UPHP

Evaluation Toolkit

Table of Contents

Introduction

Healthcare professionals are considered champions of health. However, their substance misuse and addiction rates are not different from the general population. It is suggested that 10-15% of health care professionals will misuse substances throughout their lifetime. Healthcare professionals and the general population face similar barriers with similar consequenses, such as suicide and overdose. However, healthcare professionals with substance use disorders, who delay seeking treatment, may place their patients at immediate risk for harm.

Professional Health Programs, such as the Utah Professionals Health Program (UPHP), are available to healthcare professionals with substance use disorders, and offer a confidential, non-punitive approach while assiting the healthcare professionals on their road to recovery. A comprehensive clinical evaluation must be performed before participating in a Professionals Health Program to determine the participant's eligibility as well as to determine the best course of treatment. The successful evaluation of healthcare professionals has unique challenges as these professionals and positions may enable the individual's substance use disorder and increase the risk for both patient harm and self harm. It is therefore critical that evaluators of healthcare professionals with substance use disorders are specifically trained on how to work with this population

UPHP Process

  1. Referral — Referral to UPHP is made either through self-referral or from a reliable source, including regulatory agencies, employers, colleagues, family, and friends
  2. Intake — UPHP makes contact with the healthcare professional to coordinate an initial interview, evaluation, or referral
  3. Evaluation — Objective, high-quality, independent, diagnostically rigorous evaluation is performed which assesses the professional's fitness for professional practice, as well as a recommended level of treatment/care.
  4. Initial Treatment — Healthcare professional is referred to appropriate care using the American Society of Addiction Medicine (ASAM) criteria for safety-sensitive populations. Ongoing treatment is anticipated to continue throughout the duration of the healthcare professional's participation in the UPHP.
  5. Monitoring — Upon receipt of the evaluation, treatment, and/or other medical records, UPHP develops the terms and conditions for the professional to maintain health and wellness accountability. The participant is offered the opportunity to enter and comply with a UPHP agreement that contains specific terms and conditions for participation in UPHP. Generally, monitoring lasts for 5 years.
Counseling

The Comprehensive Clinical Evaluation

The UPHP determines a potential participant’s eligibility for participation in the program based upon the findings of a comprehensive clinical evaluation. By rule (R156-4a-102), the comprehensive clinical evaluation is a Division approved independent evaluation of a participant that is: diagnostically rigorous, tailored to the specific needs of the participant, includes collateral information, and assesses the presence of a substance use disorder and of any other conditions that may affect the participant’s physical or psychological fitness for practice.

Further, R156-4a-102 specifies that the comprehensive clinical evaluation must be completed by: A multidisciplinary team at an evaluation center that has established expertise in the assessment of healthcare providers or other safety-sensitive professions with substance use disorders, or a qualified specialist approved by UPHP.

Substance use disorder - at risk form

Purpose of the Comprehensive Clinical Evaluation

  1. To assess the presence of a substance use disorder and of any other conditions that may affect the licensee’s physical or psychological fitness for practice.
  2. To determine the appropriate level of care using ASAM criteria for safety sensitive populations.
  3. To determine if the licensee is currently able to practice their profession safely.
  4. To determine eligibility to participate in UPHP.

Evaluators

Requirements of Evaluators Appropriate for Division Approval (FSPHP, 2019)

Evaluators must have:

  1. The understanding that there is no therapeutic relationship. The evaluation is forensic in nature.
  2. The ability to provide an evaluation process with forensic qualities that determines diagnoses, level of care and addresses current safety to practice.
  3. The understanding of the differences between workers in safety-sensitive positions and other individuals with substance use disorders.
  4. The familiarity and knowledge of Federation of State Physician Health Program (FSPHP) Guidelines, (or other professional assistance program guidelines) and American Society of Addiction Medicine (ASAM) Criteria for safety-sensitive workers.
  5. The professional knowledge and expertise necessary to fully evaluate the conditions of possible impairment or the ability to refer for further evaluation.
  6. The commitment to provide full disclosure of costs prior to the evaluation and disclosure that the evaluation could result in the need for further evaluation.
  7. The resources to arrange timely intake and evaluation (within 7 days of contact).
  8. The ability to refer for medical or psychiatric hospitalization if needed.
  9. The ability to appropriately administer standardized psychological tests and questionnaires during the evaluation process.
  10. The resources to conduct comprehensive and discrete collateral interviews of colleagues, appropriate others, and other involved parties to develop an unbiased picture of all circumstances, behavior, and functioning.
  11. The ability to keep UPHP/DOPL fully advised throughout the evaluation process, including advising the UPHP if the participant is reluctant or refuses to fully participate in the evaluation.
  12. The ability to conduct timely documentation, including a brief preliminary written summary of findings and recommendations at the completion of the evaluation (within 1 business day of meeting with the licensee). A comprehensive written evaluation should follow within 10 business days.
  13. The ability to make recommendations regarding rehabilitation/treatment and outstanding items that need further evaluation.
  14. The ability to conduct evaluations face-to-face and in accordance with accepted professional standards (telehealth may be acceptable).
  15. The willingness and ability to testify at an administrative hearing or regulatory board hearing regarding comprehensive evaluation findings, if necessary. As such, the evaluator must have the licensee sign a waiver of liability at the time of evaluation.
  16. The willingness to review possible conflicts of interest in advance of the examination.
  17. The willingness to decline to perform the evaluation if there is a conflict of interest.
  18. The willingness to disclose to the participant any affiliation with a treatment facility prior to scheduling the evaluation.
  19. The ability to interpret toxicology reports and make recommendations based on findings.

The Federation of State Physician Health Programs (FSPHP). (2019). 2019 FSPHP Physician Health Program Guidelines (1st Edition). https://www.fsphp.org/fsphp-guidelines--policies--position-statements

Qualifications of Evaluators

  • Evaluators must have a license in good standing in the following professions:
    • Physician (MD or DO)
    • Licensed Mental Health Professional (LCSW, CMHC etc.)
    • Psychologist
    • APRN
    • Physician Assistant
  • In addition, physicians should:
    • Be certified by a board of the American Board of Medical Specialties and have completed a residency program accredited by the Accreditation Council for Graduate Medical Education
    • Be board certified in Addiction Psychiatry or Addiction Medicine
  • Other qualifications:
    • Must carry own malpractice insurance
    • Must have completed approved ASAM training and provide the certification
    • Must have experience conducting comprehensive clinical evaluations and provide a written sample of your work
    • Must provide resume documenting experience working with and treating substance use disorders; at least one year prior experience conducting and writing comprehensive clinical evaluations.

How to become a Division approved evaluator:

  1. Complete initial evaluator training, and annually thereafter.
  2. Complete the application and submit all required documentation for approval.

Evaluation Samples & Forms

Resources and Guidelines

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