Drug Testing in Child Welfare: 

Practice and Policy Considerations

i

Drug Testing in Child Welfare:

Practice and Policy Considerations

Substance Abuse and Mental Health Services Administration

Center for Substance Abuse Treatment

And

Administration for Children and Families

Administration on Children, Youth and Families

Children’s Bureau
ii

Acknowledgments

This document was prepared by the National Center on Substance Abuse and Child Welfare 

(NCSACW) under Contract No. 270-027108 for the Substance Abuse and Mental Health 

Services Administration (SAMHSA) and the Administration for Children and Families (ACF), 

both within the U.S. Department of Health and Human Services (HHS). Nancy K. Young, 

Ph.D. developed the document with assistance from SAMHSA’s Center for Substance Abuse 

Prevention (CSAP). Sharon Amatetti, M.P.H. served as the Government Project Officer from 

the SAMHSA Center for Substance Abuse Treatment (CSAT) and Irene Bocella, M.S.W. 

served as the Project Officer from the ACF Children’s Bureau.

Disclaimer

The views, opinions, and content of this publication are those of the authors and do not 

necessarily reflect the views, opinions, or policies of SAMHSA or HHS. Resources listed 

in this document are not all-inclusive and inclusion in the list does not constitute an 

endorsement by SAMHSA or HHS.

Public Domain Notice

All material appearing in this document is in the public domain and may be reproduced or 

copied without the permission of SAMHSA. Citation of the source is appreciated. However, 

this publication may not be reproduced or distributed for a fee without the specific, written 

authorization of the Office of Communications, SAMHSA, HHS.

Electronic Access and Copies of Publication

This publication may be downloaded or ordered at www.samhsa.gov/shin. Or call SAMHSA’s 

Health Information Network at 1-877-SAMHSA-7 (1-877-726-4727) (English and Espanol). 

In addition, this publication can be ordered from the Child Welfare Information Gateway at 

1-800-394-3366.

Recommended Citation

Center for Substance Abuse Treatment. Drug Testing in Child Welfare: Practice and Policy 

Considerations. HHS Pub. No. (SMA) 10-4556 Rockville, MD: Substance Abuse and Mental 

Health Services Administration, 2010.

Originating Office

Office of Program Analysis and Coordination, Center for Substance Abuse Treatment, 

Substance Abuse and Mental Health Services Administration, 1 Choke Cherry Road, 

Rockville, MD 20857 

HHS Publication No. (SMA) 10-4556
iii

CONTENTS

I. INTRODUCTION 1

II. CONSIDERATIONS FOR USING DRUG TESTING 2

Organization and Purpose of This Paper 2

Agency Values and Mandates 2

III. DRUG TESTING CONSIDERATIONS 6

Establishing a Collaborative Approach before Implementing 

Drug Testing 3

Drug Testing in Substance Abuse Treatment and Child Welfare Programs 3

Drug Testing in Substance Abuse Treatment Settings 4

Drug Testing in Child Welfare Settings 5

Determine Whom to Test 6

Specimen Types 6

Detection Window 8

Drug testing Methods 10

IV. INCORPORATING DRUG TESTING INTO CHILD WELFARE CASEWORK 15

Discussing Drug Testing With Parents 15

Frequency of Testing 15

Addressing Drug Test Results and Refusals 17

VI. APPENDICES 22

Coordination and Collaboration 19

V. SUMMARY 20

Appendix A: Drug testing Policy Example, Sacramento County, CA 22

Therapeutic Intervention and Experience 25

S.T.A.R.S. forms 28

Appendix B: Establishing Cutoff Levels 35

Appendix C: Considerations in Contracting with a Vendor for Drug Testing 37

Appendix D: Definitions and Terms 39

VII. REFERENCES 41
iv
1

I. INTRODUCTION

Alcohol and other drug use can impair a parent’s judgment and ability to provide 

the consistent care, supervision, and guidance that all children need. For child 

welfare workers who are charged with ensuring the safety of children, it is often 

difficult to determine what level of functional improvement will enable a parent 

with a substance use disorder to retain or resume his or her parental role without 

jeopardizing the child’s well-being. Child welfare professionals are faced with the 

difficult task of collecting adequate information about families, making informed and 

insightful decisions based on this information, and taking timely and appropriate 

action to safeguard children.

The Adoption and Safe Families Act (P.L. 105-89) of 1997 requires that child welfare 

agencies and courts ensure that permanency in children’s caregiving relationship 

is provided consistent with statutory timelines. These timelines, including a court 

hearing to oversee that a permanent placement is obtained twelve months after a 

child is placed in out-of-home-care, created a renewed urgency for finding effective 

ways to address concurrent substance abuse and child maltreatment in families 

whose children have been placed in protective custody.

Drug testing is one tool that child welfare workers often use to facilitate decisionmaking with these families. Drug testing refers to the use of various biologic 

sources such as urine, saliva, sweat, hair, breath, blood and meconium to 

determine the presence of specific substances and/or their metabolites in an 

individual’s system. Child welfare workers use test results to make informed 

decisions regarding child removal, family support services, family reunification, or 

termination of parental rights. However, limited information has been available to 

child welfare workers, judges, and attorneys on the utility of drug testing and how 

to correctly interpret the results in the context of child welfare practice.

A drug test alone cannot determine the existence or absence of a substance 

use disorder. In addition, drug tests do not provide sufficient information for 

substantiating allegations of child abuse or neglect or for making decisions about 

the disposition of a case (including 

decisions regarding child removal, 

family reunification, or termination of 

parental rights). Child welfare workers, 

judges, and attorneys must make these 

decisions using information from the 

child abuse investigation, child safety and 

risk assessments, family assessments, 

and a comprehensive substance abuse 

assessment. It is helpful for these 

practitioners and policymakers to 

establish partnerships with their local substance abuse treatment counterparts, 

who can assist in the decision making that is critical to successful development and 

implementation of drug testing policies.

A drug test alone cannot determine the 

existence or absence of a substance 

use disorder. In addition, drug tests 

do not provide sufficient information 

for substantiating allegations of 

child abuse or neglect or for making 

decisions about the disposition of a 

case.
2

Organization and Purpose of This Paper

The purpose of this paper is to guide child welfare agency policymakers in 

developing practice and policy protocols regarding the use of drug testing in 

child welfare practice. This guidance describes the practice and policy issues 

that policymakers must address to include drug testing in the comprehensive 

assessment and monitoring that child welfare agencies provide. 

The paper focuses primarily on drug testing of parents who come to the attention 

of child welfare agencies and courts through reports of child abuse or neglect. 

However, court practices and policies might use testing in other child welfare 

contexts. For example, drug testing might be useful for conducting home studies 

for prospective foster or adoptive parents, understanding drug use patterns 

among teens in out-of-home care, or evaluating older youth in independent living 

programs. 

Throughout the paper, we identify key action steps to help child welfare agencies 

implement drug testing. We also include an appendix describing the Sacramento 

County, California, Divisions of Child Protective Services and Alcohol and Drug 

Services drug testing policy and procedures as an illustration of a well-developed 

policy.

II. CONSIDERATIONS FOR USING DRUG TESTING

Agency Values and Mandates

Policy discussions about drug testing often focus on technical testing methods, 

verification of test results, costs, staffing issues, and legal issues related to 

confidentiality. The values that shape drug testing policy are discusssed less often. 

However, the values of child welfare, substance abuse agencies, and courts deserve 

adequate attention at the beginning of the policy-making process to clarify the 

reasons for using drug testing. 

Substance abuse treatment agencies and child welfare agencies commonly use drug 

testing for different purposes because they have different mandates and different 

underlying values and missions. These 

agencies’ and professionals’ values 

include attitudes about the nature of 

addiction, abstinence, and relapse, and 

about the effects of substance use and 

abuse on parenting. 

These attitudes influence approaches to identifying and working with parents 

with substance use disorders, beyond drug testing. However, drug testing policies 

typically reflect agency mandates and values as well. The National Center on 

Substance Abuse and Child Welfare (NCSACW), funded by the Substance Abuse 

and Mental Health Services Administration and the Administration for Children 

and Families, has adopted the Collaborative Values Inventory (CVI) developed 

by Children and Family Futures. Partner agencies can administer the inventory 

Key Action Step: Partner agencies need 

to understand value differences across 

systems concerning approaches to families 

affected by substance use disorders.
3

anonymously to a group and then review the results to explore group members’ 

values. Several of the questions address values related to drug testing. We 

recommend that partners explore these values when they begin forming policies 

and procedures governing drug testing. For information about the CVI, visit http://

www.ncsacw.samhsa.gov.

The Special Issues of Testing for Prenatal Substance Exposure

Several factors influence policies regarding the testing of newborns for evidence of 

prenatal substance exposure. These factors include cost and privacy concerns as well as 

societal, systems, and organizational values. Very few hospitals test newborns routinely, 

and studies have indicated that hospitals do not usually inform child welfare or other 

State agencies about the number of infants tested at birth, test results, or referrals to 

child welfare agencies (Young et al., 2008). However, recent legislation in some States 

requires a referral of children to a child welfare agency when drug exposure is detected, 

based on States’ efforts to follow the Federal policy stated in the 2003 amendments 

to the Child Abuse Prevention and Treatment Act. Children with fetal alcohol spectrum 

disorders have also received increased attention in some States including the 

development of State policy committees. In addition, some States and localities have 

significantly expanded prenatal screening, rather than relying solely on testing at birth.

Establishing a Collaborative Approach before Implementing 

Drug Testing

Drug testing by child welfare agencies is not a stand-alone activity. It should be 

part of a larger effort to address substance use by parents and must therefore 

fit into the agency’s and community’s approach to substance abuse and take into 

consideration any State law or prior court cases affecting practice or policy. For 

additional information about creating a comprehensive, collaborative approach 

to address the screening and assessment needs of families with substance use 

disorders who are involved in the child welfare system, consult Screening and 

Assessment for Family Engagement, Retention, and Recovery (SAFERR), a 

guidebook developed by the National Center on Substance Abuse and Child Welfare 

(Young, et al., 2007). 

Drug Testing in Substance Abuse Treatment and Child Welfare 

Programs

Historically, child welfare agencies and substance abuse treatment agencies have 

used drug testing for different purposes. Both types of agencies conduct drug 

testing because it provides information about a client’s drug use behavior that can 

confirm or contradict what the agency has learned through other assessments and 

observations. Agencies test people who might underreport or deny substance use 

due to fear of real or perceived negative reprisals.

Drug test results indicate only that the drug or its metabolite is present at or above 

the established concentration cutoff level in the test specimen. They do not reveal 

whether a parent abuses or is dependent on illicit drugs or alcohol. Conversely, 
4

child welfare agency professionals should not rely on a negative drug test result 

as the sole determining factor for ruling out substance use, abuse, or dependence. 

A negative drug test result only indicates that the test did not detect the drug or 

its metabolite or that its concentration is below the established cutoff level in that 

particular specimen at that time. Similarly, a drug test on a newborn at birth does 

not determine whether the mother’s use or the extent of the mother’s use has 

compromised her infant’s growth or development. 

The best way to evaluate the probability that 

someone is not using drugs is by using a 

combination of random drug tests, self-reports, 

and observations of behavioral indicators 

by substance abuse treatment providers 

or professionals and child welfare workers. 

Observations include positive changes in hygiene and grooming; improved 

functioning in daily life; improved work behavior; avoidance of people, places, and 

things associated with drug use; and improved consistency in complying with child 

welfare and substance abuse treatment case plan requirements. 

Drug Testing in Substance Abuse Treatment Settings

Substance abuse treatment providers commonly use drug testing as a tool to help 

clinically diagnose substance use disorders, plan treatment, monitor progress, 

and support recovery. Substance abuse treatment professionals use behavioral 

indications, such as those described above, to determine whether a parent is 

sustaining recovery, and they view drug testing as a useful test to confirm drug use.

Specifically, substance abuse treatment providers use drug testing to:

● Provide objective data in assessing and diagnosing substance use disorders 

and monitoring progress during treatment;1

Provide an opportunity to address a parent’s denial, inability, or unwillingness 

to recognize a need for intervention or treatment services and to address 

their motivation to stop using drugs;

Provide an additional measure of accountability for clients and agencies by 

monitoring treatment efficacy; and

Key Action Step: Complete 

training on recognizing signs and 

symptoms of substance 

use disorders.

1 Although drug testing has several uses, it has limited value for diagnosing a parent’s current substance use, abuse, or dependence on substances. Biological, genetic, and clinical research findings 

have shown that substance dependence is a chronic disorder and, unlike substance abuse, is associated with tolerance or withdrawal, loss of control of the frequency and/or amount of substance use, 

and continued use despite adverse consequences (American Psychiatric Association, 2000). Drug testing is only one component that addiction professionals use to establish a diagnosis. Other information 

sources include parent interviews, generally using standardized instruments, as well as a review of the 

parent’s pertinent history. Although an addiction professional can conduct an assessment to identify 

a substance use disorder, in most States, only a licensed practitioner (such as a physician, registered 

nurse practitioner, psychologist, or licensed clinical social worker) can make a diagnosis in accordance 

with the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 4th

Edition (DSM-IV) (2000). 
5

● Present objective evidence to the courts, child welfare agencies, criminal 

justice agencies, and other involved agencies that a parent is not using 

drugs, particularly when testing is conducted randomly over a period of time.

Drug Testing in Child Welfare Settings

Child welfare settings employ drug tests for 

different purposes than substance abuse 

treatment settings. Some of the more frequent 

uses for child welfare drug testing, in concert 

with other tools, are to: 

● Provide proof of or rule out substance abuse as part of a child maltreatment 

or child abuse investigation and determine whether substance abuse is 

associated with child risk;

Monitor whether a parent is continuing to use during an open child welfare 

case;

Provide evidence that family reunification is warranted or unwarranted; and,

Provide documented evidence that the parent is drug free (courts often order 

such documentation).

Child welfare agencies can also use drug testing 

to motivate parents who use substances to 

become involved in treatment and to provide 

motivation and positive reinforcement for parents 

in the early stages of recovery. 

Drug testing in child welfare settings should 

be one component of a comprehensive family 

assessment to identify or eliminate substance abuse as a contributing factor to 

maltreatment.

Situations in which drug testing is not appropriate in child welfare practice and 

policy include:

● The parent is an active participant in a substance abuse treatment program 

that already requires frequent random drug testing.

 The parent informs the case manager, treatment provider, or both of a 

relapse. In this circumstance, the case manager or treatment provider 

should assess the child’s safety and risk. The provider should also consider 

assessing the parent’s current drug use patterns and need for a treatment 

or alternative intervention. If the parent is under the court’s jurisdiction, 

providers should also ask the parent to sign a drug use acknowledgement 

form as is common practice in criminal justice probation agencies.

Key Action Step:Identify a clear 

purpose forusing drug testing.

Key Action Step: Determine 

how drug testing currently 

fits with the child welfare 

agency’s overall risk and safety 

assessment protocols.
6

III. DRUG TESTING CONSIDERATIONS

Policymakers must make several decisions to launch a drug testing program in a 

child welfare setting. These decisions include whether to test all parents reported to 

the agency, as well as where to conduct tests, the types of specimen to collect, and 

which substances to test for. Administrative considerations are important as well 

and include staff training and qualification requirements and costs associated with 

testing. Each of these issues is addressed below.

Determine Whom to Test

Due to the high rates of substance use disorders in parents reported to child 

welfare agencies for suspected child abuse or neglect, some child welfare agencies 

have decided to conduct drug tests on all parents under court jurisdiction. However, 

given the limitations of drug testing, this might not be cost effective. Selective 

testing is an alternative to testing all parents by providing the option to choose 

which parents need to undergo a drug test. This option potentially reduces the 

overall cost of the testing program by reducing the total number of tests. 

When only testing selected parents, child welfare staff members should base 

decisions on which individuals to test using information from the child abuse 

investigation, child safety and risk assessments, and family assessments. Other 

considerations in determining who to drug test may involve mothers of babies who 

were identified at birth as having been prenatally exposed to drugs. Remember, 

drug testing can be a component of the child welfare assessment process, but is not 

a substitute for a substance abuse assessment. 

A comprehensive substance abuse assessment involves a review of an individual’s 

drug use pattern and areas of life affected by 

substance abuse such as family and social 

relationships, criminal justice, and psychological 

distress. 

Specimen Types 

Drugs and/or their metabolites can be detected in several different biological 

matrices. Drug testing facilities use the term “matrix” to refer to the specimen 

type analyzed in a drug test. Each specific specimen matrix including urine (the 

most common matrix used), saliva, sweat, hair, breath, blood, and meconium has 

a unique set of considerations during testing. Due to the serious implications of 

testing, every possible precaution should be in place to ensure the accuracy of the 

testing procedures. 

The Substance Abuse and Mental Health Services Administration (SAMHSA) certifies 

drug testing laboratories for the Federal Workplace Drug Testing Program. This 

certification is currently only available for urine specimen testing, but proposed 

Federal guidelines are under consideration that may extend the process to hair, 

oral-fluid, and sweat-patch testing. Child welfare agencies are not bound by the 

Federal Employee Drug Testing Program requirements, but they might want to 

Key Action Step: Decide which 

individuals to test.
7

adopt this model program to ensure a high level of accuracy. For more information 

about the Federal drug testing program, as well as a list of certified laboratories, 

visit http://workplace.samhsa.gov/DrugTesting.

The following section provides a description of the various types of specimen tests 

and some of their implications based on information from the U.S. Department of 

Justice (2000) and Office on National Drug Control Policy (2007).

Urine specimens are the most widely used, cost effective, and well-researched 

specimens for detecting drugs in adults, older children, and youth. Most illicit drugs 

are excreted into urine during the 48 hours after use. For some drugs, frequent and 

multiple drug use can result in an extended detection period. For example, chronic, 

high dose marijuana users may produce confirmed positive results in urine for up to 

30 days (Ellis, Mann, Judson, Schramm & Tashchian, 1985). To deter the individual 

who is undergoing the drug test from tampering with or adulterating his/her urine 

specimen, or from substituting his/her specimen with a specimen from someone 

else, agencies must use a supervised collection method. At this time, urine is the 

only biological specimen for which Federal guidelines are available.

Oral fluid, or saliva, is a more recently used matrix for drug testing. An oral 

fluid specimen is collected on a swab placed inside the cheek within the mouth. 

The advantages of testing oral fluids include the ease of collecting a sample, the 

noninvasive sample collection method, and the ability to identify drugs used within 

the previous 24 hours. Drug testing on oral fluid specimens can be performed 

either with a point-of-collection device or a laboratory test. Oral-fluid tests may be 

unable to detect use after 48 hours with some metabolites or drugs and may be 

less effective than urine tests in detecting past marijuana use. In addition, although 

studies have demonstrated that oral-fluid testing has clinically useful levels of 

accuracy, not all commercial drug testing products for oral fluids are equally 

reliable.

Sweat specimens are collected by applying a gauze patch with a tamper-evident 

adhesive seal directly to the skin for typically a 7-day period. The patch is usually 

applied to the upper arm or upper back. The sweat patch is analyzed by the 

laboratory for drugs and/or their metabolites. The sweat patch specimen provides a 

cumulative record of the individual’s drug use during the time frame that the patch 

is worn. The advantages of using sweat patch tests include its cumulative record 

of drug use. Although this type of collection is noninvasive, it may be unsuitable 

for people with sensitive skin. External contamination from drugs is possible due to 

improper skin cleansing prior to patch application. Individual differences in amounts 

of sweat produced can also affect drug test results.

The use of hair specimens to detect drugs has become more common in recent 

years. Hair specimen tests can detect drug use over several months, depending 

on the length of the hair specimen. Other advantages of hair testing include the 

ability to pinpoint long-term changes in drug use patterns, difficulty of substituting 

specimens or invalidating results, and the noninvasive specimen collection method. 

Disadvantages include the test’s inability to detect single-drug use within the last 3 
8

days. Hair specimen testing is not effective for monitoring compliance on a regular 

basis because it cannot discriminate between recent drug use and use that occurred 

months earlier. Differences in hair structure, porosity, use of hair-color products, 

and external contamination can affect drug test results.

Breath specimens are collected using a device that estimates a person’s bloodalcohol content. For forensically valid use, breath testing devices, commonly 

known as “breathalyzers”must be calibrated according to the U.S. Department of 

Transportation standards and State statutes or regulations (U.S. Department of 

Transportation, 2007). The major advantages of this specimen collection method 

include that it is inexpensive, noninvasive, and reliable for detecting the presence 

and concentration of alcohol. A limitation of breath specimen testing is that it only 

provides information about recent alcohol use but not drug use. 

Blood specimens are collected to detect use of both alcohol and drugs. However, 

the process for obtaining blood specimens is invasive and qualified personnel must 

collect these specimens.

Meconium (contents of fetal intestines) specimens are collected from early 

newborn stools. Meconium testing detects the presence of drugs and alcohol, which 

helps determine if the infant has been prenatally exposed to these substances, 

indicating that the mother used drugs after 13 weeks of pregnancy. Meconium 

testing can detect use of alcohol, cocaine, marijuana, opiates, barbiturates, 

benzodiazepines, amphetamines, and phencyclidine (PCP) during pregnancy.

When deciding which specimen(s) to collect, child welfare agencies should 

determine which types of testing devices or instruments used to analyze specimens 

are available from vendors. They should choose the most accurate and costeffective testing device for their program. 

Key Action Step: Select the type of specimen 

to collect and the testing device to use.

Detection Window 

Timing is a critical factor in drug testing. The specific drug used, amount of drug in 

the person’s body, the frequency of drug use, and metabolism affect how long the 

drug remains in the body. The detection window determines the type of specimen 

to collect because different types of specimens have different detection timeframes. 

Table 1 provides additional information from the Office of National Drug Control 

Policy (Office of National Drug Control Policy, 2002) on the pros and cons of various 

drug testing specimen matrices. The table also provides general guidelines from 

SAMHSA (Center for Substance Abuse Treatment [CSAT], 2006) on the detection 

period for each specimen matrix to help in the selection of the appropriate specimen 

type. The table also includes information on breath, blood, and meconium testing.
9

●●●●●●●

●●●●●●●●●●●●●●●●●●●●●●●●●●

Table 1: Pros and Cons of Different Specimen Sources

Specimen Window of 

Detection

Pros 

Urine Up to 2–4 

days

● Most accurate results

Least expensive

Most flexibility for testing different drugs

Most likely to withstand legal challenge

Specimen can be adulterated, Limited detection window Collection can be invasive or eSpecimen handling and shippin

Oral Fluid Up to 48 

hours

Collecting the oral fluid specimen can be observed 

Minimal risk of tamperingNoninvasiveCan be collected easily in virtually any environment

Can be used to detect alcohol useCan be used to detect recent drug use

Drugs and drug metabolites do urineLess efficient than other testinmarijuana usepH changes can alter specimenModerate to high cost

Sweat FDA ceared 

for 7 days

Relatively noninvasive

Sweat patch typically worn for 7 daysQuick application and removal of sweat patchPatch seal tampering minimizedLonger window of drug detection than urine and bloodRelatively resistant to specimen adulteration No specimen substitution possible

Only a few laboratories offer swThose with sensitive skin may Possible time-dependent drug Possible external drug contamicleansing prior to applicationFor marijuana, current use by For marijuana, positive sweat abstinent, but previously chronSweat production dependentModerate to high cost

Hair Up to 4–6 

mnths

Collecting the hair specimen can be observedLong detection window Does not deteriorate

Can be used to measure chronic drug useConvenient shipping and storage; needs no refrigerationNoninvasiveMore difficult to adulterate than urine

Moderate to high costCannot be used to detect alcohCannot be used to detect drug Not effective for compliance mExternal contamination

Breath Up to 12–24 

hours

Minimal costReliable detector of presence and amount of alcohol 

Noninvasive

Very limited detection window Can only be used to detect pre

Blood Up to 12-24 

hours

Can be used to detect presence of drugs and alcoholTest produces accurate results

InvasiveModerate to high cost

Meconium Up to 2-3 

days

Can be used to detect long-term useCan be used to detect presence of drugs and alcoholEasy to collect and highly reliable

Short detection window after in

(Office of National Drug Control Policy, 2002; Substance Abuse and Mental Health Services Administration, Center for Substance Ab
10

Drug testing Methods

Point of Collection and Laboratory Testing

Drug testing of specimens can be conducted at the point of collection or the 

specimen can be transported to a laboratory for testing.

Point-of-collection tests are screening tests conducted in the field at such locations 

as treatment facilities, child welfare offices, and courts. Field tests should be 

confirmed by a laboratory. Results from point-of-collection screening tests are 

usually visually interpreted by an analyst but many new technologies are using 

laboratory instruments to verify color differences. Some point-of-collection tests 

produce results in the form of a color on a dip stick. Differences in color acuity, 

color perception, and lighting can lead to misinterpretation of results. Staff 

conducting point-of-collection tests must be qualified in interpreting test results. If 

the results are to be used in court proceedings for purposes other than monitoring 

case progress, agencies should have the specimen confirmed using a laboratory test 

or procedure (see below).

Point-of-collection drug testing devices can only be used with urine, saliva, and 

breath specimens. The U.S. Food and Drug Administration (FDA) has approved 

several urine point-of-collection devices but only one saliva point-of-collection 

device. To find out more information about which point-of-collection devices are 

FDA approved, visit http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPCD/

PCDSimpleSearch.cfm.

Key Action Step: Determine when to use point-ofcollection versus laboratory testing.

Laboratory tests usually involve two phases—an instrumented screening test and a 

confirmatory test. The screening test can detect the presence of a substance, but 

the quantitative confirmatory test distinguishes the presence of a specific drug and/

or metabolite in the presence of other various drugs and determines the drug’s 

concentration. Screening tests are used initially to determine if a confirmatory 

test should be conducted. Laboratories use confirmatory tests to clearly identify 

the drugs that are present. Details on the types of tests conducted for screening 

and confirmatory testing and common terminology and acronyms used in these 

processes are often found on laboratory test reports.

Screening for a specified panel of drugs typically involves the use of immunoassay 

technology (a laboratory technique that makes use of the binding between an 

antigen (i.e., drug) and its homologous antibody to identify and quantify the 

specific antigen or antibody in a sample). Common immunoassay technologies 

that are utilized for laboratory screening testresults include the enzyme multiplied 

immunoassay technique (EMIT), fluorescence polarization immunoassay (FPIA), 

radioimmunoassay (RIA), and kinetic interaction of microparticles in solution 
11

(KIMS). These screening assays are very sensitive to the presence of a drug or 

its metabolites. Immunoassay technologies have become less expensive, provide 

results rapidly, and are sufficiently sensitive to detect targeted drugs, their 

metabolites, or both. 

However, chemical reactions that occur during this process can make it difficult 

to distinguish a given drug from other drugs, such as a prescription drugs with a 

similar chemical structure. Therefore the potential for cross reactivity with another 

substance to create a misleading drug test results always exists. For example, some 

over-the-counter cold medications (e.g., pseudo-ephedrine and ephedrine) have 

chemical structures very similar to amphetamine metabolites and therefore may 

cross react with the drug assay and cause a positive amphetamine screen result. 

For this reason, immunoassay manufacturers recommend confirming all positive 

drug screening results with a more specific confirmatory test that uses an 

analytically different technology (U.S. Department of Justice, 1999). Laboratories 

perform this quantitative level of drug testing to confirm positive drug test results 

on the same specimen, typically using gas chromatography/mass spectrometry 

(GC/MS) technology (a method which identifies and quantifies compounds that 

can be vaporized without decomposition). The results of the GC/MS test must 

agree with the initial drug screen result to confirm a positive drug test result (HHS, 

2008). Confirmatory analyses can be significantly more expensive than screening 

tests but are much more sensitive and accurate for detecting a specific analyte or 

drug. A positive screening drug test result is considered a “presumptive positive” 

until confirmed by GC/MS methodology. Agencies should use a SAMHSA-certified 

laboratory to confirm drug test results that will be used in court proceedings. 

http://workplace.samhsa.gov/DrugTesting.

When child welfare agencies present drug test results in court that could result 

in serious consequences for the parent and his or her children (such as requiring 

substance abuse treatment for the parent or removal of the children from the 

parent’s custody), agencies should perform confirmatory instrument testing to 

ensure the drug test’s accuracy. Tests results used in case decisions require the 

greatest accuracy possible. 

Specimen Integrity

To ensure the testing program’s integrity, agencies must ensure that parents do not 

tamper with or alter their specimens and that they correctly match each specimen 

to the parent who provided it. The likelihood that a parent can tamper with a 

specimen depends on the specimen type. Unfortunately, tampering attempts are 

not uncommon with the type of specimen tested most frequently—urine. 

Agencies must take steps to minimize 

specimen tampering to obtain an accurate 

drug test result. 

Key Action Step: Establish the 

procedure for specimen collection 

and observation.
12

When a staff member of the same sex as the parent is not available to monitor 

urine collection, the agency must implement other measures to reduce the 

likelihood that the parent will adulterate or substitute the specimen. These 

measures might include checking the specimen’s temperature and adding a tint 

to the toilet water to prevent the parent from giving toilet water as a specimen 

or diluting the specimen with toilet water. Random testing reduces the possibility 

that parents will bring another individual’s clean specimen as a substitute for their 

own. In addition, agencies must make every effort to ensure that they identify 

each specimen with the name of the person who provided the specimen. A chain 

of custody protocol helps document the specimen’s handling and storage. For more 

information on preventing tampering and maintaining the chain of custody, visit 

http://www.drugfreeworkplace.org.

Which Drugs to Test For

In deciding which drugs to test for, the agency should consider the prevalence 

of different drugs in the community, which drugs are prone to be abused, and 

the history of the individual undergoing the test. Single drug tests can screen for 

the presence of only one drug, whereas panel testing screens for multiple drugs. 

Panel testing is particularly useful for testing parents because most parents who 

use drugs may use several different drugs. The National Institute on Drug Abuse 

(NIDA) suggests testing for a panel of five drugs: marijuana, cocaine, opioids, 

amphetamines, and phencyclidine (PCP) (NIDA, 2007). Some jurisdictions modify 

these five drug panels to reflect their local drug use patterns. With panel drug 

tests, parents can provide one specimen and obtain multiple drug test results. 

For example, a typical six-panel test might include marijuana, cocaine, opiates, 

benzodiazepines, amphetamines, and barbiturates. Agencies can also use tests 

to detect alcohol, but due to its short duration in the bloodstream and its short 

detection window in urine, agencies do not usually include alcohol in these panel 

tests unless they have reason to believe that the person has consumed alcohol 

in the past 12 hours. However, many agencies supplement the panel test with a 

breathalyzer to detect alcohol use.

Many laboratories also offer a wider set of screening and confirmatory tests for 

additional drugs that might be prevalent in a given geographic area. These could 

include pain management medications, such as oxycodone and hydrocodone, and 

benzodiazepines (Valium®, Xanax®, and others). Some drugs, such as steroids and 

d-lysergic acid diethylamide (LSD), require special laboratory testing procedures at 

a considerably higher cost.

Key Action Step: Determine which drug(s) to include in the test panel.

Costs

Cost is an important consideration in developing the agency’s drug testing protocol. 

When planning a drug testing program, agencies must determine how much staff 

time, space for collecting specimens, and storage space they will need, as well as 
13

how they will transport specimens. These considerations are especially important 

if the agency anticipates a high volume of drug testing. Costs have been reduced 

in some sites that have established guidelines that, in most cases, do not include 

conducting a drug test if the parent admits drug use and by implementing random 

testing protocols, which allow for less frequent tests.

The costs of drug tests depend on the number of drugs tested for, the drug testing 

matrix, the specimen collection method, the vendor, and the volume of tests 

conducted. Testing a specimen for a panel of drugs costs more than testing a 

specimen for one drug. Tests that use specialized laboratory equipment or extensive 

laboratory procedures are more costly. Agencies must consider these factors before 

implementing a drug testing program and must continually evaluate their program’s 

cost effectiveness.

Key Action Step: 

Consider cost implications of the drug testing protocoland choice of a vendor.

Laboratories and vendors charge less per test for point-of-collection tests as the 

total volume of tests conducted for an agency increases. If the agency’s drug test 

volume is high, an investment in point-of-collection devices might be cost effective. 

Furthermore, many State correctional agencies negotiate statewide contracts with 

vendors for testing by all probation staff throughout the State. Although multiagency contracts might not be feasible for community-based child welfare agencies, 

negotiating with vendors in partnership with a local substance abuse treatment 

agency or criminal justice agency might yield better prices than separate contracts 

with vendors. Considerations in contracting with vendors include specifying 

which services will be included in their responsibilities such as data collection and 

reporting, scheduling with clients for testing times, testifying in legal proceedings, 

and responsibilities for communicating with child welfare and the courts.

Staff Skills and Qualifications

Staff need training to perform different drug testing procedures and to collect the 

different kinds of specimens. The agency’s vendor should provide adequate staff 

training on the use of their equipment and testing procedures. Staff who administer 

drug tests should have experience in laboratory drug testing and point-of-collection 

drug testing, as well as documented training.

With the increased use and abuse of opiate-derivative pain killers, such as 

oxycodone and hydrocodone, additional precautions against false positives need 

to be taken when testing for misuse of opiates, such as heroin or prescription 

medications. Unlike illegal drugs, where any use is always a red flag, use of 

prescription medication is often under a physician’s care. Agencies should consult a 

Medical Review Officer (MRO) to establish appropriate drug testing procedures and 

to interpret drug test results for prescription drugs. 
14

An MRO is a physician with expertise in substance abuse who receives, interprets, 

and evaluates drug test results. General information about MROs is available at the 

U.S. Department of Transportation’s Web site at

http://www.dot.gov/ost/dapc/mro.html.

Key Action Step: Determine the type of staff training to provide on drug testing and the 

type of qualifications needed to administer the tests.

Drug Enforcement Administration Guidelines

The U.S. Drug Enforcement Administration provides guidelines on Drug-Free 

Workforce Programs http://www.alwaystestclean.com/dea_guidelines.htm.

DEA suggests the following guidelines for drug testing programs:

● Contract with a reliable, professional drug testing vendor who will 

ensure quality control and chain of custody for drug test samples. More 

information on factors to consider when contracting with a vendor is 

provided in Appendix C of this paper. SAMHSA maintains a list of federally 

approved laboratories at http://www.drugfreeworkplace.gov/DrugTesting.

To obtain certification from the HHS National Laboratory Certification 

Program, drug testing laboratories must successfully complete three 

rounds of performance testing on samples, undergo a laboratory 

inspection, and ensure that the personnel providing the services are 

trained in the drug testing procedures. Laboratories must document 

this training and maintain and test the equipment according to the 

manufacturer’s instructions (HHS, 2007).

Implement drug testing in as fair, accurate, and legally defensible a 

manner as is reasonable. Ensure that the collection, handling, and drug 

testing procedures are reliable and accurate and that they reduce the risk 

of misidentification.

Establish legal counsel’s approval of the drug testing methods.

Perform a confirmation drug test when an initial drug test result is 

positive, preferably using GC/MS, and have a Medical Review Officer 

review the results.

Provide timely notification of drug test results to the parent and other 

interested agencies.
15

IV. INCORPORATING DRUG TESTING INTO CHILD 

WELFARE CASEWORK

Discussing Drug Testing With Parents

When an agency’s drug testing protocol calls for testing a parent, agency staff 

should: 

● Discuss drug testing with the parent, allowing the parent to self-disclose 

what the drug test results are likely to reveal and his or her past use of illicit 

drugs and the misuse of prescription drugs, including previous patterns of 

drug use and specific drugs used. This discussion should be conducted in an 

effort to engage the parent in services without using pejorative terms such as 

“clean or dirty” test results.

Discuss with the parent the need for 

complete disclosure of medical conditions and 

prescription and over-the-counter drugs and 

medication. With the increase in prescription 

drug misuse and abuse, it is important to get 

an accurate history of current and recent prescription medications. Provide 

the information that the parent discloses to the Medical Review Officer at the 

drug testing laboratory.

Advise the parent of the purpose of the drug testing, which is to assist in 

case planning and to monitor progress if substance abuse treatment services 

are warranted. The parent needs to understand the consequences of positive 

and negative test results, how the agency will interpret a refusal to undergo 

a test, and how the agency will use the results in assessing child safety and 

risk.

Describe the agency’s drug testing procedures, including the testing location 

and date and the need for the parent to bring identification to the testing site 

and if the protocol includes random testing, the procedures for how random 

specimens are collected. It is helpful to provide a calendar that lists the 

parent’s drug testing appointments and requirements and it is important to 

provide this information in writing so that it is easily understood.

Frequency of Testing

Recovery from drug use can be a long-term process and requires a disease 

management approach to recovery which acknowledges the chronic nature of 

substance use disorders. Parents might need several months of substance abuse 

treatment to reach stability and integrate recovery into their lives sufficiently to 

ensure their children’s safety. 

Key Action Step: Develop 

a parent-engagement 

strategy.
16

Drug testing can help child welfare workers assess the effectiveness of substance 

abuse interventions in reducing threats to child safety and risks of future 

maltreatment. Early in the parents’ participation in child welfare services and 

a treatment and drug testing program, drug test results may likely be positive. 

Helping the parent understand the scope and implications of his or her substance 

use disorder is an important task in this phase of treatment engagement and 

agencies should consider positive initial drug test results in this context when 

implementing consequences.

After initial drug testing, a randomized or ongoing drug testing program could 

be beneficial to provide evidence of success for parents, monitor compliance and 

evaluate progress in treatment. For example, Table 2 describes the frequency 

and intensity of the State of Arizona’s testing services for parents undergoing a 

substance abuse treatment program (Arizona Department of Economic Security 

Child Protective Services, 2007).

Table 2: Drug Testing Service

Timeframe Suggested Frequency

0-60 days Twice weekly

61-120 days Twice per month

121 days or when behaviors indicate no further use Monthly

Agencies should make decisions to modify 

drug testing frequency and intensity with input 

from the parent, supervisor, substance abuse 

treatment provider, and other professionals 

working with the family, particularly when drug testing is being conducted in 

multiple settings or agencies. 

When making such decisions, child welfare workers should take into account the 

following:

● The type of drug used and how long it can be detected;

Clinical diagnosis, including the severity of the substance use disorder, 

the parent’s historical patterns of use, and changes in affect and physical 

appearance;

Whether the parent is participating in a residential treatment program 

(because testing is not usually beneficial until the individual has left the 

campus or otherwise has access to alcohol or drugs);

Whether the parent consistently attends or participates in service delivery, 

particularly substance abuse treatment, self-help groups, or other recoverysupport activities, and his or her level of cooperation with the case plan;

Parent’s denial or minimization, which can indicate that the parent does 

not understand the seriousness of his or her substance use and its 

consequences; and

Key Action Step: Establish 

frequency of testing.
17

● The parent’s relapse-prevention plan, including the coping skills that the 

parent will use in unsafe environments in which he or she might face 

pressure to use, and whether the parent has made changes in the people, 

places, and things associated with his or her substance use.

Child welfare case workers may discontinue testing, with supervisor approval and 

input from the substance abuse treatment provider, if the parent no longer exhibits 

substance use behavior or the parent has received consistent negative drug testing 

results. With supervisory approval, the parent might need additional drug tests 

after the agency has stopped testing the parent if a staff member suspects that the 

parent has relapsed and is not admitting to resumed use. If a court has ordered the 

drug testing, child welfare workers should consult their supervisor and legal counsel 

for guidance regarding modification of drug testing.

Substance-Exposed Infants

Substance-exposed infants are exposed to alcohol and other drugs that the mother 

ingested during pregnancy. This exposure may or may not be detected by drug 

testing. 

Clear, standardized procedures for newborn testing are not available and policies 

vary among hospitals. In an estimated 90–95% of babies born who have been 

exposed to alcohol or illegal drugs, the exposure is not detected at birth and the 

infants go home with their birth parents without any interventions (Young et al., 

2008). Some people perceive efforts to identify infants who have been prenatally 

exposed to conflict with privacy rights and others are concerned that detection 

will not lead to effective treatment, but only to punitive action. Recent prenatal 

screening and prevalence surveys have documented that 10-20% of all babies 

born have been exposed prenatally to illicit drugs or alcohol (Young et al., 2008). 

The 2003 amendments to the Child Abuse Prevention and Treatment Act required 

States receiving funding through the Act to provide a “plan of safe care” for infants 

determined to be “drug-affected” and to report such cases to a child protective 

services agency. A review of State policies on substance-exposed infants is available 

from the SAMHSA document, Substance Exposed Infants: State Responses to the 

Problem, available at http://www.ncsacw.samhsa.gov.

Addressing Drug Test Results and Refusals

Agencies must make policy decisions regarding how to address a parent’s 

negative drug test result, positive test result, refusal to submit to a drug test, and 

adulteration or dilution of a specimen. These decisions should include consideration 

of the differences in responses to parents under a court order and to parents who 

are not court ordered for drug testing. For parents under a court order, all drug test 

results and refusals should be reported to the courts for any implications this may 

have in the parent’s case.
18

Drug tests serve as a mechanism to enhance discussions about recovery. Negative 

drug test results provide an opportunity to offer the parent positive reinforcement, 

recognize the parent’s accomplishments, and offer continued support and 

encouragement. Parents often have difficulty being forthright about relapses, even 

when they are unlikely to suffer any punitive responses. Also, parents under a court 

order who demonstrate negative test results may receive certain incentives that 

parents without a court order may not receive.

A positive drug test result might mean a one-time lapse, or it might signal a return 

to chronic use. Child-welfare workers should view positive drug test results as 

indicators that the substance abuse treatment plan needs adjusting. As with the 

initial child safety assessment, child welfare workers should assess positive drug 

test results along with other indicators (such as a change in the parent’s behavior 

or appearance, missed appointments, or failure to follow through with case plan 

objectives) to determine its potential impact on a child’s safety and risk. A positive 

drug test result can also create an opportunity for intervention that the parent 

might have resisted previously.

Finally, a positive drug test result can 

provide an opportunity to employ strengthbased or motivational-enhancement 

techniques to encourage the parent to 

continue to work on completing the case 

plan, particularly if he or she under a court order. Information about the use 

of motivational enhancement techniques can be found in a SAMHSA Treatment 

Improvement Protocol on the SAMHSA website at 

http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=hssamhsatip&part=A61302.

When a parent receives a positive drug test result, the child welfare worker should:

● Discuss the results in a timely manner with the parent, preferably within 1-2 

days of obtaining the results, giving the parent the opportunity to explain the 

results;

Obtain an assessment by a substance abuse professional if the parent is not 

receiving substance abuse treatment or recovery services;

Consult with the parent’s substance abuse treatment provider; this 

consultation should include a review of the parent’s relapse prevention plan 

and a reassessment of the array of services and interventions in which the 

parent is currently participating, as well as modifications of the parent’s 

relapse prevention plan as needed; and

Consider modifying the frequency of current drug testing for the parent.

Agencies might consider a parent’s refusal to submit as a failure to test on that 

given day. Policies can also be developed to specifically address parents who 

tamper with or adulterate the drug test specimen. At a minimum, substance abuse 

treatment staff should record refusals in the parent’s case file and should notify the 

judge and appropriate attorneys about parents under the court’s jurisdiction. 

Key Action Step: Decide how to 

address positive drug test results, 

negative results, refusals to undergo 

testing, and adulterated specimens.
19

Key Action Step: Develop a procedure to notify child welfare agencies 

and courts of drug test results.

Coordination and Collaboration

Child welfare agencies expect most of the families they serve to complete numerous 

tasks as part of their case plan. Agencies should coordinate these services with the 

family and the service agencies responsible for providing these services to prevent 

unrealistic burdens on families. When a child welfare agency initiates ongoing drug 

testing for the parent, it needs to inform case workers whether the substance 

abuse treatment or probation agency is also requiring the parent to participate 

in drug testing. When health insurance pays for the testing, considerations for 

the protection of health information under the Health Insurance Portability and 

Accountability Act (HIPAA) of 1996 (P.L.104-191) must be addressed. 

When parents must pay for drug testing, agencies should avoid duplicative drug 

tests. Sacramento County, California, pays for drug tests for parents with an open 

child welfare case because the financial cost could create a barrier to reunification. 

Depending on the jurisdiction, courts might decide who has to pay for a drug test 

and, in some circumstances, they might require parents to pay for their drug test at 

a local service provider. The use of valid information-release forms can enable these 

agencies to share drug test results, minimize costs to parents and agencies, and 

increase the likelihood of the parent’s compliance. This coordination can ensure that 

drug testing contributes to child safety assessments and evaluations.

Key Action Step: Establish drug testing coordination and monitoring strategies 

with treatment agencies and courts.

In 2007, the NCSACW published the Screening and Assessment for Family 

Engagement, Retention and Recovery (SAFERR) Model. This model provides 

guidance on strengthening cross-system collaborations to improve outcomes for 

families with substance use disorders who are involved with the child welfare 

system and those who are also involved with the court system (Young et al., 

2007). NCSACW conducted an extensive review of the literature and concluded 

that, at present, no definitive research-driven or evidence-based method exists 

to determine whether drug use is contributing to child maltreatment. However, 

research and practical experience repeatedly indicate that parental substance use 

disorders and child maltreatment are highly correlated and that many, if not most, 

children under the jurisdiction of child welfare agencies and the courts come from 

families with substance use disorders (Young, Nakashian, Yeh & Amatetti, 2007).

NCSACW examined the wide variety of available screening and assessment 

methodologies to identify the best tools for identifying child maltreatment or risk 

and for screening for potential substance abuse and dependence. The Center 

found that the quality of the teamwork among the agencies involved is much more 
20

important than the quality of any tool or set of tools (Young, Nakashian, Yeh & 

Amatetti, 2007).

This message has powerful implications for this discussion of the role of drug 

testing in child protection. The tool, in this case the drug test, cannot by itself 

convey a full picture of the strengths and needs of the family being served. A single 

tool screens for only one set of challenges and therefore requires additional input 

from multiple agencies with a broader perspective on the whole family to enable 

an agency to assess the child’s safety and the parent’s progress in recovery. Joint 

case staffing or family case conferencing with appropriate training can enhance 

this effort to share important information, continuously assess a family’s progress 

in meeting case plan goals, and change case plans accordingly with the family’s 

progress and evolving needs. More information on improving collaborative practice 

for families affected by substance use disorders and child maltreatment can be 

found at http://ncsacw.samhsa.gov.

V. SUMMARY

Throughout this document, we have identified key action steps to help child welfare 

and substance abuse agencies develop comprehensive policies and protocols 

covering several critical dimensions. These key steps are summarized here: 

♦ Understand value differences between partner agencies concerning 

approaches to families affected by substance use disorders.

Complete training on recognizing signs and symptoms of substance use 

disorders.

Identify a clear purpose for using drug testing.

Determine how drug testing fits with the child welfare agency’s overall risk 

and safety assessment protocols.

Decide which individuals to test.

Select the type of specimen to collect and the testing methodology to use.

Determine when to use point-of-collection versus laboratory testing.

Establish the procedure for specimen collection and observation.

Determine which drug(s) to include in the drug testing panel.

Consider cost implications of the drug testing protocol and choice of a vendor.

Determine what type of staff training to provide on drug testing and the 

qualifications needed to administer the tests.

Develop a parent engagement strategy.

Establish frequency of testing.
21

♦ Decide how to address confirmed positive drug results, negative results, 

refusals to undergo testing, and adulterated specimens.

Develop a procedure to notify child welfare agencies and courts of drug test 

results.

Establish drug testing coordination and monitoring strategies with treatment 

agencies and courts.

Drug testing can be an important addition to a child safety and risk assessment, 

family assessment, comprehensive substance abuse assessment, case planning, 

and substance abuse intervention and treatment services. Test results can provide 

useful information for determining whether a parent is using or abstaining from the 

use of illicit drugs or misuse or abuse of legal drugs. Agencies should not use drug 

testing as the sole or primary measure of the existence or absence of a substance 

use disorder, degree of impairment, or parent’s ability to effectively care for his 

or her child; agencies can best make these determinations using a combination 

of ongoing assessment, random drug tests, observations of the parent’s behavior 

and participation in the case plan, and parent self-reports. Before implementing 

drug testing, child welfare agencies need to develop policies and procedures for 

testing, provide adequate staff training, and procure the services of a drug testing 

laboratory and Medical Review Officer. 

When used effectively, drug testing can serve as a catalyst for the individual to 

stop using drugs, a deterrent to continued drug use, and positive reinforcement for 

continued abstinence. Drug testing results contribute to the full spectrum of client 

monitoring and support needed to ensure a child’s safety, permanency, and wellbeing, as well as family recovery.
22

VI. APPENDICES

Appendix A: Drug testing Policy Example, Sacramento County, CA 

The following is a detailed description of the drug testing protocol that Sacramento 

County, California implemented. The county has more than a decade-long history 

of service system reforms to address parental substance use in the child welfare 

population. This description includes the county’s decisions and agreements among 

the substance abuse, child welfare, and court agencies to use drug testing results 

most effectively and efficiently in conjunction with other behavioral signs and 

symptoms to monitor progress in treatment and family case plans.

Policy Environment and Purposes

The Specialized Treatment and Recovery Services (STARS) program conducts a model 

drug testing program in accordance with the county’s collaboratively established drug 

testing policies and procedures. STARS workers (referred to as recovery specialists) 

provide recovery-management services to all parents with substance use disorders 

and an open child welfare case in two settings: (1) voluntary services programs 

in which the child has not been removed from parental custody, and (2) family 

reunification programs for families whose child is in protective custody. 

STARS recovery specialists ensure immediate access for the parent to substance 

abuse treatment services. They also offer monitoring and accountability for the 

parent’s treatment requirements. In addition, the recovery specialists communicate 

drug test results and compliance with treatment requirements to the child welfare 

agency and the court under a negotiated protocol among all three parties.

The STARS program offers parents a supportive environment with an emphasis 

on honesty and recovery and uses drug testing to assist parents in their recovery 

process. The goal of drug and alcohol testing is to hold parents accountable for 

their substance use and to provide opportunities for intervention at critical points in 

the recovery process. Observed urine collection can be invasive and embarrassing 

for parents, so recovery specialists are trained to put parents at ease. Most STARS 

workers are in recovery themselves, and they quickly develop trusting, supportive 

relationships with parents. 

The STARS program philosophy is based on helping parents improve their lives and 

the well-being of their children; the program’s purpose is not to “catch” parents 

using drugs. Rather, the drug testing program is presented to parents as an effective 

way for them to gather evidence about their successes and ability to care for their 

children.

The STARS drug testing model is intended to significantly reduce costs to the 

county by reducing the number of drug tests required for each parent as he or she 

progresses in recovery by eliminating duplication of testing across county agencies. 

The model also reduces the number of tests required by not testing parents who 

admit to substance use.
23

Funding

The STARS program is a 501(c)(3) nonprofit organization, funded by general funds 

from Sacramento County’s Child Welfare Services and Alcohol and Drug Services. 

STARS also receives financial support from its parent company, BRIDGES, Inc. A 

toxicology laboratory has a contract with the county’s Division of Child Protective 

Services (CPS) to provide testing equipment and laboratory services for all STARS 

parents involved with CPS. The STARS program contracts directly with another 

vendor for laboratory tests that the primary contractor cannot provide, such as 

benzodiazepine panels. 

Drug Testing Procedures

All STARS parents are required to undergo observed drug and alcohol testing on 

a random schedule. The recovery specialists determine the appropriate number 

of tests according to STARS protocol. The recovery specialists can do the drug 

and alcohol testing and can send specimens for confirmations. Parents must sign 

an authorization form for release of health care information and the client drug 

screening agreement form prior to submitting a specimen for drug testing. Parents 

must also review the STARS “Client Guide for the Safe Use of Medications in Your 

Recovery” and sign the medication management agreement form. All forms used in 

the STARS program are included at the end of this appendix.

Random Tests

Recovery specialists are required to assign all drug and alcohol testing in a random 

manner, implementing irregular testing patterns in consecutive bimonthly reporting 

periods. However, recovery specialists may direct parents to undergo an alcohol or 

drug test if they suspect that a parent has used a substance.

Color Code System 

In addition to testing requested directly by recovery specialists, STARS parents are 

required to submit to observed drug and alcohol tests according to a color code 

system. The system assigns parents to one of four testing colors at enrollment 

intake. Men are assigned to the green group (about 30% of parents in STARS are 

fathers) and women are assigned to the red or yellow group. All STARS parents who 

have participated in the program for 6 months are assigned to the blue group. The 

system assigns all of the parents in a recovery specialist’s case load to the same 

group. The system develops a color code calendar each month and distributes it to 

STARS recovery specialists to help them schedule appointments and contact the 

parents. A sample monthly calendar is included in this appendix. 

Parents must call the STARS office every Sunday, Tuesday, and Thursday after 6:00 

p.m. to find out if their group needs to be tested. If so, the parents must appear 

at a testing site by the end of the following business day to submit a specimen for 

drug testing.
24

STARS calls in parents for testing in irregular patterns. Recovery specialists monitor 

the frequency and reporting of alcohol and drug tests from both the color code 

scheme and the additional random tests that they order. 

Frequency

The number of drug tests that each parent must undergo depends on how long 

the parent has participated in STARS, his or her progress in recovery, relevant 

court orders, CPS mandates, and the STARS support service plan which details 

the substance abuse treatment requirements. Typically, parents are tested at least 

twice per week initially; the frequency decreases over time to about twice per 

month after 6 months in most cases.

Testing Equipment

Recovery specialists use two types of point-of-collection devices, the Intoximeter 

breathalyzer and the ValTox specimen bottle and urine drug test strip, also known 

as a dipstick.2Specialists use the breathalyzer tests and test strips because of their 

low cost and because they provide immediate results that can form the basis of a 

therapeutic intervention.

● Intoximeter breathalyzer: Each recovery specialist uses an Intoximeter 

breathalyzer to determine the presence of alcohol in the parent’s breath. 

The vendor services and recalibrates the Intoximeters weekly to ensure test 

reliability. Parents blow into the breathalyzer mouthpiece, and results are 

instantaneous. 

ValTox specimen bottle and urine drug test strips: The recovery specialist 

transfers each urine specimen into the ValTox specimen bottle provided 

by the contracted vendor. The specimen bottles contain a preservative, a 

temperature strip, a lid, and a label. A STARS worker dips a test strip into the 

urine specimen and reads the results within 5 minutes. This strip tests for the 

presence of amphetamine/methamphetamine, cocaine, tetrahydrocannabinol, 

phencyclidine (PCP), and opiates.

Chain of Custody

STARS require each recovery specialist to maintain custody of the instant test 

strips, breathalyzer mouthpieces, and specimen bottles. To obtain testing 

equipment, recovery specialists must request the items they need in the STARS 

inventory log. Only authorized STARS personnel are allowed to distribute test 

devices and kits. 

If the ValTox test result is positive, the recovery specialist asks the parent if he or 

she wants to have laboratory confirmation testing. When sending a urine specimen 

to the laboratory, the recovery specialist indicates the date, time, and temperature 

of the specimen on the label. After signing the label, the recovery specialist places 

2 The Intoximeter and ValTox brands that the STARS program uses are only some of the many devices available. 

Agencies need to determine which brands their vendors provide and choose the brand that is best for their drug 

testing program.
25

the specimen in the laboratory envelope, which contains information about the 

parent, test date, recovery specialist signature, and parent signature. The recovery 

specialist then places the envelope in a secure specimen lock box located in the 

STARS offices.

Whenever recovery specialists send specimens for further testing, they must record 

the specimen transfer in the laboratory testing logbook. The STARS building has 

two logbooks, one near each of the two locked specimen containers.

Therapeutic Intervention and Experience

Negative Drug Test Result

When the results of a STARS screening drug dipstick and alcohol breathalyzer 

test are negative, the parent and the recovery specialist sign a negative results 

receipt and each receives a copy of the receipt. A sample receipt is included in this 

appendix. In most cases, parents with a negative urine drug test strip result do 

not undergo further drug testing. A recovery specialist might order a confirmatory 

laboratory analysis, however, if the parent’s behavior is not consistent with point-ofcollection test results or if the specimen temperature suggests laboratory testing is 

warranted. 

Positive Drug Test Result

If the result of the breathalyzer or screening dipstick drug test is presumptively 

positive for any substance, the recovery specialist offers the parent the opportunity 

to admit to recent use and sign a statement of noncompliance with their case plan. 

If the parent denies drug use and requests that a confirmation test be conducted, 

the recovery specialist labels the bottle, deposits the bottle into the laboratoryprovided envelope, records the test in a laboratory-testing logbook and parent 

file, and sends the specimen for confirmation testing. In such cases, the program 

considers the point-of-collection-testing results to be presumptive until confirmatory 

results are available.

If the parent admits to use, the recovery specialist asks the parent to sign a 

statement of noncompliance, which the recovery specialist also signs. The recovery 

specialist discusses the use with the parent and develops a plan to address any 

barriers to success and to prevent additional substance use. The recovery specialist 

encourages the parent to call his or her CPS social worker immediately to inform 

him or her of the noncompliance and describe the plan for continuing recovery.

The statement of noncompliance specifies the substance used and date of last 

use. The parent, CPS, and recovery specialist receive copies of the form. A sample 

form is provided in this appendix. Depending on the substance(s) that the parent 

reports using and other behavioral indicators, the recovery specialist might order a 

confirmatory laboratory test.
26

Voluntary Positive Reports 

STARS recovery specialists give parents the opportunity to admit to recent drug or 

alcohol use at any time, without the need for a drug test. If a parent admits recent 

use, the recovery specialist discusses the use with the parent and develops a plan 

to address any barriers and prevent future use. The recovery specialist encourages 

the parent to call his or her CPS social worker immediately to inform him or her of 

the noncompliance and describe the plan for continuing recovery.

The recovery specialist also asks the parent to sign and date a statement of 

noncompliance. The recovery specialist also signs and dates the statement, which 

specifies the substance used and date of last use. The parent, social worker and 

recovery specialist receive copies of the statement.

Tests that are Considered Not Compliant with Court Orders

● STARS does not consider any test not directed by STARS personnel, either 

directly or via the color code call-in system, to be a valid authorized test for 

their reporting to the court or CPS.

STARS considers any specimen left unattended or not handled according to 

chain-of-custody guidelines to be invalid.

STARS considers any failure to provide a specimen to be a failure to test.

Recovery specialists use the test temperature gauge included on the bottle 

and visual checks to evaluate if the specimen may have been diluted. If so, 

they send the urine specimen to the laboratory for verification of test strip 

results. These confirmatory tests are paid for by the STARS program.

STARS recovery specialists report to the court and to CPS any tests involving 

diluted urine specimens and urine specimens whose temperature is out of the 

normal range as the parent is noncompliant with the testing requirements of 

their case plan. 

Notification of Confirmed Positive Drug Tests and Failures to Test

STARS requires recovery specialists to inform the CPS social worker, treatment 

provider, and STARS supervisor of all positive test strip results and failure-to-test 

incidents. If a parent has a positive test result for alcohol or drugs or fails to test 

and the parent has a child in his or her care or has unsupervised visits with the 

child, the recovery specialist is required to notify a CPS staff member within 30 

minutes of the test. The notification must be made directly to a CPS staff member; 

a message cannot be left on an answering service.

In the fall of 2009, confirmation test procedures were changed in that CPS now 

considers all positive strip results as positive and specimens are only sent for 

confirmation if the parent states that the strip test is not accurate and requests that 

a confirmation be conducted. The parent must pay the $20 for the confirmation 

test to be conducted and if the result is negative, the parent receives a refund from 
27

CPS. If the test confirms that there is a positive result, the parent is responsible for 

the $20 confirmation test fee.

For more information about the STARS program, please contact Jeff Pogue, STARS 

program director:

Jeff Pogue, Director

STARS Program

3600 Power Inn Road, Suite D3

Sacramento, CA 95826

Phone: 916/453-2704, Ext. 17

E-mail: jeff@bridgesinc.net

The following forms are provided as samples to assist organizations in developing 

drug testing policies and procedures.

● Client Drug Screening Agreement

Client Drug Screening Agreement Track III

Authorization for Release of Health Care Information

Medication Management Agreement

Drug and Alcohol Screening Test – Negative Results

Drug and Alcohol Screening Test – Presumptive/Altered Results

Color Code System Calendar

(Bridges, Inc., 2001).
28

S.T.A.R.S.

Specialized Treatment And Recovery Services

A program of Bridges Inc.

CLIENT DRUG SCREENING AGREEMENT

All STARS clients are required to submit to random observed drug and alcohol screenings 

unless otherwise instructed. With the prior approval of both the client’s social worker and 

the director of STARS, clients may be assigned to a blanket-testing schedule, which will 

consist of testing on each:

______ Monday, Wednesday, and Friday

OR

______ Tuesday, Thursday, and Saturday

If the client fails to test on the day that they are instructed to test on, they will receive an 

administrative positive which will automatically make them non-compliant during that report 

period. Clients directed to Valley Toxicology to test must obtain proof of test and submit 

it to their Recovery Specialist by the last day of the report period to receive credit for the 

test. Clients in residential treatment are excused from participating in the process described 

above while in treatment but must begin doing so on the first day following discharge. 

The Recovery Specialist, apart from the process described above, will also direct clients to 

test on a random basis. The Recovery Specialist may direct the client to test on any day 

either with the Recovery Specialist or at a Valley Toxicology testing site. If a client fails to 

test as directed by their Recovery Specialist, they will receive an administrative positive 

which will make them automatically non-compliant during that report period.

Upon completing any test at Valley Toxicology or the Effort, all clients are required to call 

and report the test to their Recovery Specialist’s phone extension. If any client fails to 

test as required by the this agreement or directed by their Recovery Specialist they must 

immediately call their Recovery Specialist and they are required to appear at the STARS 

Program office the next day before 10:00 AM. 

Clients are to be ready to test at all scheduled Treatment sessions. Clients are required to 

be on site at the Treatment Provider 15 minutes before their scheduled treatment session 

and then wait 15 minutes after the treatment session in case the Recovery Specialist shows 

up to test the client. Failure to show at a scheduled treatment session will result in an 

administrative positive if the Recovery Specialist shows up to test the client and the client 

is not present. Recovery Specialists are required to wait up to 15 minutes for the client to 

produce a specimen and to furnish the client with a receipt.

1. I understand that I am required to follow the above testing 

instructions and that a failure to test as directed will result in an 

administrative positive.

2. I understand that I am required to submit to random observed drug 

and alcohol screening as directed by the Recovery Specialist and that 

I should be ready to test 15 minutes before and after all scheduled 

Treatment sessions.

Client Date

Treatment Coordinator Date
29

TRACK III

CLIENT DRUG SCREENING AGREEMENT

All Track III STARS clients are still required to submit to random observed drug and alcohol 

screenings. Each Level III client will be assigned the color Blue. They will be required to 

call the STARS telephone number (916) 453-2704) every Sunday, Tuesday and Thursday 

evening after 6:00 pm to receive instructions whether they are supposed to go to a Valley 

Toxicology testing site the next day to be tested based upon their color assignment. If 

the client fails to test on the day that they are instructed to test on the recorder, they will 

receive an administrative positive which will automatically make them non-compliant during 

that report period. Clients directed to Valley Toxicology to test must obtain proof of test and 

submit it to their Recovery Specialist by the last day of the report period to receive credit for 

the test. Clients in residential treatment are excused from participating in the call in process 

described above while in treatment but must begin calling in on the first day following 

discharge.

Clients will also be directed to test on a random basis by their Recovery Specialist apart 

from the call in process described above. The Recovery Specialist may direct the client to 

test on any day either with the Recovery Specialist or at a Valley Toxicology testing site. If a 

client fails to test as directed by their Recovery Specialist, they will receive an administrative 

positive which will make them automatically non-compliant during that report period.

Upon completing any color code or directed test all clients are required to call and report the 

test to their Recovery Specialist’s phone extension. If any client fails to test as required by 

the color code or as directed by their Recovery Specialist they must immediately call their 

Recovery Specialist and they are required to appear at the STARS Program office the next 

day before 10:00 AM.

Clients are to be ready to test at all scheduled Treatment sessions. Clients are required to 

be on site at the Treatment Provider 15 minutes before their scheduled session and then 

wait 15 minutes after the session in case the Recovery Specialist shows up to test the client. 

Failure to show at a scheduled Treatment session will result in an administrative positive if 

the Recovery Specialist shows up to test the client and the client is not present. Recovery 

Specialists are required to wait up to 15 minutes for the client to produce a specimen and to 

furnish the client with a receipt.

1. I understand that I am required to call STARS every Sunday, 

Tuesday, and Thursday evening after 6:00 pm to receive testing 

instructions and that failure to call or to test as directed on the 

recorder will result in an administrative positive.

2. I understand that I am required to submit to random observed 

drug and alcohol screening as directed by the Recovery Specialist 

and that I should be ready to test 15 minutes before and after all 

scheduled Treatment sessions.

Client Date

Recovery Specialist Date
30

Specialized Treatment and 

Recovery Services

3600 Power Inn Rd. Suite C

Sacramento, CA 95826

Office 916 453-2704

Fax 916 453-2708

Authorization for Release of Health Care Information

To: Dr. ___________________________

Your patient __________________________________ is receiving services from 

the Specialized Treatment and Recovery Services (STARS) program. This program 

provides case management for your patient for the purposes of recovery from 

substance abuse. As a part of the program, your patient is subject to random urine 

drug testing for controlled substances. For that reason your patient has been asked 

to provide us with a list of prescribed medications.

It is our hope that in the treatment of your patient, non-narcotic medications can 

be prescribed whenever possible to help your patient continue in recovery and 

eliminate potential positive drug tests.

Occasionally, it is necessary to contact the prescribing physician to confirm that a 

participant is receiving a prescribed medication that has resulted in a positive drug 

screening. Your patient has signed this release of information so that the specified 

recovery specialist may contact you for this information. PLEASE KEEP THIS 

RELEASE IN YOUR PATIENT’S RECORDS.

Thank you for your assistance

Sincerely,

Jeff Pogue

Director/Drug Court Coordinator

Specialized Treatment and Recovery Services

RELEASE OF MEDICAL INFORMATION

I hereby authorize the release of information regarding any medication, which could 

result in a positive test on a drug screening that is currently being prescribed for 

my medical use. The information is to be released only to STARS Director Jeff Pogue 

or to Recovery Specialist _________________________.

This authorization will be effective for one year from the date of my signature or 

until my STARS case is closed.

Signature __________________________________Date_____________________

Witness____________________________________Date_____________________ 
31

Specialized Treatment and 

Recovery Services

3600 Power Inn Rd. Suite C

Sacramento, CA 95826

Office 916 453-2704

Fax 916 453-2708

Medication Management Agreement

This agreement between _______________________________________and 

Specialized Treatment and Recovery Services (STARS) is for the purpose of 

establishing an agreement and to clarify the conditions upon which STARS is willing 

to accept the use of mind-altering prescription medications. This agreement is a 

necessary factor in establishing and maintaining the trust and confidence necessary 

to accurately report your progress to the Dependency Court. The patient agrees to 

and accepts the following conditions for the use of prescription medications:

I will not use any illegal or uncontrolled drugs.

I will not share, sell, or trade my medications for money, goods, or services.

I will not attempt to obtain additional pain type medications or other mind-altering 

medications from any other health care provider without notifying this office. I 

understand that doing so may result in a non-compliant report from this program.

I agree to safeguard my medications in such a manner that it will prevent loss or 

theft. 

I agree that I will use my medications exactly as prescribed, at a rate no greater 

than prescribed.

I understand that unless otherwise specified by my physician, my 

prescription is only valid for thirty (30) days from the date the prescription 

is filled. The only exception to this is a chronic pain diagnosis or other 

medically documented reason. The STARS director must approve these 

exceptions. 

I have read & understand all of the above policy.

This agreement is entered into on this day ____________________, ___________.

Client Signature: ____________________________________________________

Please Print Name: ___________________________________________________

Witness: ___________________________________________________________
32

Sacramento County

Department of Health and Human Services

Specialized Treatment and Recovery Services (STARS)

Drug and Alcohol Screening Test – Negative Results

Client Name______________________________________

Test Date ______/______/______ Temperature_______

Social Worker__________________________ Worker Code____________

Test Location

STARS___ Treatment Provider___ Field___ Home___ Other___

I submitted to a breath and urine sample on the above stated date and the results were 

negative 

 

[Date]	 	 Client Signature

 

[Date]	 	 Recovery Specialist Signature
33

Sacramento County

Department of Health and Human Services

Specialized Treatment and Recovery Services (STARS)

Drug and Alcohol Screening Test – Presumptive/Altered Results

Client Name______________________________________

Test Date ______/______/______ Temperature_______

Social Worker____________________________________ Worker Code____________

Test Location

STARS___ Treatment Provider___ Field___ Home___ Other___

I understand that I submitted a breath/urine sample on the above stated date and that the 

breath/urine sample has indicated a presumptive positive result for the following: 

Alcohol Breathalyzer Result: 

______________

Methamphetamine/Amphetamine

Cocaine

Marijuana/THC

PCP

Opiates

Benzodiazepines

Sample Diluted/Altered

_________I waive my option of a confirmation test and accept the positive result of the 

initial screen. I recognize that this acceptance constitutes a full admission of drug use and 

further admit using the above drugs on the date listed _________________.

_________I waive my option of providing a breath and urine sample and admit that I used 

the above noted drug/alcohol on the date listed________________.

_________ I do not accept the result of the initial screen that resulted in the presumptive 

positive and/or diluted/altered test. I hereby request a confirmation test to be completed.

[Date]	 	 Client Signature

[Date]	 	 Recovery Specialist Signature
34

Sun Mon Tue Wed Thu Fri 

STARS COLOR CODE CALENDAR
35

Appendix B: Establishing Cutoff Levels

Established cutoff levels are preset thresholds that laboratories use to determine 

whether a drug test result is negative or positive. Positive drug test results have 

concentration levels above the cutoff levels, whereas the levels in negative results 

are below the cutoff levels. Laboratories set the levels at a value designed to 

indicate whether a certain amount of an illicit drug is present. Depending on the 

purpose of the drug testing program, these values may vary between laboratories 

or for specific clients of the laboratories. 

The Mandatory Guidelines for Federal Workplace Drug Testing Programs have 

established cutoff levels for Federal workplace settings (HHS, 2004). Table 3 

displays standards that can serve as the basis for developing child welfare testing 

protocols, although local jurisdictions might want to adapt these standards for their 

child welfare or treatment practices. These levels reflect the 5.1.2010 Guidelines.

Table 3: Cutoff Level Standards for Federal Workplace Drug Testing Programs, in

Nanograms per Milliliter

Cutoff Levels Initial Screen Confirmatory Test

Amphetamines 1000 500

Cocaine Metabolites 300 150

Marijuana Metabolites 50 15

Opiate Metabolites 2,000 2,000

Phencyclidine (PCP) 25 25

Another example of established cutoff levels comes from the Professional Health 

Monitoring Programs (personal communication, 2009). Table 4 shows drug testing 

program standards for compliance monitoring for physicians, nurses, dentists, 

lawyers, social workers, psychologists, pharmacists, and health paraprofessionals.

Table 4: Cutoff Level Standards for Professional Health Monitoring Programs, in

Nanograms per Milliliter

Cutoff Levels Initial Screen Confirmatory Test

Amphetamines 1,000 200

Antidepressants 100 100

Antihistamines 100 100

Barbiturates 300 200

Benzodiazepines 50 10-50

Narcotics/Opiates 100-750 100-500

Stimulants 500 500
36

Child-welfare and substance-abuse treatment agencies should consult their 

laboratories to determine the cutoff levels used to indicate a positive drug test 

result. These cutoff levels might be lower than the Federal standards for drugfree workplaces, resulting in a higher likelihood of positive drug test results. For 

example, cutoff levels for amphetamines, including methamphetamine, might be 

200 nanograms per milliliter (ng/mL), which is well below the Federal Drug Free 

Workplace standards. However, 300 ng/mL would be a confirmed positive drug 

test result based on the cutoff levels used by the Professional Health Monitoring 

Programs with a confirmatory cutoff of 200 ng/ml. Although using Federal DrugFree Workplace cutoff levels is more defensible than other cutoff levels in court, 

these levels might under-indentify individuals who have used an illicit drug.

Determining appropriate cutoff levels in child welfare practice is a local 

implementation issue for policymakers. We recommend that the child welfare 

agencies consult with their general counsel and local alcohol and drug treatment 

administration when determining what cutoff thresholds to use. Some local 

jurisdictions set common cutoff levels for multiple systems, including criminal 

justice and probation, child welfare, and substance abuse treatment agencies. If the 

laboratory does not use the same levels as those that the systems use, the courts 

and each system should train its staff members to ensure that they give parents 

common messages and use the same approaches to drug testing.
37

Appendix C: Considerations in Contracting with a Vendor for Drug 

Testing

In 2003, the U.S. Drug Enforcement Administration developed Guidelines for a 

Drug-Free Workforce. Agencies should consider these guidelines when contracting 

with a vendor to implement drug testing:

● The vendor should provide guidance in developing collection procedures to 

ensure that agencies obtain specimens properly and that parents do not 

tamper with their specimens.

The vendor should provide all of the materials that the agency needs for 

specimen collection and written instructions for collecting specimens. These 

materials might include containers, chain-of-custody and report forms, 

evidence tape, prepaid tamper-proof mailers, and labels. The contract price 

should include these items as well as courier service. An agency might need 

to make separate financial arrangements if it requires a urine-collection 

vendor in addition to the laboratory services. If an agency uses a separate 

collection vendor, this vendor should be a facility that specializes in specimen 

collection for workplace drug testing.

Containers should be sterile and not contain preservatives that might alter 

the drugs or metabolites being tested for or interfere with the drug test 

result. Containers should also include a built-in temperature strip that can 

measure the urine specimen’s temperature. This is useful for detecting 

specimen substitutions or other attempts to tamper with the specimen.

The vendor and its drug testing analysts must comply with State and Federal 

licensing and certification requirements.

The vendor must provide a clear, up-to-date procedure manual for laboratory 

drug testing and point-of-collection methods. Laboratories certified by the 

National Laboratory Certification Program follow the procedural guidelines 

approved by HHS (HHS, 2007).

The laboratory must furnish an analytical plan to ensure that it confirms all 

screened positive drug test results with a GC/MS confirmatory test and that 

it does not transmit any results to the agency based solely on the initial 

screening drug test result. In other words, the vendor should automatically 

submit all initial screening positive drug test specimens for GC/MS 

confirmation and quantization testing.

The vendor should define the analytical sensitivity and specificity for each 

drug test procedure. Most employers, including non-regulated employers, 

follow the cutoff levels established by the U.S. Department of Transportation’s 

drug testing program. However, the agency and the vendor should agree on 

any change from the drug test laboratory’s normal thresholds for detection in 

writing.
38

● The vendor’s drug testing procedures should differentiate between legitimate 

therapeutic drug, illegal drug use or misuse, and illicit drug use. Thus, 

the tests should rule out legal medications that parents use for legitimate 

medical reasons before declaring a drug test result to be positive. Agencies 

should consider contracting with a Medical Review Officer to determine 

whether the parent might have used prescription medications for legitimate 

purposes.

The vendor should be able to identify any of the normally abused illegal 

drugs or their metabolites and offer several drug panel tests as a cost 

effective option.

Once the specimen has arrived at the laboratory via an approved courier, the 

vendor should deliver a confirmed written drug test result within 2–3 days. 

Agencies should never base their child-placement actions on oral notification 

of drug test results. The vendor and child welfare agency or substance abuse 

provider should establish procedures to maintain confidentiality, and the 

laboratory should offer refrigerated storage for confirmed positive specimens.

With timely notification, the vendor should make available expert testimony 

in the form of written records and personal appearances to describe results, 

drug testing methodology, and opinions.

Technical and managerial laboratory personnel should be trained and 

qualified to conduct all point of collection and laboratory drug testing.
39

Appendix D: Definitions and Terms

Adulterated Specimen. A specimen that has been altered, as evidenced by test 

results showing either a substance that is not a normal constituent for that type of 

specimen or showing an abnormal concentration of an endogenous substance.

Aliquot. A fractional part of a specimen used for testing, representing the whole 

specimen.

Calibrator. A solution of known concentration in the appropriate matrix that is 

used to define expected outcomes of a measurement procedure or to compare 

the response obtained with the response of a test specimen aliquot/sample. 

The concentration of the analyte of interest in the calibrator is known within 

limits ascertained during its preparation. Calibrators may be used to establish a 

calibration curve over a concentration range.

Chain of Custody (COC). Procedures to account for the integrity of each specimen 

or aliquot by tracking its handling and storage from point of specimen collection to 

final disposition of the specimen and its aliquots.

Control. A sample used to evaluate whether an analytical procedure or test is 

operating within predefined tolerance limits.

Cutoff. The decision point or value used to establish and report a specimen as 

negative, positive, adulterated, substituted, or invalid.

Donor. The individual from whom a specimen is collected.

HHS. The U.S. Department of Health and Human Services.

Initial Drug Test. The test used to differentiate a negative specimen from one that 

requires further testing for drugs or drug metabolites.

Invalid Result. The result reported by an HHS-certified laboratory in accordance 

with the criteria established in Section 3.8 when a positive, negative, adulterated, 

or substituted result cannot be established for a specific drug or specimen validity 

test.

Laboratory. A permanent location where initial and confirmatory testing, reporting 

of results, and recordkeeping is performed under the supervision of a responsible 

person.

Medical Review Officer (MRO). A licensed physician who reviews, verifies, and 

reports a specimen test result to the agency.
40

Negative Result. The result reported by an HHS-certified laboratory, IITF, or 

POCT tester to an MRO when a specimen contains no drug or the concentration of 

the drug is less than the cutoff concentration for that drug or drug class and the 

specimen is a valid specimen.

Positive Result. The result reported by an HHS-certified laboratory when a 

specimen contains a drug or drug metabolite equal to or greater than the cutoff 

concentration.

Sample. A performance testing sample, quality control material used for testing, or 

a representative portion of a donor specimen.

Specimen. Fluid or material collected from a donor at the collection site for the 

purpose of a drug test. Urine is the only specimen allowed for Federal workplace 

drug testing programs.

Standard. Reference material of known purity or a solution containing a reference 

material at a known concentration.
41

VII. REFERENCES

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Center for Substance Abuse Treatment. (2006). Substance abuse: Clinical issues in 

intensive outpatient treatment. Treatment Improvement Protocol (TIP) Series 47.

HHS Publication No. (SMA) 06-4182. Rockville, MD: Substance Abuse and Mental 

Health Services Administration. 

Ellis, Jr GM, Mann MA, Judson BA, Schramm NT, Tashchian A. Excretion patterns 

of cannabinoid metabolites after last use in a group of chronic users. Clinical 

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National Institute on Drug Abuse. (2007, September). Frequently asked questions 

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gov/DrugPages/testingfaqs.html

Office of National Drug Control Policy. (2002, July). What you need to know about 

drug testing in schools. Retrieved September 26, 2007, from http://www.ncjrs.gov/

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U.S. Department of Transportation. (2007, December). Conforming products 

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Transportation, National Highway Traffic Safety Administration. Retrieved April 1, 

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U.S. Department of Health and Human Services. (2007, October). National 

laboratory certification program. Retrieved April 3, 2008, from http://www.

workplace.samhsa.gov/DrugTesting/Files_Drug_Testing/Labs/Natl_Lab_Cert_Prog_

Background1007.pdf

U.S. Department of Health and Human Services, Substance Abuse and Mental 

Health Services Administration. (2004). Mandatory guidelines for Federal workplace 

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U.S. Department of Health and Human Services, Substance Abuse and Mental 

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of Workplace Programs. (2008, March). Making your workplace drug-free: A kit for 

employers. Retrieved March 21, 2008, from http://download.ncadi.samhsa.gov/

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42

U.S. Department of Justice, Office of Justice Programs, Bureau of Justice 

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U.S Drug Enforcement Agency. (2003). Guidelines for a Drug-Free Workforce.

Young, N. K., Gardner, S., Otero, C., Dennis, K., Chang, R., Earle, K., & Amatetti,

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(SMA) 09-4369. Rockville, MD: Substance Abuse and Mental Health Services 

Administration, 2009.

Young, N. K., Nakashian, M., Yeh, S., & Amatetti, S. (2007). Screening and 

assessment for family engagement, retention, and recovery (SAFERR). HHS 

Publication No. (SMA) 07-4261. Rockville, MD: Substance Abuse and Mental Health 

Services Administration.
44

HHS Publication No. (SMA) 10-4556

Substance Abuse and Mental Health Services Administration

Printed 2010