1. Substance Abuse Management Training Presented by Diana Byrnes June 27, 2007

2. 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!

3. Knowledge Assessment Quiz 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 Scores are not announced or shared with other participants Please take the next few minutes to answer the questions independently.

4. Acronyms 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

5. Substance Abuse Policy Discussion

6. 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)

7. 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

8. 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

9. FDOT Model Policies Available http://www.cutr.usf.edu/byrnessamsite

10. Any Questions related to our discussion on Substance Abuse Policy Requirements?

11. Pre-Employment Administrative Duties

12. 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

13. 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.

14. 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

15. Pre-employment testing odds ‘n ends Agency may conduct both drug and alcohol pre- employment 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 pre- employment drug test conducted by another agency

16. 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

17. Any Questions related to our discussion on Pre-employment Administrative Duties?

18. Take a 10 minute break!

19. Developing a Compliant Training Program

20. 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

21. 1. Education Component 49 CFR Part 655.14: display distribution “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.”

22. Display and Distribution Items 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

23. Resource for Display and Distribution Materials cutr.usf.edu/byrnessamsite

24. Additional web site resources for Display and Distribution Materials Substance Abuse and Mental Health Services Administration –www.samhsa.gov www.samhsa.gov National Institute on Drug Abuse (NIDA) –www.drugabuse.gov www.drugabuse.gov National Institutes of Health –www.nih.gov www.nih.gov Street Drugs (Images, stats, great information) www.streetdrugs.orgwww.streetdrugs.orgwww.streetdrugs.org

25. 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 time- clock, restrooms) Include a message about Rx meds as well as prohibited drugs

26. 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.”

27. 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

28. 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.

29. 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: moore@cutr.usf.edu

30. 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

31. 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

32. 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”.

33. 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

34. Suggested training material for Supervisor training 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

35. Suggested Supervisor Training Material FTA video and training manual, available via web: http://transit- safety.volpe.dot.gov/safety/datesting/reasonablesuspicion.asp

36. 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.)

37. Any Questions related to our discussion on the three training requirements?

38. Implementing a Compliant Random Testing Program

39. 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

40. 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

41. 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

42. Any Questions related to our discussion on Random Testing?

43. Conducting Post Accident Testing within FTA Thresholds

44. 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.

45. 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

46. 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)

47. 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:

48. 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

49. 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.

50. 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.

51. 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

52. Any questions related to our discussion on Post Accident Testing?

53. Take a 10 minute break!

54. Reasonable Suspicion Testing

55. 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

56. 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*

57. 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

58. Best Practices in Reasonable Suspicion Testing 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

59. Any Questions related to our discussion on Reasonable Suspicion Testing?

60. Collection Site Monitoring and Problems

61. 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

62. 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

63. 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.)

64. 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

65. 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)

66. 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

67. 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

68. 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

69. 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

70. 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. Problems at the Collection Site Continued

71. 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

72. Any Questions related to our discussion on Collection Sites?

73. It’s time for our final 10 minute break!

74. Put your thinking cap on, its time to compete for some prizes!!

75. 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: byrnes@cutr.usf.edu http://www.cutr.usf.edu/byrnessamsite