Brandon M. Cook

Using RecoveryTrek, a success management software (SMS) designed to assist case managers with tracking the progression of participants through a court’s treatment program; A’lexus and I were able to identify most of the trends and issues seen among veterans, along with the mitigation efforts employed by the court. These assessments were compiled in order to track the veteran’s compliance through their time in the treatment program and to evaluate the effectiveness of mitigation efforts used by the Veteran Treatment Court (VTC) to benefit its members. Our results were mainly demonstrated to the VTC through our RecoveryTrek presentation and the multiple compliance graphs we created, while we also briefly discussed some of the issues we experienced with the software or the courts utilization of it, to aid those who may do similar work in the future. Overall, the Team Combat practicum experience was more intriguing and gripping than I could have ever imagined, being able to observe the statistics we mentioned in class firsthand, added a chilling personal and emotional aspect to the internship. Along with this, it opened my eyes to the disheartening and alarming side of being a United States military veteran, as before I would have only regurgitated the parts that are glorified in society. Lastly, though I am personally connected with many veterans, I had never heard of a Veterans Treatment Court before this experience. However, I was not alone in this regard as according to the survey we conducted only 13% of service members from Fort Bragg had any inclination to what a VTC was or does for veterans. As a result, one off our dominate concerns to be addressed in the future is the urgent need for more Veteran Treatment Courts around the nation and the dissemination of their benefits to rural service members in the immediate future.

The way in which these RecoveryTrek assessments were completed is as follows; first, I developed an outline to be used for the case notes as they were updated weekly and written in an uncomprehensive and sporadic fashion. This outline contained a trends, issues, and mitigation effort section for each veteran for each week they were in the Veteran treatment court and allowed me to read through the case notes and add information as I saw fit. This outline helped me organize this information and allowed me to reference specific dates when designing the graphs and PowerPoints or when questions were asked during our in-person presentation. Specifically, this delt with the seventh and nineteenth foundational Public Health competencies as we assessed the veterans needs and assets that affect the health of the community and the individual. I displayed this information in a concise manner; utilizing graphs, written/spoken words, pictures, statistics, and videos to obtain the best understanding of our information. Additionally, I worked to condense all the information I found into a comprehensive and abbreviated version that could be presented in under ten minutes as that was all the time we were allotted to speak at the courthouse, due to time restraints and the fact the courthouse only had one courtroom for us to use (rurality issue). Finally, using the presentations, graphs, and videos we presented our RecoveryTrek findings to the court staff and suggested possible advancements that could be made in the future to not only benefit the employees but the veterans as well.

National Farmers Day is an annual celebration to honor the heritage of farmers around the world, originating in West Africa, more specifically Ghana in 1985. However, now this observance is held around the world to give thanks to the individuals who sustain the rest of the population, surprisingly in the United States farmers only make up 2% of the population, according to census data. Thus, the Team Combat group was invited to the Coats annual Farmers Day celebration to assist the veteran’s treatment court (VTC) in spreading awareness about their mission, program, and how community members could contribute to this underserved population of veterans, who inadvertently had already contributed to the Coats community. Overall, this considerably aided in my understanding of the community in which I’m now apart of, the issues revolving around funding, how to diffuse information about the Veterans Treatment Court, and how difficult it can be to enact change by relying on a population that is disproportionately disadvantaged along with the individuals we are attempting to support.

During my time at the Coats Farmers Day festival, I was encouraged to see a community, especially a rural one, able to acquire the resources to commemorate a population often overlooked. The feeling during the day was an optimistic one for many reasons, first I witnessed the participants of the festival excited to get outside again, since as a society we are still dealing with a pandemic. Also, the gathering instilled a since of enthusiasm in me and allowed me to realize change is possible, especially for those who feel neglected. Our practicum group had our first experience communicating with our community members and fellow veterans; we accomplished our competencies by handing out pamphlets created by the veteran’s treatment court and collected donations that will be used to enhance the outreach of the treatment court. Specifically, this method accomplished our eighteenth and nineteenth public health competencies, which puts an emphasis on communication. Most notably characterized by using communication strategies that encompass different audiences and sectors. We did by having different modes to deliver the message; by using brochures and donation jars with written, visual, and numeric material, and oral communication to effectively spread the courts message. These methods allowed us to supply information to many populations including able bodied community members, those who have disabilities such as being deaf or hard of hearing, blind, or even children by utilizing pictures and slogans on the jars to convey the message. All of which I believe, made the communication of our information and the effect it had on the community that much more substantial.

The complications around funding and disseminating information in a rural community isn’t a new one but is a wicked one that needs to be altered to enhance underserved populations. By no fault of a certain individual, but rather a combination of social determents; rural populations face many issues not seen by their urban counterparts. Specific to the context of trying to spread information and collect money, events like these don’t happen very often in rural communities and asking an already impoverished community for funding can be extremely difficult. When discussing the scarcity of events like this in rural communities, its usually because of multiple factors, most common these include low participation caused by geographic isolation, far travel distances for members or a lack of public transportation, conflicts when members must decide how to use their time (work vs. fun), and limited ability of rural workers to set their own schedule. Along with this, the issue of collecting donations is a problematic one especially when asking a community that is disproportionately poorer than urban counterparts. Higher poverty rates in rural communities are caused by a host of contributors such as lower education attainment and employment opportunities, medical expenditures due to higher chronic illness rates, changes in the environment (since agriculture is a major industry) and many more that could affect how much spare income members have to donate. Lastly, because of all these rural specific issues the Veterans Treatment Court must work harder to attain resources and funding, along with creating innovative solutions to better inform its community members. All of which is in the hopes of helping this subpopulation of the community and therefore the community as a whole, thrive.

This week I finished reviewing all my veterans case notes and completed my RecoveryTrek assessment which identified the trends, issues, and court mitigation efforts for the time they spent in the program. Using this information, I started to create my presentation that will be used to demonstrate my findings to the veteran treatment court and Rural Health class in mid-November. (The veterans name, photo, and ID number have been removed for confidentiality)

The National Association of Drug Court Professionals (NADCP) conference is a four-day event that takes place in Washington, D.C. and includes speakers ranging from medical doctors, veterans, social workers, lawyers, and many more. The aim of the conference is to premier new training, membership, and advocacy organizations for the improvement of the treatment court model. After the conference, the Harnett County Veteran Treatment Court (VTC) holds a District 11A off-site workshop to discuss what staff members gathered from their experiences at the NADCP conference and how the valuable information they learned could be integrated into the Harnett County VTC in order to enhance the efficacy and principles of the court on its participants and staff. While observing the half-day workshop, the VTC allowed all staff including the Chaplain, District attorney, Clerk of court, Mentor coordinator, Case manager, Defense attorney, and Judge to present the training or information they gained from the NADCP conference to their colleagues. The reason the VTC takes this approach is because, depending on your position in the court, staff will attend separate classes or training sessions, with each class diving into the specifics related to that position within the court. Along with presenting new information or training designs, the time allows court staff to identify what they feel needs to be improved or revised within the Harnett County VTC system to fix issues recognized prior to or as a result of the NADCP conference. Overall, I felt this workshop was extremely beneficial to me as it allowed me to witness the steps the court is taking to ensure constant improvement of Public Health standards and demonstrates the necessity of readily correcting the issues regarding the court’s rurality and lack of resources do to that rurality.

The main issues the VTC is currently having is operating with a lack of resources or funding, achieving equality for its participants whether that’s based on race, ethnicity, sexual orientation, religious views, or gender, increasing the number of veterans who qualify for the VT, and dealing with the institutional foundation of veteran drug use. In which all of these concerns are a direct result of the courts rurality and the demographic of the veterans it servers. Throughout the workshop the most common problem was the courts lack of resources, this included a range of items such as a lack of transportation for the veterans to court, appointments, work, along with funding for new programs such as inpatient treatment centers and stable housing for the VTC participants. These issues stem from the court’s rural location in Harnett County as it is a well measured statistic that rural counties receive far less funding than their urban counterparts. This could be amended by constant/ unwavering out-reach by the VTC and community to stakeholders, beneficiaries, or other community members to establish the importance of this need and how it would positively affect the health of the whole community. The defense attorney also mentioned how this immense issue of veteran drug use started, mostly for the Team Combat students benefit as we have never been exposed to this type of information. He stated many of the issues come from the overmedication of soldiers in combat to keep them “healthy” and able to fight even with the amount of stress, exhaustion, and urgency they are placed under. This demonstrates how the extensive substance abuse seen in veterans is a result of their environment and what the government needs out of them rather than an individuals personal issues leading them to use drugs. Demonstrating the wicked rather than technical issues that could be causing a major spike in drug use among this population and how the issues related to it can’t be fixed by simply working on an individual level, proving the importance of adopting some universal programs.

Another major issue that was discussed during the workshop was the courts unequal treatment of its members based on their race, ethnicity, sexual orientation, religious views, or gender; whether the discrimination/prejudice was consciously executed or not. In which the case manager discusses in detail some of the things she learned from the NADCP conference and how they could actively combat these disparities. This proposition most closely aligns to our foundational competencies in Public Health, most notably competency 14 which states “Advocate for political, social or economic policies and programs that will improve health in diverse populations”. Specifically, she mentioned the importance of the VTC to incorporate culturally appropriate incentives, spiritual therapy in combination with medical therapy for those who hold strong religious views and understanding the mistrust that exists between the judicial system and those it has historically oppressed. By including these improvements along with many more the case manager believes this will ensure the Harnett County VTC doesn’t perpetuate a systematically oppressive structure. This is of the upmost importance as it would allow for more grant money to be acquired and most importantly would improve the health of the whole community dramatically.

Today I was able to return to the Harnett county courthouse to speak with my preceptor Mr. Teachey about the progress and accuracy of my RecoveryTrek assessments. Throughout the short meeting he gave me some advice on how to better my assessments and how to prepare for the final presentation, which we have now scheduled for November 17th.

Within the first month of my group practicum, Team Combat, I am working at the Harnett County (District 11) courthouse with the veterans’ treatment court. I have met some tremendously resilient individuals and learned a substantial amount about how attorneys prepare for court, how court proceedings are handled, how defendant’s progress is tracked throughout their time in the system, and most notably how the court decides who is eligible for their services. Specifically, the Harnett County veteran treatment court helps high and low-risk, high-need veterans from Morehead city to Raleigh’s research triangle park (RTP) and anywhere in between. According to the court, risk is determined based on multiple tests completed by the cases that determine the likelihood of the defendants to reoffend, relapse, or not comply with court orders. Along with this, the court has labeled need as the number of assistance programs/resources the veterans will require from the court, similarly determined by a series of assessments and questionnaires. However, within just the first month, I have recognized a need for the treatment court to start including high-risk, low-need veterans (those who are more likely to relapse but have fewer needs) into the programs and to possibly incorporate the assistance of local churches to help guide those veterans who were extremely motivated by faith.

While sitting through my first court hearing with the veteran’s treatment court, I noticed how all the clients were either high/low-risk and high-need. After this discovery I asked my preceptor Mr. Teachey why there was no low-need veterans on the schedule. His reply was simple and one that before starting this Public Health program would have bewildered me, he stated “high-risk, low-need veterans aren’t worth our time”. This is a response I should have seen coming based on our discussions in class as he explained due to their rurality his team didn’t have the time or receive the resources needed to incorporate these individuals into the treatment programs. Along with this, he stated the veterans wouldn’t be worth the risk to supply all these resources to just to reoffend, when those same resources could of went to an individual that was ready to better their lives. Before starting this program, I probably would have had the same outlook about these individuals, however this program though short lived has showed me the importance of trying to gather resources to help those the most in need since “what’s good for the bee is good for the hive”. From my perspective, it seems these high-risk, low-need veterans are the ones most in need of the court’s assistance, because of their location, assets, and the fact no program will admit them, they have nowhere else to turn for assistance.

I believe this could be accomplished by first acquiring more funding/resources, whether that be through the government, fundraising, private grants, or churches. Obviously at first this will be challenging as rural programs don’t get the same attention as those in more populated areas, but I believe after showing the community the importance of helping those at their lowest in order to make the community stronger, that support will come. Along with this, I think the best way to stretch our services further would be to only use specific facilities, this way we could work out a lower cost for each participant by filling the centers in bulk. Lastly, I think the county should implement a transportation service that runs a predetermined route best fit for all the resources they provide. In which the program could then seek to find employment, treatment facilities, housing, and food for all participants that falls close to this predetermined route, to ensure all veterans have transportation to and from all desired locations. This change won’t come easily, especially with the lower need for these services in rural areas, however, by demonstrating the difference it could make in the community, I believe they can be accomplished and if not currently present these resources can be established within Harnett County. Specifically, this need sums up the third rural health competency, in which it discusses the access to care barriers experienced and the health care utilization issues most commonly seen in rural communities.

Not only would including high-risk, low-need veterans into the program increase the courts outreach, I believe that incorporating the assistance of local churches would also be extremely beneficial. Based on only a single hearing, I have heard remarks such as “without god it wouldn’t be possible”, “I pray every day”, “I ask god to look over me”, and “without him I wouldn’t be here” just to name a few from certain veterans. As a result of this enthusiasm towards religion present in a majority of those who spoke (most likely due to the higher prevalence of religion in rural communities), I believe using churches as a strategic partner would help reach those individuals private organizations couldn’t and find/acquire resources otherwise unused. While churches can be a hindrance towards progress in some areas, I believe if we could find a group of churches who were on board with content congruence, network influence, and followed the level of involvement we wanted from them, the partnership would be extremely beneficial to the court system and the veterans who would like a more religious approach. However, the issues with this approach would be finding churches who fit these criteria and don’t want to impose a different message than the one we intend.

This week, I was tasked with continuing the RecoveryTrek assessments on my three veterans currently undergoing the treatment program. This once again involved reviewing case notes from each of the veterans court appearances this time with a new 2-4 month period. Afterwards, trends were identified along with issues, mitigation efforts, and an updated assessment was composed from the information provided during the allotted time period. The assessments are being completed in the hopes of compiling all files at the end of the semester, to present the effectiveness and impact of the treatment program on its participants throughout their time in the treatment program.