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Study Finds Three Key Factors Increase Childhood Physical Abuse Risk

By Lindsey Getz

A recent study published in Child: Care, Health & Development found that adults who had parents who struggled with addiction, unemployment, and divorce are 10 times more likely to have been victims of childhood physical abuse.

The study, conducted by the University of Toronto’s Factor-Inwentash Faculty of Social Work, found that more than one-third of adults raised in homes where all three risk factors (addiction, unemployment, and divorce) were present reported they had been physically abused by someone close to them while under the age of 18 and still living at home. The results found that only 3.4% of those with none of the three risk factors reported they had been physically abused. However, with each additional risk factor experienced, the prevalence of childhood physical abuse increased dramatically.

Lead author Esme Fuller-Thomson, PhD, MSW, the Sandra Rotman Chair in Social Work and a professor of family and community medicine, says that for the past four years, she and coauthor Jami-Leigh Sawyer, MSW, a doctoral candidate and a social worker at Toronto’s Hospital for Sick Children, have been documenting the strong link between childhood physical abuse and a wide range of negative adult health outcomes, including cancer, heart disease, arthritis, ulcers, anxiety, and obesity. “We became very interested in potential avenues to prevent child abuse,” Fuller-Thomson explains. “The first task was to more effectively identify those at higher risk for physical abuse.”

Between Fuller-Thomson and Sawyer’s frontline practice experience and their review of literature, they were aware that child abuse was much more common in families that face adversities such as parental addictions. This prompted the pair to investigate whether these factors also could identify children at risk of childhood physical abuse.

“We were confident we would find some relationship between these three early adversities and childhood physical abuse,” Fuller-Thomson says. “We also anticipated there would be a cumulative effect, meaning those with two or three adversities would be more likely to report maltreatment than those who had experienced just one adversity. However, we were astonished by the magnitude of the association. Among adults who had experienced all three risk factors—parental addiction, parental divorce, and long-term parental unemployment—the prevalence of childhood physical abuse was 10 times higher than that reported by those without any of these risk factors.”

In fact, the researchers were so shocked by the findings that they repeated their research. “We were so astonished by the magnitude of the association between the combination of these three risk factors and child abuse in the 1995 survey that we replicated the analysis with a different sample from a 2005 survey,” Sawyer says. “The findings in both data sets were remarkably consistent and very worrisome.” Each survey included approximately 13,000 Canadians aged 18 and older.

Addiction Highest Indicator
Of the studied risk factors, parental addiction was the highest indicator of potential abuse. Even in the absence of parental long-term unemployment or divorce, individuals whose parents were addicted to drugs or alcohol had five times the prevalence of childhood physical abuse compared with individuals from families without addictions, according to Fuller-Thomson. “However, the prevalence of childhood physical abuse increased substantially among those who had experienced parental unemployment in addition to addiction,” she says. “Unemployment adds a great deal of stress within the family and can also exacerbate addiction issues.”

From the retrospective data, Sawyer and Fuller-Thomson say they cannot determine why parental addictions are so strongly associated with abuse. “However, we do know that alcohol and drugs are associated with lower inhibition and impulse control, which may lead to physical abuse behaviors,” Fuller-Thomson says. “Even in cases where the parent with an addiction is not a perpetrator of violence, he or she may not be as alert or vigilant in protecting the child from maltreatment.”

The Social Worker’s Role
The study’s findings have important clinical implications for social workers. Sawyer says the researchers hope the findings may eventually lead to better screening tools. “Currently, the World Health Organization does not recommend routine, universal screening of children for abuse because there is a high likelihood of false-positives,” she says. “Future research is needed to evaluate if using the three factors we studied to screen for childhood physical abuse improves targeting such that the vast majority of those at risk for abuse are correctly identified without incorrectly identifying many who are not at risk.”

Unfortunately, much of the screening that does take place for childhood physical abuse occurs only after a child presents to a health professional with a physical injury, according to Sawyer. “However, we are hoping that a better screening tool will identify those at risk so interventions can occur before the child is physically abused or at least before the violence has escalated to the level of serious physical injury. Until a rigorous evaluation of the efficacy of this screening strategy has been conducted, we can only suggest that social workers be particularly vigilant for abuse with their clients who are facing addictions, unemployment, and/or divorce.”

Both Fuller-Thomson and Sawyer believe this is an area where social workers can have a significant impact. Often they may be in a place to intervene when these risk factors present. “These findings underline the importance of providing effective interventions to decrease parental addictions and long-term unemployment,” Sawyer says. “In households where these risk factors are present, social workers have a role in assisting parents with locating appropriate resources as well as assessing the child’s well-being. In addition to decreasing the well-known negative consequences of these adversities, it is probable that eliminating these issues could decrease the prevalence of child abuse.”

Though social workers may be surprised just how significantly these adversities—particularly parental addiction—increase the likelihood of childhood physical abuse, Fuller-Thomson says that most social workers probably already knew that these factors play some role in abuse. “Our research underlines the extreme vulnerability of these families and the urgent need for holistic interventions which address parental addictions, unemployment, and family breakdown in addition to child maltreatment. Each of us has a moral responsibility to protect children from abuse. To keep the most vulnerable children safe, we must all be vigilant.”

“As a frontline social worker in pediatric health care who has experience in emergency department social work, it is clear that medical social workers in particular should be aware of these findings,” Sawyer says. “Often when children present to the hospital with physical injuries, we worry about potential child abuse. However, this study shows that our assessments need to extend beyond physical injuries to include screening for abuse in families who experience two or more risk factors including addictions, unemployment, and divorce.  This type of screening could be valuable in preventing future childhood physical abuse.”

— Lindsey Getz is a freelance writer based in Royersford, PA, and a frequent contributor to Social Work Today.