Deborah Gibbs

Family violence in the military: a review of the literature

Family violence, including both child maltreatment and spouse abuse, is a public health concern in both military and civilian populations. However, there is limited knowledge concerning violence in military families relative to civilian families. This literature review critically reviews studies that examine child maltreatment and spouse abuse among military families and compares family violence in military versus nonmilitary populations. Physical abuse and neglect compose the majority of the reported and substantiated cases of child maltreatment in military families, followed by sexual abuse and emotional abuse. On the other hand, physical abuse represents more than 90% of all substantiated cases of spouse abuse in military families, followed by emotional abuse, neglect, and sexual abuse. Mixed results were found when comparing military and nonmilitary families in terms of child maltreatment and spouse abuse, in part because of a lack of consistency in policies and practices between military and civilian agencies.

Dynamics of Stigma for Alcohol and Mental Health Treatment Among Army Soldiers

Stigma associated with substance abuse is less understood than stigma of mental health. Moreover, neither issue has been studied in depth within the military. We conducted focus groups with soldiers at six installations to explore how perceptions regarding substance abuse and mental health issues influenced attitudes toward treatment of these issues. Analyses indicate that negative attitudes toward treatment for alcohol abuse are based on their association with infractions that precipitate treatment and acceptance for soldiers with deployment-related mental health issues. However, the military context appears to moderate the influence of perceived responsibility and danger on stigmatization. Our data suggest several strategies that may useful in reducing stigma associated with alcohol abuse treatment in the military.

Increasing evaluation capacity within community-based HIV prevention programs

Abstract Funding agencies use technical assistance to strengthen the evaluation capacity of community-based organizations (CBOs). We used qualitative methods to describe beliefs and attitudes related to evaluation and to identify factors influencing evaluation capacity, based on interviews with 61 CBOs, nine health departments, and 28 technical assistance providers. Four factors influencing evaluation behavior among CBOs were identified: funding agency expectations, resources, leadership and staff, and evaluation tools and technology. Using these factors, we developed a model that describes three stages of evaluation capacity: compliance, investment, and advancement. We propose strategies by which funding agencies and technical assistance providers can help strengthen evaluation capacity within CBOs.

Stigma as a Barrier to Substance Abuse and Mental Health Treatment

This article provides an overview of stigma associated with mental health and substance abuse treatment in military settings and discusses articles included in this issue. These articles examine the predictors of and barriers to treatment entry; assess the influence of military culture and unit influences on attitudes toward treatment; examine unique challenges associated with reserve personnel; and address policy changes to improve access to care. We review challenges associated with reducing stigma and the importance of policy, culture, education, and leadership to effect the desired changes.

Mental Health and Substance Abuse Treatment Stigma Among Soldiers

Few studies have compared persons in treatment to those not in treatment with regard to perceived stigma. We surveyed soldiers to examine differences in stigma perceptions among those in treatment for substance abuse and/or mental health problems (n = 470) and those not in treatment (n = 966). Analyses revealed that soldiers in treatment perceived greater stigma regarding mental health treatment compared with soldiers not in treatment. These findings support the notion that personnel most in need of treatment perceive greater stigma associated with these services and as a result may be less likely to pursue them. We discuss the implications of our findings for theory, research, and practice.

Spouse abuse and child abuse by army soldiers

This study analyzed data collected by the U.S. Army’s Family Advocacy Program, the group primarily responsible for family violence prevention, identification, evaluation, treatment, and follow-up on Army installations. Patterns of spouse abuse and child abuse perpetrated within a five year period (2000–2004) were examined in a sample of 10,864 Army Soldiers who were substantiated for family violence offenses. Three groups of family violence offenders were compared: (1) those who perpetrated spouse offenses only; (2) those who perpetrated child offenses only; and (3) those who perpetrated both spouse and child offenses. Results showed that the majority of substantiated family violence offenders were spouse offenders who had not committed child abuse (61%), followed by child offenders who had not committed spouse abuse (27%), and finally those who committed both spouse and child offenses (12%). The three groups of family violence offenders differed in terms of the types of abuse they perpetrated (neglect of children, emotional abuse, physical abuse, and sexual abuse), their experiences of being a spouse abuse victim, and sociodemographic characteristics. Twelve percent of all spouse abusers committed multiple spouse abuse incidents, and 10% of all child abusers committed multiple child abuse incidents.

Empowering programs with evaluation technical assistance: outcomes and lessons learned.

Although empowerment evaluation has gained widespread currency, few reports have described its outcomes. This article combines perspectives of participants and technical assistance providers to describe the process and outcomes of the Evaluation Assistance for Sexual Violence Programs project. Participating programs reported substantial enhancements in evaluation capacity, resources devoted to evaluation, and the extent and sophistication of their evaluation practice, as well as numerous examples of the application of evaluation findings to program improvement. Experiences from evaluation technical assistance providers identified aspects of the process that were particularly useful in achieving these outcomes, including investing in collaborative relationships, maximizing participation among program staff, tailoring the content and form of technical assistance to program preferences, and combining structured learning with program-specific technical assistance.

A national, geographic database of CDC-funded HIV prevention services: development challenges and potential applications.

BackgroundFrom 2000–2002, the Centers for Disease Control and Prevention (CDC) funded a study that was designed to improve the information available to program planners about the geographic distribution of CDC-funded HIV prevention services provided by community-based organizations (CBOs). Program managers at CDC recognized the potential of a geographic information system (GIS) to organize and analyze information about HIV prevention services and they made GIS a critical component of the study design. The primary objective of this study was to construct a national, geographically-referenced database of HIV prevention services provided by CDC-funded CBOs. We designed a survey instrument to collect information about the geographic service areas where CBOs provided HIV prevention services, then collected data from CBOs that received CDC funding for these services during fiscal year 2000. We developed a GIS database to link questionnaire responses with GIS map layers in a manner that would incorporate overlapping geographies, risk populations and prevention services. We collected geographic service area data in two formats: 1) geopolitical boundaries and 2) geographic distance.ResultsThe survey response rate was 70.3%, i.e. 1,020 of 1,450 community-based organizations responded. The number of HIV prevention programs administered by each CBO ranged from 1 to 23. The survey provided information about 3,028 prevention programs, including descriptions of intervention types, risk populations, race and ethnicity, CBO location and geographic service area. We incorporated this information into a large GIS database, the HIV Prevention Services Database. The use of geopolitical boundaries provided more accurate results than geographic distance. The use of a reference map with the questionnaire improved completeness, accuracy and precision of service area data.ConclusionThe survey instrument design and database development procedures that we used for this study successfully met our objective. The development of the HIV Prevention Services Database for CDC is an important step toward the implementation of a spatial decision support system. Due to the costs involved in a nationwide survey such as this, we recommend that future data collection efforts use Web-based survey methodologies that incorporate interactive maps.

Child Maltreatment and Substance Abuse Among U.S. Army Soldiers

Although substance abuse has consistently been linked to child maltreatment, no study to date has described the extent of substance abuse among child maltreatment offenders within the military. Analysis of U.S. Army data on all substantiated incidents of parental child maltreatment committed between 2000 and 2004 by active duty soldiers found that 13% of offenders were noted to have been abusing alcohol or illicit drugs at the time of their child maltreatment incident. The odds of substance abuse were increased for offenders who committed child neglect or emotional abuse, but were reduced for child physical abuse. The odds of offender substance abuse nearly tripled in child maltreatment incidents that also involved co-occurring spouse abuse. Findings include a lack of association between offender substance abuse and child maltreatment recurrence, possibly because of the increased likelihood of removal of offenders from the home when either substance abuse or spouse abuse were documented.

Substance Use by Soldiers Who Abuse Their Spouses

Data on 7,424 soldier spouse abuse offenders were analyzed to determine the prev alence of substance use during abusiv e incidents, and to examine differences between substance-using and non-substance-using offenders. Results showed that 25% of all offenders used substances during abusiv e incidents, with males and non-Hispanic Whites being more likely to hav e used substances. Substance-using offenders were more likely to perpetrate physical spouse abuse and more sev ere spouse abuse. These findings underscore the importance of educating military personnel (including commanders) about links between substance use and domestic v iolence, and of coordinating prev entiv e and therapeutic substance abuse and v iolence-related interv entions.