Victimization and Adversity in Child Welfare Involved Youth

Lombardi, B. M., Bledsoe, S. E., Killian-Farrell, C., Lanier, P., & Skinner, A. (2021). Victimization and adversity in child welfare involved youth: the cumulative influence on child and caregiver reported behavioral health symptoms. Journal of interpersonal violence, 36(21-22), NP11647-NP11673.

What we know
This study explored the relationship between childhood victimization and adversity (CVA) and behavioral health outcomes (depression, anxiety, trauma symptoms, delinquency, and aggressive behaviors) of youth involved in Child Welfare (CW). Previous research has focused primarily on a small part of CVA (child abuse and neglect), but this study used a Cumulative Risk Model which included not only maltreatment but also conventional crime, peer victimization, sexual victimization, household stressors, and witnessing violence or struggles in the home and community.

What this study adds
When using the Cumulative Risk Model for CVAs, CW involved youth experience double the amount of CVAs when compared to a national study. Over half of children being served by CW experienced 3 or more domains of the CVA scale and a quarter experienced 4 or more. Children who experienced 4 CVA domains were 6 times more likely to experience internalizing behaviors (withdrawn, anxiety, and depression), externalizing behaviors (aggression and delinquent behaviors), and PTSD symptoms at clinically significant levels than youth who reported 0 or 1 domain.

What this means for practice or policy
By broadening what is defined as a CVA, those concerned with the care of CW involved youth can create more comprehensive evaluations that allow for better treatment of behavioral health diagnoses caused by CVAs and also help identify children who need behavioral health intervention in CW placements. The outcomes of this study were comparable to the outcomes of similar studies with youth involved in the Justice System, adolescent mothers, and youth in psychiatric care. This means that programs for these groups could also be used for CW involved youth.

How do we know this is a good study
The authors used the National Survey of Child and Adolescent Well Being (NSCAW) II (2009) which included over 5,800 children and collected data from the child, caregiver, and caseworker. A subsample of youth aged 8 to 17 (n =1,887) was used from NSCAW. CVA included six domains: (1) Maltreatment, including physical abuse, emotional abuse, or physical neglect; (2) Peer Victimization, including bullying, gang violence, peer or sibling assault; (3) Sexual Victimization, including forced sexual contact by per or adult; (4) Home and Community Violence, including caregiver domestic violence, witnessing violence in the home, and lack of safety in the neighborhood; (5) Household Stressors, including caregiver substance use problem and caregiver with serious mental health problem; and (6) Conventional Crime, including assault or being threatened by a stranger and gunshot wound. Behavioral health was assessed using the Child Depression Inventory, Trauma Symptom Checklist, and the internalizing and externalizing subscales of the Child Behavior Checklist. Logistic regression was used to explore the association between the number of CVA reported and the risk of clinical-range behavioral health symptoms.