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Study Raises Concern of Significant Underreporting of Child Abuse Within U.S. Army

Only 20% 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—according to a recent PolicyLab study.

This rate is less than one-half of the rate (44%) of medically diagnosed child abuse cases substantiated by civilian Child Protective Services (CPS). Researchers say this contrast raises questions about the Army-reported rates of child abuse, and suggests underreporting of abuse cases by medical providers and/or a breakdown in communication between civilian CPS and established military services.

The study, published by Child Abuse & Neglect, also found that the number of medically diagnosed abuse cases with corresponding substantiated Army FAP reports was poorest for children cared for at civilian treatment facilities (9.2%), but still low for children receiving care from military health care providers (24.2%).

"For many years, the U.S. Army has reported rates of child abuse well below that of the civilian population," says 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, who was senior author of the study. "This study calls those reports into question. 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.

"When any health care provider suspects a child has been abused, they are required to report that case to a child welfare agency, or risk losing their license. The Department of Defense 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, FAP, in 1981. 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.

"Unfortunately, what is implied by the low number of substantiated abuse cases by U.S. Army FAP compared with known substantiation rates in the civilian population is that some children are falling through the cracks of a broken system. Military children move across states more frequently, making it particularly important that FAP know about any maltreatment since they can monitor at-risk military children wherever they are. Although the numbers of abuse cases linked to substantiated reports were higher from military treatment facilities, where health care providers are required to report to FAP, still only one in four diagnoses were linked to a substantiated report, suggesting that underreporting may be part of the problem at military treatment facilities.

"Among civilian health care providers, the problems are even more complicated. 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. They may well be reporting cases to civilian agencies—that are then assisting children in need—but for the most part, those cases are not communicated back to FAP, which is best positioned to intervene with military families.

"What this study tells us is that we have an incomplete picture of what is happening to a large population of children in this country who might need our help. We must support further research that will detect how systematic true underreporting and underrecognition is within the Army and other military branches and shed light on why underreporting may be occurring. We must also hold CPS accountable for identifying the military family when they are reported to them, and for communicating their involvement back to FAP so the agency can provide consistent military-specific services to children and families in need.

"Finally, by knowing the true magnitude of this stress to the U.S. Army family, we can better identify the resources FAP needs to meet its obligations in serving military families," Rubin says.

PolicyLab partnered with U.S. Army FAP on this research.

Source: Children's Hospital of Philadelphia