Child abuse and neglect within U.S. Army families continue to be significantly underreported, according to researchers at the Children's Hospital of Philadelphia.
New data confirms a previously published study that found only a fifth of diagnosed child maltreatment cases in active-duty Army families resulted in a substantiated report to the service's Family Advocacy Program, or FAP.
The civilian rate is 44 percent for cases of child abuse or neglect cases substantiated by local Child Protective Services departments.
Doug Strane, a research project manager at PolicyLab at Children's Hospital of Philadelphia, told the Defense Health Board on July 11 that his team confirmed the findings of the original report, which studied medically diagnosed cases of maltreatment among active-duty soldiers' dependent children and substantiated Family Advocacy Program reports.
That research, based on data from 2004 to 2007, was published in December 2016 in the journal Child Abuse & Neglect.
A new comparison, using data from 2015 to 2016, "has confirmed these findings," linking just 20% of maltreatment diagnoses to a substantiated report to the FAP, although Strane did not release the exact statistics.
"These findings raise serious concerns for underreporting of child maltreatment to the Army Family Advocacy Program," he said, adding that underreporting puts children at risk and can "falsely reassure military leadership of maltreatment risk among Army service members' families."
The Defense Health Board is reviewing the Defense Department and military services' policies and practices on preventing, detecting and addressing maltreatment of military dependents.
The board is examining existing support and reporting programs and policies; methods for tracking children at risk; best practices for screening, diagnosis and treatment of children; and training for Defense Health System personnel to provide care and services.
"In light of recent research and given the increased incidence of child maltreatment within the military, there may be opportunities to improve the policies and practices currently in place for health providers caring for military personnel and their families," Defense Health Board officials noted in their issue statement.
According to the DoD, there were 12,849 reports of suspected child abuse and neglect sent to FAP in fiscal 2017 and 6,450 confirmed incidents of child abuse and neglect across the armed services that year.
The DoD rates for child abuse and neglect in fiscal 2017 were "much lower than their counterpart rates in the U.S. civilian population as compiled by the U.S. Department of Health and Human Services," a child victim rate for of 5 per 1,000 military children compared with a fiscal 2016 rate of 9.1 per 1,000 children, according to the Report on Child Abuse and Neglect and Domestic Abuse for Fiscal Year 2017.
The DoD determined that there has not been any statistically significant increases in child abuse or neglect across the services compared with prior years.
But in its mission statement, the Defense Health Board noted that, from fiscal 2009 to fiscal 2014, there has been a slight upward trend in the rates of child abuse and neglect.
Nearly 60 percent of the reported incidents are related to child neglect, not abuse, board members added.
The PolicyLab study and recent data raise questions over the DoD's claims. Noting that the researchers studied only data for the active-duty Army, Strane said the research shows more must be done to teach civilian medical providers about the FAP and its role in tracking and supporting families and children who are victims of maltreatment.
According to the study, the number of diagnosed abuse cases with a substantiated FAP report was lowest among those children treated by civilian health providers, at 9 percent. It was 24 percent for children who get medical treatment at a military treatment facility.
"The Family Advocacy Program is a critical service that provides continuity of services to families but can only do so when they have knowledge of instances of maltreatment," Strane said.
Some of the recommendations suggested by children's advocates who attended the Defense Health Board meeting in Falls Church, Virginia, included signed agreements to report between children's advocacy centers, law enforcement and military bases and mandatory reporting by civilians to their local FAP.
The DoD also is crafting a new instruction for military health providers to report suspected cases.
The Defense Health Board hopes to produce a preliminary report on its findings by August.