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					                           Strengthening Indiana’s
                           Citizens and Communities:
                           Promoting Resilience &
                           Recovery

Portland, Oregon                May 9, 2006
                                Indianapolis, Indiana
                                Barbara J. Friesen
Research and Training Center
   on Family Support and
  Children’s Mental Health
     www.rtc.pdx.edu
                    Questions
1.   What is resilience? Why is it important? What’s
     the bottom line?
2.   To whom does it apply? Is the definition of
     resilience and are resilience strategies
     universal?
3.   What is the relationship of recovery and
     resilience? How do they fit with the system of
     care framework in children’s mental health?
     Where is there “value added?”
4.   What are the implications of this information
     for:
        o Practice
        o System change
        o Evaluation?
                                                   2
          Question #1:

What is resilience?

Why is it important? What’s the
  bottom line?




                                  3
“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 life’s 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
                                                           4
        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.

                                                5
             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)



                                                             6
                 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; Bronfenbrenner’s2 synthesis
of evidence about influence of external influences on
the family as the context for the development of
children (Bronfenbrenner, 1986).




                                                        7
Relationships of Child, Family, & Community
               Community

                 Family
                          1

                                   2
                  Child


                               3
                 Family

               Community
                                        8
   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.
                                                          9
                             Emotional problems
                             Substance abuse
                             Delinquency


                                          Child Temperament &
      Academic Failure                    Other Characteristics

Poor Teacher Relationships

  Deviant Peer Group



                                              Parenting and Parent
Conduct Problems                                 Characteristics




                                                                     10
                           Emotional problems
                           Substance abuse
                           Delinquency


                                        Child Temperament &
      Academic Success                  Other Characteristics

Good Relationships with Adults

  Positive Peer Group



                                            Parenting and Parent
Conduct Problems                               Characteristics




                                                                   11
          Question #2:

To whom does the concept of resilience
   apply?

Is the definition of resilience and are
    resilience strategies universal?



                                          12
                              Resilience
• Concept of resilience has developed over last 4-5
  decades
   – Longitudinal research: Garmezy’s study of children whose
     parents had schizophrenia ; Werner’s 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                              13
          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).


                                                    14
    Resilience-building Interventions

Masten and Coatsworth (1998):
• “1st generation”: Interventions that strengthen
  children’s 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).

                                                       15
                 Question #2:

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




                                                    16
                  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.
                                                         17
             Question 3:

 What is the relationship between
    recovery and resilience?

How do they fit with the System of Care
 framework in children’s mental health?

    Where is there “value added?”



                                          18
              System of Care Principles,
           Concepts of Resilience & Recovery
   Resilience                   SOC                      Recovery
 Core Concepts               Principles                  Elements
Definition:           Definition:                   Definition:
A dynamic process     A comprehensive               The process in which
encompassing          spectrum of mental health     people are able to
positive adaptation   & other services…in a         live, work, learn, &
within the context    coordinated network to        participate fully in
of significant        meet the multiple &           their communities.
adversity (Luthar,    changing needs of children    For some, recovery is
Cicchetti, &          & their families. (Stroul &   the ability to live a
Becker, 2000).        Friedman, 1986)               fulfilling & productive
                                                    life despite a
                      A range of treatment          disability. For
                      services & supports           others, it implies the
                      guided by a philosophy &      reduction or complete
                      supported by an               remission of
                      infrastructure (Stroul,       symptoms (PNFC,
                      2002)                         2003).
                                                                       19
                 Distilled Crosswalk:
         System of Care, Resilience & Recovery

    Resilience                  SOC                  Recovery
  Core Concepts              Principles              Elements
                       1. Comprehensive         1. Holistic (C)
                       services

Specification of       2. Individualized        2. Individualized &
Elements: (V)          services                 Person Centered (C)
  Reducing Risk                                 3. Strengths-Based
  Enhancing                                     (C)
Protective factors
                       3. Community-based       (Assumed)

Racial socialization   4. Culturally &          Healing historical
Healing historical     linguistically competent trauma (V)
trauma (V)                                                        20
               Distilled Crosswalk:
       System of Care, Resilience & Recovery
    Resilience                   SOC                   Recovery
  Core Concepts               Principles               Elements
Solid basic & applied   5. Early
research base for       intervention
prevention and early
intervention (V)

                        6. Family & youth         4.   Empowerment
                        participation             5.   Self Direction
                           Family-driven
                           Youth guided,
                        directed
                        7. Service Coordination

                        8. Interagency                           21
                        Coordination
            Distilled Crosswalk:
    System of Care, Resilience & Recovery
   Resilience               SOC             Recovery
 Core Concepts           Principles         Elements
                     9. Protective of   6. Respect, stigma
                     rights             reduction (V)

                     10. Transition     (Life planning)


Future orientation                      7. Hope, optimism
Optimism (V)                            (V)
                                        8. Non-linear
                                        (acceptance of
                                        setbacks)
                                        9. Responsibility
                                                            22
                                        10. Peer support
       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


                                                  23
         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


                                              24
IMPLICATIONS




               25
               Resilience:
      Principles for service design

1.   Resilience is dynamic, can change quickly.
     Individualization calls for reassessment,
     adjustments in programming & supports;


2.   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;

                                                  26
      Resilience Principles: Service Design
3. 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

                                                                 27
   Resilience Principles: Service Design

3. 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).
                                                               28
                Resilience:
       Principles for service design

4. 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);
5. Need careful evaluation – tie to program
   theory. Be sure that outcomes we measure can be
   logically expected from what we do (what if we’re
   promoting competence, but measuring changes in
   problem behavior?).

                                                        29
         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



                                             30
      Implications for service planning
                 & practice

1.    Hope, optimism, and future planning
     a) 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?
     b) Extract practice and program lessons from
        literature on hope and positive emotions.
                                                              31
      Implications for service planning
                 & practice

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



                                                   32
        Implications for service planning

Resilience                   Recovery
• Use data about child,      • Development of life
  family, community, risk      planning processes (youth
  factors for individualized   AND families);
  planning;                     – Outcomes
• Use data about children’s     – Quality of life
  strengths & competencies        indicators (AACP)
  for service planning;      • Make transition planning
• Use information re:          standard service:
  strengths, competencies,      – Employment & training
  and outcomes to planning,       opportunities
  review, & evaluation team
  at child and family level     – Tangible, social support
  (CQI).                                               33
             Implications for planning
              & system development
Resilience                   Recovery
• Assess community            • Use youth/family
  strengths & assets (e.g.,     experiences of stigma to
  Search Institute) that        plan for stigma-reduction
  are protective factors        strategies;
  (access to positive         • Provide national/local
  activities; adults who care   support for peer-run,
  (informal or formal);         mutual support groups,
• Work to increase              organizations (youth and
  community strengths,          families);
  reduce risks (e.g.,         • Evaluate mutual support
  poverty, violence,            services (build evidence
  neighborhood crime,           base).
  biohazards);
                                                      34
Two Notable Community Initiatives

1.       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).

                                                        35
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.



                                                    36
           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)?


                                                  37
           Resilience & Recovery:
        Implications for evaluation

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

  – ________________________________

  – ________________________________




                                              38
Next steps for Indiana?


   Questions? Discussion?


                            39
                                                     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 agency’s 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 40
        consensus statement on mental health recovery. Downloaded May 1, 2006 from http://www.mentalhealth.samhsa.gov/
            Portland, Oregon


   Research and Training Center
      on Family Support and
     Children’s Mental Health

www.rtc.pdx.edu
  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.
                                            42
     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.
                                            43
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).


                                             44
                                      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
Portland, Oregon
                                      The National Institute on Disability and
Research and Training Center
                                      Rehabilitation Research, U.S.
   on Family Support and
  Children’s Mental Health            Department of Education.




          Center for Mental Health Services,               National Institute on Disability
          Substance Abuse and Mental Health
                                                           and Rehabilitation Research,
          Services Administration, U.S. Department
                                                           U.S. Department of Education
          of Health and Human Services

                                                                                          45

				
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