Page 115 - Journal of Special Operations Medicine - Fall 2017

task performance, can be applied to both personal and profes- key drivers for delivery of these large-scale programs are stan-
sional domains, and also aid in easing transitions to seeking dardization, fidelity, and consistency, which are necessary for
education or employment outside of the military. For example, evaluating programs and outcomes.
take the skill of goal setting [see the HPO series in Journal
of Special Operations Medicine, 2014;14(4)]. Goals positively Top-down efforts typically assume that health, fitness, perfor-
impact performance by focusing on mastering needed skills mance, and resilience needs are somewhat consistent across
and knowledge, by directing attention to where it is neces- many subpopulations. Certainly some performance/health/
sary, energizing and motivating, increasing persistence, and fitness standards can be generalized across SOF, but existing
enabling goal setters to use themselves more completely and in programs do not account for the specific contexts or differ-
new, strategic ways. Goal setting can aid in enhancing com- ences in unit culture where the skills and concepts might be
20
mitment by reducing goal conflict through analyzing priori- applied. Each group has strengths and vulnerabilities within
ties, intentionally planning behaviors, proactively considering SOF and these vary based on job role and branch of service.
the mental and emotional states required for progress, and for A remote drone operator harnesses different strengths (e.g.,
developing accountability strategies and support systems nec- attention control) and vulnerabilities (e.g., sedentary work
essary for success. Goal setting is a skill that can be applied to hours, focused on a computer screen, remote exposure to
many domains of TFF. Learning to set and execute realistic trauma) compared with a Navy SEAL’s strengths (e.g., agility)
21
physical fitness, nutrition, or financial goals, and harnessing and vulnerabilities (e.g., exposure to extreme environmental
the motivation to follow through can benefit the performance conditions, first-hand exposure to trauma).
and health of an Operator.
Moving from resilience to HPO, the paradigm needs to shift
HPO initiatives may also reduce mental health stigma through to one that is integrated and more community based. One way
highlighting how negative beliefs about mental health may to address unique community requirements is to outline the
hinder positive changes and growth that occur upon receiv- knowledge, skills, and abilities (KSA) and the mission essential
ing help. Emphasis on HPO in a military setting will help task list (METL) for specific positions within SOF. The KSA
22
SOF understand that resilience is about building capabilities and METL requirements should be reviewed by leadership and
for thriving, mitigating observed and known weaknesses, and SOF within each of the units and provide insight into where
capitalizing on strengths and skills, to promote overall well- and how targeted fitness and performance efforts should be
being and enable optimal performance. This occurs while deployed. Operators can gain awareness of their individual
simultaneously decreasing the stigma associated with seek- strengths and vulnerabilities, and feel empowered to work
ing psychological support. A focus on solely ameliorating pa- on competencies that enable them to optimize performance.
thology misses the opportunity to help SOF address expected Leadership may also gain insight into both vulnerabilities for
reductions in performance through intentional skill building. the unit as a whole, for specific positions, and for individual
Importantly, HPO initiatives can eliminate stigma by convey- Operators. HPO initiatives can then accurately target the pre-
22
ing the malleability of all health behaviors for SOF and their cise needs of the group at hand; hence, precision performance.
families. A holistic approach is valuable because nutritional,
physical fitness, social, spiritual, financial, and psychological Future HPO efforts must take into account the unique cultures,
fitness are intertwined. mission sets, and circumstances that can influence program
delivery and effectiveness. Tailoring approaches through cul-
27
HPO initiatives that enhance social health can promote skills tural adaptation should enhance acceptability, intrinsic moti-
individuals can learn, and include cohesion-building exercises vation, and sustainability. Future HPO initiatives should be
28
units can practice and family-level components. Team commu- driven from the bottom up, integrating language and concepts
nication and cohesion are essential in tactical environments. familiar and recognizable for the specific occupations within
Skills such as communicating with respect, tolerance, and a community. It should have clear mission-driven metrics,
trust; expressing emotions effectively; understanding nonver- dynamic monitoring/feedback to inform the Operator when
bal communication; and embracing diversity can build social adjustments are needed, and the ability to adjust quickly to
resilience 23,24 and enhance individual and team performance. unanticipated demands. Those who execute the tasks and du-
Family-level resilience skills include, but are not limited to, ties essential for a particular role should determine the key
developing a family identity and belief system, being flexible metrics of importance. The approaches must support the core
and connected to family members, establishing family routines values, creeds, and language used in their units or service,
and traditions, being emotionally responsive, and engaging in which already reflect resilience as a central organizational
collaborative problem solving. 25 identity. Finally, influential members within the community
26
itself should be the trainers; they should not rely solely on
outsiders like contractors, academics, researchers, or persons
Tailoring HPO Initiatives
who are not inherently connected to the military community.
As the landscape of warfare continues to evolve in the face Increased collaboration among, integration of, and education
of more sophisticated, unpredictable, and technologically for service providers on the unique cultural facets of SOF can
advanced threats, tailoring HPO-focused efforts becomes further boost the impact of HPO initiatives.
increasingly important. Enhancing internal and external ca-
pabilities to thrive through challenge will yield returns on per- Measurement
formance and positive adaptation. To date, however, many In policy and in practice, what is measured is what becomes
26
programs intended to enhance resilience and fitness follow a valued. The measurements used both in research and prac-
top-down approach, initiated by policy or by leadership, con- tice, and for determining whether an individual is ready and
ceptualized in conjunction with academics or researchers with fit have focused mostly on the absence of negative outcomes
the evidence to support, and then pushed down the ranks. The and are still primarily derived from a medical model. Mental

A Shift from Resilience to HPO in SOF Training | 111