Transcript Substance Abuse Management Training

Substance Abuse Management
Training
Presented by Diana Byrnes
June 27, 2007
Today’s Training Agenda
• Knowledge Assessment Quiz
• Substance Abuse Policy Discussion
• Pre-employment Requirements
– Break
• FTA Training Requirements
• Implementing a compliant Random Testing Program
• Discussion on Post Accident Testing Thresholds
– Break
• Reasonable Suspicion Testing
• Collection Site Monitoring and Collection Problems
– Break
• Drug and Alcohol Game Show~ Prizes for the
winning team!
Knowledge Assessment Quiz
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Purpose: to assess the level of knowledge
of drug and alcohol testing regulations
within the group
– Ensures that any misconceptions or inaccuracies
are addressed during the training session
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Scores are not announced or shared with
other participants
Please take the next few minutes to
answer the questions independently.
Acronyms
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DAPM- Drug and Alcohol Program Manager
DER- Designated Employer Representative
MRO- Medical Review Officer
TPA- Third Party Administrator
CCF- Custody and Control Form
BAT- Breath Alcohol Technician
FTA- Federal Transit Administration
DOT- Department of Transportation (Federal)
FDOT- Florida Department of Transportation
CUTR- Center for Urban Transportation Research
SAP- Substance Abuse Professional
Substance Abuse Policy Discussion
FTA Policy Requirements
 Identity of Designated Employer Representative along with the
contact information to reach this individual
 Date policy was prepared and/or adopted by local governing
board
 List of all job positions covered by the FTA regulation and the
policy
 The five prohibited substances
 The six test types (reasons to test)
 Periods of coverage: when employees are subject to testing
and the requirement to comply as a condition of employment
 The testing methods used (may reference 49 CFR Part 40)
 The actions that would constitute a refusal to test
 Consequences of a positive test or a refusal to test (Zero
Tolerance or Second Chance)
Policy Discussion Continued
• Every covered employee must receive a copy
of the policy and any subsequent revisions of
the policy
• Documentation of employee receipt of the
policy must remain on file for a minimum of
two years~ (per revision)
• FDOT has produced two model policies, one
for Zero Tolerance agencies and one for
Second Chance agencies
FDOT Model Policies
• Model policies were approved by FTA in 2004
as a result of an audit of FDOT
• Adoption of model policy is an FDOT
requirement for all 5311 sub-recipient
agencies and their covered contractors as of
Sept. 2004
• Must be approved and adopted by local
governing board
FDOT Model Policies Available
http://www.cutr.usf.edu/byrnessamsite
Any Questions related to our
discussion on Substance Abuse
Policy Requirements?
Pre-Employment Administrative Duties
Prior to Hire
1. Interview applicant, ask if they have ever tested
positive on a DOT pre-employment test for
which they did not get the job
2. Conduct DOT previous employer background
check (detail on next slide)
3. Provide applicant with Substance Abuse Policy
4. Conduct pre-employment testing
5. While awaiting negative test result, begin
training employee
6. Once employee’s negative result is in hand,
employee can begin safety-sensitive functions
Previous DOT Employer Drug and Alcohol
Background Checks
• 49 CFR Part 40.25 requires that DOT employers (all
modes) for previous 2 years are asked if applicant
has ever had:
1. An alcohol test result of 0.04 alcohol concentration or
greater;
2. A verified positive drug test;
3. A refusal to test;
If employee had previously tested positive and has
successfully completed the DOT return-to-duty
process, the previous employer or employee must
provide documentation to this effect.
Background Checks
– Must obtain consent from applicant (Release of
Information form)*
– Must document good faith efforts to obtain
background check
– Can put employee to work while waiting to obtain
data. However, if you have not made a good faith
effort within 30 days you must remove employee
from safety-sensitive functions until good faith
effort is documented
– Maintain documentation on file for three years
Pre-employment testing
odds ‘n ends
• Agency may conduct both drug and alcohol preemployment testing
– Pre-employment alcohol testing is rare and generally not a
good indicator of an employee’s prevalence to misuse
alcohol
• If applicant does not proceed immediately to
collection site, it is not a refusal
• If applicant leaves collection site prior to the
commencement of the collection, it is not a refusal
• You must have a negative drug test result prior to
employee’s performance of safety sensitive duties
• You cannot use the result of any other preemployment drug test conducted by another agency
In Summary- 4 Steps
1. Inquire
 Ask applicant about previous violations
2. Investigate
 Perform background check
3. Test
 Conduct a Pre-employment test
4. Train
 Conduct all required components of training
Any Questions related to our
discussion on Pre-employment
Administrative Duties?
Take a 10 minute
break!
Developing a Compliant
Training Program
Training Requirements
FTA Regulation §655.14 requires three
components of training:
1. Education Component- Display and
Distribution of material
2. Covered Employee Drug Awareness Training
3. Supervisory Training for Reasonable
Suspicion Referral
1. Education Component
49 CFR Part 655.14:
“The education component shall include the
display and distribution of informational
material and community service help line
telephone numbers for employee assistance,
to every covered employee.”
Display and Distribution Items
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Community help lines (phone numbers)
Posters
Flyers
Newspaper clippings
Magazine articles
EAP contact information
A statement of agency’s open door policy
You must distribute the Substance Abuse
policy and any revisions to all covered
employees
Resource for Display and
Distribution Materials
cutr.usf.edu/byrnessamsite
Additional web site resources for
Display and Distribution Materials
• Substance Abuse and Mental Health Services
Administration
– www.samhsa.gov
• National Institute on Drug Abuse (NIDA)
– www.drugabuse.gov
• National Institutes of Health
– www.nih.gov
• Street Drugs (Images, stats, great information)
• www.streetdrugs.org
Best Practices for Meeting the Display
and Distribution Requirement
• Vary the message
• Change out posters, flyers etc. every couple
of months
• Be accurate in your message
• Deliver the message often (repeatedly)
• Add a drug and alcohol briefing to your
safety meetings, driver meetings, etc.
• Post the message in places that will give it
maximum exposure (driver’s lounge, above timeclock, restrooms)
• Include a message about Rx meds as well as
prohibited drugs
2. Employee Drug Awareness Training
49 CFR Part 655.14
“Covered employees must receive at least 60
minutes of training on the effects and
consequences of prohibited drug use on
personal health, safety, and the work
environment, and on the signs and
symptoms that may indicate prohibited drug
use.”
Suggested Training Materials
 Substance Abuse Policy specific to your
agency
 Video or other visual media, such as Clean
Sober and Safe
(specific to FTA covered employees)
 Clean Sober and Safe Handbook
 Employee Drug Awareness Manual
 Employee Drug Awareness Assessment Quiz
 All items are available on the CUTR Substance
Abuse Management Website:
http://www.cutr.usf.edu/byrnessamsite
Clean Sober and Safe
• 23 minute video for employee drug
awareness training with handbook
• Covers the events leading to the requirement
of drug and alcohol testing
• Discusses the five prohibited drugs and their
effects on the mind and body
• Briefly addresses the collection and MRO
process
• Explains circumstance under which the
employees are subject to testing
• FTA approved aid to meeting the 60 min.
Clean, Sober and Safe Video
http://www.cutr.usf.edu/byrnessamsite
Video is available for
download free of
charge in Windows
Media Player and
RealPlayer formats
Also available on DVD;
request via e-mail to:
[email protected]
Sample Training Agenda for
Covered Employees
10:00 a.m.
Distribution and oral review of substance abuse
policy key points; employee documentation of policy
receipt
10:15 a.m.
Distribution of Clean, Sober and Safe Handbook
followed by viewing of Clean, Sober and Safe video
10:40 a.m.
Distribution and review of Employee Drug
Awareness Manual
10:50 a.m.
Distribution of Employee Drug Awareness
Assessment Quiz (open book)
11:10 a.m.
Oral review of assessment quiz
11:30 a.m.
Collection of sign in sheet; adjourn
Best Practices for meeting training
requirements
• Exceed the 60 minute minimum
• Conduct the training as part of the new
employee orientation
• Provide varying forms of training media
• Conduct refresher training annually
• Foster an “Open Door” policy to encourage
employees to seek help if needed
• Make informational material related to the
drug and alcohol program accessible
3. Supervisory Training
“Supervisors and/or other company officials
authorized by the employer to make
reasonable suspicion determinations shall
receive at least 60 minutes of training on the
physical, behavioral, and performance
indicators of probable drug use and at least
60 minutes of training on the physical,
behavioral, speech, and performance
indicators of probable alcohol misuse”.
Who’s your trainer?
• Who is qualified to conduct the training for
covered employees?
– Anyone equipped with knowledge about the drug
and alcohol testing program and access to
training materials
– FTA does not require the trainer to obtain or hold
any certification or educational credentials
Suggested training material for
Supervisor training
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FTA Video available for download (details on next slide)
Props and or photos of drug paraphernalia
NIDA Fact Sheets
Group discussion of specific scenarios
Role playing exercises
Message that management supports supervisors
Message that supervisors are not responsible for
diagnosing substance abuse or alcohol misuse
problems, but only for identifying when an
employees behavior may jeopardize safety
Suggested Supervisor Training
Material
• FTA video and training manual, available via
web:
http://transitsafety.volpe.dot.gov/safety/datesting/reasonablesuspicion.asp
Best Practices for meeting
Supervisor Training Requirements
• Training must be conducted prior to a supervisor
assuming the role
• Required only once in the tenure of employment, but
suggested annually
• Role play and discussion of scenarios are important
training tools that increase the comfort level of
supervisors
• Supervisors must feel that management supports
and encourages them to come forward
• Training should include the protocol and policy to
follow when reasonable suspicion testing needs to
take place (transport, supervision, who to contact, etc.)
Any Questions related to our
discussion on the three training
requirements?
Implementing a Compliant
Random Testing Program
Random Testing
• As of January 9, 2007 FTA lowered the
minimum percentage of covered employees
to be tested annually for drugs.
– Rate reduction was in response to a national
positive rate of less than 1% for the previous
three years (2003,2004,2005)
– Formally 50%; now 25%
– Alcohol testing remains at 10%
– Agencies can continue testing at 50%
– Agencies using the First Lab statewide testing
pool are testing at the 25% rate
Random Testing Pitfalls
 Agencies not spreading testing throughout all
hours of operation
 Agencies not spreading testing throughout all
days of operation (must include weekends and
holidays if you operate on those days)
 Agencies establishing a predictable pattern of
testing (i.e.: most testing done on Tuesdays or
most testing done between 10:00 and 2:00)
 Agencies not updating the employee
database with the service provider to ensure
that all covered employees are part of the
testing pool
Best Practices for Random Testing
• Never conduct “group testing”- this sends the
message that testing has been completed for that
testing period
• Test employees at odd hours of the day (you may need
to arrange this with collection site)
• Never give employees advanced notice of a random
testing requirement
• Keep random lists secure and confidential
• Update employee database often to ensure that all
covered employees are included
• “Sprinkle” the testing throughout all hours of the day
and throughout the whole testing period
• Schedule your testing using Microsoft Outlook or
another form of task monitoring
Any Questions related to our
discussion on Random Testing?
Conducting Post Accident
Testing within FTA Thresholds
FTA Post Accident Criteria
• The FTA defines an accident as an occurrence
associated with the operation of a revenue service
vehicle in which:
1. An individual dies;
2. An individual suffers bodily injury and immediately
receives medical treatment away from the scene of
an accident;
 Unless employees actions can be completely discounted as a contributing
factor.
3. One or more vehicles incurs disabling damage and is
transported away from the scene by a tow truck or
other vehicle
 Unless employees actions can be completely discounted as a contributing
factor.
Disabling Damage
“Damage that precludes the departure of
vehicle from the scene of the occurrence in
its usual manner in daylight hours after
simple repairs is known as disabling
damage”.
Ref: Implementation guidelines for Drug and Alcohol Testing in Mass Transit
Summary of Criteria
Fatality of anyone involved
 TEST
If an individual requires immediate
transportation to a medical treatment
facility away from the accident scene
 TEST
(unless the covered employee’s actions can be completely
discounted)
If one or more road vehicles have
disabling damage (as defined) that
requires a tow from the site
TEST
(unless the covered employee’s actions can be completely
discounted)
Arriving on the scene of the
accident:
• Treat any injury first. The accident victim’s
physical health is always a higher priority than
conducting a substance abuse test
• Cooperate with law enforcement officials.
Note: the results of a test given for law enforcement
purposes do not satisfy your requirement to test
• Determine if the accident meets the FTA
criteria to test Using the Post Accident
Decision Form, document the accident, if it
does:
At the scene continued
• Explain the need for testing. Tell the
employee(s) that a urine drug test and
breath alcohol test are required by FTA (This is
important because an employee who fails to remain for testing
will be considered to have refused the test.)
• Conduct tests promptly. Notify collection site
of a post accident test requirement or
contact a mobile collector to conduct on-site
testing
Testing Window for Alcohol
• Breath alcohol testing should be conducted
first and within 2 hours of the accident. It
must be conducted within 8 hours of the
accident.
– If not conducted within the first two hours, FTA
requires that the reason for delay be documented
– After 8 hours attempts to test for alcohol misuse
must cease and documentation as to the reasons
for failure to test must be prepared and kept on
file.
Testing Window for Drugs
• Urine drug screenings should be conducted
within the first 8 hours following the accident
– Reasons for delay must be documented
– Attempts to test should continue until 32 hours
after the accident
– Reasons for failing to conduct testing must be
documented and kept on file
Important note: Failure to locate collectors or
breath alcohol technicians are not legitimate
reasons for failure to conduct testing. If you have
difficulty obtaining testing services contact your
TPA immediately.
Best Practices in Post Accident
Testing
• Train supervisors on FTA Criteria to test
• Stress that testing when criteria is not met is
just as bad as not testing at all
• Keep Post Accident Decision and
Documentation Forms* accessible for road
supervisors and others who will be on the
scene of the accidents
• Document, Document, Document
• Have an established protocol in place
• Make sure that operators, dispatchers,
supervisors, etc. know how to get in contact
with after hours testing sources
Any questions related to our discussion
on Post Accident Testing?
Take a 10 minute break!
Reasonable Suspicion Testing
Reasonable Suspicion Testing
Key Points
• Only Supervisors trained in the signs and symptoms
of probable drug use and the signs and symptoms of
probable alcohol misuse can “make the call to test”
• Regulations require that only one trained company
official needs to witness the behavior to “make the
call”
• Gut feelings, hunches, gossip and rumor are not
legitimate cause for referral to testing
• The referral must be based on specific,
contemporaneous, observations concerning the
appearance, behavior, speech or body odor of the
covered employee
The Interview Process
• Approach employees discreetly
• Conduct the interview in a respectful,
diplomatic way
• Conduct the interview behind closed doors so
as not to embarrass employee or cause a
scene
• Documentation of the signs and symptoms
observed is critical to the integrity of the
supervisor’s referral- the use of a reasonable
suspicion documentation form is highly
recommended*
Reasonable Suspicion Interview
and Testing
• It is imperative that reasonable suspicion
decisions are based on the objective facts
that are present at the time of observation
• Use of a second supervisor’s observation is
beneficial in avoiding claims of harassment or
discrimination
• Escort employee to and from testing site
– Arrange for transportation home if necessary
– If breath alcohol test result is between 0.02 and
0.039- remove employee from duty for a
minimum of 8 hours
Best Practices in Reasonable
Suspicion Testing
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Train Supervisors well
Reinforce often, the support of management
Document, Document, Document
Consider training dispatchers as they interact
often with employees
• Don’t be afraid to conduct reasonable
suspicion interviews, even it does not result
in testing; interviews can uncover health
concerns or Rx medication issues
Any Questions related to our
discussion on Reasonable
Suspicion Testing?
Collection Site Monitoring and
Problems
A Word or Two on Collection Sites
• Often the weakest link in the program
• Monitoring of the sites is not a regulatory
requirement
• However: regulatory compliance of the
collection site affects your overall compliance
• Lack of collection facilities or breath alcohol
testing sites is not an excuse for failure to
conduct any of the testing required
• Your TPA should be vigilant in addressing
your areas of concern with collection sites
Minimum Requirements of
Collection Sites
• DOT qualified collectors and breath alcohol
technicians
• A privacy enclosure with toilet
• A secure area for personal belongings to be
stored during collection
• An area for hand washing prior to collection
• No contaminants, cleaning products, soaps,
or water source available to adulterate
specimen
• No trash receptacles, loose ceiling tiles, or
other areas that a donor could hide a
contaminate or substituted specimen
Collection Site Requirements
Continued
• Bluing agent in toilet bowl to detect if toilet
water is used to dilute specimen
• Established and reliable delivery method for
transporting specimens to the lab
• The name of a specific contact within your
agency to call when issues or areas of
concern arise (shy bladder, refusal, etc.)
Monitoring the Collection Site
• Conduct an “undercover” audit of your
collection site
• Use the Collection Site Monitoring Toolkit
(available on the CUTR website) to document any
findings
• Submit your findings to your TPA and ask for
follow up to your concerns
• Visit with the collection site supervisor to
discuss your concerns
• Maintain a good rapport with the collection
site management
Desktop Monitoring
• The following are Red Flags that your collection site
may not be on top of things:
– Employer copies of the custody and control forms are not
promptly delivered to the attention of the DAPM
– Test type is frequently marked incorrectly
– Employees are reporting that collections are conducted
hastily or that there are extraordinary delays in testing
– An increase in the turn around time for result reporting is
noted
– An increase in the number of correctable flaws are noted
– The DAPM is not notified when a shy lung or shy bladder
situation occurs
– The information provided by the collector on the CCF is not
written legibly
– The donor’s initials are seen on the employer copy (this
indicates that labels were initialed prior to vials being
sealed)
Problems at the Collection Site
• Shy Bladder
– Donor does not produce the minimum of 45 mL of urine for
testing
– Donor must be offered 40 ounces of fluid during a period of
up to 3 hours- (employer should be contacted at this time)
– Refusal to consume fluid is not refusal to test
– If donor is unable to provide sufficient quantity within the
three hour time period, donor must be evaluated for a
medical cause within 5 days
– Refusal to be evaluated and/or the finding of no medical
explanation are both “Refusals To Test” which constitutes a
positive result
– Collector must document attempts made by donor and a
copy of the chain of custody form should still be delivered
to employer-regardless of the lack of specimen
Problems at the Collection Site
Continued
• Shy Lung
– Donor is not able to produce enough breath for
the equipment to register a result
– After three attempts, donor must be evaluated by
a licensed physician to determine if there is a
medical explanation
– Refusal to be evaluated or a finding that lacks
medical explanation is a Refusal to Test- which
constitutes a positive result
– Technician must document attempts on ATF
(alcohol testing form) and notify employer
Problems at the Collection Site
Continued
• Blue/Green Specimen
- Donor has attempted to adulterate the specimen
(most likely with toilet bowl water)
– Collector must continue to process specimen,
(send it to lab)
– Collector must then conduct an observed
collection on donor
– Lab will analyze blue green specimen and report it
as a adulterated specimen
Problems at the Collection Site
• Cold Specimen
– Donor has attempted to submit a specimen that
was provided by another individual
– Collector will document the temperature of the
specimen and notes in the remarks section of the
CCF
– Collector will discard the cold specimen and
require donor to undergo an observed collection
Problems at the Collection Site
Continued
Behavior That Constitutes a Test Refusal
Failure to appear for a test in the time frame specified by the employer.
Failure to remain at the testing site until the testing process is
completed.
Failure to provide a urine specimen, saliva, or breath specimen, as
applicable.
Failure to provide a sufficient volume of urine or breath without a valid
medical explanation for the failure.
Failure to undergo a medical examination to verify insufficient volume.
Failure to cooperate with any part of the testing process.
Failure to permit the observation or monitoring of specimen donation
when so required
Failure to take a second test required by the employer or collector.
Failure to sign the certification on Step 2 of the Alcohol Test Form.
A drug test result that is verified by the MRO as adulterated or
substituted.
Best Practices for Collection Site
Monitoring
• Conduct undercover auditing as well as
scheduled visits with staff
• Monitor your employer copies of the chain of
custody forms for red flags
• Gain feedback from employees on their
experience at the site
• Watch your turn around times (this could be
due to an unreliable specimen delivery
method or due to correctable flaws having to
be made)
• Keep a good rapport with the collection site;
if they know you care- they will care
Any Questions related to our
discussion on Collection Sites?
It’s time for our final 10 minute break!
Put your thinking cap on,
its time to compete for
some prizes!!
Thank you for attending my training session today. Please
feel free to contact me at anytime for answers to your drug
and alcohol testing program questions~
Diana
Diana Byrnes
813-426-6980
E-mail: [email protected]
http://www.cutr.usf.edu/byrnessamsite