Helping Veterans Heal

Anne Klee, PhD, CPRP, completed her graduate work at the Ferkauf Graduate School of Psychology of Yeshiva University, Bronx, New York and her undergraduate work at Columbia University. After completing predoctoral and postdoctoral fellowships at the Yale University School of Medicine, New Haven, Connecticut, she accepted a position at VA Connecticut Healthcare System, where she has worked for the past 15 years in various roles.  She is also an assistant professor in the Department of Psychiatry of the Yale School of Medicine.  Professionally she is devoted to developing quality, recovery-oriented programs for individuals with serious mental illness, training and supporting the work of peer specialists, and training the next generation of clinicians in the field of psychosocial rehabilitation and engaging them in careers in public mental health.  She serves in national and state capacities.  She is a Council Representative of the American Psychological Association (APA), a Past Presidents of Psychologists in Public Service (Division 18) of APA, the current president of the Connecticut Psychological Association, and a member of the Connecticut State Innovation Model Practice Transformation Taskforce.  She is licensed in Connecticut.

Anne Klee: Hi, I’m Anne Klee. I am a psychologist by training. I work at VA Connecticut Health Care System and I’m the director of peer services, and we hire and train peer specialists who work on our clinical teams. And peer specialists are veterans with lived mental health experience who are hired onto our clinical teams. I love going to work every day. It’s such a pleasure to help people support other people.

Jewel Edwards-Ashman: I’m Jewel Edwards-Ashman and welcome to a new episode of Progress Notes: A Podcast Keeping Tabs on the Practice of Psychology. Dr. Anne Klee is a psychologist, an APA council representative for division 18 and president of the Connecticut Psychological Association. In this episode of Progress Notes, Dr. Klee shares the unique way that she’s applied her skills as a clinical psychologist —training military veterans to help other veterans who are living with a mental illness.

During his time in office, former President Barack Obama issued an executive order mandating that Veterans Affairs hire and train 800 new peer specialists. Peer specialists are trained and certified to help military veterans who have mental health conditions, including depression or post-traumatic stress disorder. The VA considers these specialists to be an important part of veterans’ mental health recovery. They also help vets learn the ins and outs of the VA system. Dr. Klee is part of a team at the VA that’s responsible for training peer specialists.

Anne Klee: Peer specialists are people in recovery from mental illness and sometimes they are still active in their recoveries. And they are great additions to our programs because they understand what mental illness is all about and they are the voice of hope for folks.

In one of our residential programs, one of the program participants, he worked closely with a peer specialist and said, “I want to be like you one day.” And that one day took him about two years but two years later he was hired onto one of our clinical programs and now he himself is a peer specialist giving back to others. And really what he shares is the steps he took to get his life back together. When people are struggling, the great thing about a peer specialist is they can say “Yeah, I’ve been there. I’ve done that, and these are the steps I took, and this is what worked for me.”

Jewel Edwards-Ashman: Most VA hospitals only have about three to five peer specialists on staff. The VA in Connecticut has about 25 peer specialists currently, and at one point they had up to 35 peer specialists. Dr. Klee says it’s because their leadership has made a commitment to hiring people in recovery and embedding them in mental health programs.

Anne Klee: When you think of VA positions, you often think of PTSD work. You think of health psychology, traumatic brain injury. But there are a number of people in the VA who do work in the field of psychosocial rehabilitation. Our VA, this is probably not a typical VA job, because our VA has a significant number of peers.

And we know that the research indicates that peer interventions have been associated with fewer hospitalizations, fewer days in the hospital, longer community tenure after hospitalization, increased hope, improvements in self-care, enhanced sense of well-being. Studies also will show decreased drug and alcohol use and improvements in quality of life. It’s very supportive the research. And there are some individual studies have shown that program participants interacting with peers will have longer stays in the community and fewer hospital stays or shorter hospital stays, and sometimes often more importantly fewer emergency department visits which creates such high costs for care.

But that’s always compared to those in treatment as usual. Some of these studies also show that no differences in rates of hospital admissions provided by peer supporters than care as usual. So often times these are demonstrating outcomes that parallel those in professionally trained staff. It’s just nice to see that there is some promising research out there for this work.

Jewel Edwards-Ashman: Dr. Klee hires, trains and provides support to peer specialists in their roles working with other veterans. Their training includes an 80-hour program where peer specialists learn some of the basics about mental illness and diagnosis, boundaries and the right types of language to use.

Anne Klee: There’s only so much you can learn in an 80-hour training. So, where I fit in is that I think about training and their training needs, and I bring in trainers. I bring in different educational seminars, and I think strategically about what kinds of skills and supports they need to be successful in their jobs.

Part of the work that peer specialists do is they’ll tell their own stories and they sometimes give advice, which sometimes, you know, with motivational interviewing you’re not trying to be prescriptive. You’re trying to let people come to their own decisions, helping them weigh the pros and cons. And so we had to sort of think about when is it appropriate for a peer to say “Well this is what I went through.” And we now know that we can and do train peer specialists in motivational interviewing. And recently the VA has allowed peer specialists to attend national motivational interviewing evidence-based practice rollouts. So, peer specialists are invited to participate in some national trainings now for motivational interviewing. 

Jewel Edwards-Ashman: Peer specialists have become such a vital part of the VA’s program for helping veterans. Dr. Klee acknowledges, however, that initially there was some skepticism about how the work peer specialists were doing could compliment that of VA’s mental health clinicians.

Anne Klee: When we first started hiring peer specialist, sometimes we had some resistance from some of our clinical team members. What’s going to be the role of this person? Can we share confidential things with them? Is it going to take away our jobs? It took time and it took some training and supervision for everyone involved to understand what the role and responsibilities of the peer specialist was and how that person would interact with the clients. Over time there were some team members that will say,” I don’t know how we ever did this work without a peer specialist. They bring so much to the team.” But definitely takes time. And what we also learned was the more structured the role of the peer specialist on the team is, the better they do. And I think that speaks to everybody on a team or in a job. The more you know what you’re expected to do the easier it is to do your job.

Jewel Edwards-Ashman: Psychologists on clinical teams at the VA maintain their roles in providing treatment for veterans’ various mental health conditions. The peer specialists’ interactions with veterans, however, often yield additional information that can help clinicians develop treatment plans for patients.

Anne Klee: A peer specialist won’t diagnose a client, but he or she, like anybody else, can do observations and say, “I think Mr. Smith is more depressed than usual.” Actually, a better example is, I was with Mr. Smith today and he shared this and this with me,” and that data is so important. Or the peer specialist may say, “I just have an inkling that Mr. Smith is using again, and I think we need to intervene.” So, the peers just have this natural way of picking up on things and they’re in tune to things and they’re also advocates but they will go back to the team and they’ll give them the information they have, and the team will think about it together. And oftentimes if someone’s struggling they’ll send out another team member to assess the situation further. Where peer specialists really thrive is engaging clients who are difficult to engage, especially other veterans who may be hesitant to come into the system. We have several peer specialists who served in Iraq and Afghanistan. They’re engaging somebody who is newer to the system, they have that shared history.

They can do such a nice job engaging somebody who’s hesitant to come into the VA or unsure of what the VA can offer them.

Jewel Edwards-Ashman: Dr. Klee says peer support is a great way to address stigma especially with military veterans who are new to the VA system or have never been treated for mental illness, among providers who treat veterans and in the broader veteran community.

Anne Klee: When you think about peer support it reminds me of Frank Riessman's helper therapy principle, which is the idea that when an individual helps another person the helper benefits as well. Even though the peers are hired to give back and help veterans who are currently struggling you see that the peers themselves also grow and help themselves further. They really grow from the work that they are doing.

And let’s just say the team is frustrated with a client. The peer specialist who is a member of the team will say, “Hey, this is my experience. Let’s not write him off yet.”

Jewel Edwards-Ashman: That’s it for this episode of Progress Notes. We’re taking off for the holidays. But you can subscribe to this podcast on iTunes and Google Play to make sure you don’t miss our first episode of 2019. Thanks for listening!