Types of Traumas Experienced By Adolescent Girls Involved in Child Welfare: Relationship to Mental Health and Behavioral Problems

Background and Purpose: Trauma histories among adolescents involved in child welfare have been linked to negative mental health and behavioral outcomes including PTSD, re-victimization and aggression towards others. Surprisingly, only a few studies have described the traumas that this population has experienced, despite the recent recognition that trauma-informed child welfare services are needed.  To better understand the types of traumas experienced and subsequent problems of adolescents who are referred for services, the following questions were addressed: 1) What are the most frequent types of traumas experienced by girls referred to trauma-focused services, and are there any differences in frequency of traumas by demographic variables? 2) To what extent is trauma exposure associated with the common reactions to trauma such as PTSD symptoms, aggression (as victims and perpetrators), substance use, and school problems, controlling for significant demographics?  

Methods: The study utilized baseline data from a trauma-focused CBT study that included 127 adolescent girls, ages 12-18 years old (mean age=15.4, SD=1.6). The girls were referred by staff associated with child protective services. The sample was primarily African American (83 %) and White (17 %).  The girls’ living situations were as follows: 60% with biological parents, relatives, or adopted parents; 24% in foster homes; and 16% in group homes. Structured face-to-face interviews included the following: 1) Frequency and mean of trauma types ever experienced (UCLA PTSD Index: Part 1, 13 items); 2) PTSD symptoms (Foa, 2001); 3) Aggressive behaviors—victims (18 items) and perpetrators (18 items); 4) Substance use; 5) School problems; and 6) Demographics (age, number of lifetime home placements, ethnicity). Data analyses included descriptive statistics, simple correlations, and multiple regression models for each of the dependent variables.

Results: The mean number of types of traumatic exposure was 6.6 (SD=2.6). The most common individual types of trauma were: illness or injury of someone close (85.8%), death of someone close (85.8%), serious accident (63.8%), separation from parent/guardian (59.8%), and witness to physical abuse at home (55.1%).  Likewise, the most common category of traumas endorsed included events related to illness, injuries, and death. Girls with a greater number of lifetime home placements reported more types of traumatic exposure (p< .001), yet no differences were found in number of traumas by age or ethnicity. Bivariate analyses indicated that girls with more types of traumatic exposure reported higher PTSD symptom severity (p<.001), aggressive behavior as perpetrators (p<.001) and as victims (p<.001), alcohol and substance use (p<.0001), and school problems (p<.01).  These associations remained significant when controlling for number of home placements in multiple regression models.

Conclusions: Findings indicate that child welfare-involved adolescent girls who are referred to services have high rates of trauma exposure which are strongly associated with serious mental health and behavioral problems. In addition to family and interpersonal traumas such as abuse and family violence, girls also experience high rates of traumas related to death, injury, and illness. Trauma-informed child welfare services that recognize the cumulative risk status of this population and that do not focus solely on abuse and neglect are warranted.