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Katie and Katie of Tactical Recovery · Moral Injury Support Network Podcast

• 0:00
  SPEAKER_03: On today's episode, we not only have one but two Katie's on the podcast today.
• 0:05
  SPEAKER_03: Katie Ross is a seasoned professional in the veteran and military space.
• 0:09
  SPEAKER_03: She has dedicated her career to serving those who serve.
• 0:13
  SPEAKER_03: Katie currently serves as the Director of Veterans Services for Summit Behavioral Health Medical Care's Tactical Recovery Program.
• 0:22
  SPEAKER_03: Katie worked to design the Tactical Recovery.
• 0:24
  SPEAKER_03: This program was created because very few addiction and mental health centers are genuinely qualified in understanding and treating veterans.
• 0:34
  SPEAKER_03: Far too often, veterans do not receive the level of treatment they deserve from people who understand the full impact of their service.
• 0:42
  SPEAKER_03: She wanted to change this.
• 0:44
  SPEAKER_03: For her, this is personal.
• 0:46
  SPEAKER_03: Katie is a seasoned military spouse and grew up as a military bride.
• 0:51
  SPEAKER_03: Her dedication to serving those who serve is exemplified in both her professional roles and her volunteer roles in the community.
• 0:59
  SPEAKER_03: We also have Katie Siboletto Stinger, who is a force multiplier in the veteran community.
• 1:06
  SPEAKER_03: Katie now serves as a National Veterans Services Coordinator for Summit Behavioral Health Care's Tactical Recovery Program, serving veterans in need of residential treatment for mental health and addiction.
• 1:19
  SPEAKER_03: Katie has spent nearly a decade working with the veterans and their loved ones to improve access to care and the services provided to veterans, service members and their loved ones.
• 1:31
  SPEAKER_03: Katie has served in case management, project management, and care coordination roles over the past 10 years.
• 1:39
  SPEAKER_03: In 2011, Katie fell into veteran services to a family friend who struggled with what we know as moral injury.
• 1:47
  SPEAKER_03: At the time, assessing services for veterans who were struggling with reintegration, PTSD, and MI was complex and lacked access.
• 1:59
  SPEAKER_03: Her career focus shifted to address gaps in services and barriers to care for the veteran and military population in relation to mental health needs.
• 2:10
  SPEAKER_03: While it took her some time to realize, she grew up in a strong military family with grandparents in both World War I and the Korean War.
• 2:19
  SPEAKER_03: So she wasn't fortunate enough to hear either of their stories firsthand.
• 2:23
  SPEAKER_03: Katie is an alumna of Cornell University's Sloan Program in Health Administration.
• 2:31
  SPEAKER_03: Thank you both for joining us tonight.
• 2:33
  SPEAKER_03: Starting with Katie S.
• 2:35
  SPEAKER_03: Could you tell listeners more about yourself and your professional career?
• 2:40
  SPEAKER_03: And then following Katie Ross, do you mind sharing some of your information as well with us?
• 2:45
  SPEAKER_02: Yeah, of course.
• 2:46
  SPEAKER_02: Can you hear me all right?
• 2:48
  SPEAKER_03: Yes.
• 2:49
  SPEAKER_02: Perfect.
• 2:50
  SPEAKER_02: So I've spent about a decade in the military and veteran space.
• 2:54
  SPEAKER_02: I've done a lot of work with the veteran and military families, looking at their access to care.
• 3:00
  SPEAKER_02: And that really started, as I kind of mentioned in the intro, of with a good family friend of mine who came back and he had served in the initial portion of the post-9-11 war on terror.
• 3:12
  SPEAKER_02: He was really struggling when he came back.
• 3:14
  SPEAKER_02: He'd just gone through a divorce.
• 3:17
  SPEAKER_02: He was struggling with a lot of alcohol and substance use.
• 3:21
  SPEAKER_02: And he was really lost.
• 3:23
  SPEAKER_02: And we connected, it was my brother's best friend, and we just kind of started talking and I was listening.
• 3:29
  SPEAKER_02: And I found him one night after he went out for the Marine Corps birthday, huddled up at a table after we had lost him and searched for him for about an hour on a rainy night.
• 3:39
  SPEAKER_02: And he was just talking to another veteran from a different era of service and just finally had found somebody that he could talk to.
• 3:48
  SPEAKER_02: And despite every effort I had, which was to try to let him know that I was standing there and I was listening.
• 3:54
  SPEAKER_02: And I wanted him to know that he was not just talking to this other man, that I was there.
• 3:59
  SPEAKER_02: I couldn't even, you know, break through to him because he was just like in this trance.
• 4:04
  SPEAKER_02: And so we started talking a couple of days later, and he just kept saying, you know, could I do anything stupid?
• 4:11
  SPEAKER_02: And I was like, no, you didn't do anything stupid, but at the end of the night, you did do a line of cocaine off your car key.
• 4:18
  SPEAKER_02: So that part wasn't really the best choice that I've seen you make, you know.
• 4:22
  SPEAKER_02: And I called all my friends that were active duty and um a couple of my veteran friends, and I said, you know, I've heard of demons, I've heard what's going on, but I don't know if I should tell him what I know because he didn't want anybody to know the experience that he had.
• 4:38
  SPEAKER_02: And so that was a mixed fag of what I heard people say.
• 4:44
  SPEAKER_02: Like 90% of the people that I had consulted with had said, you know, absolutely not.
• 4:50
  SPEAKER_02: Don't tell him you know anything.
• 4:51
  SPEAKER_02: It's just gonna be devastating.
• 4:53
  SPEAKER_02: You can't let him know that you know what he struggles with on a daily basis.
• 4:57
  SPEAKER_02: And um, I just couldn't do it.
• 5:00
  SPEAKER_02: I couldn't like not tell him what I had heard and help him to process that information.
• 5:06
  SPEAKER_02: So eventually I sat down with him late one night and we just talked all night long and just let him know that like he wasn't alone, that I understood, that somebody was mad at him, and I helped him to access services.
• 5:20
  SPEAKER_02: And so that's really what broke me into that system of leaving for my master's in healthcare administration.
• 5:27
  SPEAKER_02: And he was probably the only person that was a hundred percent the full time that I was going to get in.
• 5:32
  SPEAKER_02: It was an Ivy League school, it was really competitive, and I was like on the fence if I was gonna get in or not.
• 5:39
  SPEAKER_02: And the entire time he just supported me through that.
• 5:42
  SPEAKER_02: So I was happy to be able to support him through that.
• 5:45
  SPEAKER_02: Shortly after I did some work with nonprofit called Veterans One Stop Center left for New York, where he worked on their peer-to-peer support program, which is the Joseph Fire program, and then I did case management um for the FSPF or the Support of Veterans and Families program through the VA, but monitored through another nonprofit called Volunteers of America, the Colorado Ranch.
• 6:08
  SPEAKER_02: And then after that, I ended up at give an hour where I crossed paths with Katie actually.
• 6:13
  SPEAKER_02: And um, when I found out the work she was doing at Tacto Coal Recovery, I was like bugging her bi-weekly to tell me more about what she was doing and how she was working alongside the VA and what that looked like and how I could become part of it.
• 6:28
  SPEAKER_02: And luckily enough, it worked out, and now we're working together.
• 6:33
  SPEAKER_01: Yeah, it has been.
• 6:34
  SPEAKER_01: Oh.
• 6:35
  SPEAKER_02: No, you can go ahead.
• 6:37
  SPEAKER_01: I was gonna say, we're really happy to have Katie join our tactical recovery team.
• 6:42
  SPEAKER_01: It's been only about a year.
• 6:44
  SPEAKER_01: Um, and like you mentioned in in the intro, I was a military brat growing up, uh, moved many, many times, 11 times actually, and um, you know, went through having a parent that was deployed, did a little tiger cruise, which was the best stationed overseas.
• 7:00
  SPEAKER_01: And that's where we saw um one of my family members struggle quite a bit.
• 7:06
  SPEAKER_01: Um, although overall, like it was a really positive experience.
• 7:09
  SPEAKER_01: We really enjoyed kind of the new perspective that came with being stationed overseas.
• 7:14
  SPEAKER_01: Um, we also very much still felt the impact of being separated from your support system, your family and friends.
• 7:21
  SPEAKER_01: And um, that's when the value of the military community became really evident to me because that's kind of really what helped us literally survive.
• 7:29
  SPEAKER_01: I mean, there was there were suicidal ideations that my family member was struggling with.
• 7:34
  SPEAKER_01: And so um when we saw the other military families coming around us and being supportive and you know, helping out with childcare and spending holidays together, I was like, oh wow, like this is that's as even as a young person, I realized that this is not a job, you know, this is really a lifestyle.
• 7:53
  SPEAKER_01: Um and I probably not surprisingly looking back, um, I uh stuck with what I knew and I married active duty.
• 8:01
  SPEAKER_01: Um my husband just retired after after 20 years, and he is a 100% disabled veteran due to 14 uh locally mild but traumatic brain injuries as well as um PTSD.
• 8:14
  SPEAKER_01: And um, as I was, we were PCSing and seeing the impact of the lifestyle on our kids, and I really wanted to find my my way to serve because I had a I appreciated, embraced that.
• 8:26
  SPEAKER_01: I became an ombudsman and um decided that instead of being you know program management defense contracting, I wanted to have something that was more impactful and went back to graduate school to get my master's degree in clinical social work, um but specifically for military veteran mental health.
• 8:42
  SPEAKER_01: Um and so I I knew that was that was kind of my calling to serve back to my tribe, really.
• 8:48
  SPEAKER_01: And um my first placement as a social worker was um in uh the VA's military sexual trauma program in the women's clinic, um, and really just every day getting to work face to face directly with these women who, as um as a woman myself, um, I admired the things that they were able to accomplish, um, certainly you know the current generation, but especially, you know, one the one before mine, um, that it was even more challenging and they were really like breaking a lot of barriers and glass ceilings and all those things, especially within the male-dominated military community.
• 9:29
  SPEAKER_01: I always very much admired them and um I feel very honored that I was able to be of some support when they were in such a vulnerable state.
• 9:37
  SPEAKER_01: So, you know, when they were coming uh for those mental health, behavioral health services and listening to their stories.
• 9:45
  SPEAKER_01: Um, and that that sold it for me.
• 9:48
  SPEAKER_01: Like I knew that was my career, my calling to do whatever I can do to uh make sure that the care that is out there is going to be really high quality and culturally competent because it's not something that's separate.
• 10:02
  SPEAKER_01: It's not just a job.
• 10:03
  SPEAKER_01: It's um the lifestyle of the military is all entwined with all of those experiences.
• 10:08
  SPEAKER_01: And I so I think it is very helpful for that to also be part of the recovery process as well.
• 10:14
  SPEAKER_03: That's fantastic.
• 10:15
  SPEAKER_03: Thank you both for sharing both your personal and professional careers within your fields because these our listeners are people who are either experiencing trauma from their service or who are in the service currently.
• 10:31
  SPEAKER_03: And a lot of people, our main goal is to open up that community and have a conversation around it.
• 10:39
  SPEAKER_03: Because these are things that need to be recognized so that veterans know and current people who are in service understand that they're not alone in this.
• 10:49
  SPEAKER_03: There are other people who are experiencing the same things that they are, not necessarily in the same exact way, but very similar.
• 10:57
  SPEAKER_03: And to show that there are ways that you can get help and make a life from your trauma.
• 11:08
  SPEAKER_03: I guess that's would probably be the best way to say that.
• 11:11
  SPEAKER_03: But I know a couple of topics that we wanted to address was mental health and substance abuse disorders and veterans' access to care.
• 11:19
  SPEAKER_03: So, Dr.
• 11:20
  SPEAKER_03: Roberts, do you have any knowledge on kind of like those topics that you'd want to share with us?
• 11:27
  SPEAKER_00: Yeah, so um, you know, for for moral injury, you know, substance abuse is is um a common uh a common symptom, if you will, uh, as well as a lot of other things that go with moral injury, such as uh such as guilt and shame.
• 11:46
  SPEAKER_00: Um I once talking to a ranger um that had not heard of moral injury before, but he and a lot of his friends um drank a lot after combat operations and there was some drug drug use and stuff like that.
• 12:04
  SPEAKER_00: And so uh after he learned it, and so he had PTSD, he was on PTSD medicine and stuff like that, and it wasn't seeming to help him.
• 12:14
  SPEAKER_00: Uh, after he found out about moral injury what it was, he said that's why we drank, that's why we abused alcohol because we had so much guilt from so from some of the things that we did.
• 12:27
  SPEAKER_00: Um and where for some in some cases innocent people died um in in combat operations, stuff like that.
• 12:39
  SPEAKER_00: So for the Cades, um, I I know that's uh a major theme.
• 12:44
  SPEAKER_01: Um tell us tell us about that substance abuse, what you're encountering with with veterans and and how you how you kind of help them with in those processes or help them through the Yeah, I think what you identified is that that correlation between them using it really as a as a an unhealthy or maladaptive coping mechanism is is is 100% accurate.
• 13:10
  SPEAKER_01: Um I honestly, you know, not every client that I've worked with, whether active duty or um you know separated from their service, not necessarily had a diagnosis of a mental illness and the diagnosis of a substance use disorder.
• 13:24
  SPEAKER_01: Some people just have a certain diagnosis, but those are really functional labels that help us kind of decide what's going to be an effective treatment.
• 13:32
  SPEAKER_01: Um, what matters is the experience for the individual.
• 13:36
  SPEAKER_01: And what I've seen from that perspective is that it doesn't happen in isolation.
• 13:41
  SPEAKER_01: Um, if somebody is abusing substances, there's a reason.
• 13:46
  SPEAKER_01: There's, you know, there's some internal turmoil or conflict that they may not even be conscious of, but they're certainly using that as a um, you know, as a self-medication, unfortunately.
• 14:00
  SPEAKER_01: And so when you go to treat that and and help them, they're ready to, you know, to get sober.
• 14:08
  SPEAKER_01: Um, it has to be done together as much as possible.
• 14:12
  SPEAKER_01: Um and I think there's some really effective interventions, you know, that have been evidence-based that are out there that people have researched and have shown really effective, especially within the veteran population.
• 14:25
  SPEAKER_01: Um, a lot of folks have heard of or tried like EMDR as a trauma therapy, but also even cognitive behavioral therapy, CBT, is really effective because it's challenging those thoughts.
• 14:38
  SPEAKER_01: When we talk about guilt and shame, um, it's it's really a cognitive distortion.
• 14:43
  SPEAKER_01: It's all tied together with the way I'm viewing this is maybe not um, I'm being hard on myself, right?
• 14:51
  SPEAKER_01: And so you get those mountains out of molehills, black and white thinking, all or nothing.
• 14:55
  SPEAKER_01: Those are all different types of cognitive distortions.
• 14:57
  SPEAKER_01: So cognitive behavioral therapy is really effective at helping the person challenge that and really just be kinder to themselves, and which is probably more realistic to the scenario that happened too.
• 15:07
  SPEAKER_01: Um, but treating one one of their challenges and not the other um may help them at like in the short term, but to have really promote long-term recovery, you have to look at it more holistically than that.
• 15:19
  SPEAKER_00: Okay.
• 15:20
  SPEAKER_00: Um so um of the now are now are you when you're the veterans you're working with, are they mostly male or um are there a lot of females too, or how what's the kind of um percentages or or yeah, that's a great question.
• 15:43
  SPEAKER_01: I think um, I mean, we all know that there are far more men in the military than women.
• 15:50
  SPEAKER_01: I I believe our current stats are somewhere around 17% female.
• 15:54
  SPEAKER_01: Is that correct?
• 15:54
  SPEAKER_01: You guys probably would have a better is that about right?
• 15:57
  SPEAKER_01: Okay.
• 15:58
  SPEAKER_01: I would say um looking at it on the treatment side, um, it's it's a pretty close mirror image um from the when we look at active duty.
• 16:10
  SPEAKER_01: On the veteran side, there's even a higher percentage of males or you know, smaller percentage of female veterans just because of all the war errors and how we've how we've kind of evolved and adapted um the military population over time.
• 16:23
  SPEAKER_01: Um, but the women seem to, it's hard to say.
• 16:27
  SPEAKER_01: I don't want to, you know, we assumptions is a dangerous thing to do.
• 16:32
  SPEAKER_01: But um I would say that the trauma histories um or maybe even just the willingness to get support, um, there's a higher percentage of of women than there are in the population getting treatment.
• 16:48
  SPEAKER_01: So if 11% of veterans are women, it's more like 20% um of the veterans seeking treatment are females, if that makes sense from the current, oh I'm sorry, you can go ahead.
• 17:03
  SPEAKER_00: Yeah, no, I just try kind of getting a sense of of what your what your experience is in that from that perspective.
• 17:12
  SPEAKER_00: Um, and you know, if you see a difference in those populations.
• 17:16
  SPEAKER_01: Yeah, and when we talk about like milieu and in in like healthcare management, you think like milieu management, um, it's a it's a really important topic to to pause and really um make some thoughtful decisions on when you when you have the females and males together in treatment, um especially with the potential for sexual trauma history.
• 17:39
  SPEAKER_01: Um so it's one thing to talk about, oh, we should put all the veterans together.
• 17:43
  SPEAKER_01: But um, if we know that the clients have experienced that, it means that there needs to be more of a conversation and really identifying comfort levels.
• 17:52
  SPEAKER_01: Um, and because if somebody still doesn't feel safe, then no matter how good the good quality the intervention you're providing is, um, it's not going to be effective if they don't feel safe.
• 18:03
  SPEAKER_01: You know, that's that has to come first and foremost.
• 18:06
  SPEAKER_01: All of our locations um serve female veterans as well.
• 18:11
  SPEAKER_01: And and very early on, even before they you know they arrive, we talk to them about whether or not they would feel, you know, would you like the to be part of the specialty track and and um you know program with the veterans?
• 18:24
  SPEAKER_01: Or if you would rather, then um, you know, you can um have a slightly different sort of flavor of your experience if that's something that's not going to be comfortable for you.
• 18:35
  SPEAKER_03: I'm a current per public health student at East Carolina University.
• 18:40
  SPEAKER_03: And that's a big thing that we're noticing is that uh there's a greater percentage of women who go and get treated for their diseases, mental health illnesses.
• 18:52
  SPEAKER_03: And what we're trying to do is create programs that are going to encourage men to go through and get more of the testing that is available to them and the services that could help them with their diseases, illnesses, mental health, because there's just a big gap right now in between those two, because more women are more than likely to go get help than men are.
• 19:19
  SPEAKER_03: And it's just in so many fields right now that that's happening.
• 19:24
  SPEAKER_01: Yeah, I think um it's kind of what I find the most interesting is sort of the the rebranding that has happened within the mental health field that is really helping reduce the stigma.
• 19:34
  SPEAKER_01: I mean, there's really good programs.
• 19:36
  SPEAKER_01: Um, you guys may be familiar, or some of your audience, with focus, uh families overcoming under stress that the DOD has rolled out in multiple locations.
• 19:45
  SPEAKER_01: Um, that help it's they call it resiliency training for active duty families to kind of navigate the um the deployment cycles and communication styles and challenges and things just really in our culture.
• 20:00
  SPEAKER_01: And they, I mean, they use clinicians to do that.
• 20:04
  SPEAKER_01: And it was mental health clinicians who created that model and in the activities that are part of it.
• 20:10
  SPEAKER_01: It's very um, you know, data-driven, and they've done a lot of um uh academic you know, reviews of journals, um, articles on the findings, and it's a very effective intervention.
• 20:23
  SPEAKER_01: But with the reframing it as resiliency training, which absolutely is that, um, has helped open the door and get more people comfortable because obviously military community, we're we're very familiar with training and how important it is, and we value it a lot.
• 20:37
  SPEAKER_01: And so why not train your brain, right?
• 20:39
  SPEAKER_01: And that's really what therapy is too.
• 20:42
  SPEAKER_01: Um, so uh though that's one example.
• 20:44
  SPEAKER_01: I even moral injury um being defined, um, it helps take some of that stigma away.
• 20:51
  SPEAKER_01: I I think for me, and I talked to my husband about this a little bit too, um, when we frame it in that way, it sort of makes it normalizes it more so and it's um, I guess more digestible, less clinical and institutional feeling.
• 21:06
  SPEAKER_01: It's not just a a doctor putting a label on me, like that's more of an experience.
• 21:11
  SPEAKER_01: And I know I had experiences.
• 21:12
  SPEAKER_01: So of course I'm struggling with that.
• 21:14
  SPEAKER_01: Um so that that's been really effective.
• 21:17
  SPEAKER_01: I think um peer support is another one, having that evolution in our mental health, our mental wellness approach, especially in the military community, is fantastic.
• 21:29
  SPEAKER_01: Um, and I and for women, I think it's even um has even higher value because there it's a smaller subpopulation within the military community.
• 21:40
  SPEAKER_01: So a female vet to be able to support a female vet is um is so powerful.
• 21:47
  SPEAKER_03: That's it.
• 21:48
  SPEAKER_03: We had a guest, our last guest for this past month was Jessica Greenbaum.
• 21:53
  SPEAKER_03: And one of the things that she offers are poetry support groups.
• 21:57
  SPEAKER_03: So she has one of her projects was.
• 22:00
  SPEAKER_03: Going through and working with 9-11 responders.
• 22:03
  SPEAKER_03: And she had them go through and write this poetry, but it was in a group setting to where they get to hear other people.
• 22:11
  SPEAKER_03: And she was explaining to us, and it wasn't necessarily just about their experience with 9-11 and being a first responder.
• 22:18
  SPEAKER_03: She said, just write down an event that you remember.
• 22:21
  SPEAKER_03: And we actually had Dr.
• 22:22
  SPEAKER_03: Roberts try it during the episode.
• 22:26
  SPEAKER_03: But like you're saying, having that group setting and having the peers come through and help each other and help build each other and just showing that you're not the only person who is going through something.
• 22:39
  SPEAKER_03: Because I think humans in general always assume and take on a lot of their own pain and trauma within them.
• 22:48
  SPEAKER_03: And just think my situation is not someone else couldn't possibly feel what I'm feeling.
• 22:54
  SPEAKER_03: And there could be people out there who are indeed have some of the same feelings that you might have, or other experiences that might make you rethink your experience.
• 23:04
  SPEAKER_03: So I agree that peer help is a phenomenal thing.
• 23:09
  SPEAKER_03: And I think that's a great barrier that we're breaking down as a society is building each other up rather than keeping all of our personal uh as personal belongings to ourselves.
• 23:22
  SPEAKER_03: We're opening and sharing it as a community.
• 23:25
  SPEAKER_03: And that's just the big thing we're trying to do on the podcast is create that community where people can come on and speak about their different projects and beliefs so that we can show how many different possibilities there are, even outside the field of moral injury.
• 23:45
  SPEAKER_03: So I think that's great.
• 23:47
  SPEAKER_03: So another thing we want to talk about was navigating healthcare outside of the VA.
• 23:52
  SPEAKER_03: What are your thoughts on that?
• 23:54
  SPEAKER_02: So I think that comes into play when we think about access to care.
• 23:58
  SPEAKER_02: So while the VA is really great at certain modalities of treatment and certain services that they offer, there's also programs outside of the VA that have different areas of specialty they can really layer on additional pieces that meet the individual's needs.
• 24:12
  SPEAKER_02: So gosh, I don't remember what year it was, but they started talking about the veteran experience of being a snowflake.
• 24:20
  SPEAKER_02: Every single person has honestly the most intricate level of detail and differences and what they experience.
• 24:27
  SPEAKER_02: Even if they experience things side by side, their outcomes, their symptoms, um, the way that they process that experience can be a lot different.
• 24:37
  SPEAKER_02: So I think one of the things that we look at when we're considering that aspect is A, what does it look like?
• 24:42
  SPEAKER_02: Like how far away do they have to go to treatment?
• 24:44
  SPEAKER_02: If they have to go, what is their level of comfort?
• 24:47
  SPEAKER_02: What's their level of specialty when we look at that?
• 24:50
  SPEAKER_02: And then how easy is it to break through any barriers that might be presented?
• 24:55
  SPEAKER_02: So for me originally, even before looking at veteran services, I lived in a rural community.
• 25:02
  SPEAKER_02: And the access to care was honestly pretty horrific in terms of what you could achieve from a medical standpoint or especially a mental health standpoint, because for the entire county, there was two, maybe three mental health providers.
• 25:17
  SPEAKER_02: So looking at that and looking at that cultural competency.
• 25:20
  SPEAKER_02: So not only, you know, how do you access those services, but also are they appropriate for you and your individual needs?
• 25:28
  SPEAKER_02: And I think that's one of the things that I love about our program is looking at how competent competent our staff is when it comes to that military culture, that um entire dynamic.
• 25:41
  SPEAKER_02: And we talk about, and Katie can talk a little bit about how she kind of designed the program, but we utilize type armor for education for um everybody within our treatment program.
• 25:52
  SPEAKER_02: So what that looks like is not just the clinicians who are providing services, becoming culturally competent, but everybody that touches that veteran, from their admission staff to the gender that might work at the location to the front desk staff, to their clinical and their directors, their CEOs, everybody that's working in that space becomes at least somewhat familiar if they don't have their own personal experience, either a first degree or second degree, or even third degree connection to the military community and understanding of what it looks like, they have some level of competency.
• 26:26
  SPEAKER_02: And I think that's really important.
• 26:31
  SPEAKER_00: So do you do you um as far as your providers, do you provide uh specialty training to develop that competency in them?
• 26:41
  SPEAKER_00: Do you do you hire them already with that competency?
• 26:44
  SPEAKER_00: How do you uh ensure that competency in your in the providers?
• 26:51
  SPEAKER_01: Yeah, we kind of have a um a three-level approach.
• 26:56
  SPEAKER_01: The first being is recruiting um and promoting current staff members who have a personal connection to the military community, either a veteran themselves, a military spouse, a reservist, um, sometimes even parents of a service member, or um someone who you know who grew up in the military community and and has uh just a real passion for supporting this this community is one piece of it.
• 27:26
  SPEAKER_01: Also, like Katie mentioned, everyone on staff has gone through the PsychArmor certification, um, so that each of our treatment facilities are um have earned uh the status of being a veteran-ready healthcare organization.
• 27:43
  SPEAKER_01: Um, and PsychArmor is a very well-respected and established nonprofit that's nationwide that has a variety of these trainings for professionals and also layperson and then even in other industries they've expanded to now, but really starting and making sure providers are equipped to support veterans.
• 28:01
  SPEAKER_01: Um so we go through that training for everyone on staff.
• 28:07
  SPEAKER_01: And then the the third piece is the um modalities that we use in the centers are um a lot of them mirror what the VA provides in their setting just because that's what has been tried and true the most.
• 28:26
  SPEAKER_01: Um, or in military healthcare facilities, um, looking at what they have shown to be effective in this community and utilizing those same modalities.
• 28:37
  SPEAKER_01: Um, it's all a kind of a mix and match to fit what best works for the individual.
• 28:44
  SPEAKER_01: Um, but we know that they are trauma-informed approaches, um, given how you know widespread that trauma history is.
• 28:53
  SPEAKER_01: And then also that the art providers are have gone through training in those modalities.
• 29:01
  SPEAKER_01: So they're not just like given a pamphlet to follow the directions, they've they've gone through courses to be certified in those evidence-based practices, like we were mentioning earlier, cognitive behavioral therapy being a really big one, EMDR, um, sometimes dialectical behavior therapy, DBT, it just really depends on the the individual and what their what their goals are and and what their challenges are.
• 29:24
  SPEAKER_00: So does that so does that relate to the tracks earlier?
• 29:28
  SPEAKER_00: You mentioned something about tracks.
• 29:30
  SPEAKER_00: Um is are those things you just are those the kind of tracks or or when you said tracks earlier, like specialty track, was it something else you were referring to or those those modalities?
• 29:45
  SPEAKER_01: Yeah, so kind of what makes up um more of a track is that they're getting veteran-specific groups throughout the week as well.
• 29:55
  SPEAKER_01: Um, and they're very deliberate, thoughtfully paired with clinicians that have an extra level of experience in supporting this population when they do their individual sessions, um, that we're making sure if someone needs and is ready to work on the trauma history piece, um, because there's that's not always the right time and place for that.
• 30:18
  SPEAKER_01: It really depends on a lot of factors before you um jump into trauma work on someone.
• 30:25
  SPEAKER_01: Um, so those are um factors a lot of our locations will do like a battle buddy orientation for folks that are new to the program, because we're um primarily residential treatment.
• 30:38
  SPEAKER_01: So typically an individual will come and stay with us for about 45 days at a time, 30 to 60, some a couple times um up to 90, um, depending on you know how are the how well they're progressing and what their what their needs are.
• 30:51
  SPEAKER_01: And um so there are times when they're integrated with the general um population of clients at the treatment center, which I've found is especially effective for folks that are struggling that have challenges related to transition to civilian life.
• 31:08
  SPEAKER_01: Um, you know, learning how to communicate with, you know, with a civilian is is really therapeutic in and of itself.
• 31:15
  SPEAKER_01: So they have some time with sort of a mixed population in group sessions, and then they have some time where it's just them and other veterans.
• 31:24
  SPEAKER_01: Um, and then there are um gender-specific groups throughout the week as well.
• 31:30
  SPEAKER_01: Uh and we do offer some first responder um programs in certain locations too.
• 31:35
  SPEAKER_01: So those are sort of kind of the different tracks once you get into a program.
• 31:41
  SPEAKER_03: Something that I found interesting that Katie Stenger had touched based on was making sure that all the employees working there had competencies on the military base ideas, because a big thing that we talked about, I leave in our first episode was moral injury and why it's so important to understand what it is, because when you're going into the workplace, you work with a wide variety of people.
• 32:10
  SPEAKER_03: Regardless of what your job is.
• 32:12
  SPEAKER_03: You could be a janitor, a chef, anyone can work with anyone who feels and experiences different traumas, mental health, et cetera, in life.
• 32:25
  SPEAKER_03: And it's good to know how to address it and how to be a person who has some form of an understanding, going off what you said, like the first degree, second degree, third degree, just some form of knowledge to show that you are there and you have a form of understanding.
• 32:46
  SPEAKER_03: So I like that aspect a lot.
• 32:49
  SPEAKER_02: That definitely helps to break down barriers.
• 32:51
  SPEAKER_02: So if you can understand, like during a conversation, you know, just generally terms that exist within the military population.
• 32:59
  SPEAKER_02: So PCF or um like MOS, those types of things that if you've never been experienced, you have no exposure, you can easily become almost an additional barrier.
• 33:11
  SPEAKER_02: So for a long time, I used to hear veterans that said I only ever want to have a veteran therapist because civilians just can't understand.
• 33:18
  SPEAKER_02: And that shifted a lot because of what Katie had mentioned, just learning that civilians can actually understand.
• 33:24
  SPEAKER_02: And I think in some cases, depending on what it is that they're struggling with, having a civilian understand some of the deep demons that existed in the military population can be even more impactful than having another service member, especially when you're talking about moral injury type of events, um, dealing with a child, dealing with an elderly person, dealing with animals, things like that, the things that we would experience without being too triggering, those types of things can be to them so completely outlandish to be able to explain like this happened, um, to be able to experience that and have somebody truly be compassionate and caring and understanding and not look at them like they've done the worst thing on earth.
• 34:08
  SPEAKER_02: Um, I think can really open up and create that level of trust and seeing, I think other people have experienced some traumatic events that may not be military related, but have been significant in their life.
• 34:22
  SPEAKER_02: And for the first time during those treatments, they have that opportunity, especially when we start looking at things like MFT or traumatic or sexual assault or um other variations of that and childhood trauma, that gives that opportunity to recognize that like I might feel really alone, but other people outside in the world have experienced something like I have, and opening that might be helpful to them, something that they've never been able to do before.
• 34:50
  SPEAKER_01: And I mean, when we stress the importance of um providers, caregivers being educated on military culture, I like to kind of add the footnote though, that um just as though your oncologist doesn't need to have experience cancer themselves to be able to help you recover from cancer, that's the same for you know a mental health provider.
• 35:15
  SPEAKER_01: They don't need to be veterans to it or you know, service members to be able to help someone in the military recover from those pieces of their experience.
• 35:26
  SPEAKER_01: Um, however, uh it like as Katie was mentioning, it's very helpful for building rapport.
• 35:32
  SPEAKER_01: So, one, in the beginning, if somebody's finally maybe trying that type of support for the first time, we want to make sure that it's as comfortable as possible so that they don't um, you know, if they have a negative experience the first time they seek that type of support, they may never ask for that type of help again, um, which can be very, very dangerous.
• 35:49
  SPEAKER_01: And so we want to make sure they have a good first experience.
• 35:52
  SPEAKER_01: Um, and then another part of it is not so much what to ask and that they need to like know what the ranks of every branch of the military are and memorize that.
• 36:01
  SPEAKER_01: And that's not it at all.
• 36:03
  SPEAKER_01: But um partly what not to say, like how triggers to avoid, you know.
• 36:09
  SPEAKER_01: Um it it there is a shocking number of civilians who will not hesitate.
• 36:15
  SPEAKER_01: Oh, you served in the military, did you ever kill anybody?
• 36:18
  SPEAKER_01: Like if you, especially in a mental health setting, if you come out with a question like that, just out of sort of uh ignorant, you know, being naive, or um they think it may be something you're proud of, perhaps, um, and they're trying to thank you.
• 36:32
  SPEAKER_01: But um, it can obviously stir up some memories and just discomfort that they don't want to talk to um, you know, someone about, especially in that that moment.
• 36:45
  SPEAKER_01: So some sometimes those things like to avoid bringing up more so than the ones you should bring up.
• 36:51
  SPEAKER_01: And then the last piece of that cultural um education, too, is um, oh gosh, oh, strengths.
• 37:00
  SPEAKER_01: I mean, I'm I'm a social worker, so I love to look at things from the strengths based.
• 37:04
  SPEAKER_01: And we talked a little bit earlier about um just kind of reframing it so it doesn't seem so cold when we talk about wellness and using things like training for your mind and thinking of it from a positive sort of psychology perspective.
• 37:19
  SPEAKER_01: That's how I think of even treatment when these, you know, these individuals have had diagnoses now, they do need a higher level of care.
• 37:26
  SPEAKER_01: They're they're really in a time of crisis in their life.
• 37:29
  SPEAKER_01: Um, so it's not that we're trying to soften that up, but um it's being more effective in the intervention itself.
• 37:38
  SPEAKER_01: What are things, what are strengths of this culture, what are strengths of this community?
• 37:42
  SPEAKER_01: Let's leverage that.
• 37:44
  SPEAKER_01: Um, it's going to save time, it's gonna have be more likely to have you know long-term recovery and not something that they struggle back with or return to use so quickly again.
• 37:56
  SPEAKER_01: Um, and so we talk about the like the sense of mission, you know, the um a purpose um higher than than themselves for others, these the sense of service that's so natural and ingrained in military culture, like those can be very effective approaches in treatment as well.
• 38:15
  SPEAKER_01: Um, so we like to do like service projects and things like um food drives, or if it's a location that has um uh equine therapy, you know, there's quite a few locations that do that.
• 38:27
  SPEAKER_01: We have one that actually has bovine therapy.
• 38:30
  SPEAKER_01: We have these really adorable miniature cows named Maverick and Goose at one location.
• 38:36
  SPEAKER_01: And the veterans um really it's a moment of a source of pride for them when they've earned, they've made enough progress that they're chosen to be the ones to take care of maverick and goose for the week.
• 38:49
  SPEAKER_01: And it's something that gives them a sense of purpose, a reason to wake up.
• 38:53
  SPEAKER_01: They're helping another creature.
• 38:54
  SPEAKER_01: It does take patience.
• 38:56
  SPEAKER_01: Um, so you know, when you can kind of give somebody um a mission and a focus and talking about helping each other out in that, you know, that camaraderie of the military culture, um, all those types of strengths is is is another thing that's really valuable that comes out of ensuring military cultural competency training um in the staff that is supporting this community.
• 39:19
  SPEAKER_00: So um these are all really great answers, uh really uh fantastic information.
• 39:28
  SPEAKER_00: I appreciate it.
• 39:30
  SPEAKER_00: What type of professionals um do you employ in your work?
• 39:34
  SPEAKER_00: You mentioned you're a social worker, yeah, psychologist, psychiatrist, do you have chaplains?
• 39:41
  SPEAKER_00: What's the range of of professionals that that are working with with veterans in your programs?
• 39:49
  SPEAKER_01: Yeah, um you you hit most of them right there.
• 39:53
  SPEAKER_01: Um uh social workers, LCSWs, um, you know, counselors, um, certified substance abuse counselors, so LPCs, um CSACs, LADCs, there's a bazillion acronyms in the mental health field just like in the military.
• 40:08
  SPEAKER_01: Um psychologists, psychiatrists, um, I mean, just medical doctors, a lot of nurses as well, behavioral health technicians.
• 40:18
  SPEAKER_01: Um, so there's a whole host.
• 40:20
  SPEAKER_01: I don't, that's a great question if we have any chaplains on staff.
• 40:25
  SPEAKER_01: Um, I definitely need to look into that.
• 40:27
  SPEAKER_01: I know that, especially at one of our locations, um, or really two.
• 40:32
  SPEAKER_01: We've got one in Pennsylvania and one in Iowa that are um the spiritual aspect is very much ingrained in their programming.
• 40:39
  SPEAKER_01: Um, at most locations, it's something that if they would like to incorporate into their treatment, we can absolutely do that.
• 40:45
  SPEAKER_01: Um several of our locations do have a chapel on site.
• 40:49
  SPEAKER_01: And so they have not necessarily a chaplain on staff, but they have um different types of um, you know, clergy, rabbi from a local community who will come in and offer services.
• 41:03
  SPEAKER_01: And it's just sort of an open session for anybody who's in treatment at the time, if they'd like to participate, um, they're invited to do so.
• 41:10
  SPEAKER_01: So um, you know, it's very we talk a lot of the biopsycho, the holistic person, right?
• 41:15
  SPEAKER_01: So the aspects of um biopsychosocial, um, spiritual, and cultural are all part of it.
• 41:22
  SPEAKER_01: So the more um of those aspects that you can incorporate into your treatment, the more effective it's gonna be overall.
• 41:30
  SPEAKER_02: And I think the other thing that I've noticed is a lot of the centers will have like a Sunday time slot where they can decide whether they want to go to participate and either something denominational or non-denominational or stay back and kind of do their own, like whatever it is if they want to participate, kind of have like that free time.
• 41:49
  SPEAKER_02: So I definitely think there's a lot of overlap in incorporation as well, um, just in kind of a different lens.
• 41:57
  SPEAKER_03: A topic I thought of while listening to y'all describe your programs is actually a research study that the Moral Injury Support Network for Injury Service Women is working on.
• 42:09
  SPEAKER_03: It's exploring military moral injury and service members' uh spouses.
• 42:15
  SPEAKER_03: So I was wondering if Dr.
• 42:16
  SPEAKER_03: Roberts, you wanted to share more information on that because I think that is a great topic that correlates with what we're discussing tonight.
• 42:25
  SPEAKER_00: Yeah, sure.
• 42:26
  SPEAKER_00: So um right now we're conducting interviews with spouses of um spouses of service members who were diagnosed with PTSD, should have been diagnosed or might have been diagnosed with PTSD as a result of their service.
• 42:43
  SPEAKER_00: So spouses could be men or women, and the service members could be men or women, and spouse also means uh intimate partners or ex-spouses, ex-partners of um service members.
• 43:00
  SPEAKER_00: Sometimes, as you know, marriages don't survive um moral injury um or PTSD.
• 43:07
  SPEAKER_00: And so we're interviewing um and also doing surveys with spouses um who meet that criteria, and we're finding that for a lot of them, you know, they they say there are a lack of services uh for them because uh a lot of focuses on the service member themselves, and spouses kind of get left out in the cold.
• 43:35
  SPEAKER_00: And spouses have also a unique, unique issues.
• 43:38
  SPEAKER_00: Um, as as you mentioned, Katie, I think Katie Ross, I think you said you're a caregiver.
• 43:43
  SPEAKER_00: So there's a there's caregiver support, there are some caregiver support services out there, um, but it's a unique, you know, the caregiver has their own unique traumas um that they're that they're struggling with, but often don't have the time.
• 44:00
  SPEAKER_00: to take care of themselves or don't feel they can take the time to take care of themselves because if they have a spouse that that is very high needs, um has maybe a lot of uh mental struggles or suicidal ideations or or needs to be constantly watched is not not very capable of of taking care of themselves or or doing basic functions, then they end up spending so much of their time taking care of them, there's not much left for them.
• 44:32
  SPEAKER_00: And then you know just just getting knowing where to get care a lot for a lot of them even some of them that are getting care, it took a long time to find those services um to get access to them.
• 44:49
  SPEAKER_00: So part of it's informational part of it's a lack of care or lack of services available.
• 44:56
  SPEAKER_00: And then and then two just probably not enough programs that that zero in on spouses and and their unique stressors.
• 45:08
  SPEAKER_00: Can you speak to that or or touch on that subject at all?
• 45:13
  SPEAKER_01: Yeah I I think um a big part of it is is logistics like you were saying um the varying degrees of support that the the service member or veteran needs from from the caregiver or even not if you're not in a caregiver stage fully but just a spouse and being a supportive spouse and trying to kind of empathize as much as you can and and and be compassionate and understanding.
• 45:40
  SPEAKER_01: And so a lot of times what happens is they voluntarily you know take on more household duties, more of the childcare stuff or just the household logistics, who's going to take care of the taxes this year and dig up all those receipts and who's gonna take the kids to the doctor's appointments and um especially in the um you know our current society where even in the military community far more spouses are working than than they were in previous military family generations.
• 46:12
  SPEAKER_01: It used to be considered a um a dual I forget the the term for it like a dual spouse career.
• 46:20
  SPEAKER_01: It was thought in the military community you needed the both of you to to keep promoting and get the most out of it.
• 46:26
  SPEAKER_01: But a lot of spouses work now and in there are a lot that are underemployed and have a hard time getting jobs or finishing their education because of moving around but a lot of times it is those extra household duties that you're just your partner is under high stress, you know, the op tempos um and the deployment cycles and when you're changing roles all the time with new commands, yeah you having time for yourself is way, way low on the priority list.
• 46:58
  SPEAKER_01: And and there are an abundance of resources.
• 47:01
  SPEAKER_01: I mean we are very fortunate in this post-9-11 generation that there are I mean there's 4000 veteran service organizations in the country.
• 47:08
  SPEAKER_01: That's not that's just a nonprofit that's not including the the private services that are offered especially the medical side of the house or in the health side of the house.
• 47:18
  SPEAKER_01: But navigating it especially when you don't have a tribe established um if you haven't leaned into the military community or you've relocated recently and haven't had a chance to build that up to try to navigate on your own when you've got all those balls in the air already you're like eh someday maybe someday I'll come around to that case management is huge in for us I think um I I if I if a if some um policymaker or you know legislator asked me hey where's the best place to direct the funds that we have that support the military community I would without hesitation tell them case management.
• 47:57
  SPEAKER_01: There are some organizations that we work with regularly like the Independence Fund, UnderWarrior Project, Code of Support, Sumper Five fund that have staff that are their job is to help these families navigate the resources eligibility criteria is different.
• 48:17
  SPEAKER_01: But then they're also coming from that peer support angle.
• 48:20
  SPEAKER_01: So they're tying together like what I think are two of my favorite things and and most effective things with that case management and that peer support.
• 48:26
  SPEAKER_01: What we really are lacking when we relocate all the time and have become so independent as a as a society that we really need to survive.
• 48:37
  SPEAKER_02: And I think that's a great topic that you're covering for research because I've noticed that widely it is not talked about.
• 48:43
  SPEAKER_02: When I was working at given hour that was something that we kind of talked about as a need and even looking at suicidality among the military community including the dependents in the spouses is not something that's measured.
• 48:53
  SPEAKER_02: So a lot of impact on mental health my husband's active duty kind of like Katie mentioned optiplate changes things change and we're completely outside of a military community right now.
• 49:04
  SPEAKER_02: So we went from being in a dense military community at Fort Carson to being out in the middle of southern Oregon where there's really not that support um and it is different.
• 49:14
  SPEAKER_02: And even though I'm familiar with the systems and the the agencies out there, the nonprofits and things like that, it can still be challenging to kind of wade through those waters and find the things that the kids need or um that we might need just as a family a lot of things go away when that's the case and it just reminds me of my old role which is um which was looking at the military from the reserve and national guard perspective and for all kind of comparison points that's really what a lot of people that are in recruiting are are living that same kind of lack or lack of resources in a dense population like you would see around the installation.
• 49:52
  SPEAKER_02: So it's really interesting and I thank you for looking into that and I think you know it's gonna vary depending on the type of person and and when they entered the relationship and I think the other thing that's been pretty interesting is a lot of times and I didn't um I wasn't married to my service member while he was deployed um he and I got together after he had been in for 12 years.
• 50:15
  SPEAKER_02: And so looking at that huge piece of his life that I wasn't part of and don't necessarily understand and trying to kind of pull apart information that brings him to where he is today a lot of times when I'm talking to spouses and family members that are helping people to access treatment, they're kind of in that same boat and they they're not really sure whatever happened and if they don't have an open communication line with their spouse or their spouse feels like they don't understand their service or their pastor what any part of it is.
• 50:46
  SPEAKER_02: My husband and I talk pretty freely and openly because I do understand the culture and I do understand what he's saying and he doesn't have to kind of like Barney style it to me.
• 50:56
  SPEAKER_02: And it gives us an opportunity to really connect but at the same time you know the spouses that are in the same space as I am so other people in his unit right now, they have no idea what their husbands do on a daily basis.
• 51:09
  SPEAKER_02: And I think that's another interesting piece as well.
• 51:12
  SPEAKER_00: I think a another part of the study as we as we were putting it together we first were looking at spouses of service members with PTSD but part of our we use a community based participatory approach.
• 51:29
  SPEAKER_00: So we put together some consultants from from the very community that we that we're seeking to research.
• 51:36
  SPEAKER_00: So spouses chaplains other other people that work in the in the veteran nonprofit sector and they said a lot of us don't know we think our husband might have been diagnosed with PTSD but we don't know I mean nobody told us or we think he probably should have been or she should have been but you know because of um we don't always get told what they're being diagnosed with and the service member doesn't always share with us.
• 52:07
  SPEAKER_00: So that's where we change their criteria to be um if they might have been diagnosed or if they should have been diagnosed then then we consider them in the project and um it really comes down to using that P PTSD criteria was nothing more than we want to get we want to get to spouses that experience trauma or either you know secondary trauma if you will but how do you do that?
• 52:39
  SPEAKER_00: And so the PTSD criteria was not clinical.
• 52:43
  SPEAKER_00: It was just this is a this is one that we can zero in on um because you can't interview every spouse in the world so you have to have to be able to select some but we were never we were never totally comfortable with that only because we knew that there were probably going to be some spouses we needed to talk to um that that maybe didn't fit the criteria and that's always when you're doing research you always have to make some choices about who's who's part of the study and who doesn't you always have to accept the fact you're gonna not get everybody uh but you hope that you can get uh the ones you need and the other piece of it is too we hope that through the research uh there will be other studies so we can glean what we can this is very exploratory in nature and then we can you know we continue continue to adjust the criteria and adjust the study or do do a follow-on study that that gets after based on the data the data we're seeing so um there's a lot of some very tragic stories of course um and a lot of angles to pursue uh one one last piece I wanted to kind of mention uh Katie uh Siboleto Stinger as you talked about um dense veteran population there was actually a case where I think he was a Marine once he got PTSD and was separated from the Corps then he he actually didn't want to be around or or was not he was sort of persona non grata in a sense because his his fellow Marines it was almost like they were afraid it as she said they were almost like afraid they might catch his disease you know it's like that that kind of thing might affect them in some way and and plus he felt bad that he was no longer part of the team so they actually moved away from from a a veteran population to try to you know make a new start or whatever but that created its own its own set of issues and that they were their neighbors had had no comprehension whatsoever and uh he had a pretty severe case so there were some some things that happened um between that involved neighbors and so on people in the civilian community that it was really hard to explain so so they end up with these very very difficult challenges um and and I have a tons of respect for those spouses because of all that they they have gone through and for many many people given some of the stories would probably say you know you should you should leave that person you know that's you shouldn't stay in that situation.
• 55:48
  SPEAKER_00: But they felt like it's not his fault.
• 55:52
  SPEAKER_00: I mean he went to war he served his country he got messed up and they have learned to set some boundaries over time um but and they certainly thought about leaving but they thought you know I'm if I don't help who who will that kind of thing and sacrificial love and so on.
• 56:12
  SPEAKER_00: So to see that displayed in them and and to see their courage um you know I'm very proud of them.
• 56:19
  SPEAKER_00: I I know it's very very difficult.
• 56:22
  SPEAKER_00: And also look at my own spouse and say you know um my experiences haven't been as tragic and so on as a military person but you know she goes through a lot.
• 56:34
  SPEAKER_00: I'm home I I'm still in the military in my day job and so you know I'm gone I'm gone a lot.
• 56:40
  SPEAKER_00: The kids are teenagers so she has to take them to school and go to their games and do all the thing and pay the bills and do stuff that I normally do at home like taking out the trash and all the other additional things and sort things out.
• 56:56
  SPEAKER_00: Fortunately I mean the great thing is we have video chats and we can talk every night but still you know um it's it's creates a lot of extra burden for her um when I'm gone even if I'm not deployed even if I'm just some other state so um it's a lot it's a lot to deal with and any help we can give spouses and like you said okay there's a lot of resources out there but helping people navigate find them use them um and and also I I think there's a cultural awareness piece for spouses you know helping we just we get so zeroed in on veterans sometimes and service members that you know we forget that not only forget about spouses but also understanding what they go through and helping civilian providers maybe understand what what it's like to be a spouse of a military person and the loneliness and the fear and all that kind of stuff that go with it I think is an important piece.
• 58:07
  SPEAKER_01: Yeah absolutely um there's a that whole cultural aspect that we think about the service member but um it it certainly impacts the spouses and they can't just sort of process um and get the the unique support that's most effective from the neighbor necessarily it's often other military spouses.
• 58:28
  SPEAKER_01: I think that's probably even more so true and harder to find for male spouses.
• 58:36
  SPEAKER_01: And there are a couple of really cool guys who have have popped up on the scene to have a male military spouse sort of community for support.
• 58:50
  SPEAKER_01: But I I hope that that continues and grows and expands because it's really unique and very very helpful makes a big difference for sure.
• 58:58
  SPEAKER_01: And I'll say of our locations we have right now the tactical recovery program is in well in the next couple of weeks it'll be in 18 locations across the country and those are all partnered with the VA so they can use the veterans benefits that way.
• 59:16
  SPEAKER_01: And then we have a couple of locations that are also a network for with TRICARE.
• 59:20
  SPEAKER_01: So those locations help active duty service members but all of them as well can work with family members and do take a lot of private insurance.
• 59:31
  SPEAKER_01: So somebody didn't necessarily need to retain their TRICARE or have set up their VA benefits to come to a culturally competent treatment program.
• 59:42
  SPEAKER_01: If that's what they need, they can still participate in that specialty track even if they've you know they've gotten a new civilian job after their service.
• 59:51
  SPEAKER_01: But something Katie and I and our other team members pride ourselves on is really just being a no-wrong door.
• 59:57
  SPEAKER_01: To me if somebody has knocked and they're asking for some sort of guidance or support or treatment um if we're not the right fit, it's it's not oh so sorry we can't help you.
• 1:00:06
  SPEAKER_01: It's it's what do you need?
• 1:00:08
  SPEAKER_01: Okay, um let me make a couple phone calls I know somebody like you know we'll we'll make sure even that it's not going to be just passing a phone number and a website that we're actually kind of vetting them for them and making sure hey that place is still open.
• 1:00:21
  SPEAKER_01: Yeah, they've um they can take your insurance or they have spots open soon and you need to go soon.
• 1:00:27
  SPEAKER_00: So we'll kind of do that um the challenging navigation um or we'll hook them up with one of those four organizations we mentioned earlier that does that really good case management work and just make sure that it's all warm handoff that there's there's never a wrong door for for any member of our community the family members military kids um is another big topic that we don't even have time for today but that's a very sensitive population that is underserved as well as the spouses um and the active duty service members so really a no wrong door I think is um is what folks need so um thank you so much for that I um we're uh we're a little over an hour um this is administrative we'll cut this out but um I have another meeting I have to go to or get started in a few minutes um so I I need to cut this one short um or cut this one off but what I would say is um is there I guess a good question to ask from here would be just you know any final thoughts or final ideas that you'd like to share with our audience um as as we close this session.
• 1:01:50
  SPEAKER_03: I was gonna ask before we close up the session are there any resources that either of you would like to share with listeners?
• 1:01:58
  SPEAKER_03: That's a big thing that we love to have guests share are resources that you think are very beneficial for people to look at.
• 1:02:05
  SPEAKER_03: And then along with that whatever resources you do want to provide or if you think of them later, please share them with us and we'll put them in the description of the episode.
• 1:02:16
  SPEAKER_01: Okay, awesome yeah we can definitely help with several resources outside of Summit Behavioral Healthcare and Tactical Recovery for folks that do need residential treatment are struggling with sort of that higher level of mental health and substance use disorder needs, tacticalrecovery.com is our website and we'll put the phone number as well in there and we've got folks that answer the phone all day every day and can be there as a you know a friendly voice and can offer some guidance on the other end of the phone for anybody curious about treatment and what it might look like.
• 1:02:54
  SPEAKER_01: But tacticalecovery.com has a lot of great information on there about our programs.
• 1:03:01
  SPEAKER_01: What's the other one I was going to mention for providers um PsychArmor I can't say enough good things about them as far as the education piece and and even as somebody who's a you know lifelong member of this community I learned some new things from going through those trainings.
• 1:03:17
  SPEAKER_01: So even if you're a veteran yourself if you're in a different role now check it out and and you may be surprised what you pick up too because sometimes we get very brand specific in our experiences and and they really take care of the whole community.
• 1:03:30
  SPEAKER_01: And I think then the last piece which is probably should be the biggest takeaway is is to do those like those buddy checks.
• 1:03:38
  SPEAKER_01: And that applies to spouses too you know especially if the service member is on travel or deployed or um or maybe if you just know that they're going through some struggles um just check in or not maybe just haven't talked to them in a while maybe they're doing great you know who doesn't love talking to somebody who's in a great mood check in on your friends on your you know your fellow service members on your fellow veterans um even if you haven't talked to them in years um I think a lot of folks are afraid to ask like really how people are doing because they might get a real answer and they're not sure what to then how to help.
• 1:04:10
  SPEAKER_01: But sometimes even just really asking the question is enough.
• 1:04:13
  SPEAKER_01: They just want to know somebody still cares.
• 1:04:16
  SPEAKER_01: They want to know that their frustrations with maybe what's going on politically is frustrating for someone else too.
• 1:04:21
  SPEAKER_01: Doesn't mean you have to be everything for them just check in on them and coach them into getting the support that they need.
• 1:04:27
  SPEAKER_01: It's a lot more likely for someone to seek help and get that treatment if a trusted fellow service member veteran or military spouse is recommending and say like encouraging them to check it out.
• 1:04:43
  SPEAKER_01: So don't hesitate to help up you wouldn't leave somebody behind in combat you know sticking with that military community theme.
• 1:04:50
  SPEAKER_01: So if you notice that they can need some mental health or substance you know addiction treatment help them through that too point them in our direction.
• 1:04:58
  SPEAKER_02: Absolutely and a lot of times it takes more than once so no matter what it is that you're looking at just the way that the brain operates the more often and more frequently you talk about it and you really ask them like hey how are you doing today?
• 1:05:10
  SPEAKER_02: Or I mean depending on your level of rapport with them I've asked my friends who I know are struggling like are you ready to you ready to actually tell me what's going on and and sometimes the first few times it's like no okay this is what I'm doing you know this is how I'm struggling.
• 1:05:26
  SPEAKER_02: So making sure that we're just really not being too much pressure but being persistent in what we're asking even with our spouses sometimes you're like yeah I know you're not just mad because you dubbed your toe or I know you're really bad from you know something a lot deeper than that.
• 1:05:41
  SPEAKER_02: And for other pieces I want to say before um Dr.
• 1:05:45
  SPEAKER_02: Robert gets off, I want to first thank you for coming and doing a CE event with us in a couple of months.
• 1:05:50
  SPEAKER_02: We're really excited for that and you want to add in some more on that um and some audio and talk about what you're expecting to do for the presentation.
• 1:05:59
  SPEAKER_02: I think that Be great to add to this episode.
• 1:06:02
  SPEAKER_02: But also thank you for everything you do and the support you provide to your family.
• 1:06:06
  SPEAKER_02: Because even though it might be hard when you're away, um, it's definitely worth it.
• 1:06:11
  SPEAKER_02: And there's a lot of support that you all provide to us as well.
• 1:06:14
  SPEAKER_02: And I think um we all feel that, and we couldn't do it without you.
• 1:06:21
  SPEAKER_00: I I appreciate that.
• 1:06:23
  SPEAKER_00: Thank you very much.
• 1:06:24
  SPEAKER_00: Um, I will mention real quickly, as I as I thought about the continuing education program, in um I I do a monthly uh moral injury community of interest meeting with Canadians.
• 1:06:37
  SPEAKER_00: Um, and one of the things we talk about a lot is is just collaborative effort because, and you mentioned this before, the uniqueness of every person's situation, their moral injury situation or their PTSD, whatever it is, that we're all very unique.
• 1:06:55
  SPEAKER_00: So there's no one size fits all, one approach, one thing.
• 1:07:00
  SPEAKER_00: It's wouldn't be great if if we if every group support network, whatever it is, was able to take a very holistic approach to every veteran.
• 1:07:12
  SPEAKER_00: And so what I'm gonna talk about is from a chaplain perspective, emotional and spiritual support, um, some of those things, how we can think holistically and how we can bring other folks to the table uh to provide help to to struggling veterans.
• 1:07:32
  SPEAKER_00: And and and part of that will be just talking about what are some of the things that women veterans are are going through.
• 1:07:39
  SPEAKER_00: What are some of the what are some of the stressors?
• 1:07:41
  SPEAKER_00: What are the what are some of the moral injurious experiences from our research that they're you know, a lot of people think MST, right?
• 1:07:50
  SPEAKER_00: Military sexual trauma, but there's so many other ways that that women experience trauma in the military that is by percentage-wise, much much more common for them than it is for men.
• 1:08:05
  SPEAKER_00: Um, although, you know, certainly men get sexually assaulted too.
• 1:08:10
  SPEAKER_00: So so looking at that holistic point of view and and how do we, when it comes to women veterans or service women, how do we really help and bring you know other collaborators as as support as a community supporting community, how do we work together to each um you know provide something critically important to helping people cope, recover, move forward in their lives um after experiencing you know trauma.
• 1:08:43
  SPEAKER_00: So those are that that's kind of what I'm gonna get after.
• 1:08:48
  SPEAKER_00: And I think it should be some really, really good discussions.
• 1:08:51
  SPEAKER_00: I really want to, as we do with everything, discuss and have some good feedback, uh, hear from others' experiences.
• 1:08:59
  SPEAKER_00: So it certainly won't be a lecture, it will be it will be uh conversation, I'm hoping.
• 1:09:07
  SPEAKER_01: So no, I'm looking forward to it.
• 1:09:10
  SPEAKER_02: Collaboration is essential.
• 1:09:13
  SPEAKER_02: I think one of the things that you were just talking about, and I'm thinking like through my little Rolodex of all my friends who are service members that are female, thinking of the biggest, you know, the largest population of them, actually, they're dual mill, which I would say would probably be an entire new layer of what that looks like.
• 1:09:32
  SPEAKER_02: But of my 15 friends that are service members that are females or service women, um I would say close to 10 of them are married to another service member.
• 1:09:42
  SPEAKER_02: So thinking about that level of complexity and what that looks like.
• 1:09:44
  SPEAKER_02: Family care plan is always a nightmare.
• 1:09:46
  SPEAKER_02: I've been signed up for hundreds of them while being close to the base and you know, everything that's going on, and then like what they're promised in terms of getting the same location as their spouse and who has to make sacrifices and going for leadership courts and taking a baby with them because their spouse is also a commander.
• 1:10:06
  SPEAKER_02: Um what those things look like as well might be something that you want to deep dive in when you have some time, because like you're not busy as the way.
• 1:10:16
  SPEAKER_00: No, that's that's really good.
• 1:10:18
  SPEAKER_01: Yeah, well, we're looking forward to it, and we really appreciate you having us on this episode.
• 1:10:22
  SPEAKER_01: Thank you so much, Mia and Dr.
• 1:10:23
  SPEAKER_01: Roberts.
• 1:10:24
  SPEAKER_01: Um we're uh excited to keep working with you all and collaborating in the future.
• 1:10:28
  SPEAKER_03: Yes, and thank you both so much for making the time to come on with us today and giving us so much information to share with our listeners.
• 1:10:36
  SPEAKER_03: I know they'll absolutely love this episode, and I look forward to adding your resources to the description of this episode as well.
• 1:10:44
  SPEAKER_03: So thank you so much again.
• 1:10:46
  SPEAKER_03: Thank you.
• 1:10:47
  SPEAKER_03: Have a good night.
• 1:10:48
  SPEAKER_02: Thank you, take care.