the patient [12]. As a result of this Act, all EAP records are considered confidential.

This law was created to protect the privacy rights of U.S. citizens and permanent residents. It safeguards privacy in four specific ways [13]:

The Act applies only to certain federal government agencies; state and local governments are not covered by the Privacy Act [13].

HIPAA establishes national standards for electronic healthcare transactions and national identifiers for providers, health plans, and employers. It also addresses the security and privacy of health data.

The HIPAA Privacy Rule establishes national standards regarding the use and disclosure of individuals' health information, called protected health information (PHI), as well as standards for individuals' privacy rights to understand and control how their health information is used. A major goal of the Privacy Rule is to protect individuals' health information while also allowing the flow of that information as needed to provide and promote high-quality health care. The Privacy Rule establishes requirements of providers to notify patients regarding their privacy practices, to obtain written authorization for disclosure, and to disclose only minimally necessary amounts of information. The Privacy Rule also outlines individual patient rights, such as a right to access records, to request amendments, to request an accounting of disclosures, and to file a complaint [14].

The HIPAA Security Rule establishes national standards for protecting the security of certain health information that is held or transferred in electronic form [14]. The Rule outlines three sets of administrative, technical, and physical security procedures for "covered entities" to use that will assure the confidentiality of electronic PHI. Covered entities include health plans, healthcare clearinghouses, and healthcare providers who transmit certain health information electronically [14]. Half of the regulations in the Security Rule fall under the Administrative Safeguards section, which requires the development and documentation of policies and procedures for managing day-to-day operations, access of workforce members to electronic-PHI (e-PHI), and the selection, development, and use of security controls. Physical safeguards refer to regulations designed to limit physical access to electronic information systems while ensuring authorized access. This may include the use of security guards, locking offices, or placing computers with patient information in restricted areas. Technical safeguards include access control policies and procedures that allow only authorized access to e-PHI, audit controls for information systems that contain or use e-PHI, integrity controls that ensure e-PHI is not destroyed or improperly altered, and security measures to protect against unauthorized access to PHI that is transmitted electronically [14].

The perception of confidentiality is just as important as maintaining confidentiality. This is most important for EAP counselors who are onsite at the client company. The goal is to maintain a place for employees to visit that allows them to safely discuss personal and sensitive concerns. EAP staff can promote and facilitate this atmosphere by holding collaborative meetings in private (e.g., staff office) rather than public (e.g., the lunchroom) settings.

EAP counselors hold licensure that is regulated through various state and other jurisdictions. Most jurisdictions mandate an exception to confidentiality to report suspected child or elder abuse and to protect the client from self-harm or from harming another person. In addition, counselors are required to notify the appropriate authorities if a client threatens them (as established by The California Supreme Court decision Tarasoff v. Regents of the University of California).

Employees with a security clearance are often concerned that seeking EAP counseling will result in the loss of their clearance and then loss of their job. It is often best to refer these employees back to the EAP program manager or to their security office for clarification about these concerns. Regulations of the U.S. Office of Personnel Management (OPM) and the U.S. Department of Defense (DOD) state that security clearance will not be revoked or denied solely on the basis of seeking mental health counseling. It can be useful to remind employees that resolving personal problems can protect their security clearances and jobs by promoting personal and professional performance. Employees who need counseling and who fail to seek counseling will likely, over time, find problems escalating, symptoms worsening, and work performance declining, which puts their security clearance at risk.

In a memorandum that addressed the post-traumatic stress often experienced by military personnel, former Secretary of Defense Robert Gates stated that seeking professional mental health care should not be perceived as jeopardizing an individual's security clearance, whereas failure to seek care increases the likelihood that psychologic stress could escalate and preclude the individual from performing sensitive duties [15].

The evaluation guidelines for issuing security clearance to an individual who has a psychologic condition require a review of the individual's judgment, reliability, and trustworthiness. According to OPM guidelines, conditions that could raise a security concern and may be disqualifying include: (a) behavior that casts doubt on an individual's judgment, reliability, or trustworthiness that is not covered under any other guideline, including but not limited to emotionally unstable, irresponsible, dysfunctional, violent, paranoid, or bizarre behavior; (b) an opinion by a duly qualified mental health professional that the individual has a condition not covered under any other guideline that may impair judgment, reliability, or trustworthiness; (c) the individual has failed to follow treatment advice related to a diagnosed emotional, mental, or personality condition (e.g., failure to take prescribed medication) [16].

If an EAP counselor is contacted by a security clearance investigator, it is important that the investigator provide the EAP counselor with an authorization (or release of information) that specifies the EAP and what information that particular EAP can disclose. An EAP counselor should not accept a general medical release as authorization to release information.

Another misconception and concern of many employees is that seeking the services of an EAP will result in termination or in the inability to be promoted. It is important to assure employee clients that EAP services are confidential and that EAP records are not shared with their manager or with the organization. In addition, EAP records are not a part of any personnel records and are maintained according to federal confidentiality laws. EAP professionals should also emphasize that, as discussed, failure to seek EAP assistance may result in escalation of problems, decline of job performance, and thus result in job termination or an inability to be promoted.

The Family and Medical Leave Act (FMLA) of 1993 entitles eligible employees to take up to 12 weeks of unpaid, job-protected leave in a 12-month period for specified family and medical reasons [17]. Reasons for taking FMLA may include birth and care of the newborn child of the employee; for placement with the employee of a son or daughter for adoption or foster care; to care for an immediate family member (i.e., spouse, child, parent) with a serious health condition; or to take medical leave when the employee is unable to work due to a serious medical condition. In 2008, the first-ever amendments to FMLA were signed into law. They provide new military family leave entitlements, including leave for a qualifying exigency arising out of the fact that an immediate family member (i.e., spouse, child, parent) is a covered military member on covered active duty. Up to 26 weeks of leave in a single 12-month period may also be granted to care for a covered service member with a serious injury or illness if the eligible employee is the service member's spouse, son, daughter, parent, or next of kin [17]. In some cases, leave may be taken intermittently. FMLA applies to both public-sector employers and private-sector employers who employed 50 or more employees in 20 or more workweeks in the current or preceding calendar year. To be eligible for FMLA, an employee must work for a covered employer; have worked for the employer for a total of 12 months; have worked at least 1,250 hours over the previous 12 months; and work at a location in the United States or a U.S. territory.

Workers' compensation, sometimes referred to as "workman's compensation" or "workers' comp," is the name given to a system of laws meant to protect injured workers. Workers' compensation laws are designed to ensure that employees who are injured or disabled on the job are provided with fixed monetary awards, eliminating the need for litigation. These laws also provide benefits for dependents of workers who are killed because of work-related accidents or illnesses. Each state has its own workers' compensation laws. Most laws provide for partial pay of an employee's salary following a workplace accident and coverage of medical expenses [18].

The Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1986 provides certain former employees, retirees, spouses, former spouses, and dependent children the right to choose temporary continuation of health coverage at group rates. This coverage, however, is only available when coverage is lost due to certain specific events (e.g., voluntary or involuntary termination of employment for reasons other than gross misconduct, reduction in the number of hours worked, transition between jobs, divorce or legal separation, death, other life events). Group health coverage for COBRA participants is usually more expensive than health coverage for active employees, and qualified individuals may be required to pay the entire premium for coverage up to 102% of the cost to the plan [19].

The U.S. Equal Employment Opportunity Commission (EEOC) is responsible for enforcing federal laws that make it illegal to discriminate against a job applicant or an employee because of the person's race, color, religion, sex (including pregnancy), national origin, age (40 years or older), disability, or genetic information. It is also illegal to discriminate against a person because the person complained about discrimination, filed a charge of discrimination, or participated in an employment discrimination investigation or lawsuit. Most employers with at least 15 employees (or 20 employees in age discrimination cases) are covered by EEOC laws. Most labor unions and employment agencies are also covered. The laws apply to all types of work situations, including hiring, firing, promotions, harassment, training, wages, and benefits [20].

The Employee Assistance Professionals Association (EAPA) is the world's largest, oldest, and most respected membership organization for EA professionals. The EAPA has members in more than 40 countries worldwide and publishes the Journal of Employee Assistance, which focuses on professional development for EAs. The organization also hosts professional conferences, offers a variety of online training opportunities, and facilitates professional networking (Resources).

The Employee Assistance Society of North America (EASNA) is a tri-national (Canada, United States, and Mexico) employee assistance trade association with a focus on promoting the growth of the EA field [21]. EASNA's diverse membership includes employee assistance and work/life professionals, behavioral health and addiction treatment practitioners, and human resource and benefits professionals. EASNA sponsors an annual educational conference and provides online training opportunities (Resources).

Other, smaller, professional EA organizations include:

EA professionals may find additional support in related fields and organizations, including the Society for Occupational Health Psychology (SOHP) and the Society for Industrial and Organizational Psychology (SIOP), which is a division of the American Psychology Association (APA).

The Certified Employee Assistance Professional (CEAP) program is administered by the Employee Assistance Certification Commission (EACC), an autonomous credentialing body established in 1986 by the EAPA. The CEAP program is recognized worldwide and was the first credential to represent the EA profession [22].

There are four pathways to becoming a CEAP, each with a designated combination of education and experience: Master's degree with experience; no Master's degree with experience; Master's degree without experience: and all other candidates. "Experience" is defined as a minimum of 1,000 hours paid or unpaid EAP work within previous 10 years. Depending on an individual's education and experience, certain prerequisite and postrequisites must be met to become a CEAP [22].

CEAP certification demonstrates mastery of the body of knowledge required for competence in EA practice. Those who earn the CEAP credential may benefit from increased compensation and career opportunities. Surveys have found that many companies hire only CEAP-certified individuals to provide EA services, as these individuals, through continuing training and education, help companies remain on the cutting edge of developments in the EA field. Having CEAP-certified EAs on staff also demonstrates that the company subscribes to the CEAP code of conduct [22].

EA professionals who already have their CEAP certification may choose to qualify as a Substance Abuse Professional (SAP) and perform SAP services, as outlined by the U.S. Department of Transportation (DOT). EAP services and SAP services have some overlap in responsibilities and duties. However, while EAP professionals have a responsibility to the general well-being of a workplace, employers, and employees, SAP services are primarily meant to serve public health and safety. SAP services are designed for employees who have failed to adhere to a DOT drug and alcohol program, particularly employees who hold positions of high responsibility, such as pilots, bus drivers, subway car engineers, or other occupations that require great concentration because of the potential risk to the public. SAP services include treatment, follow-up, continued drug and alcohol testing, and education for employees who violate a DOT drug and alcohol program [23].

In order to qualify as an SAP, EA professionals must familiarize themselves with the 49 CFR, part 40, Subpart O, and the Substance Abuse Professional Guidelines, as provided by the U.S. Department of Transportation. Professionals hoping to become an SAP must also complete a training course and pass an exam. Once qualified as an SAP, professionals must complete continuing education courses every three years [22].

More information about certification programs can be found on the EAPA website (Resources).