On the relatively rare occasions when public officials talk about the need for increased addiction treatment services, they invariably refer to the needs of indigent clients who seek help from public agencies. In many communities, however, employed individuals covered by health insurance are even less likely to seek treatment for addiction services than those who are poor, jobless, or homeless.
Recognizing this problem, advocates for treatment services in Tucson, Ariz., applied for and won one of 15 Demand Treatment! grants awarded by Join Together, a Boston-based national resource center for communities fighting alcohol and other drug addiction. Led by the Pima Prevention Partnership, the Tucson Demand Treatment project works to encourage insured individuals to demand treatment through their EAPs, HMOs, and other avenues.
To achieve this goal, the Tucson group publicizes National Alcohol Screening Day each spring, is developing Internet self-screening tools, and links to traditional and alternative treatment and recovery-support services. A speaker's bureau also is used to encourage treatment demand.
One of the key partners in the Tucson Demand Treatment project is Don Jorgensen, Ph.D., CEAP, president-elect of the Employee Assistance Professionals Association (EAPA) and principal of The Jorgensen Group. Jorgensen says that EAPs can play a critical role in increasing the demand for, and accessibility of, high-quality addiction-treatment resources.
“I think EAPs have a better handle on the private sector” than the community-based organizations typically involved in such advocacy efforts, he said. “At the same time, EAPs have a handle on the people who self-pay because of confidentiality fears.”
Understanding such nuances of treatment demand is especially important as Tucson officials embark on a project to determine the percentage of employees who have insurance coverage for addiction and how many are actually utilizing those services. “We want to get a snapshot of where things stand before we start to work to increase availability or access to treatment,” said Jorgensen.
EAPs Get Involved Nationally
EAPA is one of the co-sponsors of the Demand Treatment project, and a number of the local Demand Treatment partnerships in cities around the nation (including Boise, Idaho, Chicago, Denver, Des Moines, Iowa, Houston, Indianapolis, Knoxville, Tenn., Manchester, N.H., Mobile, Ala., Nashville, Pittsburgh, San Antonio, San Francisco,and Trenton, N.J.) feature participation by EAP providers.
In Chicago, for example, Bill Heffernan, co-owner of Employee Resource Systems, is working with a Demand Treatment project that is seeking to increase addiction screening and brief interventions in the Cook County Hospital System. The City of Houston's EAP program is involved in an advertising and educational project targeting EAP managers, primary-care providers, and clergy members to encourage people with insurance to demand treatment services. And in Des Moines, Employee and Family Resources, Inc., is urging local businesses to voluntarily adopt parity for addiction treatment, meaning that people with addictions would not be subject to insurance limitations not applied to other health-care services.
Margaret Altmix, EAP director for Employee and Family Resources, Inc., says that building relationships between EAPs and the Demand Treatment initiative can have benefits for all involved. Interaction with community-based organizations and groups like Join Together can give EAPs access to important data and information that can help them make the case to employers about improving treatment services for employees, she noted.
“EAPs have a hard time justifying sending people to treatment if it's not available, or if treatment outcomes are nonexistent,” noted Altmix. “If we have no substantive information on how treatment is working, then the employer stops believing in treatment. We're in daily contact with purchasers, and have to defend what they pay for.”
Altmix has tapped Join Together's website for data on treatment as well as the AUDIT addiction screening tool, which Employee and Family Resources employees are being trained to use in order to better identify EAP clients with addictions and refer them to needed services.
Some of the goals of the Des Moines Demand Treatment initiative, such as increasing primary-care physician screenings for addiction, may only be indirectly related to the day-to-day work of EAPs, Altmix admitted. But, she noted, “If our employees get the same questions from their personal physicians as we ask, we're going to have a better chance of breaking through their denial of addiction problems.”
Accessing Corporate Decision-makers
EAPs also can offer community-based efforts to increase treatment availability and quality invaluable access to key corporate decision-makers, particularly employee-benefits staff.
“Community groups don't have connections to them, or even understand that that is where the decisions [on employee health coverage] are made,” said Altmix. “EAPs also can build knowledge of what employers cover, especially external EAPs that deal with many clients.”
To make the case for greater addiction coverage, Heffernan said that advocates for treatment need to get cost-benefit data into the hands of human-resources personnel and corporate financial officers — and in the simplest format possible. “Many benefits consultants know as little about addiction as other people,” he noted. “They don't want to hear stories about recovery. They want to see a return on their investment.”
Advocating for employees with addiction problems is one of the core values of EAPs, experts noted. “We advocate for individuals with addiction all the time, helping employers see addiction as a health issue and not a 'will' issue,” said Altmix.
So, as some Demand Treatment projects move their advocacy efforts into the legislative arena, they have turned to EAPs as possible conduits to influential business leaders. “EAPs bring to the table the clout of corporations and the number of employees they represent, and who come to them for help,” noted Bill Layfield, assistant director of the Drug Education Council, Inc., of Mobile, Ala.
Allies for Parity
Corporate support is especially important as advocates argue for parity insurance coverage for addictions, since insurers and business groups have traditionally been among the chief opponents of parity legislation. For example, Tara Wooldridge, EAP manager for Delta Airlines, testified before the U.S. Senate on behalf of parity last year. “We're not telling other companies what to do, but said this is what we're doing and why we think it makes sense for our employees,” said Wooldridge, a member of Join Together's National Advisory Council.
Treatment advocacy by EAPs is neither unfettered or universal, however. Some insurers now offer EAP services as an add-on to their policies; such EAPs are unlikely to be strong advocates for issues like parity. And as one provider put it, EAPs that demand treatment too loudly without lining up support from their corporate clients first might “kiss their business goodbye.” Agrees Heffernan: “I'm a strong proponent of treatment and Demand Treatment, but if I worked for a big EAP firm I would be hard-pressed to take such a strong position.”
But, said Altmix, while “employers may not be fans of parity, [EAPs] can still talk to employers about how they cover this issue.” Rich Barrett, director of the City of Houston's EAP, says EAPs have an obligation to hold health insurers accountable for providing adequate treatment. “Many EAPs can be and are involved in ensuring that clients are not just getting the services that are the cheapest,” he said.
In addition to providing access to addiction-screening tools, outcomes data, and local treatment resources, EAP leaders say that partnerships with community-based initiatives like Demand Treatment also can help convince employers to adopt EAPs that fulfill the core competencies outlines by EAPA.
As EAPs have broadened their focus to addressing an array of work/life issues, experts said, some have lost their focus on confronting the addiction problems that gave rise to the EAP movement in the first place. “Many EAPs have moved away from even screening for substance abuse,” said Altmix. “EAP personnel need to be trained in that, and they're not.”
Jorgensen, the EAPA president-elect, said that addiction can get overlooked when EAPs focus too much on the clinical aspects of employee assistance, and only deal with employees who voluntarily seek assistance. He argues that an effective EAP needs to maintain a strong presence in the workplace.
“You need supervisors and managers to be trained to identify employees with problems and refer them to treatment,” said Jorgensen. “The farther away the focus is from the workplace, the less impact the EAP will have on addiction.”
Jorgensen said one role that Demand Treatment can play is to educate employers about what a good EAP is. “We don't have to focus on one area at expense of another,” he said. “From the start, addiction has been the most prominent problem that employees and their families face. We do have to maintain that role, and I think collaborating with Join Together and Demand Treatment is an excellent way to restate our commitment in that area.”