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More About Vet to Vet

Vet to Vet is a self-help program where veterans help other veterans live with mental illness, overcome substance abuse, and deal with other issues they face in their lives. Participants work every day towards lives that are stable, safe, and sober. The program provides a place for mutual self-help, support meetings, and incorporates practices from other mental health programs.  Vet to Vet gives veterans their own forum, where they can talk together about the mental, health, emotional, and life issues they share. It is unique because these are veteran-run meetings and not attended by program staff. 

 

Vet to Vet was established in 2002 at ECCC (the Errera Community Care Center) in West Haven, CT, as part of the Veterans Affairs (VA) Mental Health Care System.  Its creator, Moe Armstrong is a veteran who returned from the Vietnam War diagnosed with post-traumatic stress disorder (PTSD) and schizophrenia.  He is currently the Senior Peer Specialist at Errera Community Care Center.  He was previously Director of Consumer and Family Affairs for Vinfen Corporation of Cambridge, MA.  Vinfen is a private, non-profit human services organization that provides a comprehensive array of services to adults and children with mental illness, mental retardation, and behavioral health disabilities. 

 

In creating Vet to Vet, Moe worked with Dr. Robert Rosenheck, Yale School of MedicineProfessor of Psychiatry and Epidemiology and VA Public Health Director, Division of Mental Health Services and Outcomes Research Northeast Program Evaluation Center. Dr. Rosenheck published papers demonstrating the value of receiving peer support.

 

There are now more than 110 Vet to Vet centers throughout the country.  For creating Vet to Vet and for his other work with veterans, Moe has become a national figure in the mental health field. He describes Vet to Vet in these words:

 

Vet to Vet is dedicated to the concept that people who share psychiatric experiences and/or conditions can be of help to ourselves and our system.  

We believe in the Each One, Reach One, Teach One model.   We teach and learn at the same time.   We share our knowledge, hope and strength with each other.  We all can learn and grow together.

We read materials which are recognized in the mental health profession.  

We teach others through reading.  We then have discussions about what we read.  We talk to each other about how our lives fit or do not fit into the information that we have just read.

Gladly Teach and Gladly Learn.   We can learn from each other.  We can work with each other.  We can work with the mental health system.  

Sometimes we can not work.  

Sometimes things don’t work out.  We start again.  We are glad to part of the mental health system.  The mental health system is an opportunity and not a sentence. 

 

 

At ECCC, there are five Vet to Vet group meetings each week:

 

  • Recoveryusing The Recovery Workbook: Practical Coping and Empowerment Strategies for People with Psychiatric Disability, by LeRoy Spaniol, Martin Koehler, and Dori Hutchinson.
  • Disability Awareness/Disability Pride, a course where groups refer to the books Don’t Call Me Nuts, by Robert Lundin, and Transforming Madness, by Jay Nuegeboren.
  • Writers Meeting, where the group generates material from ideas exchanged at meetings, some of which are used in the Disability Awareness/Disability Pride course.
  • Mental Illness Anonymous (MIA), based on Alcoholics Anonymous’ 12-step program, and published by MIA Press. Groups deal with mental illness and all forms of abuse (e.g., substance, verbal, physical). 
  • Wellness, based upon wellness training materials created by Eli Lilly and others.

 

There are one or two facilitators at each group session. 

The Vet to Vet facilitator plays a key role in making sense of mental health and rehabilitation services provided by the community and the VA.   

At the meetings, veterans not only help one another, but they also learn how to become support-group facilitators.  Vet to Vet is not intended to replace healthcare professionals or social workers.  

 

The group meetings are egalitarian and provide a non-judgmental and supportive environment for the veterans.  Participants demonstrate great respect for their fellow veterans without regard to their degree of disability. 

 

While meetings are structured, conversations may be loosely organized around books written by mental health experts, including Armstrong, and materials written by the participants themselves. Materials are often read aloud to the group and then discussed.  The topics covered may include subjects such as: taking responsibility for mental illness instead of relying solely on disability benefits and medication; methods of combating depressive cycles; dealing with anger, self-destructive activity and isolation from society.

 

 

The Vet to Vet Preamble states:

 

§         We are proud to be part of the Vet to Vet program.

§         We are proud to be part of an alliance with family members, professionals, and other mental health consumers.

§         We work together out of a sense of shared respect and dignity.

§         We work to improve and increase mental health services through community education and services.

§         We work together, not against one another.

§         We try to find solutions through education, hence our motto, “Gladly Teach. Gladly Learn.”

§         We believe that people with a psychiatric condition and our families, friends, and advocates have the right to services and information that assist them to make informed choices.

§         We believe that services for people with psychiatric conditions should be driven by them.

§         We believe that our program should focus on the functional needs of the veteran with mental illness, with possible family involvement.

§         We believe that education and community service aimed at recovery can lead to job opportunities in mental health services.

§         We are veterans in a self-help program called “Vet to Vet.”

 

 

In an article appearing in the Fall 2004 issue of Psychiatric Rehabilitation Journal (download below)authored by ArmstrongRosenheckDr. Laurie Harkness (Director, Recovery Services at ECCC and Associate Clinical Professor Psychiatry at Yale Medical School), Mary Sperrazza, Director of ECCC’s CRP, and Dr. Sandra G. Resnick  the Vet to Vet program at ECCC is characterized as an example of consumer-provided mental health services in which consumers work within the mental health systemas contrasted with models that emphasize full independence from professional services.  The authors describe Vet to Vet as a “consumer-professional partnership model in which consumer services are embedded in a mental health system.” 

 

The program at ECCC is described as follows:

 

Vet-to-Vet is an adjunct to existing services and is entirely voluntary.

Although primarily attended by veterans who are currently receiving services from the psychosocial rehabilitation program, meetings are open to all.  Each 45-minute meeting is held at the same time each day when there are no competing staff-led activities. . . . Meetings are educational in orientation, and structured around reading material.  However, there is flexibility in what is selected and discussed; if there are pressing issues, reading material addressing that topic may be substituted for the planned text in order to facilitate discussion on relevant issues.  Confidentiality is discussed at the beginning of each meeting. Peer facilitators are not VA staff and do not have access to charts. However, facilitators maintain confidentiality, except when obligated to notify staff due to suicidality,

homicidality, and threats of violence.

 

 

The authors describe the selection and training process for facilitators:

 

Current peer facilitators may nominate individuals based on the following qualifications: evidence of commitment, sincerity, responsibility, and consistency; attendance and completion of a 3-month group-based treatment program; and previous attendance at Vet-to-Vet groups.

Nominations are discussed during group supervision, and new trainees must be approved by a unanimous vote. Staff then approach the nominated veterans and invite them to join the next training session.

 

Training consists of four weekly 45-minute training classes and ongoing observation and feedback, and is held whenever new nominees agree to become peer facilitators. In addition, trainees are expected to co-facilitate 2 groups a week during the training period.  Classes are designed to provide a conceptual framework to complement the "on the job training" of co-facilitating groups.  Trainees are monitored with the Peer Facilitator Rating Scale (PFRS, available from the first author) developed for the purposes of supervision and monitoring of fidelity to the Vet-to-Vet model.

The PFRS was based on two existing instruments, the Skills Training

Implementation Scale (Bond, Evans & Resnick, 1998) and the Work Performance Inventory (Bryson, Bell, Lysaker & Zito, 1997). Peer Facilitators in training are observed and rated on the PFRS by a current peer facilitator.  After the meeting, the trainee completes his or her own self-ratings on a second copy of the PFRS. Then, the trainee and the peer facilitator compare and discuss their ratings, which allows for concrete feedback and supervision. Ratings are made in the following areas: Preparation (e.g., peer facilitator is on time), Orientation (e.g., presents overview of day's topic), Facilitation Skills (e.g., encourages everyone to participate), Meeting Protocol Adherence (e.g., circulates attendance sheet), and General (e.g., is appropriately dressed).  Mandatory weekly supervision groups are co-led by a professional and a peer supervisor. Supervision topics vary, including discussions of how difficult situations were handled during the prior week, self-care, the status of the Vet-to-

Vet program, and peer facilitator recruitment.

 

A Facilitator shared his view of the program:

 

A big difference from other programs is that Vet to Vet is not mandatory.  Everyone is here because they want to be.  This sets us aside from AA or NA programs where some attend because they’re ordered to as part of a court proceeding.

 

The relationships are peer to peer, not a doctor patient relationship.  Everybody shares and you get something from everybody. There is no wrap up with staff, so everything that is said here, stays here.  The common denominator is the veteran. Civilians in general do not connect to the issues of a vet.  They say “that was 20 years ago.”  Ignorant people say “just stop”.  We’re sick.  We have a psychiatric condition, compounded by some type of an addiction.  It can go from substances to over-eating to abusiveness, etc…

 

I was here when Vet to Vet started.  At the beginning, I hated groups and they thought I could do better on the other side.  It took me awhile to get used to it.  At the beginning there were about five people in a group meeting.  Now there are always 15-20 people in the groups.

 

While we start with a topic, in all the groups we can veer off the topic if necessary to address a thought of one of the group members.

 

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