Telecounseling Finds Favor With EAPs

    More recently, the phone has graduated to a starring role, as some companies advance from using it as a referral tool to integrating telephone therapy into their EAP-based work/life and mental-health offerings. In what’s been dubbed teletherapy or telecounseling, instead of an office visit, mental-health professionals working in off-site call centers conduct counseling sessions with employees who phone in from home, the office or the road. All but the most serious problems--such as severe addiction or depression--are being dealt with this way, through one-time or multiple, long-term phone sessions. Most teletherapy offerings, which can also include e-mail and Internet-based help, come from third-party EAP vendors or managed-care companies, which the vast majority of Fortune 1000 companies contract with to provide EAP services.

    The development isn’t without controversy. Opinions are strongly divided over the effectiveness of teletherapy and the motives for offering it. Proponents claim that phone-based counseling gives people faster access to help, leading to higher usage and success rates, and ultimately increased worker productivity. They say it’s especially well suited to companies with workers in rural areas underserved by mental-health professionals, or businesses with employees who travel or are spread across the country.

    But opponents claim that without face-to-face interaction, it’s easier to miss or misdiagnose problems. They’re troubled by confidentiality and licensing questions surrounding phone-based therapy, and point to the lack of empirical evidence to support outside EAP vendors’ claims of success. They maintain that because most outside contractors are paid a set amount per employee per year regardless of use, vendors offer teletherapy because it’s cheaper, and lower costs translate to higher profits. Companies "are being sold a bill of goods that the telephone is as good as in person," says David Sharar, a self-styled industry watchdog. "My argument is it should be an adjunct, not a replacement."

    In many cases, changes are occurring beneath the radar of corporate human resources departments. Proponents and critics alike agree that many human resources managers don’t keep abreast of changes in the delivery of EAP services. "You’ll find companies that don’t know that it’s a problem," says Sharar, managing director of the EAP division of Chestnut Health Systems in Bloomington, Illinois.

    But teletherapy backers say that human resources managers care more about having services available and getting positive outcomes than how the services are offered. "I really haven’t been with any clients that have proposed we go with one over the other," says Chuck Taylor, executive vice president of the employer solutions division of ValueOptions in Norfolk, Virginia, a top EAP outsourcer.

    Some of the uncertainties surrounding the treatment method are being addressed. A trickle of scientific research is making its way into publication. At least one EAP trade association is updating practice standards to include specific guidelines for teletherapy.

    Meanwhile, the debate isn’t stopping vendors from rolling out the next generation of teletherapy services, in which e-mail and Web-based counseling play an even larger role in treating things like diabetes, obesity and smoking.

A convert at Bridgestone
    Ron Tepner was one of the skeptics. As vice president of human resources at BFS Retail and Commercial Operations LLC, an arm of Japanese-based Bridgestone Corp., Tepner provides EAP to 22,000 employees in 2,000 Bridgestone tire stores throughout the country. Traditionally, Bridgestone paid for employees to receive in-office counseling through the company’s medical-benefit plan. "I thought you needed to sit down to talk to someone or lie on a couch somewhere," Tepner says. But the service was expensive. Employees weren’t inclined to use it because they didn’t want someone in human resources to know they had a problem, didn’t want to wait days or weeks for an appointment, or, in smaller communities, didn’t want their cars seen in the parking lot of the town psychologist, Tepner says.

    About eight years ago, he heard about a telephone-based EAP outsourcer being used by Wal-Mart and Kroger. Tepner arranged for a tour of the call center run by the two-year-old company, Resources for Living (RFL), in Austin, Texas. He quickly warmed to the concept of teletherapy, viewing it as a means of helping employees faster and reducing costs.

    The change paid off. Once teletherapy was introduced, EAP use jumped 70 percent, according to statistics that RFL compiles for Bridgestone. About 9.6 percent of employees call in during a given year, amounting to approximately 1,500 calls. Family or personal issues make up 40 percent of the calls; emotional issues, 17.9 percent; work/life balance, 17.6 percent; risk-related issues such as workplace violence or harassment, 15.1 percent; and work-related issues such as trouble with managers or coworkers, 9 percent. According to RFL officials, calls average 26 minutes, though some, such as marriage-counseling sessions, run up to 90 minutes. "I found out that 90 percent, maybe more, of everyone who calls in needs immediate attention," Tepner says.

    Before teletherapy was introduced, Bridgestone’s EAP effectiveness--described as the percentage of people who get better--was 30 percent to 50 percent, typical for face-to-face outpatient therapy, according to Mary Beth Chalk, RFL’s chief operating officer. Today, Bridgestone’s EAP success rate runs about 92 percent, Chalk says. Much of the increase has come in the past two years, after RFL introduced software that enables its 75 call-center counselors to predict by the second call whether a given individual will respond to teletherapy. If not, the person is referred to a face-to-face therapist.

    There’s no question that teletherapy has cut costs. In the first year, Bridgestone’s EAP costs dropped 25 percent to 30 percent, even with higher usage, Chalk says. Tepner won’t disclose exactly what his annual EAP budget was before using RFL or what it is now, but says his 2004 costs will run $300,000 to $700,000, or somewhere between $13.63 and $31.82 per employee. "For every $1 we put into RFL, we probably save $2 by avoiding more costly face-to-face intervention," he says.

    Not everyone is convinced that teletherapy is the way to go. Wells Fargo is one of the few Fortune 1000 companies still running its own EAP operation.

    The employee assistance consulting department provides mental-health and work/life services for the San Francisco corporation’s U.S. workforce of 145,000. The division employs 35 counselors trained in clinical mental health or behavioral health, plus a 10-person support staff to run a 24-hour call center in Minneapolis and offices in Phoenix, San Francisco and Los Angeles. Counselors field incoming calls to a toll-free Wells Fargo EAP hotline. Though the counselors do some short-term problem-solving over the phone, most employees are referred to two company Web sites for educational materials on mental-health topics, or to in-person therapy with health-care or mental-health providers covered under Wells Fargo’s benefits package.

    Counselors also consult with Wells Fargo managers who call in to discuss everything from problem employees to helping workers cope with bank robberies. In September, they provided moral support to bank managers and employees dealing with distraught customers in the aftermath of the hurricanes in Florida.

    The company’s employee-assistance managers made a conscious decision not to provide teletherapy, based on concerns about employee confidentiality and lingering questions about licensing requirements for call-center counselors. In fact, when counselors discuss cases through e-mail, they encrypt messages. "We’re hypervigilant," says David Cambronne, employee assistance consulting manager. "There’s a great deal of controversy around online counseling, and until some of that gets resolved, we’ve made a decision not to do that."

    Wells Fargo employee-assistance managers declined to discuss how many employees use EAP programs annually or how much the banking company spends on the service.

    Recent developments in the field could help stem some of the criticisms. In August, the Journal of the American Medical Association published one of the first scientific studies of phone-based therapy. Researchers in Seattle conducted an 18-month study of 600 patients receiving antidepression treatment; a third of the group received eight sessions of teletherapy in addition to medication. According to the study, by the end of treatment, 80 percent said their depression was "much improved," compared with 55 percent of those given usual care.

    While the results are promising, it’s not a complete endorsement, says Dr. Greg Simon, the study’s lead researcher and a senior investigator at Group Health Cooperative, a nonprofit health-care system in Seattle. "We studied how telephone treatment helped people who were getting no treatment at all," prior to the study, Simon says. "The real question is how does telephone treatment compare with regular treatment." He expects to begin such a study in the next few months.

    Elsewhere, officials at Resources for Living say a study of two years’ worth of data on the effectiveness of teletherapy collected through their proprietary software was published in the September issue of the Journal of Brief Therapy, a peer-reviewed psychology research journal.

    At least one industry group is working to expand existing EAP standards to include teletherapy. The Employee Assistance Professionals Association, an industry trade group in Arlington, Virginia, with 5,000 members, is revising practice standards to include teletherapy. The issue is sure to be a topic of conversation at the group’s annual conference in November, says Katie Borkowski, EAPA professional services manager. "I can’t imagine it not coming up anymore," she says.

    Though questions remain, progress continues. Outsourcers such as RFL and the Center for Health Promotion, a publicly traded spin-off of the Group Health Cooperative, are beginning to market e-mail and Web-only health and wellness programs for weight control, smoking cessation and diabetes management to EAP managers. In some programs, employees get counseling through live chat sessions or e-mail, and receive additional help at secure Web sites customized to their needs.