Knee Deep in the Hooah!

Most of you are probably aware that last week there were a couple of write ups in some notable and reputable journals about a study conducted on Army families. This study was used to basically establish a correlation between the stress associated with combat related deployment and the increased incident of child abuse by the parent left at home. I have not read the study so I am not able to address that directly, but I have to admit that the write-ups did leave me concerned for a few reasons. When we realize the implications for practice that this research has, my concerns will either go away or reach a heightened state. Only time will tell.

The write-ups that I have read do seem to be asserting that these findings apply to all Army families. I do not know enough about the study to say for sure, but the write-ups lead one to believe that the only family cases that were used for this study were families with at least one substantiated child abuse or neglect charge brought against them in the past — before the study and possibly before any deployment had occurred.

We are not talking about a good cross section population of the Army if that is true. We are talking about a small subset of the larger population — a subset that, statistically speaking, are at a higher risk for future incidents. Maybe the title of the various write-ups should have implicated that the focus of the study was on the recurrence rate of child abuse and neglect instead of implying that deployment causes new cases to materialize. Families who have already been identified as a household at risk since there was already a substantiated case are the true subjects of this study. Really this does not tell us much about whether or not child abuse rates increase in the general population, but rather it may imply that children in at risk homes may be at higher risk during deployment. Ok, I could have told you that for free.

I understand why this kind of research is done. I really do. You do not spend years in mental health as a social worker and not understand why the very obvious has to be researched and written up. I know that programs have to be justified. I do not begrudge that in the least. I am a huge proponent of evidence based practices. This is why I have some problems with the write-ups of this research.

There seems to be a common thread in the headlines and the harping points in many of the articles. One title even exclaims “Combat-Related Deployments Responsible for Increased Child Abuse, Neglect Among Army Families” I have to disagree with that assessment. Really. Deployments does not cause child abuse. Deployments are responsible for increasing stress in the family. Deployments cause families to endure a tremendous amount of stress and strain, yes, but “responsible” for child abuse? Give me a break. Is it any wonder that there was a Buzz among us Army wives?

With this kind of write up there is a tacit accusation that somehow all military families who have a father in a combat related deployment are at risk for abusing their child(ren). That is very faulty logic and an unfair conclusion to draw from research that was performed on families who already had a substantiated case of abuse or neglect. How are those results generalized to the entire Army family population who are facing combat related deployments? This can not be generalized because we are talking about families that have a variable that sets them apart from the other families, and that is substantiated proof that they are already guilty of child abuse or neglect.

As I said earlier deployment is certainly responsible for a tremendous amount of stress in the family, but as a social worker I have always understood through study and witnessing first hand that many factors are responsible for child abuse. Situational stress does most certainly increase the risk of incident, but it is not responsible for the actions of the abuser, necessarily. Usually characteristics such as a history of abuse, poor coping skills, poor support network, substance abuse, mental health diagnosis, unrealistic expectations on children and a lack of understanding childhood development, and a general sense of a lack of control are all indicators for risk that are linked directly to the character of the abuser.

If you take a woman who has a few or all of these (and others that I have not identified) characteristics and you put her under the stress of deployment then she may very well act out of frustration, anger and fear and lash out at her children. There are usually patterns in families where child abuse and neglect occur, so this is not something that just crops up in light of a deployment. An Army wife does not just wake up one morning and think “Gee, Bill is gone to Iraq so now is a good time to beat my kids!” Child abuse is not a sudden incident. It is a familial pattern that is perpetuated by the characteristics listed above. Coupled with stress and a child who is having his own struggles with separation from the missing parent, it certainly does have the propensity to increase abuse and/or neglect in both incident and severity.

Would it not make more sense in the light of this research to start focusing on promoting resiliency, self-assertion/self advocacy, pro-social skills, mentoring, and many other characteristics that we see in the healthy Army families? How many Army families are in the Army community who face the same stress — sometimes more, sometimes less — than the families who do abuse and neglect their children, and they take excellent care of their children, their homes and themselves? We will never know because for some reason we never seem to think that researching the very characteristics of the healthy gives us any information on how to promote health in the unhealthy.

I am not against doing research to show the prevalence of abuse. What I have always had a problem with is when that information is taken and used for practice and the focus becomes a pure medical model — and herein lies the biggest problem with prevention based social programs (in my opinion, and many others too). There has been a tremendous amount of research done in the past 2 decades concerning the differences between promotional models and prevention models in social programs. Prevention models simply do not offer the same level of desired outcomes that are sustainable. When I was in mental health I worked under a System of Care grant. SOC was a state regulated, Federally funded pot of money that was being used to research the validity of the Strengths Based Approach and another approach called “Wraparound Services.” Both of these approaches were very beneficial for the clients involved because we focused on things that were sustainable. We knew that professional intervention should foster growth, and a change that leaves the client feeling empowered and more aware of how to obtain the support she needs.

In many medical model programs families are “treated,” but they are not necessarily an active participant in the changes that need to take place. It’s the difference between “doing” and being “done for.” You can imagine how resistant a dis-empowered person is going to be to a social worker coming into her home and “treating” her. Usually there is compliance, but that is not enough. What happens when she PCSs again, or her husband does not reenlist? Social workers can not follow families around forever. Abuse may be prevented for a period of time, but were the skills she needed ever promoted, strengthened or learned? Was she given opportunities to learn, be mentored, and develop the skills she needs to deal with the stresses in her life better than she has in the past? Usually, not in prevention and treatment based programs.

There is also a misguided thought that somehow the absence of dysfunction equates the presence of good functioning. This too was a prominent thought in the medical community until about 20+ years ago. When the WHO blew the lid off of that thinking by asserting that health and disease do not lie on the same continuum, social workers started to chomp at the bit too. Of course! It makes perfect sense. Unfortunately we still use a medical model/deficit based and prevention/treatment approach most of the time when child abuse is involved. I think it was Einstein who once said that “Insanity is doing the same thing over and over again and expecting different results.”

We now have a much better understanding and the evidence to back up the assertion that “preventing” abuse is not the same as building resiliency — just like being cancer free does not mean that you are healthy — or being healthy does not necessarily mean you can’t have a disease. They are two separate things altogether, and we simply have to stop thinking that preventing abuse from happening when a social worker is able to basically babysit a family, is a good or desired outcome.

I really think that the military has some incredibly strong, smart and able women within its community. There are so many resources and life experiences to benefit from on any given base. Many of these families feel a very close connection to the other families around them. We are an extended family. I just hope that the outcome of this research will show us how the Army is a leading institution in not just combat, but many things! Maybe we can encourage family support that is organic, promotional based, and ground breaking! The best way to promote “Army strong!” is to promote strong Army families! Hooah!