DOT-regulated employers with employees performing safety-sensitive duties must take drug and alcohol violations seriously. When a DOT violation occurs, the employee cannot return to safety-sensitive duties until the required return-to-duty process has been completed.
The first step in that process is an evaluation with a qualified Substance Abuse Professional (SAP). The SAP conducts a comprehensive clinical evaluation, makes individualized recommendations for education and/or treatment, and later determines whether the employee has successfully complied with those recommendations before a return-to-duty test can take place.
The employer’s Designated Employer Representative (DER)—the employer’s designated point of contact for its DOT drug and alcohol program—must provide the employee with information about qualified SAPs. In some areas, finding a qualified SAP nearby may be relatively easy. In others, particularly rural areas, an employee may have to travel a considerable distance for an appointment. That can create delays and additional expense for both the employee and an employer hoping to move the return-to-duty process forward efficiently.
How Remote DOT SAP Evaluations Became an Option
Prior to the COVID-19 pandemic, DOT SAP evaluations were conducted face-to-face and in person. During the pandemic, beginning in April 2020, the U.S. Department of Transportation temporarily permitted qualified SAPs to conduct evaluations remotely.
DOT later made the remote option permanent. On May 2, 2023, DOT amended 49 CFR §40.291, with the changes becoming effective June 1, 2023.
Today, 49 CFR §40.291 expressly permits a SAP to conduct an evaluation either face-to-face in person or remotely, at the SAP’s discretion, provided the regulatory requirements for a remote evaluation are met.
A remote evaluation must use technology that permits real-time audio and visual interaction. The technology must also provide sufficient audio and video quality for the SAP to gather the information that would normally be available during an in-person evaluation, while protecting the confidentiality of the communication. SAPs must also practice within the geographic limitations applicable to their professional license or credential.
DOT guidance further clarifies that the decision to conduct the evaluation remotely or in person belongs to the SAP—not the employee or the employer.
From a clinician’s perspective, allowing remote video evaluations substantially changed the landscape of SAP evaluations. It clearly improved accessibility. But after conducting remote evaluations with safety-sensitive employees, I believe the impact goes beyond convenience.
While some employers may assume that a remote video session is somehow lower in clinical quality than an in-person assessment, my experience suggests that this is not necessarily the case. In some circumstances, a telehealth video evaluation can offer clinical advantages that are not as readily available in a traditional office appointment.
The Home Environment Can Provide Additional Clinical Information
One potential advantage of telehealth is something an office evaluation cannot easily reproduce: the opportunity to see an employee in their everyday environment.
An office is an artificial setting. An individual arrives for an appointment, sits in a professional environment for a limited period of time, and then leaves.
When an employee participates in a video evaluation from an appropriate private location at home, the SAP may gain additional context about the individual’s lifestyle and surroundings.
The goal is not to scrutinize someone’s home or make assumptions based upon what happens to appear in the background. Rather, the employee’s natural environment can occasionally provide additional context that contributes to the broader clinical picture when interpreted appropriately alongside the interview and other available information.
Employees May Be More Comfortable—and More Open—at Home
A comprehensive SAP evaluation depends heavily on obtaining accurate information from the employee.
For some individuals, sitting in an unfamiliar clinical office can increase anxiety or defensiveness. Participating from a familiar, private environment may help the employee feel more comfortable.
That can matter clinically.
When an employee is more relaxed, the interview may feel less adversarial and more conversational. In my experience, this can sometimes lead to greater openness when discussing substance use, the circumstances surrounding a DOT violation, treatment history, personal stressors, and other sensitive subjects.
Telehealth does not automatically make every employee more forthcoming. Some individuals may actually be better suited to an in-person setting. But for others, removing the unfamiliar clinical environment can create conditions for a more productive interview.
General Appearance and Self-Care Can Still Be Observed
Another misconception about telehealth is that the evaluator loses the ability to make meaningful visual observations.
With a high-quality video connection, a SAP can still observe many of the same characteristics considered during an in-person clinical interview, including general appearance, grooming, attentiveness, behavior, facial expressions, and other nonverbal cues.
These observations are not diagnostic by themselves. They are individual pieces of information considered as part of a comprehensive clinical evaluation.
High-Quality Video Can Make Facial Expressions Easier to Observe
Anyone who has participated in a high-quality video call on a modern tablet or computer has probably noticed how close and detailed the other person’s face can appear.
That can have clinical value.
With a strong internet connection, a high-resolution camera, appropriate lighting, and a quality display on the clinician’s end, subtle facial expressions and changes in affect can be particularly visible during a telehealth interview.
The SAP can closely observe how an employee responds while discussing different subjects throughout the evaluation.
This does not mean video is inherently superior in every clinical circumstance. It does mean that the assumption that an evaluator necessarily “sees less” through telehealth is outdated. With appropriate technology, a remote evaluation can provide excellent visual and auditory information.
The Clinical Standard Does Not Change
Whether an evaluation takes place in an office or by secure video, the SAP’s responsibility remains the same.
DOT requires the SAP to conduct a comprehensive assessment and clinical evaluation that is individualized to each employee. The SAP uses professional judgment to determine the appropriate education and/or treatment recommendations and later evaluates whether the employee has successfully complied with those recommendations before the return-to-duty process can continue.
The SAP’s role is not to advocate for either the employee or the employer. The SAP’s responsibility is to protect the public interest in safety through a professional and individualized evaluation.
Telehealth changes the setting in which that clinical work occurs; it does not lower the clinical standard.
Is Telehealth Always Better?
No.
No single evaluation format is clinically superior for every person or every circumstance.
There may be situations in which a SAP determines that an in-person evaluation is preferable. An employee’s individual circumstances, technology limitations, privacy concerns, or other clinical considerations may influence that decision. Licensing or geographic restrictions may also determine whether a particular SAP can evaluate an employee remotely.
But the reverse is also important: an in-person appointment should not automatically be considered more clinically thorough simply because the evaluator and employee are physically in the same room.
When appropriate technology is used and the evaluation is conducted by an experienced, qualified SAP, telehealth can provide a comfortable interview environment, excellent observation of verbal and nonverbal behavior, and additional contextual information that may not be available during a traditional office appointment.
For some employees and some circumstances, those factors may make a video evaluation clinically preferable.
A Different Way to Think About Telehealth SAP Evaluations
For employers, DERs, and other referral professionals, perhaps the question should not simply be:
“Is a telehealth SAP evaluation as good as an in-person evaluation?”
A better question may be:
“Which setting allows the SAP to conduct the most effective clinical evaluation of this particular employee?”
Current DOT regulations recognize both properly conducted in-person and remote evaluations. The format itself does not determine the quality of the assessment.
The skill of the clinician, the thoroughness of the evaluation, the information available to the SAP, and the SAP’s professional judgment matter far more.
DOT Regulations Permit Remote SAP Evaluations
Remote SAP evaluations are expressly permitted under current U.S. Department of Transportation regulations.
Under 49 CFR §40.291, a SAP may conduct the initial assessment and evaluation either face-to-face in person or remotely, at the SAP’s discretion, subject to applicable licensing and credential requirements.
For a remote evaluation:
- The technology must permit real-time audio and visual interaction between the SAP and employee.
- The audio and video quality must be sufficient for the SAP to gather the visual and audible information that would otherwise be available during an in-person evaluation.
- The technology must provide appropriate security to protect the confidentiality of the communication.
- The SAP must comply with the geographic limitations applicable to their professional credential.
DOT guidance also makes clear that the method of evaluation—remote or in person—is the SAP’s decision, not the employee’s or employer’s.
In other words, telehealth is not a lesser or unofficial version of a DOT SAP evaluation. It is an expressly permitted method of conducting the required clinical evaluation when the regulatory requirements are met.
Need to Refer an Employee for a DOT SAP Evaluation?
ND Assessments provides DOT SAP evaluations for employees who have violated DOT drug and alcohol regulations and need to complete the return-to-duty process.
Our evaluations are conducted by qualified Substance Abuse Professionals and are designed to provide employees, employers, DERs, and referral professionals with a clear, efficient process while maintaining the clinical and regulatory standards required by the U.S. Department of Transportation.
Contact ND Assessments if you have questions about referring an employee for a DOT SAP evaluation or would like to discuss whether a telehealth evaluation is appropriate.
About the Author
Brian T. Davis, LISW-S, is a Licensed Independent Social Worker with more than 30 years of clinical experience providing mental health and substance use evaluations. As founder of New Directions Assessments (ndassessments.com), Brian has extensive experience working with DOT-regulated employees, attorneys, courts, employers, and other referral professionals.
His evaluations emphasize objective, individualized clinical assessment and compliance with applicable DOT rules and regulations. Brian also writes and provides professional presentations on topics related to substance use, family law, DOT SAP evaluations, and court-ordered evaluations.