Quality health plans & benefitsHealthier livingFinancial well-beingIntelligent solutions

A manager’s guide to making effective EAP referrals

44.05.101.1-ARFL (7/12)

Aetna Resources For Living SM

Making referrals to the EAP

There are three kinds of referrals a supervisor can make to the Employee Assistance Program (EAP).

1. Informal referral — There are no job performance concerns at present. However, without supportive EAP services, the situation may result in a future performance breakdown. The employee makes the choice to follow through on the referral or not. There is no reporting to the workplace by the EAP.

2. Formal referral — A decline in work performance exists. The employee may already be receiving performance coaching. The manager desires additional help from the EAP to help the employee correct the work performance problem. The referral is made part of a corrective performance plan. There are expectations for the employee to use the EAP as a tool to correct the performance problem. The employee signs a release so that the EAP can report to the supervisor that the employee is attending and cooperating in using the EAP services.

3. Mandatory referral — A mandatory referral is made to the EAP only when an employer is at the corrective action or work performance stage, where discipline or dismissal of the employee is likely, and there are mitigating circumstances that motivate company management to provide an opportunity for the employee to resolve the problem. Compliance with such a referral is required. Failure to follow through with the EAP referral evaluation, treatment and service recommendations in full may be the basis for termination. This should only be done where company policy provides for this action. The employee signs a release so that the EAP can report to the supervisor that the employee is attending and cooperating in using the EAP services.

The employee’s job is at risk if the employee does not follow through with the assessment and recommendations.

Reasons for mandatory referrals:• Violence or threats of violence in the workplace

• Domestic violence/harassments

• Sexual harassment in the workplace

• Age discrimination

• Nation of origin discrimination

• Suicidal evaluation

• Hostile work environment

• Drug/alcohol in the workplace or self-reported to the workplace

There can be a great many factors that play into each of the situations described above. It is often helpful to consult with a management consultant before deciding what level of referral to make, as well as how to communicate the referral to the employee.

Steps in gathering information, assessing the situation and contacting the EAP to make formal and mandatory referrals are:

1. Your EAP will help you focus on your employees’ performance and your role in maintaining your organization’s management standards.

2. Document objective observations, using your organization’s procedures.

3. Review policies.

44.05.101.1-ARFL (7/12)1

44.05.101.1-ARFL (7/12)

4. Consult with Human Resources.

5. Begin feedback process with employee, according to your policies and procedures.

6. Call your EAP and ask to speak with an EAP management resource consultant(MRC)todiscusshowtomakeaneffectiveEAPreferral.

7. It is best for you to discuss the referral with your management resourceconsultantwithouthavingtheemployeeintheofficewithyou. Your consultant will record the relevant information.

8. Communicate workplace expectations to the employee (preferably in writing). Include the expectation that the employee will contact the EAP by a certain date. You will be given the name and phone number of a management resource consultant (MRC) at the EAP’s Organizational Risk Management Center for your employee to call to get an appointment scheduled.

9. Explain to the employee that a Management Referral Form (MRF) which also acts as a release of information must be signed. This is to allow the employee’s participation and cooperation in using EAP services to be reported to you. Be sure to provide assurance that personal information shared with the management resource consultantwillremainconfidentialandonlysharedwiththoselistedon the release.

10. The employee will typically speak to the same EAP management resource consultant. The MRC will gather initial information and set up an appointment for the employee. It is best for the employee to have privacy when making this call, as the MRC will be asking personal questions during the phone call.

11. Fax any necessary paperwork to your MRC. This might include a written disciplinary letter, memo of expectations, etc.

12. You will be asked by your MRC to have the employee sign the Management Referral Form (MRF) which also acts as a release of information in the workplace. Please fax a signed copy back to your MRC.

13. Let your MRC know how often you wish to have reporting on attendance and compliance (for example, weekly, once a month or only after there is an instance of absence or non-compliance). Your MRC will contact you as agreed and will also gather feedback from you on how the employee is progressing in terms of the expected workplace improvements. This information will be shared with the EAP Counselor to help guide the direction of counseling sessions.

2

Reasonable suspicionAs a manager, you have multiple responsibilities that include such tasks as monitoring your team’s job performance, addressing performance problems and ensuring job tasks are completed. You bring these elements together, resulting in the delivery of quality service to your customers. The single most important quality you possess as a manager isyourabilitytocreateanefficientandsafeworkplace.

Oneofthefactorsthatcansignificantlyimpactthesafetyofanorganization’s work environment is that of substance use or abuse by employees. This document outlines information about recognizing, documenting and addressing cases in which there is reason to believe an employee’s behavior and performance are being compromised due to substance use or abuse.

There are six steps in making a reasonable suspicion decision:

1. Recognition: Use the reasonable suspicion worksheet on page four of this document to recognize the signs and symptoms that could indicate alcohol and/or substance use.

2. Documentation: Record your observations. Be objective. Using a checklist will help you to stay objective.

3. Consultation: Speak with the appropriate people in your organization according to your policies and procedures. Consider speaking with an Employee Assistance Program (EAP) management resource consultant (MRC) to help you determine whether reasonable suspicion exists.

4. Plan of action: In conjunction with HR or the designated person in your organization, as well as your EAP, develop an appropriate plan of action. This may include: removal from safety-sensitive functions, reasonable suspicion drug test, suspension or administrative leave, a management referral to the EAP, etc.

5. Meet with employee: In your meeting with the employee, be prepared to discuss your factual observations, policies and procedures that pertain to substance use/abuse in the workplace, clear expectations for the employee going forward and the potential consequences for not following company policies and procedures.

6. Support and supervise: Continue to support the employee. However, make sure you are holding him/her accountable to maintain a safe work environment for all employees.

Note: Reasonable suspicion drug/alcohol testing can implicate the federal, state or local laws. To ensure compliance, consult with appropriate legal and other professionals to verify that your policy and actions pursuant to that policy comply with applicable law.

3 44.05.101.1-ARFL (7/12)

Use this worksheet to help identify your observations. Always consult with your organization’s Human Resources, Legal and other professionals to properly apply your organization’s own reasonable suspicion drug/alcohol testing policy.

An employer’s determination that reasonable suspicion exists must be based on direct observations that are:

• Specific

• Factual

• Current

• Easy to articulate

This determination must be about the employee’s:

• Appearance

• Behavior

• Speech

• Body odors

Document and take action according to company policy if you suspect or think an employee meets any of the following:

• Ispresentlyundertheinfluence

• Is not safe to be performing his/her job duties

• Is behaving in a manner that is not characteristic

• Makes you believe that you have a good cause for reasonable suspicion

It would benefit you to review all materials on a drug-free workplace before taking action. If possible, get a second or third observer (that is, management).

1. Write down your sensory observations to support your suspicions.

2. Make notes for yourself about what you:

• See

• Hear

• Smell

3. Whatdoyoufirstobserveabouttheemployee’sconditionoractions?Remembertobespecificandfactualonly.Donotofferopinionsorconclusions about what you observe.

4. Consult with your Human Resources and other professionals in your organization to discuss your observations.

Observation and recognition

44.05.101.1-ARFL (7/12) 4

Immediate work behaviors to be concerned about are:

• Sudden falls or almost injures self

• Immediate problem with functioning

• Obvious safety rule violations

• Sudden drop in quality/quantity of production

• Inability to get along with anyone(somethingdifferentfrom the norm)

• Unusual tardiness to work

• Psychomotor (coordination) problems

• Dulled mental process

• Odor of alcohol on breath

• Possible constricted pupils

• Sleepy or dazed condition

• Slowed reaction rate

• Slurred speech

• Hyper-excitability, restlessness

• Dilated pupils

• Increased heart rate and blood pressure

• Heart palpitations and irregular beats

• Flushing and profuse sweating

• Rapid respiration

• Confusion/panic

• Inability to concentrate

• Heightened aggressive behavior

• Mood swings

• Impaired mental functioning and alertness

• Depression and apathy

• Drowsiness and fatigue

• Nausea, vomiting and constipation

• Impaired respiration

• Decrease in breathing rate

• Numbness of the extremities

• Vomiting

• Drooling

• Dizziness

• Illusions and hallucinations

• Slow and garbled speech

• Distorted perception of space and time

• A condition of “seeing” things that causes erratic driving

• Analgesia – a condition in which pain stemming from a significantinjuryisnotfullyfelt – or felt at all

Ask yourself:

• Doesthispersonappearill?

• Can she/he safely do the work today?

• Isthisunusualforthisperson?

• Has something happened on the job that might explain this unusualbehavior?

Please note that there may be many other explanations for any or all of the above delineated behaviors. Be sure to consult with your organization’s Human Resources and other professionals to properly assess your observations.

Acute situations vs. Chronic patternsWhat is an acute reasonable-suspicion situation?

5 44.05.101.1-ARFL (7/12)

What is a chronic work-performance condition?

Please note that there may be many other explanations for any or all of the above delineated behaviors. Be sure to consult with your organization’s Human Resources and other professionals to properly assess your observations.

The change in the employee has been happening gradually. You may not even be aware of it at the time, but after some months, you knowsomethingisdifferent.Youbegin to be more concerned about a pattern of behavior. A developing pattern of work performance indicators can include:

• More frequent falls

• Repeated incidents of almost injuring self or others

• More common accidents and near accidents

• Increasingly late for work

• More sick days being used, especially Monday absences after Friday paycheck

• Decreased reliability

• Physical functioning changes

• Physical appearance changes

• Problems in relationships with others, complaints from subordinates and co-workers

• Increasing money problems — borrowing from co-workers, evictions,otherfinancialdisasters

• A don’t-care attitude

• Deteriorating or erratic performance (may be some improvement spikes, but gradually worsens over time)

• Increased frequency of hangover symptoms

• Greater use of drug culture jargon

• Increasingly secretive behavior, such as disappearing from work area

• Wanting to be alone – avoiding “straight” (non-using) workers or change in peer group at work

• Forgetfulness, indecision and erratic judgment

• Impulsive and temperamental behavior

• Changes in hygiene

• Increasing jitters, hand tremors, hyper-excitability

• Increased carelessness

• Sleeping on the job

• Slowing reactions

• Increasing fatigue

• Delayed decision making (not as sharp as used to be)

• Confusion and lack of concentration or memory loss

• Difficultylearningnewtasks

• Anunusualeffortmadetocover arms at all times.

• Wearing sunglasses at inappropriate times (indoors or at night, for instance), not only to hide dilated or constricted pupils, but also to compensate for the eye’s inability to adjust to sunlight; also increased use of eye drops

44.05.101.1-ARFL (7/12) 6

Substances: types, effects and withdrawal symptoms

Type Possible effects Effects of overdoseWithdrawal sypmtoms

ALCOHOL:Beer, wine, distilled spirits

Impaired coordination, judgement, percpetion, comprehension and concentration; drunken behavior with odor of alcohol

Loss of coordination; inability to react; sleepiness; aggression; liver, heart and brain damage; possible death

Violence; confusion and hallucinations; frenzied excitement; tremors

CANNABIS:Marijuana, tetrahydracannabiona: hashish oil

Euphoria; relaxed inhibitions; increased appetite; disorented behavior

Fatigue; paranoia; possible psychosis

Occcasional reports of insomnia; hyperactivity; decreased appetite

DEPRESSANTS:Chloral hydrate; barbiturates; gutethimide; methaqualone, benzodiazepines, other depressants

Slurred speech; disorientation; drunken behavior without odor of alcohol

Shallow breathing; cold, clammy skin; dilated pupils; weak and rapid pulse; coma; possible death

Anxiety; insomnia; tremors; delirium; convulsions; possible death

HALLUCINOGENS:LSD, mescaline, peyote, amphetamine variants, phencyclidine analogs, other hallucinogens

Illusions; hallucinations; poor perception of time and distance

Longer, more intense “trip” episodes; phychosis; possible death

Withdrawal symptoms not reported

NARCOTIC:Opium, morphine, codeine, heroin, hydramorphine, meperidine, methadone, other narcotics

Euphoria; drowsiness; respiratory depression; constricted pupils; nausea

Slow shallow breathing; clamminess; convulsions; coma; possible death

Watery eyes; runny nose; excessive yawning; loss of appetite; irritability; tremors; panic; chills and heating; cramps; nausea

STIMULANTS:Cocaine, amphetamines, phenmetrazin, methylphenidate, other stimulants

Increased alertness; excitation; euphoria; increased pulse rate and blood pressure; insomnia; loss of appetite

Agitation; increased body temperature; hallucinations; convulsions; possible death

Apathy; long periods of sleep; irritability; depression; disorientation

7 44.05.101.1-ARFL (7/12)

1. If there is no basis for a test, remind the supervisor to review the employee’s performance issues, and remind the employee about the organization’s policies and option to self-report.

2. If there is a basis for a test AND your company policy allows for reasonable suspicion drug/alcohol testing, scrupulously follow your organization’s reasonable suspicion drug/alcohol testing policy, involving your company’s Human Resources, Legal, and other advisors as dictated by such policy. This may involve the following:

• Remove employee immediately from any safety position

• Discuss observed behaviors with employee

• Arrange “for cause” drug testing (per your company policy for undertheinfluence)

• Drive or have employee driven to clinic

• Alert Human Resources

• Contact EAP

• Consult with Human Resources

• Holdaprivatemeeting–alwaysrespectconfidentiality

• Communicate the employee’s value to you and the company

• Bespecificabouttheproblemsandexpectationsconcerningjobperformance

• Listen to employee

• Communicatespecificconsequencesiflackofimprovement

• Refer to the EAP per your company procedures

Tips on documentation

Thekeytoasuccessfulconfrontationforreasonablesuspicioniseffective,thorough and non-judgmental documentation. Use all of the tools at your disposal:

1. Training material on a drug-free workplace

2. Checklists and worksheets such as this one

3. Company policy and procedure manual

4. Witnesses

5. Job descriptions

6. EAP consultations

Be wary of enabling

Please note that “supervisory enabling” (avoiding the confrontation because you feel uncomfortable or hate to get someone in trouble) doesn’t help the employee who is in trouble with substance abuse. Often, the employer’s confrontation provides the motivation to get help.

Components of enabling:

• Minimizing

• Letting it slide

• Picking up the slack

• Ignoring the problem

• Making excuses for the employee

Next steps

44.05.101.1-ARFL (7/12) 8

Aetna Resources for LivingSM is the brand name used for products and services offered through the Aetna group of subsidiary companies. The EAP is administered by Aetna Behavioral Health, LLC, Aetna Health of California, Inc. and Aetna Health and Human Resources Company, Inc.

This material is for informational purposes only and is neither an offer of coverage nor medical advice. It contains only a partial, general description of programs and services and does not constitute a contract. Aetna is not a provider of health care services and, therefore, cannot guarantee any results or outcomes. All participating providers are independent contractors and are neither agents nor employees of Aetna. The availability of any particular provider cannot be guaranteed and is subject to change.

All calls are confidential, except as required by law (i.e., when a person’s emotional condition is a threat to himself/herself or others, or there is suspected child, spousal or elder abuse, or abuse to people with disabilities). Services are available to you and your household members, including dependent children up to age 26, whether they live at home or not.

All materials are created as tools to assist in determining reasonable suspicion of an employee’s behavior that may indicate alcohol and/or substance use. These guidelines do not constitute Legal or other professional advice and are not a substitute for any drug and alcohol testing policy that you may have. At all times you should consult HR, Legal and other professionals to ensure that whatever policies you have are legally compliant and appropriate for your workplace.

These are merely guidelines and are not a conclusive or complete guide towards making such determinations. They are not a stand-alone instrument. Each potential situation presents its own unique set of challenges and is fact specific and contextual. In referring to these guidelines, you should work closely with your HR and Legal professionals in addressing each specific situation to ensure that you properly apply your policies and follow applicable law.

©2012 Aetna Inc. 44.05.101.1-ARFL (7/12)

Organizational Risk Management Center

Remember that our Organizational Risk Management Center has qualified management resource consultants (MRCs). These consultants are available to help you in making determinations about reasonable suspicion and safety concerns.

To access any of the management services described in this brochure, call our dedicated management services line or visit us online.

Services are available 24 hours a day, 7 days a week, through our dedicated management services number.

Aetna Resources For Living SM