Welcome back to the Healing Pain Podcast with Dr. Jeremy Fletcher, PT, DPT

We will look at a case study as to how one physical therapist is creating and evolving peer-to-peer models for the treatment of chronic pain. Adults living with chronic health conditions are more likely than other adults to seek peer advice and support from those that are experiencing or have overcome similar health challenges. Peer-to-peer support can happen online or offline via email, phone or even through social media. In fact, a Cochrane review described positive outcomes in people with chronic health conditions, including a reduction in pain, disability and fatigue once self-management programs were led by lay individuals rather than licensed health professionals.

Here to discuss peer-to-peer models for chronic pain is Dr. Jeremy Fletcher. He is a Doctor of Physical Therapy and a Professor at the University of South Alabama, Doctor of Physical Therapy Program. Prior to his career in academia, he served in the US Army as a physical therapist. He continues to serve his community through nonprofit board membership and organizational consultation with a focus on improving health-related quality of life. In addition to his role as a consultant, he’s also been trained in Acceptance and Commitment Therapy and combines it with his treatment of physical therapy.

In this episode, you will learn what is missing from our current management of patients with persistent pain from the social perspective of the biopsychosocial model, how peer-to-peer interaction can bring value to the recovery process, the opportunities and challenges with integrating peers into clinical practice and should peers deliver clinical interventions such as the bullseye that is used in Acceptance and Commitment Therapy. I’m excited to share Jeremy’s work with you, as well as to discuss peer-to-peer models for the treatment of chronic pain and other health conditions. As we move into the next year, you’re going to see a lot more group programs happening both online and offline.

With those group programs, they’ll often have a peer-to-peer component, which has been very helpful for those overcoming chronic pain. We will also talk a little bit about how practitioners can infuse Acceptance and Commitment Therapy into their treatment of chronic pain and other health conditions. If you’re any practitioner who treats chronic pain, make sure to hop on the waiting list for the Acceptance and Commitment Therapy (ACT) for Chronic Pain Program that I’ll launch in mid-January. Make sure you go to the IntegrativePainScienceInstitute.com, click on Courses and you’ll see a tab there where you can join the waitlist for the ACT for Chronic Pain Program. The program is appropriate for any health and wellness professionals. Let’s meet Dr. Jeremy Fletcher.

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Peer To Peer Models Of Pain Management With Dr. Jeremy Fletcher, PT, DPT

Jeremy, welcome to the show. It’s great to have you on this episode.

I am glad to be here. Thanks.

Someone introduced me to you and your work. I started googling your name and looking at your CV, reading your professional experience and looking at the peer-to-peer models with regard to pain management that you’ve been doing. I was excited to see the work you’re doing because it’s groundbreaking, it’s new, innovative and I can’t wait to share all the information you have with everyone in this episode. You started as a physical therapist assistant, which is interesting, but you’ve been a physical therapist. You got your DPT in 2010. You’ve been going at this for many years. I want to take you back a little bit to your early career. You seem to have some interesting jobs, positions and responsibilities that led you to where you are now. Take us back to the Winn Army Community Hospital. It was your first job as a staff physical therapist, but you did some interesting and innovative things there that you can do in physical therapy when you’re in the military that you can’t do in the private sector. Tell us about that.

I began as a physical therapy specialist, as they call it. In the training, I got through the military and decided to go back to a physical therapy school after doing that and I did that. I got my commission as the captain in the Army. My first duty station was at Winn Army Community Hospital at Fort Stewart, Georgia. I only spent about eight months in their clinic. It was a traditional outpatient clinic setting. I was moved out to the 4th Infantry or Light Infantry Brigade Combat teams. Within that role, I was one physical therapist for a population of about 4,500 soldiers. Within that environment, your primary job is to keep people deployable and keep the mission ready. There were lots of interesting things that happened because of that.

One was I became heavily involved in CrossFit. That was the fitness program of the day. People engaged in that heavily. As I’m thinking about how do I keep these people moving well enough to deploy, I figured I better get smart on that and I did. I was able to implement a 40-hour training session with about 250 squad leaders, who would essentially become Master Fitness Trainers, but we developed a program called the Vanguard Fitness Trainer. We ran those and they became the eyes and ears for me on the ground. They would go out and integrate some of the new training programs. They would supervise some of the strength conditioning things.

Now that’s the Army is fully, they actually have a course called the Master Fitness Trainer Course that their personnel do. It’s a very athletic environment and they enjoyed that for a season of life. From there, I was deployed to Afghanistan in an area of operations that was quite large. It covered about 8,500 to 9,000 personnel, including special forces operation units and then our own units. I knew that I had to innovate a little bit. I relied on frontline medics a lot to deliver first-line care. I developed a training program for them. Myself and my other PTA developed a training program for our medics within our brigade that taught them how to do knee and ankle evaluations and general shoulder things that would maximize their function until I would rotate out by helicopter to these combat outposts and visit them.

The medics would bring them to me, but they had already started some early care, which facilitated a quicker recovery. In that space, I was able to add value to the mission of getting people moving earlier, quicker and returning to duty faster. That was a unique experience in a very different environment. After that, I came back to Winn Army Community Hospital and became the Assistant Chief of the rehab facility where I was in charge of PT, OT, chiropractic services for soldiers and family members. From there, I went to Patient-Centered Medical Home. I was responsible for putting PT into a patient or soldiers in the medical home at that time. We were able to open up a direct access clinic so that about the 16,000 people in Fort Stewart had direct access to physical therapy care.

Along with that, I was able to do some cool stuff such as looking at low back pain imaging within that population, how to reduce imaging, how to implement screening tools like the STarT Back Screening Tool where people would come in and we would say, “You’re at low-risk. Let’s get you to the chiropractor where he can apply evidence-based care to you and it gets you to follow back up in a week if needed.” We looked at the middle-risk people there and they would get on my schedule within seven days. There are cool things that I was able to do from a performance improvement perspective that added value to the health system at large. I was able to go and be on the Community Health Promotion Council for the population of about 65,000 beneficiaries. I was able to look at some larger population health things there. It is a cool experience in that environment. Those were all the things that I was able to do while I was at Winn.

Somewhere in your history, you mentioned you’ve worked with Direct Access. You’ve done some research. You supervised and managed a number of different types of professionals. You did some innovative things with training professionals in Frontline Care. You also worked in a couple of different settings where you were responsible for ordering imaging and medications as well, which is unique for a physical therapist.

I enjoyed that autonomy. I would love to see us have that level of access as a civilian provider within our healthcare system. It did reaffirm my skills as a physical therapist. Whenever you’re working with or hanging out with radiologists, when you send them an image, they get excited because they’re going to read something that’s probably not normal and they will tell you that they can read normal all day long. I was able to develop those in that environment.

Were all the environments you’ve worked in have been VA/Military environments?

I’ve never worked in the VA, Veterans Affairs Facilities. I am working now with a nonprofit organization that collaborates a lot with the VA. As a physical therapist, I’ve exclusively worked with the military population.

Tell us some of the things that you’re doing with the peer-to-peer models for pain management and how that came about?

I’ll start with how it came about. I was looking to do something as an extension of my experiences when I was in the military learning how these peers played a tremendous role in mission readiness. What I learned through this reconditioning program was when you hold people accountable for their care, then you offer resources to make sure that they get those things, people got better. It wasn’t because of the exercises that they were doing in these group settings. It was more about the social aspect of what they were doing. I’ve always been interested and wanted to continue that. I reached out to a researcher here on campus who had specialized in veteran mental health issues, specifically related to things like moral injury and PTSD. I reached out to him and said, “I’d love to work with you on something. I’m interested in chronic pain management. I’m interested in working with peer models and delivery.”

We started talking more. I had a Reserve Commander. I’m still an Army Reserve. My commander was developing substance abuse and rehabilitation clinic for veterans with mental health issues. We were talking and he was like, “You need to join my team.” I was like, “Yes, sir.” Me, John Kilpatrick and Joe Currier, a psychologist, started talking more. We had a grant opportunity through the Robert Wood Johnson Foundation that allowed us to fund that effort. It’s a three-year grant and it has allowed us to try to test out these models of peer-to-peer interactions in both mental health but then also in chronic pain management. That’s what led us up to where we started in 2018.

Why do you feel that the social aspect is what’s missing? That’s a lot of what your work focuses on, that social aspect. Why are you zeroing in on that?

When we look at this biopsychosocial model of pain, we’re good at the bio, but we’re not good at psycho and we have no idea what to do with the socio. We don’t know what to do with it. Some of the experiences that I’ve had as a therapist, as a military member, and I’ve had some issues where the social environment shaped my behaviors and expectations of recovery in many ways. I began to think about how that plays a role in peer-to-peer stuff and what the medical system is currently providing in that environment. I think the medical system has lost trust. That’s the fundamental thing that’s been lost in our medical system. When someone is suffering and they’re struggling, they need someone to relinquish their sense of power and autonomy to say, “Can I trust you? I’m in a very vulnerable position right now. Can I trust you enough to allow you to be in life?” With the terminology and the language that we use within our medical profession, it’s a very fear-based language. It creates heightened levels of anxiety. If you’re thinking, “How do I know if I trust somebody?” If this person is speaking a different language than you are, then that puts up a barrier to a relationship.

In psychology, we know that it’s the relationship that predicts the degree of change that someone is going to embrace. When I think about, “How do you build a trust system and shared experiences, empathy and compassion?” These things are the foundations of a trusting relationship. If you’ve got a medical system that people are already distrusting, then how do you restore that? I think peers are one of the avenues that we can explore to say, “This person has lived experiences and they’ve been able to endure and embrace suffering in some ways.” Especially in the PTSD populations were stigmatized the veteran population with PTSD. I don’t want to wear this label and peers can deliver a different message and can say, “You can have PTSD, but that doesn’t have to be who you are. Let me tell you about post-traumatic growth, which you’re going to gain a greater sense of appreciation for life and you’re going to have a deeper spirituality because of the trauma that you experienced.” Those are the ways that we’re hoping that peers would be able to inculcate hope and that’s the way we’ll work.

Essentially because there’s not a whole lot of peer-to-peer interaction in any model of healthcare. There’s not a whole lot in pain care at all. What do you hope? What are you seeing as the value of that peer-to-peer interaction as you’re working on these pilots and developing this program? To clarify for everyone, is it only one program or two different programs? Is it a chronic pain or is it a PTSD? Oftentimes, these are treated together and they are comorbidities.

We’re not separating those things out. We’re using peers to deliver. There are different ways that peers can support a clinical team. We’re a multidisciplinary clinical team. We have PA, a PT, a psychologist and OT. The peer is part of our interdisciplinary clinical team. The whole idea is that, when we look at the interactions between PTSD, chronic pain and TBI, they all do share a similar basis in both mental and physical health. They share a lot of similarities. We find that whenever one is better managed, the other one is better managed. The skills that you learn to manage those are a lot of the same skills that you would manage any recovery process. That’s what we’re trying to use the peers for. It’s not like I’m saying, “How does the peer affect your pain? How does the peer affect your mental health?” It’s more about how are you within a context of acceptance and commitment therapy? How are you living a value-based life? How can I help you move in that direction? It’s not a diagnostic model. It’s more of, how can we help you move to where you want to go model approach?

There is a physical therapist, a psychologist, OT, a physician assistant and a peer. What does it look like? How do people enter into this model? How does it function? Can you talk to us about some of the details of it?

There are two different programs. I’ll add another interesting thing that’s happened to us, which is we’ve been asked to develop the same program for our local fire department. We’re in the first responder populations, very paramilitary-like in their culture. That’s very interesting.

I have a friend who’s a yoga instructor and she does therapeutic yoga. She said that she has a lot of friends who are firefighters and they don’t get any type of care around PTSD and chronic pain, things that to deal with on a daily basis. It’s interesting that you just brought that up.

In fact, I’m doing module two trainings of their peer support training to a group of about 25 firefighters. I’m going to learn a lot in that population, but I’m getting back to the way the team works. Veterans enter into the clinic, whether they’re referred by another veteran, we have other people that we call peer ambassadors. They are the eyes and ears of our organization. They find other veterans are struggling and they make a connection with them. They’ll tell them about our clinic so they’ll come to our clinic. We get them in to see our PA first so that we can evaluate them physically and medically. Oftentimes, you’re being managed by multiple providers that have multiple medications. We try to consolidate that down into one based on their needs and their desires.

It’s a very patient-centered or veterans-centered approach that we use. We also have a peer that’s an option for them. Our PA is trained in trauma-informed care, so that’s the approach that she uses. She often says, “Tell me what it is you want to take as your next steps. Whether it’s mental health or physical health and that’s the road they take.” If it’s mental health, they will get an appointment with one of our psychologists for an initial evaluation. Somewhere along the lines, we all serve under the umbrella of Acceptance and Commitment Therapy being our theoretical foundation of what we’re using. I’ve been through some training on that myself and it’s interesting to talk with a psychologist about that.

They’ll go to the psychologist and they will do their evaluation. They usually offer peers as a way to support or connect with that person. Sometimes people don’t want that. We respect their autonomy, but sometimes they do. The way the peers interact is either face-to-face meetings with them and that can happen outside the clinic walls. It doesn’t have to happen within the context of the clinic such as text messaging and phone calls. We’re looking at a whole different way of interacting with them outside of the clinic. I’ve done this work myself. The most valuable aspect that the peer provides is that we know about 50% of veterans will never seek care.

Those 50% that do seek care go through enough therapy to be beneficial. The peer plays an important role in encouraging adherence to their treatment programs. We call different things in the military. Some are like, “That witch doctor. He was like a brain guy or whatever. He’s got into my head. I don’t like this and it’s not fun.” They were like, “You’re going to have some sleepless nights because of this stuff. It’s going to be terrible.” It’s more of expressions of empathy to understand like, “I know where you’re going through. Believe me at the end of the day, it’s going to be worth it. Just hang in there.” The critical component is hope.

Does the peer have to go through the program first themselves? Do they receive training? Do they contact, such as yourself, to connect with if they feel like, “My peer is having a hard time?” If they weren’t sure how to respond or answer questions or provide support, can they come to you for additional feedback?

That’s a critical step in the implementation of the peer support program. They need supervision and training. In Alabama, there’s a state accreditation for peer support training and mental health and substance abuse. We only have one that state-certified, but there are other training organizations that do provide training. We’ve had about 6 or 7 peers that have been trained through about a 40-hour block of training. Those people do have supervision with our clinic director or one of the psychology interns provides oversight over their peers. We also interact with each other quite frequently. We get to share stories about the challenges that we’re having and those discussions also get delivered in an interdisciplinary clinical team meeting that happens once a week.

How long do the average participants stay in the program?

We’ve been open since last November. It’s still a pretty short period of time. We’ve cared for 170 veterans at this point within our model. We’ve had people that have been there since the beginning. We were now collecting real data to be able to tell us what’s working and what isn’t. It’s still early to know what the average is, but we have people that have come in there for three or four sessions and that’s all they need. We’ve had people that have been with us from the start. In fact, I’ve got a couple of peers that I work with that I met in the very first part of our staff.

As some practitioners are tuning in to us, this is interesting and this might be a missing piece that maybe I can begin within my clinic in your town, my community, my church or somewhere. What are some of the challenges that they may run into as they’re thinking this over, their curiosity’s being piqued and they’re starting to say, “I’m going to try a version of this. I’m going to run my own pilot,” so to speak.

I’ve been talking to a local clinic owner about what that would look like in their clinic. I think this happens a lot. When I’m training the firefighters, I was like, “A peer-to-peer relationship is another term for being a good friend to someone else.” It is sharing a story about life with another person. I was thinking about that within the context of physical therapy and your traditional outpatient clinic models. I told my friend, “Get two people together that had the same story and let them start talking and then connect them together.” It’s that easy so that they can share.

There are negative aspects to that. I think one of the challenges is that you want to inculcate hope. You’re trying to be hopeful and positive. The same thing happens in social environments where you could sit around that waiting room with the person that has a very negative effect. They’re very discouraging. They’ve been tainted by the medical system to a degree. They can also be the bad apple and then that can spread. That could be a challenge is to make sure that you’re selecting the person, one that’s willing to do that thing and to make sure there is willingness.

As long as they’re willing to do that and then providing them support, they’re going to hear things that come up in these conversations that medical providers do not hear and that’s valuable about. They feel isolated. They may not have money like some of these social determinants of health, that’s also an area where we’re looking at the peer to be able to gather data for us to bring back into the clinical environment. It’s the training, support and then making sure you have the right people on board that are willing to do this work and feel supported to do that type of work are things that I think about.

We see some of this in physical therapy practice. If you go into a larger physical therapy gym and you see two patients lying side by side on a plinth, they started chatting and they have similar or maybe even the same diagnosis. You see that happening, but we’ve never quite leveraged it the way you’re doing here in this program, which is interesting.

In our profession, we’ve shied away from group therapy. There are some beneficial social aspects of group therapy. I think it needs to be facilitated because there are some risks with groups. We are beginning to learn the implications of the social environment and how it influences our ability to perceive threats and how much that implicates or is implicated in the pain and how we perceive pain.

As you mentioned, through the Robert Wood Johnson Foundation, is this free to participants? Are they not paying or is it not through their insurance?

We serve veterans, regardless of their ability to pay. If they do have the VA, the VA now has what’s called the Choice Act, which allows veterans to choose. It’s got some logistical challenges that we’re trying to work through, but only about 40% of veterans use VA. A lot of veterans are employed and they use Blue Cross Blue Shield. They use third party administrators and we accept those as well. We accept Charity Care as well to anybody that’s a veteran basically. We call it veteran, anyone that has served one day on active duty.

The area where you live and work has a higher percentage of veterans. Can you talk about that a little bit?

The Gulf Coast has the second-highest density of veterans in the country. The first is the San Diego area. We’ve got about 1 in 10. It is about 10% of our population in Mobile and Baldwin counties, where veterans live.

It’s a big population you are serving in there and you’re doing great work. Tell me about if someone says, “This sounds great. It’s a great pilot and they had this whole team of people.” They play devil’s advocate.” Some people might be thinking, “Should a peer be delivering care whether it’s an extension of physical therapy or an extension of psychology? Should they fit that role and is it safe?”

Back to my experiences in the military where I had to look at a more of a skills and capacity approach and say, “What are the skills that are needed by someone that enable them to provide the level of care that I need at the right place, at the right time?” When you take that approach to that, you begin to look and say, “What is the real need at that moment in time for that person?” I wouldn’t be using a peer in a traditional physical therapy clinical environment. Having said that, there might be someone with a lived experience that was working as a tech that might be talking to people about their lived experiences while they were in the traditional outpatient setting.

The real value is the lived experience. It was like, “I’ve been through this. I know what this feels like. I can share in your suffering with you.” If you think about it that way, then all they’re doing is providing empathy and compassion and trust because you’re not able to do that. It’s not because you’re a bad therapist or anything else, it is because you don’t offer the same thing that this other person who’s had this shared struggle does. In that way, the care that they’re providing is more related to things that I bring back to trust and what builds the relationship. I’ve always said this, “I feel like the peers are more like trust brokers.” They kind of broker the relationship between the two that one is not able to because of the position that they’re in. The peer is able to all set that and that’s the value that they bring. I tend to be an innovative person. I tend to think differently. I like challenges to think of those things because I think it’s going to deepen and enrich the discussion about it.

It definitely is a very different perspective and a very different approach to caring for people along, whether it’s chronic pain or a disability-related to PTSD. People might be going to say, “It’s innovative but I don’t feel like I could do this.” Why does our medical system need a store to look at an approach like this and say, “Let’s at least try this or take aspects of this and weave it into what we’re currently doing?”

The theme of our life is the value. How our profession provides value to the healthcare system. I love Steven George’s work on chronic pain management and what that value-based proposition may look like within chronic pain. In his work and he uses a framework that talks about this perceived need and how to determine what the perceived need is. In the value-based conversation, that’s a perception. It is not much pain, it’s much about perception. We need to understand the qualitative aspects of what people are searching from us as physical therapists. The peer in my mind can play a role in understanding what that perceived need is. That’s different than the person that doesn’t have that and communicate that differently. The value of that relationship is being able to better understand the value perception of this other person if we’re understanding that value is a perceived construct.

Within the medical system at large, we’re moving to a value-based payment model. You have to move to that. It’s going to happen no matter what resistance we provide, it’s going to happen. When we think about what does value looks like, there’s a quality measure. There’s a cost and within this quality, we also know that it’s going to be somewhat tied to health outcomes. When we look at health outcomes, we have to say, “What drives health outcomes?” Health outcomes are more related to social determinants of health, which comprise about somewhere between 40 %and 60% of the outcome is determined by social determinants of health. We have access to physical therapy only to process about 20% at most if we’re adding ourselves to this value conversation. We have lifestyle behaviors, which is another 40%.

When I’m looking at how does our profession brings value to this transformation toward value-based care, I want to know what the perception, what the perceived need is because that’s a value construct. That’s where my mind is, “How do we shape or better understand what our value needs are?” At least we were I’m working on this and I had a conversation with someone about how do we find out what the social determinants of health are. There are ways to code these things in the ICD-10 called Z codes. If I were to use a peer to somebody that has had lived experience to go down a checklist with a patient and say, “Can you share with me these things that are going on?” Then, I can collect data about what this social situation is and the social environment is. I can also be able to leverage the peer who’s lower cost. We’re talking about $15 an hour type of people. I can leverage these people to all the social structures that would support this person. In a way, they’re an advocate or a navigator, there are some terms that you could use for them, but I see them as being another value proposition for our profession. Hopefully, that makes sense.

It does. What you’re saying is they’re economically efficient and in some ways, affordable. They’re scalable, which is important. If we look at the amount of chronic pain, chronic disease and mental health problems we have. Even if all of us jumped in as licensed professionals from all the professions, we probably still wouldn’t be able to fit the need. You’re working on something that’s scalable, bringing other people in that can help move the message along with their peers.

That’s the hope and desire. We had a conversation with an expert. He was like, “If you could do this, it would be groundbreaking.” I was like, “That sounds exciting, but it’s also a lot of work. It’s going to require a lot of people to get behind that type of effort, especially the economic argument, it is going to be difficult to make.” It is fine and I like it.

You’re innovative and you’re doing amazing things. How do we start to fan the fire under physical therapists who are working in the private sector outside of VA military, not for profit to encourage them, to motivate them, to make some of the changes that would need to happen in our profession? I think we extremely underutilized in healthcare, both in where we work and how we function as a physical therapist. How do we start to move that along a little bit faster?

The other thing that is coming around in my life is this term empowerment. How do you empower people? I feel like many of the therapists that I’ve worked with here locally, I do courses and I talked with people. I feel that there is a sense that the medical system is hopeless. They don’t feel like they have the capacity to change or make a difference in any way. We all have to think about ourselves as being influencers of change to a degree. We all have our locus of control. We all have the things within our span of influence that we can begin to move the needle on and began to start asking tougher questions. The way that we could all collectively do that is to think, “What can I do today that would push the envelope toward where I want to be tomorrow?”

If that were to gain some momentum over time, then that does become empowered action and motivation, but we have a problem. Within the Acceptance and Commitment Therapy and that framework of value-based decision making, “What is our value-based proposition in our profession?” It’s challenging. You have many people with different views of what that looks like and where to go. We have a set of core values that I teach our students about. If we stick to those values, within that is excellence, within that is altruism, and within that is those things that will propel us in a value-based direction. That’s could maybe change the conversation. I don’t know. I’d like to know your thoughts on it, Joe.

We talked about that. My thoughts are that, when I went to school, I originally had a Bachelor’s Degree in Physical Therapy. The university I went to, it was their last bachelor’s program. The year after I graduated, I went to a Master’s. About five years later, I went to a Doctorate. You watched the whole physical therapy profession transition probably within the matter of ten years from a bachelor’s to a doctorate degree, which was awesome. I was a proponent of it. With that, I went back and got my transitional DPT. What has occurred very slowly, in my opinion, is that our scope of practice remains small.

We need to change our scope of practice at the national level and make sure each state follows suit. I believe at this point, each state needs to have one core practice act that we’re working from in all 50 States, Puerto Rico and the US Virgin Islands, all work from that practice. It gets hard when in one state you can do dry needling and the next state, you can’t do dry needling. One state, you can do nutrition the next state, you can’t talk about nutrition. It’s a disservice to the profession and those in leadership positions need to focus on that.

I’ve talked about this on the show, now that we are Doctoral-trained professionals, we probably need to function more as primary care providers exactly what you did in the military. It’s a little bit easier in the military to do things like that. As far as working in a private environment, that’s challenging because it’s a bit of a practice act change. I’ve talked to physical therapists about this. Some are on board with like, “I feel like I could evaluate and treat a patient direct access.” I’ve talked to others who were like, “I feel like I can’t.”

I don’t know if that’s a function of training or that’s a function of someone’s confidence level and not necessarily the competence level. I think we’re graduating competent PTs. I’m more curious about their confidence level when they come out if they had those tools. Those are my big two things that where I think the profession should go, but it’s not necessarily up to me. People have to be on board with that vision of reinventing what physical therapy could look like. In that reinvention of physical therapy, we have to redefine who we are. As you mentioned, to redefine that we have to be the ones who make change happen.

The vision has been laid out as a societal vision. That’s a real positive thing to this discussion, but when I talk to people about topics related to health, it’s hard to see yourself there. When I think about confidence and how you build that visual imagery, self-efficacy and goal-setting, those things are the way to build this level of confidence, but the vision was important. I tell my students sometimes I feel like I’m training them from an environment that doesn’t exist. Fortunately, I was able to participate in an environment and I want them to have something similar because they aren’t competent. It’s a good thing that we’re going to be in this profession for a while.

Your perspective is unique. When I look at your professional experience and your life experience, all of that has framed this perspective. How has this whole program changed the type of clinician you are?

It is empowerment. It’s enabled me to let go of the outcome and to understand people from the personal environmental factors that influence their ability to move forward with life in general. Those are things that I have held within my practice as a physical therapist. One of the valuable things about our profession is that we do have leaders. People are willing to step outside the box. People are willing to do different things but at the same time, we have some people that are somewhat risk-averse. When I look at the things that I’ve experienced as a physical therapist and what do I bring of value from the experiences that I’ve had with the community at large, within the social environment that I live, they’re all of those values.

They’re the things that were instilled in me first as a physical therapist and my ability to acculturate to this profession. That I still hold true to myself. That hasn’t gone anywhere and that hasn’t left. The things that have changed are that I feel like I’m more of a therapist now than I was when I graduated and where I was a Doctor of Physical Therapy. That’s where the pendulum has swung back for me is, “I had this expertise, but I’m learning that it’s a relational profession that we’re in.” I think that’s something that this work has brought me back to has been this idea that it’s about relationships with people that make the difference. That’s something that’s influenced me.

Jeremy, it’s been a pleasure talking to you on the show. For everyone to know, the peer-to-peer model of pain management that he’s developed is called Together, Let’s End Their War: Promoting a Culture of Health among Veterans on the Gulf Coast. Jeremy leads that group of four or five practitioners. I want to thank all of them for their support in creating this group and showing with us. Please tell everyone how they can learn more about you and everything that you have going on.

I’m going to provide a link. It’s ClinicalScholarsNLI.org/Projects/Together-Lets-End-Their-War-Promoting-A-Culture-Of-Health-Among-Veterans-On-The-Gulf-Coast.

If you go online, you can Google, “Together, Let’s End Their War: Promoting a Culture of Health among Veterans on the Gulf Coast.” It’ll pop up and I suggest you read the page. You’ll get lots of good information about what the program is about. If you know someone who may be appropriate for it, they can check it out. If you’re a practitioner and this starts to resonate with you, you can read through that page and find out what the objectives and missions and the goals are of that wonderful program. It’ll give you great ideas for what you can do in your hospital, your practice, your community, your church and anywhere that you are and you want to help people with physical and mental challenges that they’re trying to overcome, whether it’s a veteran or anyone else.

I want to thank Jeremy for being on the show. I’d love to have you back on, Jeremy, when you get your results back from this pilot study because it’s going to be exciting. I know you’re collecting lots of great data to share people. Thanks for being here. If you can share this out with your friends, family, and colleagues, that would be great. Share us on Facebook, Twitter or LinkedIn. Grab the link, drop it into a Facebook group or there are lots of veterans or professionals that are treating people with chronic pain or other types of challenges. They would benefit from all this work. It has been a pleasure being here with you. We will see you on our next episode.

Important Links:

• Dr. Jeremy Fletcher.
• ClinicalScholarsNLI.org/Projects/Together-Lets-End-Their-War-Promoting-A-Culture-Of-Health-Among-Veterans-On-The-Gulf-Coast
• Facebook – Dr. Joe Tatta’s Facebook page
• Twitter – Dr. Joe Tatta’s Twitter page
• LinkedIn – Dr. Joseph Tatta’s LinkedIn page
• https://integrativepainscienceinstitute.com/act-for-chronic-pain-waitlist/

About Dr. Jeremy Fletcher

Dr. Jeremy Fletcher is a board-certified Orthopedic clinical specialist, a current Robert Wood Johnson Foundation Clinical Scholars Fellow (2018-2021), and an Assistant Professor at the University of South Alabama. Prior to his career in academia, he served in the US Army as a Physical Therapist where he worked on multiple efforts to improve health of active duty and family members. Dr. Fletcher continues to serve his community through non-profit board membership and organizational consultation with a focus on improving health equity and innovation to improve health-related quality of life. In addition to his role as a consultant, he is also been trained in Acceptance and Commitment Therapy.