Halifax

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Strengthening Indianas Citizens and Communities
Promoting Resilience Recovery
May 9, 2006 Indianapolis, Indiana
Barbara J. Friesen
www.rtc.pdx.edu
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Questions

• What is resilience? Why is it important? Whats
  the bottom line?
• To whom does it apply? Is the definition of
  resilience and are resilience strategies
  universal?
• What is the relationship of recovery and
  resilience? How do they fit with the system of
  care framework in childrens mental health?
  Where is there value added?
• What are the implications of this information
  for
• o Practice
• o System change
• o Evaluation?

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Question 1

• What is resilience?
• Why is it important? Whats the bottom line?

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The ultimate goal of mental health
transformation is to create a consumer-driven
system focused on recovery and resiliency.
Recovery refers to the process by which people
are able to live, work, learn, and participate
fully in their communities. Resiliency refers to
those factors that help us cope with lifes
challenges. It relates to a dynamic process that
creates positive adaptation within the context of
adversity.
Kathryn Power in an address to the National
Alliance for the Mentally Ill, September 10,
2004
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Resilience Definitions

• A dynamic process encompassing positive
  adaptation within the context of significant
  adversity (Luthar, Cicchetti, Becker, 2000).
• Risk must be present
• Resilience can be identified only after
  exposure to adversity
• Protective factors can be identified.

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Resilience Definitions

• Resilience is the process of adapting well in
  the face of adversity, trauma, tragedy, threats,
  or even significant sources of stress such as
  family and relationship problems, serious health
  problems, or workplace and financial stressors.
  It means bouncing back from difficult
  experiences
• (Discovery Health Channel and APA Practice
  Directorate, 2002)

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Conceptual Framework

• Developmental science perspective the
  individual functions as an integrated organism
  and development arises from the dynamic
  interrelations among systems existing within and
  beyond that person (Farmer Farmer, 2001, p.
  172).
• Ecological perspective Bronfenbrenners2
  synthesis of evidence about influence of external
  influences on the family as the context for the
  development of children (Bronfenbrenner, 1986).

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Relationships of Child, Family, Community
Community
Reciprocal
Family
Embedded
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Child
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Family
Dynamic
Community
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Why are resilience and resilience-building
important?

• Buffer, protect against future challenges
• Successfully adapting to difficult situations
  helps to strengthen coping skills and
  competencies
• We can act to increase protective factors
• We can act to reduce known risks.
• Good news
• Many EBP prevention, early intervention programs
  promote resilience
• Some address either/both substance abuse/mental
  health issues.

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Emotional problems Substance abuse Delinquency
Chess Thomas
Child Temperament Other Characteristics
Academic Failure
Poor Teacher Relationships
Deviant Peer Group
Parent-Child Relationship Problems
Parenting and Parent Characteristics
Conduct Problems
Beardslee
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Emotional problems Substance abuse Delinquency
Henggeler MST
Chess Thomas Parent Training
Child Temperament Other Characteristics
Academic Success
Good Relationships with Adults
Positive Peer Group
Parent-Child Relationship Problems
Parenting and Parent Characteristics
Conduct Problems
Beardslee Parents with Depression
Webster-Stratton Incredible Years
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Question 2

• To whom does the concept of resilience apply?
• Is the definition of resilience and are
  resilience strategies universal?

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Resilience

• Concept of resilience has developed over last 4-5
  decades
• Longitudinal research Garmezys study of
  children whose parents had schizophrenia
  Werners Kawai study of Hawaiian children
• Identification of risk, protective factors
• Positive, strengths-based implications
• Focus on competence, positive development
• Ordinary Magic - children are resilience unless
  major systems (intellectual functioning,
  parenting) are compromised (Masten, 2001)
• Shift from resilient children to resilience as
  a dynamic process
• Intervention development
• Building competence, skills in individuals
• Reducing risk
• Enhancing protective processes

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Resilience Correlates

• Individual (good intellectual functioning,
  easy-going disposition, self-efficacy, high
  self-esteem, talents, faith, future orientation)
• Family (close relationship to caring parent
  figure, authoritative parenting warmth,
  structure, high expectations, socioeconomic
  advantage, connections to extended family
  networks)
• Community (bonds to prosocial adults, connections
  to prosocial organizations, attending effective
  schools).

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Resilience-building Interventions

• Masten and Coatsworth (1998)
• 1st generation Interventions that strengthen
  childrens adaptive capacities, or changing
  parenting through direct intervention
  Necessary, but not sufficient (effects limited,
  short-lived).
• 2nd generation Ecological models that take
  into account environments that have an impact on
  the child (family, peers, neighborhood, schools,
  community organizations).

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Question 2

• To whom does the concept of resilience apply?
• Across the age span. Longitudinal studies have
  followed children into middle age and beyond.

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Question 2b

• Are the definition of resilience and resilience
  strategies universal?
• The broad idea of resilience is universal, but
  the definition of doing well varies by culture.
  Also, strategies to promote resilience must be
  culturally-based
• o Individual vs. collective
• o Importance of intergenerational
  relationships and relationships with
  ancestors
• o Emphasis on strengthening cultural identity.

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Question 3What is the relationship between
recovery and resilience? How do they fit with
the System of Care framework in childrens mental
health? Where is there value added?
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System of Care Principles, Concepts of
Resilience Recovery
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Distilled CrosswalkSystem of Care, Resilience
Recovery
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Distilled CrosswalkSystem of Care, Resilience
Recovery
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Distilled CrosswalkSystem of Care, Resilience
Recovery
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Resilience Value Added

• Future orientation, hope, optimism.
• Identify risk, protective factors, align with
  outcomes
• Suggestion approaches to healing historical
  trauma
• Build foundation of research for prevention,
  early intervention
• Child
• Family
• Community

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Recovery Value Added

• Explicit focus on hope, optimism
• Life planning, future orientation
• Quality of life as legitimate outcome
• Self-determination, self-management
• Recovery related to trauma of illness and
  negative experiences with system
• Empowerment
• Children, youth, families
• Service providers

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Practice
IMPLICATIONS
System Change
Evaluation
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Resilience Principles for service design

• Resilience is dynamic, can change quickly.
  Individualization calls for reassessment,
  adjustments in programming supports
• Resilience comes not from avoidance of all risks,
  but from successful engagement with challenges
  (Rutter, 1987). Parenting strategies and
  services should aim to progressively promote
  competence

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Resilience Principles Service Design

• Resilience-building services should be targeted
  (beyond generic strengths-based), when
  possible. Examples
• a. Tebes, et al., study of children whose
  parents had mental illness.
• Social processes, not symptoms, most important
• Effects on parenting
• Poverty
• Family Stress
• Interaction of intervention results
• Reductions in family stress associated with
  reduction in problem behaviors
• Improved parent-child bonding associated with
  greater child competence

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Resilience Principles Service Design

• Resilience-building services should be targeted
  (beyond generic strengths-based), when
  possible.
• b. Study of Midwestern farm families who
  suffered economic downturn (study of effect of
  poverty on children and families) Conger Conger
  (2002). Children developed mental and emotional
  problems not in response to direct deprivation,
  but to changes in parenting
• Parents worry about finances and family problems
  affected their ability to provide nurturance and
  emotional closeness
• Parents of children who did well (were resilient)
  could still provide emotional nurturance, or the
  children had other important supportive
  relationships (siblings, other adults).

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Resilience Principles for service design

• Research findings may not hold true across
  cultures, e.g., authoritative parenting
  promotes competence in many cultural groups, but
  authoritarian parenting also produces good
  results in African American and Asian children
  (Kotchick Forehand, 2002)
• Need careful evaluation tie to program theory.
  Be sure that outcomes we measure can be logically
  expected from what we do (what if were promoting
  competence, but measuring changes in problem
  behavior?).

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Resilience Recovery Implications for service
planning practice

• Overall Establish/use processes for youth
  family participation in developing recovery and
  resilience-building outcomes and processes at all
  levels
• - Service and educational planning
• - System development
• - Evaluation and feedback

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Implications for service planning practice

• Hope, optimism, and future planning
• Review current practice and policy re messages
  conveyed to families and youth
• Do intake practices inadvertently communicate
  blame?
• What is stated or implied about the future in
  planning and discussions?
• Do service providers hold pessimistic attitudes
  and beliefs about the future of children and
  youth with emotional disorders?
• Extract practice and program lessons from
  literature on hope and positive emotions.

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Implications for service planning practice

• Acknowledge and address trauma
• Strengthen practice approaches that address
  trauma experienced by individuals (abuse, loss,
  exploitation)
• Eliminate system-based negative experiences (get
  feedback from families and youth)
• Promote practice competence re trauma
  experienced by entire groups (i.e., Native
  American, African American youth families).

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Implications for service planning

• Resilience
• Use data about child, family, community, risk
  factors for individualized planning
• Use data about childrens strengths
  competencies for service planning
• Use information re strengths, competencies, and
  outcomes to planning, review, evaluation team
  at child and family level (CQI).

• Recovery
• Development of life planning processes (youth AND
  families)
• Outcomes
• Quality of life indicators (AACP)
• Make transition planning standard service
• Employment training opportunities
• Tangible, social support

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Implications for planning system development

• Resilience
• Assess community strengths assets (e.g., Search
  Institute) that are protective factors (access to
  positive activities adults who care (informal or
  formal)
• Work to increase community strengths, reduce
  risks (e.g., poverty, violence, neighborhood
  crime, biohazards)

• Recovery
• Use youth/family experiences of stigma to plan
  for stigma-reduction strategies
• Provide national/local support for peer-run,
  mutual support groups, organizations (youth and
  families)
• Evaluate mutual support services (build evidence
  base).

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Two Notable Community Initiatives

• Sheldon Park Pride. Began doing early childhood
  assessments, but moved to leadership training,
  job training and development, community
  gardening, and literacy training.
• Results higher employment, better relationships
  among residents, lower child abuse rates, child
  developmental gains. (Feikema, Segalavich,
  Jeffries, 1997).

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Notable Community Initiatives-cont.

• 2. Better Beginnings, Better Futures in Ontario,
  Canada helped 3 low-income communities develop
  prevention programs for children and build the
  capacity of parents, families, neighborhoods to
  promote healthy development.
• Results lower rates of emotional or behavioral
  problems, better social functioning, and improved
  general health in children
• Improved parental health, housing conditions.

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Resilience Recovery Implications for
evaluation

• Resilience and recovery concepts may suggest
  possible evaluation topics, e.g.,
• What percentage of individual child and family
  plans show evidence of building on strengths?
• What is the youth/family service experience re
  hope and future orientation? Does information
  received in intake, assessment promote
  optimistic, long-term view (vs. pessimistic,
  short-term, narrowly focused perspective)?

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Resilience Recovery Implications for
evaluation

• Resilience and recovery concepts may suggest
  possible evaluation topics, e.g.,
• ________________________________
• ________________________________
• ________________________________

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Next steps for Indiana?

• Questions? Discussion?

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References Bibliography Beardslee, W.R.,
Versage, E.M., Van de Velde, P., Swatling, S.,
Hoke, L. (2002). Preventing depression in
children through resiliency promotion The
Prevention Intervention Project. In R.J. McMahon
R.D. Peters (Eds.), The effects of parental
dysfunction on children. New York Kluwer
Academic/Plenum. Bronfenbrenner, U. (1986).
Ecology of the family as a context for human
development Research perspectives.
Developmental Psychology, 22(6), 723-741.
Conger, R.D., Conger, K.J. (2002). Resilience
in Midwestern families Selected findings from
the first decade of a prospective, longitudinal
study. Journal of Marriage and the Family,
64(2), 361-373. Curie, C.G., Brounstein, P.J.,
Davis, N.J. (2004). Resilience-building
prevention programs that work A federal
perspective. In C. Clauss-Ehlers M. Weist
(Eds.), Community planning to foster resilience
in children. NY Kluwer Academic/Plenum.
Discovery Health Channer and APA practice
Directorate. (2002). The road to resilience.
Brochure produced with the Discovery Health
Channel. Washington, DC American Psychological
Association. Dudley-Grant, G.R., Comas-Diaz, L.,
Todd-Bazemore, B., Hueston, J.D. (2003).
Fostering resilience in response to terrorism
For psychologists working with people of color.
In the Fostering resilience series of the APA
Task Force on Resilience in Response to
Terrorism, R. Levant and L. Barbanel, cochairs.
Washington, DC American Psychological
Association. Farmer, T.W., Farmer, E.M.Z.
(2001). Developmental science, systems of care,
and prevention of emotional and behavioral
problems in youth. American Journal of
Orthopsychiatry, 71(2), 171-181. Feikema, R.J.,
Segalavich, J.H., Jeffries, S.H. (1997). From
child development to community development One
agencys journey. Families in Society, 78,
185-195. Friesen, B.J.. Brennan, E.M. (2005).
Strengthening families and communities
System-building for resilience. In Ungar, M.
(Ed). A handbook for working with children and
youth Pathways to resilience across cultures and
contexts (pp. 295-311). Thousand Oaks, CA
Sage. Kotchick, B.A., Forehand, R. (2002).
Putting parenting in perspective A discussion of
the contextual factors that shape parenting
practices. Journal of Child and Family Studies,
11(3), 255-269. Luthar, S.S., Cicchetti, D.,
Becker, B. (2000). The construct of resilience
A critical evaluation and guidelines for future
work. Child Development, 71, 543-562. Masten,
A.S., Coatsworth, J.D. (1998). The development
of competence in favorable and unfavorable
environments. American Psychologist, 53(2),
205-220. New Freedom Commission on Mental Health
(2003). Achieving the promise Transforming
mental health care in America Final Report
(DHHS Pub. No. SMA-03-3832). Rockville, MD
Author. Rutter, M. (1987). Psychosocial
resilience and protective mechanisms. American
Journal of Orthopsychiatry, 57(3),
316-331. Stroul, B.A. Friedman, R.M. (1986). A
system of care for severely emotionally disturbed
children and youth. Washington, DC Georgetown
University, CASSP Technical Assistance Center.
Tebes, J.K., Kaufman, J., Adnopoz, J.,
Racusin, G. (2001). Resilience and family
psychosocial processes among children of parents
with serious mental disorders. Journal of Child
and Family Studies, 10(1), 115-136. US Department
of Health and Human Services, Substance Abuse and
Mental Health Services Administration (nd).
National consensus statement on mental health
recovery. Downloaded May 1, 2006 from
http//www.mentalhealth.samhsa.gov/
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www.rtc.pdx.edu
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Fostering Developmental Assets in Youth

• Since 1989, the Search Institute has developed,
  tested, and disseminated an approach focusing on
  40 key developmental assets that youth need to
  succeed (Benson, 1990 Scales Leffert, 1999).
• Through Healthy Communities-Health Youth
  initiative, communities have been called upon to
  strengthen developmental opportunities for youth,
  and to focus change efforts on multiple sectors.

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Strengthening Neighborhood and Community
Resources

• Need to have network of adults with shared goals
  who back each other up in times of stress.
• Collective efficacy of neighborhoods is linked to
  levels of violence and victimization, child
  maltreatment, and opportunities for positive
  experiences.

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Comprehensive Community Initiatives

• Built on a community action framework that
• Strengthens the capacity of community adults to
  support youth.
• Increases the quality and quantity of
  developmental opportunities for youth. (Connell
  Kubish, 2002).

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Funds to support this activity come from The
Child, Adolescent and Family Branch, Center for
Mental Health Services, Substance Abuse Mental
Health Services Administration, U.S. Department
of Health and Human Services and from The
National Institute on Disability and
Rehabilitation Research, U.S. Department of
Education.
Center for Mental Health Services, Substance
Abuse and Mental Health Services Administration,
U.S. Department of Health and Human Services
National Institute on Disability and
Rehabilitation Research, U.S. Department of
Education