By Annette M. Boyle
PHILADELPHIA—Abuse and neglect of children of Army personnel appears to be under-reported, according to a new report which also suggests a breakdown of communication between civilian child protective services and the military.
The report, published in the journal Child Abuse & Neglect, noted that only 20 percent of medically-diagnosed child abuse and neglect cases in U.S. Army dependent children between 2004 and 2007 were found to have a substantiated report with the Army’s Family Advocacy Program (FAP)—the agency responsible for the investigation and treatment of child abuse.
PolicyLab, an advocacy and research group associated with Children’s Hospital of Philadelphia Research Institute, which conducted the study with the Army’s FAP, noted that the reported rate was less than half the rate, 44%, of medically-diagnosed child abuse cases confirmed by community Child Protective Services (CPS) agencies.
That disparity, according to researchers, raised questions about the Army-reported rates of child abuse. They question whether the problem is under-reporting of abuse cases by medical providers and/or a breakdown in communication between civilian CPS and established military services.
The number of medically-diagnosed abuse cases with corresponding substantiated Army FAP reports was lowest for children cared for at civilian treatment facilities, 9.2% but also low for children receiving care from military healthcare providers, 24.2%.
“For many years, the U.S. Army has reported rates of child abuse well below that of the civilian population. This study calls those reports into question,” explained Dave Rubin, MD, MSCE, director of PolicyLab at Children’s Hospital of Philadelphia (CHOP), pediatrician at CHOP and a presidential appointee to the federal Commission to Eliminate Child Abuse & Neglect Fatalities. “Yet, the U.S. Army can only report cases they know about, and our findings suggest that they may not be aware of the majority of their cases.”
Looking at 2004 to 2007, researchers employed medical claims data to identify 0- to 17-year-old child dependents of soldiers who received a medical diagnosis of child maltreatment, calculating linkage rates of maltreatment medical diagnoses with corresponding substantiated FAP reports.
Results indicated that, across 5,945 medically-diagnosed maltreatment episodes, 20.3% had a substantiated FAP report. Adjusting for covariates, the study said that the predicted probability of linkage to a substantiated FAP report was higher for physical abuse than for sexual abuse, 25.8% vs. 14.5%.
It further pointed out that, when early care was provided at civilian treatment facilities, the cases were less likely to have a FAP report than those treated at military facilities, 9.8% vs. 23.6%.
Rubin suggested that DoD “created an extra layer of support for children in military families—recognizing their unique needs related to the stress of deployment and frequent moves around the country—by establishing its own child and family services program in 1981, the Family Advocacy Program (FAP). With offices across each military branch, FAP is tasked with investigating child abuse cases and providing treatment and supportive services for affected military families. However, FAP can only provide these supports if both military and civilian health care providers either report cases directly to them or if Child Protective Services reports all cases they receive involving a military child back to FAP.”
While the intentions might have been good, the study uncovered unintended consequences.
“Unfortunately, what is implied by the low number of substantiated abuse cases by U.S. Army FAP compared to known substantiation rates in the civilian population is that some children are falling through the cracks of a broken system,” Rubin emphasized.
The greatest concern is that communication lapses are putting some Army dependents in danger, study authors said.
“The percentage of medically-diagnosed abuse cases with corresponding substantiated FAP reports was significantly higher for children cared for at military treatment facilities than for children cared for at civilian medical facilities, but it was still low at 24.2%,” lead author Joanne N. Wood, MD, MSHP, assistant professor of pediatrics at the Perelman School of Medicine at the University of Pennsylvania, told U.S. Medicine. “This finding raises concern that even serious cases of child abuse and neglect diagnosed at military medical facilities may not be consistently reported to FAP, the military agency charged with protecting military children. This means that vulnerable children aren’t receiving the military-specific services FAP provides. What we don’t know is whether these children were reported to civilian child protective service agencies or whether these children remained unknown to either system.”
The situation is potentially more complicated for civilian healthcare providers, Rubin added, noting, “Since they are located off-base, these providers may not be aware of the need to report to FAP, and there is no mechanism to mandate they do so.”
Wood said the lower rates of reporting for children treated at civilian medical facilities, 9.2%, was not unexpected, “as civilian medical providers may be unfamiliar with the U.S. Army FAP system and, thus, may be making reports to civilian child protective service agencies but not making an additional report to FAP. In some locations, agreements between civilian CPS agencies and FAP allow for sharing of information about reported cases, but we don’t know how frequently this is occurring.”
Both Wood and Rubin said that ensuring that at-risk Army children and families are supported and protected will require collaboration and communication between medical providers, the Army FAP program and civilian child protective service agencies.
“Future research will need to focus on identifying and understand the facilitators and barriers to successful reporting of child abuse and neglect to FAP by medical providers and effective communication between civilian child protective service agencies and FAP,” Wood suggested. “This information will be critical for informing the development of programs and policies that improve reporting to FAP and better support children and families.”
- Wood JN, Griffis HM, Taylor CM, Strane D, et. al Under-ascertainment from healthcare settings of child abuse events among children of soldiers by the U.S. Army Family Advocacy Program. Child Abuse Negl. 2017 Jan;63:202-210. doi: 10.1016/j.chiabu.2016.11.007. PubMed PMID: 27955871.