“For NSW, our leadership saw some trends several years ago, when we were in the thick of Iraq and Afghanistan,” he recalled. “They saw that it was going to be a long war with lots of kinetic ops. At the same time, we were starting to see some troubling trends in divorce rates, suicides, and safety incidents. And that was just hard metrics that we were able to track.

“The boss told us to identify, assess, and address the things that were out of whack and then help heal and strengthen,” he related. “He wanted us to be proactive and not react to things that have already happened. And he included everybody in NSW: SEALs, SWCCs, and their enablers, who unfortunately were seeing some of the same higher trends and incidents. In part, that was because the enablers hadn’t really been through the same SOF training processes.”

Created in cooperation with organizations like the Navy’s Bureau of Medicine (BUMED), the POTFF concept has four main pillars that work together: Psychological/Behavioral; Spiritual; Physical/Tactical Athlete; and Family Support.

In addressing the first two pillars, for example, Gilmore said the POTFF process began by identifying the psychologists, chaplains, family support personnel, and other professionals who would be needed and then spreading them out through the force.

He described the Physical/Tactical Athlete pillar as “both human performance program and sports medicine,” he said. “Obviously, there is a lot of physicality in this type of work. But this is not just ‘gym rats’ trying to pump as much iron as possible. Rather it is that there are special kinds of workouts. There are different kinds of rehabilitation programs. And there are special diets and sleep patterns that you need to have to perform well on the battlefield and after you come back.

“Family is 50 percent of the force,” Gilmore continued. “And when that message comes from the boss, it resonates. So an example of how we implemented that message came when BUMED said that they would fund a program to give pre- and post-deployment retreats for every deploying team and educational workshops with subject-matter experts who come in and talk about resilience, marriage communication, grief, stress, child care, and things like that. And that was huge.”

The family support process also worked to incorporate existing Department of Defense programs like Military Family Life Counselors (MFLCs).

“USSOCOM has taken part of it [MFLC], and assigned security clearances so that those people can assist without being constrained by what the guys and their families say.

“MFLCs are a little bit different from the psychologists and the chaplains in that the program is designed so that they don’t keep any records,” Gilmore continued. “If somebody wants to talk to a MFLC, they go to Starbucks or they go to a picnic bench somewhere or an office off base. And they just talk. Mostly the MFLCs just listen. And sometimes they might suggest a referral to another professional.

“Some people may not like the program because it’s not clinically based or they feel that reporting is critical to continuity of care. But my opinion is that if a guy goes to a MFLC because he’s afraid of going to a psychologist or doesn’t want to talk to a chaplain, at least he’s seeing someone. So you have a spectrum of counseling and care and listening. And as long as they are all integrated and sharing information, then that’s a good thing. And they still have a duty to warn about threats of suicide or child abuse – things that anyone would be legally required by law to report,” he said.

We send a psychologist, a chaplain, and a command representative to Germany or Spain or possibly somewhere in CONUS [continental United States] before they return home. It allows the team members to get some down time with each other, to get into a regular sleep pattern, and to shift their mindset from the battlefield to thinking about reintegrating with their families, friends, and communities.

Gilmore emphasized that personal responsibility, command leadership, and the NSW Ethos still provide overarching behavioral guidance for all active-duty members.

“There’s not a point where you inject it,” he said. “There’s not a point where it doesn’t matter. It’s just always there. So I want to make it clear that nothing about POTFF takes away from the fact that our NSW warriors are responsible for themselves. We want to help them be responsible for themselves. And if they fall, we have ways to help them get back up. But at the end of the day, it is personal responsibility, command leadership, and NSW Ethos overarching the whole thing.”

Along with the contributions of professionals, representative POTFF tools include the “resilience assessment,” an online anonymous survey that individuals can elect to take.

“It’s about 100 questions and takes less than an hour,” Gilmore explained. “And it gives both active-duty members and spouses instantaneous feedback as they fill it out, telling them about their coping skills, their resilience, and/or where they may need assistance. It’s a very professional psychological tool built by NSW and BUMED psychologists, using proven methods that come together. It provides links, resources, reading materials, and things that support the development of coping skills.”

But because the resilience assessment is anonymous, it can also be used in the aggregate to collect inputs on a specific unit, for example, and to see where they are having unique challenges or might need special resources.

“As an example, if we know that SEAL Team Five was really having challenges with couples’ communications and SEAL Team Four might need more grief counseling because of a death it had on the battlefield, we can use that information to build those agendas with the counselors and tailor them for each team,” Gilmore said.

Turning to the example of POTFF retreat activities, he continued, “Four to six weeks before a team deploys, the active-duty member, their spouse, and children attend a retreat with an agenda of great speakers. We’ve had Condoleezza Rice, [USMC] Gen. [Peter] Pace, Adm. [Eric T.] Olson, Bob Delaney, Dr. Daniel Amen, and other renowned resilience specialists come and speak. It’s a busy time before deployment and personal time is precious. The retreat is fun enough that people want to go, then while they are there, they absorb skills toward sustainment. The pre-deployment retreats tend to be a little bit more preparation, while the post-deployment retreats tend to be a little more celebration and reintegration.”

Another POTFF element, dubbed Third Location Decompression, features a brief stop between theater kinetic operations and the return home.

“We do it without adding a lot of time to the deployment or separation,” Gilmore said. “But it really provides a chance to decompress. We send a psychologist, a chaplain, and a command representative to Germany or Spain or possibly somewhere in CONUS [continental United States] before they return home. It allows the team members to get some down time with each other, to get into a regular sleep pattern, and to shift their mindset from the battlefield to thinking about reintegrating with their families, friends, and communities.

“We had 100 percent resistance before we instituted it but 100 percent acceptance after we did it,” he added.

Other resilience building resources range from the child-centered Project FOCUS (Families Overcoming Under Stress) to the Care Coalition, a USSOCOM organization designed to take care of SOF wounded for life.

Describing close cooperation between USSOCOM and the NSW community, Gilmore said that the Care Coalition “can facilitate med boards or serve as nurse case managers. They will see guys who come from a hospital in Germany back to the United States and walk them through the processes at Walter Reed or Bethesda, back here to Balboa [Naval Medical Center San Diego] and then check up on them. Their average caseload is about 200; and they track them all to varying degrees depending on the specific issues and needs of the service member.

“The concept is that SOF is your advocate for life,” he summarized. “Whether you stay on active duty or retire, we will advocate for you and get you the best care possible, while also helping you through the minefield of medical paperwork.”