An Untapped Market

By Maureen Carney and Chris Knoepke


Small businesses are gaining in prominence and importance in the American labor market. Between 1980 and 2010, there was a 30% reduction in manufacturing jobs and a 75% increase in service sector employment (Bodenheimer & Grumbach, 2012). Moreover, nearly 90% of all businesses in the United States have fewer than 20 employees.
In the U.S., EAPs evolved from workplace substance use programs (Masi, 2007) typically offered by large unionized companies, making EAP models and services in a manner most apropos to these organizations. This means that, in order to meet the needs of companies and employees in the 21st century, EAPs need to change to match the present nature of the American workforce. These shifts may include any number of changes, including where services are provided to employees, how utilization reporting occurs and what it includes, and what clinical issues are given the greatest level of attention.

Industries at Highest Risk
Historically speaking, small businesses – disproportionately represented by service-oriented companies – have lacked access to EAP and other benefits while also illustrating an increased incidence of substance use and mental health concerns. National data consistently rank a few specific industries at the highest risk for workplace problems, including hospitality and accommodations; construction and maintenance; food service; and arts, and entertainment and recreation (SAMHSA, 2007).

Small Business Vulnerability
Why might smaller businesses be more susceptible to workplace issues? Consider that, unlike large companies, they often lack a Human Resource department that can develop and interpret workplace policies. In many cases, the owner is the H.R. department by default. Small businesses in the industries noted above also frequently have:

* Higher turnover;
* A lack of “checks and balances” (what the boss says goes);
* A more permissive culture toward substance abuse;
* Hourly/”tipped wage” pay and associated economic volatility;
* Male-dominated workplaces (especially construction); 
* Inconsistent work schedules (9-to-5 hours aren’t as typical as they are in larger firms); and
* Lack of access to affordable health insurance and other fringe benefits (limiting the opportunities employees have to seek care). (Hartwell, Steele, French, Potter, Rodman, & Zarkin, 1996; U.S. Department of Labor, 2005)

These issues may contribute to both an increased risk of mental health and substance use problems among small business employees and increased difficulty in accessing EAP and other support services. 

EAP Challenges
With the lack of organizational policies and framework that is often present in larger companies, it is not difficult to see why a workplace issue can be much harder to resolve at a smaller business. By their very nature, small businesses provide particular challenges to EAP. They include:

* Financial constraints (they typically can’t afford EAP services along the usual pricing models);
* Confidentiality (when everybody knows everybody, and anyone’s absence from the office is noticeable, it can be hard to keep something a secret);
* Lack of context (they’ve never had EAP);
* Scheduling (when everyone wears a lot of hats, scheduling appointments is difficult); and
* Denial of employee issues (a small business can be like a “little family” that doesn’t want to let an “outsider” like the EAP know what’s going on).

The financial challenge can be offset by considering consortium models that allow a firm to pool their monetary resources with other small businesses. Education and marketing are also vital.

Workplace Prevention Services
Funded by the Colorado Office of Behavioral Health, and formerly through the U.S. Small Business Administration (SBA), Peer Assistance Services, Inc. (PAS), offers the Workplace Prevention Services program. Its core components include: policy development (including Drug Free Workplace Policies and testing referrals), supervisor training, resiliency training for employees, and short-term problem resolution and referral services for employees of eligible companies.

Utilization
Services are valuable only when they are utilized. Increasing utilization generally leads to desirable outcomes including: decreased substance use and associated problems; decreased absenteeism/presenteeism (e.g. less time dealing with problems while at work); and increased morale.

At the company and promotional levels, higher employee utilization is associated with: 1) HR and management promotion of EAP (Azzone, 2009); 2) on-site EAPs interacting with staff, theoretically decreasing stigma (Jacobson, 2010); 3) employees being given procedures specific to EAP, theoretically increasing confidence and familiarity (Weiss, 2003); 4) supervisors being trained on EAP, improving the referral process (Weiss, 2003); and 5) EAPs being adequately staffed, providing timely service (Weiss, 2003).

Conversely, lower EAP utilization is associated with: 1) Employee fear of discrimination and shame at work (Jacobson, 2010); and 2) “Unusual and significant” employee stress, such as layoffs, natural disasters, etc.; which may increase barriers to services, such as distrust of company, and lack of basic resources (Azzone, 2009).

To drive utilization, it is important to provide support to managers. Our outcome data seems to suggest that the provision of management consultation services consistently predicts increased employee utilization among small business clients, even when company factors and the presence or absence of other services are accounted for.

PAS learned a number of important lessons necessary to building successful EAP services and relationships with small businesses. Different companies, in different sizes and industries, will develop different cultures, attitudes, and expectations related to workplace professionalism and boundaries. EAPs who are accustomed to working with larger, more traditional organizations should be aware of these differences in culture when working with small businesses.
In terms of problem solving with small businesses, the EAP can have a tremendous impact at an individual level, which can aid companies who rely heavily on these individuals in a variety of ways. Finally, our data clearly illustrate that management consultations led to higher utilization among small business clients.

Summary
“Uncle Bob’s Car Lot” is today’s General Motors. Small businesses are an untapped EAP market: in fact, these firms have a high need for EAP services. However, there are also unique considerations that need to be taken into account when working with small businesses, including staffing, schedules, available resources, maintaining confidentiality, and others.

Maureen Carney, LCSW, CEAP, CPS II, is Program Manager, Workplace Prevention Services with Peer Assistance Services in Denver, CO. Chris Knoepke, MSW, LSW, ABD is a Workplace Programs Coordinator at Peer Assistance Services. He also served as President of the Colorado Chapter of EAPA. 

References

Amaral, T.M. (1999). Benchmarks and performance measures for employee assistance programs. In J. Oher (Ed.). The Employee Assistance Handbook (pp. 161-178). New York: John Wiley. 

Bodenheimer T. & Grumbach, K. (2012). Understanding Health Policy: A Clinical Approach. New York: McGraw Hill. 

Employee Assistance Professionals Association. (October 2011). Definitions of an employee assistance program (EAP) and EAP core technology. Retrieved February 2, 2013 from http://www.eapassn.org/i4a/pages/index.cfm?pageid=521. 

Hartwell, T.D., Steele, P., French, M.T., Potter, F.J., Rodman, N.F., & Zarkin, G.A. (1996). Aiding troubled employees: The prevalence, cost, and characteristics of employee assistance programs in the United States. American Journal of Public Health, 86(6), 804-808. 

Masi, D.A. (2007). Employee Assistance Programs. In The Social Welfare History Project. Retrieved February 2, 2013 from http://www.socialwelfarehistory.com/programs/employee-assistance-programs/. 

Substance Abuse and Mental Health Services Administration (SAMHSA), Office of Applied Studies. (August 23, 2007). The NSDUH Report: Worker Substance Use, by Industry Category. Rockville, MD. 

United States Department of Labor, Bureau of Labor Statistics. (2005). National Compensation Survey: Employee Benefits in Private Industry in the United States, March 2005. Retrieved January 28, 2012 from http://www.bls.gov/ncs/ebs/sp/ebsm0003.pdf .