The Impact of Maltreatment on Relationships

Bryan Samuels, CommissionerAdministration on Children, Youth and Families

A History of Maltreatment Is the Norm among Children and Youth in Many Systems

Miller, EA; Green, AE; Fettes, DL; & Aarons, GA., 2011. Data come from a representative sample of 1,715 youths aged 6–18 who received services from one or more of five San Diego County public sectors of care.

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Percent of Children/Youth Served with Maltreatment History

Maltreatment Impacts How Youth Form Relationships with Adults

Maltreatment affects a child's health and well-being as well as the quality of his or her relationships.  Child maltreatment represents an extreme form of child–parent relationship disruption (Harden, 2004; Milan & Pinderhughes, 2000).

Child maltreatment can be considered as a chronic interpersonal trauma, to which the child is exposed on a daily basis within the context of the caregiver-child relationship (Perry, 2008; van der Kolk, 2005). 

Children’s capacity to adequately cope with stress depends largely on the nature of the stress and on the attachment figure’s capacity to diminish or counter the effects linked to the stressor (Lyons-Ruth et al., 1999). 

The developmental stage of the child at the onset of the abuse and neglect will influence the type and severity of the consequences (Frederico, Jackson & Black 2005; Perry 1995). 

For many maltreated children, nurturing and supportive parental behavior was inconsistent or unavailable, resulting in children who lack confidence to explore new environments and relationships (Bretherton, 2000; Sorce & Emde, 1981).

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Extensive research has documented the impact of child maltreatment on the development of regulation and relationship-formation

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Student Shootings in Chicago 2007-2009

Demographics

90% of all shootings are male

69% of all shootings are between the ages of 15 to 17

21% are in Special Ed.

Misconduct

78% have either no Misconduct Code violation or one that is a 3 or less

48% have never been suspended from school

Enrollment

74% have been continuously enrolled in the same school for at least three semesters

97% have been continuously enrolled in CPS for at least three semesters

Temporal

70% of all shootings occur outside of Extended Day Hours

Attendance

Shooting victims had an average attendance rate of 42% for the month prior to the shooting

32% of shooting victims attended school on the day of shooting or on the prior school day if shooting occurred on a weekend.

Spatial

Shootings happened closer to the victims home address than to the school.

	-Median Distance from shooting to victims home: 0.41 miles 

	-Median Distance from shooting to victims school: 1.41 miles

Academic Performance

0.95 grade point average for shooting victims. 

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Path of Maltreatment’s Impact on Relationships throughout Life

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Abusive or Neglectful Parenting

Insecure Attachments, Emotional Dysregulation, Negative Internal Working Models

Maladaptive Coping Strategies

Poor Social Functioning, Disturbed Peer Relationships

Psychological Distress

Adult Relationship Dysfunction

Relationship Functioning in Child Welfare

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Casanueva, Ringeisen, Wilson, Smith, & Dolan, 2011.

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Very Low Social Skills among Children Receiving Child Welfare Services, by Placement Setting

Percent of Children with Very Few Social Skills According to the Social Skills Rating System

Relational Functioning as Well-being?

Collishaw, Pickles, Messer, Rutter, Shearer, & Maughan, 2007.

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Correlates of Resilience to Adult Psychopathology

Typical Programs for Youth Yield Poor Outcomes
| Chaffee Foster Care Independence Program Type | Outcomes Measures                                                                                                                                                                                                                                                                                                                                      | Findings                                                                                                                                                                                                          |
|-----------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Tutoring and Mentoring                        | Age percentile in reading and math, school grades, high school completion, highest grade completed, and school behavior problems                                                                                                                                                                                                                       | No statistically significant difference on key outcomes                                                                                                                                                           |
| Life Skills Training                          | High school completion, current employment, earnings, net worth, economic hardship, receipt of financial assistance, residential instability, homelessness, delinquency, pregnancy, possession of personal documents, any bank account, and sense of preparedness in 18 areas of adult living                                                          | No statistically significant difference on key outcomes                                                                                                                                                           |
| Employment                                    | High school completion, college attendance, current employment, earnings, net worth, economic hardship, receipt of financial assistance, residential instability, homelessness, delinquency, pregnancy, possession of personal documents, any bank account, and sense of preparedness in 18 areas of adult living                                      | No statistically significant difference on key outcomes                                                                                                                                                           |
| Intensive Case Management and Mentoring       | High school completion, college enrollment and persistence, current employment, employment past year, earnings, net worth, economic hardship, receipt of financial assistance, residential instability, homelessness, delinquency, pregnancy, possession of personal documents, any bank account, and sense of preparedness in 18 areas of adult livng | Higher rates of college attendance and persistence among treatment than control group youth but difference was largely explained by continued child welfare system involvement among youth in the treatment group |

Koball, Heather, et al., 2011.

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Barriers to and Facilitators of Interpersonal Connection

	Establishing or repairing of a protective, emotionally responsive child–adult relationship for a maltreated child or a child at risk of maltreatment should be the central focus of services.  

	If we choose to intervene on behalf of maltreated children, it is incumbent on us to rehabilitate the capacity of these children to engage in healthy relationships.

Barriers to Connection:

Fear of the Emotional Risk

Fear of indebtedness

Fear of being failed

Being pushed to bond too quickly

Resistance to directive advice

Adult lacks understanding of youth’s culture or background

Facilitators of Connection:

Adult has persistence/patience

Authentic displays of affection by adult

Adult opens up/shares their own experiences

Adult respects youth/their past experiences

Adult goes beyond prescribed relationship

Shared characteristics between youth and adult

Youth experiencing a period of vulnerability/extreme emotional need

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Model adapted from: Ahrens, KR; Dubois, DL; Garrison, M; Spencer,R; Richardson, LP; & Lozano, P. (2011). Qualitative exploration of relationships with important non-parental adlults in the lives of youth in foster care. Children and Youth Services Review. 33:1012.

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Healthy Adult Functioning

(Reese, 2010)

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Understanding of Relationships

Effective Verbal and Non-Verbal Communication

Understanding of Self

Understanding of the value, safety, reliability, and predictability of protective relationships

Effective strategies for using relationships

Appropriate concepts of normal behavior, roles, and responsibilities

Intuitive attunement to others’ feelings; empathy

Understanding of pragmatics, nuance, works for feeling, facial expression

Good self esteem; coherent life story; healthy identity

Awareness of personal strengths and limitations; valued roles and responsibilities; ability to exercise choice

Safe personal boundaries

Understanding of the World

Awareness of danger; ability to judge and manage risk

Education; practical independence skills

Parenting skills

Adaptability and Resilience

Safe coping and stress-regulation strategies

Tolerance of change; ability to relinquish control

Effective executive function: planning, concentration, learning from experience

Ability to regulate emotion, anxiety, temper, mood

Ability to “reframe,” accept and learn from difficult experiences

Ability to use services effectively

References

Bretherton, I. (2000). Emotional availability: An attachment perspective. Attachment & Human Development 2(2):233. 

Casanueva, C., Ringeisen, H., Wilson, E., Smith, K., & Dolan, M. (2011). NSCAW II Baseline Report: Child Well-Being. OPRE Report #2011-27b, Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services. 

Collishaw, S; Pickles, A; Messer, J; Rutter, M; Shearer, C & Maughan, B. (2007). Resilience to adult psychopathology following childhood maltreatment: Evidence from a community sample. Child Abuse and Neglect. 31:211.

Crittenden, PM. (1988). Distorted patterns of relationship in maltreating families: The role of internal representation models. Journal of Reproductive and Infant Psychology. 6(3):183.

Frederico, MM; Jackson, AL; & Black, CM. (2005). Reflections on Complexity: The 2004 Summary Evaluation of Take Two. Bundoora, Victoria: School of Social Work and Social Policy, La Trobe University. 

Harden, BJ. (2004). Safety and stability for foster children: A developmental perspective. Future of Children. 14(1):30.

Koball, Heather, et al. (2011). Synthesis of Research and Resources to Support At-Risk Youth, OPRE Report # OPRE 2011-22, Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services. 

Lyons‐Ruth, K; Bronfman, E; & Atwood, G. (1999). A relational diathesis model of hostile‐helpless states of mind: Expressions in mother‐infant interaction. In: Solomon J & George C (Eds.). Attachment disorganization (pp. 33‐69). New York: Guilford. 

Milan, SE & Pinderhughes, EE. (2000). Factors influencing maltreated children’s early adjustment in foster care. Development and Psychopathology. 12(1):63.

Miller, EA; Green, AE; Fettes, DL; & Aarons, GA. (2011). Prevalence of Maltreatment Among Youths in Public Sectors of Care. Child Maltreatment. 16(3):196.

Perry BD; Pollard RA; Blakely TL; Baker WL; & Vigilante D. (1995). Childhood trauma, the neurobiology of adaptation and use‐dependent development of the brain: How ‘states’ become ‘traits.’ Infant Mental Health Journal. 16:271‐291. 

Perry, BP. (2008). “Child maltreatment: A neurodevelopmental perspective on the role of trauma and neglect in psychopathology.” In Beauchine, TP & Hinshaw, SP. (Eds.). Child and Adolescent Psychopathology (pp. 93‐128). Hoboken, NJ: John Wiley & Sons. 

Reese, CA. (2011). All they need is love? Helping children to recover from neglect and abuse. Archives of Disease in Childhood. 96:969.

Sorce, JF & Emde, RN. (1981). Mother’s presence is not enough: Effect of emotional availability on infant exploration. Developmental Psychology. 17(6):737.

van der Kolk, BA; Roth, S; Pecolvitz, D; Sunday, S; & Spinazolla, J. (2005). Disorders of extreme stress: The empirical foundation of a complex adaptation to trauma. Journal of Traumatic Stress. 18(5):389.

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