Journal of Evidence-Informed Social Work

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Correlates of Child Maltreatment Among Adolescent Mothers With Young Children Maria Scannapieco & Kelli Connell-Carrick To cite this article: Maria Scannapieco & Kelli Connell-Carrick (2015): Correlates of Child Maltreatment Among Adolescent Mothers With Young Children, Journal of Evidence-Informed Social Work, DOI: 10.1080/15433714.2014.992696 To link to this article: http://dx.doi.org/10.1080/15433714.2014.992696

Published online: 05 May 2015.

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Date: 14 November 2015, At: 12:06

Journal of Evidence-Informed Social Work, 00:1–17, 2015 Copyright q Taylor & Francis Group, LLC ISSN: 2376-1407 print/2376-1415 online DOI: 10.1080/15433714.2014.992696

Correlates of Child Maltreatment Among Adolescent Mothers With Young Children Downloaded by [University of Manitoba Libraries] at 12:06 14 November 2015

Maria Scannapieco and Kelli Connell-Carrick Center for Child Welfare, School of Social Work, University of Texas at Arlington, Arlington, Texas, USA

Child maltreatment and teen pregnancy are serious social problems facing America today. In 2010, 3.3 million referrals of child abuse and neglect resulted in approximately 461,297 confirmed victims. Teen pregnancy has similarly been a cause of serious political and social concern. Although the teen birth rate has declined overall during the last half century, the United States still has a higher teen birth rate than other industrialized countries. Young maternal age is generally considered a risk factor for child maltreatment. What is not known is what separates adolescent mothers who maltreat their children and those who do not. This study compares the ecological correlates of adolescent mothers who maltreat their children to adolescent mothers who do not maltreat. Implications for practice and future research are discussed. Keywords: Child maltreatment, adolescents, young children, ecological correlates

Child maltreatment (Finkelhor, 1996) and teen pregnancy (Brooks-Gunn & Chase-Lansdale, 1995) are serious social problems facing America today. In 2010, 3.3 million referrals of child abuse and neglect resulted in approximately 461,297 confirmed victims (USDHHS, 2010). Since Kempe, Silverman, Steele, Droegemueller, and Silver (1962) coined the term, “battered child syndrome,” researchers have attempted to discover the various risk factors for child abuse, including the roles of substance abuse (Scannapieco & Connell-Carrick, 2005, 2007; Thomas, 1995), poverty (Drake & Pandey, 1996; Gelles, 1992; Korbin & Coulton, 1997; Scannapieco & Connell-Carrick, 2003), social support (Azar, 1991), single parenthood (Gelles, 1992), and young maternal age (Connelly & Strauss, 1992; Gelles, 1992; Lee & Goerge, 1999; Stier, Leventhal, Berg, Johnson, & Mezger, 1993). Teen pregnancy has similarly been a cause of serious political and social concern (Annie E. Casey, 2004; Brooks-Gunn & Chase-Landsdale, 1995; Centers for Disease Control and Prevention, 2012). Although the teen birth rate has declined overall during the last half century, the United States still has a higher teen birth rate than other industrialized countries (Centers for Disease Control and Prevention, 2012). The teen birth rate in 2010 was 34.3 births for every 1,000 females age 15 – 19 in the population in the United States (Centers for Disease Control and Prevention, 2012); and in 2010, there were over 750,000 mothers under the age of 20 (National Campaign to Prevent Teen and Unplanned Pregnancy, 2010). Moreover, the U.S. teen birth rate rose in 2006 and 2007, suggesting that cause for concern still exists (Holcombe, Peterson, & Manlove, 2009). Teen pregnancy is a social concern because teen parents are at risk of low education attainment (Centers for Disease Control and Prevention, 2012; Klepinger, Lundberg, & Plotnik, 1995), reliance on public assistance (Holcombe et al., 2009; Johnson & Favreault, 2004) and the provision of poor care to their children (Bos, Polit, & Quint, 1997), which may increase the likelihood of child maltreatment. Address correspondence to Maria Scannapieco, Center for Child Welfare, School of Social Work, University of Texas at Arlington, Arlington, TX 76109, USA. E-mail: [email protected]

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Young maternal age is generally considered a risk factor for child maltreatment (American Academy of Child and Adolescent Psychiatry, 2004; Klerman, 1993; Stier et al., 1993). What is not known is what separates adolescent mothers who maltreat their children and those who do not. Young maternal age can place a child at risk of maltreatment, but young maternal age alone does not explain the occurrence of maltreatment. Research into what places adolescent parents most at risk for maltreating their children has been called for in the literature (De Paul & Domenech, 2000).

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Young Motherhood Adolescent pregnancy is a serious social and health problem. Teens who become pregnant must tackle the demands of adolescence with first time parenthood (Wekerle & Wolfe, 1993). Pregnancy forces an adolescent to simultaneously handle tasks of adolescence and those of adulthood. Identity development, an important developmental task of adolescence, is coupled with motherhood, possible marriage, and adult responsibility. Therefore, the provision of good maternal care of an infant is a primary concern of teen pregnancy (Stier et al., 1993). While it is promising the birth rate for teens is decreasing, the context of adolescent pregnancy is changing since more teens are unmarried and less likely to get married than ever before. The importance of marriage to teen pregnancy is not the marriage, per se, but the immediate social support marriage provides (Klerman, 1993). Similarly, marriage can bring economic support to a family, and researchers have called for interventions to reduce the economic stress for young mothers (Lee & Goerge, 1999) to ameliorate the risk of maltreatment. Teens that become pregnant are less likely to marry, as individuals are getting married at later ages more than ever before (U.S. Bureau of Census, 2011). Whereas 85% of all teen births occurred within a marriage in 1960 (Martin et al., 2003), only 13% did so in 2009 (ChildTrends, 2011). In fact, teen pregnancy has been associated with a decrease in the likelihood of ever marrying (Lichter, & Graefe, 2001), marital instability, and divorce (Abma, Chandra, Mosher, Peterson, & Piccinino, 1997; Holcombe et al., 2009). Adolescent mothers also experience lower educational attainment (Holcombe et al., 2009; Klepinger et al., 1995) and increased likelihood of receiving public assistance than adolescents who do not have children (Holcombe et al., 2009; Johnson & Favreault, 2004). A child born to a teenager who is unmarried and has dropped out of high school is 10 times more likely to be living in poverty than a child born to a mother without these characteristics (Annie E. Casey, 2003). Furthermore, the children of adolescent mothers are at increased risk of health problems, poor academic performance, incarceration, and unemployment in young adulthood (Centers for Disease Control, 2012; Holcombe et al., 2009). Compared to children of older mothers, children of teen mothers are more likely to suffer abuse and neglect, be placed in foster care, or have multiple caregivers throughout their childhood (National Campaign to Prevent Teen and Unplanned Pregnancy, 2010). Teen pregnancy costs taxpayers over 9 billion dollars annually, including increased health care, prison, and child welfare for children with adolescent mothers (Hoffman, 2006; Pazol et al., 2011). The purpose of the authors in this article is threefold. First, they will present an overview of the literature regarding young maternal age and its relationship to child maltreatment. Second, they will discuss the risk factors and consequences of maltreatment in young children. Finally, they will present an exploratory study identifying correlates of the substantiation of maltreatment in a sample of young mothers with at least one child 48 months of age or younger.

EMPIRICAL REVIEW Young Mothers and Maltreatment The impact maternal age has on the occurrence of child maltreatment is unclear and often contradictory (Massat, 1995; Stier et al., 1993; Zuravin, 1988). While some research has found an

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association between young maternal age and child maltreatment (Connelly & Strauss, 1992; De Paul & Domenech, 2000; Lee & Goerge, 1999; Schellenbach, Whitman, & Borkowski, 1992), other research has failed to support this link (Altemeier, O’Connor, Vietze, Sandler, & Sherrod, 1984; Massat, 1995; Miller, 1984; Zuravin, 1988). Zuravin (1988) found the stress early childbirth causes is a major contributor to neglect rather than age alone, although age remained significant in predicting physical abuse. Similarly to Zuravin (1988) findings, Miller (1984) found age alone did not predict maltreatment, but rather the interaction was more integral to the complexity of issues teen pregnancy brings, such as family disorganization, stress, and lack of social support. In a review of 23 studies examining the risk of maltreatment to young mothers, Stier et al. (1993) found the research was inconclusive, with 14 studies citing maternal age as a risk factor for maltreatment and 9 failing to find an increased risk of maltreatment in young mothers. On the other hand, ConnellCarrick (2003) in a review of 24 studies examining correlates of child neglect found young maternal age a risk factor for the occurrence of neglect. Nonetheless, differences have been found between teen mothers and older mothers. Teen mothers tend to have less knowledge of child development, provide less stimulating environments (Osofsky, Hann, & Peebles, 1993), and have more psychological problems (Wurtz-Passino et al., 1993). Adolescent mothers have been shown to be at risk of child abuse when they have less social support satisfaction (Budd, Heilman, & Kane, 2000). It is important to interpret the body of research on maternal age and maltreatment with caution. Methodological problems associated with research on maternal age and risk of maltreatment is noteworthy (Klerman, 1993; Stier et al., 1993), which has made comparison across studies difficult. It is necessary, however, that the specific nature of the relationship between maternal age and maltreatment be explored. First, age of mother is frequently used as a risk factor in prevention programs (Wolfe, Edwards, Manion, & Koverola, 1988). Secondly, assessment and practice strategies should be empirically based, and exploring the specific nature of this relationship is the beginning of research-based program development to this vulnerable population. Finally, an exploration into what places adolescent parents most at risk for maltreating their children has been called for in the literature (De Paul & Domenech, 2000). Maltreatment and Young Children Exploring the relationship among young maternal age and occurrence of maltreatment is imperative given the serious consequences that can occur to the developing child. Most maltreatment occurs during the first 4 years of life. The highest victimization rate for maltreatment is for those 0 to 4 years of age, and substantiation of maltreatment is inversely related to age (USDHHS, 2010). The majority of victims experience neglect (approximately 79%), followed by physical abuse (18%) (USDHHS, 2010).

Neglect. Young children are at greater risk of neglect than other forms of maltreatment (Jones & McCurdy, 1992; USDHHS, 2004), and young age is also a risk factor for fatal neglect (Margolin, 1990). Poverty and low income have consistently been shown to be risk factors for neglect (Brown, Cohen, Johnson, & Salzinger 1998; Lee & Goerge, 1999; Sedlack & Broadhurst, 1996), although research has also shown differences between families in poverty who maltreat their children and those who do not (Scannapieco & Connell-Carrick, 2003). Lee and Goerge (1999) found the combination of poverty and young maternal age to be a risk factor for the occurrence of neglect. They found children born to mothers 17 years of age and younger were 17 times more likely to have a substantiated case of child neglect than children born to mothers 22 years of age or higher in low poverty. Families who experience neglect also tend to have more individuals living in the home than non-neglecting families (Brown et al., 1998; Jones &

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McCurdy, 1992; Sedlack & Broadhurst, 1996). Single parenthood (Brown et al., 1998; Gillham et al., 1998; Margolin, 1990; Sedlack & Broadhurst, 1996) and non-married status (Chaffin, Kelleher, & Hollenberg, 1996) have also been identified as correlates of neglect. In fact, Sedlack and Broadhurst (1996) found single parenthood increases the risk of neglect by 87%. Neglectful families tend to be more chaotic, less organized, expressive of less warmth, and lacking leadership than non-neglectful families (Gaudin, Polansky, Kilpatrick, & Shilton, 1996). In addition, characteristics of the caregiver have been found related to the occurrence of neglect. Young maternal age has been found to be a risk factor for neglect (Brown et al., 1998; Chaffin et al., 1996; Connell-Carrick, 2003; Jones & McCurdy, 1992). Mothers who neglect their children have been shown to be more depressed (Christensen, Brayeden, Dietrich, McLaughlin, & Sherrod, 1994; Connell-Carrick & Scannapieco, 2006; Coohey, 1998), lonely and impulsive (Gaudin, Polansky, Kilpatrick, & Shilton, 1993) and lack self-esteem (Christensen et al., 1994). They have also been shown to have low education (Brayden, Atlemeier, Tucker, Dietrich, & Vietze, 1992; Brown et al., 1998; Zuravin & DiBlasio, 1996), fewer parenting skills (Brayden et al., 1992), and fewer problem solving skills (Coohey, 1998). Overall, caregivers who neglect have less social support than nonneglecting caregivers (Brayden et al., 1992; Coohey, 1996; Gaudin et al., 1993), including smaller social networks (Coohey, 1996; Gaudin et al., 1993) and less contact with social networks (Coohey, 1996). A more thorough discussion of risk factors for neglect can be found in the literature (Connell-Carrick, 2003). Young victims of neglect are at risk for a host of developmental consequences (Scannapieco & Connell-Carrick, 2002) and even death (Margolin, 1990; Petit & Curtis, 1997). The first 3 years in a child’s life are the most important. The foundation for personality and future behavior are laid, and child maltreatment can seriously disrupt the course of healthy development (Scannapieco & Connell-Carrick, 2002). Children who experience neglect may experience nonorganic failure to thrive (Wallace, 1996), problems with attachment (Carlson, Cicchetti, Barnett, & Braunwald, 1989; Crittenden, 1989; Egeland & Sroufe, 1981), low weight, retarded brain growth, and iron deficiency anemia (Dubowitz, 1991; Mackner, Starr, & Black, 1997). They may also experience emotional instability and attention deficits (National Research Council, 1993); increased dependency and anger; and problems with cognitive development and academic achievement (Eckenrode, Laird, & Doris, 1993). Neglected children are also at risk of future delinquent behavior (Maxfield & Widom, 1996). The most devastating consequence of neglect is fatality, especially among the youngest victims. Neglect is more likely than other forms of abuse of young children to result in child fatality (Petit & Curtis, 1997; USDHHS, 2003). Physical abuse. Physical abuse of infants and toddlers is equally as serious as neglect. Correlates of physical abuse include low maternal education, number of children in the home, substance abuse, maternal depression, and receipt of Medicaid (Bishop et al., 2001; Brewster et al., 1998; Cadzow, Armstrong, & Fraser, 1999; Kotch, Browne, Ringwalt, Dufort, & Ruina, 1997: Kotch, Browne, Dufort, & Winsor, 1999). Kotch and colleagues (1997) found life event stressors did not make a difference in the substantiation of physical abuse when high social supports were present, but also concluded life event stresses can increase the risk of a substantiated maltreatment report during infancy. This is relevant to the current study given the focus on adolescent mothers who may already experience increased life stress given the co-occurrence of parenthood, limited income, delayed educational attainment, and the demands of adolescence. Consequences of physical abuse in infancy and toddlerhood include delayed language development (Oates, Peacock, & Forrest, 1984), insecure-avoidant attachment pattern with caregivers (Ainsworth, Blehar, Waters, & Wall, 1978), more aggression toward others (Egeland, Sroufe, & Erickson, 1983), and death (USDHHS, 2004). Physical abuse may further result in developmental delays (Connell-Carrick & Scannapieco, 2006), retardation, and paralysis (Perry, Mann, Palker-Corell, Ludy-Dobson, & Schick, 2002). Therefore, the risk factors associated with

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maltreatment in young children, and especially those with young mothers, need to be explored in order to adequately assess and intervene with these young and vulnerable victims. The impetus for this study is to explore more completely the risk correlates of maltreatment in a sample of adolescent mothers. The authors examine the correlates of maltreatment in a sample of adolescent mothers who have been investigated by Child Protective Services (CPS) with at least 1 child 0 to 48 months of age. The rationale behind focusing on young children is: (1) children under the age of 4 are at greatest risk of maltreatment; (2) these children experience the most devastating consequences of maltreatment; and (3) preventative and intervention program need to take into account the uniqueness of both young children and young motherhood.

METHODS This study is part of a larger study on child maltreatment in children 0 to 48 months of age (Scannapieco & Connell, 2000). In 1999, Dallas County, Texas CPS formed “high-risk” units that receive all the investigations and ongoing work for families in which at least one child is 0– 4 years old and who are referred to CPS for: (1) physical abuse, (2) physical neglect, (3) medical neglect, and (4) neglectful supervision. The high-risk units handle only life-threatening types of maltreatment for children four and younger, which is why sexual abuse and emotional maltreatment are not included as primary allegations in their repertoire of abuse and neglect. The current study includes only families in which the mother is 20 years of age or less who have been investigated for physical abuse, physical neglect, medical neglect, or neglectful supervision and have at least 1 child 4 years old or younger in the home. The research question is: What variables predict the substantiation of maltreatment in a sample of families with mothers age 20 and younger who have been investigated for child maltreatment with least one child age four or younger in the home? Design In this study we use an ex-post facto design. The unit of analysis is family. Data were collected from administrative case records in the high-risk units over a nine-month time period from March 2000 to December 2000. A case abstraction form was developed by the researchers and case information was systematically applied to the abstraction form to obtain study variables. The CPS caseworker makes the substantiation determination, and the researchers abstracted information from the case files to obtain case information. Inter-rater reliability of the case abstraction instrument is 92%. Sample As part of the larger study, a computer-generated list of all investigated cases referred to the highrisk units was identified. In cases where a family was referred to CPS more than one time during that time period, only the most recent investigation was included. A random sample of the entire list was conducted resulting in a sample size of 437 for the larger study. This study has a sample size of 74 families, which includes all families from the original sample that: (1) have a mother 20 years of age or less, and (2) were investigated for physical abuse or neglect. Variables and Operationalization of Variables The ecological model of child maltreatment drives the inclusion of variables in this study. While the ecological model is not being tested, it serves as theoretical framework from which to include and organize variables.

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M. SCANNAPIECO AND K. CONNELL-CARRICK

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Predictor Variables Variables for this study were abstracted from CPS case records. The variables in this study include data from the CPS mandatory risk assessment (Baumann, Law, Sheets, Reid, & Graham, 2005) as well as other variables, such as previous history of maltreatment and previous out-of-home care. Many variables from this study are abstracted from the mandatory risk assessment form each caseworker must complete on the family. Caseworkers rate families on a scale from 0, indicating no risk, to 4, indicating extreme risk, on seven overall areas of concern: (a) child vulnerability; (b) home environment; (c) caregiver capability; (d) quality of care; (e) social environment; (f) response to CPS; and (g) maltreatment pattern. Within each area of concern exists sub-categories as well as specific items requiring a rating of yes, no, or unknown. For example, the variable home environment includes sub-categories about specifics of the home including stressors and dangerous exposure. The sub-categories also have a 5-point rating scale from no risk to extreme risk. Similarly, the rating of each sub-category is informed by individual items requiring a response of yes, no, or unknown. To illustrate, a question “Does any family member have a history of alcohol or drug abuse” requires a response of yes, no, or unknown, and informs the rating of parental capacity. While the use of the risk assessment form has its limitations in this research, the caseworkers are trained on how best to use the form as well as how to assess the information the risk assessment requires. Caseworkers are trained at two different times on how to use the risk assessment form. They are first provided basic training and then advanced training after they have used the instrument for a few months. Five categories of variables guide the ability to answer the research question. The five factors are: (a) child characteristics, (b) home characteristics, (c) caregiver characteristics, (d) social characteristics, and (e) maltreatment characteristics. Criterion Variable Our overall purpose in this study is to determine the characteristics of families with young mothers (age 20 or less) who maltreat their infants and toddlers and those families that do not. The criterion variable is a dichotomous variable operationalized by the substantiation of maltreatment. The criterion variable has two levels: substantiated for maltreatment and unsubstantiated for maltreatment. We compare cases investigated by CPS that were substantiated or not substantiated for maltreatment, after selecting only families with a maternal age of 20 years or less. We attempt to identify the unique predictors underlying the substantiation of maltreatment in a sample of young mothers in this article.

RESULTS Data analysis includes descriptive statistics and correlations, using Pearson’s R or Phi for dichotomous variables. Independent Samples T-tests and Chi-Square analyses were used for the bivariate analysis. After bivariate analysis, collinearity diagnostics were performed using the Tolerance Statistic. After eliminating variables identified to be collinear, multivariate analysis was performed using Logistic Regression. The alpha level for all analyses was set at .05. Description of the Sample The unit of analysis in this study is family, but Table 1 includes both family and individual characteristics. Seventy four (N ¼ 74) families met the criteria for inclusion in this study; 49 families (66%) were not substantiated for maltreatment, and 25 (34%) were substantiated.

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TABLE 1 Description of the Sample

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Maltreatment Not Substantiated (N ¼ 49) Variable

Mean

n

%

Mother age(years) Ethnicity White Hispanic Black Other Number of children in the home Adults in home Total individuals in home Income $0 –$20,549 $20,550 þ Parenting Status Single parent Dual parent Reporter Professional reporter Non-professional reporter Placement history Relative carea Foster carea

18.5

49 21 33 35 10

1.9 2.5 4.4

10 16 17 5 49 48 49 40 9

Maltreatment Substantiated (N ¼ 25) Mean

n

%

18.2

25 28 24 44 4

1.6 3.0 4.6

7 6 11 1 25 25 25

82 18

23 2

92 8

34 11

76 24

18 5

78 22

32 15 5 4 1

68 32 10 80 20

19 5 5 2 3

79 21 20 40 60

Note. aPercentage based on the number of children with a placement history.

As shown in Table 1, the demographics of families who were substantiated for maltreatment and those not substantiated for maltreatment were similar. The majority of both groups have an income of $20,549 or less. The majority of both groups were also comprised of single parent families, although families who were not substantiated for maltreatment have slightly more dual parent families (24% compared to 22%). Dual parenthood includes families who are married or cohabitating. A significant percentage of families in this study had caregivers who were not legally married, but rather lived together. In order to capture the essence of this partnership and dual parenting responsibilities, parenting status includes both legally married persons and those cohabitating. The mean age of the mother was also similar among substantiated and unsubstantiated families, both being 18years of age. Families who were substantiated for maltreatment and unsubstantiated differed in a few ways. Professionals were slightly more likely to make a referral for investigation for the unsubstantiated families (68%) compared to substantiated families (78%). Families who were substantiated for maltreatment were more likely to have had a placement history. Twenty percent of substantiated families had a history of out-of-home care, compared to only 10% of families who were unsubstantiated for maltreatment. Families substantiated for maltreatment also had slightly more persons and more adults living in the home than families not substantiated for maltreatment, but slightly fewer children. It is important to interpret Tables 2 and 3 with caution because families may have been reported more than once and with investigations having different dispositions (substantiated vs. unsubstantiated); therefore, while there have been 34 investigations of the 25 families who were substantiated for maltreatment, it does not indicate all of the families have been investigated

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M. SCANNAPIECO AND K. CONNELL-CARRICK TABLE 2 Previous History of Maltreatment: Unsubstantiated Cases

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Determination Unsubstantiated Substantiated Not investigated/Unknown disposition Total

Physical Abuse

Neglect

Emotional Abuse

N

%

N

%

N

%

N

%

N

%

7 3 5

47 20 33

8 1 6

53 7 40

2 0 0

100 0 0

3 2 5

30 20 50

20 6 16

48 14 38

42

100

15

15

2

Sexual Abuse

10

Total

previously. Rather, it indicates some families may have been investigated more than once and for more than one type of maltreatment. Some families may have been investigated several times, while others not at all. Table 2 depicts the previous histories of maltreatment of families who were not substantiated for maltreatment, and Table 3 shows the maltreatment histories of families who were substantiated for maltreatment in this study. Of the families who were not substantiated for maltreatment, 42 had previously been investigated for child abuse or neglect (Table 2). The majority of investigations were shared among neglect and physical abuse; neglect includes neglectful supervision, physical neglect, refusal to accept parental responsibility, medical neglect, and abandonment. Fourteen percent (14%) of families unsubstantiated in this study had cases that were previously substantiated. Table 3 depicts the previous histories of maltreatment in families who were substantiated in this study. Of the 25 families who were substantiated, 34 investigations previously occurred. The majority of previous investigations were for neglect, and 31% were substantiated which is a larger percentage than the previous case determinations of non-substantiated families (see Table 2). The second most investigated type of maltreatment was physical abuse, which resulted in 27% of investigations being substantiated. Before presenting the bivariate analysis, it is necessary to examine the ages of the young mothers in this sample (Table 4). The mean age of mothers was similar between those families substantiated and unsubstantiated for maltreatment, although families who were not substantiated had slightly older mothers (18.6 years compared to 18.2 years). The range of ages also differed between the substantiation determinations of families. Families where maltreatment was substantiated included mothers as young as 13, while the youngest ages in unsubstantiated families was 15. Of the 74 families who had a young mother, 34% were substantiated for maltreatment, and 66% of young mothers were not substantiated for maltreatment in this study. Although young maternal age is one risk factor for child maltreatment, it does not alone predict substantiation. Our purpose through this

TABLE 3 Previous History of Maltreatment: Substantiated Cases Physical Abuse

Neglect

Emotional Abuse

Sexual Abuse

Total

Determination

N

%

N

%

N

%

N

%

N

%

Unsubstantiated Substantiated Not investigated/Unknown disposition Total

8 3 0

73 27 0

8 4 0

67 33 0

1 1 0

50 50 0

5 3 1

56 33 11

22 11 1

65 32 3

34

100

11

12

2

9

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TABLE 4 Young Mothers and Maltreatment Substantiation

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Maternal Age # 20 Years of Age Maltreatment Substantiation

N

%

Age Range

Mean

No Yes

49 25

66 34

15–20 13–20

18.6 18.2

study is to delineate the factors affecting the substantiation of maltreatment in a sample of young mothers with infant and toddler children in the home. Bivariate Analysis Variables were first analyzed with bivariate methods to determine their independent effects on substantiation using t-tests and chi-square analyses. Table 5 shows the bivariate results.

Child characteristics. Shown in Table 5, children who were rated as being more vulnerable were more likely to have been maltreated than children who were rated as less vulnerable (t ¼ 2 2.27, p # .05). Similarly, when children were rated as having less protection the family was more likely to be substantiated for maltreatment (t ¼ 2 2.46, p # .05). Protection includes such measures as a caregiver who is unwilling or unable to protect a child, if an alleged perpetrator has access to any child in the home and if the child is unable to protect oneself. Home characteristics. Characteristics of the home environment were also examined to determine their bivariate impact on child maltreatment substantiation in families with young mothers. Families with young mothers who were substantiated for maltreatment were more likely to have an impoverished home environment (t ¼ 2 4.05, p # .001) compared to families who did not maltreat. Families who were substantiated for maltreatment also had more stressors in their home than non-maltreating families, including overcrowding, toilet training, and other immediate stressors (t ¼ 2 3.22, p # .01). Families who exposed their children to dangerous living conditions, such as unsanitary and dangerous home conditions and exposing a child to dangers in the home environment, were more likely to be substantiated for maltreatment (t ¼ 2 4.78, p # .001). Caregiver characteristics. Characteristics of the caregiver were also explored to determine their effect on the substantiation of maltreatment. Parent characteristics include caregiver skill and the quality of care they provide their children. Nine variables examined parent characteristics. Overall, families in which young mothers were present and were substantiated for child maltreatment had fewer parental resources than comparison families. Seven of 9 variables looked at parent characteristics were significant in predicting the substantiation of maltreatment. Families in which maltreatment was substantiated had caregivers who were rated as less capable (t ¼ 2 4.33, p # .001), less knowledgeable about child development (t ¼ 2 4.57, p # .001), possessing fewer skills (t ¼ 2 4.78, p # .001) and having less capacity as a parent (t ¼ 2 3.02, p # .01) than caregivers in families who were not substantiated. Additionally, families with young mothers who maltreated also provided poorer quality of care to their children than non-maltreating families with young mothers (t ¼ 2 5.20, p # . 001). Families substantiated for maltreatment also provided poorer physical care (t ¼ 2 3.99, p # .001), such as providing inadequate supervision, denying essential medical treatment, and failing to provide physically for the child. In addition, families substantiated for maltreatment had a poorer

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M. SCANNAPIECO AND K. CONNELL-CARRICK TABLE 5 Bivariate Results Maltreatment Substantiation

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x2 Child vulnerability Child fragility Child behavior Protection Ethnicity Home environment Stressors Dangerous exposure Number of adults in the home Number children in the home Total persons in home Income Parenting status Caregiver capability Caregiver knowledge Caregiver skills Caregiver capacity Maternal age Quality of care Quality of connection Emotional care Physical care Social environment Social climate Social violence Reporter Maltreatment pattern Chronicity Current severity Maltreatment trend Previous placement history Previous history of relative care Previous history of foster care Previous history with CPS History of physical abuse History of physical neglect History of medical neglect History of emotional abuse History of sexual abuse History of refusal to accept parental responsibility History of neglectful Supervision

t 22.27* 2.78 21.42 22.46*

.26 .09 .17 .28 2.06

24.05*** 23.22** 24.78*** 21.47 .88 2.54

.44 .36 .46 .17 2.10 .06 2.14 2.03 .46 .48 .50 .34 2.11 .54 .38 .18 .43 .46 .26 .45 2.12 .52 .46 .40 .46 .14 2.01 .21 .14 .09 2.06 .00 .09 .24 .17 .27

1.98

1.41 .06 24.33*** 24.57*** 24.78*** 2.302** .98 2.520*** 23.38** 21.53 23.99*** 24.35*** 22.21* 24.16*** .96 25.02*** 24.36*** 23.64** 23.91*** 1.36 .00 3.21 1.36 .55 .28 .00 .53 4.05* 2.03 5.14*

R

*p # .05. **p # .01. ***p # . 001.

connection to their children (t ¼ 2 3.38, p # .01) including attachment problems and lack of empathy for the child. Social characteristics. Social characteristics include those variables affecting the social environment of the family. Four variables examined the social characteristics of the family and three were significant. Families who were substantiated for maltreatment had poorer social environments (t ¼ 2 4.35, p # .001) and more social violence (t ¼ 2 4.16, p # .001) than families

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who were not substantiated for maltreatment. The social climate of families in which maltreatment was substantiated was also worse than families in which maltreatment was not substantiated (t ¼ 2 2.21, p # .05); the social climate included such characteristics as social isolation and negative family and interpersonal relationships. Maltreatment characteristics. In order to understand the current maltreatment situation, an investigation of the history of maltreatment within the family is necessary. Of the 15 variables within maltreatment characteristics, six were significant in predicting substantiation. Families with young mothers who were substantiated for maltreatment had more serious (t ¼ 2 5.02, p # .001) and chronic (t ¼ 2 4.36, p # .001) patterns of maltreatment than families whose cases were not substantiated. When the maltreatment situation was rated as getting more severe (t ¼ 2 3.91, p # .001) and when the current situation was serious (t ¼ 3.64, p # .01) families with young mothers present were more likely to be substantiated for maltreatment. A history of sexual abuse and neglectful supervision was also significant in predicting the substantiation of maltreatment in this study (x2 ¼ 4.05, p # .05; x2 ¼ 5.14, p # .05). Nine families had a history of neglectful supervision, and 6 (67%) were substantiated. Seven families had a previous history of sexual abuse, and 7 (58%) were substantiated in the current study. It is important, however, to interpret these results with caution due to the small sample size.

MULTIVARIATE ANALYSIS Prior to multivariate analysis, variables found significant in the bivariate analysis were analyzed for multicollinearity. Data screening using variance inflation factor (VIF) and the tolerance statistic lead to the elimination of seven variables: home environment, caregiver capability, quality of care, social environment, social climate, social violence, and maltreatment pattern. The significant predictor variables were analyzed using forward logistic regression. A stepwise procedure allows for a more parsimonious account of the variance in the criterion variable (Kachigan, 1991), which allows for a smaller set of variables to be identified that contain the same information as a larger set. Since a large number of variables were entered into the multivariate equation and since some degree of multicollinearity could still exist among the predictor variables, a stepwise method is appropriate. Additional justification of using a stepwise method is the exploratory nature of the study (Aron & Aron, 1999). Regression results indicate the overall model was significant in distinguishing between unsubstantiated and substantiated cases of maltreatment (2 2 Log Likelihood ¼ 69.05; x2 ¼ 21.00, p # .000). The model correctly classified 80% of the cases. The sample size for the multivariate analysis is 70 because some variables had missing data. Table 6 shows the results of the logistic analysis for the variables predicting maltreatment. The Wald statistic indicates two variables were significant in predicting maltreatment substantiation at the p # .05 confidence level, controlling for the influence of the other variables. TABLE 6 Regression Coefficients B Caregiver characteristics Knowledge .70 Maltreatment characteristics Chronicity .74 Constant 24.23

SE

Wald

Df

P

Exp(B)

.32

4.81

1

.03

2.01

.36 .88

4.06 12.31

1 1

.04 .00

2.09 .015

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Caregiver knowledge was significant in predicting the substantiation of maltreatment (Wald ¼ 4.81, p # .05). As the variable caregiver knowledge increases by 1, families are 2.01 times more likely to be classified as maltreating. The chronicity of the maltreatment pattern of the family was also significant in discriminating between substantiated and unsubstantiated cases. Families with a more serious pattern of maltreatment were more likely to be classified as maltreating (Wald ¼ 4.06, p # .04). As the maltreatment pattern in the family is rated as getting worse, families are 2.09 times more likely to be classified as maltreating.

DISCUSSION Significant differences emerged between adolescent mothers who were substantiated for child maltreatment and those who were not, which have implications for practice and policy. Bivariate analysis found significant differences in child, home, social, caregiver, and maltreatment characteristics. Overall, families were more likely to be substantiated for neglect when the children were vulnerable and needed protection, and when the home environment exposed the children to dangers with multiple family and environmental stressors. The capacity of the caregiver was also significant in the substantiation of maltreatment. Adolescent mothers who were substantiated for maltreatment also lacked capability, had inadequate knowledge of children and child development, had fewer parenting skills and lacked capacity as a caregiver. Not only was young mothers’ capability poorer, but the care they provided was also poorer. Adolescent mothers who were substantiated for maltreatment also provided less quality of care to their children including less connection and poorer physical care. In general, the maltreatment within family was worse in families of adolescent mothers who were substantiated, including a more chronic pattern of abuse and neglect, more severe incidents, and a trend that appears to be getting worse. The home environment was worse in families with adolescent mothers substantiated for maltreatment. They had more stressors and their children were more likely to be exposed to environmental dangers. Although families substantiated for maltreatment had slightly more individuals living in the home than unsubstantiated families (4.6 compared to 4.4), this did not predict maltreatment substantiation as has been shown in other studies (Brown et al., 1998; Chaffin et al., 1996; Jones & McCurdy, 1992; Sedlack & Broadhurst, 1996). Consistent with the literature on adolescent parents (ChildTrends, 2011; Martin et al., 2003; U.S. Bureau of Census, 2011), the majority of families with adolescent mothers in both the substantiated group and unsubstantiated group were not in dual parent families, neither married nor cohabitating. Different from previous maltreatment research, however, which has found marital status (Brown et al., 1998; Gillham et al., 1998; Margolin, 1990; Sedlack & Broadhurst, 1996) and poverty (Brown et al., 1998; Lee & Goerge, 1999) to be related to the occurrence of maltreatment, in this study we failed to find a significant relationship between income and marital status on maltreatment substantiation. This could be interpreted by the fact the characteristics of adolescent mothers in this sample are relatively homogeneous with adolescent mothers having similar demographics of single parenthood and low income. Characteristics of the adolescent caregiver produced significant differences in both the bivariate and multivariate analyses. Similar to previous research, caregivers who were substantiated for maltreatment had less knowledge of parenting, such as child developmental needs, fewer skills (Brayden et al., 1992), and a decreased capacity as a parent, including depression (Christensen et al., 1994; Coohey, 1998), substance abuse (Chaffin et al., 1996; Coohey, 1998; Sun, Shillington, Hohman, & Jones, 2001), parental history of maltreatment (Zuravin & DiBlasio, 1996; Weston, Colloton, Halsey, & Covington, 1993), or any other mental impairment (Brown et al., 1998). Adolescent parents, in particular, have been shown to have less knowledge of child development (Osofsky et al., 1993), and both bivariate and multivariate analyses found adolescent parents who were substantiated for maltreatment had less knowledge of parenting than adolescent parents who

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did not maltreat. Substantiated families had mothers who lacked overall knowledge of child development, failed to understand the child’s needs, and had unrealistic expectations regarding the child’s behavior. This is especially disturbing given these young mothers are parenting infants and toddlers, who are inherently vulnerable and at risk of serious consequences from child maltreatment. It appears while many adolescent parents may lack similar knowledge of parenting and children; those who maltreat know even less, which places their children at great risk of harm. Caregivers who were substantiated for maltreatment provided less quality care to their children, including having less attachment and physical care. Although previous research (Bos et al., 1997) has suggested the provision of poor quality care to children is a characteristic of adolescent parenthood, in this study it differentiated between maltreating and non-maltreating adolescent mothers. Previous research has also found victims of maltreatment to have problems with attachment (Carlson et al., 1989; Crittenden, 1989; Egeland & Sroufe, 1981; Egeland et al, 1983), and this finding was supported by this study. The social environments of maltreating and non-maltreating families also differed, with maltreating families having poorer social environments. Families with adolescent mothers were more likely to be substantiated for maltreatment when their social environments and social climates were poorer. These findings are consistent with previous research that has found adolescent mothers at risk of child abuse when they have less social support and less social support satisfaction (Budd et al., 2000; Miller, 1984). Families who were substantiated for maltreatment also had more social violence, including domestic and interpersonal violence, compared to families unsubstantiated for maltreatment. Finally, the maltreatment histories of maltreating and non-maltreating families differed. Families who were substantiated for maltreatment had more chronic and severe patterns of maltreatment, and maltreatment trends seem to be getting worse. Families substantiated for maltreatment were also more likely to have had a history of sexual abuse and neglectful supervision within the home, which points to the intergenerational aspect of maltreatment. Adolescent parenthood alone has been shown to have intergenerational effects on children (Annie E. Casey, 2004), and the co-occurrence of teen parenthood and maltreatment can further impact a child’s development and achievement. Our findings in this study must be interpreted in relation to the methodological limitations of its design. Specific limitations of the study include small sample size, inability to generalize beyond the sample, the use of administrative data, and collinearity. First, a small sample size limits the statistical power of the analysis. Secondly, although a random sample of cases were obtained over a 9-month time period in a large, southwestern region, generalizability is limited. The sample is, however, representative of the region from which data were collected. One obvious constraint of this study is the use of administrative data. The use of administrative data limits researcher control and the specific information collected (Drake & Jonson-Reed, 1999). On the other hand, administrative data is common in maltreatment research (Connell-Carrick, 2003), and provides a direct link between practice and research. Finally, although attempts were made to combat collinearity among predictor variables by dropping variables identified to be collinear by the VIF and tolerance statistic, it is possible collinearity still exists.

CONCLUSION Young maternal age is generally considered a risk factor for child maltreatment (American Academy of Child and Adolescent Psychiatry, 2004; Connelly & Strauss, 1992; Lee & Goerge, 1999; Schellenbach et al., 1992), but not all adolescent parents maltreat their children. Identifying the differences between adolescent parents who maltreat and those who do not is imperative to the development of empirically-based services and programs. Significant differences exist between

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teen mothers who maltreat their children and those who do not, and this is an important contribution to both the research on maltreatment and adolescent parenthood. The consequences of teen parenthood and maltreatment are independently serious, and the combination of both produces even worse consequences to the child in all areas of a child’s development. Through this study the authors provided empirical evidence for the unique risk factors of maltreatment in a sample of adolescent mothers. Differences were found within child, caregiver, home, social and maltreatment characteristics, and the multivariate analysis provides a unique set of variables predicting maltreatment. Furthermore, this research provides a foundation for future research on child maltreatment and adolescent motherhood, with the overall attempt to discern the complexities of researching and understanding the multifaceted phenomena. This study has several implications for practice, program planning, and policy formation. First, it is important practitioners realize not all adolescent parents maltreat their children. This research identifies other areas that must be explored including the home environment, social environment, and the knowledge and capability of the mother. In order to prevent maltreatment, practitioners who encounter adolescent mothers should conduct an assessment of each of these areas in order to identify areas in which the mother needs assistance. Practitioners and program planning should take into consideration the need to increase the support of adolescent mothers and attempt to increase both formal and informal support systems. Practitioners and program planners should also consider the social environment of the adolescent, and screen for social and family violence, which was related to maltreatment in this study. The home environment is equally as important and assessing the quality of the home environment and attempting to make it safe for the mother and children can reduce the occurrence of maltreatment. Finally, practitioners, program planners, and policy makers need to understand and have knowledge of child rearing and child development, and increasing parental capacity can protect against the occurrence of maltreatment. Parenting classes should be offered to adolescent mothers teaching them the importance of early childhood interaction, safety concerns, and how to provide quality emotional and physical care to a child, while recognizing the unique developmental stage of adolescence. Such educational programs will equip the mothers with knowledge and skill that may prevent the occurrence of maltreatment in the future.

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