RESILIENCE: POSITIVE

ADAPTATION

Strengths, Health, & Thriving

FACTORS THAT INFLUENCE HEALTH

Environment 22%

Genetics 17%How We

Live 51%

Health Care

10%

Source: USDHEW, PHS, CDC. “Ten Leading Causes of Death in US 1975, Georgia Bureau of State Services, Health Analysis and Planning for Preventive Services, p. 35, 1978

ACE REDUCTION: A POWERFUL FRAMEWORK FOR THRIVING

Adapted from Shonkoff, J.P., “Building a New Biodevelopmental Framework to Guide the Future of Early Childhood Policy,” Child Development, Jan./Feb. 2010.

Foundations of

Healthy Development and

Sources of Adversity

Developmental Determinants of HealthLife-Span Outcomes

Nutrition

Genetic Predispositions

Physical, Chemical, &Built Environment

Relational Environment

Skill-Building Stress:Short-Term Stressors in Supportive Environments; Protection in Sensitive Developmental Periods

Societal Expectations and Response to Behavior

Health-Related Behavior

Physical & Mental Health

Prosperity

Physiologic Adaptation; Hard-wired RapidStress Response

C: Improve Societal Expectations and Response to High ACE People to Reduce Secondary Trauma, Reduce Burden of Chronic Disease and Optimize Wellbeing Through The Lifespan.

A: Improve General Community Capacity to Come Together, Identify and Address Issues that Matter Most.

B: Reduce Median Adverse Childhood Experiences (ACEs) Scores from One Generation to the Next.

Epigenetics:Individual

Experience Affects Gene Expression

Toxic Stress:Cumulative Stressors Over Time; Sensitive Developmental Periods

Adapted to Relational, Benevolent World – Well Matched to Societal Expectations

WHAT IS RESILIENCE?

The capacity to absorb disturbance and re-organize while undergoing change, yet still retain essentially the same function, structure, identity, feedbacks.

(Walker et al., 2002)

The ability of an individual, system or organization to meet challenges, survive, and do well despite adversity.

(Kirmayer, 2009)

RESILIENCE OCCURS AT ALL LEVELS:

The natural human capacity to navigate life well.(HeavyRunner & Marshall, 2003)

Community

Individual

Family

National, Global, Ecosystem

PHASES IN RESILIENCE RESEARCH

Descriptive – What do resilient individuals have in common?

Predictive – How questions: identify and understand processes that might lead to resilience, including risk and protective factors.

Contextual –Why ages, stages, personal and family history, community context matter for promotion of resilience.

Integrative – Encompasses rapid advances in the study of genes, developmental neurobiology, neural plasticity, and the conditions, contexts, and processes that affect positive adaptation throughout the lifespan.

“Resilience rests, fundamentally, on relationships”.Suniya Luthar; Resilience in development: A synthesis of research across five decades; 2006, p. 780

RESILIENCE AS A DEVELOPMENTAL PROCESS

• None of us is perfect—we’ll all have moments when we don’t appear to be very well adapted to the conditions we’re facing.

• Resilience is complex; it is possible to be resilient in one setting and pathological in another.

• We develop competencies & characteristics that prepare us to be effective in the world we’re growing into.

• We develop the capacity to adapt in the face of challenges.

Developmental Framework for

Resilience

Age Related Patterns of

Competence

Multiple Contexts

Age-Appropriate

Social Behavior

(Developmental Tasks)

Interactions Among

Biology, Psychology,

Social Factors

Developmental Framework for

Resilience

Age Related Patterns of

Competence

Multiple Contexts

Age-Appropriate

Social Behavior (Developmental

Tasks)

Interactions Among Biology,

Psychology, Social Factors

Growth

Nourishment

Protection

Wholeness

FINDING MEANING

TEMPERING MASTERY

RECONSTRUCTING IDENTITY

NORMALIZING

AMBIVALENCE

REVISING ATTACHMENT &

BELONGING

HOPE

RELATIONAL

EXPERIENCE

From: Loss, Trauma, and Resilience; Therapeutic Work with Ambiguous Loss; Dr. Pauline Boss; 2006

THREE CORE PROTECTIVE SYSTEMS

1. Community, Spiritual & Cultural Life

2. Attachment & Belonging

3. Capabilities

“Nurturing the healthy development of these protective systems affords the most important preparation or ‘inoculation’ for overcoming potential threats and adversities in human development. Similarly, damage or destruction of these systems has dire consequences for the positive adaptive capacity of individuals.”

Ann Masten, 2009

CAPABILITY

• Intellectual & employable skills• Self regulation – self control,

executive function, flexible thinking

• Ability to direct & control attention, emotion, behavior

• Positive self view, efficacy

ATTACHMENT &

BELONGING

• Bonds with parents and/or caregivers

• Positive relationships with competent and nurturing adults

• Friends or romantic partners who provide a sense of security & belonging

COMMUNITY, CULTURE,

SPIRITUALITY

• Faith, hope, sense of meaning• Engagement with effective orgs –

schools, work, pro-social groups• Network of supports/services &

opportunity to help others• Cultures providing positive

standards, expectations, rituals, relationships & supports

KEY SYSTEMS

FOR RESILIENCE

Nourishment

Protection

GrowthWholeness

COMMUNITY, CULTURE, SPIRITUAL LIFE

PRENATAL – INFANCY PRE-SCHOOL MIDDLE CHILDHOOD PRE-TEEN & TEEN YEARS

COMMUNITY, CULTURE, SPIRITUAL RITUALS &

TRADITIONS IN

CHILDHOOD

Spiritual engagement that demands active

participation in a community of faith

Structure, rules, & responsibility to

contribute to family and community

Parents/Family has: Spiritual engagement demands active participation in a community of faithRituals & traditions supporting connection with the land (for some people)

Value systems that include notions of personhood, ethics, religion or spiritualityCultural knowledge and practices supporting coherence and a source of stability & support

PRE-CONCEPTION PREGNANCY WITH YOUNG CHILDREN

MOVING TOWARD MID-LIFE

ADULT PROTECTIVE

COMMUNITY, CULTURE, SPIRITUAL RITUALS &

TRADITIONS

Spiritual engagement that demands active participation in a community of faith

Rituals & traditions supporting connection with the land (for some people)

Value systems that include notions of personhood, ethics, religion or spirituality

Cultural knowledge and practices supporting coherence and a source of stability & support

SUPPORTING ATTACHMENT & BELONGING

PRENATAL – INFANCY PRE-SCHOOL MIDDLE CHILDHOOD PRE-TEEN & TEEN YEARS

ATTACHMENT & BELONGING IN

CHILDHOOD

Four or fewer children; 2+ years between siblings

Maternal competence: proportion of positive interactions with child

Close bond with caregiverParents have circle of people they can count on for

help and support

Emotional support from friends and family

Caregiver sensitivity and responsiveness to infant needs

No prolonged separation from parent in first year

Sources of support that increase competencies, efficacy, opportunity to develop strengths, gifts and interests, and

decrease stressful life

PRE-CONCEPTION PREGNANCY WITH YOUNG CHILDREN

MOVING TOWARD MID-LIFE

ADULT ATTACHMENT &

BELONGING

Number of stressful life events reported in

childhood, adolescence

Establish relationship with helper (doula,

visitor, etc.) opens door to whole program of

help, improves quality in relating with child

Find ecological Niche for child – support in family,

social network

Number of persons the individual turned to in

times of crisis

Help seeking; social network building (which also helps to mitigate the

negative effects of poverty)

Rewarded with repeated promotions contributes to

sense of pride

NURTURING CAPABILITYPRENATAL – INFANCY PRE-SCHOOL MIDDLE CHILDHOOD PRE-TEEN & TEEN YEARS

CAPABILITY IN CHILDHOOD

Developmentally appropriate physical activityParental involvement in, promotion of, learning

Good health & nutrition; SafetyAbility to seek comfort, support or inspiration from others

Stimulation – sound, sight, touchPlay, laughter, exploration

Scholastic competenceAutonomy, social maturity, self efficacy,

mastery motivation

PRE-CONCEPTION PREGNANCY WITH YOUNG CHILDREN

MOVING TOWARD MID-LIFE

PARENTAL CAPABILITY

Exercise, e.g. walking at 60% of vital capacityIdentifying and using one’s core gifts

Good health; SafetyAbility to seek comfort, support or inspiration from others

Resourceful and realistic in

educational and vocational plans

Imagine self as mother, dream interaction with child; redefine

self

Continuing education: academic and vocational skills

acquiredPractice of seizing

opportunities

Opening of opportunities

Successful adaptation at midlife

RISK & PROTECTION INTERACT IN A CULTURAL CONTEXT

Wholeness

Protection

Nourishment

Growth

CompensatoryIndividuals Protective

Challenge

Caring, Cohesion, Belief in Each ChildBelonging with Peers, School, Circle of Success

Family & Community Non-punitiveProvisions and Resources to Assist Belief in Societal Values

SpiritualityTraditional Activities

Cultural Traditional LanguagesTraditional healingElders

Before

Neighbors Unite To Build Community Park

WALLA WALLA COMMITMENT TO COMMUNITY

EXAMPLES OF PROGRAM & POLICY ACTIONS

• Safe Harbor Crisis Nursery in the Tri-Cities has incorporated ACEs and trauma into its day-to-day strategies and case management resulting in improved outcomes for families.

• Children of Incarcerated Parents; the Legislature has mandated the executive branch to engage in an initiative to address the needs of children of incarcerated parents. The initiative and its processes are framed to address the likelihood that these children have more than this one ACE.

• With the help of the Mental Health Transformation Grant and the Office of the Superintendent of Public Instruction (OSPI), Spokane is exploring the creation/implementation of trauma sensitive practices in public schools.

• OSPI introduced the Compassionate Schools initiative, which supports local school districts in reducing the non-academic barriers to schools success that are created by trauma (2008). (http://www.k12.wa.us/CompassionateSchools/default.aspx)

• Parent Trust for Washington Children has incorporated the ACE questions into their work with addicted parents facing court action (DV, termination of parental rights) resulting in: 1) improved outcomes in parenting classes and 2) reduced relapse among parents with 4 or more ACEs.

PORT GAMBLE S’KLALLAM TRIBE – CHI-E-CHEE (THE WORKERS) NETWORK

ADVERSE CHILDHOOD EXPERIENCE DRAFT

We Can All Help

1. Build Capacity To Reduce Adverse Childhood Experience

2. Promote Resilience

1. Expectation for Thriving Despite Oppression

2. Strength Based ≠ Solutions

3. Attending to Characteristics & Factors that Promote Resilience – Only Part of the Story

CAUTIONS ABOUT THE RESILIENCE APPROACH

PARAMETERS FOR INTERVENTION

3. Enhance the relationship between person & context.

4. Embed interventions in familiar to social setting/community contexts.

5. Attend to possibilities for lasting impact & enduring change.

1. Pay attention to critical periods and cultural context.

2. Understand resilience as both how we engage with other people and how we interact with our environment.

ENHANCING COMMUNITY CAPACITY

A DYNAMIC PROCESS OF CONNECTION

GENERAL COMMUNITY CAPACITY DEVELOPMENT MODEL

FAMILY POLICY COUNCIL

General Community Capacity is:capacity to not only sustain programs, but also to identify new community problems as they arise, and develop ways of addressing them.

General Capacity Development is a dynamic process that enhances the infrastructure, skills, and motivation of a community – changing the way we live with one another day-to-day.

Literature strongly supports the importance of general capacity building in the process of promoting effective prevention. (Livet, 2008)

This model is powerful because success in one phase propels success in the next. It is a virtuous cycle that has the power to improve population health.

VIRTUOUS REINFORCING CAPACITY BUILDING - SUSTAINABLE THRIVINGThis model is powerful because success in one phase propels success in the next. It is a virtuous cycle that has the power to improve population health.

CAPACITY BUILDING HAS POWERFUL EFFECTS

Foundations for Healthy Development ImproveFive or more different problem rates come down (http://www.fpc.wa.gov/publications/technicalpaper-ver3.pdf)

ACE Score Is Reduced from One Generation to the NextThe average ACE score of youth transitioning into adulthood and parenthood is reduced in high capacity communities. Fewer people have 3 or more ACEs, thus preventing many health problems (http://www.fpc.wa.gov/publications/Relationship%20between%20ACEs%20and%20%20BH%20and%20PH%20%206%2024%2010.FINAL.pdf)

Improved Social Responses to High ACE People Result in Better Life CourseIn high capacity communities, youth who have experienced Adverse Childhood Experiences are much less likely to use alcohol, marijuana and tobacco; thereby dramatically reducing their risk for disease, disability and problems at work, home and community (http://www.fpc.wa.gov/publications/FPC_High%20Risk%20Protect%20Youth_Nov%2009.pdf & http://www.fpc.wa.gov/publications/FPC_Social-Normative%20High%20Risk%20High%20Capacity_Dec%2009.pdf)

5.14

2.33

1.51.43

0

1

2

3

4

5

6

First Second Third FourthQuartile Levels of Community Capacity

1997-2007

Number of Better-

than-State Trends

1998 - 2006

CAPABILITY

ATTACHMENT &

BELONGING

• One question in BRFSS indicates attachment & belonging, and gives clues about community capacity: How often do you get your social/emotional needs met?

COMMUNITY, CULTURE,

SPIRITUALITY

• Family Policy Council Community Capacity Dynamics model + decade of measurement quantify neighborhood/community transformation outcomes

FAMILY POLICY COUNCIL RESILIENCE MEASURES

MEASURES1. Focus2. Learning3. Leadership 4. Results

Before

Neighbors Unite To Build Community Park

WALLA WALLA COMMITMENT TO COMMUNITY

EXAMPLES OF PROGRAM & POLICY ACTIONS

• Safe Harbor Crisis Nursery in the Tri-Cities has incorporated ACEs and trauma into its day-to-day strategies and case management resulting in improved outcomes for families.

• Children of Incarcerated Parents; the Legislature has mandated the executive branch to engage in an initiative to address the needs of children of incarcerated parents. The initiative and its processes are framed to address the likelihood that these children have more than this one ACE.

• With the help of the Mental Health Transformation Grant and the Office of the Superintendent of Public Instruction (OSPI), Spokane is exploring the creation/implementation of trauma sensitive practices in public schools.

• OSPI introduced the Compassionate Schools initiative, which supports local school districts in reducing the non-academic barriers to schools success that are created by trauma (2008). (http://www.k12.wa.us/CompassionateSchools/default.aspx)

• Parent Trust for Washington Children has incorporated the ACE questions into their work with addicted parents facing court action (DV, termination of parental rights) resulting in: 1) improved outcomes in parenting classes and 2) reduced relapse among parents with 4 or more ACEs.

PORT GAMBLE S’KLALLAM TRIBE – CHI-E-CHEE (THE WORKERS) NETWORK

ADVERSE CHILDHOOD EXPERIENCE DRAFT

We Can All Help

1. Build Capacity To Reduce Adverse Childhood Experience

2. Promote Resilience

1. Expectation for Thriving Despite Oppression

2. Strength Based ≠ Solutions

3. Attending to Characteristics & Factors that Promote Resilience – Only Part of the Story

CAUTIONS ABOUT THE RESILIENCE APPROACH

PARAMETERS FOR INTERVENTION

3. Enhance the relationship between person & context.

4. Embed interventions in familiar to social setting/community contexts.

5. Attend to possibilities for lasting impact & enduring change.

1. Pay attention to critical periods and cultural context.

2. Understand resilience as both how we engage with other people and how we interact with our environment.

ENHANCING COMMUNITY CAPACITY

A DYNAMIC PROCESS OF CONNECTION

GENERAL COMMUNITY CAPACITY DEVELOPMENT MODEL

FAMILY POLICY COUNCIL

General Community Capacity is:capacity to not only sustain programs, but also to identify new community problems as they arise, and develop ways of addressing them.

General Capacity Development is a dynamic process that enhances the infrastructure, skills, and motivation of a community – changing the way we live with one another day-to-day.

Literature strongly supports the importance of general capacity building in the process of promoting effective prevention. (Livet, 2008)

This model is powerful because success in one phase propels success in the next. It is a virtuous cycle that has the power to improve population health.

VIRTUOUS REINFORCING CAPACITY BUILDING - SUSTAINABLE THRIVINGThis model is powerful because success in one phase propels success in the next. It is a virtuous cycle that has the power to improve population health.

CAPACITY BUILDING HAS POWERFUL EFFECTS

Foundations for Healthy Development ImproveFive or more different problem rates come down (http://www.fpc.wa.gov/publications/technicalpaper-ver3.pdf)

ACE Score Is Reduced from One Generation to the NextThe average ACE score of youth transitioning into adulthood and parenthood is reduced in high capacity communities. Fewer people have 3 or more ACEs, thus preventing many health problems (http://www.fpc.wa.gov/publications/Relationship%20between%20ACEs%20and%20%20BH%20and%20PH%20%206%2024%2010.FINAL.pdf)

Improved Social Responses to High ACE People Result in Better Life CourseIn high capacity communities, youth who have experienced Adverse Childhood Experiences are much less likely to use alcohol, marijuana and tobacco; thereby dramatically reducing their risk for disease, disability and problems at work, home and community (http://www.fpc.wa.gov/publications/FPC_High%20Risk%20Protect%20Youth_Nov%2009.pdf & http://www.fpc.wa.gov/publications/FPC_Social-Normative%20High%20Risk%20High%20Capacity_Dec%2009.pdf)

5.14

2.33

1.51.43

0

1

2

3

4

5

6

First Second Third FourthQuartile Levels of Community Capacity

1997-2007

Number of Better-

than-State Trends

1998 - 2006

CAPABILITY

ATTACHMENT &

BELONGING

• One question in BRFSS indicates attachment & belonging, and gives clues about community capacity: How often do you get your social/emotional needs met?

COMMUNITY, CULTURE,

SPIRITUALITY

• Family Policy Council Community Capacity Dynamics model + decade of measurement quantify neighborhood/community transformation outcomes

FAMILY POLICY COUNCIL RESILIENCE MEASURES

MEASURES1. Focus2. Learning3. Leadership 4. Results