HOW CHILD WELFARE INVOLVED MOTHERS' TRAUMA HISTORY INFLUENCES
PARENTING: A GROUNDED THEORY STUDY
By
Emily Schmittel

A DISSERTATION
Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of
Human Development and Family Studies - Doctor of Philosophy
2013

ABSTRACT
HOW CHILD WELFARE INVOLVED MOTHERS' TRAUMA HISTORY INFLUENCES
PARENTING: A GROUNDED THEORY STUDY
By
Emily Schmittel
The goal of this qualitative study was to investigate the ways in which trauma has
impacted the life experiences of a group of mothers involved in the child welfare system. A
special emphasis was given to study how cumulative trauma and trauma symptoms have
influenced the participants’ parenting experiences. Twelve participants were recruited through
therapists who provide services to parents involved with the child welfare system. Mothers
participated in structured interviews and completed assessments on trauma symptoms and
parenting. According to the data, women were exposed to intense adversity and cumulative
trauma throughout their lives. In addition, mothers reported extraordinary testimonies of
resilience. By developing a grounded theory framework, the author proposes an integrated model
on trauma and parenting. Study strengths and limitations, as well as implications for practice
and research are discussed.

Copyright by
EMILY SCHMITTEL
2013

DEDICATION
This paper is dedicated to the participants and the other resilient women who continue surviving
despite life’s challenges.

iv

ACKNOWLEDGEMENTS
Firstly, I am indebted to my clients and participants from whom I have learned so much.
Their ability to be resilient against all odds is inspiring. I am forever thankful for them allowing
me to share in their experiences.
This study would not be what it is without the support of my doctoral committee. Each of
them has helped me develop as a scholar and individual in a unique way. I want to give a special
thanks to Dr. Rubén Parra-Cardona for the immense amount of time and effort he put into
helping shape this study. His supportive feedback throughout this process has guided me in
developing the necessary skills to be a successful academic. Without Dr. Kathleen Burns- Jager
this study would not have happened. I not only want to thank her for her recruitment efforts, but
also for her support as a supervisor, mentor and friend. Dr. Marsha Carolan has helped me
further solidify myself as a feminist researcher and therapist. I admire her un-wavering
commitment to challenging power imbalances and dedication to advocacy. Finally, Dr. Sheryl
Kubiak‘s commitment to social justice for trauma survivors has also helped guide this study, as
well as her thoughtful insight when interpreting complex social issues.
It is no secret that moving several states from my home town was initially an emotionally
taxing experience, however I quickly found a family of wonderful colleagues and friends who
would help make East Lansing, Michigan home. Thanks to the FIT team who shaped me as a
therapist. You are the most empowering group of people I know! Thank you for challenging me
to challenge myself and my worldview. You truly are AKTS! Thank you to other dear friends
who supported me throughout the years. Whether it was a Saturday tailgate, breakfast at
Sawyer’s , or many panicked phone calls, you helped me feel like I was not alone in this process
that few can really understand.
v

When I moved into my first apartment in East Lansing I was sure my parents were not
going to leave and were going to try to convince me to move immediately back to Missouri. The
fact that they did not proved their unwavering belief in me that I could handle any challenge.
Throughout my life they have always believed that I can do anything I choose. Finally, I have to
acknowledge Zach who has stuck with me throughout this entire process. Thank you for trusting
me to follow my own path. I can’t thank you enough for your unhesitating patience and
understanding over the past 7 years. I can’t wait for our next set of adventures and I feel so lucky
to have you as a partner to share in whatever the future holds.

vi

TABLE OF CONTENTS
LIST OF TABLES……………………………………………………………………………….vi
LIST OF FIGURES……………………………………………………………………………..vii
Chapter 1: Introduction………………………………………………...……….……..……..…1
Background of the Problem……………………………………………………………………….1
Purpose of the Study….………………………………………………………………………...…3
Research Questions………………………………………………………………………………..4
Theoretical Perspectives…………………………………………………………………………..5
Trauma & PTSD………………………………………………………………………..…5
Cumulative Trauma and Complex Symptomology …………………………………..…..6
Multicultural Feminist Theory……………………………………………………………6
Ecological Theory…………………………………..…………………………………….8
Chapter 2: Literature Review…………..………………………………….…………………..11
Scope of the Problem………………………………………………………………………….…11
Ecological Lens………………………………………………………………………………..…13
Defining Trauma & Trauma Responses…………………………………………………………13
Posttraumatic Stress Disorder……………………………………………………………13
Women’s Unique Trauma Experiences………………………………………….………14
Intimate Partner Violence………………………………………………..………15
Cumulative Trauma……………………………………………………………..…….…15
Complex Trauma…………………...……………………………………………………16
Perceptions of Self and Others………………….……………………..…………18
Emotional and Physical Problems…………………………….…………………18
Parenting and Child Development Outcomes…………………..…………….…………………19
Parenting Styles and Child Outcomes……………………………..…….………………19
Social Interaction Learning Theory and Parenting Behaviors…….…….………….……21
Trauma and Parenting……………………………………………………………………………22
Trauma Symptomatology and Parenting …………………………………………..……22
Specific Trauma History and Parenting Outcomes…………………………….………..24
Parental Trauma and Child Outcomes…………………………………………..……….26
Context and Trauma Recovery…………………………………………………………...……..26
Self-efficacy and Recovery………………………………………………………………28
Trauma Recovery………………………………………………………………….……..29
Service-Utilization and Recovery………………………………………………….…….30
Chapter 3: Methods……......….……………………………………………………….……….32
Design……………………………………………………………………………………………32
Overview of the Qualitative Approach ………………………………………….………32
Qualitative Research…………………………………………………………….……….32
Grounded Theory……………………………………………………………..………….33
Multicultural Feminist Qualitative Research……………………………………….……34
vii

Participants & Recruitment…………………………………………………………..……….….34
Sampling…...……………………………………………………………………….……34
Recruitment Activities…………………………………………………………..….……35
Inclusion Criteria……………………………………………………………….….….…36
Exclusion Criteria………………………………………………………………..………36
Sample Size………………………………………………………………………………36
Procedures……………………………………………………………………………….…….…37
Theoretical Sampling………………………………………………………………….…37
Participant Selection and Scheduling……………………………………………………37
Data Collection…………………………………………………………………………………..38
Self-report questionnaires………………………………………………………………..39
Brief Symptom Inventory………………………………………………………39
Adult-Adolescent Parenting Inventory-2……………………………………….39
Interviews………………………………………………………….……………………..39
Data Management………………………………………………………………………………..40
Data Analysis…………………………………………………………………………………….40
Overview…………………………………………………………………………………40
Constant Comparative Method…………………………………………………………..41
Triangulation……………………………………………………………….…………….41
Data Coding………………………………………………………………...……………41
Open Coding…………………………………………………………………..…...42
Axial Coding…………………………………………………………………….…42
Selective Coding……………………………………………………………….…..42
Memo-writing……………………………………………………………………………43
Trustworthiness of the Data……………………………………………………………………...43
Credibility………………………………………………………………………………..43
Transferability……………………………………………………………………………44
Dependability and Credibility……………………………………………………………44
Role of the Researcher……………..………………………………………………….…44
Computer Software……………………………………………………………………………....45
Ethical Considerations…………………………………………………………………………...45
Dissemination of Findings…………………………………………………………………….…46
Participant Characteristics……………………………………………………………………….46
Chapter 4: Results…...………………………………………………...……………………....48
Overview of the Grounded Theory………………………………………………………………48
Findings of Research Question A………………………………………………………………..53
Poverty…………………………………………………………………………………...53
Removal of Child from Home……………………………………………………………55
Intimate Partner Violence………………………………………………………………..55
Sexual Trauma…………………………………………………………………………...56
Childhood Neglect……………………………………………………………………….57
Parental Substance Use…………………………………………………………………..58
Physical Abuse…………………………………………………………………………...59
Removed from Parents…………………………………………………………………...59
viii

Child Welfare Involvement………………………………………………………………60
Death of a Significant Family Member………………………………………………….61
Physical Injuries………………………………………………………………………….62
Findings of Research Question B………………………………………………………………..63
Difficulty Trusting Others……………………………………………………………….63
Mood Disturbances………………………………………………………………………65
Emotional Dysregulation………………………………………………………………...66
Substance Abuse…………………………………………………………………………67
Negative View of Self……………………………………………………………………68
Health Problems………………………………………………………………………….69
Cumulative Trauma and Co-occurring Symptomatology…………..……………………70
Brief Symptom Inventory………………………………………………………………..70
Findings of Research Question C………………………………………………………………..71
Trust, Boundaries, and Parenting…………………………………………………..…….72
Hypervigilance about Safety……………………………………………….72
Children Exposed to Unhealthy Relationships……………………….…….73
Decreased Interactions with Children………………………………………73
Mood Disturbances and Parenting…………………………………………….…………73
Decreased Energy and Desire to Interact with Children…………………...73
Difficulty Setting Limits……………………………………………………74
Emotional Dysregulation and Substance Abuse Leading to Abuse and Neglect………..74
Substance Abuse Precipitating Neglect……………………………………75
Negative View of Self and Parenting Role………………………………………………76
Health Issues & Parenting………………………………………………………………..76
Decreased Amount and Quality of Interactions with Children…………….76
AAPI-2…………………………………………………………………………………...77
Findings of Research Question D………………………………………………………………..78
Difficulty Trusting and Setting Boundaries……………………………………………...78
Mood Disturbances……………………………………………………………………....79
Emotional Dysregulation.………………………………………………………………..80
Findings of Research Question E………………………………………………………………..80
Unsupportive Relationships……………………………………………………………...80
Parents/Family……………………………………………………………...81
Current/ Former Partners….………………………………………………..82
Fathers’ Absence or Lack of Involvement in Parenting…………..……82
Partner Interactions Leading to or Exacerbating Involvement in the Child
Welfare System…..……………………………………………………..82
Friends……………………………………………………………………...83
Caseworkers………………………………………………………………...83
Unprofessionalism……………………………………………………….83
Lack of Understanding and Support……………………………………..84
Caseworker Background…………………………………………………85
Supportive Relationships………………………………………………………………...86
Parents/Family……………………………………………………………...86
ix

Emotional Support……………………………………………………….86
Instrumental Support……………………………………………………..87
Partners……………………………………………………………………..87
Caseworkers……………….………………………………………………..88
Other Service Providers…..………………………………………………...89
Friends……………………………………………………………………...90
Findings of Research Question F………………………………………………………………...90
Behavioral Strategies…………………………………………………………………….91
Psychotropic Medication………………………………………………………………...91
Children as Motivation in Life…………………………………………………………...92
Cognitive Strategies……………………………………………………………………...92
Substance Abuse and Trauma Recovery…………………………………………………………93
Substance Abuse Recovery………………………………………………………………93
Improved Boundary Setting/ Trust of Others……………………………………………94
Improved Emotional Regulation…………………………………………………………94
Positive View of Self…………………………………………………………………….95
Confronting Problems……………………………………………………………………95
Positive Parenting Behaviors…………………………………………………………………….96
Parent-Child Bond……………………………………………………………………….96
Limit/ Boundary Setting…………………………………………………………………96
Emotional Support……………………………………………………………………….97
Participant Profiles……………………………………………………………………....98
Chapter 5: Discussion………..…………………………………...…………………………...101
Cumulative Trauma…………………………………………………………………………….101
Poverty……………………………………………………………………………………...…..101
IPV………………………………………………………………………………………...……102
Sexual Trauma………………………………………………………………………………….103
Childhood Abuse and Neglect………………………………………………………………….103
Exposure to Parental Substance Abuse…………………………………………………………104
Death of a Significant Family Member………………………………………………………104
Trauma Symptoms and Parenting Resulting from Cumulative Trauma………………………105
Difficulty with Trust and Boundaries…………………………………………………..107
Influence on Parenting…………………………………………………….109
Mood Disturbances and Influence on Parenting………………………………………..110
Avoidance Strategies…………………………………………………………………...111
Substance Abuse, Parenting, and Abusive Relationships…………………112
Emotional Dysregulation……………………………………………………………….112
Influence on Parenting…………………………………………………….113
View of Self…………………………………………………………………………….113
Influence on Parenting…………………………………………………….114
Health Issues and Parenting…………………………………………………………….114
Abuse and Neglect……………………………………………………………………...115
Parenting Beliefs………………………………………………………………………..116
Influence of Trauma on Women’s Interactions with Formal Social Systems………………….116
x

Supportive and Unsupportive Contexts………………………………………………………...118
Family Members………………………………………………………………………..119
Current/Former Partners………………………………………………………………..120
Friends………………………………………………………………………………….121
Caseworkers…………………………………………………………………………….121
Other Service Providers………………………………………………………………...122
Trauma-Coping and Resilient Parenting Behaviors……………………………………………122
Coping and Resilient Behaviors Reported by Women…………………………………123
Additional Signs of Recovery…………………………………………………………..124
Positive Parenting………………………………………………………………………126
Strengths and Limitations of the Investigation…………………………………………………126
Future Research Directions……………………………………………………………………..128
Implications for Practice………………………………………………………………………..129
Recommendations for Caseworkers……………………………………………………130
Establish Trust…………………………………………………………….130
Set and Model Appropriate Behaviors……………………………………131
Understanding Emotional Dysregulation…………………………………131
Response to Supportive/ Unsupportive Contexts…………………………132
Recommendations for Child Welfare Administrators…………………….132
Recommendations for Therapists………………………………………………………133
Establish Trust…………………………………………………………….133
Psychoeducation…………………………………………………………..134
Inclusion of Support Systems……………………………………………..134
Emotional Regulation Skills Training.……………………………………134
Treatment of Mood Disturbances and Substance Abuse………………….135
Self of the Researcher…………………………………………………………………………..135
Conclusion……………………………………………………………………………………...136
APPENDICES…….……………………………………………………………………….…...137
Appendix A: Study Consent Form……..………...……....………………………….…..138
Appendix B: Demographic Questionnaire………...…………….……………….……...142
Appendix C: Structured Interview Guide………… ...…………………………..……....144
REFERENCES………………………………………………………………………………....147

xi

LIST OF TABLES

Table 3.1 Participant Characteristics…………………………………………………………….46
Table 4.1 Trauma Experiences…………………………………………………………………..53
Table 4.2 Trauma Symptoms……………….…………………………………………………....63
Table 4.3 BSI……………………... ………….………………………………………………....71
Table 4.4 Trauma Symptoms and Parenting Behaviors…….……………………………...…….72
Table 4.5 AAPI-2…………………………………………………………………………….…..78
Table 4.6 Supportive and Unsupportive Systems………………………………………………..80
Table 4.7 Coping Strategies and Substance Abuse Recovery…………………………………...91
Table 4.8 Participants 1-6………………………………………………………………………..98
Table 4.9 Participants 7-12………………………………………………………………………99

xii

LIST OF FIGURES

FIGURE 1.1. Conceptual Map………………………………………………………………..…11
FIGURE 4.1. Grounded Theory………………………………………………………………….50

xiii

Chapter 1: Introduction
Background of the Problem
More than 3 million reports of child maltreatment are received by state and local agencies
in the United States each year (Center for Disease Control [CDC], 2012). At least 740,000
children and youth are treated in hospital emergency departments as a result of violence by
caregivers on an annual basis (CDC, 2012). It is estimated that the annual cost of child
maltreatment in the U.S. is approximately $104 billion (Wang & Holton, 2007). Children who
suffer maltreatment are more likely to have behavioral, emotional, and physical health issues
(CDC, 2011). Parents with a history of childhood maltreatment are more likely to maltreat their
children than parents without a history of childhood maltreatment (Dixon, Browne, & HamiltonGiachritsis, 2005; Hunter & Kilstrom, 1979; Newcomb & Locke, 2001). Estimates show that one
third of individuals with a history of child maltreatment will go on to abuse their own children
(United States Department of Health and Human Services [USDHHS], 2006). Additionally,
women with complex trauma history and symptoms are especially at risk for perpetuating child
abuse and neglect as well as intimate partner violence (IPV), putting their children at a
heightened risk for maltreatment. Due to these life experiences, related mental health problems
and lack of resources, female survivors of chronic interpersonal trauma who have children often
find themselves involved in child welfare systems (Schirmer, Nellis, & Mauer, 2009). This
system is difficult to navigate if women have difficulty managing affect regulation and effective
interpersonal skills (Briere & Jordan, 2009).
Often times, parents who enter the child welfare system are referred to parenting
programs. However, trauma symptoms can make it extremely difficult for parents to trust and
engage in such services. In addition to the immediate positive effects of parenting programs,
1

these interventions have the potential to prevent the transgenerational transmission of abuse by
identifying patterns of abuse and maltreatment across generations. However, for parenting
programs to be effective, women who are trauma survivors must first identify their own history
of trauma and abuse, how intergenerational patterns of child maltreatment occurs, as well as the
ways in which their own history of trauma affects their parenting practices. A key alternative to
support women with trauma histories consists of providing this insight and understanding, as
well as providing them with various parenting skills such as emotion regulation, appropriate limit
setting, and positive involvement with children (Kaminski, Valle, Filene, & Boyle, 2008).
Research substantiates that trauma impairs interpersonal functioning (Briere & Jordan, 2009) and
quality of parenting (Bert, Guner, & Lanzi, 2009; Cohen et al., 2008; Gara, Allen, Herzog, &
Woolfolk, 2000). However, there is a need for exploration on how the process of trauma impairs
parenting behaviors. Additionally, because complex trauma is cumulative and often on-going
throughout the lifespan, women exposed to trauma are likely to develop poor interpersonal skills,
isolation resulting from the minimization or denial from others with regards to their histories of
trauma and abuse, as well as a variety of negative physical and psychological symptoms (Briere
& Jordan, 2009). These factors can leave mothers in stressful environments with little support,
limited opportunities to emotionally and psychologically heal from their own trauma, and
subsequent impaired parenting (Kim, Trickett & Putnam, 2010; Samuels-Dennis, Ford-Gilboe,
Wilk, Avison & Ray, 2010). Even if women seek out services, interventions for trauma survivors
may be inhibited by clients’ particular symptomology, nature and intensity of trauma, limited
social support, and stigma.
If interventions lack trauma-informed components they may trigger and exacerbate
trauma symptoms leading to early termination, drop out or failure to engage in services
2

altogether (Stevens, Ammerman, Putnam, & VanGinkel, 2002; Walter, Horsey, Palmieri, &
Hobfoll, 2010). Therefore, advocates for women with histories of trauma highlight the great need
for interventions to address trauma survivors’ management of their trauma symptoms (Briere &
Jordan, 2009; Cloitre, Stovall-McClough, Zorbas, & Charuvastra, 2008; Herman, 1992).
There continues to be scarce qualitative research describing how trauma affects parenting
behaviors. Therefore, there is a high need for studies aimed at giving voice to women trauma
survivors as they embrace in efforts to provide the best parenting they can provide to their
children. Data collected in such studies could inform in interventions aimed at empowering
women in their parenting efforts, and potentially support greater efficacy and engagement.
Purpose of the Study
The purpose of this study was to create a theoretical model aimed at explaining how
women’s experiences of cumulative trauma and resulting complex trauma symptoms have
affected their parenting behaviors, parent-child relationships, and their immediate parenting
contexts. To reach this goal, female trauma survivors were asked to discuss their trauma history
and symptoms, their perceptions on how these experiences influence their parenting behaviors
and relationships with their children, and their individual coping responses to trauma. Finally,
participants were asked about their perceptions of the extent to which the contexts in which they
parent are supportive of their parenting efforts.
This study consisted of a series of semi-structured interviews with 12 female trauma
survivors. To facilitate data collection, a general set of questions were asked to all participants
(e.g., perceptions of their quality of parenting, etc.). Additionally, in an effort to fully explore the
specific trauma-related challenges experienced by each participant, individual and tailored

3

questions were asked based on responses to the Brief Symptom Inventory (BSI: Derogatis, 1984)
and the Adult-Adolescent Parenting Inventory-2 (AAPI-2; Bavolek & Keene, 1999).
With regards to the general questions, women were interviewed about their trauma
history, symptoms associated with their trauma history, and how they perceived trauma
experiences and symptoms influencing their parenting behaviors. In addition, they were asked
about their perceptions concerning the level of support experienced in their parenting contexts
and ways in which they coped with their trauma. Data was analyzed using methods of feministinformed grounded theory qualitative research. This involved a three step coding process of
open, axial, and selective coding using qualitative research software. To increase trustworthiness,
a number of strategies were be implemented in close collaboration with Dr. Parra-Cardona. The
current study constitutes a relevant contribution to the field as there are an extremely limited
number of qualitative studies focused on how mothers’ trauma symptoms influence their
parenting behaviors as well as relationships with their children (Armsworth & Stronck, 1999;
Jager & Carolan, 2009; Levendosky, Lynch, & Graham-Bermann, 2000). In addition, there
continues to be a limited number of therapeutic and trauma-informed parenting interventions
focused on promoting healthy parenting by adequately taking into consideration how trauma
impairs parenting. Therefore, a key goal of this study is to provide treatment guidelines for these
interventions. Primary reasons for poor outcomes in child welfare cases include lack of parental
involvement in services and willingness to take responsibility for meeting children’s needs
(DeRoma, Kessler, McDaniel, & Soto, 2006; Gladstone et al., 2012; O’Hare, 1996). Because it is
likely that these issues are rooted in trauma symptomology (Briere & Jordan, 2009), there is a
high need for child welfare professionals to better understand the influence of trauma on

4

mothers’ interactions with their children, as well as interactions with caseworkers, judges,
lawyers, and other services to which they are mandated.
Research Questions
The major goal of this investigation was to reach a better understanding of how
cumulative and complex trauma influences mothers’ parenting behaviors. A secondary goal
consisted of examining participants’ coping strategies, as well as contextual factors that support
their parenting efforts. Specifically, the following research questions guided this study:
A. What are the most salient experiences of cumulative trauma reported by participants?
B. What are the most salient trauma symptoms reported by participants?
C. How do trauma symptoms influence the participants’ parenting behaviors?
D. How do trauma symptoms influence women’s interactions with formal social
systems (e.g., child welfare, legal)?
E. How supportive are the contexts in which women engage as related to their parenting
efforts?
F. What examples of trauma-coping and resilient parenting behaviors are women most
likely to report?
Theoretical Perspectives Justifying the Research Questions
Trauma and PTSD
In field trials for the development of the DSM-IV, 67% of participants with childhood
abuse or neglect histories met criteria for a Posttraumatic Stress Disorder (PTSD) diagnosis
(Roth, Newman, Pelcovitz, van der Kolk, & Mandel, 1997). PTSD criteria include symptoms of
re-experiencing the traumatic event, avoidance-numbing, and hyperarousal, with symptoms
persisting for more than a month that cause significant impairment (American Psychiatric
5

Association [APA], 2000). However, interpersonal trauma often results in symptoms related to
substantial emotional and interpersonal difficulties, which do not always align with the
traditional conceptualization of PTSD (Briere & Jordan, 2004; Briere & Jordan, 2009; Briere &
Spinazzola, 2009). As a result, the symptom profile associated with interpersonal trauma has
been conceptualized as a complex posttraumatic stress disorder (Briere & Jordan, 2004; Herman,
1992). Individuals with complex trauma symptoms are likely to experience high reactivity to
emotionally evocative stimuli, difficulty calming down, anger issues, attachment disturbances,
and identity-related issues (Briere & Jordan, 2009; Briere & Lanktree, 2008; Cloitre, Cohen &
Koenen, 2006; Goldner, 2007). Complex posttraumatic stress disorder symptoms increase when
an individual has experienced multiple traumatic events across the life-span (Briere, Kaltman, &
Green, 2008). What is problematic is that these symptoms create challenges in one’s intimate
relationships, work context, parenting behaviors, and perception of social support (Briere, 1988).
Additionally, if a survivor is referred to a parenting program, these symptoms may inhibit her
acceptance of and engagement in the intervention.
Cumulative Trauma and Complex Symptomology
Complex trauma symptoms tend to result from the cumulative effects of exposure to
multiple traumatic events across the lifespan. In fact, an individuals’ trauma complexity has been
correlated with the number and nature of traumatic events they have endured (Briere, Kaltman,
& Green, 2008). Women are at an increased risk for experiencing cumulative interpersonal
trauma in comparison to men, leaving women at higher risk for PTSD and other mental health
disorders (Kubiak, 2003; Rishith, Mechanic, & Resick, 2000; Yehuda et al., 1995). Cumulative
trauma is also associated with increased vulnerability for revictimization. Therefore, individuals
with cumulative trauma are likely to experience on-going traumas that will further exacerbate
6

trauma symptomology (Turner, Finkelhor, & Ormrod, 2006). Further details of cumulative
trauma and complex trauma symptomology will be discussed further in Chapter Two.
Multicultural Feminist Theory
Multicultural feminist theory informs the conceptualization of this study. Rather than
solely targeting gender and patriarchy as the basis of oppression, multicultural feminism seeks to
critique societal and individual power imbalances based on multiple characteristics including, but
not limited to the intersections among race, ethnicity, sexual orientation, socio-economic status,
and ability status (McDowell & Fang, 2007). According to this perspective, the researcher should
engage in a critical analysis of societal structures that promote and sustain power imbalances and
inequality between individuals, families, and minority groups.
A multicultural feminist researcher further seeks to illuminate how individuals of
minority status are often pathologized as they are viewed through the lens of white patriarchal
society and seeks to challenge this pathologizing perspective. While discussing groups of
individuals, the researcher should keep an open, flexible attitude about diverse cultures and
cultural influences and needs to remain attentive to stereotypes commonly associated with
specific diverse populations. Additionally, multicultural feminist research privileges the
participants’ voices and perspectives.
From a multicultural feminist perspective, women’s behaviors as mothers must be
understood within the context in which they exist. For example, when a mother interfaces with
the child welfare system she is often labeled as abusive, neglectful, and uncaring towards her
child. However, if we look at her trauma history we can find a more accurate understanding of
her behavior- an understanding that can inform more empathic, effective interventions. This
perspective challenges the blaming position commonly found in society which views mothers as
7

solely responsible for children’s well-being (USDHHS, 1995).
Acknowledging one’s social position and biases and how they influence the results of a
study is integral to feminist research. Moreover, the primary investigator recognizes that the
current study has political implications and has the purpose of stimulating advocacy and change.
This study seeks to influence change in social systems with which mothers with trauma interact
by providing empirical data to justify a perspective of understanding of maladaptive parenting
behaviors associated with trauma, oppression, and social injustice.
Ecological Theory
In this study women’s trauma history and trauma responses are understood through an
ecological lens, which provides a theoretical structure for understanding contexts in which
individuals live (Bronfenbrenner, 1979). Bronfenbrenner (1979) conceptualizes five different
systems in which individuals exist including the microsystem, mesosystem, exosystem, and
macrosystem (1979). Each of these systems are interdependent and interrelated, meaning that
intervention in one system will likely influence the others.
Microsystems are individuals’ most immediate settings (1979). A microsystem may be an
individual’s family, school, or peer context. Guttentag and colleagues (2006) found that close
social support predicted positive change in a parenting intervention for disadvantaged mothers.
Similarly, women with a sexual abuse history have healthier parenting practices when they have
a strong support system (Kim, Trickett & Putnam, 2010). Unfortunately, accessing healthy social
support systems is often times a challenge, particularly for women with trauma histories. This is
especially the case when the mother’s family support system consists of those who perpetrated
their abuse (Sharp & Marcus-Mendoza, 2001).

8

Mesosystems are the interactions between two microsystems (Bronfenbrenner, 1979). For
example, a mesosystem may be the interaction between a child’s family and school system.
Particularly, if teachers or administrators perceive a trauma survivor to be a “deficient parent”,
collaboration in this mesosystem will likely be poor. Child welfare personnel also often times
become intimately related to women’s micro-systems as their actions and attributions have the
potential of profoundly altering the dynamics of families. Thus, this study will explore the role of
mesosystems in participants’ lives such as how women navigate relationships with foster parents,
school systems, and any other immediate contexts that have a direct influence on their children.
Exosystems are systems that have an indirect influence on individuals (Bronfenbrenner,
1979). For example, if women are in relationships with partners whose families consider trauma
survivors as “weak or drawn to deficient relationships,” chances are that partners may be
negatively influenced by their families’ deficit-based perceptions.
The macrosystem is the political and social context in which individuals, microsystems,
mesosystems, and exosystems exist (1979). This involves living in a society that privileges
white, middle class values and experiences. Currently, the U.S. macrosystem is also
characterized by an economic context in which employment and education opportunities are
limited. In addition, executive portions of the child welfare systems where policies and decisions
are made that directly impact trauma survivors constitutes an example of the powerful influence
that macrosystems can exert on the participants’ lives. Therefore, this study seeks to understand
how women’s trauma symptoms may be exacerbated by sociopolitical challenges they have
faced throughout their lives. The implications of the Adoption and Safe Families Act (ASFA) are
an example of a macrosystemic influence. ASFA allows a judge to terminate a parent’s rights if
the child has been out of the parent’s care 15 out of 22 months. As a result women with a trauma
9

history who are involved in the child welfare system have a relatively short time-frame to resolve
parenting issues that may stem from PTSD symptoms.

10

Chapter 2: Literature Review
Scope of the Problem
More than 3 million reports of child maltreatment are received by state and local agencies
in the U.S. each year (CDC, 2012). Of these reports, approximately 60% of children are
maltreated by their mothers and more than 25% are exposed to domestic violence (DHHS, 2010).
In addition, at least 740,000 children and youth are treated in hospital emergency departments as
a result of violence by caregivers on an annual basis (CDC, 2012). Because child maltreatment
costs the U.S. government $104 billion each year (Wang & Holton, 2007), understanding why
maltreatment occurs is of great importance.
Maltreatment of children is a phenomenon associated with a multiplicity of factors such
as poverty (Lee & Goerge, 1999), lack of resources (Berger, 2004; Paxson & Waldfogel, 1999;
Waldfogel, 2000), tendency towards aggression, endorsement of corporal punishment (Black,
Heyman, & Slep, 2000), and stress (Rodriguez, 2010). One consistent finding is that parents
who maltreat their children are very likely to have experienced maltreatment in their own child
and adolescent histories (Dixon, Browne, & Hamilton-Giachritsis, 2005; Hunter & Kilstrom,
1979; Newcomb & Locke, 2001). Bandura’s Social Cognitive theory has been used to explain
this pathway to maltreatment, which supports the notion that adults maltreat their children based
on the observations of their parents’ maltreating behaviors (Bandura, 1973, 1977, 1986; BowerRussa, 2005). However, more recently, alternative perspectives identify parents’ trauma
symptoms resulting from early abusive experiences and/or abusive relationships as mechanisms
by which parents engage and perpetuate abuse on their children (Milner et al., 2010).
To understand how parental trauma symptoms impact parenting, this literature review
discusses several related topics. First, trauma and posttraumatic stress disorder (PTSD) are
11

discussed including subtopics of cumulative trauma, complex symptomology, and women’s
unique trauma experiences. Next, current literature on how parental trauma and trauma
symptoms lead to impaired parenting and poor childhood emotional and behavioral outcomes
will be discussed. Finally, the role of contextual factors and recovery will be examined. Special
emphasis will be placed on describing how a biased “mother blaming” culture has been
promoted in patriarchal societies, an issue that has prevented a more thorough and systemic
understanding of child abuse and neglect. Figure 1.1 is a visual conceptual map of the major
concepts and elements that provide the theoretical justification of this investigation.
Figure 1.1 Conceptual Framework

CONTEXT
-ONGOING TRAUMA
-PATRIARCHAL SOCIETY
-SOCIAL SUPPORT
-FORMAL INTERVENTIONS
PARENTING
BEHAVIORS &
CHILD
OUTCOMES

CUMULATIVE&
COMPLEX TRAUMA
PTSD
TRAUMA SYMPTOMS

SERVICE
UTILIZATION
TRAUMA
RECOVERY

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Ecological Lens
This literature review takes into account that parenting behaviors should be understood
within an ecological context. Belsky (1984) theorized that parenting behaviors are influenced by
parent characteristics, child characteristics, and parents’ context (e.g., social support, workplace).
Of these three factors, Belsky considers that how individuals were parented is the most important
factor in determining parenting style and approach. Highlighting the critical importance of
context, scholars have repeatedly argued about the importance of thoroughly considering
multiple layers of context (e.g., family, neighborhood, society) when examining effective and
maladaptive parenting behaviors. The following review looks at how the developmental history
of trauma and the context in which trauma survivors live influence parenting and child outcomes.
Defining Trauma and Trauma Responses
Posttraumatic Stress Disorder
Currently, approximately 11 million adults in the US suffer from PTSD and other anxiety
disorders resulting from exposure to traumatic events (National Institute of Mental Health
[NIMH], 2012). To receive a formal PTSD diagnosis a person must have “experienced,
witnessed, or been confronted with an event or events that involve actual or threatened death or
serious injury, or a threat to the physical integrity of oneself or others” (APA, 2000, p.468).
Additionally, they must have responded to the event with fear, hopelessness or horror. Symptoms
that must be present for the diagnosis include intrusive recollection of the event (at least one),
avoidance or emotional numbing (at least three), and hyperarousal (at least two). Intrusive
experiences may involve recurrent images, dreams, or psychological distress and internal or
external cues that remind the person of the event.
13

Each of these three symptom domains may have a variety of emotional and behavioral
manifestations. Avoidance or emotional numbing includes efforts to avoid thoughts or feelings
related to the event, efforts to avoid any external reminders of the event, dissociation, feelings of
detachment from others, or sense of a foreshortened future. Hyperarousal may be characterized
by difficulty falling asleep, irritability, difficulty concentrating, hypervigilence, or an
exaggerated startle response (APA, 2000). A person must experience symptoms for at least a
month and find symptoms distressing or impairing to social or occupational functioning (APA,
2000).
Women’s Unique Trauma Experiences
Women are more likely to develop PTSD in comparison to men, with women having a
9.7% lifetime prevalence of PTSD, and men only having a 3.6% prevalence rate (Kessler et al.,
2005). Although women are at an increased risk for PTSD, a large proportion of women
experience sub-threshold PTSD symptoms (see Merlin & Mohr, 2000). While some researchers
argue that women are particularly vulnerable to PTSD due to their gender (i.e. Breslau, Chilcoat,
Kessler, & Davis, 1999), others argue that women are particularly at risk for PTSD due to their
increased likelihood of experiencing sexual violence across the lifespan and child abuse (Kubiak
& Cortina, 2006; Tolin & Foa, 2006). Additionally, women endure daily traumas resulting from
living in a patriarchal society in which women are oversexualized and devalued (Burstow, 2003).
An increased prevalence for PTSD may also be partially explained by national statistics from the
U.S. Department of Health and Human Services on reported incidents of child maltreatment that
show that girls are at higher risk for being victims of child abuse and neglect than boys
(USDHHS, 2010).

14

Intimate Partner Violence Intimate partner violence (IPV) affects a large proportion of
women in the United States when considering that IPV can be manifested through physical,
emotional, sexual, or financial violence (Pence & Paymar, 1993). Unfortunately a significant
proportion of mothers engaged in child abuse and neglect are also engaged in abusive intimate
relationships. Research has documented the deleterious effects associated with IPV exposure and
maternal parenting (Levendosky, 2000). For example, women report that domestic violence
impairs their parenting behaviors on issues such as emotional regulation, appropriate limit setting
and emotional interaction with their children. Furthermore, children also become IPV victims as
they are at high risk of abuse by IPV perpetrators (Renner & Slack, 2006; Saunders, 2003).
While the co-occurrence of maternal child abuse and IPV is common, there continue to be
important failures in the service-related systems to screen for and detect IPV among women who
are referred to social institutions for child abuse and neglect (Kelleher et al., 2006).
Cumulative Trauma
Although the diagnostic criteria for PTSD is considered in relation to a singular recent
event, studies show that individuals who have been exposed to multiple traumatic events across
their lifespan are at an increased risk for poor mental health outcomes including increased risk
for PTSD (Kubiak, 2003; Rishith et al., 2000; Yehuda, 1995). Essentially, the more traumatic
experiences individuals have lived, the more trauma symptoms they are likely to have (Follette,
Polusyny, Bechtle, & Naugle, 1996; Rishith, Mechanic, & Resick, 2000). For example, Kubiak
determined in a sample of drug-convicted women that women’s risk for PTSD increased 40%
with each traumatic event they experienced (2003).
Early traumatic events make individuals vulnerable for future traumatic occurrences. For
example, childhood victimization is associated with revictimization across the lifespan (Spatz
15

Wisdom, Czaja, & Dutton, 2007). More specifically, Nishith, Mechanic, and Resick (2000)
found that child sexual abuse increased vulnerability for physical and sexual abuse in adulthood.
Subsequent trauma essentially reinforces problematic beliefs about self and others that early
traumas triggered, further exacerbating PTSD symptomatology (Nishith, Mechanic, & Resick,
2000). For instance, Griffen and colleagues (2006) explored IPV survivors’ exposure to
childhood trauma and how early violence exposure influenced subsequent PTSD symptomology.
Findings indicate that women who witnessed their mothers being victims of domestic violence
were more likely to experience intrusion symptoms. A history of sexual abuse in childhood was
also related to hyperarousal symptoms. According to these research findings, intimate partner
violence also mediated a relationship between childhood physical abuse and adult PTSD
(Becker, Stuewig, & McCloskey, 2009). Similarly, Samuels-Dennis found that cumulative
trauma decreased women’s sense of self-agency, which subsequently increased their PTSD
symptom severity (Samuels-Dennis et al., 2010).
Complex Trauma
Interpersonal abuse often results in symptoms related to substantial emotional and
interpersonal difficulties that do not always align with the traditional conceptualization of PTSD
(Briere & Jordan, 2004; Briere & Jordan, 2009; Briere & Spinazzola, 2009; Herman, 1992; van
der Kolk, Roth, Pelcovitz, Sunday & Spinazzola, 2005). As a result, the symptomatic profile
associated with interpersonal trauma has been conceptualized as a series of disorders of extreme
stress not otherwise specified (DESNOS) or also frequently referred as complex posttraumatic
stress disorder (Herman, 1992; Briere & Jordan, 2004). Cloitre and colleagues (2009) found that
childhood trauma was predictive of symptom complexity in adulthood. Symptom complexity is
defined as a number of symptoms above a literature-determined cut-off.
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Herman (1992) originally identified seven categories of DESNOS trauma symptoms
including dysregulation of affect and impulses, attention or consciousness, self-perception,
perception of the perpetrator, relations with others, somatization, and systems of meaning.
Subsequently, it was empirically determined that individuals with prolonged interpersonal
trauma early in life were at risk for difficulties with affect regulation, memory and attention, selfperception, interpersonal relations, somatization, and systems of meaning (van der Kolk, Roth,
Pelcovitz, & Spinazzola, 2005). Briere and Jordan (2009) similarly described six specific
symptoms that can result from complex trauma experiences. These include cognitive
disturbances, mood disturbances, somatization, identity disturbance, interpersonal difficulties,
emotion regulation difficulties, and avoidance responses. Briere and Elliott (2003) found that
both physical and sexual abuse in childhood were associated with domains on the trauma
symptom inventory including anxious arousal, depression, anger-irritability, intrusive
experiences, defensive avoidance, dissociation, impaired self-reference, and tension reduction
behavior. Sexual abuse was additionally associated with sexual concerns and dysfunctional
sexual behavior (2003). Briere, Kaltman, and Green (2008) found that the number and types of
traumatic events women experienced in childhood predicted their future complexity of
symptoms. For example, survivors of sexual abuse and maternal emotional abuse are very likely
to report various symptoms in all scales of the Inventory of Altered Self-Capacities including
interpersonal conflicts, idealization-disillusionment, abandonment concerns, identity impairment,
susceptibility to influence, affect dysregulation, and tension reduction activities (Briere &
Rickards, 2007). Below, each primary complex trauma symptom is summarized based on Briere
and Jordan’s description (2009).

17

Perceptions of Self and Others. Cognitive disturbances refer to the distortions in
schemas about self and others. Rather than developing the belief that relationships with others
will be trusting and rewarding, a trauma survivor is likely to develop beliefs that relationships
will be characterized by rejection, abandonment, and hurt. In addition, the survivor believes that
she deserves and is responsible for this type of treatment (2009).
Briere and Jordan (2009) also highlight the issue of identity disturbance for complex
trauma survivors in which one’s identity and self-awareness becomes distorted. This presents as
confusion about boundaries resulting from a lack of ability to monitor personal needs, feelings,
thoughts, and behaviors.
Individuals with a child abuse history are likely to report problems in their marital and
social relationships (Liang, 2006). Chronic interpersonal difficulties are also associated with
complex trauma related to the cognitive disturbances that survivors are likely to hold about
relationships and others. As a result, survivors are at increased risk of engaging in abusive
relationships as they may not feel worthy to demand respect, attention, and consideration from
their intimate partners (Briere, 2009; Cloitre, Miranda, & Stovall-McClough et al., 2005).
Emotional and Physical Problems. Mood disturbances for trauma survivors include
increased likelihood to experience symptoms of anxiety and depression (2009). This highlights
the frequent co-morbidity rates of posttraumatic stress disorders with mood disorders (Kessler,
Sonnega, Bromet, et al. 1995). Related to mood disturbances, emotion regulation can be difficult
for complex trauma survivors (Cloitre, Miranda, Stovall-McClough et al., 2005) and often results
in utilization of avoidance strategies. Avoidance strategies include substance abuse, dissociation,
and tension reduction behaviors (TRBs). Dissociation is characterized by depersonalization and

18

derealization of experiences. Examples of TRBs include disordered eating, self-mutilation,
compulsive sexual behavior, and impulsive aggression (2009).
Avoidance strategies of dissociation and substance abuse seem to be primary areas of
concern related to trauma survivors' parenting difficulties (Egeland & Susman-Stillman, 1996;
Narang & Contreras, 2000). Dissociation has been strongly associated with revictimization and
further exposure to stressful life events (Becker-Lausen et al., 1995). In a sample of parents with
child abuse histories, dissociative symptoms were found to be a differentiating factor between
parents who abused their children and those who did not (Egeland and Susman-Stillman, 1996).
Substance abuse can be of particular concern for women with a trauma history. Substance abuse
rates are higher in traumatized populations including women who have a history of physical,
sexual (Brems, Johnson, Neal, et al., 2004; Knisely, Barker, & Ingersoll, 2000; Strine et al.,
2012), and/or domestic abuse (Salomon, Bassuk, & Huntington, 2002). Severity of substance
abuse has also been correlated with severity of victimization (Brady et al., 1994; Clark & Foy,
2000). Although there are multiple contributing factors to women’s substance abuse, studies
show that childhood abuse is a strong predictor. This connection has been explained as a selfmedicating process, in which substances are used to numb trauma symptomatology.
Somatization is another possible consequence of complex trauma that can lead to
psychological distress manifesting in physical pain and dysfunction (Briere & Jordan, 2009).
Abuse history has been found to be predictive of a variety of health problems and prolonged
recovery time (Drossman, Li, Leserman, Toomey, & Hu, 1996; Farley & Patsalides, 2001
Spitzer, Barnow, Wingenfeld et al., 2009).
Parenting and Child Developmental Outcomes
Parenting Styles and Child Outcomes
19

As this investigation focuses on the extent to which trauma history influences parenting
behaviors, an inherent position is taken which differentiates between abusive and adaptive
parenting. Specifically, research shows that child socio-emotional outcomes for children are best
when parents have adequate skills in key parenting domains such as effective communication,
warmth, limit setting, and maturity demands (Baumrind, 1967; 1971). Although these domains
are primarily drawn from Baumrind’s seminal research, other child development researchers
support the crucial role of these parenting behaviors on positive child and youth development
(e.g. Adams, 2008; Maccoby & Martin, 1983; Shumow, & Lomax, 2002; Rohner, 2002).
Communication involves the extent to which parents clearly convey various expectations to their
children, as well as the extent to which they are open to their children’s ideas and feedback.
Warmth is simply the extent to which parents show affection to their children. Limit setting
refers to the restrictions they place on their children’s behavior and how much monitoring they
do of their behaviors. Finally, maturity demands refers to the extent to which parents expect their
children to have age-appropriate responsibilities (Baumrind, 1967; 1971).
Baumrind identifies four parenting styles based on the aforementioned parenting
domains. Authoritative parents are those who score high on all four domains. Children of
authoritative parents tend to express high levels of positive emotions, have self-control/ selfreliance, high energy, are able to maintain relationships with peers, are cooperative, cope well
with stress, and show initiative in new situations (Baumrind, 1967; 1971).
Permissive parents are those who have high communication and warm interactions with
their children but set few limits and maturity demands. Child outcomes associated with
permissive parenting include domineering, disruptive and demanding interpersonal style,

20

impulsive, low achievement orientation, high energy and positive emotions (Baumrind, 1967;
1971).
Authoritarian parents are high on setting limits and maturity demands, but are low in
providing warmth and communication to their children. Although children of authoritarian
parents tend to be better behaved than children of permissive parents, they tend to express fewer
positive emotions, are more inhibited, passively hostile, withdrawn, aggressive, and vulnerable to
stress (Baumrind, 1967; 1971). Linking research on parenting styles, child outcomes, and trauma
is a key premise of the current investigation as there is a high need to investigate how these
issues are interrelated in the lives of women with intense trauma histories.
Social Interaction Learning Theory and Parenting Behaviors
Closely related to Baumrind’s scholarship on parenting styles, a similar set of parenting
behaviors has been connected by researchers to positive child outcomes and maternal well-being.
Specifically, 9-year longitudinal data from parenting clinical trials have been associated with
positive youth development, reduced maternal depression, and increased maternal per capita
income (Forgatch, Patterson, DeGarmo, & Beldavs, 2009; Patterson, DeGarmo, & Forgatch,
2004). Specifically, Forgatch and colleagues implemented the intervention known as Parenting
through Change (PTC) with a group of low-income and underserved divorced mothers (Forgatch
& DeGarmo, 1999), placing close attention to the promotion of both parenting skills and
maternal well-being. The intervention was developed according to principles Social Interaction
Learning (SIL) Theory, which connects child behavioral outcomes to parenting practices (Reid,
Patterson, & Snyder, 2004). According to SIL, stressful environmental factors influence
children’s behavioral outcomes indirectly and are mediated by parenting practices. PTC aims to
reduce disruptive children’s behaviors through effective parenting practices (Forgatch, Patterson,
21

& DeGarmo, 2005). PTC core parenting skills include 1) positive involvement, 2) skill
encouragement, 3) setting limits, 4) monitoring, and 5) family problem solving. These concepts
fit quite well with concept of authoritative parenting. In a large clinical trial with mothers
exposed to intense contextual stressors, researchers confirmed that effective parenting practices
led to sustained positive childhood outcomes over time, as well as maternal well-being as
demonstrated through improved mental health and economic stability (Forgatch, Patterson,
DeGarmo, & Beldavs, 2009).
Trauma and Parenting
Literature on the relationship between parental trauma and parenting is extensive,
however there is a wide variety of ways by which this phenomenon has been studied. Generally,
women with a trauma history are more likely to have decreased parenting satisfaction, increased
neglectful behaviors, and increased likelihood for using physical punishment (Banyard,
Williams, & Siegel, 2003; Banyard, 1997). Additionally, specific types of traumas, cumulative
trauma, and trauma symptoms have been investigated as influencing poor parenting and negative
child outcomes.
Trauma Symptomatology and Parenting
Researchers have confirmed that trauma symptoms mediate the relationship between
potential for childhood physical abuse and risk for perpetrating child physical abuse (Milner et
al., 2010). For example, in a study with college and US Navy personnel, it was found that for
participants in both samples, impaired self-reference, tension reduction behaviors, and defensive
avoidance predicted likelihood for perpetrating child physical abuse. For the US Navy sample,
but not for the college sample, dissociation, intrusive experiences, and sexual concerns were
significant predictors of risk for perpetrating child physical abuse. These findings substantiate
22

how complex trauma symptoms of disturbances in schemas about self and others have the
potential to impair parents’ ability to engage in healthy parent-child interactions (Briere &
Jordan, 2009).
Mood symptoms can also impair parent-child interactions (Downey & Coyne, 1990) as
well as inhibit a mother’s ability to actively engage in an intervention. Extensive research has
demonstrated the deleterious effects of depression on parenting. Depressed parents have more
negative interactions with their children, which tend to be informed by negative attributions such
as considering their children particularly rebellious or self-centered (Field, 1995; Guedeney,
2000).
Dissociation, an avoidance strategy that can result from trauma, provides a mechanism by
which parents leave themselves and their children vulnerable to further victimization (Hulette,
Kaehler, & Freyd, 2011; Narang & Conteras, 2000; Vezina, Mireille, Roberts, & McDuff, 2005).
When women with a sexual abuse history display dissociative symptoms, they are less likely to
be supportive towards their daughters and more likely to use punitive discipline (Kim et al.,
2010; Dixon, Brown & Hamilton-Giachritsis, 2005; Dixon, Hamilton-Giachritsis, & Brown,
2005). When survivors of incest were asked about their parenting experiences they often
described their experience as a parent as feeling detached, numb, handicapped, overcontrolling,
overprotective, fearful, and anxious (Armsworth & Stronck, 1999).
Substance abuse, for multiple reasons, impairs parenting (Keller, Cummings & Davies,
2005; Pears, Capaldi, & Owen; Smyth, Miller, Mudar & Skiba, 2003). First, it contributes to a
variety of negative social factors including low social support, housing problems, and poverty
(Daro & McCurdy, 1992; Marcenko & Spence, 1995; Nair, Schuler, Black, Kettinger, &
Harrington, 2003). Maternal substance abuse disorder is predictive of neglectful parenting
23

(Carter & Myers, 2007), punitive discipline strategies (Arellano, 1996; Hans et al., 1999; Kelley,
1998; Miller, Smyth, & Mudar, 1999; Schuler & Nair, 2001; Young, 1997), and out of home
placement (Marcenko, Kemp, & Larson, 2000). Substance abuse disorder also moderated a
relationship between child abuse history and severity of neglectful parenting (Dunn, Mezzich,
Janiszewski, Kirisci, & Tarter, 2008; Dunn, Tarter, Mezzich, Vanukov, Kirisci, & Kirillova,
2002). In a sample of substance abusing mothers, Hien and colleagues (2010) found that anger
arousal and reactivity predicted child abuse potential. Women who are substance abusers are
more likely to abuse or neglect their children when they are contending with more than five
contextual stressors (Nair, Schuler, Black, Kettinger & Harrington, 2003). Children of substanceabusing mothers experience better psychosocial adjustment when their mothers maintain parental
warmth and control (Suchman, Rounsaville, DeCoste, & Luthar, 2007).
Specific Trauma History and Parenting Outcomes
Parental history of childhood sexual abuse place survivors’ children at increased risk for
child abuse and psychological aggression, particularly if women are likely to minimize the
potential for engaging in abusive parenting behaviors (Cohen et al., 2008). Additionally, negative
family-of-origin experiences and sexual abuse history were related to use of violence during
parent-child conflict as well as poor satisfaction with self as a parent (1997). Mothers with a
sexual abuse history are at high risk for using punitive discipline (Kim, Trickett, & Putnam,
2010). Furthermore, when sexual abuse survivors had high levels of depressive symptoms they
were especially more likely to use physical violence with children.
Mothers with a sexual abuse history also have difficulties caring for the emotional and
psychological needs of children. This is related to a number of factors including: less consistency
and organization, lower confidence in parenting abilities, less sense of control, and lack of
24

support from partners (Cole, Woolger, Power & Smith, 1992). In comparison to mothers who did
not survive sexual abuse, mothers with a history of sexual abuse are at risk of placing
inappropriate maturity demands on their children (1992), being intrusive towards their infants
(Moehler, Biringen & Poustka, 2007), being less affectionate and involved with infants (LyonsRuth & Block, 1996), having permissive parenting styles (Kim et al., 2010), and relying more on
their children for emotional support (Burkett, 1991).
With regards to having experienced sexual abuse, a qualitative study on incest survivors’
parenting experiences, poor self-esteem was reported as one of the most inhibiting symptoms to
effective parenting (Armsworth & Stronck, 1999). Lack of a concept of appropriate boundaries
and discipline also made parenting difficult (1999). Incest survivors also reported trauma
symptoms including difficulties with closeness, being touched, and having others depend on
them to meet their needs as barriers to effective parenting (1999).
History of childhood physical abuse is predictive of child abuse perpetration, parental
punitiveness, psychological aggression, and use of physical discipline (Bert, Guner, & Lanzi,
2009; Cohen et al., 2008). Women with physical and emotional abuse histories also show less
responsivity to their infants (Bert, Guner, & Lanzi, 2009). Women with a history of physical
abuse are also at increased risk of having poor quality interactions with their children, increased
vigilance, and are more likely to have negative perceptions of their infants in comparison to nonabused mothers (Gara, Allen, Herzog, & Woolfolk, 2000).
Cumulative trauma is also predictive of poor parenting outcomes (Cohen, Hien, &
Batchelder, 2008). Although maternal trauma history predicts later deficits in parenting, it is
critical to consider that this is not a simple cause-effect relationship, but rather consequences of a
chain of events. For example, based on her research with low-income African American
25

survivors, Mapp (2007) found a sequential link by which maternal sexual abuse was associated
with maternal depression, which in turn influenced maternal locus of control, leading to
increased risk for childhood physical abuse.
Parental Trauma and Child Outcomes
Multiple studies in the early 90’s explored child outcomes of women with a trauma
history. Parental adjustment after a traumatic event has been connected to their children’s overall
mental health outcomes (Appleyard & Osofsky, 2003). Particularly when parents report high
levels of distress and have experienced PTSD symptoms following such events, their children are
at higher risk for internalizing behaviors, externalizing behaviors, lower social competence,
PTSD symptoms, and maltreatment (Famularo, Fenton, Kinscherff, Ayoub, & Barnam, 1994).
Additionally, parents with a trauma history can experience high levels of fear and hopelessness
that may prevent their children from the emotional development task of establishing a sense of
trust and security (Appleyard & Osofsky, 2003; Osofsky, 1995; Osofsky, Cohen, & Drell, 1995).
Infants of mothers with a history of physical abuse also struggled with recovery after
experiencing distress (Lang, Garstein, Rodgers, & Lebeck, 2010).
Context and Trauma Recovery
Women who have experienced trauma and display poor parenting behaviors are not
solely responsible for those difficulties. In fact, several of the struggles that survivors experience
are related to patriarchal socio-cultural structures that are prone to blame victims of diverse
forms of oppression. For example, many trauma survivors are engaged in abusive relationships.
However, rather than conceptualizing violence against women as a societal phenomenon in
which social systems (e.g., marriage, family) and formal institutions (e.g., child protective
agencies) are key contributors to the maintenance of the problem, male perpetrators of violence
26

continue to be overlooked as well as their contributing role to child abuse and neglect.
Specifically, the national study on child abuse and neglect (A Nation’s Shame) found that
although the majority of perpetrators of child neglect were women, the most intense forms of
child abuse including child fatalities were committed by aggressive men (USDHHS, 1995).
Furthermore, the study acknowledges that women are most likely to be charged with neglect.
This results from the fact that they are the ones who often bear the primary responsibility of
caring for their children and interact with institutions in which child abuse or neglect is likely to
be detected. Whereas limited paternal involvement protects fathers against being identified as the
main perpetrators of child abuse (Risley-Curtiss & Heffernan, 2003; Strega et al., 2008).
Thus, there is a high need for promoting a socio-political awareness of the social
structures that continue to oppress women. Otherwise, there is a risk for creating a culture
focused on blaming mothers who are trauma survivors, without challenging the patriarchal
systems and societies in which they live (Leschied, Chiodo, Whitehead, Hurley, Marshall, 2003;
Strega et al., 2008). “Deeply embedded in our cultural psyche is the notion of the idealized
mother; typically middle class, married, educated, and with access to resources.” (Allen, 2010,
p.162). Most women involved in child welfare do not meet these societal standards for
‘mothering’, and there is question over whether it is appropriate to expect them to do so.
This study will have a strength-focus approach in order to give voice to women and
identify their unique experiences of success as they embrace their parenting efforts. To this end,
it is critical to investigate which protective factors in the lives of trauma survivors can make a
permanent difference in their lives, their parenting practices, and the well-being of their children.
For example, Guttentag and colleagues (2006) found that social support predicted positive
change in a parenting intervention for disadvantaged mothers. Similarly, women with a sexual
27

abuse history have healthier parenting practices when they have a strong support system (Kim,
Trickett & Putnam, 2010). Samuels-Dennis and colleagues found that social strain mediates a
relationship between cumulative trauma and women’s PTSD symptom severity (SamuelsDennis, Ford-Gilboe, Wilk, Avison & Ray, 2010). However, accessing healthy social support
systems is often times a challenge for trauma survivors. This is especially the case when the
mother’s informal and family support systems consist of those who perpetrated the abuse (Sharp
& Marcus-Mendoza, 2001).
Self-Efficacy and Recovery
Resilience in the face of trauma is dependent on multiple factors including individual
characteristics, family support, and community context (Garmezy, Masten, & Tellegen, 1984).
Studies have shown that individual characteristics and sense of self-efficacy have been connected
to positive psychosocial outcomes for individuals exposed to traumatic events (Agaibi, 2005;
Ammerman, 1990; Benight & Bandura, 2003; Werner & Smith, 1989).
The role of self-efficacy in healing from trauma is clearly valued in the literature on
interventions designed for women who have experienced interpersonal trauma (Fallot & Harris,
2002; Kubany & Watson, 2002). This is evident in the permeating emphasis on “empowerment”
throughout interventions. Empowerment theoretically mirrors self-efficacy in the sense that it
refers to the extent to which individuals feel in control of the events that happen to them in their
lives. Literature on these interventions emphasizes the positive effects that empowerment can
have on women’s lives (Pollack, 2008; Worell & Remer, 1992).
Alternative responses to violence against women that promote empowerment through
community advocacy are found to be effective. A model example is the use of paraprofessionals
as advocates with women who have been assaulted by a current or former partner (Sullivan,
28

2003). Specifically, in a randomized trial with advocates assigned to IPV survivors, women who
received advocacy support reported less violence over time as well as higher social support and
perceived quality of life.
Trauma Recovery
Trauma recovery is a multidimensional process that Harvey (1996) has carefully outlined.
According to this author, one key component of trauma recovery refers to establishing control
over memories of the traumatic event (1996). An additional component refers to integrating
memory and affect, particularly as it refers to emotions associated with traumatic events (1996).
For example, the ability to tolerate distressing emotions is a key process in trauma recovery as it
requires survivors to identify emotions associated with trauma, but without becoming threatened
or overwhelmed by them (1996). Mastery of trauma symptomology is also crucial to recovery.
This may occur by using coping strategies or avoidance of negative stimuli. Improvements in
self-esteem and self-concept are also crucial to trauma recovery. After a traumatic event
challenges one’s self-worth, it is important for individuals to no longer blame themselves for the
trauma and to accept that they did not deserve the trauma they endured (1996). Especially if an
individual has experienced interpersonal trauma, it can be difficult to trust others and maintain
healthy relationships. As a result, an important part of trauma recovery consists of restoring safe
emotional attachments and healthy social support networks (1996). Finally, trauma recovery
involves assigning meaning to the traumatic event. For example, a trauma survivor may interpret
an experience of abuse as a painful episode in her life but also one that allows her in the present
life to effectively connect and advocate for other trauma survivors (Herman, 1992).
Burstow (2003) addresses trauma recovery through a feminist lens and consequently
supports a radical approach in which trauma is not viewed from a deficit-based perspective. She
29

argues that PTSD guidelines of the DSM-IV-TR do not include the frequent oppressive
experiences of women and other minorities that are traumatic and contribute to trauma
symptoms; nor does the DSM address the consequences of cumulative trauma. There is also
concern with trauma recovery interventions focus on reducing hypervigilence and fear that the
world is not safe. Burstow argues for the validity of these responses due to the fact that for some
individuals the world is not safe. Burstow draws attention to the fact that trauma exists in a
context. When a man physically assaults a woman, the trauma is related to a patriarchal, powerimbalanced context (2003). Those who perpetuate traumas tend to hold a position of power.
Trauma is further exacerbated when those in power deny or minimize traumas and their effects.
This is of particular concern for women who have trauma and child welfare involvement, and
their trauma and trauma responses are ignored or misunderstood. Burstow recommends that
interventionists should co-investigate the meaning of trauma symptomology with clients, and
avoid fostering a victim identity. Interventionists need to promote skills on how to handle
difficult situations, rather than attempting to construct a world-view that bad things rarely happen
in the world (2003).
Service Utilization and Recovery
A critical concern for mothers with a trauma history is learning to navigate social
services. Child welfare involvement results from multiple factors rather than an isolated
occurrence of child maltreatment. Thus, the extent to which trauma history influences child
welfare involvement is related to how trauma interacts with these factors. Prevention and
intervention activities in child welfare systems require addressing key underlying factors
associated with child maltreatment such as poverty, lack of resources, substance abuse, IPV
history, and unemployment (Connell-Carrick, 2003). Trauma symptoms of poor affect regulation
30

and interpersonal skills that reduce self-efficacy can sustain these issues (Briere, 1988). When
parents enter the child welfare system they are not only required to interact with caseworkers, but
they are also referred to a variety of services. However, intense trauma history paired with
interpersonal and contextual difficulties would make it difficult for mothers to trust caseworkers
and engage in services to which they are mandated. Stevens and colleagues (2002) found this
was the case in a sample of women enrolled in a home visiting program. Specifically, noncompletion of home visits was associated with history of violent trauma. Therefore, the current
investigation will not only explore the trauma backgrounds experienced by participants but most
importantly, what are the personal and social resources that have made a positive difference in
the participants’ lives.

31

Chapter 3: Methods
Design
Overview of the Qualitative Approach
This study utilized a grounded theory approach to create a theoretical model aimed at
explaining how mothers’ trauma affects their parenting behaviors. The model seeks to illustrate
how participants’ context influences their parenting practices. The qualitative approach used in
this investigation will also be informed according to feminist-qualitative research principles.
Data were collected through semi-structured interviews with mothers who report a cumulative
trauma history and current or former involvement with the child welfare system. According to a
grounded theory approach, data were analyzed by a sequential process of open, axial, and
selective coding. Triangulation, peer debriefing, audit trail, and constant reflexivity are methods
that will be used to ensure trustworthiness of the data.
Qualitative Research
Qualitative approaches and methods are those that systematically seek knowledge about
phenomena by using means that are not statistical in nature (Strauss & Corbin, 1990). Various
qualitative approaches are used to describe and explain subjective experiences of individuals.
Data generated in qualitative research often originate from multiple sources but most commonly
from direct interviews with participants and field observations (Strauss & Corbin, 1990). Miles
and Huberman (1994) summarize additional components that frequently characterize qualitative
approaches: (a) Intense and prolonged contact with the phenomena being studied, (b)
comprehensive understanding of phenomena, (c) researchers seeking to understand phenomena
according to the participants’ perspectives rather than their own, (d) data are maintained in the
original expressed form despite the fact that are condensed and analyzed by the researcher, (e)
32

there is an ultimate goal to better understand how people function in their daily contexts, and (f)
some components of data are more relevant than others but these should be confirmed by
research participants.
Qualitative approaches are used to explore a phenomenon that is unknown, or to arrive at
a new perspective for understanding regarding previously explored phenomena (Strauss &
Corbin, 1990). Qualitative methods also provide rich descriptions of phenomena that cannot be
captured through quantitative methods (Strauss & Corbin, 1990). Unlike quantitative methods, it
is not the purpose of qualitative methods to generalize results to a larger population but to reach
a deeper level of understanding of the experiences being explored with participants.
Grounded Theory
This study follows a modified, constructivist grounded theory approach (Charmaz, 2006;
Glaser & Strauss, 1965, 1967; Strauss & Corbin, 1990). Grounded theory methods seek to
formulate and integrate an emergent theory grounded in the data provided by participants. Thus,
this approach is an inductive process in which the researcher is not seeking to solely prove an
existent theory, but rather to allow for the discovery of an emergent theory (1990). To generate a
grounded theory, systematic procedures are used to identify concepts and relationships among
these that create a phenomenon of interest (1990). This study is modified grounded theory as it
considers the current literature on the topic of study (1990). Additionally, this study is
constructivist as the researcher and participants co-construct meanings from participant
experiences through interactions in the structured interview (Charmaz, 2006).
The quality of grounded theory studies are assessed according to four categories: (a) fit,
(b) understanding, (c) generality, and (d) control (Glaser & Strauss, 1967; Strauss & Corbin,
1990). A grounded theory should comprehensively ‘fit’ the phenomena for which it applies.
33

Essentially, fit ensures that the emergent theory accurately corresponds to the data provided by
participants. Understanding seeks to answer the following question: Does the integrated theory
make logical sense to the researchers and participants? Generality refers to the extent to which
data is applicable to other situations and experiences of people outside the specific study. Finally,
control is associated with the use of systematic and rigorous methodological procedures (Strauss
& Corbin, 1990).
Multicultural Feminist Qualitative Research
Multicultural feminist qualitative researchers seek to illuminate and challenge power
imbalances or oppressive circumstances in a variety of contexts (Andersen & Collins, 2004;
King, 1995; Maguire, 1987). Feminist researchers have historically questioned how knowledge is
generated and the extent to which dominant narratives can be oppressive to others (Kleinman,
2007). For example, regarding participants in this study, a dominant narrative consists of
depicting mothers involved with the child welfare system as uncooperative and uncaring about
their children. Feminist researchers also recognize the privilege and power they have based on
their positionality based on characteristics such as gender, ethnicity, SES, and sexual orientation
(DeReus, Few, & Blume, 2005; Lather, 1988; McDowell & Fang, 2007). Thus, researchers
should use their power and privilege to advocate for others with less power, particularly by
privileging their voices and their interpretations of various life experiences. Advocating for
participants is an important purpose for feminist researchers and that their research improves the
lives of participants (Maguire, 1987). Feminist researchers will work to establish non-exploitive
relationships with recruitment sources and participants.
Participants and Recruitment
Sampling
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Participants were recruited primarily through a clinician who has a contract with the State
of Michigan to provide counseling services to parents involved in the child welfare system. The
researcher accessed this strategy of recruitment through a personal and professional relationship
with the therapist. Specifically, the clinician provides individual and family-based counseling to
women involved in the child welfare system with the purpose of enhancing their parenting skills
and the quality of relationship with their children. However, great care was given to prevent
coercion, as participants experienced a professional relationship with the clinician. When
original recruitment activities did not generate a sufficient number of participants, additional
participants were recruited through a flyer distributed to other therapists.
Recruitment Activities. Participants were recruited by utilizing a sampling selection
process of mothers with current or former involvement in the child welfare system and
therapeutic services. Specifically, the clinician provided her clients who met the study criteria
with information about the study and asked them if they were interested in participating in the
study. Participants who were interested in the study signed a consent form indicating they would
like the clinician to provide their contact information to the study PI. The PI then directly
contacted potential participants to invite them to participate in the study. The clinician did not
know if clients participated in the study or not. This reduced the potential risk for coercion to the
study and concerns that participation would influence participants’ therapeutic services. Because
there was a risk of coercion based on the professional relationship that participants have
experienced with the clinician, it was highlighted to participants that their therapist would not
have access to any of the identifying information of the participants. In addition, participants
were offered the following options to withdraw from the study: (a) Decline participation after
receiving the first invitation, (b) decline participation by phone, email, or letter, and (c) decline
35

participation after receiving compensation. Participants received a $25 gift card to a local store
of their choice (Wal-mart, Meijer, Kroger) as compensation for participation in the study.
Participants also received a psychoeducational pamphlet on trauma symptoms and coping
strategies created by the researcher.
Inclusion Criteria. In order to participate in the study, each participant: (a) had an open
or closed (no older than 10 years) child welfare case, (b) had an open therapy case (c) reported a
trauma history of child abuse, neglect, and/or domestic violence as defined by Briere and
colleagues (2009), (d) was the biological mother of at least one child, (e) maintained a
relationship with at least one biological child that allows for frequent engagement in parenting
practices. Specifically, participants must report at least one weekly visitation with their children,
(f) was 18 years of age or older, and (g) provided consent to participate.
Exclusion Criteria. Participants were excluded from the study if they: (a) reported
intense psychiatric problems that will seriously impede data collection activities (e.g., active
hallucinations, intense suicidal crisis, etc.), or (b) refused to provide consent to participate.
Sample Size. Grounded theorists often use the concept of saturation to determine
whenever a sampling procedure has led to the generation of sufficient data that can be used to
generate a useful an integrative theory of the phenomena under study (Denzin & Lincoln, 2000;
Glaser & Strauss, 1967; Morse, 1995). Specifically, Bowen (2008) defines saturation as:
…bringing new participants continually into the study until the data set is complete, as
indicated by data replication or redundancy. In other words, saturation is reached when
the researcher gathers data to the point of diminishing returns, when nothing new is being
added. (p. 140)
A large sample size by definition does not necessarily benefit a study with new concepts.
Thus, saturation determines sample size according to the heterogeneity of the population, the
36

characteristics of the inclusion criteria, data collection procedures, and the complexity of
phenomena under study (Ritchie, 2003). Saturation is essentially achieved when new data
contribute little or nothing to the understanding of previously collected data. Based on previous
qualitative studies with similar samples, we estimate that the optimal sample size for the current
study should consist of a minimum of 15 women (Mason, 2010). However, due to recruitment
difficulties, 12 participants were recruited for the study.
Procedures
Theoretical Sampling
Theoretical sampling involves collecting data and recruiting participants based on
concepts that are theoretically relevant to the evolving theory (Strauss & Corbin, 1990). Strauss
and Corbin state that, “the aim of theoretical sampling is to sample events, incidents, and so
forth, that are indicative of categories, their properties, and dimensions, so that you can develop
and conceptually relate them” (1990, p. 177). Theoretical sampling allows the researchers to
deepen their focus and to accumulate variation in the data. Denzin and Lincoln (2000) further
describe the need for theoretical sampling to ensure that a grounded theory is comprehensive,
“theoretical sampling helps us to define the properties of our categories; to identify the contexts
in which they are relevant; to specify the conditions under which they arise, are maintained, and
vary; and to discover their consequences” (p. 519). In the current investigation, theoretical
sampling was implemented to ensure that participants can provide comprehensive responses to
the main research questions.
Participant Selection and Scheduling
The recruiting clinician provided the PI with a list of potential research participants who
were then be contacted by the PI and asked to participate in the study. They were informed of the
37

potential benefits and risks of participation. All participants were clearly told about the risk for
participation based on coercion due to the professional relationship with their therapist. Thus,
confidentiality issues were clearly addressed with participants, as well as the fact that they could
withdraw from the study at any point using the previously described methods (e.g., voicemails,
emails, etc.).
When an individual agreed to participate in the study, they were asked days and times
when they were available for a 2-hour interview during which they would complete an interview
and assessments. Participants were asked to meet for an interview at one of two confidential
locations suggested by the PI. However, participants generally struggled with finding
transportation. As a result, towards the end of the study participants were offered the option of
having the researcher come to their home for the interview.
Data Collection
The day of the interview, the PI greeted participants and initiated the process of informed
consent by providing participants with a paper copy of the consent form, ensured that
participants could read it, and answered any questions they may have about the consent
document. The requirement of signed consent was waived by the IRB to further ensure
participants privacy. After participants provided verbal informed consent, a copy was given to
them to use as future reference (see appendix A). Next, participants completed a demographic
questionnaire, BSI, and AAPI-2. They were told that the purpose of completing assessments was
to better inform the interview process. The interviewer briefly scanned the results of these
inventories to inform probing during the semi-structured interview (e.g., high scores on specific
domains).

38

Self-Report Questionnaires. Two self-report questionnaires were used to inform the
interview process. These are described below.
Brief Symptom Inventory (BSI). The BSI is a self-report scale that measures an
individual's level of psychopathology (Derogatis & Melisaratos, 1983). It consists of 53
questions related to various psychological symptoms. Participants rate items on a 5 point scale
from not at all to extremely, based on the extent to which they experience symptoms (1983). The
BSI also includes three global scales that measure general severity of symptoms, frequency of
symptoms, and intensity of distress (1983). Dimensions of the BSI have internal consistency
Cronbach’s coefficient alphas ranging from .75 on the psychoticism scale to .89 on the
depression scale. BSI scales have convergent validity with those of the Minnesota Multiphasic
Personality Inventory (MMPI) (Boulet & Boss, 1991).
Adult Adolescent Parenting Inventory-2. The AAPI-2 measures an individual’s
parenting beliefs on several domains (Bavolek & Keene, 1999). This assessment compares an
individual’s parenting beliefs to those of the general population regarding expectations for
children, awareness of children’s needs, beliefs on corporal punishment, as well as roles and
boundaries in the parent-child relationship. The format of the inventory is a 5-point likert-type
scale on which respondents agree or disagree with 40 statements regarding parenting beliefs.
Chronbach’s Alphas for each scale are ≥ .65 (1999).
Interviews. After completion of the questionnaires, two audio-recorders (one to be used
as a back-up) were started to initiate the conversation according to the semi-structured interview
format (see appendix B). A semi-structured interview was advantageous for this study, as
opposed to a formal structured interview, because it allowed the interviewer to let participants’

39

responses guide the interview process and reach a deeper understanding of their experiences
(Glaser & Strauss, 1967; Wimpenny & Gass, 2000).
The interview first began with basic rapport building between participant and interviewer.
The researcher initiated the interview with validating participants’ difficult experiences in the
child welfare system. The researcher was also transparent about her own experiences as a
therapist working with child-welfare involved families and the challenges she has witnessed.
Highlighting the researcher as an advocate was essential to establish trust with participants and
allowed participants to be comfortable in describing their difficult experiences. Participants were
reminded that they can take a break from answering questions or withdraw from the study at any
time. The interview was considered semi-structured because it included selected grand tour
questions that were asked to all participants, however the interviewer will use various probing
questions based on participants’ answers. Probes determined by the PI were used only after all
participants’ initial responses were explored in depth.
Data Management. Each interview was digitally recorded and transcribed. This allowed
the PI to carefully code and analyze participants’ narratives. The PI transcribed all of the
interviews in order to gain a deep understanding of the data. According to the grounded theory
approach (Strauss & Corbin, 1990), data collection and analysis occur concurrently. That is, the
interview guide was gradually adapted according to the emerging themes that are particularly
relevant to participants in order to ensure that their most relevant life experiences are adequately
captured throughout the data collection process. Analytically, this was be accomplished through
the constant comparative method and sequential data coding (Strauss & Corbin, 1990).
Data Analysis
Overview
40

This study followed a modified version of the grounded theory approach (Strauss &
Corbin, 1990). Specifically, grounded theory methods used for data analysis included the
constant comparative method, sequential coding, audit trial, and triangulation (Strauss & Corbin,
1990). Data analysis was computer-assisted utilizing Nvivo software (QSR International, 2010).
Constant Comparative Method
Data analysis consisted of two core processes: (a) Sequential comparative analysis of
data, and (b) integration of a theory by engaging in a process of permanent reflexivity (Strauss &
Corbin, 1990). The constant comparison method was a critical component of these processes
(Glaser, 1978, 1992; Glaser and Strauss, 1967; Strauss and Corbin, 1994). Bowen (2008)
outlines the four stages that characterize the constant comparison method: “(1) comparing
incidents applicable to each theme that emerges from the data, (2) integrating themes and their
properties, (3) delineate the theory, and (4) writing the theory.” (p. 139). Through the constant
comparative method, researchers ensure an appropriate fit between the data and emerging
concepts and theory (Bowen, 2008; Glaser, 2002; Glaser & Strauss, 1967). The constant
comparative method also seeks for unique data that clearly contrast with the emerging theory
(Glaser & Strauss, 1967).
Triangulation
Triangulation refers to the utilization of multiple sources of data to ensure adequate
interpretation, comprehensiveness, and consistency of the data (Cohen & Crabtree, 2006). To
facilitate triangulation of the data, two questionnaires were used to evaluate domains that were
explored in the qualitative interview. These instruments were the Brief Symptom Inventory
(BSI) and the Adult-Adolescent Parenting Inventory (AAPI-2).
Data Coding
41

Transcriptions of the data were analyzed according to a sequential process involving
open, axial, and selective coding (Strauss & Corbin, 1990). The PI led all coding procedures and
consulted with Dr. Parra-Cardona to enhance trustworthiness of the data. Data analytical
procedures are described below.
Open coding. Open coding is the first stage of the grounded theory coding process
(Glaser; Strauss & Corbin). Open codes can be defined as having the purpose, “to reduce the
mass of largely textual data into manageable groupings” (Bowen, 2008, p.144). During open
coding, data are assessed for their meaning and relevance to the phenomena being studied.
Categories are then formulated along with specific properties of the data. The unit of analysis for
open coding in this study was each individual idea as coding individual paragraphs carries the
risk of missing critical data (Strauss & Corbin, 1990).
Axial coding. Axial coding is a secondary phase of coding in which open codes are
grouped together to create larger categories. After open coding has provided an initial but large
categorization of data, the researcher integrates more refined categories of data during the axial
coding process (Strauss & Corbin, 1990). It is at this point during the data analysis that the
researcher begins forming initial relationships among concepts as well as integrating an emergent
theory (Ralph, 2005).
Selective Coding. Selective coding refers to the final stage of the data coding process
(Strauss & Corbin, 1990). Specifically, the researcher formulates a theoretical narrative that
underlies the main findings of the study according to integrated categories. Thus, selective
coding integrates components from open and axial coding and creates additional information that
further refines and develops the grounded theory. Selective coding is essentially a higher level of

42

conceptualization of the data that determines the overarching storyline and relates larger
categories to one another around core categories (1990).
Memo Writing
Throughout the data collection and analytical processes, the PI wrote notes regarding
personal ideas and reactions to the data, as well as emerging categories and theoretical notions
(Strauss & Corbin, 1990). Memo writing is critical to the research process to closely monitor the
major factors that influence the process of generating the theory that is expected to be grounded
in the data provided by participants (1990). It is recommended to utilize memo writing
throughout the research process (1990). For example, in qualitative research it can be easy to get
‘lost’ in the data. Thus, memo writing can help the researcher move from the raw data to abstract
conceptualizations of emergent theory (1990). Reflections in the current study were shared with
Dr. Parra-Cardona to enhance trustworthiness of the data.
Trustworthiness of the Data
Trustworthiness of the data refers to the extent to which research findings accurately
reflect the essence of a phenomenon under study (Baker et al., 1992). The specific dimensions of
trustworthiness will be described below.
Credibility. Credibility refers to how believable research findings are (Lincoln & Guba,
1985). Several strategies can be used to enhance credibility. For example, peer debriefing was
one technique used in this study by consulting with Dr. Parra-Cardona on emerging codes,
emerging categories, reflections recorded in memo writing, and methodological decisions
tracked in the audit trail. An additional strategy to enhance credibility refers to data triangulation.
Thus, the PI used data from the BSI and AAPI-2 assessments to inform structured interviews

43

(Denzin, 1978; Patton, 1999). Specifically, assessments helped the PI identify critical areas of
inquiry that may not have been recognized by solely relying on the interview guide.
Transferability. Transferability refers to the “degree of similarity between sending and
receiving contexts” (Lincoln & Guba, 1985, p. 316). Specifically, transferability examines the
extent to which qualitative data are limited to a particular context. To achieve this goal, memo
writing included a detailed description of the context in which the meanings were created as well
as the ways in which such contexts influenced the researcher in the process of gathering and
analyzing data.
Dependability and Confirmability. These concepts are interrelated concepts and refer
to ensuring that findings are reasonable as a result of implementing adequate methodology
(Lincoln & Guba, 1985). Specifically, dependability provides critical methodological
information that demonstrates the rigor of the study as well as guidelines to allow for the
replicability of the investigation. Thus, an audit trail (Rodgers & Cowles, 1993) was created to
keep track of key methodological decisions.
Confirmability assesses the extent to which researcher bias has shaped the findings of a
study as opposed to the data shaping the findings of the study. Confirmability is achieved if
another researcher, following the same procedures outlined in the study, could arrive at similar
conclusions. Several methods will be utilized in this study to ensure confirmability. Specifically,
memo writing, methodological audit trail, and sharing emerging categories with Dr. ParraCardona enhanced the rigor of the study.
Role of the Researcher
Feminist qualitative methodologists acknowledge the critical role of the researchers’
perspectives and biases on the research process (Kleinman, 2007; McDowell & Fang, 2007).
44

Because researchers are the main tool of data collection and analysis, data are biased according
to the researchers’ preconceived notions and perspectives. Therefore, I acknowledge my
influence on this research process as a white, middle-class, heterosexual, single woman, without
children or a trauma history.
In addition, I am also a therapist, therefore my approach to understanding clients’
experiences may be different from a researcher who has not had clinical experience with this
population. I have sat with many women in similar situations to those in the sample and have
heard their extended stories and witnessed the deep emotional pain they have experienced. This
allows me to have particular compassion and empathy towards their situation. For example, by
being a therapist, I have not been in the authority position that characterizes service providers
such as by caseworkers, lawyers, or judges.
Computer Software
After each interview was transcribed into a Microsoft Word document, each transcript
was uploaded into the Nvivo qualitative software (QSR International, 2010). Nvivo allows the
researcher to code and analyze large amounts of data quickly and efficiently. The software also
allows for a fast generation of visual maps of the data. In addition, the software can facilitate the
fast reorganization of codes during the complex phases of axial and selective coding.
Ethical Considerations
Research activities began after obtaining full approval from the Michigan State
University Institutional Review Board. Careful considerations were given to prevent coercion to
participate due to the professional relationship between the recruiting clinician and the
participants. This study posed minimal to moderate risk to participants as they have were
involved in a therapeutic process aimed at processing their trauma history. However, great care
45

was given to monitor participants’ reactions during the interview process to prevent secondary
traumatization in telling stories of abuse. It was highlighted to participants that there were no
repercussions if they decided to withdraw for the study at any time, including the fact that they
could keep their financial compensation.
Dissemination of Findings.
Findings of this study will be disseminated in several ways to ensure that they have a
benefit to the population of interest. Findings will also be distributed among academics of the
social sciences and professionals providing services to mothers with trauma and parenting
difficulties. Finally, research findings will be used to inform a parenting intervention targeting
survivors of cumulative and complex trauma.
Participant Characteristics
The average age of participants was 32.3 years, with a range of 22 to 49 years. The
majority of participants were Caucasian (n=9), two were Latina, one was African-American. On
average participants had 3 children with a range of 1-6. Half of participants were employed, and
slightly over half were in a relationship (n=7). Most participants graduated from high school or
received their GED (n=8), while two did not complete high school, and two went on to complete
some college. Most participants had an income of less than $15,000.
Table 3.1 Participant Characteristics
Participant Characteristic

Mean (range) or n

Mean Age (Range)

32.3 yrs (22-49)

Ethnicity
Caucasian
African-American
Latina
Mean Number of Children (Range)
# of Participants Employed

9
1
2
3 (1-6)
6
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Table 3.1 (cont’d)
# of Participants in a Relationship
Education
Did not complete H.S./GED
H.S. Diploma/GED
Some College
Income
< 15,000
15-30,000
>30,000

7
2
8
2
8
3
1

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Chapter 4: Results
This investigation focused on the following specific research questions:
A. What are the most salient experiences of cumulative trauma reported by
participants?
B. What are the most salient trauma symptoms reported by participants?
C. How do trauma symptoms influence the participants’ parenting behaviors?
D. How do trauma symptoms influence women’s interactions with formal social
systems (e.g., child welfare, legal)?
E. How supportive are the contexts in which women engage as related to their
parenting efforts?
F. What examples of trauma-coping and resilient parenting behaviors are women
most likely to report?
All questions were guided by an emphasis on identifying women’s testimonies of
resilience as a way to understand the multiple ways in which they have overcome adversity in
their lives.
Overview of the Grounded Theory
The grounded theory developed in this study resulted from integrating the participants’
responses to the aforementioned research questions. Emerging data centered on detailed
narratives describing the ways in which trauma symptoms influence the participants’ parenting
behaviors. In addition, women provided remarkable testimonies of resilience in the face of
intense adversity.
According to participants, their trauma histories did not center on isolated events, but
rather, on the accumulation of traumatic experiences throughout their lives. Types of trauma
48

women experienced included poverty, the removal of their child from their care, intimate partner
violence, sexual trauma, childhood abuse and neglect, parental substance use, death of a family
member, and various injuries and health challenges. Women’s cumulative trauma was evident to
women as they reported attempting to manage multiple distressing trauma symptoms in a variety
of contexts. A bidirectional relationship exists between women’s trauma and trauma symptoms.
Not only does trauma history lead to the development of trauma symptoms, but trauma
symptoms can make women vulnerable to on-going trauma. For example, if a woman has a
negative view of herself, she may be more likely to stay in an abusive relationship.
A bidirectional relationship also exists between women’s trauma history and the contexts
they exist in. The most immediate of these contexts refer to interactions with friends, family,
partners, caseworkers, and other professionals trauma history influenced women’s relationships,
and women’s relationships were sources of on-going trauma.
A bidirectional relationship exists between women’s contexts and their trauma
symptoms. For example, women reported multiple health and mental health problems that have
negatively impacted their professional lives, parenting experiences, and intimate relationships.
Participants also expressed that many of their symptoms and coping responses are not adaptive
and place them at higher risk for victimization. Substance abuse was identified by several
participants as a coping mechanism and a risk factor for engaging in abusive relationships. .
Trauma symptoms, in turn, led to negative parenting behaviors of exposing children to unhealthy
relationships, reduced quality and amount of interactions with children, hypervigilence about
children’s safety, difficulty setting limits, and abusive, neglectful interactions.
Supportive relationships play a critical role in participants’ lives. Specifically,
particularly important for women were close relationships with friends and relatives who
49

provided both emotional and instrumental support (e.g., emotional encouragement, financial
help, shelter). Case workers and other formal service providers were also identified as supportive
by women. Women’s supportive relationships had a bidirectional relationship with their ability
to cope with difficult experiences and make progress in trauma recovery. However, it should be
noted that participants highlighted the fact that their relationships with family members can be
particularly challenging, as they can both support and hinder their quality of life.
This theory demonstrates the duality of women’s relationships as both supportive and
unsupportive. All contexts, with the exception of other professionals, were characterized by both
relationships that at times supported women, but also were frequently unsupportive and sources
of trauma. These relationships were interconnected with one another. For example, if a
caseworker interacts with a friend or family member who has a conflictual relationship with the
mother, this interaction can have a detrimental effect on the mother if the caseworker develops
an alliance with the friend or family member that is not conducive towards empowering the
mother.
A set of findings that are particularly relevant refer to participants’ clear testimonies of
resilience, which demonstrate a remarkable capacity to recover from trauma and adversity. In
addition to having a personal impact, participants’ resilient behaviors also have a bidirectional
relationship with women’s contexts. Coping and recovery also facilitated positive parenting
behaviors of setting boundaries, non-violent parenting strategies, parent-child bond, and concern
for child’s emotional well-being.
Although the guiding research questions in this study did not focus primarily on
analyzing macro-level variables, present findings demonstrate the ways in which variables such
as the larger economy, lack of employment opportunities, and inefficiencies in the welfare
50

system become important barriers in the lives of participants, and at times can also become
precursors of trauma symptomatology.
Overall, the grounded theory resulting from this investigation indicates that although
cumulative trauma can have pernicious and long-term consequences on the health and mental
health of women, such intense adversity can be overcome if participants are surrounded by
supportive personal relationships and systems of care, capable of fostering their personal
strengths and sense resilience. Figure 4.1 provides a graphic display of the emergent grounded
theory, which will be explained in the detail as detailed data are reported for each of the guiding
research questions. Pseudonyms are used in quotes to enhance participants’ anonymity.

51

Figure 4.1 Grounded Theory

Macrosystem
Child Welfare Policy, Economy,
Oppression

Trauma History
Poverty, child removed, sexual trauma,
IPV, childhood abuse/neglect, parent
substance use, death of a family
member

Family
Positive Support

Partners

Systems that
Reinforce or
Reduce
Trauma
Symptoms

Negative Parenting Behaviors
Exposure to unhealthy
relationships
Reduced quality/amount of
interactions
Hypervigilence about safety
Difficulty setting limits
Abuse/Neglect

Friends

Negative Support
Other
Providers

Trauma Symptoms
Emotional
dysregulation
Substance abuse
Mood disturbances
Health Problems
Trust/Boundary
Difficulties

Caseworkers

Coping Strategies
Cognitive Strategies
Behavioral Strategies
Children as Motivation
Medication

52

Positive Parenting Behaviors
Sets limits
Non-violent interactions
Bonded to child
Concern about child’s
emotional wellbeing

Findings of Research Question A: What are the most salient experiences of cumulative
trauma reported by participants?
All participants reported multiple traumatic experiences in their lives, as well as
extremely challenging life events and relationship conflicts. For example, women expressed
being negatively impacted by some form of intimate partner violence (IPV) including emotional,
mental, and physical abuse. More than half of the participants survived some form of sexual
trauma during their childhood, adolescence, or adulthood. Six participants experienced neglect in
their childhood including physical and emotional neglect. Four participants lost a significant
family member, which they identified as traumatic. One participant lost her parent and three lost
their brothers at a young age. Two participants were removed from their parents’ custody during
childhood. Table 4.1 provides an overview of how many participants experienced each type of
trauma.
Table 4.1. Trauma Experiences
Trauma Experience
Poverty
Removal of Child from Home
Intimate Partner Violence
Sexual Trauma
Childhood Neglect
Death of significant family member
Parental Substance Abuse
Physical Abuse by parents
Removed from parents

n
12
10
10
7
6
5
3
2
2

Poverty. According to participants’ reports, the totality of women in this sample were
impacted by poverty at various phases throughout their lives. When asked about difficult life
experiences participant #5 stated, “Well I say central to all of it is poverty”, meaning that
managing finances with a low income was a contributing factor to the difficult experiences she
53

had throughout her life. She went on to explain the financial strain associated with limited health
care:
We’re very low income. When my son DHS removed my son, I lost my Medicaid., I’m
not young, I don’t have severe health problems, but I have issues that I need to see a
doctor regularly for. If I don’t have insurance, that’s 40 bucks a pop that I don’t have.
You know, and then I need prescriptions, you have to pay for those too. Medicaid is a
wonderful thing. I’m grateful I have it because I would be lost without it. I hope I never
lose it again
Other participants discussed facing challenges such as difficulty finding employment and
maintaining stable housing. Due to unemployment, participant #3 and her husband lived with
roommates who assisted them with living expenses. However, this left them vulnerable to being
taken advantage of:
Me and my husband we both have had people take advantage of us. With one of, who
was supposed to be a friend, we let her stay with us; and then she turned around lost her
rights to uh, her son; and then she moved out and she was supposed to give us money for
staying with us, help us with food, and she just moved out and completely screwed us
with bills and rent and everything.
Participant #11 discussed some of the difficult experiences related to poverty. In order to
keep a house she inherited, her brother-in-law lived with her and her family. As a result, her
children were exposed to his drug use. She described resentment towards him for “Bringing
crack into my house, smoking it. Not giving any regards to the fact that I have two small children
in the house.” She went on to describe how she ended up losing the home regardless of his
financial help:
Granted, I didn’t have to pay rent, but I did have to pay taxes on the house because I
inherited the house. I kept that house for 12 years, and we put a roof on it, and then
something else would break. I just couldn’t, I couldn’t afford it anymore.

54

Removal of Child from Home. All but two of the women had their children removed
from the home and placed into foster care. Although those two were still involved in the child
welfare system they were able to maintain physical custody of their child. In this study removal
of the child from the home is conceptualized as traumatic, since most women noted that this was
an extremely difficulty experience for them. The event of child welfare workers physically
removing the child was especially traumatic for women.
Intimate Partner Violence. Intimate partner violence (IPV) was frequently experienced
by the majority of the participants (n = 10). Specifically, women described experiences of
physical, emotional, and mental abuse by their partners. For example, participant #10 described
the controlling behaviors of her ex-husband:
The father of my kids was abusive and controlling, and after getting married, he became
very controlling, to the point where he took my truck apart so I couldn’t go anywhere
when we fought. He also broke my cell phone.
Participant #2 described the threats that she received from a former partner after she
decided to end the relationship, “That [ending the relationship] upset him really bad. He called
my cousin and threatened her because he was upset that I wouldn’t speak to him. He was gonna
run in her house, then shoot up all the kids.” At the time of this incident, this participant’s
daughter was living at her cousin’s home. Subsequent to his threats, the daughter was moved to
an unfamiliar foster home due to safety concerns. This was particularly distressing to the mother
because her daughter’s placement was a consequence of her former partner’s behavior, which
was out of her control.
Violent episodes were described by several participants. For example, participant #5
described a violent incident with her partner that occurred earlier in her life before she met her
husband and had a child with him:
55

The last night I was there we got into some kind of altercation. I’m layin’ on the bed and
he’s on top of me with his hands on my shoulders, and he’s basically daring me to hit
him. He spit in my face, and that was it.
Participant #2 described a violent situation with a firearm:
So he came in one day, I was in the room with my daughter and he pulled out his gun,
started throwin’ me around the room, pointed the gun in my face, cause he thought I was,
I don’t know another guy or something, I don’t know.
In addition to violent situations, women also reported taking action to end abusive
relationships, as participant #11 described:
The last partner I had, we used to get into fist fights. He was an alcoholic. I always went
for the bad boys, you know. Two years of being mentally and physically abused was
enough, I wasn’t gonna take it no more. I was done. I fought back, threw his shit out of
the house, and got a restraining order on him.
Sexual Trauma. More than half of the participants reported sexual violence perpetrated
against them by their fathers, relatives, and friends. For example, participant #3 described, “The
one main difficult thing that I had when I was growing up was when my stepdad molested me
when I was about 10.” Participant #1 was removed from her parents and adopted, “Cause my
dad was molesting me and my brother”. Participant #9 also reported a sexual trauma, as she
described:
I ended up getting placed with a home and my foster dad raped me. It was just me and the
foster dad a lot, like I said it ended up turning into something awkward and weird. I just
didn’t wanna be there, and instead of tellin’ somebody while I was in the home, I just
acted out and didn’t go to school. Then they ended up movin’ me outta the home.
Participant #4 was sexually assaulted by her father and a family friend on separate
occasions. Participants #10 and #12 were raped by a family friend, while participant #11 reported
that she was molested by an uncle.
Although a majority of participants reported intense trauma resulting from sexual
victimization, two participants reported details of how these experiences were particularly
56

damaging because others did not believe the victimization they suffered and there were no
actions to prosecute the perpetrators. Participant #4 described how this affected her:
I felt completely unprotected. I felt like I was better than that you know, and I became
very depressed at that time. It was very difficult for me because I felt dirty. Afterwards, I
just kept quiet and tried to avoid him.
Participant #9 also described her experienced:
I ended up telling CPS about it and I believe all they did was to take their foster care
license and that was about it. That was about it. I don’t even know if they quite believed
me. Actually, his wife ended up getting the phone number to where I was at and actually
called me. She was calling me a liar and I hung up on her and never heard from them
again. It was a while later that I did end up sayin’ something, and I think that affected the
way that DHS reacted to the allegations.
Childhood Neglect. Participants’ experiences of neglect were multiple and varied in
nature. For example, participant #4 was neglected based on her parents’ failure to protect her
from a sexual assault and subsequently avoided to take steps to report or prosecute the
perpetrator. She described:
Um, this neighbor who was a buddy of my stepdad’s um, he asked me if I wanted to go
snow mobiling, well it was something that I hadn’t done in a long time. So I went
snowmobiling with him, and he tried to assault me and um, my stepfather wouldn’t do
anything, nothing, nothing was done.
Participants #5 and #6 described feeling emotionally neglected by her parents.
Specifically, participant #6 described her upbringing as characterized by ‘tough love’ as her
parents did not provide nurturing support. She eventually was ‘kicked out’ as a teenager and
moved into an Independent Living Program (ILP) for teens:
My parents were tough love kind of people and I didn’t respond well to that. So, I moved
out and went to an alternative education program, and lived in a house called Crossroads
[Independent Living Program]. They teach you how to live on your own, and stuff like
that. Then I moved into my aunt’s house and went to alternative education. I graduated
from there and um, then I moved back in here when I was about 18 or 19
57

Other forms of neglect referred to lacking adequate monitoring and supervision, as
participant #9 stated:
We were left home alone quite a bit. During my childhood I had no rules and no authority. Both
my parents, I don’t think they even cared about what we were doing. My mother left when I was
seven and my dad raised us for a couple a years, um, till I was about 9 and we got placed in
foster care and then I became a ward of the state.
Participant #2 remembered that her father did not set limits with her because he was
struggling with addiction:
My father was using heroin, so he was always sleeping in his room. So, there was never
really no boundaries there. I hung out with my friends as late as I wanted, and did what I
wanted. It was never really dangerous or anything we just, I never had boundaries, rules
like curfew.
Participant #11 discussed how the death of her brother made it difficult for her mother to
be emotionally available, “My mother, after my brother passed, was there physically but not
mentally. So I basically grew up on my own, grew up in the streets, did what I wanted to do.”
Because her mother wasn’t able to set limits, Participant #12 started using drugs after her
brother’s death.
Parental Substance Abuse. Several participants’ parents abused substances, which
exposed participants to inappropriate behaviors and neglect during their childhood. When talking
about her parents, participant #2 described:
My dad and my mom were into drugs really bad. He straightened out till I was about 7,
then started doing drugs again. So it was like, he was always in his room high. I really
didn’t understand he was back into drugs until I was about 12, but he had been since I
was about 7. He had started back up and I was too young to understand that until I was
about 12. That’s when I would find bloody needles in drawers. Then I figured it out.

58

Participant #10 described her mother’s alcohol use by affirming that, “She was a drunk,
and so my brother took care of me most of my life.” Participant #9 described neglectful behavior
while her parents were using substances:
My parents were always drunk and drinking. As long as we were outside playin’ with our
friends, they really didn’t care what we did. I was out terrorizing the neighborhood. I
burnt down a garage, we were out smoking. We were doing everything bad.
Physical Abuse. Two participants experienced physical abuse as children, which had
pernicious effects including conflictual relationships with their fathers into adulthood. Participant
#9 described the consequences of her father’s physically abusive behavior, “He didn’t hit us a
lot, but he left bruises where it was noticeable to school, so school ended up reporting it.”
Participant #11 also reported her father was physically abusive to her, her mother, and
siblings. To illustrate her pain and lack of respect towards him, she referred to him as “The
Sperm Donor” to her mother, rather than as her father.
Removed from Parents. Three participants reported growing up while involved with
child welfare services. For example, participant #1 was adopted at a young age due to sexual
abuse by her father. Participant #10 was removed from her parents based on their drug use, as
she expressed:
I was too young to even remember, but my dad would tell me that the courts were
involved and my mom and dad were into drugs really bad. So the court said that either
you straighten that out or they were gonna take me. So my dad did, but my mom
wouldn’t so he took me from her.
Participant #9 was removed from her father due to physical abuse and neglect. After his
rights were terminated, the participant was relocated to several foster and group homes until she
eventually aged out of the foster care system.
Um, I well, first I um, my mother left when I was uh, 7, my dad raised us for a couple a
years, um, till I was about 9 and we got placed in foster care and then became a ward of
59

the state. That’s pretty much the gist of it. Well that and then, I really, I went through
several foster homes, but most of the time in foster care I did in group homes.
This participant further explained that while in group homes and foster care, it was
difficult to trust adults and have meaningful emotional connections because she did not trust any
of her foster parents. She believed that if she had caregivers who were genuine, she might have
been better able to take their guidance. Based on her own experiences in the child welfare system
as a child, she felt especially guilty for having her children removed from her care.
Child Welfare Involvement. Many of the women viewed removal of children and
involvement with the child welfare system as a traumatic experience. Participant #8 affirmed
that, “The worst thing I’ve been through in my life is having my kids taken, and the situation I’m
going through right now with DHS.” Two parents reported that their children were harmed while
they were in foster care. Participant #8 described an event when a Euro-American foster parent
cut her African-American daughter’s hair because they did not know how to care for it:
Listen, they cut her hair bald, ok. So, I’m, uh, I talked to my caseworker about it, well
they’re not supposed to cut it, she said, well they’re not supposed to do that, so I’m like,
what made them do that? I mean they couldn’t do her hair, I said well, I will do it! You
know. I will do it. So they took upon themselves to when they’re in foster care, they took
it upon themselves and cut my daughter’s hair.
This event was extremely distressing to the participant. She described many instances in
which she felt powerless as a parent due to child welfare involvement. This was one of the most
difficult events she experienced. Furthermore, this mother reported intense frustration by not
being able to do anything about what happened, particularly because there were no repercussions
for the foster parents.
Participant #2 described her intense emotional reaction when DHS came to remove her
daughter:
60

When they came and took her, yeah I was angry. I was so angry when they put her in the
car, I followed them. They had to like pull her from me cause I wasn’t gonna just hand
her over. Did they expect to be ok with that? Like, oh yeah here take her, bye. I just, I
didn’t understand. It didn’t make sense.
Participant #12 reported that the length of time she was involved with the child welfare
system was particularly challenging. Due to her struggles with managing her child who has a
mental illness, she has been involved with the Department of Health and Human Services (DHS)
for intermittent periods of time throughout 10 years. At the time of the interview, the court
system mandated a no-contact order between her and her partner due to intimate partner
violence. She reports that this forced separation has been especially difficult for her and her
family.
Death of Significant Family Member. Several participants experienced the death of a
close loved one and viewed the experience as traumatic. One woman’s child was murdered after
her rights were terminated. Three participants lost a brother at a young age. For example,
participant #4 lost her brother due to an over dose, “I’ve read part of the police report. I was told
that in the autopsy police report it says that he died from an overdose.”
Participant #11 also experienced the loss of her brother due to an overdose. She reported
that this loss led to her intense use of drugs throughout high school. Participant #10’s brother
committed suicide. This was especially traumatic for her since her brother was a parenting
figure in her life. Participant #2 lost her father, her primary caregiver, when she was 16. She
reported that she responded to this with acting out behaviors including drug use and sexual
activity:
His liver failed. It was Hepatitis C. He was the only one there so when he was gone I was
angry. I acted out really bad and got pregnant when my dad passed away, because it was
like my dad’s gone can’t nobody tell me what to do now. Not like he really did so much
before, but while he was around it was always in the back of my head, is what would my
61

dad think about, you know, this, or you know before I did anything. So once he was gone
it was like, it doesn’t matter what anybody thinks anymore. So I acted out. I would drink
and smoke weed
Participant #10 described how her brother’s suicide impacted her:
Yeah, my brother committed suicide. That happened about 5 years ago, and just watching
him in the hospital bed kinda took a toll on me. Now I have nephews that I don’t get to
see because of all the stress that went on with my brother.
Physical Injuries. Participants also reported physical injuries and accidents that
negatively affected their interpersonal relationships. For example, participant #11 described how
a car accident challenged her core sense of safety. This accident also left her physically disabled
and unable to work:
Once the car accident happened, I was not able to get up, go to work…I had to be
helped up off the couch, not being allowed to sleep in my bed because I can’t get out of
my bed, yeah, it, it just changed my whole life.
Although the participant was affected by this accident physically, she also reported
psychological symptoms of anxiety due to a decreased sense of safety. She also reported this
accident compromised her ability to trust others because the driver in the other vehicle fled the
scene after the accident.
Participant # 2 also suffered injuries from a car accident during her pregnancy:
There was a stop sign hidden behind one of the bushes and we didn’t see it until it was
too late. We got hit by a big truck. It hit my door and I wasn’t wearing my seat belt, so
my door bent in half and I flew from the car. This happened two weeks before I was
supposed to have my daughter. I was knocked unconscious, I broke my ankle, and there
was big chunk of glass that stabbed me in my side. They airlifted me to the hospital, and I
was in the hospital for about a week and a half. I had a c-section, so I never really went
through the labor. I went to sleep pregnant and woke up not pregnant, and my daughter
was just there.
Other injuries reported by participants were an electrocution accident (participant #4),
and complications from kidney surgery due to medical negligence (participant #12).
62

Findings of Research Question B: What are the most salient trauma symptoms reported by
participants?
Participants reported trauma symptoms in six primary categories. All participants
expressed difficulty trusting others, which often led to rigid or diffuse boundaries as they
establish interpersonal relationships. Most participants reported mood disturbances,
predominantly symptoms of depression and anxiety. Six participants reported emotional
dysregulation, particularly when it referred to controlling feelings of anger and frustration.
Similarly, half of the participants also reported substance abuse histories and having negative
views of themselves. Five participants reported a high frequency of health issues including
chronic pain, infections, heart problems, and migraines.
Table 4.2. Trauma Symptoms
Trauma Symptom
Difficulty trusting others and setting boundaries
Mood Disturbances
Substance Abuse
Emotional Dysregulation
Negative View of Self
High frequency of health issues

n
12
9
7
8
6
5

Difficulty Trusting Others. The most salient symptomatology reported by participants
referred to difficulty trusting others and setting appropriate boundaries in their interpersonal
relationship. Participants either had diffuse boundaries, rigid boundaries, or wavered between
the two extremes. Participant #1 described her approach to trusting others, “You can only trust
somebody to a certain point. The only one you can trust is yourself. You know, yourself is the
one who is gonna get you where you gotta go.” Although participant #1 described difficulty

63

trusting others, at the height of her addiction she had extremely diffuse boundaries as she had
many people in and out of her home who eventually took advantage of her.
Several participants expressed challenges with being vulnerable to others, as participant
#6 described her rigid boundaries, “I’m a wall for sure.” Participant #3 also described her
tendency to isolate herself, “If I’m in a mood where I don’t wanna be around anybody I’ll stay in
my bedroom while everybody is in the living room.” She connected her difficulty trusting other
to past experiences, “Because my ex-boyfriend lied to me during our relationship, it takes me a
very long time before I trust anybody.”
Although participant #3 said that she struggles trusting others, she also described
instances where her boundaries were diffuse, as she affirmed:
We had people staying with us then and they’d just take off and screw us. So given the
chance, I think people would take advantage of us. I’m a really kind-hearted person, and
can’t really say no to some people.
She further explained that she and her husband would let various people stay with them
because she felt sorry for them. On several occasions, the people they helped left without
contributing to rent or other expenses. This was especially a difficult challenge for her and her
husband because they were unemployed and experienced intense financial difficulties.
Participant #9 also reflected on the challenges associated with wavering between rigid
and diffuse boundaries:
I keep people at a distance, and then, if I do let someone get close then it’s really, really
close where we’re together all the time. Even with girlfriends. I’ll pick one friend and
then we spend all of our time together, we’re inseparable. For the most part I keep people
at a distance.
Participant #12 explained how her past experiences led to a desire to have extremely close
relationships:
64

You know, just like having my dad absent, now I struggle with wanting my partner there
all the time. I can get clingy maybe out of fear in the back of my mind that they’re gonna
take off or leave.
With regards to deciding whether or not to trust someone, participant #11 stated:
I used to be the opposite of what I am now. I have a good heart, and if you need help, I’ll
do the best that I can to help you. But I don’t trust people like I used to. I don’t like being
around [others]. My gut instinct, it’s not there anymore. I trusted one friend, found out
some crap that I shouldn’t have found out, now I don’t talk to that person any more. So
just wash my hands, and be done with you. Push ‘em away. I ain’t got nothin’ for you. I’d
rather stay in my own crib.
Participants’ answers to the Brief Symptom Inventory (BSI), also highlighted a strong
trend among participants to not trust others. Although it is critical to analyze these scores with
caution to prevent a deficit-based interpretation, one third of the participants had high scores on
the sub-scale measuring difficulty to trust others. One third of participants also had high scores
on behaviors indicating interpersonal alienation and social withdrawal.
Mood Disturbances. Although the majority of participants struggled with symptoms of
depression and anxiety, only four participants had clinically significant scores on the depression
scale in the BSI and three on the anxiety scale.
Examples of reported mood disturbances for participants included obsessive-compulsive
tendencies, depressed mood, low energy, sadness, and frequent worries. These symptoms were
distressing for mothers, particularly if they had a cumulative effect, as one participant affirmed:
Well when I was drinking I didn’t really care about anything. Definitely when I quit
drinking and then my husband went to jail, I lost my kids, lost a source of income, heck
yeah, I thought I was goin’ crazy, like I, oh my gosh, like, my anxiety is out of control,
and then they put me on Zoloft for my depression, I went through 4 rehabs, and oh my, it
was, it was bad.

65

When asked if she continues to experience anxiety or depression, participant #11 offered
her testimony, “I can check out at any time. I’m not hearing anybody, I’m like in my own little
world.” Participant #6 further elaborated on the detrimental effects of depression:
Sometimes I guess it does get in the way of my interactions with Natalie. Like she’ll
wanna do something and I’m just not motivated. You know, I can’t motivate myself
sometimes. I’m so tired.
Participant #2 described intrusive thoughts and lack of focus when experiencing anxiety:
I definitely have racing thoughts. I’ll think about a hundred things in like 60 seconds, and
then all of the sudden I’ll draw a blank and forget everything where I don’t even
remember where I was. For example, I was going to a doctor’s appointment and a lady
asked me a question, it was as simple as something like what’s your birthday, and I just
stared at her like ‘what?’
Emotional Dysregulation. Participants described the negative effects associated with a
limited ability to regulate their emotions, as well as how extended this symptomatology was as it
affected their interactions with family members, partners, children, and caseworkers. For
example, when discussing an interaction with a Department of Health and Human Services
(DHS) caseworker, a participant expressed, “I went off on them a couple of times verbally, on
the phone, then I wouldn’t let them say anything and then hung up on them…I did not want to let
them get the last word.”
Challenges with emotional dysregulation also negatively impacted their parenting skills,
in a way that was particularly distressing, as participant #10 affirmed:
I lost it, and I admit it, I lost it, when they came to me and they asked me what was going
on, I told them, I lost it… I’m sitting there telling him [her child] not to pee himself for 2
months, and then he does it as I’m telling him not to and then I expect him to go and get
on the bus…I lost it, and he did, he was expecting to walk out the door and walk on the
bus, I’m like…”You just peed yourself, what are you thinking?!”…You need a shower a
change of clothes and now I have to take you to school!”
66

Struggles with emotional dysregulation also were expressed through violent behavior as
participant #2 reported:
I would break things. I remember I punched a hole in my wall, I would break my phones,
I would be so angry and like I didn’t know, where to direct it, how to deal with it, I would
just break stuff.
The most distressing consequence of emotional dysregulation referred to the negative
effects that these symptoms had on their interpersonal relationships, as participant #11 stated:
(Referring to her family…) They are all glad that I am on my anti-depressants, because
I’m calmer, I’m quiter. Cause I have a big mouth, and I know how to use that mouth. You
push me far enough, and I’m gonna strike out at you. If I bite you like a cobra, you better
lay down and die cause I’m not gonna stop.
Participant # 3 further elaborated on this issue, providing a clear description of how
emotional dysregulation permeated conflict resolution in interpersonal relationships:
A friend’s boyfriend beat on the front door like he was the cops and it woke up the baby.
It like made me really angry because we had already asked him not knock like that, and
he did it anyways. I literally cussed him out, up one side and down the other. Told him if
he ever came to the front door beating on it the way he did, next time I’ll probably come
out the front door with a baseball bat. After I went off on him, I went downstairs, lit a
cigarette and calmed down.
Substance Abuse. Substance abuse was a common and painful challenge for
participants. Women also agreed that substance abuse was a way to cope with trauma and other
trauma symptoms. Participants reported using a variety of substances including alcohol,
marijuana, and methamphetamines. Associated with their early experiences of trauma, substance
abuse typically started early in life. Participants who used substances, also reported substance
abuse by other relatives in their families of origin. Participant #9 recounted her alcohol abuse:
Yeah, once I got introduced to the partying and it was like so hard for like, at first it just
started off on the weekends you know…But then, it turned into an everyday thing, I’d
wake up and start drinking, I mean it spiraled out of control really fast.
67

Participant #10 described how she used alcohol and marijuana to cope with relationship
stress:
For a minute my drug use was really bad. Then it became just an every once and a while
thing, like a joint a day two joints a day and I was good. But at one point when me and
the kids’ father had split up he had called CPS on, well he had his friend call CPS on me,
and she told them that I punch my son in the face, I shake him by his feet, I do this, I do
that., That made me real depressed for him to say them things about me. So, I became a
bad pothead when I was, still livin’ with him at the trailer. I became an alcoholic because
of all the stress he would put me under.
For some participants, using drugs became a coping mechanism to deal with loss in their
lives, as participant #11 described how drugs helped her to cope with the death of her brother, “I
was dealing with it the wrong way, with the death of my brother. Cause that led me into the
drugs.” Participant #2 described how she coped with the death of her father:
I acted out really bad and got pregnant when my dad passed away, because it was like my
dad’s gone can’t nobody tell me what to do now you know, not like he really did so much
before but while he was around it was always in the back of my head is what would my
dad think about you know this, or you know before I did anything. So once he was gone
it was like, it doesn’t matter what anybody thinks anymore. So I acted out. I would, I
would drink and smoke weed.
Negative View of Self. Based on their past experiences, participants reported having a
negative view of themselves as they struggled with considering that they were not worthy as
human beings, women, and parents. For example, participant #1 developed a negative view of
herself based on her past behaviors as she stated, “The feeling of self-worth is always in
question. I mean, just because of what I've done in the past.”
Participant #5 described a long-standing poor view of herself, “I really had no value, for a
really long time I didn’t have any value.” Similarly, participant #12 said, “I’m down on myself
all the time.” Participant #6 connected her negative view of herself to recent experiences with
child protective services:
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It’s hard to view myself positively when you’re going through everything in this
situation. It’s overwhelming at times. Being here now (living with her parents) because
without having the child support that I need, and the job that I need and I mean that’s
demeaning, it’s hard to live with your parents and be 30 years old and have a child, it
sucks.
Participant #3 initiated contact with DHS to get support. She reported having a negative
view of self based on her decision-making, “Sometimes I see myself as a bad mom because I
went to them, went to protective services to get help, and they turned around and screwed me.”
Although half of the participants were able to identify having a negative view of self, most did
not see this getting in the way of relationships with children, caseworkers, other professionals,
family, or friends. Participant #4 described how her father’s abuse affected her view of herself:
I think it made my self-esteem just very, very shallow. It was very difficult for me to be
able to thrive. I was just very shy. I was not outgoing. It really influenced how I saw
myself. I felt very small.
Health Problems. Participants described struggles with several health issues. Examples
of these challenges were frequent migraines, infections, chronic pain, heart disease, and diabetes.
As one participant affirmed:
I had a heart attack, which I didn’t believe that one, but evidently I did. I was having
chest pains yesterday, my head hurt yesterday, and Sherry’s (participant 11’s daughter)
like, you wanna go in? I didn’t go into the hospital. I should have, but I didn’t. I went and
I laid down in the bed. I didn’t wanna go in. Sitting for 5 hours in the emergency room is
not cool. Cause then I get mad and then the anxiety starts.
Participant #11 also describes how health problems affect her, “Not being able to go to
work, having to be helped up off the couch, not being allowed to sleep in my bed because I can’t
get out of my bed. Everyday I’m in pain.” Participant #4 described her health struggles:
I had a complete foot reconstruction. I also had an electrocution accident and so that took
away a lot of my mobility. My whole left side was affected, I had 40% of the use of my
left hand for, for a while. So um, my mobility is not always the best, um, sometimes it’s
really hard for me to get up and down.
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Participant #6 also struggled with chronic pain, “I have pain all the time. They diagnosed
me with fibromyalgia probably about four years ago, but now they’re saying its Allers-Downlo
syndrome, where my joints pop out. Who knows what it really is.”
Cumulative Trauma and Co-occurring Symptomology. Women who experienced
more traumatic events reported a higher frequency and intensity of symptoms. These participants
also reported low levels of support, more negative views of themselves, and higher incidence of
substance abuse. Participants who reported lower levels of trauma, had stronger support
systems, higher views of themselves and lower levels of substance abuse.
The co-occurrence of symptomatology was reported by participants as particularly
distressing. For example, substance abuse was used as a coping behavior to manage chronic pain
or mood disorders. Depression was usually associated with negative self-view. Health
complications could also trigger chronic anxiety or depression. Participant #5 described the
intersection of emotional dysregulation, anxiety, and substance use:
Towards the end of my drug use I was nothing but a screaming bitch all the time. I had all
kinds of anxiety, knowing that we were eventually gonna get caught. Eventually all the
shit that happened (child welfare involvement) was gonna happen if we didn’t stop doing
what we were doing.
Substance use and lack of boundaries also co-occurred, as the following participant
affirmed:
I’d just let anybody and everybody come in the house. You know, say yes to anything. I
was more centered on making other people happy, than making the kids happy. When I
was getting high I’d just let anybody and everybody around.
Brief Symptom Inventory (BSI)
Although the BSI can be interpreted from a deficit-based perspective, the measure
includes relevant items indicating level of distress and provides a point of comparison to
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qualitative data. Interestingly, the frequency of symptoms reported in the BSI was not as high as
the qualitative reports of symptomatology provided by participants. Specifically, six participants
had clinically significant scores on the obsessive-compulsive domain. Four participants had
clinically significant scores on depression, paranoid ideation, and psychoticism domains. Three
participants had clinically significalnt scores on anxiety, hostility, and phobic anxiety domains.
Two participants had clinically significant scores on Somatization and Interpersonal-Sensitivity
domains.
Table 4.3 BSI
Symptom
Somatization (SOM)
Obsessive-Compulsive (O-C)
Interpersonal-Sensitivity (I-S)
Depression (DEP)
Anxiety (ANX)
Hostility (HOS)
Phobic Anxiety (PHOB)
Paranoid Ideation (PAR)
Psychoticism (PSY)

Participants with a T-Score > 63
2
6
2
4
3
3
3
4
4

Findings of Research Question C: How do trauma symptoms influence the participants’
parenting behaviors?
Individuals in this study developed trauma symptoms that subsequently influenced their
parenting behaviors as mothers struggled trusting their children, experienced their parenting
skills negatively affected by mood disturbances, and engaged in neglectful or abusive parenting
due to factors such as substance abuse or health problems. A brief overview of these challenges
are presented in table 4.4.

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Table 4.4 Trauma Symptoms & Parenting Behaviors
Trauma Symptom

Parenting Behavior

Difficulty trusting others/ setting boundaries

Worry about children’s safety
Exposed children to unhealthy relationships
(Neglect)
Decreased quality and amount of interaction
with children (Neglect)

Mood disturbances

Decreased quality and amount of interaction
with children (Neglect)
Worries about children’s safety
Difficulty setting limits

Emotional dysregulation

Decreased quality of interactions with children
(Neglect & Abuse)

Substance abuse

Decreased quality and amount of interactions
with children (Neglect)
Exposed children to unhealthy relationships
(Neglect)

High frequency of health issues

Decreased quality and amount of interactions
with children (Neglect)

Trust, Boundaries, and Parenting.
Hypervigilance about Safety. When asked how difficulty to trust others affected their
parenting behaviors, participants described engaging in overprotective behaviors due to
increased anxiety about their children’s behaviors. For example, participant #3 stated that her
sexual abuse history affected her parenting as she became hypervigilant and over-reacting. She
provided an example of this type of reaction:
My daughter was half an hour late one day and I called the school and I had a panic
attack. I told them “My daughter’s not here, it’s been a half an hour.” She tells me, ‘Calm
down, the bus broke down’…I’m like, ‘No, I’m not gonna calm down, she should have
been here a half hour ago…where is this bus at?’…and I’m on the phone yelling at the
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person… ‘Well, here come the bus.’… I hung up on her, ran outside and grabbed
Jennifer… I’m like, no more. I’m done with the bus, I will take her myself.
Children Exposed to Unhealthy Relationships. Mothers reported engaging in neglectful
behaviors due to difficulty with setting boundaries and failing to protect children from being
exposed to unhealthy relationships and behaviors. For example, participant #1 described her
failure to protect her children:
I’d just let anybody and everybody come in the house. You know, say yes to anything. I
was more centered on making other people happy, than making the kids happy. When I
was getting high I’d just let anybody and everybody around.
Decreased Interaction with Children. Two participants also found that their tendency to
isolate themselves decreased the amount and quality of interactions with their children and
significantly increased the risk of parental neglect. For example, participant #1 noted that she
tends to isolate herself because it is difficult for her to trust other people. This leads to an
experience of loneliness and increased risk of parental neglect, as she affirmed:
I think sometimes the part about being lonely and everything is because I keep to
myself…And I, but I don't want that for my kids…I'm trying but I might not interact the
way I'm supposed to with them… I might just let them play and do nothing with them.
Mood Disturbances and Parenting.
Decreased Energy and Desire to Interact with Children. Mothers with depression
symptoms found that depression impaired their parenting behaviors by decreasing their energy
levels, which in turn made it more difficult to interact with their children. For example,
participant #6 described the exhaustion she experienced resulting from depression, which in turn
hindered her ability to interact with her child:
Sometimes I guess it [exhaustion and depression] does get in the way of me and Natalie.
Like she would want to do something and I’m just not motivated. You know, I just can’t
motivate myself sometimes, I’m just like, I’m so tired.
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Participant #9 explained how depression was linked to parenting:
I became a parent way too early. I think depression and anxiety from that are why I just
clung on to drinking. I was just tired of taking care of the kids. I was tired of not really
having a life.
Difficulty Setting Limits. Due to various health symptoms or mood disorders, mothers
reported a marked decrease in energy, which also impaired their ability to adequately monitor
their children and establish consistent and clear limits with them. As participant #10
acknowledged, “I gotta say I let the kids get away with a lot more.” Participant #6 further
described how her parenting was impaired due to chronic anxiety:
He is a very smart kid and he, he’s a manipulator….and he is just a kid…but yeah, he is
one of those kids who will keep pushing and pushing and pushing…. and back in those
days, after about 3 pushes, I was like ‘Fine, fuck, whatever!’… you know, and that’s no
way to parent a child and that’s one of the things I had to realize”.
Participant #11 described how her mood related to increased physical altercations with
her teenage daughter:
They saw me with my anti-depressants and then they saw me for five months without
them, and everybody was glad when I got back on ‘em. I was real irritable. Me and
Sherry used to get into a lot more fights than what we have been. And that, that shouldn’t
be like that. She shouldn’t try to take a swing at me, and I shouldn’t try to knock her out.
Emotional Dysregulation and Substance Abuse Leading to Abuse and Neglect.
Mothers’ lack of coping skills was commonly associated with emotional dysregulation
during difficult parent-child interactions, which in turn significantly increased the risk for
parental neglect or abuse. For example, many mothers acknowledged blaming their children for
‘triggering’ their anger. Mothers who struggled with regulating their emotions also accepted
their tendency to perceive their children as having a ‘difficult temperament.’
Participant #10 provided a vivid account of a painful reality for many mothers in this
study:
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As I was lecturing my kid and telling him not to wet himself…but he wet himself, right,
standing right in the living room. And I lost it. I whooped his butt with a belt and left
marks, so when he went to his dad, he told his dad about it…. And apparently putting him
on the toilet and making him look, this is where you pee, for a half hour, they call that
child abuse.
Participant #11 further elaborated on this struggle by describing how losing control of her
emotions would lead to harsh parenting practices:
I try not to let it [emotional dysregulation] get in the way, but there, there are times where
it, it is in the way… I’ll just start fighting with my children or arguing with them… and
making them feel bad because I feel bad.”
Participant #6 described her difficulty controlling her emotions when facing her child’s
defiance, a problem commonly shared by participants:
She’s very defiant, so it is difficult, and she knows how to push my buttons. So, it is very
hard to get her, and to set limits with her, and to know how to deal with it and, so yes, it
is very difficult.
Substance Abuse Precipitating Neglect. Participants reporting substance abuse, were
also able to identify how their addiction led to situations of neglect and abuse, as one mother
described:
There were a lot of times when I’d get drunk and come home from the bar at like 2 or 3
o’clock. The kids would have school and I would just be screaming, waking them up
because I did not want to be sitting downstairs drunk by myself.
The same participant further described how abusive situations alternated with neglect, a
painful reality shared by participants struggling with addictions:
When I was drinking, I wanted to run around with everyone else who was drinking.
Wherever they went, I went and I pushed the kids to the side; because nobody wanted to
sit home and take care of kids with me. You know, so, it was always let’s run around, so
the kids did get pushed aside.

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Participant #5 described a challenge commonly shared by mothers impacted by drug
addiction and alcoholism, which refers to the anxiety associated with being identified by law
enforcement and CPS:
Towards the end I was nothing but a screaming bitch all the time…I had all kinds of
anxiety, knowing that I was going eventually gonna get caught…Eventually all this, all
the shit that happened was going to happen if I didn’t stop doing what I was doing
Examples of neglect by parents also included black out episodes due to substance abuse,
as one mother described:
I would get so messed up on pills… I remember the incident because somebody told me
about it ...One Easter we were supposed to go over to a friend’s house and and we
did…but I had absolutely no memory of being there at all. None. And it’s like, ‘did I
remember to put my teeth in?’… I don’t remember any of it. Once you lose time like that,
it really starts to scare you because it’s like, ‘how many times have I done this before?’
Negative View of Self and Parenting Role. Although participants reported struggling
with a negative view of self, the majority of participants did not view this issue as interfering
with their ability to parent. Only two mothers were insightful in describing how a negative view
of themselves led them to perceive parenting responsibilities as distressing. To these
participants, viewing oneself negatively led to viewing their parenting as overwhelming. Thus, a
negative view of self-informed a negative view of their identity as mothers, as participant #9
said:
So I still have a lot of dependency issues. Like, you know, sometimes feel like, I still like
you know my husband still kinda tells me what to do, you gotta do this, I’m not very, feel
like almost can’t make decisions on my own, or like if do it’s the wrong decision.
Health Issues and Parenting
Decreased Amount and Quality of Interactions with Children. Participants’ health
issues predominantly interfered with their parenting practices by decreasing their ability to
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interact with their children. Mothers reported a wide range of health problems including
migraines, chronic pain, stress-related illnesses, and hospitalizations. Participants reported how
health issues interfered in their daily interaction with children as participant #6 reported when
describing her struggles with chronic pain, “It’s exhausting and it’s very painful, it’s hard to do
the physical things. My daughter likes to jump on me, and climb on me. That part’s hard.”
Participant #12 expressed sadness by realizing how her hospitalizations have impaired her
parenting practices, “With all my hospital visits, there are some days where I’m in the hospital
16, 17 straight days in a row.” Mood disorders resulting from health problems also represented a
significant challenge to mothers as these negatively impacted their parenting, as participant #11
affirmed,
I’m bitchy, and I yell a lot. I tell my kids that they don’t care about how I feel. I like
going to the zoo. I can’t go to the zoo, cause I can’t walk to the zoo. So, if I were to go do
anything, I have to have a wheel chair. That’s embarrassing to me because I am only 47
yrs old and I should be able to do the things that I had done before. You know? Get up,
work 8 hours, come home, clean my house, feed my family, go to bed and do it all over
again. Well I can’t do that now.
Adult-Adolescent Parenting Inventory-2 (AAPI-2)
The AAPI- w2as administered to obtain specific quantitative indicators of parental abuse
and neglect. In summary, the majority of participants scored at medium levels of risk in each
domain of the measure. Specifically, regarding appropriate expectations, one participant scored
at high risk for inappropriate expectations of children, and 11 at medium risk. Regarding risk for
low empathy, four participants scored at high risk, seven at medium risk and one at low risk. For
corporal punishment, three participants scored at high risk, six at medium risk, and three at low
risk. On the scale of appropriate family roles, three participants scored at high risk for
inappropriate roles, seven at medium risk, and two at low risk. In the scale of children’s power

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and independence, two participants were at high risk for not valuing their children, nine at
medium risk, and one at low risk.
Table 4.5. AAPI-2
Domain
Appropriate Expectations
Empathy
Corporal Punishment
Appropriate Family Roles
Values Children’s PowerIndependence

High Risk
1
4
3
3
2

Medium Risk
11
7
6
7
9

Low Risk
0
1
3
2
1

Findings of Research Question D: How do trauma symptoms influence women’s
interactions with formal social systems?
Individuals in this study reflected about specific trauma symptoms that influenced their
interactions with formal social systems. According to participants, trauma symptoms that
predominantly impacted these interactions were difficulty trusting others, setting boundaries,
mood disturbances, and emotional dysregulation. Mothers also reported how these symptoms
exacerbated whenever case workers displayed behaviors such as rigidity, emotional barriers,
distortion of their cases, or perceived lack of interest to return children to their care.
Difficulty Trusting and Setting Boundaries. The majority of participants reported
struggles with regards to trusting their caseworkers, particularly if women perceived that
caseworkers did not assume a supportive and empowering stance. For example, participant #1
affirmed:
I felt that the minute I met her she didn’t want me to get my kids back. She told me flat
out she didn’t want me to have my kids back. The relationship with my caseworker has
gotten a little better. At the same time I wouldn’t put it past her to say some B.S. to make
it so I couldn’t get my kids back.
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Another example refers to participant #7 struggling to trust that her caseworker was
committed to ensuring the safety of her children, “My caseworker says my kids are in a safe
place and she knows because she goes over there…But I tell her, you don’t know what goes on
at night time though, you don’t know that.” Participant #8 had similar concerns:
They take him and put him in some foster care, I don’t where he’s at, I don’t know if he’s
safe, I don’t know if they’re hurting him. Just like they don’t know if he’s safe. It’s sad
because you hear about foster parents hurting children. I don’t know if he’s getting fed
before he goes to bed, I don’t know if he’s getting bathed, I don’t know if they’re making
him brush his teeth, I don’t know any of this, and it really irritates me.
Mistrust towards caseworkers also related to painful experiences with the social welfare
system, as participant #3 affirmed when reflecting on the effects of being in foster care:
When it comes to caseworkers or anybody that has to do with the State, I don’t trust them
because of what happened with my son. They were supposed to be putting him in a home
where he would be well taken care of, and he wasn’t.
Mood Disturbances. Depression and anxiety negatively affected participants’
relationships with caseworkers. For example, participant #1 described avoiding her caseworker
when feeling depressed:
When I am depressed, I feel more snappy. When caseworkers would come over, I just
didn’t answer the door (laughing)… I responded to them with avoidance. I’d turn my
phone off cause I knew they would be calling.
Anxiety was especially triggered in response to thinking about children’s safety in foster
care, particularly because of the impossibility to confirm the children’s well-being and quality of
life, as participant #8 stated:
Just because you think they’re safe, they’re not. And I don’t know, and know where he’s
at, and I don’t know if he’s getting fed before he goes to bed, I don’t know if he’s getting
bathed, I don’t know if they’re making him brush his teeth, I don’t know any of this, and
it really irritates me.

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Emotional Dysregulation. Participants reported how emotional dysregulation negatively
affected their interactions with caseworkers, as participant #8 said, “Yeah, I went off on them a
couple times verbally, on the phone, then I wouldn’t let them say anything and then hang up on
them.”
Mothers also reflected on how emotional dysregulation was particularly problematic
when experiencing confrontations with caseworkers due to escalation in the interaction,
particularly if women perceived caseworkers as being disrespectful, as participant #12 described:
“It was very hard for me to hold my tongue with her, and there was even a couple of
times when I didn’t, and it came out, you know, with her, and it was not controllable… I
actually had someone say to me, ok you need to leave the room... Somebody had to
remind me, like ok go out and smoke a cigarette, go, leave the room… Because I mean, it
was getting pretty heated.
Findings of Research Question E: How supportive are the contexts in which women engage
as related to their parenting efforts?
Although the majority of participants identified important sources of support in their
lives, women also reported unsupportive relationships with regards to family, friends, and
service professionals. Table 4.6 illustrates the complexities of social support reported by
participants. Detailed narratives are presented below.
Table 4.6 Supportive and Unsupportive Systems
Support System
Parents/Family
Current/ Former Partners
Friends
Caseworkers
Other Services

Supportive
8
6
5
8
7

Unsupportive Relationships

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Unsupportive
6
10
5
12
0

Parents/ Family. Although parents and other family members were the largest source of
support for participants, they were also identified as important sources of stress. For example,
participant # 9 described how her father lost his parental rights when she was a child due to
abuse and neglect. Even though he was identified as a source of support once she became an
adult, this participant identified him as having a major negative impact on her, particularly as it
referred to her own parenting difficulties:
My dad lives right down the street, but he was just a drinking buddy. We would get drunk
together. When I was pregnant with my daughter my dad would drink with me.
According to him, everyone else who thought I shouldn’t be drinking was wrong. He
would always say, ‘Its ok, your mom drank with you. You turned out fine.’
Mothers also reported how family members were unsupportive if they overstepped their
boundaries, as participant #10 affirmed, “My mom supports me to a point, but she also wants to
be a parent, and she wants to control the way I parent my kids.” Participant #2 also described
unwanted input from her step-mom about her parenting:
We had got into this argument because she said that I needed to quit treating my daughter
like a princess. So I told her, you parent your way, and I’ll parent mine. Just because you
ignore your child, doesn’t mean I have to do the same to mine. I’ll do this my way and
you parent your way.
One of the most painful expressions of lack of support from families refers to legacies of
parental abuse and neglect experienced by participants, particularly as it referred to strained
relationships and lack of involvement in participants’ lives. Participant #5 explained:
It’s been 15 years since I’ve seen my parents. They live in Oregon, so there’s no way I
could get there. They could come here any time, but they don’t. They’ve never met
they’re grandson, which really, really pisses me off.
Participant #4 described her lack of contact with her father:
My kids have only met him one time and that was not what I wanted to do. It was at a
funeral. So just a casual meeting. I explained to my kids later who he was. It made me
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very sad. My daughters asked a lot of questions about him. I answered them the best that
I could.
Current/Former Partners
Fathers’ Absence or Lack of Involvement in Parenting. For many of the participants, the
fathers of their children were uninvolved in their lives. One participant affirmed:
He is no good. He was like one-time thing. We were all drunk at a friend’s house. As far
as I know to this day, he still sells weed, smokes weed, drinks, stays in the streets, you
know? I will never let him be around my daughter, ever.”
Participant #6 elaborated on her story:
He doesn’t even call on the days that he’s supposed to, so I have her call him a lot, and
make her make him cards. He went out of state and told her that he was going to visit his
dad that was sick in the hospital, he’d be back in a couple days, and never came back.
She still thinks he’s coming back, and I don’t think he’s ever gonna come back. So all I
can tell her is that your daddy’s sick and he’s with her grandparents out of state. It’s hard
for her.
Participant #1 reflected on her experience, “My daughter’s dad. He’s abusive and an
alcoholic. He showed up at my house a couple times. I had a PPO order out on him and that
didn’t matter so I think they put him back in jail.”
Partner Interactions Leading to or Exacerbating Involvement with the Child Welfare
System. Eight participants provided detailed accounts of how their partners or children’s fathers
led them to or prolonged involvement with the child welfare system. In some instances, such as
in intimate partner violence, fathers were fully responsible for instances of child abuse and
neglect. In other situations, fathers led women to engage in destructive behaviors such as
substance abuse:
I had done meth in the past, and I liked it too much so I stopped doing it. When I got with
my husband, I realized that he had a serious habit. At first I didn’t want anything to do
with it. Methamphetamine can really mess up your head, and it makes you incredibly
sexual. If the other person’s not that way, it’s really annoying. So, it got to a point where
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it’s like ok, if you’re gonna be a junkie, then I’m gonna be a junkie. I thought that would
open his eyes and stop it, but didn’t work that way
Participant #6 described how her ex-husband’s behavior caused CPS involvement:
We shared 50/50 custody and it went fine for a while. Then I noticed my daughter she
stayed, at 28 to 29 pounds for like a year and a half and it was concerning to me. I started
noticing that she would gain you know 2-3 pounds on my weeks and then when she
would come back from her father’s house she would lose those 2-3 pounds. I was noting
it for you know a few months and then I was like, alright I’m, I’m gonna take her to the
doctor. They did say that it um, they were going to call dhs because her prealbum level
was down, the nutrition level in her blood. So basically he said, if, if you don’t call, I’m
going to. So they were called, and that was the first time that they were brought in.
Friends. Participants reported that unsupportive friends frequently increased their risk for
substance abuse, as participant #5 affirmed:
The people that you’re involved with in an addiction, well, everybody takes advantage of
everybody else…Everybody loves you if you have money or dope, and when you don’t,
they’re not there for you.
Participant #10 confirmed this experience:
Yeah, and that’s what we come to realize when, now that we’re dealing with all this
[substance abuse recovery] and we completely quit, I’m like ‘dude nobody calls us no
more, nobody wants to hang out’… I’m like, ‘where’s everybody at? Oh they’re just
getting high’… And now that we don’t get high, it’s like well, now I see who our true
friends were.
Caseworkers. According to participants, unsupportive behaviors by caseworkers refer to
(a) unprofessional behaviors, (b) lack of understanding and support, and (c) caseworkers’
background.
Unprofessionalism. Participants reported several instances of lack of professional
behaviors and ethical violations, as one mother described a caseworker telling her ex-partner
word-for-word what she had told the caseworker when reporting him for neglect:

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I wouldn’t know anything that he said to her… but he could repeat to me word for word
what, what I said to her… So, it would just really make me mad… and then he said, he
said she just told me that you’re doing this to be vindictive.
Participant #7 expressed frustration about not being informed of her children’s
placements:
My kids were not all together, but the caseworker never told me that the judge ruled for
my kids not to be together all in one house. So they split my kids up, there’s two there,
and two there. So, I’m like ok, but they never told me that they got split up.
Participants also reported lack of professional behavior associated with service delivery
practices, as participant #8 stated:
The caseworker didn’t do what she was supposed to. We went to court and the judge
yelled at her because she did not do it. She wasn’t doing what she was supposed to do.
So, we were supposed to start different counseling, things like that…But she would wait
until about a week out, you know, until the court date, and then she’ll start throwing
everything at you. This stuff should’ve been done with enough time before the court date.
Lack of follow-through by caseworkers was frequently reported by mothers, as
participant 4 said:
After Malorie was removed from my home, I was told by the juvenile court officers, that
there would be some services that would open up…Finally, after months and months, I
was able to see Malorie again.
Another woman reported issues related to lack of ethical behavior:
For one, she doesn’t do the home checks like she’s supposed to. She also has lied to my
children. I don’t appreciate that. You don’t promise somebody something and then not
come through. And she did that a lot.
Lack of Understanding and Support. It was a common belief among all participants that
caseworkers were unsupportive at times and did not understand the participants’ experiences.
Participant #1 explained, “They need to understand where the parent is coming from, and at the
same time, they need to listen to what they’re going through before they make any decisions
about that person.” When asked about how caseworkers could be more supportive, participant #8
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replied, “Compassion. Learn it. Use it.”
Participant #6 stated that she sought out DHS, for support however, “Every, any time I
called her for any advice or any help, they would only give short answers, were not nice and
were not helpful.” When asked if caseworkers were a source of support, participant #10 replied,
“I gotta say, no. Because every time I brought an issue to them, they kinda blew it off.”
Mothers also perceived caseworkers being unsupportive whenever they focused on the
problems without acknowledging their strengths, as participant #3 explained, “For a long time, it
was like no matter what I did, it was wrong, wrong, wrong, wrong…And I’m like you know, you
get really frustrated with that. It’s like they never see what you do right. Participant #12
summarized this feeling, commonly shared among participants, “They’re quick to jump on the
gun, and judge someone without even meeting them.”
Caseworkers’ Backgrounds. Mothers were reactive to the fact that many caseworkers are
young and have no children, as participant #1 stated:
My foster care worker doesn’t have any kids right now. Yet, she’s telling me how I need
to raise my kids. I hate that. Until you have a kid, don’t tell me what to do with my kids.
And then I got switched to another one, she’s nice and everything, but gosh what is she,
24, 25. They don’t have a grasp on raising children is hard. They do not come with a
handbook.
In addition, many mothers considered that caseworkers did not share the experience of
knowing how painful it is to have a child removed from one’s care, as participant #8 said, “I try
to explain to them, ‘you have no idea, put yourself in my position right now, then you would
have a clue, but you don’t’”. Participant #3 suggested:
Caseworkers need to be more understanding, because parents like me don’t always get to
experience the pleasure of keeping all their children. The caseworkers do. If they haven’t
had kids, then they need to be considerate of how the parent might feel when children are
taken. Especially if the parent has raised their children for a couple years. Especially with
a mother. She’s carried the baby for 9 months, and then raised the baby. It pretty much
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ripped my heart out when my children were taken. So they need to be more considerate
that.
Supportive Systems. Although women in this study faced many challenges in their
relationships and contexts, they were also many instances in which these environments were
helpful. According to participants, supportive systems played a critical role in their lives by
helping them to reduce trauma symptoms, improve their interpersonal relationships, and enhance
their interaction with institutions and others. Specifically, women identified family members,
partners, caseworkers, friends, and service professionals as important sources of support in their
lives. This finding is relevant as participants also identified interactions with these individuals as
problematic in their lives.
Parents/Family
Emotional Support. Parents provided support to participants in a variety of ways.
Participant #3 received emotional support from her mother and other family members by,
“…always telling me that I did really good raising Jacob for the three years that I had him.”
Participant #4 also received emotional support from her mother when she needed someone to
talk to about her ex-husband, “… she has helped me sometimes when I get frustrated with him, I
call her and can tell her, “he’s driving me nuts!” Participant #2 acknowledged:
My mom is definitely there whenever I need her. I have a lot a lot of cousins and aunts
and we all live in like kind of the same area. My brother lives two apartments down from
me. If I ever need anything big or little, even as simple as a question, I can always call
somebody. I’ve never felt like, ‘What am I gonna do? Oh my gosh, I don’t know, I’m
alone in this thing.’ I have a lot of support.
Participant #8 was proud of her level of family support:
We’re never far from family. You know the saying, it takes a village, that’s actually true.
We have a great support system. Before my son started school, he always went to my
dad’s. We always did stuff with my son as a family. Our family is very odd. Even though
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they’re divorced, my mom still talks to my dad. Everybody in the family is still
connected even though they may not be together. It’s awesome, but at the same time it’s
odd, because you look at other people, and that’s not how it is. It’s cool because, we can
all as one big group go places together, we’ve done things before, all of us, divorced,
married, new married, new boyfriends.
Instrumental Support. Over half of the participants reported the critical emotional and
financial support they received from their parents, as participant #6 affirmed:
My parents have stood behind me the entire time with my ex. They have helped me get
full custody. They have, I mean, they’ve let me move in with them with my child. They
take her to daycare during the week. They help tremendously.
An additional example of support referred to taking care of children whenever women
experienced life challenges, as participant #12 said, “My mom had to step in and did the
parenting while I was in the hospital.” Participant #7 reported a similar experience of support:
My mom and dad are a support to me. If I need anything my mom and dad is there for
me. I would depend on them more than anybody. If I need anything I can call them and
say, ‘mom well I need this, dad I need this’; and they’ll say, ‘ok I’m gonna bring it to you
or come get it.’
Partners. Over half of the participants reported how partners provided varying levels of
support. One mother affirmed the strong support that she has received from her spouse, “In the
beginning, when I lost my son, it was really depressing and then, my husband helped me work
through it. It is still hard sometimes to talk about it, but my husband makes it easier.” Participant
#5 also highlighted the level of support she receives from her spouse:
He was the first person ever in my entire life who accepted me without question. He
absolutely adores me, there’s absolute no doubt about that. There’s nothing I can’t talk to
him about. He will take anything from me. It would be so easy to take advantage of
somebody like that, but that’s not who I am.
Participant #8 reported an uncommon experience for participants, in which she had a
positive relationship with her ex-partner:
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We aren’t together, but we still talk when it comes to our son. He’ll call me and tell me
what happened in school, or you know stuff like that. I was with him half my life. We
never were married, but we, practically would be. It’s a crazy scenario, but I love it
Mothers also reported instances of moderate to minimal help from parents, as well as
expressions of support characterized by controlling behaviors. For example, participant #1 stated,
“The dude I’m with now, he is supportive, but not. He’s working on himself too.” Participant #9
described her husband as supportive but also o controlling, “…my husband supports me too, but
he’s more of like a backseat driver, he wants to tell me what to do all the time.”
Caseworkers. Participants viewed their caseworkers positively whenever they were
helpful, seemed to care, were collaborative, and used direct communication. Half of the
participants identified caseworkers as sources of support. For example, participant #1
appreciated that caseworkers were a resource for various services, “Now, I can go to any kind of
case worker (laughing) and can get all the support I need.” Participant #6 found her second
caseworker to be very helpful, as she stated:
The last caseworker was great. She listened. She literally spent probably 45 minutes with
me, and listened to everything, and then asked me for all of my medical records. She
asked me for everything…I told her, ‘You can have whatever records you want, take
them. Do what you want. I just need you to help me.
Another mother described how she was open and receptive to her caseworker because she
was also collaborative and empathic:
Jennifer was pretty understanding. Even when there were times that I did get upset, she
still tried to work with me, or tried to compromise... You know, it wasn’t always ‘just
what I say goes,’ you know? It was definitely a compromise…She would say, ’Well if
you don’t feel like… can you at least do this?’
Following the same order of ideas, participant #3 described how supportive her
caseworker was:
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We were getting to like her and trust her because she was very open and honest with us
and everything about. She would even pick us up and take us to our appointments, or we
would meet her at DHS and she’d take us to where we needed to… like Henry’s doctor’s
appointments.
Mothers also highlighted how critical a direct communication style from caseworkers
was for the strength of the helping relationship, as participant #10 said, “He is 100% honest and
straight forward. He tells us how it is. He tells us what we gotta do to get it done.” Participant #7
described her varied experiences with caseworkers:
With my first caseworker, I was feelin’ real down because he would make negative
statements about me. Everything I asked him he would say one thing, and then by the
time I go to court it’d be somethin’ different. But my caseworker who I got now, I mean
it’s cool or whatever, we goin’ through it step by step basically, you know, we’re goin’
through it step by step, and it’s pretty cool.
Other Service Providers. In addition to DHS staff, women also identified additional
service providers as sources of support. For example, participant #12 found staff associated with
her wrap-around program as being helpful to her as a parent. Members of this team included a
parent support partner and foster parents. With regard to the assistance she received from this
team, she affirmed:
She has been through it, done it, you know…So, we meet once a week and she can help
me come up with strategies. We talk, you know, and sometimes it’s nice to just talk. So I
think that that’s been really, really helpful.
Participant #9 had a lay-person recovery coach whom she found to be helpful:
I’d call my recovery coach and she would come to get me and go have coffee or
something. And, you know talking about cravings and how they only last for like 20
minutes…You just have to make it through, you know, then you’re like oh thank god…I
didn’t know, they can get rough.
Participant #1 described how another type of professional offered support:

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I have a medical case manager, she’s really good. She helps with housing and you know
basically ‘cause I’m on some other medications. She’s my biggest supporter, I mean she
knows everything.
Participants also identified therapists as important sources of support, as one mother
affirmed:
You know, the therapist gave me some good resources and some good things…You
know, some good ways of trying to redirect and trying to do things differently….Like
when I was trying A, she would tell me, ‘Why don’t you try B?... She was very
resourceful.
Friends. A few participants identified friends as sources of support, as participant #6
said, “I have a really close-knit group of friends.” Similarly, participant #8 stated, “Like I have a
bunch of people. I have my close friends. My roommate is one of my closest friends. You know,
she’s always there.” Of the participants who identified friends as resourceful, frequently stated
how they would help them battle challenges in their lives such as addiction, as one mother stated:
I gotta say she really didn’t drink that often because she knew that I was struggling. I was
drinking all the time, and she wanted to protect the kids. It got to the point that she’d have
my daughter sleeping in her room at night just so my daughter didn’t wake me up. I’d
wake up and Joanne wouldn’t be in her crib. I’d realize, she’s in Lisa’s room, good she’s
in Lisa’s room. I’m goin’ back to bed.
Findings of Research Question F: What examples of trauma-coping and resilient parenting
behaviors are women most likely to report?
All participants reported examples of coping and resilient behaviors that effectively
helped them to manage their trauma symptoms, regulate their emotions, enhance their
interactions with children, and change their thoughts and cognitive schemas as they overcome
adversity. Table 4.7 presents an overview of how many participants utilized each type of coping
strategy.

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Table 4.7 Coping Strategies and Substance Abuse Recovery
Coping Strategy
Behavioral Strategies
Psychotropic medication
Children as motivation
Cognitive strategies
Substance abuse recovery

n
7
6
11
8
7

Behavioral Strategies. Participants reported behavioral changes that helped them cope
with difficult experiences. These included increased physical activity, relaxation strategies, and
setting specific goals when facing challenges. For example, participant #1 affirmed, “I make
myself get up in the morning and make myself get out. At least go for a walk once a day.
Participant #2 said, “I’ll even go in the bathroom and just take a bubble bath, and just sit there
and think, and just straighten my thoughts.” Participant #4 also used relaxation as a way of
coping, “I know my limits too. If I’m feeling a certain way or if I’m feeling overwhelmed,
sometimes taking 5 minutes and putting on my headset, typing in youtube and just listening to
some music.”
Participant #9 identified setting goals as her best coping strategy:
I set goals for myself, like I said this summer, ‘I wanna learn how to drive, I think that
will make it….I think that will get me out of the house and make me feel a little more
independent. I think that that will definitely make me feel better about my self-esteem.
So, I think that I set goals for myself.
Participant #12 pays attention to physiological indications of anxiety during her
interactions with her children. If needed, she removes herself from the situation.
Psychotropic Medication. Participants struggling with mood disturbances and emotional
dysregulation reported using psychotropic medication to medically treat these issues. For these
participants, their medical treatment was an important support to keep their mood regulated and
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to enhance their ability to cope with daily stress, as participant #1 affirmed, “I’ll be really, really
depressed or I’ll just be to a point where I can’t even stop moving. So I take a little happy pill or
whatever and I’ll be good to go.” Participant #9 described:
I still take Zoloft. That helps a lot cause when I don’t take it, like my emotions start
going all crazy. I can tell if I haven’t taken my medication. Even my husband can tell.
When he notices, he’ll ask, ‘did you take your medication today’. I get real irritated when
I don’t take it.
Children as Motivation in Life. Participants identified their children as a particularly
strong motivator in their lives, particularly when facing intense adversity, as participant #2
stated:
I do it all for my daughter and the baby I’m about to have. I just think about them
constantly. All my decisions affect my kids in some way, so I always put them first. I
think about them before I do anything. It’s really them that makes me wanna do the right
thing. Like before I didn’t really care, it’s like I don’t have nothing, or no responsibilities,
nobody. So it was just like, I’ll do what I want, and now I have my kids. So it’s lot
different. Now, I always base my decisions on them.
Similarly, participant #4 affirmed, “I’m very blessed in my life, and I feel that my
children are a really big gift to me, and that’s what keeps me going.” Participant #7 provided a
detailed description of how she finds motivation in her children when feeling depressed:
Every time I see my kids, I feel so happy….Oh my god, I can’t wait to see them when I
go to my visit. That’s how I am like so ready to go to my visit… I can’t wait until 4
o’clock so I can visit my kids.”
Cognitive Strategies. Participants took action to change their thoughts when facing
various stressful situations, in an effort to better cope with contextual stressors. For example,
taking one day at a time was a strategy used by women as participant # 6 affirmed, “I go day by
day. If I look a year down the road, it stresses me out.”

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Participants also talked about not letting little things get to them and focusing on the
positives, as one mother said, “I don’t sweat the small stuff in my head.” Staying positive, and
acceptance of self and reality were also important strategies, as participant #4 affirmed:
I’m an honest person. I’m not a perfect person. Nobody is perfect, and I’m the first
person to admit when I make a mistake. I’ll sometimes throw up my hands and say “oh, I
just totally messed up, I said that wrong or something.
Substance Abuse and Trauma Recovery
Trauma recovery is operationalized as any evidence that women displayed of
improvement in trauma symptoms investigated in this study.
Substance Abuse Recovery. The fact that all participants with a substance abuse history
were currently abstinent is evidence of trauma and substance abuse recovery, as one mother said:
I never looked at myself like an alcoholic, even when I was drinking every day, I’d say
‘Oh I can stop any time I want, you know I can quit, you know I just don’t want to.”
Then, when I tried to quit, it was like the hardest thing I ever had to do, and that’s why I
just can’t even imagine me drinking again because of just coming out of it and trying to
quit was just so hard, and depressing…It was such a hard, hard, hard thing. Like I’m just
so glad that’s over with because it was one of the hardest things I ever had to do.
Participant #5 described her recovery process:
When you go to rehab, they tell you that, you have an addiction, it’s not your fault. Your
ability not to stop is not your fault. Well you feel like after a while, it’s kind of a cop out.
Especially when you get past it. You know, then you’re like well, why couldn’t I do that
before? And it’s like, because you couldn’t. You didn’t, you were not in the right mind
space.
When asked how she keeps drug free, participant #1 replied:
I needed a reason. I don’t wanna say I needed a reason to quit using drugs. I needed for
me to figure out that I didn’t need the drugs. I realized my kids need a clean and sober
mom. They need somebody that’s gonna be there for them, not just with them. Jail time
and treatment centers also helped.

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Improved Boundary Setting and Trust of Others. Participants reported improved ability
to set healthy boundaries and trust others as participant #8 stated:
I always give people a chance. Even though I have a hard time, you know I give them a
chance. You just hope and pray, don’t screw me over. I want to teach my son to give
everybody the benefit of the doubt, you know not to jump to conclusions,
Participant #3 reported working on setting boundaries with others:
Me and my husband have both been doin’ really good for the last 11 months of staying
away from others’ drama after we moved out of where we were staying at and got our
own place. If we have friends come over, we tell them if you have drama, leave it at the
front door as you come in otherwise you go home.
Participant #1 shared her story:
I’ve tried to set better boundaries. You know I quit the drug use, so that helped out a lot. I
kinda made my house mine again. Now, you have to ask me to come in. If I let you in
that’s fine, if not I can shut the door on your face. Now I am able to tell people, ‘certain
things are mine, don’t touch ‘um.’
Improved Emotion Regulation. Participants reporting success with regulating their
emotions and described how this acquired ability improved their quality of life, as participant #3
stated, “Me and Henry have our arguments, but now we walk away from each other for a little bit
and then we come back and we talk about it and solve our problems”. Participant #4 reflected on
the positive impact of emotion regulation and child rearing, “Even if I’m having a really bad day,
you know, we have to put our emotions aside and try to do what’s best for our kids, and that’s
what I’m trying to do.” Participant #4 described a strategy she uses to prevent emotional
dysregulation:
I take time to sit down and think about like think about, like really think about things um
while I let me daughter off and watch movies or play with her toys or whatever. I’ll even
go in the bathroom and just take a bubble bath, and just sit there and think, and just
straighten my thoughts.
Participant #2 explained:
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Whenever I get those racing thoughts, I tell my daughter I need to sit here by myself for
minute. I’ll go put a movie on in her room for her and let her sit down and watch a movie
and play with her toys. Then I’ll kinda collect myself in the living room, so I won’t let
her in the middle of that. So I just put her in her room and tell her, mommy needs to sit
out here by herself for a minute and think.
Positive View of Self. Participants made statements that demonstrated self-confidence
and positive views of themselves despite difficult experiences. For example, participant #4
stated:
I saw how my father treated me, and I certainly did not want to ever have my children
treated in that way and you know I’ve always been very protective of my kids, I think
that a lot of maybe those experiences with my father caused me to make some very bad
relationship decisions; and maybe sometimes I’m too soft with disciplining my kids.
However, I feel that I did the best that I can with what situations have brought.
Participant #8 discussed how holding on to a positive view of herself has led her to be
resolved about self-care behavior, “No, I don’t throw myself into pity parties. I know that I’m a
good person, I know that I’m a good parent, I know, you know what I mean, so I just know I’m
ok with myself.”
Confronting Problems. Over time, mothers learned that confronting problems led to
better outcomes rather than avoiding them. For example, participant #2 expressed:
I’ve learned to deal with my problems because you know, they are not going to go away
unless you deal with them. You have to do something about it, or else they are just going
to always going to be there.
Participant #4 gave an example of how she confronts problems by addressing conflicts
with difficult family members:
I’d tell myself, “you know what? I really have to do this…” So, I’ll put it on the
schedule…Like for example if there’s a family member that I don’t particularly like very
much, I will like randomly pick a date on a calendar and write “OK, it’s 3 o’clock and
you’re going to call this person or send this person an email.”

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Positive Parenting Behaviors. Parents reported remarkable improvements on their
parenting behaviors and practices as a result of involvement in therapy and supportive services.
These improvements in their lives were deeply relevant as one of their major motivations in life
is to be good parents to their children. Thus, it was important for mothers to learn from their
mistakes and become the best parents they could be. They reported achieving this by
strengthening the mother-child bond, embracing effective limit setting practices, and nurturing
the emotional bond with their children.
Parent-Child Bond. Mothers reported that healing from trauma allowed for improved
bonding with children and that bonding with children facilitated additional healing, as participant
#2 described:
I really did not want to be pregnant and I was so against it…I was like “I don’t care, I’ll
just leave her at the hospital when I have her”…I was just so rebellious. But then, it was
like when I saw her, everything changed. It was like “Wow, I made her, she is mine…and
you know, it was great.
Participant #3 reflected on her experience:
I actually love bein’ around my son. If I had him with me and I was in one of my moods
of not wantin’ to be around anybody, he and my husband would be the only two I’d
wanna be around. Maybe even my son would be the only one I’d wanna be around and
not my husband.
Participant #8 described her bond with her son:
I’ve gotten into the river with him and caught crayfish with him. I was raised a tom-boy,
I’m an only daughter, you know, so I’m not scared to get dirty, and that’s probably why
he loves hanging out with me so much.
Limit/Boundary Setting. A critical indication of growth refers to participants’ ability to
use effective and non-punitive limit setting strategies, as participant #3 described, “If my baby is
going for something he’s not supposed to have, we’ll pick up and turn him away and will get him
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star playing with the toys.” Participant #5 described the importance of monitoring and rigorous
limit setting with her older child:
It’s very much a set of boundaries that don’t change, you know, in other words he doesn’t
go and spend the night anywhere if I don’t know the parents. He has to be in at a certain
time…He is not allowed to go as far as he’d like to go…Those things are non-negotiable.
Participants also reflected on how they improve their skills to allow their children to
make choices within reasonable limits, as participant #2 affirmed:
I try to like I let her make some decisions, like, what pajamas do you wanna wear to bed
tonight, or what do you wanna wear to school. Within reason, you know. I let her make
some decisions about things, like what vegetables she wants or what type of dinner. You
know, just little things. It’s not like I’m trying to control everything, just the major
things.”
Participant #12 discussed how it is important for her to protect her children when she is
struggling with difficult events and emotions, “When I’m with the kids I try to keep it happy”.
Participant #3 described tactics for redirecting her infant:
If he’s going for something he’s not supposed to have we’ll pick him up and turn him
away to start playin’ with toys. For example, we’ll turn his attention away from it by
showing him blocks because he loves blocks. If we pick him up and turn him away, or if
we pick him up and just walk around with him bouncin’ him around, he’ll laugh. If we’re
bouncin’ him, then it’ll take his mind off of it and then we’ll be able to put him back
down. Then he’ll run off and play with more toys.
Emotional Support. Several participants wanted to learn from their parent’s mistakes
and challenging upbringings. For example, mothers considered essential to offer their children
the emotional support that they did not receive. Participant #1 stated:
I don’t remember my adoptive family being there for me very much. I could never talk to
them. I know my kids will talk to me. You know, and I want them to be able to trust me
too. I’m not going to be gone for them. I'm always going to be there for them. My son has
a lot of angry tantrums. He’s very violent right now. He’s only two though, he doesn’t
know how to express himself, and I understand that. He has emotions he doesn’t know
how to deal with.
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Similarly, participant #2 said:
I never knew my mom, so I will never be away from Ann. I want her to always feel like
I’m there, so she can always come to me for whatever she needs. And I teach her how to
express her feelings, like something’s wrong, to talk to me about it, don’t just act out like
I did.
Participant #6 expressed a similar desire:
From my parent’s tough love, I learned what I don’t want for my daughter. She’s my life.
I talk to her about pretty much everything. She comes to me for anything. I want her to be
able to come to me, cause I couldn’t do that.
Participant Profiles
The following chart shows the profiles of each participant based on their trauma history,
assessment scores, and coping strategies to demonstrate the variance in women’s presentation
and experience. This helps to visualize how these different variables hang together for
participants.
Table 4.8 Participants 1-6

Trauma
Events

BSI
Sig
Dom.

Participant Participant
#1
#2
Poverty
Poverty
Child Rem Child Rem
IPV
IPV
Sex Trauma
Neglect
Fam Death
Parent Sub
Rem frm Pt
0 sig scores
O-C
I-S
DEP
ANX
HOS
PHOB
PAR
PSY

Participant
#3
Poverty
Child Rem

Participant
Participant
#4
#5
Poverty
Poverty
Child Rem Child Rem
IPV
IPV
Sex Trauma Sex Trauma
Neglect
Fam Death Fam Death

Participant
#6
Poverty

0 sig scores

SOM
O-C

Neglect

DEP
ANX

PAR

98

PAR
PSY

Table 4.8 (cont’d)
AAPI-2
Expect
Empathy
Corp Pun
Roles
Pwr-Ind
Coping
Strategy

Med Risk
Med Risk
Med Risk
Med Risk
Med Risk
Behavioral
Child Mot.

Med Risk
Med Risk
Low Risk
Med Risk
Med Risk
Behavioral
Child Mot.
Cognitive

Med Risk
Med Risk
Low Risk
Med Risk
Med Risk

Med Risk
Med Risk
Med Risk
Med Risk
Low Risk
Behavioral
Child Mot.
Cognitive

Med Risk
Med Risk
Med Risk
Med Risk
Med Risk
Behavioral
Child Mot.

Med Risk
Med Risk
Med Risk
Low Risk
Med Risk
Behavioral
Child Mot.
Child Mot.
Cognitive
Cognitive
Medication
Medication
Medication Medication
Notes. Rem frm Pt= Removed from parent; Fam Death= Death of significant family member;
Corp Pun= Corporal Punishment; Pwr-Ind=Power-Independence; Child Mot=Child motivates
Table 4.9 Participants 7-12

Trauma
Events

Participant
#7
Poverty
Child Rem
IPV

Participant
#8
Poverty
Child Rem
IPV

Participant
#9
Poverty
Child Rem
IPV
Sex Trauma
Neglect
Parent Sub
Phys Abuse
Rem frm Pt

BSI
Sig
Dom.

Participant
#10
Poverty
Child Rem.
IPV
Sex Trauma
Neglect
Fam Death
Parent Sub

O-C

0 sig scores

PSY

SOM
O-C
I-S
DEP
ANX
HOS
PHOB
PAR
PSY

Med Risk
Med Risk
High Risk
Med Risk
Med Risk

Med Risk
High Risk
Med Risk
High Risk
High Risk

Med Risk
High Risk
Med Risk
Med Risk
Med Risk

O-C
DEP
HOS

PHOB

AAPI-2
Expect
Empathy
Corp Pun
Roles
Pwr-Ind

High Risk
High Risk
High Risk
High Risk
High Risk

Med Risk
Low Risk
Low Risk
Low Risk
Med Risk

Med Risk
High Risk
High Risk
High Risk
Med Risk

99

Participant
#12
Poverty
Child Rem.
IPV
IPV
Sex Trauma Sex Trauma
Neglect
Fam Death
Phys Abuse

0 sig scores
O-C

Participant
#11
Poverty

Table 4.9 (cont’d)
Coping
Strategies

Behavioral
Behavioral
Child Mot. Child Mot.
Child Mot.
Child Mot.
Cognitive
Cognitive
Cognitive
Cognitive
Cognitive
Medication Medication
Medication Medication
Notes. Rem frm Pt= Removed from parent; Fam Death= Death of significant family member;
Corp Pun= Corporal Punishment; Pwr-Ind=Power-Independence; Child Mot= Child motivates

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Chapter 5: Discussion
The results of this investigation document the cumulative trauma and symptoms
experienced by mothers with a history of involvement in the child welfare system. Women’s
narratives confirm the deleterious effects that trauma symptoms and cumulative trauma have on
their parenting experiences. However, qualitative and quantitative data also illustrate the
participants’ remarkable sense of resilience. Whereas many of the findings of this study are
consistent with current literature on trauma survivors, the results also offer new and relevant
insights. Current findings have been used to integrate a framework explaining how their trauma
symptoms influence their parenting, which encompasses the role of formal and informal support
systems. The sections below will review the study findings according to relevant literature in the
field. Finally, strengths and limitations of the study will be highlighted as well as suggestions for
practice and future research.
Cumulative Trauma Experiences
It has long been known that women with children in the child welfare system experience
multiple stressors and are likely to report a range of trauma symptoms and cumulative trauma
(Burns-Jager & Carolan, 2010; Chemtob et al., 2011). This has been recently documented in a
study with 127 child welfare involved mothers, which found that 92% of participants
experienced one or more traumatic events and half experienced trauma symptoms (2012).
Findings from the current investigation confirm this trend as participants reported a wide range
of trauma symptomatology, as well as cumulative trauma. Specifically, women reported intense
narratives of adversity such as poverty, domestic violence, sexual trauma, childhood neglect, loss
of significant family members, and various forms of childhood abuse.
Poverty
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Although poverty is not traditionally conceptualized as trauma, the stress of managing
intense long-term poverty can be viewed as a cumulative traumatic experience, leading to the
development of complex trauma symptoms (Briere & Jordan, 2009). Access to resources can act
as a buffer against the negative effects of trauma, whereas the absence of resources can intensify
those effects (2009). Furthermore, it has been confirmed that poverty and lack of resources can
become direct precursors of abusive and neglectful treatment of children (Berger, 2004; Lee &
George, 1999; Paxson & Waldfogel, 1999; Waldfogel, 2000). All women in this study reported
being exposed to chronic poverty in addition to adverse trauma history. According to the
participants’ narratives, the prolonged exposure to poverty was particularly detrimental to their
physical and mental health.
Intimate Partner Violence (IPV)
In addition to poverty, IPV was the most common traumatic event reported by women.
This finding is relevant because it confirms research indicating that among child welfareinvolved trauma survivors, IPV is a common occurrence (Chemtob et al., 2011; Kelleher,
Gardner, Coben, Barth, Edleson, & Hazen, 2006). Moreover, data indicate that child
maltreatment and IPV are highly likely to co-occur, which has important implications for
provision of services as there is a risk for professionals to be informed according to a “tunnel
vision” that only monitors child abuse and neglect, which can lead to overlook and thoroughly
address IPV. Whereas child welfare professionals generally know that IPV is an issue for
mothers, screening continues to be inconsistent (Bourassa, Lavergne, Damant, Lessard, &
Turcotte, 2006). Remaining attentive to co-occurrence is essential not only to ensure the safety of
women and children but also to address common mental health problems resulting from

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exposure to IPV such as depression, negative view of self, and parenting deficits (CDC, 2012;
Levendosky & Graham-Bermann, 2001).
Sexual Trauma
In concurrence with the epidemiological literature on sexual violence, findings from this
study confirmed the widespread occurrence of sexual trauma, which particularly affects women
in positions of socio-economic disadvantage. In this study, 58% of participants experienced at
least one event of sexual trauma across the lifespan. In the general population, approximately
18% of women experience sexual trauma (CDC, 2012). Therefore it is not surprising to see a
higher rate in a child-welfare involved sample as these participants have been exposed to
numerous contextual challenges that constitute critical risk factors for sexual assault (2012).
Attention to the increased prevalence of sexual trauma in this population is of high relevance as
sexual trauma has been linked to emotional and psychological distress (Briere & Elliott, 2003;
Kim, Trickett, & Putnam, 2010; Griffen et al., 2006; Nishith, Mechanic, & Resick, 2000), which
women in this study confirmed. Furthermore, sexual abuse history is associated with a variety of
problematic parenting responses consistent with what mothers reported in this investigation. If
the critical influence of past experiences of sexual trauma is overlooked, the identification of
problems in mothers served by the welfare system can be narrow and thus, ineffectively address
the problematic symptoms resulting from their abuse history.
Childhood Abuse and Neglect
Neglect was a common childhood experience for women in this study, confirming
previous CDC reports indicating that neglect continues to be a widespread problem in the U.S.
(CDC, 2013). Participants in this investigation primarily experienced emotional neglect and lack
of appropriate supervision as children. No participants reported neglect related to lack of
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adequate provision of shelter, food, or medical care. Given that CDC reports also indicate child
abuse is major social issue, it was unexpected to find that only two participants reported physical
abuse as children. These participants went on to withstand multiple subsequent traumas and
trauma symptoms that drastically reduced their ability to parent. However, only one of the two
perpetuated physical abuse towards their children.
Findings support previous studies on the intergenerational transmission of abuse and
neglect (Dixon, Browne, & Hamilton-Giachritsis, 2005; Hunter & Kilstrom, 1979; Newcomb &
Locke, 2001), and confirm a need for interventions that acknowledge the cyclical nature of
family violence. Because deficits in parenting abilities can be traced back to early childhood
exposures to abuse and neglect, it is essential for this history be addressed in treatment.
Exposure to Parental Substance Abuse. One of the mechanisms that contributed to
childhood neglect for women in this study was their parents’ substance abuse (Briere & Jordan,
2009). Although women did not report their parents displaying additional mental health
problems, their narratives described home environments characterized by weak boundaries,
unstable parents, and increased risk of abuse by others due to lack of adequate monitoring and
supervision. These findings are relevant because research indicates that early exposure to
parental substance abuse and unstructured family environments are significant risk factors for
mental health problems, substance abuse, and deficient parenting (Carter & Myers, 2007; Daro &
McCurdy, 1992; Marcenko & Spence, 1995; Nair, Schuler, Black, Kettinger, & Harrington,
2003).
Death of Significant Family Member
One third of participants experienced the trauma of losing a family member to suicide or
drug-related issues. The prevalence of these losses was an unexpected finding in this
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investigation. Furthermore, the narratives illustrate that women were not the only family
members struggling with painful life experiences. Rather, family members who died from
substance abuse or suicide were also suffering mental health problems. According to research
participants, the loss of family members further exacerbated unstable family environments,
especially if the loved one was a primary support system.
According to ambiguous loss theory (Boss, 2007), these findings are relevant because not
only women were experiencing present contextual challenges, but also the loss of loved ones that
continue to be present at an emotional level in their lives. According to Boss, if important losses
in our lives remain unaddressed, they will translate into considerable mental health problems
such as depression or anxiety, which were also reported by women in this study that suffered the
death of loved ones.
Trauma Symptoms and Parenting Resulting from Cumulative Trauma
As expected, women with higher frequency and severity of trauma reported increased
complexity of trauma symptoms (Briere, Kaltman, & Green, 2008; Kubiak, 2003; Follette et al.,
1996; Rishith et al., 2000). The development of trauma symptoms and their impact on parenting
is due to the fact that women experience multiple traumas, rather than a single difficult event.
Overall, findings confirm previous research indicating the detrimental, cumulative effects of
trauma which include decreased ability to adequately function in several areas of daily life. Early
traumatic events are not disconnected from later traumas. Previous research that indicates due to
trauma symptoms, early trauma events can leave women more vulnerable to trauma later in life
(Spatz Wisdom, Czaja, & Dutton, 2007).
The most salient symptoms reported by mothers were difficulty trusting others, mood
disturbances, emotional dysregulation, identity disturbance, avoidance strategies, and health
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problems. This is in line with the symptoms that are addressed in interventions for complex
trauma survivors and disorders of extreme distress (DESNOS; Herman, 1992; Briere & Jordan,
2004). Specifically, complex trauma interventions address the issues women reported in this
study, including emotion regulation (Cloitre, 2011; Fallot & Harris, 2002), interpersonal skills
(Cloitre, 2011; Dorrepaal et al., 2011; Fallot & Harris, 2002; Zlotnick), cognitive distortions
about self and others (Waldorf & Zlotnick, 2001; Zlotnick et al., 1997) avoidance strategies and
mood disturbances (Fallot & Harris, 2002).
Women’s narratives supported the extensively documented intergenerational
transmission of child abuse and neglect (Dixon, Browne, & Hamilton-Giachritsis, 2005; Hunter
& Kilstrom, 1979; Newcomb & Locke, 2001; Reid, Patterson, & Snyder, 2004). In fact, a major
concern reported by mothers referred to the possibility of replicating the abusive and neglectful
parenting behaviors that have been modeled to them. This confirms seminal parenting research
stating that both parental developmental history (i.e. abuse and neglect), and one’s interpretation
of their parents behaviors as ‘good’ or ‘bad’ parenting, influences parenting choices (Belsky,
1984). Similar to other child welfare involved trauma survivors, the participants’ abuse histories
served as motivation to parent differently (Burns-Jager & Carolan, 2010). For example, many
emphasized how they wanted to be different from their parents and provide an experience of
emotional connection and security to their children through their parenting. Although women
desired to be better parents and had parenting beliefs focused on nurturing their children, they
also found themselves perpetuating abusive and neglectful parenting practices due to
unaddressed symptoms of depression, difficulty with trust and boundaries, emotional
dysregulation, and substance abuse.

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Trauma symptoms are an understudied factor in the intergenerational transmission of
violence, but have been shown to mediate the relationship between trauma and perpetration of
child abuse and neglect (Milner et al., 2010). Confirming existing research, these findings not
only indicate how trauma symptoms have a significant impact in the lives of participants,
including their ability to parent, but document this process in more detail (Armsworth & Stronck,
1999; Briere & Jordan, 2009; Downey & Coyne, 1990; Keller, Cummings & Davies, 2005).
Therefore, the women’s narratives illustrate how critical is to embrace a trauma lens and
strength-based perspectives to fully understand maladaptive behaviors of mothers involved in the
child welfare system (Chemtob et al., 2011; Famularo, 1994). For example, the ways in which
trauma negatively impacted the parenting practices of mothers in this study is consistent with
what has been found in research identifying trauma as a critical precursor of decreased
interaction and engagement with children, negative interactions with children, parental emotional
dysregulation, hypervigilance about children's safety, and exposure of children to other abusive
adults (Banyard et al., 2003; Becket et al., 2010; Samuels-Dennis et al., 2010). Although child
characteristics also influenced mothers’ parenting behaviors, trauma symptomatology resulting
from cumulative trauma and intensified by unsupportive contexts was a key determinant in
deficiencies associated with parenting skills. More specifically, parents struggled with ineffective
limit setting, monitoring, positive involvement, and parent-child communication.
Difficulties with Trust and Boundaries
A core experience across participants was difficulty trusting others due to repeated
interactions with others characterized by hurt and rejection (Briere & Jordan, 2009), which has
been previously documented in trauma survivors who are navigating the child welfare system
(Chemtob et al., 2011; Burns-Jager & Carolan, 2010). This trauma response inhibited
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participants’ relationships with children, partners, and caseworkers. While this issue proved to be
problematic, it is understandable why participants would adopt such a worldview based on their
trauma histories. From a feminist perspective, we can argue that the world has not been a safe
place for participants, consequently lack of trust of others is an adaptive response that has the
intention of promoting physical and emotional safety (Burstow, 2003). Participants re-counted
betrayal by friends, family members, and professionals, therefore, it would be reasonable to
expect they would have rigid boundaries within their relationships. Furthermore, participants
confirmed that survivors are likely to hold beliefs about relationships characterizing them as
sources of rejection, abandonment, and hurt (Briere & Jordan, 2009). However, women in this
study did not articulate that they deserved or were responsible for the abuse and trauma that they
have experienced in their lives, calling into question internalization processes proposed by other
researchers (Cloitre, Miranda, & Stovall-McClough et al., 2005). Following these same order of
ideas, participants’ responses to the BSI paranoid ideation scale captured women’s challenges
trusting others (Derogatis, 1982). Items on this domain include feeling others are to blame for
most of your troubles, feeling that most people cannot be trusted, feeling that you are watched or
talked about by others, others not giving you proper credit for your achievements, and feeling
that people will take advantage of you if you let them (Derogatis, 1982). Positive responses to
some of these items can be expected from trauma survivors, particularly if they are involved in
the child welfare system. For example, if a participant responds positively to feeling that she is
being watched or talked about by others, rather than an indication of paranoia, such a positive
response reflects the state of hypervigilance women developed when experiencing constant
monitoring and supervision from case managers and other service providers (Burstow, 2003;
Wells, 2006).
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One third of participants had a clinically significant score on the psychoticism scale,
which captures internal processes related to interpersonal difficulties. Items on this domain
include thinking that someone can control your thoughts, feeling lonely even when you are with
people, thinking that you should be punished for your sins, never feeling close to another person,
and considering that something is wrong with your mind. Again, positive responses to several of
these items indicate long term effects of exposure to trauma. For example, although no
participants had a positive response to the idea that someone can control your thoughts, some
participants responded positively to other items in this domain, revealing their challenges
associated with getting close to others as well as having a negative view of themselves.
In contrast, participants also described times in which they had diffuse boundaries, and
were seemingly too trustful of others. This phenomenon is explained by identity disturbances in
which women struggle with monitoring personal needs, feelings, thoughts, and behaviors (Briere
& Jordan, 2009). Women viewed the support they received from others as inconsistent. However
they had difficulty identifying how weak boundaries and unconditional trust of others left them
vulnerable to on-going trauma and revictimization. Despite this, they recognized that poor
boundaries with others was not healthy for their children.
The aforementioned findings are particularly relevant because there is a risk to interpret
specific symptomatology from a deficit-based perspective. However, the responses of research
participants describe the adaptations women have made to survive in an environment in which
they have been used by others and often times, judged by service providers without considering
the role of trauma and adversity in their lives (Blakey & Hatcher, 2013; Sykes, 2011).
Influence on Parenting. According to the data, participants’ experiences with trust and
boundary setting generally oscillated between two extremes, from rigid to diffuse boundaries.
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Similarly, their parenting practices were also characterized by these extremes. For example, a
major finding for some women referred to how difficulty trusting others led to hypervigilance of
their children. This issue confirms existing literature documenting how trauma symptoms
underlie a framework for interactions from others that is based on the perspective that the world
is a hostile place (Burstow, 2003; Briere & Jordan, 2009). Because women were concerned about
their children having the same traumatic experiences as their own, they had a heightened
sensitivity to their children’s environment and often times displayed extreme anxiety when
considering their children's safety. These findings are consistent with research conducted by
Armsworth and Stronck (1999) with incest survivors. According to these findings, survivors
permanently experience an intense fear of their children being abused, and can engage in
extreme protective behavior. Contrary to expectations, the capacity for women to be emotionally
close to their children was not affected by a difficulty trusting others. Other trauma survivors
have explained that difficulty trusting others can make it difficult to have emotionally close
relationships with their children and feel detached in their parenting (Armsworth & Stronck,
1999).
Other participants found that at times they struggled to set boundaries with others. This
carried the potential for their children to be exposed to abusive people and interactions, as well
as harm and abuse. Difficulty setting boundaries also played out in mothers’ direct interactions
with children which manifested through difficulty in limit setting practices.
Mood Disturbances and Influences on Parenting
Like other trauma survivors, participants in this study commonly experienced depression,
fatigue, and frequent worries (Briere & Jordan, 2009; Downey & Coyne, 1990; Kessler et al.
1995). These findings confirm existing literature of trauma survivors and multi-stressed parents
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involved in the child welfare system (Blakey & Hatcher, 2013; Marcenko, Lyons, & Courtney,
2011). Present findings also confirm previous studies demonstrating how depression impairs
parenting practices by increasing negative interactions and distorted perceptions of children
(Field, 1995; Guedeney, 2000). Furthermore, parents with a trauma history are more likely to
report lower parenting satisfaction when they specifically struggle with depression (Banyard,
2003). For women in this study, depression significantly reduced the quality and amount of
interactions they had with their children, including their ability to discipline. These findings
corroborate the high need for multi-stressed mothers involved in the welfare system to receive
mental health services beyond accountability-oriented interventions (Westad & McConnell,
2012). According to previous research (Kim, Trickett, & Putnam, 2010) when sexual abuse
survivors experience high levels of depressive symptoms they are more likely to use physical
violence with their children. However, this was not an overarching issue for the women in this
study.
Avoidance Strategies
It has been documented in research that avoidant coping strategies often lead to worse
outcomes for sexual abuse survivors, particularly if such strategies consist of risky behaviors
leading women to further victimization or decrease their abilities to function in various roles
(O’Dougherty, 2005). These premises were identified in the narratives provided by participants
in this investigation. Substance abuse was the primary avoidance strategy as reported by several
research participants. These women provided detailed descriptions of the ways in which
substance abuse has been as a coping strategy for trauma experiences and related emotions.
These findings have important implications for interventions with mothers engaged in the child

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welfare system because studies consistently indicate that women who abuse substances are also
at high risk for engaging in severe child abuse and neglect (Cash & Wilke, 2003).
Substance Abuse, Parenting, and Abusive Relationships. Substance abuse led to
neglectful behaviors by parents including decreased quality and interactions with children,
exposing children to potentially abusive relationships, and engaging in extreme limit setting
practices (e.g., yelling, harsh physical punishments, complete lack of monitoring). These
findings are in line with research indicating strong correlations between substance abuse
disorders and neglectful and punitive parenting (Arellano, 1996; Carter & Myers, 2007; CASA,
1999; Cash & Wilke, 2003; Hans et al., 1999; Kelley, 1998; Miller, Smyth, & Mudar, 1999;
Schuler & Nair, 2001; Young, 1997). Furthermore, substance abuse sustained abusive and
exploitative relationships with friends, family, and partners which in turn created a damaging
environment for children. This confirms that the detrimental influence of substance abuse in
women’s family functioning and community networks are associated with more neglectful
parenting practices (Cash & Wilke, 2003). Of particularly concern is the fact that when substance
abusing mothers are dealing with multiple contextual stressors, they are even more likely to
abuse or neglect their children (Nair, Schuler, Black, Kettinger & Harrington, 2003). Child
welfare-involved parents are certainly dealing with multiple stressful situations, which puts them
at risk for on-going problematic parenting.
Emotional Dysregulation
Most women struggled with regulating their emotions. This symptom exhibits the
physiological impact of cumulative trauma. According to women’s narratives, those who
experienced intense trauma, were likely to report that specific distressing situations triggered
responses as if they were experiencing the original traumatic event. These findings confirm
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existing research on the long-term effects of trauma as well as manifestations of post-traumatic
stress disorders (Briere & Jordan, 2009; Cloitre et al., 2005; Herman, 1992; van der Kolk et al.,
2005). A resounding theme across interventions for complex trauma interventions is that women
must receive emotion regulation skills training before exposure to trauma memories can take
place (Cohen , 2008 Tull, 2007). This originates from Herman’s (1992) three stage model in
which she recommends that individuals must first engage in skill building, then process trauma,
and finally re-engage into life in a way that is less affected by trauma experiences. It is also
emphasized that emotion regulation skills have to be taught early in treatment because emotional
dysregulation impairs women’s daily functioning and is a barrier to treatment engagement
(Waldorf & Zlotnick, 2001; Zlotnick et al., 1997).
Influence on Parenting. Emotional dysregulation was a catalyst for negative interactions
with children, which ranged in severity from arguing with children to becoming physically
abusive towards them. Although research on parenting identifies emotional regulation as a
critical area of intervention that can support positive parenting in other domains including limit
setting and communication (Forgatch et al., 2005; Parra-Cardona et al., 2012), research on child
welfare-involved trauma survivors has not sufficiently explored the ways in which emotional
dysregulation affects parenting (Siegel, 2013).
View of Self
Negative view of self occurs when trauma survivors associate the traumatic event with
who they are or when they blame themselves for the trauma they have experienced (Briere &
Jordan, 2009). Women confirmed that their trauma experiences influenced a negative view of
self, however they denied they were to blame for the traumatic event. Although participants had

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insights about the connection between trauma and view of self, they struggled to identify how it
impacted their interpersonal relationships.
Influence on Parenting. Research indicates that parents tend to have a poor self-concept
if they perceive themselves to have ineffective parenting skills (Forgatch et al., 2005). A
negative perception of self is particularly prevalent among trauma survivors (Banyard, 1997;
Armsworth & Stronck, 1999). Current findings indicate that this was a struggle for participants
in this study. However, much like Sykes (2011) found, women in the current study maintained
positive views of themselves in regards to their parenting, denying that viewing themselves
negatively had any impact on parenting. This documents women’s resilience and how the
identity of ‘mother’ can be a source of strength for trauma survivors. Sykes discusses this
process in the context of the child welfare system. He found the positive view of self as a parent
as an attempt by mothers to reject the ‘bad mother’ label that they are at risk of receiving from
the child welfare system. One issue he found is that holding onto an unwavering positive view of
self as a parent can lead to rejection of child welfare goals and non-compliance for
recommendations for change, which can damage progress towards having children returned to
their care (2011).
Health Issues and Parenting
Fewer women in this study reported health problems compared to those who reported
mental health issues. For women reporting health issues, somatization was a salient finding,
which confirms research demonstrating that somatization can become a central life challenge
particularly because of the slow recovery time resulting from health problems (Drossman, Li,
Leserman, Toomey, & Hu, 1996; Farley & Patsalides, 2001 Spitzer, Barnow, Wingenfeld et al.,
2009). Interpersonal trauma has been associated with physiological effects including decreased
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immune system leading chronic health problems. Participants reporting somatization issues in
this study found that health complications significantly impacted several areas of their lives
including low quality of their parenting practices due to pain and fatigue.
Abuse and Neglect
A critical finding in this investigation refers to narratives of women describing abusive
and neglectful behaviors towards their children. Often times, this issue is minimized in the
literature on survivors as deficit-based and victim-blaming perspectives continue to be
widespread in the literature and practice (Leschied, Chiodo, Whitehead, Hurley, Marshall, 2003;
Strega et al., 2008). According to research findings, participants’ abusive and neglectful
behaviors are thoroughly related to their experiences of cumulative trauma. Data also indicate the
participants’ desire to offer a nurturing and safe upbringing to their children, a finding that
challenges assumptions that depict women involved in the welfare systems as “bad or uncaring”
mothers. At the same time, data indicate the great need to avoid minimizing the severity of
abusive and neglectful behaviors perpetrated by women in this study.
Despite widespread experiences of trauma and abuse suffered by participants, only two
participants admitted using physical violence with their children. This finding is surprising given
that studies show high incidence of physical abuse among mothers who have been impacted by
negative family of origin experiences, various forms of childhood abuse, and depression
(Banyard, 1997; Kim, Trickett, & Putnam, 2010). Thus, although a majority of participants
experienced cumulative trauma and adversity in their lives, the type of abuse mostly perpetrated
by mothers in this investigation was more related to intense neglect and exposing their children
to unsafe situations (e.g., doing drugs at home with strangers). Having stated this, the two
participants who perpetrated physical abuse had a history of cumulative trauma including sexual
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abuse. This confirms literature indicating the high risk for sexual abuse survivors to engage in
punitive parenting practices if they have not been able to process their experience of abuse
(Dixon, Brown & Hamilton-Giachritsis, 2005; Dixon, Hamilton-Giachritsis, & Brown, 2005;
Kim et al., 2010).
Parenting Beliefs
Findings indicate that participants hold parenting beliefs resembling those of the general
population on all domains of the AAPI-2 (Bavolek & Keene, 1999). The fact that most
participants fall within this range of parenting beliefs constitute evidence of their strong sense of
resilience and contributes to the existing literature on mothers engaged in the child welfare
system (Baumrind 1967; 1971). Although one third of participants scored high risk on the
empathy domain (e.g., fear spoiling children, lack nurturing skills), most participants reported
high levels of empathy towards their children and had an appropriate understanding of their
children’s emotional needs.
Current data indicate that although results of the AAPI-2 document women’s resilience in
demonstrating developmentally appropriate beliefs about parenting, there are limitations to what
this means for women’s parenting behaviors. That is, for women in this study embracing positive
parenting beliefs did not necessarily translate into implementation of nurturing parenting
behaviors, a finding that has been thoroughly documented in the general parenting literature
(Forgatch et al., 2005).
Influence of Trauma on Women’s Interactions with Formal Social Systems
Despite the fact that it is well-established that parents served by the child welfare system
are likely to experience strained relationships with service providers, particularly if cases lead to
removal of children and loss of parenting rights (Alpert & Britner, 2009; Smith 2008), there is a
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scarcity of research focused on documenting the impact of trauma as mothers interact with the
child welfare system (Blakely & Hatcher, 2013; Chemtob et al., 2011). Women in this study
viewed three complex trauma symptoms as predominantly interfering with caseworker
interactions. These symptoms referred to difficulty trusting others/setting boundaries, mood
disturbances, and emotional dysregulation.
Attention to these findings is relevant because when mothers display trauma symptoms,
they may negatively impact the quality of professional relationships with their caseworkers and
the extent to which they are able to benefit from these relationships (Dawson & Berry, 2002).
There is a need for more consideration of the additional stressors associated with being
monitored by caseworkers that may trigger emotional dysregulation (Alpert & Britner, 2009;
Smith, 2008). If mothers are experiencing high emotional dysregulation and appear to case
managers as highly anxious, defensive, or uncooperative, a misinterpretation of these symptoms
could lead to the denial of supportive services or an eventual termination of parental rights,
particularly if trauma-related behaviors are recurrent. For example, some mothers in this study
described times when they yelled at caseworkers, which resulted in immediate negative
consequences such as reduction of the caseworkers’ willingness to compromise or work
collaboratively with the client. These findings confirm the call from professionals in the field to
thoroughly inform services with welfare clients according to trauma-informed frameworks
because service beneficiaries must be given all the opportunities to address unresolved trauma
and contextual challenges before custody decisions are reached (Blakey & Hatcher, 2013;
Marcenko, Lyons, & Courtney, 2007).
Alternative findings indicate that some trauma symptoms did not present problems for
interactions with caseworkers. According to the data, these symptoms were related to issues
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primarily affecting mothers but that did not bring intensity or conflict to the relationship with
caseworkers. For example, mothers reported that caseworkers were understanding of certain
issues such as substance abuse and health problems. In fact, all participants who reported
substance abuse problems were recovering successfully at the time of the interviews and they
attributed their involvement with the welfare system as a critical factor for their process of
recovery. Furthermore, participants did not consider that their negative view of self affected their
interactions with caseworkers because they saw themselves as being able to prevent their internal
struggles from impairing interactions with others. These findings highlight women’s resilience
and efforts to prevent trauma symptoms from affecting their relationships with caseworkers and
others (Banyard & Williams, 2007; Wright et al., 2005).
However, it is when mothers displayed aggressive or rejecting behaviors towards
caseworkers that the professional relationship was more likely to be damaged. Current findings
confirm the vast literature in the mental health field indicating that the nature of the professionalclient interaction is a core pillar of the helping process (Duncan, Miller, Wampold & Hubble,
2009). Furthermore, current findings indicate the high need for training service providers in the
management of aggressive or defensive behaviors directed towards them but that stem from
clients’ histories of trauma and adversity.
Supportive and Unsupportive Contexts
As an ecologically-informed study, women’s context was considered in relation to the
process by which trauma influences parenting. Supportive contexts reduced the possibility for
women's trauma symptoms to negatively impact their parenting practices. This is consistent with
research indicating that even when parents have a challenging developmental history, cumulative
trauma, or individual mental health problems, a supportive context can be essential to improve
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parent-child interactions (Banyard, 2007; Belsky, 1984 O’Dougherty, 2005). For example,
Stevens and colleagues (2002) found that supportive systems were strong mediators in helping
trauma survivors manage stress, anger, parenting beliefs, and parent-child interactions. Likewise,
an unsupportive system or lack of support system exacerbated trauma symptoms, which concur
with data from this investigation.
It is important to clarify that for the women in this study, supportive and unsupportive
systems were not dichotomous groups. That is, women reported that their most immediate social
networks were at times supportive as well as unsupportive, a finding that has important
implications for provision of services as providers should always keep in mind the possibility for
women’s support networks to represent contrasting realities. Finally, data indicate that positive
support led to positive parenting practices, whereas negative support or lack of support
intensified trauma symptoms and negative parenting behaviors (Kim, Trickett & Putnam, 2010).
Family Members. As previously stated, women reported that family members were
sources of support as well as stress. According to participants’ narratives, when families were
supportive they provided a buffer for mothers to cope with difficult experiences and trauma
symptoms. Supportive family members also assisted in providing women with emotional and
instrumental resources that improved their parenting practices and involvement with the child
welfare system.
Alternatively, family members were also a source of stress and trauma for women,
leaving women feeling vulnerable to hurt and disappointment, particularly if family members
engaged in abusive behaviors that further exacerbated women’s trauma symptoms. Present
results confirm existing research indicating the potential dual nature of immediate social
networks for women who are trauma survivors and who are exposed to multiple contextual
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challenges and adversity (Sharp & Marcus-Mendoza, 2001). Thus, these findings indicate how
critical is to consider the potential duality of immediate social support networks in the lives of
women that share common backgrounds and life challenges with the participants in this study.
Current and Former Partners. According to O’Dougherty (2005), supportive partners
can offer a particularly buffering effect that helps trauma survivors cope with trauma symptoms
(e.g., depression), as well as enhance their parenting behaviors. A few participants confirmed
these findings as they described the positive effects of being in relationships with supportive
partners. However, the majority of participants reported relationships with current or former
partners characterized by inconsistent support and even abuse. For example, although half of
participants viewed their current or former partners as supportive, they also had survived some
form of IPV with these same partners. Furthermore, the narratives of women confirmed findings
by Johnson and Sullivan (2008) describing how battering partners are likely to engage in
manipulative behaviors with caseworkers, which in turn made navigating the child welfare
system more challenging for mothers particularly if batterers are effective in conveying an image
of mothers as “uncontrollable or crazy.”
Resembling previous studies with a focus on IPV, women believed child welfare workers
did not have sufficient skills to screen for IPV nor the necessary knowledge to handle these cases
(Douglas & Walsh, 2010). Similarly, studies have found discrepancies between child welfare
professionals and mothers on the topic of managing domestic violence (Schim et al., 2010). For
example, mothers may want to end the abuse but maintain their partnership and caseworkers may
only pursue termination of IPV and the abuser-victim relationship.
Finally, four participants reported that their children’s fathers were uninvolved. These
findings confirm existing research identifying women as the primary caretakers of children,
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experiencing high levels of stress and minimal support from fathers, which leaves them at a high
risk for perpetrating abuse and neglect (Risley-Curtis & Heffernan, 2003; Strega et al., 2008).
Friends. Slightly less than half of participants found their friends to be supportive,
whereas the rest of the sample characterized their relationships as highly conflictual or
maintained solely around substance use behaviors. Various studies (Coker et al., 2002; Coker et
al., 2003; Samuels-Dennis et al., 2010) have established that social support networks can prevent
survivors from engaging in abusive relationships and serve as protective factors against trauma
symptomatology. Conversely, research (Samuels-Dennis et al., 2010) also shows an association
between women’s trauma experiences and deteriorated friendships. In this study, although
participants were able to identify the type and level of support provided by friends, there were no
reflections about how their personal behaviors impacted relationships with friends.
Caseworkers. Caseworkers were also perceived as supportive in various situations, but
also as uncommitted to success of parents. Regardless, a consistent tendency among participants
was to describe caseworkers as instrumentally supportive. These findings are relevant and
confirm existing literature indicating the critical role of caseworkers in the lives of child welfare
recipients (Alpert & Britner, 2009; Hill et al., 2012; Ryan et al., 2006; Smith, 2008). The current
study confirms that parents in child welfare would like more emotional support from
caseworkers (Alpert, 2008). Furthermore, present findings confirm the need to investigate ways
in which the unrealistic and strenuous demands placed on caseworkers by the system and their
lack of training (e.g., cumulative trauma), may set professionals up for failure in the face of
relationships with clients suffering intense trauma symptomatology (Font, 2012; Kyonne, 2008).
Mothers’ commitment to the goals set by child welfare caseworkers is conducive to
promoting child safety and well-being (Waldfogel, 1998). Therefore, finding ways to increase
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mothers’ engagement is essential. Current results highlight the need for caseworks and child
welfare professionals to remain attentive to the ways in which the investigation of service
recipients’ parenting practices may further trigger trauma-related responses from survivors (Hill
et al., 2012). Attention to this issue may alter women’s perceptions of caseworkers and improve
their willingness to collaborate with caseworkers.
Other service providers. Generally, non-caseworker professionals were viewed
positively by participants. Some of the supportive professionals participants found particularly
helpful included therapists, parent-support partners, and medical case managers. These findings
confirm that non-caseworker helping professionals who do not have the responsibility of
evaluating parenting performance do not have the additional burden experienced by caseworkers
whose responsibility is to make recommendations about returning children to biological parents
(Font, 2012; Kyonne, 2008). These referrals were primarily supportive to clients, with less of an
emphasis on evaluation of parenting, which allows for greater capacity to trust and establish
working relationships. Having these types of referrals is beneficial to improving parenting, but
also facilitates healing from trauma through trusting relationships. Although not surprising, these
findings indicate the high need for interdisciplinary work and collaboration in the child welfare
system under the umbrella of cumulative trauma and healing, particularly because there is a risk
of labeling some professionals as the “good” helpers while holding caseworkers on a negative
lens (Sykes, 2011). Furthermore, these findings highlight the need for research aimed at
experiencing the personal and professional experiences of caseworkers committed to help others
but operating in a resource-exhausted system and engaging in frequent emotionally straining
interactions with parents and children (Font, 2012; Kyonne, 2008).
Trauma-coping and Resilient Parenting Behaviors
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According to a feminist perspective, it is essential to highlight the strengths of women in
this study. Despite intense stories of adversity, all women in this study embraced a remarkable
sense of resilience, as has previously been documented regarding child welfare involved-trauma
survivors (Chemtob et al., 2011; Burns-Jager & Carolan, 2010). Utilization of coping skills is
essential to healing from trauma. As a result, skills-training is often emphasized in treatment for
complex trauma survivors. Interventions for trauma survivors teach the coping skills women in
this study displayed including confronting problems, positive self-talk, and relaxation (Waldorf
& Zlotnick, 2001; Zlotnick et al., 1997).
Coping and Resilient Behaviors Reported by Women
Garmezy (1990) has described three types of resilience according to level of individual
functioning. This typology is helpful to understand the nature of resilience reported by women in
this study. The first type of resilience identified by Garmezy refers to the highest level of
adaptive functioning individuals can reach despite the adversity they have experienced. The
second type of resilience refers to individuals being able to maintain normal functioning levels
despite adverse life experiences. The final type of resilience refers to individuals who initially
display adverse effects resulting from difficult life experiences, but who are able to gradually
adapt and display normative functioning. Women in this investigation tend to fall in the third
category of resilient individuals. In essence, all participants experienced profound trauma and
subsequently displayed maladaptive coping strategies in response to adversity. However, over
time and with the support of meaningful personal and professional relationships, they have
adapted and displayed remarkable resilient behaviors. Findings in this study parallel assertions
by other studies indicating that effective trauma coping is associated with relationship

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satisfaction, less isolation, improved health, and use of healthier parenting skills (Wright,
Crawford, & Sebastian, 2007).
For example, women in the current study used cognitive and behavioral strategies to cope
with trauma and the effects of trauma. Armsworth and Stronck (1999) observed similar resilient
behaviors in their study on child welfare involved mothers. Specifically, their participants
engaged in cognitive strategies methods such as stopping self-defeating thought processes and
integrating behavioral coping behaviors to reduce the negative effects of trauma symptoms.
Similarly to current findings, the relationship women had with their children was a significant
source of resilience and many of the women also cited their children and past experiences as
motivation for making changes in their lives (1999; Burns-Jager & Carolan, 2010).
A point of divergence with Armsworth and Stronck’s research, referred to women in the
current study being more likely to use medication to deal with trauma symptoms. Specifically,
women felt that the medical treatment of their mental health was a crucial component of their
recovery. Although it is not common in the resilience literature to identify the use of medication
as a coping mechanism (Chemtob et al., 2011; Sholtes, 2001), current findings indicate the high
need to remain attentive to preconceived notions of resilience and always nurture the promotion
of resilient behaviors according to what women identify as meaningful resources for recovery.
Women’s descriptions of the benefits of medication to regulate symptoms should not go without
notice.
Additional Signs of Recovery
A primary step of trauma recovery requires the capacity to master trauma memories and
associated physiological reactions and emotions. Women in this study displayed progress
towards achieving these skills, which improved interactions with children and caseworkers
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(Harvey, 1996). Another sign of trauma recovery was women’s capacity to develop a positive
view of self. Specifically, when survivors reported being able to feel satisfied with themselves in
interaction with others, they were more able to make further strides in their process of recovery,
which confirms existing literature on the important effects associated with developing a strong
sense of self (Banyard, 2007). However, it is important to highlight that for some women in this
study having a positive view of self, did not seem to prevent them from having on-going
relationships that were abusive or exploitative. One possible explanation for this phenomenon
refers to Harvey’s (1996) considerations on trauma and relationships, which states that exposure
to trauma significantly damages the ability to trust others, hindering the capacity to engage in
healthy, non-exploitative, and secure relationships.
Although some authors consider that an essential step in trauma recovery consists of
assigning meaning to traumatic events (Herman, 1992; Walker, 2007), and that if trauma is not
processed the individual’s mental health will continue to deteriorate, research participants did not
uniformly reported engaging in this meaning-making experience. What participants did
commonly state is how they wanted to learn from their parents’ mistakes. Thus, one meaning
derived from their trauma was learning what type of parent they wanted to be to their children.
Scholars have proposed that experiencing cumulative trauma does not constitute a sole
predictor for an individual’s perception of sense of control in life, however, the more traumatic
events an individual experiences, the more challenging it will be to reach a sense of control in
life (Agaibi, 2005; Ammerman, 1990; Benight & Bandura, 2003; Werner & Smith, 1989).
Furthermore, high levels of self-efficacy support women in continuing to participate and expand
their “resource network” despite the presence of trauma symptoms (Walter, 2010). Both
premises were confirmed in this study according to the data.
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Positive Parenting
Women reported several authoritative and engaged parenting behaviors. Moreover, the
results of the AAPI-2 demonstrate that mothers’ parenting beliefs concur with those of the
majority of parents in the general population (Bavolek & Keene, 1999). For example, mothers
reported feeling bonded to their children, learning how to set appropriate and non-punitive limits,
and increasing emotional and nurturing-based patterns of communication with their children. The
participants’ ability to embrace these parenting experiences constitutes evidence of their process
of change and recovery from trauma and adversity (Banyard et al., 2003; Banyard & Williams,
2007; Baumrind, 1967; Baumrind, 1971; O’Dougherty, 2005; Reid, Patterson, & Snyder, 2004).
Furthermore, despite qualitative reports of incest survivors describing feeling numb or
detached from their parenting roles (Armsworth & Stronck, 1999), mothers in this study
conveyed a very different experience. Specifically, research participants felt highly connected to
their children and over time, viewed themselves positively in their parenting role. This finding
also confirms research indicating that holding a positive self-perception as parent, further
enhances a process of recovery from adversity (Banyard, 2007).
Strengths and Limitations of the Investigation
Important limitations associated with this study must be identified. First, results are
limited to self-report data, which inherently carries the risk of bias as the parenting literature has
confirmed when comparing and contrasting self-report and parent-child observations of
parenting interactions. Thus, participants may have experienced personal biases when reporting
how trauma affects various areas of their lives
Because this study was qualitative in nature, findings cannot be generalized to the larger
population. This investigation was also limited based on sampling characteristics as participants
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in this study were predominantly of Euro-American descent, excluding the possibility to fully
capture the experiences of racial and ethnic minority women.
Furthermore, important macro-level variables were not sufficiently explored due to
research design limitations. Thus, the impact of variables such as economic and employment
climate, child welfare policies, institutional patriarchy, sexism, and racism were not sufficiently
explored.
Finally, the sample size is small for a grounded theory study. Although several strategies
were implemented to increase the sample size, the multiple challenges experienced by this
population became considerable barriers to the recruitment process as women initially screened
reported multiple contextual stressors that competed with their participation in this study (e.g.,
transportation and child care challenges, personal and medical emergencies).
Because participants were of a convenience sample, there are inherent biases. Several
other women were recruited to participate in the study. It is hypothesized that the women in the
sample’s ability to participate make speak to their resilience. Women who wanted to participate
were potentially unable to due to on-going stressors. Therefore, this grounded theory may not
capture the intensity of trauma or life challenges of other women in the child welfare system who
may not have had the instrumental or emotional resources to participate.
Notwithstanding these limitations, this study offers a relevant contribution to an
understudied area of research and applied scholarship. First, there is a scarcity of research
documenting how cumulative trauma and trauma symptomatology constitute barriers to the
parenting experiences of women involved with the child welfare system. Thus, this study
captures with detailed personal accounts how trauma symptoms impact the participants’ parentchild interactions, as well as other meaningful life experiences.
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This investigation also gives voice to women regarding their trauma and child welfare
experiences. This population holds a minority status and position in the system, and they run the
risk of being looked down upon as being ‘bad’ parents. Therefore, this study acknowledges and
privileges their perceptions of events as opposed to others in the child welfare system who hold
more power and who may only depict them according to deficit-based perspectives.
Finally, the collection of quantitative and qualitative data provides an opportunity to
triangulate information, as well as obtaining an in-depth description of the complexity of
women’s parenting experiences, cumulative trauma, and trauma symptoms. This data collection
strategy also allows for the identification of data focused on resilience that may not be captured
by relying exclusively on one method of data collection.
Future Research Directions
Future studies would benefit from interviewing caseworkers and other professionals
about their interactions and perceptions of clients with a trauma history. It would be particularly
beneficial to learn how caseworkers interpret and view their own responses to survivors’
narratives of adversity. For example, caseworkers and therapists could be interviewed about how
they have seen trauma influence their clients. It would be equally beneficial to investigate with
these professionals how equipped do they consider their agencies are to deal with such issues, as
well as to the extent to which their level of training is sufficient to deal with the confounding
problems that affect women (e.g., cumulative trauma and neglectful parenting).
There is also a need for in-depth quantitative investigations on the connection between
trauma symptoms and parenting behaviors. Quantitative research in this area is imperative. For
instance, an important contribution would consist of studies aimed at quantitatively assessing the
level of impact of cumulative trauma on women’s parenting practices and skills. Currently,
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quantitative research has established that trauma history predicts poor parenting, however, much
more detailed research is needed to further clarify mechanisms of moderation and mediation
associated with these processes.
Because trauma symptoms are not mutually exclusive, future research needs to
investigate patterns of association among specific trauma symptoms in order to maximize
diagnosis and treatment focused on co-occurring disorders (i.e., mental health and substance
abuse disorders). Future studies also need to explore the potential benefit of adapting parenting
interventions by fully considering the nature and impact of cumulative trauma and trauma
symptomatology. For example, research with mothers in the general population with a history of
adversity have reported benefiting from parenting interventions that emphasize self-regulation
and non-punitive parenting strategies (Forgatch et al., 2005). Future studies should also
investigate the differential impact associated with differential level of adaptation aimed at
addressing cumulative trauma. Finally, because this study was characterized by multiple
implementation challenges, research is needed to document the most optimal recruitment and
retention strategies aimed at engaging women in applied research with this underserved
populations.
This will be extremely important to explore as racial minorities face the added trauma of
social inequality and racism. Professionals need to understand minority women's experiences as
they are overrepresented in the child welfare system (CDC, 2012; Blakey & Hatcher, 2013).
Implications for Interventions
Current findings have important implications for caseworkers, mental health
professionals including family therapists, and administrators committed to working with mothers

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with a trauma history who are involved with the child welfare system. Specific recommendations
are discussed below.
Recommendations for Caseworkers. Viewing women's problematic interactional and
parenting behaviors from a trauma perspective will be particularly helpful to caseworkers,
particularly because it provides a direction for intervention that has the potential to be more
effective and engaging for women in the child welfare system. Thus, it is essential that providers
acknowledge the role of trauma in the lives of women involved in the child welfare system. As
Burstow (2003) states, overlooking this factor minimizes their trauma, thus further perpetrating
women’s difficulty trusting others and preventing healing from taking place. Acknowledging
trauma in and of itself can be validating and trust-building for clients. The results of this study
can inform provision of services to mothers with a trauma history who are child welfare
involved. It is essential that services are provided in a trauma-sensitive manner (Chemtob et al.,
2011; Burns-Jager & Carolan, 2010). For this population it is irrelevant to suggest that painful or
traumatic events will not happen. Rather, counselors and caseworkers need to assist clients in
developing skills to cope and problem solve whenever painful events occur.
Establish Trust. Caseworkers and professionals need to expect that mothers will struggle
to trust professionals. As a result, caseworkers need to react to mistrust with empathy and
understanding. One way of establishing trust will be to communicate with trauma survivors in a
clear, direct manner. Failure to do so, will likely heighten mistrust towards caseworkers.
Caseworkers will also benefit from approaching cases collaboratively with clients. Women who
have been abused often times feel powerless. Thus, whenever a caseworker takes a punitive
authoritarian approach resembling perpetrator actions, survivors are exposed to secondary
victimization through triggering trauma symptoms and perpetuating feelings of powerlessness.
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There is concern that trust between caseworkers and mothers is strained because
caseworkers are focused on parent accountability for abuse or neglect, while parents deny
accountability to maintain a positive view of self as a parent (Sykes, 2011). As a result, it has
been suggested to first secure a trusting relationship and parent engagement, prior to promoting
accountability (2011). Rather than abandon parent accountability, caseworkers may benefit from
seeking parents to understand behaviors as abusive or neglectful as a result of trauma
experiences.
Set and Model Appropriate Boundaries. Mothers involved in the child welfare system
have had many negative interactions with people that fuel lack of trust. One way to establish
trust and build a relationship with this population will be to use a strength-based approach rather
than deficit-based. Women in the current study often felt like their caseworkers focused heavily
on what they did wrong and rarely acknowledged successes. Plenty of research supports that
strength-based approaches and positive reinforcement are more effective ways of changing
behaviors than use of criticism and punishment.
Understand Emotional Dysregulation. Responding calmly to the behaviors women
commonly display with caseworkers would be challenging for most people. When someone is
screaming or cursing, it is definitely hard to be understanding. No doubt, caseworkers often face
this issue with the clients they serve. As a result, caseworkers must be able to approach these
tresponses from a trauma-sensitive lens. In these situations, it is appropriate for caseworkers to
communicate boundaries and expectations for interactions. Clients must also be supported to
identify and eventually control behaviors resulting from emotional dysregulation.
Compassionate responses will benefit the relationship by further establishing trust between
caseworkers and clients.
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Response to Supportive and Unsupportive Contexts. The child welfare system carries
the risk of being perceived as insensitive to the role of IPV in mothers' lives and of blaming the
woman for children's exposure to IPV. For example, women survivors of IPV have had their
children removed due to their 'failure to protect'. This dismisses the extent of the power that a
batterer establishes over his partner through manipulation and tactics of power and control.
Caseworkers need to be aware of up-to-date recommendations on managing cases where
IPV has occurred as well as to be guided by women’s desires with regards to their relationships.
For example, traditional IPV services have an agenda of complete separation from the abuser,
which alienates women who wish to end the abuse but preserve the relationship. Thus,
caseworkers must always remain attentive to the participants’ desires and life goals.
Recommendations for Child Welfare Administrators. Participants’ experiences with
caseworkers in the current study highlight the need for structural improvements within the child
welfare system, particularly because the burden of implementing trauma-sensitive practices in
the child welfare system cannot be fully placed on caseworkers. Thus, administrators play an
important role in creating a system that can promote and sustain these types of interventions.
Primarily training on trauma-sensitive practice must be valued and implemented at the
administrative level. Moreover, in order for caseworkers to maintain a trauma-informed
practicewith survivors, caseworkers will need a more supportive, less stressful work
environment. Burn-out is a very common problem in the child welfare field correlated with high
case-loads, low pay, low autonomy, and emotionally taxing work responsibilities (Font, 2012;
Kyonne, 2008). Therefore, funds need to be allocated to better compensation of caseworkers and
hiring of more staff to mitigate these issues that likely impair the quality of service that is

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provided. Providing trauma-sensitive services would require extra time and care with clients,
which may be challenging for caseworkers who are in over-exhausted agencies.
Recommendations for Family Therapists and Other Mental Health Professionals.
Few interventions for complex trauma have been tested in the mental health field and debate
exists regarding the most efficacious approaches (Cloitre, 2002; Waldorf & Zlotnick, 2001;
Zlotnick, Shea, Rosen et al. 1997). Conclusions from the research suggest that complex trauma
interventions for childhood maltreatment should focus first on skills training to assist in
symptom reduction before focusing on trauma- exposure components (i.e. Cloitre, 2002).
According to the data, the recommendations for treatment proposed by Briere and Carol (2004)
are timely and should consist of safety planning, establishing an empathic therapeutic alliance,
trauma processing, addressing negative view of self, working on mood disturbances, treating,
and promoting advocacy and use of psychotropic medications for mood disorders.
Establish trust. Clinicians must take time to establish trust and ensure that they are using
clear and direct communication with mothers. Whereas this is crucial in joining with any client,
therapists must take extra care and time to establish trust with child welfare-involved trauma
survivors. This is in-line with Briere’s recommendations. He emphasizes that trust is an essential
technique with trauma survivors and that without it, therapy will be unsuccessful. He further
insists that gaining the trust of survivors takes time. Therapist should not expect to quickly join
with survivors, and be patient in earning their trust. It is critical that therapists do not
underestimate the importance of this step in therapy.
Another way to establish trust is to focus on clients’ strengths. As indicated by the results
of this study, there is a potential disconnect between parenting beliefs and actual behaviors.
Although this may be the case, it provides a starting point for parenting interventions with the
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goal being more integration of parenting beliefs and behaviors. Therapists can validate parents
that mothers’ beliefs about parenting are accurate, however it is trauma symptomology that
interferes with their ability to adhere to belief systems.
Psychoeducation. Before parenting-specific interventions are used, interventionists will
need to educate participants about typical trauma symptoms associated with complex trauma
including interpersonal disturbances, emotional dysregulation, identity and cognitive distortions,
avoidance responses, somatization, and mood disturbances (Briere, 2009). It may be helpful for
professionals to describe how traumatic events and specific triggers can lead to trauma
symptoms. Understanding their reactions can be empowering for survivors and a first step to
mastering their symptoms. This is a way to acknowledge that women are having interpersonal
problems, but also removes blame and instills personal agency. Psychoeducation further helps to
balance acknowledging abuse and neglect, while being empathic to the causes of these issues.
Inclusion of Support Systems. Therapists must be cognizant that that women will learn
healthier interactional and parenting styles in therapy, but will return to social contexts that are
likely to uphold abusive or exploitative relationships. Therefore, clinicians should always find
ways to expand informal support systems.
Furthermore, IPV survivors are often held responsible for abuse against their children
overlooking the role of perpetrators. In many cases, child welfare agencies such as Child
Protective Services (CPS) refer to this as failure to protect their children, without considering
key IPV dynamics. As a result, interventionists need to be familiar about dynamics commonly
associated with IPV and the risk for secondary victimization of survivors.
Emotional Regulation Skills Training. For women in this study poor ability to regulate
emotions hurt relationships with others including interactions with their children. As a result,
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parenting interventions need to provide skills training on emotion regulation. Examples of skills
that could be taught include deep breathing, taking a time-out from distressing situations,
identifying emotions, and awareness of physiological responses associated with emotions.
Treatment of Mood Disturbance and Substance Abuse. Mood disturbances and
substance abuse are additional major concerns for trauma survivors. Therefore, women need
strategies for self-care, cognitive behavioral strategies for negative thoughts and underlying
depression. Given the frequency of substance abuse as a coping strategy for trauma and
symptoms, it is crucial that parents are assessed for substance abuse and referred to adequate
services as needed. The use of medication to treat mood disturbances was a major finding in this
study, highlighting to mental health professionals the critical need for interdisciplinary work.
Self of the Researcher
It’s important for me to acknowledge that I hold a dual role as a researcher and as a
therapist who provides services to child-welfare involved mothers. My experiences as a therapist
informed the analysis of the data. Particularly, my experiences have allowed me to witness the
pain child-welfare involved mothers endure and how the child welfare system contributes to
women’s trauma and reinforces trauma symptoms. As a feminist researcher and therapist, my
position is not neutral, but rather as an advocate for improved interventions for trauma survivors.
This investigation, as a result, had the purpose of privileging mother’s narratives of resilience
and trauma and connecting these narratives to the context in which women exist. I was amazed
by women’s ability to be resilient despite the horrific experiences they’ve been through.
Additionally, their commitment to their children and getting better for their children was very
powerful to witness; especially given that this narrative is often silenced.

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One concern I had in conducting interviews was that women would be rightfully guarded
in speaking with me. However, women were incredibly open and candid during interviews. I was
humbled when many of the women were appreciative of the study, for having the opportunity to
tell their story, and to have their experiences validated. Women were interested in providing any
information that might help make another parent’s experience with the child welfare system
better.
I also want to acknowledge my position of power in organizing and synthesizing the
results of interviews, as well as my social position which is one of a White, middle-class
graduate student. The position I hold influences the way I view participants and interpret the
data. However, I attempted to use this position of privilege to advocate for trauma survivors and
the adaptation of interventions to better suit survivors’ needs.
Conclusion
This study offers a contribution to our understanding of the life and parenting
experiences of mothers involved in the child welfare system. Despite limitations associated with
a small sample size, this investigation offers meaningful first-person accounts of the participants’
experiences with trauma and adversity, as well as powerful testimonies of personal resilience.
Moreover, this study offers relevant information for adapting interventions for survivors served
by the welfare system. Findings clearly confirm the need to inform services and interventions for
this population according to a thorough understanding of the adversity they have experienced, as
well as the multiple resources and sense of resilience that inform their lives.

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APPENDICES

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APPENDIX A

Study Consent Form

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How Child Welfare Involved Mothers’ Trauma History Influences Parenting: A
Grounded Theory Study
Consent Form
Purpose of the Study:
The study entitled, “How Child Welfare Involved Mothers’ Trauma History Influences
Parenting: A Grounded Theory Study” is being conducted to explore how difficult life
experiences influence how parents interact with their children. The goal of this study is to inform
caseworkers, therapists, and other professionals on how clients’ difficult life experiences explain
some of the struggles they have with their parenting and in navigating the various services to
which they are referred. We hope that this study will promote greater empathy and understanding
for clients and that it will help make services and interventions more effective.
What your participation would include:
There are two components to this study that you would complete if you choose to be a
part of the study. One component is an interview that would take approximately 1 hour. During
the interview you will be asked questions about any difficult life experiences you have had
throughout your life and how you think these difficult experiences have influenced your
parenting. You will also be asked about your experiences dealing with caseworkers and service
providers who are associated with the Department of Human Services (DHS). It is necessary that
interviews are audio-recorded to ensure that we accurately document your responses. By
consenting to participate in the study you are consenting to have your responses in the interview
audio-recorded.
The second component of participation in this study consists of paper and pencil
assessments. One assessment asks questions about your parenting beliefs, and another
assessment asks questions about different symptoms you have experienced in the past. You will
also answer some general questions about yourself (marital status, age, etc.). For your time and
effort given for participating in the study you would be compensated in a $25 gift card to a local
department store of your choice (Meijer, Kroger, Wal-Mart).
Privacy and Confidentiality:
Your confidentiality will be protected to the maximum extent allowable by law.
Confidentiality would only be broken if you report abuse of children, elderly adults, or if you
report you are going to harm yourself or someone else. If we suspect a child is or may be abused
or neglected, we must contact Children’s Protective Health Services immediately. The
assessments you complete will be assigned a participant ID number and will not have identifying
information so you will not be linked with any results. Unidentified data will be shared will be
shared with members of my doctoral committee. The Michigan State University Human Subjects
Protection Program may also have access to your data in the event of an audit. The recording of
your interview will be labeled with an ID number and will not be linked in any way to your
contact information. Your contact information and unidentifiable results of assessments and the
interview will be stored in a locked file in a locked office and on the researcher’s password
protected computer. We will keep all data associated with this research project for three years
after the project is closed, during which time it will be stored in a locked file in the principal
investigator’s office.
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The findings of this study will be reported to many people and organizations. People who
may hear the findings of this study include students and faculty and Michigan State University,
the Ingham County Department of Human Services, the Institutional Review Boards monitoring
the project, and the larger academic community. When the results of this study are presented and
published, pseudonyms will be used and any identifying private information will be modified or
omitted to protect the identity of participants.
Although Kathleen Burns-Jager referred you to this study, the researcher will not inform
her about whether or not you participated in the study. However, if you choose to hold your
interview at Perspectives Therapy Services, there is a chance that she will see you since her
office is located in this building. If this were to happen, her knowledge of your participation will
not affect your therapeutic services.
Your Rights to Participate, Say No, or Withdraw:
Participation in this research study is completely voluntary. You may say no to
participation or you may change your mind and decide to stop participating at any time with no
negative consequences. You may also choose not to answer any question you do not want to
answer. Withdrawing from the study or not answering questions would not prevent you from
receiving compensation for participation in the study.
Potential Risks and Benefits:
There is a risk that you might experience some discomfort while participating in this
study. For example you might feel uncomfortable reporting demographic information or
discussing difficult experiences you have had throughout your life. Please remember that your
confidentiality will be protected and your identity will not be connected to your answers. If you
do experience discomfort you may choose to not answer a question, take a break from answering
questions, or you may stop participating in the study at any time with no penalty.
You may experience benefits from participating in this study. You may experience some
relief in discussing past life experiences and to explain how you perceive those difficult life
experiences have interfered with your parenting. You can also provide feedback on how services
can better meet your needs. You may experience a sense of satisfaction in knowing that you are a
part of a project that is seeking to better inform DHS professionals on the difficult life
experiences of clients and how those life experiences have effected them so that DHS
professionals can better meet their needs.
Contact Information for Questions or Concerns:
If you have questions or concerns about this study including scientific issues, how to participate,
or to report any harm, please contact the researchers directly:
Emily Schmittel, M.A.

J. Ruben Parra Cardona, Ph.D.

Michigan State University
Human Development & Family Studies
Studies
Phone: (636) 359-1666

Michigan State University
Human Development & Family
3D Human Ecology
140

Email: schmi368@msu.edu

East Lansing, MI 48824-1030
Phone: (517)432-2269
Email: parracar@msu.edu

In addition if you have questions or concerns about your role and rights as a research participant,
would like to obtain information or offer input, or would like to register a complaint about this
research study, you may contact, anonymously if you wish, Michigan State University Human
Research Protection
Program at 517-335-2180, FAX: 517-432-4503, or email irb@msu.edu, or postal mail at: 408
West Circle Dr., MSU, East Lansing, MI 48824.
Informed Consent
You indicate your voluntary agreement to participate in this research and have your answers
included in the data set by completing and returning the attached questionnaires.
If we suspect a child is or may be abused or neglected, we must contact Children’s Protective
Health Services immediately.
You will be given a copy of this form to
keep.

141

APPENDIX B

Demographic Questionnaire

142

Demographic Questionnaire:
1. How old are you? ____________________________________________________________
2. What is your ethnicity? _______________________________________________________
3. How many children do you have? _______________________________________________
4. What are your children’s ages? _________________________________________________
5. Do your children live with you? _________________________________________________
6. If your children don’t live with you, how often do you see your children? ________________
7. Are you employed? ___________________________________________________________
8. What is your relationship status? _________________________________________________
9. What is the highest grade in school you completed?__________________________________
10. What is your approximate annual income?_________________________________________

143

APPENDIX C

Structured Interview Guide

144

Structured Interview Guide
INTRODUCTION: Thank you for agreeing to participate in this study. First let me tell you a
little bit about why I’m doing this study and what I am looking for in our interview today. I am a
family therapist and for the past few years I have primarily been working with parents and
families who have been involved with the Department of Human Services (DHS) and foster care.
One of the things that I have noticed in working with parents is that they often have had a lot of
really difficult life experiences before ever dealing with DHS. One of the problems that I have
run into is that these difficult experiences are not always taken into account by caseworkers,
judges, and even therapists in understanding why parents may be having difficulties with their
children. So what I am trying to do is put together some ideas on how parents’ difficult life
experiences influence their parenting to help all of those professionals really understand parents’
struggles with their children. I am hoping that this information can help them also be more
effective in getting parents the services and help they need. So I’ll be asking you about some of
the difficult experiences you’ve had and how you think they may or may not have influenced
your parenting. I will also tell you a little bit about ways we know how difficult experiences can
influence parenting and ask you if they fit with your experience or not. Finally, I’ll be asking you
about whether or not service-providers have been understanding of your experiences, and if you
have any suggestions for service-providers related to this topic.

GRAND TOUR QUESTION #1: TRAUMA HISTORY
First, please tell me about the most difficult experiences you had while growing up?
Probes:
 How do you think each experience affected you?
 How do you think each experience affected how you interact with others?
 How do you think each experience affected how you see yourself?
 How do you think each experience affected how you interact with your children or how
you make parenting decisions?
GRAND TOUR QUESTION #2: TRAUMA SYMPTOMS
You completed one assessment that refers to many symptoms commonly experienced by
people who have been exposed to intense challenges in life.
Which of these symptoms do you consider constitute the greatest challenge(s) to your
parenting efforts?
Probes:
145

How challenging are the following with regards to your parenting efforts?:
Identity disturbances
How challenging does confusion about your feelings, thoughts, and goals that make it difficult to
set boundaries with others make it for you to…
 parent your child?
 maintain healthy social relationships?
 interact with child welfare professionals?
Mood Disturbances
How challenging do depression and anxiety make it for you to…
 parent your child?
 maintain healthy social relationships?
 interact with child welfare professionals?
Avoidance responses
How challenging do difficulties dealing with or confronting problems; wanting to use strategies
to avoid dealing with problems; using substances, dissociating, hurting self make it for you to…
 parent your child?
 maintain healthy social relationships?
 interact with child welfare professionals?
Interpersonal difficulties
How challenging do difficulties with trusting others, getting close to others, fear of rejection or
abandonment make it for you to…




parent your child?
maintain healthy social relationships?
interact with child welfare professionals?

Cognitive disturbances
How challenging do negative views and beliefs about yourself and other people make it for you
to…
 parent your child
 maintain healthy social relationships?
 interact with child welfare professionals?
Somatization
How challenging do any sicknesses or illnesses make it for you to…
 parent your child
 maintain healthy social relationships?
 interact with child welfare professionals?
Emotion regulation difficulties
146

How challenging do difficulties calming down when you feel sad or angry make it for you to…
 parent your child
 maintain healthy social relationships?
 interact with child welfare professionals?
GRAND TOUR QUESTION #3: CONTEXTUAL SUPPORT
Who are the primary people who support you in your life/ parenting? Who do you feel safe
with? How and to what extent did the following people support you as a parent?











Partner?
Child’s Father?
Family?
Friends?
Place of employment (if applicable)?
Child’s school (if applicable)?
Others in the community (e.g. religious organizations, community organizations)?
Case management/social workers associated with your case?
Therapists or counselors that have provided therapeutic services to you?
Other professionals relevant to your case (e.g., judges)?

GRAND TOUR QUESTION #4: TRAUMA RECOVERY
Is there anything/ anyone currently threatening your safety? What have you done that has
helped you deal with:








Depression and/or anxiety
Difficulty trusting others, feeling close to others, and fears of rejection or abandonment?
Confusion about your feelings, thoughts, needs that make it difficult to set boundaries
with others
Difficulty calming down when feeling angry or sad?
Difficulty dealing with or confronting problems; wanting to use strategies to avoid
dealing with problems; using substances, dissociating, hurting self
Difficulty with sickness or illness
Negative views and beliefs about yourself and other people

147

REFERENCES

148

REFERENCES

Adams, J. F. (2008). Impact of parent training on family functioning. Child & Family Behavior
Therapy, 23(1), 29-42
Alexander P. C. (2011). Childhood maltreatment, intimate partner violence, work interference
and women's employment. Journal of Family Violence, 26, 255-261.
Allen, S., Flaherty, C., & Ely, G. (2010). Throwaway moms: maternal incarceration and the
criminalization of female poverty. Affilia: Journal of Women and Social Work, 25, 160172.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders
(Revised 4th ed.). Washington, DC: Author.
Anderson, K., Armitage, S., Jack, D., and Wittner, J. (1987). Beginning where we were: Feminist
methodology in oral history. Oral History Review, 15, 103-127.
Andersen, M. L., & Collins, P. H. (2004). Introduction. In M. L. Andersen & P. H. Collins
(Eds.), Race, class, and gender: An anthology (pp. 1-14). Belmont, CA: Wadsworth/
Thompson Learning.
Appleyard, K. & Osofsky, J. D. (2003). Parenting after trauma: Supporting parents and
caregivers in the treatment of children impacted by violence. Infant Mental Health
Journal, 24, 111-125.
Armsworth, M. W. & Stronck, K. (1999). Intergenerational effects of incest on parenting: Skills,
abilities, and attitudes. Journal of Counseling and Development, 77, 303-314.
Bandura, A. (1973). Aggression: A social learning analysis. Englewood Cliffs, NJ: Prentice-Hall.
Bandura, A. (1977). Social learning theory. New York: General Learning Press.
Bandura, A. (1986). Social foundations of thought and action. Englewood Cliffs, NJ: PrenticeHall.
Banyard, V. L. (1997). The impact of childhood sexual abuse and family functioning on four
dimensions of women’s later parenting. Child Abuse and Neglect, 21, 1095-1107.
Banyard V. L & Williams, L. M. (2007). Women's voices on recovery: A multi-method study of
the complexity of recovery from child sexual abuse. Child Abuse & Neglect, 2, 275-290.
Banyard, V. L., Williams, L. M., & Siegal, J. A. (2003). The impact of complex trauma and
depression on parenting: An exploration of mediating risk and protective factors. Child
Maltreatment, 8, 333-349.
149

Bavolek, S. J. & Keene, R. G. (1999). Adult-Adolescent Parenting Inventory AAPI-2
Administration and Development Handbook. Park City, UT: Family Development
Resources, Inc.
Becker, K. D., Stuewig, J., & McCloskey (2009). Traumatic stress symptoms of women exposed
to different forms of childhood victimization and intimate partner violence. Journal of
Interpersonal Violence, 25, 1699-1717.
Berger, L. M. (2004). Income, family structure, and child maltreatment risk. Children and Youth
Services Review, 26, 725-748.
Bertaux, Daniel (1981). From the life-history approach to the transformation of sociological
practice. In Daniel Bertaux (Ed.), Biography and society: The life history approach in the
social sciences (pp.29-45). London: Sage.
Bowen, Glenn A. (2008). Naturalistic inquiry and the saturation concept: A research note.
Qualitative Research, 8(1), 137-152.
Bower-Russa, M. (2005). Attitudes mediate the association between childhood disciplinary
history and disciplinary responses. Child Maltreatment, 10, 272–282.
Brady, K. T., Killeen, T., Saladin, M. E., Dansky, B., & Becker, S. (1994). Comorbid substance
abuse and posttraumatic stress disorder: Characteristics of women in treatment. American
Journal on Addictions, 3, 160-164.
Brems, C., Johnson, M. E., Neal, D. et al. (2004). Childhood abuse history and substance use
among men and women receiving detoxification services. American Journal of Drug and
Alcohol Abuse, 30, 799-821.
Briere, J., & Elliott, D. M. (2003). Prevalence and symptomatic sequelae of self-reported
childhood physical and sexual abuse in a general population sample of men and women.
Child Abuse & Neglect, 27, 1205-1222.
Briere, J., Elliott, D.M., Harris, K., & Cotman, A. (1995). Trauma Symptom Inventory:
Psychometrics and association with childhood and adult trauma in clinical samples.
Journal of Interpersonal Violence, 10, 387-401.
Briere, J., & Jordan, C. E. (2004). Violence against women: Outcome complexity and
implications for treatment. Journal of Interpersonal Violence, 19, 1252-1276.
Briere, J., Kaltman, S., & Green, B. L. (2008). Accumulated childhood trauma and symptom
complexity. Journal of Traumatic Stress, 21, 223-226.
Briere, J., & Rickards, S. (2007). Self-awareness, affect regulation, and relatedness: Differential
sequels of childhood versus adult victimization experiences. Journal of Nervous and
Mental Disease, 195, 497-503.
150

Briere, J., & Spinazzola, J. (2005). Phenomenology and psychological assessment of complex
posttraumatic states. Journal of Traumatic Stress, 18, 401-412.
Burke, L. (2003). The impact of maternal depression on familial relationships. International
Review of Psychiatry, 15, 243-255.
Burstrow, B. (2003). Toward a radical understanding of trauma and trauma work (2003).
Violence Against Women, 9, 1293-1317.
Carter, R. T. (2007). Racism and psychological and emotional injury: Recognizing and assessing
race-based traumatic stress. Counseling Psychologist, 35, 13-105.
Cash, S., & Wilke, D. (2003). An ecological model of maternal substance abuse and child
neglect: Issues, analyses, and recommendations. American Journal of Orthopsychiatry,
73, 392-404.
Center for Disease Control (2012). Child Maltreatment Prevention. Retrieved April 10, 2012
from, http://www.cdc.gov/ViolencePrevention/childmaltreatment/.
Charmaz, K. (2006). Constructing grounded theory: A practical guide through qualitative
analysis. Thousand Oaks, CA: Sage.
Chemtob, C. M., Griffing, S., Tullberg, E., Roberts, E., & Ellis, P. (2011). Screening for trauma
exposure and posttraumatic stress disorder and depression symptoms among mothers
receiving child welfare preventive services. Child Welfare, 90, 109-127.
Clark, A. H. & Foy, D. W. (2000). Trauma exposure and alcohol use in battered women.
Violence Against Women, 6, 37-48.
Cloitre, M., Miranda, R., Stovall-McClough et al. (2005). Beyond PTSD: Emotion regulation
and interpersonal problems as predictors of functional impairment in survivors of
childhood abuse. Behavior Therapy, 36, 119-124.
Cloitre, M. Stolbach, B. C., Herman, J. L., van der Kolk, B., Pynoos, R, Wang, J. & Petkoca, E.
(2009). A developmental approach to complex PTSD: Childhood and adult cumulative
trauma as predictors of symptom complexity. Journal of Traumatic Stress Volume 22,
399–408.
Cloitre, M., Stovall-McClough, C., Zorbas, P., & Charuvastra, A. (2008). Attachment
organization, emotion regulation, and expectations of support in a clinical sample of
women with childhood abuse histories. Journal of Traumatic Stress, 21, 282-289.
Cohen, L. R., Hien, D. A., & Batchelder, S. (2008). The impact of cumulative maternal trauma
and diagnosis on parenting behavior. Child Maltreatment, 13, 27-40.
151

Cole, P. M., Woolger, C., Power, T. G., & Smith, K. D. (1992). Parenting difficulties among
adult survivors of father-daughter incest. Child Abuse and Neglect, 16, 239-249.
Cook, A., Spinazzola, J., Ford, J., Lanktree, C., Blaustein, M., Cloitre, M., et al. (2005).
Complex trauma in children and adolescents. Psychiatric Annals, 35, 390-398.
Cortina, L. M. & Pimlott Kubiak, S. (2006). Gender and posttraumatic stress: Sexual violence as
an explanation for women’s increased risk. Journal of Abnormal Psychology, 115, 753759.
Creswell, J. (1998). Qualitative inquiry and research design: Choosing among five traditions.
Thousand Oaks, CA: Sage.
Crouch, M. & McKenzie, H. (2006). The logic of small samples in interview based qualitative
research. Social Science Information, 45(4), 483-499.
Coulton, C. J., Korbin, M. S., & Chow, J. (1995). Community level factors and child
maltreatment rates. Child Development, 66, 1262– 1276.
Denzin, N. K. (1978). Sociological Methods. New York: McGraw-Hill.
De Reus, L., Few, A., Blume, L. (2005). Multicultural and critical race feminisms: Theorizing
families in the third wave. Chapter Eighteen. Sourcebook of Family Theory and
Research. Thousand Oaks’ CA: Sage.
DeRoma, V. M., Kessler, M. L., McDaniel, R., & Soto, C. M. (2006). Important risk factors in
home-removal decisions: Social caseworker perceptions. Child and Adolescent Social
work Journal, 23, 263-277.
Douglas, H. & Walsh, T. (2010). Mothers, domestic violence, and child protection. Violence
Against Women, 489-508.
Drossman, D. A., Li, Z., Leserman, J., Toomey, T. C., & Hu, Y. J. (1996). Health status by
gastrointestinal diagnosis and abuse history. Gastroenterology, 110, 999-1007.
Dunn, M. G., Mezzich, A. C, Janiszewski, S., Kirisci, L., & Tarter, R. E. (2008). Transmission of
neglect in substance abuse families: The role of child dyregulation and parental SUD.
Journal of Child & Adolescent Substance Abuse, 10, 123-132.
Dunn, M. G., Tarter, R. E., Mezzich, A. C., Vanyukov, M., Kirisci, L., & Kirillova, G. (2002).
Origins and consequences of child neglect in substance abuse families. Clinical
Psychology Review, 22, 1063-1090.
Famularo, R., Fenton, T., Kinscherff, R., Ayoub, C., & Barnum, R. (1994). Maternal and child
posttraumatic stress disorder in cases of child maltreatment. Child Abuse and Neglect, 18,
152

27–36.
Farley, M. & Patsalides, B. M. (2001). Physical symptoms, posttraumatic stress disorder, and
healthcare utilization of women with and without childhood physical and sexual abuse.
Psychological Reports, 89, 595-606.
Follette, V. M., Polusny, M. A., Bechtle, A. E., & Naugle, A. E. (1996). Cumulative trauma: The
impact of child sexual abuse, adult sexual assault, and spouse abuse. Journal of
Traumatic Stress, 9, 25-36.
Forgatch, M.S., Patterson, G.R., DeGarmo, D.S., & Beldavs, Z.G. (2009). Testing the Oregon
delinquency model with 9-year follow-up of the Oregon divorce study. Development and
Psychopathology, 21, 637-660.
Forgatch, M.S., & DeGarmo, D.S. (1999). Parenting through change: An effective prevention
program for single mothers. Journal of Consulting and Clinical Psychology, 67, 711-724.
Gara, M. A., Allen, L. A., Herzog, E. P., & Woolfolk, R. L. (2000). The abused child as parent:
The structure and content of physically abused mothers’ perceptions of their babies.
Child Abuse and Neglect, 24, 627-639.
Gladstone, J., Dumbrill, G., L., B., Koster, A., Young, M., & Ismaila, A. (2012). Looking at
engagement and outcome from the perspectives of child protection workers and parents.
Children and Youth Services Review, 24, 112-118.
Green, A.H., Coupe, P., Fernandez, R., & Stevens, B. (1995). Incest revisited: Delayed posttraumatic stress disorder in cases of child maltreatment. Child Abuse and Neglect, 19,
1275–1282.
Green, B. L., Korol, M., Grace, M., Vary, M. G., Leonard, A. C., Goldine, C. G., & SmitsonCohen, S. (1991). Children and disaster: Age, gender, and parental effects on PTSD
symptoms. Journal of the Academy of Child and Adolescent Psychiatry, 30, 945–951.
Griffing, S., Lewis, C. S., Chu, M., Sage, R. E., Madry, L., & Primm, B. J. (2006). Exposure to
interpersonal violence as a predictor of PTSD symptomatology in domestic violence
survivors. Journal of Interpersonal Violence, 21, 936-956.
Guest, G., Bunce, A., & Johnson, L. (2006). How many interviews are enough? An experiment
with data saturation and variability. Field Methods, 18(1), 59-82.
Hulette, A. C., Kaehler L. A., & Freyd J. J. (2011). Intergenerational associations between
trauma and dissociation. Journal of Family Violence, 26, 217-225.
Jaffe, P.G., Wolfe, D.A., & Wilson, S.K. (1990). Children of battered women. Newbury Park,
CA: Sage Publications, Inc.
153

Jager, K. B. & Carolan (2009). Locating community in women’s experiences of trauma,
recovery, and empowerment. Qualitative Inquiry, 15, 297-307.
Johnson, S. P. & Sullivan, C. M. (2008). How Child Protection Workers Support or Further
Victimize Battered Mothers. Affilia, 23, 242-258.
Kaplow, J. B., Dodge, K. A., Amaya-Jackson, L., & Glenn, N. (2005). Pathways to PTSD. Part
II: Sexually abused children. American Journal of Psychiatry, 162, 1305-1310.
Kaminski, J. W., Valle, L. A., Filene, J. H., & Boyle, C. L. (2008). A meta-analytic review of
components associated with parent training program effectiveness. Journal of Abnormal
Child Psychology, 36, 567-589.
Kelleher, K., Gardner, W., Coben, J., Barth, Edleson, & Hazen (2006). Co-occurring intimate
partner violence and child maltreatment: Local policies/practices and relationships to
child placement, family services and residence. Final Grant Report to the National
Institute of Justice.
Kessler R. C., Chiu WT, Demler O., & Walters E. E. (2005). Prevalence, severity, and
comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey
Replication (NCS-R). Archives of General Psychiatry, 62, 617-627.
Kessler R.C., Sonnega A, Bromet E, et al. (1995). Posttraumatic stress disorder in the National
Comorbidity Survey. Archives of General Psychiatry, 52, 1048-1060.
Kielty, S. (2008).Working hard to resist a “Bad Mother” Label: Narratives of non-resident
motherhood. Qualitative Social Work, 7, 363-379.
Kim, J., Talbot, N. L., & Cicchetti, D. (2009). Childhood abuse and current interpersonal
conflict: The role of shame. Child Abuse & Neglect, 33, 362-371.
Kim, K., Trickett, P. K., & Putnam, F. W. (2010). Childhood experiences of sexual abuse and
later parenting practices among non-offending mothers of sexually abused and
comparison girls. Child Abuse & Neglect, 34, 610-622.
King, D. K. (1995). Multiple jeopardy, multiple consciousness: The context of a Black feminist
ideology. In B. Guy-Sheftall (Ed.),Words of fire:Ananthology of African-American
feminist thought (pp. 294-317). New York: New Press.
Kleinman, S. (2007) Feminist Fieldwork Analysis. (Qualitative research methods series).
Thousand Oaks, CA: Sage.
Knisely, J. S., Barker, S. B., Ingersoll, K. S et al. (2000). Psychopathology in substance abusing
women reporting childhood sexual abuse. Journal of Addictive Diseases, 19(1), 31-44.
Koenen, K. C., Harley, R. M., Lyons, M. J., Wolfe, J., Simpson, J. C., Goldberg, J., et al. (2002).
154

A twin registry study of familial and individual risk factors for trauma exposure and
posttraumatic stress disorder. Journal of Nervous and Mental Disease, 190, 209-218.
Koenen, K. C., Moffitt, T. E., Poulton, R., Martin, J., & Caspi, A. (2007). Early childhood
factors associated with the development of post-traumatic stress disorder: Results from a
longitudinal birth cohort. Psychological Medicine, 37, 181-192.
Koenig, A. L., Ialongo, N., Wagner, B. M., Poduska, J., & Kellam, S. (2002). Negative caregiver
strategies and psychopathology in urban, African-American young adults. Child Abuse &
Neglect, 26, 1211-1233.
Kopels, S., & Sheridan, M. (2002). Adding legal insult to injury: Battered women, their children,
and the failure to protect. Affilia, 17(1), 9−29.
Lather, P. (1988). Feminist perspective on empowering research methodologies. Women’s
Studies International Forum, 11 (6): 569-581.
Lee, B. J., & George, R. M. (1999). Poverty, early childbearing, and child maltreatment: A
multinomial analysis. Children and Youth Services Review, 21(9– 10), 755– 780.
Lindsey, D. (1994). The welfare of children. New York: Oxford.
Liang, B, Williams, L. M., & Siegel, J. A. (2006). Relational outcomes of childhood sexual
trauma in female survivors. Journal of Interpersonal Violence, 21 (1), 42-57.
Lincoln, YS. & Guba, EG. (1985). Naturalistic Inquiry. Newbury Park, CA: Sage Publications.
http://www.qualres.org/HomeLinc-3684.html
Lovejoy, M. C., Graczyk, P. A., O’Hare, & Neuman, G. (2000). Maternal depression and
parenting behavior: A meta-analytic review. Clinical Psychology Review, 25, 561-592.
Magen, R. (1999). In the best interests of battered women: Reconceptualizing allegations of
failure to protect. Child Maltreatment, 4(2), 127−135.
Maguire, P. (1987). Doing participatory research: A feminist approach. Massachusetts:
University of Massachusetts.
Mapp, S. C. (2007). The effects of sexual abuse as a child on the risk of mothers physically
abusing their children: A path analysis using systems theory. Child Abuse & Neglect, 30,
1293-1310.
Marcenko, M. O., Kemp, S. P., & Larson, N. C. (2000). Childhood experiences of abuse, later
substance use, and parenting outcomes among low-income mothers. American Journal of
Orthopsychiatry, 70, 316-327.
Mason, M. (2010). Sample size and saturation in Ph.D. studies using qualitative interviews.
155

Forum Qualitative Sozialforschung / Forum: Qualitative Social Research, 11, http://nbnresolving.de/urn:nbn:de:0114-fqs100387.
McDowell, T. & Fang, S. R. (2007). Feminist-informed critical multiculturalism: Considerations
for family research. Journal of Family Issues, 549-566.
Messman-Moore, T. L., & Coates, A. A. (2007). The impact of childhood psychological abuse
on adult interpersonal conflict: The role of early maladaptive schemas and patterns of
interpersonal behavior. Journal of Emotional Abuse, 7, 75-92.
Milner, J. S., Thomsen, C. J., Crouch, J. L., Rabenhorst, M. M., Martens, P. M., Dyslin, C. W., et
al. (2010). Do trauma symptoms mediate the relationship between childhood physical
abuse and adult child abuse risk? Child Abuse & Neglect, 34, 332-344.
Montgomery, P. & Bailey, P. H. (2007). Field notes and theoretical memos in grounded theory.
Western Journal of Nursing Research, 29, 65-81.
Morse, Janice M. (1994). Designing funded qualitative research. In Norman K. Denzin &
Yvonna S. Lincoln (Eds.), Handbook of qualitative research (2nd ed., pp.220-35).
Thousand Oaks, CA: Sage.
Morse, J. M. (1995). The significance of saturation. Qualitative Health Research, 5(3), 147-149.
Morse, J. M. (2000). Determining sample size. Qualitative Health Research, 10(1), 3-5.
Nair, P., Schuler, M. E., Black, M. M., Kettinger, L., & Harrington, D. (2003). Cumulative
environmental risk in substance abusing women: Early intervention, parenting stress,
child abuse potential and child development. Child Abuse & Neglect, 27, 997-1017.
Narang, D. S., & Conteras, J. M. (2000). Dissociation as a mediator between child abuse history
and adult abuse potential. Child Abuse & Neglect, 24(5), 653–665.
National Institute of Mental Health (2012). Post-traumatic Stress Disorder Among Adults.
Retrieved April 10, 2012 from,
http://www.nimh.nih.gov/statistics/1AD_PTSD_ADULT.shtml.
Nishith, P., Mechanic, M. B., & Resick, P. A. (2000). Prior interpersonal trauma: The
contribution to current PTSD symptoms in female rape victims. The Journal of Abnormal
Psychology, 109(1), 20-25.
O’Hare, T. (1996) Court-ordered versus voluntary clients: Problem differences and readiness for
change. Social Work, 41(4), pp. 417–23.
Osofsky, J.D., & Thompson, M.D. (2000). Adaptive and maladaptive parenting. In J. Shonkoff
& S.Meisels (Eds.). Handbook of early intervention (2nd ed., pp. 54–75). NewYork:
156

Cambridge University Press.
Parra-Cardona, J. R., Domenech-Rodriquez, M., Forgatch., M., Sullivan, C., Bybee., D., Holtrop
et al. (2012). Culturally adapting an evidence-based parenting intervention for Lation
immigranst: The need to integrate fidelity and cultural relevance. Family Process,51, 5672.
Patterson, G.R., DeGarmo, D., & Forgatch, M.S. (2004). Systematic changes in families
following prevention trials. Journal of Abnormal Child Psychology, 32, 621-633.
Patton, M. Q. (1999). Enhancing the quality and credibility of qualitative analysis. Health
Services Research, 34, 1189-1208.
Patton, M. Q. (1990). Qualitative evaluation and research methods. Newbury Park, CA: Sage.
Paulussen-Hoogeboom, M. C., Stams, G. J. J. M., Hermanns, J. M. A., Peetsma, T. T. D., & Van
Den Wittenboer, G. L. H. (2008). Parenting style as a mediator between children’s
negative emotionality and problematic behavior in early childhood. Journal of Genetic
Psychology, 169, 209-226.
Paxson, C., & Waldfogel, J. (1999). Parental resources and child abuse and neglect. American
Economic Review, 89(2), 239– 244.
Pence, E., & Paymar, M. (1993). Education groups for men who batter: The Duluth model. New
York: Springer.
QSR International. (2010). NVivo qualitative data analysis software (Version 9). [Computer
software].
Risley-Curtiss, C., & Heffernan, K. (2003). Gender biases in child welfare. Affilia, 18, 395−410.
Ritchie, J., Lewis, J. & Elam, G. (2003). Designing and selecting samples. In Jane Ritchie &
Jane Lewis (Eds.), Qualitative research practice. A guide for social science students and
researchers (pp.77-108) Thousand Oaks, CA: Sage.
Rodriguez, C. M. (2010). Personal contextual characteristics and cognitions predicting child
abuse potential and disciplinary style. Journal of Interpersonal Violence, 25, 315-335.
Rohner, K. K. (2002) Parental warmth, control, and involvement in schooling- Predicting
academic achievement among Korean American adolescents. Journal of Cross-Cultural
Psychology, 33, 127-140.
Scheeringa, M.S., & Zeanah, C.H. (2001). A relational perspective on PTSD in early childhood.
Journal of Traumatic Stress, 14, 799–815.
157

Salomon, A., Bassuk, S. S., Huntington, N. (2002). The relationship between intimate partner
violence and the use of addictive substances in poor and homeless single mothers.
Violence Against Women, 8, 785-815.
Samuels-Dennis, J. A., Ford-Gilboe, M., Wilk, P., Avison, W. R., & Ray, S. (2010). Cumulative
trauma, personal and social resources, and post-traumatic stress symptoms among
income-assisted single mothers. Journal of Family Violence, 25, 603-617.
Schim, W.S. & Haight, W. L. (2006). Supporting battered women and their children:
Perspectives of battered mothers and child welfare professionals. Children and Youth
Services Review, 28, 620-637.
Shumow, L. & Lomax, R. (2002). Parental efficacy: Predictor of parenting behavior and
adolescent outcomes. Parenting Science and Practice, 2, 127-150.
Smith, M. (2003). Parental mental health: Disruptions to parenting and outcomes for children.
Child and Family Social Work, 9, 3-11.
Spatz Widom, C., Czaja, S. J., & Dutton, M. A. (2008). Childhood victimization and lifetime
revictimization. Child Abuse & Neglect, 32, 785-796.
Strine, T.W., Dube, S. R., Edwards, V. J., Prehn, A. W., Rasmussen, S., Wagenfeld, M., et al.
(2012). Associations between adverse childhood experiences, psychological distress, and
alcohol problems. American Journal of Health Behavior, 36, 408-423.
Suchman, N. E., Rounsaville, B., DeCoste, C., & Luthar, S. (2007). Parental control, parental
warmth, and psychosocial adjustment in a sample of substance-abusing mothers and their
school-aged and adolescent children. Journal of Substance Abuse Treatment, 32, 1-10.
Sullivan, C. (2003). Using the ESID model to reduce intimate male violence against women.
American Journal of Community Psychology, 32, 295-303.
Tolin, D. F. & Foa, E. B. (2006). Sex differences in trauma and posttraumatic stress disorder: A
quantitative review of 25 years of research. Psychological Bulletin, 132, 959-992.
van der Kolk, B. A., Roth, S. H., Pelcovitz, D., Sunday, S., & Spinazzola, J. (2005). Disorders of
extreme stress: The empirical foundation of a complex adaptation to trauma. Journal of
Traumatic Stress, 18, 389-399.
Vezina, D., Mireille, C., Roberts, P., & McDuff, P. (2005). The role of depression and
dissociation in the link between childhood sexual abuse and later parental practices.
Journal of Trauma & Dissociation, 6(1), 71–97.
Waldfogel, J. (2000). ‘What we know and don’t know about the state of child protective service
system and the links between poverty and child maltreatment.’ Remarks for Joint Center
158

for Poverty Research Congressional Research Briefing on ‘Child welfare and child
protection: Current research and policy implications.’ Washington, DC, September 14,
2000.
Walsh, C., MacMillan, H. L., & Jamieson, E. (2003). The relationship between parental
substance abuse and child maltreatment: Findings from the Ontario Health Supplement.
Child Abuse & Neglect, 27, 1409-1425.
Wasserstein, S.B., & LaGreca, A.M. (1998, May). Hurricane Andrew: Parent conflict as a
mediator of children’s adjustment. Hispanic Journal of Behavioral Sciences, 20, 212–
224.
Yehuda, R., Kahana, B., Schmeidler, J., Southwick, S. M., et al (2005). Impact of cumulative
lifetime trauma and recent stress on current posttraumatic stress disorder symptoms in
Holocaust survivors. The American Journal of Psychiatry, 152, 1815-1818.

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