DEPARTMENT OF DEFENSE Challenges For FAP in “The Way Ahead” August 10, 2009

MCFP2 Challenges Demonstrating effectiveness Implementing promising, good & best practices Improving accuracy of data collection Creating joint bases Improving DoD’s response to domestic abuse and child abuse Revising the Case Review Committee process Addressing the Reserve Component Addressing Wounded, Ill, and Injured service members treatment for family violence

MCFP3 Demonstrating Effectiveness It’s a “best practice” It’s superior to alternative approach(es) because it 1.Produces better results, or 2.Produces equal results more efficiently/cheaply/in accord with values & culture It’s not superior, but it’s a “good” practice So far, it’s only a “promising” practice

MCFP4 Demonstrating Effectiveness It’s a promising/good/best practice because it: Is designed on a logic model Replicates/builds on evidence- supported practice Has positive results from program evaluation Has ongoing systematic data collection and analysis

MCFP5 Implementing Best Practice (2) 1.Build a logic model Define desired immediate, intermediate, & long-term outcomes Identify and assess strategies/activities that may produce them Are they available? Are they appropriate? Ascertain how/why would they produce them Theoretical foundation Results of prior research/evaluation Identify and assess what data will measure success/failure What data collection methods are available? What analysis needs to be performed?

MCFP6 Implementing Best Practice (3) 2.Incorporate Evidence-Supported Practice (ESP) ESP combines: Best research evidence with Best clinical experience that is Consistent with family/client values

MCFP7 ESP Categories In declining order: 1.Well-supported by research evidence 2.Supported by research evidence 3.Promising Research evidence 4.Failure to demonstrate effect 5.Concerning practice 6.Not able to be rated California Evidence-Based Clearinghouse for Child Welfare

MCFP8 ESP factors: 1.No empirical/clinical evidence or theoretical basis indicating substantial risk of harm, compared to likely benefits 2.Book, manual, other writings describing protocol 3.Form of control to show benefit of practice over placebo Randomized controlled trial (RCT) Untreated group/placebo group/matched wait list group 4.Reliable and valid outcome measures applied consistently and accurately 5.Duration of sustained effect 6.Publication in peer-reviewed professional literature 7.Replication 8.If multiple outcome studies, overall weight supports benefit of the practice

MCFP9 Implementing Best Practice (4) 3.Plan evaluation before starting Document current protocol & outcomes Select new model’s data collection strategy & select instruments Pilot test new protocol 4.Ensure fidelity to model Prepare and disseminate protocol manual Train staff in protocol Monitor fidelity of experimental and control groups to respective protocols

MCFP10 Implementing Best Practice (5) 5.Collect data Conduct edit checks Analyze and draw conclusions Identify applicability and limitations of study 6.Prepare findings for publication 7.Cooperate with replications

MCFP11 Importance of Edit Checks Errors can have consequences 2 errors on substantiated incidents per installation change: USA rates: CAN rate +/- by 0.54 DA rate +/- by 0.83 DoD rates: CAN rate +/- by 0.1 DA rate +/- by 0.2 Can lead to erroneous interpretations

MCFP12 Force Well-Being Scales “Are the wheels coming off?” Semi-annual lagging indicators Risk Behaviors Spouse abuse by AD personnel Child abuse/neglect By AD personnel By AD parent By civilian parent By combined parents Compare current half year to half year in FY 2000

MCFP13 Force Well-Being Scales (Effects of Data Errors on Army and DoD rates)

MCFP14 Implementing Joint Basing Hickam AFB Andersen AFB Bolling AFB McChord AFB NWS Charleston Fort Dix & NAES Lakehurst NAF Washington Fort Richardson Randolph AFB & Fort Sam Houston Fort Eustis NS Pearl Harbor NB Guam NSA-W Anacostia Annex Fort Lewis Charleston AFB McGuire AFB Andrews AFB Elmendorf AFB Lackland AFB Langley AFB

MCFP15 Implementing Joint Basing (2) Supported installation’s program integrates into supporting installation’s program FAP construed as “base support function” NOT “mission support function FAP standardized services approximate COLS

MCFP16 MOU Personnel Issues to Implement Joint Basing Personnel billets/positions Military FAOs & SWs Civil Service & NAF Contractors Installation or centralized contract Seniority/priority placement Credentialing process Location Supervision Funding FY 2010 PBAS, MIPRs and other temporary “fixes” FY 2011 PBAS

MCFP17 Changing the Case Review Committee Process Purposes To reduce variability in decision-making Improve quality of data in Central Registry Improve fairness Improve FAP’s reputation To promote a coordinated community response Promote command and investigative agencies’ responsibilities Refocus FAP to clinical work To ensure respect for privacy rights To improve efficiency

MCFP18 The New CRC: CCSM+IDC Clinical Case Staff Meeting (“CCSM”) Safety planning and action FAP assessment and treatment planning Occurs ASAP Incident Determination Committee (“IDC”) Administrative decision: Does incident meet criteria for incident to be entered into Central Registry with personal identifiers? FAP communicates treatment plan to unit commander

MCFP19 The New CRC: CCSM+IDC Incident Determination Committee (“IDC”) Chaired by senior commander Composition limited to those with relevant information for determination Preclude discussion of irrelevant information, especially information protected by privacy rights

MCFP20 Incident Determination Committee Joint-Service Criteria for CR To be entered into FAP Central Registry with personal identifiers incidents must have: Act (or failure to act) plus Harm (except for sexual abuse) with specific thresholds Actual injury Reasonable potential for injury Acute significant fear reaction Criteria have demonstrated validity and reliability Exclusions reduced by raising harm threshold

MCFP21 The New Process Enhances command role Unit commander pre-IDC action for victim safety Unit commander pre-IDC administrative/ disciplinary action, as appropriate Higher level commander chairing the IDC promotes: Prompt attendance Preparation Focused attention Protection of privacy rights

MCFP22 Addressing Domestic Abuse Increase OSD FAP funding for victim advocates GAO Study Civilian advocates’ issues Legislation for an OSD Office of the Victim Advocate Coordinated community response projects Availability and training of law enforcement Command priorities Enhanced visibility of command actions

MCFP23 Data collection in the Reserve Component How much family violence occurs in the Reserve Component? Civilian child abuse data collection process is problematic OSD working with HHS on NCANDS No civilian data collection system for domestic abuse No public agency system Can’t require nonprofit agencies to collect data

MCFP24 Addressing Family Violence in the Reserve Component Expanding access to FAP prevention services Web-based materials Ad Council public awareness campaign Civilian home-visiting programs Intervention Availability of resources Restricted reporting Line of duty issue

MCFP25 Data Collection Involving Wounded, Ill & Injured (WII) Service Members How much family violence occurs in WII? FAP is exploring joint research, matching databases FAP Central Registry Deployment to hostile areas Wounded/Injured Mental health problem

MCFP26 Addressing Family Violence in WII Service members Protocol for reporting family violence in Warrior Transition Units Intervention/treatment challenges Civilian advocates urge DoD to emphasize criminal justice approach Is this the right approach if domestic abuse arises after combat-operational stress and/or PTSD? Coordination with the Veterans Administration

MCFP27 Domestic Abuser Treatment for WII Personnel Are State standards for “batterer treatment” ESP? (Low rates of success) One possible reason: “one size fits all” group psycho-education by unlicensed professionals Psycho-social assessments not incorporated Doesn’t incorporate dual diagnosis problems No therapeutic alliance to change behavior FAP is proposing range of modalities by licensed professionals Individualized assessment Motivation to change

MCFP28 Treatment of Abusers with Depressive Disorders & PTSD Treatment should address: Anger and impulse control Self-medication with alcohol Low self-esteem Controlling others to maintain safe environment Addiction to risk, especially in PTSD Anxiety Need to coordinate FAP treatment with: Mental health treatment Substance abuse treatment