Safe, Stable and Nurturing Relationships
(Originally published May 2014)
The Centers for Disease Control and Prevention (CDC) has developed a conceptual framework for preventing child maltreatment based on safe, stable and nurturing relationships (SSNRs). According to Merrick, et al, (2013) “In extreme cases, SSNRs may be regarded as the positive end of the continuum while the opposing negative end represents risk. In as much, one can think of safety as being transposed with neglect and violence, while stability counters chaos and unpredictability, and nurturing opposes hostility and rejection. In less extreme cases, SSNRs may buffer the impact of negative relational and environmental contexts.”
One of the most interesting and important applications of this framework has been CDC sponsored research regarding intergenerational transmission of child maltreatment. Four studies on intergenerational transmission and a meta-analysis of these studies were published in the October 2013 issue of the Journal of Adolescent Health.
Based on decades old research, it has been common for scholars to assert that approximately one third of abused and neglected children go on to abuse or neglect their own children. There has been much scholarly speculation regarding the factors that facilitate or interrupt intergenerational transmission of child maltreatment, but a lack of conclusive evidence. These CDC sponsored studies and other research discussed in this commentary point to the quality of maltreated children’s relationships with caregivers (i.e., birth parents, foster parents, adoptive parents) and the importance of intimate relationships in young adulthood as critical factors in shaping the capacity to parent.
In “Safe, Stable, Nurturing Relationships Break the Intergenerational Cycle of Abuse: A Prospective Nationally Representative Cohort of Children in the United Kingdom,” Jaffee, et al, interviewed 2232 children drawn from a birth record of same sex twins born in England and Wales in 1994-95. Children and their mothers were initially interviewed when children were 5 years old, and there were follow up home visits when children were 7, 10 and 12. Mothers were interviewed regarding their history of childhood maltreatment through use of the Childhood Trauma Questionnaire. Almost 17% of mothers reported experiencing mild forms of maltreatment as a child, and 7.7% of mothers reported a childhood history of severe maltreatment. According to Jaffee, et al, ”Among the 178 mothers who reported a history of mild maltreatment in childhood, 46% ( n=81) had at least one twin child who experienced physical maltreatment by the time they reached the age of 12: for 54% (n=97), both children escaped exposure to maltreatment.” Mothers with a history of mild maltreatment in childhood were 3.55 times more likely to have a child who had experienced maltreatment compared with mothers lacking a history of childhood abuse.
Eighty- one mothers reported being severely abused in childhood; 56% (n=45) of these mothers had at least one child who had been physically abused by age 12. Mothers severely abused in their childhoods were 5.31 times more likely to have a child who had been physically abused by age 12. Almost 14% of the families in the study experienced child maltreatment across two generations (cycle maintainers); however, in 14.7% of families only mothers had experienced physical maltreatment (cycle breakers).
In an analysis utilizing logistic regression, the researchers found that “only domestic violence between mother and her partner(s) was associated with increased probability that the cycle of abuse would be maintained rather than broken: the odds of being cycle maintainers versus cycle breakers were over two times greater in families in which domestic partner violence was present…” Socioeconomic advantage, high maternal warmth and “mother’s healthy relationship with a partner distinguished families characterized as cycle breakers from the cycle maintainers,” the authors assert. In addition, cycle breakers had lower rates of depression, substance abuse, anti-social behavior, domestic violence and social disadvantage. “Furthermore, the authors state, “the cycle maintainers were less warm with their children (and) described their relationships with intimate partners as less trusting and close…”
This is a fascinating and important study, but it leaves unanswered the question of what experiences (early or recent) influenced cycle breakers’ capacity for positive intimate relationships with romantic partners and children. Compared to mothers who had not experienced childhood maltreatment, cycle breakers had higher rates of depression and less social support. Nevertheless, despite vulnerability to depression, these mothers were not only able to refrain from physical abuse but also able to maintain warm and nurturing relationships with their children. The authors suggest the possibility that the quality of a mother’s relationship with an intimate partner “is a causal mechanism in breaking the cycle of abuse,” but do not speculate how some mothers with childhood histories of maltreatment were able to make good choices of intimate partners, and sustain these positive intimate relationships despite periodic depressive episodes.
Based on the SSRs conceptual framework, one plausible hypothesis is that women who became cycle breakers with their own children had more positive relationships with a parent or parents, relative(s), friends, lovers in childhood and adolescence; in other words, SSRs may be responsible for recovery from the effects of child maltreatment and other adversities. Some studies of resiliency support the idea that children and adolescents can draw strength from extended family members or other supportive adults, suggesting that it is the experience of nurturing relationships in childhood and adolescence that facilitates the capacity to nurture others.
Another possibility suggested by resiliency research is that, for cycle beakers, the damaging effects of childhood maltreatment have been buffered by personal characteristics (e.g., charm, extroversion), socially recognized talents and/or academic achievement that led to positive recognition, social acceptance and better paying jobs. Positive social recognition and improved material circumstances may have, in turn, possibly led to more positive interpersonal relationships in general and less conflict in intimate relationships. The damaging psychological messages communicated by a history of childhood maltreatment may have been contravened by positive social feedback resulting from endearing personal traits or the exercise of talents and abilities.
Adolescent Parenting and Intergenerational Transmission of Child Maltreatment
It is possible that the search for distinctive traits and specific experiences that distinguish parents who become cycle breakers from cycle maintainers is fundamentally misguided, in that traits and experiences identified in these studies have been abstracted from life course trajectories that connect psychological characteristics and social functioning in complex ways. Some of the most interesting recent research regarding intergenerational transmission of child maltreatment has concerned adolescent trajectories, for example teen pregnancy, that increase the risk of a wide range of adversities, including compromised health and mental health, limited educational achievement, high rates of unemployment and increased rates of child maltreatment.
Emily Putnam-Hornstein, Bryn King, Barbara Needell and other researchers at USC and the University of California, Berkeley have recently published, or otherwise disseminated, several articles on adolescent parents in California that have begun to describe life course trajectories that increase the likelihood of intergenerational transmission of child maltreatment. In one study, these researchers were able to use birth records from 2006-07 to identify first time mothers, ages 15-19, and link birth records to CPS records from the state’s administrative data base. The sample in this study included 24,767 infants born to first time mothers, ages 15-19, in Los Angeles County during 2006-07. Approximately a quarter (25.6%) of infants were born to a mother reported to CPS between age 10 and the beginning of pregnancy. More than a fifth (20.6%, 5,113) of the entire sample of infants were reported to CPS by age 5 and 7.7% (n=1909) were substantiated as victims of child maltreatment by age 5.
This research brief summarizes its main finding as follows: “Among teen mothers who had not been reported as possible victims of maltreatment, 15.8% of their children were reported for maltreatment by age 5. In contrast, the corresponding rates of children reported among those born to a mother with an unsubstantiated or substantiated report were 30.7% and 39.8%. And “The substantiation rate was 5.4% among children born to mothers with no alleged or substantiated maltreatment history, less than half the substantiation rate of children born to mothers with an unsubstantiated report of victimization (11.8%) and one third the rate of children who had been substantiated as victims (18%).”
CPS report rates of 30-40% for children 0-5 born to adolescent mothers who themselves were alleged to have been maltreated in a CPS report after their 10th birthday and before becoming pregnant is an alarming statistic, but raises the question of how these young women were different from the 60-70% of adolescent mothers whose young children were not reported to CPS.
These researchers have recently published several articles regarding adolescent mothers in foster care that may indirectly shed light on this question. Possibly, the same factors associated with increased rates of teen pregnancy among a foster care population, ages 15-17, the great majority of whom have been maltreated in adolescence, increase the risk that these young mothers will become involved with the child protection system. In an analysis of adolescent births in California’s foster care system between 2006-10 King, et al, found “rates of birth higher among girls who had been in care for less time,” (73% higher for teens in care for less than 12 months compared to teens in care for 60 months or longer), higher birth rates for adolescent girls who “experienced the least amount of stability” (9 or more placements), moderately higher birth rates for adolescent girls in their second, third, etc. placement episode, lower birth rates for adolescent girls in guardian homes and kinship homes. The authors comment that their findings regarding the relationship between placement instability and teen birth rates “comports with qualitative research that that suggested that girls in foster care who choose to give birth do so because they believe that parenting will provide a sense of stability, increased attachment and permanence, and the opportunity to be successful in ways their own parents and the foster care system were not,” in other words some teens believed that mothering a child would lead to a safe, stable and nurturing relationship which was lacking in their life.
In another analysis of cumulative teen birth rates in California’s foster care population (2013), Putnam-Hornstein and King found that of adolescent girls in foster care at age 17, 28.1% gave birth to at least one child before their 20th birthday. Again, lengths of stay in foster care longer than 60 months were associated with lower birth rates. According to the authors, “the highest birth rates were observed among girls who had four or more placements during the observed foster care episode.” Teens who exited to guardianship or adoption had the lowest birth rates in this study.
Reflections on SSRs and intergenerational transmission
If, as the CDC maintains, SSRs play a critical role in breaking the cycle of intergenerational transmission of child maltreatment prevention advocates, public health agencies and child welfare systems must become more interested in creating the conditions that make for safe, stable and nurturing relationships between parents and children and more committed to reducing experiences that undermine these relationships. Concretely, this means that much larger investments in prevention and early intervention programs and services are needed, especially for high risk groups such as teen parents; and that these services should seek to strengthen and sustain the nurturing quality of parent-child relationships in infancy and toddlerhood.
However, the CDC sponsored research discussed above has pointed to the influence of intimate partner relationships on parenting, by increasing or undermining feelings of safety within families and through the experience of being valued and loved. Domestic violence is never a minor matter, but DV may be especially impactful on victims who were abused or neglected as children. DV undermines the conditions essential for recovery from the effects of childhood maltreatment and from early trauma, and drives home the message that intimate relationships are inherently unsafe. Treatment plans in child welfare cases need to place greater emphasis on intimate partner relationships both as an antidote to violence and to increase the frequency of affectionate interchanges among family members.
Placement instability is often an indicator of children and youth’s behavior problems, and of caregivers’ inability or unwillingness to make commitments to the unconditional care of behaviorally troubled children. Foster care systems in which a third to a half of school age children do not experience stable placements even after an initial period of instability (a finding of one important study based on NSCAW data) are doing serious emotional damage to an already troubled population. Foster care systems cannot become therapeutic entities without greatly reducing placement instability for all age groups.
Finally, child protection programs need to be far more attuned to the nurturing context in which child maltreatment occurs, and better at recognizing and responding to emotional maltreatment. The effects of physical abuse, sexual abuse and neglect are mediated by the presence or absence of nurturing parenting. Emotional maltreatment is an indicator that the nurturing environment for children is toxic. Emotional toxicity kills SSRs in the bud.
It has taken decades for child welfare scholars to achieve a minimally adequate understanding of the developmental consequences of child maltreatment and of the essential requirements for recovery from multiple adversities, including child maltreatment. The CDC’s SSR framework is the best formulation to date of the meaning of the available science.
“California’s Most Vulnerable Parents: Adolescent Mothers and Intergenerational Child Protective Service Involvement,” Research Brief, Children’s Data Network at the University of Southern California, Vol. 1-3, November 2013.
Conger, R., Schofield, T., Neppl, T., Merrick, M., “Disrupting Intergenerational Continuity in Harsh and Abusive Parenting: The Importance of a Nurturing Relationship with a Romantic Partner,” Journal of Adolescent Health, October 2013.
Jaffee, S., Bowes, L., Ouelett- Morin, I., Fisher, H., Moffitt, T., Merrick, M. & Arsenault, L., “Safe, Stable, Nurturing Relationships Break the Intergenerational Cycle of Abuse: A Prospective Nationally Representative Cohort of Children in the United Kingdom,” Journal of Adolescent Health, October 2013.
King, B., Putnam- Hornstein, E., Cederbaum, J., Needell, B., “A cross –sectional examination of birth rates among adolescent girls in foster care,” Children and Youth Services Review, 36, 2014.
Merrick, M., Leeb, R. & Lee, R., “Examining the role of Safe, Stable and Nurturing Relationships in the Intergenerational Continuity of Child Maltreatment--- Introduction to the Special Issue,” Journal of Adolescent Health, October 2013.
Putmam- Hornstein, E. & King, B., “Cumulative teen birth rates among girls in foster care at age 17: An analysis of linked birth and child protection records from California,”, Child Abuse and Neglect, in press, 2013.