Investigating Polyvictimisation in Child Abuse Cases: A multi-method study within a Danish Child Protection Context

Abstract

Background: Child maltreatment is a universal problem with serious impacts on mental and physical health. The extant literature suggests that different forms of childhood harms tend to co-occur and that exposure to multiple different types of victimisation, also conceptualised as polyvictimisation, is a particularly strong predictor of adverse outcomes among children and youth. The concept of polyvictimisation and its effects have been examined in various studies. However, there is a dearth of research (i) exploring the psychopathological outcomes of children (0-17), who have experienced multiple victimisation, across nations and under different child life conditions; (ii) applying person-centred and sex-specific approaches to childhood victimisation co-occurrence linking profiles of childhood victimisation to adverse mental health outcomes, child background characteristics, and abuse-related factors; (iii) investigating the practical and clinical implications of the polyvictimisation issue within organisations working with child abuse. The current study addresses these research gaps and investigates the concept of polyvictimisation within a Danish child protection context: The Danish Children Centres (DCC). Objectives: (1): To identify the psychopathology outcomes associated with multiple victimisation exposure among children and youth ages (0-17 years) within the global research literature; (2) To identify distinct, sex-specific profiles of victimisation co-occurrence in a clinical, high-risk child and youth sample (ages 1-17), while also examining adverse psychological outcomes, child background characteristics, and abuse-related factors associated with different exposure configurations; (3) To explore how the findings obtained from research objectives 1 and 2 can inform the interdisciplinary work processes of the DCC and strengthen future case management of multiply-victimised children.

Methods: The research gaps described above were addressed in three research phases. In phase one, I conducted a systematic literature review examining and synthesising the evidence from studies investigating the associations between childhood polyvictimisation and psychopathology. The findings of the review informed the selection of mental health outcome variables in the second phase of the study, a quantitative analysis. In this phase, latent class analysis was used to identify the optimal number of classes to explain victimisation co-occurrence among children assessed in the DCC due to suspected child abuse (N=2,198). ANOVAs and multinomial logistic regressions were used to compare male and female classes across multiple mental health variables, child background characteristics, and abuse-related factors. The findings from the second phase were brought forward to the final phase of the study. In this study part the quantitative findings of phase two were presented back to the employees of the DCC. Qualitative participatory methods such as focus groups discussions (N=13) and group exercises were used with employees at the DCC to investigate the practical implications of the findings, i.e. how the quantitative findings on polyvictimisation can be integrated into future work processes in the DCC and inform recommendations for how to work with complex cases of child abuse in the future.

Results: In phase one, 4,998 relevant references were screened (title and abstract), 255 full-text articles were assessed for eligibility, and 22 met the inclusion criteria. A total of 21 of the 22 included studies reported a significant positive association between polyvictimisation and at least one indicator of child or adolescent psychopathology. The review demonstrated that polyvictimisation, irrespective of how the construct was defined, was positively associated with multiple forms of child and adolescent psychopathology including internalising and externalising problems as well as total psychological distress. Furthermore, polyvictimisation was found to be more strongly associated with psychopathology than individual (sub)types of victimisation across studies. These findings were observed across diverse child and youth populations spanning both normative and high-risk samples and various nations and cultures.

In phase two, sex-specific profiles of victimisation co-occurrence were identified in the DCC child and youth sample. The findings suggested that polyvictimisation is a highly relevant concept within the DCC context since approximately 80% of the children fell into classes characterised by multiple victimisation exposure. Furthermore, different constellations of multiple victimisation exposures were uncovered, suggesting that the exposure to polyvictimisation covers heterogeneous experiences. Female children were characterised by more varied patterns of childhood victimisations (five classes) compared to males (three classes). Inter-class differences were found on mental health outcomes, child background characteristics, and abuse-related variables. Overall, differences in mental health status were most commonly identified between the most broadly exposed groups and the least exposed groups.

Results of the third phase derived from qualitative participatory methods suggested that the victimisation profiles identified in the DCC data and their associations with external variables largely corresponded to the clinical impressions of DCC employees. Furthermore, results from the quantitative analysis were perceived as useful by the employees in terms of providing a general framework for understanding victimisation co-occurrence as well as for offering key guidance for additional points of attention and awareness in the child assessment sessions. Additionally, the different victimisation profiles and the supplementary analysis offered a springboard to increase an interdisciplinary focus on polyvictimisation issues during the cross-sectoral case consultation meetings in the DCC. Results, however, also implied that the employees faced a dilemma in terms of case complexity being misaligned to the legally defined mandate of the DCC. The results suggested that future work with and investigation of the polyvictimisation concept within the DCC context would benefit from a further integration of ecological factors such as parental characteristics and child resilience factors. Finally, a set of recommendations for future work on the polyvictimisation concept were identified spanning four overall categories: data, assessment, final reports and recommendations, and cross-sectoral collaboration.

Conclusion: The results of this study show that polyvictimisation is a highly relevant issue to investigate within high-risk child populations for whom multiple victimisation exposure is the norm rather than the exception. Results implied that polyvictimisation is a substantial risk factor for adverse child mental health spanning both inner-directed and outer-directed difficulties and requires the attention of professionals working with child abuse cases as well as mental health policy makers. The results show that polyvictimisation covers heterogeneous experiences that are differentially associated with mental health factors and child characteristics. The issue of polyvictimisation was considered important from a professional point of view in the DCC but also raises questions regarding sectoral responsibilities and division of labour within organisations working with child abuse. This study contributed to existing knowledge in the topic of childhood polyvictimisation through a synthesis of the various frameworks and concepts for describing the co-occurrence issue of childhood harms, a systematic review of the psychopathology outcomes associated with polyvictimisation, a person-oriented and sex-specific analysis of victimisation co-occurrence and associated factors as well as a better understanding of the practical implications of the polyvictimisation concept within organisations working with child abuse cases. The implications of these findings for theory, policy, and practice are discussed.