exploring the psychosocial and behavioral adjustment outcomes of multi-type abuse among homeless...

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Exploring the Psychosocial and Behavioral

Adjustment Outcomes of Multi-Type Abuse

among Homeless Young Adults

Kristin M. Ferguson

This article explores the psychosocial and behavioral adjustment outcomes associated with

verbal, emotional, physical, and sexual abuse amon^ homeless young adults as well as the

associations amon g abuse types. Con venien ce sampling was used to select 28 homeless youn g

adults (ages IS to 24) fnini one drop-in center. Overall, subjects experienced high rates of

direct abuse (that is, verbal, em otio nal , physical, and sexual abuse) and ind irect ab use (chat

is,

witnessing family verbal and physical abuse). Ch i-squ are tests revealed that pn ipo rtion s

of clinical depression, interna lizing and extern alizing beh aviors , alcoho l use, and foster care

histor>' were higher among subjects who experienced abuse than among those vvithout

reported abuse histories.The findings suggest that homeless young adults experience coexisting

types of direct and indirec t abuse, wh ich can negatively influence ou tcom es R' :ited to th eir

psychosocial functioning and behavioral adjustment. An inclusive mu lti-type abuse appro ach,

with both direct and indirect abuse types, is needed to draw accurate con clusions reg;irding

the ctTfCts of each specific abuse type on hoineless yo ung

adults"

psychological and behiivioral

adjustment.

K EY W O R D S : homeless youti a dults; multi-type abuse;

physical abuse; sexual abuse; verbal abuse

H

omeless young people are highly likely

to come from m ulti-problem and abusive

fiimilies. Various s tudies have cited high

rates of physical abuse, sexual abuse, neglect, and

parental rejection among this population (Powers,

Eckenrode,i^Jaklitsch, IWO;IUw.Taylor-Seehafer,

& Fitzgerald,2K)l ;R yan , Kilmer, Cauce,WaCanabe,

ik Hoyt, 2000; Tyler, Cauce, & Whitbeck, 2004;

Whitbeck, Hoyt. Ackley, 1997a, 1997b). Parental

abuse is frequently among the primary reasons

homeless youths give for leaving home (Ryan et

al-, 2000; Sullivan & Knutson, 2000; Tho mp son,

McManusA'Voss,2006;Tyleretal.,2004;Whitbeck,

Hoyt.& liao,2000).

Evidence suggests that parental abuse is more

prevalent among homelessyouthsthan in the general

population (Rew et al.. 200 1; Ryan et al., 2000).

Previous studies reveal that50%to

83 %

of homeless

youths have experienced physical or sexual abuse

(Cauce et al., 2000; M olnar, Shade, Kral, 13ooth, &

Watters, t99B;Ryan et al.,20()0;Thrane,Hoyt. W hit-

beck,

Yoder, 2006; Warren, Gary, & Moorhead,

16%

for male subjects (Finkelhor, 1994). Up to 22%

of male subjects and 20% of female subjects report

childhoo d physical abuse (Briere & Elliott, 2003 ).

EFFECTS OF ABUSE ON YOUTH

DEVELOPMENT AND OUTCOMES

Researchershavedocum ented the deleterious effects

of abuse on homeless young peoples development,

psychological adjustment, and future outcomes.

Kurtz, Kurtz, and Jarvis (1991) found that homeless

youths who were physically and sexually abused

experienced a greater number of personal, fiimily,

and school problems than those without abuse his-

tories.

Havingahistory of physical and sexual abuse

is also considered a risk factor for suicide attempts

in homeless youths (Kurtz et al.,1991; Molnar et

al.,

1998; Powers et al., 1990; Rew et al.. 2001)

and mental health problems, such as depression,

conduct disorder, and trauma symptoms (Ryan et

al.,200(1;

Stifiiian, l989;Thompson, Maccio, Des-

selle,

& Zittel-Palamara,2007;Whitbeck, Hoyt,

Yoder, 1999).


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Thrane etal., 2006;Tyler, Hoy t, & Whitbec k, 2000)

and using illicit substances and oth er deviant behav-

iors,such

as

trading

sex

to survive on

the

streets(Rew

et aJ.,2001; Simons & Whitbeck, 1991 ;Tyler et al.,

2000;Ty]er.Hoyt,Whitbeck,&Cauce,2001a,2001b:

Tyler et al., 2004; W hitbeck et al., 1 9 9 9 ). Sexual

abuse histories are also associated w ith an increased

likelihood of being physically and sexually victim-

ized on ce on the streets (Ryan et al., 2000; Simons

eW liitheck, 1 9 9 1 ;Thrane et al . , 2006;Tyler et al . ,

2000,2001a. 2001b; Whitbeck etal . , 1997a).

MULTI TYPE ABUSE

Mu lti-type abuse refers to the co-o ccur rence of one

or more types of abuse, including physical abuse

sexual abuse, emotional abuse, psychological abuse,

verbal abuse, and witnessing familial abuse (Higgins

McCabe,

2001).

Recently, researchers have c on -

ducted several systematic literature reviews on how

prior studies have measured the effects of multiple

abuse types on adjustment. Higgins and McCabe's

review identified 29 studies that examined multi-

typeabuse.In fewer than half of these studies

(H

= 1 2),

researchers assessed psychological abuse or neglect.

Adjustment-related outcomes were assessed in only

12 studies in which subjects reported experienc-

ing multi-type abuse. Across each ofthesestudies,

increasing combinations of abuse were associated

with more severe adjustment problems,

Arata, Langhinrichsen-Rohling, Dowers, and

O 'br ie n (2007) updated this earlier

review,

locating

22 additional studies of the effects of multi-type

abuse.

Psychological abuse and neglect, which were

assessed in 15 studies, were still given less attention

than were other types. Consistent with the earlier

review, individuals who ex perienced mul tiple abuse

types presented the most p.sychological symptoms.

In the Higgins and M cCabe (2001) review, only one

study addressed multi-type abuse among homeless

youths, whereas no study reviewed by Arata et al.

was with this population.

Mo re recently, researchers have begun to ex amine

the differential effects of multiple forms of abuse,

although few have used neglect or psychological

abuse measures in their studies (Arata et a ., 2007).

W hen neglect and psychological abuse are includ ed

in multi-type abuse models, they are found to be

types are associated with more negative outcomes

than are single forms ofabuse or neglect (Higgins

c McCabe, 2001).

Prior research also reveals that abuse types fre-

quently co-occur (Arata et al., 2007; Higgins &

Mc Cabe, 2001 ). For ex ample, psychological abuse,

emotional abuse, and neglect were found to be

predictors of psychological outcomes in children

who also experienced physical and sexual abuse

(Briere, 1988). Likewise, existing studies show that

individuals who experience one type of abuse are

likely to be victims of other forms of abuse o r neglect

(H i^in s & McCabe, 2001) .

PRESENT STUDY

Given the likelihood ofmultiple abuse types among

homeless young peopl e and the lack of studies in this

area, further research is needed and has been called

for by o ther researchers (Ryan et al., 2000;Tyler &

Cauce, 2002). The purpose of the present study was

thus to expand the literature on multi-type abuse

among homeless young adults by conducting pre-

liminary analyses of correlates ofm ultipl e abuse types

and associations am ong them . Notably, most studies

assessing abuse histories of homeless young people

have focused on a single form of

abuse

(physical

r

sexual abuse) (Rew et al.. 2001 ;TyIer et al.. 2000,

2001 b) orn both physicalIM/sexualabuse (Kurtz

et al.,1 991 ; Mol nar et al., 1 9 9 8; Ryan et al., 20(K);

Simons

&

Whitbeck,

1991

Stiffnian,

1989;

Sullivan

& Knutson, 2000;Tyler & Cauce.

2002;

W hitbeck

etal., 1997a, 1997b). Several studies have examined

the effects of physical and sexual abuse with neglect

(Kurtz et al.,1991 ; Powers et al-, 1 9 9 0; Ryan et al.,

2000;Thrane etal., 2006;Tyler etal., 2004) or with

emotional abuse (Powers et al.,

1990;

Tyler et al.,

2004; W hitbeck et al., 1 9 9 7b). Studies that assess

up to four types of abuse among homeless youths

are less common (Powers et al.,

1990;

Tyler et ai.,

2004), whereas those that examine more than four

abuse types by includ ing verbal abuse or witnessing

family physical and verbal abuse are largely absent

(Tyler, 2006).

This gap presents limitations in the current un-

derstanding of primary abuse correlates, given the

high co-occurrence rates of abuse types found in

prior research (Arata et

al.,

2007;H i ^ i n s

&

McC'abe,


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that was assessed individually (Higg ins M cC abe ,

2001),

Further, without considering the full range

of both outcom e variables and abuse types within a

single

study,

it

is

not feasible to determ ine the efFects

of different abuse types on hom eless young peo ples

psychological and behavioral adjustment. As such,

integration of research on individual abuse types

and isolated outcomes is needed before accurate

conclusions can be drawn regarding the effects of

each specific abuse type on this popu lation (Higgins

McC abe, 2001).

Th e present study assessed th e associations among

verbal, emotional, physical, and sexual abuse and

select psychosocial and behavioral adjustment out-

comes in a sample of homeless young adults. This

study also examined associations among multiple

abuse typ es.The following three research questions

guided this study: Among homeless young adults,

(1) what are the frequency and severity of verbal

abuse, emotional abuse,physical abuse,sexual abuse,

and witnessing family verbal and physical abuse?; (2)

whatarcthe psychosocial and behavioral adjustment

outcomes associated with verbal abuse, emotional

abuse, physical abuse, and sexual abuse?; and (3)

what are the intcrrt-lationships among verbiil abuse,

emotional abuse, physical abuse, sexual abuse, and

witnessing family verbal and physical abuse?

METHO

Sampling and Recruitment Procedures

111

ihis cross-sectional study, convenience sampling

was used to select 28 homeless young adults (ages

18 to 24) from a homeless youth drop-in center. All

subjects were recruited from one program but re-

ceived differing service

levels.

Subjects w ere part of a

larger study investigating o utcom es

rom

a

vocational

training program integrated with clinical services for

homeless youths, the Social Enterp rise Intervention

(SEI).To qualify for inclusion in the original study,

subjects had to have attended the agency at

lea st

two

times a week for the m onth prior to the study and

verbally com mit to attend ing the SEI program over

a seven-month period. All study procedures were

approved by the Institutional Review Board at the

lead investigators university. Additional details on

the m ethod of the original study

have

been published

elsewhere (Ferguson, 2007).

use,

prostitution, survival sex [that is, exchanging

sex for food, clothing, or shelter|), family support,

and abuse history. Additional items included de-

mog raphic characteristics (for exam ple, age, gender,

race, education ), homelessness history (for ex ample,

age at which subject began living on streets, living

situation), service utilization (for exam ple, num ber

of agencies used for services), and family charac-

teristics (for example, foster-caR' history', parental

drug use),

Mental health status comprised three variables:

depressive symptoms, internalizing behaviors, and

externalizing beh aviors. Depressive symptom s w ere

assessed by tlie Reynolds Depression Screening

Inventory (RDS I) (Reynolds Kobak. l'J98), a

19-item index measuring the frequency and sever-

ity of symptoms of depressive disorder The RDSI

was chosen because it has been used in pr ior studies

with homeless youths (Cauce et al., 2(KI0). Raw

RDSI scores are summed to form a composite

score.The possible range of scores is 0 to 63, with

higher scores reflecting greater symptoms. Scores

of

10

or less indicate no depression, scores of

11

to

15 indicate mild clinical severity, scores of

16

to 24

indicate moderate clinical severity, ajid scores of 25

or m ore indicate severe clinical severity (Reyno lds

Kobak, 1998). In this pilot study, the C ron bac hs

alpha for the 19 items on the RDS was .84.

Internalizing and externalizing behaviors were

assessed using

the

Adult Self-Rep ort (ASR) (Achen-

bach, 2003), which consists of 126 items assessing

respondents' emotions and behaviors over the

past six months. Scoring profiles include normed

scales for internalizing behaviors (that is, anxious/

depressed and withdrawn behaviors) and external-

izing behaviors (that is,aggressive and rule-breaking

behaviors). Higiier scores reflect a higher presence

of behaviors. Raw scores between 18 and 23 (for

men) and 20 and 24 (for women) for internalizing

behaviors and between 19 and 22 (for men) and

17 and 21 (for women) for externalizing behaviors

are within the borderline clinical range. Scores

above 23 (for men) and 24 (for women) for inter-

nalizing behaviors and above 22 (for men) and 21

(for women) for externalizing behaviors are in the

clinical range (A chenb ach.2003).C ronbach alphas

for internalizing and externalizing behaviors were


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were .90 for internalizing and .86 for externalizing

behaviors (Cauce et al., 20


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of the findings for practitioners wo rking with this

popula tion. Associations am ong abuse types were

also cx.unined.

RESULTS

Subjects

Twenty-eight homeless young adults (ages 18

to 24) were recruited as part of an original pilot

study troni a homeless youth drop-in center. Col-

lectively, subjects were on average21years old{SD

= 1.41).Twenty were male, and eight were female.

Eleven subjects identified as African American, six

as Hispanic,

six as

Caucasian, four

as

mixed or oth er

ethnicity, and one as Asian. Regarding educational

backgrounds, six had some high scliool education

14 had a high school diploma or GED, seven had

some college, and one had a vocational degree.

Abuse Types, Frequency, and Severity

Across the sample. 82 ( = 23) had experienced

at least one of the six abuse types (seeTable 1). Of

the six types, participants experienced an average

of 2.96 types of abuse

{S D

= 1.88,

Mdn

= 3.00).

Seventy-one percent{n

=

20) reported histories of

three or m ore types, with

18 (

=5 experiencing

five or six types. On average, subjects reported that

abuse frequencies across all types occurred often

(one to two times per month).

A

significant posi-

tive correlation was found bet\\'cen frequency and

severity for verbal abuse (p =

.59,p =

.01) but not

for other abuse types.

Abuse Type and Psychosocial and

Behavioral Adjustment Outcomes

The frequencies and percentages of select psycho-

social and behavioral adjustment outcomes among

the sample are summarized in Table 2. Outcome

variables were dichotomized using no/yes responses

(fostercare,total alcohol, total drugs, high-risk sex),

median splits (age began living on streets), or clini-

cal threshold cutoffs (depression, internalizing and

externalizing behaviors).

For the analyses,

2

x 2 chi-square tests were u.sed

(with Fishers exact tests used when the expected

cell frequencies were five or

less

to examine group

differences in select psychosocial and behavioral

Table

1 :

Median Abuse Frequency, Severity, Age at Onset, Age at

Last Episode, and Number of Perpetrators, by Abuse Type

Type of

Abuse

Yes

N o

Emotional

Y

N o

Physical

Yes

N o

Sexual

Yra

N o

Witness verbal

Yes

N.)

Wirncw physical

Yes

Sample

19 68)

9 32)

14 50 )

14 50 )

14 50 )

14 50 )

11 .59)

17 61)

14 50)

14 50)

im

Frequency

Mdn (Range)

4.00 1-5)

4.00 1-5)

3.50 1-5)

3.00 1-4)

4.00 1-5)

4.00 1-4)

Severity

Mdn (Range)

4.00 1-5)

4.00 2-5)

5.00 3-5)

5.00 3-5)

4.00 1-5)

4.00 1-5)

Age at Onset

(in Years)

Mdn (Range)

7.00 2-17)

10.00 2-18)

7.00 2-22)

10.00 3-22)

7.50 2-16)

6.00 2-16)

Age at Last

Episode

(in Years)

Mdn (Range)

17.00 7-23)

18.00 3-24)

14.50 6-22)

15.00 6-23)

17.00 7-21)

15.00 7-22)

Number of

Perpetrators

Mdn (Range)

2.00 1-7)

1.50 1-10)

1.50 1-5)

1.00 1-2)

2.00 2-6)

3.00 2-6)


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2

6

8

7

57

53

47

3

Table 2 : Frequencies

and

Percentages of

Psychosocial and Behavioral Outcomes

Sample

ri ble i

No

y

Age (in years) began living on srrecEs

0-17

Total depression (RDSI)

SubdiniGil range (ft-l)

CLnical range (11+)

Internalizing behaviors (ASR)

Subdinical range

Borderline and clinical range

F.xrcrnaninglH-hiiviors (ASR)

Siibclinical range

Bonk'fline and clinical range

Tuial alaihol (previous 6 monrhs)

0 days

It days

Total drugs (previous 6 months)

0 days

+days

High-risk sex

0 times

1+ times

6

2

4

4

6

2

2

6

57

43

5

5

57

43

43

57

12

48

Notes A/= 28.Sample siie vanea

for

Ihewariable agebegan living on

i t rm i i u i =

15)given that nol allyuulhs were livingo nthe ilteets at the time ot the study nd

for high-rijlisex (n = 3 ) given thaithere were five nonresponseifor thij

variable.

ROSI= ReynntdDeprsion Screening Inventory [Reynolds SKobak.

1998);

ASH =

A dull Sell-Report (Achenbach. 2003);

total

akohol

= dayt iubjecthad

been

drunk;

lotal

dri jgi

dayi

subjecthad uled

drugs

for

nonmedical purposei; higH-risl

iex =

numbei

of

tm

sub)t

had been

drunk or fiigh

during semial imeicourie

without

acondom.

outcomes between subjects with and without the

fourdirectabuse typesverbal, emotional, physical,

and sexual abuse. Percentages, chi-squarc statistics,

and significance levels for the categorical outcome

variables by abuse type are presented in Table 3.

Th e p roportions of borderline clinical or clinical

depression, internalizing behaviors, and external-

izing behaviors were higher among subjects who

experienced verbal abuse.The mean RD SI score for

subjects who experienced verbal abuse was 15.42

SD - 9.16).Th e average ASR internalizing score

testimonies w ith these data provides support for the

association between verbal abuse and depression

and internalizing behaviors. As one youth noted,

At least once a month, my stepmom and stepdad

would say mean things to melike that I was fat

or stupid. It would m ake me feel upset and insecure

about

myself.

The proportion of high-risk sexual behaviors

was also higher among subjects who experienced

verbal abuse, although this finding only approached

statistical significance. The mean score of high-risk

sexual encou nters am ong those expe riencing verbal

abuse was 4.65{SD =6.85).

For subjects who experienced emotional abuse,

the proportion of alcohol abuse was higher among

those w ho reported abuse. Th e mean number of

days in the previous six mon ths on which subjects

with emotional abuse histories were drunk was

15.86 {S D= 42.44). Testimonies from the youths

support the association between substance use and

family problem s: I'd take a bunch of medications

hke Tylenol, and then I'd vomit. I did this when

I

had relationship problems and family issues. Once

I did it because my son's mother took my son away

.Hid told me he was dead six months later.

Among subjects reporting physical abuse, the

proportion of foster-care involvement was higher

amon g those with abuse historics.Thc mean number

of placements for those expe riencing physical abuse

was 3.36 {SD = 2,73). The average age at which

these subjects entered foster care was 8.55 years

{SD =

5.20). One youth with a history of foster

care noted that like 3 times a week growing u p

my uncle, grandpa, cousin, and brother would hit

me wherever they could land a punc h. Tbe y left

bruises, black eyes, bloody noses. I started fighting

them back when I was 16. It just got worse w hen

I started fighting back.

Similar to physical abuse,the proportion of foster-

care involvement was also higher among subjects

who experienced sexual abuse.The mean number

of foster care placements for subjects with histories

of

sexual

abuse was 3.67 (SD = 2.96). Th e average

age at which these young adults entered foster care

was 7.44 years (SD = 4.98).

In add ition, the p roportion of subjects wh o began

living on the streets by age 18 was higher among


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Wh itbeck, L. B., Hoy t. D. R., & B ao .w ' (2000). Depressive

symptoms and co-occurring depressive symptoms,

substance abuse, and co nduct pro blems a mon g

n.maw.Ty and homeless adolescents.Child

Development

71, 7 2 1 -7 3 2 .

Wliitbcck. L. B,, Hoy t, D. R., &Yodcr. K.A- (1999).A risk-

amplitlcation model of victimization and depressive

symptoms among runaway and homeless adoles-

cents.Am erican Journal

oJ

Community Psychology, 27 ,

273-296.

Kristin M. Ferguson, PhD, MSHis as.'niaate

professor.

School

oJ Social

IVork

Unirersily of Sotithern California. 669 West

34th

Street.

LosAngchXA 90089-0411 ;e-ntail:knfergus@

usc.eilu. lilispiht iindy

was

supported

by the

Ljirson Bihu-mait

for hinovativeiescarchai theSchoolofSodal WorbjUniversity

ofSoutiiern California.

Originalmangscripl received Match 1 1. 2008

Finalrevision received March 27 2009

Accepted

Apr i l 22 2009

N SW PRESS POLICY ON

ETHIC L BEH VIOR

T

he NA SW Press expects authors to ad-

here to ethical standards for scholarship

as articulated in the NASW Code ofEthics

.lud IVritiu^iifor '^'^ NASW Press:hiforrnatiou

fo r

Authors.

These standards include actions

such as J

.

taking responsibility and credit only for

work they have actually performed

honestly acknowledging the work of

others I

subm itting only original work to

journals

fiilly docum enting their own and otliers'

related work.

Ifpossi lebreaches of ethical standards have

been identied at the review or publication

process, the NASW Press may notify the au -

thor and bring the ethics issue to the a ttention

of the app ropriate professional body or o ther

authority. Peer review confidentiaiity will not

apply where there is evidence of plagiarism.

As reviewed and revised by

NASW National Committee on

Inquiry (NCOI).May 30,1997

Approved by NASW Board of

Directors, September 1997


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