Page 41 - JSOM Winter 2021

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Following the RAND Study, the team was expanded (2014– The model also provided an organizing, unifying structure and
present) to include subject matter experts in neuropsychology systematic approach for analyzing the performance of various
(n = 3), PTSD (n = 9), neuroscience (n = 3), learning science targets within the protocol, designing and selecting effective
(n = 2), and sport/performance psychology (n = 2). Comple- performance improvement interventions, improving and refin-
tion of the core content and process elements of the PTSD/ ing those interventions, and evaluating results. Furthermore, the
TBI protocol occurred in 2020, and formal study for use as a model stresses evaluation and change management within the
psychological performance protocol with US Military and first protocol’s content and associated processes at each of the process
response assets occurred from 2017 to 2020. The final proto- phases (HPT model) and of the intervention (SIT-NORCAL), in
col is an interlocking psychological performance and health a linear and sequential fashion, allowing for the configuration of
sustainment hybrid structured by a flexible core training al- a design algorithm and measurement systems. These factors, in
gorithm: SIT-NORCAL for human performance (Arm 1) and addition to the model’s deliberate view of challenges as oppor-
SIT-NORCAL for health sustainment and restoration geared tunities, have been critical to the success of the protocol’s rapid
toward PTSD/TBI (Arm 2). The two arms of SIT-NORCAL transition to telehealth and configuration of distance learning
have collectively undergone multiple implementations and re- options in response to coronavirus disease 2019 (COVID-19).
finement (44 cohorts; n ≥ 300) with provider and trainee-cen-
tered feedback, as well as standardized measurement from Performance Analysis of Need or Opportunity
2013 to 2020.
Organizational Analysis
The vision, mission, and values of key stakeholders in psy-
Integration of the Performance Improvement/ chological performance, health sustainment, and restoration
HPT Model
within the DoD, Special Operations Forces, and VA are unique,
Hybridization, Manualization, and Measurement demanding an independent complex assessment of goals, ob-
To address the challenges identified in the RAND study and jectives, and strategies for effective service alignment along an
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achieve the aims of hybridization, manualization, and sys- ever-widening span of need. However, among all three entities,
tematic integration of measurement capability during devel- overarching themes emerge, and an opportunity to close crit-
opment, SIT-NORCAL was structured by the performance ical gaps in suicide prevention, outreach, resilience, and ac-
improvement/HPT model (Figure 1). 26,42 This model was tai- cess to evidence-based practices becomes evident. Hybridized
lored to meet the demands of warfighters in the context of (1) human performance and psychological health sustainment
the unit and community level and (2) military treatment facil- protocols represent a paradigm shift in the delivery of psycho-
ity (MTF)/VA-level delivery, and had advantages for use in this logical performance training and care geared specifically to-
context in that it deliberately views performance improvement ward warfighters and combat veterans. These protocols have
challenges as potential opportunities, and focuses on concepts the potential to overcome obstacles in initiation, engagement,
of feasibility and sustainability within processes. retention, and success seen in traditional care. 31,32,41,47–53

FIGURE 1 Modified human performance /human performance technology model.

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BDI-II, Beck Depression Inventory-II ; CSQ, Client Satisfaction Questionnaire ; HL, Health Literacy; HPO, Human Performance Optimization;
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HRV, Heart Rate Variability; PCL-5, Posttraumatic Symptom Checklist ; TOPS, Test of Performance Strategies 46
Modified HPT model source from Van Tiem D, Moseley JL, Dessinger JC. Fundamentals of Performance Improvement: Optimizing Results
through People, Process, and Organizations. 3rd ed. San Francisco, CA: John Wiley & Sons; 2012.
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