2-Averhealth Proposal ADCS.pdf

Bid No. BPM006038 Substance Abuse Screening & Genetic Paternity Testing

Arizona Department of Child Safety

February 21, 2024

Proposal Contact: Lauren Berens Phone/Fax: (804) 508-6202 LBerens@averhealth.com mailto:LBerens@averhealth.com

February 21, 2024

Tashira Turner, Procurement Officer State of Arizona Department of Child Safety Office of Procurement & Contracts 3003 N. Central Ave., 20th Fl.

Phoenix, AZ 85012

Dear Ms. Turner, As a leader in drug testing and substance-use monitoring, Averhealth is tailored to the unique needs of criminal justice programs and social service agencies. In our current partnership with the Arizona Department of Child Safety, we have elevated, automated, and modernized drug testing for the Arizona DCS Programs and their clients. Our commitment to exceptional customer service is at the core of our values, and we're thrilled to continue to provide enhancements aimed at elevating your experience.

With a keen focus on your needs, we offer a streamlined process to ensure improved turnaround times, ensuring that your team can work to achieve permanency for all Arizona’s children through prevention, services, and support.

Averhealth has read and agrees to all requirements listed in Section 4-8 of the Solicitation Part 1. Our team is looking forward to continuing to provide the delivery of exceptional, evidence-based services tailored to your specifications. We sincerely appreciate our partnership with Arizona Department of Child Safety.

All the best, Mark Johnson, CEO

We have our own nationally accredited Laboratory.

Led by a PhD toxicologist and has been CAP-FDT accredited since 2016.

Test results reported by Averhealth satisfy the Daubert and Frye rules of evidence.

Samples are shipped to our lab with screened results posted by the next business day.

CLIA Certified by the Department of Health and Human Services and registered with the DEA.

Averhealth provides the AZ DCS drug testing program with unparalleled knowledge and experience.

Corporate Member of APPA and has participated in the Leadership Mentorship Program for six years.

We are trusted by government agencies in 26 states and provide abstinence monitoring.

1,900 active government contracts with over 512,500 unique customers.

Our processes and technology are designed to foster recovery from substance abuse and substance dependence.

Laboratory Certifications

Averhealth’s world-class substance abuse testing laboratory is certified by the Department of Health & Human Services with a CLIA certificate, and we are accredited by the College of American Pathologists under Forensic Drug Testing. We are also registered as an analytical lab with the DEA.

Averhealth is one of only 30 U.S. laboratories with a CAP-FDT certification, illustrating that our focus is on forensic toxicology specifically applicable to your needs. Our laboratory has held CAP- FDT accreditation since 2016, ensuring Averhealth follows all industry best practices. CAP certification was developed with input from more than 500 pathologists and laboratory experts and a 21-discipline checklist for running a high-quality laboratory. Our compliance team ensures we are informed and follow all applicable state, federal, and local laboratory laws and regulations.

Averhealth is partnered with Vanguard Genetics LLC dba Alliance DNA Laboratory to provide the contract-required DNA Paternity Testing with Endeavor DNA Laboratories. Alliance DNA

Laboratory has been a subcontractor providing this service to AZ DCS for six years. Alliance

DNA Laboratory maintains an AABB accreditation as a Relationship Testing Facility.

Laboratory Locations

Averhealth provides collection locations throughout the state of Arizona. We have successfully conducted collections to meet the needs of AZ Department of Child Safety since 2020. We are open to exploring additional independent collection locations and are more than happy to co-locate with any agency needing on-site collections. With the agreement of AZ DCS, Averhealth can provide tele-collections to meet the needs of rural community members or individuals required to leave the State for any given reason.

We provide Drug & Alcohol Collection Services at the following Arizona Locations

Averhealth Phoenix – Central

3341 N. 19th Ave

Phoenix, AZ 85015

Averhealth Phoenix – West

7342 W. Indian School Rd

Suite 107

Phoenix, AZ 85033

Averhealth - Mesa

423 N. Country Club Dr, #19

Mesa, AZ 85201

Averhealth – Broadway

4433 E. Broadway, Ste 101

Tucson, AZ 85711

Averhealth – Flowing Wells

4003 N. Flowing Wells, #101

Tucson, AZ 85705

Averhealth - Yuma

281 W. 24th Street, Ste 131

Yuma, AZ 85364

Averhealth - Flagstaff

2314 N. Fourth Street, Ste C

Flagstaff, AZ 86004

Averhealth - Prescott

325 W. Goodwin Street

Prescott, AZ 86303

Averhealth - Cottonwood

1423 E State Route 89A

Cottonwood, AZ 86326

Averhealth - Lake Havasu

2080 W. Acoma Blvd. West

Suite A

Lake Havasu City, AZ 86403

Averhealth - Kingman

2364 Kingman Ave

Kingman, AZ 86401

Copper Queen Hospital

101 Cole Ave

Bisbee, AZ. 85603

High Desert Clinic

77 East Fry Blvd.

Sierra Vista, AZ. 85635

Bio Family Clinic

1962 Juan Sanchez Blvd

San Luis, AZ. 85349

Colorado River Medical

Center

1401 Bailey Ave

Needles, CA. 92363

Averhealth shall continue to provide AZ DCS with qualified and supportive personnel to ensure all contract requirements and customer service needs are met. Our current organization chart is included and shows how our company and local Arizona Teams are connected and supported.

Averhealth offers drug and alcohol specimen collection services to more than 1,900 government and social service agencies across 29 states. We can conduct collections at various locations nationwide, at no extra cost to the Arizona Department of Child Safety. Moreover, if collection services are required beyond the listed sites, we can coordinate with our extensive network of partner agencies to ensure convenient, observed collections for DCS caseworkers and their clients.

Averhealth locations that are available for AZ Department of Child Safety

California (Anaheim, Fresno, Porterville, Santa Ana, Visalia, Bakersfield, Madera)

Idaho (Boise, Caldwell, Coeur d’Alene, Mountain Home, Pocatello, Moscow, Orofino, Lewiston)

Indiana (Indianapolis, Kokomo, Danville, Marion)

Kansas (Merriam, Olathe)

Kentucky (Elizabethtown, Lexington, Louisville)

Massachusetts (Brockton, Lawrence, Lynn, Springfield, Taunton, Worcester, Boston, Greenfield)

Michigan (Canton, Dearborn, Detroit, Farmington, Highland, Jackson, Lansing, Madison

Heights, Pontiac, Rochester, Roseville, Westland)

Minnesota (St. Paul)

Missouri (Clayton, Hillsboro, St. Charles, St. Louis, Troy, Warrenton)

Ohio (Columbus, Lancaster, Sandusky)

Pennsylvania (Allentown, Easton, West Chester, York, Towanda)

Tennessee (Memphis, Nashville, Murfreesboro)

Texas (Rosharon)

Utah (Salt Lake City)

Vermont (Burlington, St. Albans)

Wisconsin (Beloit, Janesville)

Automated Website

Confidentiality and HIPPA compliance are of utmost importance to our team. Aversys is hosted in multiple Amazon Web Service (AWS) data centers located in the continental US, ensuring such requirements as fire detection and suppression, power redundancy, climate and temperature controls, security, and backups. Each Aversys user is granted access by an administrative user as determined during implementation and uses log-in and password credentials to access data.

Aversys is an intuitive, web-based application that integrates random selection, client notification and compliance tracking, an electronic chain of custody, laboratory analysis, results reporting and more in a single, user-friendly application. It can be accessed on any internet-capable device where two-factor identification is possible. Aversys provides a seamless link between your team, related/authorized agencies, and Averhealth.

Aversys will provide Arizona DCS with program analytics that informs program evaluation and reporting. Our dashboard provides real-time, case-load-specific information for each supervising authority. Averhealth diligently works to ensure our partners have the most relevant, impactful caseload information at their fingertips to reduce risk or re-occurrence and recidivism. There are many new dashboard analytics offered to each case manager and supervisor, including

Today’s Compliance, Pending Orders, Results, Positive Drugs, Risk Score, Client Compliance, Frequency of Testing, Specimens by Type, and several administrative widgets for program-wide evaluation.

The Results widget shows the percentage of your clients’ results over the course of 30 days.

Each results metric can be selected to see a list of your clients, programs, panel, and last reported date for that results metric, as highlighted below. You can print the result by clicking on the PDF image on the right side of the page.

The Positive Drugs chart will indicate the percentage of positive results based on the last 30 days. Each percentage can be clicked to provide a list of those clients, their program, their last reported positive, and the number of positives for the selected positive drug result.

Reports are always provided in real-time and can be accessed at any time by any user (based on their permissions).

One of our newest features is our Risk Widget. Managers and Case Managers are given a snapshot of their caseload and related risk levels. The risk levels are based on each client’s 30-day testing history within the following criteria.

Automated Random Selection Calendar

Averhealth is committed to delivering, supporting, and maintaining a secure, HIPAA-compliant automated random selection testing calendar that can be customized to meet the specific parameters set by the Department of Child

Safety. This adaptable system allows for the creation of default parameters, specifying testing frequency, test panels, and other essential attributes. It allows scheduling participants individually or in groups, ensuring efficient coordination. Moreover, it offers the flexibility to conduct testing services throughout the year, including weekends and holidays, as needed by the Department. The calendar allows users to view past and upcoming testing events, providing comprehensive oversight. Furthermore, it empowers users to manually order one-time or unscheduled tests for individual participants through the IMS, enhancing responsiveness and adaptability to changing testing requirements.

Averhealth's automated calendar is designed to streamline and optimize the testing process, prioritizing efficiency, and customization.

Client Notification

Averhealth is committed to offering an all-inclusive participant notification system to facilitate effective communication with participants regarding the need for testing.

Our system encompasses the following features:

• Creation of a unique Personal Identification Number (PIN) for each participant.

• Detailed recording of the time, date, and phone number for all participant calls.

• Provision of language options in both English and Spanish (at a minimum), ensuring accessibility.

• The system calculates a call-in compliance score for each participant, aiding in monitoring and compliance.

• Prompt reporting in the event of a participant's failure to contact the notification system.

• Empowering supervising case managers to personalize notifications with custom text-to-speech messages for individual participants or specific groups.

• Capacity to efficiently manage a high volume of calls, particularly during peak call-in times.

• The availability of alternative notification channels such as text messages and mobile applications when applicable, offering participants added convenience alongside the traditional call-in option. Our text reminders have decreased our no-shows by 15% nationwide! A video about our text notifications can be viewed here. Averhealth is dedicated to ensuring a comprehensive and adaptable participant notification experience.

Results Reporting

Averhealth holds the distinction of being the nation's fastest nationally accredited drug testing laboratory. Samples collected are promptly sent to our facility via overnight shipping, and the results are swiftly posted on Aversys for review. Our fast results reporting ensures immediate intervention when necessary to ensure child safety. This data, spanning from October 1, 2023, to

December 31, 2023, not only meets but exceeds the Department’s results reporting requirement.

https://vimeo.com/700539355/935db4d136?share=copy

Laboratory screen results are reported within 24 hours. Our team exceeds best practice results reporting by reporting negative immunoassay screens in less than 4 hours after being received at our Laboratory. Positive LC/MS-MS confirmation tests return results about 2 days after being received at our Laboratory.

Additional Aversys features and capabilities include:

✓ Secure Web Access: From any computer, tablet, or smartphone with an Internet connection, it’s HIPAA compliant.

✓ Client Identification: Via client photo and date of birth, case number, etc.

• Stored client photo eliminates the need for government-issued identification. Collection sites may require a photo ID for each encounter due to a lack of cameras or refusal to take images.

• Specimen collectors only need to coordinate with you once to verify client identity.

✓ Electronic Test Orders:

• Client-specific panel selection and rotation.

• Ability to create a custom panel for each individual client.

✓ Data, Information & Analytics:

• No Call, Call Time, and Call Number or Notification Method (phone, text, web).

• Positive, Negative, or Dilute.

• No Show, Unable to Provide, Refusal to Provide, Excused (e.g., travel).

• Medication Tracking.

• Client Surveys.

• Predictive Indicators.

• Import/Export Capabilities.

✓ Customized Dashboard:

• Quick access to caseload(s).

• Real-time program analytics and reports (e.g., Call-in Compliance, Test Results, etc.).

• Customizable email notification to ensure each officer/case manager is immediately alerted according to individual preferences.

• Detailed and summarized on-demand reports.

• Analysis of client-specific data and trends.

• User-specific permission controls.

✓ Electronic Chain of Custody: Averhealth’s electronic chain of custody (COC) ensures legal defensibility and that a valid sample is collected, appropriately tested, and accurately reported.

• It captures who, when, what, and where information via the creation of sample-specific barcode labels.

• Bar codes provide a time-stamped audit trail that tracks samples from client check-in to sample collection to laboratory analysis to secure storage to sample destruction and all steps in between.

• Averhealth’s COC reduces waiting time for clients and County staff while enhancing client privacy.

• Improved accuracy due to reduced human error and no penmanship issues.

✓ Reliability & Redundancy:

• Delivered via secure and cloud architecture hosted in multiple enterprise-class data centers.

• Three notification means mitigate downstream availability issues (e.g., local carrier, client device) and provide built-in redundancy through independent configurations.

• Support by multiple disaster recovery layers, including instantaneous automatic failover server resources, frequent intraday differential backups, and full backups to secondary data-center location.

✓ Client-Specific Data: Key data elements include positive, negative, dilute, no show, unable to provide, refusal to provide, no call, call time, call number, and days since the last positive test, among others. “No Shows” will be reported daily, shortly after the day’s testing hours have concluded. Other available data include:

• Detailed and summary results.

• Discern new use from residual use.

• Call-in compliance score.

• Individual test reports.

• Comprehensive client test history.

✓ Information Analytics: An overview of all testing activities.

• Test results and related data segmented by program and case manager (i.e., probation officer).

• Macro trend analysis while appropriately protecting client-specific information.

• Standard and custom substance use reports.

• Export to Excel for further analysis or to printable PDF.

• Detailed views of the historical and future testing calendars (for users with the correct permissions).

Reporting Capabilities

Averhealth agrees to provide quarterly reporting to the Department as required utilizing the provided Quarterly Report (Exhibit 2). Exhibit 2 will be provided to the ADCS contract administrator (contracts@azdcs.gov) by the 15th of the month following each quarter of the fiscal year.

Additionally, Averhealth offers reports that can be provided in an electronic format to suit your needs. These reports can be created as a PDF or as a spreadsheet for easier data analysis. Some of our standard reports in Aversys are included below.

Invoicing

Averhealth will provide AZ DCS Laboratory Testing Services Summary and Details Excel, Exhibit 3, electronically in the Guardian platform within fifteen (15) days following the end of each service month. Final invoices will be provided as required and will include any and all adjustments for the previous contract year.

mailto:contracts@azdcs.gov

Testing & Results

Averhealth has proudly served the Arizona Department of Child Safety for almost four years, demonstrating a deep understanding of the agency's contractual requirements. We meticulously adhere to evidence-based practices, ensuring compliance with the AZ DCS contract while providing top-tier services. Our rigorous collection procedures for hair, saliva, and urine are consistently maintained to uphold the highest standards. Furthermore, our partnership with

Alliance DNA Laboratory guarantees AABB-certified protocols for DNA specimen collections, reinforcing our commitment to quality and accuracy.

Averhealth’s check-in, sample collection, and chain of custody paperwork are completed in 3-5 minutes. Upon check-in, our Patient Care Technicians (PCT) ask the client to verify their identity, which we match against a stored photo of the client. The client places all personal effects in a designated area. Our PCTs directly observe clients wash and dry their hands. The next steps vary depending on the specimen type.

Urine Specimen Collections

A Patient Care Technician (PCT) of the same sex enters the restroom, where the specimen is provided, with the client. The then instructs the client to raise their shirt, blouse, or dress/skirt, above the waist and just above the navel. Should a client have a device, our PCTs will request the client surrender the device and continue the collection with a new sample. In the situation where a device is found a report is written with images of the device included and sent to the supervising authority immediately following the incident.

The technician instructs the client to start urinating and then stop. The PCT then opens the sample vial and hands the cup to the client. The PCT will then directly observe the urine flow from the client’s urethra into the sample vial. Once the client has completed urinating into the vial, they hand the specimen to the technician with visual contact of the specimen vial. The technician ensures at least 30 milliliters are present. The collector seals the sample vial, places a tamper-proof bottle seal across the top of the lid and down the sides of the sample cup, and initials the tamper tape in the restroom in view of the client. The client will initial and date the tamper tape on the side of the sample cup and return the specimen to the technician. With the sealed sample in hand, the PCT exits the restroom to allow the client to finish. The collector then places the specimen in the secure staging area to prepare for shipping.

Oral Fluid Specimen Collection

While urine testing is indeed the “gold standard” of drug testing, oral fluid testing is an effective option for situations where same-sex collections are not possible. Oral fluid tests, conducted with oral swabs, enable clients to provide their samples regardless of sex and are less invasive than traditional urine collections. It’s also nearly impossible to adulterate an oral fluid test, ensuring a rigorous and legally defensible sample is collected every time.

Chain of Custody

Averhealth’s electronic chain of custody (COC) ensures legal defensibility – and that a valid sample is collected, appropriately tested, and accurately reported. We use an electronic COC with Aversys that incorporates pre-existing barcode labels. Aversys can be used by authorized personnel to check in clients, collect specimens, and electronically prepare shipments for transport.

Collections Requiring Paper Chain of Custody Forms

Aversys creates a one-page chain of custody form with the accession number on the top of the form, the bottom of the form, and on the tamper seal to begin the process at the collection site.

This unique ID is used to identify/track each specimen through every step of the process via barcode scanning functionality. The barcode on the tamper tape is affixed to the specimen at the time of collection, eliminating manual entry and transcription while reducing errors.

Each accession number is tied directly to an existing client profile and all the details for each specimen (e.g., collection information, panel composition, etc.). The accession number is comprised of the ID for the collection event (first eight digits), order/panel ID within the collection event (next two digits), and a check digit (last digit). The check digit ensures that the accession number barcode is accurately read by scanners used in each stage of its processing.

A sample chain of custody paper form is included on the next page.

Specimen Collection with Electronic Order Creation

To start the specimen collection process, the collector will verify the client’s identity via a stored photo in Aversys and approved personal information such as individual PIN or date of birth. The test order is then created for the specimen and an order is printed to include the accession ID, the client’s name, the client’s PIN, the date of collection, the collector ID, and specimen type. The specimen is collected, the specimen is sealed in the presence of the donor, and both the client and collector sign/initial the tamper tape.

Specimen Storage and Shipment to the Laboratory

The specimen is stored in a secure area and placed into the transport box insert awaiting shipment to the laboratory. The collector continues to place additional sealed specimens into the box insert until all specimen collections for the day have been completed. When collections are completed, the collector creates a shipment in Aversys. Each specimen is scanned into the shipment. A UPS label and packing list are then created. The packing list is placed into the package with the specimens and package is sealed and the label is affixed to the package. Boxes are labeled as required per CDC Guidelines. The package is transported to the laboratory via

UPS priority overnight services.

At the Laboratory

All specimens continue to follow the electronic chain of custody, documenting all steps at the laboratory from the time of arrival at our lab to specimen storage and disposal. Every team member who interacts with the specimens and aliquots will have their interaction documented in

Aversys.

The accession numbers are reviewed for the technician each time the specimen is scanned. Our system also utilizes several workflow checks that prevent specimens from being errantly scanned by a technician. For example, only specimens that are in process can be scanned into a batch. A specimen already in a batch cannot be scanned into another batch. The system queues up each specimen for the instruments capable of processing the specimen based on the accession number barcode and the instrument communicates results back to the system using the same accession barcode.

The system removes the accession from all other instrument queues after the first instrument queries for the order to prevent any errant duplicative processing of the specimen. The system also knows when to expect results from the instrument and will prevent the users from taking any action until the required results are received. The system will also ignore any duplicate results transmission from the instrument after it has received the required results.

Received Shipments

Our laboratory personnel will find the shipment on the inbound orders, determine the number of specimens that should be in the box, open the box and confirm the correct number of specimens have been received, and then mark the shipment as delivered.

Laboratory staff then change the Status (see image) to Delivered. The shipment is moved from

Inbound to Received.

If there is a discrepancy between the number of specimens in the box and what is in the shipment and on the packing list, the laboratory staff will reconcile the packing list to the specimens received in the box. Once the missing or extra specimen has been identified, the laboratory technician sends an email to the collection site and changes that accession number to

Investigating.

Accessioning Specimens into an Initial Screening Batch

The Batch Creator tool automatically assigns the box number and batch number and records the laboratory personnel handling the specimen. The technician then selects the Box Type (e.g., urine or oral fluid). A batch number will print for the aliquots and a box number will print for the specimen bottles. The box number is placed on the outside of the specimen storage box and the batch number is placed on the screening rack. The accessioner or laboratory technician removes the first specimen from the shipment, inspects the specimen for discrepancies, and if there are no discrepancies and the specimen meets the acceptable criteria outlined below, scans the specimen into the batch, labels the aliquot tube and pours the specimen into the tube. The laboratory technician then places the aliquot tube into a screening instrument rack, replaces the specimen into the storage box, and proceeds to the next specimen. Once the specimen is poured it cannot be returned to the original vial. Aversys will generate a barcode for the test tube and record the accession’s/tube’s Location in the batch. As each accession is scanned into the batch, the box on the top right of the Batch Creator screen displays an easy summary view of the accession so the user can verify the pertinent accession details. The ‘A’ in the Location represents the accessions row in the batch box and the ‘2’ represents column.

Confirmation Aliquoting

When additional testing is requested, this is conducted as follows. Picklists are separated based on specimen type and technology that needs to be conducted. The laboratory personnel will pull the original container and move it into a new storage box. Once all the specimens have been pulled into the new box, they will aliquot the specimens using the new box creator. This function will show the technician which specimen within the picklist to pull and pour. It has been set so that the specimens with the lowest initial screening value are tested first and with the highest are tested last to minimize any possible carryover.

A new aliquot is poured into test tubes by using picklist creator, scanning the original bottle, placing the accession number on a new test tube, pouring the specimen into the properly labeled test tube, and placing the test tube into a rack. This process is done by the technician handling the specimens one at a time. The aliquots are placed in temporary storage and the original bottles are placed into a storage box.

While Averhealth provides fully electronic chain of custody (COC), customers that provide their own collection services will have access to print chain of custody on specialized 1-ply paper provided by Averhealth. This includes the collection event details, client details, signature verification areas, and a barcoded tamper seal for the sample.

Storage Location When Not in Possession

All specimens are to be processed as soon as they are received by central Laboratory facility from the collection sites. If not analyzed immediately, specimens can be stored at room temperature for up to one week. After seven days, all urine and oral fluid specimens will be moved to frozen storage. Hair samples will be stored at room temperature.

Throughout the testing process the original specimen container is tracked in Aversys. It tracks the initial box, the box when a bottle is pulled for confirmation testing, and the final storage box.

The information includes a record of the individual that handled the specimen at each point.

Meanwhile, the aliquots are tracked in Aversys as they are placed into various stages of testing.

If a specimen is not placed on an instrument, it is placed into temporary storage. Temporary storage locations include the screening batch table and designated refrigerators in the LC-

MS/MS prep area awaiting testing on a designated instrument. During confirmation testing, there is an additional log that tracks who interacts with the vials while loaded and verified on the confirmation instrumentation. Once the specimens have run on the confirmation analyzer the aliquots are disposed.

Our cutoff levels are based on industry and laboratory best practices to meet levels established by NADCP, CAP-FDT, and validated manufacturer cutoffs set by the scientific community. We routinely evaluate cutoff levels based on evolving best practices and standards used in criminal justice settings and work with our customers to review levels as needed. Our judicial drug testing cutoffs are included in the assay chart below.

Name Type Cut-off Cut-off

Amphetamines Urine

1000 ng/mL or 500 ng/mL

100 ng/mL

MDA Urine 50 ng/mL

MDEA Urine 50 ng/mL

MDMA Urine 50 ng/mL

Methamphetamine Urine 100 ng/mL

Phentermine Urine 50 ng/mL

Cannabinoids Urine 20 ng/mL 5 ng/mL

Cocaine Urine 300 ng/mL or 150 ng/mL

Benzolecognine Urine 50 ng/mL

Opiates Urine

300 ng/mL

N/A

Heroin (6-MAM) Urine 5 ng/mL

Codeine Urine 50 ng/mL

Hydrocodone Urine 50 ng/mL

Hydromorphone Urine 50 ng/mL

Morphine Urine 50 ng/mL

Oxycodone Urine 50 ng/mL

Oxymorphone Urine 50 ng/mL

PCP Urine 25 ng/mL 12 ng/mL

Barbiturates Urine

200 ng/mL

N/A

Butabarbital Urine 100 ng/mL

Pentobarbital Urine 100 ng/mL

Secobarbital Urine 100 ng/mL

Benzodiazepines Urine

200 ng/mL

N/A

Alprazolam Urine 50 ng/mL

Clonazepam Urine 50 ng/mL

Diazepam Urine 50 ng/mL

Hydroxyalprazolam Urine 50 ng/mL

Lorazepam Urine 50 ng/mL

Nordiazepam Urine 50 ng/mL

Oxazepam Urine 50 ng/mL

Temazepam Urine 50 ng/mL

Buprenorphine Urine 5 ng/mL

5 ng/mL

Norbuprenorphine Urine 50 ng/mL

Cotinine Urine 500 ng/mL N/A

Ecstasy Urine 500 ng/mL 100 ng/mL

EtG Urine 500 ng/mL 300 ng/mL

EtS Urine 100 ng/mL

Fentanyl Urine

2 ng/mL

1 ng/mL

Norfentanyl Urine 1 ng/mL

Acetyl Fentanyl Urine 1 ng/mL

Acryl Fentanyl Urine 1 ng/mL

Alfentanil Urine 1 ng/mL

Benzyl Carfentanil Urine 1 ng/mL beta-Hydroxy Fentanyl Urine 1 ng/mL

Butyryl Fentanyl Urine 1 ng/mL

Carfentanil Urine 1 ng/mL

Cyclopropyl Fentanyl Urine 1 ng/mL

Fluorobutyryl Fentanyl Urine 1 ng/mL

Furanyl Fentanyl Urine 1 ng/mL

Methoxyacetyl Fentanyl Urine 1 ng/mL

Methylfentanyl Urine 1 ng/mL

Thienyl Fentanyl Urine 1 ng/mL

Sufentanil Urine 1 ng/mL

Gabapentin Urine 1.5ng/mL 100 ng/mL

Ketamine Urine 100 ng/mL 50 ng/mL

Kratom Urine

50 ng/mL

N/A

Mitragynine Urine 5 ng/mL

7 Hydroxymitragynine 1 Urine 5 ng/mL

LSD Urine 0.5 ng/mL 0.5 ng/mL

Meperidine Urine

200 ng/mL

N/A

Meperidine Urine 50 ng/mL

Normeperidine Urine 50 ng/mL

Methamphetamines Urine 500 ng/mL 100 ng/mL

Methadone Urine 300 ng/mL

25 ng/mL

EDDP Urine 25 ng/mL

Methaqualone Urine 300 ng/mL N/A

Naloxone Urine N/A 50 ng/mL

Naltrexone Urine N/A 50 ng/mL

Propoxyphene Urine 300 ng/mL

25 ng/mL

Norpropoxyphene Urine 25 ng/mL

SOMA Urine

100 ng/mL

N/A

Carisoprodol Urine 50 ng/mL

Meprobamate Urine 50 ng/mL

Tramadol Urine 200 ng/mL 50 ng/mL

Zolpidem Urine 20 ng/mL 10 ng/mL

Amphetamines Hair 500 pg/mG

500 pg/mG

Methamphetamines & Ecstasy Hair 500 pg/mG

Cocaine Hair 500 pg/mG 500 pg/mG

Opiates Hair 200 pg/mG

200 pg/mG

Codeine, Morphine, 6-MAM, Oxycodone, Oxymorphone, Hydrocodone, Hydromorphone

Hair 200 pg/mG

PCP Hair 300pg/mG 300pg/mG

Cannabinoids Hair 1pg/mG 0.1pg/mG

Benzodiazepines Hair 200 pg/mG

200 pg/mG

Alprazolam, Clonazepam, Diazepam, Lorazepam, Nordiazepam, Oxazepam, Temazepam

Hair 200 pg/mG

Amphetamines Oral Fluid

50 ng/mL

20 ng/mL

Methamphetamine Oral Fluid 20 ng/mL

MDA Oral Fluid 20 ng/mL

MDMA Oral Fluid 20 ng/mL

Benzodiazepines Oral Fluid

20 ng/mL

N/A

Alprazolam Oral Fluid 1 ng/mL

Diazepam Oral Fluid 1 ng/mL

Nordiazepam Oral Fluid 2 ng/mL

Lorazepam Oral Fluid 1 ng/mL

Oxacepam Oral Fluid 1 ng/mL

Temazepam Oral Fluid 1 ng/mL

Clonazepam Oral Fluid 1 ng/mL

Buprenorphine Oral Fluid 5 ng/mL 1 ng/mL

Cocaine Oral Fluid 20 ng/mL

2 ng/mL

Benzoylecgonine Oral Fluid 2 ng/mL

Cannabinoids Oral Fluid 4 ng/mL 2 ng/mL

Ethanol Oral Fluid 0.04 g/dL 0.02 g/dL

Fentanyl Oral Fluid 2 ng/mL

0.25 ng/mL

Norfentanyl Oral Fluid 0.25 ng/mL

Opiates Oral Fluid

40 ng/mL

N/A

Codeine Oral Fluid 1 ng/mL

Morphine Oral Fluid 1 ng/mL

Hydrocodone Oral Fluid 1 ng/mL

Hydromorphone Oral Fluid 1 ng/mL

Oxycodone Oral Fluid 1 ng/mL

Oxymorphone Oral Fluid 1 ng/mL

Oxycodone Oral Fluid 10 ng/mL

1 ng/mL

Oxymorphone Oral Fluid 1 ng/mL

Methadone Oral Fluid 50 ng/mL 5 ng/mL

Methamphetamines Oral Fluid 50 ng/mL 20 ng/mL

PCP Oral Fluid 10 ng/mL 1 ng/mL

Tramadol Oral Fluid 10 ng/mL 50 ng/mL

Breath Alcohol Test Breath 0.02 0.02

Quality Assurance

Quality assurance runs far deeper than producing accurate test results and meeting the highest laboratory standards. Averhealth works hard to maintain trust and accountability in a variety of ways. Averhealth will continue to provide quarterly reviews with Key Stakeholders at AZ DCS, internal audits regarding our results turnaround time, Secret Shops at every Averhealth-owned location in Arizona, and monthly check-ins with our subcontractors by our Area Managers to ensure quality service and contract compliance.

Averhealth uses a variety of strategies to maintain quality assurance including:

CLIA AND CAP-FDT CERTIFICATIONS

Averhealth’s toxicology laboratory is accredited by CLIA and it’s one of only 30 US labs with

CAP-FDT accreditation from the College of American Pathologists. We are heavily focused on forensic toxicology specifically applicable to your needs while ensuring we follow all industry best practices.

STRINGENT QUALITY CONTROL PRACTICES

CAP certification means we follow a 21-discipline checklist for running a high-quality laboratory.

FORENSICALLY DEFENSIBLE CHAIN OF CUSTODY PROCEDURES

Our electronic chain of custody ensures forensically defensibility procedures and that valid samples are collected, appropriately tested, and accurately reported.

LEGALLY DEFENSIBLE TEST RESULTS

Our rigorous standards mean legally defensible samples and test results.

PROFICIENCY TESTING

Every month, the Averhealth lab receives blind samples from the College of American

Pathology (CAP) and other agencies to test, analyze and report. These are run just like any other specimen and reported to the agency to ensure accurate detection and quantification of drugs.

SECRET SHOPPERS

Averhealth works with a third-party vendor who recruits, hires, and trains people to pose as clients while submitting a sample.

Secret shoppers are trained in the check-in, collection and chain of custody procedures and report their findings.

ROUTINE SITE INSPECTIONS

Conducted by Averhealth management, these inspections cover adherence to procedures, the physical condition of our Patient Care Centers and other center operations.

MONTHLY TRAINING SESSIONS

Continuing education to ensure our team follows best collection practices. This includes a review of written materials, roleplaying, and a written test.

INTERNAL AUDITS

Checks and balances are incorporated into every element of our service offering, from Patient

Care to laboratory operations.

CUSTOMER SURVEYS

We ask our customers to participate in surveys and interviews. We also conduct an annual survey that addresses every element of our operations.

ANNUAL MANAGEMENT MEETING

The Averhealth team receives regular training on delivering quality customer service and evidence-based drug and alcohol testing services.

Cultural Sensitivity

In working directly with many government agencies, Averhealth is aware of the importance of removing bias at any opportunity. We can all try to enhance our ability to understand and respect diverse cultural backgrounds when delivering services, especially to those historically underserved. As an organization, Averhealth is committed to cultural awareness in our communities in a variety of ways.

Language Interpretation and Translation Services

We offer interpretation and translation services in multiple languages. By improving accessibility to our services for individuals who may have limited English proficiency, we are reducing barriers to effective communication and understanding between service providers and clients.

We are working to gain trust by removing language barriers and effectively communicating with clients.

Community Outreach and Engagement Programs

Averhealth is actively involved in multiple diverse community-based agencies nationwide. These agencies foster trust and build rapport within our community and further reduce barriers between treatment services and court supervision.

Cultural Competency Training

Averhealth requires annual competency training for all service providers. We focus on cultural competency and sensitivity to increase effective interactions with individuals from diverse backgrounds.

Recognition of Cultural Diversity in Policies and Programs

Averhealth has organizational policies, programs, and initiatives in place nationwide to recognize and celebrate cultural diversity, including incorporating cultural celebrations, observances, and traditions into organizational events and activities. Our holiday schedule is reviewed annually to ensure we recognize our staff members’ traditions and celebrations, and we provide opportunities to connect as a team surrounding important cultural holidays and events.

Genetic Paternity Testing

Averhealth, in partnership with Alliance DNA Laboratory, is committed to upholding the guidelines outlined by the Arizona Department of Child Safety (ADCS) regarding Genetic

Paternity Testing. The AABB Certified Laboratory ensures that buccal swabs are utilized as the primary method of sample collection, while blood draws are employed when deemed necessary by the court or when it would enhance result accuracy. Each sample collection is meticulously conducted to guarantee that there is sufficient material for potential retesting if mandated by the court.

The laboratory utilizes testing methodologies that meet AABB Standards for Parentage Testing

Laboratories, further ensuring compliance with reporting criteria set forth by AABB. Averhealth ensures the stringent AABB compliant chain of custody process is followed for reliable and legally defensible results are provided without exception.

Averhealth will partner closely with Alliance to ensure no additional costs are levied to AZ DCS for repeat testing. We will ensure Alliance DNA Laboratory leverages previous sample results for tested individuals involved in other paternity determinations, without any extra charge to the state.

Averhealth is attentive to scheduling sample collections for alleged fathers, client children, or custodial parents being scheduled separately to avoid any conflict or potential issues. We will also work to provide Court-ordered testing of incarcerated individuals. As required, sample kits will continue to be delivered to correctional facilities, within ten business days of the Court-ordered request.

In cases where blood draws are necessary, we shall provide certified Phlebotomists to handle the collection process. The laboratory strictly adheres to AABB Standards for identifying individuals involved in the case appearing for draws and maintaining appropriate chain of custody protocols.

Additionally, in compliance with Occupational Safety and Health Administration (OSHA) standards, the laboratory ensures proper storage and disposal of sample collection materials and blood draws. For interstate paternity testing, Alliance DNA Laboratory follows regulations outlined in 45 CFR 303.7(e)(1), and for international clients, coordination with International

Social Services (ISS) is undertaken to ensure seamless testing processes.

Training

Averhealth will continue to offer training as requested to the AZ DCS Team. Our aim is to ensure your staff is fully equipped to utilize Aversys for effective caseload management. With 29 years of experience collaborating with various programs, we understand the challenges of drug testing. Our goal is to manage your drug testing program and allow your case managers to provide social service support to families and child safety.

In addition to any requested training sessions, we grant access to self-paced learning through

Averhealth Academy, our online training platform provided through Aversys. This resource is packed with tutorials covering Aversys usage and updated information on drug testing practices, including testing methodologies, specimen options, collection procedures, result interpretation, and more. Users will find guidance on setting up testing calendars, patient check-in procedures, shipment preparation, and other relevant topics to support ongoing training efforts.

An Overview of Averhealth Academy