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

1. Substance Abuse ProfessionalReturn-to-Duty Process Understanding the Employer & DOT-SAP Roles 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? 2

3. RULES of this Training This is adult learning Take care of yourself - get up if you need Fast-paced to cover a LOT of information If you have a question ASK IT! Only �DUMB� question � one you don�t ask! Respect others - Put phone, pager and other electronics on VIBRATE or OFF Step outside to answer a call 3

4. Goal Of This Training Provide a �DOWN-TO-EARTH� practical understanding of the Employer and Substance Abuse Professional Responsibilities in The SAP/Return-to-Duty Process Of 49 CFR Part 40 Subpart O. 4

5. Objectives Of This Training Accomplish 3 Things Today Review the Employer�s responsibilities after a drug or alcohol violation Provide you a practical, regulation based understanding of the Substance Abuse Professional & the Return-to-Duty Process Answer ANY of your questions about SAP or Employer responsibilities in this process 5

6. Today�s Process Explain The DOT SAP & Return-to-Duty Process � 49 CFR Part 40 -Subpart O Sort Out When � SAP Return-to-Duty Who � Employer vs. SAP What � Role & duties each has How � Do I document compliance? Where � Do I find SAPs & resources? Answer YOUR Questions 6

7. Subpart O Required When is SAP Evaluation Required? Any DOT rule violation Positive drug or alcohol test Applicant or Employee Refusal (11 items now) Pre-duty use violation On duty use Drugs/Alcohol in vehicle NOT � Personal DWI�s 7

8. Employer Responsibility �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. 8

9. DOT & The Employer DOT very wisely recognized 3 things A & D problems are a safety issue for transportation Each case is individual - no �one size fits all� Professionals better suited than regulation in setting individual corrective action DOT Regulation - Employer 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 No �nothing required� after a violation allowed 9

10. DOT & The SAP DOT Regulation - SAP DOT recognized need to use professionals for a health problem affecting safety Not all professionals are trained in substance abuse � they limited SAPs to those with credentials and substance abuse training Required �adjustment� to SAP�s usual purely clinical focus to include public safety Requires separation of SAP & treatment Requires education or treatment minimum Requires written communication with the employer 10

11. Who Does What? WHO Employer Responsibilities vs. SAP Qualifications 11

12. The DER Role 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. 12

13. The DER Role Employer - DER DOT defines the DER position responsible for all confidential communications DER sees that employee is removed from safety sensitive duties FIRST DER provides the list of SAPs regardless of what personnel action occurs DER is communicator with SAP Even if not coming back � violation information No additional consent needed from employee 13

14. 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 14

15. Qualifying SAP Credential 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 15

16. Required Basic 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/ 16

17. 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 Limit 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 17

18. Qualification 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 18

19. 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 Documentation SAP�s Sole responsibility Qualifying Credential Certificate of SAP Exam Demonstrate 12 PDH or CEUs every 3 years from date of exam 19

20. WHAT is Required? WHAT ARE THE SAP SERVICES? 20

21. 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. 21

22. SAP Required Services SAP Required Services? �40.291 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 22

23. I. Initial Assessment �40.293 Face-to-face Evaluation - Local Clinical Diagnostic Evaluation Requires use of 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 �claims� Wrong test, no reason, etc. 23

24. 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 24

25. 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 25

26. 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. 26

27. 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 test 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 27

28. 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 phone & contact information On SAP�s own letterhead No Personal Clinical Information No diagnosis, personal history, etc. 28

29. 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 29

30. SAP Letter EXAMPLES Review SAP Sample Letters Initial Letter Successful Letter Follow-Up Testing Schedule Unsuccessful Letter 30

31. Documentation? HOW DO I DOCUMENT COMPLIANCE SAP SERVICES? 31

32. 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 32

33. EMPLOYER DOCUMENTS � 40.311 Unsuccessful Compliance 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 33

34. SUMMARY EMPLOYER DUTIES As an employer you are responsible for your program- even if parts are 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 34

35. SUMMARY R-T-D Process REQUIRED ELEMENTS of Subpart O Initial Evaluation (Face-to-Face) Requires letter to employer Refer Education/Treatment - In Every Case Follow-up Evaluation (Face-to-Face) Requires letter to employer DER Successful: a testing schedule Unsuccessful: no testing allowed Follow-up Testing Schedule SAP sets frequency and volume - DER sets dates Negative Return-to-Duty Test - A MUST DER & SAP Communicate Directly 35

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

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 37

38. THANK YOU 38