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Benchmarking key service quality indicators in UK

Employee Assistance Programme Counselling: A CORE
System data profile
a a b b
John Mellor-Clark , Elspeth Twigg , Eugene Farrell & Andrew Kinder
a
CORE Information Management Systems Ltd , Rugby , UK
b
EAPA UK Executive Committee , Wilson , Derbyshire , UK
Published online: 27 Sep 2012.

To cite this article: John Mellor-Clark , Elspeth Twigg , Eugene Farrell & Andrew Kinder (2013) Benchmarking key service
quality indicators in UK Employee Assistance Programme Counselling: A CORE System data profile, Counselling and
Psychotherapy Research: Linking research with practice, 13:1, 14-23, DOI: 10.1080/14733145.2012.728235

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 Counselling and Psychotherapy Research, 2013
Vol. 13, No. 1, 14
23, http://dx.doi.org/10.1080/14733145.2012.728235

RESEARCH ARTICLE

Benchmarking key service quality indicators in UK Employee

Assistance Programme Counselling: A CORE System data profile

JOHN MELLOR-CLARK1*, ELSPETH TWIGG1, EUGENE FARRELL2, &

ANDREW KINDER2
1
CORE Information Management Systems Ltd, Rugby, UK, and 2EAPA UK Executive Committee, Wilson, Derbyshire, UK
Downloaded by [University of Otago] at 04:58 26 December 2014

Abstract
Background: Levels of psychological distress appear to be increasing in the workplace, in parallel with the growth of
employee assistance programme (EAP) provision offering a range of talking treatments. However, such growth takes place
in the absence of a substantive body of supporting research evidence despite a quarter of a decade of research activity. Aims:
To analyse a national sample of EAP data and profile relative service quality on a set of key service indicators. Method:
CORE System data profiles of over 28,000 clients were voluntarily donated by six EAP service providers. An established
benchmarking methodology was used to assess the relative quality of EAP service provision compared with published
CORE System benchmarks for NHS primary care and UK higher education student counselling services. Results: High
quality data profiled an EAP service clientele who were quantifiably distressed, accessed treatment quickly, with the
majority completing treatment and demonstrating high rates of recovery and/or improvement relative to published
benchmarks from the NHS and HE comparative sectors. Limitations of the study and implications for practice and further
investigation are considered.

Keywords: CORE System; CORE-OM; benchmarking; EAP; outcomes; workplace counselling

Introduction ill-health. Mental health problems are the largest

It appears the current economic climate places
increasing pressure on employers and employees.
This is evidenced by studies such as Mind’s ‘Taking
Care of Business’ (Mind & the Federation of Small
Businesses, 2011) which found that, in a sample of
over 2000 employees, 41% described themselves as
stressed or very stressed in their jobs, with workplace
stress ranked higher than money worries, marriage/
relationship problems or health concerns. The study
also reported that employees who remain in work
without adequate support for their mental health
problems cost UK businesses up to £15.1 bn per
annum. Staff turnover as a result of mental health
problems costs an additional £2.4 bn. Furthermore,
it is estimated that approximately 70 million working
days are lost each year due to employee mental
single source of disability in the United Kingdom
accounting for 23% of the total ‘burden of disease’
(Department of Health, 2011, p. 3). Importantly,
co-morbid mental health problems are also an issue
in health management. For example, the Kings
Fund & the Centre for Mental Health (2012)
reported that ‘many people with long term physical
health conditions also have mental health problems’
(p. 1), with ‘particularly strong evidence for a close
association with cardiovascular diseases, diabetes,
chronic pulmonary obstructive disease and muscu-
loskeletal disorders’ (p. 3). The financial impact of
employee mental ill-health is possibly a stronger
incentive for organisations to tackle this problem
than the impact on individual employees. Whatever
the reasons, the scale of this problem means that

*Corresponding author. Email: john.mellor-clark@coreims.co.uk

# 2013 British Association for Counselling and Psychotherapy

 Benchmarking key service quality indicators in EAP counselling
organisations, small or large, are keen to explore
possible solutions and workplace counselling offers
an attractive potential solution.
Workplace counselling has been defined as ‘the
provision of brief psychological therapy for employ-
ees of an organisation, which is paid for by the
employer’ (McLeod & Henderson, 2003, p. 103).
Employee Assistance Programme (EAP) provision is
the internal/external provision of such services,
which typically includes face-to-face counselling.
Arthur (2002) surveyed workers attending counsel-
ling provided by an EAP: 24% of attendees returned
a General Health Questionnaire (GHQ) and 87% of
respondents were experiencing significantly high le-
vels of psychiatric problems. He concluded that
employers are providing a service for those in genuine
need and suggested that employees reportedly suffer-
Downloaded by [University of Otago] at 04:58 26 December 2014
ing from stress might actually be experiencing sig-
nificant mental health problems (particularly anxiety
and depression) and be in need of professional
support. Further, McLeod (2001) concluded that
EAPs achieved 90% satisfaction rates and were not
seen as being less effective than other counselling
interventions.
According to the Employee Benefits Healthcare
Research (2011), EAP provision within organisations
has trebled within the last decade. In 2002, EAP
services were offered as a core employee benefit by
23% of survey respondents. By 2011, EAP services
were ranked as the most popular core employee
benefit, offered across 73% of respondent organisa-
tions. Yet it appears such growth takes place in the
apparent absence of a substantive archive of pub-
lished supportive research evidence (McLeod, 2001;
2008; 2010; McLeod & Henderson, 2003) and, as
observed by Alker and Cooper (2007), with little
new or substantive research activity since the early
studies by Cooper and Sadri (1991) and Cooper,
Sadri, Allison, and Reynolds (1990). This paper aims
to summarise published views on UK EAP effective-
ness, describe the use of the CORE System by UK
EAPs as standardised contemporary evaluation ac-
tivity, and compare key service quality indicators
with published data drawn from NHS primary care
psychological therapies (Bewick, Trusler, Mullin,
Grant, &Mothersole, 2006; Cahill, Potter, & Mullin,
2006; Connell, Grant, & Mullin, 2006; CORE IMS,
2011a; Mullin, Barkham, Mothersole, Bewick, &
Kinder, 2006) and UK higher education counselling
services (CORE IMS, 2011b).
McLeod’s (2001) first systematic review of the
literature on workplace counselling spanned a period
15
of 25 years and drew on studies that reflected the
experiences of more than 10,000 clients. The review
was later updated (McLeod, 2008) and helped
synthesise the current key supportive evidence for
the broad domain of workplace counselling sum-
marised in the Key Facts box (Figure 1).
Following Henderson’s critique that ‘the objective
observer looking at clinical outcomes would un-
doubtedly conclude that there is no reliable evidence
that workplace counselling is of benefit’ (McLeod &
Henderson, 2003, p. 104), McLeod (2010) offered
supportive evidence on the potential effectiveness of
workplace counselling with a meta-analysis drawn
from published ‘good quality’ outcome studies
where an effect size (ES) could be calculated. The
effect size is a measure of the standardised difference
between mean scores (using sample standard devia-
tions) and allows direct comparison between studies.
The significance of an effect size is open to inter-
pretation depending on context. However, Cohen
(1992) stated that in psychological and behavioural
research an effect size of 0.8 is considered large.
The average pre-counselling to post-counselling
effect size was calculated to be 0.9. However, the
total client cohort across all 10 studies amounted to
just 989 clients, despite spanning almost 20 years
(1987
2005).
Research support specifically for EAPs has been
very limited and in the UK little has been published
on effectiveness. Cayer and Perry (1988) pointed out
‘most research has focused on private sector EAPs
and is primarily descriptive or promotional without
much rigor in evaluation methodology or design’
(p.153). In McLeod’s (2001) conclusions to the
systematic review of the research literature, he
expressed concern that compared with other areas
Key Facts on Workplace Counselling (from McLeod, 2008)
♦ Overall, 10% of the UK employed population have access to workplace
counselling services
♦ People who make use of workplace counselling typically report high
levels of psychological distress
♦ Counselling interventions are generally effective in alleviating
symptoms of anxiety, stress and depression in the majority of
workplace clients
♦ There is no evidence that one approach to counselling is more
effective than any other. Positive results have been reported using a
variety of models of counselling including cognitive-behavioural,
psychodynamic, person-centred, rational-emotive and solution
focused
♦ Significant benefits for clients can be achieved in three to eight
sessions, with only the most severely disturbed clients appearing to
require long-term counselling or referral to specialist services
Figure 1. Key facts on workplace counselling (from McLeod,
2008).
 16 J. Mellor-Clark et al.
of counselling and psychotherapy there was little
systematic published research into EAPs. Kirk and
Brown (2003) reinforced McLeod’s view, stating
‘EAP evaluations have not yet produced the quality
of evidence that would enable an unqualified en-
dorsement of EAP interventions in the management
of stress and other personal and organizational issues
in the workplace’ (p. 141). Finally, Alker and Cooper
(2007) acknowledge the void in their commentary
on some of the complexities involved in workplace
counselling evaluation, and concur that there has
been little movement or change in evaluation pro-
cesses since any of these earlier works.
From the above brief synopsis we can conclude
there to be a relative paucity of supportive research
evidence for workplace counselling generally, and
even less to support EAP service provision specifi-
Downloaded by [University of Otago] at 04:58 26 December 2014
cally. Furthermore, we know from McLeod’s com-
mentaries that much of the published research is
limited in utility (e.g. for inclusion in effect size
calculation) due to poor (outcome) data quality and/
or therapy (process) specificity. It is against this
background that we offer an outline profile of a
decade’s investment by a small group of UK EAPs to
grow a pool of high quality practice-based evidence
to contribute to both the quantity and quality of
supportive evidence for workplace counselling.
Method
Design
The design was a retrospective, observational study
of routine outcome measurement data donated by
EAP services utilising the CORE System (Mellor-
Clark, Barkham, Connell, & Evans, 1999) and
CORE-PC standardised data collation software
between 2001 and 2011.
The dataset
Data were collated for a total of 31,871 clients
through anonymised data donations from sixUK
EAP service providers. Data cleaning removed:
clients with missing ages and/or gender (n 1937);
clients aged less than 16 or over 65 (n 37); and
clients receiving anything other than individual
therapy (n 1421). The final dataset comprised
28,476 clients distributed across donor services
contributing between 29 and 13,525 cases with
80% of data supplied by two large EAP service
providers.
Clients averaged 39.6 years in age (SD 9.75,
range 16
65); 14,466 (50.8%) were male; 23,871
(84%) were white; 687 (2%) were black; 1032 (4%)
were Asian; 434 (2%) were categorised as other or
mixed ethnicity; and for 2452 (9%) ethnicity data
was not recorded. Clients were not formally diag-
nosed, but practitioners recorded their presenting
problems and/or concerns using pre-defined cate-
gories on the CORE Therapy Assessment Form. For
those clients with assessment outcomes recorded
(n 27,891), client problems included anxiety/stress
(recorded at some level for 76%); depression (48%),
interpersonal/relationship problems (42%); low self-
esteem (38%); work problems (36%); bereavement/
loss (25%); physical problems (13%); trauma and
abuse (10%); as well as other less frequently cited
problems. Multiple problems were recorded for most
clients, with depression and anxiety (often with other
concurrent problems) being the most common
pairing (n 11,297; 41%).
The clients were seen by a total of 1786 practi-
tioners associated with six EAP providers, but it
should be noted that as practitioners may work for
several EAPs, the practitioner sample cannot be
reported to comprise 1786 individual practitioners.
Practitioner anonymity compromises the ability to
report on the number of individual practitioners.
The minimum number of clients recorded for any
single practitioner ID was 1 and the maximum was
854.
The CORE System does not record practitioner
characteristics, but therapeutic approaches were
recorded through the CORE End of Therapy
Form. The most common approaches used were
integrative (38%); person-centred (32%); struc-
tured/brief (35%); cognitive-behavioural (23%);
and psychodynamic (9%). Data on therapy type
was recorded for 24,639 clients with approximately
half of clients (51%) receiving more than one type of
treatment. The maximum number of different treat-
ment types recorded was nine. The average number
of sessions attended by clients completing therapy
was four (SD 1.6), with 1448 (6%) attending a
single session; 2790 (11%) two sessions; 3549 (14%)
three sessions; 8283 (33%) four sessions; 6821
(27%) five sessions; and 951 (4%) receiving six
sessions or more.
CORE system measures
All services donating anonymised data to the retro-
spective study used the CORE System. The system
 Benchmarking key service quality indicators in EAP counselling
includes the CORE Outcome Measure (CORE-
OM; Evans et al., 2002), the CORE Therapy
Assessment Form and the CORE End of Therapy
Form (Mellor-Clark et al., 1999).
The self-report CORE-OM consists of 34 high and
low-intensity, positively and negatively-framed items
which address subjective well-being, symptoms, func-
tioning and risk (harm to self, harm to others). A 0
(‘not at all’) to 4 (‘all of the time’) scoring scale is
used. CORE OMs are considered valid if no more
than three items are missing. CORE-OM clinical
scores (0
40) are calculated by multiplying the mean
of all completed items by 10 and rounding to the
nearest whole number. Two practitioner-completed
audit forms, the Therapy Assessment Form and End
of Therapy Form complement the CORE-OM. The
Therapy Assessment Form is completed at the first
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contact session while the End of Therapy Form is
completed at the final client contact.
CORE system benchmarks
CORE data benchmarks and averages are drawn
from pools of anonymised data donated by CORE
System and CORE-PC users. The first set of
benchmarks was drawn from 34 NHS primary care
psychological therapy services and addressed 33,587
clients seen by 637 practitioners. They appeared in a
special edition of Counselling and Psychotherapy
Research in March 2006 that rationalised and defined
the key service quality indicators used herein (see
Mellor-Clark, Curtis-Jenkins, Evans, Mothersole,
&McInnes, 2006). Subsequent donations referred to
herein have been collated for NHS Primary Care
(PC, CORE IMS, 2011a; n69,234) and UK higher
education counselling services (HE, CORE IMS,
2011b; n30,519). All CORE System benchmarks
are available for free download from the CORE IMS
website at http://www.coreims.co.uk/Support_User_
Benchmarking.html
Service-level benchmarks are generated by calculat-
ing averages for individual services on the relevant
indicator, ranking all services by these averages and
calculating means and quartiles to produce bench-
marks for that particular indicator. Client-level bench-
marks look at averages over the dataset as a whole,
irrespective of the service at which the client was seen.
Data collection
Sites determined the administration of the CORE
System individually, with guidance provided through
17
bespoke training and the CORE System User
Manual (CORE System Group, 1998). However,
all donor sites required clients to complete the
CORE-OM at their first and last contact sessions.
Practitioners completed the Therapy Assessment
Forms at intake and End of Therapy Forms at case
closure. All data were managed in-house by the
individual EAP services. The process of electronic
data donation for this review stripped all client-
identifiable data and/or variables for the purpose of
aggregation.
Reliable and clinically significant improvement
The established mean cut-off differentiating a clin-
ical and non-clinical population is a CORE-OM
clinical score of 10 (Barkham et al., 2006; Connell
et al., 2007). Clients scoring 10 or more clearly
demonstrate both psychological distress and a
greater capacity to benefit measurably from therapy.
As reported in previous published retrospective
cohort analysis (see Stiles, Barkham, Mellor-Clark, &
Connell, 2008), following Jacobson and Truax (1991),
we categorised clients as reliably and clinically sig-
nificantly improved if they entered therapy with
CORE-OM scores above the clinical cut-off and left
therapy with a sub-clinical score of a magnitude that
couldn’t be attributed to measurement error. Statisti-
cally significant change on the CORE-OM requires a
change in clinical score of 5 or more. A clinical score
reduction of 5 or more points between beginning
and end of therapy (statistically reliable change) is
classified as ‘improved’, while an increase of 5 or more
points is classified as ‘deteriorated’. Clients who move
from above the clinical cut-off to below cut-off over
the course of therapy and show a reliable improvement
(i.e. show reliable and clinically significant change) are
classified as ‘recovered’.
Effect size
This analysis uses Hedge’s g (Hedges & Olkin, 1985)
as a measure of effect size. This is calculated using
the difference between the pre- and post-treatment
means, divided by the pooled standard deviation for
the sample, with the unbiased estimator d used as a
correction factor.
Ethical approval
As a retrospective collation of anonymised routine
service evaluation data ethical approval is unnecessary.
 18 J. Mellor-Clark et al.
All clients are informed that their anonymised data
may be aggregated and used for service development
and academic publication.
Results
Completing the CORE outcome measure
From the total cohort of 28,746 clients, 91% (n 75th percentile
26,126) completed a valid CORE-OM at their first
contact session. Published average completion rates
for PC are 86% (CORE IMS, 2011a) and 83%
(Bewick et al., 2006) and for HE are 84% (CORE
IMS, 2011b).
Table I shows the benchmarks for completion of
pre-therapy CORE-OMs. Completion rates ranged
between 89% and 97%. For benchmarking pur-
Downloaded by [University of Otago] at 04:58 26 December 2014
poses, any services with less than 91% of clients with
valid pre-therapy CORE-OMs would fall in the
bottom quartile. Conversely, services having com-
pletion rates in excess of 96% would fall in the top
quartile.
To calculate benchmarks for pre and post-therapy
CORE-OM completion, clients were excluded on
two key criteria: Firstly, those who were not recorded
to have been ‘accepted for therapy’ (n 2,333), and
secondly, those who had assessment dates less than
nine months before data donation (n3,481). This
was intended to deselect clients who did not enter
therapy or who were plausibly still in therapy, and
created a cohort of 22,662 (80%) from the full
sample of 28,476.
Table II gives benchmarks for the percentage of
clients having valid CORE-OM measures at the
beginning and end of treatment. Completion rates
across services averaged 65.5% (range 42.9
76.6%).
Services within the top quartile had pre and post-
therapy completion rates in excess of 74%. The PC
published average pre and post-therapy completion
rates are 42% (CORE IMS, 2011a) and 38%
(Bewick et al., 2006). The HE average rate is 41%
(CORE IMS, 2011b).
Table I. Pre-therapy CORE-OM completion benchmarks.
Pre-therapy
Mean (SD) 93.3 (3.14)
Minimum 89.4
Maximum 96.8
25th percentile 90.8
Median 93.4
75th percentile 95.9
Table II. EAP service-level benchmarks for completion rates (%)
of pre-post and post-therapy CORE-OM.
Pre-post therapy
Mean (SD) 65.5 (8.45)
Minimum 42.9
Maximum 76.6
25th percentile 63.8
Median 67.3
74.3
Clients scoring above cut-off at intake
A total of 87.5% of clients (n 18,356) with valid
pre-therapy data scored above cut-off at intake.
Table III presents the service-level benchmarks for
percentages of clients scoring above CORE-OM cut-
off at intake (range 82
90%). Services with less than
86.4% of clients above cut-off have ‘low’ (quartile)
entry score levels while those with more than 88.1%
above cut-off have ‘high’ (quartile) entry score levels.
The PC published average percentages of clients
scoring above clinical cut-off at intake are 88%
(CORE IMS, 2011a) and 89% (Mullin et al.,
2006). The HE average percent is 90% (CORE
IMS, 2011b).
Waiting times for therapy
In addition to the general data cleaning procedures
described above, clients with no referral date pro-
vided, or with no valid values for any of the relevant
dates (n 1,039), were removed for the purposes of
waiting time calculations. Finally, individual data
values were excluded if there were more than two
years between referral/assessment and therapy, or if
the waiting times values were negative. This yielded
a final dataset of 27,437 clients representing 96% of
the total cohort.
At a client level, the mean waiting time between
referral and first assessment was 8.8 days (SD 
13.28; n 27,243). Comparative figures for PC
and HE are presented in Table IV below.
Table III. Service-level benchmarks for intake CORE-OM scores.
% above cut-off at intake
Mean (SD) 86.8 (2.46)
Minimum 82.4
Maximum 89.5
25th percentile 86.4
Median 87.2
75th percentile 88.1
 Benchmarking key service quality indicators in EAP counselling 19

Table IV. Comparison of average waiting times (days) for Higher the practitioner declared a planned or unplanned
Education (HE), Primary Care (PC) and EAP services. ending on the End of Therapy Form. It is likely that
Referral to first assessment
the percentage of unplanned endings is higher than
the ‘declared rate’ because the missing data includes
Sector Mean SD both planned and unplanned endings (see Connell
EAP 9 13.3 et al., 2006).The ‘estimated rate’ of unplanned end-
PC 64 63.9 ings is calculated to compensate for missing data on
HE 16 55.3 this performance indicator. The average ‘declared
rate’ of unplanned endings was 16.0% (SD3.45;
service range 12.5
21.9%) compared with ‘declared’
Assessment outcome
rates for PC (CORE IMS, 2011a) of 22.5% and for
Clients with no assessment outcome recorded were HE of 27% (CORE IMS, 2011b). A total of 39% of
removed from the analysis (n 585), yielding a total all declared unplanned endings in the EAP sample
dataset of 27,891. Overall, 92.5% of clients (n  were due to loss of contact.
25,803) were accepted for therapy. PC proportions The average ‘estimated rate’ of unplanned endings
of clients accepted into therapy are 80% (CORE was 27.0% (SD 8.75, range 19.8
42.9%). This
IMS, 2011a) and 81% (Cahill, Potter, & Mullin, compares with 52% for PC (CORE IMS, 2011a)
Downloaded by [University of Otago] at 04:58 26 December 2014

2006). The HE proportion is 72% (CORE IMS,
2011b). Table V details benchmarks for assessment
outcomes across participating EAP services.
Therapy endings
The data sample comprised 22,662 clients indicated
as having been accepted for therapy, or a trial period
of therapy, and with assessment dates more than
nine months before the data collection date.
As with other CORE benchmarks (e.g. CORE
IMS, 2011a), there were a number of clients for
whom no therapy ending was indicated. The average
missing data rate was 5.5% (service range 2.1

28.6%). The average PC rates of missing data on
therapy endings are 30% (CORE IMS, 2011a) and
19% (Connell, Grant, & Mullin, 2006). The HE rate
is 25% (CORE IMS, 2011b).
In line with published PC and HE benchmarks,
two sets of benchmarks for therapy endings were
calculated. The ‘declared rate’ uses only data where
and 53% for HE (CORE IMS, 2011b). Table VI
gives benchmarks for ‘declared rate’ and ‘estimated
rate’ of unplanned endings.
Table VII compares the number of sessions
attended by clients (where information is available),
against the type of therapy ending. The average
number of sessions attended by clients with planned
endings to therapy was four sessions, with over half
of clients with unplanned endings attending two
sessions or less.
Pre-post change: Recovery and improvement
Clients with no valid pre-post therapy data (n 
10,956) were excluded from this phase of the
analysis, leaving a total data sample of 17,520
clients. Individual services contributed between 17
and 8,321 clients.
For all clients with valid pre-post therapy
CORE-OM data the mean pre-therapy clinical score
was 17.4 (SD 6.01) and the mean post-therapy

Table V. Assessment outcome benchmarks (%)
whole sample.

Assessment outcome

Accepted into Accepted for trial Assessment/ one Referred to another Unsuitable for Long
therapy period session only service therapy consultation

n 25,803 340 701 288 705 54

Mean% 92.3 1.2 2.9 1.2 2.4 0.1
(SD) (9.13) (1.11) (2.06) (1.76) (5.34) (0.14)
Minimum 73.8 0 1.5 0 0 0
25th percentile 95.0 0.3 1.6 0.1 0 0
Median 95.7 1.1 1.7 0.3 0.2 0
75th percentile 96.0 1.8 3.5 1.7 0.5 0.1
Maximum 98.0 2.9 6.6 4.4 13.3 0.3
 20 J. Mellor-Clark et al.
Table VI. ‘Declared’ and ‘Estimated’ rates of unplanned endings Discussion
in EAP services.
The main aim of this retrospective analysis was to
‘Declared rate’ ‘Estimated rate’
profile the potential quality of EAP counselling
No. of clients 4359 5609 service provision on a set of key performance
Mean (SD) 16.0 (3.45) 27.0 (8.75) indicators relative to national published benchmarks
Minimum 12.5 19.8 for NHS primary care and (UK) HE student
Lower quartile 13.6 21.0
counselling services. Taken collectively, the results
Median 15.2 24.9
Upper quartile 17.3 30.3 provide strong evidence that EAP counselling provi-
Maximum 21.9 42.9 sion can be a highly effective intervention for
employees experiencing common mental health
problems including, but not limited to, depression,
clinical score was 8.8 (SD 6.09); effect size 1.43.
anxiety and stress. Six summary conclusions are
Effect sizes for specific interventions (where only one
noteworthy.
therapeutic intervention was specified) were also
Firstly, this is a sizeable dataset relative to the
calculated and are detailed in Table VIII. Effect
collective sum of data from earlier studies. As
sizes ranged between 1.16 and 1.54.
previously reported, McLeod’s original (2001) re-
Benchmarks for recovery and improvement are
view of a quarter decade of research addressed
Downloaded by [University of Otago] at 04:58 26 December 2014

presented in Table IX. The average recovery rate
across EAP services was 52%. PC average recovery
rates are 51% (CORE IMS, 2011a) and 54%
(Mullin et al., 2006). The HE rate is 57%
(COREIMS, 2011b). There was a range of over
10% between average recovery rates for the best and
worst performing services differed by over 10%, with
a maximum average rate of 59.3% recovered. The
average recovery or improvement rate across EAP
services was 70.5% compared with PC averages of
71% (CORE IMS, 2011a) and 72% (Mullin et al.,
2006) and HE average of 78% (COREIMS, 2011b).
A total of 1.6% of EAP clients showed deterioration
compared to PC benchmarks of 1% (CORE IMS,
2011a) and 2% (Mullin et al., 2006) and HE
benchmark of 1% (CORE IMS, 2011b).
around 10,000 clients which represents around
40% of the volume of client outcomes reported
herein. Similarly, effect size calculations from
McLeod’s (2010) meta-analysis were based on
around 1000 client outcomes, whereas herein they
are based on a sample of 17,500 clients. The
pragmatic utility of collating such retrospective
data samples clearly demonstrates the potential of
further collaboration between workplace counselling
providers and researchers, and begins to operatio-
nalise McLeod’s (2008) recommendation for
services to use a set of standardised quality assess-
ment benchmarks as a tool for estimating service
performance.
Secondly, the EAP providers contributing data for
this analysis demonstrated a capacity to collect high

Table VII. Type of therapy ending by number of sessions attended.

Type of therapy ending

No. of sessions attended Planned n Planned% Planned cumulative% Unplanned n Unplanned% Unplanned cumulative%

0 8 0.0% 0.0% 7 0.2% 0.2%

1 158 0.9% 1.0% 996 23.0% 23.2%
2 977 5.8% 6.8% 1399 32.3% 55.5%
3 1811 10.7% 17.5% 1196 27.6% 83.1%
4 6808 40.2% 57.7% 540 12.5% 95.6%
5 5125 30.3% 88.0% 126 2.9% 98.5%
6 1274 7.5% 95.5% 29 0.7% 99.2%
7 240 1.4% 96.9% 23 0.5% 99.7%
8 348 2.1% 99.0% 5 0.1% 99.8%
9 38 0.2% 99.2% 5 0.1% 99.9%
10 48 0.3% 99.5% 1 0.0% 100.0%
11 11 0.1% 99.5% 2 0.0%
12 46 0.3% 99.8% 0 0.0%
12 34 0.2% 100.0% 0 0.0%
Total 16926 4329
 Benchmarking key service quality indicators in EAP counselling 21
Table VIII. Pre-post change in CORE-OM scores across all participating EAP services.

n Mean pre SD pre Mean post SD post ES diff % Recovered or improved

Psychodynamic 196 16.4 5.81 9.3 6.42 1.16 65.3

Cognitive 47 17.2 5.98 8.3 5.79 1.50 78.7
Cognitive-Behavioural 811 17.5 5.96 8.4 5.87 1.54 73.5
Structured-Brief 1502 17.4 6.04 8.7 6.06 1.44 72.8
Person-Centred 1573 17 6.02 8.7 6.24 1.35 70.9
Integrative 2856 17.5 6.09 8.9 6.15 1.40 69.7

quality outcome data. Over 90% of clients com-
pleted a CORE-OM prior to therapy commencing.
This rate compares favourably with figures for NHS
primary care and UK higher education. Descriptive
data on the type of therapy ending was particularly
complete at 95%. No doubt this high quality data
helped secure the excellent rates of pre- and post-
therapy CORE-OMs which were collected for 65%
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2010 benchmarks, access times would average
around two months rather than the two-week
average wait of this EAP sample.
Fifthly, EAP clients in this study were more likely
to complete treatment than their NHS or HE
counterparts. Overall, almost three-quarters of cli-
ents were estimated to have completed their EAP
intervention relative to benchmarks rates of around

of clients and represented a pre-post completion rate
well over 20% higher than benchmark averages for
the NHS and HE comparator service sectors. Again,
it’s hoped that this level of data quality contributes
a robust resource to the literature to overcome the
limitations identified by early commentators (e.g.
Alker & Cooper, 2007; Cayer & Perry, 1988; Kirk &
Brown, 2003; McLeod, 2001, 2008, 2010; McLeod &
Henderson, 2003).
Thirdly, according to pre-therapy CORE-OM
profiles, clients presenting to EAP services demon-
strate a similar level of distress to NHS and higher
education student counselling services with 88%
scoring above clinical cut-off on the CORE measure
and thereby demonstrating their capacity to benefit
from therapeutic interventions. This finding further
validates McLeod’s (2008) conclusion that people
who make use of workplace counselling services
typically report high levels of psychological distress.
Fourthly, despite showing levels of distress com-
parable with NHS primary care patients, EAP clients
accessed therapeutic services swiftly with an average
waiting time of just nine days and the vast majority
(92%) accepted for treatment. If the clients of the
EAPs herein had to access NHS services, based on
50% for both NHS and HE sectors.
Finally, and most importantly, the 52% recovery
rate and additional 18% improvement rates are
equitable with published benchmarks for the NHS
and HE comparators. The average effect size of 1.43
is significantly higher than the average 0.90 rate
published by McLeod (2010)and ranks amongst the
top third of all 24 effect sizes calculated by McLeod
across the 10 studies in his meta-analysis. Further-
more, the range of six therapeutic interventions
delivered by EAP providers in this sample all have
effect sizes in excess of 0.90 and support modality
equivalences reported in other CORE System
benchmarking publications (Stiles et al., 2006,
2008) which have averaged six sessions which
equates to a therapeutic dose that is 33% higher
than the average EAP treatment length.
Limitations
Naturalistic, retrospective observational studies are
not without their limitations. Publications on similar
cohort studies all recognise weaknesses from the lack
of control group comparisons. Restriction from the
use of a single self-report measure (CORE-OM) has

Table IX. Benchmarks for percentage recovered/improved in EAP services.

Recovered Improved Recovered or ‘improved’ No reliable change Deteriorated

Mean (SD) 52.1 (4.55) 18.3 (2.69) 70.5 (3.25) 27.9 (3.96) 1.6 (1.09)
Minimum 47.1 15.0 64.7 23.6 0
Maximum 59.3 22.5 74.4 35.3 3.2
25th percentile 48.8 16.5 70.2 26.2 1.2
50th percentile 51.9 18.3 70.7 27.1 1.6
75th percentile 54.2 19.6 72.1 28.0 2.0
 22 J. Mellor-Clark et al.
also been a limitation identified in previous cohort
studies (e.g. Stiles et al., 2006), the limitation being
that all self-report measures are vulnerable to
distortions, with clients able to exaggerate both their
pre-treatment distress and post-treatment improve-
ment. Representativeness is also a potential limita-
tion, with 80% of the data donated for the current
study coming from just two EAP service providers
who may not necessarily represent either the profile,
practice or overall service quality profile of the wider
range of UK EAP providers.
Implications for practice
Whilst the results of this study need to be interpreted
with caution given the above limitations, they never-
theless have significant implications for practice. Not
Downloaded by [University of Otago] at 04:58 26 December 2014
only do the results bear testament to what can be
achieved through the use of a respected standardised
system supported by unrivalled resources for service
quality benchmarking, they also offer market con-
fidence to support EAP provision in a climate of
austerity where organisations are scrutinising out-
comes achieved in such services. EAPs typically
provide time limited counselling of four to six
sessions and this research demonstrates both effi-
ciency and effectiveness relative to benchmarking
comparators.
Declaration of interests
John Mellor-Clark and Elspeth Twigg are employed
by CORE IMS who supply training, software sup-
port, data analysis and benchmarking services to
users of the CORE System and other measures.
Eugene Farrell and Andrew Kinder are Executive
Committee members of EAPA (UK) who commis-
sioned this empirical study from CORE IMS.
Acknowledgements
The authors would like to thank both EAPA UK for
commissioning this study, and the EAP providers
who contributed anonymised data to resource the
analysis.
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Biographies
John Mellor-Clark led the design of the CORE
System as the first UK standardised quality evalua-
tion system for psychological therapy. As Managing
23
Director of CORE IMS John leads on commercial
and strategic development. Key interests include:
developing an expanding portfolio of free quality
measurement tools; growing a significant repository
of practice-based evidence to complement and bal-
ance evidence-based practice; and creating collabora-
tive academic and clinical international networks
sharing a common passion for exploring the delivery
and development of best practice.
Elspeth Twigg has been involved in working with
the CORE System for over a decade and has a
particular interest in outcome measurement in young
people. Elspeth has co-authored academic papers on
CORE and produced a number of Occasional Papers
and articles which can be found at www.coreims.co.
uk. She was also responsible for the development of
YP-CORE.
Eugene Farrell is a qualified health economist
with over 25 years’ experience in the UK healthcare
arena. For the past 15 years he has specialised in the
development and provision of employee support
services, including integrated healthcare, absence
management, employee assistance, wellbeing and
occupational health services. He currently provides
health and wellbeing consultancy services to major
employers in the UK and around the world, includ-
ing managing absence and sickness presence, as well
as delivering training for managing stress at work,
pressure, resilience, emotional intelligence, mana-
ging critical incidents and work life balance.
Andrew Kinder is a Chartered Counselling and
Chartered Occupational Psychologist. He was re-
cently awarded a Fellowship from the British Asso-
ciation for Counselling and Psychotherapy for his
contribution to workplace counselling and stress
management. He is an experienced member of the
EAPA and is currently the Vice Chair. He has been
closely involved in the development of CORE over
the last 9 years.