Substance Abuse Professional Return-to-Duty Process Understanding the Employer & DOT-SAP Roles

1. Substance Abuse ProfessionalReturn-to-Duty ProcessUnderstanding the Employer & DOT-SAP Roles 8th Annual FTA Conference Phoenix, Arizona Jon P. Speckman,MSM, LCAS, CCS 800-942-3784 jspeckman@adatc.com

2. Introduction - Qualification • Jon P. Speckman, MSM, LCAS, ICAADC, CCS • MSM – Masters of Management • LCAS – Licensed Clinical Addiction Specialist –NC • ICAADC – ICRC Advanced Alcohol & Drug Counselor • CCS – NC Certified Clinical Supervisor • Field of Substance Abuse for 30+ years • 16 yrs. – Clinical Treatment • 10 yrs. – Third Party Administrator • 12 yrs. – Consultant, Trainer, Clinician/Evaluator • Small Employee Assistance service • What Credentials are Important – Why?

3. DOT Expectations • DOT very wisely recognized 3 things: • Alcohol & Drug problems are a safety issue for transportation • Each case is individual – there is no “one size fits all” • Professionals are better suited than regulation in setting individual corrective action

4. DOT Regulations Overview • The Process • Puts responsibility on employee who violated rules • Penalizes (fines) employer ONLY for use of “non-compliant” employee • Does not require employer to do things outside their control • Allows an employer to help but only REQUIRES employer not to use “unqualified” individuals • Does not allow SAP to determine “nothing required” after a violation

5. The Key Players WHO Employer & Substance Abuse Professional

6. WHO - The Employer • §40.23 (d) As an employer, when an employee has a verified positive, adulterated, or substituted test result, or has otherwise violated a DOT agency drug and alcohol regulation, you must NOT return the employee to the performance of safety-sensitive functions until or unless the employee successfully completes the return-to-duty process of Subpart O of this part.

7. WHO - The Designated Employer Representative (DER) • Employer - DER -§40.3 (Definition) • An employee authorized by the employer to take immediate action(s) to remove employees from safety-sensitive duties, or cause employees to be removed from these covered duties, and to make required decisions in the testing and evaluation processes. The DER also receives test results and other communications for the employer, consistent with the requirements of this part. Service agents cannot act as DERs.

8. WHAT - The DER Role • Employer - DER • DOT defines the DER position as responsible for all confidential communications • FIRST the DER sees that violating employee is immediately removed from safety sensitive duties • DER provides referral to SAP(s) regardless of what personnel action occurs • DER is communicator with SAP • Even if not coming back – violation information • No additional consent needed from employee

9. WHAT - The DER Role • Employer DER (continued) • DER should know the SAPs on your list • SAP should be local person first • Meet & know your SAP - know their practice, get SAP credentials • Talk about your understandings & expectations for anyone you send to SAP • Only use national / non-local when your employees are not local or local SAPs change frequently

10. WHO - The SAP • The - Substance Abuse Professional • DOT recognized need to use professionals for a health problem affecting safety • Limit SAPs to those professionals with credentials and substance abuse training • Requires “adjustment” to SAP’s usual clinical focus on patient to include public safety • Requires separation of SAP & treatment • Requires education or treatment at minimum • Requires written communication with the employer

11. WHO -SAP Credentials • Only These Professionals -§40.281 • Licensed Physician (MD or DO) • Licensed or Certified • Social Worker • Psychologist • Employee Assistance Professional • Marriage & Family Therapists • State Alcohol or Drug Counselor • Only if NAADAC or ICRC Certified • NBCC -Master Addictions Counselor

12. WHAT - SAP Required Knowledge • Regardless of Degree or Credential - §40.281 • Experience in Addiction Services • Diagnosis and treatment of alcohol & controlled substances-related disorders • Knowledge of DOT Requirements • The DOT SAP Return-to-Duty Process • The DOT regulation 49 CFR Part 40 • The DOT Agency rules for your company • The DOT SAP Guidelines • ALL changes that occur to the above • Available at www.dot.gov/odapc/

13. WHAT - Qualification Training • Key DOT Drug testing requirements • Collections, lab, MRO & problems in testing • Key DOT Alcohol testing requirements • Testing process, BAT, STT & problems in testing • SAP qualifications and prohibitions • Limits referral to SAP’s own services - ethics • Initial evaluation, referral, follow-up evaluation, continuing care, the Follow-up testing plan • SAP consultation and communications • Reporting and recordkeeping requirements • Issues the SAP may & MAY NOT confront

14. WHAT - SAP National Exam • Complete a Nationally Recognized Exam • One time – Qualification only • National Exams are: • EAPA– Employee Assistance Professional Assoc. • NAADAC – Association of Addiction Professionals • ICRC – International Credentialing & Reciprocity • SAPAA– Substance Abuse Program Administrators • Others can be found on DOT – ODAPC website

15. WHAT - Ongoing Requirements • Continuing Education • 12 PDH or CEUs every 3 years Following Qualification Exam • Must be in DOT SAP relevant material – NOT just any training • Credential Documentation • SAP’s Sole responsibility • Qualifying Credential • Certificate of SAP Exam • Demonstrate 12 PDH or CEUs every 3 years from date of exam

16. Subpart O Required • What Requires the SAP Process be conducted? • Positive drug or alcohol test • Applicant OR Employee • Refusals to Test (11 items now) • Pre-duty use violation • On duty use • Drugs/Alcohol in vehicle • NOT – DWIs in Personal Car

17. SAP is Required? WHAT ARE THE SAP SERVICES?

18. SAP Return-to-Duty Process • Definition - §40.285 (a) • No Employee who has violated the DOT regulations may perform Safety Sensitive duties for ANY DOT regulated employer until he/she has completed the initial evaluation, referral for education treatment, follow-up evaluation AND passed a return-to-duty drug and/or alcohol test.

19. SAP Required Services • SAP Required Services? §40.291 • SIX ELEMENTS: • Initial Clinical Assessment • Referral to Education or Treatment • Managing Referral Access • Follow-up Clinical Assessment • Establish Follow Up Testing Plan • Provide Employer Letters • After Initial Assessment • After Follow-up Assessment with testing plan

20. I. Initial Assessment §40.293 • Face-to-face evaluation - Local • Clinical Diagnostic Evaluation • Requires use of a test instrument • Screens for any problem • Substance abuse, Mental Health, etc. • Establish treatment goals • “NO PROBLEM FOUND” not an option • Results in Initial Letter to employer • Establishes goals • No Consideration of employee “claims” • Wrong test, no reason, etc.

21. II. Referral to Service §40.299 • Always Requires Referral • Can’t refer to SAP’s own practice • Facilitates entry to services • Education Services • Structured education program • Monitored self-help • Specific goals to achieve • Treatment Services • Possible inpatient – used rarely • Outpatient most common • Weekly to multiple times a week • Often a combination of services • May have two levels over time

22. III. Referral Monitoring §40.299 • Communicates with Treatment • Monitors if change is necessary • Receives clinical progress updates • Works with counselor if problems • Receives final discharge summary • Consults with counselor on any follow up needs • Prepares for Re-evaluation • Reviews written progress reports • Consults with counselor

23. IV. Follow-Up Evaluation §40.301 • Face to Face with employee • Focuses on employee’s learning • Understanding of problem • Internalization of goals • Behavior and lifestyle changes • Two Outcomes Possible • Successful Compliance – Return-to-Duty • SAP only authorizes R-T-D testing • Employer decides actual Return-to-Duty • Unsuccessful Compliance – NO RETURN • Employer sets personnel action • Evaluates Need for Ongoing support • SAP must set follow up testing needs • Can recommend self-help, aftercare counseling, etc.

24. V. Follow-Up Testing Plan §40.307 • SAP Establishes – Employer Carries out • Recognizes relapse potential – safety risk • Testing should be employee specific – based on SAP’s knowledge of use pattern • Requires MIMIMUM 6 tests in 1st year • Can go up to 60 months – based on need • Rate depends on employee need for support • Usually drug/person specific • More intense the craving – more frequent the follow-up testing – Cocaine-Meth vs. Marijuana • Less intense – less frequent • Should be supportive not punitive • SAP sets frequency and volume • Employer sets actual dates

25. VI. Required Reports §40.311 • Letter After Initial Evaluation • Employee name & SS# (D-O-B) • Employer name & address • Reason – specific violation & date • Date(s) of assessment • SAP’s education/treatment required • SAP’s phone & contact information • On SAP’s own letterhead • No Personal Clinical Information • No diagnosis, personal history, etc.

26. VI. Required Reports - Continued • Letter After Follow-Up Evaluation • Same 1-6 items from 1st letter • Name of education/treatment service • Inclusive dates of participation • Clinical characterization of participation • SAP’s determination of employee’s successful/unsuccessful compliance • Specific follow-up testing plan • Best if an attachment – not in letter • SAP can re-evaluate after a year After Care needs if any • Must be presented at follow-up • Monitored by employer

27. SAP Letter EXAMPLES • Review SAP Sample Letters • Initial Letter • Successful Letter • Follow-Up Testing Schedule • Unsuccessful Letter

28. Documentation? HOW DO I DOCUMENT COMPLIANCE SAP SERVICES?

29. EMPLOYER DOCUMENTS §40.311 • Successful Compliance with Subpart O • Copy of original violation • Document removing from safety sensitive duties with SAP resources • Initial evaluation letter • Follow-up letter • Follow-up testing schedule • Negative Return-to-Duty drug and/or alcohol tests • Copies of ALL follow-up tests as required in SAP schedule of testing

30. EMPLOYER DOCUMENTS § 40.311 • UnsuccessfulCompliance Subpart O • Copy of original violation • Document removing from safety sensitive Duties with SAP resources • Initial evaluation letter • Follow-up Letter indicating unsuccessful compliance • Any additional correspondence to/from SAP – Possible re-evaluation, etc. • NO DOT TESTING ALLOWED • Termination letter or transfer of job duties to NON-safety-sensitive duties

31. SUMMARY - EMPLOYER DUTIES • As an employer, you are responsible for your program- even if parts contracted • You must receive both letters from the SAP BEFORE you TEST • You manage the follow-up testing dates - be sure to comply • You still must provide a referral to SAP • Employee even if terminating • Applicant even if not hiring them • SAPs are a resource for you • Document all efforts

32. Common Questions Myths/Issues-1 • AM I SUPPOSED TO KNOW THE SAP? • Yes, if you plan on returning an employee you must be on the same page as the SAP you use. • Can my SAP put a Friday Positive back to work on Monday? • NO, unless a SAP can clearly justify why a safety sensitive employee who has been trained in prohibited drug use in DOT work would suddenly violate those rules and jeopardize his/her career, not just a job.

33. Common Questions Myths/Issues-2 • Can my SAP require a Marijuana positive to also stop drinking alcohol? • YES, every SAP must fully evaluate the individual and their clinical problems and treat whatever the issues are – not just the identified drug they were positive for on a test. • Can we do more follow-up tests than the SAP stipulates? • NO, as an employer or DER you must do only what the SAP stipulates on a DOT violation.

34. Common Questions Myths/Issues-3 • Who is supposed to explain the “Dropping your pants in Return-to-Duty and Follow-up testing? • The DER, the SAP and/or the collector should clearly explain to the employee the collection process under direct observation so there is no misunderstanding. • What’s the deal with an employee using “bath salts” or that “legal Marijuana” stuff? • In the last 10 years, the use of products touted on the market as harmless bath salts or legal marijuana are far from either. These are situations where routine products are treated with chemicals that mimic stimulants in bath salts and mimic the effects of THC by spraying incense or herbs with chemicals. ALL SUCH PRODUCTS ARE ILLEGAL NOW

35. Questions Questions ABOUT DRUGS or PROCESS

36. RESOURCES • www.dot.gov/odapc • http://transit-safety.volpe.dot.gov/DrugAndAlcohol • www.health.org • www.saplist.com • www.workplace.samhsa.gov/

37. QUESTIONS & EVALUATION LAST CHANCE • Anything you didn’t get answered about the Return-to-Duty process? • Employer • Substance Abuse Professional • Documentation • Please complete your evaluation

38. THANK YOU NEED HELP FTA – 617-494-6336 ODAPC – 800-225-3784 If you can’t find the answer you need, call me for assistance: Jon P. Speckman, MSM, LCAS, CCS, 800-942-3784 jspeckman@adatc.com or www.adatc.com