Exploring the Psychosocial and Behavioral

Adjustment Outcomes of Multi-Type Abuse

among Homeless Young Adults
Kristin M. Ferguson
This article explores the psychosocial and behavioral adjustment outcomes associated with
verbal, emotional, physical, and sexual abuse amon^ homeless young adults as well as the
associations among abuse types. Convenience sampling was used to select 28 homeless young
adults (ages IS to 24) fnini one drop-in center. Overall, subjects experienced high rates of
direct abuse (that is, verbal, emotional, physical, and sexual abuse) and indirect abuse (chat
is, witnessing family verbal and physical abuse). Chi-square tests revealed that pniportions
of clinical depression, internalizing and externalizing behaviors, alcohol use, and foster care
histor>' were higher among subjects who experienced abuse than among those vvithout
reported abuse histories.The findings suggest that homeless young adults experience coexisting
types of direct and indirect abuse, which can negatively influence outcomes R'!:ited to their
psychosocial functioning and behavioral adjustment. An inclusive multi-type abuse approach,
with both direct and indirect abuse types, is needed to draw accurate conclusions reg;irding
the ctTfCts of each specific abuse type on hoineless young adults" psychological and behiivioral
adjustment.
KEY WORDS: homeless youti^ adults; multi-type abuse;
physical abuse; sexual abuse; verbal abuse
H
omeless young people are highly likely
to come from multi-problem and abusive
fiimilies. Various studies have cited high
rates of physical abuse, sexual abuse, neglect, and
parental rejection among this population (Powers,
Eckenrode,i^Jaklitsch, IWO;IUw.Taylor-Seehafer,
& Fitzgerald, 2K)l ; Ryan, Kilmer, Cauce,WaCanabe,
ik Hoyt, 2000; Tyler, Cauce, & Whitbeck, 2004;
Whitbeck, Hoyt. & Ackley, 1997a, 1997b). Parental
abuse is frequently among the primary reasons
homeless youths give for leaving home (Ryan et
al-, 2000; Sullivan & Knutson, 2000; Thompson,
McManusA'Voss,2006;Tyleretal.,2004;Whitbeck,
Hoyt.& liao,2000).
Evidence suggests that parental abuse is more
prevalent among homeless youths than in the general
population (Rew et al.. 2001; Ryan et al., 2000).
Previous studies reveal that 50% to 83% of homeless
youths have experienced physical or sexual abuse
(Cauce et al., 2000; Molnar, Shade, Kral, 13ooth, &
Watters, t99B;Ryan et al.,20()0;Thrane,Hoyt. Whit-
beck, & Yoder, 2006; Warren, Gary, & Moorhead,
1994). Extant studies show that childhood sexual
abuse prevalence rates in the general population
range from S% to 32% for female subjects and 1%
16% for male subjects (Finkelhor, 1994). Up to 22%
of male subjects and 20% of female subjects report
childhood physical abuse (Briere & Elliott, 2003).
EFFECTS OF ABUSE ON YOUTH
DEVELOPMENT AND OUTCOMES
Researchers have documented the deleterious effects
of abuse on homeless young peoples development,
psychological adjustment, and future outcomes.
Kurtz, Kurtz, and Jarvis (1991) found that homeless
youths who were physically and sexually abused
experienced a greater number of personal, fiimily,
and school problems than those without abuse his-
tories. Having a history of physical and sexual abuse
is also considered a risk factor for suicide attempts
in homeless youths (Kurtz et al., 1991; Molnar et
al., 1998; Powers et al., 1990; Rew et al.. 2001)
and mental health problems, such as depression,
conduct disorder, and trauma symptoms (Ryan et
al., 200(1; Stifiiian, l989;Thompson, Maccio, Des-
selle, & Zittel-Palamara, 2007; Whitbeck, Hoyt, &
Yoder, 1999).
Extant findings further indicate that early sexual
abuse increases the probability of running away
and early independence (Sullivan & Knutson, 2000;
CCC Code: I070-S3D9/09 S3.00 C2009 National Association of Social Workers
219
Thrane et al., 2006;Tyler, Hoyt, & Whitbeck, 2000)
and using illicit substances and other deviant behav-
iors,such as trading sex to survive on the streets (Rew
et aJ., 2001; Simons & Whitbeck, 1991 ;Tyler et al.,
2000;Ty]er.Hoyt,Whitbeck,&Cauce,2001a,2001b:
Tyler et al., 2004; Whitbeck et al., 1999). Sexual
abuse histories are also associated with an increased
likelihood of being physically and sexually victim-
ized once on the streets (Ryan et al., 2000; Simons
e Wliitheck, 1991;Thrane et al., 2006;Tyler et al.,
2000,2001a. 2001b; Whitbeck etal . , 1997a).
MULTI-TYPE ABUSE
Multi-type abuse refers to the co-occurrence of one
or more types of abuse, including physical abuse
sexual abuse, emotional abuse, psychological abuse,
verbal abuse, and witnessing familial abuse (Higgins
&: McCabe, 2001). Recently, researchers have con-
ducted several systematic literature reviews on how
prior studies have measured the effects of multiple
abuse types on adjustment. Higgins and McCabe's
review identified 29 studies that examined multi-
type abuse. In fewer than half of these studies (H = 12),
researchers assessed psychological abuse or neglect.
Adjustment-related outcomes were assessed in only
12 studies in which subjects reported experienc-
ing multi-type abuse. Across each of these studies,
increasing combinations of abuse were associated
with more severe adjustment problems,
Arata, Langhinrichsen-Rohl ing, Dowers, and
O'brien (2007) updated this earlier review, locating
22 additional studies of the effects of multi-type
abuse. Psychological abuse and neglect, which were
assessed in 15 studies, were still given less attention
than were other types. Consistent with the earlier
review, individuals who experienced multiple abuse
types presented the most p.sychological symptoms.
In the Higgins and McCabe (2001) review, only one
study addressed multi-type abuse among homeless
youths, whereas no study reviewed by Arata et al.
was with this population.
More recently, researchers have begun to examine
the differential effects of multiple forms of abuse,
although few have used neglect or psychological
abuse measures in their studies (Arata et a!., 2007).
When neglect and psychological abuse are included
in multi-type abuse models, they are found to be
significant predictors of the internalizing and exter-
nalizing behaviors associated with other abuse types,
such as physical and sexual abuse (McGee,Wolfe, &
Wilson, 1997). Also, occurrences of multiple abuse
types are associated with more negative outcomes
than are single forms of abuse or neglect (Higgins
&c McCabe, 2001).
Prior research also reveals that abuse types fre-
quently co-occur (Arata et al., 2007; Higgins &
McCabe, 2001). For example, psychological abuse,
emotional abuse, and neglect were found to be
predictors of psychological outcomes in children
who also experienced physical and sexual abuse
(Briere, 1988). Likewise, existing studies show that
individuals who experience one type of abuse are
likely to be victims of other forms of abuse or neglect
(Hi^ins & McCabe, 2001).
PRESENT STUDY
Given the likelihood ofmultiple abuse types among
homeless young people and the lack of studies in this
area, further research is needed and has been called
for by other researchers (Ryan et al., 2000;Tyler &
Cauce, 2002).The purpose of the present study was
thus to expand the literature on multi-type abuse
among homeless young adults by conducting pre-
liminary analyses of correlates ofmultiple abuse types
and associations among them. Notably, most studies
assessing abuse histories of homeless young people
have focused on a single form of abuse (physical or
sexual abuse) (Rew et al.. 2001 ;TyIer et al.. 2000,
2001 b) orn both physical IM/sexual abuse (Kurtz
et al., 1991; Molnar et al., 1998; Ryan et al., 20(K);
Simons & Whitbeck, 1991 ; Stiffnian, 1989; Sullivan
& Knutson, 2000;Tyler & Cauce. 2002; Whitbeck
etal . , 1997a, 1997b). Several studies have examined
the effects of physical and sexual abuse with neglect
(Kurtz et al., 1991; Powers et al-, 1990; Ryan et al.,
2000;Thrane et al., 2006;Tyler et al., 2004) or with
emotional abuse (Powers et al., 1990; Tyler et al.,
2004; Whitbeck et al., 1997b). Studies that assess
up to four types of abuse among homeless youths
are less common (Powers et al., 1990; Tyler et ai.,
2004), whereas those that examine more than four
abuse types by including verbal abuse or witnessing
family physical and verbal abuse are largely absent
(Tyler, 2006).
This gap presents limitations in the current un-
derstanding of primary abuse correlates, given the
high co-occurrence rates of abuse types found in
prior research (Arata et al., 2007; Hi^ins & McC'abe,
2001). Unless other forms of abuse are concurrently
assessed along with physical and sexual abuse in
homeless youtiis, one cannot conclude that certain
outcomes are specific to the particular abuse type
220 Social Work Research VOLUME 33, NUMBE R 4 DE CE MBE R l oog
that was assessed individually (Higgins & McCabe,
2001), Further, without considering the full range
of both outcome variables and abuse types within a
single study, it is not feasible to determine the efFects
of different abuse types on homeless young peoples
psychological and behavioral adjustment. As such,
integration of research on individual abuse types
and isolated outcomes is needed before accurate
conclusions can be drawn regarding the effects of
each specific abuse type on this population (Higgins
& McCabe, 2001).
The present study assessed the associations among
verbal, emotional, physical, and sexual abuse and
select psychosocial and behavioral adjustment out-
comes in a sample of homeless young adults. This
study also examined associations among multiple
abuse types.The following three research questions
guided this study: Among homeless young adults,
(1) what are the frequency and severity of verbal
abuse, emotional abuse,physical abuse,sexual abuse,
and witnessing family verbal and physical abuse?; (2)
what arc the psychosocial and behavioral adjustment
outcomes associated with verbal abuse, emotional
abuse, physical abuse, and sexual abuse?; and (3)
what are the intcrrt-lationships among verbiil abuse,
emotional abuse, physical abuse, sexual abuse, and
witnessing family verbal and physical abuse?
METHOD
Sampling and Recruitment Procedures
111 ihis cross-sectional study, convenience sampling
was used to select 28 homeless young adults (ages
18 to 24) from a homeless youth drop-in center. All
subjects were recruited from one program but re-
ceived differing service levels. Subjects were part of a
larger study investigating outcomes from a vocational
training program integrated with clinical services for
homeless youths, the Social Enterprise Intervention
(SEI).To qualify for inclusion in the original study,
subjects had to have attended the agency at lea.st two
times a week for the month prior to the study and
verbally commit to attending the SEI program over
a seven-month period. All study procedures were
approved by the Institutional Review Board at the
lead investigators university. Additional details on
the method of the original study have been published
elsewhere (Ferguson, 2007).
Measures
A structured interview assessed subjects' mental
health status, high-risk behaviors (for example, drug
use, prostitution, survival sex [that is, exchanging
sex for food, clothing, or shelter|), family support,
and abuse history. Additional items included de-
mographic characteristics (for example, age, gender,
race, education), homelessness history (for example,
age at which subject began living on streets, living
situation), service utilization (for example, number
of agencies used for services), and family charac-
teristics (for example, foster-caR' history', parental
drug use),
Mental health status comprised three variables:
depressive symptoms, internalizing behaviors, and
externalizing behaviors. Depressive symptoms were
assessed by tlie Reynolds Depression Screening
Inventory (RDSI) (Reynolds & Kobak. l'J98), a
19-item index measuring the frequency and sever-
ity of symptoms of depressive disorder. The RDSI
was chosen because it has been used in prior studies
with homeless youths (Cauce et al., 2(KI0). Raw
RDSI scores are summed to form a composite
score.The possible range of scores is 0 to 63, with
higher scores reflecting greater symptoms. Scores
of 10 or less indicate no depression, scores of 11 to
15 indicate mild clinical severity, scores of 16 to 24
indicate moderate clinical severity, ajid scores of 25
or more indicate severe clinical severity (Reynolds
& Kobak, 1998). In this pilot study, the Cronbachs
alpha for the 19 items on the RDS was .84.
Internalizing and externalizing behaviors were
assessed using the Adult Self-Report (ASR) (Achen-
bach, 2003), which consists of 126 items assessing
respondents' emotions and behaviors over the
past six months. Scoring profiles include normed
scales for internalizing behaviors (that is, anxious/
depressed and withdrawn behaviors) and external-
izing behaviors (that is,aggressive and rule-breaking
behaviors). Higiier scores reflect a higher presence
of behaviors. Raw scores between 18 and 23 (for
men) and 20 and 24 (for women) for internalizing
behaviors and between 19 and 22 (for men) and
17 and 21 (for women) for externalizing behaviors
are within the borderline clinical range. Scores
above 23 (for men) and 24 (for women) for inter-
nalizing behaviors and above 22 (for men) and 21
(for women) for externalizing behaviors are in the
clinical range (Achenbach.2003).Cronbach alphas
for internalizing and externalizing behaviors were
.67 and .61, respectively.
The ASR and Youth Self-Report (YSR) have
been used in extant studies with the homeless youth
population. In a sample of these youths, YSR alphas
FHRG U SO N / Exploring ePsychosociat and Behavioral Adjustment Outcomes of Multi-Type Ahuse among Homeless Young Adaits 2 2 1
were .90 for internalizing and .86 for externalizing
behaviors (Cauce et al., 20<K)). However, because
the subjects in the present study were older (ages
18 to 24), adult measures were used to facilitate
[racking over time in future studies. One possible
explanation for the low reliability on the ASR
scales is that adult instruments may not be the most
appropriate measures for transition-age homeless
young adults, who often experience cognitive and
developmental delays .is a result of their histories
and street involvement (further discussed in the
Study Limitations section) (Thompson, Pollio, &
Constantine, 2(t(12).
High-risk behaviors consisted of three variables
that have consistently been used in homeless youth
studies (Cauce et al., 200(1; Kipke, Unger, Palmer,
and Edgington, 19%): high-risk sex and two types
of substance abuse. High-risk sex was a single-item
indicator measuring the number of times that the
respondent had been drunk or high during sexual
intercourse without a condom in his or her life.
Substance abuse was assessed with two variables
on the ASR. each measured over the previous six
months (Achenbach, 20i)3). Alcohol use measured
the number of days the young person had been
drunk. Drug use measured tbe number of days the
young person had used drugs (including marijuana,
cocaine, and other drugs) for nomiiedical purposes.
Higher scores reflect a greater use of substances,
liorderline clinical ranges comprised raw scores
between 27 and 47 (for men) and 10 and 19 (for
women) for alcohol use and between 21 and 118
(for men) and 4 and 19 (for women) for drug use.
Clinical ranges comprised raw scores above 47 (for
men) and 1 ^) (tor women) for alcohol use and above
118 (for men) and 19 (for women) for drug use.
Different cutoff scores for men and women reflect
differing distributions of responses in the national
normative sample (Achenbach, 2003).
Abuse history included assessment of six abuse
types that were adapted from Noll, Horowitz,
Bonanno, Trickett, and Putnam's (2003) Time 3
Comprehensive Trauma Interview. Subjects were
asked about the nature and extent of their abuse
related to verbal abuse (adults said mean, insulting,
or threatening things to youth), emotional abuse/
rejection (youth felt rejected by family), physical
abuse (youth had been beaten or physically mis-
treated).sexual abuse/sexual assault (adult had done
or tried to do something sexual that youth did not
want), witnessing family verbal abuse (youth heard
caregivers say mean, insulting, or threatening things
to each other), and witnessing family physical abuse
(youth saw or heard caregivers hit or hurt each
other physically).
In addition to whether the abuse type occurR'd,
subjects were a.sked to indicate their age at each
abusive episode (age at onset), their age when the
abuse stopped (age at last episode), the identity of
the perpetrator and all parties involved, how close
they were to the perpetrator at each episode, and
the frequency with which each episode occurred.
Abuse frequency was measured as 1 (rarcly/less than
one to two times per year). 2 (occasionally/one to
two times per year), 3 (often/one to two times per
month). 4 (a lot/one to two times per week), or 5
(every day/one or more tunes per day). Subjects also
indicated how severe they found each episode to
be.The severity rating was measured as I (not at all
upsetting),2 (a little upsetting), 3 (moderately upset-
ting), 4 (very upsetting), or 5 (extremely upsetting).
Finally, subjects were asked to describe the details
of each abusive episode.
Data Collection and Analysis
Researchers conducted .l 611- to yO-mniute struc-
tured interview with 28 subjects at the host agency.
All subjects received a SIO gift card after the inter-
view. Raw data from the interview's were entered by
a research assistant into SPSS 14. Given the sensitive
topics di.scussed, interviewers held MSW degrees
and used a risk-assessment protocol to assess for
suicidal and homicidal ideation. Specific items on
the ASR and the trauma interview were used to
assess suicidal and homicidal ideation or attempts. In
the event that harm to self or others was identified,
interviewers invited the agency's hcensed clinical
social workers into the interview for immediate or
subsequent clinical attention. After the interviews,
researchers debriefed with the subjects to connect
them to other agency staff and resources.
Global empirical analysesincluding frequency
distributions, means, standard deviations, and
medianswere used to describe characteristics
among the variables. Chi-square and Fishers ex-
act tests were used to assess group differences in
categorical psychosocial and behavioral variables
and the abuse variable. Continuous mental health
variables were categorized using clinical cutof"
scores to assess differences between subjects in
the clinical and borderline clinical ranges and the
subclinical range and to facilitate interpretation
222
Social Work Research VOLUME 33. NUMBER 4 DECEMBER 2009
of the findings for practitioners working with this
population. Associations among abuse types were
also cx.unined.
RESULTS
Subjects
Twenty-eight homeless young adults (ages 18
to 24) were recruited as part of an original pilot
study troni a homeless youth drop-in center. Col-
lectively, subjects were on average 21 years old {SD
= 1.41).Twenty were male, and eight were female.
Eleven subjects identified as African American, six
as Hispanic, six as Caucasian, four as mixed or other
ethnicity, and one as Asian. Regarding educational
backgrounds, six had some high scliool education
14 had a high school diploma or GED, seven had
some college, and one had a vocational degree.
Abuse Types, Frequency, and Severity
Across the sample. 82% ( = 23) had experienced
at least one of the six abuse types (seeTable 1). Of
the six types, participants experienced an average
of 2.96 types of abuse {SD = 1.88, Mdn = 3.00).
Seventy-one percent {n = 20) reported histories of
three or more types, with 18% ( = 5) experiencing
five or six types. On average, subjects reported that
abuse frequencies across all types occurred often
(one to two times per month). A significant posi-
tive correlation was found bet\\'cen frequency and
severity for verbal abuse (p = .59,p = .01) but not
for other abuse types.
Abuse Type and Psychosocial and
Behavioral Adjustment Outcomes
The frequencies and percentages of select psycho-
social and behavioral adjustment outcomes among
the sample are summarized in Table 2. Outcome
variables were dichotomized using no/yes responses
(foster care, total alcohol, total drugs, high-risk sex),
median splits (age began living on streets), or clini-
cal threshold cutoffs (depression, internalizing and
externalizing behaviors).
For the analyses, 2 x 2 chi-square tests were u.sed
(with Fishers exact tests used when the expected
cell frequencies were five or less) to examine group
differences in select psychosocial and behavioral
Table 1 : Median Abuse Frequency, Severity, Age at Onset, Age at
Last Episode, and Number of Perpetrators, by Abuse Type
Type of
Abuse
Yes
No
Emotional
Y
No
Physical
Yes
No
Sexual
Yra
No
Witness verbal
Yes
N.)
Wirncw physical
Yes
No
Sample
19(68)
9 (32)
14 (50)
14 (50)
14(50)
14 (50)
11 (.59)
17(61)
14 (50)
14 (50)
11 im
17(611
Frequency
Mdn (Range)
4.00(1-5)
4.00(1-5)
3.50 (1-5)
3.00(1-4)
4.00 (1-5)
4.00(1-4)
Severity
Mdn (Range)
4.00 (1-5)
4.00 (2-5)
5.00 (3-5)
5.00 (3-5)
4.00 (1-5)
4.00(1-5)
Age at Onset
(in Years)
Mdn (Range)
7.00(2-17)
10.00(2-18)
7.00 (2-22)
10.00(3-22)
7.50 (2-16)
6.00(2-16)
Age at Last
Episode
(in Years)
Mdn (Range)
17.00 (7-23)
18.00 (3-24)
14.50(6-22)
15.00(6-23)
17.00 (7-21)
15.00(7-22)
Number of
Perpetrators
Mdn (Range)
2.00(1-7)
1.50(1-10)
1.50 (1-5)
1.00 (1-2)
2.00 (2-6)
3.00 (2-6)
Nolei W ^ iS. fituuency = ) (larly/leii tlidi one in 1IQ inn per year), ((diiondllyone I D IWQ times per yeof 1. 3 (oflon/onp TO two times pfi monlh). 4 I lot/oiip lo tiu
time per week), or 5 (every day/one or more limes per day); seiierity = 1 (not t all upsetllng), 2 (a liltle iipsetling), i (moderately uprening). i (very upwtli'ig). of 5 leitremely
upwtting); age al cmiet age of iubleel 41 tlist abusive episode; age al l t epirode age of tubjecl wrtieti abuse itopped number o( perpettatots - number of perpeiraiors of
abuse type reported by youth. . .
FERGU SON / Exploring the Piychosocial and Behavioral Adjustment Outcomes of Multi-Type Abuse among Homeless Young Adults 2 2 3
12
16
8
7
57
53
47
13
Table 2: Frequencies and Percentages of
Psychosocial and Behavioral Outcomes
Sample
Variable i
No
y
Age (in years) began living on srrecEs
0-17
Total depression (RDSI)
SubdiniGil range (ft-l)
CLnical range (11+)
Internalizing behaviors (ASR)
Subdinical range
Borderline and clinical range
F.xrcrnaninglH-hiiviors (ASR)
Siibclinical range
Bonk'fline and clinical range
Tuial alaihol (previous 6 monrhs)
0 days
It days
Total drugs (previous 6 months)
0 days
1 + days
High-risk sex
0 times
1+ times
16
12
14
14
16
12
12
16
57
43
50
50
57
43
43
57
u
12
48
Notes A/= 28. Sample siie vanea for Ihewariable age began living on i t rmi i ui =
15) given that nol all yuulhs were living on the ilteets at the time ot the study nd
for high-rijli sex (n = 3) given thai there were five nonresponsei for thij variable.
ROSI = ReynntdDeprsion Screening Inventory [Reynolds S Kobak. 1998); ASH =
Adull Sell-Report (Achenbach. 2003); total akohol = dayt iubject had been drunk;
lotal drijgi ^ dayi subject had uled drugs for nonmedical purposei; higH-risl! iex =
numbei of tma sub)t had been drunk or fiigh during semial imeicourie without
a condom.
outcomes between subjects with and without the
four direct abuse typesverbal, emotional, physical,
and sexual abuse. Percentages, chi-squarc statistics,
and significance levels for the categorical outcome
variables by abuse type are presented in Table 3.
The proportions of borderline clinical or clinical
depression, internalizing behaviors, and external-
izing behaviors were higher among subjects who
experienced verbal abuse.The mean RDSI score for
subjects who experienced verbal abuse was 15.42
(SD - 9.16).The average ASR internalizing score
among subjects with a verbal abuse history was 22.84
{SD = 13.37).The mean ASR externalizing score
among subjects experiencing verbal abuse was 20.79
(SD = 9.91). Triangulating the youths' qualitative
testimonies with these data provides support for the
association between verbal abuse and depression
and internalizing behaviors. As one youth noted,
"At least once a month, my stepmom and stepdad
would say mean things to melike that I was fat
or stupid. It would make me feel upset and insecure
about myself."
The proportion of high-risk sexual behaviors
was also higher among subjects who experienced
verbal abuse, although this finding only approached
statistical significance. The mean score of high-risk
sexual encounters among those experiencing verbal
abuse was 4.65 {SD = 6.85).
For subjects who experienced emotional abuse,
the proportion of alcohol abuse was higher among
those who reported abuse. The mean number of
days in the previous six months on which subjects
with emotional abuse histories were drunk was
15.86 {SD = 42.44). Testimonies from the youths
support the association between substance use and
family problems: "I'd take a bunch of medications
hke Tylenol, and then I'd vomit. I did this when I
had relationship problems and family issues. Once
I did it because my son's mother took my son away
.Hid told me he was dead six months later."
Among subjects reporting physical abuse, the
proportion of foster-care involvement was higher
among those with abuse historics.Thc mean number
of placements for those experiencing physical abuse
was 3.36 {SD = 2,73). The average age at which
these subjects entered foster care was 8.55 years
{SD = 5.20). One youth with a history of foster
care noted that "like 3 times a week growing up
my uncle, grandpa, cousin, and brother would hit
me wherever they could land a punch. Tbey left
bruises, black eyes, bloody noses. I started fighting
them back when I was 16. It just got worse when
I started fighting back."
Similar to physical abuse, the proportion of foster-
care involvement was also higher among subjects
who experienced sexual abuse.The mean number
of foster care placements for subjects with histories
of sexual abuse was 3.67 (SD = 2.96). The average
age at which these young adults entered foster care
was 7.44 years (SD = 4.98).
In addition, the proportion of subjects who began
living on the streets by age 18 was higher among
those who reported a history of sexual abuse.The
mean age at which the young people who reported
sexual abuse began living on the street was 19.50
yean {SD = 1.87). As one youth who was living on
224
Social Work Research VOLUME 33, NU M BER 4 DECEM BER 2009
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a rooftop at the time of the study revealed, "Over
three years my stepdad began molestint; me when
I was three. I shot liim when I was six with my
mom's revolver."
Associations between Abuse Types
Significant associations were observed between
six abuse types. There was a significant moderate
relationship between verbal abuse and witnessing
family verbal abuse ((() = .54,p = .01).Among those
reporting verbal abuse, 6S% witnessed co-occurring
family verbal abuse. Conversely, among those wit-
nessing family verbal abuse, 93% reported verbal
abuse as well. Verbal abuse and witnessing family
physical abuse also had a significant moderate asso-
ciation {(| > = .40.;) = .049). Among those reporting
verbal abuse, 53% witnessed family physical abuse.
For those witnessing family physical abuse, 91%
reported verbal abuse.
Emotional abuse had a significant moderate a.s-
sociation with physical abuse ((}) = .43. p = .02).
Among subjects with a history of emotional abuse,
71% reported physical abuse. Likewise, among
subjects who reported physical abuse.71% reported
emotional abuse. Emotional and sexual abuse also
revealed a significant moderate association {ij> = .51 ,p
= .01). For subjects reporting emotional abase,64%
also reported se.^ual abuse. In contrast, among sub-
jects who experienced sexual abuse, 82% reported
co-occurring emotional abuse.
In addition, physical and sexual abuse had a
significant and strong association ((j) = .80, p =
.0(1). Among subjects reporting physical abuse. 79%
reported sexual abuse. Conversely, among the 11
who reported sexual abuse. 100% had co-occurring
physical abuse.
Finally, a significant and strong association was
observed between witnessing family verbal and
family physical abuse ((j) = .80, p = .00). Among
those witnessing family verbal abuse. 79% reported
family physical abuse as well, in contrast,among the
I1 subjects who reported a history of witnessing
family physical abuse, 100% also witnessed family
verbal abuse.
DISCUSSION
The aim of this study was to explore adjustment
outcomes among homeless young adults that are
associated with multiple forms of abuse and the
interrelationships among abuse types. The present
findings add to the literature on the abuse histories of
homeless young adults in several ways. First, statistics
on abuse frequency and severity, age of onset and
last episode.and number of perpetrators have rarely
been reported in prior research (Ryan et al.. 2000).
These data are important complements to the study
of these phenomena, given that most studies have
relied exclusively on dichotomous abuse measures
(Higgins & McCabe. 2001 ; Ryan et al., 2000).This
study provided a more nuanced depiction of abme
by measuring its nature, type, frequency, and severity
and the young people s perceptions of abuse episodes,
along with ages at abuse episodes and number of
perpetrators.
Regarding abuse frequency, prevalence rates for
the six specific abuse types ranged from 39% to
68%. These findings support existing abuse preva-
lence rates among homeless young people, which
range from 50% to 83% for physical or sexual abuse
(Molnar et al., 1998; Ryan et al., 2000;Thrane et al.,
2006). However, these results also expand on prior
work with this population given that studies assessing
more than four abuse types are largely absent.
With respect to perceptions of abuse severity,
subjects rated their emotional reactions to each
abusive episode on a five-point severity scale.
Among abuse types, sexual abuse was rated as the
most emotionally distressing, followed by physical
abuse, and then emotional abuse. It is interesting
to note that no correlation was found between
frequency and severity among abuse types, except
for verbal abu.se. Even though abuse may happen
fi-equently, the victim may not perceive it as emo-
tionally distressing. Conversely, abusive episodes that
occur infrequently may have an enduring effect.
This suggests that high distress may be associated
with either high or low abuse frequency; that is, the
relationship between abuse frequency and severity
is not a linear one.
In the case of verbal abuse, a significant, moderate
correlation was found between abuse frequency and
severity, suggesting that youths experienced greater
distress with the increasing frequency of caregivers'
mean, insulting, or threatening comments. Because
verbal abuse was the most prevalent abuse type (oc-
curring among 68% of subjects), it is possible that
other more severe abuse types arose from initial
heated verbal exchanges within families. Future
inclusion of verbal abuse in homeless youth studies
will help elucidate the relationship between verbal
and other abuse types. One direction for future re-
search would be to examine whether verbal abuse
226
SodalWork Research VOLUME )3, NUMBEK 4 DECEMBER 2009
serves as a gateway abuse type, from which additional
forms of abuse emerge.
This study also offers support for incorporating
several novel abuse correlates in future research
with this population. The percentages of depres-
sive symptoms and internalizing and externalizing
behaviors were significantly higher among subjects
with histories of verbal abuse.The percentage of
subjects participating in high-risk sexual behaviors
was also higher among those with verbal abuse
histories, although the relationship only approached
significance. These findings support prior studies
with homeless youths that have revealed signifi-
cantly higher levels of depression and internalizing
problems in physically and sexually abused homeless
youths than in nonabused homeless youths (Ryan et
al., 21)00: Stiftrnan, 1989), It is important for future
studies with this population to assess these outcomes
with verbal abuse as well.
because homeless young people often come from
families characterized by dysfunction, abuse, and
parental substance use (Cauce et al., 2000; Ryan et
al.. 2000;Tyler et al.. 2004), it is plausible that the
subjects' internalizing, externalizing, and high-risk
behaviors could be associated with verbal abuse
within the home. However, given the small sample
and resulting limited statistical analyses, the direc-
tionality of these findings cannot be confirmed. It
remains unclear whether young people with behav-
ioral issues are criticized by their paa-nts for their
internalizing or acting-out behaviors and high-risk
sexual behaviors or experiencing direct and indirect
(that i.s, witnessing) abuse from parents leads them
to rebel against and escape from verbally abusive
t-nvironnients by developing behavioral problems.
Future longitudinal studies that include a range
of both outcome variables and abuse types would
help to elucidate this relationship. Homeless youth
researchers would benefit from including verbal
abuse in future studies of abuse histories, given
its prevalence in this sample, its association with
emotional problems and high-risk behavior, and its
co-occurrence with otiier abuse forms.
Another novel fmding consists of the relationship
between emotional abuse and substance abuse. In
this sample, the percentage of subjects who abused
alcohol was higher among those with histories of
emotional abuse. Homeless young people often
conic from troubled tamilics in which their parents
abuse alcohol and drugs and have mental health
problems (Whitbeck & Hoyt. 1999). Such behav-
ion can lead to ineffective parenting and rejection,
along with family conflict and abuse. Familial
dysfunction can result in the youths developing
mental health problems, such as substance abuse,
depression, und repeated runaway episodes (Kurtz
et al., 1991). At the same time, subscincc abuse is
common among homeless youths and often serves
as a coping mechanism for dealing with abuse and
trauma as well as their survival on tlie streets (Kipke
et al., 1996; Thompson et al., 2(tOf)). Civen the
exploratory nature of this study, it is not possible
to determine whether subjects were rejected or
emotionally abused by their parents becatise t)/" their
alcohol problems or turned to alcohol to cope with
parental rejection or emotional abuse. Future stud-
ies including a longitudinal design, larger sample,
and both mulriple abuse t)'pes and substance abuse
outcomes could help answer this question.
In this study, the percentage of subjects who were
previously in foster care was higher among those
with physical or sexual abuse histories, as expected.
Few studies have examined the relationship among
abuse, foster care, and homelessness. Among the 23
of the 28 subjects with at least one abuse type, 65%
were previously in foster care (compared with 57%
of the sample of abused and nonabused subjects).The
mean age at which tliese youths entered foster care
was 8.3.^ years {SD = 4.69) (compared with 9.00
years in the fijil sample), and the average number
of placements was 3.27 (.SD = 2.52). Prior studies
of abused and nonabused homeless youths have
revealed much lower percentages (33%) of foster
care histories (Cauce et al., 2000).
it is important to note that in tliis study, subjects
also reported abuse by foster parents on multiple
occasions for each abuse type. As one youth noted,
"My foster dad would call me names and try to hurt
me physically. He would grab me in a choke hold.
1 told my social workers and they took his license
away, but then my foster parents said I lied." An al-
ternative explanation is that the numerous household
transitions experienced by homeless youths who
arc passed between multiple foster care placements
can increase the pool of potential perpetrators who
may abuse them (Tyler & Cauce,20(t2).This fmding
merits further exploration of the directionality of
abuse among young people in foster care to deter-
mine whether it is more likely that they will end
up in foster care htrtm.'^f (/familial abuse or abuse is
more common once in foster care. The number of
foster care placements should be included in future
FE RG U SON / [^ploring che Psychosocial and Behavioral Adjustment Outcomes ofMulti-Type Abuse among Homeless YoungAdults 227
studies, given that greater numbers of placement
can increase a young people's exposure to potential
perpetrators of abuse.
STUDY LIMITATIONS
Tlie study fmdings and the conclusions drawn
from them should be taken with caution because
of several limitations. First, the present sample is not
likely representative ot the greater homeless young
adult population, given that the screening criterion
in the original pilot study required subjects to have
received services at least two times per week in the
month before the study. As such, the study subjects
were likely to have been more engaged in services
and to have experienced longer service histories
than those young adults who did not meet the inclu-
sion criterion for the original study. Also, because
subjects were selected within a drop-in center, it
is highly likely that street-engaged young people
who do not access agency services and who may
have more severe mental health problems were not
appropriately represented in this sampIe.The sample
size was also restricted due to the design and time
frame of the pilot study, which hampered the use
of more advanced statistical analyses.
Further, abuse assessments were conducted by
self-reports and not corroborated with agency or
other official records.The youths may also have been
reticent to convey sensitive information about their
abuse histories to adults (Thompson et al.. 2007).
However, a notable strength of the current study
was that the interviewen bad previously served as
staff with street-youth organizations and were thus
familiar witli street culture. Because the interviewers
were known and trusted by many of tbe subjects, it
was less likely that the youths would bias their re-
sponses. In a prior study comparing homeless youth
self-reports with data collected from their parents
Whitbeck et al. (1997b) found no tendency for the
youths to overreport family abuse histories.
Similarly, adult instruments such as the RDSI and
ASR were used with these young adults, which may
have contributed to the marginal reliability on the
two ASR scales found here. As noted, the Cronbach
alphas for the ASR scales were considerably lower
than those reported in earlier studies using theYSR
with younger homeless youths (Cauce et al..2000).
The low reliability on the internalizing and external-
izing scales may indeed have inuenced the results
and the interpretation of the fmdinji by attenuating
the associations between internalizing and external-
izing behaviors and specific abuse types. In future
work with this population.it is crucial for researchers
to develop and norm appropriate instruments for
young adults and to adapt existing youth and adult
measures to increase their relevance to young adults.
However, until reliable young adult measures exist,
youth measures may be more appropriate.
Finally, these data are cross-sectional and consist
of retrospective abuse reports. Biases in subject recall
of past information may bave contributed to some
over- or underreporting of events. For instance,
subjects may have experienced peritraumatic disso-
ciation during their traumatic events so as not to be
emotionally overwhelmed by the events (Noll et al.,
2003).This primitive coping mechanism may have
contributed to problems with their recall of trau-
matic events. One strength in our design, however,
is that a young adult population was interviewed
many of whom experienced abuse that was relatively
recent or, in some cases, ongoing.
IMPLICATIONS FOR RESEARCH
AND PRACTICE
Overall, several implications for social work research-
ers and practitioners with this population can be
derived fix)m this study. First, it is imperative that
researchers assess for multiple abuse forms in addi-
tion to using the common measures of physical and
sexual abuse. In this study, the majority of young
adults experienced three or more forms of abuse. A
comprehensive array of psychosocial and behavioral
outcomes should be included in fiature work with
this population as well. As noted, data on multiple
abuse types, frequenc7,and severity are largely absent
from prior studies with homeless young people.
Comprehensive assessment of multiple abuse types is
needed,given that negative sequelae can result from
abuse epi.sodes that occur relatively infrequently or
are not considered severe. One area that warrants
' future study is whether severity could be a mediator
between the abuse experience and the development
of behavioral and psychological problems-
Given the high rates of multi-type abuse found
in this study, practitioners should also be attuned
to the prevalence of co-occurring abuse types and
assess for symptoms and outcomes of multiple forms
of abuse.The co-occurrence of various abuse types
is of clinical concern because less severe forms of
abuse {for example, verbal abuse) are associated with
depressive symptoms and internalizing and external-
izing behaviors. Yet when they are identified, such
228 Social Work Research VOLUME 33, NU M BE R 4 DE CE M BE R 2009
Symptoms can be clinically treated. Practitioners
who use a comprehensive assessment are more
likely to detect both severe and more subtle types
of abuse. Further, indirect forms of abuse that were
witnessed by the youths may also alert practitioners
to other underlying, direct forms. Youths who are
reluctant to provide information on direct abuse
may be more comfortable disclosing indirect abuse
that they witnessed. Practitioners who recognize
the associations between direct and indirect abuse
types will likely be more receptive to the symptoms
of other unreported abuse forms. Understanding
of how symptoms of different abuse types manifest
and which abuse types are associated with particular
outcomes may enhance overall diagnostic, interven-
tion.and treatment efforts. Until a multidimensional
approach to investigation and treatment of abuse is
adopted by researchers and practitioners, homeless
young people's vulnerability to miilti-ty'pe abuse may
continue to be,at best,only partially understood and,
at worst, completely overlooked. B3D
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