A new approach to research on child abuse and neglect, the ‘Child Maltreatment: Risk and Protection’ (CMRP) Model, is outlined in this paper. The CMRP Model was developed from the existing research on child maltreatment, particularly the growing evidence of children’s vulnerability to multiple sources of trauma. Within the model, three separate types of variables are reviewed. First, the interrelationships between the various types of child maltreatment (sexual abuse, physical abuse, psychological maltreatment, neglect, witnessing family violence) are considered. Second, the role of factors that influence (a) the risk of maltreatment occurrence and (b) the severity of its impact are examined from a developmental victimological framework. These include environmental, relationships and child characteristics. Finally, outcomes associated with maltreatment are considered in the following six domains: behaviour, emotion, cognitions/self-concept, sexuality, social functioning, and somatic complains. The contribution of each form of child abuse and neglect to observed adjustment problems is accounted for within the CMRP model. A review of the literature reveals the lack of maltreatment-specific adjustment problems. Two research measures based on the CMRP model are described. Parallel versions of the Family and Life Experiences Questionnaire are available for (a) adult retrospective reports (FLEQ-A) and (b) parent perceptions of their children’s experiences of child maltreatment (FLEQ-P). As well as critically reviewing the available literature, data from two of our own studies are used to illustrate the usefulness of the model in providing predictions for research. The data demonstrate support for the basic tenets of the model. Finally, implications of the CMPR model for further research, prevention and intervention strategies are elucidated. The implications are focused on the need for integration across maltreatment modalities for both research and professional practice.

Overview

I will begin by presenting an overview of the current state of research in the field of child maltreatment (CM) in terms of (a) the overlap in occurrence of the different CM types: sexual abuse, physical abuse, psychological maltreatment, neglect and witnessing family violence, (b) factors influencing the occurrence and impact of CM (i.e., risk and protective factors) and (c) adjustment correlates. I shall review some data on the overlap in the occurrence of the different forms of child maltreatment, and the extent and impact of multi-type maltreatment. I shall use both theoretical and empirical arguments to explain these relationships and why children are vulnerable to multiple sources of trauma. I’ll then present a model that considers the relationships between familial factors associated with CM and each CM type to adjustment domains. Data from my own research will be briefly presented to demonstrate the utility of the model. I will conclude my talk by making some brief recommendations for protection of children from abuse, neglect, and family violence.

The ‘Child Maltreatment: Risk and Protection’ Model is presented below in Figure 1. It is comprised of three components: child maltreatment, variables influencing the risk of the occurrence of child maltreatment and its impact, and the various outcome domains summarising the adjustment problems associated with CM.

Literature review

a) Interrelationships between maltreatment types and multi-type maltreatment

The following studies provide some long-overdue data on the overlap in occurrence of the different CM types (sexual abuse, physical abuse, psychological maltreatment, neglect, and witnessing family violence):

Hamilton & Browne (1998) described a taxonomy of revictimization depending on how many different incidents and different perpetrators. I argue that there needs to be another dimension added: that of the number of different types of CM (i.e., ‘multi-type maltreatment’). The following conclusions can be drawn regarding multi-type maltreatment:

• different types of family violence/CM seem to go hand-in-hand

• multi-type maltreatment is a relatively frequent occurrence

• multi-type maltreatment is associated with greater impairment than single-type maltreatment

• experiencing one type of maltreatment places children at risk of experiencing other types

b) Variables influencing occurrence and severity of CM

Familial predictors of CM include characteristics/dynamics of the family, as well as environmental factors (e.g., low SES):

• family dysfunction (e.g., lack of cohesion, adaptability)
• marital dissatisfaction (particularly a risk factor for sexual abuse)
• social isolation
• poor quality parent-child relationship
• parental absence/presence of stepfather (particularly a risk factor for sexual abuse)

• Perpetrator psychopathology (i.e., personal attributes)

• violence
• poor impulse control (a particularly important influence on both physical and sexual abuse)
• parenting skills deficits
• substance abuse

• Structural explanations of CM

• patriarchy
• low SES (incr. risk, although CM found at all SES levels)
• family characteristics (dysfunction; parent absence)
• lack of social support

• individual characteristics of the child (age, gender, temperament, etc.)

c) Adjustment problems associated with CM

Adjustment correlates for each of the types of child maltreatment have been summarised in Table 1. From this summary, it can be seen that there is large variability in adjustment problems associated with CM, and that there are no abuse-specific correlates. A particular problem is that many studies only assess one type of CM — and therefore the contribution of other maltreatment types not assessed to the particular outcome domain is not known.

New data supporting the CMRP

Intercorrelations between maltreatment types

Data from both the Parent and Adult studies (Higgins & McCabe, 1998; Higgins & McCabe, submitted) are presented in Table 2. The degree of overlap between each of the five maltreatment types are demonstrated using correlations. Data on the proportion of respondents scoring above the mean on maltreatment scales, and the number classified as having experienced ‘multi-type maltreatment’ are described in Figures 2 and 3. The following key findings emerged:

• large degree of overlap between all the maltreatment types other than sexual abuse
• sexual abuse was significantly related only to psychological maltreatment

• all maltreatment types significantly intercorrelated
• strongest relationships between physical abuse, psychological maltreatment and neglect.

• maltreatment types typically occur together
• need to assess the degree of multi-type maltreatment and the particular impact of experiencing more than one maltreatment type

Two or more types of CM reported by 43.4% Adults and 42.0% Parents.

Familial predictors of multi-type maltreatment were:

• low family cohesion
• low family adaptability
• high level of parental traditionality (re: beliefs about role of women/children)
• high level of parental sexual punitiveness

High levels of multi-type maltreatment associated with high levels of adjustment problems — significant for all outcome measures for both Adults and Parents.

A summary of predictors from both Parent and Adult studies is provided in Table 3. Positive family characteristics (adaptability, cohesion, physical affection) were associated with positive outcomes. Negative characteristics of families (1) increased the risk of CM; (2) were associated with negative outcomes in their own right; (3) interacted with CM in predicting adjustment problems; and (4) partially accounted for some of the observed relationship between CM and adjustment problems.

The CMRP model highlights the importance of family characteristics in relation to maltreatment and adjustment. A multi-dimensional approach to prevention and intervention needs to be adopted, which recognises children’s vulnerability to multi-type maltreatment. Dysfunctional family dynamics which place children at risk of multi-type maltreatment need to be specifically targeted with support and family intervention strategies. The following implications for researchers, and both prevention and intervention programs are elucidated.

Research. Are the particular adjustment problems identified in the literature as associated with each of the forms of child maltreatment the result of that form of CM, or of another co-occurring form of CM? When all maltreatment types are measured, what are the particular patterns of association, and the particular adjustment problems associated with multi-type maltreatment? Researchers must include the contribution of family variables when considering the possible adjustment problems associated with CM.

Prevention. Family cohesion was identified as a risk factor for multi-type maltreatment. Efforts to provide families with communication skills and to develop a greater sense of unity and interconnection may reduce the risk of children from those families being subjected to multiple forms of maltreating behaviours — either from parents, or other adults. Children revictimised by multiple forms of maltreatment (who are at particular risk of adjustment problems) should be identified for special intervention as a means of prevention of further multi-type victimisation. In this way, treatment programs or other interventions can be used as an opportunity to engage in primary prevention of other maltreatment types.

Intervention. Given the frequency with which multi-type maltreatment occurs, it is important for therapists and child protection workers providing individual, group or other post-abuse therapeutic intervention to be vigilant in looking for indications of other forms of CM. Do we need to be abuse-specific in our treatment approach (e.g., sexual abuse treatment centres/groups), or perhaps a more general approach to treatment of negative childhood circumstances/events would be more suitable. To answer this question, we need more data on adjustment problems associated with each type of CM (to see if there are any abuse-specific effects), as well as some treatment efficacy studies, comparing three groups: participants in a general intervention program for negative childhood circumstances/events, participants in an abuse-specific program, and those on a waiting list or not receiving any treatment.

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