Qualitative Social Work http://qsw.sagepub.

com/

Childhood abuse and loss in the lives of low-income women

Christina Gringeri and Mary Beth Vogel-Ferguson Qualitative Social Work 2013 12: 654 originally published online 29 June 2012 DOI: 10.1177/1473325012451481 The online version of this article can be found at: http://qsw.sagepub.com/content/12/5/654

Published by:
http://www.sagepublications.com

Additional services and information for Qualitative Social Work can be found at: Email Alerts: http://qsw.sagepub.com/cgi/alerts Subscriptions: http://qsw.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav Citations: http://qsw.sagepub.com/content/12/5/654.refs.html

>> Version of Record - Sep 5, 2013 OnlineFirst Version of Record - Jun 29, 2012 What is This?

Downloaded from qsw.sagepub.com at University of British Columbia Library on November 1, 2013

Article

Childhood abuse and loss in the lives of low-income women

Christina Gringeri and Mary Beth Vogel-Ferguson
University of Utah, USA

Qualitative Social Work 12(5) 654670 ! The Author(s) 2012 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1473325012451481 qsw.sagepub.com

Abstract About 700,000 cases of physical, sexual and emotional abuse and neglect are substantiated each year, making childhood maltreatment a common form of trauma in the histories of adults. We summarize the literature on the consequences of child maltreatment across the lifespan, agreeing with those researchers who see maltreatment as a public health problem. We examine low-income womens perceptions of the impacts of childhood abuse on their adult experiences through 19 life narratives collected during 2008. Using a theoretical lens of Hobfolls Conservation of Resources, we discuss themes of loss and developmental stress in womens experiences of childhood maltreatment. We conclude with implications for professionals and case managers working with low-income women, suggesting that assessment for childhood maltreatment is an important aspect of supporting low-income women and their families on the road to self sufficiency. Keywords Adult survivors of child maltreatment, developmental loss and stress, low-income women, social constructionism

My stepfather was very abusive. It was very dicult .. . . My mom was gone all the time. So the only adult I had in my life at the time was my grandfather and he was sexually abusive towards me and my sister. Terry, participant in the Life Narrative project

Corresponding author: Christina Gringeri, College of Social Work, 395 East 1500 South, University of Utah, Salt Lake City, UT 84112, USA. Email: cgringeri@socwk.utah.edu

Gringeri and Vogel-Ferguson

655

While there is recognition of the acute trauma caused by child abuse, maltreatment may create chronic loss and trauma that are dealt with later in life by aected adults. Adult survivors of child maltreatment may experience challenges in areas such as family and work relationships, parenting, and friendships. In this article, we present briey the literature on the consequences of childhood abuse and neglect as background to our analysis of 19 narratives from low-income women who are adult survivors of child maltreatment. In the process of analyzing the narratives, childhood abuse and violence emerged as a prominent, recurring theme in the lives of these participants, prompting us to examine the connections between child maltreatment, social support, and poverty using a theoretical lens of Conservation of Resource Loss (Hobfoll, 1989).

Child maltreatment
Childhood abuse and the resulting trauma are prevalent experiences in the United States, with approximately 700,000 cases of physical, sexual and emotional abuse and neglect substantiated each year; in 2009, 702,000 cases were conrmed (Sedlak et al., 2010), although federal prevalence rates may underestimate child maltreatment due to the reliance on reported and substantiated cases. Other sources indicate higher prevalence rates; for example, Collins et al. (2010) report 900,000 substantiated cases annually. The high rates of abuse and neglect and their multiple consequences across the lifespan prompt several researchers to discuss it as a social and public health problem with signicant impacts on adult physical and mental well-being (Collins et al., 2010; Cross, 2001; DeLillo et al., 2000; Felitti and Anda, 2010; Martsolf and Burke Draucker, 2008). Child welfare researchers have documented the myriad ways in which abuse and neglect harm developing children. Attachment disorders, disrupted or diminished relationship abilities, alterations in self-perception, and changes in systems of personal meaning are frequently documented consequences of child abuse and neglect (Collins et al., 2010). Maltreated children are at greater risk for decreased academic performance, increased behavioral problems, depression, lower self-esteem, obesity, and poor physical health (Noll, 2005). Children who were physically abused tend to view relationships as centered on power struggles and intimidation, and saw themselves as lacking worth and ability (Frederick and Goddard, 2008). Literature on loss tends to focus more on adult perceptions of how childhood maltreatment continues to aect their lives, which is helpful in understanding the narratives of low-income women who have histories of maltreatment.

Maltreatment as loss
Loss is also an important theme in the literature on child maltreatment, particularly in works that examine adult survivors narratives (Bloom, 2002; Murthi and Espelage, 2005). Bloom (2002: 5) recognized the importance of loss when she wrote complicating the process of grieving for adult survivors, is the fact that the losses

656

Qualitative Social Work 12(5)

that accompany child maltreatment are cloaked in silence, lost in the shrouds of history, and largely unrecognized. Losses due to abuse and neglect become an important part of a survivors history, of the self she takes forward into adulthood. Much of the research examining consequences of child maltreatment directly or indirectly suggest the developmental, emotional, physical, relational and material losses experienced by survivors of abuse. In this article, loss includes not only what was lost through maltreatment, such as relationships and developmental support, but also that which the child never had. Examining adult narratives with respect to how maltreatment has shaped their lives through Hobfolls lens of Conservation of Resources helps us highlight and understand adult manifestations of loss and trauma that may continue to challenge adult survivors (Hobfoll, 1989). Hobfoll (1989) understood stress as a result of ones interaction with the environment in which one perceives or experiences actual or threatened loss of resources. Individuals manage or reduce psychological stress by creating and maintaining the personal characteristics and social circumstances most likely to generate positive reinforcement, and by avoiding the loss of such characteristics or circumstances. Resources are those objects, personal characteristics, conditions, or energies that an individual values, and that may serve as a means to acquire them. Environmental conditions or events may threaten or diminish an individuals resources, or they may support an individual in acquiring resources. In general, Hobfoll argued that people strive to develop a surplus of resources, in part to protect against future losses, but also because a surplus tends to support wellbeing. Resource loss causes stress and increases vulnerability to further loss. Hobfoll observed where individuals are ill-equipped to gain resources, in contrast, they are likely to be particularly vulnerable and rely on self-protective strategies to manage stress and loss (1989: 517). Personal characteristics are of particular salience for understanding losses in relation to child maltreatment, and are dened by Hobfoll as emanating from an individuals view of and relationship to the world, and include self-esteem and a sense of mastery (1989). Healthy personal characteristics come from ones ability to see events as predictable and the social context as conducive to ones best interests. These characteristics lead a person to experience less stress in general, or to manage it better when loss does occur. For developing children, personal characteristics in this sense are dependent on the adults in the environment, and their ability to shape the childs relationship to the world by responding to the child in ways that are developmentally appropriate and conducive of growth. The family sets the foundation for resource development and accumulation in infancy and early development, mainly through the establishment of stable, trusting relationships and a safe, predictable environment. Thus, one can see healthy attachment as a foundation to developing personal characteristics that allow an individual to create and maintain the resources necessary to manage lifes stressors. Healthy attachment may nurture a childs trust in caretakers and the environment, which helps the child see events as predictable and favorable, thus nurturing relational skills necessary for the development of social support later in life. As Hobfoll noted, social supports eect

Gringeri and Vogel-Ferguson

657

seems to hinge on its value in promoting or supporting a positive sense of self and a view that one can master or at least see through stressful circumstances (1989: 517). Child maltreatment produces lasting trauma and loss, and thus impedes the probability of establishing the foundation necessary for developing the personal characteristics that aid in resource creation and maintenance. The losses that children experience as a consequence of maltreatment begin with, but are not limited to, the loss of the basic trust relationship that allows a child to see the world as a safe and supportive environment, and continues through losses in academic and social learning that aect a childs later ability to be successful in the tasks of adulthood, such as interpersonal relationships and employment. In Hobfolls view, these losses create a spiral of stress and increased vulnerability that may manifest in adulthood as lower social support, and increased risk of interpersonal violence, PTSD, depression, anxiety, and poor physical health (Felitti and Anda, 2010; Frederick and Goddard, 2008; Greeneld and Marks, 2010; Hall, 2000; Vranceanu et al., 2007; Zolotor and Runyan, 2005). Many of the identied consequences are directly related to the ways in which abuse aects a childs developing brain. Ongoing and complex trauma in childhood aects the development of the brain, as well as the balance of neuro-chemicals; the stress that children experience with abuse often results in the childs brain focusing on surviving and responding to environmental threats (Child Welfare Information Gateway, 2009). They become adept at perceiving threats in the environment at the expense of other potential capabilities, such as complex and abstract thinking. Hagele (2005) reported that maltreated children may develop an exaggerated response to minor environmental stresses, and their developmental progress lags. While developing hyper-vigilance regarding environmental threats can be seen as a needed adaptation in a hostile environment, such over-development of one function of the brain at the expense of others may leave abused and neglected children at a disadvantage, especially with regard to learning. While these children are often labeled learning disabled, the reality is that their brains have developed so that they are constantly alert and are unable to achieve the relative calm necessary for learning (Child Welfare Information Gateway, 2009: 9). Observed changes in the brain are linked to higher risk of depression and attention decit/hyperactivity disorder, panic disorder, post-traumatic stress disorder, dissociation, and decreased memory (Hagele, 2005).

Maltreatment-related loss in adulthood

Adult survivors of childhood maltreatment may experience loss in a number of ways. Many studies have found diminished parenting skills and challenges in their intimate relationships (Collins et al., 2010; Frederick and Goddard, 2008; Hagele, 2005; Liang et al., 2006; Murthi and Espelage, 2005; Vranceanu et al., 2007). Physical health problems adult survivors of abuse may experience include chronic fatigue, altered thyroid function, altered immune function, eating disorders,

658

Qualitative Social Work 12(5)

obesity, asthma, hypertension, and peptic ulcer disease; in addition, they may experience cognitive decits in attention, abstract reasoning, impulse control, and long-term memory (Hagele, 2005). Compared with adults not reporting childhood abuse, adult survivors report twice as many subsequent sexual assaults, higher rates of interpersonal violence, and four times as many self-harm incidents (Hagele, 2005). These ndings suggest a persistent cycle of violence, as described by Noll (2005), in which abuse begins in childhood, re-emerges in adolescence and early adulthood as physical and/or sexual re-victimization, and ultimately puts the next generation of children at greater risk for maltreatment. Child welfare advocates have long known of the deleterious eects of child abuse and neglect on developing children; until fairly recently, however, there has been less evidence regarding adult social and physical health correlates of adverse experiences in childhood (Felitti and Anda, 2010; see also http:// www.dcd.gov/ace/prevalence.htm#dysfunction). The Adverse Childhood Experiences (ACE) project is a collaborative study involving Kaiser Permanente Health Maintenance Organization (HMO) in southern California and the Centers for Disease Control (CDC). The ACE projects ndings add greater detail to the portrait of adult manifestations of loss due to childhood maltreatment. From 19951997, ACE researchers enrolled 17,337 adults who were privately insured by Kaiser Permanente; each individual responded to 10 survey items regarding adverse childhood experiences prior to age 18, such as physical, psychological or sexual abuse, emotional or physical neglect, parental separation or divorce, living with an adult who used substances, had a mental illness or was incarcerated, or witnessed violence against their mother. The survey does not account for multiple exposures to the same category of adverse experience, but only counts exposure to each type once. The researchers followed the participants for 10 years, and collected detailed information about their adult physical and mental health status. By participant self-report, 10.6 percent experienced emotional abuse, 28.3 percent were physically abused, and 20.7 percent were exposed to contact sexual abuse; 10 percent reported physical neglect, and 15 percent experienced emotional neglect. Women reported greater exposure to emotional (13.1% vs. 7.6%) and sexual abuse (24.7% vs. 16.0%), and less exposure to physical abuse (27% vs. 29.9%) and neglect (9.2% vs. 10.7%) than did men (http://www.dcd.gov/ ace/prevalence.htm#dysfunction). This sample is largely middle class and educated, and thus the prevalence reported may be understated for the US population as a whole. Researchers have found that exposure to adverse childhood experiences is strongly correlated with decreased adult physical and psychological well-being, such as increased smoking, drug and alcohol use in adulthood, premature death, increased attempted suicide, teen pregnancy and impregnation, chronic obstructive pulmonary disease, heart disease, increased number of sexual partners, cancer, stroke, and diabetes, among others (Felitti et al., 1998; Felitti and Anda, 2010; http://www.dcd.gov/ace/prevalence.htm#dysfunction). Additionally, self-rated job performance and perceived social support varied inversely with ACE exposure

Gringeri and Vogel-Ferguson

659

(Felitti and Anda, 2010). These ndings point to losses we may observe in the experiences narrated by low-income women. Higher prevalence of child maltreatment among low-income families has also been suggested. One federal study found that abuse is three times more common, and neglect is seven times more likely in low-income families (Sedlak et al., 2010). In one sample of 127 low-income African-American mothers, 53.5 percent reported physical and/or sexual abuse in childhood; 37.8 percent reported sexual abuse alone (Marcenko et al., 2000). A Utah study of 1075 women receiving cash assistance found 60 percent reported experiences of physical and/or sexual abuse prior to age 18 (Harris and Vogel-Ferguson, 2007). Poverty is likely one of the complex factors creating stress in family lives, rather than a direct cause of abuse or neglect. Given the higher prevalence of abuse and neglect in low-income households and the multi-faceted and far-reaching consequences, it is important to examine the ways maltreatment may shape adult survivors experiences. Our aim in this article is to examine losses women survivors of abuse experience as impacting the creation and maintenance of resources in adulthood, and that pose challenges for them in carrying out adult tasks. Poverty adds an additional and often chronic stressor, exacerbating the challenges survivors of abuse already face in maintaining personal resources. Because the ACE studies focus on middle-income adults with private insurance who reported child abuse, we aimed to examine low-income adult womens ongoing experiences with the consequences of childhood maltreatment.

Methods
The life narrative participants (n 32) were an urban sub-sample of a larger Utah survey of cash assistance recipients (Harris and Vogel-Ferguson, 2007). In 2006, the rst year of the larger survey, 1144 cash assistance recipients participated in interviews averaging 90 minutes; of these, 357 were located in an urban area. Social support data was used to cluster participants into three groups reecting low, medium and high levels of social support. From these groups, 101 participants were randomly selected to participate in the life narrative interview; however, only 75 completed all three waves of the cash assistance survey, a criterion for participation in the life narrative interview. Of the 75 eligible respondents, 32 completed life narrative interviews; 31 of them were women. The majority of those who did not participate did not return phone calls, and after several attempts, were removed from the list. The life narrative interviews were conducted by the rst author and lasted an average of 90 minutes. All procedures were approved by the University Institutional Review Board; participants received $20 for each interview. Nineteen of 31 women mentioned childhood maltreatment and their narratives form the basis of the present analysis. At the time of the interview, the women ranged in age from 20 to 48; 12 identied as Caucasian, ve as Hispanic, and one each as Asian-American and African-American. Most of the women had

660

Qualitative Social Work 12(5)

experienced some combination of physical, psychological, or sexual abuse; no one reported only one form of abuse in childhood. Twelve participants did not report childhood abuse. Their narratives varied signicantly from the narratives of participants reporting abuse. These 12 participants reported a positive parental relationship and supportive family members, less drug use, better health and mental health, as well as more access to medical care up to age 18. While those not reporting abuse were not signicantly dierent with regard to educational achievement, they did overall report fewer academic or behavioral problems at school.

Narrative interview project

Social constructivism is a paradigm or worldview in which the researcher understands reality as constructed by the individuals who experience it and give it meaning (Gringeri, Barusch and Cambron, in press; Guba, 1990; Guba and Lincoln, 2005). Our understanding of complex social realities, within this paradigm, is deepened through interactions with individuals as they share their lived experiences and the meanings they attribute to them. Social constructivism guided the framing of the life narrative project, including the development of the narrative interview, which asked each participant to reect on her journey from childhood to the present; the interview was introduced as an opportunity for the participant to narrate the story of how she got where she is today. The interviews were open and conversational, designed to allow the participant to narrate her experiences as she chose, yet focused on covering topics related to her family of origin, experiences with school and learning, friends, relationships, employment, goals for self and hopes for children, social support, and perceived physical and mental health.

Researcher positionality
Reexivity is the practice of reecting on our relationship to our work, and in research, to our participants as well (Gringeri et al., 2010; Pascale, 2010; Wahab et al., 2012; Watt, 2007). As an ongoing approach, reexivity helps build transparency in the conduct of the research, and oers readers a window through which to view the social positionality of the researchers. The authors of this study have focused much of our research eorts on multiple aspects of the work that women do, particularly low-income women. As social workers interested in social policy, womens work lives are important to us in the context of a political discourse that often seems to assume that women do not work hard, especially poor women who are seen as making wrong choices for themselves and their families. We bring to this work a critical approach that seeks a more complex, nuanced understanding of the lived experiences of low-income women than the one typically presented in the public rhetoric, with the goal of sharing this understanding with those who provide services to low-income women.

Gringeri and Vogel-Ferguson

661

Power shapes social relationships, and the researcher-participant relationship is no exception (Pascale, 2010; Thapar-Bjorkert and Henry, 2004; Wahab et al., 2012). In this work, the rst author entered each relationship with a security blanket of questions and topics that changed throughout our conversations. She learned to follow the story as the narrator wanted to share it, knowing that each participant has power over her disclosure, and thus over our understanding. The narrative interview questions were based on the authors combined interests, privilege, and our knowledge and lack of knowledge, but each participant responded according to her interests and experiences. Each of us exercises some power in the interview setting. As researchers, we exercise power when we analyze the data and write, and are fully responsible for the choices we make in doing so; our ethical responsibilities as researchers and social workers commit us to staying grounded in the experiences shared by the women, and to use the understanding of their experiences to their best interests.

Data analysis
We analyzed participants narratives for themes and patterns related to social support, particularly examining relationships with the family of origin, current family, friends and partners, as well as experiences with education. After verbatim transcription, the rst author immersed herself in reading the transcripts several times, noting predetermined themes reecting the researchers initial, literature-based perspectives on the issues. Themes emerged organically from the narratives and all interviews were coded in N-Vivo8. We utilized line-by-line coding to maintain delity to the experiences of the participants and to examine processes in the narratives in detail (Charmaz, 2006). After detailed coding, thematic and analytic coding were utilized to examine the interrelationships among themes (Marshall and Rossman, 2010). The themes of childhood violence and loss emerged from the analytic coding of the womens narratives. These themes were embedded in the womens narratives as they talked about their families of origin, rather than in response to specic questions about maltreatment.

Findings: Loss and childhood maltreatment

The losses associated with childhood abuse, as observed in the life narrative data, can be grouped in ve categories: relational, personal identity, material, learning/ school, and institutional. We developed these groups of losses directly from the ways the women narrated their experiences. The women tended to see their experiences of child maltreatment as the center of a matrix of losses, from which these additional losses spiral outward, aecting more areas of life, especially as she entered adulthood. These losses undermined the development of personal characteristics and contributed to diculties in the maintenance or accumulation of resources that may have helped support their development into adulthood.

662

Qualitative Social Work 12(5)

Relational losses
Participants described many relational losses within their family of origin, primarily the loss of trust and protection. Sara experienced family violence and sexual abuse as a child and interpersonal violence as a young parent before the age of 18; she observed, I started noticing that I didnt trust people when I turned 16, when my daughter was very young, but I dont think I ever trusted anybody when I was younger, either. The loss of trust is a core developmental loss, a rupture of the basic relational foundation human beings require for healthy development. This loss was often compounded by the lack of parental or adult protection upon disclosing the maltreatment. Abby was physically abused throughout her childhood, sexually abused by an extended family member, and sexually assaulted as a young adult; her siblings were also physically abused. When asked if she was ever able to discuss this with her mother, she replied, no, cause she is like how could you say that about your father? . . . She was there when it happened, but she likes to pretend that she doesnt know anything about it. Within these experiences, the foundation on which personal characteristics as resources should be built is greatly damaged, both at the time of maltreatment and subsequently aecting future development. Lack of trust in others makes relationships dicult at best, and often avoided; lack of protection sends a strong message that one does not deserve it, leaving one feeling vulnerable and hence hyper-vigilant. Many participants recognized that their experiences of abuse resulted in a loss of innocence and childhood. The ability to see events as occurring in ones best interests in the context of a predictable world is integral to creation and maintenance of personal resources. But the loss of childhood, rather than meaning that one has to grow up too soon, really entails the loss of this view and makes it more dicult to enter adulthood. Terry testied against one of her abusers, and reected on the loss of innocence resulting from sexual abuse.
Its still rape. And calling it molestation is like its not as bad bull. It is as bad. In fact, in my opinion, in a way, its worse, because youre not a child anymore. You dont even look at things the same anymore. That innocent view is gone. Your whole world comes crashing down.

Those who might help her rebuild her world, such as siblings or other family, represent another loss, as several women mentioned losing family and siblings due to abuse. Abbys brother disclosed abuse and was removed from the home, at rst temporarily, then permanently when their parents left him in state custody. Rayna was adopted into a family in which her father meted out physical abuse for minor reasons, such as getting a B on a report card; she left home as a teenager, and has not re-established contact with her family. Several participants recalled being threatened with loss of family as a means to impede disclosure. Sandra was threatened by her mother before each of the court hearings regarding her disposition. My mother told me Okay, tell them this, youre never going to talk to your

Gringeri and Vogel-Ferguson

663

brother and sister ever, ever again if you dont say that none of it happened. Siblings who might be a source of support regarding maltreatment become a weapon with which to try to impede disclosure, threatening further loss, which is already all too real for the child. Other participants experienced a loss of extended family, when they disclosed sexual abuse by cousins or uncles; their family tree was permanently pruned when they observed, that side of the family doesnt have nothing to do with us anymore. Terrys story illustrates the loss of childhood and innocence. After she disclosed the abuse to authorities, she took custody of her younger sister, to protect her from further abuse. Terry was still a teenager, had born a child as a result of the sexual abuse, and was sheltering her younger sibling, who was suicidal at the time.
All of this actually was while we were in my apartment and I was dealing with [her sibling] and her suicide attempts and my newborn child, and I was testifying against him and putting him in prison and taking my sister to counseling and had her with the psychiatrist. All the things that nobody had done for me, I was trying to do for her. And, it was a little bit more than I could chew, I think.

Becoming a parent involuntarily, trying to shield a sibling from abuse, engaging the judicial system to resolve some of the abuse are adult tasks that are more than one can chew, given that Terry was cut o from childhood, without the skills and resources to manage adult responsibilities. Relational losses included having parents who did not model good parenting or adult skills, critical areas of guidance typically received from parents. Sometimes this lack of mentoring and guidance was experienced in very basic areas, such as hygiene or appropriate dress. One participant found her elementary school report card; on it was a note from the teacher highlighting her inadequate hygiene. Another participant, who had been sexually abused by a family friend, and neglected and physically abused by her adoptive parents, talked about a lack of basic sex education that might have been helpful to her in processing the maltreatment. I didnt really have any examples . . .. They didnt talk about sex. They didnt talk about what happens to a woman. So I didnt know what was going on, so I think I could have put myself in the position to be assaulted. Her willingness to take responsibility for abuse may be a coping mechanism to deal with her history as an adult; but it may also suggest a relational loss, in which those responsible for protecting and guiding her had abdicated their adult obligations.

Personal identity losses

Women talked openly about their childhood experiences of abuse, focusing on losses of safety/security, integrity and honesty, voice, perspective on relationships, and self. Sandras story illustrates these losses; she experienced physical and sexual abuse from her stepfather, and emotional abuse from her mother and stepfather, starting at an early age. She remembered being removed from her home when she

664

Qualitative Social Work 12(5)

was fairly young, and being in temporary care for three or four years. Her stepfather and mother physically abused her, and as she entered adolescence, her stepfather sexually abused her. As a teenager, she ran away to avoid his rage following her disclosure of maltreatment at school. Sandra disclosed the abuse to a student who ridiculed her appearance and lack of hygiene, only because she wanted the ridicule to stop. I told one of these girls, because I didnt really have friends and I wanted them to understand that it wasnt my fault that I didnt have nice clothes like them to wear. And they didnt need to make fun of me because I had that in life. So I told them what happened at home and I told them please dont tell anyone because if my stepdad and my mom nd out Ill be in really big trouble. The girl told a teacher, who talked with Sandra and then connected her with a caseworker. Sandra requested again that her parents not be told that she had disclosed. A school administrator brought in her parents, and her mother called her a liar, threatened her with loss of her siblings if she did not retract, and then made Sandra go in front of the school and say I lied and said that my stepdad sexually abused me. It didnt happen. So nobody wanted to be my friend after that because they thought I was a liar. These losses represent some of the high costs victims pay for disclosure of abuse. Sandra was not safe at home and she was not safe at school where she was ridiculed and disbelieved. Out of desperation to make the ridicule stop, and because she did not have friends to protect her from it, she disclosed the abuse, only to have her integrity questioned. Multiple times she requested court protection from her parents, but in the end was left in their hands. She was punished and humiliated for using her voice and trying to protect herself, rather than experiencing the justice of the perpetrators punishment. Abby did not even try to disclose the abuse: It was rough. I went to school with black eyes and fat lips. I never told anyone. I always lied to my teachers and my friends about what happened. Sandra and Terry both used street drugs to help them cope with the pain of losses. Terry stated she turned to illegal drugs in order to survive. I had to do dope to survive. Sandra smoked marijuana and over-used prescription drugs trying to make myself happy. I was sad, and I wanted to be happy, and I thought [the drugs] would make me happy. Other participants reported using alcohol to deal with or to avoid dealing with the pain of past abuse.

Material losses
Childhood abuse can occasion material losses, as well. Participants lost home as a physical place to be, as a shelter from the elements, sometimes temporarily, other times permanently. One participant experienced being locked out of the house by her parent, regardless of the weather, for minor issues such as not nishing homework on time. Several recounted running away from abusive situations, living on the street, sleeping in vehicles, or being forced from their homes by the abuser or the non-protecting adult. Adults in places that were supposed to oer protection

Gringeri and Vogel-Ferguson

665

from the original abuse, such as foster homes, often were abusive as well, and children suered the loss of multiple homes or shelters. Neglect and abuse exacerbated material losses related to appearance, clothing, hygiene, and nutrition. Beths father was away from home often due to work, her mother was absent and neglectful, and her brother was abusive. She recalled her mother locking up the food and not giving the children enough to eat when her father was away; when her father returned, they had regular, balanced meals. Her mother did not attend to laundry, often sending the children to school in dirty clothes without having properly washed themselves. Material losses, such as these, often lead to other losses, such as the loss of peer friendships and support at school. Indeed, these losses often resulted in intrapersonal losses due to ridicule and bullying the children experienced because they were targeted by their peers.

Losses in learning
School as a safe haven and source of protection from abuse did not materialize for many of the participants. Some of the women were stalked at school by their abusers; reporting these incidents did not gain them the needed protection. Beth had experienced violence from peers, and although she reported it, they were never punished. Afterward, she was stalked at school. He had these girls coming to my school and threaten me and try to beat me up, and he would sit out in the parking lot. I was terried. Thats when I started sloughing school. She dropped out of high school, and missed at least three years of her education. The changes to the developing brain as a result of abuse have a great impact on learning. All of the participants talked about being at school physically, but not being present mentally; school made demands on them that they often could not meet. Paying attention to what was going on in the classroom was often too challenging because they were constantly alert for dangers or threats or because they did not feel accepted or connected to their peers or teachers. They dropped out of school because, as one participant said, I didnt know what I was doing there. Memory is often aected by the ongoing stress of abuse, and as they progressed further in school, they often found they could not keep up with the increasingly complex tasks of school; they fell further behind their peers, often without knowing why. Leaving school meant entering the world of work with signicant decits that limited opportunities and wages; most of the participants left school to work in fast food and customer service industries.

Institutional failures and loss of trust in social institutions

Most of the participants never saw their abusers brought to justice; abusers most often escaped public as well as family accountability, and the survivors often experienced punishment for disclosing the abuse. Some of the participants experienced the judicial systems failure to protect them from their abusers, either by

666

Qualitative Social Work 12(5)

returning them to their families of origin, or placing them in foster homes where they were re-victimized. One participant reported sexual abuse by an older family member in her foster home: When they found out he had molested me, it was either he moved out or we moved out. And we had to move out. The abuser was given preference, and she found herself without a home once again, unprotected by either family or the child welfare system. Churches were not experienced as protective by the participants who mentioned religious involvement. Abby recalled her abusive father hiding the reality behind the facade of a religious patriarch with the perfect family. She described her father as the good, Amen, praise God type on Sundays. Then we would go home; he was like God damn it! and she felt shocked at the contrast and the hypocrisy. Her father hid the abuse behind the image of the God-fearing father, and the pastor, among others, believed it. When she became sexually active as a teen, her father and the pastor made her confess it publicly to the entire congregation, so after that, no parents wanted their kids to be friends with me. Within the institutions of the family, the church, the judicial system, and the school, adults often failed to believe and protect children regarding the abuse they experienced and thus contributed to the perpetuation of the abuse itself. As such, they contributed signicantly to the developing childs diculties in creating and maintaining personal characteristics that would help them develop the resources to oset the major losses related to maltreatment.

Discussion
We applied Conservation of Resources as a framework to highlight the matrices of multiple losses experienced by survivors of child maltreatment, from immediate losses to those experienced years later as adults. Through this lens, we see that the women perceived losses that accumulated over time, impeding their acquisition of those resources that might oset the stress of loss. The women referred to ongoing losses with regard to themselves and their relationships, and the challenges they face in developing the internal resources that will support them in family and work relationships. Thus, these womens narratives are consistent with Hobfolls theory relating childhood abuse, resource loss, and adult wellbeing, and illustrate well the ways in which childhood events continue to leave survivors vulnerable to stress and diminished resources in adulthood (Vranceanu et al., 2007). All of the survivors talked about the ways they tried to avoid the abuse, change the situation, or otherwise compensate for their losses. That is, as Hobfoll (1989) noted, they sought to be in situations that would positively reinforce them, even if that generated other losses, such as running away or disclosing the abuse. As children, they often took great risks to change their situation, and thus made great eorts to at least maintain, if not accumulate, the resources they needed to develop more successfully. As parents, they all expressed a strong desire to protect

Gringeri and Vogel-Ferguson

667

their children from similar situations, a desire that can become a foundation to help survivors strengthen parenting and relational skills. Understanding maltreatment-related losses in the framework of resource loss illuminates some of the missing pieces for survivors in adulthood, especially with regard to social support. Personal identity and relational losses, along with early developmental losses, combine to weaken ones attachment to basic institutions, such as family, school and church, where one might, over time, begin to develop the connections that make up a support network. Having a diminished support network increases vulnerability to abuse in childhood and violence in adulthood, and decreases the resources that might compensate for loss; in addition, less social support in adulthood is linked with greater likelihood of depression, unemployment and of abusing ones own children (Zolotor and Runyan, 2005). Researchers have observed that social support is a critical factor that helps mediate the impact abuse has on adult survivors mental health, and ongoing stress and resource loss may result in diminishing social resources (Vranceanu et al., 2007). While Hobfoll does not directly address institutional sources of resource loss, the participants narratives open up this avenue of inquiry by pointing to the ways in which experiences of child abuse interconnect survivors, their families and community structures in ways that may mediate or exacerbate the losses due to abuse. In contrast with the narratives of women reporting abuse, those who did not report abuse provided ample evidence of the ways in which family, friends, schools and community structures supported development, minimized stress, and allowed them opportunities to accumulate resources. Making the connections between histories of childhood maltreatment, social support and employment is one important piece, given that all the participants had received cash assistance. Assessment of childhood maltreatment may be a key piece in supporting low-income parents as productive citizens and heads of families. Helping individuals process and manage the stress and loss associated with earlier child maltreatment will contribute to their ability to nd and maintain employment, earn wages to adequately support their families, promote the mental and physical health of their families, and develop social support. These women demonstrated strength and resiliency in their ability to talk about their history of maltreatment and its impacts on their lives, as they deal with it in the present and make eorts to move forward in their families best interests. Social workers can build on these strengths to support women in developing their parenting and employment skills, and encouraging them in their desire to nurture and provide for themselves and their families. A holistic approach to shoring up the social, emotional and economic bases of low-income families is indicated here, one in which state-level agencies managing public health, federal public assistance programs, and mental health and child welfare services collaborate on the development and delivery of interventions. Child maltreatment is a signicant public health issue in the United States, aecting early child and adolescent development, brain development and learning, physical and mental well-being, relational skills and social support, and the ability to take

668

Qualitative Social Work 12(5)

on and manage the developmental tasks of adulthood. As such, child maltreatment adds to the lifetime costs of providing services in health and mental health care, public assistance and child welfare, education, and the judicial system. As a society, our ability to respond eectively to maltreatment as a public health issue and as a signicant barrier to engaging in work activity and healthy relationships is greatly constrained by our insistence on viewing child maltreatment only as a mental health problem within dysfunctional families. Bringing the issue out of the shadows through proper assessment in health care, child welfare, and public assistance arenas can be critical steps to improving future outcomes for individuals and families. Funding
This research received no specic grant from any funding agency in the public, commercial, or not-for-prot sectors.

References
Adverse Childhood Experiences (ACE) Study (2010) http://www.dcd.gov/ace/ prevalence.htm#dysfunction. Bloom SL (2002) Beyond the beveled mirror: Mourning and recovery from childhood maltreatment across the lifespan. In: Bloom SL and Vargas LA (eds) Loss, Hurt and Hope: The Complex Issues of Bereavement and Trauma in Children. Newcastle, UK: Cambridge Scholars Publishing, pp. 449. Charmaz K (2006) Constructing Grounded Theory: A Practical Guide through Qualitative Analysis. Thousand Oaks, CA: SAGE Publications. Child Welfare Information Gateway (2009) Understanding the Effects of Maltreatment on Brain Development. Washington, DC: US Department of Health and Human Services. Available at: www.childwelfare.gov/pubs/issue_briefs/brain_development/ (accessed April 2011). Collins K, Connors K, Davis S, Donohue A, Gardner S, Goldblatt E, et al. (2010) Understanding the Impact of Trauma and Urban Poverty on Family Systems: Risks, Resilience, and Interventions. Baltimore, MD: Family Informed Trauma Treatment Center. Available at: http://fittcenter.umaryland.edu/WhitePaper.aspx (accessed April 2011). Cross W (2001) A personal history of childhood sexual abuse: Parenting patterns and problems. Clinical Child Psychology and Psychiatry 42(5): 563574. DiLillo D, Tremblay GC and Peterson L (2000) Linking child sexual abuse and adult physical abuse potential: The mediating role of maternal anger. Child Abuse and Neglect 24(6): 767779. Felitti VJ and Anda RF (2010) The relationship of adverse childhood experiences to adult medical disease, psychiatric disorders, and sexual behavior: Implications for healthcare. In: Lanius RA, Vermetten E and Pain C (eds) The Impact of Early Life Trauma on Health and Disease: The Hidden Epidemic. Cambridge: Cambridge University Press, 7787. Available at: www.annafoundation.org/LV%20FINAL%202-7-09.pdf. Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, et al. (1998) The relationship of adult health status to childhood abuse and household dysfunction. American Journal of Preventive Medicine 14(4): 245258.

Gringeri and Vogel-Ferguson

669

Frederick J and Goddard C (2008) Living on an island: Consequences of childhood abuse, attachment disruption and adversity in later life. Child and Family Social Work 13(3): 300310. Greenfield EA and Marks NF (2010) Sense of community as a protective factor against long-term psychological effects of childhood violence. Social Service Review 84(1): 129147. Gringeri C, Barusch A and Cambron C (in press) Epistemology in Qualitative Social Work Research: A review of published articles, 20082010. Social Work Research. Gringeri C, Wahab S and Anderson-Nathe B (2010) What makes it feminist? Mapping the landscape of feminist social work research. Affilia: Journal of Women and Social Work 25(4): 390405. Guba EG (1990) The Paradigm Dialog. Thousand Oaks, CA: SAGE Publications. Guba E and Lincoln YS (2005) Paradigmatic controversies, contradictions, and emerging confluences. In: Denzin NK and Lincoln YS (eds) The Sage Handbook of Qualitative Research, 3rd edn. Thousand Oaks, CA: SAGE Publications, pp. 183216. Hagele DM (2005) The impact of maltreatment on the developing child. North Carolina Medical Journal 66(5): 356359. Available at: www.ncmedicaljournal.com/wp-content/ uploads/2010/11/Hagele.pdf. Hall JM (2000) Women survivors of childhood abuse: The impact of traumatic stress on education and work. Issues in Mental Health Nursing 21(5): 443471. Harris N and Vogel-Ferguson MB (2007) Family Employment Program (FEP) Study of Utah: A Snapshot in Time 2006: Wave 1. Social Research Institute, College of Social Work, University of Utah. Hobfoll SE (1989) Conservation of resources: A new attempt at conceptualizing stress. American Psychologist 44(3): 513524. Liang B, Williams L and Siegel J (2006) Relational outcomes of childhood sexual trauma in female survivors: A longitudinal study. Journal of Interpersonal Violence 21: 116. Marcenko MO, Kemp SP and Larson NC (2000) Childhood experiences of abuse, later substance abuse, and parenting outcomes among low-income mothers. The American Journal of Orthopsychiatry 70(3): 316326. Marshall C and Rossman GB (2010) Designing Qualitative Research, 5th edn. Thousand Oaks, CA: SAGE Publications. Martsolf DS and Burke Draucker C (2008) The Legacy of childhood sexual abuse and family adversity. Journal of Nursing Scholarship 40(4): 333340. Murthi M and Espelage DL (2005) Childhood sexual abuse, social support, and psychological outcomes: A loss framework. Child Abuse and Neglect 29(11): 12151231. Noll JG (2005) Does childhood sexual abuse set in motion a cycle of violence against women? What we know and what we need to learn. Journal of Interpersonal Violence 20(4): 455462. Pascale C (2010) Cartographies of Knowledge: Exploring Qualitative Epistemologies. Los Angeles, CA: SAGE Publications. Sedlak AJ, Mettenburg J, Basena M, Petta I, McPherson K, Greene A and Li S (2010) Fourth National Incidence Study of Child Abuse and Neglect (NIS4): Report to Congress. Available at: http://www.acf.hhs.gov/programs/opre/abuse_neglect/natl_incid/. Thapar-Bjorkert S and Henry M (2004) Reassessing the research relationship: Location, position and power in fieldwork accounts. International Journal of Social Research Methodology 7(5): 363381.

670

Qualitative Social Work 12(5)

Vranceanu AM, Hobfoll SE and Johnson R (2007) Sequelae of child multi-type maltreatment: The role of social support and stress. Child Abuse & Neglect 31(1): 7184. Wahab S, Anderson-Nathe B and Gringeri C (2012) Joining the conversation: Social Work contributions to feminist research. In: Sharlene Hesse-Biber (ed.) Handbook of Feminist Research, 2nd edn. Los Angeles, CA: SAGE, pp. 455474. Watt D (2007) On becoming a qualitative researcher: The value of reflexivity. The Qualitative Report 12(1): 82101. Zolotor AJ and Runyan DK (2005) Social capital, family violence, and neglect. Pediatrics 117(6): 11241131.