Recommended Practices: Monitoring
Monitoring refers to the post-treatment activities that are directly related to compliance with the requirements of the SIA (Special Issuance Authorization) and the pilot’s HIMS program. Peer meetings, supervisory meetings, and sobriety testing fall within this group. However, as noted in the section on continuing care, the separation between post-treatment healthcare functions and monitoring is somewhat ambiguous. For example, a pilot identified as “relapsed” at a group therapy meeting would properly view that circumstance as an example of monitoring, even though group therapy is normally classified as continuing care. The same would be true of a pilot identified as “relapsed” by his IMS (Independent Medical Sponsor) when taking his physical exam. But, for the purposes of this section, we’ll limit our discussion to the peer and supervisory meetings used to monitor program compliance. Sobriety testing will be discussed in the next section, as that topic is fairly complex and deserves a separate examination.
FAA expects pilots in the HIMS program to participate in regular meetings with a peer pilot. These meetings normally occur on a monthly basis and the peer pilot provides a report of the meeting to the IMS. These reports are reviewed by the IMS and the information provided is used to help assess the state of the HIMS pilot’s recovery. The IMS does not expect the peer report to meet clinical standards, but rather it is a layman’s report on the behavior of the HIMS pilot. FAA also uses these reports in determining whether or not a HIMS pilot should be released from his/her monitoring requirements at the end of the minimum specified monitoring period. Since the reports are used as an assessment tool, they should be as specific, detailed, and personalized as practical. They should also be primarily limited to factual information, as the peer pilot is not qualified to draw conclusions about the mental or emotional state of the HIMS pilot. Under normal circumstances, a high quality report can be provided in less than one page.
Peer meetings with HIMS pilots should normally be conducted face-to-face. While meeting in this manner places a burden on both the peer and the HIMS pilot, the quality of the meetings is vastly improved over other methods. Some airlines have chosen to use telephonic communication rather than face-to-face meetings. Experience has shown that even when the frequency of telephone contact is greater than monthly, the ability to discover high-risk behavior and relapse is diminished. The process of scheduling a meeting in person, keeping that commitment, and being observed and interacting for 30 minutes to an hour provides significant information about a person’s recovery. And, of course, non-verbal communication can also be a source of information to the peer, and this type of communication is much more available in a face-to-face meeting. Modern technology has provided a hybrid form of communication in the video call. While “skyping” is sometimes used in place of a face-to-face meeting, we recommend its use be limited. A good example of proper use would be when a HIMS pilot is deployed with a military unit for several months making direct contact impossible. Video calls should not be used as a substitute for face-to-face meetings on a regular basis.
When conducting a meeting, the peer pilot should remember they are not acting as the HIMS pilot’s union representative, company supervisor, or AA sponsor. The peer pilot’s role is to evaluate the quality of a pilot’s recovery and thereby contribute information to help determine the pilot’s likelihood of maintaining his/her sobriety. The peer pilot has a responsibility to communicate with other people involved in the pilot’s recovery including the pilot’s supervisor and the IMS. Due to this responsibility, the peer pilot cannot provide privacy, privilege, or anonymity to the HIMS pilot. But, of course, the peer pilot is expected to act with the upmost discretion and not talk about the pilot with those who do not have a “need to know.” The peer pilot is also not in the position to “punish” the pilot or enforce any sanction in the event of undesired behavior. The peer pilot is limited to communicating their observations to the IMS and company supervisor. The peer pilot is also not responsible for the HIMS pilot’s recovery. If the peer pilot cares more about the pilot’s recovery than the pilot, then there is a problem.
Peer meetings can take place in an individualized or group setting. Both methods have advantages and disadvantages. Group settings are easier to coordinate in that a large number of pilots can be seen at one meeting. In these settings the other recovering pilots present may also be a good resource to use when working with a pilot who is having difficulty. Since group meetings of this type usually involve supervisors and healthcare professionals in addition to peer pilots, there is a “multi-eyeball” advantage in evaluating the behavior of any given pilot. Disadvantages of these group settings are that they only provide one “snapshot” of the pilot. All the monitors see the pilot at the same time. Additionally, because a number of pilots must be addressed, each individual pilot is likely to receive less time and attention than they’d receive in an individual meeting. And, the “multi-eyeball” advantage may be lost if one or more of the monitors is prone to defer to another. For example, a supervisor or peer might defer to a healthcare professional whose view may or may not be more accurate than his/her own.
An individual meeting with a HIMS pilot may overcome some of the disadvantages of a group setting, but individual meetings can have their own set of problems. While an individual meeting allows more time for an in-depth discussion, this is only true if adequate time is scheduled for the meeting. Meetings should generally be for 30 minutes to an hour, and additional time should be set aside for writing the report. Also, the “multi-eyeball” advantage is lost in a one-on-one meeting, along with the ease of communication present in a group setting. It is essential if the individual model is used that any concern that arises with one monitor be immediately communicated to the other monitors. Finally, multiple individual meetings are harder to schedule and more time consuming for the HIMS pilot and the monitors.
Some airlines have a preference of one type of monitor meeting over another. Generally, airlines with dozens of pilots in their HIMS program tend to use the group model, while airlines and domiciles with smaller numbers use the individual approach. In practice, both work equally well if the limitations are recognized and properly addressed.
The HIMS monitoring program also includes meetings with supervisors. We recommend the supervisor selected be the pilot’s direct supervisor. The relationship that will develop from these meetings will benefit both individuals. Over time, the supervisor should gain confidence the pilot, who was often a “problem” employee prior to treatment, has become a reliable asset for the company. Additionally, the pilot will begin to change his/her view of the role and responsibilities of their supervisor. For some companies, these meetings begin when the supervisor visits the HIMS pilot in treatment. These meetings can provide a baseline for future interactions between the two individuals. In other cases, the supervisor meetings occur following discharge from treatment. The timing of these meetings in either case is preferable to waiting for the pilot to return to work.
The pilot supervisor may feel “unqualified” to evaluate the HIMS pilot’s recovery. While understandable, this attitude hasn’t proven to be a valid concern. The supervisor can attend an HIMS training program to receive specific help in executing their responsibility. Additionally, if uncertain about a pilot, the HIMS supervisor can contact other members of the pilot’s monitoring team. In fact, regular communication between team members is highly encouraged. Also, good recovery behavior is not difficult to recognize. The pilot should become increasingly open and honest, willing to do what is required, and more willing to help others who are new to recovery. In short, the supervisor should feel increasingly comfortable as the pilot progresses in his/her recovery program.