Resilience in the context of child maltreatment

1. Resilience in the context of child maltreatment Christine Wekerle, Ph.D. Associate Professor, Pediatrics, McMaster University wekerc@mcmaster.ca

2. Maslow’s (1954) Hierarchy of Needs (Individual-level resilience)

3. Maslow’s (1962) Behaviours promoting Self-actualization • Child-like approach: playful, discovery, “zone” • Evaluating experiences by listening to your own feelings (self-valuing) • Avoiding pretense ('game playing') and being honest • Being prepared to be unpopular if your views do not coincide with those of the majority • Taking responsibility and working hard • Awareness of your defenses (win-win preferences; acceptance & realism)

4. Bronfenbrenner’s Ecological Model: Multiple-levels of Influences

5. Definition of Resilience • Garmezy, Masten & Tellegen(1984) – emphasis on individual competence “competence in children despite exposure to stressful events” • Rutter (1985) – emphasis on personal and social competence “self-confidence and social competence to increase through mastery and appropriate responsibility” • Masten (1994) – emphasis on adaptation “pattern over time, …good eventual adaptation despite developmental risk, acute stressors, or chronic adversities” • Ungar (2012) www.ccycnetwork.org - emphasis on capacity • In the context of exposure to significant adversity, resilience is both the capacity of individuals to navigate their way to the psychological, social, cultural, and physical resources that sustain their well-being, and their capacity individually and collectively to negotiate for these resources to be provided in culturally meaningful ways. • ….But What About Resilience Behaviours and Outcomes?

6. Maltreatment and Adolescent Pathways (MAP) Study Principal Investigator: Christine Wekerle, Ph.D. (wekerc@mcmaster.ca) Co-Investigators: Michael Boyle, Ph.D.; Harriet MacMillan, M.D. (McMaster) Deborah Goodman, Ph.D.; Randy Waechter, Ph.D., Eman Leung, Ph.D. (University of Toronto) Bruce Leslie, M.S. W.; Brenda Moody, M.B.A. (ON Children’s Aid Society) NicoTrocmé, Ph.D. (McGill) Collaborating Scientists: Abby Goldstein, Ph.D. (University of Toronto) Jonathan Weiss, Ph.D. (York University) Stephen Ellenbogen, Ph.D. (Memorial University) Tiffany Thornton, MSW (Health Canada) Lil Tonmyr, Ph.D. (Public Health Agency of Canada) Marlyn Bennett, Ph.D.(First Nations Child & Family Caring Society of Canada) MAP Advisory Board: Kong Chung, Lori Bell, Natasha Budzarov, Darlaine Mathews, David Firang, Dan Cadman, Susan Gaines Cherry Chan, Mario Giancola, Judith Wharton, BervinGarraway, Carla DaFonte, Jacqueline Bittencourt MANY THANKS to ALL the YOUTH and CASEWORKERS for their time and efforts!

7. Maltreatment and Adolescent Pathways (MAP) Longitudinal Study • 561 Adolescents (14-16) who were receiving services from Children’s Aid Societies (63% Crown Wards) followed over 2 years • Testing every 6 months –many outcomes • See publications, go to…. www2.oacas.org Enter your full email as username Enter mapguesttest as password

8. Self-Compassion Scale (SCS) • 26-item self-report measure, with three SCS components: • (1) Self-kindness:“I try to be loving towards myself when I’m feeling emotional pain” • (2) Common humanity: “When things are going badly for me, I see the difficulties as part of life that everyone goes through” • (3) Mindfulness: “When something upsets me I try to keep my emotions in balance” • Responses: (1) almost never to (5) almost always • Reliability in study sample: α = .89 • Presently, a short-form available (12 items), shows good correlation to outcomes as full scale (26 items) in MAP; also Compassion Towards Others • Neff, K. D. (2003). Development and validation of a scale to measure self-compassion. Self and Identity, 2, 223-250. • Raes, F., Pommier, E., Neff, K. D., & Van Gucht, D. (2011). Construction and factorial validation of a short form of the Self-Compassion Scale.  Clinical Psychology & Psychotherapy. 18, 250-255.

9. Child & Youth Resilience Measure • Standard stem (“To what extent…”) rating 30 items on a 5-point scale from “Not at all” to “A lot” • Total Resilience Score can be calculated from all 30 items (Cronbach’s alpha MAP sample = .94) • Three subscales have been used: • Community (11 items)(e.g., “Do you feel supported by your friends?”) (MAP sample Cronbach’s alpha = .86) • Family (6 items)(e.g., “Do you feel that your parent(s) / guardian(s) watch you closely?” (MAP sample Cronbach’s alpha = .84) • Individual (9 items)(e.g., “Do you cooperate with people around you?”) (MAP sample Cronbach’s alpha = .83) * Ungar, Liebenberg, Boothroyd, Kwong, Lee, Leblanc, Duque, & Makhnach, 2008; 4- factor model, 13-19 year olds: (1) Individual: “I try to finish what I start”; “I am aware of my own strengths”; (2) Relationships with caregivers: “My caregivers know a lot about me”; “If I am hungry, there is enough to eat”; (3) Relationships with peers: ;”My friends stand by me during difficult times” “I have people to look up to”; (4) Environmental context: “Spiritual beliefs are a source of strength for me”; “I think it is important to serve my community”; “I am treated fairly by my community.”

10. Results – Child Maltreatment & Self-compassion • Self-compassion Scale; Childhood Trauma Questionnaire • Mean (SD): 3.10 (0.56)

11. Results: Suicidality Outcomes over time (N=119) • *p ≤ .05; AUDIT – Alcohol Use Disorders Identification Test (http://whqlibdoc.who.int/hq/2001/WHO_MSD_MSB_01.6a.pdf) • Continuous variables (log transformed; non-normal distribution) analyzed via ANCOVA and Scheffé (unequal n’s) post-hoc tests, categorical (clinical cut-off) variables (%) analyzed via X2 • 1 Remained significant after using ANCOVA to control for child maltreatment

12. MAP Dating Violence (DV) - Prevalence by gender • Among 136 (72 F; 64 M) who participated in all 4 time points • MAJORITY - NO DATING VIOLENCE INVOLVEMENT F Initial: 62.5% 6 Months: 63.9% 18 Months: 72.2% 24 Months: 56.9% M Initial: 62.5% 6 Months: 76.6% 18 Months 64.1% 24 Months: 60.9% DATING VIOLENCE INVOLVEMENT OVER 4 TIME POINTS • MINORITY - DATING VIOLENCE INVOLVEMENT REPEATEDLY F 1 DV: 29.2% 2 DV: 22.2% 3 DV: 12.5% 4 DV: 8.3% M 1 DV: 25.0% 2 DV: 17.2% 3 DV: 17.2% 4 DV: 6.3% • Analysis of DV continuity showed significantly more females than males experienced DV two or more times during two years. • For 2 or more DVs timepoints, DV consists of both roles as perpetrator and victim – no pure group of victim only or perpetrator only

13. Results – Self-compassion & Dating Violence over time DV continuity measured by DV at 2 or more time points, • There was a group difference, χ2 (1, N = 77) = 10.4, p = .001 • There was no case with pure-type continuous dating violence.

14. Self-compassion Interventions • Self-compassion relevant for maltreated adolescents • Self-compassion represents a warm and accepting attitude towards self (Neff, Kirkpatrick, & Rude, 2007) • Need to conduct analyses to see if self-reported self-compassion and resilience scores “explain” the link between child maltreatment and outcomes • Self-compassion as an intervention - Existing programs in self-compassion Cognitive Behavior Therapy (Gilbert et al.), self-compassion meditation as part of or separate from yoga practice • See Dr. Kristen Neff’s website for meditations and articles and more… http://www.self-compassion.org

15. What is resilience in the context of maltreatment? • Forming a coherent narrative that eliminates self-disgust, self-blame, guilt, attributions of personal responsibility or fault ….Enhancing self-compassion. • Recognizing and crafting safety – stable, secure, predictable contexts….zero tolerance for violence in partnerships • Confirming strengths and social network – maintain and build upon resources • Voting for yourself! Because maltreatment was about attention to others’ needs, not the child’s

16. Thank you for your attention!