Community Case Study_ Part 3_Greer

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MILITARY MALE SEXUAL ASSAULT RESPONSE 1 Community Based Approach to Military Male Sexual Assault Prevention and Response Paul B. Greer School of Behavioral Science Liberty University Author Note Paul Brian Greer I have no known conflict of interest to disclose. Correspondence concerning this article should be addressed to Paul Brian Greer. Email: pbgreer@liberty.edu

MILITARY MALE SEXUAL ASSAULT RESPONSE 2 Abstract When it comes to prevention and support for this unique military population, religious and veterans’ organizations, social services and military supported services are often not aligned in planning or support efforts thereby leading to redundancy in services or creating gaps in service to the veteran and military population. Since the COVID pandemic, the mental health system has been overtaxed among the military and community health systems leading to greater outsourcing and increase of military chaplain care to fill the gap. One trend that has emerged is male sexual assault victim self-reporting to chaplains. Military chaplains are unique positioned to offer pastoral care, but are often ill equipped for this type of service, as are many community support resources such as churches and veterans support organizations. As such, a sociological-ecological model that ties together military and community resources in a coordinated community response as a coalition to organize prevention and response, as well as education and advocacy programs is critical to assist with the unmet needs of military male sexual assault victims. Keywords : military, veteran, male sexual assault, community-based approaches, veteran support organization partnerships, community partnerships, community coalition, prevention, advocacy, religious support, moral injury, triphasic model of trauma recovery, spiritually integrated psychotherapy, forgiveness therapy.

MILITARY MALE SEXUAL ASSAULT RESPONSE 3 Community Based Approach to Military Male Sexual Assault Prevention and Response As a provider in the military-centric community of Hampton Roads, Virginia, which includes Langley Air Force Base, Army’s Fort Story and Fort Eustis, Naval Weapons Station Yorktown, Naval Air Station Oceana and Dam Neck Annex, Joint Expeditionary Based Little Creek, and Naval Station Norfolk which is the largest naval base in the world. According to the Hampton Roads Economic Development Alliance (2022), the military represents approximately 45% of the region's economy and supports over 315,000 jobs. In terms of military personnel, there are over 87,000 active-duty service members, over 25,000 civilian personnel, and over 80,000 military family members living in the Hampton Roads region yielding a military population of over 192,000. As a result, the community and military are inextricably linked and mutually interdependent, especially when caring for the large population of military members and their dependents. Lack of Coordination and Outsourcing However, when it comes to prevention and support for this unique military population, religious and veteran service organizations (VSO), local government based social services and military social support and medical support services are often not aligned in planning or support efforts, thereby leading to redundancy in services or creating gaps in service to the veteran and military population. Additionally, since the COVID pandemic, the mental health system has been overtaxed the military and community health systems with excessive wait times and increase in virtual care (Wosik et al, 2020). This has led to military referrals and outsourcing of uniformed service member mental health care through the TRICARE network and Military One Source for self-referrals. According to a study published in the Journal of Mental Health Policy and Economics, in 2017, the average wait time for a mental health appointment within the TRICARE

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MILITARY MALE SEXUAL ASSAULT RESPONSE 4 network was 22.6 days (Wang et al., 2017). To address this issue, TRICARE outsourced mental health care to civilian providers, resulting in a reduction in wait times to an average of 5.5 days (Wang et al., 2017). As such, in Hampton Roads and military centric communities at large, community partnerships and coalitions are critical to assist with the unmet and under supported mental health needs for military members, especially military male sexual assault survivors. Chaplains Filling the Gap Chaplains are members of the military who are trained to provide religious and spiritual support to military personnel and their families. In addition to their religious duties, chaplains can also serve as counselors to military personnel who may be struggling with personal or professional issues. According to research, mental health issues are prevalent among service members and as a result, it's crucial to provide adequate support to service members with shortfalls in mental health caregivers embedded in units, and one way to provide such support is by having more chaplains (Dyer et al., 2019). The naval service in the Hampton Roads area in particular is looking to significantly increase the number of chaplains to help support mental health efforts and support to service members (Wilson, 2023). Military chaplains offer a unique resource to male sexual assault victims not found in the local community. Military chaplains have the unique benefit in the Department of Defense as not being required to abide by mandatory reporting requirements of any kind, including compliance with local and state law requirements while performing their duties as federal employees, and have unlimited confidentiality under the clergy penitent tradition and protections of military law (Wilson, 2023). As such, victims of trauma and sexual assault primarily seek out chaplain support services first before other resources knowing their story is kept strictly confidential and can avoid revictimization often associated with reporting. This lends to a unique problem and

MILITARY MALE SEXUAL ASSAULT RESPONSE 5 need for specialized training for military chaplains to avoid doing harm for this unique and sensitive population in their most critical time of need. As the leader in the military chaplain community, I can attest first-hand that chaplains are primarily trained in theology with a minimum of nine hours of pastoral counseling in a Master of Divinity degree. In the chaplain community, the array of caregiving competencies varies from those with the minimum education standard, to those with clinical chaplain residency education, board certification and others holding clinical counseling licensure and credentials. The wide array of pastoral care and education competencies is likewise mimicked in the local community among clergy. This creates a unique challenge for chaplain and pastoral care competencies lacking consistency in the standard of care that is delivered to male sexual assault victims among community clergy. This issue lends to the need for a coordinated community clergy response and educational program to increase awareness and competencies for religious professionals supporting military male sexual assault victims. Emerging Problem Further, since the COVID pandemic, not only has there been an increase in mental health service utilization, but a trend is also emerging among chaplain reporting with increases in sexual assault disclosure by victims to military chaplains. Specifically, there has been a unique increase in male service members disclosing sexual assault prior to entry into military service when seeking primary services for depression, anxiety, and skill-building in response to maladaptive coping and increases in legal issues from destructive behaviors such as alcohol and substance abuse, DUIs and self-mutilation. This trend is overtaxing chaplain competencies and the need to increase education and skill-building. Further, chaplains are struggling to find unique collaborative support services for client referral and have identified gaps in military and

MILITARY MALE SEXUAL ASSAULT RESPONSE 6 community-based partnerships for victim support. As such, there is a need to develop a coalition of support for male sexual assault victims from the sociological-ecological model with direct and indirect approaches to cooperative community-based outreach, advocacy, prevention and care. Description of the Population It is important to note that sexual assault can happen to anyone, regardless of their gender or age. However, men are often less likely to report sexual assault than women due to a variety of factors including stigma, shame, and fear of not being believed (Davies et al., 2002). In general, men may be less likely to report sexual assault compared to women and may take longer to come forward due to attitudes about masculinity and the societal stigma and shame associated with male sexual assault (Davies et al., 2002). According to a study by Dr. John Briere and colleagues (2004), the average age of men reporting sexual trauma is around 52 years old, thus lending to the hypothesis that male sexual assaults are significantly underreported and there is a significant male population suffering in silence and not receiving the care needed leading to maladaptive coping impacting society at large. According to the Department of Defense's "Population Representation in the Military Services" report as of September 30, 2020, the United States Military is 85.6% male (Department of Defense, n.d. ). This uniquely patriarchal organization with its cultural norms of toughness and compartmentalization of stressors for mission prioritization does not lend itself to encourage self- reporting or help-seeking among victims dealing with the effects of sexual trauma. Identification of Need To determine any identification of need, there are several steps and approaches to identification of need. These include social indicators as noted among chaplain caregivers as an initial indicator in Hampton Roads. Additional assessments is needed, but may include

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MILITARY MALE SEXUAL ASSAULT RESPONSE 7 community forums, surveys, interviews with potential consumers or service providers (Lilley, 2023) as well as additional research including longitudinal studies. The following highlights existing research. Demographic Research According to a study by the Department of Defense, out of the estimated 20,500 incidents of sexual assault in the military in 2018, approximately 38% involved male victims (Department of Defense, 2019). Another study by the Rand Corporation found that among military personnel who experienced unwanted sexual contact, approximately 23% were male (Lefebvre et al., 2014). In a study of male veterans seeking treatment for PTSD at a VA hospital, 15.1% reported experiencing sexual trauma during their military service (Kimerling et al., 2007) illustrating the disparity in reporting. The United States military as a male dominated organization poses unique challenges for chaplains and mental health providers in caring for male sexual assault victims. Recruits come from a large swath of American society, especially from socio-economically challenged subset of culture often associated with neglect and abuse which often leads to revictimization in the military (Loughran et al., 2018). "Research indicates that higher levels of childhood abuse and trauma are associated with an increased likelihood of military enlistment, as individuals seek out the structure and discipline of military life." (Ruscio et al., 2001, p. 199). A review of the literature on trauma and military service found that up to 30% of military personnel may have a history of childhood trauma, and that this is associated with an increased risk of PTSD, depression, and substance abuse (Griffin et al., 2018). A study of Army recruits found that 12.5% reported a history of physical abuse, 14.5% reported a history of sexual abuse, and 25.9% reported a history of family violence (Brenner et al., 2011). In the United States, a study

MILITARY MALE SEXUAL ASSAULT RESPONSE 8 published in the Journal of Interpersonal Violence found that 1 in 6 males had experienced sexual violence at some point in their lives, predominantly before the age of 18 (Swartout et al., 2014). It can be assumed from the data that the military reflects this societal statistic but poses unique challenges for male victims of sexual trauma due to military recruitment pools compared to other civilian hiring agencies. Military cultural values including those of masculinity, stoicism, toughness and resiliency, further negatively impacting self-reporting and help seeking among make victims, as well as contributing to increased maladaptive coping and destructive behaviors. Intervention Strategies Triphasic Model The triphasic model of trauma recovery is a framework developed by Judith Herman (1992), a psychiatrist and trauma specialist, which describes the stages of recovery that individuals go through after experiencing trauma. The triphasic model has been widely used in the field of trauma treatment and has informed many evidence-based interventions. The three phases of the triphasic model are: Safety and Stabilization : In this phase, the focus is on establishing safety, both physically and emotionally. This may involve creating a safe environment, establishing routines and structure, and developing coping strategies to manage symptoms. Remembrance and Mourning : In this phase, the focus is on processing and integrating the traumatic experience. This may involve talking about the trauma, expressing emotions, and working through feelings of guilt, shame, and anger. Reconnection and Integration : In this final phase, the focus is on reconnecting with the world and establishing a new sense of normalcy. This may involve reconnecting with others, establishing new goals and interests, and finding meaning in the trauma experience.

MILITARY MALE SEXUAL ASSAULT RESPONSE 9 In Herman’s (1992) theory, she suggests that recovery from trauma involves a process of resolving contradictions between two opposing needs: the need for safety and the need for connection. In an effort to explain these dialectics, Goodwin (2013) developed what he calls the wobble adaptation proposing that survivors may experience a "wobble" between these two needs as they move through the recovery process which help describe how a male sexual assault survivor experiences the recovery process. This "wobble" may involve moments of feeling unsafe or disconnected, followed by a return to a sense of safety or connection. There is a wobbling between a constriction of numbing and avoidance and intrusion and re-experiencing the trauma. This is experienced in cognitive, emotional, relational and behavioral spheres. This leads to a polarization of cognition with constricted or intrusive thoughts, dysregulated emotions, unpredictable behavior and inconsistent interpersonal behaviors and relational needs (Goodwin, 2013). Understanding this wobbling theory is critical in aiding male sexual assault survivors through psychoeducation for awareness of the way they experience trauma recovery through the tri-phasic model (Herman, 1992), and for the caregiver to aid them in navigating through the recovery process in a safe and supportive environment. Clergy Interventions According to the American Psychological Association (APA), chaplains can play an important role in helping individuals cope with trauma and its aftermath (APA, 2013). Chaplains and clergy in general play a unique role in caring for male sexual assault survivors and aid in the recovery process through the use of their pastoral authority. In the context of spiritual care, pastoral authority can be a powerful tool for promoting healing and growth among those who are seeking support and guidance. One study that highlights the use of pastoral authority in spiritual care by Min-Ah Cho and colleagues (2018) found that pastoral authority played a significant role

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MILITARY MALE SEXUAL ASSAULT RESPONSE 10 in empowering individuals to confront their challenges and pursue growth and healing. Pastors who were able to use their authority in a compassionate and supportive way were able to foster a sense of trust and safety among those seeking spiritual care (Min-Ah Cho et al., 2018). Chaplain interventions for trauma can include spiritual care, emotional support, and counseling, as well as dealing with moral and spiritual injuries and provide a safe space to process their trauma. One study by Flannelly et al. (2017) examined the effectiveness of chaplain interventions for patients who experienced trauma in a hospital setting. The study found that patients who received chaplain interventions had lower levels of anxiety and depression compared to those who did not receive chaplain interventions. Another study by Pargament et al. (2019) investigated the role of chaplains in providing spiritual care for individuals who experienced trauma. The study found that chaplains can provide a safe space for individuals to discuss their spiritual needs and concerns, which can help promote healing and recovery. Overall, chaplains can offer important support for individuals who have experienced trauma and can complement the work of mental health professionals in providing holistic care. Role of Forgiveness Forgiveness therapy is a type of psychotherapy that aims to help individuals who have experienced trauma to forgive themselves and others who have caused harm. In the context of sexual trauma, forgiveness therapy can help survivors to heal from the emotional and psychological wounds caused by their experiences (Enright et al., 1998). Forgiveness therapy has been studied as a potential intervention for survivors of sexual assault to help reduce symptoms of distress, anger, and resentment. According to a study by Worthington et al. (2007), forgiveness therapy involves a series of steps aimed at promoting forgiveness, including acknowledging the harm done, accepting negative feelings, offering empathy and compassion to the offender,

MILITARY MALE SEXUAL ASSAULT RESPONSE 11 making a commitment to forgive, and finally, working to release negative emotions and thoughts related to the offense. Forgiveness is a critical biblical principle that aids in healing and one’s own relationship with the divine. Matthew 6:14-15 states “For if you forgive others their trespasses, your heavenly Father will also forgive you, but if you do not forgive others their trespasses, neither will your Father forgive your trespasses” (ESV). While one may not be the offender and justice not be fully recognized, the Bible helps to teach that it is bitterness that hurts from the inside out. In fact Ephesians 4:31 teaches “Let all bitterness and wrath and anger and clamor and slander be put away from you, along with all malice.” Bitterness itself is described by the Bible as an internal poison that creates self-harm and can even harm others (Hebrews 12:15). As such, Jesus example serves as a model to address forgiveness among those who had wronged him unjustly. 1 Peter 3:21-23 states “Look to Jesus, who despite being betrayed, persecuted, hated and left to die a sinner’s death alone did not respond with insults or scorn but entrusted Himself to the Father who judges all things justly” (ESV). Chaplains can play an important role in providing forgiveness therapy to survivors of sexual assault as part of a larger spiritual care approach. According to a study by Flannelly et al. (2017), chaplains can use forgiveness therapy to promote healing and reduce symptoms of distress in survivors of sexual assault, but it must be used appropriately, timely and judiciously as part of a process in the recovery journey. To address forgiveness too quickly and not a part of a forgiveness process could do harm to the recovery process. Moral Injuries Moral injury is a psychological response to experiencing an event or events that violate one's moral or ethical values (Currier et al., 2019). Chaplains, as religious leaders, can play a

MILITARY MALE SEXUAL ASSAULT RESPONSE 12 crucial role in providing moral injury interventions to service members who have experienced traumatic events during their service. In a randomized controlled trial of chaplain-led spiritual interventions with military service members undergoing treatment for PTSD and moral injury The results demonstrated that the chaplain-led interventions were effective in reducing symptoms of PTSD and moral injury, and increasing spiritual well-being (Currier et al., 2019) This study suggests that chaplains can play an important role in providing effective interventions for moral injury in military service members by addressing moral injuries. Spiritually Integrated Approaches One way to build spiritual strength with trauma survivors is through a therapeutic approach that integrates spirituality into the healing process. This approach has been called "spiritually integrated psychotherapy" (SIP) and has been shown to be effective in helping trauma survivors increase their spiritual strength and resilience (Hodge, 2019). SIP is an evidence-based approach that incorporates the client's spiritual and religious beliefs into the therapeutic process. It involves using spiritual practices, such as prayer, meditation, and mindfulness, as well as exploring the client's beliefs and values to help them find meaning and purpose in their lives (Hodge, 2019). Chaplains and clergy in a community-based approach to males sexual assault caregiving can greatly benefit from SIP integration in their pastoral care, as with professional counselors for true holistic care in a biopsychosocial-spiritual model. Studies have shown that SIP can help trauma survivors increase their sense of hope, meaning, and purpose, which can lead to greater psychological and emotional well-being (Hodge, 2019). It can also help them cope with symptoms of trauma, such as anxiety and depression, by providing a sense of connection and support. One study of SIP with trauma survivors found that participants reported increased spiritual well-being, greater meaning and

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MILITARY MALE SEXUAL ASSAULT RESPONSE 13 purpose in life, and improved mental health outcomes (Frazier et al., 2015). Another study found that SIP helped survivors of childhood sexual abuse decrease symptoms of PTSD and depression (Korbman et al., 2021). Overall, incorporating spirituality into the therapeutic process can be an effective way to build spiritual strength and resilience in trauma survivors. Maintaining spiritual practices is a critical part of recovery from moral and spiritual injuries. One study by Harris (2019) explored how trauma survivors use spirituality to build resilience and cope with trauma. The author found that trauma survivors often use spiritual practices such as prayer, meditation, and connecting with a higher power to build spiritual strength and find meaning in their trauma. In another study by Howard et al. (2017) the authors conducted qualitative interviews with adults who had experienced trauma and identified as having spiritual strength. The authors defined spiritual strength as "the ability to transcend traumatic experiences, to find meaning and purpose in life, and to maintain a sense of hope and faith" (Howard et al., 2017, p. 2). The study concluded that it was that spiritual fortitude that played a significant role in the trauma survivors' ability to cope and recover. The participants reported that their spiritual beliefs and practices helped them to find meaning in their experiences, provided a sense of comfort and support, and enabled them to maintain a positive outlook on life (Howard, et al., 2017). The authors concluded that spirituality and spiritual resources that serve as an important resource for trauma survivors that can promote healing, wholeness and growth (Howard, et al., 2017). These studies highlight the importance of incorporating spirituality in trauma-informed care and why clergy and religious professionals play a critical role in a community response to male sexual trauma. Resiliency Factors

MILITARY MALE SEXUAL ASSAULT RESPONSE 14 Resilience factors for male victims of sexual violence are crucial for their recovery and well-being. According to Dworkin et al. (2017) factors that can contribute to resilience in male victims of sexual violence include: Social support : Having supportive friends and family members can help male victims of sexual violence to cope with the trauma and feel less isolated. This can include emotional support, practical assistance, and access to resources. This is why a community based approach and coalition is so important for trauma recovery, especially among military male sexual assault survivors due to their sense of camaraderie among the military community. Here, veteran support organization and religious organizations and churches helps provide social support to the recovery process. Positive coping strategies : Developing healthy coping strategies can help male victims of sexual violence to manage the trauma and reduce the risk of developing mental health problems such as depression, anxiety, or post-traumatic stress disorder (PTSD). Self-efficacy : Believing in one's ability to cope with the trauma and overcome challenges can increase resilience in male victims of sexual violence. Cognitive restructuring : The ability to change negative thought patterns and beliefs can help male victims of sexual violence to develop a more positive outlook on life and cope with the trauma more effectively. Positive interpersonal relationships : Building positive relationships with others, whether romantic, platonic, or professional, can provide a source of support, validation, and a sense of belonging. This again is where veteran service organizations, group work and religious organization in a community-based approach help foster these positive social and interpersonal relations.

MILITARY MALE SEXUAL ASSAULT RESPONSE 15 Access to mental health care : Seeking professional help can be beneficial for male victims of sexual violence to process their trauma and develop healthy coping strategies. Male survivors of sexual violence can benefit from professional counseling or therapy to address issues related to trauma, receive trauma focused therapy and psychoeducation to promote healing. This is why advocacy in a community based approach is so critical to enhance access to care. Education and awareness: Educating the public about male sexual assault and challenging harmful stereotypes can help reduce stigma and promote understanding and support for survivors. Positive self-image: Encouraging a positive self-image and self-esteem can help survivors rebuild their confidence and sense of self-worth. In the tri-phasic model of trauma recovery (Herman, 1992), the ultimate goal is to connect with the authentic self through reconnection with a positive self-image. Spirituality: For some individuals, religious or spiritual beliefs can provide comfort, hope, and meaning during difficult times, as well as spiritual disciplines and practices. There is evidence to suggest that certain spiritual disciplines and practices can be beneficial for trauma recovery such as mindfulness and meditation, prayer, forgiveness, scripture reading and gratitude (Harris et al., 2003). These practices can help individuals develop a sense of meaning and purpose, improve coping skills, and reduce feelings of anxiety and depression (Harris et al.,2003). Military Resilience Factors Literature also notes unique resiliency factors found among military members that assist in trauma recovery. These include:

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MILITARY MALE SEXUAL ASSAULT RESPONSE 16 Positive coping strategies : Military members who use positive coping strategies, such as seeking social support and engaging in physical activity, tend to be more resilient. (Bartone et al., 2008). Optimism : Optimism, or the tendency to view situations positively, has been linked to greater resilience in military members. (Morgan et al., 2013). Sense of purpose : Military members who have a strong sense of purpose and meaning in their lives tend to be more resilient in the face of challenges. (Westerhof et al., 2010). Emotional intelligence : Military members who are emotionally intelligent, meaning they are able to recognize, manage and regulate their own emotions as well as those of others, tend to be more resilient. (Chiang et al., 2018). Training and preparation : Military members who receive adequate training and preparation for the challenges they may face tend to be more resilient. (Patterson et al., 2013). Strengths Based Approach Understanding these resiliency factors and how to utilize them is critical in recovery especially when utilizing a strengths-based approach with males. A strengths-based approach to trauma recovery focuses on identifying and utilizing the personal strengths and resources of individuals to help them overcome the effects of trauma. According to this approach, trauma survivors are viewed as having the ability to heal and recover, and the therapist's role is to support and facilitate this process by helping them identify and draw upon their existing strengths and resources. One study that highlights the effectiveness of a strengths-based approach to trauma recovery is by Friborg et al. (2014). The study examined the effectiveness of a six-session strengths-based intervention for trauma survivors with posttraumatic stress disorder (PTSD). The intervention involved helping participants identify and utilize their personal strengths, and the

MILITARY MALE SEXUAL ASSAULT RESPONSE 17 results showed significant improvements in PTSD symptoms, as well as reductions in depression and anxiety. The importance of a strengths-based approach cannot be understated. Individuals who have experienced sexual assault may engage in maladaptive coping strategies, such as substance use or avoidance, to cope with the trauma they have experienced. These coping strategies may provide temporary relief, but in the long run, they can be harmful and prevent individuals from fully processing and healing from the trauma they have experienced. Trauma survivors who have developed these maladaptive coping strategies may be reluctant to give up these behaviors without something in replacement, thus reconnecting and drawing upon strengths aids in helping to make a healthy transition. To address the need for a strengths-based approach for individuals who have experienced sexual assault, the American Psychological Association (APA, 2019) recommends focusing on building resilience and coping skills. This approach emphasizes the strengths and resources of the individual and recognizes that each person has unique strengths and abilities that can be used to promote healing. One example of a strengths-based approach is trauma-focused cognitive-behavioral therapy (TF-CBT), which has been shown to be effective in treating individuals who have experienced sexual assault (Deblinger et al., 2011). TF-CBT focuses on building coping skills and resilience by addressing negative thoughts and beliefs related to the trauma, developing relaxation and grounding techniques, and promoting social support networks (Deblinger et al., 2011). Study participants who received TF-CBT showed sustained improvement in PTSD symptoms compared to those who received non-directive supportive therapy. The study also found that the TF-CBT group had a significantly greater reduction in depression and behavior

MILITARY MALE SEXUAL ASSAULT RESPONSE 18 problems than the non-directive supportive therapy group (Deblinger et al., 2011). The research thus demonstrates that strength-based approaches to trauma focused therapy can significantly improve trauma recovery for male sexual assault survivors. Coalition A Coordinated Community Response (CCR) to male sexual assault involves the collaboration of various community agencies and organizations to provide support, prevention, and intervention services to male survivors of sexual assault (Greeson et al., 2016). This approach recognizes that male sexual assault is a complex issue that requires a comprehensive response from various sectors of the community, including law enforcement, healthcare, social services, education, and advocacy groups, which by extension includes veteran support organization, local government and community clergy for holistic care, prevention and advocacy. Dr. Greeson has worked with the American Psychological Association (APA) to develop guidelines for implementing a coordinated community response to male sexual trauma. These guidelines provide a framework for identifying and addressing the needs of male survivors of sexual trauma, as well as promoting prevention efforts. The guidelines emphasize the importance of a trauma-informed approach, which recognizes the impact that sexual trauma can have on individuals and focuses on creating a safe and supportive environment for survivors. They also highlight the need for culturally sensitive and responsive services that take into account the unique experiences and needs of men from diverse backgrounds (Greeson et al., 2016). One study that examined the effectiveness of CCRs in addressing male sexual assault is "Evaluation of a coordinated community response to male sexual assault" by Ullman et al. (2005). The study evaluated the impact of a CCR program in a large urban area in the United States. The program involved the collaboration of a rape crisis center, a mental health center, a

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MILITARY MALE SEXUAL ASSAULT RESPONSE 19 hospital emergency department, and law enforcement agencies. The results of the study showed that the CCR program had a positive impact on male survivors of sexual assault. The program improved access to services, increased reporting of sexual assault, and reduced the stigma associated with male sexual assault, all aims for a coordinate community response and offer a promising approach for addressing male sexual assault and best practices for implementing a coalition approach. Gleaning from this study, by expanding a CCR approach to military male sexual assault clients to include veteran and military centric organizations, religious and local leadership, a more holistic approach to care could exist. Local, state and federal governments, military leadership, religious organizations, clergy, veteran support organizations, social services, mental health practitioners, professional counseling organizations and their lobbyists, non-government organization and not for profits such as 1in6.org have a unique opportunity to develop a community-based ecological approach in support of male sexual assault survivors. By coordinating and collaborating in planning and programming, their combined efforts could reduce redundancies, fill gaps in services provided, maximize resources and community-based efforts to share the case management and prevention, thereby increasing program capacity, capability and effectiveness. By aligning as a community- based collation, CCRs combined efforts aid to promote professional advocacy resulting in policy changes, greater accountability for offenders, increased resource funding and support services for victims, as well as strengthen efforts in outreach and messaging which aids in reducing male sexual assault stigmatization. Advocacy Program Veteran support organizations have been the voice of advocacy and support for policy and legislative changes. Jasinski et al. (2017) suggests that veteran support organizations could play a

MILITARY MALE SEXUAL ASSAULT RESPONSE 20 critical role in the community due to their nationwide community presence and unique understanding of the military culture. Veteran support organizations play a crucial role in advocating for legislative and policy changes that benefit veterans and their families. They use various methods to influence policy and decision-making, including lobbying, grassroots organizing, media campaigns, and public education. One example of a veteran support organizations that engage in advocacy and lobbying is the Veterans of Foreign Wars (VFW). The VFW has a long history of advocating for policies and legislation that support veterans, such as access to healthcare, education, and employment. They use their strong network of members and volunteers to push for changes at the local, state, and federal levels. According to a report by the Congressional Research Service, veteran service organizations like the VFW provide a valuable perspective on veterans' issues, as well as a well- organized lobbying presence in Congress (Schwartz, 2019). Another example is the Disabled American Veterans (DAV), which also engages in advocacy and lobbying on behalf of disabled veterans. The DAV has been successful in influencing policy and legislative changes that improve the lives of disabled veterans, such as expanding healthcare benefits and increasing disability compensation. In a study published in the Journal of Military and Veterans' Health, the authors note that veteran service organizations have been successful in leveraging their political power to shape public policy and legislation that affect the well-being of veterans and their families (Meadows et al., 2017). Overall, veteran service organizations play a crucial role in advocating for the needs and concerns of veterans and their families. Their efforts have led to important legislative and policy changes that have improved the lives of countless veterans. The main issue with veteran service organizations is that they are fractured and often competitive failing to synchronize efforts (Phillips, 2021).

MILITARY MALE SEXUAL ASSAULT RESPONSE 21 Challenges and Barriers to Services Veteran Service Organization Fracturing Veteran service organizations (VSOs) can provide significant social support for military male sexual assault victims. This comes in the form of assistance in filing claims with the Veterans Administration, and peer to peer support among a community that understands military service and culture. Unfortunately, veteran service organization are not well prepared to provide peer to peer support or facilitate military peer sexual trauma support groups, nor are they necessarily collaborative in their approach to veteran support and care. According to Pope (2016) the organizational culture of veteran service organizations and negatively impacts their ability to effectively serve veterans. One aspect of organizational culture discussed is the competition and struggles between VSOs. Pope (2016) notes that these conflicts can arise due to differences in ideology, funding sources, and the desire to be seen as the primary voice for veterans. This can lead to a lack of collaboration and duplication of efforts, which can ultimately harm the veteran population. Non-male Focus A cursory review of available service in the greater Hampton Roads area demonstrates that the Virginia Sexual and Domestic Violence Coalition, as well as local crisis services focus primarily on women, children, and the LQBTQ community, but rarely mention or provide services specific to males or military males. In fact, it was not until 2012 when the American Psychological Association published a report highlighting the need for greater attention to male sexual victimization and addressing some of the barriers to reporting and treatment (Stemple et al., 2014). Defentions for rape and sexual assault generally involved receptive penetration for females only (Stemple et al., 2014). When the definition of sexual assault was expanded to

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MILITARY MALE SEXUAL ASSAULT RESPONSE 22 include nonconsensual sexual contact, the rates of sexual assaults began to equalize between men and women (Stemple et al., 2014). While professional associations and laws have begun to catchup to the equality needed in recognizing and validating male sexual assault, society and culture at large have a long way to go. Perceptions of Masculinity in Culture Men may experience unique challenges in disclosing and seeking support for sexual trauma due to social attitudes and stigma surrounding male victimization. Research suggests that men may face societal pressures to conform to traditional masculine norms, which may discourage them from disclosing experiences of sexual trauma (Koss, 1990; Bullock et al., 2011). Male socialization can contribute to male sexual victimization by fostering beliefs and attitudes that condone and normalize sexual aggression and discourage men from reporting or seeking help for victimization experiences (Peterson et al., 2004). For instance, traditional masculine gender roles emphasize dominance, aggression, and control, which may lead some men to view sexual conquests or coercion as a way to assert their power or masculinity (Koss, 1990). These attitudes and behaviors can perpetuate sexual violence and make it difficult for male survivors to seek support or disclose their experiences (Davies, 2002). Moreover, men who disclose experiences of sexual trauma may face skepticism or disbelief from others, including mental health professionals, due to prevailing societal stereotypes that men are perpetrators rather than victims of sexual violence (Rozée et al., 2001). How culture views men through the social lens of beliefs and attitudes, and the misperception of how men on a personal level experience trauma creates the need for greater education through this social lens due to the barriers it creates in society and in male victims seeking help. One approach to a community-based coalition to overcome this barrier it to partner

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MILITARY MALE SEXUAL ASSAULT RESPONSE 23 with education and advocacy groups such as in6.org and the Rape Abuse and Incest National Network (RAINN) through the education and advocacy programs. Specifically, 1in6.org utilizes their “Truth Telling” seminar which could be used for community clergy, veterans organization caregivers, first responders, sexual assault victim advocates, sexual assault response coordinators, mental health providers and military social workers. This seminar focuses on male- centered approaches to psychotherapy, male psychology and how this “coding” of masculinity intersects with the lives of men facing trauma and post-traumatic responses. An overview of current research on both male sexual abuse and assault, and an analysis of how trauma commences, and a conceptual lens to the recovery process. With proper awareness, education and skills-based learning, community coalition stakeholders could fill a critical void in the community by meeting the needs of military male survivors of sexual assault with support and resources that do not currently exist. Lack of Advocacy Advocacy for male sexual assault victims is an essential aspect of addressing the issue of sexual violence. However, there are several barriers that prevent effective advocacy for male survivors. These barriers can be categorized into individual, systemic, and cultural factors that influence attitudes towards male sexual assault and the provision of services. One of the individual barriers is the reluctance of male survivors to disclose their experiences. Men may fear being stigmatized or not believed, leading them to remain silent about their experiences (Katz, 2018). Additionally, some male survivors may not recognize their experiences as sexual assault due to societal stereotypes that perpetuate the myth that men cannot be sexually assaulted (Widanaralalage et al., 2022).

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MILITARY MALE SEXUAL ASSAULT RESPONSE 24 Systemic barriers also play a significant role in hindering advocacy for male sexual assault victims. For example, services such as rape crisis centers are often geared towards female survivors, making male survivors feel unwelcome or uncomfortable seeking help. Furthermore, there may be a lack of funding and resources dedicated to male sexual assault advocacy, resulting in a lack of programs and services available to support male survivors. Cultural factors also contribute to barriers to male sexual assault advocacy. Stereotypical notions of masculinity and gender norms that associate men with power, strength, and control that reinforce the idea of men as powerful and in control may make it challenging for male survivors to come forward and seek help (Rozée et al., 2001). These stereotypes may lead to assumptions that men cannot be victims of sexual assault, or that if they are, they should be able to man up and deal with it on their own (Peterson et al., 2004). These cultural messages perpetuate the myth that sexual assault only happens to women may lead to the marginalization of male survivors and a lack of public awareness and understanding of their experiences that leads to advocacy, support and funding for male oriented sexual assault recovery programs. Conclusion In conclusion, sexual trauma can have significant and lasting impacts on men, including physical, emotional, and psychological consequences. However, social attitudes and stigma surrounding male victimization can make it difficult for men to disclose and seek support for sexual trauma, highlighting the need for increased awareness and understanding of male sexual victimization. Addressing these barriers requires a multifaceted approach that involves addressing societal stereotypes and myths, as well as increasing funding and resources for male sexual assault advocacy programs and services, and providing education and training to professionals, as well as community-based stakeholders. By developing a community-based

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MILITARY MALE SEXUAL ASSAULT RESPONSE 25 approach in a coordinated community response to military male sexual assault support and prevention, planning and programming can reduce redundancies, fill gaps in services, maximize existing resources and increase service utilization among potential clientele and provide the social support needed that these men may no longer suffer in silence. Partnerships with clergy and veteran support organizations provide a critical linchpin for social support and with specialized education, an avenue for spiritual and group intervention strategies for male veterans in their recovery from sexual trauma. References

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MILITARY MALE SEXUAL ASSAULT RESPONSE 26 American Psychological Association. (2013). Chaplain interventions for health care. Retrieved from https://www.apa.org/pi/about/publications/caregivers/practice-settings/religious- spiritual/chaplain-interventions American Psychological Association. (2019). Guidelines for Psychological Practice with Survivors of Sexual Assault. Retrieved from https://www.apa.org/practice/guidelines/sexual-assault-survivors-guidelines Bartone, P. T., Roland, R. R., & Picano, J. J. (2008). Psychological hardiness predicts success in US Army Special Forces candidates. International Journal of Selection and Assessment, 16 (1), 78-81. https://doi.org/10.1111/j.1468-2389.2008.00412.x Brenner, L. A., Ivins, B. J., Schwab, K. A., Warden, D., Nelson, L. A., Jaffee, M. S., & Terrio, H. (2011). Traumatic brain injury, posttraumatic stress disorder, and postconcussive symptom reporting among troops returning from Iraq. Journal of Head Trauma Rehabilitation, 26 (4), 312-318. https://doi.org/10.1097/htr.0b013e3181cada03 Briere, J., Kaltman, S., & Green, B. L. (2004). Accumulated childhood trauma and symptom complexity. Journal of Traumatic Stress, 17 (1), 67-75. https://doi.org/10.1023/B:JOTS.0000014671.90356.7 a Bullock, C. M., & Beckson, M. (2011). Male victims of sexual assault: Phenomenology, psychology, physiology. Journal of the American Academy of Psychiatry and the Law Online , 29 (2), 197–205 Retrieved from https://jaapl.org/content/39/2/197 Chiang, H.-H., Chen, K.-J., & Yang, C.-C. (2018). Model of coping strategies, resilience, psychological well-being, and perceived health among military personnel. Journal of Medical Sciences, 38 (2), 73. https://doi.org/10.4103/jmedsci.jmedsci_60_17

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MILITARY MALE SEXUAL ASSAULT RESPONSE 27 Currier, J. M., Holland, J. M., & Malott, J. (2019). A randomized controlled trial of chaplain-led spiritual interventions with military service members undergoing treatment for PTSD and moral injury. Journal of Traumatic Stress, 32 (3), 422-432. https://doi.org/10.1002/jts.22390 Davies, M. (2002). Male victims of sexual assault and rape: Challenges and barriers to accessing services and support. Journal of Aggression, Maltreatment & Trauma, 6 (1), 131-148. https://doi.org/10.1016/s1359-1789(00)00043-4 Davies, M. (2019). Sexual Violence Against Men and Boys: A Hidden Problem. Journal of Interpersonal Violence, 34 (3), 471–479. https://doi.org/10.1177/0886260519871532 Deblinger, E., Mannarino, A. P., Cohen, J. A., & Steer, R. A. (2011). A follow-up study of a multisite, randomized, controlled trial for children with sexual abuse-related PTSD symptoms. Journal of the American Academy of Child and Adolescent Psychiatry, 50 (5), 526-537. https://doi.org/10.1016/j.jaac.2011.01.017 Department of Defense. (2019). Sexual Assault Prevention and Response Office Annual Report on Sexual Assault in the Military. Retrieved from https://www.sapr.mil/public/docs/reports/FY18_Annual/FY18_Annual_Report_on_Sexua l_Assault_in_the_Military.pdf Department of Defense. (n.d.). 2020 population representation in the military services. 2020 Population Representation in the Military Services – OPA.gov. Retrieved from https://www.opa.mil/research-analysis/recruiting-awareness/population- representation/2020-population-representation-in-the-military-services/

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MILITARY MALE SEXUAL ASSAULT RESPONSE 28 Dyer, J. G., & Smith, L. (2019). The role of chaplains in promoting mental health in the military: A literature review. Journal of Psychology and Theology, 47 (2), 110-119. https://doi.org/10.1177/0091647119829255 Enright, R. D, Freedman, S., & Rique, J. (1998). The psychology of interpersonal forgiveness. In R. D. Enright & J. North (Eds.), Exploring forgiveness (pp. 46-62). University of Wisconsin Press. Flannelly, K. J., Handzo, G. F., Weaver, A. J., & Dusek, J. A. (2017). A systematic review of chaplaincy interventions for patients with trauma. Journal of Health Care Chaplaincy, 23 (1), 3-21. https://doi.org/10.1080/08854726.2017.1344501 Flannelly, K. J., Weaver, A. J., Handzo, G. F., & DuBard, L. C. (2017). The chaplain's role in providing spiritual care to survivors of sexual assault. Journal of Healthcare Chaplaincy, 23 (2), 49-62. https://doi.org/10.1080/08854726.2017.1314258 Frazier, P. A., Tix, A. P., Barron, K. E., & Mintz, L. B. (2015). Spiritually integrated psychotherapy: Understanding and addressing the sacred. Guilford Publications. Friborg, O., Martinsen, E. W., Martinussen, M., Kaiser, S., Overgård, K. T., & Schmierer, P. (2014). Composing the Strains of Recovery from Trauma: A Prospective Longitudinal Mixed Method Study of Within-Person Processes That Change During Intervention. Psychological Trauma: Theory, Research, Practice, and Policy, 6 (6), 553–560. https://doi.org/10.1037/a0037281 Goodwin, J. (2013). The wobble hypothesis: an adaptation of Herman's dialectic of trauma. Psychological Trauma: Theory, Research, Practice, and Policy, 5 (1), 89-91. https://doi.org/10.1037/a0024422

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MILITARY MALE SEXUAL ASSAULT RESPONSE 29 Greeson, M. R., & Campbell, R. (2016). Coordinated community response to male survivors of sexual violence: A review of the literature. Trauma, Violence, & Abuse, 17(2), 185–197. https://doi.org/10.1177/1524838015587509 Griffin, M. G., McDevitt-Murphy, M. E., & Wangelin, B. C. (2018). Trauma and military service: A review of the literature. Trauma, Violence, & Abuse, 19 (4), 399-410. https://doi.org/10.1177/1524838016683459 Hampton Roads Economic Development Alliance. (2022). Annual Report 2022. Retrieved from https://www.hreda.com/wp-content/uploads/2022/01/HREDA-Annual-Report-2022.pdf Harris, A. H. S., Thoresen, C. E., & Johnson, R. J. (2003). Spiritual practices and health: A review of the literature. Journal of the American College of Health, 50 (6), 325-332. https://doi.org/10.1080/07448480309595758 Harris, J. I. (2019). Building spiritual strength in trauma survivors: A qualitative study. Journal of Religion and Health, 58( 2), 666-680. https://doi.org/10.1007/s10943-018-0661-9 Herman, J. L. (1992). Trauma and recovery: The aftermath of violence--from domestic abuse to political terror. Basic Books. Hodge, D. R. (2019). Spiritually integrated psychotherapy: A review of empirical evidence. Journal of Clinical Psychology, 75 (10), 1773-1785. https://doi.org/10.1002/jclp.v75.10 Howard, K. J., & Yates, B. T. (2017). Spiritual strength in trauma survivors: An exploratory study. Journal of Spirituality in Mental Health, 19 (1), 1-11. https://doi.org/10.1080/19349637.2016.1192054 Jasinski, J. L., & Kaufman, M. (2017). Meeting the needs of male survivors of sexual assault: Recommendations for best practice. Journal of Interpersonal Violence, 32 (1), 3-24. https://doi.org/10.1177/0886260515587237

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MILITARY MALE SEXUAL ASSAULT RESPONSE 30 Katz, J. (2018). The invisibility of male sexual victimization: Implications for family therapists. Journal of Marital and Family Therapy, 44 (3), 386-397. https://doi.org/10.1111/jmft.2018.44.issue-4 Kimerling, R., Gima, K., Smith, M. W., Street, A., & Frayne, S. (2007). The Veterans Health Administration and military sexual trauma. American Journal of Public Health, 97 (12), 2160-2166. https://doi.org/10.2105/AJPH.2006.093490 Korbman, M. D., Pirutinsky, S., Feindler, E. L., & Rosmarin, D. H. (2022). Childhood sexual abuse, spirituality/religion, anxiety and depression in a Jewish community sample: The mediating role of religious coping. Journal of Interpersonal Violence, 37 (15–16). https://doi.org/10.1177/08862605211001462 Koss, M. P. (1990). The hidden rape victim: Personality, attitudinal, and situational characteristics. Psychology of Women Quarterly, 14 (3), 327-354. https://doi.org/10.1111/j.1471-6402.1985.tb00872.x Lefebvre, R., Srinivasan, S., & DeVoe, E. (2014). Sexual assault and sexual harassment in the U.S. military: Volume 2. Estimates for Department of Defense Service Members from the 2014 RAND Military Workplace Study. Retrieved from https://www.rand.org/pubs/research_reports/RR870z2.html Lilley, S. (2023). Subject matter conversations: program development [PowerPoint slides]. Retrieved from https://canvas.liberty.edu/courses/421318/discussion_topics/3837754? module_item_id=48004028 Loughran, D. S., & Humphreys, M. (2018). The US military and the socioeconomic divide. Annual Review of Sociology, 44 (1), 599-620. https://doi.org/10.4324/9781315126616

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MILITARY MALE SEXUAL ASSAULT RESPONSE 31 Morgan, N. R., Acker, M. A., & Zimmerman, M. A. (2013). Optimism and resiliency in military families experiencing a combat deployment. Journal of Family Strengths, 13 (1), 1-15. https://doi.org/10.4135/9781483369532.n196 Office of the Assistant Secretary of Defense for Manpower and Reserve Affairs. (2020). Population Representation in the Military Services: Fiscal Year 2020 Summary Report. Retrieved from https://www.cna.org/CNA_files/PDF/DOP-2021-U-029989-Final.pdf Pargament, K. I., Smith, B. W., Koenig, H. G., & Perez, L. M. (2019). The role of chaplains in providing spiritual care for survivors of trauma. Journal of Trauma & Dissociation, 20 (5), 550-564. https://doi.org/10.1080/15299732.2019.1663600 Patterson, J., Arthur, W., & LaPorta, A. (2013). Military training and the development of resilience. In C. L. Cooper & M. F. Flint-Taylor (Eds.), From stress to well-being (Vol. 2, pp. 218-232). Palgrave Macmillan. Peterson, Z. D., & Muehlenhard, C. L. (2004). Was it rape? The function of women's rape myth acceptance and definitions of sex in labeling their own experiences. Sex Roles, 51 (3-4), 129-144. https://doi.org/10.1023/b:sers.0000046608.19947.75 Philipps, D. (2021, February 27). Veterans’ Groups Compete With Each Other, and Struggle With the V.A. The New York Times . Retrieved from https://www.nytimes.com/2021/02/27/us/veterans-va-groups.html Pope, J. E. (2016). When veterans come home: The impact of organizational culture on veteran service organizations. Armed Forces & Society, 42 (1), 92-113. https://doi.org/ 10.1177/0095327X14535432 Rozée, P. D., & Koss, M. P. (2001). Rape: A century of resistance. Psychology of Women Quarterly, 25 (4), 295-311. https://doi.org/10.1177/036168430102500305

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MILITARY MALE SEXUAL ASSAULT RESPONSE 32 Ruscio, A. M., Borkovec, T. D., & Ruscio, J. (2001). A taxometric investigation of the latent structure of worry. Journal of Abnormal Psychology, 110 (2), 193–200. https://doi.org/10.1037/0021-843X.110.2.193 Schwartz, M. A. (2019). Veterans service organizations: Background and issues for Congress. Congressional Research Service . Retrieved from https://fas.org/sgp/crs/misc/R40076.pdf. Stemple, L., & Meyer, I. H. (2014). The sexual victimization of men in America: New data challenge old assumptions. American Journal of Public Health, 104 (6). https://doi.org/10.2105/ajph.2014.301946 Swartout, K. M., Koss, M. P., White, J. W., & Thompson, M. P. (2014). Trajectories of the likelihood of experiencing forced sex: Effects of victimization and characteristics of sexual assaults. Journal of Interpersonal Violence, 29 (13), 2333-2357. https://doi.org/10.1177/0886260514534524 Ullman, S. E., Townsend, S. M., & Filipas, H. H. (2005). Evaluation of a coordinated community response to male sexual assault. Journal of Interpersonal Violence, 20 (8), 977-992. https://doi.org/10.1177/0886260505277547 Wang, P. S., Berglund, P. A., Olfson, M., Pincus, H. A., Wells, K. B., & Kessler, R. C. (2017). Failure and delay in initial treatment contact after first onset of mental disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 64 (6), 603- 613. https://doi.org/10.1001/archpsyc.64.6.603 Westerhof, G. J., & Keyes, C. L. (2010). Mental illness and mental health: The two continua model across the lifespan. Journal of Adult Development, 17 (2), 110-119. https://doi.org/ 10.1007/s10804-009-9082-y

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MILITARY MALE SEXUAL ASSAULT RESPONSE 33 Widanaralalage, B. K., Hine, B. A., Murphy, A. D., & Murji, K. (2022). “I didn’t feel I was a victim”: A phenomenological analysis of the experiences of male-on-male survivors of rape and sexual abuse. Victims & Offenders, 17 (8), 1147–1172. https://doi.org/10.1080/15564886.2022.2069898 Wilson, A. (2023, February 27). Chaplains to serve as counselors aboard all Navy destroyers by 2025. Stars and Stripes. Retrieved March 17, 2023, from https://www.stripes.com/branches/navy/2023-02-27/navy-chaplains-destroyers- counseling-suicide-9268265.html Worthington, E. L., Witvliet, C. V. O., Pietrini, P., & Miller, A. J. (2007). Forgiveness, health, and well-being: A review of evidence for emotional versus decisional forgiveness, dispositional forgiveness, and reduced unforgiveness. Journal of Behavioral Medicine, 30 (4), 291-302. https://doi.org/10.1007/s10865-007-9105-8 Wosik, J., Fudim, M., Cameron, B., Gellad, Z. F., Cho, A., Phinney, D., ... & Curtis, L. H. (2020). Telehealth transformation: COVID-19 and the rise of virtual care. Journal of the American Medical Informatics Association, 27 (6), 957-962. https://doi.org/10.1093/jamia/ocaa067

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