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Transcript for February 2017

>> Thanks -- thank you for being here. My name is Chuck [inaudible] [assumed spelling] rehabilitation counseling partner. We're here for a homeless to employment, perceptions of OEF and OIF veterans with post-traumatic stress disorder. I'm very happy to introduce our primary speaker Paul [inaudible] who completed this as his master's project in May of 2013. And, Paul -- maybe the number four [inaudible] four to five year history with our program. So, he did it, and it's an amazing study. We're also joined by Dr. Margery Olney [assumed spelling] and Dr. Mark Tucker [assumed spelling], also members of Paul's committee, and what I told Paul is we'll jump in from -- maybe from time to time [inaudible]. But, it's really Paul's presentation, and this is a dry run for a presentation that we're going to give at the FC -- FCRRE conference coming up in April. And, so it was selected as a seminar presentation which is the first year that they're doing this category of presentation. I was told by the -- the executive director of MCRE that this presentation got very high ratings, probably the highest ratings of the seminar proposals. So, it's a really honor and testament to the quality of his work. So, with that we're going to get started. I'll be managing the questions online. So, as questions come in, Paul will have me raise my hand saying we have somebody who wants to offer a question. So, I'd think you'd probably be taking most of your questions at the end.

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>> Yeah.

>> Right? Okay. And, then we have [inaudible] units, give us your email and then [inaudible] something on there that says [inaudible] for that. Was that--.

>> --Do you want me to do it off of here--?

>> --We're just kind of using it as [inaudible].

>> Okay. So, and that's to the right -- the click. Never used one of those before. It was right click [inaudible]. Got it. Okay. Good afternoon, everyone. Happy to see you here. We -- the first slide that I want to talk about is an emphasis for why I wrote or why I collaborated with the other professors to write the article. I served a tour in Iraq in '03, '04 as a military police officer. And, I had experienced stressors from a previous combat tour that came back to me very vividly while I was in Iraq, and it was very stressful and very frightening, and I decided that I needed to get some help. So, when I got back from Iraq, I decided that I would go to VA and get myself checked in. So, I went to the VA in -- in 2005, and I was screened and diagnosed and then rated for PTSD. And, after that I decided that I needed to go to some therapy. So, what I did is I enrolled in a cognitive behavioral therapy program. I went to the eye movement desensitization, and we processed -- we processed some therapy, and I went through PTSD therapy again, and at this time I still -- I still go to therapy. I -- I -- I have a doctor at the vet center down at Liberty Station. I see him at least once a month and that's been for probably the last year and a half, and before that I had a break, but I had gone previously to another center for about a year.

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So, I -- I've been through quite a -- quite a bit of counseling and -- and therapy. So, I'm happy to be here to share that with you. So, after -- let's see -- around -- gosh, this is so small [inaudible]. Let's see -- yeah, so I worked in rehabilitation position at a residential treatment center, and at that time I was there for about three years. And, during that time I had an opportunity to -- to discuss this study with several of the veterans who worked at -- that resided there, and out of that discussion that I had with several -- several of the veterans I was able to recruit veterans to -- to process for a study. And, gosh -- so, I had very interesting time conducting the study, because it was -- I had to deal with a lot of people with PTSD, and many of them were I should say probably still out in the cold. They hadn't -- they had never come in for any kind of treatment. A lot of them were -- had been homeless for a number of years and were negative about treatments. Drug and alcohol treatment -- they didn't want the therapeutic treatment for and counseling for PTSD -- they didn't want. So, it was very difficult to find ten people that would actually join the study. Ultimately, they did, and I think that -- and Chuck asked me, you know, to tell a little bit about how I felt about doing this study. Well, I didn't have any problem with it at all or writing the article. I think it was interesting because of helping veterans regain their dignity. That was the primary reason that I -- that I wanted to help them. The secondary reason would be for -- for me to conduct an academic pursuit and to help me understand myself and my personal PTSD battle which I still -- still battle every day. But, I'm here, and I'm well, and I'm moving forward in life. [Inaudible] remember. So, focus of the present study. It is likely that most rehabilitation counselors--.

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[ Inaudible Comment ]

>> Great. I appreciate that. I forgot all about that. I think I did that at the last [inaudible], forgetting to advance. So, the focus of the study -- we felt that, as a committee, that it -- it was probably likely that rehabilitation counselors possessed limited understanding of the lived experiences of post-deployment challenges of OEF and OIF veterans. That may not be true, but that was what we thought would be the challenge, to provide information to rehabilitation counselors, so that they could better understand veterans that have PTSD and better able to help them. So, for the current -- the current counsel on the rehabilitation education core 2014 standards do not require specific curriculum content on serious mental illness, which includes PTSD for the core program graduates -- required to learn about military organization culture and post-deployment challenges. I would imagine that several of you folks that are currently working at -- at -- at the VA maybe I think more than a doctor needed at this point in time on -- on vocational rehabilitation counseling, which I -- I hope is true. So, [inaudible] slides here [inaudible] have to guess what I'm looking at. Thanks, Mark, appreciate that. So, we think -- we feel that also it might be likely that rehabilitation counselors do not benefit from a lived military experience. Now, some of you may -- may have been in military and learned that culture and came into the VA to assist gratefully. I know one veteran in the room that -- that did, and I appreciate her service.

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So, we estimated -- well, it is estimated -- I shouldn't say we, but it is noted that less than a half of one percent of the United States population are in armed forces, with 49 percent -- this is kind of an interesting concept here -- of all active duty personnel congregated in California, Virginia, Texas, North Carolina, and Georgia. So, a lot of the states don't have any. Well, they do have a lot of active duty and reserve personnel stretched out across the -- the United States, but it's interesting to know that -- that only five have 49 percent of -- of all active duty personnel. So, the shortcoming in awareness among rehabilitation counselors is -- is unfortunate given the likelihood that they will work with veterans impacted by PTSD. So, what we want to try to do is -- is get the message out to rehabilitation counselors that more are needed to provide mental health counseling and awareness to PTSD veterans. So, the Veterans Benefits Administration is the primary setting for vocational rehabilitation and employment services, where -- where rehabilitation counselors provide the veterans with quality of service connected disabilities with rehabilitation services leading to employment. And, I see [inaudible] difference positive. Okay. Yes?

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>> We got a couple comments online, who weren't really sure what OEF and OIF--.

>> --Okay, let me -- let me go. I'm -- I'm on that right now, so let me clarify that. OEF is Operation Enduring Freedom in Afghanistan. It started in -- in 2001, and I don't know that the -- the -- the stop date on that, but there are contingency activities going on in that area now, with US Seals and army and marine corps and air force, of course. OIF Is Operation Iraqi Freedom, and that's -- as it says, that was in Iraq. I was there in OIF one, so 2003 is -- I was actually in Jordan at a forward operation's base, and then we moved across the [inaudible] and went into Iraq, and I wound up in Bagdad. OND is Operation New Dawn. That -- that took over when Operation Enduring Freedom and Operation Iraqi Freedom terminated. So, there are still some New Dawn activities in -- in Africa, but it's not significant enough to -- to really get into here. So, Operation New Dawn went -- began in Afghanistan in 2010, and as of 2015 they were in some other kind of an operation, and I'm not really sure what that is. But, that's -- that's the explanation on those. So, we didn't have any predetermined assumptions or hypotheses when we decided to do the study. We just wanted to make sure that we were using a qualitative methodology to -- which would speak for itself in -- in the article. We designed and provided a foundation for future research.

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So, with therapy development, clinical interventions to give voice to the lived experiences of the OEFOIF veterans with PTSD. We chose to do a phenomenological approach to the study with subjected perceptions of events and meaning that individuals make of their own events. So, the study participants -- participants experienced a phenomenon not accessible to most counselors in the public. Next slide. Thanks, Mark. So, the participants that I chose for the -- for this study were -- ten -- ten of them -- eight were male, and two were female, and I had a discussion with Chuck about that -- and Mark. And, the problem was that where I worked in the -- in the training area, an employment training facility -- there weren't very many women that came in to get services in that area. Mainly men -- a lot of men weren't necessarily looking to go back to work. They just wanted to come in and talk to somebody. So, there was a lot of therapy going on there, but to get -- to get ten people to join the study it took three months over that three-year period of time, but nevertheless I got them all. A couple of them fell out early in -- in -- in -- not quite up to the study yet but just in preliminaries of vetting the -- the veterans. A couple of them fell out, and they were replaced both with women.

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So, that -- that's how we got the ten, and the -- the inclusion criteria that we used for -- for the -- the veterans that were coming in -- we -- we limited this to OEF and OIF veterans. There were a lot of Vietnam veterans and Golf War veterans there as well, but that wasn't our -- our population. We were looking specifically at OEFOIF. They had to have -- they had some specific requirements. They had to have warzone -- warzone duty at a warzone's -- a warzone duty assignment, be separated from the military no less than one year prior to the interview date. They had to meet DOD definition of PTSD, which is in short a persistent reexperiencing, avoidance, and increased arousal symptoms of traumatic -- of a traumatic event. And, they met the VA criteria for combat trauma exposure by experiencing clinical -- clinical symptoms. And, lastly, they were willing to share their experiences with me which were all very confidential, and any -- any names that were used have been used with pseudonyms, and I tried to keep them out of the -- out of the -- the -- the Power Point presentation. So, and you can look at table one which describes military service and PTSD ratings for all ten of the participants. So, VA disability ratings reflect overall disability compensation that they're getting for that particular disability, and--.

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>> --Paul? So, the participants all had [inaudible]?

>> Sure.

>> We've got one army, one, two, three, four, five navy, two marines. And, then the PTSD rating range from ten percent all the way to 100 percent. So, we had three individuals -- or rather five individuals with 70 percent PTSD ratings, one 100 percent, three with 30 -- 30 percent, and then two with ten percent. And, so in terms of the combat assignments -- combats -- it was either combat support, combat service support, or combat, and combat was more common.

>> Yes. Okay. Does everybody know the distinction between combat, combat support, and combat service support? Okay. You -- you know? Or, you don't? Okay. Okay, so what is -- is combat is, you know, it stands alone. It's the -- you're actually involved in combat activity against the foreign belligerents. So, the combat support is -- are the people in the -- that assist the combat fighters with their -- their supplies and logistics and movement, and getting them where they have to go, and that type of thing. And, then the combat service support is in -- generally in the rear. Admin, cooks, laundrymen, you know, people like that. Not -- not to disparage any one of them, because they were all in a combat area, combat zone, and they could've been injured or killed at any -- at any moment at that time. But, that's what that -- that's what that would mean. So, I already went over the -- the two -- the eight men and the two women, but the ages were between 25 and 35 years of age. And, just for -- well, we did -- six were white, five were separated by the divorce, six were navy veterans, and six had some college or -- or professional school experience. And, the population of the facility was overwhelmingly male. So, that's why it was difficult to find any -- any other females who wanted to participate, and a lot of them were a little bit leery about, you know, what -- what would this be all about. So, the guys didn't really mind that much. They said, "Fine, I'll -- I'll get in there and help you out."

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So, [inaudible] one, we -- we just went through that with -- with -- earlier. It just summarizes the demographic backgrounds of the participants and military branch their -- their influencing factor in the participate -- participant section. And, military branch they served in until questions were asked during the interview. Okay. So, the procedure is that we obtained approval to conduct the study -- limited participant recruitment pool -- three months, ten -- ten participants, and they were not permit -- not -- there was no retribution. If -- if the service member wanted to join the study, there was no way that anybody could ever tell them, "You can't do that. You're not allowed to do that. We'll -- we'll ban you from the -- the facility." There was none of that. So, it was very smooth -- a smooth transition from getting them to come in and get in and then from going into the information gathering state or stage. So, I didn't have any problem with that. So, after -- what I did -- this is just the protocol for -- for conducting a -- a -- a research study approved by the university is to provide a letter of introduction about the study, give informed consent, and [inaudible] and then overview the purpose, methods, and expected outcomes of the study, and there was no financial remuneration was offered to anybody to participate in the study. The participants were scheduled to meet for audio recordings of their interviews.

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Nobody balked at that. They all thought that that was a pretty good way to go, and most of the -- most of the interviews lasted between 35 and 75 minutes. I don't know what the, you know, I didn't -- I didn't work out the average on that, but it was -- some were very quick and -- and short, because the -- the people could talk quickly and get the information out. Others wanted to think about things and try to change their words and -- and not be confused with the meaning with what they were saying. So, predetermined interview questions were used to elicit the -- and preserve the candid insights of -- of each of one of the individuals, and we used a semi-structured interview format with open-ended questions. All of them were open-ended questions, and that was used to foster the freedom and flexibility of them while they talked about specific experiences. So, of that, rich descriptions of their perceptions and experiences emerged, and it's quite interesting to see how that grew. Interview questions were grouped into domains which were rooted in the Herschensohn model of vocational adjustment. That was the -- the model that I chose to use for the thesis that I worked on with the rest of the team, and in Herschensohn, positive that people that experienced sequential process of vocation development in response to their particular contexts and circumstances in three domains are included in the work personality, which is work, self -- work, self-concept, motivation to work, perceived work confidence, which is work habits, and physical, mental, and interpersonal skills. And, then development of realistic work goals. So, that's basically what everybody in that study was -- was working toward this to have to that self-concept and -- and, you know, gain their dignity back, so that they can get out in -- in the workplace and -- and get a job.

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So, the phenomenological research asks questions to coalesce around a few major areas, and those are what have you experienced in terms of the phenomenon and what context of situations have typically influenced or affected your experiences of the phenomenon? So, in the Herschensohn model it was chosen to -- because it had the utility in examining how individuals perceive themselves and how they regard to -- in regard to the process of moving from homelessness, substance abuse, other negative indices, and moving to a place of hope and vocational success and adjustment. So, the present study -- present study's interview protocol included questions asked in or anchored at -- I'm sorry -- at each of Herschensohn's model domain. Each participant was prompted to respond to follow-up questions that were asked and designed to provide an opportunity for them to clarify, change, or, modify, or have another explanation for the answer. So, it was very fair, and as I said very open-ended, and they had a lot of opportunity to -- if they said something that -- that didn't come out quite right, they would be able to change it immediately and go forward. So, the -- I have an example of the follow-up questions that -- that were asked. Chuck, what screen is the questions on?

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>> [Inaudible] questions on the slide.

>> Okay.

>> Or, they're in the article.

>> Okay. All right. Well, examples of the follow-up questions that -- that I asked of each one of the veterans is can tell me a little bit more about that? And, I worked -- worked with Marge on these -- these questions, because a lot of times you can ask an open-ended question, you can get a short answer, but it didn't really explain much. So, going with the additional questions, can you tell me more about that or what was it like, what was that like for you, or is there anything else you would like to add, and of course, that elicited more information, and which was perfectly fine, because everything was recorded, and that wasn't a problem. So, the recordings were transcribed verbatim, and the answers were -- answers to the questions were modified only as needed and to insure privacy. And, as I mentioned earlier with the pseudonyms were provided for anonymous purposes. The study resulted from the inducted method of phenomenology. That's where this researcher systematically collects qualitative data and -- and -- and analyzes it -- analyzes the data for connections and insights and transcribes the interview. And, when I did that, it generated 53 single spaced pages which was quite a bit for ten people. So, they were downloaded -- we downloaded with Marge's help, again, downloaded the -- the information into the Saturate web-based, qualitative analysis application, and it was quite amazing how -- I can't explain it, because it's -- it's a kind of a drawn out process. But, if -- if you ever have an opportunity to use Saturate [inaudible], which some of you probably have, it's a great tool. It's great, very proactive.

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Okay, so in qualitative research author Creswell [assumed spelling] in '09 argued that the researcher serves in the role of being a data collection instrument which necessitates the identification, the personal values, assumptions, and biases at the offset of a study. I have to agree with that. There was a lot of activity going on with gathering the information and basically acting as an instrument that -- that took care of everything in the study with the assistance of some of the other professors. Not difficult but time-consuming. So, as the first author I viewed the findings from -- from my perspective as a former army officer in -- in a combat situation in OIF, and that's how I looked at things that I was trying to get out in -- in the article, and through my work as a vocation rehabilitation professional. So, my analysis is or was further influenced by participation [inaudible] which completed in the time of data collection analysis.

[ Inaudible Comment ]

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With data analysis, I ordered to maintain the credibility of the data that we -- that I gathered and applied on [inaudible] -- sorry -- applied in analytic [inaudible] working with the second and third authors with Marge and Mark on the coding process using the open-end actual coding strategy offered by Strauss [assumed spelling] and Corbin [assumed spelling]. Excuse me. Let me get a drink. So, in accordance with the constant comparative method as the -- being the first author, I used open coding and assigned initial codes and then from there, shared interview transcripts and initial cods with the second and third authors throughout the interview process. So, there was a lot of going back and forth and looking at the codes and then recoding and more going back and forth. So, it was pretty intensive. As the interviews were conducted and transcribed, all three of us met on a regular basis to discuss this refinement to the codes which, as I mentioned, there was an awfully lot of refining of the codes. During -- during -- during our meetings, I shared my feelings about the interviews and assignment of the codes with the others and was able to emotionally process what I was thinking and feeling and trying to make sense of all the data. And, I never -- never once thought, gosh, you know, I'm going to quit this, because it's too hard.

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Never even had that thought, because it's quite an honor to -- to be something like this and to assist veterans and to move them forward. So, that was more of what I was concerned about rather than the coding or how difficult it might have been. So, previously coded data were recoded and [inaudible] logical home and connections between the codes resulted in refining some of the main themes by combining related categories which accommodated the original codes and allowed for better coherence within the themes. So, the final set of codes that emerged in the present study resulted from the shared perspectives among the first three authors and the first three -- what the first three authors collectively determined. Data saturation was reached through the ten participants' interviews, because no new themes -- no new themes had emerged. So, it seems that no new themes had emerged, because all of the ten participants agreed upon the five different areas -- themes that we wanted to -- to add into the -- the -- to the paper. So, now that we didn't have to worry about that. It was -- it was a done deal, and we just added in the -- we -- we combined themes when we had to, and some themes had additional sub elements to them, and I think one had none.

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What -- that was the process that we used to -- to gather and put together the themes that you can see in -- in the article itself. To -- to establish the confirmability of the data, a member check was conducted with a participant. He was asked to examine the data and comment on whether or not the codes accurately reflected the themes of the interviewer's findings, and he largely confirmed the accuracy of the analysis and the positive impact of participating and the part following. This is the statement of the person that we did the data check with, just to make sure that somebody was paying attention. He stated that oftentimes I don't get the opportunity to share on these topics and encouraged not by -- not to by others and often avoid in -- in entirely avoid it -- entirely due to aggravation from others in my past However, this experience was the opposite, and overall I think that this study did me some good on a therapeutic level. I was speaking to a professional, patient, and understanding fellow veteran who really wanted to just hear what I had to say. I hope that this study helps veterans reconnect with themselves and find better ways to embrace their military service, even if it wasn't so easy and get back into the workforce. Semper fi. Okay. So, that was very meaningful to me. That hit me pretty hard when -- when I -- when I read that the first time. It was an excellent [inaudible] and it was really -- I was grateful that I had an opportunity to help him.

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>> Paul, I had -- I should -- for a lot of these quotes were very powerful like that. I mean, I think that's one of the -- the characteristics that distinguishes qualitative research.

>> Yeah.

>> Yeah, you mentioned the 53 single pages of text. The reading for that -- I mean you have to kind of pace yourself, because it -- it's not just, you know, reading, like, a logistic [inaudible] a bunch of numbers or whatever. You know, this is, like, you know, people's voice speaking, you know, to you, and so there's somebody [inaudible] like that. Hopefully, as we go through the themes, we may want to read off some of the quotes just to kind of help illustrate that, you know, in the article.

>> Sure. Okay. So, as I mentioned the themes earlier, there were -- it turned out to be five overlapping themes that emerged from the interviews, and they're arrayed in -- arrayed in order of apparent importance to the participants. I wasn't the one that -- that decided to arrange those for them. They decided by themselves what was most important to them and their families and to their welfare and wellbeing and their -- their dignity and -- and whatever else they had that was important to them. They came up with these -- these themes, and the topics that -- that were more salient to them were the fallout from PTSD. So, that's -- that's number one. That's the number one item that they wanted to resolve while they were in -- in therapy. Motivation to change, family support, rehabilitation counseling, and developing new work identity. So, the subthemes undergirding the major themes are provided, and you can see those as well, and that's what Chuck was mentioning earlier about some possible quotes that can come out of there. So, throughout the result section, the participants' quotes are used to use to both illustrate and substantiate the findings.

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So, the theme number one is -- is the fallout from PTSD, and PTSD symptoms and experiences being mood -- mood issues, run-ins with the law, physical disability, family issues, legal problems, homelessness, and substance abuse, anger, depression, and anxiety are the things that mostly resonated with the veterans, because those were what disrupted their families. And, that's why they wanted to get that treatment so that they could get back into a family setting, reintegrate, and get home. So, lots of them had -- and a couple of them in -- in particular had relationships that resulted with confrontations with the -- with law enforcement, and so all of them had temporarily derailed careers, creating the need to start again with -- with new career development. And, that's what several of them were doing. They were working on certificates, degrees, working on getting jobs out -- out in the community, and several of them did that while they were there, which made me pretty proud that -- that they had done. So, the significance of the problem is the subtheme is abusive substances interfered with the ability to cope successfully. So, alcohol abuse impaired -- impaired decision-making. Alcohol was used to cope with the pain and confusion or depression, anxiety, or panic attacks. So, resulted to alcohol. Most of them resulted to alcohol for self-medication, and I'm -- I'm very happy that most of them -- most of the people in the facility survived that. It was pretty difficult for a lot of them, because it wasn't just alcohol. They were smoking marijuana, and crack, and cocaine, and everything else.

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So, another sub -- subtheme is apprehension about living with PTSD and comorbid -- comorbid health conditions. Several struggled with PDI, significant bilateral hearing loss in one gentleman in particular, lower back injury and struggled with depression and anxiety, and he was significantly abusing alcohol in an attempt to reduce his symptoms which never really works. He needs -- he needed to take time to heal, and luckily for him he sought counseling through the VA. Very strongly recommended, and he didn't mess around with it. He went directly to the VA, and he got himself into a program. So, that was a very positive step for him. Legal difficulties are common among -- among this -- this group, sometimes resulting in incarceration, causing extended family turmoil. We had a couple of those as well. Fear of being judged by past behaviors, recognizing fallout from PTSD as central to their daily experience and feeling nonacceptance, because some people don't like former service members. I've never run into anyone like that, but apparently they're out there. So, this gentleman was -- he was rather timid anybody else. He didn't like to talk about his experience in the marine corps. So, whether it was dealing with the disability -- disability -- disability managing perceptions with family relations -- relationships, dealing with the law or battling substance abuse, the participants saw that the fallout from the PTSD to be a central or to be central to their daily experiences, and I have to agree. Theme two was motivation to change, and this -- this involved gaining awareness.

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So, they needed to -- to -- the group needed to get aware -- become aware of their personal values which would allow them to achieve fulfillment and to feel useful, independent, and self-sufficient. Personal development presented a range of emotions that required ability to overcome fear and confusion, reluctance to accept new commitments, and motivation to change was their ability to adapt to new environments and accept new expected behaviors. And, with all the classes that they had to attend and learn how to act properly again in society and get out into the community were very important to them. And, they, as a group, they followed the -- the requirements and went through their programs, and that's why they succeeded. And, the -- the -- the next subtheme is need to change. So, six of the participants had been homeless and another four were at risk based on the challenges of chemical dependency, family disruptions, physical disabilities, mental health challenges, multiple incarcerations and exclusion from the labor force. So, those are -- those are all very challenging for anybody with PTSD or without to -- to try to overcome. So, this is what we had to work with on a regular basis, and I'm just happy that a lot of them had the desire to want to change and not to during the study.

>> Can I offer a -- a quote from the [inaudible]?

>> Sure.

>> And, I think it really gets to your point.

>> Yeah.

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>> So, this veteran says, I have two children at home. Ever since I got out of the military I've been homeless, bouncing from place to place. The longest I've been at a place is -- is a shelter for eight months. I've been kind of depressed because I don't have a job and I'm not providing for my children. We've lived in my car, we've lived out of -- out on the streets. We've lived in the shelter, and now transition to housing in the family program. I don't want my children to go back there or wind up in this position again. My number one concern is to get a job and give them the life that they deserve rather than what they have had during the last years since I've been out.

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>> Perfect. Yeah, I think that explains it quite well, and I remember Erin, she had it pretty rough. That's for sure. I'm sure she's moved on, but wow. So--. --Yeah, so the desire to change, the most motivating factor is just to be independent. And, a lot -- a lot of them in the study included that and their daily regimen was to -- I've got my -- I'm getting my independence. I'm moving through the program, and I will be independent when I get -- get back out on the streets, or, back to the family. The -- the one -- there's a quote here too, just a quick one. It really scares me because I -- I was very good at what I did, and now going out into the real world and getting something that's maybe completely different. So, there was some fear, and some -- some ability to think about what it might be like going back out into the real world. But, that's what a lot of those folks thought, because they had gone into military right out of high school, you know, without any real education, and they put in ten or 12 or 15 years. Most of them put in somewhere between two and four, but some of the people in the study were -- were -- had been in for ten or 11 years, 12 years. And, this particular gentlemen that said this to me is very successful. I have to tell you, he's -- he somehow, and I'm -- I'm not sure how he did this. I didn't delve into this, but the gentle had -- has three -- he manufactures military boots. And, he has three patents for different styles of boots that the military buys. So, he's doing extremely well. And, he started in China, and now he's back here in the states with his manufacturing. Pretty good deal. So, key number three is family support, where -- whereas some people talked about being estranged from their families of origin, several participants became very passionate when talking about family bonds. So, probably most of them did. They appeared to benefit from positive kind of family relationships. However, it seemed that both participants as members of their nuclear family sometimes undervalued family support efforts. For several participants, family involved -- involvement and support felt tangible and emotional motivated them to work toward continued recovery.

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>> I want to add a quote here, and it just says [inaudible] my family helps me every way possible. They helped me very much in my childhood and young adult life, but for some reason I chose to do things my own way. I don't know if it's a sense of pride, or just needing separation from having such a close family, but I've chosen to do things my way, and it's not always the best decision. They have given me tremendous support in everything. My dad gifted me with my vehicle back for nothing. It was such a huge gesture, gave me that -- that freedom and ability to travel to my job.

>> I remember that. Yeah. Yeah. Thanks, Marge. And--. Okay, so -- now let's see. So, this theme -- them number four on rehabilitation counseling addresses the preparation of participants to enter civilian life as part of the recovery program. All participants who received rehabilitation counseling services to find employment, make career decisions, prepare for work, and eventually lead the facility. And, under new career plans, several of the participants needed to retool their plans. So, one who formally tended to emergency room hospital patients and provided hospice care found a positon that did not require close contact with people. Now suiting him -- it now suits him better that he's discovered satisfaction in healthcare, but apparently healthcare subconsciously has been a trigger to his PTSD, keeping him in that frame of mind. So, a lot of people thing, well, why don't you just forget about that stuff? Don't even worry about it. You know, it's -- have your day. You do your thing. Here's a prime example of a gentleman that can't get it out of his head because he's always reminded of it when -- when he's working with people. Initially he started out as a -- an operating room nurse after he got here, and he couldn't handle it after a short period of time because it -- it reminded him of his days as a medic in Iraq. And, he just went to pieces.

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That's why he wound up in the facility, drugs and alcohol. He's doing very well now, which is good. Go on to the next -- and part of it -- part of a quote here is that I now have the basic goal of helping people, but in this case I'm taking care of people on more a global level for a mental level rather than such a personal level. That was -- that was his quote. Getting to the next level is doing the preparation to begin work is important -- is an important aspect of career development. And, one participant was searching for a better quality of life by keeping the career that would move her forward, provide potential growth, and equip her with skills to find sound equipment -- employment, excuse me. Entering a new career or preparing for a career was important to participants. These activities took place within the context of rehabilitation counseling, although participants did not specifically identify the counselors, which they didn't have to. Developing a new identity, and curing the disability was life changing for all -- all participants. Similarly, becoming employed as a civilian contributed to a positive sense of self in most cases. Movement toward develop -- developing a new identity involved going past the stigma of receiving help and finding a new basis for identity beyond their military service and entering civilian employment. And, on to identity issues. One of the participants said that he stated he felt being a marine has been the most important aspect of his life, and after discharge he attempted self-healing and coming to terms with everything that happened during his military experience. He was very disheartened to acknowledge his new civilian role because he was so clearly identified by his third-generation active military status. He tried to moderate thoughts of his military experience, but acknowledged they were always -- they would always be present, which was true.

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Okay, so employment as recovery. Another participant was a rare personal health wellbeing development, and additional factors that contributed to his new identity as a person with a disability. And, his statement is that his disability has a part in depression and being depressed is partly because he felt useless. He admitted to needing a lot more therapy. So, that's how severe that can be. Identity and stigma. Participants who are sensitized to being identified as a person with a disability in the workplace, and employment criteria for hiring by federal contractors with disability -- via disability rating of the degree of disability, which this gentleman had considered stigmatizing if he shared with a potential employer. So, he was not -- not happy that part of that process was for him to -- to actually self -- self-disclose to an employer that he had PTSD. I don't -- when I -- in my counseling role I don't tell anybody to self-disclose any kind of a disability. I wouldn't want them to do that, but this guy, he just said, hey, I've got -- these guys are probably not going to hire me. I told them I had PTSD, so he lost out on that job. So, he's a former mortgage broker, and lost a promising career within a very short time as a result of his PTSD triggers and depression. So, that -- that's how serious it can be.

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Through the phenomenological method, the present study provides insight into how the ten formerly homeless and -- and unemployed OEFOIF veterans transitioned into seeking employment and recovering. Completing the treatment and vocation rehabilitation process allowed participants to achieve independence or continue to be directed toward that goal. The results indicated that six of the ten participants became in full time positions, whereas four participants did not find employment. And, it wasn't that they didn't try to find employment. A couple of them were pretty well beat up. One of them is 100 percent disabled, and walked with a walker and -- it wasn't -- I -- I'm -- I'm supposing that he probably could find a job if he really wanted to. But, he just chose not to at that time because he was in such pain, and -- and he was going to take a long time to recover from his disabilities. So, two were not able to work because of disability related reasons, and one withdrew of the program and a another participant remained in treatment to complete her 12 step program. I remember her. She didn't want to go back out into the community while she was not sober. And, she decided that she would stay at the -- at the program, finish off the 12 steps and then complete and information technology employment preparation course while she was doing that. And, she did. She got a certificate in information technology employment.

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So, that is good for her, and I'm glad that she stayed. Implications for rehabilitation counseling. Findings speak to the need for rehabilitation counselors to assist veterans with PTSD in the process of returning to family relationships, employment, and community participation. So, I think a lot of folks in here are probably on -- on to that. They are providing that at this point in time. Findings also suggest that preparing rehabilitation counselors with knowledge of effective PTSD treatment, vocational rehabilitation approaches, work adjustment, and specialties and other specialties is essential to the overall success of OEFOIF veterans with PTSD. And, after their informative training, rehabilitation counselors need ongoing continuing education through attending conferences, taking classes, participating in webinars, and reading journal articles and books.

>> I'd like to add to the last [inaudible].

>> Sure.

>> One of the things, you know, we talk about in the article is just that, as you talked about before, the lack of training that master's level rehabilitation counselors get in the programs, as well as people, you know, working out in the field. But, I think thankfully that's changing to some degree, which is one of the reasons why your -- your presentation got accepted by MCRE. I mean, there were a number of military veterans specific to areas and mentioned the call for proposals for the conference--.

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>> --Yes--.

>> --That, you know, [inaudible] recognition that -- that the profession's really, you know, seen this as a -- as a need. You know, I think to your point earlier about where most of the, you know, the military's so concentrated so many, you know, just a few select areas of the country.

>> Yeah.

>> There's not a lot of rehabilitation counselors that really have -- just a very limited ongoing, you know, contact with veterans and active duty military. So, here, you know, we're a little bit different because we're -- this self-run center.

>> Yes.

>> So, getting to address a national audience at this conference is really a very helpful [inaudible].

>> Yeah, I believe so. Yeah, it should be. Does anybody -- I'll just ask a question. Does anybody disagree with the -- with the process of counseling and rehabilitation, that rehabilitation counselors still need more training to work with veterans? Not just OEFOIF, but all veterans with disabilities? Everybody's happy with that?

>> Yeah, I think everybody would agree. I [inaudible] training and kind of additional brief depression training. Every conflict is different.

>> Sure.

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>> And, then you know, [inaudible] radical difference and changes from the [inaudible]--.

>> --Yeah--.

>> --To what we've go now for urban warfare versus jungle warfare, and different -- some underlying truths that remain constant as well. And -- and so, I believe that there needs to be ongoing education and the hardest part I have to think is sitting on the other side of the desk and trying to work with somebody that has PTSD. And, my own personal [inaudible] everybody can speak for themselves, is trying to make -- trying to get information from -- what I can use that [inaudible] aircraft mechanic. And, you've got a good government job right now, make five to 6000 dollars a month over at North Island.

>> Sure.

>> And, you're -- but it -- is it the sound? Is it the aircraft? What can I -- what can I help you to adjust to to better fit into the situation where you can use those transferable skills because you like doing those things. And, yet maybe not the best place you could be. So, how you -- having the conversation that says this is what I need from you guys. This is what -- this is what I've been able to identify.

>> Sure.

>> And, [inaudible] driving on the roads where there's a crash on the side of the road, because--.

>> --Yeah--.

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>> --Of -- of the problems. And, so if they -- if they know what their triggers are when they come in or if they're able to [inaudible] with us a little bit to identify that. And, then we start to look at the next profession that is helpful. And, that's where we kind of have the difficulty a little bit. They're like, you know, they have anger issues. Well, what are you going to do, you know? Try to [inaudible] every person? Are you angry at females? Are you angry at males? You know, you're angry at people in uniform. You know, don't just say I'm angry, because that's hard -- it's hard to work with that.

>> Exactly. Thank you.

>> Then, you know, it just depends. [Inaudible] had, in the field as a practitioner, what we're seeing is that if counselors come in and they're scared to have those conversations and help people sort out what their triggers are in order to make a -- a plan for future employment that really works and makes sense. That would be a really important skill to have coming to the workforce.

>> Yes.

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>> Yeah. That's what [inaudible] said. I mean, it -- it -- there's a lot that goes into -- [inaudible] the very personal [inaudible]. And -- and it's very uniquely different for a lot of people with a lot of things that people have [inaudible]. And, I think those who [inaudible] disabilities that work with it every day. And, so we can have that conversation, but we won't want to -- we don't want to push anybody [inaudible].

>> Absolutely. I understand.

>> And, that's [inaudible] when we say, you know, [inaudible] job, [inaudible] school, you know, don't ask me. And, it's kind of like, okay. We're trying to find the right job for you, so that's why we're asking.

>> Sure.

>> And, it's just a thing that you have to do in the -- in the counseling to try to find out what's going to set them off, or you try not to. And -- and so I think that's what the -- the education really hit them with the practical aspect of integrating someone and really giving someone [inaudible] finish out in some time, you know?

>> Thank you. I appreciate it.

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>> I think I would say [inaudible], but you know [inaudible] that -- that I hear when -- when--.

[ Inaudible Comment ]

And, so the question that you give them that you think would be helpful. Tell me more. [Inaudible].

>> Yeah.

>> What was that like to helped? You know, and everything that you thought about when you were out and about. And, ask them right out. But, in terms of being a care [inaudible] is insulting, how do you -- how do you adjust them? How do you pull that up? [Inaudible] something that patronizes try to pull some strength from -- in just a short amount of time.

>> Exactly.

>> And, really get them moving forward and [inaudible].

>> True.

>> But -- and that's why [inaudible] are here because we want [inaudible]--.

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>> --I agree--.

>> --[Inaudible] to be more [inaudible], to be more efficient, and the [inaudible] we have to do [inaudible].

>> Great.

>> And, just the numbers. I -- I don't think that [inaudible] PTSD, I don't think [inaudible].

>> Yeah.

>> So, that makes it even more difficult.

>> Yeah. Yes.

>> I just want to say from personal experience, we can do a lot more to pair them before they transition out to civilian life as well. Like my husband, for instance, when he got out, you know, it was pretty much like you go to a couple classes, just like, on transition out. But, they don't really teach so much either, and I think maybe they can also provide some counseling services. Not just necessarily as a mandatory thing, but kind of something that, you know, helps them, because I think a lot of them [inaudible] fear of what's going to happen next. Or, if you have PTSD, you know, like, how am I going to deal with, like, day to day life then.

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>> Very true, yeah. A lot of that stuff to GPS activities is web-based and it's all about ONET and how does your rating or MOS translate over to the civilian side. And, I've worked with quite a few people that say I -- you know, I really don't need to see that again. I've been beat up with that over the last two weeks, and I don't want to look at that any more. So, can we just talk and maybe I can -- we can figure out what I need to do? Well, assessment testing is very -- I think necessary any time -- any time anybody wants to come in and look for a job. Give them an assessment test, and that generally will help them make a determination, two or three options have been laid out. So--.

>> --I've got a question from earlier on that -- I told this person that we would ask this later. [Inaudible] wanted to know did divorce among the participants -- was it more likely to happen, you know, before or after deployment? Was it related to, you know, symptom [inaudible] the PTSD? Maybe as you think about the question is how to overall, like, how you saw the post-employment challenges affecting family relationships, marital relationships, and that kind of stuff.

>> Sure. Okay, hold it for now or?

>> What [inaudible] now. Yeah.

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>> Sure. I don't think I -- I did any kind of research on whether it was pre-deployment -- pre-deployment, deployment, or post-deployment on -- on that question. But, it seems that several of the people that were -- that we had four I think divorced in the group. And, I never really asked them specifically when did you get divorced, you know? Or, what's your -- was your spouse in the military when you did that or did you do it when he or she came home or what the case was. So, I don't really know.

>> Yeah.

>> Yeah. Okay.

>> I -- I have question for the group basically, [inaudible] researchers and when Paul does this, he goes through a very systematic process of determining what those five things were. And, I'm very curious from practitioners, whether you're seeing that those five things ring true in terms of your own experience with vets with PTSD?

>> Yeah, I work with veterans with PTSD, and I would say, I forgot about that thing that you learn.

>> Yeah.

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>> But, I would say, yeah, that's exactly [inaudible] of that. [Inaudible]. And, you can see that it really does -- like even from [inaudible] it's not going to be one thing. It's going to be a [inaudible] same as before.

>> Exactly.

>> And, [inaudible] counseling them [inaudible] they really are.

>> Yep.

[ Inaudible Comment ]

Yeah. Well, thanks for the input. I appreciate it. Okay. The implications for research. So, the findings that we came up with from the -- from the study support the role of vocational planning and employment as a key element in PTSD treatment. Okay, so vocational planning and employment, key elements, and our findings also document the value of treatment and employment for improving family relationships. So, it's pretty much all about the family with this. For some participant -- participants, this sometimes required repairing strained or broken relationships with family members often resulting from the struggles of living with PTSD. And, a lot of time when there was visitation, a few people would come and visit and they didn't stay very long and then they would leave and a lot of the people never had anybody come and talk to them at all. Quite sad, and then -- it was unfortunate. So, we looked at the -- the limitations of the study, and we found that basically, you know, we do have limitations because our focus was on OEFOIF veterans. And, they had functioned in a combat and combat support or combat service support role in Afghanistan or Iraq. They were separated from military service at a minimum of one year prior to the study, and they sustained PTSD as the result of the warzone counter-stressor. So, that -- those are the -- the specific limitations that we found conducting the study.

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>> [Inaudible] from a methodology -- from a perspective -- why do you -- individual interviews as opposed to doing focus groups with -- with this population?

>> Okay, good question. It -- as -- as -- to bring a focus group and to try to determine -- that could be either -- it could be a group of mixed veterans, non-veterans. It doesn't matter. But, they all have a certain opinion and in order for them to process anything with an individual can get very sticky and the individual may not be amenable to speaking to four or five people at a time. So, to do a one on one interview is, in this case, the best process that could be utilized for veteran on veteran conversation because the focus group -- you don't know who they really are. You'd have to vet them first to have them come into a -- a interview situation. But, I wouldn't do that because it's more personal and private when you're one and one and you can gain, in my estimation, a lot more information than talking to a group, because they don't know who's going to -- whether they're going to sell this information, are they going to post it somewhere? Are they going to put it in an article? I don't want that. They don't -- I don't know what they're going to do. So, going through the process of the institutional requirements and working with, you know, human subject, it was more sensible to me that -- to do one on one. And, it -- I think it made a big difference on people being able to open up and share. Yes.

[ Inaudible Comment ]

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No, there was no contact between the subjects and -- and the interviews. They didn't even know who each other were. They may have passed each other in the hallways or out in the -- in the out -- outdoors somewhere. They have been in the same classes together, but they -- normally they wouldn't know one -- one person from the other because it was all confidential.

>> [Inaudible], you know, I -- using -- using the support group as a therapy tool I think is a great idea, and I think especially around [inaudible] and getting people prepared to enter the workforce. I can't believe that's my phone. It is after 1:00?

>> Yeah. It's quite a bit after 1:00.

>> But, so -- so I think [inaudible] great suggestion in terms of things that we can do to really facilitate healing. [Inaudible] because they look at us with sadness [inaudible] as much of that as possible it kind of helps to relieve some of that fear.

>> Sure.

>> That going back into a civilian workplace isn't the end of the world.

>> Yeah, absolutely.

>> [Inaudible] part of the idea of what I'm trying to--.

>> --Yeah--.

>> --[Inaudible] that I thought I had.

>> Yeah. I -- I agree.

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>> [Inaudible] was that these veterans are coming out with PTSD, their commanders know have PTSD, people around them know they have it. And, so they bring that up thinking that -- and we don't -- and I tell them, you don't have it [inaudible] that they know that they don't have to [inaudible] part of that fear.

>> Sure.

[ Inaudible Comment ]

>> Yeah.

>> Yeah, big stigma too. [Inaudible], I mean, I think [inaudible] people are -- vets are really aware of the fact that people in the public have a lot of fear and concern about hiring somebody who may or may not be [inaudible].

>> [Inaudible] hire, and they're the ones to check off that we hired certain vets and if you walk in and you're upright and you don't have any missing limbs. And, they look at you and they're like [inaudible]. But [inaudible]. [Inaudible] one of the [inaudible] that I felt [inaudible]. I'm interested in the experiential aspect to some of this in that when we talk about recovery, we kind of think that if -- if there's some spiritual aspect that [inaudible] a power other than yourself in [inaudible].

>> Yeah, that's a good suggestion. Yeah.

>> That cannot be [inaudible] people talk about that--.

>> --No--.

>> --And it says that part of the motivation changed or--.

>> --No, just well -- just [inaudible].

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[ Crosstalk ]

>> You can go ahead. I'm sorry.

>> One thing I found out [inaudible] anger is that it ultimately comes down to they're angry at God [inaudible] go on [inaudible] out there and war and [inaudible]. And, [inaudible] I've had people [inaudible]. They even [inaudible] falling off their shoulders [inaudible]. You know, changes don't [inaudible].

>> Yeah, I would [inaudible].

>> Yeah, good questions. Okay, we'll go ahead and move this along to a conclusion at this point in time. So, the -- the increasing numbers of veterans with PTSD symptoms are separating from military service with many pursing community integration, vocational and educational services. I work out at Mesa College, and I have a lot of veteran students that come in for assistance. And, it's really great. I love it when they come in because they -- they want to get an education. They're looking to get a degree and move on, and a lot of them are transferring over to SDSU and UCSD, and it's -- it's quite -- quite fulfilling, I have to say. It's a very enjoyable position and I actually love being there because every one of the students that comes in has a special story and I like to help them out. So, unintended consequences of military downsizing replacing inordinate financial and personal burden on healthcare professionals, supporting service providers, community resources, families, and employers. And, findings from the study as well as future research can serve as a guide for veterans with PTSD to navigate both the veteran and the civilian in social service systems, and to develop an understanding of complex skills and training. The topic of veterans with psychiatric disabilities and their capacity to return to work has not received sufficient attention in the rehabilitation counseling literature.

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>> I just had a question from online. This person asks, how did veterans connect with the VA? How long did veterans -- how long did it take for veterans to come to the VA for treatment from discharge date?

>> And, I think [inaudible] the military. I'm asking veterans to come to the VA earlier. It may prevent them -- to come home and still receive treatment service [inaudible].

>> That's really a great question, and I don't know the answer to that, because in my interviewing I never asked -- I asked what branch you were in, and how many years you have served. But, I didn't ask anybody if, you know, where -- did you go to the VA the first day you got back or have you been yet? Some of them didn't ever go the VA, and it's like the one in here went to the VA after his interview. He said, I've got to go get myself straightened out. I just told you everything about me and I'm going to go to the VA and get -- get cleaned up and get off of the -- the booze and the dope and all this kind of stuff and straighten out. And, so I don't know. I mean, in my experience, I went the day after my terminal leave. I walked right into the VA and I said I've got some issues and we need to get it straightened out here.

>> One person said that he was responding to your point, and this is a -- a -- it's a student in our program. The VA system is backed up and it has just recently started to use -- started to use the Choice program [inaudible].

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>> Yes, and I can attest to that because I've used it. Yeah. So, let's see. Okay, I think we're finished up with that one. It is anticipated that as we -- that as more OEFOIF veterans with PTSD reintegrate into civilian life, it will stimulate advancements in training, research, and service provision for this population. So, findings also reinforce the idea that with effective intervention, veterans with PTSD are capable of attaining -- of obtaining, maintaining, and retaining employment and successful reintegration. Okay? [Inaudible].

>> Thank you.

[ Applause ]

>> And, [inaudible] a lot of words, but we got through.

>> We're over time, but--.

>> --Questions--?

>> --[Inaudible].

>> Yeah? Any questions? I'm happy to entertain them. No?

[ Inaudible Comment ]

>> Do you want me to help [inaudible]?

[ Laughter ]

>> Marge is the -- Marge is the -- the expert on this subject.

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>> Okay, well, one of the thing that Paul is talking about is the [inaudible] and what happens is that with those transcripts, each passage receives a code. And, sometimes they come to [inaudible] and [inaudible] comparative method of going from one transcript to the next to the next, continues on and on. So, [inaudible] 100 codes, from those codes you develop larger categories, with codes underneath them and from those categories, build out to larger themes. So, the themes ultimately emerge from that coding process where each passage was coded. And, [inaudible] if it can take codes and sort them according to code. So, if you [inaudible] codes that say alcoholism for instance, it'll put all those -- every single passage that referred to that would be within that code. And, that's how you can distill it down and develop the ultimate theme with the category and then the code under the theme. And, then for all the [inaudible], too, it's from that whole process of winnowing down from [inaudible] from the code building up the theme and then figuring out what in each of those themes and categories, which codes exists, which codes are there, which ones are you going to use to both illustrate and kind of illuminate what that theme [inaudible]. Is that helpful?

>> Yeah. [Inaudible] before. Yeah, [inaudible].

>> [Inaudible] three percent. I think 30 years ago it was pretty unconventional, and now the quality of research is used all the time [inaudible] most federal grants, they're looking for funding for a research study [inaudible] to see at least some interviews, some focus groups as part of that study in order to really get exactly what it is that -- that participants are saying about the particular thing you're researching. So, now it's pretty much acceptable research and really, really good introductory, exploratory research to set the stage for other kinds of research.

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>> Yeah, if I could just add onto that, a number of our doctoral students [inaudible] complications. And, so a number of our doctoral students are using this as qualitative research [inaudible]. I had a student last year who interviewed females [inaudible], women who had separated -- they were already out of the service and they were in community college. And, she did a similar thing where she interviewed [inaudible] different people, all women. And, looked at their experiences of coming to community college, that whole transition of coming into college and what was happening next and -- and some of the same themes that we found [inaudible] the kind of changes that they were going through. And, she did that [inaudible].

[ Inaudible Comment ]

>> On a national level, we have a higher percentage of females veterans that apply to vocational rehabilitation.

>> Really?

>> And, the females are more successful. So, the question is [inaudible], well, if they're [inaudible] seeing combat issue that makes the males more susceptible.

>> I don't know. We didn't go that far. Our cohorts [inaudible] average of six [inaudible]. We kind of focused on [inaudible] cohort.

>> Sure.

[ Inaudible Comment ]

Yeah. Interesting.

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>> Well, I did do, like, a research paper that kind of talked about that. Mine was, like, more towards, like, sexuality and veterans, but it included PTSD. And, it just kind of stated how, you know, like, women are a little bit more willing to be open with their feelings, whereas men, you know, they still feel [inaudible] opening up kind of -- it's that, you know, they keep their guard up. I think [inaudible].

[ Inaudible Comment ]

>> Got another question online.

>> Sure.

>> What do you [inaudible] -- I think she's probably talking about the people in your study. What do veterans think about employers' perceptions about combat veterans or veterans in general?

>> That's a good question, but I know that there are an awful lot of veterans that are being hired, not just hear locally, but nationally. I think you hit it on the head earlier, you know, when you said, you know, it's a plus to get the veteran on your staff or to be able to say, hey, look, we hire veterans. And, I support that, I just don't -- I don't have any idea that anybody would go in and say I'm a combat vet. I'm here to blow crap up, you know? What can I do? You know, because that's generally what they do, but they don't say crap, but they say something else. But -- and a couple of the guys that were in that study, they -- all they wanted to do was destroy stuff. You know, SEALs and those special ops guys are -- they're kind of funny that way. They like to blow stuff up. And, you're not going to walk into an employer and say, hey, check my calves out. I'm special ops. You got any jobs? They don't do that.

>> [Inaudible] we actually talk about positive and negative stereotypes.

>> Yeah.

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>> And, we're very fortunate in the military, there was many positive stereotypes or more positive stereotypes than there are negative stereotypes.

>> Exactly.

>> So, that's what we want to highlight--.

>> --Sure--.

>> --When we talk to veterans about getting jobs. It's like, you're -- you're used to working with a multiple of personalities. You're [inaudible] all the time different people from different countries. You're a hard worker, you're not tied into the 9:00 to 5:00 routine. You know, that --- you know, you're very flexible, you're [inaudible] something, they can teach you something else, and you can pick it up because you've done that now for a period of time.

>> Yeah.

>> And, so, you know, those are the things that [inaudible] want to work with, that the people going out to look for work [inaudible] to offset the few measurements that are out there. And, [inaudible] the negative in San Diego, the negative stereotypes, in my -- my experience, [inaudible] working with employed veterans [inaudible]. I mean, there's been more and more poverty as a negative, and so -- which happens to come up face to face [inaudible].

>> Yeah--.

[ Crosstalk ]

>> --Which is one of the biggest--.

>> --Yeah--.

[ Crosstalk and Laughter ]

>> You're on time if you're 15 minutes early.

[ Crosstalk ]

>> No.

[ Inaudible Comment ]

Yeah.

[ Crosstalk and Laughter ]

>> Well--.

>> --[Inaudible] a difference, but every person [inaudible].

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>> Sure. All right, just a -- as an aside, when I -- when I was working in a facility, I probably helped at least 100 veterans write resumes. And, lot of the special ops guys just wanted to put down how many airplanes that they jumped out of, how many different weapons could they -- could they fire in one day, strip them down, put them back together again, how far could they swim with -- without flippers. And, I said, you know, this is really not -- this is not a resume. You -- you want to talk about your skills, your -- your level of skills that you have. Management, supervision, these kinds of things. And, they finally said, gosh, I didn't know I could do that. I -- I just thought that I had to put how many bunkers I blew up.

[ Inaudible Comment ]

Yes. Yes.

[ Inaudible Comment ]

Yeah, it's--.

>> --It's [inaudible] in front of the entire family, you know, [inaudible] because you -- or he tried [inaudible] they're -- they're -- the military guy or girl, whatever member [inaudible].

>> Sure.

>> Okay, now I'm going to go look at [inaudible]. I know my doctor [inaudible].

>> Exactly.

>> [Inaudible] so when they transition out and then -- then [inaudible] together, and I think a lot of times the military members looking at the -- at the [inaudible] you've been one. You know, the teaching and [inaudible] and this person's going, well, I've [inaudible] in the military for the last [inaudible]. So, it's a very interesting dynamic--.

>> --Yeah--.

>> --That they [inaudible] divorce is so high--.

[ Inaudible Comment ]

>> --Exactly. Yeah.

[ Inaudible Comment ]

>> You know, I did -- going back to the [inaudible] education--.

[ Inaudible Comment ]

>> --Yeah--.

[ Inaudible Comment ]

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>> --My job, get the rest of it out of here. I don't want to talk about it. I don't want to [inaudible], you know? [Inaudible], I think [inaudible] have to be really in tune with how they're feeling and how much they can take. And, [inaudible] to make sure that does [inaudible].

>> I have to agree with you on that--.

>> --That's very important--.

>> --Very important.

[ Inaudible Comment ]

[ Laughter ]

>> You have to take care of yourself.

>> Yes, thank you, Marge. [Inaudible]. That is very important that we take care of ourselves so that we can take care of others.

>> Exactly.

>> I'm [inaudible] program, too. Yay.

>> Yay.

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[ Inaudible Comment ]

>> But, to be there for our clients and not just women, too [inaudible] program [inaudible] with disabilities and they're at different levels of contemplation, whereas [inaudible]. It's so important -- so important, and I'm so grateful thinking, I just want to say also thank you all for doing it.

>> Well, thank you.

>> I came here not on a workday, but because this is so important to me to be reminded that I do need outside training, that I do need [inaudible] thank you very much [inaudible]. I do need to say [inaudible] in -- in -- in the research that has been done because it is [inaudible] and not only evolving for me, but evolving for the veterans, evolving for the regulations that we follow. [Inaudible] right here right now, and -- and thank you again, all of you for being here for me.

>> Well, thank you.

>> That's important--.

>> --You're welcome--.

>> --Because it has reminded me that [inaudible].

>> Exactly.

>> And, in probably the last four or five year where it's been really noticeable at conferences [inaudible] where there are specific questions around [inaudible] taking care of yourself. How do we -- how do we be more aware of how things are piling up, you know, and -- and not taking it out and [inaudible] examples that you talked about. And, I think, you know, it would be -- it's nice to see that it's becoming more a regular thing. I mean, every conference now [inaudible] session about, you know, strategies and the importance of it and people [inaudible] groups on it. So, I -- I think that we've hit it where people are becoming much more aware that it's something you can just take for -- for granted. [Inaudible] it's as much [inaudible], right?

[ Laughter ]

[ Inaudible Comment ]

>> Any more questions? [Inaudible]. Yeah, okay. Well, thank you, everybody for coming today. I really appreciate it. We do -- our team appreciates that very much, and we'll see you at the NCRE.

[ Laughter ]

[ Applause ]

[ Crosstalk ]

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