Project

Child Neglect and Maltreatment in Military Families

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Project log

Stephen Cozza
added a research item
Objectives The goal of this session is to characterize the types of child neglect and their associated risk factors within the US Army community to inform effective prevention, policy, and strategy. Methods A record review of 400 randomly sampled substantiated neglect cases from 4 Army installations with the highest number of substantiated cases from 2003 to 2009 were conducted, and the Modified Maltreatment Classification System was used to classify cases into 5 distinct neglect types (ie, failure to provide physical needs, lack of supervision, emotional neglect, moral-legal neglect, and educational neglect) and to determine severity. A systematic series of analyses were conducted (including latent class analysis and multivariate logistic regression modeling) to examine the distribution of neglect types and event severity across the sample groups, explore clustering of neglect types among cases, and identify potential risk factors (eg, military deployment status, substance misuse, and family risk factors) as predictors of neglect types. Results The cases (62%) involved young, junior enlisted (E1 to E4) families. Seventy-six percent involved a civilian spouse as the offender, either alone or with a service member; 21 percent of cases involved multiple types of neglect. Lack of supervision (42%) and emotional neglect (41%) were most common, with the latter being most severe and associated with exposure to parental intimate partner violence. Concurrent deployment at the time of incident increased the risk of failure to provide physical needs compared with other types (OR = 5.6; 3.1–10.1), as well as multiple versus single types of neglect (OR = 3.4; 1.9–6.1). Previous (nonconcurrent) deployment increased the risk for moral-legal neglect (OR = 3.1; 1.1–9.0). Both incident-related substance abuse and prior history of substance abuse increased the risk for moral-legal neglect (OR = 9.5; 2.9–31.8 and OR = 5.1; 1.1–23.9, respectively). Family mental health problems, childcare problems, and family disagreements increased the risk for failure to provide physical needs (OR = 3.1; 1.6–5.9), lack of supervision (OR = 3.6; 2.0–6.6), and emotional neglect (OR = 3.4; 2.0–5.6), respectively. Conclusions Child neglect within the US Army is multidimensional and varies in prevalence and severity. The understanding of unique risk contributions can further the development of prevention, treatment, and policy efforts.
Stephen Cozza
added a research item
Recent theory and empirical research suggest that child neglect is a heterogeneous phenomenon characterized by various types. This study examined family risk factors associated with five neglect types including failure to provide physical needs, lack of supervision, emotional neglect, moral-legal neglect, and educational neglect in 390 substantiated cases of neglect in four U.S. Army communities. Family factors associated with elevated risk of each neglect type relative to other types were identified using multivariate regression. Relatively distinct sets of family risk factors were differentially associated with the neglect types. Family mental health problems and larger family size were associated with risk of failure to provide physical needs, childcare problems and larger family size were associated with risk of supervisory neglect, and family disagreements were associated with risk of emotional neglect. None of the family factors were associated with elevated risk of moral-legal or educational neglect. Results can inform the development of indicated and relapse prevention strategies for families affected by different neglect types.
Claudio D Ortiz
added a research item
-Understanding features of community strength both on and off the military installation will help identify and address the needs of military families. This study introduced a measure to identify adequacy of community resources for military families. Using confirmatory factor analysis with data from 717 service users (M age = 37.3 yr., SD = 10.6) representing four large U.S. Army installations, two domains of community resource adequacy were identified: resources on the installation and resources off the installation. This measure could be used in health research with military families and in improving resources available to this population.
Stephen Cozza
added a research item
Increases in combat deployments have been associated with rises in rates of child neglect in U.S. military families. Although various types of child neglect have been described in military families, it is unknown whether deployment status is associated with specific types of child neglect and whether other factors, such as substance misuse, play a role. To determine the contribution of service member deployment status to the risk of specific child neglect types, data were collected from 390 substantiated U.S. Army child neglect case files. The contributions of deployment status at the time of the neglect incident and parental alcohol or drug-related misuse to risk of neglect types were examined controlling for military family rank and child age. Compared to never deployed families, families with a service member concurrently deployed at the time of the neglect incident were at higher risk for failure to provide physical needs, lack of supervision, and educational neglect, but at lower risk for emotional neglect. Being previously deployed incurred risk for moral–legal neglect. Substance misuse added risk for moral–legal and educational neglect. Findings indicate the need for tailored prevention strategies to target different periods within the deployment cycle.
Stephen Cozza
added an update
Cozza, Whaley, Fisher, Zhou, Ortiz, McCarroll, Fullerton & Ursano: Deployment Status and Child Neglect Types in the U.S. Army. Child Maltreatment 2017.
Increases in combat deployments have been associated with rises in rates of child neglect in U.S. military families. Although various types of child neglect have been described in military families, it is unknown whether deployment status is associated with specific types of child neglect and whether other factors, such as substance misuse, play a role. To determine the contribution of service member deployment status to the risk of specific child neglect types, data were collected from 390 substantiated U.S. Army child neglect case files. The contributions of deployment status at the time of the neglect incident and parental alcohol or drug-related misuse to risk of neglect types were examined controlling for military family rank and child age. Compared to never deployed families, families with a service member concurrently deployed at the time of the neglect incident were at higher risk for failure to provide physical needs, lack of supervision, and educational neglect, but at lower risk for emotional neglect. Being previously deployed incurred risk for moral–legal neglect. Substance misuse added risk for moral–legal and educational neglect. Findings indicate the need for tailored prevention strategies to target different periods within the deployment cycle.
 
Stephen Cozza
added 3 research items
Military families include 2.9 million people, with approximately 40% of all service members having at least one child. Rates of child neglect in this population have increased in recent years, but little is known about the characteristics of the neglect. To better identify targets for intervention, it is necessary that we refine our understanding of child neglect in the military. In this review, we examine definitions of child neglect and the specific definitions used by the U.S. Army. We identify domains of neglect and caregiver behaviors and affiliated. We suggest that this approach can inform prevention efforts within the Institute of Medicine's framework for preventive interventions. Understanding risk and protective factors in the military family are important to interventions for child neglect in military families.
Background: Preventing child maltreatment fatalities is a critical goal of the U.S. society and the military services. Fatality review boards further this goal through the analysis of circumstances of child deaths, making recommendations for improvements in practices and policies, and promoting increased cooperation among the many systems that serve families. The purpose of this article is to review types of child maltreatment death, proposed classification models, risk and protective factors, and prevention strategies. Methods: This review is based on scientific and medical literature, national reports and surveys, and reports of fatality review boards. Findings: Children can be killed soon after birth or when older through a variety of circumstances, such as with the suicide of the perpetrator, or when the perpetrator kills the entire family. Death through child neglect may be the most difficult type of maltreatment death to identify as neglect can be a matter of opinion or societal convention. These deaths can occur as a result of infant abandonment, starvation, medical neglect, drowning, home fires, being left alone in cars, and firearms. Models of classification for child maltreatment deaths can permit definition and understanding of child fatalities by providing reference points that facilitate research and enhance clinical prediction. Two separate approaches have been proposed: the motives of the perpetrator and the circumstances of death of the child victim. The latter approach is broader and is founded on an ecological model focused on the nature and circumstances of death, child victim characteristics, perpetrator characteristics, family and environmental circumstances, and service provision and need. Many risk factors for maternal and paternal filicide have been found, but most often included are young maternal age, no prenatal care, low education level, mental health problems, family violence, and substance abuse. Many protective factors can be specified at the individual, family, and community level. Early interventions for children and families are facilitated by the increased awareness of service providers who understand the risk and protective factors for intentional and unintentional child death. Discussion/impact/recommendations: There is currently no roadmap for the prevention of child maltreatment death, but increased awareness and improved fatality review are essential to improving policies and practices. Prevention strategies include improving fatality review recommendations, using psychological autopsies, serious case reviews, and conducting research. We recommend a public health approach to prevention, which includes a high level of collaboration between agencies, particularly between the military and civilian. The adoption of a public health model can promote better prevention strategies at individual, family, community, and societal levels to address and improve practices, policies, and public attitudes and beliefs about child maltreatment. The process of making recommendations on the basis of fatality review is important in terms of whether they will be taken seriously. Recommendations that are too numerous, impractical, expensive, lack relevance, and are out of step with social norms are unlikely to be implemented. They can be helpful if they are limited, focused, lead to definitive action, and include ways of measuring compliance.
The purpose of this study is to understand the recently documented increase in rates of child maltreatment and neglect in the US Army. The project employs a three prong research methodology (using clinical chart reviews, survey methodology of key informants, and demographic community analyses) to: 1) facilitate understanding of the phenomenology of Army child neglect, 2) identify child, parent, and family risk and protective factors that contribute to neglect, 3) identify military community contributions to neglect, including deployment, and 4) identify surrounding community factors that may also contribute risk or protection to child neglect behaviors. Key accomplishments for Year 1 of the study include: IRB/Human Subject approval submission; identification of 30 criteria appropriate Army sites and communities surrounding these sites for inclusion in the study; development of the key informant survey and clinical record review template; contact with clinical record review site managers to coordinate their IRB processes; development of database structure, and the hiring of specified personnel. Under current development, is the strategy for creating a contact list of key informants at each installation (e.g., addresses, phone numbers, email addresses, etc.) for upcoming survey administration.
Stephen Cozza
added a research item
This study examined the relationship of on- and off-post resources to perceived residential neighborhood quality in 432 soldiers and their spouses from the four largest U.S. Army installations. Participants completed a questionnaire that measured one important element of perceived neighborhood quality (social cohesion/interrelatedness) and the extent to which community resources met the needs of military families. Higher levels of perceived on- and off-post resources were independently related to greater perceived neighborhood quality. After adjusting for demographics and off-post resources, on-post resources continued to be associated with perceived neighborhood quality (B = .17, p ≤.01). Access to diverse, high-quality, and readily available community resources, particularly on-post, may enhance perceived neighborhood quality and strengthen military communities.
Stephen Cozza
added 2 research items
Background: Neglect has been linked to short-term and long-term deleterious outcomes in children, but has received little attention in the research literature. Objective: Identify types, subtypes, and severity of child neglect in a sample of substantiated cases at 4 U.S. Army installations. Describe demographic correlates of victims and offenders by type and subtype. Participants: Data were collected from archived clinical records. A stratified random sample of 100 substantiated child neglect case files were selected per site (N = 400). Data from a single child per case file were used. Results: 5 types and 17 subtypes of neglect were represented, singly or in combination, with varying severity. Lack of Supervision was most common (n = 177, 35.3%), followed by Emotional Neglect (n = 159, 31.8%), Failure to Provide Physical Needs (n = 131, 26.2%), Moral-Legal Neglect (n = 20, 4%), and Educational Neglect (n = 13; 2.6%). Child neglect occurred mostly among young children and in young enlisted families. Conclusions: Current results highlight the need to focus on types, subtypes, and severity of neglect incidents that provide specific understanding of child risk to better inform policy. Further study should examine specific risk factors and their relationship to neglect types and severity outcomes.
Since 2001, the United States has seen the largest sustained deployment of military service members in the history of the all-volunteer force. More than 2 million military children have been separated from service member parents because of combat deployments. Most families have experienced at least 1 deployment, and many have undergone multiple, involving 3, 4, or even 5 or more family separations and reunifications. Others have struggled with combat-related psychiatric disorders, such as posttraumatic stress disorder (PTSD) and physical injuries, including traumatic brain injury (TBI), which can affect children and families for years. Primary care and mental health clinicians in the United States know little about military children or the costs imposed on their health and functioning owing to their parents’ military service.