Studies of Adversity Resilience and Child Studies of Adversity, Resilience and Child Mental Health

61 Pages·2012·6.97 MB·English

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Theresa S. Betancourt, Sc.D., M.A.
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Director, Research Program on Children and Global Adversity
François-Xavier Bagnoud Center for Health and Human Rights
Harvard School of Public Health
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(cid:134)(cid:134) BBackkgroundd: researchh on chhiillddren, ffamiilliies andd
adversity
(cid:134)(cid:134) GGuiiddiing fframeworkks
(cid:134) Longitudinal Study of War-Affected Youth in
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(cid:134) Mental health risks and processes of resilience in
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(cid:134) Implications for programming and policy
The Nature of War is changgingg with
devastating consequences for Civilians
□ Worldwide, over 1 billion children live in countries
affected by armed conflict (UNICEF, 2008)
□ IIncreases iin regiionall andd iinttra-nattiionall confflliictts
□ non-state actors
□□ lliittttllee rreeggaarrdd ffoorr iinntteerrnnaattiioonnaall ccoonnvveennttiioonnss
□ Civilians, particularly young people, are often the
most vulnerable
□ Wars of destabilization; infrastructure is undermined
□ Impplications for survival,, but also trajjectoryy of
development
Refugee Children and Adolescents in the US
□ Resettlement of ~3 million refugees in the US since 1973,
roughly half are children
(Bureau of Population Refugees & Migration, 2010)
□ Refugees and asylees face stress of isolation,
socioeconomic disadvantage, cultural adjustment
language barriers, insecurity of legal status
□□ HHiigghh lleevveellss ooff wwaarr-rreellaatteedd ttrraauummaa ddooccuummeenntteedd ffoorr
refugee youth, with profound MH consequences
(American
Psychological Association, 2010).
□ Challenges in treatment engagement and retention,
very little services research
Research on Children,
WWar && MMenttall HHealltthh
Children and War (Fred & Burlingham, 1943)
(cid:137) Research on adults:
(cid:131) “concentration camp syndrome” (Eitinger, 1961)
(cid:131)(cid:131) wwaarr vveetteerraannss “sshheellll sshhoocckk” ((WWWW II, IIII, VViieettnnaamm))
(cid:137) Focus on relationship between war-related trauma and
ppoosstt-ttrraauummaattiicc ssttrreessss ddiissoorrddeerr ((PPTTSSDD))
(cid:131) Cambodian refugees: 50% developed PTSD (Kinzie, 1985)
(cid:131) Bosnian refugees: 25% PTSD and 17% depression dx (Weine, 1995)
(cid:137) Criticism of PTSD focus- CONTEXT: There is no “post” …in many
of the wars children face around the world insecurity is constant
- AAvaiillabblle researchh iis lliimiittedd iin iitts applliicattiion tto programs andd
policy
Resilience: “A construct representing
ppoossiittiivvee aaddaappttaattiioonn ddeessppiittee aaddvveerrssiittyy””
(Luthar, Cicchetti & Becker, 2001)
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(cid:137)Peopple who overcame situations normallyy
associated with poor mental health and
developmental outcomes
(cid:137)Poverty, Socioeconomic Disadvantage
((Werner))
(cid:137)Mentally Ill Caregivers (Rutter)
(cid:137)Abused and Neglected Children (Cicchetti)
(cid:137)(cid:137)CChhiillddrreenn EExxppoosseedd ttoo VViioolleennccee ((GGaarrbbaarriinnoo))
RReessiilliieennccee
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characteristics of the individual that
helpps them to achieve desirable
emotional and social functioning
despite exposure to considerable
aaddvveerrssiittyy.
Resilience as a pprocess: “Resilient
mental health outcomes”
- ((MMaasstteenn,, 11999911;; CCiicccchheettttii && GGaarrmmeezzyy,, 11999933;; RRuutttteerr,, 11998855. MMaasstteenn &&
Garmezy, 1985; Werner & Smith, 1992; Luthar, 1996).
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(Lazarus & Folkman, 1984)
Resources
SS
t
r •Individual Characteristics
e
-i.e. coping skills Mental
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•Familyy Characteristics HHeeaalltthh
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-i.e.social support Adjustment
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•Community Characteristics
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-i.e. belonging/
s
ccoonnnneecctteeddnneessss
Research Program on Children and Global
Adversity (RPCGA): Goals
□ Identify factors contributing to risk and resilience in
cchhiillddrreenn, ffaammiilliieess aanndd ccoommmmuunniittiieess ffaacciinngg aaddvveerrssiittyy
globally
□ focus on capacities, not just deficits
□ Contribute to an evidence base on intervention
ssttrraatteeggiieess::
□ Contribute to closing the implementation gap
□ Develop and test high quality and effective services