Military Family Advocacy in the U.S. Army: Program Service Outcomes and Family Participation
Abstract: Violence in military families remains a vexing problem. Since the advent of the Global War on Terror, there is inconsistent evidence that the prevalence of family violence is increasing, particularly during and after military deployments. However, child neglect appears to increase significantly during military deployments. The military has developed family advocacy programs designed to keep families safe and intervene to reduce the deleterious effects of exposure to family violence. This is one of the first studies to examine the quality with which a family advocacy program is implemented and the degree to which families engage with the program. To conduct this study, the case files of 226 families who came in contact with the Army Family Advocacy Program (FAP) and whose cases were closed in 2013 were reviewed and coded across several implementation and service outcomes. These included involvement of qualified staff, whether or not appropriate victim and offender assessments were completed, degree of inter-agency communication, and appropriateness of referrals, among others. Soldier and family member participation in FAP and other Army-sponsored programs designed to reduce violence was also assessed. Generally speaking, the Army Family Advocacy Program was implemented with high quality, established processes and procedures for handling cases were largely followed, and FAP staff responded rapidly and thoroughly to reported abuse. However, family engagement with Army services and supports was low. Developing robust approaches to engaging families in family programming must be a high priority going forward.
Abstract: Introduction: Persistent inequities exist in obstetric and neonatal outcomes in military families despite universal health care coverage. Though the exact underlying cause has not been identified, social determinants of health may uniquely impact military families. The purpose of this study was to qualitatively investigate the potential impact of social determinants of health and the lived experiences of military individuals seeking maternity care in the Military Health System. Materials and methods: This was an Institutional Review Board-approved protocol. Nine providers conducted 31 semi-structured interviews with individuals who delivered within the last 5 years in the direct or purchased care market. Participants were recruited through social media blasts and clinic flyers with both maximum variation and homogenous sampling to ensure participation of diverse individuals. Data were coded and themes were identified using inductive qualitative research methods. Results: Three main themes were identified: Requirements of Military Life (with subthemes of pregnancy notification and privacy during care, role of pregnancy instructions and policies, and role of command support), Sociocultural Aspects of the Military Experience (with subthemes of pregnancy as a burden on colleagues and a career detractor, postpartum adjustment, balancing personal and professional requirements, pregnancy timing and parenting challenges, and importance of friendship and camaraderie in pregnancy), and Navigating the Healthcare Experience (including subthemes of transfer between military and civilian care and TRICARE challenges, perception of military care as inferior to civilian, and remote duty stations and international care). Conclusions: The unique stressors of military life act synergistically with the existing health care challenges, presenting opportunities for improvements in care. Such opportunities may include increased consistency of policies across services and commands. Increased access to group prenatal care and support groups, and increased assistance with navigating the health care system to improve care transitions were frequently requested changes by participants.