EAP Clinical Assessment Form
An Employee Assistance Program (EAP) is
a benefit paid for by employers to provide a means for employees and their household members to access
help in a crisis or when their personal problems interfere with their work performance or quality of
daily life. EAP services can help employees restore and maintain productivity. They also help
employers retain valuable employees.
A thorough clinical assessment is important in order to offer
the member who accesses EAP the tools they need to restore and/or maximize their functioning.
An initial assessment should be broad-based, with a focus on both problem and member strength
identification, and should also include a solution-focused action plan. Special consideration
should be given to appropriately assessing substance use issues, depression and risk of harm to
self and others. Additionally, a thorough assessment is important in meeting clinical quality
and practice standards.
CIGNA Behavioral Health (CBH) has developed an ‘EAP Clinical
Assessment Form’ which should be used for all EAP authorizations. This form allows the user to complete
a comprehensive assessment that may result in recommendations to a vast array of work-life,
community and behavioral resources available to EAP members and their families. The form also
underscores the importance of follow-up with the member in order to assure quality service.
The Management Referral section of the assessment tool should be
completed only when an Employee Assistance Consultant (EAC) contacts you and identifies the case
as a management referral.
The EAP Clinical Assessment Form, which includes a check-box format,
was designed to be easy to use. Please access this form on the CBH website (
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