The DOT-Qualified Substance Abuse Professional (SAP)

1. The DOT-Qualified Substance Abuse Professional (SAP) Roles and Responsibilities Scott J. Watson, MA, LCAC, SAP, BRI Heartland Intervention, LLC Indianapolis, IN

2. Objectives Explore the purpose and utility of the Part 40 Rule Examine the stated roles and limitations of the SAP Examine the stated roles and limitations of the employer and covered employee. Review challenging cases, errors and suggestions relevant to the Return to Duty Process.

3. SAP Overview Face to face assessment Recommendations for education/treatment Monitor progress Follow up assessment Determine compliance Follow up testing plan Aftercare plan if appropriate

4. Employer Overview Meet and comply with all rules Designate a DER Ensure qualification of service agents Obtain testing from previous employers (2yrs) Conduct all required tests Receive (via DER) all communication from MRO, SAP, etc. Provide training according to rule

5. Employer Overview Inquire of previous employers Remove verified positives from duty Provide names of SAPs Conduct all required tests Function as custodian of records Cooperate in all audits Submit reports as required

6. The Substance Abuse Professional • Qualifications • Medical Doctor, Psychologist, Social Worker, MFT, EAP, Addictions Counselor • Must complete Qualifying SAP Training • Must satisfy a SAP examination • Must have knowledge and experience in dx & tx of substance use disorders

7. The Substance Abuse Professional So… What about the Certified or Licensed SAP? How do you KNOW that your SAP is qualified?

8. Who is the SAP Client? Employer Employee C-TPA Union Travelling Public

9. Do I Need a SAP? • Any verified positive result from an MRO is considered a violation…. • Pre-employment • Random • Follow up • Return to Duty • Post Accident • Reasonable Suspicion

10. Violation……or Not? Employee is given permission to use a company bus while off duty to transport some kids from his baseball team to a clinic. With no one else on the bus, it gently brushes a parked car and knocks off a rear view mirror. Police are called to complete an accident report after which the employee is charged with DUI.

11. Do I Need a SAP? • Any verified positive result from an MRO is considered a violation…. • Pre-employment • Random • Follow up • Return to Duty • Post Accident • Reasonable Suspicion

12. Violation…..or Not? 8 year employee goes for his DOT physical on a yearly basis. This year it includes a UDS. The new collector sees it’s for a “DOT” physical and marks the form as a “pre-employment” which subsequently comes back positive for THC. Violation?

13. SAP Requirements • Initial Evaluation • Must be clinical in nature • Million nosey questions • Must be face to face (40.291a) • Must include an assessment tool • Recommendation of Assistance (40.293 b1 and c/d) • Education and/or Treatment

14. SAP Requirements • Initial Letter to DER (40.311a) • Must be on SAP’s letterhead • Must be written • Must have signature, phone # and date • Also must include (40.311c) • Employee’s name and SSN • Employers name and address • Specific violation and date • Date of assessment • Recommendation of education and/or treatment

15. SAP Requirements • Initial Letter • Must be sent directly to the DER (40.311a) • Copy MAY be sent to 3rd party • Does NOT require a release • May not be changed or amended (40.311b)

16. SAP Considerations Insurance coverage and/or financial issues Employment based agreements for treatment Policies regarding leave or similar SAP word is final and trumps the above which still may be considered

17. SAP Requirements • Must monitor treatment progress • Contact with providers • Appropriate documentation • Need to revise recommendations • Follow up recommendations

18. SAP Requirements • Complete follow-up evaluation • Face to face • Assessment tool • Determination of employee compliance

19. SAP Requirements • Letter of Compliance • Employee name and SSN • Employer name and address • Specific violation and date • Dates of evaluations and summary of plan • Dates of program participation • Clinical characterization of compliance • Follow up testing plan • OPTION of continuing care • SAP signature, phone # and date

20. SAP Requirements • Letter of NON-Compliance • Employer may NOT return employee to duty • More time needed or personnel action needed? • Letter contains same basic info as when compliant

21. Follow Up Testing Employer is responsible party Not just “more randoms” but a TOOL for employers At least 6 in first 12 months Can last up to 5 years Designed to be individual in nature Can include alcohol and/or drugs Not to be given to employee Goal: Monitor employee to ensure no drug use

22. Scenario • EFG company purchases the HIJ and LMNOP company. The EFG DER becomes the DER for the new company. • She realizes that: • 3 drivers inherited from the purchase were fired from EFG 2 yrs. ago for DOT violation. There is no documentation at new company. • 1 employee has a follow up testing plan from 3 years ago but there is no documentation a follow up has EVER occurred.

23. Scenario Small town has there bus driver’s in for a meeting. During a break it is suggested that Sandy smells like ETOH. Small town calls their local police department who gives PBT and determines BAC= .065. Employee is above threshold but not drunk. She is sent (not driven) home and a SAP is contacted the next week to do an eval according to city policy.

24. Five Friendly Suggestions Understand Follow Up tests for what they are Maintain a company substance use policy Consider a “Return to Work” agreement for all SAP cases Develop a relationship with a SAP