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JUDITH T. TERRY TOWN CLERK REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 FAX (5~6) 765-! 823 TELEPItONE (516) 765-1801 December 18, 1989 Mr. Thomas Walsh lighthouse Counseling Center 8 East Main Street Riverhead, New York 11901 Dear Tom: Transmitted herewith are three resolutions adopted by the $outhold Town Board at their December 12th regular meeting: (1) engaging the services of Lighthouse Counseling Center for directing a $outhold Town Employee Assistance Program, effective January 1, 1990; (2) adopting a Policy and Program; and (3) adopting a Policy Statement. Please note that in customizing Town executive orders the adopted resolution suggested format in your proposal. of Southold policy statements and does not completely follow your If you have any questions, please do not hesitate to contact me. Very truly yours, Southold Town Clerk Enclosu res JUDITH T. TERRY TOWN CLERK REGISTRAR OF VITAL STATIST/CS MAI~RIAGE OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (516) 765-I823 Telephone (5 t6) 765- t 801 THiS BELD POLICY: THAT THE SOUTHOLD TOWN BOARD, AT A REGULAR MEETING ADOPTED A RESOLUTION REAFFIRMING TH~ FOLLOWING POLICY ON SOUTHOLD TOWN EMPLOYEE ASSISTANCE PROGRAM WHERE~S, it has long been recognized that alcohol and other substance abuse as well as other personal problems have serious impact on the health, welfare, and social life of the individual, and his other family, and community; anc~ WHEREAS, the use of alcohol and substances, as well as other problems of employees are of immediate concern to the Town of Southold, as an employer when it results in a job-impairing problem; and WHEREAS, job-impairing problems have been recognized as. any condition of abnormal behavior resulting directly or indirectly from the chronic and habitual use of alcohol beverages or other substances or the inability to cope with other personal problems; and WHEREAS, the Town of Southold has created an Employee Assistance Program which the Town may consult with for additional expertise; and WHEREAS, experience indicates that employee assistance programs constitute an effective means for ameliorating difficult personal problems; and WHEREAS, it is essential and desirable that all Town departments participate in a unified program to combat alcoholism, substance abuse, and other job-impairing problems in a humane and constructive manner; now, therefore, be it RESOLVED that the Town BOard of the Town of Southold hereby adopts the following PROGRAM on the SOUTHOLD TOWN EMPLOYEE ASSISTANCE POLl CY AN D PROGRAM: SECTION I. a) SECTION 2. SECTION 3. SECTION a) POLICY The Town government, as an employer, is concerned and will take appropriate action when an employee experiences a ]ob-impairing problem. b) A job-impairing problem exists when the employee's competent or safe performance of his or her assigned duties or dependability in performance is apparent. c) It is To~vn policy that the employing department initiate non- disciplinary procedures under wh ich the employee is offered rehabilitative assistance when experiencing personal problems which impair job performance. d) Thi~ policy is riot to be construed as waiving management's responsibility to maintain discipline or its mandate to invoke disciplinary proceedings in the event of misconduct which may result from, or be associated with, the use or abuse of substances or untreated emotional problems. APPLICABILITY The policies and program contained in this resolution shall apply to all Town employees. EMPLOYEE ASSISTANCE PROGRAM The Town of Southold has contracted for an Employee Assistance Program to be provided by Lighthouse Counseling Center, 8 East Main Street, Riverhead, New York 11901. This agency will provide services to Town employees consistent with established procedures. The office of the Town Supervisor shall be responsible for coordinating the Employee Assistance Program on a Town-wide basis, and shall issue such further directives and instructions to Town departments as are required, consistent with the policies enumerated in this resolution. EMPLOYEES No employee shall have job security or promotion opportunities jeopardized by a request for counseling or referral assistance. b) The confidential nature of Employee Assistance Program records of employees shall be preserved in the same manner as all other medical records but not in their personal record files. -2- c} Where an employee has exhausted sick and annual leave balances, the agency head may under certain conditions and at his or her discretion, grant the employee a medical leave of absence without pay to undergo a prescribed program of rehabilitation treatment. Judith T. Terr-~- Southold Town Clerk March 10, 1993 -3- JUDITH T. T~'E~RY TOWI~ CLERK REGISTRAR OF VITAL STATISTICS OFFICE OF TBE TOWN CLERK TOWN OF SOUTHOLD Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 FAX (5~6) 765-1823 TELEPHONE (516) 76S-180I THIS I,S TO CERTIFY THAT THE FOLLOWING RESOLUTION WAS ADOPTED BY THE SOUTHOLD TOWN BOARD AT A REGULAR MEETING HELD ON DECEMBER 12. 1989: RESOLVED that the Town Board of the Town of Southold hereby engages the services of Lighthouse Counseling Center for directing a 5outhold Town Employee Assistance Program, effective January 1, 1990, for the following Budget/Contractual Fees: Preparation of customized Town of Southold policy statements, executive orders, flow charts, table of organization, intake forms, releases, records and folders 1,600.00 Preparation of initial notices, payroll flyers, media releases, articles for Town of $outhold distribution 800.00 Presentation to the Town Government and designated union/management committee members Education/training component Counseling Center facility to Southold presented by Lighthouse employees of the Town of TOTAL no fee no fee $ 2,400.00 December 15, 1989 JUDITH T. TERRY Town Hall, 53095 Main Road · P.O. Box 1179 So~thoId, N~v York 11971 FAX (5/~6) 765-1823 TELEPHONE (516) 765-1801 OFFICE OF TRE TOWN CLERK TO~N OF SOLrrliOLD THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION WAS ADOPTED BY THE SOUTHOLD. TOWN BOARD AT A REGULAR MEETING HELD ON DECEMBER 12. 1989: WHEREAS, it has long been recognized that alcohol and other substance abuse as well as othe[ personal problems have serious impact on the health, welfare, and social~ life of the individual, and his other family, and community; and WHEREAS, the use of alcohol and substances, as well as other problems of ~mployees are of immediate concern to the Town of Southold, as an employer when it results in a job-impairing problem; and WHERE;AS, job-impairing problems have been recognized as any condition of abnormal bel;~avior resulting directly or indirectly from the chronic and habitual use of alcohol beyerages or ot,her substances or the inability to cope with other personal problems; and WHEREAS, the Town of Southold has created an Employee Assistance Program which the Town ma~ consult with for additional expertise; and WHE,R~AS, ~-~t~erience indicates that employee assistance programs constitute an e:ffect[v~ meai~ for amel.iorating d fficu t persona problems; and WHERE~S, ~ [s essent al and des rab e that a Town departments participate in a u~ied~ pro§yam to ,combat a,lcoholism, substance abuse, and other job-impairing p~oblems in a? .humane, and constructiwe manner; now, therefore, be it ~ESO~/ED ~,Ita. t t~ T~own Board of the Town of Southold hereby adopts the fol~owing P(]~_I,CY ,~NI~ PROGRAM on the Southold Town Employee Assistance Prog r~m: SECT~)N 1. a) b) c) d) POLICY The Town government, as an employer, is concerned and will take appropriate action when an employee experiences a job-impairing problem. A job-impairing problem exists when the employee's competent or safe performance of his or her assigned d~ties or dependability in performance is apparent. I~t is Town policy that the employing department initiate non- disciplinary procedures under which the employee is offered rehabilitative assistance when experiencing personal problems which impair job performance. This policy is not to be construed as waiving management's responsibility to maintain discipline or its mandate to invoke disciplinary proceedings in the event of misconduct which may result from, or be associated with, the use or abuse of substances or untreated emotional problems. SECTION 2. SECTION 3. SECTION 4. a) b) c) This Policy take effect Janua~ry 1, APPLI CA'B ILI TY The policies and program contained in this resolution shall apply to all Town employees, EMPLOYEE, ASSI'STANCE PROGRAM The Town of So~Jthold has contracted for an Employee Assistance Prog'ra~0 to'be provided by Lighthouse Counseling Center, 8 East Main StreeT, Riverhead~ New York 11901. This agency will provide services to Town employees consistent with established procedures. The. o£fice of the Town. Supervisor shall be responsible for c0ord~:n~,ting the E~'ployee A~s~s~:ance Program gn, a To~n wide basis, and' s~'A],l issOe s~ch ~.~.rther, direc,~ives and [nstr~uctio~ to Town dep~rt~nts aS', are requi~-ed, con. sistent ~ith' the policies enumerated in this reS°tuition. E~P~(~EE~S No ~0~/~e shall have job security or promotion opportunities ~eopa~d~:ed by a request for counseling or referral assistance. The c;opfidential nature of Employee Assistance Program records of e, mpio~ees, shall be preserved in the same manner as all other medical record~ b,ut not in their personal record files. Whe,re, an employee has exhausted sick and annual leave balances, l~e a~enc¥ head may under certain conditions and at his or her d~iscr~e~ti~n, grant the employee a medical ~eave of absence without pay to unc~e~'g~ a prescribed program of rehabilitation treatment. and Program on the Southotd Town Emplo~4ee Assistance Program shall 1990. Judith T. Terr~ Southold Town Clerk December 15, 1989 JUDITH T. TERRY TOWN CLERK REGISTRAR OF VITAL STATISTICS OFFICE OF THE. TOWN CLERK TOWN OF SOUTHOLD Town Hall, 53095 Main Road P.O. Box 1179 Southold. New York I 1971 FAX (516) 765-1823 FELEPHON~ (516) 765-1801 THIS IS TO CERTIFY THAT THE FOLLOWING RE-SOLUTION WA~ ADOPTED BY THE SOUTHOLD TOWN BOARD':AT A REGULAR :MEETING HELD ON DECEMBER 12. I985: RESOLVED that the Town Board of the Town of Southold hereby adopts the following POLICY STATEMENT with respect to the Southold Town Employee Assistance Program: The Town of Southold, New York, (hereinafter referred to as the Town), recognizes that alcoholism and drug abuse, and other personal problems may impact directly or indirectly in an employee's poor job performance. The Town recognizes that successful early intervention, resulting in the employee's participation in a treatment plan can greatly improve the condition of the employee and, result ~n similar improvements in job performance. T:o this e~d, the Town is mandating the establishment of an Employee Assistance Prog~ram (EAP) of which employees may avail themselves in the event of encountering ~substance abuse or other job-impairing personal problems. Employees enco~rntering substance abuse or addiction or other job-impairing personal problems will enjoy the same employee benefits as employees suffering from other medical illnesses. The Town supervisory staff will not diagnose or attempt to treat employee problems. Rather, they will make referrals to Lighthouse Counseling Center on the basis of impair-ed job performance. It is Town policy to initiate non-disciplinary proceedings through which employees will be offered rehabilitation assistance appropriate to the problems encountered. To this end, management and unions will share the responsibility of refer'ring emplo, yees to the Employee Assistance Program. The employee is responsible for complying with the recommendation to seek assistance from the Employee Assistance Program when evidence of job impairment is apparent. It is the employee's responsibility to seek assistance for any illness, suspected or real, Employees who refuse help or demonstrate little or no effort to perform satisfaetorily are subject to normal disciplinary action if impaired job performance contintres. Town, Stats, and Federal laws will continue to govern the confidentiality and privacy of employee records without the Employee Assistance Program and related information will not be made part of any employee personnel or medical record. · Employee Assistance ProDram records will not be used in disciplinary or arbitration proceedings without the employee's signed consent. Employees' promotional opportunities or job rights will not be jeopardized by a ree~uest for help and subsequent participation in Employee Assistance Program and/or treatment. Southoid Town Clerk(_/' December 15, 1989 PROP<)SAL EMPLOYEE /%SSISTANCE PROGRAM FOR THE TOWN OF SOUTHOLD FRANCIS J. I4URPHY SUPERVISOR TABLE OF CONTENTS A. Historical B. Rationale C. Stage One: D. Stage Two: E. Stage Three: F. Stage Four: G. Stage Five: H. Stage Six: Identification Service Provided Training and Education Implementation Fees to Employees Budget, Contractual Page 1 2 2 3 4 5 5 6 APPENDICES: Appendix A Appendix B Appendix C Appendix D Appendix E Appendix F Appendix G Appendix H Appendix I Flow Chart - Policy Statement - Executive Order - Problem Indicators - Self Test - Confidential Questionnaire - Training Assignment - Priority Referral Employee Assessment SUBMITTED BY LIGHTHOUSE COUNSELING CENTER 8 East Main Street Riverhead, New York 11901 AN EMPLOYEES ASSISTANCE PROGRAM CUSTOMIZED FOR THE TOWN OF SOUTHOLD, BY: LIGHTHOUSE COUNSELING CENTER N.Y. HISTORICAL: Lighthouse Counseling Center was founded as the first private treatment center for the chemically dependent person living on the East End of Long Island. While initially serving the unmet need for holistic treatment services to the alcoholic client, we quickly realized and met the need to provide drug and other non-alcohol related services. Lighthouse Counseling Center has close ties to the medical, psychological, psychiatric and legal systems throughout the East E~d. Our own staff consists of Licensed Professionals both C.S.W. and C.A.C. headed by a board Certified psychiatrist. Several staff members are on the faculty at SUNY Stony Brook. We not only have contact with all hospitals within Suffolk County, but throughout the Country. With these services as a back up - it enables us to customize each service to client need. We have quality service agreements with many service agencies within oUr c~tchment area. Lighthouse receives clients from such diverse industries as colleges and universities, doctors and lawyers, schools and churches, judges, hospitals, and of course, the bulwark of our referrals comes from "those who know us." At the present time, we are the contract resource for the Town of Riverhead's Employee Assistance Program which services 364 persons~ This includes the Riverhead Town Police Department. We are al~o treatment resources for two banks and a laboratory. We have provided "Information Intervention" to personnel of school districts, businesses and townships. All began to realize the enormous stake they had in taking constructive action regarding employees involved in seemingly unsolvable, debilitating personal problems. What occurs off the job certainly influences the employees' work performance. our programs have helped to alleviate the distress of off-site personal, familial or health related problems and thereby improves that emPloyee's work performance. RATIONALE: Most studies of Employees Assistance following productive results. Programs indicate the Increases in productivity and morale also increases the investment value of the employee. Reduction in absenteeism and lateness also reduces disciplinary actions and workplace problems. An economic factor of a nine fold return for each investment dollar. Lighthouse Counseling Center firmly believes that enlightened self-interest is the heart of any Employees Assistance Program. The early successful programs were originally aimed at alcoholism identification, intervention, treatment and recovery. Then we learned that few alcohol problems exist in isolation. Other addictions are uncovered which inherently cause a host of other symptoms such as family disintergration, econemic chaos, a myriad of medical maladies and stressful emotional dysfunctioning. We also found certain characteristics about alcoholics that hold true under close scrutiny. They are usually highly skilled, hard working and suQcessful despite their drinking. This complex physical and emotional disease seems to strike sensitive self- starting people. Now we know that alcoholism is progressive; fairly easy to identify and above all, treatable and arrestable. For these reasons Lighthouse Counseling Center recommends the combining of the self-interest of humanitarian, caring for one another, with the pragmatic dollars and cents approach that increases productivity, and, therefore, profits all concerned. Lighthouse Counseling Center recommends the "broad brush" approach when implementing an Employee Assistance Program even thoughour experience has shown that over 70% of employee problems stems from drug or alcohol abuse. This broad brush approach insures that agency supervisory staff will not attempt to diagnose and/or treat a troubled employee. Impaired job performance, well defined and documented, shall be the basis for referrals to our Agency. STAGE ONE: IDENTIFICATION Early identification and motivation to treatment services for a troubled employee is the backbone of any program. We at 2 Lighthouse can employees. :deemed of to provide a wide range of direct services to Town · when in those instances other services are we can and will refer the employee to the facility and at the same time monitor the recovery. a) containment of costs to the Town and to the hardship; b) immediate service involved in the distressful plight list"; c) transportation andadmission ~ithout charge. before this Stage One can be implemented, Lighthouse Center .Wit~. be h~ppy, to review your Policies and ruins. This wltl enable the Town of Southold Organization and create a flow chart each department's "turf" remains intact patterns, skills, background and After these initial meetings, we forms, folders, chronoloqies, records only to State and Federal standards of to those promulgated by the Town as well. STAGE TWO; SERVICES PROVIDED Lighthouse CouDseling Center will accept all employees of the Town of Southold and/or any member of their families into this Employees Assistance Program. Referrals can be effected by one of the following: a) A mandated referral as a Town employee; b) A union consultatiog~ referral; c) A self-motivated evaluation referral; d) A f~mi~y crises intervention referral. We believe that by providing a customized service to the Town we can provide you with a direct consultation for use before your supervisors or in-house representative initiates any interventional process with a troubled employee. A thorough exploration of the facts of each situation with a Lighthouse professional will result in a positive, motivational intervention to alleviate the employee s decllnl~ng work performance, thereby enabling both the Town and the employee to achieve optimum potential. We will provide Southold Town employees with the following services: Immediate consultative services to designated Town per- monnel regarding all aspects of the Program and prior to meeting with each mandated employee. Assessment/Evaluation appointments for any Town employee and/or family member within seventy-two hours. Our caring sional staff are not limited to a 9-to-5 work 4t Each treatment plan is designed for the individual and customized for his or her educational and theraputic needs. Constant monitoring services should an employee need hospitalization or psychiatric intervention s~rvices. and insure progress towards but only within ~rescribed by Local, statutes. and educational programs to inform all members of Town of. Southold employment system of the avail- o~ the Employees Assistance Program. Fot~ow-up reports (numbers only) for the statistical evaluation of the entire program. Provide follow-up materials as well as original notices for distribution to all Town employees. STAGE THREE: TRAINING AND EDUCATION We use a combination didactic/group work format supplemented by films or guest lecturer as needed. Each session will not exceed two hours and will be scheduled at the convenience of the Town. For ultimate performance, we ask that a limit be set of 50/100 people per session. We recommend that once begun, all presentations be scheduled as soon as possible and in close proximity to each other to prevent "rumor mongering" and inaccurate assumptions. In these training educational sessions, we believe in involving the attendees as much as possible. We, therefore, have each employee fill out a questionnaire and submit questions that they would like to address. This is done specifically and anonymously. Ail training sessions are conducted on designated Town facilities. We will provide consultation with the appropriate Town of Southold personnel to enhance all aspects of the program. © instances, we wilt provide censult~ti~ns~ for to refer an employee for counseling er propriate, conduct an on-site crises inter- liaison person~ the supervisor, the union and the employee present. STAGE FOUR: IMPLEMENTATION counseling Center will help the designated Town ~id of the Town Attorney and members of the ~he necessary Policy statements a~d necessary, we will help update and We will prepare payroll flyers for your program to inform Town of the availablity and procedures of the Employees Ass Program. (Appendix E, Self Test, is sent through ,endix F, Confidential Questionnaire, is mailed home.) It is that often motivate successful family and/or self ~ me ~11 work closely and help prepare public information notices and news releases, articles and special interest programs but defer' to the Town or Union information office to implement same. Our office in Riverhead, although centrally located on the busy.~in Street has ample off-street parking in the rear and our premises occupy both floors of the building. We have group rooms, waiting room, and consultation offices. We would invite all to visit. We are prepared to acquire offices in the Town in consult with appropriate parties. STAGE FIVE: FEES TO EMPLOYEES The quality of service will be the paramount criteria for referral. Hopital, rehabilitation, psychiatric and psychological expenses are usually covered by Blue Cross and Major Medical services contracts. Where the nature of the employee's problems or other con- ditions warrant referral to special practitioners or faciliies, the employee will be given a choice of places and fee schedules appro- priate to their financial ability. Lighthouse Counseling Center uses a sliding scale fee policy for treatment which simply stated is a minimum fee of $25.00 plus one dollar per thousand of the earned annual income of each employee with a maximum fee of seventy-five dollars. Group fees 5 are one-half of the individual fee set at the time of the second evaluation. Ail hospital and rehabilitation facility transportation will bearranged and provided by Lighthouse Counseling Center at no cost to the employee. Lighthouse Counseling Center is licensed by the New York State Alcoholism an~ Alcohol Abuse as a free standing such cgYerage. of any employee and fees not be covered by existing health insurance, or, should be only partially covered, the employee, not the Town of SOut~old, Will be responsible for the expense. Lighthouse counseling cen~er feels strongly ~hat something for nothing is rarely aPPreciated in present day society. At the same time, 6ur record will show "no one is turned away." STAGE SIX: BUDGET/CONTRACTUAL FEES Preparation of customized Town of Southold policy statments, executive orders, flow charts, table of organization, intake forms, releases, records and folders Preparation of initial notices, payroll flyers, media releases, articles for Town of Southotd distribution Presentation to the Town Government and designated union/management committee menbers Education/training component presented by Lighthouse Counseling Center faculty to employees of the Town of Southold $1,600.00 800.00 no fee no fee TOTAL $2,400.00 © APPENDIX A FLOW CHART ~OWN'OF SO~THOLD ~MPLOYEE$ ~S~STANCE PROGRAM ~LO~ C)t~A~T Supervisor Consults With The Lighthou,se Center Supervisor Documents Employee's Unsatisfactory Job Performance Superylsor Conducts ~Inter'~ent_iat S~s$,1~0t~ with ~mpldyee & Ol~fers Program Participation I Work Performance Do~ Not Improve Supervisor Consults With The Lighthouse Center Supervisor and The Lighthouse Center Se¢and Intervential Session With Employee and Offer Program Participation Employee Refuses Assistance 'l Work Performance Again Unsatisfactory Refer to The Lighthouse Center and/or Disciplinary Action I Final Disciplinary Action Empl~ee Cooperates I' Evaluation and Formulation of Plan and ~ction The Lighthouse Center Job Performance Improves Satisfactory ~roqres~ ~ [Relapse Recovery APPENDIX B PROPOSED POLICY STATEMENT POLICY STATEMENT (Proposed) The Town of Southold, New York, (hereinafter referred to as the Town), recognizes that alcoholism and drug abuse, and other personal problems may impact directly or indirectly in an employee's poor job performance. The izes that successful early intervention, tion in a treatment plan can emptoyee and res~lt in similar To t~e Town is mandating the establishment of an e Program (EAP) of which employees may avail of encountering substance abuse or other personal problems. j ob- encountering substance abuse or addiction or other personal problems will enjoy the same employee employees suffering from other medical illnesses. The Town supervisory staff will not diagnose or attempt to treat employee pcoblems. Rather, they will make referrals to Lighthouse Counseling center on the basis of impaired job per- form~nce. It is Town policy to initiate non-disciplinary proceedings through which employees will be offered rehabililtation assistance appropriate to the problems encountered. To this end, management and unions will share the responsibility of referring employees to the Employee Assistance Program. The employee is responsible for complying with the recom- mendat~?n to seek assistance fro~ the Employee Assistance Program when ~idence of job impairment is apparent. It is the employee's responsibility to seek assistance for any illness, suspected or real. Employees who refuse help or demon- strate little or no effort to perform satisfactorily are subject to normal disciplinary action if impaired job performance continues. Town, State, and Federal laws will continue to govern the con- fidentiality an~ privacy of employee records within the Employee Assistance Program and related information will not be made part of any employee personnel or medical record. Employee Assistance Program records will not be used in dis- ciplinary or arbitration proceedings without the employee's signed consent. Employees, promotional opportunities or job rights will not for help and subsequent participation and/or treatment. © © APPENDIX C PROPOSED EXECUTIVE ORDER EXECUTIVE ORDER (PropoSed) POLICY AND PROGRAM ON EMPLOYEE ASSISTanCE PROGRAM WHEREAS, it has long been recognized that alcohol and other substance abuse as well as other personal ~roble~s h~ve.s~rious ~imPact on we~lfare, and social life o~he indivIdual; and his and community; and WHEREAS, the use of alcohol and substances, as well as other problems of employees are of immediate concern to the Town of Southold, as an emp!o~er when it results in a job-impairing problem; and WHEREAS, job-impairing problems have been recognized as any conditio~ of abnormal behavior resulting directly or indirectly from the Chronic and habitual use of alcohol beverages or other substances or the inability to cope with other personal problems; and WHEREAS, the Town of Southold has created an Employee Assistance Program which the Town may consult with for additional expertise; WHEREAS, experience indicates that employee assistance programs constitute an effective means for ameliorating difficult personal problems; and WHEREAS, it is essential and desirable that all Town depart- ments participate in a unified program to combat alcoholism, substanee abuse, and other job-impairing problems in a humane and constructive manner; NOW, THEREFORE, by the power vested in me as Supervisor of the Town of Southold, New York, it is hereby ordered as follows: SECTION 1. POLICY a) The Town government, as an employer, is concerned and will take appropriate action when an employee ex- periences a job-impairing problem. b) A job-impairing problem exists when the employee's com- petent or safe performance of his or her assigned duties or dependability in performance is apparent. c) It is Town policy that the employing department in- itiate non-disciplinary procedures under which the d) SECTION 2. employee is offered experiencing persnal formance. habllltatlve assistance when problems, which impair job per- Th~s policy is.not to be construed as waiving manage- ment's responsibility to maintain discipline or its mandate to invoke disciplinary proceedings in the misconduct which may result from, or be with, the use or abuse of substances or problems. in this Order shall SECTION 3. ESIPLO~EE ASSISTANCE PROGRAM of Southold has contracted for an Employee Program to be provided by Lighthouse Center, 8 East Main Street, Riverhead, N. Y. 11901. This agency will provide services to Town employees cons.istent with established procedures. The office of the Town Supervisor shall be responsible for coordinating the Employee Assistance Program on a Town wide basis, and shall issue such further direc- tives and instructions to To%rn departments as are required, oonsistent with the policies enumerated in this. Order. SECTION 4. EMPLOYEES a) N? employee shall have job security or promotion op- p rtunltles jeopardized by a request for counseling or referral assistance. b) The confidential nature of Employee Assistance Program records of employees shall be preserved in the same ~nn~r as all other medical records but not in their personnel record files. c) Where an employee has exhausted sick and annual leave balances, the agency head may under certain conditions and at his or her discretion, grant the employee a medical leave of absence without pay to undergo a pres- cribed program of rehabilitation treatment. This Order shall take effect immediately. Francis J. Murphy Supervisor APPENDIX D WORKPLACE PROBLEM INDICATORS W__ORKPLACE PERSONAL PROBLEM INDICkTORS Thedl tresslng progression of unsolved persoat problems first m~nifeststhemselves in the individual, then the family, eventually they begin to evidence themselves on the j. ob. The items listed below rarely occu~ in any predictable or~er, and reoccur wi~n increasing frequency as the problems remain UnreSolved. PRODUCTIUITY quality of work diminishes quantity of work declines ~ncrease in mistakes or judgment errors increased monitoring of assigned tasks required loss of potential loss of leadership capabilities beginnin~ and continued work performance confrontations ATTENDANCE extended morning and afternoon breaks extended lunch hours requests to leave early beginning and increasing lateness increasing absenteeism frequent and repeated minor illness excuses APPEARANCE AND ATTITUDE increasing nervousness and irritability increasingly withdrawn blames others or situations for his/her mistakes increasing forgetfulness avoids suervisor or supervision decreasing neatness increasing confusio~ behavior begins causing moral problems IF CORRECTIVE PROCEDURES ARE NOT IMPLEMENTED - THE SUPERVISOR will experience feelings of frustration,guilt and anger will be distracted from advanoing your unit will have your own productivity decline APPENDIX E SELF TEST ON ALCOHOLISM 5. 6. 7. 8. 9. 10. 11. 12. © LIGHTHOUSE COUNSELING CENTER P.O. Box 7!7, Riverhead, N. Y. 11901 Qffice: 8 E. Main Street Riverhead, N. Y. SELF TEST ON ALCOHOLISM Phone: ~1~72~1177 When someone suggests having a drink, or when you go to a place where drinks are served, are you in a hurry for the first one? someone or a frdstrating or frightening ex- e mp~ls to have a dr4nk to relax? Do you feel that you a~d so, on than other handle your liquor better than most other people occasions, you frequently have more to drink Thee eve drinking, are there some times that you cannot remember last night? Has anyone ever told you that you cut down on your drinking? If so, have you given them a logical reason for your drinking? When you ar going to a party or any place where you know that drinks will he served, do you ever drink before going? If you go to a party or another social occasion, and you find that drinks are not available, ~oes this make you nervous or upset? You feel that you really should cut down on your drinking but you just haven't gotten around to it yet. Are you having arguments with your wife or husband or parents or someone at school or work about your drinking? Once you start drinking, do you drink more than you intended to? Do you feel depressed or gloomy or anxious at any time? When you feel this way, is your remedy a drink or twO? Do you feel bad or guily about your drinking and its consequence? · ~on~ pood pu~ KiS~Tpam~T dieU ~seS inoX ~nq ~ saou~ euoKIeAa pu~ &I eA~q noK 'SUOT~Ser~B~om ~o ~H& o~ S~A peleasu~ noX ~I 'I~u~off ~STIOqOOI~ noK ~ -nI*A* noX dlwq o~ aOlWSunoD peI~guepw~D ~ qg~a uo~g~insuoo ~ss pInoqs noK 'suo~senb OM& ao ~NO o~ ~-~ pa~asu~ hex ~I APPENDIX F CONFIDENTIAL QUESTIONNAIRE (Spouse) LIGHTHOUSE COUNSELING CENTER P.O. Box 717, Riverhead, N.Y. 11901 8 £. ~'ain Stree[ Riverhead, N. ~. Phone: (516) 727-1177 EMPLOYEE ASSISTANCE PROGRAM Confidential Questionnaire (Spouse) Circle each one that applies to you and your family 1. Does your spouse drink too much? 2. His/her drinking embarrasses you. 3. Holidays are depressing with their drinking. 4. His/her friends drink too much. 5. He/she has mood swings. 6. He/she promises to quit tomorrow. 7. He/she says "no problem. It's only beer". 8. Are you "protecting" bis/her job and reputation? 9. Can he/she remember everything after drinking? t0. Does he/she discuss tke drinking? 11. Does he/she "justify" the drinking? 12. Does he/she drink before going out? 13. Do you feel guilty for~ their drinking? 14. Does he/she drink and drive? 15. Does he/she frighten the children? 16. Does he or she frighten you? 17. Do friends mention his drinking? 18. Do y~u ride with hlm/h~r ~hen drinking. 19. Does he or She apologize ~or too much drinking? 20. When the d~flking stop~, are things better? XIUO 5uT~uTap 'aeq~amaa '~aom ao ~HH~ o~ ~-~-X pslaasu~ noK ~I -aep~o uT s~ aoI~unoD ~s!ioqooi~ psi~u~p~aD ~ q~a uo~ni~Aa u~ 'suo!~sanb OMA ~o ~NO o~ S~--~ pa~a~su~ noX ~I APPENDIX G TRAINING ASSIGNMENT #1 LIGHTHOUSE COUNSELING CENTER P~O. Box 717, Riverhead, N.Y. 11901 Office: Main Street Riverhead, N. Y. Phone: (5t6~ 727-1177 EMPLOYEES ASSISTANCE PROGRAM TRAINING ASSIGNMENT #1 In order to enchance these Training Sessions to meet these individual needs of all persons in the Employee Assistance Program and to help us customize this program toy our agency/department, we ask you to complete the following assignment. List the five questions that you wish discussed. The topics can cover the proqram, alcoholism, how to refer, other drugs or any area. It is not necessary to sign this form. APPENDIX H PRIORITY REFERRAL FORM Priority Referral From: Agency Address To: Lighthouse Counseling Center 128 ,East Main Street Riverheae New York (5161 727~1177 Phone Attention: Marcel le J. Welsh. C.S.W. - C.A.C, Clil~ic D/rector Referred by Apnor~appo~ntment~s~equestedfOrthepersonlist~dbelo : NAME D,~'I:E OF BIRTH MAILING ADDF ESS TOWN/VILLAGE ZIP HOME PHONE# Bt)SI'NESS PHONE # Reason for referral ...... nsttuct OhS ca 1727-1177 weekdays between 1 a;qd 5 P.m. for aPPointment Consent to 'Release Information It iS requested that Lighthouse Coun seliri~l Center provide cert,ain in'formation to the referral ~ou?ce above named. The extent or natur8 of the information to be disciosbd is limited to the following,: · Dates of scheduled e~try, Iht,eke ~nd Group Sessions: · l~ates an~l reason~ foe br~tncb'll~d appointments · DrinK/fie br ~ttug use d'ering treatment ~ R~s0n for completion ~nd/Or te'rminati~n Note: Results 'of this evaluation will be for- W~ride~l to ~he r'efbr¢al agency Cl~t Refbrral Agenby Li~hlboube Repres~n'~fiV~ Wl~it8 Copy - Lighthouse Yellow'Ct)~y - Client P~bk '~opy - Referral Agency APPENDIX I EMPLOYEE ASSESSMENT FORM LIGHTHOUSE COUNSELING CENTER Employee Assistance Program Employees with problems create stress, not only to the emptoye~ but Go ~o-Wor~ers. There are many tell-tale slg~s, some obvious, 9~ers, not so. following are acceptable reasons to ask for an evaluation of In narrative form, brle~ly describe how your employee may exhibit the following characteristics: on t~e job site (including coming to Absenteeism, on and off the job; tardiness; excessive sick leave; improbable excuses; missing from post; long breaks; leaving early; Monday or Friday absence Accidents on and off the job; equipment damage; personal damage; difficulty concentrating; takes more time; cannot recall instructions and supervisors directions Lowered Job Efficiency includes missed deadlines; wasted materials; mistakes due to poor judgment or inattention; improbable excuses for poor job performance; rational- ization and justification for incomplete assignments; bad decisions Relationships on the criticism; wide mood carrying grudges and job which include over-reaction to any swings; borrowing from co-workers; projecting blame onto others NOTE: A referral is in order for any combination of the above characteristics evaluation and possible resolution. trauma. However a will insure a full oo~ o 0