Secondary Prevention of Family Maltreatment in the U.S. Air Force: A Systematic Review

Background and Aims: The United States Air Force (USAF) has implemented secondary prevention activities aimed at preventing family maltreatment among active duty members and their families. In this context, USAF Family Advocacy Program (FAP) leaders are asking whether the current array and combination of interventions are optimal for the secondary prevention of family maltreatment. The current FAP logic model proposes two primary targets for prevention activities that promote family resilience in the context of family risk and vulnerability: (a) family protective factors in the form of safe, stable and nurturing family processes, and (b) ecosystem supports from installation/unit leaders as a component of the formal community and fellow service members and families as a component of the informal community. This systematic review aims to assess the extent to which the empirical literature substantiates the FAP logic model, and to identify other factors for potential inclusion in the logic model.

Methods: We employed best practices for the conduct of systematic reviews as outlined by Cooper (2010) and Littell, Corcoran, and Pillai (2008). We also incorporated AMSTAR and PRISMA guidelines. After consulting with a university social science reference librarian, we identified an appropriate search string and searched seven electronic databases. We also conducted manual searches in 10 leading journals that publish articles addressing family maltreatment in the military. We used the following a priori inclusion criteria: a) empirical, peer-reviewed journal article, b) published in 2000 or later, c) samples comprised of US active duty military members, d) analyses focused on some form of family maltreatment as a key outcome. Pilot-tested coding sheets were used to record relevant study information, particularly statistical findings and their congruence with elements of the current FAP secondary prevention logic model.

Results: Our search yielded 586 potentially relevant studies. A total of 26 studies satisfied all a priori inclusion criteria (including one study identified from our manual journal searches). At this point in our review, we have found preliminary support for the current FAP secondary prevention logic model. Specifically, indicators of safe, stable, and nurturing families (e.g., relationship satisfaction) distinguish families that perpetrate family maltreatment from others, as well as buffer risk factors associated with family maltreatment. Also, as predicted, supportive unit leaders reduce the probability of family maltreatment, and have a direct and positive influence on safe, stable, and nurturing families. Supportive relationships with fellow unit members also reduce the probability of family maltreatment. We have also begun to identify factors predictive of family maltreatment among active duty members that are not currently included in the FAP secondary prevention logic model, including community safety, member deployments, mental health concerns, and substance use.  

Conclusion and Implications: Systematic reviews have become increasing popular in the behavioral and social sciences, especially in the context of evidence-based practice. Most often this method is used to investigate the efficacy and effectiveness of targeted policy and program interventions. The current investigation supports the power of this method in evaluating program logic models that inform the selection of intervention activities and approaches.