Since 9/11, the issues and needs facing our nation’s service members, veterans, and their families have been at the forefront as never before in the history of our country. This has led to challenging questions about how we address the needs of this extensive population, both needs that are specifically related to the uniqueness of military life and needs that are similar to the general population. These challenging questions are nearly the same in communities across the country and there have been myriad efforts in the last 15 years, with varying degrees of success, impact, and sustainability.
Arizona is home to more than 600,000 service members and veterans. When factoring in their immediate and extended family members, the impact of military service on communities across our state is extensive. In 2009, a statewide needs assessment was conducted to determine what was most important for our military and veteran community. The most consistent response from service members, veterans, family members, and the helpers and providers who assist them was not a need for more resources or funding, but rather that there were so many different resources across the military, government, and community that it was overwhelming to navigate through the systems.
Looking at a population that spans from newborns of military and veteran families to aging World War II veterans requires a robust and well executed plan. And the stakes could not be higher for this effort. According to the Arizona Violent Death Reporting System, the risk of suicide is three times higher among Arizona veterans than non-veterans. And the risk of suicide is four times higher among older Arizona veterans than non-veterans.
In Arizona, our community of stakeholders has taken a unique approach to addressing this risk and meeting the needs of this vast population. Using a public/private partnership model, we have spent the past eight years implementing a comprehensive, long-term plan to create a sustainable ecosystem of support for all who serve and their families. The success of this effort to date and the promise it shows for future growth and development offer lessons that can be applied to different target populations, causes, and communities across the country.
Right Resource & No Wrong Door
Eight years ago, when we launched this effort, we set forth a vision that every service member, veteran, and family member is connected to the right resource at the right time. Inherent in this vision was also the concept that there should be no wrong door to which these individuals and their families could turn to for help. While these are the type of concepts that are often stated with ease when talking about vision statements, our approach was different. We took a step back and looked at exactly what it would take to get to the point where this approach (right resource, no wrong door) would be upheld the majority of the time.
What’s interesting about this goal is that it takes a very human interaction -- connecting one person or family to the right resources for their situation in a timely way to ensure that they receive support that they need. It also requires a focus on how to scale this type of interaction in response to hundreds of thousands of people in need across the entire state.
Arizona’s military, veteran, and family population is a huge group with diverse needs. There can be a tendency to think of “veterans” or “military families” as a homogenous group, when in reality they are a cross-section of our community. Military families can include those serving in active duty, the National Guard, or the Reserve. Veterans can span from a 22-year-old in college just completing a four-year tour of service to a mom of three making her way through the corporate world to a World War II era veteran. Their individual needs may be vastly different, however their need for information, support, and connection to resources is the same.
Amid the backdrop of the goal to bring this vision of right resource and no wrong door to reality, are the realities of the stakes involved. The headlines trumpet the key issues, including Traumatic Brain Injury, post-traumatic stress, substance abuse, and a significantly higher risk of suicide. As a community we simply must do better because the stakes are too high. If we can change the way we intervene we can potentially prevent the negative impact of these issues on individuals who have served and their families.
From the Old Model to the New
The old model dictates that to get help everyone needs to go through one door. This is usually touted as a “one-stop shop” or similar concept. It’s not that these resources and concepts don’t have their place, we just can’t rely on herding everyone to one specific door as the only strategy. It’s not how people access resources. While some will take the initiative to find the door for a specific type of help, many will not take that step on their own due to myriad reasons (reluctance to ask for help, the unknown of a new situation, stigma, and others).
The other issue is that people today are simply overwhelmed with information and often do not have the knowledge or context to filter out what does and does not apply to their situation. We heard this repeatedly in the needs assessment conducted in 2009 at the start of this effort. Both the people we are seeking to help and the people in a position to help them (community members, volunteers, providers, etc.) cited the overwhelming amount of resources as a barrier to accessing help, as well as the lack of coordination between the hundreds of organizations that serve the military and veteran population. As one provider put it, “It’s not just that the left hand doesn’t know what the right hand is doing. It’s that each finger doesn’t know what the other is doing.”
Coupled with this, it was troubling to learn that, in many cases, there was a significant underutilization of resources simply because it was so difficult to connect the right people with the right resources in this sea of overwhelm. While service members, veterans, and their families did not know all that was available to them, conversely the organizations providing the resources and services did not know how to find their target audience (e.g. families with children under the age of five, or those who are in college, or veterans over the age of 55, et al.). This results in efforts to market to the masses, which is inefficient and only adds to overwhelming the general population with information.
After this needs assessment, we knew what overarching issues were troubling our two types of constituents the most. We also knew that the old model of relying on singular doors for everyone was not effective. This set us on a trajectory to find a different approach. The cornerstone of that approach is not one perfect door that everyone needs to go through, but thousands of great doors that serve as a mechanism to connect people to the right resources for their specific situation. The next challenge we faced was how to build those thousands of doors needed.
The right resource at the right time and no wrong door for more than 600,000 people and their families across more than 100,000 square miles of our state is a daunting task. Yet, this was our target and it was clear from the beginning that this would not be achieved through a surface level “collaboration” to serve the military and veteran community. This would require a thoughtful, well-planned approach that included broad-based support and active engagement from the dozens of key stakeholders involved in serving our military, veteran, and family population, whether these organizations were aware that they were serving this population or not.
Our solution required a focus on different levels: individual, organization, system, and community. It needed to be statewide, but with the capability to localize at the regional and community level. And at the forefront of everything was the importance of sustainability. If we are going to ask our stakeholders to invest in this effort, we needed to create value in that investment for the community we serve by doing everything possible to create a sustainable effort.
Initially, after the needs assessment, it became clear that this effort would require a centralized entity to shoulder primary responsibility for execution of this plan, with the ongoing partnership of the stakeholder agencies. The concept behind this was simple, the members of the planning team had seen all too often that when fostering collaboration is a shared responsibility, it is rarely sustainable. The mission of the individual organizations will always supersede the shared responsibility (and rightfully so).
With our effort, we wanted to bypass that pitfall and create an entity whose sole purpose was implementation of this effort and supporting the engagement and participation of the stakeholder organizations. Out of this concept, the Arizona Coalition for Military Families (ACMF) was established in August 2009. Structured as a public/private partnership to bridge the gap between sectors, the Coalition is the backbone support organization for our collective impact initiative.
The Coalition was initially incubated within the Arizona National Guard as part of the Joint Family Support Assistance Program (JFSAP), a federal program out of the Office of the Secretary of Defense. The program included a small team of professionals, including licensed mental health counselors, in each state and a broad mandate to “build support for all military families.” The scope of work included direct service (non-medical counseling) and community capacity building.
Since we knew that JFSAP would be a time-limited program (although the exact timeframe was unknown at the start), the decision was made to focus on capacity building, as that was 1) a scope of work not funded by any other means while the counseling services were available through multiple other means; and 2) the best use of the resource to make a lasting impact on the community.
An Ecosystem of Support
With this approach, the focus turned to creating a strategic plan and building the infrastructure needed to implement our vision. We set out to create an ecosystem of support with the capability to connect each person and family to the right resources at the right time. This ecosystem is both top down and a grassroots initiative, it engages leadership, systems, organizations, individuals, and communities. It can be adapted and implemented with different sectors, systems, populations, and needs. The model has six inter-connected parts:
Key stakeholder engagement – The foundation of everything we do is engagement of military, government, and community stakeholders. They are essential to the effectiveness of an effort like this. It may take time to generate the necessary buy-in and it is essential for sustainability to build relationships throughout an organization, not only with a single leader. In the past eight years, our Coalition has weathered changes in nearly every top leadership position with our stakeholders, including a change in governors, three different directors of our Arizona Department of Veterans’ Services, a change in The Adjutant General of the Arizona National Guard, Director of the Governor’s Office of Youth, Faith & Family, and more.
In almost all cases, despite these changes, the engagement of stakeholders has not only been maintained but deepened due to the strength of our relationships with the organizations overall.
Cross-sector collaboration – Working across sectors and systems is potentially fraught with challenges relating to communication issues, territory, and cultural differences. A strong backbone organization can be the bridge between these worlds, supporting strong cross-sector collaboration. One of our partners described the role of the Coalition with this statement, “What is so effective is the Coalition provides the neutral space for organizations to step into and work together.”
As part of our work over the last eight years, our Coalition team has had the opportunity to participate in a series of state-level strategic planning activities with the Substance Abuse and Mental Health Services Administration (SAMHSA) Technical Assistance Center for Service Members, Veterans & Their Families. Through this process, we created the statewide plan for Arizona, and we have provided technical assistance to state teams from every other state and territory, sharing our model, lessons learned, and best practices. We witnessed situations where state teams could not even sit around a table and begin discussions on a state plan simply because there were too many issues of inter-agency conflict and territorialism in the way.
Guidelines for CARE – At the start of this process, a significant gap emerged very quickly. How do you define an organization that is equipped to meet the unique needs of the military, veteran, and family population? We set out to find a national standard and were unable to find anything across the country. In fact, there were national websites at the time that were touted as “one-stop” trusted resources for the military and veteran community. Yet, when you dug a little deeper, it turned out that not only was there no standard or vetting process for the organizations listed on the website, but a person could literally type their information into the site and 30-seconds later they would appear live as a “trusted” resource.
This was not acceptable to us. While it isn’t possible to control for the thousands of interactions that take place every day between service providers and the people and families we serve, we felt it was our responsibility to do everything we could to vet and equip the organizations serving our community.
So, as a community, we created a common standard for being equipped to serve the unique needs of the military and veteran population. This included a year-long community norming process funded by a local foundation, and included workgroups and focus groups. The end result is a set of eight guiding principles, eight ethical considerations, and our CARE model. CARE focuses on the elements identified as the most important when serving this population: How the organization Connects to the culture, Asks the right questions at the right time, Responds effectively, and Engages in the military and veteran community.
We then take these Guidelines and adapt them to different sectors and types of organizations (e.g. mental health, housing & homeless providers, employers, faith communities, libraries, and more). The Guidelines serve as a map for how organizations can be equipped to serve our population.
Training – In order to support organizations in fulfilling the Guidelines, we developed specialized, interactive training to help organizations meet the common standard. Over the past eight years, we’ve trained tens of thousands of people in nearly every community and corner of the state. This training can take the form of one-hour workshops on military/veteran culture to our annual two-day Statewide Symposium (held for the eighth time in 2017) to full Military Immersion Trainings that give civilians a slice of the military experience to better inform their service delivery. This year, we will be branching out into online training, in partnership with PsychArmor Institute, a national provider of online education for working with the military and veteran population.
Resource Navigators – One of the cornerstones of our training program, is our Arizona-developed Military/Veteran Resource Navigator training. This is the key to moving from one perfect door to thousands of great doors. The underlying philosophy of this program is that we never know who will be able to offer help and support to, a service member, veteran, or family member. Therefore, we need trained people embedded throughout our community so that help is always a short distance away. This approach also builds upon help and connection to resources coming from a known individual in a person or family’s life, with the idea being they are more likely to listen and respond to a trusted individual.
We equip people in our community with the knowledge, skills, and confidence to reach out or respond with a three-hour training and the tools they need to assist someone. Thus far, we’ve trained more than 2,500 navigators statewide, including librarians, first responders, mental health counselors, human resource professionals, attorneys, and more. Since our community of helpers often are service members, veterans, and family members, there is a strong peer support element to this program as well.
Through this approach, we move from the expectation that service members, veterans, and family members must seek out singular doors and instead equip the trusted people in their lives to be the one to connect them to needed resources.
Resource Network – The final element in our strategic plan to build an ecosystem of support is a technology platform and online Resource Match Tool. Paired with our navigators, this platform provides an entirely new way of matching people to resources. Traditional systems generally use basic keyword searches and a simplified system of categorizing organizations. For example, even if an organization has a dozen different programs, each with its own set of eligibility criteria and target audience, they will all be grouped under one listing. The greatest challenge with these systems is that you not only have to know the exact problem to find information, you almost have to know your solution as well. We also know that people who are experiencing stress, lacking time, and feeling overwhelmed are likely to not be able to navigate through these systems effectively.
Our Resource Network is meant as a tool for use by the helpers and organizations in our ecosystem. It levels the playing field of knowledge amongst helpers and better equips them to access vetted information in a timely manner.
Building Upon a Foundation
Over the last eight years, we’ve built out the infrastructure and processes for the above six elements of our strategic plan. At some times it was more sequential and at other times it was concurrent. For example, there was a heavy focus on key stakeholder engagement and cross-sector collaboration in the beginning, and then those efforts continued concurrently as we built out the other elements of the plan.
Now that we have most of the six elements built out and in place (although it’s always a work in progress), we can use these elements and layer on to accomplish specific goals. One example of this is our Be Connected program. This is a statewide suicide prevention pilot program that stems from a federal law focused on how the U.S. Department of Veterans Affairs (VA) and community work together to reduce deaths by suicide in the veteran population. Arizona was designated as a pilot program state in 2016 and a model was developed that built upon our existing infrastructure.
Using the six elements as a foundation, Be Connected adds 24/7 phone support through a partnership with a local crisis agency and targeted training for helper populations. The program model is based on a program previously implemented in partnership with the Arizona National Guard (AZNG). In 2010 the AZNG experienced the highest rate of suicide ever. The Adjutant General at the time approached the Coalition and other partners to help with eradicating the high suicide rate. In response, we helped develop a program to focus on reducing the stigma and barriers to accessing help while creating protocols for training, prevention, intervention, and postvention. As a result of this program, the AZNG went from their highest rate of suicide to three years of no suicides while the program was in operation. Our goal with Be Connected is to expand the impact of this effective model to the broader veteran population.
A Strong Solution
There are some elements that have been particularly impactful on our ability to implement this project effectively. Setting out in 2009, we knew the goal but we did not know it would take eight years to get to this point. The strength of our collaboration and the commitment of our stakeholder organizations speaks to a long-term vs. short-term focus. Additionally, the willingness of our partners to not only participate but also to fund the key elements of the strategic plan has been instrumental in our infrastructure building phase.
Arizona is a ripe environment for this type of work. As a younger state and community, with people who come from all over, there is an openness to trying new approaches that lends itself well to this type of project. We have been fortunate to have strong leadership across our key stakeholders and systems that embraced the vision of the right resource and no wrong door.
Another important factor is our team. One of the pitfalls that we observed in the efforts of others is a lack of balance between passion for the cause and the skill set to execute their mission. We have been able to establish and grow a team that combines these two essential elements and who can effectively execute the implementation plan on behalf of and in partnership with our partners and stakeholders.
It’s important to note that this field of practice, capacity and collaboration building in support of the military and veteran population, is relatively young. The Coalition is not quite eight years old, and yet we are one of the oldest, if not the oldest, statewide organizations and efforts nationally. We are honored to have been repeatedly recognized as a best practice model for state-level collaboration by entities such as the Office of the Chairman of the Joint Chiefs, National Guard Bureau, the Substance Abuse and Mental Health Services Administration Technical Assistance Center, White House Joining Community Forces initiative, the Center for a New American Security, and the Points of Light Foundation Community Blueprint.
Tracking the Impact
With all elements of our strategic plan becoming operational in 2017, we expect to move toward full implementation at the statewide, regional, and local level over the next one to two years.
To fully track and measure our impact, this year we will introduce the Arizona Veteran Survey. This is the first ever comprehensive statewide survey of our military, veteran, and family population. The survey includes questions on an array of markers and topic areas, including: employment, the needs of children, substance use, access and utilization of healthcare, and more. The survey will provide baseline data for many of our key initiatives, including Be Connected. It is anticipated that the survey will be administered every two years going forward.
We want Arizona to be the standard for capacity building and collaboration in support of the military and veteran population, but ultimately, we believe there is potential for this model to be used for other target populations and in other communities nationally. We believe that our organization will demonstrate a new approach to address the challenge of connecting people and resources.
Funding & Partnership
Our Arizona effort is a public/private partnership and our funding reflects this structure. Through the years we have had in-kind and financial grants and contracts from state agencies (both state and federal funding sources), local and national foundations, and corporations.
One notable aspect of our operation is our legal and fiscal structure. Since 2010, the Coalition has been operated as a public/private partnership with a nonprofit fiscal sponsor. This has been a very effective structure for our organization, allowing our program team to spend the maximum amount of effort on implementation of our strategic plan while also providing the foundation and backing of an established nonprofit organization for our operations. For a reasonable administrative fee, the fiscal sponsor provides all human resource, bookkeeping, auditing, and reporting.
We are on the cusp of full implementation of our strategic plan. While we’re building this ecosystem of support for our military and veteran community specifically, we know that as we build our community’s capacity to serve this population, all boats rise and there is a potential ripple effect for our efforts to also benefit other populations. Anecdotally, we know that when we train people to help our military and veteran community, they will use those same skills to help other people in need around them.
This point in time represents the contribution, goodwill, trust, and partnership of thousands of people across Arizona, all in support of our service members, veterans, and their families. As we advance our collaboration, we look back to appreciate our shared journey and look forward to realizing our collective impact.
Arizona Violent Death Reporting System: https://cvpcs.asu.edu/projects/arizona-violent-death-reporting-system
Arizona Department of Veterans Services: https://dvs.az.gov/
Nicola M. Winket, MPA is the Project Director for Arizona Coalition for Military Families