1. Psychological Fitness Defining Total Fitness for the 21 st Century Conference Uniformed Services University of the Health Sciences December 2009

2. 2 Fitness for duty standard: minimum level of functioning for a person to work without risk to own or others’ health and safety (Cox, Edwards, & Palmer, 2000). Resilience: sum total of psychological processes to maintain or return to previous levels of well-being and functioning in response to adversity (Zamorski et al, 2008). Recovery: process of healing and transformation from an injury or illness … to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential (USDHHS & SAMHSA, 2004). Performance enhancement: Relatively precise, controlled and combined application of certain techniques, substances, or devices over the short and long-term to achieve optimization in a person or unit’s performance. Adapted from Human Performance Optimization (HPO; Russell, Buckley, & Grafton). ReadyInjuryReactionThriving Fitness for duty standard RECOVERY RESILIENCE FITUNFIT PERFORMANCE ENHANCEMENT Illness Total Fitness Continuum Model

3. 3 Analysis-Driven Theoretical Model Environmental resources Policy Leadership Units Families & Community Programs & Services Education & Training Personal resources Job competence Awareness Executive Functions Cognitive resources Beliefs/ perceptions Physical & emotional regulation Social skills Key Mediators Confidence in self Engagement Cognitive agility/ adaptability Social support & cohesion Targeted Outcomes Enhanced Performance Resilience Strong Morale Unit cohesion Focused energy and attention Operational demands Small force High operational tempo Repeated deployments Harsh conditions High physical and cognitive demands Protracted conflicts Based in part on Conservation of resources theory. Ref: Hobfoll et al. “Fact or Artifact: The Relationship of Hope to a Caravan of Resources”

4. 4 Execution: Modifying external resources can enhance mission-related outcomes via mediators Environmen- tal resources PolicyLeadershipUnits Families & Community Programs & Services Education & Training Personal resources Job competence Awareness Executive Functions Cognitive resources Beliefs/perce ptions Physical & emotional regulation Social skills Key Mediators Confidence in self Engagement Cognitive agility/ adaptability Social support & cohesion Outcomes Resilient outcomes Performance enhancement Beliefs/ perceptions Meaningfulnessself-efficacy sense of belonging sense of purpose Leadership clear expectations sense of belonging opportunities to grow/advance Performance enhancement energy/ burnout productivity organizational commitment retention Engage- ment Engagement: positive and fulfilling state of mind that is characterized by vigor, dedication, and absorption Note: For efficiency, we are highlighting this path of action for just one of several mediators

5. 5 Other Mediators: Definitions and components Self confidence –aka self-efficacy –Composed of one's belief that one has the capability to complete a task and the belief that one will be successful (Bandura, 1994) Cognitive agility –Ability to successfully navigate dynamic environments by changing decision frameworks or knowledge to meet the environmental needs (Haynie, 2005) –Also referred to as adaptability or the ability to change when necessary Social support/cohesion –Interactions between people that functionally and meaningfully support them (Hobfoll, 1988).

6. 6 Table of outcomes, variables, and metrics Outcome categoryOutcome variableSample metrics PerformanceTeam/organizational job performance Organizations inspections (e.g., compliance), unit surveys (e.g., climate), Performance and Resilience Unit cohesion and morale Cohesion assessments (e.g., MHAT) Performance and Resilience Safety performanceLost day rates, POV fatality rate, class ‘A’ mishaps PerformanceIndividual task performance Scores on written and practical tests, 360 surveys, customer feedback PerformanceTeam task performanceEvaluation of team coordination and maneuvering in simulated performance scenarios ResilienceHealth and functioningPDHA, PDHRA, Shirom-Melamed Burnout measure, CES-D, PTSD Checklist-Military version ResilienceEnhanced recoveryInpatient and outpatient healthcare utilization rates ResilienceHigh risk behavior and antecedents Measures of suicide and substance abuse risk/misuse. Alcohol related incidents, indiscipline rates ResilienceRetentionEarly separations, decision to re-enlist ResilienceFamily functioningFamily maltreatment rates, divorce rates

7. 7 Bottom line for the Line Promote strengths-based approach and constructive attitudes and beliefs (engagement) Reinforce sense of belonging and contribution to team (engagement & social support) Provide tough, realistic training (self-efficacy) Cultivate effective problem solving skills, including both critical and creative thinking (cognitive agility) Ensure regular periods of decompression and rest

8. 8 Non-animated version of slide 3 follows

9. 9 Execution: Modifying external resources can enhance mission-related outcomes via mediators Environmental resources PolicyLeadershipUnits Families & Community Programs & Services Education & Training Personal resources Job competence Awareness Executive Functions Cognitive resources Beliefs/perce ptions Physical & emotional regulation Social skills Key Mediators Confidence in self Engagement Cognitive agility/ adaptability Social support & cohesion Outcomes Resilient outcomes Performance enhancement Beliefs/ perceptions Meaningfulnessself-efficacy sense of belonging sense of purpose Leadership clear expectations sense of belonging opportunities to grow/advance Performance enhancement energy/ burnout productivity organizational commitment retention Engagement: positive and fulfilling state of mind that is characterized by vigor, dedication, and absorption Note: For efficiency, we are highlighting this path of action for just one of several mediators