Do Fairly-Decided Maltreatment Determinations Significantly Reduce Recidivism? A Quasi-Experimental Evaluation of a System-Level Intervention Implementation

Two studies examined the impact of the implementation of the Field-tested Assessment, Intervention-planning, and Response (FAIR) system, a system-level intervention for determining whether allegations of family maltreatment meet threshold for abuse or neglect, on alleged recidivism. Data were collected at the 10 U.S. Army installations with the largest family maltreatment caseloads. Participants were family members who had an allegation of family maltreatment (i.e., child maltreatment or partner abuse) during one of the two study periods. Data were collected when Family Advocacy Program staff used the then-in-place system (Case Review Committee) and later the FAIR system. In Study 1, cases were followed for 6 months following the initial maltreatment allegation to measure the occurrence of subsequent allegations of any type. Additionally, at five installations, alleged victims of partner abuse were recruited into a study (Study 2) in which they anonymously reported on intimate partner violence via telephone. In Study 1, the advantage for the FAIR condition was concentrated in cases with unsubstantiated initial determinations; the mean relative risk reduction for recidivism was 0.48. In Study 2, FAIR extended median time to recidivism by approximately 170%. These results replicate and extend earlier findings that employing the FAIR system can result in decreased family maltreatment re-offense.

Psychological maltreatment: An operationalized definition and path toward application

Psychological maltreatment (PM) of children has been difficult to define and even more challenging to operationalize consistently. This fact contributes to child PM being under-recognized and under-addressed by professionals that interact with children with mental health, behavioral, and developmental issues; and by systems such as child welfare, clinical and judicial systems. In this paper, we propose a definition of child PM that is both overarching and operationalized in a manner that will support consistent, fair, and unbiased application in applied contexts. The operationalized definition delineates the nature of caregiver acts that can amount to PM, as well as the level of experienced and potential impact of said act (s) that constitute PM. We detail our rationale for the definition. We discuss the need for field trials to establish the utility of the definition. We explain the necessary training and systems that would be required for the definition to be consistently and accurately applied. We believe that this definition has the potential to substantially enhance systems' abilities to recognize and address child PM, and thereby enhance children's and families' wellbeing.

Creating and Testing the Reliability of a Family Maltreatment Severity Classification System

Child maltreatment and intimate partner abuse determinations often include judgments (e.g., severity) that go beyond whether or not the allegations are founded. Severity ratings inform multiple stakeholders (e.g., researchers, policymakers, clinicians, supervisors) and response pathways (e.g., "differential response" to child maltreatment). However, because severity guidelines typically only provide global direction for raters, these gradations are often of questionable reliability (and thus validity). Extending earlier work developing and implementing reliable and valid family maltreatment substantiation criteria (e.g., Heyman & Slep, 2006, 2009), a classification system for maltreatment severity was created, refined, and field-tested with a sample of clinicians from the largest maltreatment protection agency in the United States The goal was to develop operationalized criteria delineating mild, moderate, and severe maltreatment that could be consistently applied across types of maltreatment, raters, and clinics. To facilitate proper use, a computerized clinical decision support tool for the criteria was created. First, the severity classification system was piloted and refined at four sites throughout the United States. Then, clinicians at these sites (N = 28) and a master reviewer independently rated de-identified cases as part of the clinicians' routine assessments. Agreement between clinicians and the master reviewer was excellent for all types of maltreatment. Implications for practical dissemination are discussed.

Evaluation of Two Approaches for Responding to Allegations of Family Maltreatment in the U.S. Army: Coordinated Community Response Impacts and Costs

INTRODUCTION

The U.S. Air Force (USAF) conducted a program of research to develop and disseminate reliable and valid criteria for partner and child maltreatment (comprising abuse [physical, emotional/psychological, and sexual] and neglect). These criteria are now used in all branches of the U.S. military. The U.S. Army was the first service outside the USAF to adopt the criteria sets and computerized decision support tool but maintained the original committee composition (the "Case Review Committee" [CRC]) instead of adopting the entire assessment, allegation determination, and treatment planning process (the "Field-tested Assessment, Intervention-planning, and Response" [FAIR] system). The Army commissioned this study to compare the CRC and FAIR processes by testing (1) intra-committee process (i.e., three facets of committee functioning-fidelity to regulations, cohesion and team process, outsized influence of unit representatives); (2) coordinated community response to maltreatment (i.e., perceptions of fairness to alleged offenders and victims, impact on unit representatives, and (3) collaboration between the Family Advocacy Program (FAP, the military's maltreatment response agency) and outside agencies; and (4) the time expended and cost.

MATERIALS AND METHODS

New York University's Institutional Review Board approved the study protocol, and the Army's Human Research Protection Office provided permission to collect data. The ten Army garrisons with the most annual maltreatment cases participated. Committee members, FAP social workers, unit commanders, and independent observers completed assessments of individual meetings and of their overall impression of the processes. A test of whether the means significantly differed between phases was then performed separately for each outcome, and 95% CIs of the unstandardized mean difference between phases were estimated.

RESULTS

Independent observers rated FAIR meetings as significantly more faithful to regulations. Unit representatives (i.e., commanders and/or first sergeants) perceived the committee to function better during FAIR (although other committee members and independent observers did not perceive differences). Unit representatives not only rated FAIR as significantly more fair to both alleged offenders and victims (ratings from other committee members did not differ), but also were more likely to attend FAIR meetings and, when they did, rated their ability to serve soldiers and families higher during FAIR. However, FAP social workers rated their relationships with units as being better during CRC, and outside agencies rated their relationship with FAP as significantly better during CRC. Costs to the Army were nearly identical in the two committee structures.

CONCLUSION

Results indicated that the CRC and FAIR processes cost almost identical amounts to run and that the FAIR system was superior in ways most likely to impact service members: (1) independent observers judged its meetings to be more faithful to Army and DoD Instructions; (2) unit representatives were more likely to attend and believed the FAIR system to be fairer (to both alleged offenders and victims) and better functioning. Care should be taken, however, in nurturing relationships between FAP and (1) unit representatives and (2) outside agencies, which may have weakened during FAIR.

Enhanced definitions of intimate partner violence for DSM-5 and ICD-11 may promote improved screening and treatment

Nuanced, multifaceted, and content valid diagnostic criteria for intimate partner violence (IPV) have been created and can be used reliably in the field even by those with little-to-no clinical training/background. The use of such criteria such as these would likely lead to more reliable decision making in the field and more consistency across studies. Further, interrater agreement was higher than that usually reported for individual mental disorders. This paper will provide an overview of (a) IPV's scope and impact; (b) the reliable and valid diagnostic criteria that have been used and the adaptation of these criteria inserted in the latest Diagnostic and Statistical Manual of Mental Disorders (DSM) and another adaptation proposed for the forthcoming International Statistical Classification of Diseases and Related Health Problems (ICD); (c) suggestions for screening of IPV in primary care settings; (d) interventions for IPV; and (e) suggested steps toward globally accepted programs.

Child maltreatment in DSM-5 and ICD-11

Child maltreatment is widespread and has a tremendous impact on child victims and their families. Over the past decade, definitions of child maltreatment have been developed that are operationalized, face valid, and can be reliably applied in clinical settings. These definitions have informed the revised Diagnostic and Statistical Manual (American Psychiatric Association, 2013) and are being considered for the International Classification of Disease-11 (World Health Organization). Now that these definitions are available in major diagnostic systems, primary healthcare providers and clinicians who see children and families are poised to help screen for, identify, prevent, and treat child maltreatment. This article reviews the definitions of maltreatment in these diagnostic systems, along with assessment and screening tools, and empirically supported prevention and intervention approaches.