Transcript EAP & SAP: Working Together

EAP & SAP: Working Together
Presented October 6, 2006 by:
Reed A. Morrison, Ph.D.
President/CEO
American Substance Abuse Professionals (ASAP)
www.go2asap.com
888-792-ASAP
©American Substance Abuse Professionals, Inc. 2006 All Rights Reserved
Quiz Question #1
What is the difference between
EAP and SAP?
A.
B.
C.
D.
One has an “E”, the other an “S”
One comes from a tree, the other from a frog.
Nothing, they’re really the same.
One provides employee benefits, one does not.
Quiz Question #2
Yes or No: An EAP services provider can
be an SAP services provider?
A. Yes
B. No
C. Yes and No
D. Yes or No
E. All or none of the above
Why address this question?
• Because client companies frequently
receive concurrent Employee Assistance
Professional (EAP) and Substance Abuse
Professional (SAP) services.
• In many cases, the EAP is the primary
contractor and outsources SAP services to
a SAP vendor provider.
And …?
• This arrangement, when well-coordinated
and effectively delivered, enhances
product and delivery efficiencies.
• When delivered without effective
coordination and delivery, boundaries can
become blurred, confusion can abound
and costly risks can arise.
…. And this is not good.
So …
• This workshop aims to provide clarifying information and
useful directions for helping SAP and EAP services work
together effectively.
• In particular, it will address the configuration where the
EAP is the primary contractor and the SAP provider is an
outsource vendor.
• It will seek to help EAP providers better understand the
product, the objectives and the protocols of an effective
SAP provider.
Course Objectives …
1.
Identify three basic similarities shared by SAP and
EAP services.
2.
Identify three distinct differences between SAP and
EAP services.
3.
Name at least two sources of confusion that can
interfere with the effective delivery of EAP and SAP
services.
4.
Name at least three components of an effective
EAP/SAP vendor partnership.
What’s a SAP?
The Substance Abuse Professional (SAP) is
– A clinician with specialized training and
credentials
• Who evaluates employees who have violated a DOT
drug and alcohol program regulation and
• Makes recommendations concerning education,
treatment, follow-up testing, and aftercare.
Who Does the SAP Serve?
• The SAP’s client is public safety.
• Substance Abuse Professional Guide:
“As a SAP you are advocate for neither the
employer nor the employee. Your function is to
protect the public interest in safety by
professionally evaluating the employee and
recommending appropriate education and/or
treatment, follow-up tests, and aftercare.”
Why Do We Need Them?
• Because … the DOT says we do!
• The Omnibus Transportation Employee
Testing Act of 1991 requires drug and alcohol testing of
safety-sensitive transportation employees in aviation, trucking, railroads, mass transit,
pipelines and other transportation industries. DOT publishes rules on who must
conduct drug and alcohol tests, how to conduct those tests and what procedures to
use when testing. These regulations cover all transportation employers, safetysensitive transportation employees and service agents -roughly 12.1 million people.
Encompassed in 49 Code of Federal Regulations (CFR) Part 40, the Office of Drug &
Alcohol Policy & Compliance (ODAPC) publishes, implements and provides
authoritative interpretations of these rules.
Why do EAPs want a
SAP Services Vendor Provider?
• Specialization: The SAP Provider is an expert
in the delivery of a highly specialized service.
• Saves money: expenses for training, staffing,
network development, credentialing, etc.
• Saves time: the SAP provider is on 24/7 ‘standby’ for referrals; SAP cases can consume
valuable time and resources
• Reduces Risk: avoids confusion re: protocols,
confidentiality
• Promotes Productivity: allows the EAP to
focus on its core concerns
What Makes a SAP?
• A SAP must have qualifying pre-requisite
credentials, possess specific knowledge, receive
training, and achieve a passing score on an
examination. There is also a continuing
education requirement. For details, see “The
Substance Abuse Professional Guidelines”
under Documents/Publications/Forms on the
DOT website:
http://www.dot.gov/ost/dapc/documents.html
What’s a SAP Service Provider?
• An organization that is hired to take on the
responsibility of managing an employer’s
compliance to DOT regulations.
• In DOT parlance, the SAP Services
Provider is contracted by the EAP to
function as a Service Agent to the
Employer.
SAP Provider Responsibilities
1. Consulting/developing employer SA
policies
2. Consulting on DOT policies as they
effect employer and employees
3. Recruiting, credentialing, maintaining a
network of SAPs
4. Coordinating SAP evaluation referrals
SAP Provider Responsibilities
cont’d
5. Case Managing
a. SAP evaluations/reporting
b. Employee compliance
c. RTD procedures
6. Managing Aftercare
a. Aftercare testing
b. Aftercare SAP recommendations
What is an EAP?
• An employee assistance program (EAP) is a
worksite-based program designed to assist …
• (1) work organizations in addressing productivity
issues and
• (2) "employee clients" in identifying and
resolving personal concerns, including, but not
limited to, health, marital, family, financial,
alcohol, drug, legal, emotional, stress, or other
personal issues that may affect job performance.
http://www.eapassn.org
Core EAP Technologies
•
1) Consultation with, training of, and assistance to work organization leadership
(managers, supervisors, and union stewards) seeking to manage the troubled employee,
enhance the work environment, and improve employee job performance, and outreach to
and education of employees and their family members about availability of EAP services;
(2) Confidential and timely problem identification/assessment services for employee
clients with personal concerns that may affect job performance;
(3) Use of constructive confrontation, motivation, and short-term intervention with
employee clients to address problems that affect job performance;
(4) Referral of employee clients for diagnosis, treatment, and assistance, plus case
monitoring and follow-up services;
(5) Consultation to work organizations in establishing and maintaining effective
relations with treatment and other service providers and in managing provider contracts;
(6) Consultation to work organizations to encourage availability of, and employee
access to, health benefits covering medical and behavioral problems, including but not
limited to alcoholism, drug abuse, and mental and emotional disorders; and
(7) Identification of the effects of EA services on the work organization and individual
job performance.
Benefit vs. Compliance Service
• The EAP service is often positioned as a ‘company
benefit’.
• The SAP duty is a compliance service. It is not a
company benefit! It is not optional.
• If an employer does not comply with DOT regulations (49
Part 40 and its subparts), it can be fined.
• If an employee violates DOT substance abuse
regulations and does not comply with the stipulated
return-to-duty process, s/he can be fired and prohibited
from engaging in DOT regulated work until compliance
requirements are met.
EAP/SAP Boundaries
Are SAP and the EAP counselors the same?
• They may have similar or even identical credentials.
(Some EAP counselors are also SAPs.)
• Their functions are distinctly different.
EAP/SAP Boundaries cont’d
Can the Same Counselor Perform
EAP and SAP Duties for the Same
Employee?
• Technically, yes. An dual-credentialed EAP
counselor can provide traditional employee
advocate services to an employee, ‘change
hats’ and perform SAP DOT compliance
duties for the same employee.
So What’s the Problem?
Confusion ….
•
•
•
•
The employee can be confused by dual
processes and dual professional identities.
The counselor can be confused by dual
protocols and responsibilities.
The employer that fails to fulfill DOT SAP
compliance responsibilities risks fines and
suits.
The EAP that perpetrates the confusion can
be held responsible, by the employer, for the
non-compliance consequences.
Sources of Confusion
• Protocols: The credentialed SAP must be
prepared to enact and enforce appropriate
DOT 49 Part 40 regulations as well as
corresponding regulations for each modal
body governed by the DOT Office of Drug
& Alcohol Policy & Compliance: FMCSA,
FAA, FRA, FTA, PHMSA & the USG.
Sources of Confusion cont’d
• DOT protocols stipulate SAP core
functions that can be in violation of
clinical EAP professional ethics and in
contradiction with EAP core functions.
What are the SAP Core Functions?
• “Gatekeeper” for DOT’s return-to-duty process.
• To protect the public interest in safety by
professionally evaluating the employee and
recommending appropriate education and/or
treatment, follow-up tests, and aftercare.
• To provide a comprehensive face-to-face
assessment and clinical evaluation to
determine what level of assistance the employee
needs in resolving problems associated with
alcohol use or prohibited drug use.
SAP Core Functions cont’d
• To recommend a course of education and/or
treatment with which the employee must
demonstrate successful compliance prior to
returning to DOT safety-sensitive duty.
• To serve as a referral source to assist the
employee's entry into an acceptable program.
• To provide, prior to the employee's return to
safety-sensitive duties, a face-to-face follow-up
evaluation with the employee to determine if the
individual has demonstrated successful
compliance with recommendations of the initial
evaluation.
SAP Core Functions cont’d
• To develop and direct a follow-up testing plan
for the employee returning to work following
successful compliance.
• To provide recommendations for aftercare
when an employee needs continuing
assistance with an alcohol or drug problem even
if the employee is ready to return to work. At
these times, you will provide the employee and
employer with your recommendations for
“aftercare” – continuing education and/or
treatment needed after return to safety-sensitive
duties.
Sources of Confusion cont’d
Confidentiality
• A primary point of contradiction lies in the
area of client confidentiality.
• EAP confidentiality protects the employee.
• SAP confidentiality protects the public.
Confidentiality
•
EAP records are subject to HIPAA.
– Information is released via a HIPAA
compliant ROI.
•
SAP records are HIPAA exempt and
must be shared with certain parties in the
DOT 49 Part 40 Return-to-Duty process.
– Information release is mandated by the DOT
and explicated by the Statement of
Understanding.
Confidentiality cont’d
• EAP records are protected as ‘medical records’.
They may contain diagnoses, procedure codes
and psychotherapy notes.
• While the SAP, in the course of a clinical
evaluation, may consider all of the above,
reports and records that are subject to DOT
release may not contain diagnoses, procedure
codes and psychotherapy notes.
• The SAP report and records are intentionally not
part of a medical record system. (For this
reason, most insurance companies will not cover
SAP evaluations.)
The Statement of Understanding
• The Statement of Understanding explains
the SAP process and stipulates that the
following information may be shared among
appropriate parties without the employee’s
express consent:
1. The violation of DOT regulations (prohibited conducts)
2. Drug and/or alcohol test results
3. The Substance Abuse Professional’s (SAP) synopsis of
the treatment plan
4. The SAP’s assessment and treatment plan
Statement of Understanding cont’d
5. * Diagnostic information, where applicable
6. Treatment progress reports
7. Program completion information, including discharge
summary, if
applicable
8. Program involvement dates, attendance reports
9. Other relevant information as it pertains to my returnto-duty
process
* SAP reports may not include a clinical diagnosis.
Statement of Understanding cont’d
The parties that may share pertinent information include:
•
•
•
•
•
•
•
•
•
SAP
Treatment/Education Provider:
EAP
The SAP Service Vendor
DER (Designated Employer Representative
Manager
MRO (Medical Review Officer):
C/TPA (Consortium or Third Party Administrator
Managed care, insurance carrier, HMO
Statement of Understanding cont’d
• The Statement of Understanding should include adequate
explanations for sharing information, including the limits of
releasing information. The following are examples:
– The purpose of the exchange of information is to comply with DOT
requirements that must be met before I may take a Return to Duty
drug and/or alcohol test, prior to being considered by my employer
for returning to the performance of safety-sensitive functions under
DOT regulations.
– I understand that my records are protected under the federal
regulations governing Confidentiality of Alcohol and Drug Abuse
Patient Records, 42 CFR Part 2, and cannot be disclosed without
my written consent unless other wise required by law, or provided
for under DOT regulations.
Statement of Understanding cont’d
– I understand that communication between service agents/entities is
required under U.S Department of Transportation rules and
regulations, and is permitted without my authorization. In addition, the
regulations permit the SAP to send required reports to my employer,
without my authorization. However, in order for the SAP to provide
reports to employers other than my current employer, including future
employers, the SAP must obtain my written authorization.
– Lawful release of records is permitted under the following conditions:
if you pose a clear and imminent danger to self or others, if there is
know or suspected child abuse or neglect, if medical records are court
ordered by a judge compelling disclosure, when the SAP seeks
medical or legal consultation, if the SAP is to make case records
available, on request, to DOT agency representatives and/or
representatives of the National Transportation Safety Board in an
accident investigation.
How it works …
1.
2.
3.
4.
Employee registers positive test
DER refers Employee to EAP
EAP refers case to SAP Vendor.
The SAP Vendor furnishes a Case
Manager (CM) who provides procedural
oversight and documentation for the
entire DOT return to duty process.
How it works … cont’d
5. SAP Vendor CM contacts Employee for
telephonic intake.
– If the Employee also has non-DOT issues,
the SAP CM refers Employee to the EAP for
concurrent services.
– The SAP CM arranges the Employee’s
appointment with local SAP for the DOT
mandated initial evaluation.
How it works … cont’d
6. The SAP CM reviews the SAP evaluation
with the local SAP prior to its submission
to the Employer (DER).
•
Since many SAPs are therapists who infrequently
perform SAP evaluations, the CM acts as a consultant
for DOT procedures. The SAP CM may not determine
or modify SAP recommendations. The SAP remains
an independent party in the DOT process.
How it works … cont’d
7. The SAP CM updates the EAP.
•
•
Frequency of updates is negotiated by the EAP
and SAP providers.
The SAP CM will always contact the EAP in
atypical situations, e.g., employee refuses
appointment, no-shows, non-compliance, etc.
How it works … cont’d
8. The SAP CM, via continuous contact with
the SAP, monitors the Employee’s
treatment compliance and success. If the
SAP changes recommendations, the SAP
CM confers with the SAP and ensures that
proper DOT procedures are followed. The
EAP is updated.
How it works … cont’d
9. When employee compliance is established, a
follow-up SAP evaluation is scheduled for the
employee by the SAP CM. The SAP CM once
again provides procedural consultation to the
SAP re: aftercare recommendations and the
follow-up testing plan.
10. The SAP sends the Follow-up SAP Report to
the employer (DER). The EAP is updated by
the SAP CM.
How it works … cont’d
11. The employee is tested for RTD.
12. The SAP CM consults with the DER re:
aftercare requirements and the aftercare
testing schedule. The EAP is updated.
The DER may opt to use the SAP Provider as
a Service Agent to manage aftercare
compliance and the employee’s aftercare
testing plan.
What does the SAP program
accomplish?
1. Protects public safety
2. Protects workplace safety
3. Protects employer from compliance
violations and workplace safety costs
4. Protects employee’s job
5. Promotes recovery
Alcohol Treatment
Success Rates
70%
60%
50%
40%
30%
20%
10%
0%
UNM CASAA 2001
ASAP 2005
Substance Abuse
Treatment Success Rates
80%
70%
60%
50%
40%
30%
20%
10%
0%
TEDS 2002
ASAP 2005
What makes a good
EAP/SAP Partnership?
• SAP Provider supports the EAP mission.
• The SAP Provider must function in ways
that protect and enhance the reputation of
the EAP.
• The SAP Provider must be familiar with
EAP programs and protocols
• Mutual respect for people and programs
What makes a good
EAP/SAP Partnership?
cont’d
• The SAP Provider must quickly and efficiently
respond to EAP service requests.
• The SAP Provider must have flexible programs
to serve a wide spectrum of EAP programs and
clients re: network coverage, language, work
shift flexibility, etc.
• Good communication channels: well defined
points of contact, regular conference calls, etc.
What makes a good
EAP/SAP Partnership?
cont’d
• A good contract that defines boundaries,
stipulates responsibilities and addresses
liability.
• The SAP Provider must be audit capable
• The SAP Provider must have a QA system
What makes a good
EAP/SAP Partnership?
cont’d
• The SAP Provider must have DOT
compliant record keeping
systems/practices
• The SAP Provider should have the
capability to provide co-training with the
EAP, e.g., DER & HR training
• The SAP Provider must be able to be
oriented by the DER to EAP client
company policy
How Does the EAP Know When
the Partnership is Working?
• Minimal complaints
• Problems are exploited for improvements
• The client company is satisfied
– Case closure surveys
– Client company satisfaction surveys
– Internal EAP surveys re: the SAP Provider