Pathways to Resilience Among Children in Child Welfare,Corrections, Mental Health and Educational Settings: Navigation and Negotiation

In this paper I explore how social service delivery systems influence the pathways children travel to resilience. In particular, I look at children’s navigation to the health resources that are available through service delivery systems and their negotiation with service providers for service once under a provider’s mandate. Two case examples are used to illustrate health-enhancing and health-challenging patterns of service provision and utilization among high-risk youth. I then address two questions that are critical to understanding children’s pathways to resilience: “What services do children say they need to achieve resilience?” and “How does the structure of services affect children’s access to the health resources required to nurture and sustain resilience?”     

Vulnerable youth,dialogic exchanges and resilience: Some preliminary findings from an exploratory study in East London

There has been little exploration in the literature of the dialogic exchanges among marginalized youth, including the kinds of associations they may have, if any, with resilience. Based on preliminary findings from an ethnographic study in East London, we explore some of the dialogic exchanges about resilience among ethnically diverse groups of vulnerable youth to suggest alternative ways in which it can be contextualized. Youth narratives are used as an analytical tool to unravel the ambiguities of the terms resilience and adversity and to illustrate ways in which the respondents' association and understanding of resilience and adversity can contextualize more effectively the covert processes they undergo as they navigate through personal and cultural adversities. What is their association with the concept of resilience? Do these connections (if any) influence the ways they contextualize and face their daily adversities? How and where can the voices of vulnerable youth be positioned in the health resilience literature?     

Health Realization: A Principle-Based Psychology of Positive Youth Development

While we have numerous research-based programs for youth aimed at curbing drug use, violence, suicide, teen pregnancy, and delinquency, we lack a rigorous principle-based psychology of positive youth development. Instead of focusing on fixing what is assumed to be missing or broken in at-risk youth, we need a psychology grounded in fundamental causal principles that reveal clearly how such children and adolescents can become self-motivated, socially competent, compassionate, and psychologically vigorous adults. While the emerging field of positive psychology has attempted to shift the field's emphasis from understanding and treating youthful dysfunction to facilitating well-being and resiliency in young people, it lacks a principle-based foundation and continues to mistakenly endorse external causes of positive affect and prosocial behavior. This paper offers a unique, principle-based psychology of positive youth development commonly known as health realization (HR). The underlying principles of HR are delineated, contemporary research that supports its major assumptions cited, and the results of applied HR research with at-risk youth in clinical, educational, and community empowerment settings described.     

The Social Construction of Resilience Among “Problem” Youth in Out-of-Home Placement: A Study of Health-Enhancing Deviance

Case studies of 43 youth with experience in child welfare, mental health, and correctional settings examined how resilience is socially constructed by participants and their caregivers. The deviant behaviors of these youth are explained as ways they successfully cope with the risk factors they face. Placement in institutions and community-based residential programs offers to high-risk youth forums in which to create continuities or discontinuities in their identity stories. Getting placed, surviving inside, and going home are experienced by high-risk youth as opportunities to enhance their discursive empowerment in the social discourse which defines them as either vulnerable or resilient. Collaboration between service partners can have a negative or positive impact on the development of healthy identities in high-risk youth depending on whether care providers participate in the construction of problem-saturated or health-enhancing identities. Support for this understanding of healthy deviance can be found in a number of studies of high-risk adolescent populations.     

School-based programs: lessons learned from CATCH, Planet Health, and Not-On-Tobacco

Establishing healthy habits in youth can help prevent many chronic health problems later in life that are attributable to unhealthy eating, sedentary lifestyle, and overweight. For this reason, many public health professionals are interested in working with school systems to reach children in school settings. However, a lack of familiarity with how schools operate can be a substantial impediment to developing effective partnerships with schools. We describe lessons learned from three successful school health promotion programs that were developed and disseminated through collaborations between public health professionals, academic institutions, and school personnel. The programs include two focused on physical activity and good nutrition for elementary and middle school children--Coordinated Approach to Child Health (CATCH) and Planet Health--and one focused on smoking cessation among adolescents--Not-On-Tobacco (N-O-T). Important features of these school health programs include 1) identification of staff and resources required for program implementation and dissemination; 2) involvement of stakeholders (e.g., teachers, students, other school personnel, parents, nonprofit organizations, professional organizations) during all phases of program development and dissemination; 3) planning for dissemination of programs early in the development and testing process; and 4) rigorous evaluation of interventions to determine their effectiveness. The authors provide advice based on lessons learned from these programs to those who wish to work with young people in schools.     

Behavioral Adaptation Among Youth Exposed to Community Violence: a Longitudinal Multidisciplinary Study of Family, Peer and Neighborhood-Level Protective Factors

Several studies across fields have documented the detrimental effects of exposure to violence and, separately, the power of developmental assets to promote positive youth development. However, few have examined the lives of youth exposed to violence who demonstrate resilience (that is, positive adjustment despite risk), and hardly any have examined how developmental assets may shape resilient trajectories into adulthood for youth exposed to violence. What are these resources and relationships that high-risk youth can leverage to tip the balance from vulnerability in favor of resilience? We used generalized estimating equations to examine multilevel longitudinal data from 1,114 youth of ages 11–16 from the Project on Human Development in Chicago Neighborhoods. Behavioral adaptation was a dynamic process that varied over time and by level of violence exposure. In the short term, being a victim was associated with increased aggression and delinquency. In the long term though, both victims and witnesses to violence had higher odds of behavioral adaptation. Baseline family support and family boundaries, friend support, neighborhood support, and collective efficacy had positive main effects for all youth. Additionally, having family support, positive peers, and meaningful opportunities for participation modified the effect of exposure to violence and increased odds of behavioral adaptation over time. Policies, systems, and programs across sectors should focus on building caring relationships/supports with family members and friends, positive peers, and meaningful opportunities especially for witnesses and victims of violence, to promote behavioral resilience and related outcomes into adulthood for high-risk youth.     

Health services utilization, satisfaction, and attachment to a regular source of care among participants in an urban health provider alliance

This study examines the effect of a provider alliance on service utilization, satisfaction , self efficacy, and attachment to a regular source of care for participating low income urban children and their families. The use of Physician Assistants and community health workers to expand community outreach, primary care services, pediatric sub-specialty care, and service coordination within and between care settings improved health services utilization, satisfaction with health services, parental self efficacy in navigating the health care system for their children, and service convenience for an at-risk population. Also, the use of Physician Assistants to provide pediatric sub-specialty services did not have a negative effect on parental satisfaction with a child's care. Parents were slightly more satisfied with services received from a Physician Assistant in comparison with the physician sub- specialists in cardiology and nephrology clinics.     

Developing resilience: how women maintain their health in northern geographically isolated settings

The purpose of this study was to explore how women maintain their health in northern geographically isolated settings, using a feminist grounded theory method. Twenty-five women of diverse backgrounds in northern British Columbia, Canada, engaged in qualitative interviews over a 2-year period to express perspectives about how the north affects their health and how they maintain their health in northern settings. Findings reveal that the women experienced vulnerability to physical health and safety risks, psychosocial health risks, and risks of inadequate health care. The women responded to these vulnerabilities by developing resilience through the strategies of becoming hardy, making the best of the north, and supplementing the north. These strategies, which reflect both individual and collective actions, were determined by the needs and interests of the women and their social and personal resources. The findings have implications for women's health research and health practices and policies in geographically isolated settings.     

Peer Reviewed: School-based Programs: Lessons Learned from CATCH, Planet Health, and Not-On-Tobacco

Establishing healthy habits in youth can help prevent many chronic health problems later in life that are attributable to unhealthy eating, sedentary lifestyle, and overweight. For this reason, many public health professionals are interested in working with school systems to reach children in school settings. However, a lack of familiarity with how schools operate can be a substantial impediment to developing effective partnerships with schools.

We describe lessons learned from three successful school health promotion programs that were developed and disseminated through collaborations between public health professionals, academic institutions, and school personnel. The programs include two focused on physical activity and good nutrition for elementary and middle school children — Coordinated Approach to Child Health (CATCH) and Planet Health — and one focused on smoking cessation among adolescents — Not-On-Tobacco (N-O-T).

Important features of these school health programs include 1) identification of staff and resources required for program implementation and dissemination; 2) involvement of stakeholders (e.g., teachers, students, other school personnel, parents, nonprofit organizations, professional organizations) during all phases of program development and dissemination; 3) planning for dissemination of programs early in the development and testing process; and 4) rigorous evaluation of interventions to determine their effectiveness. The authors provide advice based on lessons learned from these programs to those who wish to work with young people in schools.

     

“It <Emphasis Type="Italic">Really</Emphasis> Takes a Village”: A Socio-Ecological Model of Resilience for Prevention Among Economically Disadvantaged Ethnic Minority Youth

Promoting resilience prevents maladaptation among economically disadvantaged ethnic minority (EDEM) youth. EDEM youth need access to a variety of assets and promotive factors (i.e., resources) in the family, school, and community system to counter risks and promote positive adaptation. However, the field lacks a socio-ecological model of resilience for prevention targeted towards EDEM youth. We aim to review assets and promotive factors in the family, school, and community systems to present a socio-ecological model of resilience for the prevention of negative educational and health outcomes among EDEM youth. We reorient the social ecologies of EDEM youth from “at risk” to “at promise” focusing on family and community-centered prevention models. We discuss implications for the design of prevention strategies as well as their implementation and methodological challenges.     

Nothing can defeat combined hands (Abashize hamwe ntakibananira): protective processes and resilience in Rwandan children and families affected by HIV/AIDS

In Rwanda, the dual vectors of HIV and legacy of the 1994 genocide have had devastating consequences for children and families. In this and other low-resource settings, extreme poverty, poor access to services, family conflict, and other adversities put children and families affected by HIV/AIDS at increased risk of mental health problems. However, even in the face of tremendous hardship, many children and families demonstrate better than expected outcomes. To design interventions that harness these natural sources of resilience, greater knowledge of local protective processes is needed. This study used free listing exercises (N = 68) and key informant interviews (N = 58) with adults and children (ages 10-17) to investigate strengths and sources of resilience in Rwandan children and families at risk for psychosocial difficulties due to HIV/AIDS. Clinician key informants (N = 10) were also interviewed. Five forms of protective resources emerged through this research: perseverance (kwihangana); self-esteem/self-confidence (kwigirira ikizere); family unity/trust (kwizerana); good parenting (kurera neza) and collective/communal support (ubufasha abaturage batanga). Operating within individual, family, and collective/community systems, these resources support children at multiple ecological levels. Study evidence suggests that these protective processes provide "leverage points" for strengths-based interventions designed to increase resilient outcomes and prevent mental health problems. This information on culturally-appropriate practices for building resilience, along with input from local community advisory boards and the government, has informed the development of a Family Strengthening Intervention, which has broad applications to many forms of adversity and trauma.     

The impact of service dogs on children,youth and their families: A systematic review

BackgroundHaving a service dog can help to increase independence and well-being among people with a disability or a chronic health condition. Although there has been an increasing use of service dogs among children and youth their impact has not yet been synthesized.ObjectiveThe purpose of this article was to conduct a systematic review assessing the impact of service dogs on children, youth and their families.MethodsSystematic searches of seven international databases from 1985 to 2020 led to 29 studies meeting our inclusion criteria. Using a narrative synthesis review approach we analyzed these studies regarding their sample characteristics, methods, results and quality of evidence.ResultsThere were 29 studies in our review that included 1121 children and youth (or parents representing them) that spanned across six countries over a 32-year period. Although the outcomes of the impact of service dogs varied across the studies, 23/29 of them reported an improvement in at least one of the following: physical health (i.e., diabetes management, seizure management, mobility), psychological health (i.e., quality of life, safety, behavior, stress, anxiety, self-confidence and independence), social well-being (i.e., social interactions, school and work) and dog-owner-bond. Children, youth and their parents also described several challenges in owning a service dog.ConclusionsOur findings highlight that service dogs have potential to provide many benefits for children, youth and their families. Further research, including more rigorously designed studies, is needed to fully understand their impact.     

Preventing Youth Suicide: Potential “Crossover Effects” of Existing School-Based Programs

Notable increases in youth mental health problems combined with strains on the already stretched mental health workforce raise concerns that there will be an ensuing increase in youth suicide thoughts, behaviors, and even deaths. Schools are recognized as crucial settings for youth mental health support and suicide prevention activities, yet schools also face staff shortages and ever-increasing responsibilities for student well-being. Evidence is emerging that prevention programs originally designed to improve problem-solving skills and social-emotional functioning in youth have demonstrated downstream, “crossover effects,” that is, unanticipated benefits, on youth suicidal behavior. Relatively little research on crossover effects has been conducted within school settings, despite the strong potential for commonly administered programs to have an impact on later suicide risk. We review key suicide risk factors and their proposed mechanisms of action; we also discuss factors that may protect against suicide risk. We then identify upstream prevention programs targeting the same factors and mechanisms; these programs may hold promise for downstream, crossover effects on youth suicide risk. This paper is intended to provide a framework to help researchers, practitioners, and policymakers as they consider how to prevent youth suicide using existing school-based resources. Rigorous investigation of upstream prevention programs is urgently needed to determine ideal approaches schools and communities can deploy to prevent youth suicide.

     

Exploring the Feasibility and Benefits of Arts-Based Mindfulness-Based Practices with Young People in Need: Aiming to Improve Aspects of Self-Awareness and Resilience

Research in mindfulness-based methods with young people is just emerging in the practice/research literature. While much of this literature describes promising approaches that combine mindfulness with cognitive-behavioral therapy, this paper describes an innovative research-based group program that teaches young people in need mindfulness-based methods using arts-based methods. The paper presents qualitative research findings that illustrate how young people in need (children and youth involved with child protection and/or mental health systems) can benefit from a creative approach to mindfulness that can teach them emotional regulation, social and coping skills, and that can improve aspects of their self-awareness, self-esteem, and resilience.     

Yoruba culture and the resilience of HIV-positive adolescent girls in Nigeria

Abstract

Although there is a growing body of research exploring the influence of culture on the resilience of African youth, few studies have examined how culture constrains or enables resilience among HIV-positive adolescent girls from the perspective of the young women themselves. This paper reports on the findings from a qualitative study of five purposively selected girls living with HIV in Ibadan, Nigeria. By analysing data drawn mainly from interviews and observations, we explored how cultural influences promote or limit resilience in participants. Social-ecological resilience theory was used to document and interpret the findings. While some cultural values and perceptions enable resilience, others constrain participants’ resilience trajectories. However, the girls were able to navigate through these constraints using their cultural identities and coping strategies, such as future dreams, emotional and physical resources linked to spirituality and networks of friends and families. Findings have implications for policymakers, researchers and programmers in strengthening the health and resilience of young people in the face of HIV.     

Investigating the social organization of family health work: an institutional ethnography

This article reports findings from focus group conversations and in-depth interviews about the things that parents do to take care of their children’s health in Toronto, Canada. Our data demonstrate that within a single urban setting, parents are differently positioned to effectively find and engage existing healthcare resources. Parents’ ‘family health work’ is shaped by systemic expectations for health and institutional literacy and inter-institutional navigation skills that not all parents possess in equal measure. The intensive focus in Ontario paediatric healthcare settings on patient and parent education suggests increased interest in cultivating autonomous health information seeking and use strategies among parents. But the degree to which parents’ health-information seeking and use strategies are deemed effective depends on whether they are able to construct coherence between what they know about their child’s health and how to take care of it, and the knowledge the medical system requires to support diagnosis and treatment. Our research suggests that the healthcare system is only interested in information-seeking autonomy insofar as it supports patients’ engagement with the systems’ existing practices, frames of validity and service pathways. People who are unable to demonstrate health knowledge and work that support existing systemic processes cannot effectively use what they know and do to support their children’s health and wellness.     

‘Youth-friendly’ characteristics of professionals in mental health settings

Abstract

Adolescents have a unique developmental vulnerability to suicide, with youth presenting as the second most vulnerable group to suicide across the lifespan. Youth have been recognized as underserved mental health service recipients, with only one in six of those in need receiving care. Calls for innovative mental health services to better serve youth have been articulated for over a decade and the adolescent health and mental health communities have responded. However, to date there has been little empirical discussion of the caregiver characteristics that would increase the likelihood of youth feeling comfortable discussing their mental health concerns. Objectives of this study were twofold: (1) to ask a large sample of Canadian youth [n?=?11 171: 5146 males, 6001 females (n?=?24 participants did not indicate their sex )] to identify characteristics of mental health professionals they would define as ‘youth-friendly’, and (2) to test which youth-friendly characteristics are deemed important to youth based on their circumstances, including those experiencing recent suicidality. Gender differences are also tested and explored. The absence of youth-friendly mental health service provision is proposed to be a modifiable barrier to help seeking in at-risk youth.     

Living resiliently: The voices of a group of child protection social workers in South Africa

Child protection social workers (CPSWs) do critical work protecting vulnerable children. Given the demanding nature of this work, CPSWs are reportedly at great risk for negative outcomes, such as burnout and depression. Another outcome is often unsatisfactory service delivery by CPSWs, leaving vulnerable children exposed to continued maltreatment. Understanding how some CPSWs do well, despite the demanding nature of their work, is important to inform future interventions that could potentially promote CPSW resilience and improve CPSW service delivery. While some research on the resilience of CPSWs exists, very little is known about resilience in South African CPSWs. The aim of this qualitative study was to contribute to the ongoing conversation of CPSW resilience, by exploring resilience among CPSWs in Gauteng, South Africa. Participants shared their lived experiences of workplace adversity and resilience. In this paper, we report only on the findings related to their resilience, which was analysed using thematic analysis. Findings reveal that participants’ resilience was informed by a safe and appealing space away from work; drawing strength from religion; relaxation and self-care as healing modalities; a passion for CPSW; the positive influence of personal background; supportive care systems; self-efficacy and personal agency; and a positive outlook. The resilience of these CPSWs, although dependent on supportive and responsive ecologies, was mostly self-directed since they appeared fundamentally accountable to procure support.