Human Intervention Motivation Study. Captain Chris Storbeck Former ALPA National HIMS Chairman with Lynn Hankes, MD, FASAM

Transcription

1 Human Intervention Motivation Study Captain Chris Storbeck Former ALPA National HIMS Chairman with Lynn Hankes, MD, FASAM

2 Disclosures I have no relevant financial relationships with proprietary entities producing health care goods or services related to the content of this presentation.

3 Qualifications? Delta Air Lines Captain, transoceanic, B767ER USAF instructor and fighter pilot (T-37, F- 4E & G) 13 years as Delta HIMS Chairman, 4 years as National HIMS Chairman HIMS graduate and recovering alcoholic (25 years sober)

4 Before HIMS Do airline pilots suffer from alcoholism? If so, is it possible to identify, treat, and safely return them to the cockpit? Could the program survive the anticipated negative public reaction? Pre-HIMS FAA medical policy lists alcoholism as a disqualifying Dx, with no exemptions granted.

5 The Beginning Dr. Richard Masters approached the ALPA Board of Directors (BOD) about the problem of alcoholism in the pilot group. Following some information gathering, the BOD approved the development of a program in Captains Rod Gilstrap and Gil Chase assisted Dr. Masters in the development of HIMS.

6 Fundamental Assumptions Alcoholism is a primary treatable disease characterized by chronicity and relapse. Early identification and treatment is possible - and it works. Total abstinence is essential to successful rehabilitation. Intensity of job motivation will yield a higher recovery rate for airline pilots.

7 Period of original National Institute on Alcohol Abuse and Alcoholism (NIAAA) grant to HIMS 375 petitions to FAA 305 granted All legacy carriers, except one, establish rehabilitation structures using the HIMS Model HIMS Model not standardized

8 1980 s - Expansion Pilot Leadership Capt. Dick Stone 15 new programs started Federal Grant support sporadic Gradual expansion of aftercare/monitoring 900 pilots successfully treated and returned to work

9 1990 s Medical Model 1991 Fargo incident 1992 DOT random testing begins Increasing FAA guidance Dr. Pakull Dr. Audie Davis becomes Program Manager 1500 pilots certified

10 Doctors in Charge HIMS Model increasingly defined by medical standards Aviation Medical Examiner/ Independent Medical Sponsor (AME/IMS) role expanded Alcoholism + other Chemical Dependency Increased influence of P&P 1700 pilots recertified

11 2010 Present Back to the Future Reinvigorating role of recovering pilots and management Reemphasizing HIMS TEAM approach Expanding HIMS to include general aviation Best Practices Model

12 HIMS Structure Chairman First Officer Corey Slone Program Manager Dr. Quay Snyder FAA Contracting Officer s Technical Representative Dr. Nicholas Lomangino Advisory Board Industry-wide composition Pilot Reps., Physicians, Airline Managers, FAA

13 Functions of HIMS Staff Educate industry representatives in HIMS model Refine and improve HIMS model Advisory support to established and new HIMS programs Industry-wide information and referral resource for pilots/families

14 HIMS Accomplishments Approx. 5,000 pilots successfully identified, treated and returned to flying under close supervision One-time relapse rate of 15-20% Long-term success rate of 88-90%

15 HIMS Penetration? Major U.S. carrier 12,000 pilots Number of pilots in, or previously participants of HIMS Penetration 1.8%

16 HIMS Elements Identification Assessment Treatment Psychological and Psychiatric Eval (P&P) Medical Recertification Monitoring

17 DOT Positive Identification DUI charges: 1 per 1000 pilots per year Missed appointments Heavy use of sick leave and/or last minute sick-outs Irregular pilot proficiency Isolation Volatile personality/erratic behavior

18 Assessments Client selected or FAA directed based on circumstances Must address FAA standards

19 Treatment 28 day residential treatment is recommended

20 Assess mental functioning including intelligence, attention, memory, language, and personality.

21 Psychiatric Evaluation Make and/or Confirm Clinical Diagnosis Rule out Disqualifying psychiatric condition(s) Assess Quality of Recovery / Prognosis/ Relapse Risk Assess Fitness-For-Duty

22 Medical Recertification Independent Medical Sponsor is a HIMS trained AME (Aviation Medical Examiner) Collates treatment, P&P, and other records Conducts a physical evaluation Evaluates all factors related to the pilot s fitness-for-duty Recommends medical special issuance to FAA

23 Day 1 Intervention, Requested Help Widely variable Intensive outpatient or individual therapy as needed HIMS Certification Flow Sheet Day 2-4 Evaluation Minimum 28 days Residential treatment > 30 days to 90 days Aftercare/relapse prevention/ AA with sponsor well established Concurrent Identify peer and company monitor Allow 3-4 weeks Psychological and Psychiatric Exam 1-2 weeks Collect and review records 7-14 days FAA exam case to FAA days Case at FAA FAS SI certificate 6 months 7 days Case at OKC

24 Monitoring Monitoring normally lasts 3 5 years Special Issuance Authorization will require weekly group therapy and continuous abstinence Abstinence testing is normally left to the AME but may be supplemented by company testing Program requirements vary by airline but will likely include: Monthly meetings with company supervisors Monthly meetings with peers AA / NA meetings

25 Address Risk of Relapse Watch for high risk behavior not following program requirements, HALT, repetitive anger, etc. Structure monitoring to address risk More support early in sobriety Rigorous random testing taking advantage of look-back If relapse is suspected remove from duty, communicate to monitoring team, conduct an investigation, and determine appropriate treatment

26 Additional Considerations The program requires continuous education A team approach is best Good communication between team members is imperative

27 HIMS Relapse Statistics 5% - Folklore 8% - Our best rate HIMS programs 12.2% - Database ( but caveats ) 15% - Estimated overall rate 15-20% - Probable true overall rate

28 Other Relapse Rates 8% - Best rate Physician Health Programs 15-20% - Overall PHP rate 10-30% - Other professionals programs 45-60% - General public

29 Data Comparison PHP 60% - random testing 20% - worksite monitor 20% - other HIMS 22% - random testing 9% - worksite monitor 29% - self-report 11% - other 29% - DUI s

30 Breakdown by Primary Drug

31 Website

32 Questions?