Presentation on theme: "Encouraging Natural Resilience for Child & Adolescent Mental Health"— Presentation transcript:
1Encouraging Natural Resilience for Child & Adolescent Mental Health Presented April 23, 2003 at the Community Assessment and Intervention Center (CAIC)Katherine Best, MSW, MPH
2Objectives Defining Resiliency The Problems in Research The Importance of Contextualizing our UnderstandingIdentify Predisposing Conditions that Contribute to Poor OutcomesThe Difference Between Protective Factors and Protective Processes
3More Objectives Impacting External Protective Factors Identify Resiliencies in those Who Have Overcome AdversitiesDiscuss Strategies that Foster ResiliencyDiscuss the Ways Providers Perceive Resiliency
4Understanding Resilience Resilience is defined by Merriam-Webster Dictionary:(1) “As the capability of a strained body to recover its size and shape after deformation caused especially by compressive stress”;(2) “An ability to recover from or adjust easily to misfortune or change” (1993).
5Lack of Consensus in Resilience Research A type of “phenomenon characterized by good outcomes in spite of serious threats to adaptation or development” (Ann Masten, 2001).Ability to cope or recover equilibrium in the presence of stress and trauma utilizing protective factors that mediate the relationship between risk and competency (Smith & Carlson, 1997).
6More DefinitionsResilience has come to mean both a set of behaviors (within cultural norms) and internal capacities (Gilgun, 1999).Resiliencies are clusters of strength developed as one struggles against the effects of hardship… It is persistence in the face of adversity…It is a paradox of vulnerability and strength in the same person at the same time (Wolin, 2001).
7More Terms Risk Factors Vulnerabilities Resilience Protective Factors Definitional ambiguity for related terms :Risk FactorsVulnerabilitiesResilienceProtective FactorsProtective ProcessesHas resulted in inconsistent sets of variables being used to study the trajectories of children growing up under adversity.(Ungar, Boothroyd, Duque, & Le Blanc, 2003)
8Tipping Point for Resilience Research A PsychInfo Search demonstrates a new shift from medicalization to interest in resilience:article1985 – 3 articles1990 – 47 articles1995 – 67 articles2000 – 141 articles2002 – 126 articles
9Why are there Problems in the Field Foucault spoke of mental health, deviance, and disorder as things that those in power, “experts”, defined for others. To illustrate some historical trends and errors within mental illness:Mental illness was punishment by God for disobedienceThe insane needed to be chained or caged in Asylums to protect the public (we still criminalize our mentally ill)Stories by female patients of sexual abuse were instead perceived by Freud as fantasiesThe term sexual abuse only came into vogue in the early 1980’s before then survivors lacked a language to define abuseEver changing diagnostic categories(Ungar, 2002)
10Challenges in the Field The way in which we define resilient or good outcomes not only changes from one decade to the next, it is arbitrary and often does not take into account social and cultural differences.In Hong Kong: “obedience” versus “autonomy”In Palestine: being a “freedom fighter” is goodIn Halifax: escaping abuse by becoming a “street youth” is being a survivorIn USA: “running away” from abusive and multiple foster placements may be a sign of resilience(Ungar, Boothroyd, Duque, & Le Blanc, 2003)
11Survivors Pride : From a teen who remained silent for many hours each day… “I’m boiling with rage, and yet I mustn't show it. I’d like to stamp my feet, scream, give mom a good shaking, cry, and I don’t know what else, because of the words, mocking looks, and accusations … I can’t let them see the wounds …they have caused, I couldn’t bear their sympathy…it would only make me scream all the more. If I talk everyone thinks I’m showing off, when I’m silent they think I’m ridiculous; rude if I answer, sly if I get a good idea, lazy if I’m tired, selfish if I eat a mouthful more than I should, stupid, cowardly, crafty…”
12Adolescent Wellness: In the eye of the beholder From The Promotion of Wellness in Children and Adolescents(Cicchetti, Rappaport, Sandler & Weissberg, 2000)“The residual of truncated life options in relation to oppression and poverty, limited resources, and the accelerated life course resulting from a foreshortened life expectancy intersect to shape the time perspectives, coping strategies, and locally defined successful adaptations. Physical survival, becomes a bottom line indicator of success.” (Pg. 379)
13Competing Conceptions of Competence and Wellness Differences in perceptions exist between and within:Mainstream and dominant cultural codesInner-City YouthLatinosAsiansBlacksBicultural YouthHaves and have notsIt is proposed that there are unnamed protective processes found in the lived experiences of others within contexts. This can only be found by giving power to minority voices through unique definitions of positive outcomes.
14Methodological Issues with Resilience Distinguishing between resilience and factors promoting or reducing resilienceChoosing sources of measuresSelecting scoring criteria to indicate resilienceDetermine when to measure resilienceDetermine adequate comparison groupExamine the stability of resilience over time
15Risk and Protective Model Theoretical ModelsOutcomes OrientationRisk and Protective ModelMain Effect ModelAdditive ModelPostulates that protective factors increase the likelihood of a positive outcome (e.g. parenting qualities, intellectual functioning, SES, positive self perceptions) (Smith & Carlson, 1997).
16Buffering Effect Model Theoretical ModelsProcess OrientationThe Challenge ModelInteraction ModelBuffering Effect ModelPostulates that resilience is a constructive approach to hardship which is developed through compensatory experiences, analogous to building resistance to infection through immunization (Caprara & Rutter, 1995).
17Protective Factors: Variables that modify a person’s response to risk: Individual factors – average IQ, and the ability to illicit positive responses from othersFamily – attachment with caregivers that promote trust and autonomyCommunity factors – support systems with youth groups, church, or school
18Protective Processes: Successful engagement with risk that involves a change from risk to adaptation such as processes :Reduce impact of risk exposureReduce or stop chain of events to minimize long term effects of exposure to stressorsDevelopment of self-esteem and competence through adaptationTurning point: where new opportunities are opened up
19Predisposing Conditions & Negative Mediating Variables Trauma/Abuse/Neglect/ or WitnessConsequences of TraumaFear of being bad, unwanted, unworthy,Fear condition will occur againNegative MediatorsFew opportunities to understand the meaning of exposure to trauma or abuseExposure to anti-social models of copingExposure to negative ways of attaining sense that self is good (e.g. drinking, rage, denigration of opposite sex, or the “other”)Committing Acts of ViolencePoor coping behaviors
20Predisposing Conditions & Positive Mediating Variables Trauma/Abuse/Neglect/ or WitnessConsequences of TraumaFear of being bad, unwanted, unworthy,Fear condition will occur againPositive MediatorsOpportunities to understand the meaning of exposure to trauma or abuseExposure to pro-social models of copingExposure to positive ways of attaining sense that self is goodNot Committing Acts of ViolenceDevelopment of pro-social coping(Jane Gilgun, 2002)
21Designing Strategies for Prevention & Intervention “Kids can walk around trouble if there is some place to walk to and someone to walk with.”(Tito a Gang Member, quoted by McLaughlin, Irbv, & Langman, 1993)Key ElementsReduce Risk or ThreatIncrease ResourcesFocus on Process
22Family Risk & Protective Factors From the Florida Alcohol & Drug Abuse Association Family Risk FactorsGeneticsFamily ConflictCondoning Drug or Alcohol UsePoor MonitoringInconsistent DisciplineOver/Under Involvement with FamilyFamily Protective FactorsFamily BondingGood ParentingShared ResponsibilityClear ExpectationsQuality Time
23Individual Risk Factors In the adult literature…Cocaine/opiate users 10 Xs more likely to meet PTSD criteria.Other drug use 4 Xs more likely to meet PTSD criteria (Cottler, et al., 1992).Parent substance abuse directly predicts later substance abuse in adulthood (Stein, Leslie, Nyamathi, 2002).Subjects experiencing 4 or more childhood adverse events were more likely to consider themselves alcoholics, and had used drugs (Felitti, et al., 2001).
24Individual Risk Factors In the adolescent literature…One study found 19% of chemically dependent youth met criteria for PTSD (Deykin & Buka, 1997).Females are 6Xs more likely to develop PTSD symptoms than males following exposure to violence (Fitzpatrick & Boldizar, 1993; Schwab-Stone et al., 1995).A recent study found females with substance abuse issues scored higher for traumatic stress (Stevens, Murphy, McKnight, 2003).
25A Model for Impacting External Protective Factors Strong Connections to Individuals, Schools, or Community that have a Positive InfluenceCompetencies in Academics, Social Skills, Problem-Solving, and/or Recreation and ArtsResponsibility for the Well-being of Others/Giving or Helping Others (volunteerism or social interest)High Expectations for Behavior and PerformanceHope and Optimism about the Future(Best, Friedman, Jetson & Gaunt, 2003)
26Changing Paradigms The Damage Model Focuses on injuries of the past rather than living well in the presentLures survivors into the Victim TrapInstills feeling of being a walking time bombThe Challenge ModelBuilds on strengthsBreaks the chain by improving deliberately on their parent’s lifestylesSeeks alternative mirrorsEstablishes new routines and family rituals(Wolin & Wolin, 1993)
27How have you been resilient? Think of a hardship, trauma, or loss you have experienced in the past…Describe what you did to help yourself through the situation…
28REFRAMING THE PAST Grief - loss of childhood Comfort – secret is out no longer aloneAnger – due to sufferingPride – completing something parent’s couldn’t have doneLoss – of love and acceptanceCourage – seeing the way your life has already improvedFear – you will fall into yourparent’s patternsValidation – someone acknowledged the wrongsShame – because of originsClarity – you know what needs to change to re-build your life
297 Resiliencies: How we Overcome Adversities (Sybil Wolin, 2001) Insight: Asking Tough QuestionsIndependence: Being your Own PersonRelationships: Connecting to PeopleInitiative: Taking Charge of ProblemsCreativity: Using ImaginationHumor: Finding What’s FunnyMorality: Doing the Right Thing
30Insight Damage Model: Intellectualization Challenge Model: Sensing (early childhood) -Detected patterns of behavior that spelled troubleKnowing (adolescence) –Labeled your family as troubled made effort to gather more informationUnderstanding (adulthood) –Do you watch yourself in action accepting the role you play in your own difficulties
31Insight: Forewarned is Forearmed “I don’t know what the word ‘Mommy’ means…the hardcore truth is, my mother didn’t take care of us. She couldn’t cope with herself, let alone three daughters… I had to teach myself not to settle for less. My family hated that I spoke out…I want to break the cycle.”
32Independence Damage Model: Fear of Intimacy Challenge Model: Straying (early childhood) –Distancing from painful family scenes to avoid being a messenger, whipping post, sexual object or confidantDisengage (adolescence) –Stepping out of the ‘parental orbit’ and becoming the commander of their own futureSeparating (adulthood) –Survivors stop looking to their families for satisfaction and aim to break the chain for future generations
33Independence: A Delicate Negotiation “I kept myself going by plotting my getaway and putting my plan in motion. I decided to leave after high school and work to support myself. When I was 14 I took my first job… I picked the brain of every adult I could…I was going to endure and leave the awful life with my family. I was going to be something they never dreamed of…”
34Relationships Damage Model: Co-Dependency Challenge Model: Connecting (early childhood) –Attracting the attention of available adultsRecruiting (adolescence) –Enlisting a friend, teacher, neighbor, or minister as parent substituteAttaching (adulthood) –The ability to form and keep mutually gratifying relationships with regard for the well-being of others as well as oneself
35Relationships: The Search for Love “I felt wonderful whenever it was time to cook because it also meant doing something that my parents had never encouraged in my thirteen years of living with them: bonding with other girls…” “At the group home… I met people who really cared about me, who accepted me without judgment, who gave me the love and attention I needed.”
36Initiative Damage Model: Overachievement Challenge Model: Exploring (early childhood) –Conducting trial & error experiments, achieve a sense of effectivenessWorking (adolescence) –Focused, organized, goal directed over a wide range of activitiesGenerating (adulthood) –A lifelong attraction to generating projects that stretch the self and promote growth
37Initiative: The Pleasure in Problems At 7 he struggled to free himself from his mother’s psychotic delusions, at 15 he “broke” and was hospitalized… years later one of the most prominent theorists on rational thinking wrote –“One of the direct consequences of my mother’s poor mental health was that I started to forego playing for serious work very early in childhood in order to take refuge in a private and non-fictitious world. I have always detested any departure from reality…” Jean Piaget
38Creativity Damage Model: Useless Fantasy Challenge Model: Playing (early childhood) -Spending much of the time in imaginative playShaping (adolescence) –Using art to express feelings in an undisguised formComposing (adulthood) –Artistic hobby or profession: creating compensates for pain of the past
39Creativity: Building a New World on the Ruins of the Old “ I came from ugliness. I’m horrified by ugliness. I feel compelled to make beauty…”“I chose writing to impose order on the chaos that was life with Mother…the brain is cunning in looking for ways to live when you’re ready to give up. On paper, I get to choose what happens, even if I have to wrestle every word to the ground with brute force, when I win the victory is sweeter than any other I can imagine.”
40Humor Damage Model: Compulsive Clowning Challenge Model: Playing (early childhood) –Spending much of the time role playing to restore confidenceShaping (adolescence) –Using humor to transform family situation into something betterLaughing (adulthood) –Seeing the absurd and awful and using humor to diffuse tension
41Humor:Power to Reduce Something into Nothing “I was born an accident, raised a burden, my mother was a prostitute, she got sloppy and conceived one night and so she had to take a ‘sabbatical’, after dropping me off on my widower grandfather who wanted me as much as an advanced-stage cancer I decided to get serious about being funny. “During manic episodes, my mother ran around the street in her nightgown. I lived in terror…when she was finally hospitalized I was relieved. I thought mental hospitals were places set up to give families a vacation…”
42Morality Damage Model: Over Responsible Challenge Model: Judging (early childhood) –They know the rights and wrongs of their caregiversValuing (adolescence) –Compassion, justice, loyalty, and fair play are critical, standing up against hypocrisy and crueltyServing (adulthood) –Living a meaningful life, willing to risk self for ‘doing the right thing’
43Morality:Holiness in an Unholy World “The worst was the way my father would go after the younger kids who couldn’t defend themselves. He was a bully- a coward at heart. I felt I had to protect the little ones. It was a moral obligation, something any decent person would do.”“Coming from the kind of home life I had, you never stop remembering that things could have been different. I certainly have my horrible days, but I also have an abiding sense of appreciation for what I have – a sense of indebtedness and obligation to repay.”
44How providers Can Apply Resiliency Theories… Awareness of Deficits and Illness based VocabularyInterventions Decreasing Risks and Increasing Protective FactorsBuild Inner Strengths through Encouragement and ModelingHonor the Struggle to be Strong
45Individual Level Strategies From “Playing at Being Bad” by Michael Ungar Strategy 1: Ask “what is true for you?” Help children become critical consumers of everyone’s values, including those of parents, peers or anyone who would have them believe their truth is the “Truth”.Strategy 2: Encourage them to “shop around”. Youth may need to become part of a different peer groups if they are to discover who they really want to be.
46Individual Level cont’d Strategy 3: Celebrate Storytelling. Listen closely to the complex stories young people tell about themselves.Strategy 4: Accept the Unusual. Acknowledge the identity a child or youth chooses. Find the positive aspects of that identity and show whatever acceptance is possible.Strategy 5: Stop Blaming our Youth’s Peers. Youth are equal participants in creating their group identity.
47Family Intervention Strategies Develop interventions that foster self-determination in school-aged children by increasing a sense of self-efficacy and self-relianceDevelop intervention strategies that are empowering for children and families rather than punitiveDevelop subsequent booster interventionsChildren with MalTX may experience new difficulties as a function of developmental capacities
48Fostering Resilience at Community Level Prevent maltreatment through psycho- educational home-based outreach modelsPrevention and reduction of sequelae associated with Mal TX through early provision of servicesFind methods to reduce community violenceDevelop interventions that foster self-determination in school-aged children by increasing a sense of self-efficacy and self-reliance(Cicchett, Toth & Rogosch)
49We can change the mental health outcomes of our nations children. Why is this important…Resilience and thriving reflects the noble side of the human experience…overcoming the odds, making something good out of something bad…If we can reduce the burden of damageIncrease protective factors in the environmentAnd encourage insight and teach skills to children and familiesWe can change the mental health outcomes of our nations children.
50There is a possibility of joy…” “One discovers that destiny can be directed, that one does not have to remain in bondage to the first wax imprint made on childhood sensibilities. Once the deforming mirror has been smashed, there is a possibility of wholeness.There is a possibility of joy…”Anais Nin