Running head: Cultural Competence in the Core Technology of Employee Assistance Programs
The relevance of incorporating Cultural Competence in the Core Technology of Employee
Assistance Programs
A conceptual paper
Sudha Nagarajan
Cultural Competence in the Core Technology of Employee Assistance Programs
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The relevance of incorporating Cultural Competence in the Core Technology of Employee
Assistance Programs
The world of work in the 21st century reflects vast structural changes and will continue to
evolve in response to trends in the economy and society. Globalization and technology are two
factors that have contributed to the mobility of people and businesses, enabling exchange of
ideas and competitiveness in the marketplace. The contemporary world of work reflects changes
in economies and industries, including rising investment in business services, outsourcing,
technological impact, mobility, wars impacting the economy, immigrant workers, and the
changing nature of employees because of globalization (“Futurework”, 2000). In their report,
Egerter, Decker, An, Grossman-Kahn and Braveman (2008) described the changes in the world
of work in the 21st century from manufacturing to service industries, multidisciplinary jobs
requiring knowledge-based work, workforce diversity reflected in terms of age, gender and
ethnicity, increased use of technology and collaborative work. The report also highlighted the
detrimental impact of workplace culture, job demands, physical and psychological strain related
to balancing work and family life, social support at work, and gender and racial discrimination in
the workplace on employee productivity and health.
The evolving nature of work and attributions of meaningful work depend on many
subjective factors based upon material and psychological satisfaction (Steger, Dik & Duffy,
2012). Compensation for work could relate to decisions regarding healthcare and lifestyle.
Traditionally, job benefits include health insurance, paid sick leave, access to workplace
wellness programs, retirement planning, legal services, childcare services and behavioral
healthcare. Some of these workplace benefits are offered through Employee Assistance
Programs (EAPs). The traditional function of EAPs is to provide a wide-range of services for
Cultural Competence in the Core Technology of Employee Assistance Programs
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employees as well as provide consultation and strategic planning for organizations through
knowledge and expertise of professionals trained in human behavior and mental health (EAPA,
2011). These functions are designed to enable a healthy work environment fostering growth for
the organization and its employees.
The development of EAPs is related to the need of employers to manage the adverse
effects of alcoholism on workplace productivity, working in conjunction with worker’s
compensation laws for employee safety (Sandys, 2012). The program was supported by the
passage of The Hughes Act of 1970 and the Drug Free Workplace Act of 1988, mandating the
development of education and support for employees struggling with alcoholism and substance
abuse through workplace interventions (Kurzman, 2013). Eventually, as the need grew, the
services of EAPs increased to include employees and their family members and offered a wide
range of services including mental health, work-life balance, crisis intervention, childcare, elder
care, wellness and prevention. This expansion of services (Steele, 1998) also corresponded with
the development of standards and guidelines for EAP practice (EAPA, 2010) through accrediting
bodies in order to define the role and functions of EAPs with local and global significance
(EASNA, 2013). EAP programs and services are modeled on the principle of evaluating
employee work performance, distinguishing it from the functions of occupational health services,
coaching, and mental health services (EASNA, 2009). The core functions of EAPs have been
defined by their accrediting bodies to include assistance to leadership, training for employees,
confidential services to employees and their family members, timely problem identification,
assessment, short-term interventions and treatment referrals, and performance evaluations
(EAPA, 2010).
Cultural Competence in the Core Technology of Employee Assistance Programs
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Commissioned by the U.S. Department of Health and Human Services (DHHS) Center
for Mental Health Services (CMHS), the National Business Group on Health (NBGH) formed
the National Committee on Employer-Sponsored Behavioral Health Services (NCESBHS),
which reported on “recommendations to improve the design, quality, structure and integration of
employer-sponsored behavioral health services” (NBGH, 2008, p. 5). The report is very
comprehensive, focused on the business value of EAPs for organizations, highlighting the returnon-investment (ROI) prospects of utilizing an effective EAP, and identifying the major
challenges for designing programs in keeping with current trends in the workplace. The NBGH
(2008) definition for highly effective EAPs reads:
“Employee Assistance Programs provide strategic analysis, recommendations, and consultation
throughout an organization to enhance its performance, culture, and business success. These
enhancements are accomplished by professionally trained behavioral and/or psychological
experts who apply the principles of human behavior with management, employees, and their
families, as well as workplace situations to optimize the organization’s human capital.”
The core functions of EAPs are summarized as: conducting assessment of needs,
regulatory compliance, advisory functions, service delivery functions, policies and operating
procedures, staffing criteria and regulations, case consultations, supervision, professional
development, record keeping, ethical issues, including confidentiality and regulatory guidelines
(EAPA, 2010). The Council on Accreditation (COA), which serves to accredit EAPs, defines the
program in terms of certain core technology, as published by EAPA (2010, p.6):

Consultation with, training of, and assistance to work organization leadership (managers,
supervisors, and union officials) seeking to manage troubled employees, enhance the
work environment, and improve employee job performance;
Cultural Competence in the Core Technology of Employee Assistance Programs

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Active promotion of the availability of EA services to employees, their family members,
and the work organization.

Confidential and timely problem identification/assessment services for employee clients
with personal concerns that may affect job performance;

Use of constructive confrontation, motivation, and short-term intervention with employee
clients to address problems that affect job performance;

Referral of employee clients for diagnosis, treatment, and assistance, as well as case
monitoring and follow-up services;

Assisting work organizations in establishing and maintaining effective relations with
treatment and other service providers, and in managing provider contracts;

Consultation to work organizations to encourage availability of and employee access to
health benefits covering medical and behavioral problems including, but not limited to,
alcoholism, drug abuse, and mental and emotional disorders; and

Evaluation of the effects of EA services on work organizations and individual job
performance.
While these roles and responsibilities address the essential functions of EA services, they
lack specific mention of adaptation of services to meet emerging workplace needs. Stakeholders
in the EA industry and researchers in the field like Attridge (2012) endorse the adaptation of
EAP Core Technology to suit the specific needs of organizations in different countries as a trend
for EAPs. Given the huge diversity in the current workplace such as differences due to ethnicity,
age, gender, sexual orientation, ability and returning military personnel to a civilian workplace,
cultural competence can be viewed as a basic requirement for employees, management and
organizations. Organizations have a corporate social responsibility to address the healthcare
Cultural Competence in the Core Technology of Employee Assistance Programs
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needs of vulnerable groups of employees, which is demonstrative of the ROI in terms of
improved productivity.
In the wake of changing trends in the workplace, EAPs have made reciprocal adjustments
to their role and in their service delivery. These adjustments not only include change and
expansion of services offered (Steele, 1998) but the development of standards and guidelines for
practice in employee assistance programs (EAPA, 2010) as well as the establishment of an
accrediting body (EASNA, 2013). The Employee Assistance Professionals Association (EAPA,
2010) and Employee Assistance Society of North America (EASNA, 2013) are committed to the
development of standards of excellence for EAPs, providing ongoing educational needs of EA
professionals, focusing on the development of EAP core technology and best practices, and
identifying areas for research. EASNA, described as a trade association of the employee
assistance industry, was designed in 1985 to conduct research, and provide education, and
advocacy of mental health and wellness in the workplace in addition to the development of best
practices for EAPs. The EAPA Standards and Professional Guidelines (2010) stated that
program design must incorporate the needs and goals of the employees and the organization, and
evolution and assessment of programs should be continuous in keeping with changing needs.
The following standards are noteworthy in this context:
E. ADDITIONAL SERVICES
STANDARD: The employee assistance program shall remain alert for emerging needs and may
add new services when they are consistent with and complementary to the employee assistance
program (EAP) core technology. (EAPA, 2010, p. 10).
Though EAPs offer services to employees and dependents to address their mental and
emotional wellbeing, an argument can made that there is under-utilization of such services for a
Cultural Competence in the Core Technology of Employee Assistance Programs
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plethora of reasons. Some of the reasons for under-utilization of EA services include lack of
visibility of services, stigma and discrimination regarding mental health and addictions, and
external models with reduced promotion and usage (Attridge, 2012). The trends in EAP models
reflect the inclusion of proactive and consultative services, and the role of mental health in
employee productivity and organizational performance (Attridge & Burke, 2011). Making the
workplace an avenue to reduce healthcare disparities can ensure both employee wellbeing and
organizational productivity, maximized by the provision of services that are culturally
appropriate. This orientation towards cultural sensitivity must be incorporated into the core
philosophy of the EA industry as a timely recognition of the need to acknowledge the impact of
diversity and inclusion in the workplace. Indeed, if new services addressing diversity needs are
included to EAPs, it should be reflected in the EAP Core Technology as a standard that is
“complementary and consistent” with it (EAPA, 2010, p. 10).
Cultural competence is best understood from the context of healthcare equity and equal
employment opportunity. According to the Office of Minority Health, a division of the United
States Health and Human Services department, an adaptation of cultural competence as
developed by Cross, Bazron, Dennis, & Isaacs (1989) reads as follows:
Cultural and linguistic competence is a set of congruent behaviors, attitudes, and policies that
come together in a system, agency, or among professionals that enables effective work in crosscultural situations. 'Culture' refers to integrated patterns of human behavior that include the
language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial,
ethnic, religious, or social groups. 'Competence' implies having the capacity to function
effectively as an individual and an organization within the context of the cultural beliefs,
behaviors, and needs presented by consumers and their communities.
Cultural Competence in the Core Technology of Employee Assistance Programs
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Cross et al. (1989) postulated the development of cultural competence along a continuum
of cultural destructiveness, incapacity, blindness, pre-competence, basic competence to advanced
competence. The National Culturally and Linguistically Appropriate Services (CLAS)
Standards, based on this definition, are a mandated set of culturally competent services that are
required of the health service industry (Office of Minority Health, USDHHS, n.d.). The
taskforce of the Office of Minority Health (OMH), in conjunction with the agency of the
Affordable Care Act (ACA), is dedicated to develop initiatives to reduce healthcare disparities
among a growing population of minorities through collaboration with governmental agencies
such as: National Institute of Health (NIH), Centers for Disease Control & Prevention (CDC),
Food & Drug Administration (FDA), Substance Abuse & Mental Health Services Administration
(SAMHSA), Agency for Healthcare Research & Quality (AHRQ). The specific goals of the
DHHS Action Plan (DHHSOMH, 2015) to address healthcare disparities include “improving
cultural competency and diversity of the behavioral health workforce” (p.18). Georgetown
University Center for Child and Human Development (GUCCHD) has conducted a lot of
research on cultural competence based on the work of Cross et al. (1989). In order to practice
cultural and linguistic competence, organizations are required to value diversity in the workforce,
conduct self-assessment for cultural competence, effectively manage the dynamics of a diverse
and globalized marketplace through the incorporation of values and policies that reflect
inclusion, and implement diversity practices in policy making, administration, and service
delivery. Such an institutionalized practice of cultural competence is required to involve
consumers, key stakeholders and communities for organizations to adapt to a constantly evolving
globalized workplace (National Center for Cultural Competence, GUCCHD, 2004).
Cultural Competence in the Core Technology of Employee Assistance Programs
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According to an Executive Order 13583 (2011), issued by President Obama, ‘workforce
diversity’ refers to differences between people that can be based on characteristics such as race,
ethnicity, language ability, age, gender, sexual orientation, socioeconomic status, family
structure, and disability. ‘Inclusion’, is the organizational culture facilitating connection of
employees to the organization through collaboration, anti-discriminatory practices, and
empowerment through equal opportunity. The Executive Order (2011) highlighted three goals
specific to the federal workplace: diversity, inclusion and sustainability achieved through the
adoption of identified best practices to promote integration, collaboration and equal opportunity.
In citing federal laws pertaining to such practice in governmental workplaces, the order called
for the practices to be extended by example to high performing organizations responding to the
difficult 21st century global workplace.
As the incidences of racism and terrorism increase globally, they impact people
transnationally through direct as well as vicarious traumatization. In order to respond effectively
to ensure the safety of employees and organizations, EAPs must be staffed by mental health
professionals and educational trainers who practice to enable cross-cultural understanding for the
prevention of risk to employees and the organization. EAPs responding to emerging needs of
global workplaces have a responsibility to adapt and innovate their programs and products in
order to be effective.
To add credibility to EAP services and add value to the Return-On-Investment (ROI) of
such programs, connections can be made directly between theoretical underpinnings of EAPs
and practical application through evidence-based practices (EBP) in organizations. The
Evidence-Based System for Innovation Support (EBSIS) is a logic model proposed by
Wandersman, Chien and Katz (2012) incorporating four elements (tools, training, technical
Cultural Competence in the Core Technology of Employee Assistance Programs
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assistance and quality assurance/quality improvement) interactively to achieve identified
outcomes in programs, policies and processes. Needs assessment enables the determination of
current capacity in organizations as well as identification of desired outcomes. According to the
EBSIS model, a Getting To Outcomes (GTO) framework can be utilized to structure the
evidence base from theory to evidence, practice and accountability. There are ten steps in the
GTO which involve needs assessment, establishment of goals, identification of best practices,
assessment for best fit, capacity concerns, development and implementation of plan, process
evaluation, outcome evaluation, ingoing quality improvement, and sustainability issues
(Wandersman, et al., 2012). This model can be effectively conceptualized for the development
of EBP to enhance workplace adjustment and productivity through an inclusion of cultural
competency in the services offered through EAPs.
Gregory Jr., Van Orden, Jordan, Portnoy, Welsh, Betkowski, Charles, and DiClemente
(2012) conducted a study incorporating cultural competence in an Interactive Systems
Framework (ISF) with a purpose of innovative research and practice in human capacity building.
Their research suggested that the ISF refers to the use of heuristic approaches to emergent
prevention research. The authors presented a very succinct description of the ISF in terms of
systemic interaction between dissemination of research for practical use, capacity building to
facilitate innovation, and an evaluation of current use of innovation. Gregory Jr. et al. (2012)
conducted a needs assessment of the agency that participated in the project to incorporate
culturally competent innovative practices. An initial meeting discussed the objectives of the
research and elicited areas for improved service delivery, which was attended by members of the
leadership staff and stakeholders. The needs assessment was completed by the agency’s director
and key administrative staff and included information regarding the agency’s organizational
Cultural Competence in the Core Technology of Employee Assistance Programs
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structure, clientele, screening and interventions practiced, standards of care, interest in training,
staff capability, leadership style, organizational climate, and ongoing measures of quality
improvement of programs. Optimizing the use of EBP was achieved by approaching the agency
with feedback that was nonjudgmental and encouraging. Since it was a participatory action
research, the feedback was disseminated in a collaborative manner, thereby facilitating
ownership of innovations by the staff with the knowledge of EBPs and agency culture aiding the
ongoing process of capacity building. Questionnaires and anonymous evaluations following
trainings were one way the agency performed continuous evaluation. The success of such an
interactive model is demonstrated by the effectiveness of disseminating EBPs that responded to
the needs of the agency with innovations implemented and continuously evaluated for cultural
competency.
The model for capacity building strategies developed by Gregory Jr. et al (2012) can be
adapted for the development of evidence-based cultural competency in EAP service. The model
is adaptable for any organization that is contemplating innovation in services. Organizations can
effectively reduce their healthcare costs and improve employee performance by providing
preventative and proactive services using existing EAPs. Conducting a needs assessment would
provide the basis for customizing services to suit the employee demographics of the organization
and make effective use of human capital. Assessing utilization of existing services and
innovations required would help organizations make optimal use of employee healthcare
services, catering to emerging needs and reducing underutilized and perhaps obsolescent
services. Responding to changing employee needs requires corporate commitment and
responsibility and could ensure organizational accountability as well as employee loyalty and
Cultural Competence in the Core Technology of Employee Assistance Programs
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retention. The call for action to the EA industry as utilizing EBP through scientific research was
articulated by Bennett, Bray, Hughes, Hunter, Frey, Roman and Sharar (2015).
Organizations such as the Robert Wood Johnson Foundation (RWJF) support a mission
to build a Culture of Health for all Americans and the Foundation provides philanthropic support
to communities, organizations, and business leaders to achieve social change by partnering with
them (Robert Wood Johnson Foundation, 2015). Organizations have a corporate social
responsibility towards the health and well being of their employees. They are mandated to
provide equal opportunities and desist from discriminatory practices based on gender, age, sexual
orientation, and ability. However, organizational productivity can be enhanced by facilitating
better employee-workplace adjustment, bridging the gap between services and their utilization,
and by increasing inclusion practices through diversity training that is infused in the vision and
mission of the organization, and practiced through existing employee assistance services using
innovative models of human capacity building. In view of emerging needs, it would be a wise
investment for the employee assistance industry to expand existing services to include the
development and implementation of diversity training customized for organizational needs.
More importantly, the EA profession would make a very prudent and salient ideological decision
to incorporate the language of cultural responsiveness into the principles of EA Core
Technology.
Cultural Competence in the Core Technology of Employee Assistance Programs
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