Page 114 - Journal of Special Operations Medicine - Fall 2017

remain ready to withstand the many, diverse, known, and un- participation in kinetic operations. A comprehensive approach
expected stressors of training and combat, and have prioritized would incorporate the TFF/POTFF framework and broaden
the design and delivery of programs to enhance performance, programmatic interventions to include the entire performance-
resilience, and overall well-being and readiness. POTFF pro- illness continuum (Figure 1).
vides integrated support to SOF through four components:
(1) human performance, which addresses the unique physi- Figure 1 Performance-illness continuum.
cal and nutritional needs of SOF so they can endure austere
environments and recover quickly from injury; (2) psycho-
logical performance, which aims to enhance capabilities for
managing stress and maintaining cognitive function, as well as
reducing the stigma associated with mental-health help seek-
ing; (3) spiritual performance, designed to enhance awareness
of values and beliefs, and instill a sense of meaning and pur-
pose; and (4) social performance, which supports the stability
of the family and social networks of SOF.
This report reviews the shifting focus from resilience to human
performance optimization (HPO), describes human perfor-
mance initiatives, and then provides strategies for advancing
the application of HPO to existing programs. This topic is
related to both HPO and precision performance, which em-
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phasizes the importance of individualized performance needs.
To advance the practice of enhancing and sustaining perfor- The right side of Figure 1 showcases the disease and trauma
mance in SOF, we propose that HPO should (1) inclusively treatment approach, the current model of the military health-
focus on holistic fitness and incorporate domains of the Total care system. This approach addresses dysfunctions that
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Force Fitness (TFF) framework, (2) be tailored to the culture- emerge in response to stressors, injury, and aging, and fo-
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and mission-related needs of the diverse communities within cuses solutions on developing better assessments for diagno-
SOF targeted, and (3) advance ways to measure outcomes of sis, and subsequently increasing the availability of therapeutic
interest. Incorporating these aspects into new HPO initiatives services. This is problematic because it places an increasing
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more fully embraces a capability-based orientation. burden on the military health-care system.
From Resilience to HPO HPO, in contrast, is an orientation or framework to be opera-
Resilience initiatives of the past decade have been developed tionalized through “left-side” training, with optimal perfor-
in response to a call for more proactive approaches to protect mance and health as the outcome. Otherwise known as “left of
SOF and their families, with the primary catalyst centered on the bang” or “left of the boom,” this approach aims to bolster
preventing suicide and mental illness, as well as inoculation capabilities before an Operator encounters a “bang,” sustain-
from persistent stress exposure. One of the greatest chal- ing job- and mission-related performance, and “[increasing]
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lenges of both researching and developing training and educa- the chance that the member will return to health and optimal
tion to promote resilience is the lack of a single, unified, or functioning if injured.” It is time to transition to HPO, with
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consensual definition of resilience. It is still unclear whether movement and attention to activities that, when applied to the
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resilience is “a single trait, a collection of traits, or an outcome whole of the SOF and other populations, can and should ben-
of traits” or a set of competencies that enable successful re- efit all, no matter where they are on the continuum.
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covery and adaptation from adversity. Resilience has most
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often been defined as the ability to recover after facing a sig- A Focus on Holistic Fitness
nificant adversity or trauma, or as the capacity to respond to a HPO initiatives can influence outcomes across the entire per-
stressful circumstance in adaptive ways. 16 formance-illness continuum and potentially reduce the need
for “right of the bang” interventions, particularly when they
In contrast, the past several years have seen a notable shift incorporate all aspects of fitness and resilience. Fitness is con-
toward integrating HPO and TFF into training, expanding cerned with building the capacity and ability to perform opti-
thinking beyond mental health to include the multitude of mally when called upon. SOF and their families need to have
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factors that contribute to sustaining the health and capabili- the capacity to endure and grow in the face of stressors and
ties of SOF and their families. In the Chairman of the Joint this occurs when HPO-based skills are developed, nurtured,
Chiefs of Staff instruction of TFF, Admiral Mullen introduced and expanded upon during training. Actionable skills that are
the triple aims for preserving the capabilities of SOF. These easily taught and naturally learned by SOF and their families
included enabling Servicemembers to (1) adapt to the chaos are critical and require clarity on what the essential compo-
and complexity of the battlefield, (2) maintain vigilance in nents of fitness are as well as the particular needs within spe-
the peace, and (3) coexist peacefully in civil society. Yet SOF cific units and for individual Operators.
programs, like many other DoD initiatives, still tend to target
alleviating symptoms and focus on returning an Operator to HPO initiatives can be seen as supporting SOF throughout
the medical readiness standards for deployment. These initia- their lifespan—that what is taught through HPO efforts not
tives have been successful in introducing the concepts of HPO/ only bolsters success as an Operator but also provides skills
TFF to the total Force, but still fall short of fully embracing a to be used in different dimensions of life, within one’s family
proactive, comprehensive, and holistic approach at the onset and community as well as after retiring. Once integrated, these
of SOF training, rather than after frequent deployments and skills may have secondary benefits beyond improving discrete

110 | JSOM Volume 17, Edition 3/Fall 2017