Trauma resilience among youth in substitute care demonstrating sexual behavior problems.

Abstract

The purpose of this longitudinal study was to examine the relationship between several proposed protective factors and trauma symptoms among highly vulnerable youth in the child welfare system.
Participants were 142 youth identified with a sexual behavior problem and their caregivers. Two waves of data were collected for each participant an average of 18 months apart. Foster parents reported on perceived level of support from the child welfare agency, youth involvement in club activities, and perception of youths' interpersonal and emotional competence. Youth provided self-reports of their sexual and physical abuse experiences, trauma symptoms at both time 1 and time 2, and ratings of parenting practices.
Youth with higher rates of sexual abuse showed more negative affect and higher levels of sexual and non-sexual rumination at time 2, controlling for time 1 scores. Boys and youth who experienced better parenting practices displayed lower negative affect. Youth with higher levels of emotional and interpersonal competence showed lower levels of non-sexual rumination. Moderation analyses revealed that youth with more significant sexual abuse histories whose foster parents did not feel supported by their child welfare caseworkers had higher levels of sexually ruminative thoughts. Finally, the results revealed that only youth without sexual abuse histories experienced the benefits of club involvement in terms of lower sexual rumination scores.
This study demonstrated that youth with significant vulnerabilities can still exhibit a degree of protection from trauma symptomatology in the presence of a wide range of personal and social variables. These findings support the efforts of stakeholders to promote strengths at the level of the individual, family, and broader social network and community.

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Child Abuse & Neglect 32 (2008) 67–81
Trauma resilience among youth in substitute care
demonstrating sexual behavior problems
Scott C. Leona,∗, Brian Ragsdaleb, Steven A. Millerc, Steven Spacarellic
aLoyola University Chicago, Department of Psychology, 6525 N. Sheridan Road, Chicago, IL 60626, USA
bCalifornia State University, Fullerton, Department of Psychology, Fullerton, CA, USA
cChild Abuse Unit for Studies, Education, and Services, Chicago, IL, USA
Received 8 August 2005; received in revised form 26 March 2007; accepted 18 April 2007
Available online 21 December 2007
Abstract
Objective: The purpose of this longitudinal study was to examine the relationship between several proposed
protective factors and trauma symptoms among highly vulnerable youth in the child welfare system.
Methods:Participantswere142youthidentifiedwithasexualbehaviorproblemandtheircaregivers.Twowavesof
data were collected for each participant an average of 18 months apart. Foster parents reported on perceived level of
support from the child welfare agency, youth involvement in club activities, and perception of youths’ interpersonal
and emotional competence. Youth provided self-reports of their sexual and physical abuse experiences, trauma
symptoms at both time 1 and time 2, and ratings of parenting practices.
Results: Youth with higher rates of sexual abuse showed more negative affect and higher levels of sexual and
non-sexual rumination at time 2, controlling for time 1 scores. Boys and youth who experienced better parenting
practices displayed lower negative affect. Youth with higher levels of emotional and interpersonal competence
showed lower levels of non-sexual rumination. Moderation analyses revealed that youth with more significant
sexual abuse histories whose foster parents did not feel supported by their child welfare caseworkers had higher
levels of sexually ruminative thoughts. Finally, the results revealed that only youth without sexual abuse histories
experienced the benefits of club involvement in terms of lower sexual rumination scores.
Conclusions: This study demonstrated that youth with significant vulnerabilities can still exhibit a degree of
protection from trauma symptomatology in the presence of a wide range of personal and social variables. These
findings support the efforts of stakeholders to promote strengths at the level of the individual, family, and broader
social network and community.
© 2007 Elsevier Ltd. All rights reserved.
Keywords: Child welfare; Resilience; Maltreatment; Sexual behavior
∗Corresponding author.
0145-2134/$ – see front matter © 2007 Elsevier Ltd. All rights reserved.
doi:10.1016/j.chiabu.2007.04.010

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S.C. Leon et al. / Child Abuse & Neglect 32 (2008) 67–81
Introduction
Resilience among youth has been defined as the “dynamic process encompassing positive adaptation
within the context of significant adversity” (Luthar, Cicchetti, & Becker, 2000). Characteristics that
precipitate resilience are known as protective factors (Luthar et al., 2000; Luthar & Zigler, 1991; Werner,
1989). The resilience literature has evolved to posit three interacting factors that affect adaptation to
adversity among youth: (1) qualities of the individual (e.g., temperament, intelligence), (2) qualities of
the youth’s family (e.g., parenting practices), and (3) qualities of the youth’s broader social environment
(e.g., involvement in extra-curricular activities) (Heller, Larrieu, D’Imperio, & Boris, 1999; Luthar et al.,
2000). The current study explores the effects of a range of possible protective factors across a sample of
high-risk youth in the child welfare system (substitute care) who are beginning to demonstrate atypical,
exploitative, and/or developmentally premature sexual behavior, known as sexual behavior problems
(Ryan, 1997).
Child maltreatment
Recentestimatesindicatethatover800,000childrenareabusedorneglectedannuallyintheU.S.(U.S.
Department of Health and Human Services, Administration on Children, Youth and Families, 2006).
Additionaladversitiesoftenexistformaltreatedyouthenteringthechildwelfaresystem(Levine,Doueck,
Freeman,&Compaan,1996;Roberts,2002).Researchindicatesthatthepossibilityofmultiplefostercare
placements, disrupted medical and educational services, and the potential for abuse while in foster care
all place youth in substitute care at risk of increased health, developmental, and psychological problems
(Benedict,Zuravin,Somerfield,&Brandt,1996;Newton,Litrownik,&Landsverk,2000;Roberts,1993).
The effects of maltreatment also have been studied, and the presence of trauma symptoms is common
among survivors of abuse (e.g., McLeer, Deblinger, Henry, & Orvaschel, 1992; Wolfe, Sas, & Wekerle,
1994). These symptoms may also be a trigger for sexual behavior problems among some youth (Pithers,
Cumming,Beal,Young,&Turner,1989).Consequently,understandingthefactorsthatworsenordecrease
trauma symptoms among youth beginning to demonstrate sexual behavior problems could have critical
implications for therapeutic intervention.
Resilience maltreated children
Maltreated children have received considerable attention in resilience studies; resilience is frequently
couched in terms of recovery from trauma (Masten, 1994). Research methods employing strict criteria
for resilience, such as the presence of better-than-average functioning across more than one assessment
period,haveledtolowratesofresilienceinthemaltreatedpopulation(Bolger&Patterson,2003;Cicchetti
& Rogosch, 1997; Farber & Egeland, 1987). For example, Cicchetti and Rogosch (1997) followed 213
maltreated and non-maltreated low-income youth over 3 years. Among the maltreated population, only
1.5% of youth demonstrated high functioning over all three assessments, compared to 10% of youth in
the non-maltreated sample. In light of these findings, research exploring resilience among maltreated
children has focused more on the relative benefits of what are termed protective factors in this highly
vulnerable population.
A protective factor is any positive attribute or strength that, when present, leads to relatively better
outcomes over time; it, therefore, is critical to use longitudinal designs when studying protective factors

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(Luthar et al., 2000). Luthar et al. (2000) proposed six different protective factor typologies based on how
youths’ strengths interact with adversity to affect outcomes: protective, protective-stabilizing, protective-
enhancing, protective-reactive, vulnerable-stable, and vulnerable-reactive. A youth strength that emerges
as a main effect is simply protective in Luthar et al.’s model because it acts to promote adaptation equally
at all levels of adversity. Strengths that promote adaptation differentially based on level of adversity are
considered moderated types protective factors and are tested using interactions. For example, a variable
suchassocialcompetencemightleadtolong-termprotectionagainsttraumasymptomsamongmaltreated
youth, but only for youth who experienced low levels of maltreatment. Luthar et al. (2000) proposed that
a variable acting in this way be considered protective-reactive. On the other hand, variables such as
certain forms of creativity might only trigger adaptation when the individual experiences higher levels of
adversity. Luthar et al. (2000) propose that such a variable be termed protective-enhancing.
Protective factors at the individual level among youth include intellectual ability (Herrenkohl,
Herrenkohl, & Egolf, 1994), internal locus of control (Moran & Eckenrode, 1992) a sense of self-worth
(Cicchetti, Rogosch, Lynch, & Holt, 1993; Moran & Eckenrode, 1992) and ego resilience and control
(Cicchetti et al., 1993). Examining ego resilience, research has demonstrated that youths’ ability to be
reflective, persistent, attentive, dependable, planful and relaxed is protective for both maltreated and non-
maltreated populations (Cicchetti et al., 1993), making it simply protective in Luthar et al.’s typology. In
addition, ego over-control, the ability to modulate impulses and shield oneself from external stressors,
has been found to enhance adaptive functioning in maltreated youth (Cicchetti et al., 1993), making it a
protective-stabilizing variable in Luthar et al.’s (2000) typology.
Protective factors at the proximal social level include the presence of a mutual friendship (Bolger &
Patterson, 2003) and familial cohesion, such as the presence of a caring and supportive adult (Egeland,
Carlson, & Stroufe, 1993; Romans, Martin, Anderson, O’Shea, & Mullen, 1995; Spaccarelli & Kim,
1995). For example, research exploring family cohesion has found that the presence of attentive and
supportiveadultscanleadtoresilience(Egelandetal.,1993;Romansetal.,1995).Taylor(1996)hasfound
that youth who perceive social support and family organization demonstrate lower problem behaviors.
Among youth from urban settings, high levels of family support have been linked to lower problem
behaviors even in the context of adversity (Quamma & Greenberg, 1994).
Factors surrounding youths’ involvement in the community also have been shown to be protective and
include participation in religious group and extra-curricular activities (Egeland et al., 1993; Herrenkohl
et al., 1994). In a sample of 3,281 youth between the ages of 12 and 17, Perkins and Jones (2004) found
that involvement in extra-curricular activities was associated with lower rates of alcohol use and suicide
attempts. Research has not explored whether the quality of services surrounding the child welfare agency
serves as a protective factor. However, prior research has found a connection between the quality of
caseworker support and foster parents’ willingness to house and care for youth in the future (Denby,
Rindfleisch, & Bean, 1999).
Insum,theliteratureonresiliencehasevolvedtoofferseveralconsistentconclusionsregardingtherole
ofprotectivefactorsinmaltreatedyouths’adaptationtoadversity(Helleretal.,1999).However,resilience
research should explore in greater detail variations in resilience patterns among unique demographic and
clinicalpopulationsofat-riskyouth(Lutharetal.,2000).Asmoreuniquepopulationsarestudied,distinct
context-specific protective profiles are likely emerge, lending more support to the notion that what is
protective for one type of youth may not be protective for others.
Prior research has not explored the effects of hypothesized protective factors among neglected or
maltreatedyouthcurrentlyinthechildwelfaresystemandbeginningtoexhibitsexualbehaviorproblems.

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This study seeks to address this gap in the literature. Maltreated youth in the foster care system beginning
todemonstratesexuallyproblematicbehavioraresignificantlydisadvantaged;therefore,itisreasonableto
hypothesizethatanyidentifiedstrengthswilldolittleornothingtoimprovetheirpsychologicaloutcomes.
However,thepotentialprotectivefactorvariablesexploredinthisstudy,suchasparentingpractices,extra-
curricular involvement, and interpersonal and emotional competence, have been consistent predictors of
improved outcome in the resilience literature. Therefore, it is hypothesized that the variables explored
here will predict improvement in the psychological symptoms of trauma.
Thecurrentstudyexaminedtheeffectsofseveralprotectivefactorsonsymptomsoftraumainasample
of 142 youth in substitute care identified as exhibiting sexual behavior problems. Youth in substitute care
who demonstrated these problem behaviors were identified for inclusion in the study as part of an overall
effort to understand the escalation and/or maintenance of sexual behavior problems over time among
youth in substitute care. Protective factors are explored across the individual, foster family, and foster
parent perception of foster care agency.
Method
Participants
Participants included youth and foster parents who participated in this two wave longitudinal study of
children with identified sexual behavior problems living in Cook County, IL and under the custody of
the state’s child welfare system (Department of Children and Family Services-DCFS). Participants were
consecutive referrals to the study after initially being screened by DCFS based a report that they were
involvedinsexuallyinappropriatebehavior,describedbelow.ThestudywasconductedbytheChildAbuse
Unit for Studies, Education and Services (CAUSES), a private clinical services and research agency in
Chicago, Illinois under contract with DCFS. DCFS policy requires that Unusual Incident Reports (UIRs)
be filed by the youth’s caseworker for events such as elopement, abuse, or in the case of youth in this
study, the occurrence of sexual behavior problems. The enrollment period lasted from May 2000 until
the end of February 2003.
There were 174 youth originally identified for participation in the study. Fourteen of these youth were
deemedinappropriateforfurtherstudyduetosevereemotionaldisturbanceorseveredevelopmentaldelay.
An additional 18 subjects were lost to refusal, attrition, or severe emotional disturbance (e.g., previously
undiagnosed psychotic disorders discovered upon initial interview). The final sample consisted of 142
youth for whom we collected both time 1 and time 2 data. On average, sample youth had been in state
custody since age 5.6 (SD=3.7). Youth had experienced multiple placements, ranging from 1 to 23 prior
to the screening incident; the mean number of placements was 7.0 (SD=4.0). Twenty-seven percent of
the sample was female, and the mean age was 13.2 years (SD=1.9). The ages ranged from 10.4 to 17.9
years; 88% of the sample was African American.
Intermsofthefosterparents,53%ofprimarycaregiverswereAfricanAmerican,43%wereCaucasian
and the remainder were Latino or Other; 43% were employed full-time, 41% were unemployed, and 15%
were employed part-time. In terms of education, 4% received less than a high-school education, 23%
received some high-school education, 23% received a high-school diploma or equivalent, 30% had taken
some college courses, 10% had an Associate’s degree, 9% had a Bachelor’s degree, and 1% received a
Master’sdegree.Thirty-sevenpercentweresingle,36%wasmarried,and26%werewidowedordivorced.