Veterans can be a tight-knit group.
Having spent years building a community on whom they could depend with their lives, many Veterans find retirement from the military—and the sudden loss of that community—unsettling, at best.
This is one reason why Veterans recovering from behavioral health or addiction disorders often benefit from the support of a group that sees individual well-being as a community responsibility—a model of care for one another that recalls the unique cooperative culture of military service.
Particularly for those recovering from the effects of post-traumatic stress disorder (PTSD)—a diagnosed condition that can develop following exposure to a traumatic event, common in Veterans after military service—the collective care approach to treating the psychological aftermath of trauma is indispensable for thriving in civilian life.
For Kate Hoerster, helping Veterans help each other through peer support interventions has become a decade-long career path and passion.
A psychologist at the Seattle PTSD Outpatient Clinic for the VA Puget Sound Health Care System, core investigator for the VA Health Services Research & Development Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, and associate professor for the UW School of Medicine Department of Psychiatry and Behavioral Sciences, Kate envisions a future in which her research builds on those Veterans’ meaningful relationships with one another to bring health to Veterans throughout the country.
In a gratifying example of blooming where one is planted, what started as a graduate internship with the VA Puget Sound while Kate was studying clinical psychology jointly at San Diego State University/University of California, San Diego—her first experience working with Veterans—became a post-doctoral fellowship and then a staff psychologist role, complete with a faculty appointment to UW Medicine.
Having grown up in Seattle, Kate was delighted to return to her hometown after a dozen years away.
As a public health and social justice advocate, and a niece and granddaughter of Veterans, including a celebrated WWII Air Force Veteran, Kate’s commitment to the VA’s emphasis on collective care and support for Veterans is both professional and personal.
“The VA,” she said, “is an incredible place to work as a mental health professional hoping to address mental health conditions using a public health approach.”
Showing up for each other
Kate discovered very quickly after beginning her clinical internship at the VA Puget Sound that the military culture of team unity and collective support carries over into life after service.
“Veterans really show up for each other,” she said, which is especially important for those dealing with PTSD or other mental health conditions. “One of the most powerful tools for healing I’ve observed is Veterans partnering with other Veterans to provide support and solve problems.”
Her research, which informs her clinical practice, emphasizes understanding how contextual factors like social support and health policy affect mental health, as well as comorbid medical conditions like cardiovascular disease and health behaviors like physical activity and healthy eating.
PTSD in Veterans can negatively impact psychological functioning and quality of life, as well as physical health, including a disproportionately higher risk of obesity, diabetes and other chronic diseases.
To address this issue, Kate co-developed and piloted a behavioral weight management program for Veterans with PTSD called MOVE!+UP. Incorporating group therapy sessions, peer support counselors and group walks, the program addressed the increased risk of weight-related mortality through a collective care model.
“As a clinician, it is a true honor to get to work alongside Veterans with PTSD and other mental health conditions as they pursue recovery and a full and meaningful life,” Kate explained.
About halfway through each two-hour MOVE!+UP group intervention session, participants took a break to enjoy short walks together in the community along with a peer support counselor.
“The walks are an essential component of the program,” Kate explained. “For exercise, but also to grow community connection and address isolation and hypervigilance-related beliefs and behaviors, which are common in those diagnosed with PTSD.”
One of the peer support counselors who has been instrumental in the success of the MOVE!+UP program is Lamont Tanksley Sr., a Veteran who served 22 years in the U.S. Army and Navy.
In his decade working for the VA Puget Sound PTSD Outpatient Clinic, Lamont has spent nearly all of it supporting the MOVE!+UP program, leading all five of the program cohorts and co-authoring, with Kate and other contributors, a peer-reviewed journal article describing the results of the pilot.
Also influential to the program is research coordinator Nadiyah Sulayman, a born-and-raised Seattleite who has worked with MOVE!+UP for seven years, centering issues of health disparities among people of color and underserved communities.
“Lamont and Nadiyah have been instrumental in the success of MOVE!+UP—part of our really awesome team,” Kate enthused.
Now Kate and her team are testing whether MOVE!+UP improves health and mental health outcomes in a large VA-funded randomized clinical trial. The results of that trial are slated to be released in 2025.
MOVE!+UP isn’t the first trial she has led. Her team recently completed a trial testing a remotely-delivered, self-directed behavioral weight management program based on the Diabetes Prevention Program, the findings of which were published in Dec 2022 in JAMA.
“One takeaway from the study is that while self-delivered programs are often convenient, for many people meaningful human contact is essential for creating lasting, meaningful change,” Kate said.
Advocating for a better world
As if Kate’s day job were not enough to keep her busy, this mother of two is an engaged community organizer and advocate for public health, accessible public transportation, pedestrian-friendly urban neighborhoods and environmental justice.
Her Twitter bio sums it up nicely: “Day: PTSD treatment & recovery. Night: climate, transportation, & public health advocacy. 24 hours: a more just world for my kids & yours.”
A prolific writer who uses storytelling to foster greater community engagement and influence policy development, Kate has contributed opinion pieces and expert analysis to a variety of local media outlets—The Seattle Times, the South Seattle Emerald, KUOW, The Urbanist, UW Medicine’s Right as Rain—on topics as varied as eco-grief, exercise and mental health, body image, and public transit.
“I’m invested in maximizing research impact by communicating about science to the public and policymakers,” she said.
Kate first explored the use of scientific storytelling to make complex topics accessible to the public as an undergraduate psychology major in Connecticut. On a four-month study abroad trip to Mysore (Mysuru), in the southern Indian state of Karnataka, she collected stories of women’s early experiences with menstruation.
The research was later published in the peer-reviewed journal Women & Health, and the profundity of her experience in India solidified her interest in pursuing public health research through a community-engaged lens.
In a fitting nod to her storytelling skills and advocacy work, last month Kate was awarded the 2023 Leading the Narrative Award from the Society of Behavioral Medicine, which recognizes influential community engagement and successfully communicating behavioral science to a general audience through public scholarship.
Addressing health inequity
Too often, access to good health is shaped by the conditions we face as we live, learn, work and play – collectively called social determinants of health. For Veterans, BIPOC-identified people and those who are poor—or who are all three—those social determinants can play a decisive role in overall well-being and longevity.
Particularly for the BIPOC Veterans Kate sees in her clinical practice, interventions designed to address the disproportionate impact of these social determinants are essential to their effectiveness. A member of the racial justice workgroup at the VA PTSD clinic, Kate takes seriously the charge to address health inequities by disrupting structural racism in America.
Kate is Co-principal Investigator, alongside her close colleague Dr. Barbara Baquero, for the Participatory Active Transportation for Health in South Seattle (PATHSS) study, funded by the UW Population Health Initiative. Guided by a mobility justice lens, PATHSS seeks to center the voices of Beacon Hill neighborhood community members to identify ways of improving access to active and public transportation in South Seattle.
The community members interviewed as part of PATHSS have identified and advocated for a host of recommendations for public transportation, infrastructure, and policies to improve safe, free and healthy movement in South Seattle. This includes an inspiring group of youth who have advocated for fare-free transit and other improvements to public transportation and infrastructure.
“The City of Seattle could achieve their climate change mitigation and public health goals through policy changes to transportation,” Kate said. “For example, when the city offered free ORCA [transit] cards to youth in 2021, it was an incredible boost to transportation access for everyone. We want to see more policy wins like that.”
However, Kate argues, large-scale policy changes cannot be implemented without careful consideration through an anti-racist lens. And the need for change is by no means limited to Seattle.
Alongside PATHSS team members Barbara Baquero and longtime community activist KL Shannon, Kate co-authored a piece in The Urbanist, where they argued that people of color face significant barriers to the universal right to access outdoor activity: a legitimate fear of being racially profiled or, as in the case of Ahmaud Arbery and other innocent Black people exercising outdoors, killed.
They assert that society must put in the collective work to make our communities safer for people of color.
“To achieve true population health, well-being and justice,” Kate and her team wrote, “the structures blocking free movement by Black Americans must be torn down.”
Walking can be a key solution
A committed walker, Kate promotes walking as the panacea to many of society’s troubles. In addition to its many physical and mental health benefits, walking decreases carbon emissions that cause global warming, saves time and money spent on commuting, and encourages community building—all for the cost of a good pair of walking shoes.
Kate’s daily commute to the VA campus has been on foot for more than a decade, and she swears by running shoes from Brooks (whose global headquarters sit near the UW campus on the Burke-Gilman trail). For wet days, it’s her L.L. Bean duck boots. “Unfashionable, perhaps,” she laughed, “but they keep my feet dry.”
She has made, and maintains, lifelong friends on her walks, including colleagues from the VA, her longtime walking buddy and fellow mobility justice advocate Dori Rosenberg, and Mr. Sheppard, the delightful military Veteran who serves as a crossing guard at her son’s school and with whom she has partnered to advocate for safer intersections in the neighborhood.
“My 5-mile round-trip commute is filled with birdsong, kind strangers and exercise,” she wrote in a piece for the Seattle Times about her commitment to active commuting.
In fact, Kate’s entire family walks, bicycles or uses public transit for almost every trip. Her husband, a stay-at-home dad, taught their daughter to ride a bike when she was just three years old. These days, at four, she’s working on her bike tricks.
Kate and some parents from her son’s elementary school have been hosting a “walking school bus” to their local school daily during May, wherein they walk an approved district route to various stops, picking up about a dozen kids along the way and delivering them to school. They hope to grow the program as community interest grows.
Recognizing the myriad benefits of active commuting to physical health and mental health, along with its social, economic, and climate benefits, Kate advocates to make active transportation options, such as walking, biking and taking the bus, accessible to more Seattle families. This is also why the health behavior-mental health interventions she delivers at the VA frequently emphasize the benefits of community-based walking.
Her family does have a car, helpful for going on trips to see the grandparents or weekend adventures. It’s a 1999 Subaru—with comparatively low milage, naturally.
But mostly, Kate walks. And thinks—about how she can meaningfully show up for her community and about how her research and clinical work can facilitate better health outcomes for Veterans and her South Seattle community.
“I hope to be a facilitator of Veteran- and community-driven solutions,” she said. “Solutions that promote resilience, joy and well-being.”