todd i. herrenkohl university of washington, seattle
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Resilience from Child Abuse and Childhood Exposure to Domestic Violence Results of an Extended Longitudinal Study. Todd I. Herrenkohl University of Washington, Seattle. Presentation Overview. Researcher-practitioner lens; orientation to prevention - PowerPoint PPT PresentationTRANSCRIPT
Resilience from Child Abuse and Resilience from Child Abuse and Childhood Exposure to Domestic Childhood Exposure to Domestic
ViolenceViolence
Results of an Extended Longitudinal StudyResults of an Extended Longitudinal Study
Todd I. HerrenkohlTodd I. Herrenkohl
University of Washington, University of Washington, SeattleSeattle
Presentation OverviewPresentation Overview Researcher-practitioner lens; orientation to Researcher-practitioner lens; orientation to
preventionprevention
Background: child abuse and children’s exposure Background: child abuse and children’s exposure to domestic violenceto domestic violence
Conceptual definitions: Risk, protection, and Conceptual definitions: Risk, protection, and resilienceresilience
Lehigh Longitudinal StudyLehigh Longitudinal Study
Overview and relevant findingsOverview and relevant findings
Trajectories of resilience in maltreated children: Trajectories of resilience in maltreated children: Illustration using case studiesIllustration using case studies
Child MaltreatmentChild Maltreatment A global problem; rates of moderate and severe A global problem; rates of moderate and severe
forms of abusive discipline vary by societies and forms of abusive discipline vary by societies and culture; definitions and data sources.culture; definitions and data sources.
In 2005, approximately 3.3 million referrals for In 2005, approximately 3.3 million referrals for alleged maltreatment were made to child protective alleged maltreatment were made to child protective service agencies in the U.S. (USDHHS, 2007). service agencies in the U.S. (USDHHS, 2007). 899,000 children in the U.S. were officially documented as 899,000 children in the U.S. were officially documented as
having been maltreatedhaving been maltreated
Highest rate of victimization: Children birth to age 3; Highest rate of victimization: Children birth to age 3; just more than half are girls (50.7%). just more than half are girls (50.7%).
Physical child abuse is second to neglect in overall Physical child abuse is second to neglect in overall prevalence.prevalence.
Officially documented cases are a fraction of the total Officially documented cases are a fraction of the total (physical abuse prevalence >10%). (physical abuse prevalence >10%).
Developmental ConsequencesDevelopmental Consequences
ChildhoodChildhood AdolescenceAdolescence AdulthoodAdulthood
Isolation, Shame, Isolation, Shame, Fear, Guilt; Insecure Fear, Guilt; Insecure AttachmentAttachment
Alcohol and Drug UseAlcohol and Drug Use
Early Onset Early Onset Depression/ AnxietyDepression/ Anxiety
PTSD Symptoms/ PTSD Symptoms/ DisorderDisorder
Eating Disorders; Eating Disorders; ObesityObesity
Childhood Childhood Aggression; BullyingAggression; Bullying
Additional Health Additional Health Risks: Smoking; Risks: Smoking; Sexual Risk Taking Sexual Risk Taking (STDs); DUI, Suicide (STDs); DUI, Suicide Attempts…and Attempts…and Teenage PregnancyTeenage Pregnancy
Somatic Somatic Complaints; Complaints; Chronic Pain and Chronic Pain and Fatigue; Fatigue; Cardiovascular Cardiovascular Disease; Poorer Disease; Poorer Overall Health; Overall Health; More Use of More Use of ServicesServices
Overall Less Education and Unemployment
Low Academic Achievement; School Dropout
Context of Family Context of Family ViolenceViolence
DV ExposureDV ExposureChild AbuseChild Abuse
Family stressors
Overlap in Child Abuse and Childhood Exposure to Overlap in Child Abuse and Childhood Exposure to IPVIPV
Low incomeParental unemployment
Parental substance use
and mental health
Community stressors
Community
poverty
Neighborh
ood
disadvanta
ge and
violence
Social
Isolation
Overcrowdi
ng
Compounding Stress in the Surrounding Environment
Additive or Cumulative Risk Additive or Cumulative Risk Exposure and Developmental Exposure and Developmental
EffectsEffects A graded (additive) association: more
adverse childhood events= more risk of serious health and mental health consequences.
A caveat: research on child maltreatment includes numerous findings from cross-sectional studies using retrospective measurement…and few account for overlapping stressors and/or prior and current exposures.
Resilience and Resilience and ProtectionProtection
Some children are “Some children are “resilientresilient”– they overcome ”– they overcome the odds of negative outcomes.the odds of negative outcomes.
Studied as an end-point determination a Studied as an end-point determination a child’s having adjusted well (i.e., achieved child’s having adjusted well (i.e., achieved positive outcomes or avoided negative positive outcomes or avoided negative outcomes) despite earlier risk exposure… outcomes) despite earlier risk exposure…
……but better conceptualized as a dynamic, but better conceptualized as a dynamic, changeable quality, or “relative concept” changeable quality, or “relative concept” influenced by the surrounding environment.influenced by the surrounding environment.
Interaction of Stressors and Interaction of Stressors and Protective Factors-Leadbeater Protective Factors-Leadbeater
et al., 2004et al., 2004
Study of Resilience in Victims of Child Study of Resilience in Victims of Child Abuse—Replicated in Two or More Abuse—Replicated in Two or More
Longitudinal StudiesLongitudinal Studies
IndividualIndividual Family/CommunityFamily/Community
Low Distress (low Low Distress (low emotionality)emotionality)
Maternal Maternal CompetenceCompetence
Affectionate/Affectionate/Engaging Engaging TemperamentTemperament
Close Bond with Close Bond with Primary CaregiverPrimary Caregiver
SociableSociable Supportive Supportive GrandparentsGrandparents
Average or Above Average or Above Average IQAverage IQ
Supportive SiblingsSupportive Siblings
Internal Locus of Internal Locus of ControlControl
Competent Peer Competent Peer FriendsFriends
(Werner, (Werner, 2005)2005)
Lehigh Longitudinal StudyLehigh Longitudinal Study
Started as an Started as an evaluation project evaluation project on a child abuse on a child abuse and neglect and neglect treatment and treatment and prevention prevention program in two program in two counties of eastern counties of eastern Pennsylvania.Pennsylvania.
Lehigh Longitudinal StudyLehigh Longitudinal Study
Longitudinal panel study began in 1976-1977Longitudinal panel study began in 1976-1977 preschool, 18 mths.- 6 yrspreschool, 18 mths.- 6 yrs schoolage (1980-1982)schoolage (1980-1982) adolescence (1990-1991) with 91% retentionadolescence (1990-1991) with 91% retention adult assessment (2008-2010)adult assessment (2008-2010)—extensive —extensive
survey of current and prior experiences, survey of current and prior experiences, interpersonal relationships, mental and interpersonal relationships, mental and physical health, aspirations, child rearing physical health, aspirations, child rearing practices (brief open-ended questions about practices (brief open-ended questions about turning pts and transitions)turning pts and transitions)
Multiple data sources, including parents about Multiple data sources, including parents about their disciplining of children, and children (as their disciplining of children, and children (as adolescents) about their experiences growing adolescents) about their experiences growing up. up.
Study SampleStudy Sample
Sample Composition:Sample Composition:
Child welfare abuse (n=144) Child welfare abuse (n=144)
Child welfare neglect Child welfare neglect (n=105)(n=105)
Head Start programs (n=70)Head Start programs (n=70)
Day care (n=64)Day care (n=64)
Middle income nursery Middle income nursery (n=74)(n=74)
248 (54%) males and 248 (54%) males and 209 females.209 females.
52% (n=155) of families 52% (n=155) of families with 1 child; 43% with 1 child; 43% (n=128) of families (n=128) of families with 2 children; 5% with 2 children; 5% (n=14) with 3-4. (n=14) with 3-4.
80.7% White; 5.3% 80.7% White; 5.3% Black or African Black or African American; 11.2% more American; 11.2% more than one race; 1.3% than one race; 1.3% American Indian/Alaska American Indian/Alaska Native; 1.5% Native; 1.5% other/unknown. other/unknown.
Total: Total:
457 457 children children from from 297 297 familiesfamilies
Measuring Child MaltreatmentMeasuring Child Maltreatment
Developed as a non-equivalent control Developed as a non-equivalent control group design.group design.
However, analyses of case records and However, analyses of case records and then mothers’ own reports of their then mothers’ own reports of their disciplining revealed that abuse and disciplining revealed that abuse and neglect were present in all groups.neglect were present in all groups.
Case records: incidents of child physical Case records: incidents of child physical abuse in the “neglect” group were abuse in the “neglect” group were comparable in severity to those in the comparable in severity to those in the “abuse” group; 46% had been physically “abuse” group; 46% had been physically abused.abused.
Measuring Child Maltreatment Measuring Child Maltreatment (cont.)(cont.)
Mothers’ prospective reports also revealed Mothers’ prospective reports also revealed abuse in other groups.abuse in other groups.
Mother: “hit a child so as to bruise”Mother: “hit a child so as to bruise” 91% in child welfare abuse; 64% in child welfare 91% in child welfare abuse; 64% in child welfare
neglect; 88% in Head Start; 68% in day care; and neglect; 88% in Head Start; 68% in day care; and 40% in the middle income group.40% in the middle income group.
Analyses use original group status and full Analyses use original group status and full group models with prospective and group models with prospective and retrospective data (approach supported by retrospective data (approach supported by evidence that indicators of child well-being do evidence that indicators of child well-being do not differ on the basis of substantiation status --not differ on the basis of substantiation status --NSCAW).NSCAW).
Continuation Study: Continuation Study: Overlapping Forms of Violence Overlapping Forms of Violence
and Resilience in Adulthoodand Resilience in Adulthood Co-occurrence of DV exposure, child
abuse, and other stressors Unique and combined effects of
exposure to DV and direct abuse on outcomes in adolescence and early adulthood
Psychosocial mechanisms leading to adverse outcomes
Sources of protection and resilience, including late-onset, adult recovery from early violence exposure
Typologies, Developmental Typologies, Developmental Outcomes, and Protection from Outcomes, and Protection from Maltreatment and DV ExposureMaltreatment and DV Exposure
Adolescent Outcomes:
o Violence/ Violence/ DelinquencyDelinquency
o DepressionDepression
o Drug/ Alcohol Drug/ Alcohol UseUse
o Running AwayRunning Away
o School DropoutSchool Dropout
o Teenage Teenage PregnancyPregnancy
Sex differences
Child characteristics (e.g., Child characteristics (e.g., IQ; self-reflection)IQ; self-reflection)
Qual and Availability of Qual and Availability of Caregiving Caregiving
Attachment to Attachment to parents/othersparents/others
Peer involvement and Peer involvement and support support
Child Maltreatm
ent
Children’s Exposure to
DV
Ph
ysical E
motio
nal
Sexu
al
Neg
lec
t
Socioeconomic factors
Preschool
N=457
CW Abuse (144)
CW Neglect (105)
Head Start (70)
Middle Income (64)
Nursery (74)
Schoolage
N=345
High Functioning (88)
Moderate (141)
Low Functioning (116)
Adolescence
N=23/25
Resilient: HS completion (14/23~61%)
Fewer assaults, index and property crimes, less juv. detention
Adulthood
Multidimensional Assessment of Resilience:
Employment
Schooling
Interpersonal Connections
Mental Health
Criminal Behavior
child’s average or above-average child’s average or above-average intelligenceintelligence
sporadic-not chronic- abusesporadic-not chronic- abuse
a stable living environment (fewer a stable living environment (fewer transitions) and/or stable caretakingtransitions) and/or stable caretaking
clear expectations from one or more clear expectations from one or more caregivers for success in various life caregivers for success in various life domains (e.g., school)domains (e.g., school)
Of those from child welfare, 25 children were high functioning “resilient”
Who remains resilient?
Who doesn’t?
Who emerges as resilient later?
Resilience from Child abuse and Children’s Exposure to DV
Defining Resilience in Early Defining Resilience in Early AdulthoodAdulthood
McGloin and Widom (2001): Resilience among adults (ages 18-41) who had been maltreated in childhood.
At least 6 of 8 criteria: achieved successful employment avoided becoming homeless graduated high school been involved in social activities not developed a psychiatric disorder not developed a substance use disorder not been arrested not perpetrated violence
Challenges in Defining Adult Challenges in Defining Adult ResilienceResilience
What is it? (e.g., interviewers’ observations vs. research-What is it? (e.g., interviewers’ observations vs. research-derived definitions).derived definitions).
Thresholds of positive functioning. What qualifies as Thresholds of positive functioning. What qualifies as resilient? (e.g., absence of depressive symptoms vs. resilient? (e.g., absence of depressive symptoms vs. absence of diagnosis).absence of diagnosis).
Accounting for developmental shifts toward resilience:Accounting for developmental shifts toward resilience:-- case exclusions based on prior behavior, although an individual -- case exclusions based on prior behavior, although an individual may have experienced--but then overcome– one or more life may have experienced--but then overcome– one or more life challenges.challenges.
Case studies on the dynamic features of resilience:Case studies on the dynamic features of resilience:-- goal to increase understanding of developmental patterns and -- goal to increase understanding of developmental patterns and influence of social, contextual, and situational factors that influence of social, contextual, and situational factors that promote, sustain, and lessen growth and positive change.promote, sustain, and lessen growth and positive change.
Who remains resilient?Who remains resilient?Continuity from childhood to Continuity from childhood to
adulthoodadulthood
achieved successful employment
avoided becoming homeless
graduated high school
been involved in social activities
not developed psychiatric or substance use disorders
not been arrested
(?) not perpetrated violence
Who doesn’t?Who doesn’t? Discontinuity from childhoodDiscontinuity from childhood
achieved successful employment
avoided becoming homeless
(-) graduated high school
(-) been involved in social activities
(-) not developed psychiatric or substance use disorders
not been arrested
(-) not perpetrated violence
Who doesn’t?Who doesn’t? Discontinuity from AdolescenceDiscontinuity from Adolescence
achieved successful employment
avoided becoming homeless
graduated high school
been involved in social activities
(-) not developed psychiatric or substance use disorders
(-) not been arrested
(-) not perpetrated violence
Who emerges as resilient Who emerges as resilient later?later?
achieved successful employment
avoided becoming homeless
graduated high school
been involved in social activities
not developed psychiatric or substance use disorders
not been arrested
(-) not perpetrated violence
Overall FindingsOverall Findings Resilience IS a relative concept: individual- Resilience IS a relative concept: individual-
and between-individual differences in and between-individual differences in trajectories and outcomes.trajectories and outcomes.
Person-environment interactions (mix of Person-environment interactions (mix of individual qualities, relationships, and individual qualities, relationships, and surrounding context).surrounding context).
Key factors: IQ; self-reflection and goals Key factors: IQ; self-reflection and goals (attribution of responsibility); social support; (attribution of responsibility); social support; group participation that facilitates prosocial group participation that facilitates prosocial involvement with peers; access to adult involvement with peers; access to adult mentors, community.mentors, community.
Implications for Further Implications for Further ResearchResearch
Further study of resilience as a life course Further study of resilience as a life course process; individual, social, and environmental process; individual, social, and environmental interactions.interactions.
Multidimensional assessments and Multidimensional assessments and measurement of risks, processes, and measurement of risks, processes, and outcomes.outcomes.
Attention to overlapping forms of violence Attention to overlapping forms of violence exposure (and abuse types); unique and exposure (and abuse types); unique and combined effects.combined effects.
Implications for Practice Implications for Practice and Policyand Policy
Primary prevention with attention to multiple Primary prevention with attention to multiple risks and stressors; to lessen violence risks and stressors; to lessen violence potential and strengthen families.potential and strengthen families.
-- Parenting interventions to reduce punitive -- Parenting interventions to reduce punitive disciplining; promote stable, positive relationships.disciplining; promote stable, positive relationships.
Social and emotional skill-building in Social and emotional skill-building in children-- selective and more universal children-- selective and more universal approaches.approaches.
Supports to enhance academic achievement Supports to enhance academic achievement and high school graduation; motivate goals and high school graduation; motivate goals for the future.for the future.
Contact: Contact:
Todd I. HerrenkohlTodd I. HerrenkohlUniversity of Washington University of Washington
School of Social WorkSchool of Social [email protected]@u.washington.edu
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