Organizational Capacity for Sexual Assault Prevention Within a U.S. Army Installation

ABSTRACT

Introduction

Preventing military sexual assault (SA) is a DoD priority. Building prevention capacity could strengthen the impact of prevention programs and improve outcomes. Capacity was conceptualized as implementation knowledge and skills using the Getting To Outcomes (GTO) process and organizational-level capacities using the Prevention Evaluation Framework, a framework that applies best practices in prevention and implementation science to prevention at the program and organizational level. The present study assesses implementation knowledge and skills currently possessed by SA prevention personnel in one U.S. Army installation with the goal of identifying preexisting proficiencies and potential gaps. The study uses the Prevention Evaluation Framework organizational-level domains to identify organizational capacities that could be improved.

Materials and Methods

Fifteen SA prevention program personnel were recruited for individual 1-hour interviews from one U.S. Army installation. A semi-structured interview guide was developed by the study team to assess knowledge and skills within the GTO framework. Applied thematic analysis guided data coding and analysis.

Results

Participants reported a range of proficiencies and gaps in capacity for SA prevention. Within the prevention workforce capacity, proficiencies were skill in tailoring training, and an existing train-the-trainer model. Gaps were training to facilitate difficult conversations, and an inability to tailor trainings to audience needs. Two proficiencies related to the comprehensive approach were having a victim advocate present during trainings, and providing training across leadership levels. The final proficiency involved data. Existing data sources were viewed as useful for identifying the nature and extent of local problems. However, participants reported a lack of confidence and skill in selecting appropriate outcome measures and collecting and using primary data. Gaps in leadership capacity were cultural norms, lack of trust, leader investment, logistical difficulty working with leaders, and comfort engaging with leaders. Gaps in collaborative relationships were the lack of informal networking within the SA prevention area to include civilians.

Conclusions

The GTO-specific knowledge and skills of SA prevention personnel at one U.S. Army installation revealed proficiencies and gaps in organizational capacities influencing the prevention mission. Findings indicate that GTO support could be useful for improving the quality of program activities. However, results also indicate that GTO support would be more effective if they were paired with sufficient prevention infrastructure at the organizational level.

INTRODUCTION

Sexual assault (SA) is a major problem facing today’s soldiers. The most recent data indicates the prevalence of SA in active duty service members was 8.4% for women and 1.5% for men,¹ most often either committed by military members or occurring in military settings.² Prevalence rates are particularly alarming given the serious personal and professional consequences of SA. Military women who are sexually assaulted are more likely to seek treatment for PTSD and report higher rates of mental health disorders and suicide attempts.³ Professionally, these women often experience demotion in rank and eventual attrition from military service.³ Although markedly less research has examined the consequences of SA in male service members, consequences include physical injury, depression, anxiety, nightmares, flashbacks, self-blame, low self-esteem, problems with anger control,⁴ and attrition from the military.⁵ Males are less likely as female service members to report assaults⁶ and often suffer substantial unmet mental health care needs.

PREVENTION EFFORTS

Reducing the incidence of military SA is a priority for many leaders at the DoD.⁷ However, until recently, reporting and response have been emphasized more than prevention. Priorities began shifting in 2020 when the DoD Policy on Integrated Primary Prevention of Self-Directed and Prohibited Abuse or Harm⁸ outlined the goal of a DoD-wide integrated prevention system, followed by the Independent Review Commission on Sexual Assault in the Military’s recommended improvements, including establishing a dedicated prevention workforce.⁹ Hiring began in 2022, with the goal of adding 2,000 new personnel by 2028. The U.S. Army’s prevention efforts are led by the Sexual Harassment and Assault Response and Prevention (SHARP) program. Knowledge of how best to implement evidence-based prevention practices can support SHARP as integrated prevention develops.

PREVENTION CAPACITY PROFICIENCIES AND GAPS

One effort on the part of DoD to build capacity for better prevention was to employ Getting To Outcomes (GTO),¹⁰ a 10-step process that guides practitioners through stages of program implementation and evaluation. In multiple randomized trials comparing organizations attempting to implement evidence-based programs with and without GTO support, organizations with GTO demonstrated better implementation of programs preventing drug use,^11–13 sexually transmitted infections,^14,15 and improved outcomes in sexual health programming.¹⁶ The recent GTO pilot in installations across every branch within the U.S. military yielded improved SA prevention capacity.¹⁷

Getting To Outcomes provides support that builds the knowledge and skills needed to select, implement, evaluate, and improve programs.¹⁸ However, prevention capacity includes organization factors beyond knowledge and skills. Gaps at the organizational level may need to be addressed to utilize GTO most effectively. The Prevention Evaluation Framework (PEF)¹⁹ was created to measure prevention capacity using the elements of DoD’s Prevention Plan of Action. The PEF applies best practices in prevention and implementation science at two levels. The program level focuses on specific prevention programs, whereas the organizational level focuses on factors with organization-wide impact (see Table 1 for definitions of organization-level domains). Previous research using the PEF found that program implementation has been challenged by both limited prevention capacity, such as a dedicated workforce, as well as DoD’s organizational complexity, which has an underdeveloped prevention infrastructure.²⁰

Table 1.

Prevention Evaluation Framework—Organizational-Level Factors

Organizational factors
Factor	Definition
Leadership	Leaders use best evidence, monitor prevention activities, and hold subordinates accountable for their prevention work.
Prevention workforce	Sufficient personnel with appropriate training and regular contact with leadership.
Collaborative relationships	Prevention personnel collaborate with each other inside the organization and with experts outside the organization.
Data	Data are collected to document the specific nature of the problem locally and data are also used to track prevention impact.
Resources	Sexual Assault and Harassment prevention efforts have a dedicated budget for staffing, adaptation, implementation, evaluation, sustainability.
Comprehensive approach to prevention	Prevention activities are evidence-based, target multiple risk factors across multiple ecological levels, and build skills as well as attitudes and knowledge.
Quality implementation	Implementation processes are monitored for multiple elements of fidelity.
Continuous evaluation	All prevention is regularly evaluated and improved.

The present study assesses SHARP personnel in 1 U.S. Army military installation to determine their GTO-relevant prevention knowledge and skills and identifies proficiencies and potential gaps in organizational capacity using the PEF organizational-level domains.

METHODS

Participants/Recruitment

Participants were recruited from 1 U.S. Army installation of 15,000 to 20,000 service members. During the study time period, SHARP responsibilities were managed at the battalion level by non-commissioned officers who had SHARP assigned as a collateral duty (i.e., additional assigned work) and were supported by garrison-level and installation-level SHARP officers and civilians, including victim advocates (VAs) and Sexual Assault Response Coordinators (SARCs). Table 2 presents the participant demographics. A list of 46 SHARP personnel was provided by the managers of the installation SHARP program, including U.S. Navy personnel who were stationed on the Army installation. Of those, 15 participated in interviews, 10 had incorrect contact information or were no longer working at the installation, 20 declined to participate or were non-responsive, and one was unable to get approval for participation from their command. Snowball sampling was used to recruit 17 collateral duty personnel but all were non-responsive. This study was reviewed by the university and installation institutional review boards and ruled not human subjects research.

Table 2.

Participant Demographic Information

Participant	Role	Support	Assignment
001	SARC	Garrison	Full time
002	VA	Brigade	Full time
003	VA	Brigade	Collateral duty
004	VA	Brigade	Collateral duty
005	VA	Navy	Collateral duty
006	VA	Navy	Collateral duty
007	SARC	Brigade	Full time
008	VA	Navy	Collateral duty
009	VA and SARC	Brigade	Reserves
010	SARC	Battalion	Collateral duty
011	VA	Navy	Collateral duty
012	SARC	Navy	Collateral duty
013	VA	Brigade	Full time
014	SARC	Brigade	Full time
015	VA	Battalion	Collateral duty

Abbreviations: Sexual Assault Response Coordinator, SARC; VA, victim advocate.

Sex omitted to preserve confidentiality. There were 5 males and 10 females. One of the Army SARCs was a reservist.

Data Collection

Interview data were collected by the Principal Investigator and a research assistant with PhD-level qualitative training. One-hour interviews were recorded using Microsoft Teams between September 2021 and April 2022 and professionally transcribed. Field notes were recorded immediately following the interviews. Data saturation was discussed after 8 interviews were completed and judged to occur by interview 15.

A semi-structured interview guide was developed by the study team to assess knowledge and skills within the GTO framework and piloted with two SHARP personnel before widespread data collection. After assessing participants’ current roles and experiences with program implementation, a hypothetical prevention program was described and visually presented to participants for feedback. The hypothetical program included gender-specific modules focusing on being a victim and a perpetrator, developing an understanding of SA survivors’ experiences, obstacles to reporting, recognizing harassing behaviors and potentially dangerous situations, learning how to involve others, and practicing confronting other soldiers. Getting To Outcomes-specific questions asked participants how they would assess fit (step 4), capacity, (step 5), plan (step 6), and evaluate both implementation process and program outcomes (steps 7 and 8) of the hypothetical training. Questions also asked how participants could promote ongoing learning, take a leading role in changing the culture at their installation, and the nature of their current relationships with SA specialists across the installation and in the community.

Data Analysis

Data coding and analysis were conducted separately by two doctoral research assistants (A.D.H. and K.M.) using applied thematic analysis.²¹ First, 3 interviews were coded separately using NVivo, with any disagreements resolved through discussion with the PI. After reaching 97% agreement, the remaining transcripts were coded separately. Getting To Outcomes-specific codes relevant to process steps were created from the interview guide with 35 subcodes. Major codes include the current SHARP training, the planning process, assessing program fit, program implementation, program outcomes, ongoing learning, and relationships within the unit, installation, and civilian community.

Interview questions focused on steps 4 through 8 of the GTO process. Analyses identified 80 preliminary themes that were collapsed through team discussion. Irrelevant minor themes were not included. Themes were organized into 5 thematic categories and identified proficiencies and gaps were then matched with the GTO steps and PEF domains. Results were shared with SHARP and SAPRO leaders for feedback. Additional details were incorporated into the manuscript, but results were not substantively changed. Final data analyses were then reviewed and verified by two other PhD researchers (S.K.C. and K.R.C.), who were not involved in earlier analyses.

Important Context

Approximately halfway through the study, interviewers noted significant policy changes to the SHARP program. Command leaders were directed to conduct all SHARP trainings, which influenced the experiences of SHARP personnel. This change was considered during analysis and where applicable, we have noted where these policy changes may meaningfully address a need or a gap raised by participants.

RESULTS

Interviewees revealed knowledge and skills relevant to several GTO steps. In general, there appeared to be no systematic approach for obtaining local input before selecting programs for implementation (GTO steps 1–3). Program implementation decisions were typically made by higher-level leaders and then handed off to participants who implemented the program as directed. However, participants did report that Fit (step 4) and Capacity (step 5) were assessed informally after programs were assigned, and participants worked to address recognized gaps. Participants indicated that Planning (step 6) was typically limited to practicing the training activities. Participants reported efforts to assess the quality of implementation through Evaluation skills (steps 7 and 8). Participants’ techniques for improving fit, capacity, and planning (steps 4–6) are presented below under the first 4 thematic categories. Skills and gaps regarding evaluation (steps 7 and 8) are presented under the fifth thematic category.

Thematic Category 1: Engaging SA Training Audiences

Many participants mentioned that SA prevention training had not been formally updated in years, felt outdated, and was not relevant to audiences. Some participants discussed an overreliance on podium presentations, called “death by PowerPoint” (Battalion SARC, Interview #010), an approach that reportedly changed during the study as new guidelines were implemented. Several participants believed that effective and engaging training required skills in ensuring the training fit the audience (step 4). For example, one participant stated, “you can’t tailor training to a group of people that’s that large without making it generic. So, if you wanna make it pertinent and relevant to the smaller group of people, you have to modify or ad lib” (VA, #005). Giving the audience opportunities to share their experiences was viewed as more effective than using scripts but required skills in facilitating difficult conversations.

Participants discussed perceived resistance from higher-level SHARP staff to adapting training. One participant mentioned how SHARP leaders “steadfastly continued to use that old, outdated training, even though I begged them to update it to be relevant” (VA, #008). The same participant explained, “We were told to give the training as it was. I was honestly probably the one who was coloring a little outside of the lines by augmenting my own training.” This participant pushed the boundaries by adding more to the training, but other participants did not feel they had permission to do so.

Thematic Category 2: Managing Cultural Resistance to SA Training

Participants reported an overarching challenge of cultural resistance to SA training. As one participant explained, “sexual assault and sexual harassment is the least talked about. You know—everybody clams up. They’re a little bit scared” (VA, #002). These challenges, according to participants, were believed to be exacerbated by norms that discount the value of trainings focused on diversity and cultural sensitivity. Cultural challenges discussed by participants included generational differences related to age and military experience, as well as concerns about challenges to discussing the role of gender in SA. Participants also reported a lack of trust in unit leaders and the SHARP program. One participant expressed that “our number one enemy right now is trust,” particularly in terms of its impact on soldiers’ willingness to report an incident (SARC, #001).

Participants believed that ensuring audience fit (step 4) was essential for managing cultural resistance. Specifically, vignettes used in training should be relatable to the experiences of the audience. One participant explained that “most of our victims are between the age of 18 to 24, but some of our perpetrators are probably the age of 26 to 30, … some vignettes need to be for that culture of that demographic” (SARC, #007). Ensuring audience fit also required sensitivity to audience members who could have previously experienced victimization. The presence of a credentialed VA in these trainings, a requirement of the recent SHARP program protocol, was considered an important precaution to ensure emotional and psychological safety for participants.

Thematic Category 3: Leveraging Unit Leaders for Successful SA Training

As unit leaders became responsible for conducting trainings as part of the recent policy shift, participants believed that successful efforts to ensure fit, develop capacity, and plan more effectively (steps 4–6) would require these leaders to recognize the value of prevention efforts. Early participants recognized that success would require unit leaders to act as owners of the program to ensure its success:

If you don’t have leaders involved in every aspect of the program, we cannot do anything without leadership. We’re implementing the program. We’re the program managers. We’ve—but they have to be—it’s their program. It’s a leader’s program. … It is the commander’s program, and we have to always let them know, this is your program. Yes, we’re facilitatin’, we’re implementin’, but you—it’s your program. You gotta own it. I don’t own it. You own it. (SARC, #007)

According to participants, unit leaders who were invested in the program could increase prevention capacity by serving as additional resources. Invested leaders could also aid SHARP personnel to ensure fit and plan effectively by helping them understand their units’ readiness for training and help trainers meet their unit’s specific needs. However, participants reported barriers to leveraging unit leaders. Logistics were a significant concern, with training requiring complex scheduling and significant advance notice. Another concern was SHARP trainers’ comfort with engaging unit leaders when concerns arose. One participant noted that civilian members of the military workforce with little experience with the military system and/or no relational connection with unit leadership may find it difficult to approach unit leaders when there is a concern with content knowledge or training.

Despite these difficulties, some participants reported skills in leveraging unit leaders. Participants reported utilizing a train-the-trainer model to prepare unit leaders to conduct trainings as part of their planning process (step 6). Participants felt that this approach increased leaders’ comfort with the training role they were being asked to take on, which included a prepared presentation, introductions of SHARP personnel who may participate in or supplement a training, and facilitating their own discussions with soldiers. Training tailored specifically to multiple levels of leadership allowed unit leaders to “supplement what we put out in the trainings so that they can spot-check their soldiers on maybe how they feel or they know what to look for” (SARC, #010). This approach also allowed leaders to “work out any of those bugs” in the program (SARC, #001) and was thought to increase unit leaders’ ability to keep cultural sensitivity and victim safety in mind.

Thematic Category 4: Networking Skills

Networking skills were largely viewed as an unmet need (step 5). Networking could potentially help SHARP personnel improve and enhance SA prevention and response efforts and professionalize their prevention work. Networking opportunities were scarce, as no formal structure exists for facilitating these connections either internally or externally with the civilian community.

Internal networking

Participants believed that developing relationships with the SHARP main office, communicating with other units across the military installation, and building connections with military medical professionals could fill knowledge gaps. One participant, describing previous experience reaching out to a colleague for advice, found that these connections helped build on their initial program training: “I would call him and I would say, ‘Okay, well I’ve got another weird one for you…’ because it was not… what you get in your initial training” (VA, #011). These same connections were described as serving a different purpose for leaders who often felt disconnected from the units under their purview. Networking often allowed SHARP leaders the opportunity to check in on their SARCs, providing them with needed support, and track victim report numbers in specific locations, which they reported were often difficult to access.

Networking with civilians and community-based organizations

One participant noted that civilian networking is important because soldiers “don’t live in a uniform 24 hours a day, seven days a week” and often live off the military installation (SARC, #014). Additionally, civilian connections were described as important because the SHARP program has limited capability to intervene in the civilian community and to meet the needs of non-military spouses and family members who may witness or experience SA. Developing connections with civilians and community-based organizations was recognized as a means of addressing these capability gaps. Civilian connections were also viewed as potential partners who could increase capacity through knowledge-sharing or serving as potential training resources (VA, #011).

Thematic Category 5: Assessing Quality of SA Training and SHARP Program

Skill in creating and analyzing surveys, effectively soliciting feedback, and applying evaluation data to successfully adapt and develop new training programs were recognized by participants as important. However, analyses revealed gaps in regard to knowing what measures to use for evaluation, how to collect the necessary data, and which measures were useful for evaluation of program implementation as opposed to program effectiveness (steps 7 and 8). Existing data collection skills centered around measurements of the training audience (1) experience (i.e., enjoyment of the training), (2) knowledge (i.e., knowing where, what, and how to report or seek assistance for experienced or witnessed SA), (3) victim experiences (i.e., whether victims understood all of their rights and felt supported through the process), and (4) culture of trust (i.e., service members’ comfort and experience with talking to their chain of command about SA and/or having confidence that SA reports would remain confidential). Notably, these outcomes are focused more on evaluating the SHARP reporting mission than the prevention mission.

The policy change requiring unit leaders to oversee SHARP training yielded new areas participants believed were important for evaluation. First, participants believed evaluations should explore leaders’ general content knowledge regarding SA, as well as their program-specific knowledge. Second, participants recognized a need for evaluations that explore leaders’ ability and comfort with facilitating conversations with their units about sensitive subject matter. Notably, the credentialed VA and SARC whose presence is now required at these trainings were recognized as an existing, but underutilized avenue for program evaluation.

Existing evaluation techniques

According to participants, evaluation data were actively collected using paper forms or online surveys, after-action reviews, reaching out directly to specific soldiers, and engaging the audience in discussions without leadership present. Evaluation data were also actively collected through interviews with unit leadership (e.g., Commander and Sergeant Major). These informal conversations offered the opportunity to evaluate leader knowledge to adapt future training to address gaps, an important existing skill for program evaluation (step 7). Program evaluation also included reviews by higher-level SHARP program leaders using a program checklist, providing an “external look” at the program that helps to determine training effectiveness (SARC, #001). Evaluations were also conducted by the Office of the Inspector General, including interviews with service members at all levels.

Anonymous command climate surveys which provide data about experiences, perceptions of unit leaders, SA case numbers, and reporting rates, as well as informal conversations with soldiers, were regularly used by participants. This passive and informal approach to data collection was often used for outcome evaluation (step 8); however, confidence in interpreting these data was mixed. Some saw decreases in case numbers and reports as a positive sign of success, while others argued “… all they’re seeing is a drastic reduction in reporting of sexual assaults” (VA, #005). Increased unrestricted reporting was also viewed as an indicator of program trust.

Prevention Evaluation Framework

The identified knowledge and gaps are presented in Table 3, organized by thematic category, and matched to the related GTO step and PEF domain. All of the identified proficiencies were matched to GTO steps 4 (Fit), 4 (Capacity), and 7 and 8 (Evaluation), while many gaps were not directly relevant to a GTO step. However, all of the proficiencies and gaps were relevant to a PEF organizational domain. Within the prevention workforce domain, proficiencies were skill in tailoring training and having an existing train-the-trainer model. Gaps were the need for training to facilitate difficult conversations, and a perceived inability to tailor trainings to audience needs. Two proficiencies related to the comprehensive approach to prevention domain were having a VA present during trainings, and providing training across leadership levels. Within the data domain, proficiencies were having existing data sources that were viewed as useful for identifying the nature and extent of local problems. However, a gap was the lack of confidence and skill in selecting appropriate outcome measures, collecting, and using primary data. Gaps in the leadership capacity domain were cultural norms that challenge the effectiveness and importance of training, lack of trust in leaders and/or the SHARP program, leader investment in the program and training activities, logistical difficulty working with leaders, and comfort in engaging with leaders. Gaps in collaborative relationships were the lack of informal networking within the SA prevention area, including with off-base civilian SA prevention practitioners.

Table 3.

Proficiencies and Gaps Within the PEF Organizational Domains

Thematic category	Proficiency	Related GTO step	PEF organizational domain(s)
1	Skill in tailoring training	Step 4 (Fit)	Prevention workforce
2	Victim advocate present during trainings to ensure psychological and emotional safety	Step 4 (Fit) Step 5 (Capacity)	Comprehensive approach
3	Train-the-trainer model in place	Step 5 (Capacity)	Prevention workforce
3	Training across multiple leadership levels	Step 5 (Capacity)	Comprehensive approach
5	Use of data such as command climate surveys, case numbers, and reporting rates to identify the nature and extent of problems as well as informal interviews	Steps 7 and 8 (Evaluation)	Data
Thematic category	Gap		PEF organizational domain(s)
1	Training not updated or relevant to audiences	Step 4 (Fit)	Quality implementation
1	Need training to facilitate conversations		Prevention workforce
1	Inability to tailor training—policy-related		Prevention workforce
2	Cultural norms that challenge the effectiveness and importance of training		Leadership
2	Lack of trust in leaders/SHARP program		Leadership
3	Leaders who are invested in the program/training activities		Leadership
3	Logistical difficulty in working with leaders		Leadership
3	Comfort engaging leaders		Leadership
4	Need for internal networking		Collaborative relationships
4	Need for networking with civilians and community-based organizations		Collaborative relationships
5	Lack of confidence and skill in selecting appropriate outcome measures, collecting necessary data, and applying the data	Steps 7 and 8 (Evaluation)	Prevention workforce, data

Abbreviations: GTO, Getting To Outcomes; PEF, Prevention Evaluation Framework; SHARP, Sexual Harassment and Assault Response and Prevention.

DISCUSSION

This study explored GTO-specific knowledge and skills of SHARP personnel at one U.S. Army installation in order to understand the capacity to implement an SA prevention intervention. Results from this study revealed a range of proficiencies and gaps in organizational capacities for SA prevention. Proficiencies were oriented toward the prevention workforce, the comprehensive approach to prevention, and the data domains. Gaps were also identified in the prevention workforce and the data domains, as well as the collaborative relationship, leadership, and quality implementation domains. Notably, interviews revealed recent changes in policy that may aid in addressing some of the identified gaps. For example, the new requirement for command leaders to direct and conduct all SHARP trainings represents an improvement in the leadership domain and has improved the capacity gap in leader investment in the program and training activities. Similarly, the “death by powerpoint” criticisms raised by participants may be more effectively addressed with tailored training being implemented by a new, dedicated prevention workforce.

Our findings complement those found in a GTO pilot study across 10 military bases.¹⁷ Participants reported significant needs at the organizational level. Some organizational-level gaps, including a comprehensive approach to prevention, quality implementation, and continuous evaluation might be addressed, at least in large part, through training in GTO. However, other organizational level gaps, specifically prevention workforce, leadership, and collaborative relationships must be addressed separately in order to improve GTO efficacy.

LIMITATIONS

Although the findings of this study provide meaningful insights into understanding the knowledge and skills proficiencies and gaps for implementing SA prevention programming, there are several limitations. Data were collected at one U.S. Army installation that included units that likely have a higher proportion of women compared to combat arms units. Some findings may not transfer to units that are more male-dominated. For example, some participants reported trying to overcome gender-based cultural biases. It could be the case that such gender biases are seen as too strong to challenge in other units. Thus, there may be more training gaps Army-wide than revealed in this study. Notably, interviews with Naval personnel stationed on the installation revealed similar knowledge and skills, suggesting that many findings may transfer across services. Additionally, we were only able to interview approximately 30% of the eligible participants at the sampled installation. Difficulty in gathering a larger sample may be reflective of the broader networking problem discussed by our participants. As such, participants may vary from non-participants in important dimensions such as command support and available time. Results should not be interpreted as representative of the installation, rather results indicate potential areas where knowledge and skills currently exist and by inference where gaps may also exist. Finally, the PEF proficiencies and gaps represent a snapshot of the state of the U.S. Army SHARP program at one installation, in the very early stages of program improvements. For example, the U.S. Army is currently engaged in a large hiring effort to increase the number of prevention professionals. The implementation of the Integrated Prevention Program may already be improving capacities across the DoD. Future research could use this study as a baseline to determine whether the Integrated Prevention Program addresses observed capacity gaps.

CONCLUSION

By exploring the GTO-specific knowledge and skills of SHARP personnel at one U.S. Army installation, we identified existing implementation proficiencies and gaps influencing the prevention mission, highlighting specific needs at the organizational level. Considering the scale of SA in the military and its dire consequences, implementing effective prevention service-wide is paramount. Our findings identify how GTO training could be useful for filling gaps in knowledge and skills and add to existing calls to continue ongoing work to increase prevention infrastructure at the organizational level to improve implementation and ensure GTO activities can be performed to attain the best outcomes. In other words, GTO can help installations with prevention, but it could be even more effective when paired with sufficient organizational support.

FUNDING

This study is funded by the Department of Denfense, Congressionally Directed Medical Research Program (PT190165).

CONFLICT OF INTEREST STATEMENT

None declared.

DATA AVAILABILITY

The data underlying this article cannot be shared publicly because of the privacy assurances provided to study participants. The data will be shared on reasonable request to the corresponding author.