An Ecosystem of Military Family Support with Nicola Winkel (S.5, Ep.5)

[music]

Kalin Goble: Welcome to Practicing Connection, a podcast exploring the personal stories and collective practices that empower us to work together to improve our resilience and readiness in a rapidly changing world. Here to start the conversation are Jessica Beckendorf and Bob Bertsch.

[music]

Bob Bertsch: Hi and welcome to the Practicing Connection podcast. I’m Bob Bertsch.

Jessica Beckendorf: I’m Jessica Beckendorf.

Bob: Our guest today is Nicola Winkel, project director at the Arizona Coalition for Military Families, a nationally recognized public-private partnership focused on building Arizona’s capacity to care for and support all service members, veterans, their families, and communities. She’s worked for more than 20 years in the nonprofit community, specializing in program development and implementation, bringing a mix of planning, project management, communication, team coordination, and problem-solving skills that drive execution of complex projects and build sustainability.

Nicola was awarded the Adjutant General Medal by Major General Hugo E. Salazar for her efforts in implementing the coalition and strengthening support for Arizona’s military veteran and family population. She holds a master’s degree in public administration from the University of Illinois and a systems thinking certificate, which will be very relevant, I think, to this conversation from Cornell University. We are so honored to have her join us on the podcast. Welcome to Practicing Connection, Nicola.

Nicola Winkel: Thank you so much.

Bob: Let’s start with how we’ve come to this moment, at least from your perspective. What led you to your work supporting military families?

Nicola: It really is an intersection of my personal interest in this field as well as my professional background and passion. I am the spouse of a veteran. My husband served in the Marine Corps in Operation Desert Shield Desert Storm during the first Gulf War. Obviously what happens to our service members, veterans, and their families is very important to me and to us personally. Professionally, my background is in non-profit program development and implementation and really looking at those great opportunities in the non-profit space to see a need and then develop a solution and to collaborate to address complex problems.

An opportunity came up to bring my experience in the non-profit world into the military environment and it was a unique opportunity and moment in time. That was almost 15 years ago now.

Bob: Can you tell us a little bit more about the Arizona Coalition for Military Families and what you guys do?

Nicola: Yes, absolutely. We’re a statewide public-private partnership. Our focus is Arizona’s 500,000 service members, veterans, and their families who live statewide. We are a collective impact initiative and our coalition team is the backbone team for that collective impact initiative. We are really the bridge between these different worlds and sectors that are important to this population. We bridge military, government agencies at all level, federal, state, tribal, local, as well as the community.

That’s all aspects, so non-profit, faith-based, private sector with employers, and understanding that they are all important to the well-being of the people we serve and that connection and collaboration is key to strengthening how we collectively support them. When we started 15 years ago, this was a very new field and not nearly as developed as it is today, and it’s still growing. It was a vision to build something that could help sustain this collective and collaborative work over time. That was our goal with creating the coalition.

Jessica: Nicola, you are speaking to my heart right now. This is just the perfect example of a lot of the work of Practicing Connection is trying to help people see. Bob and I have talked about being able to see the networks and then, of course, understand how to work within them so that you’re getting the most benefit for the folks that you’re trying to serve. You’ve mentioned public-private partnership before, and I’m really curious about how you see this being an essential part, the fact that the public and private partnership is working together. How do you see that being as an essential core element? You’ve mentioned that a little bit, and I’d love to hear just a little more about that.

Nicola: Yes, absolutely. When you look at our service members, veterans, and their families, by nature of who they are, they will intersect with multiple systems. It’s almost inevitable. If we’re going to effectively serve and support them, we cannot do it siloed. We can’t do it siloed as organizations, and we can’t do it siloed as sectors and systems. Yet our systems just aren’t built and funded to function that way. We have to as a community, artificially inject that collaboration and that de-siloization. It can be done if you have willing partners and you have the backbone and you have a clear vision about where you’re going.

It is just simply not possible to do it for any one organization, do it alone. That’s the beauty of collective impact. We do things that each organization alone cannot do but with each organization doing exactly what they need to be doing. That public-private partnership is absolutely at the heart of everything that we do.

Jessica: This partnership, the Arizona Coalition for Military Families has resulted in this ecosystem of support for military families. What does that mean to you? What is the ecosystem of support?

Nicola: Again, when you look at, if you’re trying to impact the life of a service member, a veteran, or a family member, you can’t look at it one-dimensionally. You really have to look at it that they are moving through their life, they’re intersecting at different points with different systems, different services, their needs will evolve with time, their life circumstances will change. You throw a pandemic in there on top of all the other things that could be happening to a service member, veteran, or family member at any one time. It’s just constant.

Instead of looking at it like we can meet their needs through one approach, the ecosystem of support creating that, nurturing that, which is part of the role of the coalition and our partners, to us, that’s essential, because what you’re trying to do is build an environment that is supportive and is consistent. That’s what we’re going for over time, is more consistency about how we provide those services and support. We learned a lot about this through our very early work with the coalition, which was with the Arizona National Guard.

That being a very closed ecosystem where you have a chain of command. They had a period of time where they were really struggling with three consecutive years of the highest number of suicides they had ever had in the history of the organization. This was at the height of the post 9-11 deployments. Everyone was overwhelmed, the stress on the force, the organization, the service members, family members was immense. The adjunct general you mentioned in the introduction basically said, “I don’t believe there’s nothing that could have been done to prevent these deaths, so figure out what needs to be done and we will do it.”

That’s exactly what we did as a community. We basically looked at it and said, “We need to change essentially the ecosystem that these people are operating in. That was everything from command messaging, de-stigmatizing getting help. Everyone will get help, there’s no stigma because everyone’s going to do it. 24/7 response, training all 8,000 guard members as helpers. You’re creating an environment in which it is normalized to help and to be helped and you are putting the resources at the fingertips of the people who need them. The result of that was three consecutive years of zero suicides while that program was in operation.

We learned a lot of lessons from that about, again, creating that ecosystem or that environment to be able to have those better outcomes for our community and population. Now since 2017, we’ve been working on that with Be Connected with our entire population of 500,000 people plus in Arizona. It’s very different because you don’t have a closed ecosystem. You don’t have a chain of command, but those same lessons are things that we’re carrying over, which is about equipping helpers, making sure our different organizations are working together, and shortening the distance between someone who needs help and somebody getting that help.

Bob: That’s awesome work and thank you for doing it and the impact that you’ve had on military families in Arizona. That’s so awesome. You mentioned collective impact a little bit earlier and I’m curious about the collective impact model. Can you give our listeners some insight into it and maybe tell us why it’s been important to the work you’re talking about?

Nicola: We’re all about collective impact in Arizona. We like to say that we were doing collective impact before we even knew that’s what it was called. This approach came about organically, simply by our founding group of members who established the coalition, simply us drawing upon our experience being involved in collectives and collaboratives that did not work and that did not go and looking at the pitfalls basically. We just said, “We want to build something not for the next six months to a year, but something that will last years and years into– decades into the future.”

That was our vision for it because we knew also that the amount of time and energy and effort and resources and funding that you put into these things, you need that to last over time. What we’ve seen in other states that have struggled over the 15 years we’ve been doing this, most other states have been through at least three to four iterations of the type of work that we’re doing or some variation of that in that time. That’s because a lot of times the efforts are driven by things like executive orders or proclamations or things like that.

There’s nothing wrong with that, but from a sustainability standpoint, it’s very challenging to maintain something like that that has strong ownership to one leader. When we started out, we said, “Everyone is invited to be a part of it, but nobody owns it.” We were really clear about that from the beginning in terms of that vision. We were just really fortunate to have leaders in our community who bought into that and understood it and were willing to fund it. That’s a big thing too.

We really focused in on, we want to be really focused on what we’re trying to do. We didn’t want it to become about the mechanism of the group itself or the entity itself. We had a rule early on that I think was a struggle for some people, but it worked for us in this case, which was we had a rule that there would be no meetings for the sake of meeting. That every time we convened our partners or community, there had to be a point to it. That’s a small example, but what it speaks to is this idea that we just understood that if you are going to keep people engaged, you have got to provide a clear direction and value for their time because we’re all–

This was 15 years ago. We’re even more busy today than we were then. This idea of, we’re all going to work together. We’re going to have a backbone team. When you ask about collective impact, there are some different key elements, but one of them is to have a backbone team. That’s essential because we had all, again, been involved in efforts where when responsibility for the collaboration is shared, those things are very hard to sustain because the individual’s job or organization’s mission, those individual things will always supersede the collective. They should because sometimes these are things required by law, mission, funding.

To expect people to prioritize something else is not really realistic. They definitely want to contribute, but that’s what having the coalition as the backbone allows for is that we continue to drive these efforts forward and they plug in when it makes sense for them to do so, and they go about their business the rest of the time. It’s just something that was born out of our experiences with things that we didn’t want to replicate. Then as we went on and we learned about from Stanford, the term collective impact, and it was like, “That’s what we’re doing.” [chuckles] That was a fun discovery.

Jessica: You’ve mentioned the Be Connected initiative earlier, and I’m wondering how does that Be Connected program embody this model that you’ve been talking about and your dedication to upstream prevention?

Nicola: Great question. In 2015 to 2016, there was an 18-month period where the risk of suicide for Arizona veterans was three to four times higher than the general population. There has been over the past decade, a disparity in veteran suicide being higher than the general population, but that 18-month period was an anomaly where it really spiked. What it said was that despite many people, many organizations, a lot of money being spent on this effort, we just weren’t having the collective impact that we wanted to. So it prompted the partners to come together basically and say, “Okay, what do we want to do differently? What course do we want to set?”

It was a year-long strategic planning process. It was not always sunshine and roses. It was extremely challenging, but a cross-sector workgroup. After a year, what emerged was taking those lessons that we learned from our work with the guard and looking at how do we zoom out and apply those to our general population and focus more upstream to get out of this very narrow focus on crisis intervention, which is super important that cannot go away. Your chances of intervening with somebody in that crisis period is very low and highly dependent on luck, really, that somebody who is trained and willing to help is there at that moment.

So we thought, “If we can help people before they go into crisis, that would be better.” Now, the interesting thing for us about upstream prevention is that it’s something that you’ll hear people talk a lot about, but what our experience has been is it is actually very difficult to get over the hump and go upstream because it just requires a ton of intentionality and everything down to how you message about what this is. You will very rarely see us talk about Be Connected as a suicide prevention program because people have historically equated suicide prevention with crisis intervention.

We talk about Be Connected as an ecosystem of support, as being here for the 500,000 service members, veterans, and their families, as a phone number you can call anytime. You don’t have to be in crisis. We call it a support line. We don’t call it a crisis line. There are some very intentional things that we do to shift that focus upstream. This is also like a lot of the work that we do, a very long-term vision. This is not something where you’re going to do something today and next month you’re going to necessarily see the effects. We see this as like a multi-year, several-year process to put the pieces in place.

Again, when you’re talking about the ecosystem, we’re trying to set the conditions for people to have the support that they need in order to not have those outcomes. This has been an incredible journey for the last, it’ll be seven years since we launched Be Connected next year, and really giving us an opportunity to stretch ourselves when it comes to collective impact. We use every tool in our collective impact toolbox to implement this program and all the different pieces that fall under it and really try to create that prevention, intervention, postvention continuum that’s really important to this issue.

Bob: Nicola, you mentioned the difficulty of moving upstream. I wonder if you can talk a little bit about that. Is the difficulty letting go of some of the things that you’ve been doing and reporting? Is it a mindset shift? Is it all of it? Why did you think that the group found that difficult?

Nicola: That’s a very good question. The challenge is that because historically suicide prevention has been crisis intervention, a lot of the infrastructure around suicide prevention is crisis-oriented. You can say, “I want to do upstream prevention,” but if your focus is, say, doing gatekeeper training or suicide intervention training, again, those are very good things to do, but if that is all you do, are you really stretching yourself upstream? I was in a community practice meeting and it was really interesting to hear a person share who had been doing this work for a long time in a community. She said, “We always say upstream prevention, but everything we do is focused around crisis intervention.”

She was frustrated, and I heard that. That’s why I say it’s not enough to say it. You have to shift your focus and you have to build different systems and infrastructure to support this upstream prevention approach. Again, we have fantastic crisis response partners. We have the national veterans crisis line. We have our state crisis line. We have crisis teams. To be clear, we’re not discounting the importance of that at all. It’s just that we want to complement that with, here’s where you can send people before they’ve spiraled into crisis. We are building a suite of programs that can address their employment, their connectedness, social isolation.

We have a whole connection coaching program, helping them navigate care, mental health care, physical care, care transitions, just connecting to information and resources. When I say it’s difficult, I mean that you just need that intentionality and you have to have partners who are willing to support that work that complements the crisis intervention. It’s been a really interesting process because I feel like in a lot of ways, there really wasn’t a model for us to follow. We just had to work on it. We started Be Connected with a phone line and one person answering that phone line. The phone rang five times in the first two weeks and then it took us I think about 18 months to hit 5,000 encounters.

Then it only took us six more months to hit 10,000 encounters. You can set up a phone line and you can say, “We’re going to do upstream prevention and we’re going to help people,” but if nobody calls, it doesn’t really matter that you did it. For us, it was important to see if we put this messaging out, it’s not crisis, it’s a support line, will people call? People have called ever since then. We actually had the opportunity once to do an evaluation project with the CDC. One of the things we looked at was, are we actually reaching our audience upstream as intended?

Again, if you set up a support line and you’re like, “This is not a crisis line,” but half the people calling are in crisis, you may not be reaching your target audience. We were able to do an evaluation of the acuity of the callers and found that about 85% of the callers were what we would call low acuity, meaning that our team members were able to help them, connect them to resources, give them the information they needed. Then about 14.5% were more moderate where they needed additional support to navigate those resources, connect to what they needed. Then only about 0.5% were more in that orange-red zone of needing crisis or crisis support.

That was really encouraging because you can set it all up, but you then have to see did it work? How did we get over that hump to upstream? That’s a little bit about that journey.

Jessica: Just staying on this topic for a second, I have been working in community development for a long time. One of the things I see with this idea of trying to get upstream and there being this barrier or a number of barriers to doing that. Part of that is that a lot of the resources have been spent on that, in this case, crisis prevention phase. I see in other projects, a lot of the resources get spent on a particular phase of whatever the big issue is you’re trying to address in the community. It’s really hard to convince funders sometimes, not always, but sometimes it’s really hard to convince funders because there’s so much need in that phase, that there’s a reason why the resources have been spent there.

There’s so much need there, but it can be really difficult to try to move beyond that in part because that’s where the resources go. If you’re not addressing that directly, it’s hard for you to scrape for those dollars. It’s just something I’ve observed and I’m wondering was that part of the hurdles for you or is that something you’ve also observed in other areas?

Nicola: I definitely hear what you’re saying about that. I think that is a huge challenge. I think what has been different in Arizona is that, from the very beginning, we cast this vision for what was possible. It’s humbling to think about that vision we were talking about, what we’re living today is even more than I imagined. It’s more. We knew that there was this potential. I think one of the things that we were effectively able to do very early on was to communicate that vision to the partners in a way that they saw it and they bought into it and they were willing to put their resources behind it, whether those were in-kind resources, time.

From the beginning, it was funding. To say, “Yes, a backbone team is important. Yes, a neutral entity is important.” Then as we’ve gone, once you have that, then it builds momentum for you to be able to do, you start with a small thing. We do a lot of consulting with state teams across the country through the VA SAMHSA Technical Assistance Center. We work with other states and territories and help them provide guidance about this process. One of the things we talk about is, “Hey, don’t try to do this giant thing right off the bat. It’s pretty likely you’re going to really struggle with that. Do a very small thing.

Our small thing, in the beginning, was we did like one training for healthcare providers on PTSD and TBI. Then you do that one small thing successfully and what happens? The partners go, “Oh, that was fantastic. What a great training. Oh, people came. Oh, they liked it.”

Jessica: We want more of that.

Nicola: Yes. They’re like, “That was a really good experience. Oh, okay. Now we’re going to do something a little bit bigger and a little bit bigger.” Then you build that trust to say that we can facilitate this and we as a community can accomplish these things. As you go, you want to be building that. You want to be demonstrating that we are action-oriented, that we are able to execute on the things that we say we’re going to do. That doesn’t mean that there’s never a time you have to pivot or adjust, but that, we’re able to clearly say, “This is what we’re planning. This is why we want to do it. This is how we’re going to do it. This is the resources that we need.”

As you build trust with your partners, then it allows you to do more things as you go on. Talked about Be Connected and starting with just that one person and answer the phone and do it well. Then we’ve been able to grow to have this team of teams that’s now delivering all these different services. I think our situation being that we had invested a lot of time in growing that trust. I wouldn’t even say that there wasn’t resistance, I would just say that there was buy-in to say, “We’re going to add upstream prevention, as an upstream prevention is suicide prevention.” It’s not crisis intervention, but it is suicide prevention.

I guess to that end, it evolved more naturally than coming into a cold being like, “Now we want to do this and we need to carve out money for this.” We built the relationships with all the partners to say, “This is what’s possible if we work together on this.”

Bob: I love what you’ve shared about relationships and trust and how important those are. I’m wondering if there are any other lessons that you’ve learned about the amazing partnerships and longstanding partnerships that you’ve been able to build. What lessons have you learned or advice that you might offer to folks who are looking to build stronger partnerships?

Nicola: Yes. Relationships are so important. I’ll say one aspect of that, that we talk a lot about in this space is that it’s really important that you build relationships throughout an organization at all levels of an organization. If your relationship is only with the boots on the ground people, it’s going to be hard to get done maybe what you need to get done systemically to support the work that you’re doing. Conversely, if your relationship is only with people at the top leadership, you’re not going to have the buy-in from organizationally to maybe implement things that you want.

One of the things that we built the coalition for and why we have this collective impact initiative is that the only constant is change. We have in the past, almost 15 years now, obviously, we have had multiple changes in governors. Our directors of our VAs have changed. They change on a regular basis. Changes in our state agency directors, these are all very important key partners for us. You really want to look ahead and say, “I’m going to assume,” and that was what we did. We said, “We are going to assume all of these things will change. How can we build the coalition as an entity, a partnership, an organization so it can weather those changes?”

A big part of that is that our relationship-building is throughout these organizations. Then what happens when a new leader comes in and they’re oriented and we get to meet them, introduce them to what we’re doing, what our history is, what we’re working on now, the people around them in the organization can vouch for us and say, “Yes, we partner, we do this, we do that.” It really smooths those transitions in a way that if you didn’t have those relationships, it would be very easy to lose that institutional connection, right? Because the person you were connected to leaves and there isn’t that continuity. All of a sudden, you’re back to square one.

That does happen, but I’ll just say that overall, our relationships with these organizations have only grown over that time, even with all of those changes. That’s the thing that I think is very important when it comes to relationship building.

Jessica: That’s so cool. Do you have any personal practices that help you stay healthy and engaged in the work or just healthy and engaged in general?

Nicola: That’s a fantastic question. [chuckles] It’s been very much on our mind, especially the last three or four years. It’s, I think just brought to the forefront that we have to take care of ourselves and each other and do a better job. I’ll say that I have definitely for myself, drawn stronger boundaries around just containing my work. It’s so important to me, but also it used to bleed more into everything and just being like, “Okay, that’s that and that’s done for right now, and go do other things, live life or whatnot.”

That’s something we really try to impart with our team is unless something’s gone real off the rails, you should not get an email from anyone in our organization after five o’clock. Something has gone very wrong if we have to communicate like that. We feel really strongly as a management team about modeling that for our team that yes, give us your best when you’re here, but this is not your whole life. Even when you’re this mission-driven and especially when you’re this mission-driven, it doesn’t need to be your whole life. It can be an important part of your life, but not your whole life.

That’s something that’s been really important. Then I think just the recognition, this work is so challenging and it can feel sometimes over time, it takes a lot out of you. It can be very heavy when you think about what we’re trying to do, which is literally prevent people from dying. It’s like you have to give yourself that space to just be like, “I will do my absolute best. I will give my best to this,” but you have to build that space to be able to also go about your day and do- because there’s a lot of mundane things that go into the work too.

I think for me, just understanding that that toll is there. Then also just soaking up the moments when a really good thing happens, and when our team member shares like, “Hey, I am working with a 52-year-old Gulf War veteran. Yesterday he felt like he had no way forward and didn’t want to live and today he has hope because we’re working together and we’ve figured out some different things he can try or someone who was really socially isolated. Now they’re working with our connection coach and they’re feeling hopeful or somebody who didn’t have transportation. Now we help provide transportation.

Then just wins that we have where we work a lot with systems and that is long, arduous work [chuckles] that spans years in some cases. There is a breakthrough there, and all of a sudden, we’re going to be able to do something that we weren’t able to do before to take those wins. Really not let them just fly by, but to really soak them up and appreciate them and let it help fuel you.

Bob: That’s awesome advice. Thanks so much for that, Nicola. Thank you so much for joining us for the podcast. We’ve really, really enjoyed our conversation.

Nicola: Thank you for having me.

Bob: You can learn more about the great work that Nicola and her team are doing at arizonacoalition.org and www.beconnectedaz.org.

Jessica: That’s it for this episode. Thanks so much for joining us. You can keep up with Practicing Connection by subscribing to the podcast in your favorite podcast app, joining the Practicing Connection community on LinkedIn, signing up for the Practicing Connection monthly email, and by following Practicing Connection on social media. For links to all those opportunities, visit oneop.org/practicingconnection.

Bob: Thank you so much for joining us for this conversation. Thanks again to our guest, Nicola Winkle. We’d also like to thank our co-producer, Coral Owen, our announcer, Kalin Goble, Maggie Lucas, and Terry Meisenbach for their help with marketing, and Nathan Grim who composed and performed all the music you hear on the podcast. We hope you’ll join us again soon. In the meantime, keep practicing.

[music]

Kalin: The Practicing Connection podcast is a production of OneOp and is supported by the National Institute of Food and Agriculture, US Department of Agriculture, and the Office of Military Family Readiness Policy, US Department of Defense under Award Numbers 2019-48770-30366 and 2023-48770-41333.

[00:38:22] [END OF AUDIO]