Violence Prevention for Adolescent Girls With Prior Maltreatment

Childhood maltreatment for survivors creates a risk for the perpetuation of a cycle of violence in the form of sexual violence, intimate partner violence, and child maltreatment of the next generation of children. Consistent empirical evidence across studies confirms that abuse and neglect in childhood is associated with: dating violence, serious delinquent behaviors, engaging in risky sex and substance use, physical and sexual revictimization as adult women and maltreatment as parents. Adolescent girls in foster care with histories of childhood maltreatment are at increased risk of multiple forms of interpersonal violence, as adolescents and adults, due to the presence of a multitude of additional risk factors. Mental health problems associated with the trauma of childhood maltreatment include depression, PTSD, and behavioral disorders. These problems tend to be more elevated and prevalent in adolescent girls in foster care. Additionally, these girls often experience multiple behavioral, mental health, and drug and alcohol-related problems that are also linked to interpersonal violence, suggesting that youths in foster care have different and more urgent prevention needs than other adolescents. The magnitude of the relationship between childhood maltreatment, trauma-induced mental health problems and subsequent revictimization and perpetration is so substantial and the consequences so deleterious that researchers have emphasized the necessity of targeting early intervention and prevention resources toward children exposed to violence.

There is a clear need for intervention and prevention efforts to be directed at female survivors of child maltreatment. We are targeting our intervention/prevention efforts at girls for several empirically important reasons. Prevalence studies consistently reveal that girls are more frequent victims of childhood sexual abuse, adult sexual assault and intimate partner violence. Childhood sexual abuse in particular is more strongly correlated with the development of serious mental health and substance abuse problems than other forms of maltreatment. Girls are more vulnerable to physical and sexual re-victimization in adolescence and adulthood and re-victimization increases risks of mental health and substance abuse problems, which further increases risks for re-victimization. Research has demonstrated that girls/women are more vulnerable to the development of PTSD than boys/men even when exposed to comparable levels and types of trauma, and PTSD has been shown to increase risks for re-victimization. A growing body of literature indicates that trauma responses are mediating factors in re-victimization. Consequently, if trauma symptoms (PTSD, depression, anxiety, cognitive distortions, and maladaptive coping strategies) can be ameliorated there is greater potential to prevent revictimization.

Despite the strong empirical evidence that girls with histories of maltreatment are at greater risk than other adolescents of engaging in youth violence and interpersonal violence as adults, there are no reports of violence prevention programs tailored for female adolescents in foster care. The Task Force on Community Preventive Services of the Centers for Disease Control (CDC) has identified cognitive behavior therapy as an effective treatment to reduce psychological harm among youth exposed to traumatic events and to promote healthy relationships among youths who have experienced trauma. Trauma-focused cognitive-behavioral therapy has been adapted for children exposed to community or family violence utilizing a group format and delivered in community settings. The school-based version of the intervention is known as Cognitive-Behavioral Intervention for Trauma in School, or CBITS. The study adapts the CBITS program for use with adolescent girls assessed or served by Children's Division (GAIN) who have experienced previous maltreatment for delivery within community-based settings, and evaluates its impact in preventing re-victimization and perpetration of interpersonal violence.

The specific aims of the study were to:

1. Adapt the CBITS program for girls who have been assessed or served by the Children's Division (GAIN) that targets mental health problems as they relate to risks of revictimization and perpetration of interpersonal violence.
2. Utilizing a randomized controlled design, implement the GAIN program with 125 adolescent girls who have been assessed or served by Children's Division compared with 125 girls who receive usual care.
3. Conduct a process evaluation that will monitor treatment integrity through ratings of session content delivered, participants' attendance, program relevance and satisfaction, and tracking comparison and experimental group adolescents to reduce study attrition.
4. Conduct an outcome evaluation to compare the effectiveness of the GAIN program on primary outcomes such as trauma-related mental health problems (i.e., PTSD, depression), aggression, and revictimization and on secondary outcomes such as self-efficacy to control anger and internalizing and externalizing behavior problems.