Ken Huey 0:00

Welcome to The Voice of Hope, where bold leaders and healers share how they're building hope, not just talking about it. I'm Dr. Ken Huey. Let's meet the change makers transforming lives from the therapy room to the boardroom. Hello, and welcome to The Voice of Hope. Today's guest is Emily Cato, a healthcare operations executive and licensed social worker with more than a decade of experience across behavioral health and recovery services. She's led multi-state healthcare operations supporting thousands of individuals, overseeing more than 120 million in annual revenue, and built her career around creating stronger systems that help people and communities thrive. Today she is also CEO of Aokato Plumbing, a family-owned business serving the Louisville and southern Indiana communities. Emily, welcome. So I'm glad to have you.

Emily Catoe 0:51

Thanks for having me, Ken. I'm glad to be here.

Ken Huey 0:54

Yeah. I always like to start with asking those that I talked to kind of why. What brought you to social work and helping people navigate hard chapters in their lives?

Emily Catoe 1:05

So when I was in my 20s, I experienced some drug addiction myself. I struggled at the very end of my 20s for a period of time and found recovery. And since then, I always knew I wanted to help people. And I didn't realize how I wanted to help people. So I thought I was going to be an attorney, honestly. And it turns out that wasn't the path for me. So after finding the rooms of AA and NA, I looked into finishing my degree in social work and getting really involved and expanding access to resources and navigating recovery systems and realized like that's what I wanted to do was help other people figure it out because of how hard it was for my family to figure it out when nobody knew what they were doing.

Ken Huey 1:54

All right. You know, years of working in addiction recovery. What have you learned about what gives people genuine hope when they're feeling stuck?

Emily Catoe 2:06

So my experience says the hope comes from the person on the other end of the phone still answering and still taking those phone calls. One of the biggest things that I've seen is that people start to think that nobody wants them to do better because that's what their addiction is telling them. And knowing that there is someone who's going to answer that phone, hear what they're going through, and doesn't even need to solve a problem for them, but is just that listening ear. That's where a lot of these hope shots come from. And those a lot of the time are people who have experienced some of this themselves and can empathize with where the individual is at when they make that phone call.

Ken Huey 2:45

You've helped thousands of people through recovery housing programs. What stories give a story that from that work that has really kind of stayed with you?

Emily Catoe 2:56

Oh, I have an individual who came to me years ago. She and I are still really great friends today. And not only had she suffered through drug addiction, but she was on an outpatient program where she was on methadone as well. One of the things that she couldn't find was a housing option where people were accepting of her choice of path to recovery. And we'd found that a lot in working with housing, that not everybody agreed with a methadone assistance program or any kind of medication assisted treatment. And so she came to us and we were able to get her housing. And this is an individual who is now celebrating well over 10 years being in recovery just because someone said, you know what, I don't care what your pathway is, we're going to accept you right where you are. And so that's probably one of the biggest takeaways I've gotten. And her story is so similar to all these other people who just needed somebody to accept what they needed for them in their life at that time.

Ken Huey 4:03

Emily, there's really a fair amount of disagreement among professionals on medically assisted therapies. How would you explain your stance on that? Give us your take.

Emily Catoe 4:14

Well, I have a really great personal story that I can relate this back to. So when I first got into the field, I didn't agree with it. I thought it was a crutch and that people were just using it as a replacement. When I went back for my social work degree and started getting more information on the evidence behind it, during the same time, a childhood friend who had been on methadone for two and a half years, who had not returned to using street drugs, who had gained her child back, who had a home, who had a full-time job, got into a car accident. And when she got into that car accident, she broke her back and she had to have major surgery, which required some pain medication. She wasn't put back on her methadone. She was put on pain medication when she left the hospital. Unfortunately, this is an individual who never found her way back into the rooms. She never got her life back. Unfortunately, the last couple of weeks, she's actually been charged with a major felony and is probably going to prison for the next 10 years. Her story is what changed my mind on how we should look at things. I can't treat you if you're not alive. And so I want people to be alive today. And if that means that they need something that's going to help them not put a needle in their arm, not fall back into a lifestyle that leads to things like institutions in prison, then I'm all for what works for the individual. And I'm not saying it works for everybody. There are definitely people out there that is not the path that they are going to go down. But there are some people who, at the end of the day, that's going to be what keeps them from using something that could kill them. And I'm going to support them on that.

Ken Huey 5:54

All right. People in recovery teach you things in kind of a different way. What have you learned about resilience that you didn't learn from a textbook, but from working with people?

Emily Catoe 6:03

So when we were reading the textbooks, they teach us all about dopamine and how we have this dopamine release. And that is going to be what triggers our pleasure center. And so with working with people with drug addiction, I anticipated that it would take years and years for them to start to understand that everyday natural things could start to trigger that. It wasn't until I started working day in and day out with people that I started to realize that things as simple as learning to have fun in recovery start to replace that dopamine that you were getting from the drugs and the alcohol and tell you that you're having pleasure again. And so over my time, what I've done is I've worked with people to teach them that the little things matter. And that has been one of the biggest things that I've seen that's led to resilience in the individuals that are in recovery. So when working with them, it's great to read the textbook, right? Everybody is not going to fit into that. So what works for me isn't going to work for you. But seeing how accomplishing these small tasks that you can start to fit into your everyday, and it might be something as simple as waking up and looking at yourself and saying, I am great today, like it builds a sense of self that people just had lost for so long. I have seen people crawl out of the depths of things that I never could have imagined being. And they are running businesses today. I think my husband and I are a really good example of that is how you can come from whatever background that you're going to, and people can learn to trust you again and you gain your family back. And those are going to be the key factors in it. But like I said, reading the textbook and learning about these, the dopamine and how you develop resources and eco maps and how all of that's going to build these people into someone that can be resilient. That's nothing compared to actually getting to see them, discover those individual aspects of their recovery and build it into their lives.

Ken Huey 8:07

You know, there are those that would say you just need to kind of grab your own bootstraps and pull them out. Come on. You've talked about stable housing, community, a sense of belonging. How does that stack up? Why do we not just pull ourselves up by our bootstraps? Why do we need those things?

Emily Catoe 8:23

I mean, if we could just pull ourselves up by the bootstraps, then wouldn't we all just be doing that? It wouldn't matter if you're struggling with drug addiction or if you're struggling with a sex addiction or a gambling addiction. Honestly, I think if we relate this back to mental health, it's the same concept. People can't just always get out of bed when they're in a depressive episode. Except we expect addicts and alcoholics to do that when we provide resources for other people. It just doesn't work that way. Anyone that's going to be successful, whether it's a substance use addiction, a mental health issue, they need to have more than just themselves in order for them to be able to be prosperous. And I think when we talk about this, it's not just housing, it's not just resources, it's the fellowship, it's developing a sense of relationships, it's finding second chance opportunities for employment. Again, if we want to treat someone, we have to treat the whole person. That's gonna be every aspect of what's gone on in their lives and not just the substance they've been using. I tell my patients, substances are simply a symptom of what's been going on. If we don't start treating all of the things that brought that symptom about, then we're not gonna have a high success rate. So those treatment plans that we developed for them, that's what we really look at is are we treating you as a whole person? Are we looking at everything that's gonna play into you having sustainable long-term success?

Ken Huey 9:53

Yeah, a little pause. That's a winner, really. Thank you. I love that. It sort of bonks people on the head that one and it's such a silly damn argument. And so I appreciate it.

Emily Catoe 10:03

It is. It drives me crazy. And like I get the call. Sometimes I'll get calls from like a family member, and they're like, I don't understand why they just can't get up and move. And I'm like, you've never come off of opiates before, have you? Like, yeah, like it's not gonna work that way. And until you stop thinking that it's as simple as getting out of bed, we're just not gonna, that's gonna be a hard place for your family member to move forward on. So yeah.

Ken Huey 10:29

All right. Emily, you have worked to improve how long people remain stable in recovery housing. What makes someone feel safe enough to stay committed to recovery?

Emily Catoe 10:40

So I'm gonna actually relate this back to my job. It was at Oxford House, which is an amazing organization. I got the opportunity to work for them for seven and a half years. And during that time, I started to understand, and this relates back to the question we just were talking about building a network. Oxford House does something that is very different with their housing than I see with a lot of other housing options. They build a family-oriented environment. So when I was first moving into an Oxford house and starting the networking for them, someone told me that if I would stay for 16 months, I would have an 87% success rate to reaching long-term recovery. And so I decided that I would do that. But in doing so, what I learned is a really valuable lesson. Stick things out. Take the time to develop what you need to develop. This is not a race. There's no end game here. Like this is an everyday thing that we're going to have to be a part of. Oxford House did that for me, and they do it for so many people where they develop networks of individuals at every level you can think of, from just the people living in the house all the way up to these national and regional conferences that they do. They do trainings, they do fun things, they connect people with resources, they have staff that are just there in order to make sure that people get what they need to develop. They're not running the homes, they're teaching you how to do it yourself. Those are going to be those added components that people really need. Are you able to start advocating for yourself? Are you able to start making good decisions? Have you practiced that long enough for that to be something that becomes innate with you? And that's where I see people really start to be successful is through the development of all of those things.

Ken Huey 12:30

So you speak well, Emily, about the human side of behavioral health. How do you balance that against the operational needs?

Emily Catoe 12:40

Oh, that's a fun one. So personally, one of the things that I've learned is that I'm the advocate for the human part of it. As a VP in operations, what I had to remember is there's a business and there's a bottom line. And that people for the financial component represent a number. But for me, being an individual who not only oversees the operations, but does it from more of a micro-level social work perspective as well, because I'm on site, I have to be able to relate to the individuals who sit in an office and see the individuals as a bottom line. I have to relate that back to this is the experience we're having today in the facility. This is why that number isn't going to work. How can we make this individual and their needs prioritized while still fitting into the priority that I know that the board has of being able to make a profit to continue to operate business? But I would like to go a little bit deeper on that because I also think it's not just about convincing other people that individuals are humans and not just an operation. Oftentimes we have to convince the individuals that we don't just see them as a bottom line and that we do see them as individuals and we want to meet their needs. One of the things that I love to do, especially in my role as a VP, was to go into facilities and sit in the groups, participate in the groups, meet with individuals and actually use my clinical license one-on-one and just hear what they're saying and run focus groups and let them know that, like at the end of the day, maybe I can't make all the changes that they would like me to make. I may not have all that control, but I heard them. And so by doing those things from both levels and both aspects, it's been really successful. I've been able to scale operations and meet the needs of both a board and a C-suite, as well as the individuals that we're serving in the population.

Ken Huey 14:35

I think that a lot of patients, guests, clients are abused by the system in some ways. Or and it's easily, it's either apathy or it's greed somewhere on that continuum. People that just don't care as much as they used to and apathetically treat somebody and that that comes away bad. Or the dollars are what matters. Oh, you've run out of days on your insurance. Goodbye. What do you do for the trust broken for that person? How do you approach that client?

Emily Catoe 15:04

Well, I actually have this experience. So one of the things that I've realized is that it's okay to put myself on the line to help a client through something like that. Recently, we we opened a brand new program in a state that I was overseeing. And we had an insurance company that was ending people after 14 days. They did not care. That was how many days you were going to get, not only at inpatient, but also in a low-intensity residential. So what I did was I said, listen, I'm going to take the 14 days they're going to give me. But if we haven't found you the appropriate step down that's safe and supportive, then I'm going to just keep you here until we can do that and it fits. That typically doesn't take very long. But once you gain the trust of that one individual and you say, you know what, I would rather not make the $271 today off of another person taking that bed and make sure that you don't come back to it, it changes the perspective of all of the population that's coming to your program. And so that's been one of the ways that I've done that is just to step up and advocate and say, you know what, I'll take the heat. I'll be the one to say, you know what, one day with this individual is going to matter more than you getting one day paid. And it has worked very well. And I've taken the heat a lot of times on it. So yeah. Most of those individuals, though, I would say are not typically returning clients. The ones that see you go the extra mile for you, but see those little tiny extra things, and they don't think that they were, like we were saying, just a number. They tend to do better because they've started to see the value that they have in themselves because someone else has placed that value on them.

Ken Huey 16:44

You know, what we do has some real risks in terms of burnout. Compassion fatigue is a reality. How do you lead teams through that? What advice do you give to those that are really on the front line?

Emily Catoe 16:59

Every therapist should have a therapist. There should always be someone you're talking to. If you have an employee program, take advantage of that. If you are struggling, like as a supervisor, I will schedule one-on-ones with my direct reports every single week. Let's talk it through. Do you need some time off? Maybe you don't even have PTO, but you might just need to step away because you're going to be better when you come back. Like whatever we need to do to meet our staff and people where they're at, I think we should be doing that. As an individual who has worked in the field for a long time, I can feel the burnout myself. I think that's part of why I've decided to take a step back from operating healthcare to operate at my own company while working, doing group therapy on this side, is just so that I could get back into the why do I do this job again moment? Like, where does my passion come from? Historically, that's been exactly what I've needed to get over it. And so I like to share those experiences with other people. But back to the beginning, definitely like if you are working in this field and you're not talking to someone regularly about what you take on emotionally, all that baggage you are getting from individuals, that would be my very first suggestion is to find someone that can hear you so that you can let go of it and not take it all home with you.

Ken Huey 18:20

Emily, you've recently moved from healthcare leadership into a family-run business, family-owned business. What lessons have transferred over?

Emily Catoe 18:31

There is no such thing as days off. It doesn't matter if you're in healthcare or family-run business. My 50 to 60 hour weeks were still 50 to 60 hour weeks. But what I've really learned, honestly, is that it doesn't matter what you're doing. People are the priority. At the end of the day, people want to be heard, whether it's a plumbing issue or a substance use issue. If you can listen to them, hear what they're saying, you don't have to solve their problem. Just offer them a listening ear and then a potential opportunity for a solution. That really is what makes or breaks it when you are expanding and scaling operations that involve people and their problems. Also, budgeting, the day-to-day management, the development, it's all the same. It's just a different subset that I'm working with at this point.

Ken Huey 19:18

In your work today, what really gives you hope for those in recovery and sort of wandering through life trying to find the right meaning?

Emily Catoe 19:29

That's a hard one. Can we rephrase that?

Ken Huey 19:32

Sure. So in your career, you work with people that are in recovery, you work with people that are trying to figure out their job. But in spite of the difficulty, there's got to be things that just really kind of give you hope. It feels like, you know what, we're going to be okay. What would you say about that?

Emily Catoe 19:46

So I think what gives me hope is that every day I know that we are doing something for someone to help them have a better day. So when someone calls me and they've got a leak going on now, I'm able to give them some opportunity for a solution on that. The idea that social work only is needed in one aspect of our society just doesn't fit anymore. And having that background where, like, I know what I want to do is help resolve an issue that someone has, whatever that means. That's what gets me up and gets me to work today. And then the really cool part is I get to work with my family and I'm getting to scale operations that are going to impact not just my husband and I and our children, but our grandchildren, because we're developing something that can span generations. So I think that would be my secondary thing that really gives me hope for what we can do for society. I think that being an employer that's going to start offering second chance opportunities and then going and advocating for that with other individuals and other companies, like that for me is going to be a huge factor in what we're doing. We just met with a ministry that asked if we would hire some of the individuals that are living in their substance use houses. And we said, absolutely. So for me, when we relate it back to the recovery aspect, what I'm really looking forward to is being able to partner with other organizations and provide job opportunities and resources to individuals who are struggling and maybe just don't know that people are going to give them a second chance and being able to be that person for someone today.

Ken Huey 21:27

Okay. Emily, really wide-ranging in your work with both systems and businesses and right on the front lines with people is just fascinating and engaging. Thank you so much for spending a little bit of time talking with us here.

Emily Catoe 21:40

Yeah, absolutely. I really appreciate you having me on. And this has been a really cool opportunity, so thanks.

Ken Huey 21:47

Thanks for joining us on The Voice of Hope. If you were inspired, share the light. And remember, hope's not just a feeling, it's a force. We'll see you next time.