Resilience programs for children in disaster

© 2001 Blackwell Science Ltd

ORIGINAL RESEARCH Ambulatory Child Health (2001) 7: 75–83

Resilience programs for children in disaster

Edith Henderson Grotberg1,2,3

1Civitan International Research Center, University of Alabama at Birmingham, USA, 2Institute for Mental HealthInitiatives, School of Public Health and Health Services, the George Washington University Medical Center,Washington, DC, USA and 3Psychology Department, Ahfad University for Women, Omdurman, Sudan

ABSTRACT

Objectives The long-term objectives of the International Resilience Research Project(IRRP), were to indicate: a. how children become resilient and how serviceproviders incorporate the promotion of resilience into their programs. Theintermediary objectives were to: (1) indicate how resilience is promoted indifferent cultures with different age groups; (2) identify what resiliencebehaviors deal with and overcome the potentially damaging aspects ofadversities and disasters; and (3) identify the role of adults in promotingresilience in their children and in themselves.

Method The data from the International Resilience Research Project were reanalysedin order to link the results to subsequent research and programdevelopment, including resilience programs for children in disaster. Themethodology was based on purposeful samples of selected families withchildren in specific age groups (0–3; 4–6; 9–11 years). Each researcher,representing 27 sites in 22 countries, received the Methodology Guidanceand Manual for the Training of Interviewers, designed and developed by anInternational Advisory Committee; a demographic sheet; a packet of the 15constructed situations and forms with the questions to be answered; andadditional standardized tests for validation. Data were returned to the projectdirector for scoring, with reliability checks, and qualitative data analysis atCivitan International Research Center, University of Alabama, Birmingham.

Results Parents and children at 27 sites in 22 countries, from Russia to Vietnam,from Namibia to Finland, from Chile to Canada, provided the data. A total of1225 target children and their families participated, with 2204 responsesfrom parents, and 1194 responses from children. The results of the datagathered from 1993 to 1997 were, briefly, these: (1) one-third of therespondents exhibited resilience or its promotion; (2) by the age of 9 years,children can promote their own resilience at the same rate as adults; (3)socio-economic status had an insignificant impact on resilience promotionand behavior; (4) boys and girls had the same frequency of resiliencepromotion and behavior, with girls relying more on interpersonal skills indealing with adversities and boys relying more on pragmatic problem solvingskills; and (5) cultural differences exist, but do not prevent the promotion ofresilience.

Conclusion Resilience can be promoted, and programs for children in disaster arefeasible. Such programs can be adapted to children, adults, serviceproviders, students, and those working with children in disasters. The

76 E Henderson Grotberg ORIGINAL RESEARCH

IntroductionIt is easy to focus on thepathological impact of dis-asters, and, of course, suchimpact happens, and spe-cial help may be needed.However, humans have thecapacity to deal with, over-come, be strengthened by,and even transformed byexperiences of adversity, including both manmade andnatural disasters. That human capacity is resilience.Resilience helps people who are living in adverse con-ditions or experience neglect, abuse, loss, disastersand other adversities, function with low levels of distress and high levels of hope and confidence ade-quate for effective social and personal functioning.Resilience also contributes to their mental health.1

The International Resilience Research Project(IRRP)2 drew on the resilience factors identified byresearchers who were interested in the nature ofresilience, the factors of resilience, and the expres-sions of resilience. [Two outstanding research reportsand integrations are in: Vol. 5(4) Fall, 1993. Develop-ment and Psychopathology Dante Cicchetti (ed.);3

and Resilience and Development. M.D. Glantz & J.L.Johnson (eds.) (1999) Kluwer Academic/Plenum Pub-lishers.]4 The resilience factors identified in the estab-lished research became the basis for the IRRP, whichintended to answer two new questions: (1) how areresilience factors and resilience behavior promoted;and (2) how can the promotion of resilience be incor-porated into programs?

There were three assumptions: first, resilienceresponses to situations of adversity implied resilience

had been promoted;second, the promotion ofresilience is related to thegrowth trajectory; and third,adults play a critical role inthe promotion of resiliencein children.

The resilience factors usedin the IRRP were organizedaround their sources: pro-vided external supports,

developed inner strengths, and acquired interpersonaland problem solving skills, labelled, respectively, IHAVE, I AM, I CAN.

I HAVE

People around me I trust and who love me, no matterwhat.

People who set limits for me so I know when to stopbefore there is danger or trouble.

People who show me how to do things right by theway they do things.

People who want me to learn to do things on my own.People who help me when I am sick, in danger or

need to learn.

I AM

A person people can like and love.Glad to do nice things for others and show my

concern.Respectful of myself and others.Willing to be responsible for what I do.Sure things will be all right.

© 2001 Blackwell Science Ltd, Ambulatory Child Health 7(2), 75–83

The sources of resilience are fromprovided external supports (I HAVE);developed inner strengths (I AM); andacquired interpersonal and problemsolving skills (I CAN). Socio-economicstatus had an insignificant impact onthe amount and kind of resilience.

programs can be independent or incorporated as part of existing serviceprograms. Further, such programs can be adapted to different cultures.

Implications for Professionals can incorporate the promotion of resilience into their service practice programs in regular or disaster settings. As a consequence, they can

improve services and thereby the physical and mental health of children andfamilies coping with disaster.

Keywords cultures, disasters, programs, promotion, resilience

ORIGINAL RESEARCH Resilience programs for children in disaster 77

I CAN

Talk to others about things that frighten me or botherme.

Find ways to solve problems that I face.Control myself when I feel like doing something not

right or dangerous.Figure out when it is a good time to talk to someone

or to take action.Find someone to help me when I need to.

These statements of the resilience factors are put insimple terms, with children in mind. They can bewritten in more adult terms without loss of meaning.However, as data came in, additional resiliencefactors were noted, such as responsible risk-taking,negotiation, preparation, humor. These new factorswere not used in the research, but have an importantrole to play in programs to promote resilience.

MethodThe methodology was based on purposeful sam-ples of selected families with children in specific age groups (0–3; 4–6; 9–11 years). Each researcherfrom 27 sites in 22 countries, selected from a pool of researchers qualified to conduct the research,received the Methodology Guidance and the Manualfor the Training of Interviewers; a demographic sheet;a packet of the 15 situations, and forms with the questions to be answered; forms for reporting on per-sonal experiences of adversity; and additional stand-ardized tests for validation. Data were returned to the project director for reliability checked scoring, and for qualitative data analysis at the Civitan Inter-national Research Center, University of Alabama atBirmingham.

The methodology and instruments were examined by the International Resilience Research Project Advisory Committee, made up of representatives fromUnited Nations Educational, Scientific and CulturalOrganization, United Nations International ChildrensEmergency Fund, World Health Organization, PanAmerican Health Organization, International Chil-dren’s Center, Civitan International Research Center,University of Alabama Birmingham, and the Interna-tional Catholic Child Bureau.

Here is an example of a constructed situation ofadversity: Raul is 6 years old. He had an accidentwhen he was aged 3 years, and his legs will no longerhold his weight. His arms and hands are all right andhe uses them all the time. He is building a fence ofsmall sticks around a piece of wood that he is pre-tending is the house. He has increasing trouble reach-ing around for small sticks, and his useless legs keepknocking down parts of the fence. He becomes sofrustrated that he begins to throw the small sticksaround the room and starts to cry.

The questions to be answered include: what did theadult do? (It is assumed an adult is nearby.) How didthe adult feel? What did the child do when the adultdid that? How did the child feel? How did things comeout or how are things now?

When children could answer, these were the ques-tions: What did the adult do? What did the child dowhen the adult did that? How did the child feel? Howdid things come out or how are things now?

The child was not asked about the feelings of the adultbecause of concern about rousing anxiety in the childor the adult by asking the question requiring assess-ment of the adult’s feelings. The Advisory Committeeadvised against using the question.

The responses were scored by determining whichresilience factors from I HAVE, I AM, and I CAN wereused to deal with the adversity. A resilience response,scored 3, contained resilience factors used to pro-mote resilience and resilience behavior in a completeepisode – a beginning, a process, an ending oroutcome. This meant those involved in promotingresilience did so by using resilience factors inaddressing the adversity with an outcome that waseffective, non-damaging, and helped the target per-son deal with the adversity. A score of 2 was given to responses that were mixed, sometimes usingresilience factors, like providing loving support, butcountering that with giving no autonomy to the childto help in dealing with the adversity. A score of 1 wasgiven to responses that were destructive to the child’sdevelopment, punitive, abusive, or had little or no evidence of resilience.

Here is another example of a constructed situation:four children aged 9–11 years are at a market and arewalking around looking at the food and clothes for sale



and talking among themselves. They are having agood time when suddenly they hear gun shots. Theyknow what they are because they have heard thenoises before. They stop and look at each other.

In this situation, the children will need to do somethingthemselves. To promote their resilience, they will wantto feel safe and may do that by hiding under some ofthe display stands. One of them can try to get help byslipping away without being seen. They would needthe confidence to work toward a safe end, and theycan show caring for each other by expressions ofconcern and encouragement to stick with it until it is over. If they panic or scream, they will attract theattention of the shooters, and will feel traumatized andincapable of protecting themselves. After it is all over, they may be ashamed of their behavior, or theymay live in fear of another such incident and refuseto return to the market ever again. This is where anadult who knows how to promote resilience becomescritical.

The same questions were asked in reports of personalexperiences of adversity. Here are a few examples ofsuch personal experiences:

‘My father gets drunk. He said he was going to kill my mother and me. My mother put me withfriends and ran away. I don’t know where she is’. (6-year-old girl)

‘I was in the yard with my dad. He and the man nextto us got into an argument. Pretty soon it was a fight.The man pulled out a knife and stabbed my dad’. (8-year-old boy)

Here is how resilience can be promoted in such a situation:

The boy thinks of something he can do to help hisfather and runs to his grandfather’s home (I CAN). Heshows his father he loves him by saying comfortingwords to him (I AM). He will also promote his ownresilience if he knows there are people at home or ata neighbor’s from whom he can get to help him so hisfather can get medical attention (I HAVE). People whodo help him can add to the promotion of resilience inthe boy by praising him for what he has done to helphis dad, to comfort him, and to make sure the fatherreceives the medical attention he needs. The boy ispraised for getting help from the grandfather, and for

not trying to solve the problem himself, because he istoo young.

Resilience is not promoted if the boy simply collapsesinto tears or runs away taking no action, if he is tooafraid to seek help for fear he will be stabbed, too, orif someone scolds him for not getting help or for doingnothing to prevent the stabbing. He might even beasked if he was the cause of the argument in the firstplace.

ResultsThere was a total of 2204 responses to situations pri-marily from parents and 1194 responses from childrenaged 4–6 and 9–11 years. The data came from 27sites in 22 countries and were gathered between 1993and 1997. The major findings are:

1 One-third of the respondents exhibited resilience.This finding is consistent with the findings in the earlystudies. It seems that no matter what country peoplelive in, no matter what conditions they live under,about one-third of the people have developedresilience. It is the other two-thirds that need help inbecoming resilient, and that is the challenge for thoseinterested in promoting resilience to help people dealwith the adversities and disasters of life.

2 Resilience is promoted more by parents and olderchildren in situations where there is less fear of lossof control of the situation, there is minimal arousal offear for oneself, or where there had been experiencewith a similar situation. Fear of loss of control of whatis happening often causes people to engage in inef-fective or random behavior, with little concern for thegreater dangers they expose themselves to. Beingfearful for one’s safety tends to trigger flight behavioror very aggressive fight behavior, and preventsdealing with the adversity. If someone has experi-enced a similar situation, such as war or a hurricane,some resilience behavior may have been learned andthe person has less difficulty dealing with the pre-senting, but similar, adversity. But for most, resiliencefactors and resilience behavior need to be developedand practiced so that the person is more prepared foradversities. Knowing what to do if the house is on fireor if someone is not breathing is preparation fordealing with adversity.



3 Children under the age of 9 years need moreoutside I HAVE supports to promote their resilience.Age and stage of development make a difference inbecoming resilient. Children aged 9 years and abovecan promote their own resilience as frequently asadults, but reach out for help more than adults. It isimportant, then, to encourage parents to promote theresilience of the younger children, and to be availableas the older children reach out for help or clearly needhelp.

4 The older boys and girls had the same frequencyof resilience scores as adults and with each other, but girls drew more on interpersonal skills in dealingwith adversities, whereas boys were more pragmatic,relying on problem-solving skills. Gender differencesare important to recognize, but should not detract fromthe need for boys to show empathy and girls to bemore independent in using problem-solving skills.

5 Socio-economic status had an insignificant impacton the amount and kind of resilience. The differenceswere in the number of resilience factors used forresilience behavior, with families in poverty usingfewer factors. However, the results were the same.There are some unfortunate tendencies to link resili-ence to academic achievement and socio-economicstatus. The confusion seems to be that children whoare successful in school and come from middle orupper middle class homes are resilient because theyare not as involved in drugs, sex, or delinquency, aschildren in poverty. The research, however, indicatesthat the families of these children protect them fromsuch adversities by involving them in other activitiesand organizations. This is avoidance of adversities,not dealing with them. A school that posts ‘This is aDrug-Free Zone’ signs is protecting the students andno resilience is needed. On the other hand, if a veryclose classmate is into drugs and wants the friend tojoin in, resilience is needed. Does he join because hewants to continue the friendship? Does he help thefriend deal with the threat of drugs? Does he reporthis friend to an authority in the school? Protectionfrom harm is, of course, important, but it should notbe confused with resilience. Resilience is to deal withadversities, to become empowered to overcomethem.

6 The research findings from the IRRP suggest thatevery country in the study drew on resilience factorsto promote resilience in their children. Cultural differ-

ences were marked primarily by the degree of controlin relation to the degree of autonomy given to children;the kinds of punishments and the reasons; the age at which children are expected to solve their ownproblems; the amount of love and support provided in dealing with adversity. Some cultures rely more onfaith than on problem-solving skills in facing adversi-ties. Some are more concerned with punishment andguilt, whereas other cultures discipline and reconcile.Some cultures expect children to he more dependenton others for help rather than becoming autonomousand more self-reliant. The parents in some countriesmaintain a close relationship with their children,whereas others ‘cut off’ their children at about the ageof 6 years. The resilient children manage this kind of rejection; non-resilient children withdraw, submit,are depressed, and often become runaways. It isimportant to recognize cultural difference, but it is also important to recognize that cultures have more in common than they have differences, especially inhelping their children deal with adversity. Each culturepromotes resilience factors, but not necessarily thesame ones to the same degree.

Here is a comparison of responses to a common con-structed situation from three countries and cultures:Katatura, Namibia, a former homestead for Blacks;Yerevan, Armenia, maintaining traditional familysystems while under the control of the USSR; andMetropolitan Khartoum, Sudan, in a continuous stateof civil warfare. The responses are from parents andtheir children who are aged 9–11years.

Constructed situation

Nine-year-old Rita walks to school every day andpasses a place where a group of older children standaround. When she passes them they call to her, makefun of her and sometimes push her. She has becomeso frightened she refuses to go to school any moreand tells her mother she is sick. Her mother knowsshe is healthy.

In Namibia, the most frequently used parentresponses that promoted resilience include: calmingthe girl (sense of being lovable, I AM); urging talkingabout what is going on (communication, I CAN);Expressing love (trusting, loving relationship, I HAVE);showing empathy (empathy, I AM); pointing out thatschool attendance is her responsibility (responsible,



I AM); helping her solve her problems (seeking helpwith problem-solving, I CAN).

The most frequently used parents’ responses thatprevent the promotion of resilience in children include:hitting the girl for lying; forcing the truth; feeling sadand afraid for the girl, but not helping; feeling angry,but doing nothing; forcing the girl to go to school.

The most frequently used children’s responses thatpromote resilience include: telling the truth even whilefeeling guilty for lying (responsible, I AM); resolvingthe problem with the help of the parent (trusting rela-tionship, I HAVE; problem-solving, I CAN).

The most frequently used children’s responses thatprevent resilience include: feeling anger and shamefor being beaten for lying; fearing she will not havefriends if her mother appears; feeling anger and rejec-tion at being shouted at; fearing the problem will continue.

In Armenia, the most frequently used parents’responses to the same situation that promote thedevelopment of resilience are: listens to girl andshares feelings (communication, I CAN; trusting rela-tionships, I HAVE); shows the girl how to deal with thesituation (role model, I HAVE); helps the girl solve theproblem (problem solve, seek help, I CAN); helps the girl feel safe (trusting relationships, I HAVE);shows she feels the girls pain (empathy, I AM); calmsthe girl and assures her everything will be all right(hope and faith, I AM); shows the girl how much sheis loved (lovable, I AM).

The most frequently used parents’ responses thatprevent resilience include: mother forces attendance;girl continues to feel fearful; parent does nothing butfeels she should intercede; thinks the girl believes sheis bad, but does nothing to help; girl would learn herlesson and tell the truth after this.

The most frequently used children’s responses thatpromote resilience include: mother and girl discussthe problem together and agree on a strategy (com-munication and problem-solving, I CAN); girl feelsconfident; loved and respected by her mother (hopeand faith, being lovable, self-respect, I AM); girl trustsher mother to help her and to urge her to participatein solving the problem (trusting relationships, encour-aging autonomy, I HAVE); when parent is not helpful,

girl solves problem with her friends (seeks help, com-municates, solves problem, I CAN).

The most frequently used children’s responses thatprevent the promotion of resilience include: parentaccuses the girl of lying and ends the discussion; childfeels afraid and needs to confess, but there is no reconciliation; the problem is not resolved; the girl is scolded and spanked; the girl continues going to school and continues to feel afraid; the girl feelshelpless, with no support.

In Sudan, the most frequently used parent responsesthat promote resilience include: helping the girl re-solve the problem (role model, I HAVE; problem-solving, I CAN); encouraging the girl to resolve theproblem herself (autonomy, I AM).

The most frequently used parents’ responses thatprevent the development of resilience include: forcingthe truth; punishing the girl for lying; leaving her aloneto solve her own problem; expecting the girl to hateschool, not attend or become ill; displaying littleemotion of caring or empathy to the girl.

The most frequently used children’s responses thatpromote resilience include: asking a parent or teacherto help (trusting relationships, I HAVE; seeking help,I CAN); ignoring the kids or making friends with them(autonomy, I AM); solving the problem alone or with afriend (problem solving, seeking help, I CAN).

The most frequently used children’s responses thatprevent the development of resilience include: notexpecting help from parents; doing nothing; wanderthe streets instead of going to school; feeling sad,angry, afraid; becoming ill; running away.

Parents in each country used similar and/or differentresilience factors in promoting resilience in their children. However, it should be noted that resilienceresponses always included at least one resiliencefactor from each category of I HAVE, I AM, and I CAN.

Namibian children receive more empathy and com-munication, are seen as lovable and are encouragedto seek help. Armenian children receive more help inbecoming autonomous and in becoming confident.Sudanese children receive more encouragement tobecome autonomous and independent.



Children from each country drew on the resiliencefactor of trusting relationships, but in Armenia the children also expected help in becoming moreautonomous. In terms of inner strengths, Sudanesechildren rely heavily on autonomy; Namibian childrenrely on being responsible for their behavior; andArmenian children draw more on confidence andhope, seeing themselves as lovable, and having self-respect. The children all had problem-solving skills,but Armenian children relied more on communicatingfeelings and exploring alternative solutions.

7 The findings provided the information for thedevelopment of A Guide to Promoting Resilience inChildren: Strengthening the Human Spirit.5 They alsowere part of the movement to develop programs in countries and for special services. Australia, forexample, has incorporated resilience into its mentalhealth program, developing booklets for training andpractice, one of which is on resilience.6 And JudyPaphazy, through personal communication, indicatedthat as she has worked to promote resilience in chil-dren attending the Australian schools, the incidents ofbullying have dropped significantly. The United Stateshas made resilience an integral part of governmentsupport for research and program development in thehealth, education, welfare, and justice systems. Therecently published Helping the Children: A PracticalHandbook for Complex Humanitarian Emergencies,7

incorporates aspects of resilience promotion in itschapter on development and mental health. The F.Edward Herbert School of Medicine, USA, is trainingpediatric medical students in promoting resilience in both parents of children with special needs and inthe children themselves.8 And Tapping Your InnerStrength9 describes how resilience is being promotedin different homes, schools, work, for different agegroups, and in different service settings. In Argentina,in the Province of San Luis, Nestor Suarez, who wasa member of the Advisory Committee for the IRRP,has made resilience a goal for the communities in theprovince (personal communication and visits).

Giselle Silva10 provided the clearest evidence of therole of parents in helping their children deal with theeffects of political violence with resilience. She exam-ined the reaction of parents to the trauma and theimpact of the parents as role models on the resilienceof their children. Many parents became poor as theyescaped the violence, moving from the countrysideand the mountains to the city and lower lands. They

were required to make a new life in the new settingand raise their children there. Two major reactions tothe trauma distinguished families who were promot-ing resilience in their children from those who werenot. The families that focused their attention on thetrauma of the violence and the necessary escape toa new environment engaged in these behaviors: thefocus of the family is on the violent events it experi-enced; the close relationships in the family areaffected; the orientation is toward the past; the socialrelationships are negatively affected with lack of con-fidence, feelings of fear, and remaining isolated; thereis no adaptation to the new setting, with fantasiesabout returning to the former home; deep feelings ofnostalgia and focusing on memories.

The children of these families did not becomeresilient, and, in fact, developed many social and psy-chological problems, adopting many of their parents’behaviors. In addition, the children showed a lack ofconfidence in others, changes in relationships withparents, frequent feelings of sorrow over the lossesfrom the violence, frequent games repeating thetrauma, and difficulty in communication.

By contrast, families that focused their attention on thenew environment sought out opportunities in the newsetting – jobs, education, friends; refused to allow thetrauma to affect family relationships; focused on thehere-and-now and the future; were receptive to newrelationships with neighbors; adapted and adjusted tothe new setting; remembered sad experiences of thepast, but used them to encourage progress.

The children of these families were optimistic aboutthe future; made plans for the future; attended schoolfor the first time; learned Spanish for the first time;helped out during vacations; talked through theirexperiences of violence; sometimes showed fear anduncertainty, but could recover.

In short, these were resilient children.

Implications for practiceThe promotion of resilience can be adapted to differ-ent public and private health, education, and socialservices, as well as to justice systems, and to differ-



ent cultures. There is sufficient knowledge availableto incorporate resilience into ongoing services or to establish new programs for the promotion ofresilience. Materials are becoming increasingly avail-able, one of which merits comment.

The Pan American Health Organization, part of theWorld Health Organization (Munist,M. et al. 1998)11

developed Manual de identificacion y promocion dela Resiliencia en ninos y adolescentes (Manual toidentify and promote resilience in children and youth).The manual provides information about researchstudies on resilience and program developmentbased on the research. It emphasizes the relationshipbetween stages of development and the resiliencefactors most appropriate to promote resilience at thedifferent stages. It includes:

1 The concept of resilience as it relates to risk andto poverty.

2 A profile of a resilient child and examples of thebehavior of resilient children.

3 The characteristics and actions that promoteresilience through the psychosocial developmentof children and youth.

4 Strategies for programs promoting resilience inchildren and youth, recognizing cultural differ-ences, and including community-based programs.

5 Suggestions for group activities in the promotionof resilience.

The manual integrates the extensive theoretical andempirical information and data about resilience andprovides practical ways to promote resilience in chil-dren and youth, and to develop programs that canachieve success in promoting resilience. This manualis being used extensively throughout the Westernhemisphere and can be downloaded.11

Another example of how professionals and familiesused resilience is in a publication developed to helpin dealing with the Oklahoma, USA, bombing of 1995.The publication, in the form of a booklet, was distrib-uted to over 30 000 survivors and service providersafter the bombing.12

References

1 Hiew C, Mori T, Shimizu M and Tominaga M (2000)Measurement of Resilience Development: Preliminary

Results with a Stat /Trait Resilience Inventory. Journal ofLearning and Curriculum Development, 1: 111–117.

2 Grotberg E H (2000) The International ResilienceResearch Project. In: Comunian A L Gielen U, eds. Inter-national Perspectives on Human Development. AbstractScience Publishers, Vienna; pp. 379–399.

3 Cicchetti D, ed. (1993) Development and Psy-chopathology, Special Issue: Milestones in the Develop-ment of Resilience, 5: 479–793.

4 Glantz M D and Johnson J L, eds. (1999) Resilienceand Development. Kluwer Academic/Plenum Publishers,New York.

5 Grotberg E H (1995) A Guide to Promoting Resiliencein Children. The Bernard van Leer Foundation, The Hague.http://resilnet.uiuc.edu (also in Spanish and in Polish).

6 Australia’s National Mental Health Strategy. http://www.curriculum.edu.au/mindmatters; and http://www.mentalhealth.gov.au.

7 Mandalakas A, Torjesen K and Olness K (1999)Helping the Children: A Practical Handbook for ComplexHumanitarian Emergencies. Health Frontiers, Kenyon MN. Distributed by the Johnson & Johnson Pediatric Institute.

8 Hanson J L and Randall V F (1999) Evaluating Impacton Medical Students: Home Visits in the Pediatric Clerk-ship. Research Day, USUHS.

9 Grotberg E H (1999) Tapping Your Inner Strength:How to Find the Resilience to Deal with Anything. New Harbinger Publications, Oakland, CA.

10 Silva G (1999) Resiliencia y violencia politica en ninos.Universidad Nacional de Lanus, Lanus, Argentina.

11 Munist M, Santos H, Kotliarenco M, Suarez N, InfanteF and Grotberg E (1998) Manual de identificacion y pro-mocion de la Resiliencia en ninos y adolsecentes. Organi-zacion Panamericana de la Salud; Fundacion W.K. Kellogg& Autoridad Succa para el Desarrollo Internacional (ASDI),Washington, DC.

12 Grotberg E, Baruch R and Stutman S (1995) What Do You Tell The Children? How to Help Children Deal with Disasters. Institute for Mental Health Initiatives, Washington, DC.

Biosketch

Edith Henderson Grotberg is the Director, Interna-tional Resilience Research Project and serves on thefaculty at the Civitan International Research Center,the University of Alabama at Birmingham, USA; theInstitute for Mental Health Initiatives, School of Public



Health and Health Services, The George WashingtonUniversity Medical Center, USA; and the PsychologyDepartment, Ahfad University for Women, Omdur-man, Sudan. She also leads workshops on the pro-motion of resilience; has written books and articles onresilience and its application to services; developsprograms for the promotion of resilience for differentkinds of services; and lectures at universities andinternational organizations on the promotion ofresilience by service providers.

Financial disclosure: The New Harbinger Publica-tions published my book, Tapping Your InnerStrength: How to Find the Resilience to Deal withAnything (1999).

Correspondence: Edith Henderson Grotberg, 4141 N.Henderson Road, Suite 1205, Arlington, VA 22203-2424,USATel: 703 525 9045; e-mail: [email protected]


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Resilience programs for children in disaster