Work First Substance Use/Mental Health Initiative There are many barriers to employment for Work First applicants and recipients, such as lack of education, work experience, mental and physical health challenges and substance use. It is important to recognize that families must be strengthened, and children protected, while achieving self-sufficiency. The Work First program understands that substance misuse and mental health issues are significant barriers to successful program participation and family well-being. North Carolina General Statue 108A-29.1 requires substance use screening and testing for the illegal use of controlled substances, if there is reasonable suspicion, for each Work First program applicant or recipient as a condition of eligibility to receive assistance. Substance use testing (urine toxicology) is only requested when there is reasonable suspicion to suspect the applicant/recipient is engaged in the illegal use of controlled substances. Reasonable suspicion for the purposes of making a referral for substance use testing is determined by the following criteria: A score of three or above on the Drug Abuse Screening Test (DAST-10). A criminal conviction relating to an illegal controlled substance within the past three years. The intent of the law is to assist in the identification of potential substance use issues and refer applicants/recipients to resources for assistance to resolve these issues. Mental health challenges that go unidentified may impact a family’s ability to achieve and maintain economic self-sufficiency. Many applicants and recipients may be hesitant to self-report mental health challenges because they do not recognize the symptoms, or they want to avoid the possible stigma and consequences. To assist in the identification of mental health concerns all Work First applicants and recipients may volunteer to complete a mental health screening. The mental health screening is not a condition of eligibility.