Child Abuse & Neglect Lifetime assessment of poly-victimization in a national sample of children and youth

Objective: To use a lifetime assessment of victimization experiences to identify children and youth with high cumulative levels of victimization (poly-victims). Also to compare such children to other victims and non-victims, and assess the contribution of cumulative victimization to levels of psychological distress. Design: A national sample of 1,467 children aged 2–17 recruited through random digit dialing and assessed via telephone interviews (with caretakers and youth themselves) about a comprehensive range of 33 types of victimization experiences in the previous year and at any time in their lives. Results: Nearly 80% of the children and youth reported at least one lifetime victimization. The mean number of lifetime victimizations was 3.7 and the median 2.6. The total number of different lifetime victimizations was highly predictive of symptoms of current distress. The best linear prediction of distress on the basis of cumulative victimization entailed weighting child maltreatment and sexual assault by factors of 4 and 3 respectively compared to other victimizations. We proposed classifying poly-victims as those 10% of children and youth with the highest victimization scores, and calculating different thresholds for children at different ages. Poly-victims designated in this way had significantly more distress, more non-victimization adversities than other youth and were less likely to come from an intact family. Conclusion: Lifetime assessment of victimization has value as a means of identifying groups of highly victimized children and youth. Practice Implications: This paper describes a procedure under which practitioners can assess for a group of children, termed “poly-victims,” who have a very high burden of lifetime victimization. These children merit identification because they have high levels of psychological distress, some of the most serious victimization profiles, and a presumed vulnerability for further victimization. © 2009 Elsevier Ltd. All rights reserved. In several recent papers, we have introduced the concept of “poly-victimization” and promoted its utility for the field of child victimization and childhood trauma (Finkelhor, Ormrod, & Turner, 2007a; Finkelhor, Ormrod, & Turner, 2007b; Finkelhor, Ormrod, & Turner, 2007c; Finkelhor, Ormrod, Turner, & Hamby, 2005). Poly-victimization and poly-victim are concepts that help target and understand a group of children who suffer from particularly high levels of different types of victimization, for ! For the purposes of compliance with Section 507 of PL 104-208 (the “Stevens Amendment”), readers are advised that 100% of the funds for this program are derived from federal sources, (this project was supported by Grant Nos. 1999-JP-FX-1101 and 2002-JW-BS-0002, awarded by the Office of Juvenile Justice and Delinquency Prevention, Office of Justice Programs, US Department of Justice). The total amount of federal funding involved is $584,549. Points of view or opinions in this document are those of the author and do not necessarily represent the official position or policies of the US Department of Justice. ∗ Corresponding author. 0145-2134/$ – see front matter © 2009 Elsevier Ltd. All rights reserved. doi:10.1016/j.chiabu.2008.09.012 404 D. Finkelhor et al. / Child Abuse & Neglect 33 (2009) 403–411 example, physical abuse, peer bullying, property crime, and exposure to domestic violence. In a recently reported national survey, we found that 22% of the youth 2–17 years old suffered four or more different kinds of victimizations in a single year, and 10% suffered seven or more. The identification and focus on poly-victimized children has a number of benefits in our view: 1. It helps draw attention to a very important subgroup of victimized children, the ones with the highest burden of victimization, who also have extremely high levels of psychological distress and symptoms (Finkelhor et al., 2007a,b). These poly-victimized children also comprise a large percentage of those with certain forms of serious victimization like sexual abuse. As a group, they are the children responsible for most of the statistical associations between victimization and trauma. This approach of looking at individuals with multiple intersecting forms of adversity is also one that has drawn increasing attention in the fields of child development, mental health and traumatic stress (Appleyard, Egeland, van Dulmen, & Sroufe, 2005; Cook, Blaustein, Spinazzola, & van der Kolk, 2003; Felitti, Anda, & Nordenberg, 1998; Saunders, 2003). The interest in multiple types of victimization or maltreatment has also grown, although it is been operationalized in a variety of different ways (Clemmons, Walsh, DiLillo, & Messman-Moore, 2007; Manly, Kim, Rogosch, & Cicchetti, 2001; Morojele & Brook, 2006; Rossman & Rosenberg, 1998; Stevens, Ruggiero, Kilpatrick, Resnick, & Saunders, 2005). In general, this literature shows a linear relationship between the number of childhood adversities and the level of adverse outcome (Appleyard et al., 2005; Felitti et al., 1998). 2. The focus on multiple forms of victimization also draws attention to the intersection of different kinds of victimization and overcomes fragmentation in the study of child victimization, a domain that has been previously subdivided into variety of distinct but overlapping subfields, concerned about restricted domains such as bullying, sexual abuse, sexual harassment or exposure to domestic violence. 3. The identification of poly-victimization also helps correct for possibly misleading conclusions about victimization and its impact by research models that only pay attention to a limited subset of victimizations, and do not account for co-occurring, unmeasured other forms of victimization that may be part of what is contributing to a child’s difficulties (Finkelhor et al., 2007b). What may account for the high levels of distress in poly-victimized children is their vulnerability to victimization across a number of contexts and a number of different relationships (Finkelhor, 2008). Our previous research on poly-victimization has revolved around use of the Juvenile Victimization Questionnaire, which assesses 33 different types of victimization during childhood. In most of this research, we have assessed poly-victimization on the basis of victimizations occurring during a 1-year period (Finkelhor et al., 2005, 2007b,c), both to have a standardized timeframe and to take advantage of recency of recall. However, it is very common for child victimization researchers to assess victimization history over a longer time or even the course of a full childhood (Hanson et al., 2006). Much developmental theory about trauma maintains that negative events have cumulative impacts over much longer periods than a single year (Cook et al., 2003; Kaplow & Widom, 2007; KendallTackett & Becker-Blease, 2004). On the other hand, victimization assessments over a longer period may be less valid because of the difficulty of remembering and reporting information over such a span. This concern in part motivated our focus on a single year of victimization in our initial studies. However, because of increasing interest in expanding the poly-victim concept to cover a longer assessment period, we explore the implications of a lifetime format for the concept. The present paper investigates the implications of identifying poly-victimized children using victimization information concerning the child complete lifespan. As part of this investigation, the paper compares the merits of lifetime versus past year assessment of poly-victimization, assesses the associations of lifetime poly-victimization with psychological distress, and looks at the characteristics of polyvictimized children in contrast to other children, both victims and non-victims.