Employee Assistance Program

How EAP Works

Eligible members can contact Duke EAP 24-hours/seven days a week by calling 1-800-336-DUKE (3853). All persons who utilize the EAP will receive an evalation of the nature of their problem and recommendations about the most appropriate course of treatment. In all cases, clinicians will make a judgment concerning whether the client's problem can be resolved in a brief treatment model, or if the problem will require longer term intervention. When brief treatment is judged clinically appropriate, the client(s) will receive additional counseling sessions up to the defined limit per covered individual or immediate family member. Multiple issues within a family unit will be dealt with on a case-by-case basis. "Immediate family members" are defined as those who are covered or are eligible for coverage as dependents, under the company's insurance plan. This definition will be broadened when appropriate and when approved by the EAP administrator.

In cases where a couple or a family presents with a problem, the number of available sessions will still be the defined visit limit per covered individual rather than the sum total of eligible sessions for the persons involved. If any family member who is seen in conjoint sessions encounters another unrelated problem during the year, he/she will still be entitled to his/her full individual benefits of up to the defined visit limit. However, the total number of sessions to which a family is entitled will not exceed the sum of their individual benefits. In the rare event when a "troubled family" uses up all the available benefits, Duke OMHP will continue to provide referral services as needed.

When long-term outpatient, outpatient intensive, or inpatient care is determined to be the treatment model of choice, referral outside the EAP may be made after the initial evaluation session(s). Duke OMHP will coordinate this referral through the client's insurance. Typically at least two and usually three referral alternatives are provided. In the case of referrals for outpatient intensive or inpatient care, covered individuals may receive their EAP benefit at the conclusion of their hospitalization if the conditions are appropriate for short-term intervention.

When a referral outside the EAP is needed, Duke OMHP staff will make referrals to providers in the community appropriate for the client's problem, taking into consideration the client's financial circumstances. We make a concerted effort to match clients with the level of care most appropriate for the identified problem. We carefully consider the appropriateness of both professional care and self-help or para-professional options, such as Alcoholics Anonymous or similar organizations. We believe that both the client's and the company's interests are best served by recommendations which begin with the least restrictive care environment possible. Duke OMHP staff suggests Duke treatment services only in cases when this is the most appropriate source of treatment for the problem. (Even in these instances, we also offer non-Duke alternatives.)

Quality Assurance

Duke EAP maintains a quality assurance program that ensures continuous evaluation of our program, providers, and services. Quality assurance is achieved through:

1. Periodic review of treatment records.
   
   Chart are circulated among team clinicians and evaluated by qualified therapists. A standard Evaluation Form of Provider Cases is provided for documentation of assessment. Aspects of the treatment assessed include conceptualization of the presenting problem, mental status evaluation, diagnostic impression, and treatment strategies used and recommended. For complex cases, additional assessment of records is obtained from experienced psychiatrists. If any reviewer identifies problems with a case, the chart is further examined in a multi-disciplinary meeting including psychologists and other mental health professionals, such as social workers and/or psychiatrists. This team makes recommendations for corrective actions if needed, and direction is provided to the clinician working with the case.
   
   Duke EAP's own Quality Assurance activities may require further action to be taken if quality concerns are observed regarding a pattern among clinical records or the specific care of an individual. Duke EAP staff conducts this review and the client's identity is not revealed to anyone outside of the program.
   
   
2. Anonymous client satisfaction survey.
   
   This survey addresses the client's satisfaction with the services provided, as well as the outcome of his/her treatment in terms of presenting problems and symptoms. Permission for this follow-up evaluation, which is mailed to clients, is obtained at the initial intake session.
   
   
3. Appeal Process
   
   The appeal process addresses quality related complaints. If a client reports dissatisfaction with the quality of services, a "complaint file" will be opened. Duke EAP will collect relevant information and will submit the file for review of its multi-disciplinary quality team. If, in the team's judgment, additional evaluative information is needed, then another provider will complete an independent evaluation. In complex cases, an independent multidisciplinary evaluation may be requested.
   
   Once the quality team has completed the information collection process, an action plan will be developed and implemented. If the problem appears to be primarily a result of a "personality conflict" between a provider and a client, the client will be encouraged to seek help from another qualified provider. If the problem appears to be related to a legitimate quality concern, then the response will depend upon the severity of the incident. If the issue is minor in nature (i.e., a client complains that a provider was fifteen minutes late for a regularly scheduled appointment), then the EAP will assist the client, as needed, in resolving the matter with the provider. If the issue is more serious (e.g., a violation of the ethical principal governing care such as a breech of client confidentiality), then the response could involve steps up to and including removing the provider from the referral network and reporting the violation to the appropriate licensing board.

Reports

Quarterly, Duke EAP provides standardized reports at no additional charge. These reports indicate program utilization according to the number of clients seen, employee participation, dependent participation, self referrals, supervisory referrals, male participation, female participation, the types of presenting problems, client disposition, and additional services provided (e.g., 24 hour emergency contacts, supervisory consultation, organizational development, phone consultations).

Employee privacy and confidentiality is maintained by providing aggregated statistical reports to the company's management on utilization and costs. These reports do not provide information identifying individual clients or diagnoses. If, in our judgment, the release of specific statistical information may compromise confidentiality, we will not provide those results. Instead, we look for alternative ways to report which satisfy management needs without compromising confidentiality. Thus, the confidentiality of an individual employee who utilizes Duke EAP is assured, while a thorough account of utilization can be reported to the company.

Confidentiality

Duke EAP will protect the confidentiality of its clients to the fullest extent permitted by law. Except as noted below, no information of any kind is released to anyone, including the employer, without the client's written consent (or, in the case of a minor, the parent/legal guardian).

Exceptions to Confidentiality:

• Imminent Danger to Self or Others
  If a client informs Duke EAP of intent to harm him/herself or others, Duke EAP will be required to take reasonable steps to protect the client or others from harm and to arrange for needed professional services. In most situations, it is possible to develop a plan with voluntary consent of the client. When a voluntary plan is not possible, Duke EAP may find it necessary to contact appropriate persons without the client's consent (e.g., family members, emergency or public safety personnel, mental health professionals, law enforcement and court officials, and/or any person specifically threatened by a client).
  
  
• Child or Elder Abuse or Neglect
  If a client informs Duke EAP of behavior toward a child or a mentally incompetent or elder adult which might lead Duke EAP to suspect abuse or neglect, Duke EAP is required to notify appropriate state authorities. These authorities are empowered by the state to conduct an investigation, to take appropriate steps to protect suspected victims of abuse or neglect, and to seek appropriate legal remedies.
  
  
• Authorized Legal Access
  Lawyer and insurance requests for records are authorized only with the written permission of the client or formal subpoena by a court.