Family
Advocacy
Research
Digests

RESEARCH REVIEWCURRENT RESEARCH FOR FAMILY ADVOCACY PROGRAMS • Volume 1, Issue 2 • Summer 2016
In This Issue
We present the second edition of Research Review (RR), a publication of the Joining Forces Joining
Families group, on a variety of recent publications. RR consists of summaries of published researchstudies that are of interest to family advocacy and medical and social service providers. The articles
are grouped by topic: child neglect, factors affecting child maltreatment, effects of child maltreatment,
effects of intimate partner violence (IPV), and interventions for IPV. In each summary, we highlightits relevance to clinical providers and for program and policy makers. Finally, we note some articles
that we believe represent innovations in the field of child maltreatment and IPV.
CHILD NEGLECT

Increased Risk of Child Neglect for Children with Disabilities
Whose First Report is Not SubstantiatedChild neglect is difficult for child protective services(CPS) to substantiate due to limitations related to its definition, lack of societal agreement, cultural expectations, andpoverty, particularly when neglect may be a matter of omission of caregiving. Children with disabilities are among themost vulnerable for abuse and neglect. The increased risk ofneglect of children with disabilities was compared to children
without disabilities using data from the National Child Abuse
and Neglect Data System (NCANDS, 2014). Disability wasclassified as chronic medical neglect, behavioral problems,
emotional disturbance, learning, intellectual, or physical disability, or vision or hearing impairment. Children whose report for child neglect in 2008 that was not substantiated were
followed for four years to determine if they were re-referred
to CPS and then were later substantiated for neglect. There
were 12,610 (2.7% of all children followed) children withdisabilities. Children with disabilities were more likely to be

re-referred (45% compared to 36%), experience substantiatedmaltreatment (16% vs 10%), and be placed in foster care (7%vs 3%) compared to children without disabilities. Providers
who encounter children with disabilities should be aware of
the possibility of neglect. In addition to showing that children
with disabilities are at higher risk for future maltreatment
after an initial unsubstantiated report, this study indicates theimportance of the need for a targeted intervention plan toprevent subsequent maltreatment of disabled children.
References
Kistin CJ, Tompson MC, Cabral HJ, Sege RD, Winter MR, &Silverstein M. (2016). Subsequent maltreatment in children
with disabilities after an unsubstantiated report for neglect.
Journal of the American Medical Association; 315(1): 85–87.
NCANDS. (2014). http://www.ndacan.cornell.edu/datasets/
dataset-details.cfm?ID=195

CONTENTS
Increased Risk of Child Neglect for Children with Disabilities
Whose First Report is Not Substantiated ..................................... 1
Youth’s Reported Experiences of Child Neglect.................................. 2
Neighborhood Factors Can Influence Child Maltreatment............... 3
Type of Parental Debt May Affect Children’s Well-Being.................. 3
Multiple Maltreatments of Children Can Be Classified Differently
and Can Lead to Different Outcomes........................................... 4
Spanking and Child Outcomes: Old Controversies and New
Analyses............................................................................................ 4
Childhood Maltreatment Increases the Risk of a Suicide Attempt... 5

Emotional Abuse May Have a Unique Effect on Later Depression.. 5
Strangulation in Intimate Partner Violence......................................... 6
Correlates of Intimate Partner Violence Perpetration........................ 6
Trauma Informed Care........................................................................... 7
Relationship Education for Military Couples...................................... 7
The Relationship of Deployment and Marital Satisfaction to the
Perpetration of Physical Violence ................................................. 8High Prevalence of Intimate Partner Violence among Trauma
Patients.............................................................................................. 8

CHILD NEGLECT

Youth’s Reported Experiences of Child Neglect
Neglect, as a one-word description of maltreatment,
is inadequate to understand the acts of caregivers and theexperiences of children. Records of 303 children identified bya large public welfare agency as maltreated were abstracted
to describe the nature of neglect in child welfare clients, todescribe their experiences, to examine typologies, and tounderstand how types of neglect co-occurred with eachother and with other forms of maltreatment. Abstraction was
conducted by use of the Maltreatment Case Record Abstraction Instrument (English and LONGSCAN, 1997). Child
Protective Services (CPS) had classified 41% of the children
as neglected, but this review revealed that 71% actually qualified as experiencing some type of neglect. This discrepancy
could have been due to the practice of classifying a child’smaltreatment only as the type that brought the child to theattention of the authorities and not additional maltreatments.
This higher prevalence of neglect found by the abstraction
suggests that neglect is part of a larger pattern of maltreatment that may be obscured in official records.
There were 13 types of parental behavior that wereclassified into five subtypes of child neglect: supervisory(72.5%), environmental (61.6%), care (42.4%), educational(30.8%), and medical (23.2%). There was a high rate (55.3%)of caretaker absence or inability to provide adequate care forthe child due to physical or mental illness or drug abuse. All

types of neglect except medical neglect were correlated witheach other indicating that the prevalence of several types ofneglect was common.
When compared to maltreated children who were notneglected, maltreated children who were neglected experienced a higher overall prevalence of maltreatment as well as
more different types of maltreatment. Neglect was accompanied by an additional type of maltreatment in 95% of thecases. The highest rate of co-occurrence was with emotional
abuse, nearly two-thirds of the children. Practice implications
suggested by the authors included the need for individualizedinterventions for neglected children based on their uniqueexperiences and the needs and characteristics of the family.
At a minimum, when neglect is found to occur, the practicesuggestion is that other types of neglect, as well as additional
forms of maltreatment, should be explored.
References
English DJ, & the LONGSCAN investigators. (1997). Modified
Maltreatment Classification System (MMCS). http://www.
iprc.unc.edu/longscan/. Accessed 30 June 2016
Mennen FE, Kim K, Sang J, & Trickett PK. (2010). Child neglect:Definition and identification of youth’s experiences in official reports of maltreatment. Child Abuse & Neglect; 34:
647–658.

When compared to maltreated children who were not neglected, maltreatedchildren who were neglected experienced a higher overall prevalence ofmaltreatment as well as more different types of maltreatment.

JOINING FORCES
Joining Families

RESEARCH REVIEW
Editor-in-Chief
James E. McCarroll, PhD
e-mail to James.McCarroll.ctr@usuhs.mil(301) 319-8003
Joining Forces Joining Families—Research Review is a
publication of the Family Violence and Trauma Project,
Center for the Study of Traumatic Stress, Departmentof Psychiatry, Uniformed Services University, Bethesda,
Maryland 20814, and the U.S. Army Installation
Management Command, Fort Sam Houston, TX 78234.

2 • RESEARCH REVIEW | Joining Forces/Joining Families

Editorial Advisor
LTC Ricky J. Martinez. PhD, MSC, USA
Family Advocacy Program Manager
Installation Management Command
Department of the Army
Editorial Consultant
Joshua C. Morganstein, M.D.
Commander, U.S. Public Health Service
Scientist, Center for the Study of Traumatic Stress
Department of Psychiatry, Uniformed Services University

Summer 2016

FA C T O R S A FFECTING CHILD MALTREATMENT

Neighborhood Factors Can Influence Child Maltreatment
Exploring the relationships between communities andchild maltreatment is an innovative approach to its prevention. In addition to individual and family factors that can
influence child maltreatment, neighborhood ecologicalfactors can also play a role. Among neighborhood factors
are poverty, housing stress and instability, childcare burden,
substance availability, residential density, immigrant concentration, and crime. Neighborhood social impoverishment has
been suggested as a mechanism to influence child maltreatment in three major ways: inhibited sharing behaviors amongneighbors due to need; a dearth of positive role models,
which reinforces inappropriate and inadequate behaviors;
and a lack of intimate and confident interactions, which
inhibits nurturance and feedback (Garbarino & Barry, 1997).
However, there are protective factors in neighborhoods thatcan be mobilized to reduce child maltreatment and socialand physical disorder. Among these factors that can strengthen communities are collective efficacy, intergenerational
closure, and social networks. Collective efficacy is the sharedbelief of a group in their capabilities to succeed (Sampson,
2003). Intergenerational closure refers to the extent to whichpeople know each other’s children and the parents of theirchildren’s friends. Social networks are indicators of intimate
and community social relationships.
The relationship between child maltreatment and neighborhood social processes was tested in Chicago by examining

child maltreatment data from 1995–2005 (Molnar, Goerge,
Gilsanz, et al., 2016). Child maltreatment outcomes were
neglect, physical abuse, sexual abuse, and substance-exposed
infants. Neighborhoods that were higher in collective efficacy,intergenerational closure, and social networks had lower
proportions of neglect, physical abuse, and sexual abuse.
Similarly, higher collective efficacy and social network size
predicted a lower proportion of substance-exposed infants.
There are social and policy implications to this work. The
authors suggested that mobilizing neighborhoods to improve
protective factors can decrease child maltreatment and may
be more effective than individual and family-focused efforts
in lowering child maltreatment.
References
Garbarino J & Barry F. (1997). The community context of childabuse and neglect. In J. Garbarino, & J. Eckenrode (Eds.), Understanding abusive families: An ecological approach to theory
and practice (pp. 556–85). San Francisco: Jersey-Bass.
Molnar BE, Goerge RM, Gilsanz P, et al. (2016). Neighborhoodlevel social processes and unsubstantiated cases of childmaltreatment. Child Abuse & Neglect; 51: 41–53.
Sampson RJ. (2003). Neighborhood-level context and health:
Lesson from sociology. In I. Kawachi & LF Berkman (Eds.),
Neighborhoods and health (pp. 132–146). New York: Oxford
University Press.

FA C T O R S AFFECTING CHILD MALTREATMENT

Type of Parental Debt May Affect Children’s Well-Being
When family finances are stretched, the associated stresscan affect family functioning and is a risk for child maltreatment. Financial stress was considered in the National Longitudinal Study of Youth, which included 9,011 children andtheir mothers observed annually or biannually from 19862008. Socioemotional well-being was also measured. Mothers
responded to 28 questions about their child’s behavior. Analyses were controlled for time stable variables and time varying
variables. Total amount of parental debt was associated withpoorer child socioemotional well-being, but the association
varied by type of parental debt. Higher levels of home mortgage and education debt were associated with higher levelsof child well-being whereas higher levels of and increases in
unsecured debt (credit card, money owed to businesses, andmedical debt) were associated with lower levels of child wellbeing. Credit card debt accounted for 2/3s of all unsecured
debt. Thus, debt is not universally harmful. Debt that allows

http://www.CSTSonline.org

for home investment may provide access to better neighborhoods and schools. Unsecured debt may reflect limited
resources to invest in children as well as parental stress. Clinically, providers might inquire of parents whether they areexperiencing unsecured debt and if there are other financialrelated stressors and how these stressors might be affecting
their relationships with their children and their parenting.
There are many resources for debt counseling. For example,
referrals could be made to a financial coach or a community
agency for help as a means of reducing household stress andpreventing family maltreatment.
Reference
Berger LM & Houle JN. (2016). Parental debt and children’ssocioemotional well-being. Pediatrics; 137(2): e20153059 1-8.
doi: 10.101542/peds.2015-3059.

RESEARCH REVIEW | Joining Forces/Joining Families • 3

E F F E C T S OF CHILD MALTREATMENT

Multiple Maltreatments of Children Can Be Classified Differently
and Can Lead to Different Outcomes
Many, if not most, child victims of maltreatment suffer
more than one type. It is not clear whether any one or any
combination of maltreatments has a greater impact. This
study of 358 maltreated German children and adolescents(ages 4-17) aimed to identify maltreatment profiles and associate them with short-term clinical outcomes. Data wereobtained between 2012-2015 through clinical assessments,
questionnaires, interviews from participants and their primary caregivers on their history of maltreatment, sociodemographics, psychopathology, psychosocial functioning,and quality of life. Six types of maltreatment were explored:
sexual abuse in general, sexual abuse with penetration, physical abuse, emotional abuse, neglect, and exposure to domestic
violence. Analysis resulted in three classes based on the history of maltreatment: (1) multiple maltreatments excluding
sexual abuse (63.1%), (2) multiple maltreatments including sexual abuse (26.5%), and (3) predominantly sexual
abuse (10.3%). Eighty-five percent of participants reported
more than one type of maltreatment. The children in class 2
showed significantly worse short-term outcomes on psycho-

pathology, level of functioning, and quality of life comparedto the other classes. However, exposure to multiple forms ofmaltreatment was associated with worse outcomes for all variables. Members of class 3 showed the most resilience, defined
as an absence of psychopathology. The authors speculated that
this was due to the lower level of exposures to maltreatment.
About half the children (45.5%) showed no psychopathology
suggesting resilience in other classes as well. However, this wasa short-term outcome study and resilience is likely to changeover time. The authors further suggested that their study
shows that it is not the specific type of maltreatment that matters, but the occurrence of multiple types. Providers working
with abused children should carefully explore the extent ofmaltreatment histories as well as the outcomes.
Reference
Witt A, Münzer A, Ganser HG, Fegert JM, Goldbeck L, & Plener
PL. (2016). Experience by children and adolescents of morethan one type of maltreatment. Child Abuse & Neglect; 57:
1–11.

E F F E C TS OF CHILD MALTREATMENT

Spanking and Child Outcomes: Old Controversies and New Analyses
This research reported in this article tackled the question of whether spanking children is harmful or helpful. In
addition to concerns of parents and the many organizations
and individuals interested in child welfare, the result has possible legal and policy implications. This study was conducted
through the use of meta-analysis, a statistical technique foranalyzing the results of several studies in order to answer a
research question that might have different, and sometimes
conflicting, results in single studies. The statistic of interest
from a meta-analysis is simply the difference between noeffect and the outcome of interest. A total of 558 studies wereselected for inclusion in the analysis.
The effects investigated were detrimental outcomes forthe child or adult based on a history of spanking by parents.
The effects could be grouped as affective, cognitive, andbehavioral. Examples of negative childhood outcomes were
aggression, antisocial behavior, low self-esteem, and mental
health problems. The adult negative outcomes were antisocial behavior, mental health problems, and positive attitudes
about spanking. A total of 13 out of 17 negative outcomes
were statistically significant, nine for children and four for
adults. All the negative outcomes indicated a link between

4 • RESEARCH REVIEW | Joining Forces/Joining Families

spanking and increased risk for detrimental child outcomes.
The authors also examined studies that compared spanking
with physical abuse. They found that spanking and physicalabuse were significantly associated and had relations withchild outcomes that were similar in magnitude and in thesame direction. The analyses reported in this study also foundno evidence that spanking was associated with improved
child behavior.
The authors noted that these results can have large societal impacts in that there is no evidence for spanking doing
good; the evidence examined here points to the risk of harm.
Healthcare providers, social services and medical personnel
should educate families about the harmful effects and lackof benefit associated with spanking. Given the similarity inoutcomes between spanking and child physical abuse, policy
makers should consider the implication of these findings in
the development of broader public health policy.
Reference
Gershoff ET, & Grogan-Taylor A. (2016). Spanking and childoutcomes: Old controversies and new analyses. Journal of
Family Psychology; 30: 453–469.

Summer 2016

E F F E C T S OF CHILD MALTREATMENT

Childhood Maltreatment Increases the Risk of a Suicide AttemptChild maltreatment is associated with an increased rateof suicide attempts. Various types of child maltreatment
frequently co-occur, but it is not known if the effects of maltreatment are specific to the type or occur as a general resultof all types of maltreatment. This question was examined byanalyzing the responses of 43,653 adult respondents to the
2004–2005 National Epidemiologic Survey on Alcohol and
Related Conditions, weighted to be representative of the 2000
U.S. Census data for the civilian population. Types of childhood maltreatment inquired were emotional neglect, physicalneglect, emotional abuse, physical abuse, and sexual abuse.
Participants were asked if they had ever attempted suicide.
The analysis was controlled for demographic factors and psychopathology. Childhood maltreatment was associated withan increased risk for attempting suicide at an earlier age forfirst attempters. This relationship occurred mostly throughshared effects of childhood maltreatment. In other words, therisk of suicide was conferred through a broad liability, not a
specific one based on the type of child maltreatment. The exception was for sexual abuse, which had a direct effect on therisk for suicide above the shared risks for all other types. The
authors concluded that the prevention of all types of maltreatment may have broad benefits on children’s suffering,
but also on the long-term risk of a suicide attempt. Providers
should be aware that risks for self-harm can be associatedwith all types of child maltreatment as well as combinationsof several.
Reference
Hoertel N, Franco S, Wall MM, Oquendo MA, Wang S, Limosin
F, & Blanco C. (2016). Childhood maltreatment and riskof suicide attemwpt. Journal of Clinical Psychiatry; 76(7),916–923.

E F F E C T S O F IN T IMATE PARTNER VIOLENCE PERPETRATION

Emotional Abuse May Have a Unique Effect on Later Depression
Intimate partner violence (IPV) has many adverse healthoutcomes including depression. An evaluation of the effects of
IPV was conducted in a group of 156 women who had left therelationship and were receiving legal and case managementaid (Estefan, Coulter, & Weerd, 2016). This program included
a wide variety of interventions such as safety, employment,
finances, transportation, housing, health care, and social support to improve the quality of life for them and their children.
The program followed the women for an average of two years
after they left the violent relationship. A data collection measure was developed for this project, the Global History Questionnaire (GHQ), which included depression as the outcome
variable. This was asked as a single question: “Are you currently depressed?” Independent variables included demographics,
violence, safety, and other social support measures. Clientscompleted the GHQ upon entry to the program, after about
six months of services, and when they exited the program. At
entry, 37% reported depression; at post-test, 22% continued
to report depression. The likelihood of depression for those
women who experienced emotional abuse more than once per

week (57% of respondents) was almost five times that of those
who did not experience emotional abuse (odds ratio=4.864,
95% CI=1.246-18.992). Those who were worried about contact by the abuser were almost six times as likely to experiencecurrent depression (odds ratio =5.898, 95% CI=1.690-20.580).
Emotional abuse was the only form of IPV that showed thiseffect. The correlations between physical abuse and depression
and sexual abuse and depression were not statistically significant. The authors suggested that emotional abuse may be themost critical long-term effect to be considered in intervening
in the long-term mental health of IPV survivors. Clinicians
should be especially aware of the possibility of depression in
victims of emotional abuse as well as those who fear being
stalked by the abuser.
Reference
Estefan LF, Coulter ML, & Weerd CV. (2016). Depression in
women who have left violent relationships: The unique impact of frequent emotional abuse. Violence Against Women;
1–17. doi: 10.1177/1077801215624792.

The likelihood of depression for those women who experienced emotional abuse morethan once per week (57% of respondents) was almost five times that of those who did notexperience emotional abuse. Emotional abuse may be the most critical long-term effect to beconsidered in intervening in the long-term mental health of IPV survivors.

http://www.CSTSonline.org

RESEARCH REVIEW | Joining Forces/Joining Families • 5

E F F E C T S O F IN T IM ATE PARTNER VIOLENCE PERPETRATION

Strangulation in Intimate Partner Violence
Strangulation is common in intimate partner violence(IPV) and sexual assault (SA). It can be used to control and toharm the victim. A review of 1,542 medical encounters witha forensic nurse examiner from 2004-2008 found 650 for
IPV and 893 for SA (Mcquown, et al., 2016). Strangulation
was reported in 38% of IPV cases, 12% in SA. Patients weresignificantly more likely to be strangled by an intimate partner than by another perpetrator, only 20% by a non-family
member. Victims were more likely to be strangled if pregnant
or the perpetrator was the owner of a firearm. There weresignificant risk factors for lethality in 97% of the IPV cases:
presence of a firearm, threats of suicide or homicide by theperpetrator, significant bodily injury, loss of consciousness,
loss of bladder or bowel control, voice changes, or difficulty
swallowing. It is important for providers to inquire aboutstrangulation in cases of IPV during pregnancy as well as
when visible injury to the neck is seen. Without documentation, strangulation is difficult to prove in criminal or medical
proceedings.
A similar study of 1,064 women referred to a sexualassault resource center for alleged non-fatal strangulation(NFS) reported data on demographics, assault characteristics,
and forensic findings (Zilkens, et al., 2016). NFS varied by age
group and type of assailant. The highest proportion of NFS
was in women 30-39 years old who were sexually assaulted byan intimate partner. Additional factors associated with NFS
during sexual assault included deprivation of liberty, verbal
threats, being assaulted in the woman’s home and the use ofadditional blunt force. External signs of NFS were absent in
49.4% of all NFS cases.
Victims of strangulation can experience pain, terror, anda sense of impending death (Armstrong & Strack, 2016).
Among 300 cases of strangulation in San Diego County

in 1995, 94% were women who were strangled by a malemember of their household. As most victims are strangled byhands, these cases can leave little or no sign of injury. Otolaryngology (ear, nose, and throat) is the branch of medicine
most likely to be able to conduct a thorough evaluation of
victims who seek care for hoarseness, sore throat, respiratory disturbance, or accidental injury to the neck. Evaluation
between 48-72 hours is likely to reveal injury such as hoarseness, bruising, or other temporary injuries. A variety of medical procedures may be performed in evaluation, but the mostsensitive is magnetic imaging of the neck. Providers should
consider domestic violence in patients with throat complaints
or bruises on the neck. Strangulation of an intimate partner
often occurs in front of children. Repeated strangulation
brings the risk for brain injury and death.
The findings of these three related studies lead to similar
conclusions for medical and social service practitioners andlaw enforcement including greater awareness of strangulation
in IPV incidents and screening for NFS by those who comein contact with victims of sexual assault as well as other typesof IPV.
References
Armstrong M, & Strack GB. (2016), Recognition and documentation of strangulation crimes. JAMA Otolaryngology-Headand Neck Surgery: A review. doi: 10.1001/jamaoto.2016.0293.
Mcquown C, Frey J, Steer S, Fletcher GE, Kinkopf B, Fakle M, &Prulhiere V. (2016). Prevalence of strangulation in survivorsof sexual assault and domestic violence. American Journal of
Emergency Medicine.
Zilkens RR, Phillips MA, Kelly MC, Mukhtar SA, Semmens JB,& Smith DA. (2016). Non-fatal strangulation in sexual assault. Journal of Forensic and Legal Medicine; 43: 1–7.

E F F E C T S O F IN T IM ATE PARTNER VIOLENCE PERPETRATION

Correlates of Intimate Partner Violence Perpetration
There is no regular national United States report of intimate partner violence (IPV). However, prevalence data canbe extracted from periodic surveys. Wave 2 (2004-2005) of
the National Epidemiologic Survey on Alcohol and Related
Conditions provided data on the association of IPV perpetration with psychiatric disorders and other correlates of IPVsuch as alcohol use and psychosocial functioning. A total of
25,631 U. S. respondents 18 years of age or older, married,dating, or living with someone were interviewed face-to-face.
A total of 1,677 individuals (6.5%) reported perpetrating IPVin the past 12 months, 4.2% male and 7.0% female perpetra-

6 • RESEARCH REVIEW | Joining Forces/Joining Families

tors. Women tended to perpetrate less severe violence thanmale perpetrators. The IPV perpetrators had greater odds of
having any psychiatric disorder (67.7% of perpetrators and
42% of non-perpetrators). Perpetration was associated with awide range of factors: having an alcohol use disorder, personality disorder, younger age, being Black or Native American,
not married or cohabiting, low levels of social support, andlow income. There were no gender differences in these variables. IPV victimization had the strongest association withperpetration. These authors suggested that mental healthevaluations of IPV perpetrators might provide the opportuContinued on next page
Summer 2016

IN T E R V E N T IO NS FOR INTIMATE PARTNER VIOLENCE

Trauma Informed Care
Trauma informed care (TIC) is a topic of clinical interest as well as one with policy implications for child mental
health and child welfare. TIC has grown out of the increasing awareness of trauma to children from adverse childhood
experiences and other adversities arising from stressful life
experiences. Such exposures can confer significant risk forpoor health, including mental health outcomes. A trauma informed approach, as defined by SAMHSA (www.samhsa.gov/
nctic/trauma-interventions), includes awareness of trauma
and its impact on organizational functioning. However, as
Berliner and Kolko point out, the SAMHSA principles are essentially those of good care: safety, trustworthiness, collaboration and mutuality, empowerment, voice, and choice. In thisarticle, the authors review major concepts and issues of TIC.
Among these issues are what defines TIC and how would
providers know they are delivering it. There is no common
definition of TIC, the concept has not been operationalized,

tools are needed to identify traumatized children for services, and training programs are needed for providers. At theinstitutional level, cross-system collaborations and increased
access to evidence-based treatments, such as trauma-focusedcognitive behavior therapy, should occur. The most important question regarding TIC is whether awareness actually
benefits children. The authors recommend that the practicechanges that are most likely to have an impact of improving
trauma informed care are screening for trauma exposure,assessing trauma impact, and increasing access to traumaspecific treatment. These are among the many challenges toimplementing TIC and creating systems that identify traumatized children and ensure that they receive effective care.
Reference
Berliner L, & Kolko DJ. (2016). Trauma informed care: A commentary and critique. Child Maltreatment; 21(2): 168–172.

IN T E R V E N T IO NS FOR INTIMATE PARTNER VIOLENCE

Relationship Education for Military Couples
Military personnel and their families often do not seek
services for personal concerns such as mental health needs,
marital problems, and child behavior problems in spite of thefact that services are generally available and free on military bases. This article reviews best practices in relationshipeducation (RE), a form of couple’s intervention that teaches
skills such as communication, conflict management, support,
intimacy, and relationship goal-setting. The authors proposethat RE has the potential to overcome barriers to help-seeking in military couples and enhance mental health promotion
services in the military environment. This article also reviews
protective and risk factors that may affect mental healthand family functioning. Among the protective factors are
subsidized housing, employment and its associated financial
security, and free health care. Risk factors include frequent relocations and deployments, the latter with significant traumaassociated contributors to personal and family disruption:
substance abuse, interpersonal violence, re-establishingconnections, mental health symptoms such as hyperarousal
and aggression, lack of time for participation, and fear ofnegative influence on the service member’s career. This article
describes a number of different approaches to RE and dis-cusses issues that should be considered such as timing (whencouples are receptive to intervention), educator selection
and training (providers who understand the special needsof military families), program format (small face-to-facegroups, flexible delivery such as online or in person, single
intervention or multiple sessions, audio-visual and writtenmaterial, and programs designed for one partner when theother is unavailable), and support from key personnel suchas senior leaders and specialist experts. Practitioners with anunderstanding of the risk and protective factors of militaryfamilies as well as have the training and experience to conduct such programs can have a significant effect on family
functioning and facilitate positive relationship changes. RE
can be an innovative and effective alternative or supplement
to traditional mental health and marital counseling.

Correlates… from page 6nity to identify and treat psychiatric disorders and improvethe clinical course of conditions affected by violence.

Reference
Okuda M, Olfson M, Wang S, Rubio JM, Xu Y, & Blanco C.
(2015). Correlates of intimate partner violence perpetration:
Results from a national epidemiologic survey. Journal ofTraumatic Stress; 28: 49–56.

http://www.CSTSonline.org

Reference
Bakhurst MG, Loew B, McGuire ACL, Halford WK, & Markmans HJ. (2016). Relationship education for military couples: Recommendations for best practices. Family Process;
1–15, doi: 10.1111/famp.12211.

RESEARCH REVIEW | Joining Forces/Joining Families • 7

IN T E R V E N T IO NS FOR INTIMATE PARTNER VIOLENCEThe Relationship of Deployment and Marital Satisfaction
to the Perpetration of Physical Violence
There are many complex effects of military deployment,
particularly when the service member has had numerous
ones. U.S. Navy personnel anticipating an 8-month deployment were surveyed to determine whether the number ofprevious deployments and relationship satisfaction predicted
their reports of perpetrating intimate partner violence (IPV)(Kelley, Stamgaugh, Milletich, & Snell, 2015). Of the possible
295 persons contacted by e-mail to participate in the survey,
72 responded positively (52 men and 18 women). Perpetration of physical IPV was measured by means of selected
items from the Revised Conflict Tactics Scale (CTS2; Straus& Douglas, 2004). Respondents answered 10 items, each on a
9-point scale, regarding the perpetration of violence by themselves or their partner over the past 12 months. Relationshipsatisfaction was measured by the Relationship Assessment
Scale (RAS: Hendrick, 1988), with 7 items, each on a 5-point
scale, that assess general relationship satisfaction. Seventeen out of 72 (23.6%) reported at least one act of physicalviolence against their partner. The most common items were
grabbing (76.4%) and pushing or shoving (71.6%). Results
were that as relationship satisfaction increases, the effect the

number of deployments has on perpetrating physical violence decreases. This research suggests that interventions for
perpetration of IPV should consider relationship satisfactionin the context of the number of deployments. Enhancementof relationship satisfaction could also be a target for prevention by a variety of social and clinical services by making
people aware of the value of such relationships in coping with
deployment as well as other family stressors.
References
Hendrick SS. (1988). A generic measure of relationship satisfaction. Journal of Marriage and the Family; 50: 93–98.
Kelley ML, Stamgaugh L, Milletich RJ, Veprinsky A, & Snell
AK. (2015). Number of deployments, relationship satisfaction and perpetration of partner violence among U. S. Navymembers. Journal of Family Psychology; 29(4): 635–641.
Straus MA, & Douglas EM. (2004). A short form of the Revised
Conflict Tactics Scale, and typologies for severity and mutuality. Violence and Victims; 19: 507–520.

IN T E R V E N T IO NS FOR INTIMATE PARTNER VIOLENCEHigh Prevalence of Intimate Partner Violence among Trauma Patients
An analysis of records of patients reported in the National Trauma Data Bank from 2007-2012 found 16,575 patientsout of 2,910,122 experienced intimate partner violence (IPV).
Patients were stratified by age: children (≤18 years), adults(19-54 years), and elderly (≥55 years. Of the total, 61.7% werechildren, 33.2% were adults, and 5.1% were elderly. Of thechildren, 69% were infants, 60% were male, the median age
was 3.5 years, and the median Injury Severity Score was 14(range, 4-17). The prevalence of domestic violence againstchildren increased from 14/1,000 discharges in 2007 to
18.5/1,000 in 2012, a statistically significant increase.
There were 5,503 adults who experienced IPV. Of these,
63% were female, the mean age was 35 years, and the Injury
Severity Score was 5 (range, 1-10). Of all trauma patients, females were significantly more likely to have experienced IPVthan other traumatic events (64% vs 26%). The prevalence of
IPV against adults also increased significantly, from 3.2/1,000
discharges in 2007 to 4.5/1,000 in 2012.
Of the 848 elderly patients who experienced IPV, 57.1%
were female, the median age was 66.6 years, and the medianInjury Severity Score was 9 (range 4-16). The most common
8 • RESEARCH REVIEW | Joining Forces/Joining Families

perpetrators of IPV among elderly patients were other relatives (42.7%), followed by a significant male relative (44.6%),
and a significant female relative (31%). The increase in elderly
patients also increased, but was not statistically significant(0.8/1,000 in 2007 to 0.96/1,000 in 2012). Male relatives
included father, stepfather, boyfriend, husband, or ex-spouse;female relatives included mother, stepmother, girlfriend, wife,
or ex-spouse; other relative included children, sibling, or
grandparent. Of all IPV trauma patients, head injury was themost common injury (46.8%) followed by extremity fractures(31.2%). The overall mortality rate was 5.9% (n=980).
The prevalence of IPV trauma has increased significantly
in children and adults. The authors concluded that a robust
mandatory screening for IPV in trauma patients is warranted
along with a focused national intervention.
Reference
Joseph B, Khalil M, Zangbar B, et al. (2015). Prevalenceof domestic violence among trauma Patients. JAMA Surgery;
150(12): 1177–1183.

Summer 2016