The Association between Familial Risk Factors and Maltreatment Exposure Among Youth Residing in Psychiatric Residential Treatment

Background: An estimated 672,000 children experienced maltreatment in 2016 (U.S. Department of Health & Human Services, 2019). Risk factors associated with maltreatment include substance abuse, financial issues, domestic violence, parental characteristics/personal history, mental health issues, family conflict, and lack of social support (Center for Disease Control and Prevention, 2019). Risk factors associated with physical abuse include domestic violence, family conflict (Antle et al., 2007; Moylan et al., 2010; Stith et al., 2009; Yang & Maguire-Jack, 2018), and parent psychopathology (Stith et al., 2009). Child neglect associated risk factors include parental unemployment, mental health issues, and criminal history (Mulder et al., 2018; Yang & Maguire-Jack, 2018). Much research has focused on risks in subsets of maltreatment (i.e. physical abuse, sexual abuse) or maltreatment as a whole with little research examining risk factors across maltreatment types. Moreover, the literature is even more sparce as it relates to youth residing in residential treatment facilities. The purpose of this study was to explore the association between familial risk factors and maltreatment exposure in youth residing in psychiatric residential treatment facilities.

Method: This study analyzed secondary data (Boel-Studt, 2017) of 330 youth in psychiatric residential treatment facilities between 2007 and 2012. Four binary logistic regressions were run to test the associations of domestic violence, limited social support, parental mental illness, parental substance abuse, and chronic family conflict and the odds of having suspected and confirmed maltreatment history (i.e. neglect, sexual abuse, physical abuse, and emotional abuse). Ages ranged from 5 to 17 (M = 10.63, SD = 2.60) and the sample consisted of slightly more males (n=258, 59.6%) than females. From the sample, the highest risk factor was chronic family conflict (n=189, 43.6%), followed by a caregiver with a mental health issue (n= 181, 41.8%) familial limited social support (n=158, 36.5%), substance abuse issues (n=122, 28.2%), and domestic violence (n=118, 27.3%). In terms of maltreatment history, neglect was most prevalent (n=218, 50.3%), followed by physical abuse (n=212, 49%), emotional abuse (n=209, 48.3%), and sexual abuse (n=162, 37.4%).

Results: The findings suggest that gender was a significant predictor for physical (OR = .09; 95%CI 1.10, 2.51) sexual (OR = .87; 95%CI 1.10, 2.51), and emotional abuse (OR = .61; 95%CI 1.07, 2.43), with girls having higher odds of experiencing maltreatment in these categories. Familial history of domestic violence increased the odds of experiencing physical abuse (OR = .69; 95%CI: 1.64, 4.41) and neglect (OR = .60; 95%CI: 1.00, 2.58). Finally, chronic family conflict was associated with increased odds of youth experiencing emotional abuse (OR = 1.25; 95%CI: 1.47, 3.43) and physical abuse (OR = .64; 95%CI: 1.08, 2.51). Across the models, parental substance abuse, mental health issues, and limited support did not predict outcomes of maltreatment.

Conclusion: Findings suggest that history of family domestic violence and chronic family conflict are important components to consider during the assessment and treatment planning phases of residential care. Specifically with female clients, assessment and treatment planning should account for gender differences. Further implications for research and practice will be discussed.