Health and wellbeing: International employee assistance programmes

If you read nothing else, read this …

  • Employee assistance programmes (EAPs) are now available in over 150 countries.
  • Employers should first consider whether they want to offer an EAP centrally or localise it to each global worksite.
  • Challenges to consider in implementing an international EAP are cultural barriers, cost, language, and the infrastructure of each country.

Case study: Johnson and Johnson takes a global view for employee assistance

Johnson and Johnson introduced an employee assistance programme (EAP) in 1977 to deal primarily with substance abuse issues among its 50,000 US staff.

However, the concept of holistic health led to a desire to broaden its EAP’s scope, says Janice Lenehan, the pharmaceutical firm’s worldwide director of employee assistance.

In 2004, she was tasked with globalising the EAP for the decentralised organisation’s 120,000 staff in 67 countries across more than 250 companies.

Today, 90% of its workforce is covered by an EAP, and it has a different programme in each country. “The Johnson and Johnson workforce is diverse and encompasses a broad range of ethnicity, religion, language, age and gender,” says Lenehan. “It is critical to select EAP counsellors who are sensitive to each [employee’s] needs.”

For example, in Juarez, Mexico, the firm has 6,000 Mexican staff, most of whom are aged under 30. “In that area, it can be difficult to access mental health professionals,” says Lenehan.

Johnson and Johnson now offers Juarez staff an onsite psychologist, as well as doctors and nurses. But there is a different emphasis at its headquarters in New Jersey, where the average staff age is 45.

“In companies where the population tends to be older, there may be support groups for caregivers of the elderly, workshops dealing with empty-nest issues, and resources for helping sort through the college process.” says Lenehan.

There are many local variables to take into account when designing an employee assistance programme for a global workforce, says Jennifer Paterson

As organisations have expanded internationally, so the global employee assistance programme (EAP) market has grown exponentially, with providers now offering services in more than 150 countries. But extending EAP benefits across the world has its challenges, including cultural barriers, costs, language, and the varying infrastructure of each country.

Historically, there was only a handful of global EAP providers, each offering Anglo/American-centric services from a single hub, says Wolfgang Seidl, executive director of Validium. “Then customers became more savvy in their purchasing strategy and demanded more localised services, which came in parallel with EAPs as a concept that was known globally,” he explains.

Although a centralised EAP model offers employers advantages such as centralised account management and data collection, local provision has improved and grown. This expansion of services on an international scale sets employers the challenge of how to provide the benefit throughout their organisation’s offices worldwide.

Eugene Farrell, business manager at Axa Icas, says: “If you are a global provider and want to have the exact same benefits everywhere, then that is a little bit tricky. An EAP does not necessarily mean it is an EAP in every part of the world. As long as you are getting the basic psychological services, which is the core of the EAP, then that is perfectly reasonable.”

Cultural differences between countries will also determine what is offered. In the UK, for example, EAP services are provided through counsellors or, in some cases, psychologists. In other countries, counsellors are less common, so such services may be provided exclusively through psychologists.

Expatriates and locals have different expectations

Another consideration for multinational employers is whether to offer an EAP to expatriate employees or local nationals. Each group is likely to have different expectations and views of the benefit. For example, if an expat does not want to see a local counsellor because their cultural heritage and preferred experience is back in the UK, the desired route may be to connect with a counsellor in the UK by telephone. But a local national employee may prefer to use a local counsellor who speaks the same language and shares their cultural experience.

David Smith, secretary of the Employee Assistance Professionals Association (EAPA), says: “If staff are expats, employers might be able to use simplified access points, such as international telephone services that dial straight to the UK, which will keep costs down and keep the service structured. If staff are local nationals, they are probably going to want something that is answered locally.”

An international EAP service may also be modelled on what is already on offer to an organisation’s domestic workforce. Mark Coleman, international sales director UK at Cigna, says: “It is almost like a commonality or equalisation of benefits across the whole workforce. If an employee lives and works in the UK and gets an EAP, then if they go on assignment, their employer will want to give them an EAP as well, along with medical and dental cover. We tend to find it is organisations that have a culture of providing this to their localised workforce that would be seeking to provide it to their more mobile and international workers.”

EAP service delivery costs overseas are higher than back in the UK, so employers must be prepared for a much more expensive contract. Typically, this is because there are a limited number of providers in the market and variations in charging rates.

Language can also be a barrier. Axa’s Farrell says: “If [employers] want to do a roll-out on a global basis, they have to consider that it is essentially multi-sited, so their communications material has to be adapted to all cultures and languages. It has got to have a local flavour.”

Local infrastructure is a challenge

Another challenge to consider is the infrastructure of each country, including the business climate, legislation and state healthcare systems. Alan King, president and chief operating officer at provider Workplace Options, says:

“What we try to do is look at delivering services that meet the culture and the infrastructure of a particular country, but also deliver things that can be common in all countries. A good EAP should be able to provide uniform and consistent quality regardless of the location where the service is delivered. The user’s experience and branding of the service across multiple countries are things EAPs can and should do that enhance the aggregate value of the service to the company.”

Organisations based in the UK, North America or continental Europe may have a perception of EAP services that influences how they think a programme should look in locations such as India or China. King adds: “In addition to delivering a service that is culturally appropriate in a country, there is also the challenge of educating the buyer to understand that what they may be experiencing in the UK is not going to be the same thing that may be available in India, Sri Lanka or Senegal.”

For example, in certain parts of the world, talking to a stranger about your problems might be considered taboo. Farrell explains: “We are finding some of the younger people in employment are coming through and thinking in a different way. In India there is a growing acceptance that counselling is there and it is useful, whereas the older generations in India would consider that as something you just would not do.”

So, as the globalisation of EAPs continues, programmes have to develop as different animals in different countries to cater to the local population, says Validium’s Seidl. “In India, nearly two-thirds of the counselling services are delivered via email. In China, EAPs are now slowly emerging as well, but there is a different emphasis on promotion of the service to what we practise in the UK or US environment.”

Recent advances in EAP offerings include online therapeutic services, such as computerised cognitive behavioural therapy (CBT) and instant-message counselling, and are designed to streamline programmes across international workforces. The EAPA’s Smith says: “You have a conversation that builds up so the employee can view the questions and responses, and store them so they can refer back to them. The great thing about this is it is not time-specific or country-specific. You could get a counsellor in the US who is doing that at midday, but it is midnight on another part of the globe.”

EAPs often deal with employees’ marriage or financial problems, but an international service is also concerned with issues such as relocation, settling into a new environment and culture, and schooling for children. Cigna’s Coleman adds: “There is a potential angle that says it is much more critical to provide an EAP to an international workforce than to a domestic workforce.”

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