EAP & SAP: Working Together

Presented October 6, 2006 by:

Reed A. Morrison, Ph.D. President/CEO

American Substance Abuse Professionals (ASAP)

www.go2asap.com888-792-ASAP

©American Substance Abuse Professionals, Inc. 2006 All Rights Reserved

Quiz Question #1

What is the difference between

EAP and SAP?

A. One has an “E”, the other an “S”

B. One comes from a tree, the other from a frog.

C. Nothing, they’re really the same.

D. 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, safety-sensitive 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 ‘stand-by’ 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 results3. The Substance Abuse Professional’s (SAP) synopsis of the treatment plan4. The SAP’s assessment and treatment plan

Statement of Understanding cont’d

5. * Diagnostic information, where applicable 6. Treatment progress reports7. Program completion information, including discharge

summary, if applicable8. Program involvement dates, attendance reports9. Other relevant information as it pertains to my return-

to-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. Employee registers positive test

2. DER refers Employee to EAP

3. EAP refers case to SAP Vendor.

4. 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

0%

10%

20%

30%

40%

50%

60%

70%

UNM CASAA 2001 ASAP 2005

Substance Abuse Treatment Success Rates

0%

10%

20%

30%

40%

50%

60%

70%

80%

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