Breaking the cycle of intergenerational abuse: The long-term impact of a residential care program
Introduction
Child maltreatment is related to a host of adolescent behavioral and personality problems. Research has shown that many youth with conduct and substance use problems have histories of abuse and neglect (Crowley, Mikulich, Ehlers, Hall, & Whitmore, 2003; Egeland, Yates, Appleyard, & van Dulmen, 2002; Widom, Weiler, & Cottler, 1999). For example, studies have found that 50% of abused children meet the diagnostic criteria for anti-social behavior as adolescents (Egeland et al., 2002), and that childhood abuse is related to high rates of violent delinquency (Alfaro, 1981; Haapasalo & Moilanen, 2004; Kratcoski, 1982).
Given the relationship between child maltreatment and dysfunctional behaviors in adolescence, it is not surprising that youth who come into residential care programs have often experienced abuse or neglect. Research examining the history of maltreatment for youth in residential care has reported percentages between 57.0% and 80.5% for physical abuse, 61.0% and 78.0% for neglect, and 16.2% and 43.9% for having witnessed inter-parental violence (Brady & Caraway, 2002; Holland & Gorey, 2004; Hussey & Guo, 2002).
Childhood maltreatment is also associated with increased risk of violence later in life (Rivera & Widom, 1990; Widom & White, 1997). For example, many childhood abuse victims become adult perpetrators of both marital and parental aggression, creating intergenerational transmission of abuse (Carr & VanDeusen, 2002; Schafer, Caetano, & Cunradi, 2004; Stith et al., 2000). Of specific relevance to this study, there is a strong link between having a history of abuse and becoming either a perpetrator or victim of intimate partner violence (IPV; Coker, Smith, McKeown, & King, 2000; Herrenkohl et al., 2004; Murphy & Blumenthal, 2000; Schafer et al., 2004).
Data from an impressive longitudinal study found similar results. Ehrensaft et al. (2003) examined the connection between exposure to abuse and domestic violence in childhood and the risk of adult IPV. The data used were from a 20-year longitudinal study initiated in 1975 with children and their mothers in two upstate New York counties (Kogan, Smith, & Jenkins, 1977). In her research, Ehrensaft et al. (2003) used data from the fourth wave of the study which was conducted in 1999 with a sample of 815 of the original children; 582 individuals (M = 31 years of age) responded to the survey. Results showed that youth who had been abused had an IPV rate of 36%, while those who had witnessed domestic violence had a 42% IPV rate. Being a victim of or witnessing domestic violence doubled or tripled an individual's risk of becoming a victim or perpetrator of IPV (Ehrensaft et al., 2003; Whitfield, Anda, Dube, & Felitti, 2003).
In addition to the strong research base supporting a link between either experiencing abuse or witnessing domestic violence as a child and the increased risk of becoming an adult perpetrator of IPV, there has also been substantial research on treatment issues associated with IPV. However, most of this research has focused on the identification of and intervention with those involved in IPV (Battaglia, Finley, & Liebschutz, 2003; Matevia, Goldman, McCulloch, & Randall, 2002; Rhodes & Levinson, 2003; Wathen & MacMillan, 2003). These efforts, while necessary, approach the problem retrospectively and deal with IPV only after it has occurred. A research review has found that efforts made to prevent IPV have met with limited success (Hickman, Jaycox, & Aronoff, 2004). This study seeks to address this gap in the research by examining the outcomes of a long-term residential, out-of-home program as it relates to breaking the intergenerational transmission of abuse, specifically IPV. It examines the relationship between a stay in a residential care program for adolescents and their involvement in IPV as adults, 16 years after leaving the program.
The long-term residential care program has as its primary goal to provide a safe and therapeutic environment for at-risk youth. The youth typically come from unstable environments and face a wide array of problems such as prior abuse, behavioral disorders, and criminal activity. Most of the youth have had several prior out-of-home placements, have been unsuccessful at school, and were placed in the program by juvenile courts or state social services.
The intervention uses the Family Home Program, a modification of the Teaching Family Model. Group homes using the Teaching Family Model serve over 3,000 youth a year. The program emphasizes family-style living. A married couple lives in each home with six to eight girls or boys, ages 10–18. The couple, with the help of a full-time assistant, focuses on each youth's physical, spiritual, emotional development, and treatment needs. On average, youth stay in the program about 18 months.
The Family Home Program is based on behavioral theory and is characterized by five key elements (Davis & Daly, 2003). First, youth are taught how to build and maintain healthy relationships. An immediate and consistent emphasis is placed on youth getting along with others and developing positive, non-exploitive relationships. Second, youth are proactively taught interpersonal and life skills. Interpersonal skills include the appropriate way to act when meeting someone and how to follow directions. Life skills include how to keep a house clean, shop, and prepare food. Third, the program promotes moral and social development with an emphasis on values and a solid spiritual foundation. Youth attend religious services weekly and have basic values coursework in school. Fourth, the program is based on a family-style approach. The teaching family couple serves as parental figures in the home and engages youth in normal family activities, such as shopping for food, preparing meals, chores around the house, and leisure activities. The living environment is designed to mimic family life to the extent that it is possible. And finally, an emphasis is placed on teaching and practicing self-government and self-determination. Youth are consistently involved in making meaningful decisions about their lives, and encouraged to take on leadership roles within the program.
This approach has been effective at bringing positive behavioral change to youth both during and shortly after treatment. Research involving 440 male and female youth found that they had improved significantly on 16 of 17 standardized outcome measures (e.g., CBCL, DISC, ROLES) during their residential stay (the exception was CBCL Social Problems for boys, which showed a non-significant improvement), and were functioning as well as national samples 3 months after discharge (Larzelere, Daly, Davis, Chmelka, & Handwerk, 2004). However, questions remain regarding residential care programs’ ability to produce lasting positive changes into adulthood. The current study examines the impact of residential care on mediating the effects of childhood maltreatment on adult IPV.
This effort surveyed individuals who received family-style residential care in the early 1980s and assessed their outcomes in adulthood, approximately 16 years later. The specific research question was: Does residential care mediate the negative impact of childhood maltreatment on adult IPV?
Section snippets
Participants
The study protocol was approved by the Girls and Boys Town IRB, and informed consent was obtained from participants. The sample was drawn from 587 consecutive youth who were accepted for admission to a large residential care program in the Midwest between May 1981 and June 1985. During an earlier longitudinal study some of the study participants had requested no further contact and others were now deceased. A total of 464 individuals were eligible for participation in the current study, 399 who
Results
The IPV rates for the residential and comparison groups are shown in Table 2. Logistic Regression was used to examine the IPV rates for the residential and comparison groups. For this analysis, the NSFH national normative data set comprised the reference category against which the IPV rates for the other groups were compared. Results indicated that there was a significant group effect for IPV [Wald statistic (3) = 7.89, p = .048], with the comparison group (i.e., those accepted to the residential
Discussion
This paper reports the only long-term study evaluating the impact of adolescent residential treatment on adult IPV. This was done by comparing the IPV rates for residential care and comparison groups to the US national data obtained from the National Survey of Families and Households, 16 years after the residential care group had left treatment. Our findings were consistent with the view that residential care can be associated with a decrease in adult IPV for individuals who are at high risk of
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