Resilience in the context of child maltreatment

Christine Wekerle, Ph.D.Associate Professor, Pediatrics, McMaster

Universitywekerc@mcmaster.ca

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

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)

Bronfenbrenner’s Ecological Model: Multiple-levels of Influences

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?

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)

Nico Trocmé, 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 GainesCherry Chan, Mario Giancola, Judith Wharton, Bervin Garraway, Carla Da Fonte, Jacqueline

Bittencourt

MANY THANKS to ALL the YOUTH and CASEWORKERS for their time and efforts!

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.orgEnter your full email as usernameEnter mapguesttest as password

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.

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.”

Results – Child Maltreatment & Self-compassion• Self-compassion Scale; Childhood Trauma Questionnaire

– Mean (SD): 3.10 (0.56)SCS High SCS Low Cohen’sN = 56 N = 62 d

CTQ score (SD )Physical abuse 9.7 (5.7) 11.9 (6.1) 0.49 0.053Sexual abuse 6.8 (4.3) 8.2 (6.1) 0.28 0.168Emotional abuse 10.3 (5.4) 13.2 (6.3) 0.58 0.011Physical neglect 9.3 (4.4) 9.9 (4.1) 0.24 0.432Emotional neglect

13.3 (5.4) 16.0 (6.1) 0.45 0.025

P

• *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

(A) No suicidal thought (n=76)

(B) Suicidal thought, 1 time-

point (n=21)

(C) Suicidal thought, 2+ time-

points (n=22)

Resilience (CYRM) Total Score: M (SD)1

Community Score: M (SD)1

Family Score: M (SD)1

Individual Score: M (SD)1

3.85 (.73) *4.01 (.76) *3.58 (1.0) *3.99 (.75) *

3.80 (.37) 3.96 (.40) 3.13 (.95) 4.16 (.42)

3.22 (.77) * 3.35 (.81) * 2.69 (1.0) * 3.48 (.75) *

Self-compassion (SCS)Total Score: M (SD)1

3.30 (0.63) * 2.95 (0.47) 2.74 (0.41) *

Psychological Distress GHQ-12 at 2-year follow-up

*15.4% * * 40.0% 47.6% *

AUDIT = Alcohol problem at 2-year follow-up

10.8 % 10.0% * 38.1% *

Self-rated LGBT vs. Heterosexual *

40.0%

68.5%

33.3%

20.5%

26.7%

11.0%

Results: Suicidality Outcomes over time (N=119)

MAP Dating Violence (DV) - Prevalence by gender

• Among 136 (72 F; 64 M) who participated in all 4 time points– MAJORITY - NO DATING VIOLENCE INVOLVEMENTF 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 REPEATEDLYF 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

Results – Self-compassion & Dating Violence over time

-There was a group difference, χ2 (1, N = 77) = 10.4, p = .001-There was no case with pure-type continuous dating violence.

DV continuity measured by DV at 2 or more time points,

Continuity of dating violence

2+ times across 4 time points

No dating violence at all time points

77.8 41.5

Both types at least 2 of 4 time points

22.2 58.5

SCS High, n=36 (%) SCS Low, n=41 (%)

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

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

Thank you for your attention!