This paper describes the need for coaching to improve resiliency of Special Operations Forces and discusses a means for evaluating readiness in military populaions.

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Performance Coach: Health Advocate for Enhancing Career Longevity of Special Forces
Major Philip A. Sanabria, Krista Austin, Ph.D., Steve Roush

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“Humans are more important than hardware”, is the most critical SOF Truth that we as a
regiment must always remember. This statement keeps leaders focused on the most important
aspect of SOF, our people. This truth embodies the belief that relationships are the foundation of
our endeavors and dependent on creating a family atmosphere centered on trust and teamwork.1
During the past 10 years we have made great strides in optimizing Operator potential through the
development of multiple resources. The THOR3, P3, medical, and spiritual programs are a
tremendous resources for our Operators, however there is a critical gap between the Operator and
the multiple resources available. Currently, it is up to the individual Operator to seek out these
resources, which they may or may not do based on factors such as lack of education or
awareness, missing symptoms, or the belief that help comes with consequences or is
unattainable.2
To outsiders, including Congress, Special Operations Forces are known as
America’s “tough guys” and inappropriately it has been conveyed that much of the resistance to
help is a function of Operators being “taught to fight through injury and remain stoic about
pain”.2
However, this misperception was highlighted over the last six months by Dr. Krista
Austin while embedding with SFOD-A 7124 to research how to define “Readiness” for Special
Forces Soldiers. During this time, she was able to identify a unique gap- an Operator centric
performance coaching gap- in how to engage resources needed by the Operator. Through guiding
Operators to resources that were needed to enhance readiness, Operators changed their approach
to readiness and sought more medical resources to address their health. Her unique embedded
experience evaluating the team throughout an entire red, amber, green cycle, shed light on
current processes and how they could be optimized to create a better Operator with increased
longevity. Together we determined that more professional oversight is needed to know the
individual, know the team, and be able to work with the soldier to communicate the needs to
available resources. This Performance Coach is needed at the company level to synchronize all
available resources, monitor individual and team readiness, provide daily care and identify
problems early.
Soldier Health: Effects of Operational Tempo on Health
Exposure to traumatic and life-threatening events, intense training, chronic relative
energy restriction and blast exposure has left many SOF personnel with ongoing injuries,
endocrine dysfunction, impaired mental health and maladaptive behaviors resulting in increased
health problems and higher mortality rates. The incidence of musculoskeletal injuries in U.S.
Army SOF has been reported to be 20.8 injured individuals per 100 individuals per year.
Seventy-seven percent of these injuries were classified as preventable and impeded optimal
training for readiness.3
Endocrine dysfunction has been identified in 42% of male veterans who
had at least one mild TBI (mTBI).4
According to medical records, mTBI incidence rate of
Special Operations Forces between years 2011 to 2013 ranged from 13% to 18%, showing high
incidence in this population. In SOF personnel, combat experiences have been associated with a
positive screen for maladaptive behaviors such as alcohol abuse5
and anecdotal evidence suggest
this is one means SOF utilize to self-medicate on-going issues related to post traumatic stress
disorder (PTSD).2
Due to the high volume of individuals suffering from these adverse health
outcomes and their incredible cost, the Institute of Medicine’s Committee on Assessment of
Ongoing Efforts in the Treatment of Post-Traumatic Stress Disorder recommended further
development of innovative and alternative modalities for prevention of PTSD.7
Based on the
above lines of evidence , it suggests a need for a unique interventional model that is preventative
in nature. Evidence from studies of innovative sustainability practices in healthcare and coaching

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psychology have demonstrated a role for embedding practitioners and the use of a coach to lead
in proactive responses necessary for innovating change that leads to increased resilience, reduced
stress and depression and improved health outcomes.8-9
Embedded Practitioner from High Performance Sport
Dr. Austin comes from high performance sport where she has worked for the United
States Olympic Committee and English Institute of Sport. She has consulted on projects for elite
groups such as the Nike Oregon Project and the Brazilian Olympic Committee. Her
qualifications include a Doctorate in Movement Science, 24 years of coaching experience and18
years as a practitioner in multiple areas of sport science including high performance planning,
strength and conditioning, performance nutrition and physiology. Specialty training Dr. Austin
performed throughout her career included endocrinology, musculoskeletal injury, cardiac and
pulmonary rehabilitation and Burn ICU. Key experiences throughout her career include
providing pastoral care to breed and sustain athletes over the course of their career and
significant exposure to highly successful coaches and unconventional practitioners. In addition,
she spent two and half years with Marine Corps ground combat elements, including eighteen
months with Marine RECON, which provided significant insight into differences between sport
and the military community.
Problems Identified Through Embedded Observation
During the observation period, three key areas were identified at the team level that could
be addressed to improve sustainment of an Operator. The first is the ability to objectively
evaluate SFODA performance at the team and individual level. Without tiered assessments and a
matrix consisting of test sets indicative of readiness, it is unknown whether operational readiness
is transpiring throughout the pre-deployment period. This is especially critical given the diverse
schedule maintained by the individual Operator. Secondly, while the Team Sergeant is
responsible for evaluating the physical, mental and medical readiness of team members, there is
a lack of training and expertise in these areas to optimize soldier health. A Team Sergeant may
have zero experience with identifying the symptoms of various medical conditions such sleep
apnea, or hormonal issues. Team Sergeants will also have varying levels of expertise and
thoughts on fitness, creating various degrees of readiness from team to team. Lastly, protocols
for recovery and preparing for physical and mental occupational demands were unavailable. This
was especially true for medical aspects, including hormone repletion, that need to be addressed,
so that health is maintained and performance can then be the focus of day to day physical and
mental training.
At the company level, it was observed across the board the belief that access to getting
help for ongoing, unsolved health related issues was a primary limiter in performance and
sustainment. In addition, Operators wanted someone to consult with and share personal aspects
related to who they are as a person, needs as an individual and daily life concepts that were
relevant to their sustainment. All Operators were open to methods that would improve them as a
person and in their occupation; an indicator that there is a need for someone to work with them in
the best interest of their development. The members of SFODA 7124 rapidly adapted to having
an embedded individual with the holistic coaching knowledge analyze their performance based
on metrics. Having their performance analyzed prompted the Team Sergeant to begin utilizing
resources already available, but not being used by the team prior.

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Improvement Seen at the Team Level
During the six months that Dr. Austin was embedded with SFODA 7124 significant
improvement has been seen across the SFODA. They have quickly become one of the top
performing teams in the company. The Team Sergeant and Captain are much more aware of
how to evaluate individual and team performance, strengths, and weaknesses. The SFODA is
now much more aware of injury prevention methods prior to training, as well as different
resources to assist with quick recovery. Individuals with injuries are seeking out proper care,
while still training in ways to not further injure themselves. Their training progression is better
tied into their operational calendars. The Team Sergeant is focused on mission preparation and
post mission/training recovery, which has led to a more cohesive team that still trains hard, but is
not continuing to break individuals down. Dr. Austin was able to provide insight into these areas
and give the team feedback down to the individual level, and also make the Operators want to
seek outside personnel, such as medical staff, to provide specialty assistance when needed.
Need for further specialty care and different construct
The sustainment of Operators requires a system that is able to maintain the individual for
a period of 20 years or more. Over the course of an Operator’s career, the occupational
requirements change substantially and the ability to enhance the occupation and optimize the
human must accommodate these shifts in paradigm. It must be responsive to the needs of the
Operators and provide a positive coping mechanism as they move through an occupation filled
with unique stressors. As such, the construct implemented must be Operator centric and account
for the individual care required to ascend the occupation’s pathways. This varies significantly
from sport systems in which most sustain an athlete for a minimum of 4 years and rarely for
more than 8 years. Observations of elite athletes pursuing their career for greater periods of time,
especially through their forties, highlight the significant differences in the approach utilized to
sustain performance. Frequently this is achieved through a key individual who is responsible for
guiding all aspects of the athlete’s performance and working in their best interest at all times.
The position of individuals responsible for care of the Operator needs to be embedded
and appreciated as an essential component of their environment.8
The High Performance Team
Coaching (HPTC) model utilizes an embedded coach to drive the center of its system as this
provides a greater level of psychological safety to team members and trust is developed leading
to greater honesty and risk taking.10
A key characteristic of successfully implementing coaching
into a team is the creation of a strong identity with the team’s mission which allows the coach to
build strong interpersonal commitments, forge close-knit relationships, integrate values and goals
with the team’s commitments to their cause, promote a greater sense of humor to maintain
camaraderie and instill a belief that each individual has the ability to accomplish the impossible.
Success of military units is highly dependent on the leadership placed within and determines the
performance and behavior taken on by the unit. By embedding the coach within the unit and
serving under the direction of the Commander, greater buy-in will occur and result in improved
outcomes and performance.11
A performance coach is used in sport to drive the implementation of resources that can
positively impact the health and performance of athletes.12
These coaches supervise performance
and medical services, ensure the welfare of the individual is the highest priority, supportively and
creatively challenge the individual, assist the individual in realizing their full performance

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potential, continually monitor progress and assess impact of interventions, document and guide
performance targets and provide daily care. In the same manner, a performance coach embedded
with Operators could serve to ensure the occupational construct is maintained in services
provided, provide operational coordination, manage individual and team services, provide
advance support of each Operator and serve as the expert in occupational and medical science. It
would be anticipated that this will also result in long term costs savings through improving the
health and sustainment of each Operator.
Throughout sport and business organizations, implementation of a coach has significantly
assisted in the refinement of resource utilization and economic return of investments. After a
disappointing finish at the 2014 Winter Olympics in Sochi, USA Curling decided to revamp how
it funds and trains it’s elite teams. Through the 2014 Winter Olympic Games, U.S. curling teams
directed their own training and utilization of medical and performance resources. Coaches have
since been implemented and a strategic use of resources has led to a 2018 Olympic Games gold
medal and a 2016 world championship medal.13,14
Similarly, high achieving teams in the
business arena utilizing the HPTC coach model have been shown to reduce costs faster, go to
market sooner and launch products more smoothly.15
In business organizations, 70% of team
effectiveness is dependent on structure and design, a 30% increase in financial return is observed
when the team has a clear purpose and line of sight to company goals and high performing teams
provide a twenty-three percent greater economic return.16,17
Collectively, sport and business
organizations have repeatedly proven the effectiveness of a coach to create proper context,
conditions and processes to optimize team success and sustainment.18
It is already known that a holistic approach to sustaining the Operator is needed to
optimize our force. While resources are available to improve various factors that must be
managed, we continue to be reactive, not preventive when it comes to sustaining the Operator. A
Performance Coach who works for the Company Commander can track and provide specific
attention to all factors related to sustaining each Operator and provide detailed analysis directly
to the commander. Company leadership would then be armed with the information from the
Performance Coach and have the tools already in existence to be preventive with regard to
overall unit health. We must identify issues early before ailments have had years to break down
our soldiers, essentially shortening the amount of time they can serve on a detachment.
Operators will no longer go years with sleep or hormone problems because soldiers fail to
recognize the symptoms. The Performance Coach will know how to assess and track the
individual, identify problems, provide day to day care, and resource specialists in a rapid manner
to prevent decrements in health. We owe it to our Operators to provide the best level of care
possible. We need to have professionals managing our teams and truly caring about their
performance over time.
Recommendation:
I recommend the addition of a Performance Coach to work at the company level in order
to identify issues, track and assess performance, provide daily care and synchronize available
resources for our Operators. In order to improve soldier performance an overall Performance
Coach needs to work with a manageable population size. Having one coach per company will
allow the coach to truly know the individuals and the team. This person will be able to follow
the company through all phases of the Red-Amber-Green cycle, and synchronize their use of

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available assets. This will optimize individual and team performance, and assist the command on
truly evaluating unit readiness.

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