Chapter 8. EMPLOYEE ASSISTANCE PROGRAMS,

REHABILITATION, AND TREATMENT

Under the FMCSA controlled substances use and alcohol misuse regulation, you are required to refer any driver to an SAP for evaluation, who has used controlled substances or misused alcohol, regardless of the consequences specified in your policy (see 49 CFR part 40, subpart O). For example, you must provide these referrals to your drivers

even if your policy is to terminate drivers who violate the controlled substances use and alcohol misuse regulations. You must also inform your drivers of resources available to resolve problems associated with controlled substances use and alcohol misuse.

You are not required by this regulation to provide, or to pay for, rehabilitation and treatment programs. However, many employers choose to do so because research and experience have demonstrated that such programs can be highly cost-effective.

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Programs that address substance abuse problems in the workplace are often referred to as "employee assistance programs" or "EAPs." Many EAPs address other problems of drivers and their family members.

Providing EAP services to support the controlled substances and alcohol regulations may be relatively inexpensive if you already have an EAP in place. In many cases, your existing EAPs may already be providing some, or all, of the recommended services, such as assessment and counseling.

For these reasons, employers that currently do not have EAPs should carefully consider the economic and other benefits of establishing them when implementing their controlled substances use and alcohol misuse testing programs. Employers that already offer EAPs should review them for opportunities to integrate their FMCSA-mandated testing programs. You should ensure, however, that the testing programs do not compromise, or appear to the drivers to compromise, the integrity of the EAP.

The relationship of the SAP to the EAP is a complex and sensitive one. Under the regulation, the SAP must evaluate those who fail controlled substances and alcohol tests. The SAP is required to recommend the appropriate treatment and/or education to a

driver who has tested positive on a DOT controlled substances or alcohol test. According to the regulation, the employer is responsible for ensuring that the SAP does not refer drivers to a treatment provider that has a financial relationship with the SAP. This provision applies whether or not the employer offers an EAP or other treatment coverage.

SAPs are also responsible for ensuring that drivers satisfactorily complete treatment before they are permitted to return to safety-sensitive duties. In this case, an SAP associated with the EAP or other treatment program may, at the employer's option, be the one to certify readiness to return to duty even if a financial relationship exists between the SAP and the treatment provider. Since not all counselors in treatment programs will possess the credentials required in the regulations to qualify as a SAP (§382.107), employers must confirm this qualification prior to accepting the return-to-duty recommendation.

Section 1. EMPLOYEE ASSISTANCE PROGRAMS

EAPs help drivers and their family members with personal and behavioral problems, including but not limited to health, marital, financial, alcohol, drug, legal, emotional, stress, and other concerns that may adversely affect performance and productivity.

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EAP services may be provided directly by the employer or union, or they may be contracted out. Generally speaking, employers with fewer than 3,000 employees will find it more cost-effective to contract out for services. In addition, regardless of the number of employees, if workers are geographically dispersed or if the EAP is intended to be "full-service" and to cover a broad range of problems, contracting out is often cost-effective.

Internal EAPs (those operated directly by the employer) are typically established within human resources or medical departments. Although the company operates the EAP, the EAP facility may or may not be on the employer's property.

External EAPs are contracted services provided for the employer or union by an outside vendor. Vendors may be large national or international EAP providers, local specialized EAP providers, or university-based or other mental health clinics. As with the internal EAPs, physical facilities may or may not be located on the employer's property.

Finally, just as with testing programs, EAPs may be cost-effectively developed through consortia (see Chapter 10, "Joining a Consortium"). Small employers or unions join together to combine their resources and

achieve purchasing power and operational expertise typically unavailable to any one consortium member acting individually. For example, a 10-driver employer that could not afford to purchase external EAP services on its own could join a consortium with other similar employers and achieve more favorable financial terms.

Because consortia EAP offer both advantages and disadvantages, their use should be carefully considered. On the positive side:

• Consortia reduce costs for small and medium-sized employers.

• Confidentiality is easier to maintain.

• Community resources are usually better identified and employed.

• A greater range of employees can be served.

• Often the counseling staff has greater diversity and better credentials.

On the negative side:

• Some supervisors and managers will be reluctant to bring

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"company matters" before "outsiders."

• The consortium providers (like other external EAP operations) have limited knowledge of the company.

• Role definition between the consortium and the individual members may be unclear, leading to misunderstandings.

• Participating employers may disagree about services needed and apportionment of costs.

• Counselors may find it difficult to integrate themselves into your work force.

Clearly, several of the negatives apply to all external EAPs and not just to consortia. Sound management, a spirit of cooperation, and careful selection of the consortium management and staff can alleviate many of the potential negatives.

The specific services your EAP will provide are a matter of program design. You can choose to include any services you believe will improve the productivity and safety of your work force. Table 8.1 suggests features

that EAPs should provide whether they are internally, externally, or consortium-operated.

In addition, some specific requirements of the new testing regulations lend themselves to being performed by EAPs. Examples of these requirements include

• Maintenance of confidential program records

• Program reporting

• Testing (particularly return-to-duty and follow-up)

• Supervisory training and driver education on the requirements of alcohol and drug testing regulations.

You should keep in mind, however, that your EAP may object to conducting drug testing, particularly testing that is not conducted for return-to-duty or follow-up purposes. This may be the case even if the EAP normally conducts testing as a part of its treatment regimen. EAPs often feel that conducting company drug testing makes them appear to be part of the disciplinary or security functions of the company, and as such discourages self-referrals for treatment services.

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• Needs Assessment
• Program Design
• Policies and Procedures Development
• Union Integration
• Start­Up Meetings with Key Personnel and Advisory Committee

• Annual Face-to-Face Employee Orientations (or Video)
• Wellness Seminars
• Posters
• Paycheck Stuffers and Wallet Cards
• Personalized EAP Brochure

• Face-to-Face Assessment, Counseling, and Referral Services
• 24-Hour Response
• Appointments Within 48 Hours
• Telephone and Face-to-Face Follow-Up for a Minimum of 3 Months until Problem Resolution

• Training Programs (2.5 Hours Each)
• Periodic Updates for New Managers and Supervisors
• Supervisor's Guide

• Consultation With Key Managers as Needed
• Unlimited Telephone Consultation and Assistance to Individual Supervisors as Needed

• Quarterly Reports Analyzing Performance
  (Statistical Summaries and Narrative Reports With Recommendations)
• Semi-annual Presentations to Senior Management

• Per Capita Fee
• Sliding Scale Based on Utilization
• Administrative Fee/Per-Case Basis

• Critical Incident Response
• Executive Assistance Program
• Drug-Free Workplace Training and Consultation Workplace Seminar Series

Providing an EAP.

As mentioned above, the testing regulations do not require you to provide treatment or rehabilitation for your drivers. Nonetheless, many employers in a variety of industries, with and without testing programs, have discovered the value of providing employee assistance services for their employees and their immediate families.

According to the U.S. Department of Labor, corporations are increasingly turning to EAPs to deal with their employees' substance abuse problems. More than 10,000 EAPs operate across the country.

All sizes and types of employers have instituted EAPs. They can help save money by decreasing absenteeism, the number of accidents, use of medical and insurance benefits, worker's compensation claims, grievances and arbitrations, and employee replacement costs.

Major Decisions to be Made in Establishing an EAP

The decisions you must make in establishing an EAP fall into three broad categories:

• Program Scope

— Employee eligibility (e.g., all employees, safety-sensitive employees only, probationary

employees, immediate family members, significant others)

— Number of work sites to be served

— Location of work sites

— Types of problems to be addressed (e.g., substance abuse, legal, financial, marital, psychological).

• Program Type

— Internal: provide in-house EAP

— External: purchase services of external company

— Consortium: combine with other employers to purchase services.

• Program Administration

— EAP interface with other departments and programs (e.g., personnel, benefits, unions, training and development, controlled substances use and alcohol misuse testing, progressive discipline)

— Resources, facilities, and staffing

— Program launching and promotion

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— Education, training, and consulting

— Program accountability (statistical reporting, records, program evaluation).

Steps in Establishing an EAP

Because the steps you will follow to establish an EAP closely parallel those you have followed in establishing your controlled substances use and alcohol misuse program, much of the work may have already been accomplished. At the very least, you will have procedures and processes in place that can guide your EAP development.

While there are many ways to approach EAP development, the following steps have proved useful for many organizations:

• Create a program advisory committee.

• Conduct a needs assessment.

• Select a provider.

• Estimate the cost.

• Determine what needs to be done after an EAP service provider is in place.

• Determine additional resources available.

Creating a Program Advisory Committee.

You may have established such a committee or task team to implement your controlled substances use and alcohol misuse program. The program advisory committee involves many components of the employer organization in designing and implementing the EAP. This can be critical later in promoting the acceptability and use of the program.

Typically, a program advisory committee will include representatives of both labor and management. It will also cut across employer divisions and departments. The general rule you should follow in selecting participants is that if their support will be important in implementing or operating the program, they should be included. Obvious departments to include are human resources, medical services, labor relations, legal, and security, as well a broad representation of employees to be covered by the program. Because of the importance of the interface between your controlled substances use and alcohol misuse testing programs and the EAP, whoever manages those programs should be on the advisory committee. However, if your EAP will provide typical services and will not

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simply be a counseling arm of the testing program, the manager of the testing program should not be the chair of the program advisory committee or the coordinator of the EAP.

The responsibilities of the program advisory committee will be to develop, implement, and oversee the EAP. This committee will be the primary force moving the creation of the EAP, but its responsibilities will not end once the EAP has begun operating.

The program advisory committee will develop the EAP policy (which may require negotiation between management and bargaining units) and ensure that the policy and the program are properly integrated with other policies and operations of the employer.

To meet its responsibilities in these areas, the program advisory committee may turn to outside resources, including

• Other employers of CDL holders who operate EAPs

• Independent personnel and employee benefits consultants

• EAP professionals, including local and national employee assistance professional associations

Conducting a Needs Assessment.

The needs assessment is used to help you determine the scope of services the program should offer and other elements of program design. It can be useful in identifying characteristics of the work environment that affect employee performance, as well as in predicting utilization levels for various EAP services. This last information can be particularly valuable since it will help you staff the EAP appropriately and budget accurately. It can also suggest the most advantageous fee structure in any contract to be negotiated with an external EAP service provider.

You may also choose to conduct a needs assessment on an annual or biennial basis as a part of an organized evaluation and planning tool for assessing and improving EAP performance.

Selecting a Provider.

If you choose to operate a program internally, once you have your needs assessment in hand, you are ready to begin identifying staff and establishing the program.

Many employers will choose to contract for external EAP services either individually or as members of a consortium. If you have determined that a consortium is the best

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approach, you will need to identify potential partners. Local associations of EAP professionals, chambers of commerce, other business groups, and your State industry association may be helpful. However you identify your partners, you should work with them on a program advisory committee so that the EAP consortium is responsive to all members' needs. While, as with all committees, this may result in a better program than you might have designed individually, you may also need to compromise on design issues in ways that you would not if you were not a part of a consortium.

You will need to prepare and release a request for bid (RFB) to obtain EAP services. Because of the wide variety of types of EAP services and the different interpretations of common terms, your RFB should be very specific about the services you want to purchase and how you expect the bidders to prepare their responses. This specificity will help make sure that you are purchasing the services you expect and that proposals from different vendors are comparable. Just as importantly, it will serve as the basis for a very specific contract that you will negotiate with the service provider.

The appendix to this chapter contains a sample RFB for purchasing EAP services. You should review it to determine the extent to which it meets your program design needs.

Send the RFB to EAP providers who serve your area. You will be able to generate names by talking to other employers in the area, by consulting your local or State employee assistance professionals association, or by looking in your Yellow Pages directory under a heading such as "Employee Counseling Services."

Be sure to allow bidders adequate time to provide the detailed information you have requested in the format you have specified. Make the results of your needs assessment available to those who request it. If your company's purchasing procedures permit, meet with vendors who request meetings. EAPs are very "people-oriented," and you should take the opportunity to get to know the people who want to provide this service for your work force. You must be comfortable with them. You are, after all, turning over the care and well-being of your most valuable asset to them.

The draft RFB in the appendix suggests selection criteria you will want to employ in choosing among bidders. Relevant criteria might include, for example,

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• Services offered

— Assessment

— Short-term counseling

— Referrals

— Follow-up

— Referral source maintenance

• Case management procedures

• Clinical supervision procedures

• Reporting procedures

• Managerial and supervisory training

• Management consultation

• Employee education and program announcement

• Staff qualifications

• Office space, facilities, and hours of operation

• Methods for evaluating EAP performance

• Organizational experience

• Understanding of your employees, work force, and needs

• Confidentiality and record keeping procedures

• Participation rates (historical and anticipated/guaranteed)

• Financial capability

• Understanding of multiculturalism, multilingual forces

• Price.

In the end, your best indication of how good a particular vendor will be might be determined best through interviews of other organizations the vendor serves. Once you have narrowed your search to two or three finalists who seem to meet your criteria, call several clients of each and ask detailed questions. While it is important that the EAP vendor understand workers in your industry, it is just as important that they have a thorough knowledge of the resources available in your community. Therefore, when you check references, be sure to call companies located in your community, as well as other companies in your industry.

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Estimating the Cost.

Depending upon the size of your work force, its location, types of programs available, number of problems in your work force, whom you cover, and many other factors, the cost may vary significantly. This is true whether your program is internal or external. The more responsibilities the EAP has, the more it will cost. Internally, these costs are borne through the salaries and administrative costs of the program. Externally, they are recovered through the vendor's pricing structure.

The pricing structure may vary. You may have the option of paying on a per-capita basis, where you pay a set amount per year for each employee, whether or not each employee uses the program, or you may pay on a fee-for-service basis, where you pay only when an employee actually sees a counselor.

Actual pricing may vary from $10 to $110 per employee annually. In all but unusual circumstances, you can probably obtain comprehensive services at no more than $30 to $50 per employee per year.

Determining What Needs to Be Done After an EAP Is in Place.

Regardless of whether you have an internal, external, or consortium EAP, someone

must be in charge. We refer to that person as the EAP coordinator although, in fact, the person may have a different title in your company (e.g., nurse, human resources specialist, vice president). Typically, this person will be the same one who coordinated the planning for the EAP with the program advisory committee.

The responsibilities of the EAP coordinator include

• Coordinating program advisory committee meetings

• Overseeing implementation of the EAP

• Scheduling senior management briefings

• Planning and coordinating EAP activities (e.g., training, employee orientation sessions, news articles)

• Overseeing EAP promotional activities

• Negotiating the EAP contract (usually annually)

• Monitoring the effectiveness of the EAP

• Monitoring the EAP provider's performance.

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Determining the Additional Resources Available.

Implementation of the EAP is a time consuming-process that should not be rushed. If you do not have a program now and wish to consider incorporating one as a rehabilitation component to your controlled substances use and alcohol misuse program, begin right away! EAPs that succeed have been carefully planned and developed with the support and cooperation of many levels of management and union participation as well.

In addition, many companies, including those employing CDL holders, have implemented EAPs before you. Take advantage of their experience. As discussed above, consultants are available to help you establish a program, but a great deal of free and nearly free information is also available.

Section 2. REHABILITATION AND TREATMENT

As noted earlier, the FMCSA regulation does not require you to provide, or pay for, rehabilitation and treatment programs. However, rehabilitation and treatment programs are often an integral part of successful substance abuse programs. The decision to provide rehabilitation to affected employees should be made with both the employer's and employees' needs in mind.

Inpatient and outpatient services are available. The inpatient mode often involves a 1-to-4 week stay in a hospital or residential treatment center and may be targeted toward the more severely addicted person. The outpatient mode is appropriate for those persons who are employed and can benefit from education and behavior modification to remain drug-free and/or alcohol-free.

Intensive Inpatient Services.

Inpatient centers treat dependent people with physical and/or psychological complications. Patients in intensive treatment may need supervised detoxification and may suffer physical withdrawal symptoms. As part of treatment, patients will attend education and awareness lectures and group therapy sessions. Frequently, family members are involved in treatment, since dependency affects the entire family.

Intensive Outpatient Services.

These services generally treat dependent patients who have fewer physical or psychological complications. They offer effective and less expensive alternatives to residential care for individuals with relatively stable home environments and supportive employers. The patient receives education, group therapy, and individual counseling for up

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to 10 weeks, with most sessions scheduled in the evenings (generally three sessions per week). These programs often require some family involvement. Costs are generally one third to one half of those for intensive inpatient treatment.

Outpatient Follow Up Services.

Patients discharged from intensive treatment need further help. Help may be provided through an outpatient follow-up program lasting several months to a year or more. One visit per week is typical. Many inpatient and intensive outpatient treatment plans include weekly follow-up sessions at no additional cost.

Usually your employee assistance

counselor develops a treatment program that best meets the needs of the employee in a cost-effective manner. If, however, you participate in making a treatment referral, the following guidelines will assist in evaluating the treatment program's effectiveness.

• Cost. High cost does not guarantee effectiveness. Conduct a cost comparison of programs. It could be, for example, that cost disparities are in the number of professionals per bed, total hours of one-on-one counseling and

group therapy, number of days of treatment, amount of aftercare counseling, or extent of other medical resources utilized.

• Reputation. Ask other SAPs and former program participants for their candid opinions concerning the effectiveness, service, and reliability of the treatment program.

• Staff qualifications. A quality program should have a balance of professionals. Intensive inpatient programs should be staffed by nurses, physicians, psychologists, social workers, and formerly dependent counselors. There should be medical management of detoxification. Intensive outpatient programs should be staffed by a mix of psychologists, social workers, and formerly dependent counselors. In both cases, all professional staff should be State-certified treatment specialists or counselors interning for certification.

Although an EAP is not required under the FMCSA regulations, a policy decision to attempt to reclaim human resources should be carefully considered.

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At first glance, it may seem inappropriate to allow anyone to work again who has demonstrated a high-risk behavior such as controlled substances use or alcohol misuse. However, treatment and rehabilitation can be effective. In addition, trained, skilled labor is a valuable resource. You should consider employee replacement costs, as well as the impacts on work productivity and morale, as you evaluate the cost-effectiveness of EAP rehabilitation services.

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Chapter 8 Appendix

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(Reproduced from the Employee Assistance Program for Transit Systems Manual, September 1991)

SAMPLE

Request for Bid

for

Employee Assistance Program Services

Purpose: To Provide Employee Assistance Program (EAP) Services to Company Employees who are now subject to the controlled substances and alcohol regulations of the DOT and FMCSA.

Closing Date:

Place Due:

For Further Information Contact:

I. Purpose of Request for Bid

The purpose of this Request for Bid (RFB) is to solicit proposals to provide EAP technical and professional services for the Employer.

II. Description of the Project

The Employer, with an average population of (#) regular employees, is seeking to provide professional and confidential counseling and referral service to those employees experiencing personal problems. The Employer is requesting a comprehensive, broad-brush approach in the provision of diagnostic, treatment, referral, and follow­up activities to employees. Included in the program service is the basic training of company managers and supervisors in the purposes and uses of EAP.

III. Scope of Services

Provide EAP services including, but not necessarily limited to, the following:

A. Confidential, professional, and comprehensive diagnostic, counseling, and referral services for any employee experiencing personal problems. The first session should be initially offered within a reasonable time from employee contact.

B. Program administration, recordkeeping, and reporting. Assignment of staff to administratively service the Employer's EAP, maintain complete and confidential

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records, and report quarterly to the Employer on various program and utilization statistics.

C. Annual supervisory training sessions to company supervisors in the function and uses of an EAP.

D. Communication and consultation with EAP staff by company supervisors about nonconfidential issues, should the need arise.

E. Periodic development and provision of EAP informational materials to the Employer work force.

F. Office space to provide necessary services.

IV. General Instructions

A. Proposal Content

Proposals must set forth full, accurate, and complete information as required by the RFB, and should:

1. Describe how the respondent will deal with each item outlined in the section of this RFB headed "Scope of Services." This applies even if it is the intent of the respondent to eliminate the item or to substitute some other activity.

2. Set forth an implementation plan specifying the staff credentials, capabilities, tasks to be performed, and relevant timetables for service.

3. Provide budget breakdown and fee schedule.

4. Provide original and five copies of bid.

5. Provide reference list and permission statement allowing the Employer to contact references as needed.

6. At the option of the respondent, include examples of no more than two relevant or similar projects provided by the respondent. It is highly desirable that, if such material is submitted, it be in the form of a brief summary that includes a description of the customer, description of services provided by respondent, description of the methodology employed, and examples of reporting forms used.

V. Criteria for Evaluating the Bids Received

The prospective contractor will be selected principally on the following criteria, though not necessarily in this order of ranking:

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A. Offeror's proposed statement of work. Emphasis will be on soundness of approach, service provisions, previous experiences, and the quality of recommendations in meeting the Scope of Services.

B. Capability for establishing working relationships. The personnel of this project must be able to work effectively with the management of the Employer. Documentation of previously successful relationships is preferred. Interviews with prospective contractors within competitive range may be conducted to provide input for this criterion.

C. Background and previous experience of agency/personnel (including consultant and subcontractors) to be assigned to provide EAP services and their demonstrated competence in the type of work to be performed (include a complete resume and time commitment for professional persons to be assigned).

D. Budget and fees.

E. Organization and management. Consideration will be given to administrative, management, and program controls, and the ability to commit staff and relevant resources to an EAP.

F. Ability to satisfy minimum indemnification and insurance requirements as detailed under Section IX herein.

VI. Contract Requirements

A formal contract arrangement will be entered into with the EAP provider selected and the Employer. The providers considered will be selected from responses to this RFB. Time period of the contract shall cover one year.

VII. Compliance with Federal and State Laws

The provider shall comply with all applicable Federal and State laws, rules, and regulations, and will not discriminate or permit discrimination against any person or group of persons on the grounds of sex, race, color, age, religion, or national origin in any manner prohibited by law.

VIII. Acceptance Period

In submitting a proposal, RFB respondents agree that the proposal remain valid for a period of 60 days after the closing date for submission of proposal and may be extended beyond that time by material agreement.

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IX. Indemnification and Insurance Requirements

A. IndemnificationThe EAP provider agrees to defend, indemnify, and hold harmless the Employer and its employees from any claims, liabilities, obligations, and causes of action of whatsoever kind and nature for injury to or death of employees of the provider or any other person and for damage to or destruction of property, or loss of use, including property of the Employer, in connection with services performed under this agreement regardless of cause except that provider shall not be required to assume responsibility or indemnify the Employer for such injuries, damages, or claims deemed by law to be due to the sole negligence of the Employer or its employees.

B. Insurance RequirementsThe EAP provider agrees to procure and maintain in effect for the duration of this agreement the following insurance coverage with insurers licensed or approved to conduct business in the State and holding a current financial rating satisfactory to the Employer.

1. Professional Legal LiabilityInsuring against claims or suits brought by employees alleging injuries or damages, including claims brought directly by the Employer, due to errors and omissions and deemed to have arisen out of work or services performed under this agreement. Coverage shall be broad enough to include:

a. Contractual Liability

b. Contingent Liability

Claims Made PolicyShall provide for not less than 12 month discovery period or agreement that coverage will be renewed for a period of not less than 1 year, such completion of work or services under this agreement. In the event the Employer requires coverage beyond such extension, it will retain the right to implement such requirement prior to expiration of existing coverage as specified above.

2. Commercial General LiabilityInsurance against claims or suits brought by employees alleging bodily injury or damages of property and claimed to have arisen out of services provided under this agreement. Coverage shall be broad enough to include:

a. Premises and Operations

b. Contingent Liability

c. Contractual Liability

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Limits of LiabilityShall not be less than $1,000,000 for coverage under 1 and 2 above.

Additional Named InsuredNaming the Employer as an additional insured.

Knowledge of OccurrenceStandard Wording

Notice of OccurrenceStandard Wording

3. Workers Compensation and Employers LiabilityInsuring in accordance with statutory requirements in order to meet obligations toward employees in the event of injury or death sustained in the course of employment. Employers Liability (Coverage B) shall not be less than $100,000 each claim.

Policies under 1, 2, and 3 shall be endorsed to include the following:

Notice of CancellationIn the event of nonrenewal or cancellation, provider's insurance shall give written notice to the Employer indicating that such cancellation or non-renewal shall not be effective in less than 60 days from the date the notice is received by registered mail.

Certificate of InsurancePrior to start of work or operations under this agreement or contract, a properly authorized certificate of insurance evidencing that the above described coverage is in effect.

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