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Social work grand challenge: build healthy relationships to end violence: conjoint couples group therapy to reduce intimate partner violence for Army couples

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Social work grand challenge: build healthy relationships to end violence: conjoint couples group therapy to reduce intimate partner violence for Army couples

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Content Social Work Grand Challenge: Build Healthy Relationships to End Violence
Conjoint Couples Group Therapy to reduce Intimate Partner Violence for Army couples
by
Ulu Elia Porter
MSW, Fayetteville State University, 2010
MA, Pacific Lutheran University, 2001
BA, Rocky Mountain College, 1995
Capstone Proposal Submitted in Fulfillment
of the Requirements for the Degree of
Doctor of Social Work
University of Southern California
May 2020

Table of Contents
Section I: Abstract…………...…………..………………………………………………………..0
Introduction...………………………………………………………………………….......1
The problem of Intimate Partner Violence…………..……………………………………3
Review of previous interventions…………………………………………………………4
Section II: Conceptual Framework…….………………………………………….………………7
Definitions………………………………………………………………….……………..7
Review of Theoretical Approaches……………………………………….………………7
Conceptual Framework………………………………………………….…….…………..9
IPV-CCGT Logic Model………………………………………………………………...10
Section III: Problems of Practice and Solutions/Innovations……………………………………11
IPV-CCGT Description…………………………………………………...…...………...11
Broader Impact of IPV-CCGT Innovation………………………….………….....……..12
Perspective of Other Stakeholders……………………………………….……..…….…12
Building on Existing Practice and Research……………………………………………..13
Assessing Potential for Success………………………………………...………………..15
Section IV: Project Structure, Methodology, and Action Components………….………….…...16
IPV-CCGT Prototype………….………..………………………………..……………...16
Market Analysis……………………………..…………………………….…….……….17
Implementation………..……………..…………………………………….…………….17
Process and Outcome Measures and Evaluation………………………………………...20
Plan for Measuring Outcomes……………..…………………………………....……….21
Dissemination Plan……………………………………………………...……………….24

Overall Revenue Strategy………………………………………………………...……...25
Revenue Projection..……………….…………………………………………………….26
Phases of Intervention……………..…………………………………………………….26
Unit of Service………………………..……………………………………….………...28
Staffing Planning and Cost……………………………………………………..……….29
Other Spending Cost…………………………………………………………………….31
Line Item Budget………………………………………………………………………...31
Section IV: Conclusions, Actions ,and Implications…………………………………………….32
References………………………………………………………………………………………..34
Appendix A: Logic Model………………………………………………………………….……41
Appendix B: Prototype Program Curriculum Wireframe…..……………………………………42
Appendix C1: Market Space…………………………………………………………………..…43
Appendix C2: Market Analysis………………………………………………………………….43
Appendix D: RE-AIM……………………………………………………………………………44
Appendix E: Gantt Chart...……………………………...……………………………...…..……45
Appendix F: Dissemination Plan………………………....………………...……………………52
Appendix G: Unit of Service….…………………………………………………………………55

I. Abstract
The U.S. Army has been engaged in two simultaneous combat operations for over 17 years in
Afghanistan and Iraq, marking the most protractive war in US military history with a harmful
cumulative impact on military families. This has led to not only an alarming increase in
psychiatric problems such as suicides, Posttraumatic Stress Disorder (PTSD), Substance Use
Disorders (SUD), but also Intimate Partner Violence (IPV) recidivism rates among US Army
couples. While the Army developed many worthy initiatives to tackle these psychiatric problems
among its population, not nearly the same can be said regarding efforts on IPV, particularly with
military couples experiencing IPV who may choose to remain in their relationship. Current gaps
in tackling IPV among military couples include the lack of a clear and coherent standardized
clinical intervention, evidence-based or empirically-informed program for conjoint couples, as
well as strategies to measure either clinical outcomes or program evaluation. Under the Grand
Challenge of Build Healthy Relationships to End Violence, this author presents an innovative
approach in conjoint couples treatment to bridge the current gap within the landscape of IPV.
The Intimate Partner Violence-Conjoint Couples Group Therapy (IPV-CCGT) is a couples’
group psychotherapy and psychoeducation program design for a clinical practice setting to treat
Army couples. It directly targets known IPV risk factors in the Army to reduce IPV recidivism
rates, while simultaneously enriching marriage quality and resiliency. IPV-CCGT is underpinned
by three pillars when combined altogether, can be considered an innovative approach to tackling
the IPV phenomenon. Those three pillars are 1) employ the best qualified clinical staff, 2) use an
empirically-informed couples’ curriculum, and 3) implement data metrics to track the couple's
clinical outcomes, staff productivity, and program evaluation and efficacy.
RUNNING HEAD: COUPLES GROUP THERAPY FOR IPV IN THE US AMRY 1

Introduction
Intimate Partner Violence (IPV) is a phenomenon that is universally known but
frighteningly acceptable in many societies (WHO, 2005). It impacts every community and can
become a lifetime affliction for those directly and indirectly exposed to such violence.
Historically, there has been tremendous rallying and harnessing of effort by families, medical
professionals, policymakers, researchers, law enforcement, spiritual leaders, and others to not
only better understand, but more importantly, reduce and/or eradicate IPV. The 12 Grand
Challenges (GC) of Social Work, particularly its GC of Build Healthy Relationships to End
Violence, offers a groundbreaking initiative to synchronize efforts by social researchers and
practitioners to address violence (GCSW, 2020).
IPV is considered among the broad range of problems under the GC of build healthy
relationships to end violence initiative. As part of a contribution to this initiative, this paper
presents an intervention program that has been developed with the aim of tackling the problem of
IPV. In particular, the problem of IPV among US Army couples in light of the current gap in
couples' intervention to directly reduce IPV incidents. Intimate Partner Violence-Conjoint
Couples Group Therapy (IPV-CCGT) is a program developed by this author out of an altruistic
concern over the existing problems of IPV in the Army, and the limited or lack of an intervention
program that directly target IPV among Army couples. Three main pillars at the foundation of
the IPV-CCGT program are, 1) employ the best qualified clinical staff in the form of Licensed
Independent Practitioners (LIP), 2) use an empirically-informed couples’ curriculum, and 3)
implement data metrics to track couples clinical outcomes, staff productivity, and program
evaluation and efficacy.
IPV IN THE US ARMY 2

Given the sensitivities surrounding the problem of IPV and considerations for
interventions, particularly when addressing clinical concerns with safety and potential IPV
comorbidity or sequelae from psychiatric condition(s), employing LIP was considered best
qualified or superior over non-LIP staff. This is an important consideration given the fact that
any potential staffing/employment for IPV-CCGT ultimately falls under the auspices of Office of
Personnel Management (OPM) and Department of Defense (DoD) hiring practices. IPV-CCGT
curriculum has been developed based on the empirical literature from the works of Stith and
colleagues on Couples Therapy for Domestic Violence: Finding Safe Solutions (2004), Family
Violence Recidivism Command Support Study (Kaye, Aronson, & Perkins, 2018), and John
Gottman and Gottman Institute (2015); it is also informed by other major DoD guidelines, and
Army reports that includes DoD Manual 6400.01 (2015), Army 2020 Generating Health &
Discipline in the Force (DA, 2012) and Leader’s Guide for Building Personal Readiness and
Resilience (DA, 2016).
For implementing metrics to measure outcomes, IPV-CCGT adopted several
scientifically-reliable psychometrics available in the Behavioral Health Data Portal (BHDP).
BHDP is a web-based platform, sanctioned by DoD to measure patient clinical outcomes; as well
as using the DoD/Army Healthcare Provider Relative Value Unit (RVU) and Full-Time
Equivalent (FTE) target benchmarks to measure LIP productivity (ASM, 2012). It is also used to
measure overall program evaluation by combining the results of clinical outcomes, LIP
productivity, program completion rates, and the results from the telephonic survey offered to
group members who have completed the program. IPV-CCGT is currently in coordination for a
pilot implementation site at the Family Advocacy Program (FAP) clinic in Weed Army
Community Hospital (WACH), Fort Irwin, California.
IPV IN THE US ARMY 3

Considering the complexity and prevalence of the IPV phenomenon, this paper offers a
conceptual framework, synthesize from a review and analysis of several theories of human
development and behavioral change, to enable a reasonable understanding of the etiological
underpinnings of IPV. In developing this conceptual framework, it draws from the works of
Albert Bandura's Social Cognitive Theory (SCT; Bandura, 1989) and Dahlberg & Krug (2006)
Social-Ecological Model (SEM). Selected concepts from SCT and SEM are integrated not only
to develop a conceptual framework but also to build the IPV-CCGT program and its logic model.
The Problem of Intimate Partner Violence
IPV is a wicked problem that is not only prevalent on a global scale, but also throughout
the United States of America at large. Studies have shown the impact of IPV is indiscriminate,
negatively affecting every ethnic and cultural group, and members of all socio-economic status
(Flyn & Graham, 2010). The World Health Organization (WHO, 2005) conducted a landmark
research project on domestic violence, which surveyed over 24,000 women across 10 different
countries. The results of the study indicated that between 29% and 62% of women reported
either being physically or sexually abused by their intimate partner at some point in the
relationship. Smith and colleagues (2017) conducted a survey study for IPV and, Sexual
Violence (SV) with 22,590 women and 18,584 men. The results indicated 59-86% of women
experience at least one IPV-related incident in their lifetime, whereas men reported 38%. The
highest rate of sexual violence associated with IPV were Native American women at 45%
(Tjaden & Thoennes, 2000; Smith et al., 2017).
Similarly, the US Military population also experience problems with IPV. In 2001, DoD
reported more than 18,000 cases of spousal abuse, with 84% of those cases involving physical
violence. According to an IPV study conducted by Campbell and colleagues (2003) of 616 active
IPV IN THE US ARMY 4

duty military women, 22% of women reported experiencing IPV while serving on active duty.
The DoD Task Force on Domestic Violence (2001) reviewed military DV homicides data from
1995 to 2001 and found 54 DV homicide cases in the Navy and Marine Corps, 131 for the Army,
and 32 cases in the Air Force. In examining the problem of IPV in the US Army, evidence
indicates an alarming increase in IPV incidents since the start of Afghanistan and Iraq wars.
According to the Department of the Army (DA; 2012), from Fiscal Year 2006 to 2011, there was
a 33% increase in overall DV incidents in the active-duty Army. In their study of veterans
returning from combat that suffer PTSD, Gerlock and colleagues (2014) reported that a PTSD
diagnosis directly related to a combat deployment negatively impacted a couples’ relationship,
and led to higher rates of marital discord and some form of partner abuse (Gerlock, Grimesey, &
Sayre, 2014). Since the Army installation of Fort Irwin (California) is the projected site for
piloting IPV-CCGT, it too has problems with IPV. During interviews on SOWK 723, senior
leaders on base such as USA Garrison Commander and FAP-Manager reported an increase in
problems with domestic violence and IPV. The FAP clinic at WACH also reported
approximately 320 cases of DV/IPV for 2018, with an IPV recidivism rate of 9.14%, which is
significant for a total base population of approximately 10,000 residents.
Review of Existing Interventions
While an extensive body of research exists regarding efforts to tackle the IPV
phenomenon directly, outcomes from those interventions and efforts remain unclear (Choo,
DeLuca, Tape, Cowell, & Zlotnick, 2015; Edleson, Lindhorst, & Kanuha, 2015). The majority of
those existing interventions, particularly in the civilian sector and some in the military are almost
exclusively gender binary, and separately treat individual victims from perpetrators of IPV.
These approaches have been well justified given the sensitivities and considerations for the
IPV IN THE US ARMY 5

safety of victims, and potential for retaliation from perpetrators (McCollum & Stith, 2008). In
fact, over 40 US states have guidelines for certifying psychoeducation programs toward
perpetrators to change their attitudes and beliefs about DV and IPV, which are considered
batterer intervention programs (Parker, 2007; Gandolf, 2012).
DoD established a partnership with the National Institute of Food and Agriculture to
develop an organization that would evaluate clinical and support programs to be used in the
military, mainly to reduce barriers to evidence-based practice for military applications (Perkins,
Aronson, Karre, Kyler, & DiNallo, 2015). As a result, they funded the Clearinghouse for
Military Family Readiness with Penn State University, which has reviewed an extensive amount
of clinical and support programs used within the military setting. The Clearinghouse includes a
team of researchers and evaluation scientists that would review and examine a specific program,
and then designate that program along the continuum of evidence, which consists of the
following designations: Effective, Promising, Unclear, and Ineffective. While they have reviewed
more than 900 programs used by military personnel and families, several programs they have
reviewed are consistent with the modality of conjoint couple therapy/group and multiple family
member interventions for cases of IPV and/or domestic violence (Perkins et al., 2015).
The Choice Program is a program implemented by the US Navy to stop verbal and
physical abuse in intimate partner relationships. The program focuses on building skills to
effectively improve relationships but reduce negative behaviors associated with partner violence.
These skills include problem-solving, communication, developing trust, understanding control,
anger management, and taking time outs to mention a few. Based on the Clearing House review
of this program, it designated the program's effectiveness as Unclear. It required a program
evaluation that demonstrates at least one year of sustained positive effects (Clearinghouse, 2015).
IPV IN THE US ARMY 6

The Duluth Model is a program that has been used by some clinical practitioners in the
military to treat IPV or DV perpetrators and victims. The program is underpinned by the
principle that battering is a technique or strategy used by men to impose control over their female
partners. Therefore, it focuses on holding offenders accountable, encourages change in societal
norms and attitudes about men's use of control over women. In its evaluation of the outcomes
and efficacy of the Duluth Model, the Clearing House found that this model offered mixed
findings, and designated its program effectiveness as Unclear; moving the Duluth Model from
Unclear to Promising category required at least a one-year evaluation from start of the program
with a demonstration of positive effects (Clearinghouse, 2016). Similarly, STOP DV Program is
an intervention used by FAP clinics at a variety of different Army installations to treat victims
and perpetrators of IPV and DV. In this program, victims and perpetrators are treated separately.
The program offers group skills-training in order to improve communication and relationship
skills for group members. According to the Clearing House review, the effectiveness of the
program is considered Unclear due to the lack of program evaluation or mixed results
(Clearinghouse, 2016).
The Family Wellness: Survival Skills for Healthy Families is a program used by all
branches of the military designed to improve family communication and relationships,
particularly in preventing domestic violence, child abuse, and drug and alcohol abuse. The
program is intended to be used with individuals and large groups of families. It is a six-session
program that provides education and skill-building curriculum. The Clearing House examination
of this program indicated that the effectiveness of the program is Unclear, and requiring one
peer-reviewed evaluation demonstrating positive effects for at least six months to fully consider
any level of effectiveness (Clearinghouse, 2017).
IPV IN THE US ARMY 7

It should be noted that all these programs are civilian sector programs, but have been
adopted for use by military clinical and non-clinical practitioners. While these programs provide
a broad range of interventions to support IPV victims and perpetrators separately or conjointly,
their effectiveness and outcomes have been limited, often requiring further program evaluations.
There are a host of reasons why IPV-CCGT invariably differs from these programs. IPV-CCGT
focus exclusively on working with couples conjointly, uses an empirically-informed curriculum,
facilitated by hospital credentialed LIPs; it measures outcomes that include staff productivity,
individual clinical outcomes, and overall program evaluation that consists of a two-year
telephonic survey of voluntary group members that have successfully completed the program.
Most importantly, IPV-CCGT closely monitors the safety of individual group members and
employs safeguards that are prescribed by DoD guidelines. For all these reasons, IPV-CCGT
may offer the best opportunity to support Army couples in their effort to specifically reduce
violence while remaining in the relationship, as well as supporting Army Readiness.
II. Conceptual Framework
Definitions
According to the Centers for Disease Control (CDC) and Prevention, Intimate Partner
Violence (IPV) is described as violence that includes physical and sexual contact, stalking, and
psychological aggression by a current or former intimate partner (Smith et al., 2017). World
Health Organization similarly describes IPV as any act of violence, including physical,
psychological, or sexual, against an intimate partner (WHO, 2012). Finally, the U.S. Army
defines IPV as any violence or abuse by a current or former partner or spouse. Those acts include
physical, sexual, and emotional abuse (DOD, 2015).
Review of Theoretical Approaches
IPV IN THE US ARMY 8

Scholars and researchers have attempted to understand and explain the etiological
underpinnings of IPV using several theoretical frameworks appropriate for understanding human
development and behavioral change. John Bowlby’s seminal work on Attachment Theory
(Bretherton, 1992; Basham, 2007) is among those theoretical frameworks. At the foundation of
attachment theory is the emphasis of the healthy development of parent/caregiver-child
relationship and bond during early child development, which theoretically leads to the healthy
development of relationships with others. More importantly, when forging this bond a child
would develop a response system towards the parent/caregiver in the form of an attachment style
or working models. Among those attachment styles is insecure/anxious attachment, which has
been recognized as early markers or predictors of IPV.
Albert Bandura’s (1971) Social Learning Theory (SLT) on the other hand, attempted to
understand behavioral change based on social interactions. The concept of modeling within SLT
is the most salient in understanding IPV. Bandura recognized that while external reinforcement
can help in shaping behaviors, learning through modeling actions of others have an even more
substantial impact on shaping one's behaviors. Studies have shown that children who grow up in
abusive homes are at higher risk of becoming IPV offenders (Hyde-Nolan et al., 2012). Murrell
and colleagues (2007) in their study of adult males that were offenders in IPV and DV incidents,
found that those very same adult males reported early childhood exposure to IPV (Murrell,
Christoff, & Henning, 2007).
Family Systems Theory by Murray Bowen (1972) also offers an adequate understanding
of factors that underpin the IPV phenomenon, particularly in the context of the family unit.
Bowen’s concept of differentiation involved an individual's ability to successfully differentiate
not only within one's self but also from one's family; which occurs at both the intrapsychic and
IPV IN THE US ARMY 9

interpersonal levels. Poor differentiation and problems that may surface to derail the family
functioning can lead to the development of risk factors associated with IPV, both in the family of
origin and over the lifespan of an individual (Walsh, 2003; Peleg, 2008).
Albert Bandura later build on SLT to develop Social Cognitive Theory (SCT; McAlister,
Perry, & Parcel, 2008), considered among the most comprehensive approaches to explaining the
etiological development of IPV. SCT considers the importance and impact of early childhood
development experiences, particularly children modeling behaviors of adults in their lives; it also
integrates cognitive aspects of processing (working models) the relationship between self and
others. SCT considers the impact of a community on shaping attitudes, norms, and tolerance for
family violence and IPV (McAlsiter et al., 2008). Finally, Social-Ecological Model (SEM;
Dahlberg & Krug, 2006) also provides a comprehensive understanding of family violence and
IPV. According to SEM, there are four levels of understanding of violence. First, the Individual
level, which focuses on biological and personal aspects of an individual that may lead to
becoming a victim or perpetrator of violence. Second, the Social Relationship level, which
considers a person’s relationship with others that may influence a person’s experience and
behavior. Third, the Community Context level, which examines how a community context and
characteristics shape an individual’s tendency to be a victim or perpetrator of violence. And
fourth, the Larger Society level, which includes an understanding of societal factors and their
impact on rates of violence.
Conceptual Framework
Given the comprehensive approaches of both SCT and SEM, not only do they provide a
robust theoretical framework and foundation for explaining IPV, but equally describe factors that
may perpetuate and reinforce IPV beyond childhood or the individual. More importantly, it
IPV IN THE US ARMY 10

offers long term impact on the GC build healthy relationships to end violence, particularly the
community and larger society level within SEM context (Kazemi, Allahverdipour, Pourrazavi,
Nadrian, & Jafargbadi, 2018). When juxtaposed with other mentioned theoretical frameworks,
SCT and SEM appear to have strong associations with Bowlby's attachment theory and Bowen's
family systems theory. However, when certain SCT and SEM concepts are synthesized, not only
are they sound as a foundation in developing a conceptual framework, but also superior in
formulating an implementation strategy and intervention for IPV. The synthesizing of both SCT
concepts (e.g., Reciprocal Determinism, Self-Efficacy, Incentive Motivation, Observation
Learning, and Moral Disengagement) and SEM concepts (e.g., Secondary Prevention, Tertiary
Prevention, Universal Interventions, and Selected Interventions) will facilitate the development
of IPV-CCGT conceptual framework and logic model.
IPV-CCGT Logic Model
The IPV-CCGT logic model is establish to ensure the development and implementation
of IPV-CCGT in the Army, as well as its potential pilot site at Fort Irwin, California. The IPV-
CCGT logic model is illustrated in Appendix-A. It identifies resources, activities, outputs and
outcomes for the IPV-CCGT implementation, growth, and sustainment. The IPV-CCGT logic
model is underpinned by previously mentioned three foundational pillars of IPV-CCGT. Those
three pillars are aligned with INPUTS of the logic model, and complements the conceptual
framework that is synthesized from elements of SCT and SEM. In particular, social, cognitive,
and environmental factors that influence clinical outcomes, and the bidirectional impact of both
the individual and societal level context in reducing IPV recidivism, while increasing marriage
quality and resiliency.
IPV IN THE US ARMY 11

In the IPV-CCGT logic model, outcomes and impacts are considered along three
different phases. These three phases are associated with Short-Term, Medium-Term, and Long-
Term. Short-Term phase starts in the beginning of the one-year pilot and ends after the
completion of the one-year pilot program; the Medium-Term phase starts immediately at the end
of the one-year pilot and not exceed a one-year period; and Long-Term phase starts immediately
after the end of Medium-Term phase, and continues as part of the program sustainment.
III. Problems of Practice and Solution(s)
IPV-CCGT Description
IPV-CCGT is a six-week, one 2-hour session per week conjoint couples group therapy
modality that directly focuses on the problem of IPV with military couples, increasing awareness
of risk factors associated with IPV incidents, and developing both individual and couples
strategies/skills to not only increase marriage quality and resilience, but also to reduce rates of
IPV recidivism. The program curriculum adheres to Health Insurance Portability and
Accountability Act (HIPAA) and DoD Manual 6025.18 (2019) regarding matters of
confidentiality, and DoD Manual 6400.01-Vol. 4 (2015) regarding “Limited on Use” and
“Contraindications” for inclusion and exclusion from enrollment into the program.
The program will be co-facilitated by two credentialed LIP at all times. Safety is the
utmost consideration for the program, which will be closely monitored throughout the program
and during each weekly session. Participation is strictly voluntary. An offender or perpetrator of
IPV/DV must have completed a DV intervention program at least 30 days prior to the date of
screening appointment for IPV-CCGT. The couple must be at least 30 days free of any IPV/DV
incidents prior to screening appointment date for IPV-CCGT. All participants will complete
selected clinical psychometrics prior to each session in order monitor safety concerns, as well as
IPV IN THE US ARMY 12

other clinical symptoms (e.g., suicidality, depression, PTSD, etc.) deem essential in the overall
consideration of IPV. The clinical psychometric surveys will be administered and completed by
each participant on the BHDP (ASM, 2012) via a computer tablet provided by the program. The
psychometric surveys are used for purposes of measuring individual and couples clinical
outcomes, clinical staff effectiveness, and program evaluation. The one-year propose pilot
location for the program is at the FAP, Fort Irwin, California. The program days/hours are on
Thursday at 1500-1700. If/when daycare is required, couples may directly coordinated free of
charge daycare services through the FAP-Management (FAP-M).
Broader Impact of IPV-CCGT Innovation
The IPV-CCGT innovation truly has broad impact across many communities of America.
Two major GC closely connected to this innovation are build healthy relationship to end violence
and harnessing technology for social good. IPV-CCGT innovation directly contributes to build
healthy relationship since it interject to disrupt abusive and distressed partner relationships by
providing clinical treatment that is empirically-informed, uses measures and screenings, targets
clinical outcomes, and facilitated by LIPs specifically trained and competent on both IPV and the
use of couples group intervention. The use of technological applications within IPV-CCGT is
important to developing an appreciation of its contribution to the grand challenge of harnessing
technology for social good. BHDP is a tremendous technological platform and application that
assists both LIPs and patients in tracking their progress, along with aiding treatment
recommendations/planning and diagnostic clarification.
Perspective of Other Stakeholders
Most of the stakeholders on Fort Irwin that are connected to the IPV problem have
presented their views on IPV during direct interviews with this author in course work SOWK
IPV IN THE US ARMY 13

723. During an interview with a FAP clinical social worker, he indicated that IPV was a
significant problem in the Army, and commanders and leaders do not take it seriously. In an
interview with a FAP-Management worker, she stated that IPV is a major concern, but family
members must also be mandated for treatment like service members. During an interview with
the USA Garrison commander, he too saw the problem of IPV as significant and complex, and
would prefer a more focused approach on the “drivers” for IPV or domestic violence incidents.
In an interview with the Chief of Directorate of Emergency Services (DES), he had expressed
great concern about the problem with family violence and IPV on Fort Irwin, as well as across
the Army given his almost 20 years of service and having served at more than 10 different Army
bases (SOWK 723, 2018). The aforementioned Fort Irwin stakeholders were also asked about
their views on this author’s proposed innovation of conjoint couples’ psychotherapy group.
Virtually all the stakeholders agreed that the proposed intervention is needed for Army couples
and the problem of IPV. Stakeholders that were involved in clinical care understood the need to
have a standardized approach across the Army, and welcomed this innovation as a great idea in
filling a gap in current clinical intervention.
Building on Existing Practices and Research
In order to tackle the wicked problem of IPV in the Army, this author proposes an
innovation that focus on implementing an empirically-informed conjoint couple group therapy,
also known IPV-CCGT. The aim of this innovation is to increase marriage quality and resiliency,
while reducing IPV recidivism rates among Army couples at Fort Irwin, and eventually Army-
wide. Additionally, IPV-CCGT will specifically target drivers and risks factors that have been
known to trigger IPV incidents. These drivers and risks factors are by and large informed by
IPV IN THE US ARMY 14

empirical research, Army literature, emerging research evidence, and interviews conducted with
proponents and key stakeholders in the Army on the issue of IPV.
There are a host of reasons to take on the approach and innovation of implementing IPV-
CCGT at Fort Irwin and across the Army. In current Army clinical practice settings, the Army
does not have a specific conjoint couple group therapy that specifically target IPV. The Army
does offer separate group therapies for either victims or offenders of domestic violence and IPV,
but not for conjoint couples. While the Army FAP does offer marriage therapy in general for
couples with domestic violence, it is far short of evidence-based or empirically-informed
treatments threshold. Similarly, in the current Army non-clinical practice setting or community-
based settings, the Army FAP-M offers only psychoeducation groups for couples; and their
outcomes and effectiveness are not being measured or tracked.
Unfortunately and a matter of fact, current efforts by Army FAP clinicians have been a
hodge-podge of interventions that varies significantly based on the clinicians’ experience and
arbitrary clinical comfort, and often short of the evidenced based practice threshold.
Furthermore, both the Army and those clinicians appear either ill-equip or disinterested in
implementing any metrics to measure the effectiveness of their interventions. The Clearinghouse
for Military Family Readiness (Kaye et al., 2018) conducted a recent study regarding family
violence recidivism rates across 11 different Army installations. The results of the study
indicated one of its principle recommendation was to overhaul current programs that have been
proven ineffective, and simultaneously employ the application of evidence-based and
empirically-informed treatments that focus on factors proven to contribute to IPV incidents.
Stith and colleagues (2004) conducted an empirical study of 53 couples that had
previously experienced domestic violence or IPV but had decided to stay together. The couples
IPV IN THE US ARMY 15

were randomly assigned to three different groups of intervention that included individual
couple’s therapy, multi-couple group therapy, and a comparison group. Findings from the study
indicated the couples’ in multi-couple group demonstrated significantly lower rates of recidivism
compared to the other two groups. IPV-CCGT builds on gains achieved from those studies. Then
there is the most pragmatic reason and justification for implementing an IPV-CCGT
intervention. Consider that at least 50% of Army couples that have experienced IPV remain in
the marriage, although the number is likely higher given Army culture that impact accurate
reporting (SOWK 723, 2018). Even those in the Army that seek separation or divorce
immediately after an IPV incident are more than likely to remain in the marriage. In fact, the top
two contributors to Army divorce rates are multiple/extended deployments and difficulty dealing
with PTSD (for both the service member and the spouse/children), not IPV (LawInfo, 2018).
According to McCollum & Stith (2008), approximately 50% to 70% of women remain with their
partners after being assaulted by their partner. For all those reasons, IPV-CCGT offers an
opportunity to potentially bridge the existing gaps in practice and research.
Assessing the potential for IPV-CCGT Success
The overall likelihood for success of IPV-CCGT is medium to high. There are five
factors to consider in the overall projection of IPV-CCGT success. First, the problem of IPV in
the Army and military is not only prevalent, but has been trending upward since the commencing
of combat operations in Afghanistan and Iraq, along with intensification of other global
commitments as part of the US National Defense Strategy. Global commitments are not going
away any time soon, as well as the problem with IPV; particularly when current interventions
continue to be ineffective and insufficient, while many couples ultimately remain in their
relationships. Second, the cost potentially associated with this type of effort and innovation may
IPV IN THE US ARMY 16

not be as significant. This will be discussed in detail in the overall revenue strategy section.
Third, this author has received some initial support of this innovation from some significant and
influential individuals, not only in the military, but scholars and research scientist in this problem
area, such as Dr. Daniel Perkins of the Clearinghouse for Military Family Resilience, and Dr.
Sandra Stith, a university distinguished professor at Kansas State University and one of the
primary authors of the Intimate Partner Physical Injury-Risk Assessment Tool (IPPI-RAT).
Fourth, there has been some signs in shift of attitudes by Army senior leaders’ towards
sensitivities of DV and SA. The current Chief of the Joint Chiefs of Staff, General Miley has
recently published his priorities for the entire Army, this included a clear message about zero-
tolerance for acts of DV/SA, and such acts is a violation of Army Values. And lastly, the
potential ethical implications of such program on individuals or couples given not only the social
stigma, norms, and attitudes surrounding IPV, more importantly the safety and further harm it
can impose on victims. In light of those well placed potential ethical concerns, this program has
been developed with a paramount emphasis on assessing and on-going monitoring of members
personal safety throughout the program, as well as implementing the safeguards for this modality
outlined in DoD Manual 6400.01 (2015).
IV. Project Structure, Methodology, and Action Components
IPV-CCGT Prototype
The prototype selected for IPV-CCGT innovation is the program curriculum, illustrated
in Appendix-B, and an included website link at the conclusion of this paper. IPV-CCGT
curriculum draws from the empirical works of John Gottman and Gottman Insititute (2015),
Couples Therapy for Domestic Violence: Finding Safe Solutions by Dr. Stith and colleagues
(2004), Family Violence Recidivism Command Support Study (Kaye, Aronson, & Perkins,
IPV IN THE US ARMY 17

2018), and informed by other major Army reports that includes Army 2020 Generating Health &
Discipline in the Force (DA, 2012) and Leader’s Guide for Building Personal Readiness and
Resilience (DA, 2016). The program curriculum outline is as follows: Session-1: Introduction to
IPV-CCGT, The Landscape of IPV, and Honoring the Problem; Session-2: Mindfulness & Time-
Outs; Session-3: Emotional Regulation; Session-4: Understanding Military Lifestyle Stressors;
Session-5: Understanding Psychiatric Conditions; and Session-6: Summarizing IPV-CCGT
Experience. Long-Term Safety & IPV Recidivism, and Termination.
Market Analysis
The current market for programs on IPV has increase variability, saturated with a broad
range of approaches that include IPV victim or batterer-only group programs, individual
counseling, advocacy and support services, and family or marriage counseling (McCollum et al.,
2008; Edleson et al., 2015). These programs exist in the military, but mostly in the civilian
sector; some were mentioned earlier in the existing program(s) section of this paper. However, in
conducting an analysis of current programs in the military and civilian sector, IPV-CCGT offers
a more competitive edge when juxtapose with other existing programs in the Army, other
military sister service, and civilian programs. Market competitive analysis is further illustrated in
Appendix-C1 and C2.
Implementation
The implementation framework selected for IPV-CCGT is the Reach, Effectiveness,
Adoption, Implementation, and Maintenance (RE-AIM). RE-AIM has been chosen because of its
goodness of fit for IPV-CCGT in areas of program implementation and evaluation. When
considering the clinical and data-intensive nature of IPV-CCGT, the RE-AIM framework
provides the most comprehensive approach in assessing those two major areas (Weaver, 2014;
IPV IN THE US ARMY 18

Glasgow, Vogt, & Boles, 1999; Nilsen, 2015). Appendix-D outlines a table depicting the RE-
AIM framework alignment with the logic model phases, along with a Gantt Chart in Appendix-
E. In the Reach component, Fort Irwin has a population of approximately 10,000 people.
However, the percentage of the population directly impacted by IPV-CCGT is 15% (640 people
or 320 intimate partners/couples). This was determined based on data collected by the Fort Irwin
FAP, which reported 320 couples referred for treatment/services in 2018 as a result of reported
IPV incidents to Military Police (MP) or other mandated reporting entities/persons (SWOK 723,
2018). Given the 15% segment of the Fort Irwin population involved in treatment due to IPV in
2018, that number becomes the initial baseline planning/estimate factor as a target to reach for
this program. The reach component is conducted during the Short-Term phase of the logic
model.
In the Effectiveness component, three major areas will be assessed to determine if the
intervention achieve its goals. These areas are 1) clinical outcomes, 2) staff/LIP productivity, and
3) overall program effectiveness. In assessing the effectiveness of clinical outcomes, the
participants’ clinical scores from all psychometric instruments will be reviewed. These
instruments are IPPI-RAT and Couples Satisfaction Index (CSI). Since the instruments are
administered during pre-entry, participating, and post-program intervention phases, data will be
collected throughout all those intervention phases (ASM Research, 2012). Of note, the
intervention phases are conceptually different from program implementation phases. Whereas
clinical intervention phases are align under the umbrella of evaluation phases and strictly focus
on the clinical data/outcomes, program evaluation phase is broader in nature. The increase in
scores during pre and post-test score from IPPI-RAT and CSI surveys will suggest improvement
in clinical outcomes and positive changes in behaviors. Improvement in Therapeutic Alliance
IPV IN THE US ARMY 19

(TA) psychometric score, as well as clinical staff monthly compliance with RVUs generation
performance expectation will suggest increase in staff effectiveness and productivity. The overall
effectiveness and efficacy of the program will be based on clinical outcomes measures, staff
effectiveness/productivity measures, and the long-term outcomes from the telephonic surveys
offered to participants a duration of two years. The IPPI-RAT survey will serve as the primary
questionnaire for the post program telephonic survey. The effectiveness component is conducted
throughout all three phase of the logic model.
In the Adoptions component, IPV-CCGT will be delivered at/by Fort Irwin FAP clinic.
The staff includes the program director, two LIP, one data analyst, and one administrative staff.
The adoption will be assessed based on structured interviews of the staff by the Chief of
Behavioral Health Department at Fort Irwin (Glasgow et al., 1999). The interview will tease out
areas that address adoption elements, particularly staff insights about staff satisfaction, potential
risks, and barriers/constraints associated with the program and its implementation. Each staff
member will be interviewed before the start of the intervention, and upon the completion of the
intervention after each cohort. A comparison of the two interviews will determine the
effectiveness of the adoption component. The adoption component is conducted throughout all
three phase of the logic model.
The Implementation component is assessed by how each participant participates
throughout the six-week program, including completing all clinical instruments weekly, and fully
completing the program. Because of the importance of program fidelity in implementation
component, auditing by program director of pre-screening biopsychosocial encounters between
clinical staff and participant will be completed; in order to determine if the participant was fully
informed (e.g., informed consent form, etc.) about the scope and expectations of the program.
IPV IN THE US ARMY 20

This sets the stage of ensuring the program will be delivered as it had intended. Other items
assessed will be reviewing the weekly check-in and check-out log, as well as reviewing LIP’s
weekly clinical notes and documentation (ensuring compliance with documentation standards
based Joint Commission and local policies), and the weekly completion of clinical instruments.
Other selected methods to assess the effectiveness of implementation are structured-interviews of
staff, and reviewing the participants weekly feedback sheet; which include questions about the
effectiveness of the delivered curriculum for that session, and staff effectiveness during the
session. The implementation component is conducted throughout all three phase of the logic
model. In the Maintenance component, the six-month increment of telephonic surveys for a total
of two years will provide an indication of maintenance effectiveness on participants’ clinical
progress and outcomes over time. Additionally, maintenance effectiveness for the program is
assess with the full completion of the one-year pilot, and successfully transition to the next phase
of scaling the program at selected Army installations. Other aspects of maintenance that will be
assess are the quality and efficiency of program outcome-reports, particularly presenting the
outcome-reports at the bi-annual Review & Analysis (R&A) to the Army Family Advocacy
Committee (FAC) and Army Installation Management Command (IMCOM) at Joint-Base San
Antonio (JBSA) in San Antonio, Texas. The maintenance component is conducted during long-
term phase of the logic model.
Process and Outcome Measures and Evaluation
The IPV-CCGT will be implemented and evaluated based on outcomes objectives. Three
areas will be used as objectives to measure the program outcomes. These areas have already been
briefly presented in the Effectiveness section of the RE-AIM framework, however, this section
will explain their purposes further. In the area of clinical outcomes, two clinical web-based
IPV IN THE US ARMY 21

psychometrics will be administered to measure clinical outcomes; these are IPPI-RAT and CSI.
The IPPI-RAT is a 15-item survey that not only reports past and current incidents of domestic
violence, but also predict risk for future incident of domestic violence (Keohnae, 2016). The CSI
is a four-item clinical survey that identifies relationship satisfaction and distress (ASM Research,
2012). However, there are other psychiatric conditions that may meet or exceed clinical
thresholds for appropriate psychometrics within BHDP; such as GAD-7 (Anxiety), PCL-5
(Depression), AUDIT (Alcohol), BAM (both Alcohol and Drugs), CSSRS-S (Suicidality), and
BASIS-24 (Overall Distress). Given that some of these psychiatric conditions can be comorbid
or sequelae to IPV, if identified or meet clinic threshold during the screening and comprehensive
assessment appointment, they too will be added to the individual clinical outcome measure, but
only as a secondary measure. In the area of staff effectiveness and productivity, two things will
enable the assessing of this outcome; they include the TA survey, which is a three-item clinical
survey that indicates the effectiveness and strength of response from the participant to the
clinical provider (ASM Research, 2012). Staff productivity will be measured based on RVU
matrix that sets workload/productivity benchmarks for each staff based on their specialty and
work setting. The overall program effectiveness outcome will be measured based on clinical
outcomes, staff effectiveness and productivity, and the outcomes of the six-month telephonic
survey (using IPPI-RAT instrument) increment for a duration of two years.
Plan for Measuring Outcomes
The plan for measuring outcomes for IPV-CCGT is the use of a quasi-experimental
single group pretest-posttest design, with a simple linear regression analysis model (See
Appedix-10 for outcome measures). The group will compose of one cohort, which consist of at
least four and no more than six couples. For the clinical outcomes, the IPPI-RAT and CSI web-
IPV IN THE US ARMY 22

based surveys will be administered to each individual participant prior to starting the program
(during prescreening appointment). This will be completed using the BHDP. Participants will
then complete the same surveys on BHDP immediately before leaving the final session (6
th

session) of the program. The data analysts collects the scores from pre and post-test for analysis
and coding, and then review the outcomes with the program director. Improved scores on both
IPPI-RAT and CSI will suggest effectiveness of clinical outcomes. Of note, BHDP is a secure
and confidential data portal that can only be accessed based on specific clearance and
authorizations by the military.
For staff effectiveness and productivity, the TA score and RVU generation will measure
their outcomes. The TA is also part of BHDP. The TA survey will be administered to
participants when reporting for the third session and the remainder of the program. Because TA
measures the responsiveness of the participant to the clinical staff, it would be unfair to
administer TA during the first and second session because the participant is just starting to build
a rapport with the clinical provider. The RVU compliance will be monitored on a monthly basis
to assess if the clinical staff is meeting workload/productivity expectations. Improved TA scores
and improved RVU compliance will suggest staff effectiveness and productivity.
In measuring overall program effectiveness, data from clinical outcomes (IPPI-RAT and
CSI scores) and staff effectiveness & productivity (TA and RVU compliance) will be used to
evaluate the overall program effectiveness. The only other addition is the data and outcome of
the telephonic surveys administered to participants every six-month increments from the date of
program completion for a duration of two years. The IPPI-RAT survey will be the primary
survey used for the telephonic survey. The telephonic survey will only be given to those
participants whom volunteer for the telephonic survey; one of the designated LIPs will be
IPV IN THE US ARMY 23

responsible for administering the IPPI-RAT during telephonic survey, and the LIP will document
results in participants’ electronic medical record. A score of “NO” on all 15-items on the IPPI-
RAT during telephonic surveys will suggest effectiveness of the program. The data analyst will
collect, analyze, and code all three major measured objectives and review with program director,
and generate appropriate outcome-reports.
The strengths of the evaluation is the use of both scientifically-reliable psychometrics and
empirically-informed curriculum. It also includes the efficiency of data collection from data
input using computers to complete web-based (BHDP) structured questions on the surveys; more
importantly, the storage and safeguarding of the data that is secured in a military access-only
data portal. The hiring of a data analyst is also a strength of the program implementation, which
will provide the most optimal expertise to ensure all aspects of data collection, analysis, coding,
and reporting are performed to standard. Another strength is the ability monitor the long-term
maintenance of this program with the two-year telephonic survey; providing the opportunity to
assess the long term effectiveness of the program on couples and their behaviors. The ability to
be accountable with milestone reporting requirements to higher echelons (e.g., FAC, IMCOM,
etc.) bi-annually is also a strength; this ensures the program is responsive and accountable to
external institutions. Another identified strength is the effectiveness and productivity of clinical
staff. Far too often, most mental health clinical intervention/programs focus on only
participants/clients behavioral changes; IPV-CCGT ensures the effectiveness and productivity of
the clinical staff is evaluated, particularly its potential effect on participants clinical outcomes.
There are some limitation associated with program evaluation. Given the historical
military demographics of IPV cases referred to FAP for services and support, it is anticipated
that that trend will continue. Historically, FAP cases were predominantly enlisted rank E-5 and
IPV IN THE US ARMY 24

below, ages 18-26, and of some minority group. This demographic trend will likely not be
representative of the Fort Irwin total population, since there are also soldiers at Fort Irwin with
the rank of E-6 and above as well as officers in the rank of O-1 and above; in addition, there are
also soldiers older than age 26, and along with soldiers and families of Caucasian. The sample
size is also a limitation. There are only four to six couples per cohort, which is a very small
sample. Even if you add up all the six cohorts from the entire one-year pilot, that still only
equates to 24 couples, and not including the potential for a drop-out rate of perhaps one couple
(25%) per cohort.
The way to overcome some of these limitations is developing an active engagement and
networking strategy with military commanders. Military commanders wield a lot of authority
and control over the day to day lives of soldiers and their families. They can be very helpful in
promoting IPV-CCGT and its advantages to preventing or reducing IPV incidents, particularly
newly arrived service members to Fort Irwin, and high-ranking Soldiers. The unit commander
can also ensure the Soldiers understand the voluntary nature of the program and reducing
perceptions about negative career implications or stigma associated with seeking treatment in a
FAP setting.
Dissemination Plan
The plan to disseminate IPV-CCGT outcomes/findings will focus on two major
stakeholders (See Appendix-F for Dissemination Plan illustration). One stakeholder is in the
inner-context while the other is in the outer-context. The findings for the program will be
presented and disseminated by the program director in person to the Army FAC and IMCOM
(outer-context) bi-annually at JBSA, San Antonio, TX. The program findings will also be
presented and disseminated in person by the program director to the Fort Irwin Community
IPV IN THE US ARMY 25

Health Promotion Council (CHPC; inner-context). This will be done quarterly when the CPHC
conduct its quarterly meeting. The CHPC is responsible for disseminating information, trends,
statistics, safety, best practices, information program and services, and many other items
regarding the Fort Irwin community. Both presentation will be conducted using digital
presentation of outcomes, depicted in the form of statistical models and graphs, as well as data
point trends.
Overall Revenue Strategy
The overall revenue strategy will be based solely on appropriated funding by US
Congress, which will eventually be distributed by Office of the Secretary of Defense (OSD)
funds and dollars to the Army FAP. There is no other source of revenue stream authorize by the
Army or DOD for funding of FAP operations outside of OSD dollars. Compared to most pilot
programs of this nature, the cost potentially associated with the IPV-CCGT innovation may not
be as significant. Particularly given that most of the high cost price items (clinical and
administrative staffing, infrastructure, web-based clinical survey in BHDP) connected with this
innovation are already baked within the Army FAP infrastructure and service delivery
capabilities. For example, the Army FAP is fully funded by congress through appropriated funds
earmarked for military family programs, which is not authorized to be used by local military
commanders for any discretionary use outside of the expressed purpose of FAP programs. IPV-
CCGT will be proposed under the umbrella of FAP service delivery, which if approved, will be
supported and protected under OSD dollars for FAP services. The only other items not already
baked into the current FAP program delivery is the propose IPV-CCGT curriculum, data
collection and analysis, and presentation of the pilot outcome(s). These items will require
additional allocated funding, which will be part of the overall propose program budget.
IPV IN THE US ARMY 26

Revenue Projections
Given IPV-CCGT will be a program and service delivered under the Army budget
operating structure, the only revenue stream authorized to be used for Army programs are OSD
funds appropriated by congress, as the auspices for Army budget and spending authorizing
environment. It is anticipated that the Army will commit the appropriate amount of revenue
dollars to support this program. In particular when considering the uptick of IPV problems and
incidents in the Army since 2001, especially when current interventions have been ineffective or
average at best. However, the overall funding magnitude of the IPV-CCGT is significant if not
fully funded by congress. The total cost of the program for the one-year pilot period is estimated
at $192K. This cost is based on a projected annual budget plan, and outlined in the program’s
line item budget format that considers the cost of spending on items like staffing, program
curriculum, web-based clinical surveys, equipment (computers), building space/rent, utilities,
and office supplies.
Phases of Intervention
For clients participating in IPV-CCGT, they will go through three major phases of the
program intervention. Those phases are pre-entry, participating, and post-program. In the pre-
entry phase, this is where potential clients, including all Fort Irwin residents, will be receiving
program marketing information. This will include program brochures mailed to local army
leaders, provided to Soldiers and families during newcomers briefing, and placed in information-
stands throughout the base (e.g., Post-Exchange, Commissary, gas station, etc.). It will also
include weekly announcements of the program on the Fort Irwin radio station, and displaying the
program information on the major marketing digital information boards across the base.
However, the most important part of the pre-entry phase is the pre-screening of potential
IPV IN THE US ARMY 27

participants based on voluntary self-referral. The pre-screening will include a comprehensive
clinical interview of the potential participant by a LIP, ensuring the individual and the couple are
a good fit and appropriate for the program. Of note, screening and comprehensive assessment
will be conducted individually. The assessment will documented in the FAP Intake template in
BHDP. Also during this phase, the individuals will be given more detail information about the
nature and scope of the program, as well as expectations, standards, and rules for the program.
Participants will also complete initial clinical surveys in order to determine baseline data and
pre-entry scores. This phase ends when the participants show up for their very first session.
In the participating phase, this is where couples are involved in the six-week program
intervention. Which includes being physically present for a two-hour group session once a week
at the FAP clinic conference room. Participants will also complete clinical surveys weekly before
the start of the group. They will be given the weekly empirically-informed curriculum by the two
co-facilitators (LIPs), a host of different interactive group exercises and learning lesson, as well
as experiencing the conscious and subconscious elements of group process and dynamics.
During this phase, the co-facilitators will be using both psychotherapy and psycho-education
techniques to facilitate the group process. These interventions/strategies, as well as the
curriculum are designed and expected to achieve behavioral changes for participants based on
this program’s overarching conceptual framework (SCT and SEM). The potential changes in
behaviors will be observed by co-facilitators during this phase based on participants self-report
during interactive weekly sessions, as well as analysis by the program director and data analyst
of the completed weekly BHDP clinical surveys. LIPs will also fully document participants’
session in their medical record in accordance with Army medical policy on clinical
IPV IN THE US ARMY 28

documentation. This phase ends when the participants complete the 6
th
session of IPV-CCGT,
and have a confirmed exit interview schedule within a week of completing the 6
th
session.
In the post-program phase, it starts with the exit interview with the participants conducted
by a LIP. The participants will complete the post program clinical surveys, and review with the
LIP the pre and post scores; mutually discuss any changes or lack of changes in behaviors; bi-
directional feedback between participants and LIPs on program effectiveness and lessons
learned; address issues of safety and safety planning; and informing participants of the voluntary
telephonic survey every six-months from program completion date for the duration of two years;
as well as clearly explaining to the participants the intent and rationale for the telephonic
surveys, and what is required of the organization and the participants regarding the telephonic
survey process (e.g., data collection and storage, HIPAA, etc.), and the voluntary nature of
participating in the survey. In the broader context of program design, the program
implementation and logic model phases are conceptually different from program intervention
phases. While the program intervention phases are align within the program implementation
phases, program implementation phases are much broader than the intervention phase. There a
three major phases in program implementation, they are short-term, medium-term, and long-
term. The program implementation phases are also outline in the logic model.
Units of Service
There are four major areas designated for units of service in IPV-CCGT (see Appendix
G). These areas are clinical psychometric instruments or surveys, telephonic surveys, number of
sessions completed, and LIP competency. IPPI-RAT and CSI will be used to measure the clinical
psychometric unit of service, particularly improvement of scores in those surveys. The
telephonic survey unit of service is based on the IPPI-RAT survey that will be used during the
IPV IN THE US ARMY 29

telephonic survey every six months post program completion for a duration of two years.
Success will be determined based a response of “NO” on all 15-items of the survey. If “NO” is
indicated on all 15-items, that will mean there has been zero incidents of IPV since post
completion of the program.
The number of sessions completed units of service are is measured by the amount of
sessions completed. Participants must complete at least four out of six sessions to be considered
a success for the program. This will be monitored by reviewing patient check-in status with the
administrative staff for each session, as well as reviewing the sign-out roster completed by the
participant immediately before departing each session and collected by one of the designated co-
facilitator. The LIP competency unit of service is measured by how many cohorts were co-
facilitator (LIP) complete during the pilot year. An LIP must complete >75% of cohorts for pilot
year to be considered a success in the program.
Staffing Planning and Cost
In designing the IPV-CCGT program, staffing planning is an enormous consideration
given the clinical and technical expertise, logistics, and operations required for the program.
There will be a total of five staff hired to execute IPV-CCGT. Because of the scope, workload,
and productivity required for the program, each staff member is hired under a .25 FTE unit of
workload. The staff composition includes one program director, two licensed clinical social
workers (LCSWs), one medical support assistant (MSA), and one data analyst (DA). The
program director is hired under the position description (PD) of a clinical supervisor, having a
master’s degree and fully independent licensed, as well as having at least five years of
supervisory experience. The programs director has overall responsibility of IPV-CCGT. This
includes monitoring the quality of care measures, productivity of clinical staff and other staff
IPV IN THE US ARMY 30

members, as well as generating reports and data to ensure the efficacy and fidelity of program
outcomes and measures. The cost to hire a program director for the pilot period will be
approximately $22,500.00 base salary, along with benefits that will be calculated based on 30%
of base salary.
The LCSWs are hired under the PD of clinical social worker, having a master’s degree
and fully independent licensed, as well as having at least three years of clinical experience in
work settings/areas such as family violence, domestic violence, IPV, and child protective
services (CPS); additional pay incentives may be negotiated with those with previous
experiences working in military settings, and/or advance expertise (fellowship, board certified
diplomate, etc.) in couples and group modality intervention. The LCSWs are responsible for all
direct clinical care components of IPV-CCGT. This includes completing a comprehensive
biopsychosocial assessment of participants prior to entry into the program; provides
couples/group intervention therapy using program curriculum; monitors participants’ outcomes
and safety risks, and keeps the program director informed of any critical concerns that may
impact the performance and quality care of the program. They will also have opportunities to
attend training for competency if/when appropriate. The cost to hire one LCSW for the pilot
period will be approximately $18,750 base salary, along with benefits that will be calculated
based on 30% of base salary.
The MSA will be hired under a PD of a Medial Support Assistant, with responsibility to
provide direct assistance to the program director and clinical staff in supporting IPV-CCGT. The
MSA will provide a variety of administrative tasks that includes checking in patients and record
keeping for all administrative aspects of IPV-CCGT. The cost to hire a MSA for the pilot period
will be approximately $10,000.00 base salary, along with benefits that will be calculated based
IPV IN THE US ARMY 31

on 30% of base salary. The DA will be hired under a PD of a Health Systems Specialist (HSS),
with a bachelor degree in information management; and specialized training/certification in data
quality and management. Additional pay incentives may be negotiated with those with additional
certification (e.g., lean six sigma, etc.). The HSS will be responsible for direct support to the
program director; collect, store, analyze, and code all the data metrics; and provide outcome
reports to the program director. The cost to hire a HSS for the pilot period will be approximately
$13,750.00 base salary, along with benefits that will be calculated based on 30% of base salary.
Finally, the total costs associated with benefits for all five positions at a rate of 30% of salaries is
$25,125 for the pilot period. When adding the cost for staff base salaries and benefits, the total
cost for personnel expenses of IPV-CCGT is $108,875.
Other Spending Plans and Costs
Other spending associated with IPV-CCGT are considered operating cost items or
expenses. This includes conference room space (rent), equipment (computers), technology (web-
based applications/clinical surveys), training and travel, program curriculum, and other necessary
supplies (paper, pencil, pens, binders, etc.). The conference room rent for the pilot period is
$8,400; cost of utilities is $360; cost for six computers/laptops to access and complete clinical
surveys is $6,000; the cost for web-based applications is $40,000; the cost for staff travel and
training is $8,000; the cost for the empirically-informed curriculum is $20,000; and the cost for
other supplies is $300. For the pilot period of IPV-CCGT the total cost associated with operating
expenses is $83,060.
Line Item Budget
The line item budget for IPV-CCGT outlines revenues, which is based on appropriated
funds by congress for Army family programs, and are further distributed by DOD to each local
IPV IN THE US ARMY 32

installation under OSD funds. The line item budget also outlines expenses associated with the
staffing and operation costs of the program, as well as any surplus or deficit after calculating the
revenue and expenses. Given the estimated revenue provided by OSD dollars for IPV-CCGT,
which is $192K, and the estimated expenses generated by the requirements of IPV-CCGT pilot,
which is $191,935, it would appear as though the result is a surplus of $65. The cost of staffing
and operating expenses estimated for IPV-CCGT are closely related to current projection of FAP
spending at Fort Irwin. The IPV-CCGT budget consideration was based on both Army and OPM
staffing models, including pay scales associated with federal employees under General Schedule
(GS). The bottom line on cost analysis and consideration for IPV-CCGT, when funded by the
congress in the form OSD dollars, the program pilot period will be fully implemented. However,
as mentioned earlier, if not fully funded by congress, then the magnitude of the cost is
significant. Particularly since the program falls under the Army, and other potential funding
revenue streams cannot be considered outside of OSD funds.
V. Conclusions, Actions, and Implications
Conclusion
IPV remains a wicked problem in American society and throughout the world. A
proliferation of interventions and initiatives to tackle the IPV phenomenon over the past 20 years
have been tremendous. However, far more sustained commitment and action in improving
policies, research, and practice remains quite an undertaking to eradicate IPV. IPV-CCGT aims
to offer an alternative approach to solving problems with IPV. Albeit controversial in the rightful
view of many, there have been some research and emerging evidence that suggests how this type
of approach can be beneficial when implemented with the appropriate safeguards in place
(Edelson et al., 2015). Outcomes from the IPV-CCGT pilot programs can help inform potential
IPV IN THE US ARMY 33

future decisions and actions by practitioners and program developers regarding either replicating
this approach or discourage further use of such approach. A significant amount of work remains
in changing behaviors, attitudes, and cultural beliefs that promote tolerance for IPV, such as
male privilege and androcentrism. So it is not lost on this author the real world implications,
limitations, and risks this approach has on participating members. This author recommends
further work on program evaluation, data collection and sharing to determine the true
effectiveness of current programs that are funded to support individuals and communities
impacted by IPV and DV. Finally, while IPV-CCGT is among the many innovative efforts to
tackle the IPV problem, it should be noted and understood that no single effort or approach can
fully eradicate IPV. When considered through the lens of SCT and SEM, eradicating IPV will
require an amassing of efforts that will include commitments from the individual level, family,
community, and society at large. In advancing to the next step for the program, the impact of
CONVID-19 has led to the cancellation and deferring of presentation of the program to several
senior Army leaders, which would have enabled the potential piloting of the program at Fort
Irwin as outlined in planning frameworks such as IPV-CCGT logic model and gantt chart. These
presentation are now on-hold until further notice, but will likely take place in the early to late fall
this year. Prototype link is as follows: https://couples-group-for-ipv.mn.co/all-courses

IPV IN THE US ARMY 34

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IPV IN THE US ARMY 41

Appendix-A: Logic Model

IPV IN THE US ARMY 42

Appendix-B: Prototype Program Curriculum Wireframe

IPV IN THE US ARMY 43

Appendix-C1: Market Space

Appendix-C2: Market Analysis

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Appendix-D: RE-AIM

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Appendix-E: Gantt Chart

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Appendix-F: Dissemination Plan

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Appendix-G: Units of Service

Abstract (if available)

Abstract The U.S. Army has been engaged in two simultaneous combat operations for over 17 years in Afghanistan and Iraq, marking the most protractive war in US military history with a harmful cumulative impact on military families. This has led to not only an alarming increase in psychiatric problems such as suicides, Posttraumatic Stress Disorder (PTSD), Substance Use Disorders (SUD), but also Intimate Partner Violence (IPV) recidivism rates among US Army couples. While the Army developed many worthy initiatives to tackle these psychiatric problems among its population, not nearly the same can be said regarding efforts on IPV, particularly with military couples experiencing IPV who may choose to remain in their relationship. Current gaps in tackling IPV among military couples include the lack of a clear and coherent standardized clinical intervention, evidence-based or empirically-informed program for conjoint couples, as well as strategies to measure either clinical outcomes or program evaluation. Under the Grand Challenge of Build Healthy Relationships to End Violence, this author presents an innovative approach in conjoint couples treatment to bridge the current gap within the landscape of IPV. The Intimate Partner Violence-Conjoint Couples Group Therapy (IPV-CCGT) is a couples’ group psychotherapy and psychoeducation program design for a clinical practice setting to treat Army couples. It directly targets known IPV risk factors in the Army to reduce IPV recidivism rates, while simultaneously enriching marriage quality and resiliency. IPV-CCGT is underpinned by three pillars when combined altogether, can be considered an innovative approach to tackling the IPV phenomenon. Those three pillars are 1) employ the best qualified clinical staff, 2) use an empirically-informed couples’ curriculum, and 3) implement data metrics to track the couple's clinical outcomes, staff productivity, and program evaluation and efficacy.

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Asset Metadata

Creator Porter, Ulu Elia (author)

Core Title Social work grand challenge: build healthy relationships to end violence: conjoint couples group therapy to reduce intimate partner violence for Army couples

School Suzanne Dworak-Peck School of Social Work

Degree Doctor of Social Work

Degree Program Social Work

Publication Date 05/03/2020

Defense Date 04/17/2020

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag couples therapy,group therapy,intimate partner violence,Military,OAI-PMH Harvest

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Lewis, Jennifer (committee member)

Creator Email uporter@usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c89-294627

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Legacy Identifier etd-PorterUluE-8406.pdf

Dmrecord 294627

Document Type Capstone project

Rights Porter, Ulu Elia

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Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...

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