**Section 9:**

**Promising Approaches: Coordination Between**

**Employers, Substance Abuse Treatment, and Workforce Investment**

Achieving a drug-free workforce requires concerted efforts by and
coordination between employers, the workforce investment system, and the
substance abuse treatment system. This section highlights the practices
of several organizations that have developed coordinated efforts at one
or more levels. The sites described below were identified by members of
the Drug-Free Workforce Conference Core Planning Group and Research
Committee, as well as by individuals referred by Planning Group and
Research Committee members. The highlighted sites from across the U.S.
include two employers, two substance abuse treatment programs, and two
workforce investment programs.

# Promising Approach Highlights

The examples of promising approaches described below encompass a wide
range of practices and varying degrees of coordination with other
systems. There are, of course, numerous approaches to coordination, and
the practices cited are intended to serve as examples---rather than
prescriptions---for how to begin working toward coordination across
systems or communities. In addition, coordination as a process is never
truly complete, but always "in process." Nevertheless, each of the
profiles included below highlights one or more aspects of a promising
approach to coordination around substance abuse and employment.

The highlights of each promising approach are described below in Table
5A. Detailed descriptions of the six sites follow.

### Table 5A: Highlights of Promising Approaches

+--------------------------+------------+------------------------------+
| # Site                   | #          | # Promising Approach         |
|                          | Type of Or |                              |
|                          | ganization |                              |
+--------------------------+------------+------------------------------+
| Artistic Landscapes of   | Employer   | -   Drug-Free Workplace      |
| Louisiana, Inc.          |            |     Program includes EAP and |
| (Shreveport, LA)         |            |     return-to-work           |
|                          |            |     opportunities            |
+--------------------------+------------+------------------------------+
| Colony Management        | Employer   | -   Drug-Free Workplace      |
| Corporation (Richmond,   |            |     Program includes EAP and |
| VA)                      |            |     return-to-work           |
|                          |            |     opportunities            |
+--------------------------+------------+------------------------------+
| Center for Learning and  | Treatment  | -   Incorporates employment  |
| Health, Johns Hopkins    | Provider   |     and Drug-Free Workplace  |
| School of Medicine       |            |     practices into treatment |
| (Baltimore, MD)          |            |                              |
+--------------------------+------------+------------------------------+
| Positive Alternatives,   | Treatment  | -   Integrates employment    |
| Joseph P. Kennedy        | Provider   |     and training services    |
| Institute                |            |     into treatment           |
|                          |            |                              |
| (Washington, DC)         |            | -   Enrolls clients at       |
|                          |            |     One-Stop Career Centers  |
|                          |            |                              |
|                          |            | -   Accommodates for         |
|                          |            |     disabilities             |
+--------------------------+------------+------------------------------+
| Nashville Career         | One-Stop   | -   Developed relationship   |
| Advancement Center       | Career     |     with Drug Court          |
| (Nashville, TN)          | Center     |     treatment program        |
+--------------------------+------------+------------------------------+
| Workdrugfree (Portland,  | One-Stop   | -   Developed system-wide    |
| OR)                      | System     |     standards for how        |
|                          |            |     One-Stop providers       |
|                          |            |     address substance abuse  |
|                          |            |     problems among           |
|                          |            |     job-seeker customers     |
+--------------------------+------------+------------------------------+

1.  **Employers with Promising Approaches**

**9.1.1 Artistic Landscapes of Louisiana, Inc.**

Artistic Landscapes of Louisiana has seven employees and has operated
for just over a decade in Shreveport, Louisiana. Artistic Landscapes
participates in the Shreveport EAP Drug-Free Program for local small
businesses.

The promising approach highlighted for Artistic Landscapes is:

-   A Drug-Free Workplace Program that includes EAP and return-to-work
    opportunities.

# Drug-Free Workplace Program description 

Artistic Landscape's Drug-Free Workplace Program has the following
components:

-   *Drug-Free Workplace Policy:* Written policy mirrors the template
    received from the EAP Drug Free Company program. The policy contains
    a "no-tolerance" prohibition against persons being under the
    influence of drugs or alcohol at work.

-   *Drug testing*: Pre-employment and for-cause (triggered by
    suspicious behaviors, such as poor job performance, chronic
    tardiness, and multiple absences). A positive drug test causes the
    employee to be automatically suspended from the job until he or she
    tests "clean." Length of suspension varies by drug or severity of
    infraction.

-   *Return-to-work opportunities*: Will work with employees if they are
    willing to get help. If employees need residential treatment their
    jobs will still be there when they complete treatment---there is no
    time limit.

-   *Employee Assistance Program (EAP)*: Offers various counseling
    programs, including drug/alcohol and marital/family; team-building
    resources; and educational seminars. Provided by a private
    contractor.

# Program history and rationale

-   The owner first saw the value and benefits of EAPs when he observed
    the usefulness of EAP marital counseling for someone he knew.

-   The business had a long-term problem with employee absences and the
    owner began to suspect substance abuse. In retrospect, there was
    probably at least one employee on every work crew in the company's
    first nine years who had a substance abuse problem.

-   The owner wanted to be sure about whether substance abuse was
    occurring and to have other options to deal with substance abusing
    employees besides just firing them.

-   After an on-the-job accident in 2002, the owner paid for the
    employee involved in the accident to be drug-tested, and the test
    result was positive.

-   The owner mentioned the substance abuse related problems among his
    employees to an EAP counselor with whom he was acquainted, who
    recommended the Shreveport EAP Drug-Free Program.

**Reasons for offering treatment and return-to-work opportunities for
employees with substance abuse problems:**

-   The owner wants to treat others the way he would want to be treated.

-   With only seven employees, the business is a close-knit group, so
    the owner wants to help the people he works with; business is more
    than just making a profit.

-   Decrease turnover.

# Costs and funding sources for Drug-Free Workplace Program 

-   Employers who sign up and adopt no-tolerance programs receive EAP
    services and drug testing free of charge through the Shreveport EAP
    Drug Free program. Shreveport's program is funded by a Coverdell
    Grant from the U.S. Small Business Administration.

**How program success is measured**

-   The owner of Artistic Landscapes considers it impossible for the
    program to be a failure since it costs him no out-of-pocket expenses
    and minimal time commitment. The free services are renewable for
    multiple years.

**Extent of coordination with workforce investment and substance abuse
treatment**

-   The owner knows there is a One-Stop Career Center in the area, but
    has never used it.

-   He has a contact at a local detoxification facility, which enables
    Artistic Landscapes to get priority admissions for its employees.
    Due to privacy requirements, treatment facilities are not allowed to
    give information about Artistic Landscapes' employees in treatment.

**Similarities to and differences from peers' approach to Drug-Free
Workplace issues**

-   The owner believes Artistic Landscapes is the only company in the
    local landscaping market who is in the Shreveport EAP Drug-Free
    Workplace Program. There is not much interaction with other
    landscaping companies because there is no local trade association
    and they view each other as competitors.

**If starting over again,**

***Things to keep the same:***

-   On-demand drug tests, available any day the employer requests it.
    Within three days after requesting a drug test from the testing
    center, the paperwork is ready and the owner can take the employee
    to be tested. Faced with going to a drug test, some employees have
    admitted to drug use without being tested, while others have walked
    off the job.

-   Individual access to counselors.

## Things to do differently 

-   Would have gotten involved earlier.

**9.1.2 Colony Management Corporation**

Colony Management Corporation, a business of 40 employees, manages eight
apartment complexes with a total of 1,550 units in Richmond, Virginia.

The main promising approach used by Colony Management Corporation is:

-   A Drug-Free Workplace Program that includes EAP and return-to-work
    opportunities.

# Drug-Free Workplace Program description 

Colony Management's Drug-Free Workplace Program has the following
components:

-   *Drug-Free Workplace policy and employee education.* New employees
    learn of Colony Management's Drug-Free Workplace program via new
    employee orientation, where they receive a copy of the EAP brochure.
    The Drug-Free Workplace program is also explained in the employee
    handbook and at annual all-staff meetings.

-   *Supervisor training.* Four high-ranking supervisors (the Vice
    President of Finance and Human Resources, the Maintenance Director,
    the Vice President of Operations, and the Property Manager) are
    trained to speak at new employees' orientation at each company site
    and conduct drug tests as needed.

-   *Drug testing.* Pre-employment tests are conducted at the head
    office for all new employees. Worksite tests are done for-cause (if
    the employee appears to be intoxicated) and post-accident. The
    company conducts random tests of one employee per month. Any current
    employee with a positive drug test is mandated to attend counseling
    via the EAP.

-   *EAP.* Any employee and their family members can get three free
    counseling visits per year on any issue. Employees must pay
    \$45/hour for any additional visits for any reason. Mandatory
    counseling due to a positive drug test is subject to the above price
    structure. Self-referrals to EAP are confidential (employee can use
    services without the company knowing). The company tracks only how
    many people have used the EAP in a given year.

-   *Treatment.* After attending EAP counseling, if an employee needs
    more help for substance abuse, he or she can be referred to
    treatment. Colony's health plan includes coverage for drug
    treatment. All full-time employees get health coverage within 30
    days of hire.

-   *Return-to-work opportunities.* Employees in treatment can take an
    indefinite leave of absence if needed and can return to their
    previous positions. So far, only one employee has missed more than a
    week for treatment; he used vacation time and was back in a few
    weeks. However, second chances are limited. An employee who fails
    another drug test can be terminated if this occurs within a year
    after treatment. If the positive drug test is more than a year after
    treatment, the employee is suspended for five days and has another
    chance to go through treatment with return-to-work opportunities.

# Program history and rationale

-   In Virginia, employers with Drug-Free Workplace programs receive
    discounts on all insurance, especially Workers' Compensation and
    liability and also health coverage. For this reason, Colony
    Management started its program in 1992.

-   The company switched its EAP provider in August 2002 due to customer
    service issues (e.g., to gain access to the three free counseling
    visits per employee per year).

**Reasons for offering treatment and return-to-work opportunities for
employees with substance abuse problems:**

-   Good employee retention. If troubled employees are willing to take
    care of their problems and return as good employees, that's a
    benefit.

# Costs and funding sources for Drug-Free Workplace Program 

-   Colony Management considers its Drug-Free Workplace program part of
    its overall cost of doing business.

-   EAP's three free sessions per employee per year cost
    \$12.50/employee/year, or \$500 total per year, paid for by the
    employer. Employees who need more sessions than the annual limit pay
    \$45 per hour.

-   Drug testing costs \$24 per person for multiple substances. The
    staff members trained for this purpose perform the tests on-site and
    send the samples directly to the lab, which costs less than sending
    employees to a testing center.

    -   Company pays for pre-employment and random drug testing.

    -   Employees who test positive pay for random follow-up tests for
        the first six months after they return to work; they can pay via
        payroll deduction.

    -   Costs of the for-cause and post-accident tests are paid by the
        employee if the result is positive and by the company if the
        result is negative.

**How program success is measured**

-   The company saved significantly on Worker's Compensation costs since
    instituting its Drug-Free Workplace program, not only due to the
    premium discount but also due to lower usage ratio and accident
    rates.

-   Most claims were for injuries suffered by maintenance workers, who
    used to have many small accidents (e.g., cuts, falls, sprains, back
    injuries, etc.).

-   The Worker's Compensation "mod number" (based on usage, where \>1 is
    bad) fell from 0.94 in 1994 to 0.82 in 2002.

-   The company's Worker's Compensation bill fell from \$17,000 in 1994
    to \$14,000 in 2002. This figure is not adjusted for inflation, so
    it actually understates the savings in real terms.

**Extent of coordination with workforce investment and substance abuse
treatment**

-   The company sends statistical reports to the Virginia Employment
    Commission (VEC), but does not use VEC for hiring. Most of Colony
    Management's hiring is via word-of-mouth referrals from current
    employees and occasional want ads.

-   The company's only relationship with treatment providers is via its
    EAP.

**Similarities to and differences from peers' approach to Drug-Free
Workplace issues**

-   Some employers may do pre-employment drug tests only of certain
    classes of employees (such as drivers), but Colony Management tests
    everyone including upper management.

-   Colony Management may be one of the only members of its local trade
    association (Richmond Apartment Owners Association) to have a
    Drug-Free Workplace program. Most other members are much smaller
    (average of 200 units and 5-6 employees) and thus neither
    participate in the Workers' Compensation system nor have a human
    resources department.

**If starting over again,**

***Things to keep the same:***

-   The program as established has worked very well.

-   Pre-employment screening has been successful (some job applicants
    have walked out when told of pre-employment drug tests).

## Things to do differently 

-   Would have liked better EAP counseling opportunities from the
    beginning.

    1.  **Workforce Investment Entities with Promising Approaches**

**9.2.1 Nashville Career Advancement Center (NCAC)**

The Nashville Career Advancement Center (NCAC) is the main One-Stop
Career Center serving Tennessee's Local Workforce Investment Area #9,
which includes the city of Nashville and the surrounding counties. NCAC
operates the Career Access Network (CAN), a program providing additional
services for job-seeker customers with disabilities that is funded by a
Work Incentives Grant from the U.S. Department of Labor. CAN has served
approximately 1,400 job seekers with disabilities in the two years since
the program began in April 2001. A significant share of CAN participants
consists of persons in recovery, referred by the local Drug Court
program.

The main promising approach used by the Nashville Career Advancement
Center is:

-   A relationship with a Drug Court treatment program.

# Estimated extent of substance abuse issues among job-seeker customers 

-   An estimated 30% of the CAN customers come from Drug Court; no
    information is available on how many are still in, versus graduated
    from, treatment.

**How individuals with substance abuse problems enter system**

***How substance abuse problems among job-seeker customers are
identified***

-   NCAC does not use a screening system.

-   The referral source is tracked only for CAN customers.

-   Some substance abuse issues are known up front because the majority
    of customers with these issues are referred from the residential
    Drug Court program, while others are referred from treatment
    programs, including those that have an employment component.

-   A relatively high proportion of customers from other federally
    funded programs may have substance abuse issues, particularly from
    Food Stamps and Families First (Tennessee's Temporary Assistance for
    Needy Families program, which stops the benefits time limit clock
    while a recipient is in substance abuse treatment).

-   Other job seekers may self-disclose. Some walk-in customers who are
    in recovery volunteer this information.

-   Some job seekers come with unidentified drug problems.

***How job-seeker customers with substance abuse problems enter the
workforce system***

-   A small percentage "walk in."

-   The majority of clients in recovery are referred from Drug Court.

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-   Drug Court participants must obtain employment in order to graduate
    from the program, so they come to the NCAC for small-group
    orientations at the resource center. Participants usually find a job
    within 1-2 weeks.

-   While employment as a graduation requirement motivates Drug Court
    participants to take any job, even if it is not their first choice,
    they can return to NCAC in a few months in order to obtain more
    services and better-paying jobs.

***How the workforce system serves job seekers with substance abuse
problems***

-   Job listings are open to all and career facilitators (caseworkers)
    work with all populations. Staff treat everyone the same.
    Philosophically, NCAC does not separate people out for special
    treatment, because very few people are completely free of issues or
    disabilities. This removes stigma so that people are more willing to
    use the system.

-   The secret is to identify each individual's specific needs,
    including any disabilities, and get them what they need. This
    requires trained staff and resources in the community.

-   Job seekers who reveal their drug problems are usually enrolled in
    CAN or referred to other sources for additional help.

-   Treatment is not required as a condition to use workforce services.

-   NCAC has leadership programs where longer-term workers in recovery
    are peer counselors to newer workers and job seekers.

**Extent of coordination with employers and substance abuse treatment**

-   NCAC teaches case managers at treatment providers and other
    community service providers how to use the workforce system.

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-   They educate employers about legal and sensitivity issues related to
    disabilities. Staff assumes that there are already people working
    with disabilities or substance abuse issues who just do not
    self-disclose them.

-   NCAC has not done any employer education specifically about
    substance abuse, but staff do discuss it in the context of viewing
    persons with disabilities as a broad population to engage in the
    workforce.

-   NCAC organizes symposiums, job fairs, etc. for employers to inform
    them that job-seekers will include people in special populations
    (public housing residents, Drug Court clients, etc.). Employers
    don't know which job seekers are from these populations unless the
    individual wants to reveal it. Since employers are customers, NCAC
    does not want to be perceived as a welfare agency, and certainly
    does not advertise the disability status of job-seeker customers.

-   Drug Court does not restrict disclosure of a job seeker's
    participation; everything is open. So far there has never been a
    Drug Court participant who asked their status not to be revealed.
    Most want to be open up front in order to avoid problems with being
    found out later. Confidentiality is only a problem if the person has
    a felony charge, because then the employer won't hire them.

-   NCAC staff members educate employers about EAPs as a way to get help
    for their workers.

**History and rationale of approach to addressing substance abuse**

-   NCAC took a broad look at "what is a disability" when applying for
    the Work Incentives Grant, which seeks to make One-Stop Career
    Centers accessible to persons with disabilities. They focused on
    physical disabilities, but also wanted to reach out to people with a
    drug addiction disability, primarily because the treatment
    organizations were the most willing to work with NCAC.

-   They started relationships with treatment providers after receiving
    the grant in January 2000. It ends June 2003.

-   Staff found that people who have been through treatment are
    excellent workers, "really amazing people who have taken their lives
    back." When people who have been using drugs begin to work, they
    build an identity outside of their drug use. This can also transform
    their familial relationships by improving the individual's
    self-image. Being engaged with work helps individuals better
    understand why they need treatment and stimulates them to recovery.

**Costs and funding sources**

-   Only registered WIA service costs get tracked. Customers and costs
    are not tracked by individual services for persons with special
    needs.

-   To use resource centers and other core services, a person only needs
    to give his or her name and Social Security Number (SSN) and show
    identification.

-   Costs are not tracked by referral source. This would require
    matching individual SSNs with programs.

-   The Work Incentives Grant was for \$1 million for 30 months.

-   General WIA funds are also available, but how much of these go to
    the Drug Court participants is unknown since this is not tracked.

-   After the Work Incentives Grant runs out, NCAC can continue its
    current approach without a special program because staff are now
    being trained better. NCAC may have to identify a resource center
    staff member to be the single point of contact for referring
    agencies in the community.

**Measuring program benefits/success**

-   Customer satisfaction surveys are given upon service completion and
    three months after service. These don't distinguish Drug Court
    customers but overall ratings have been between 4 and 5 on 5-point
    scale.

-   WIA's current performance measures, which are designed for a
    self-serve, open-ended system, do not lend themselves to tracking
    services for persons from specific populations. NCAC is working to
    devise a follow-up system for all registered WIA customers.

-   Nashville's Local Workforce Investment Area represents only 11% of
    Tennessee's population, but served one-third of the state's job
    seekers who used WIA in the 2001-2002 program year.

**Similarities to and differences from peers' approach to substance
abuse issues**

-   Staff believes that other local areas around the country tend to
    "cream" (serve easier-to-serve job seekers) to get better WIA
    performance results. NCAC is committed to not creaming.

-   Some One-Stop Career Centers do drug testing for employers.

-   To staff's knowledge, other workforce investment areas in the region
    are not focusing on people in recovery.

-   NCAC is the only Work Incentive Grant site that has a relationship
    with Drug Court to focus on drug addiction; the other grantees focus
    on other disabilities.

# Peer learning and sharing with other workforce investment agencies 

-   NCAC staff participate in national conference calls with other Work
    Incentive Grant sites.

-   Before the Workforce Investment Grant, NCAC was a partner in
    CASAWorks, which provided good information and a philosophical basis
    for combining treatment with job training.

-   NCAC participates in a planning committee for a grant to provide a
    continuum of substance abuse services to young women ages 14-23 of
    all income and substance use levels.

**If starting over again,**

***Things to keep the same:***

-   Continue to have a relationship with treatment and other agencies
    who help people in recovery

***Things to do differently:***

-   Take NCAC's services directly to people (e.g., do workshops on-site
    at treatment centers).

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-   Do more to inform employers and the general public about substance
    abuse issues and that addiction and other disabilities are issues
    that affect all working people, not just poor people. Treatment is
    designed for people who realize they need help, so the greatest need
    is to get people with substance abuse problems to the point where
    they seek help and know where to get it.

-   Ask job-seeker customers why they lost or didn't get a job, to help
    detect special needs (such as failing a drug test).

**9.2.2 Workdrugfree**

Workdrugfree is a non-profit program within Worksystems, Inc., the local
Workforce Investment Board for the four-county Portland, Oregon local
area. Worksystems Inc. serves 12,000 job-seeker customers per year
through 34 service providers. Workdrugfree provides Drug-Free Workplace
services (prevention education, supervisor training, and EAPs) to
employers, unions, One-Stop Career Centers, and schools across Oregon.

The main promising approach used by Workdrugfree is:

-   System-wide standards for how One-Stop providers address substance
    abuse problems among job-seeker customers.

**Estimated extent of substance abuse issues among job-seeker
customers**

-   All partner agencies recognize that substance abuse is a significant
    problem in the customer population.

-   9% of job seekers are officially identified as having untreated
    substance abuse problems.

-   Front-line staff suspect that a much higher percentage of clients
    (40-60%) have mental health or substance abuse problems and have low
    confidence that they can do anything about it.

-   Job seekers are not asked whether they are in treatment or recovery;
    no estimates are available.

**How individuals with substance abuse problems enter the system**

***How substance abuse problems among job-seeker customers are
identified***

-   Every job-seeker customer uses a standard one-page assessment form
    at orientation or intake that includes some direct questions about
    drug use (*e.g.,* "If offered a job today, could you pass a
    pre-employment drug test?"). 5% of customers self-identify in this
    assessment as having a substance abuse problem.

-   Another 4% of customers are identified at some other point
    (self-disclose in case management, fail an employer's drug test,
    etc.)

-   Workdrugfree is refining questions in its database to match program
    and demographic information with the goal of better identifying
    where in service delivery substance abuse issues arise.

***How job-seeker customers with substance abuse problems enter the
workforce system***

-   Right now these customers are entering alongside all other
    customers.

-   Some may be referred *to* treatment but currently none are referred
    *from* treatment.

**Description of approach to job seekers with substance abuse problems**

Workdrugfree developed the following system-wide standards for all
service providers in the Portland Local Workforce Investment Area:

-   Comply with the federal Drug-Free Workplace Act of 1988 by notifying
    customers that drug use is not tolerated in a One-Stop. (Applies to
    all workforce agencies and service providers.)

-   Educate workforce staff, via direct testimony from employers, that
    work-ready means drug-free in order to satisfy the demand side of
    the job market. 66% of Portland area employers drug test.

-   Implement agency policy that states expectations and sanctions
    regarding substance use. Cannot impose stricter sanctions than what
    WIA Section 181 permits.

-   Educate all customers about this agency policy, including
    information on help available.

-   Post signs that say employers expect workers to be drug-free.

-   Train all front-line staff in a best-practice skill set from the
    treatment community on how to manage job-seeker customers. This
    skill set, called Motivational Interviewing, uses the Stages of
    Change model to assess a customer's readiness for change and to help
    them move to the next step in dealing with any issue, including
    substance abuse. Front-line staff members have responded
    enthusiastically to this training, which lasts 12 hours and includes
    a certificate of completion.

-   Each agency must have a written protocol for referrals.

-   If agency chooses to conduct drug testing (not required, so only
    five do), it must have a written policy that complies with WIA
    regarding maximum penalties and funding restrictions.

**Extent of workforce system coordination with employers and substance
abuse treatment**

-   25% of the Portland area's workforce service providers say they work
    with both employers and treatment providers. It is not clear what
    the extent of the coordination is.

-   Some specialized programs have direct relationships with treatment
    providers. The rest have referral relationships with assessment
    resources. Staff have found that assessment quality and timeliness
    varies. Some programs have inaccurate referral lists.

-   Coordination should improve over time since implementation of
    Workdrugfree is still in progress.

**History and rationale of approach to addressing substance abuse**

-   The main "champion" for the Workdrugfree project was the elected
    Multnomah County Executive, who attended an employer focus group
    whose participants said that they would not use employment agencies
    (public or private) that refer job applicants that fail drug tests.

-   The private sector has a huge investment in substance abuse
    prevention. Getting to the job applicant stage costs money. Oregon
    has been hard hit by recession, and is currently the state with the
    highest unemployment rate in the nation.

-   The County Executive is also aware that employment is positively
    correlated with recovery from substance abuse.

-   System-wide standards were developed for workforce development in
    the absence of a federal requirement.

-   Phase 1 (educating the workforce system about treatment issues) was
    implemented in September 2002, preceded by 12 full months of
    planning and preparation and discussion with all stakeholders in the
    WIA system.

-   Phase 2 (educating substance abuse treatment providers and the
    county treatment agency about the workforce system) began in
    spring 2003. The County Executive is requiring participation by all
    county-funded treatment providers.

**Costs and funding sources**

-   Program implementation and staff training (\$4,500 total for 200
    people) are one-time costs.

-   Supervisor training on the Drug-Free Workplace Act cost \$900.

-   Attorney time to research WIA and state law provisions about
    Drug-Free Workplace policies and drug testing cost \$5,000

-   Unrecorded in-kind costs include task group participation, etc.

-   Funding sources: WIA and federal Substance Abuse Prevention and
    Treatment (SAPT) block grant. A portion of this grant is reserved
    for statewide activity; Portland's program is a local pilot of
    prevention services for unemployed persons.

**Measuring program benefits/success**

Portland State University is developing a data system to measure and
analyze system-wide outcomes in Phase 2. Some of the data system's tasks
will include:

-   Measure prevalence of substance abuse among customers against the
    "official" 9% baseline to find out whether more substance abusers
    are detected.

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-   Count numbers of referrals to substance abuse assessment.

-   Provide aggregate data on effects of staff training, etc. by
    provider.

-   Match outcomes to demographics of providers' service areas to find
    any salient relationship.

-   Count the number of referrals from treatment agencies to the
    workforce system.

-   Continue to measure client employment outcomes that are already
    required by WIA.

-   Treatment outcomes will not be tracked.

**Similarities to and differences from peers' approach to substance
abuse issues**

-   Most other WIA areas lack a systematic approach to substance abuse.
    Workdrugfree uses a proactive, public health prevention model proven
    to be effective.

-   While Workdrugfree offers Drug-Free Workplace information and
    referral services for employers, with two full-time staff dedicated
    to workforce substance abuse prevention, most of their impact is
    through leveraging local agencies and businesses to improve their
    prevention programs. Workdrugfree provides supervisor trainings to
    small businesses statewide, along with prevention education and
    referrals to legal, EAP, and drug testing experts, in cooperation
    with the Oregon Small Business Development Center Network. Distance
    learning and web-based opportunities are offered in cooperation with
    Portland Community College.

-   Workdrugfree also works with high school career programs (e.g.,
    School-to-Work).

**Peer learning and sharing with other workforce investment agencies**

-   Staff members attended training on Americans with Disabilities Act
    and substance abuse.

-   No formal mechanism for peer learning with other workforce
    development agencies. Not enough regular training and other events
    focus on Drug-Free Workplace issues.

**If starting over again,**

***Things to keep the same:***

-   It took time to create wide stakeholder involvement and buy-in from
    providers in all three funding streams, and key leaders in the
    system. This really paid off, allowing continual progress even in
    the face of obstacles.

-   Not everyone is always enthusiastic, but knowing that the market
    demands drug-free workers (and that substance abusing job seekers
    hurt WIA performance and alienate employers) is keeping partners
    involved.

-   Partners also stay because they are not asked to go outside their
    role (e.g., workforce agencies don't have to act as treatment
    agencies).

***Things to do differently:***

-   Allow more time to complete work (training, technical assistance,
    etc.). All of the activities completed this year were originally
    planned for the first year. Partners have differing organizational
    priorities and vary in their levels of readiness, flexibility, and
    organizational capacity, so rollout can take more time than
    anticipated.

    1.  **Substance Abuse Treatment Providers with Promising
        Approaches**

        1.  **Center for Learning and Health**

The Center for Learning and Health, established in 1996, is a clinical
research unit of the Johns Hopkins University (JHU) School of Medicine
that develops, evaluates, and disseminates interventions to address the
inter-relationship between poverty and substance abuse. The Center
focuses on the hardest to treat population: low-income, chronically
unemployed people with persistent drug addiction (*i.e.*, individuals
who continue to use drugs even during or after drug treatment). The
Center developed a "Therapeutic Workplace" model, which combines paid
occupational training and employment with regular drug testing as a
vehicle to encourage abstinence from drugs. Since April 2000, the Center
has operated a non-profit business called Hopkins Data Services, which
provides data entry for scientific research studies and employs
graduates of the Center's training.

The main promising approach used by the Center for Learning and Health
is:

-   Incorporating employment and Drug-Free Workplace practices into
    treatment.

# 

# How this program addresses employment 

## Clients' typical work status and goals at program entry

-   Every participant enters as part of a randomized controlled study on
    a specific population of unemployed, low-income persons with
    addiction problems (such as pregnant women, homeless alcoholics, or
    methadone maintenance patients).

-   So far, every study participant in both the treatment and control
    groups has been unemployed at the beginning.

-   Most participants lack clear long-term plans when they enter; they
    are motivated by the financial incentives and are very unlikely to
    attend unpaid training.

## How employment fits within a client's treatment process and goals 

-   Employment is a vehicle for delivering treatment via monetary
    incentives for maintaining abstinence and penalties for using.
    Employment is also a personal and treatment goal.

## Employment-related activities during treatment 

-   Each study participant signs a consent form and is randomly assigned
    to either the treatment or control group.

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-   Both groups are periodically monitored via urinalysis and interviews
    with the Addiction Severity Index (ASI).

-   Both groups continue to receive services from the treatment provider
    they were recruited from as well as any other service providers,
    such as community groups or welfare agencies.

-   The control group receives no additional services from the Center.
    The treatment group participates in the "Therapeutic Workplace"
    treatment model.

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-   "Therapeutic Workplace" treatment consists of:

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-   Approximately six months of intensive occupational training in
    typing, keypad, and data entry skills and in "soft" employment
    skills, such as attendance, punctuality, and professional demeanor.
    Training is during regular weekday hours (10 AM -- 3 PM with a lunch
    hour) to simulate an office workplace.

-   Vouchers exchangeable for goods and services, given to participants
    based on their hours in training, with bonus amounts added for high
    performance.

-   Drug testing three times per week. After the first month of
    training, a clean drug test is required in order to attend training
    and earn vouchers. A person who fails a drug test is sent home but
    can come back for the next drug test.

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-   Training is self-paced and delivered via individual computer
    workstation, which monitors each trainee's performance and
    progresses in difficulty with his or her skill levels. A "swipe
    card" system records trainees' arrival and departure times to
    measure their attendance and time in training and to calculate
    voucher values.

-   Training graduates can work in the Center's non-profit business
    component, Hopkins Data Services, to earn wages and paid personal
    leave or vacation days instead of vouchers.

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-   Hours are closer to full time (9 AM -- 4 PM with a lunch hour).

-   Base pay is \$5.25/hour[^1] (\$.10 above the federal and Maryland
    minimum wage of \$5.15), with productivity incentives of \$5 added
    per data batch (2000 characters) and \$.08 subtracted per error.
    Employees earned an average of \$9.88/hour during their first year
    in the business.

-   Penalties for arriving late or leaving early are being developed.

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-   After 18 months in the study, a participants' drug monitoring is
    reduced to a monthly basis.

## Screening for co-occurring disabilities 

-   No formal or general disability screening.

-   People who are suicidal or hallucinating are excluded. People with
    persistent addictions are at high risk for suicide.

## History and rationale of this approach to employment

-   Substance abuse treatment research shows that:

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-   Employment by itself may not suffice to maintain abstinence from
    substances.

-   Financial incentives and accountability are highly effective for
    promoting abstinence, particularly among patients who have not
    responded to other treatments.

-   Financial incentive payments for abstinence must be maintained over
    time in order to stay effective, and their efficacy grows with
    payment size.

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-   The Therapeutic Workplace model applies the above findings by using
    work earnings as the financial incentive payments for abstinence.

-   In a study of occupational interests among patients at a
    JHU-affiliated women's treatment center, participants' top three
    occupational interests were office jobs, cosmetology, and child
    care. Data entry was chosen because it is a critical task for
    conducting research studies and thus the office job most familiar to
    Center staff.

## Costs and funding sources of employment-related services 

-   No good cost estimates available.

-   Almost all funding was via research grants from the National
    Institute of Drug Abuse (NIDA) and the National Institute on Alcohol
    Abuse and Alcoholism (NIAAA), which last for five years. The Center
    is diversifying funding sources to prepare for the end of the
    research grants.

-   Non-research funding includes a small foundation grant and wage
    subsidies from the Baltimore City Department of Social Services for
    the first six months of employment of study participants who receive
    TANF.

**How this employment approach resembles or differs from other treatment
providers**

-   Most treatment providers' main methods are counseling and
    medication. The Therapeutic Workplace model uses financial
    incentives and accountability as its main treatment methods.

-   Employment related interventions of most treatment providers
    typically focus on quick entry into the job market (job searches,
    resumes, interviewing skills, etc.). The Therapeutic Workplace
    approach to employment is more intensive and is focused on skills
    development; in some ways it resembles supported employment.

-   The Center's training and business hours easily accommodate other
    forms of treatment; for example, participants typically have 30
    minutes of counseling once or twice a week.

## Outcomes measurement and data 

-   Drug use outcomes are measured via urinalysis and the Addiction
    Severity Index (ASI) as well as participant self-reports.

-   Employment outcomes are measured in terms of days/hours worked,
    earnings, and attendance (easy to track due to the computer and
    swipe card system). The training was found to be effective in
    teaching people with as low as a 2^nd^-grade reading level to type
    and do data entry.

-   Compared to the control group, Therapeutic Workplace clients had
    twice the number of negative drug tests for cocaine and opiates and
    maintained these trends for three years after entering the program.

-   About half of the first treatment group completed the training, and
    40% were successfully employed in the business component for four
    years.

-   The Therapeutic Workplace model may be adaptable to regular
    workplaces and different populations (such as addicts who
    successfully complete standard drug or alcohol treatment;
    unemployed, non-addicted drug users; or employed people with drug
    problems).

## Coordination with employers 

-   The Center is focused on developing employment positions at Hopkins
    Data for everyone who completes the program. It also offers a job
    club to help training graduates find employment elsewhere. There is
    no direct contact with employers because the Center is trying to
    develop business as part of its intervention.

-   Developing ways for other employers to establish incentives for
    abstinence is a big task. The difference from other drug-free
    workplace testing programs is that positive tests result in
    short-term suspension and docked pay, but not firing.

## Coordination with the workforce investment system 

-   The Center's staff has little knowledge of One-Stop Career Centers.
    Some participants are referred to Catholic Charities for support
    services.

-   Unfortunately, trainees tend not to use outside services that do not
    offer financial incentives. Referrals to these services bring very
    high no-show rates. This suggests that persistently addicted drug
    users are very difficult to employ successfully via outside
    referral.

**If able to start over again,**

***What would stay the same***

## Probably nothing---the Therapeutic Workplace program is continuously adapted, based on research findings. 

## 

## What would be done differently 

## The following major changes to the Therapeutic Workplace model have already been implemented or are currently being researched: 

-   Phasing out the case management and counseling services originally
    provided, because many participants can receive them elsewhere from
    providers with more expertise in those areas.

-   Training switched from classroom to computer-based format due to new
    clients' social problems (interpersonal conflict).

-   Early cohorts of participants had to abstain from all drugs from the
    first day of training, which led to high dropout rates. Currently
    researching changes to the drug testing and abstinence requirements
    to see if they will improve participant attendance and retention,
    such as delaying drug tests until after the first month of training,
    or requiring abstinence from only one drug at a time.

    1.  **Positive Alternatives Program, Joseph P. Kennedy Institute**

Positive Alternatives is a vocational rehabilitation program for adults
with a co-occurring developmental disability and substance abuse.
Positive Alternatives provides a comprehensive, holistic, supportive
approach to address this population's many and complex needs and
barriers to employment.

The main promising approaches used by Positive Alternatives are:

-   Integrating employment and training services into treatment.

-   Enrolling clients at One-Stop Career Centers.

-   Accommodation for co-occurring disabilities.

# How this program addresses employment 

# *Clients' typical work status and goals at treatment entry* 

-   Many have been unemployed for more than five years, with sporadic
    work histories and minimal to no career training.

-   The majority are either receiving or seeking Social Security
    benefits.

-   Many fear that full-time employment would cause the loss of Social
    Security benefits.

## How employment fits within clients' treatment goals and process 

-   The primary goals are employment and maintaining abstinence from
    drug and alcohol use.

-   Consumers must abstain from alcohol and other drugs for at least six
    months prior to job development and placement activities.

## Employment-related activities during treatment 

-   Employment and training are incorporated into all daily activities
    during treatment.

-   Life Skills Management classes on maintaining sobriety and enhancing
    recovery.

-   Job development and job placement after 6 months of sobriety.

-   Earlier employment activities (before job development and
    placement): Job Club, work adjustment training, skills training
    (such as computer, custodial, child care), adult education
    activities, vocational evaluations, and identifying internships and
    on-the-job training opportunities.

## Screening for co-occurring disabilities 

-   All consumers have a developmental disability and a history of
    substance abuse.

-   At least 95% also have a learning disability or mental illness.

## History and rationale of program's approach to employment

-   Started in 1995 in response to the "revolving door" between the
    Vocational Rehabilitation (VR) system in Washington, DC and the
    Employment and Training program at the Kennedy Institute.

-   Consumers' drug and alcohol problems were going undetected by the VR
    counselors; hence their needs were not adequately addressed in their
    employment and training programs.

-   Kennedy Institute received a three-year model demonstration grant
    with the U.S. Department of Education from 1995-1998 to address the
    vocational rehabilitation needs of consumers with addictions and
    co-occurring disabilities.

## Costs and funding sources of employment-related services 

-   Staff resources: Each program site has at least three staff members
    (two employment specialists and one relapse prevention counselor),
    serving at least 12 to 15 consumers on a daily basis.

-   Consumers' length of stay ranges from 5-6 months before job
    development activities.

-   Current funding sources:

    -   USDOL (since 1998).

    -   Work adjustment training component uses VR funding from Maryland
        and the District of Columbia.

**How this employment approach resembles or differs from other treatment
providers**

-   Positive Alternatives is mainly a VR (rather than treatment)
    program, although many treatment programs do have a transition phase
    that focuses on employment and training outcomes.

-   Most traditional treatment programs and their staff lack awareness
    of and accommodations for disabilities. Thus, treatment clients with
    learning and other cognitive disabilities may be labeled as
    "resistant" to treatment, when their problems actually stem from the
    lack of reasonable accommodations for their disability.

-   To work effectively with treatment clients who have co-occurring
    disabilities, the program uses:

    -   Staff who are sensitized to the issues of disabilities and their
        impact on functioning.

    -   Modified delivery of relapse prevention and job development
        services and a more hands-on approach.

## Outcomes measurement and data 

Of the 71 consumers who enrolled in the program from May 2002 through
May 2003:

-   6 obtained employment and maintained it for 90 days.

-   26 have maintained abstinence from drugs and alcohol.

-   5 enrolled in and completed training, or secured a GED or a
    certificate of completion at an institute of higher education.

-   3 accomplished other goals they identified, such as obtaining
    housing, benefits, etc.

## Coordination with employers 

-   Networking and building partnerships and collaborations.

-   Securing on-the-job training (OJT) opportunities, internships and
    volunteer experiences for those consumers with minimal work
    experience.

-   Attending job fairs.

## Coordination with the workforce investment system 

-   Program helps consumers enroll at the One Stop Center to identify
    jobs and additional employment services.

**If able to start over again:**

## What would stay the same 

-   On-site services, with a focus on employment readiness.

-   Comprehensiveness of the program services and activities

-   Continue to build strong partnerships and collaborations with the
    VR, One Stop Centers, and other providers for services our program
    is unable to provide.

## What would be done differently 

-   Streamline consumers' eligibility determination, since so many of
    them meet the admission criteria, but have complex needs that
    require lengthy, intensive interventions and hinder program
    outcomes.

-   Identify staff members who understand both disability and substance
    abuse treatment. It is challenging for staff trained in only one of
    these disciplines to work effectively with consumers.

[^1]: The City of Baltimore has a "living wage ordinance" that currently
    requires the City's private contractors and suppliers to pay wages
    of at least \$8.49/hour. Hopkins Data Services is not subject to
    this ordinance because it is not a contractor or supplier for the
    City of Baltimore. However due to the performance incentives, the
    average employee at Hopkins Data Services earns more than
    Baltimore's "living wage."