BTM65 Transcription

Welcome to Episode 65 of Behind The Mission, a show that sparks conversations with PsychArmor trusted partners and educational experts. 

My name is Duane France, and each week I'll be having conversations with podcast guests that will equip you with tools and resources to effectively engage with and support military service members, Veterans and their families. Find the show on all the podcast players by going to www.psycharmor.org/podcast.

Thanks again for joining us on Behind The Mission. Our work and mission are supported by generous partnerships and sponsors, who also believe that education changes lives. This episode is brought to you by PsychArmor, the premier education and learning ecosystem, specializing in military cultural content. PsychArmor offers an online e-learning laboratory that's free to individual learners as well as custom training options for organizations. You can find more PsychArmor at www.psycharmor.org. 

On today's episode, I'm having a conversation with Dr. Carie Rogers. Dr. Rogers currently serves as the Chief Program Officer at PsychArmor and is a clinical professor of psychiatry at the University of California, San Diego School of Medicine. Prior to joining the team, she was the Associate Director of the Education and Dissemination Unit at the VA Center of Excellence For Stress and Mental Health in San Diego, California. 

She received her PhD in clinical psychology in 2000, from the University of Oregon and completed her internship and postdoctoral training at UCSD and the San Diego VA. A licensed clinical psychologist in the State of California, Dr. Rogers is also board certified in clinical psychology by the American Board of Professional Psychology. 

You can find out more about Dr. Rogers by checking out her bio in our show notes. Let's get into my conversation with her and come back afterwards to talk about some of the key points. 

DUANE: You're currently the Chief Program Officer at PsychArmor, which we can talk about that role in a minute, but you've been a clinical mental health professional serving the military affiliated population for a number of years. I'm interested in hearing what brought you to clinical work and to working with Veterans and military families specifically.

CARIE: So my path to clinical work was actually not particularly straight. I started an interest in psychology in college, probably. And I was fascinated with the process of research. That was initially what I really wanted to do and did pursue that and still am a researcher in addition to my interest in actually providing clinical care. But I really got interested in investigating where we get hung up sometimes in our mental health and how to help people move through those stuck places where they sometimes are not feeling well. And then got really curious about why some ways of helping work better than others.

And how do we know that? How do we know when something's working really well? How do we measure that? How do we make sure that we're providing quality solutions to people who are struggling, who in the time of struggle, don't need to be trying to figure out what works and what doesn't and what snake oil and what's helpful.So I was fascinated with all of those questions that I initially entered psychology because I was interested in the process of hypothesis testing. What's the question on how do you get to the answer. Then, I think that I became super interested in the idea of how that applies to helping people.

Initially, in my graduate school career, I worked a lot with children and I worked a lot with children who were struggling with what we call externalizing behaviors, right? So they're acting out, they're being removed from the home and taken into foster care. And then I moved to San Diego where I currently live and did some of my final training at a VA site at the San Diego VA.

And just fell in love with the population that I was working with. And some of them were young. They were younger Veterans, but certainly not early adolescence, which is where I'd started my training at. But really just so enjoyed working with Veterans and their families. It just changed my career, shifted my career around.So that is how I came to that. 

My father served. He was in The Army. My brother served for a number of years. He was also in The Army. They both served in The Army. My father before I was born and my brother served after I went to college. So I didn't live in a house where I consider myself a military kid. I didn't do the moves. I didn't have an active duty service member living in the home as I was growing up. But certainly that service has always been something I've seen and has been part of the family culture. I really came into working with Veterans and their families through my training at the VA. 

DUANE: No, that's something that I think a lot of people aren't aware of is that the Department of Veterans Affairs is one of the premier training grounds for psychology professionals. A psychologist specifically, but also master's level clinicians. That is where a lot of mental health professionals get their start, in the VA system.

CARIE:That's true. And it's true for physicians as well. Actually, it's a huge training site for physicians, psychologists, social workers, depending on what state you're in. There are different training opportunities for different health professionals, but occupational therapy, physical therapy. All of those occupations, one of the major places where people get trained is at the Department of Veterans Affairs. And so it's very interesting to me because I think what we see in the community of healthcare providers is that they're not always screening for Veteran status. They're not always checking to make sure that they're identifying the patients that they have who have served or who are connected to somebody who served. And yet many of them actually trained in facilities, run by the Department of Veterans Affairs. 

DUANE: Yeah, I think that, and obviously there are different parts of the VA, but the Veterans Health Administration, it is the largest health network with a very specific population. Also, a very identified population, but also a population that has a number of whatever we wouldn't call them challenges, problems, or things like that, but these unique, especially if someone is interested in what works for trauma, service members and Veterans, are exposed to trauma. And that's a really good opportunity for mental health professionals to understand what works, what doesn't work, with some of these really specific problems.

CARIE: Yeah, that is absolutely true. So there are a few things that are really interesting. Some of what we see when we're working with specific populations, Veterans, as we're talking about here are experiences, specific experiences and maybe specific challenges that are more prevalent because of their affiliation with The Army, Navy, Air Force, Marine Corps, Coast Guard. Some of what is also important about that is culture. We talk at PsychArmor a lot about military culture and how the culture that somebody works in and lives in impacts the way that they maneuver through the world. How'd they get stuck sometimes, something happens and then they don't get better. And so I think that's a really important piece of the puzzle when working with any subpopulation, but certainly Veterans. Indeed there is, perhaps, a higher prevalence of certain kinds of trauma exposure, but there's also a culture in which people function that makes it harder or easier to recover from some of those experiences. Having a provider who understands that can make life a little bit easier.

DUANE: And that's especially critical is we both know. but I think for listeners that's especially critical for mental health providers, because it's all wrapped into the brain, the mind and stuff like that. It's physical health, it doesn't matter if I blew my knee out playing basketball or jumping out of a helicopter, a blown knee is a blown knee.

And obviously there are some unique differences there. But that cultural understanding pieces, especially important for mental health providers, because it's all wrapped into everything.

CARIE: Yeah, that's absolutely true. And much of what we do to serve that population as people who work with mental health challenges is we spend a lot of time talking to people. We spend a lot of time framing their experiences and helping them navigate the world in a different way. And that's a little different than putting somebody on crutches, right? You have to frame that a little bit differently. We want to talk about that a little bit differently. We may need to have more understanding of some context to treat some of the things that we look at when we're working with somebody with mental health concerns. Having said that, I think that for any provider, knowing the person that you're working with, your patient or client who served, is going to give you a leg up with rapport building, which is really important in any kind of profession, especially in medical professionals. But also knowing what to look for in the person sitting in front of you. Somebody who served in the infantry, for example, maybe that has something to do with the way their knee blew out. Then you might want to ask some of those questions. They may also be eligible for services that some of your other patients might not be eligible for, and you might be able to assist with that. So there's a lot of reasons, I think, to be mindful of the population that you're serving, especially, someone who's served in our military. 

DUANE: And I think that's absolutely correct. I recall when I was retiring, I had an orthopedist where I was getting some surgery done on my hand and basically they were saying that I had the nerve conductivity of a 90 year old and I was in my forties. And they were like, the military did this. And so I, yeah, there are those pieces. and I think that's critically important. But in addition to your clinical work and your research work, you've also been focused on training and education first with clinicians and now with PsychArmor. Why do you think education is a critical part of supporting service members, Veterans, and their families, and those that want to help them?

CARIE: I think it's really connected to what we were just talking about which is the way that we help. The way we support should be informed by what we know about a population of people. And so knowing something about military culture, knowing something about the questions that you might want to ask somebody, questions that you might not want to ask somebody ways of talking about things.

It's really critical and I spent years working at the VA and I really enjoyed my time there. I loved my service in that department. But I know that not all Veterans seek care there. And in fact, the community of people who are connected to somebody who's warm, the nation's uniform are in communities everywhere.

They're your neighbor, they're your coworker. Veterans are an integral part of every community in the country. And so educating more broadly those of us who haven't served, those of us who haven't worn the uniform, educating that group of people about what military service members and Veterans have experienced, how they functioned, what their lives have looked like during their service can be really valuable in creating meaningful connections and conversations.

CARIE: And. That's what I'm really excited about. Not just with mental health providers or even medical providers more generally, we know that rapport, we know that conversations, comfort are super important in those relationships. If I'm working with somebody who's struggling with a mental health challenge, I need to know who they are. I need to know how to talk to them. I need to gain some trust. That's true for physical health providers, but I also think that we all, as neighbors, as coworkers, as friends, want to be paying attention to wherever we're at. And so encountering somebody who's served I'm going to be mindful of the things that I've learned over time, about ways that they may see the world that are different. So I may engage with them a little bit differently, cause I think that's really important. 

DUANE: No, I appreciate that distinction. I think that, and again, like you were saying, talking about medical professionals, someone can be technically skilled in and you were referring to something that is evidence-based and really that we know works with trauma, for example, but not really culturally proficient and not do what's best, I think are able to support that. What's best for even a community provider, for example, that's supporting homeless Veterans, right? If they know, or if they're connecting with Veterans, they have different resources that they may be able to tap into. But if they're not able to build that trust, or even as you said earlier, even asking whether or not the individual served, then you could be as technically skilled in what you do all day long, but you're still missing the mark if you're not culturally proficient.

CARIE: Absolutely. It's interesting as you were speaking, I was thinking about working with community providers when I was a VA clinician, part of what I did was train community providers about military culture and how to do some specific interventions with military Veterans. And one of the things that I encountered was the opposite of that, which we don't talk about a lot, but I would talk to clinicians in the community who would say, “Well, I didn't serve so I could not possibly work with Veterans. I don't understand them. I just need to refer that person out of my practice” and it astonished me. Because that's just not true. What you want to learn, how to do is have a conversation with somebody who maybe has a different experience than you do. Learn a little bit about where they're coming from, what their lens is in the world, and then ask some good questions, be ready to listen, and be open to sharing experiences.

And so we don't want to air too much on the other side, which is if I'm not like you, I can't be helpful. Or I have to know everything there is to know about where you come from and who you are before I can engage in any kind of meaningful connection with you. We want to find that sweet spot, where we begin to see that people have different experiences and we will never understand everything about another person's experience, but how do we know enough to ask some good questions? To be sympathetic to engage in meaningful discourse. 

DUANE: And I think that is critically important. Again, as we're talking about community providers but also just anybody providing support. If you're not in a military community and you're providing support to the homeless population, for example, if you say we're not the place for homeless Veterans, we'll guarantee you if you're not asking the question, there are going to be Veterans in that group. 

Now, speaking of training and education, you and some of the team at PsychArmor recently obtained a certification in the Kirkpatrick Model for analyzing and evaluating the results of training and educational programs. Now, this is an important step. We can provide as many training opportunities as possible, but unless we're able to determine the effectiveness of those opportunities, we're just releasing balloons into the sky. Right? Why do you think this certification is important and how do you see it being applied to PsychArmor?

CARIE: We do, as you said, at PsychArmor, we do a ton of training. We do education. We're all about providing people with information that can help them better engage with other people, whether it's coworkers or neighbors or patients, whoever it is. And specifically with military-connected community, but you're right.

We can do all sorts of trainings. And if people come to them, but they don't like them, or they don't learn from them or they don't change the way that they engage in the world then we have no impact. And so it's really important to us as an organization that we are paying a lot of attention to whether or not what we're doing is well-received or whether people learn from it, get new information, acquire new skills, feel more competent about those skills, but also do they actually take that and apply it in their life in some meaningful way? So are we changing the conversations that people are having with the service member, Veteran, connected family member, whoever, that they’re interacting with. Because ultimately if you know a lot about military service, but it doesn't change the way you engage with people, I'm not sure what the value is of that. So at PsychArmor we really want to make sure that we're not just increasing people's scores on a questionnaire about the branches of service and what the rank structure in those branches. We want to make sure that the education that we're providing, the training that we're providing changes the conversations that people are having.

Now, we've talked in the Veteran serving community for a long time about the military-civilian divide. When we used to talk about that a lot at PsychArmor and social isolation, which we spend a lot of time talking about now, it's not helpful if people learn a lot and don't use it. So we are working very hard to make sure that we are having an impact on people's behavior.

And that change in behavior actually results in better quality of life for the Veteran community and the military-connected community. So the Kirkpatrick Training Evaluation Model allows us to pay attention to the impacts that we have in a really structured way. So that we can report how we're doing and where we're missing the mark we can go back and change things. If you're not checking to see how you're doing, you can't get better. And so that's a huge part of what we're doing. We are using the results that we're getting from our evaluations to change things, to make them better. And we're doing them some iterative process. We're doing that all the time.And we really liked this model. It's been around for a long time. It's speaks really well to the kinds of training and education efforts that we have. And it evaluates impact across different levels. It's easy to have people take a post-test and did they learn something, but this model really allows us to follow up and say, how did you use what you learned and what was the impact of that changed experience? 

So we're super excited. We've gone through the first level of training now. Our goal for the year is to continue on and finish out the certification and continue to work with this model and help other organizations to partner with us to do the same thing. 

DUANE: I'm hearing a theme. First, starting out in research and then practical application of that research and then sharing the results of that practical application with others. And doing research again. And that's really where it sounds like for you specifically but I think that's how an organization as you mentioned learns and grows. 

CARIE: Absolutely. I think that we all let PsychArmor feel really strongly, that we want to make sure that we are doing the work that we think we're doing. And I've certainly, I think everybody's come across treatments or organizations or efforts that seem like a really good idea but then when you follow up later don't really have the kind of impact that people had hoped for. And so our goal is to be doing that kind of evaluation regularly and making sure that where we're not having impact, we change things so that we can start to have impact and where we are having impact and we learn where that is and we build on it.

It's our goal to make sure that our efforts are not wasted. And that we're really creating the change that we want to see. And I think it's a responsibility. I think when you are a not-for-profit organization,we get grants, we have philanthropic giving and we need to steward that money well. If we're not making sure that what we're doing is effective, that it has some good reach and that it's changing the way that people engage in the world, then we probably shouldn't be around.

DUANE: Hopefully, that's not the case because I think that many organizations know and understand the value of PsychArmor so it’s great to hear that we're working to continue that.

CARIE: Well, we've been collecting data for a couple of years now, and actually it looks great. We didn't know that there are places that we want to continue to grow. We are hearing from our learners, from the people that we train, that things are changing. The way that they engage with people changes after they do the education. It's our goal to really continue to stretch and make differences, but we're very committed to making sure that we continue to support this community. And if you're not evaluating what you're doing, you're really not making sure that your helping. 

DUANE: As we always said in the army, the doer does what the checker checks. And if you're not checking on what to do or does then, how effective can you really be? Carie, I really appreciate you coming on the show today.

CARIE: It's been a pleasure. Thank you so much. 

Once again, we would like to thank this week's sponsor, PsychArmor. PsychArmor is the premier education and learning ecosystem specializing in military culture content. PsychArmor offers an online e-learning laboratory. That's free to individual learners as well as custom training options for organizations. And you can find more about PsychArmor at www.psycharmor.org.

I'm always glad to share the stories and insights from the team at PsychArmor. I think it adds depth and context to those of you who are listening, who are also taking the courses on the PsychArmor platform. The first point that I'd like to make is something that Carie referenced at the beginning and even ties into her own story about how not all Veterans seek care through the VA and how she grew up in a Veteran household, but not a military household, a subtle distinction, but an important one. Veterans are everywhere and many of them don't express it or show it. Many are hiding in plain sight. That group of older gentlemen hanging out in the corner at the local fast food restaurant. A few of them have walked the streets of Saigon or woven and out of the trees of a rubber tree plantation. One of them, might've served with the 10th special forces group in bed, told Germany during the Cold Qar. Another, might've been at submariner aboard the Ohio on its maiden voyage. It would be easy to dismiss them as the group of old guys in the corner, but it would also be a mistake. The guy handing out towels at your local gym. He's been on the highway of death during the Gulf War, the nice lady behind the checkout counter she was a drill instructor in the Marines, although you might not believe it.

 I once had the privilege of meeting a Veteran who had served as a military policemen with the 82nd airborne division in Panama and deployed to the Persian Gulf in the first Gulf War. After his discharge, he then served in a different way. 22 years in Folsom Prison for things that happened after he got out of The Army in the early nineties. Did what happened later diminished what happened before? Not necessarily. As Carie said, some of these Veterans may be getting care at the VA, but likely a large number of them are not. And then the medical and mental health providers supporting them in the community, whether they were trained in the VA or not need to ask the right questions to be able to identify them as Veterans and understand military culture in order to help them in the best possible way. 

And that's the goal of PsychArmor to support those who are supporting those who served so that when a Veteran identifies themselves, they get the support they need. This leads me to my second point, our conversation about technical proficiency and cultural proficiency. In The Army, we had these two phrases that described how good we were at our job, technical and tactical proficiency. 

Technical proficiency is knowing how to do the job we were assigned. Do we have the relevant skills, knowledge and abilities required. Tactical proficiency is how well we did that job, how well we applied the skills, knowledge, and abilities we had. Technical proficiency is useless without tactical proficiency and tactical proficiency is ineffective without technical proficiency. We needed both to get the job done. Both the what and the how part of our job. So I can tell you probably thinking where you going with this. It's not like we're taking a hill or securing a beach. But consider a provider or a community support person who knows how to do their job really well. As I mentioned in our conversation, let's take the example of a homelessness service provider. They're really good at their job. They know all of the resources available in the community. They have good collaboration with everyone they need to get the support for someone who is unhoused. If that person is not familiar with or uncomfortable around Veterans, however, they are technically proficient in their job. But that technical proficiency doesn't apply to this particular population. 

Of course, we're not talking about tactical proficiency in a non-military setting, but we can substitute cultural proficiency or cultural responsivity instead. As Carie mentioned in the conversation, however, there's a need for those who have technical proficiency to understand that they can develop cultural proficiency. They have the skills, they just have to be able to apply those skills to those who served. There might be an assumption on the part of those who haven't served that they could not, or should not support Veterans because the provider hasn't served. Some don't feel as though they have the right to work with those who read in the military because they weren't in the military themselves. 

Not because there's some anxiety or trepidation around what Veterans may be like or some personal aversion to working with them. But because the professional with the non-military background feels like they can't help them. Or that they don't want to say the wrong thing or offend them. 

I had a colleague who was a former Marine and he told me a story about how he had started to see a new therapist and his new therapist told him I never served in the military. So I'm not sure I know how to help you. 

He told me that he told her I'm not coming to you as a Veteran to talk about my veteran stuff. I'm coming to you as a human to talk about my human stuff. So, yes, we need to have cultural proficiency when working with Veterans, but just because someone is not familiar with the unique culture and experiences of those who served doesn't mean that they can't care for them. If you find yourself interacting with Veterans regularly, or you start asking the question about military service and find that you have more Veterans around you than you might think, then it just takes a bit of time to take some training and do some research. It just so happens that I know of a place where you can get some of that training. Right here at psycharmor.org. So I appreciate Dr. Rodgers coming on the show this week. If you appreciated it, as much as I did, we'd like to hear about it. You can leave a review on the podcast player that you're listening to this on if it allows you to do that, or you can drop us an email at info@psycharmor.org or you can reach out over social media. All of those are linked in our show notes, of course, but reach out to us and let us know what you think and what suggestions you might have about future guests. 

For this week, PsychArmor resource of the week, we'd like to share the PsychArmor course, 15 Things Veterans Want You To Know For Healthcare Providers. As much of my conversation with Dr. Rodgers focused on medical and mental health providers, this course was created to educate healthcare professionals who care for our military Veterans. PsychArmor asks hundreds of Veterans what they wanted civilians, employers, educators, healthcare providers, and therapists to know about them. We share the results of those conversations with you. In this course, You can find the link to the course in our show notes.