Over the past few months, I have written about the difference between a workplace drug and alcohol policy and a program, how a program brings a policy to life, and whether that program is working as intended.
One place that question becomes very real is when a substance-use concern involves a specific employee. A positive drug or alcohol test is reported. An employee makes a voluntary disclosure. A supervisor raises a fitness-for-duty concern. An employee is preparing to return to work following treatment.
What can look like one problem requiring one decision can quickly become a series of decisions involving several people, different areas of expertise, and information that needs to move accurately from one stage to the next.
The first decision is only the beginning
The immediate workplace question may be clear: what do we need to do right now?
What follows is often less straightforward. Does the situation require a professional assessment? What does a drug or alcohol test tell us, and what does it not? How do professional recommendations fit with the employer’s policy, operational requirements and the employee’s circumstances? What needs to happen before a return to work?
Depending on the circumstances, a case may involve the employer, HR, supervisors, a Substance Use Expert, testing or treatment providers, occupational health professionals, a union representative, legal counsel and other specialists.
Each may have an important role. That is precisely why continuity matters.
One case, several roles
Different professionals bring different responsibilities and expertise. A Substance Use Expert will provide an external assessment and recommendations. Treatment providers support treatment and recovery. Specimen collectors follow a standard protocol to protect specimen integrity and the chain of custody to the lab. Once the specimen reaches the lab, it’s analyzed and directly reported to the employer or the administrator of the collection company, who then reports it to the employer. The employer representative who deals with test results is usually an HR or Safety manager. This is where the hard decisions start. Most employers don’t know what to do, and the result is usually termination or a protracted administrative mess that results in the employee rarely ever returning to work.
A case manager has a different role: helping keep the process connected. That can include ensuring the right expertise is involved at the right time, helping the employer understand recommendations, keeping professional roles clear, supporting communication and documentation, and following the process from one decision to the next from start to finish.
Case management does not replace the employer’s decision-making or the work of other qualified professionals. It helps make sure those separate pieces are coordinated and become a workable process.
The gaps between decisions matter
Most problems arise not because someone didn’t do their job, but because it wasn’t clear what needed to happen next or who was responsible for making it happen.
- A recommendation is made, but it is not translated clearly into specific workplace requirements.
- A return-to-work agreement does not accurately reflect professional recommendations of experts or the employee’s current stage of recovery.
- Testing is included in a return-to-work plan, but its purpose, method or follow-up process is not clearly understood or applied.
Often different people assume someone else is responsible for the next step. These gaps can make an already sensitive situation harder to manage and create confusion for the employee, employer and professionals involved.
What continuity looks like in practice
Every case is different, but many move through some version of these stages:
- A workplace concern or triggering event, such as a positive test result, requires a response.
- Appropriate assessment or specialized expertise is brought in.
- Recommendations about treatment and recovery supports are put in place where required.
- Readiness and requirements for returning to work are evaluated.
- Professional recommendations are translated into practical workplace applications.
- Recovery-oriented support must be ongoing and include follow-up, monitoring, testing and more.
Someone needs to understand what has already happened, what still needs to happen, who is responsible for each part, and whether the information being used for the next decision is complete and current. That is the continuity case management provides.
The employer still makes the workplace decisions. The case manager helps ensure those decisions are made with the right information, the right expertise, and a clear understanding of what comes next.
From program to practice
A workplace substance-use policy provides the framework. A strong program adds the procedures, education, testing processes, responsibilities and resources needed to apply it.
Case management is where employers find out whether those pieces work together when a situation becomes personal and complex, as it always does.
The goal is a process that supports workplace health and safety, treats people fairly, keeps responsibilities clear, and gives the employer the information needed to make informed and consistent decisions from the first concern through whatever comes next.