USASOC: BRINGS A "TEAM APPROACH" TO BRAIN HEALTH IN ARMY SPECIAL OPERATIONS

BY SCOTT R. GOURLEY

Humans are more important than hardware. It’s not only the “First SOF Truth,” but it is a reality that applies across myriad elements of physical, emotional, and brain health support available to the special operator and their family members. In few places is this support more evident than U.S. Army Special Operations Command (USASOC). Long known for its extreme tactical capabilities and lethality, USASOC has implemented an impressive and integrated spectrum of team efforts designed to support the broader special operations forces (SOF) family. One key element of this spectrum involves brain health.

USASOC BRAIN HEALTH

According to Col. Mark Ray, director of human performance and wellness at USASOC, brain health consists of two main components: a clinical/research component and an integrated network of support that exists outside of the clinical setting.

“Our clinical and research component includes premier credentialed, medical professionals, including our command surgeon, along with the different physicians, surgeons, and medical personnel throughout USASOC, as well as premier research institutes exploring the high-end challenges that we are working through,” he said.

Complementing the clinical/research side of brain health, Ray pointed to a non-clinical integrated peer/leader/family network of support, characterizing it as “a bigger part” of USASOC’s contribution to brain health.

“How do we better inform peers so that they can potentially recognize signs of brain health issues?” he asked. “And it’s not just traumatic brain injury, but possibly indicator precursors, or maybe overall stress management or behavioral health or psychological health concerns. How do we best equip peers so that they can possibly recognize a sign in a conversation and either help that person or, if it exceeds what that peer can do, connect the person to a trusted professional, taking it to the next level of counseling or treatment?”

Ray noted that one of the challenges facing the non-clinical side is the fact that USASOC is relatively large, with approximately 35,057 service members and 58,000 family members.

“Those are small numbers compared to the larger DOD, but they are large for special operations,” he said. “Another complication is the fact that those operators and their surrounding family community … are spread around the globe, mostly within the United States, but at many different installations. So, for us, part of the challenge is making sure that we’ve got the right resources, the right programs, and the right capabilities in the right locations, so that the person who needs the resources gets them pretty quickly.”

He added, “We can come up with some programs, concepts, or thoughts in our building at Army Special Operations Command at the three-star level. And we can put a great concept on a dry erase board. But our challenge is how we make sure that the concept turns into something that’s useful on the ground, where it matters, in a timely manner, so that you can get the right people, the right help.”

pUSASOC’s Human Performance and Wellness Program (HPW) was established to make sure USASOC personnel are ready for the mission and able to overcome adversity.

From the clinical side of brain health, Col. Patrick Depenbrock, USASOC Surgeon deputy director, outlined a foundational need to make sure that the medical providers are trained and up to date on traumatic brain injury diagnosis and treatment tools.

“And then the other role I see on the clinical side is ensuring that our brain health policy is informed by the best medical practices,” he said. “I think that is part of our challenge, because, I believe, when it comes to brain health, we as a scientific community are still learning a lot. So that has been a big point of emphasis for me over the last couple of years. We don’t conduct research at USASOC, but we do support it. So we are trying to reach out to reputable partners and stakeholders in the DOD and civilian academic research communities and bring them in where it makes sense for the USASOC community.”

Pointing to his own early background as a sports medicine physician, Depenbrock noted parallels between human performance and brain health.

“In both cases, at one end of the spectrum you’ve got health and wellness,” he explained. “Those include things like our daily activities of daily living, interfacing with our families, our relationships with our significant others, sleep, and diet and exercise. Those things are very important. And then, if you push far down to the other end of that spectrum, you get closer to optimizing performance to conduct high-risk mission sets within USASOC. And so, cognitive performance, or brain health, is really, in my mind, conceptually very similar to musculoskeletal health. In both cases, we are making sure that we’re able to surveil, enhance, treat, and rehab. But there is a lot left to be researched, so we are engaging with those people that can help us.”

HUMAN PERFORMANCE AND WELLNESS

In response to these challenges, USASOC has established the Human Performance and Wellness (HPW) program, which Ray described as “a comprehensive and integrated team” that includes experts and providers in the fields of sports medicine, strength and conditioning, performance nutrition, licensed clinical social workers, and peer network coordinators, all working tightly with behavioral health specialists, unit ministry teams, and the USASOC surgeon’s office.

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“The purpose is to make sure that our men and women are ready for the mission and that they’re able to overcome adversity,” Ray said, adding that such adversity “could be physical adversity on target on a battlefield. It could be injury recovery from either an acute or chronic injury that they’ve sustained in the course of their duties. Or it could be life stresses that they’re trying to balance. And this HPW team works together to make sure that that person is able to get back into the fight and conduct the mission, not just now but for decades, because that is what we need special operators to do.”

Ray characterized the HPW effort as an outgrowth of several different programs within U.S. Special Operations Command (USSOCOM) and subordinate service components that focused on optimizing human performance.

“In the late 2000s and early 2010s, many of the organizations were either contracting strength and conditioning coaches, or strength conditioning and human performance organizations, to help them with their missions by making sure that they were able to go deployment after deployment because people were ready for the fight,” he said.

USSOCOM efforts to consolidate many of these programs led to SOF’s Preservation of the Force and Families (POTFF) program. Introduced in the early 2013 time frame, it was designed to address the physical, psychological, social, and spiritual demands that had been placed on SOF servicemen and women through, at that point, a decade of the Global War on Terrorism.

Col. Mark Ray, director of human performance and wellness at USASOC.

“About three years ago, at USASOC, we identified a gap and where we needed to evolve the program,” Ray said. “And part of that gap was that Preservation of the Force and Families didn’t necessarily connect to Army or DOD programs that were already out there. It didn’t always connect to Army family programs that were organic to a unit or installation, other Army community services, or garrison services that were available. There was a seam. There might have been two great programs working side by side, but they weren’t connected to each other.”

He said that current efforts are working to eliminate that seam, optimizing resources to reflect USASOC’s portion of the larger Army mission and merging programs as appropriate.

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USASOC TRAINING AND MATERIEL INTERFACES

In addition to the traditional entities supporting HPW, Depenbrock highlighted additional support from places like the USASOC training and materiel development communities.

“When I was group surgeon at 3rd Special Forces Group about four years ago, our commander came to me and asked me what we were doing as a medical community with regards to blast exposure,” he began. “And in that discussion, we realized that there was an opportunity to really improve our surveillance and monitoring for low-level blast exposure injury during training throughout the various [Special Forces] groups. At 3rd Group, for example, there was an Advanced Urban Combat training course that was about five or six weeks long. We started to do some surveillance with blast gauges, along with some other metrics that looked at cognitive performance, sleep, et cetera. Then, when I came up to USASOC Headquarters, we had an opportunity with one of our explosive breaching courses at one of our ranges here at ‘SWCS’ [U.S. Army John F. Kennedy Special Warfare Center and School], called SFARTAETC [Special Forces Advanced Reconnaissance, Target Analysis, and Exploitation Techniques Course]. It’s a longer course, closer to eight weeks, but with similar breaching exercises and low-level blast exposure. So we took the program that we started at 3rd Group, got input from some of our other tactical and special mission units, and really took it to the range. We brought in some subjectmatter experts from our Psychological Applications Directorate, some folks from Human Performance, some folks from the Surgeon’s office, and really put together a tiger team to build a relationship with the instructors at [SFARTAETC], and really apply blast exposure monitoring. But we adapted it so that it interfered with the training as little as possible. We wanted as much passive data collection as possible, leading to information that we could deliver back to the operators rapidly, so that they can make informed decisions on their training and their health. We also brought in a team from a DOD lab at MIT and they kind of threw [in] some new technology, like new sensors that detect the impact of low-level blast exposure on the body. And I’m really proud of that effort that everyone put together.

Col. Patrick Depenbrock, USASOC Surgeon deputy director.

“Since then, we’ve been able to invite observation by other DOD brain health stakeholders, realizing that there are a lot of other people out there doing research, whether it’s at USSOCOM or at our sister service component commands like NSW or AFSOC or MARSOC,” he continued. “And there’s great stuff going on in the conventional Army, as well as DOD entities that are really the heavy hitters for conducting research. We want to make sure that we aren’t ‘stovepiped’ in what we are doing here. So, for the last few years, we have started inviting a lot of these stakeholders to Fort Bragg to come out to see what we are doing at one of our training ranges, and also to share the other great things that were going on at the other CSUs [component subordinate units] with their own brain health monitoring; the 75th Rangers, 7th Group, and 10th Group, 1st Group, 5th Group, and our aviation units. And in doing that, I think we’ve really started to improve communication, help avoid duplication of research, and really provide a voice to those subject-matter experts from the operational force as to what their operational gaps and research needs are.”

In terms of participation from the materiel development community, Depenbrock cited a recent visit to the U.S. Army’s Medical Readiness and Development Command at Fort Detrick, Maryland, which included what he described as “a profound discussion” regarding the input that they need to optimize their support to the operational force.

Service members assess hand-eye coordination through a monitoring program device. USASOC’s Surgeon and HPW program collaborate for programs such as the monitoring devices for the overall health and welfare of soldiers.

“They have got to have a capabilities document or formal needs assessment to move out,” he said. ”But they want that input from the operational force, so that we are working to thicken those relationships.”

As an example of materiel accomplishments to date, he pointed to feedback from the Army’s 75th Ranger Regiment and other units regarding a particular mortar system.

U.S. Army Rangers assigned to 2nd Battalion, 75th Ranger Regiment, fire a 120mm mortar during a tactical training exercise. USASOC is developing technical and materiel solutions to reduce the impact of blast overpressure on operators of weapon systems.

“From our dialogue with those units, we received feedback that included complaints over some potential concussion symptoms by the operators of the 120mm mortar system and certain shoulder-fired weapon systems. We were able to provide a document, essentially, outlining those concerns to the Army’s Program Executive Office Ammunition [PEO Ammunition] as well as the U.S. Army Medical Research & Development Command [MRDC]. This helped with the continued process of developing technical and materiel solutions, such as blast flanges, to reduce the impact of blast overpressure. And we have started to get definitive feedback on the results of that just within the last couple of weeks,” he said.

“One of the advantages I see that we have currently within USASOC is there are many different pieces, not just under the HPW umbrella, that are working together,” Ray echoed. “We have a very integrated team. And that doesn’t happen naturally. We connect very well, not just at the USASOC Headquarters level, but, more importantly, down at the group/brigade/regiment levels, and with their staffs and the experts that they have at those levels. And they are very connected to the leaders and soldiers throughout.”

Service members participate in wheelchair basketball during a Paralympic-style competition. USASOC’s Surgeon and HPW program partner with key stakeholders to provide quality care and activities for U.S. Army special operators who may have been injured as a result of serving the nation.

A CHALLENGING BUT POSITIVE FUTURE

To support his optimistic vision, Ray identified several indicators that reflected both increased participation and broader acceptance of the need to monitor and address behavioral health.

“We have a good process in place,” he said. “And I think it will continue to improve, because when we talk to rising leaders – new platoon sergeants, new team sergeants, rising company commanders, and newly promoted sergeants major – we emphasize that they are at a new level of leadership and that there is this integrated team at their disposal.”

Depenbrock shared the positive vision, while acknowledging some remaining challenges, such as enhancing people’s willingness to avail themselves of the available resources.

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“For various reasons, that can be difficult in some places and in different situations,” he said. “And because of that, I’ve been really excited about the way that we’ve seen the growth of these ‘holistic check-ins’ at the various CSUs over the last five or six years. And it’s not just the human performance team, saying, ‘Hey, everyone come by and see your physical therapist.’ It is command-directed. And you’re seeing an integrated team – with human performance and the surgeon and behavioral health and the chaplain – descending on our soldiers or operators and giving them an opportunity to have a human touchpoint with each one of these subject-matter experts.”

“I really don’t think there’s a substitute for that human touchpoint,” he said. “And folks have to feel that there is that psychological safe space to bring up what’s truly ailing them or bothering them. So I think brain health takes into account everything: behavioral health, relationships, how you perceive pain, the huge contribution of sleep, and other factors. It’s really creating that safe space where our men and women can feel comfortable to let us know how they’re truly doing. That is the challenge. We may not be there completely yet, but I think we’re making great progress towards that goal.”

“The message that I would have for our soldiers is, we need you in Army special operations,” Ray added. “We need your family. We value what you do and what you have done and what you are ready to do in the future. A lot goes into recruiting, assessing, selecting, and training the right person to be an Army special operator. We know it’s a stressful job. There are high demands. There is a high tempo. What’s consistent across all parts of the Army special operations community is that we are bringing in very independent and critical thinkers. We need them to be that way, because they are going to be operating in small groups in sensitive areas around the world on different missions.”

He concluded, “We are not just going to hand people a list of things to do. Instead, we want to inform them. We want to empower them. As part of that, we want them to know that these staffs and these experts that we have discussed here are for their use. Either as an independent soldier or as a leader, they are here for you. They are here to help you address whatever you might have to jump on to get some help with yourself or your family to get you back into the fight. That’s where we need you.”