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The Effect of Employee Assistance Programs (EAPs) on Behavioral Healthcare Utilization: The Role of Race/Ethnicity

  • Author(s): Coles, Courtney
  • Advisor(s): Ettner, Susan L
  • et al.

Research Objective: Employee assistance programs (EAPs) are employer-sponsored interventions aimed at addressing a variety of issues that impact employee well-being and job performance. EAPs are designed to offer early intervention to mitigate problems experienced by employees and their spouses and dependents without requiring copayment. Despite the widespread offering of EAP services, there is little evidence in recent years describing the types of patients who utilize EAP services. It has been estimated that EAP services are benefits offered by tens of thousands of employers; however, estimates suggest only upwards of 6% of employees utilize these services. Researchers have urged that future research in the EAP field focus on identifying facilitators and barriers to EAP utilization and characteristics of EAP users. Compared to gender and age, race/ethnicity is a characteristic less commonly examined as a potential factor influencing EAP service use. This is likely because the study often lacks race/ethnicity data. The differential use of EAP services by race/ethnicity reported in the literature suggests that there may be a group that potentially benefits from these services, but is not obtaining them – due to inaccessibility, unawareness or negative perceptions of these services. Therefore, it is important to characterize employees who underutilize EAP services when they have access with little to no financial obstacles to utilize these services.

Predictors of behavioral healthcare resource utilization are commonly studied; however, the receipt of EAP services has rarely been examined in recent years. A key research question yet to be answered is whether EAP services serve as a complement or a substitute for behavioral health services. Few studies have rigorously evaluated the effect of EAP use on subsequent behavioral healthcare utilization and the results are mixed. Further, the literature is inundated with evidence that there are lower rates of behavioral health treatment by minorities compared to Whites, and it is plausible that EAP services may serve as an entry point specifically for minorities who would not otherwise pursue behavioral health services. Understanding whether minorities have an alternative route to behavioral health treatment may be helpful in ameliorating behavioral health care disparities. In summary, the research objective of this dissertation was to evaluate if 1) race/ethnicity serves as a predictor of EAP service utilization, 2) individuals utilize EAP services as a complement or a substitute for behavioral health services and 3) whether that relationship differs by race/ethnicity.

Study Design: An individual-level retrospective, cross-sectional analysis. The unit of observation was the person-year.

Principal Findings: Among the sample of commercially-insured adults with access to both EAP services and behavioral health services through a managed behavioral health organization

(n=1,364,539 person-years), the EAP service utilization rate was 2%. Most minorities were found to have statistically significantly lower EAP service utilization relative to Whites, after controlling for other variables in the model. EAP services were utilized as complements – rather than substitutes – of traditional behavioral health services. When examining the results stratified by race/ethnicity, this association is seen by each racial/ethnic group.

Conclusions: The low EAP service utilization suggests stakeholders (e.g. employers, EAP vendors) should consider options to increase utilization. The study findings also suggest that, in a population of adults with employer-sponsored insurance, there are racial/ethnic differences in EAP service utilization. Due to the similar rates of behavioral health disorders relative to Whites, it is unclear why minorities would utilize these services less often. The finding that EAP services were utilized as complements suggests that access to the EAP may have encouraged more employees to seek outpatient behavioral health services as EAPs are typically promoted to employees in a way designed to have a destigmatizing effect. This was found to be true among all racial/ethnic groups.

Implications for Policy or Practice: A key challenge facing stakeholders is how to best encourage racial/ethnic minorities to utilize behavioral health services. Due to the overlapping nature of EAP services and behavioral health services, EAP services appear to be a valuable substitute for traditional behavioral health services.

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