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Transcript for February 2014 Brown Bag

>> I'd start off today. I'd like to say that I would be remised if I didn't recognize three of my professors from Interwork that were on my committee for the thesis that I wrote and had published last year. I'd like thank Chuck, Dr. Degeneffe for being my thesis adviser, Dr. Olney and Dr. Tucker. And actually, I wanted to say that I really appreciate all the support, the help, the guidance and the mentoring that I got from all three of these professors while I was doing my research. And the result of that research is this presentation you're going to hear today because what I'm doing now is I'm preparing to write an article condensing the thesis into a publishable article in a peer review journal. So, we've had a couple of preliminary meetings on that and making a decision on which journal to publish it in and then which direction to go. And so I'm trying to pare this big paper down into about a 20 to 25 page paper to get published. So it's pretty exciting and I'm pretty happy with it and let's see how things go as we progress. So in way of introduction, I would like to say that I had an interest in PTSD because I have PTSD. So that was to me a great challenge through research, PTSD and how it applies to veterans. I wanted to look at the OEF/OIF cohort of veterans, the recently returned veterans from Iraq and Afghanistan. I served in Iraq so I was concerned about my rehabilitation, my vocational rehabilitation when I got back home. So I had this interest built in and this is what I did. I wanted to see what the barriers to civilian work integration were for the cohort that I was going to study where I work at BBSD [phonetic]. And of course in my paper, it is not called BBSD but you get the drift. It's the same setup. And all of the clients that I used for my research came from BBSD. So the conceptual framework of my study was structured around David Hershenson's 1996 work adjustment model.

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And I wanted to look at that because I wanted to check the effects of military incurred PTSD against the Hershenson model because in the past, they had been used on TBI individual. So we're talking about a cognitive disability in both of those cohorts fit that category. So I looked into this in the terms of how would the work adjustment, how would the effects of the PTSD actually, I guess affect the work adjustment, work integration and career development of these disabled veterans. So that was my primary goal to look into that. I think that the research, at least I hope it did and I had one example. I think it contributes to the literature on veterans with PTSD because it pretty much mirrors the research that I did. The literature review that I did I confirmed that the literature is correct in its assumptions of veterans with PTSD as I found them at BBSD. So they did have unique challenges to employment and that's what the paper did. It was trying to get an understanding of how that occurs. So the literature review for the background of the paper was to look at PTSD symptoms in the general public as opposed to the Gulf War II veterans. So I wanted to get a look at that to see is there a commonality or is there any distinction or how does that flesh out? Also, look at postwar deployment adjustment, the barriers that the Gulf War vets incurred when they separated from military service, and I wanted to apply Hershenson's model of work adjustment to that population. So I looked at Hershenson's model in the context of examining how it would affect shaping success or work integration for these folks. It's rather--it turned out to be an efficacious process. The work adjustment model fits it quite well. The veterans go through the same sequentially developed intrapsychic domains that the cohort of TBI veterans did in their original study, so it matched up. What I looked at distracts us. I'm sorry. I--pardon me, OK? I know I should have given you the thumb but I didn't, OK, sorry. Pardon me folks. It should say methodology impact. Yeah, no, no, we're on methodology now. Yes, my apology, OK? Kind of getting wrapped into this and--

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[ Laughter ]

I like talking about this in my discussion, as a few of you know. So at any rate, what I looked at again was the word personality which consists of the worker's self-concept and that becomes very difficult to identify in some cases depending on what type of maybe coexisting injuries or conditions the veteran has. So it was very interesting to do that. I also had to recruit a couple of additional people because some of them dropped out. They didn't feel comfortable with the type of information they would be sharing during the interview process. Looked at their work competencies which consist of their habits, their job-related physical skills and their interpersonal skills. Work goals, what are the measurable, obtainable goals that we can identify in this particular group of veterans. And from there, went into the research design which thankfully for Marge. She taught me how to do a qualitative research methodology. I think Chuck had something to do with that as well. And they really--I think they gave me a lot of good guidance to do this type of research. One thing I want to mention is that this type of research requires a lengthy protocol through the institutional review board and I went through quite a process to do that. So anybody who wants to do any kind of--my recommendation would be if you want to do any kind of human research study or research, get an advisor quickly and get to the IRB quickly because it took me a couple of different semesters to clean all that up and get through that and there was a lag time. So my recommendation is go early if you choose to do human research studies. So at any rate, so we're back to Hershenson's model. Power and Hershenson in 2003 applied the model, as I mentioned before, to persons with TBI and they found it to be very efficacious in their treatment. So that's what prompted me and that's what I stuck with. I found that in the literature and essentially what Power and Hershenshon said is that, you know what, we try this model with this group and you try it with the group that you're interested in and see if it fits and talk to Chuck about it and says, "There shouldn't be any reason why I wouldn't." And it does fit, it was a very comfortable fit to put this group of people into the same type of model that they proved is appropriate for this population. I looked at--you're talking about going through employment criterion. I looked at what the--what each one of these veterans had achieved either pre-military, during their military, what kind of acquired skills they gained and what kind of post military skills they had acquired once they were separated.

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And most of these veterans were separated within when I say recent--recently separated, that's considered to be within the last four years. So all of them had been separated within that time, four years before 2012 I guess when I began that study. So we wanted to find out or I wanted to find out what relevance did all these play in their ability to get into the civilian workforce after treatment in a substance abuse treatment center. That's what I was after. These guys have--they have issues involving drug and alcohol dependence. Some of them had psychological issues, so how are they going to turn out? Were they going to be able to actually get in to civilian employment? So, with the grounded theory design parameters, I went ahead and pushed on with the relevance of Hershenson's theory and what I looked at was we're going to apply it to the participants in the method in which you see here, recognized the research and this line for investigating individual method of grounded research. That was--the most important thing was looking in the grounded theory. And during the research, there were interviews. I'll talk about them in a little bit but I'll mention that during the interview process, I was able to--I interviewed 10 individuals with 12 specific questions. And of the interviews, I had 53 pages of narrative which was amazing. I had no idea and I had over 400 codes that I had pulled out of those narratives. So I had quite a bit to work with and obviously, you can see that when I get to writing the article, I mean I have to trim that down considerably. So we have a concept of how to do that as well. The process that I used was designed for a semi-structured, what would be the interview, which is just talking to your client and to your veteran and getting the information that you're looking for as a way of doing business, nothing specific about it. The interview has generated the descriptions of the meetings that were attributed to each one of these participants. And I obtained the results by pure non-mathematical formula of course because it's qualitative, throw that out to Mark down there because it's quantitative--

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[ Laughter & Inaudible Remarks ]

 

So I didn't have--

[ Inaudible Remark ]

OK. I didn't have to worry about any statistics in my program and that there won't be any in the article either, I can guarantee you. So through--basically, I obtained all the information that I needed to have through the interview process of collecting, transcribing, coding and analyzing the data and coming up with developing that data into how it objectively reports the PTSD of each one of the veterans. And the primary research questions that I looked at to begin with were how do veterans with PTSD view their work competencies. This is what I was really concerned with. It really feel like once you come to a treatment center, you're ready to step back out and you know, get your--you have your ability to go to work and sustain yourself. That was primary to what I wanted to know. And what significant work integration or work adjustment challenges do these veterans with PTSD experience. And a lot of them--well, they came out of combat zones. They were very, I think, delicate once they came into the program, into the treatment program. They needed a lot of help, a lot of care. And I had to be very careful during some of that because some of them as I said earlier decided to withdraw themselves from the study because of the type of questions that they knew they would have to answer. And they didn't want to do that, they weren't at that level of comfort yet. So the other question would be how veterans with PTSD adjusted to work from pre to post military. So that, again during the literature review, I think, clarified that for me and I proved it to myself that that's what works. It actually is part of the process. So the data collection recruitment was ten individuals, all Gulf War II era vets, a cross section of different services and I had eight males and two females. And what I did was I recruited them over about--it took me about ten months to recruit all of them because of some of the dropouts. And then there were some that were not necessarily certain that they wanted to be in a study, so I had to do a lot of convincing. And how that happened was through introductory meetings. I introduced myself to each of them. I held a quick meeting with them individually in the private room. And before I did any recording, I talked to them and I just kind of got a feel for where they were. And told them about the purposes, methods and expected outcomes of the study. And once I had ten that agreed to participate, then I could start the interviews. But what I did was I wanted to gather their information, this personal information and talk to them about their military assignments where they actually were, what type of--what type of interest they have in the study and just basically get an idea of what they needed in order to trust me as an outsider. They didn't know me from how to--I approached them within the employment section where I work and talked with people. And once I got their concurrence on being interviewed, I would sit with them and build a trust with them, a level of trust. So once that happened, I think we're off to the races. The participants--this is--it characterized the struggles that I had already mentioned are similar that I soon found to be similar within the studies, homelessness, alcohol and drug addiction, mental challenges that had gone undiagnosed, inability to work, being late to work or being terminated after a short period of time. So there are a lot of different reasons why these veterans have had difficulties finding employment. So the criteria that I used for the study was to make sure and as I've repeated several times, Gulf War II era veteran, discharged or released from service, more than a year out. Anybody less than a year, I didn't even attempt to talk to.

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I wanted to make sure that they all had war zone assignments and some of them were on military ships that were in the Gulf and that actually participated in combat so they were also eligible for the study, and to meet the combat trauma exposure criteria. And Chuck and I talked about that and we decided that anybody that had vicarious experience with PTSD if they heard somebody, they overheard a story, let's say in the galley having lunch and they heard someone talking about, "Did you hear what happened to Joe?" And that was a vicarious experience and we weren't going to count that. We wanted to have direct exposure. So we were looking at that criteria, trauma exposure, which would be as you saw on that first slide, the team--the IED blowing up near the military vehicle, that type of exposure, and then verified PTSD conditions, rating conditions which are when I say rating I'm talking about the conditions that a veteran can go to the--veterans affairs and file a claim for disability with PTSD or any other service connected disability. So these all had verifiable PTSD. And I think I recall that I put that in my paper, I think 70 percent was the highest rating. I'd have to go back and look at it and write that down after this. But they all had PTSD ratings. So now as far as data extraction goes for this, I've already mentioned a couple of things and I did, but there were a couple of other different meetings and I did it, and the demographic survey was one of them. I sat down with each person. I had them fill out a lengthy demographic survey. I wanted to know their status, know their personal status, employment status, disability status, their military--post military status, how long they spent in the military, where they serve, what they did, what their job was, their duty in the military. And then I crafted with the help of the professors, I crafted 12 questions to ask each one of them and relating to their ability to work, their belief in their work competencies, what type of work they were prepared to do, when they were prepared to do it and so on. The audio equipment that I've used was I had a--Marge [assumed spelling] hooked me up with the saturate program and I had that I used the audio recorder and I hooked it to my computer and tried to get the digital flash recorder to work and it was kind of a tough job in conjunction with my--with the equipment that I had, I took interviews from each one, they would answer the answer the 12 questions, when I transcribed those into a narrative data at which I mentioned earlier it was 53 pages of single space information. And from there the demographic questions--well, we've included--I should have said this earlier. They included a self report survey questionnaire and on that, well, this personal data, disability information, employment information so I already mentioned that. I got ahead of myself. Twelve contextual opened them in questions. Some are structured purpose of questions. Those--those who are generated. Do you have question there?

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>> No, no--I don't know--

 

>> You want to make me comment about that?

[ Inaudible Remark ]

>> Yeah. Whoa, sometimes I don't really know to do these things. You can--you can punish me now, scold me. But, yeah, the process of the data extraction was actually a lot of fun. It was time consuming and tedious but I enjoined doing it because I couldn't remember of course everything that everybody said. And actually some--some of these data in this was--some of the trauma that they had experienced and some of the war wounds, you know, the physical wounds, some of these guys were articulate. I mean they were exclusive in their--in their expressions of how they felt, what had happened before they had come home and had problems with families, you know, wives, spouses, children these kinds of things and you know, just the anxiety that came with all of that without having to work being unemployed, being in trouble with the law, arrested, you know, convicted and then going to jail and all of this types of things, you know, you start reading these accounts and you really realize how damaged some of these veterans really are. And Brianna [assumed spelling] can give you the first interview of that, she is been interning with me for the last couple of days and she has seen it as well and it's--it is very true that it does exist. And again, that's why I wanted to get in into this field and boy, I think I'm making an impression on some of the veterans down there BBSD. So, we talked about the extensive data. We don't know how that went so. The next slide, it's good to go. I'm not talking till it will change, OK. So again, more data analysis, process under the methodology. Again, examining the domains that Hershenson had set up in his 1996 work adjustment model. I think it was--the actual investigations which determine to be significant because it did put in the context to perceptions that--that veterans have and it's also been exposed in the literature. The word personalities are barriers to obtaining more. Their ability to successfully integrate into the workforce is very difficult. Not all of them can. A lot them do but not all of them can. Not all of them will. The word competencies in relation through obtaining work are very important and most of the veterans that I talked with did feel that they were very competent and going back to work. A lot of them had already gone through training and a lot of them--I think there were seven that made to work within that study that I do seven out of ten which is pretty impressive. And then one I just heard about--so I know eight they went to work. One of them--one of the females got a good job, very good job making 18 dollars an hour. I was pretty impressed with that. Their work goals for maintaining employment are also very critical. And actually being able to maintain and then retaining that employment. And so far, the veterans that I see that are returnees to the program are not any of the ones that I had in my study so I'm pretty happy about that. I think it shows that the majority of them that went out have become successful and several of them are family people, they have spouses and children. So I'm thinking that they're doing pretty well.

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>> There is also a perception, that ability to achieve specific work adjustments may not be appropriate for veterans and all veterans and yeah, we've seen that. I think that I have a couple of--again, back to Brianashe has seen a couple of the people that I worked with here in the last few days, and some of them are having difficulty adjusting. They may not ever be able to have a specific job that they--for one that they may want or the career that they're after. But I think with more work, more psychological work with them, they can at least obtain some type of employment to be self sustaining. It may not be a 50 dollar an hour job but it will give them the ability to self sustain.

>> So, we already know about Hershenson and the purpose of measuring employment and with his TBI group. So I kind of see what else I can say here. I felt--what I want to say on this. Can we just--just some more information here on this particular slide that PTSD it does affect their condition. It does create interpersonal challenges that may be with them for the rest of their lives. Several veterans have gone through specific types of training, cognitive process of training, cognitive processing. I mean behavioral or cognitive processing therapy and prolonged exposure, EMDR, and some different therapies involving dog therapy, music therapy, Mark can tell you about that, horse therapy and water therapy. But they may never be cured of their PTSD. There's a possibility that it can be reduced and somewhat managed, but a lot of these veterans were more than likely be on medication for the rest of their lives. If not, maybe, you know, in the next 10 or 15 years. So we did find connection between that and that also is a major challenge for obtaining, maintaining, retaining work. And as I say, the current--the group of my clients, I have a lot of criminals within that. I don't want to say criminals, I mean ex-offenders, OK, with felony. I was pretty proud of myself. Last week I got three of those people placed in two days, two of them have three felony convictions and one had one so I was pretty--pretty happy about that. Seven felony convictions among three veterans is pretty intense. So they are all working full-time right now and they're overjoyed and overwhelmed and it's just, you know, it really makes you--it makes me feel pretty happy, pretty proud of myself that I'm able to get these folks out there and into their current employment. It's actually pretty cool. Let's see, well this systematic analysis of data within the specific narratives, I think all I can say about that is it--it was very, I think very--very personal experience to do that and, you know, to work with these folks because I respect everyone of them for what they did and what they do. So, and I find it by doing this that you know, I made a conclusion going back to the literature and everything that I've read that they're functioning within this process of, you know, that's been interpreted to show that they're they become maybe not whole but again self sustaining. So, we move on the--I just tell you the results. They were tried to merge in themes that come up of the research and you can see what they are there on the screen. Actually, 19 sub themes popped up which is, you know, marginalized, sat down, look at this for a while and we decided that rather than having so many themes and then so many sub themes below them we would go ahead and combine some of the themes into what you see here. So what you see where it says family support and quality of life where education and create preparation and motivation. Those are blended together because they were very similar in regards to the thought processes that I determined from the perceptions of the veterans as they gave--as they gave them to me in the interviews. So, I think that concludes what I have to say. And if you have any questions, thoughts, comments, what I wanted to tell you at the beginning that I didn't is even thought I am doing this--preparing an article for publication. If you have any thoughts or comments on that or suggestions I'd like to hear them. And sort of open to every here, and if you have any questions asked ask away, [inaudible]?

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>> I have a question. I'm curious [inaudible] so I've been wondering, if you begin [inaudible] approaching individual on campus [inaudible]. I know that you have shared some to us that you were--you had to take them from the employment.

 

>> Yes.

>> --so it's not probably about--

>> Correct.

>> I'm curious, how did you approached it and interviewed yourself. Did you interview [inaudible] graduate student or did you expect that you had opened [inaudible].

 

>> Sure. As I mentioned to you earlier, the whole process for that was I had to get permission from the agency or from my director in the agency in order to contact veterans and interview them and discuss their personal issues. I was not permitted to go to the treatment side of the house. It was then called the Veterans--

 

>> Sorry to interrupt, can you repeat the question kind of summarize to the questions?

 

>> Oh.

 

>> You know, that question comes out to the room, my [inaudible].

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>> Sure. Essentially, the question is, how did I approach the veterans on campus to connect with them to actually get them to join into the study? Was I--Did I approach them as a veteran or, you know, an employee? How did I do that? And was it just within the employment center? And yes, it was. I was told not to contact anybody in the--it was called the Veterans Rehabilitation Center at that time. It's not called the Veterans Treatment Center, the VTC. And I was told, "Don't go there because some of the veterans that are going through treatment there are in a delicate state. And, you know, you may cause them to have a flashback or relive a trauma." And I didn't want to do that. So, in talking to my boss, he said, "Look, you know, once they're pretty much done over there, they'd go into another phase. They'd go into phase two which permits them to come into the employment and training section so that they can apply for those services." So, I waited for veterans and this is why it took almost 10 months to recruit this group, always down to one per month. I would wait for them to come in and once they finished working in the computer lab or if they came in to ask a question, I would just interject something in the conversation like, "So where'd you served? And what branch were you in? What was your job? What did you do?" And that would just be a normal conversation I would have with the veteran in the employment section. They would think nothing of it. They wouldn't say, "What are you talking about? Why would you ask me that?" You know, this is normal day to day operations. And the ones that were receptive to it would talk to me and I'd say, "Look, you know, I'm a veteran as well. I know you have right of that. Would you give me a couple of minutes of your time in private?" And if they said, "Sure," and I'd say, "I just want to ask you a few questions. And I'm a graduate student over at SDSU. And I'm conducting research for a thesis. And I'm wondering if you might want to be interested in participating? It's about go forward [phonetic] to veterans with PTSD and how they respond to work adjustment, work integration." And those that said, "Yeah, I'd do that," then I would schedule an appointment and go in with my electronic equipment and do the interviews. And then, I had to do the transcriptions immediately after the interviews. And believe me, some of those interviews were very--they were stuck on by lots of loud noises, incursions. I would have to play them back two or three times to catch some of the wording. And I went back a second time and after I had typed out the entire narrative, the 53 pages and listened again and found other words or what I thought was a specific word and it turned out to be something completely different than what I thought I heard. So that's how I did that. Yes?

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>> I have a question on the process of it. During the whole process of--

 

[ Inaudible Remark ]

>> I think that that's a very good question. And I can answer it by telling you that some--I don't think that there was resistance, necessarily. But some of the veterans were I think and one of the concerns that Chuck had earlier was, well, asking them and I had to ask if they were on any kind of medication, or do you think that you can get through the interview in March? And I thought about this, can you get to your interview without having a flashback or without having a traumatic experience to interrupt your interview? And there were a couple of times, one gentleman attempted suicide. Let me say that he got to the point where he was about three seconds from pulling the trigger. He had the gun in his mouth. And he chose to live because he had so much to live for. He had so much love in his life even though he had been hurt during his active duty and he was convicted of a couple of crimes when he got home. He was still a very valuable person. And that, you know, it awoke in him when he had that pistol in his mouth. And he withdrew it from his mouth and he sat and he thought, "What am I doing?" And this all came out in the interview. And he had to stop and breathe a little bit, you know, for--you know, a minute or so to kind of acclimate himself back to where he was. And I think it was pretty indicative that, you know, there were a couple of other people that were in the same condition not necessarily to the point of going to shoot himself or kill himself, but were very psychology damaged from their experiences. And they had to take a time out. But they always came back and finished their interview. Nobody ever got up and walked out and said, "I'm done with this." We never got to that point. OK, Marge, you have a question?

>> Yeah, actually two questions.

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[ Inaudible Remark ]

 

Do you see the ways constructed in those 12 questions providing an opportunity for the veterans to really do some case exploration of their own experience? Do you think it's unlike the experience with therapeutic, or what do you think about that?

 

>> I do. I think it was very therapeutic because a lot of them--I don't know that a lot of them actually thought about some of those questions because I don't think they were at that level yet in treatment or finishing up treatment. And I think essentially that it was probably cathartic for several of them.

>> Yeah.

 

>> I think because there is a PTSD group there, it's called Triple Threat. And it gets pretty violent sometimes, you know, language-wise and, you know, people, you know, posturing at that time. It gave them an opportunity to talk about their experiences without being threatened, without having anybody sneer at them or disregard their statements. And I think that that was very important for them because a lot of them had not talked about that for some time. They--Not all of them were in the Triple Threat group. A lot of them said, "I don't want to have anything to do with those crazy guys, those PTSD guys. I don't have nothing to do with that." Knowing that they had PTSD and they were at a very high level of kind of disability rating. And I just think that it helped clear the air for a lot of them.

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>> And that--

>> Oh--

[ Inaudible Remarks ]

>> I had two questions but maybe it's not there.

[ Inaudible Remarks ]

The other thing was that, you know, I'm thinking about the five themes that would've--sort of ultimately what you've used?

>> Yeah.

>> How do you think those themes fit with Hershenson's model? Was there upset? I mean, did they accepted a merge from your study also look right in headers of very logical homes in Hershenson?

 

>> You know, Marge, I don't know that I actually analyzed that, to be honest with you. But I think, you know, in reading how they went through their TBI process that there's a lot of commonality. And, you know, the people with the TBI, it's a cognitive disability that they had. And so, we work efficiency, work proficiency, you know, workability are--probably, all very much the same. And I think that, you know, the homelessness and the addictions go along with that as well. So, I think that even though I didn't specifically looked and say, "Oh, this is perfect. It fits," I do believe that it fits, maybe not all the categories but I think most for what Hershenson's model indicates.

[ Inaudible Remark ]

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Yeah, we can.

>> It's kind of to answer your--you know, to address your question, Marge, and so, I think definitely the structure of the--the semi-structure interviews having met, you know, under guard as in the Hershenson's model, I think it worked pretty well to kind of examine in kind of [inaudible] again. And in terms of the data, I'm not sure. I think some of us does. Someone just believes down, you know, do. But just that the family support, quality of life, you know, maybe kind of in a related way but not directly to be out completely reeducation and career preparation, and motivation. Definitely, that answers that connection that you see [phonetic].

 

>> Yeah.

>> So I think that's something in the article, we've definitely going to want to flush up this--

>> Yeah. Yeah. I have--And the more I think about it, I think that's pretty clear.

>> Yeah.

>> That that has to be done.

 

>> Yeah. This is a question from one of the people online. And this is from Dylan Reed [assumed spelling]. I don't know, probably [inaudible] of things. He graduated from a program and he's at the doctoral part of Illinois, University of Illinois. So, he says, "I was at another seminar earlier today discussing the veteran's program [inaudible] in Carnegie Mellon working to increase the number of vets and vets with disabilities entering [inaudible]." So if you haven't heard on it, maybe it's worth checking out. It seems they have shops really to success. And then he was saying he still has some trouble hearing and facing a lot of questions.

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>> A lot? OK, all right. Well--

 

>> Probably Marge's questions.

 

>> I'm sorry. I apologize.

 

>> Yeah.

 

>> Dylan.

 

>> Can you say hello to Dylan for me?

 

>> Marge says, hello, Dylan.

 

[ Laughter ]

 

[ Inaudible Remark ]

 

Sure.

>> I know that you have set criteria that a certain particular type [inaudible] to be a part of the study.

>> Yes.

>> I'm not sure if it'd be best fit and to not--I know that these individuals had been rated for their PTSD intervention. We're also participants encouraging this repeat some types of therapeutic treatment before participants of the study.

>> No, those aren't the requirement.

>> OK. Did you consider one if they had all for these treatments?

 

>> I would say that the majority of them had--I don't--I can't come up with a number like if I did and if I didn't. But the most severe ones and I would say that probably the most--the most severe one of all was an airborne medic that had way more than his fair share of trauma. You know, when you're trying to patch up guys laying out in the field, it's pretty rough. And then there was also a marine sniper with three tours under his belt. And, you know, you get those kinds of traumas and those kind of, you know, guys that are having these night tremors and they're freaking out. And they're hypervigilant and everything that goes with that. They had quite a bit of therapy and they're still angry. But they're employable. And both of those guys have jobs. Yes?

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>> I'm sure that you have [inaudible], some type of plan in how you would handle like that someone with PTSD have some types of episodes or symptoms. Have you encountered that?

>> Yes.

 

>> What was involved in your plan? How would you have handled that if someone has these symptoms?

 

>> Well, Chuck and I went over that during that part of the protocol. And specifying that we felt that what the type of questions that would be asked because we weren't--I wasn't asking any questions about necessarily their--how they're--any kind of triggers or traumas are affecting them. It was all related to their ability to go to work if they felt that they have the appropriate competencies either pre or post-military. Transferable skills, what type of employment are you ready for? Have you received any training since you've been out of the military? Those were the types of questions. So, it was--we determined at that time that there would be very little, if any, concern. However, if there was, if there as an issue, we would stop the interview and allow the veteran to maybe get up and walk around or reflect, or maybe terminate the interview at that time without any prejudice, and then come back at a later time. But that never happened. Most of them--the way I interviewed people is I'm very personable with my clients. And I get them to laugh and we joke. And that was the common bond that I had with all of them was I sit down with that and, yeah, I had been through with bunch of crap myself but you know what, we're all human. We're all the same. And I just want to ask you a couple of questions. And I'd start off with just some kind of, you know, humor. And just maybe go a little bit aside from what I really wanted to know and then refocus. And, you know, just get them to relax a little bit and as we've been talking lately, enter that tranquil state and breathe properly. And that's how the interviews were conducted. And a lot of times, it was like pushing a button and letting the recorder go and these guys would just regurgitate this information out and they wouldn't stop. And some of these, you know, that's why I have 53 pages of information [inaudible], OK. That answered your question?

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>> It does, yeah. I have another question.

 

>> Sure.

 

>> How do you verify that they were involved in combat trauma?

 

>> They all have DD-214s that show me that they were in combat or in a combat zone to begin with. And then, they all have PTSD ratings from the VA. And they would report--I've got this rating and I could've got, yeah, [inaudible]. So, there was validation and verification and a lot of information was exchanged. I looked at paperwork. I didn't just want to have any veteran and I wanted to make sure that this person wasn't just over at the marine base for four years and ready and actually are asked to fire zone, where you're in a combat MOS or doing combat type-related. I opened it up to combat, combat support, and combat service support because everybody in a combat zone is receiving [inaudible] and you could be driving down the road as a truck driver, you know, then I review those often during combat and you got a combat injury. So it wasn't just specific to the, you know, the weaponized troops that are out in the field that, you know, that are in the Fallujahs and the Ramadis that are going up against heavy opposition. It could be anybody. So--And so here you have this myriad of different people. And 70 percent--70 percent, 30 percent, 20 percent, whatever it happened to be, and they were all rated in one way or another. Actually and to be honest with you, I tell you, one gentlemen who was in a combat zone gave an order to a subordinate to go perform a job, a task. That subordinate disappeared. It took him two or three hours searching the ship to find that subordinate who was hanging in a locker by the throat. He went and he said, "OK, I will do that job," and went down and hanged himself. He couldn't take it anymore. So, that was his trauma, finding his subordinate in there, trying to get him off of the hook. He was already dead but he's struggling to getting near to try to try to revive him. Yeah. Melissa, you must have something to say? You must have a question?

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>> Well, I don't know how relevant this is but, why [inaudible] the military is really based on rank even though it's not supposed to be a big deal? It really is 'cause it's [inaudible]. So I guess I'm wondering, could you--you started talking considering about [inaudible] open-ended. I'm wondering if you knew the rank of each gentlemen, and if you share and put your rank was, and if you kind of shared that, and so, what have made a difference between officer in the [inaudible] and vice versa?

 

>> Well, you know, that's a great question. And I wasn't trying to withhold information from anyone. But of course, with a demographic survey, I had all their rank information.

>> Right.

>> And the number of years they served and where they were in combat, and the type of disabilities they had, and the coexisting disabilities. I had all that. And I think one or two of them probably suspected that, you know, I was at a different level.

>> Right.

>> And I don't try to--you know, that's not part of my thing. "Hey, you know what, you're all only in E3.

>> Right.

 

>> Guess where I was?" I didn't do that, kind of thing. If they ask me, I would tell me, yeah, you know, I was an officer. I didn't always expose my rank but they would say, "You were probably an officer, weren't you?" And I said, "Yeah. Well, I was." But, you know, I--the highest ranking person that I interviewed was an E7. So, that would be--in the army, that would be a--what is that? It's a--

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[ Inaudible Remark ]

Sergeant first class. So, that was the highest rank of anybody that I ever interviewed. Most of them were lower ranking, you know, have been in the army, you know, the marine corp, maybe three to five years [inaudible]. You know, some of them are sergeants, that type of thing. So they did--they had leadership roles. But yeah, that's how I handled that. Yeah, Chuck?

 

>> A question from [inaudible] from Dylan. I'm curious if you saw much indication of all the medicating either from doctors or self-medicate?

 

>> That's a great question, Dylan. And one of their questions was, are you on medication now or during--not just during the interview but are you taking meds for your condition? And I only had, I believe, one that was taking medications currently. And none of them self-medicated because they had been on the program. This is a residential program. And to self-medicate is the best way to be terminated from the program. So, no, there was none of that that I'm aware of, let me put it that way. You can never be positive but the rules of the road are in alcohol and drug therapy. You comply with the conditions that are imposed on you.

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>> And the drug testing function?

>> Drug--I'm sorry? Drug?

>> You test their--

>> Yes. And they are tested on a regular basis. There is no getting around that. So they--It's--they were all clear. And I hope that answers your question. Oh, I got three questions. How about you back there?

[ Inaudible Remark ]

Yes, it was. And thanks, Rahani [assumed spelling], for coming. I appreciate seeing you and thanks for the question. Yeah, it was all PTSD medication, although one gentleman did have--he was diagnosed as bipolar as well. So he escaped doing meds. So--And I don't how that affected him but he--I don't think he probably is employable at this point in time because he was the one that found the suicide victim and I don't know if he's ever going to recover from that. So, who else [inaudible]? Brianna?

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>> You have just stated that all of the [inaudible] for participants were part of the treatment program [inaudible].

 

>> Yeah.

 

>> I'm curious to know if [inaudible] part of the criteria [inaudible] if not, how to do you think it would have differ [inaudible]?

 

>> Well, the criteria was if they were--I wanted to conduct the study within the organization within the treatment center. So, everyone that came to me or that came into the employment section. I didn't necessarily know they were not a resident initially but everybody wears a badge a batch that's a resident so you can--you know, within a maybe the first and second or third time if not the first. Sometimes they're disguised under the jacket or in sweater depended on what time of year. And all of them were identified within a matter of a few minutes, maybe the first or second time. And there was no question anybody that came in from off the street was not going to be approached for the study.

 

>> I think part of my question, [inaudible] would you consider doing the additional study and if you think that it would provide different [inaudible]?

 

>> Yes, with veterans from outside? I'm sure they would because those veterans not all of them are homeless and, you know, I was looking at a homeless population, so I would be looking an additional or a follow on would be looking at--you're talking about a different cohort, they would be not--or they could be OEF/OIF that they would be probably a mixed bag employed/unemployed, homeless/not homeless, families/no family, they might be a little more difficult to do that kind of a study, because a lot of them that that are on the outside if they have an insurance plan or, you know, they're covered in one way or another they probably were getting--or even if they go to the vet center, they probably have a better chance of recovery than being in because when you look at BBSD, and we talked about this, there's are recidivism rate. It's not equal to or the same as recidivism in prison but it's a recidivism rate and we see people coming in and out on a regular basis. I don't what the percentage down here now. I don't anybody has ever done the study and maybe actually do that. Just, you know, maybe do write another article.

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>> Sure.

>> Right Chuck.

>> Yes, that's right. So, along those lines, you know, we have several students, we have one [inaudible] student's current program, so you're number four going through the thesis process in the history of the [inaudible].

>> I think that was number three [inaudible].

[ Inaudible Remark ]

>> All right.

>> I think it's 40 years.

>> OK.

>> Yeah. So, what was experience in doing masters thesis, would you recommend it for students who are thinking about doing that?

>> Absolutely. And, I've talked to some of the students that I was in classes with. And some of them were very interested in the possibilities of doing it but they were getting in on the [inaudible]. And probably they--a lot of them didn't want extend there time in school or, you know, they didn't to go through the exhaustive research or whatever the case maybe. But for me I think it was--it served my needs for what I was looking at I was reflecting and there's a lot of introspection into this because I wanted to know a little bit more about myself. And I think I discovered quite a bit about myself. And I would recommend and I mean that if anybody is looking to do a thesis and then, you know, in this kind of a population from our human research study it is a wonderful experience. I would repeat it. And as I told you, you can't discard me from doing this. I'm stuck on it, I want to do this and, you know, I view results, you know, I look back out and I go you probably could have done little better here, a little better there but the idea would be, if that might go also.

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>> So a great step?

>> Yeah.

[ Inaudible Remark ]

I spend an extra year.

>> Yeah.

>> Yeah.

>> OK. I think just, you know, check that [inaudible] three or four and then you kind of communicate without telling [inaudible] and you have and you just probably acquire because, you know, what you are is actually number three of four.

>> OK.

>> Great, OK. All right. Yeah, so you have to get to the end of the track, yeah.

>> Yeah.

>> I would never do that, I would never even think of that.

>> Well, I don't think that's far [inaudible] is kind of an important [inaudible] taking that on.

>> Yeah.

[ Inaudible Remark ]

Yeah, it's.

[ Inaudible Remark ]

 

You know, it's a commitment. You know, you have to be--I mean, I committed myself to this and my wife said, "Well, you know, I'll see you when you get home tonight." What do you do in Saturday? Oh, don't tell me, I know. Library, right? Yeah, OK. So, whatever happened to be, I wanted to do this. I found a theory that looked like it would work for what I was interested in and found that it was perfect. And I think, you know, rather--you know, anybody can--I'm not putting anybody down. Anybody can take a test. You know, you can do--you can go to a program and take a test. And I probably could have done that too and, you know, maybe not have done so well. I just wanted to challenge myself. And I think that that's where I'm coming from. And I think anybody that wants to challenge himself would probably do that. Yeah.

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>> How much time would you think that each week on this project.

 

>> Wow. It became a full time job, you know.

 

>> Are you working at the same time?

 

>> Not when I started but toward the end of the paper, about midway--midway between, I guess, I was working full time, yeah. And, you know, I would say probably I have to dedicate myself. If I didn't do it I have to put my guitar down. I know that makes Mark kind of sad--you know, but I had to do that. I had to put that thing down and just say goodbye, you know, I love you, I'll get back at you. And, I had to put 40 hours a week into writing a paper, because as Chuck well knows, I would provide him and say "Look at what I did." And he would go, wow, OK, you just gave me 25 pages we're going to go with two. And I brought a chapter and he'd go, "You know, what that was a nice try, you really did a nice job of that." That was--

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[ Inaudible Remark ]

 

You know what, OK, I'm exaggerating a little bit. But, you know, there were times where I would write all night long and I think I had something really cool. And I'd go back and look at it the next thing and go, "What am I talking about." And I'd scramble the whole thing and scratch it, dump it, or I take one piece out of it and clip it in somewhere else. So there was a lot of time for the end of this thing. It's not something that you just do within in six months. I guess some people can but, you know, not me. I wanted to know more about it and the more I read about it the more I wrap--got wrapped into it. So, that's what I did. Anybody else with a question, comment? Mark?

[ Inaudible Remark ]

Oh yeah.

[ Inaudible Remark ]

Yeah.

[ Inaudible Remark ]

 

Yeah. I have that experience. And then--And so Marge, you know, helped me out with this part. If they would say no, then I would say, well, would you like to maybe--would you want me to reframe that, or would you like to tell me a little bit more about this, or can you add a little bit--can you add something to that? You're just giving me a flat note, can we extrapolate on that a little bit, maybe to sketch it up, maybe give me three words. And, that's what I had to do. So I had those little snippets that went in there. And you can see them when you read the paper, you can, you know, that would be something Marge would know. And then, well, can you, maybe you go back maybe a minute and then let's move forward again. There was a lot of that.

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>> Yeah.

>> So, yeah

[ Inaudible Remark ]

That's--absolutely.

[ Inaudible Remark ]

Yeah.

[ Inaudible Remark ]

Yeah, I think so.

[ Inaudible Remark ]

Yeah. I get that everyday and I have to tell them the same thing, [inaudible]. Oh, in the back.

>> Hi. I'm Paul.

>> Hi Paul.

[ Inaudible Remark ]

Wow, that's a good question. I, you know, I haven't thought about that before. But I think I could answer that by telling you that, probably not having that experience and then trying to interview veterans with PTSD and not knowing exactly what that is and how it works and how you cope with it. It may have been a little more difficult. I wouldn't say it would impossible but it might be a little more difficult. So having the knowledge from the background and military culture and knowing the language and how you--you know, the little nuances and the inflections when you're talking to somebody like that I think that was plus.

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>> Thank you.

>> You're welcome.

>> And here's that the position in college [inaudible] research and that we probably visit but where the author is reflected.

>> Yes.

>> And, in then [inaudible] where you would talk about their own experience--

>> Yes.

>> --how it matches. So, everything is very transparent which I think to make a strong study. Here's a study where we cannot generalize [inaudible] where, you know, people are telling the truth.

>> Yeah, yeah, I agreed. And then [inaudible] correct about their reflection. Because, you know, as I said I talked about my experience because [inaudible]. So, you're a big guy, a big deal here, what did you do? And I told them, "No." And then there's a couple of horizons [phonetic] and I've seen what it's all about and they have done that. And they, you know, and somebody might call a little bit deeper and then I would tell them, "OK, here's my background. Here's exactly what I did." And they go, "OK, thanks." So, yeah, very true. Anything else Mark?

[ Inaudible Remark ]

Yeah.

[ Inaudible Remark ]

Yes.

[ Inaudible Remark ]

Yes.

[ Inaudible Remark ]

Yeah. Well, yeah. And I started off like, you know, I think on a couple of them, I told them as I pulled Brianna and a couple of the other--some of the other interns that at the BBSD. I'd say, "Watch out, watch out for that employee over there. Watch out with those. They're navy." Well, I was making them. I'm surrounded on all sides. You guys are killing me. We're working with all this navy going on. I would have that at all. And, you know, another marine coming in here and they [inaudible] I love marines but--you know, and they go, "Oh, OK." So there was--you know, there's that kind of stuff going on. It's more just [inaudible] fun than anything else, you know.

 

[ Inaudible Remark ]

 

Yeah, it's good natured stuff. So, well.

 

>> It's pretty great, yeah. Anyone else need PRC [phonetic]? Take this, OK. All right. And, for those of you who have PRC [inaudible]. So [inaudible] meet everybody. Anyone else [inaudible]?

[ Inaudible Discussion ]

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