CEAPA is representative of the Canadian EAP community and is committed to addressing relevant issues as they arise across the country.
The Executive, through its Standards Committee, will research and develop Standards and Guidelines on timely issues to serve as a framework for the various EAP's to use in their worksite.
The Standards Committee will develop the Policies primarily through tele-conferencing/electronic communication and they will be adopted at the biannual CEAPA meeting in Ottawa (starting in November, 1997), as long as these gatherings exist. Where urgent Policies need to be endorsed, the CEAPA Executive will endorse these through a teleconference.
B. REVIEW PROCESS:
All policies are able to be brought up for review at the biannual meetings, by any CEAPA member in good standing requesting a review through sending a request to the CEAPA President.
I. PRACTICE SAFETY STANDARDS
In conjunction with the following practice guideline, personnel and their employees should be aware of and adhere to the standards of their respective provincial or territorial "Occupational Health and Safety Act" and abide within these guidelines.
Every occupation has its own unique set of safety issues. Employee Assistance personnel are placed in a wide range of practice settings, some of which may be directly or indirectly hazardous or injurious. A proactive approach entails developing an awareness of the different environments within which you are placed and for the employer to be aware of potential risk situations and prepare contingencies should they arise.
1. Each employer should have in place a safety and security policy and manual including procedures for dealing with high risk verbal and physical abuse situations and the contact number of security personnel.
2. Each employer should have in place a fire procedure policy and all staff (full time, part-time, contract) should be verified and aware of their responsibilities regarding personal and client safety.
3. Whenever possible there should be two staff members present on site, particularly after regular business hours.
4. On site staff should notify security when working off hours, including evenings and weekends.
5. Off site personnel, when visiting a work site, should inform security of their presence on site, especially when visiting or working outside of regular business hours.
6. A schedule of off hours practice times should be posted so that staff are aware when others are working.
7. A buddy system for staff should be implemented with emphasis placed upon those working outside of regular working hours.
8. All staff should have a secured office and a secured entrance and exit.
9. Employee Assistance personnel should only be required to meet with clients in their home under special circumstances.
10. Employee parking should be well lit and located in a highly visible area. Whenever possible parking should be in a secured lot, especially if it is underground.
11. Staff should have access to a cellular/digital telephone if their responsibilities include travelling to different work sites or office locations.
12. All staff should be covered by their provincial or territorial Workers' Compensation Act for any work-related injury, illness or disabling accident/event.
1. Harassment is one or a series of unwanted, and/or unsolicited remarks, behaviours or communications in any form based upon a prohibited ground of discrimination, which has the effect of:
a) creating an intimidating, hostile or offensive psychological or emotional climate of work;
b) undermining work; and/or;
c) preventing or impairing full and equal enjoyment of employment.
2. Each employer should have in place a policy outlining a definition of harassment by clients or other staff members.
1. All new employee orientation should include information on personal safety, fire safety and harassment.
2. A manual should be prepared and distributed to all staff (full-time, part-time, contract) outlining the organization's policies and procedures on personal safety, fire safety and harassment.
II. PROFESSIONAL MISCONDUCT STANDARDS
Members of CEAPA shall abide by its Practice Guidelines, in particular Section 3.3 on Statement of Ethics and Section 4 on EAP Characteristics.
Professional Misconduct for CEAPA members means that an individual or organization has violated the Association's Practice Guidelines.
A member who is found in violation of these guidelines shall be subject to action of the Board of Directors.
Procedures for Review of Complaint:
A complaint against a member shall be submitted in writing to the CEAPA President. The President shall designate an appropriate investigating committee (or refer to Standards Committee). The Committee shall review the complaint and determine if a hearing is required into a formal complaint.
A copy of the formal complaint is delivered to the member (by registered mail) with not less than 30 days notice of the time and location of the hearing. Hearings shall be conducted by two Regional/Provincial CEAPA representatives at the request of the President. The member may be represented by any voting member of the CEAPA in good standing.
At the conclusion of the hearing, the Committee shall determine if a violation of the Practice Guidelines has occurred and prepare a written confidential report to the President/Executive/Standards Committee
Within 30 days, The Executive/Standards Committee shall prepare a recommendation to dismiss the complaint, to educate the member to the CEAPA Practice Guidelines; or to suspend CEAPA membership for a determinate period, with training conditions.
The member shall be advised promptly of the recommendations by registered mail, if necessary. Procedures for notifying other Regulatory Bodies, if appropriate, while ensuring confidentiality, will be in place where the President sends a certified copy of the complaint.
The findings of the Committee shall be conclusive. The member may appeal to the CEAPA Board of Directors concerning the interpretation of the evidence or the recommended outcome. This appeal may be in writing, in person or teleconference, within a reasonable time period.
III. AUDIT STANDARDS
As you are aware, the practice of auditing employee assistance programs is a relatively new development in the EAP industry. The following standards are intended to provide some guiding principles to ensure that the interests of all stakeholders are protected, including the plan sponsor (i.e., the organization and/or its unions), the employees covered by the program, as well as the EAP service provider.
A third party audit is an independent and objective review of an EAP provider's delivered services over a specified historical period of time.
Periodic third party audit of employee assistance programs should be recognized as a legitimate program review activity and as part of an on-going evaluation process to foster service accountability, due diligence, and program development.
The audit firm and/or its designated auditor should be independent of the EAP plan sponsor and the EAP service provider.
At all times during an audit, client confidentiality must be protected.
3.1 The scope of an EAP audit is bound by the confidentiality policy which was in effect during the established audit period.
3.2 The auditor's access to client records is limited to the scope defined in writing and as agreed in advance by informed client consent (i.e. for the strict purpose of verifying client eligibility for services).
3.3 Client consent to release information for the purpose of pursuing audit objectives must not be obtained retro-actively.
3.4 Components of files or records must not be copied and/or removed from the EAP provider's location(s) being audited.
The audit firm and/or its designated auditor(s) should limit its/their audit activities to areas of demonstrated professional competence.
The scope of the audit review should be mutually agreed in advance by the contracting organization (i.e., the plan sponsor) and the EAP service provider, and the audit will restrict itself to this predetermined scope.
If the use of a third party is a consideration for on-going program evaluation, including program audit, a provision for the use of a third party should be incorporated into the EAP service contract.
The auditor should be prepared to share the audit observations with the EAP service provider, and the EAP service provider should have the opportunity to respond to the auditor's observations.
A minimum prior notice period should be afforded the EAP provider in order to prepare for the audit and to permit data retrieval, etc.
The cost for performing evaluation activity including periodic third party audit should be included in the EAP budget, and may legitimately be incorporated into the fee structure as part of an EAP service contact. However, the audit fees should be paid for by the party requesting the audit, usually the plan sponsor.
The EAP service provider should be prepared to cooperate to facilitate the auditor's review as part of its regular Contract Management activity and without extraordinary charges to the plan sponsor.
The audit firm and its designated auditor(s) should be prepared to sign non- disclosure and confidentiality agreements to protect the EAP service provider's intellectual and proprietary property.
The audit firm and its designated auditor(s) must maintain appropriate Errors and Omissions insurance coverage.
IV. RECORD KEEPING
Record keeping is a process that provides the evidence of the standard of care that was given the client. Meaningful and accurate record keeping is necessary for all complete assessments and formalizing of the plan of care.
Poor documentation can lead to client negligence and malpractice. Having no formal documentation does not protect the client, and can place the practitioner in jeopardy as they have no evidence to support their actions. Rules for Record Keeping
All statements should be objective, particularly those relating to drug and alcohol use, sexual activities, mental competency, or other sensitive matters.
Information should be recorded contemporaneously - when the event occurs or as soon as possible thereafter. Time should be set aside on a regular basis to update on professional actions.
Entries should be made in chronological order.
Subsequent alterations or additions should be made openly, with the original entry left intact and legible.
Any corrections should be initialled, signed and dated. Ensure that computer records are properly notated.
The author should limit the records to issues that are relevant to the client's treatment. Extra care should be taken when documenting high risk clients (suicide, violence, abuse, etc.). Notes should include direct wording, information that may relate to client's actions or behaviours as well as the assessment and observations of behaviour supporting the assessment.
Items that are relevant should not be omitted simply because they are embarrassing or uncomplimentary.
Records should be complete as any omission will likely be interpreted negatively.
Entries should be made by the practitioner providing the service.
The record should be in ink and legible.
The client records should include the following:
Client personal information (name, phone #, address, demographics, workplace)
Assessment of presenting problem
Treatment plan and outcome, reason for selection of treatment modality
Dates and summary of all contacts
Signed consent form
Release of information
Consultations with other professionals
Failure to keep adequate records may be grounds for professional misconduct.
Maintenance of Files
There is a responsibility on the part of the practitioner to maintain the files in a secure manner. If they are stored electronically, care should be taken to ensure security with passwords. Also care should be taken to backup files to discs, these should be stored under lock and key. All paper records should be stored in a locked filing cabinet with access restricted to the practitioner. Any confidential information that is discarded should be shredded. Client files should be kept for the time specified in applicable provincial legislation. EAP client files should be kept separate from any company, personnel or medical files.
Release of Information
Client files should be written with the view of possible release of information. A written release should be signed by the client before any information is released on their behalf. This consent form should include the data, client's name and signature, witness' signature, who the information will be released to, what information will be released, the purpose for the release of the information, and an expiration time for the release. Clients may request access to their file. It is important that the practitioner protect other information (i.e. gained from family members). Any request for release of information should be reviewed by an attorney or the applicable provincial ministry. This could be done through provincial legislation such as The Saskatchewan Freedom of Information and Protection or Privacy Act. A subpoena is the only other condition for release of information. The EFAP or service provider may apply to the courts for Privilege.
V. SHARING INFORMATION IN SAFETY-SENSITIVE JOBS PREAMBLE
Under the Canadian Human Rights Act (CHRA) it is discriminatory practice for an employer, employee organization or organization of employers:
to establish or pursue a policy or practice, or
to enter into an agreement affecting recruitment, referral, hiring, promotion, training, apprenticeship, transfer or any other matter relating to employment or prospective employment
that deprives or tends to deprive an individual or class of individuals of employment opportunities on a prohibited ground of discrimination.
Under the CHRA:
"Disability" means any previous or existing mental or physical disability and includes disfigurement and previous or existing dependence on alcohol or a drug.
*Employees have a duty to accommodate individuals with a dependence, short of undue hardship.
Members of CEAPA shall abide by its Practice Guidelines, in particular Section 3.3 on Statement of Ethics and Section 4 on EAP Characteristics.
Safety-Sensitive Positions/Jobs - can be described as those posing great risk to oneself, co-workers, the public, environment. These tasks/jobs/duties may vary from company to company. Safety-Sensitive Position(s) within the organization must be clearly identified, defined and known by all parties concerned with the daily operations of the company. All employees are required to be fit for duty at all times, a basic requirement of the position/job during their shift. Some companies limit the category to those with a key and direct role in the operation where performance can impact safety for oneself...and that are significantly unsupervised with limited opportunity for operational checks. Still others extend the category to include those whose decisions or actions may affect safe operations (risk sensitive positions). Examples of such positions/jobs may include:Airline Industry: pilots, certified aircraft technicians, ground support staff, equipment handlers, loadmasters, weight and balance planners.
Substance Abuse Professional - The Department of Transportation (DOT) rules define the SAP to be a licensed physician (Medical doctor or Doctor of Osteopathy), a licensed or certified Psychologist, a licensed or certified Social Worker, or a licensed or certified Employee Assistance Professional. In addition, alcohol and drug abuse counsellors certified by the National Alcoholism and Drug Abuse Counsellors (NAADAC) Certification Commission, a national organization that imposes qualification standards for treatment of alcohol-related disorders, are included in the SAP definition. In Canada this may also include the Addiction Intervention Association (A1A). All must have knowledge of and experience in the diagnosis and treatment of substance abuse-related disorders (the degrees and certificates alone do not confer this knowledge).
In addition to understanding substance abuse-related disorders, SAP's must understand the U.S. rules and their role under them. Refer to SAP qualifications according to Canadian Motor Carrier Consortium - consistent with U.S. requirements.
There are growing concerns and questions from Canadian Labour Groups, Corporations, Health Professionals, Civil Rights Organizations, Federal and Provincial governments, as well as EAP service providers regarding the 1991 "Omnibus Transportation Employee Testing Act" (and subsequent amendments) on drug testing in safety-sensitive positions that have been passed by the DOT in the United States of America.
To date, the primary focus of these laws is the Trucking Industry. However, there is absolutely no intention by the U.S. government to extend their requirements to any other mode of transportation. It is clearly understood that non-compliance to these laws will result in severe penalties up to and including loss of operating authority into the United States. The penalties are against the company - not the driver.
SAP Role and Responsibility:
SAP's are used by companies after a policy violation, or tested positive, or refused to be tested. There is an automatic referral to the SAP as part of the disciplinary process, and the driver is unqualified to operate a commercial motor vehicle until the SAP process is complete. THIS IS NOT A CONFIDENTIAL OR VOLUNTARY PROCESS. This is the difference between the EAP and the SAP function.
The SAP's fundamental responsibility is to provide a comprehensive face-to-face assessment and clinical evaluation to determine if the employee needs assistance resolving problems associated with alcohol use or prohibited drug use.
If the employee is found to need assistance as a result of this evaluation, the SAP recommends a course of treatment with which the employee must demonstrate successful compliance prior to returning to safety-sensitive duties. Treatment recommendations can include, but are not limited to: in-patient treatment, partial in-patient treatment, out-patient treatment, education programs, and aftercare. Upon the determination of the best recommendation for assistance, the SAP will serve as a referral source to assist the employee's entry into an acceptable treatment or educational program.
The SAP shall have a working knowledge of quality programs and qualified counsellors as well as insurance, benefit plans, and payment requirements. In addition, the SAP, when possible, should be cognizant of the employer's policies regarding payment for treatment, on-duty-time treatment programming, and the granting of administrative, sick and/or annual leave for both in-patient and out-patient treatment.
Return to Safety-Sensitive Duties Protocol:
Prior to the employee's return to safety-sensitive duties, a SAP - in collaboration with the treatment centre - is required to determine if the individual has demonstrated successful compliance with recommendations of the initial evaluation. This evaluation serves to provide the employer with assurance that the employee has made appropriate treatment progress. The SAP also directs a follow-up testing plan for the employee returning to work following treatment. The number and frequency of such tests are clearly outlined by the DOT guidelines.
Substance Abuse Policies, Employers and EAP's:
The Canadian Employee Assistance Program (CEAPA) strongly recommends that employers create a clearly defined Substance Abuse Policy and a jointly managed EAP program. A company/organization which has in place policies relating to substance abuse in the workplace and/or Safety-sensitive job descriptions, should periodically review/update them - incorporate and work within the following guidelines:
Federal and Provincial Human Rights Acts
Criminal and Common Law Codes
Professional Association(s) Codes of Ethics
Industrial Health and Safety Regulations
Canadian EAP Practice Guidelines
The EAP program is based on neutrality, confidentiality, and is not part of the disciplinary process. Clients enter this program on a voluntary basis - they cannot be forced. Also, referrals to the EAP can be of an in-formal or formal nature. In order for an EAP to operate effectively and for any length of time, it must have explicit written rules, guidelines as to record-keeping and to who has access to these records. Also, it must have a strong commitment to confidentiality.
Client records and statistical reports should never have names attached and/or become part of an employee's personal/work file. Thus, CEAPA recommends that Ethical standards for EAP's be followed and adapted for the SAP service provider. *Knowledge and understanding of the concepts of law with which EAP's and SAP's may be concerned:
a) Contract - Ad Idem (Reliance and Consent)
b) Tort - The Duty to Warn and the Duty to Protect (1974, 1976 Tarasoff v Board of Regents of the University of California)*The only other act of authority that can supersede any EAP policy is that of a Court of law under the power of a subpoena. Confidentiality and the EAP/Client Relationship:
One of the basic principles in all EAP policies is confidentiality. The principle of confidentiality requires that NO information of a personal nature be shared with anyone without the expressed written consent of the client. However, a person's right to confidentiality is negated when a direct threat (real or perceived) is made to the safety and security of oneself, children, general public, state/government, and the Crown. Also behaviours related to the safety within the workplace and to others could negate confidentiality.
CEAPA recognizes that breaching confidentiality under the above mentioned conditions applies equally to EAP practitioners, Peer Referral Agents, Medical professionals/Practitioners, and Addiction Counsellors. However, the SAP confidentiality issues are much different than the EAP, peer agent, medical practitioner, etc. The employer gets more information from the SAP because the individual being assessed has broken the rules, is at risk of losing their job, and the SAP assessment is one part of their condition of continuing employment.
In conclusion, CEAPA is aware of the many concerns being raised by those in the Human Services profession regarding the recent passage of legislation by the DOT in the USA and its impact on Canadian Industry. Also, as there is no regulating body governing this new (SAP) designation within Canada, CEAPA strongly recommends that individuals entering this field be well prepared and adequately trained.
Note*** There are clear differences in the roles and responsibilities of EAP's and SAP's as defined in their contractual commitments. They are two separate functions and should be performed by separate individuals. Many EAP providers have decided not to provide SAP services to ensure their historic function is not compromised.