Building Resiliency in Youth and Families

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Building Resiliency in Youth and Families

• ODMH Dialogue
• February 6, 2007
• ODMH Resiliency Workgroup

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Clinical Quality Agenda
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Presidents New Freedom Commission on Mental
Health

• Care must focus on increasing consumers ability
  to successfully cope with lifes challenges, on
  facilitating recovery, and on building
  resilience, not just on managing symptoms.

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Resiliency Definition

• Resiliency is an innate capacity that when
  facilitated and nurtured empowers children,
  youth, and families to successfully meet lifes
  challenges with a sense of self-determination,
  mastery, and hope.
• Ohio Resiliency Workgroup (ODMH)

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Resiliency Mission Statement

• To empower youth and families to expect, define,
  and experience a lifetime of hope, well being,
  and achievement with full participation in their
  communities.
• Ohio Resiliency Workgroup (ODMH)

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• There is never anything wrong with us that
  something right with us cant fix.
• Mark
  Katz

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Resiliency is an Ordinary Process

• Resiliency is an ordinary process available to
  all youth.
• Ann Masten

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Resiliency an Expectation

• Resiliency is an EXPECTATION and not an exception
  for youth with significant emotional and/or
  behavioral challenges

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Resiliency is Contextual

• Resiliency evolves and interacts within contexts
• Best conceptualized utilizing an ecosystemic
  framework
• Youth live and function in multiple worlds, each
  with their own set of risk and protective factors
  (family, community, schools, neighborhoods,
  peers, culture, etc)

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Risk and Protective Factors

Outcome
Positive Resilience
Negative Vulnerability
D
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Resiliency in Context
School
Informal Supports


Family
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-

Youth
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Peers
Community


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Protective Factors
-
- Risk Factors
Work
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Both the person and the context matter

• It is the interaction between individual traits
  environmental resources that promotes resilience
  and healthy development (Nancy Davis,
  SAMHSA)
• Person and context are mutually interactive by
  increasing the developmental strengths of one
  kind tends to increase the strengths of the other
  (Benson et al. 2006, P. 5)
• Avoid either only focusing on building young
  peoples skills or only changing the environment
  or contextual variables the best results occur
  with simultaneous efforts to do both (Benson et
  al. 2006, p. 6)

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Asset Building Literature

• 40 Developmental Assets The Search Institutes
  Framework of Developmental Assets
• External Assets Positive, structured growth
  environments
• Internal Assets the values, skills, and
  self-perceptions needed for self-regulation
• http//www.search-institute.org/

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Nurtured Resilience

• Internal qualities that can be developed and
  fostered through relationships of those around us
  (core people)
• Ohio Resiliency Workgroup Member

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Facilitated Resilience

• Youth who present with unique challenges may need
  additional assistance, in the form of services
  and supports, to facilitate the development of
  their resilience and well being.
• Facilitated Resilience involves shaping the
  natural environment to enhance each youths
  success, and augmenting that with targeted
  supports and services to maximize the youths
  growth, functioning, and achievement.

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Supported Resiliency

• Efforts embraced by the community to build and
  sustain a foundation of supports and
  opportunities necessary for the development of
  resiliency for youth of all ages, abilities, and
  needs

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Policy Implications

• Community-wide efforts to build developmental
  nutrients are as important as those on the
  organization, family, and individual levels.
• Seek to bring about change in multiple systems
  and environments
• Increasing the number of developmental nutrients
  across settings is what matters most, not
  increasing specific strengths or combinations of
  strengths in any single setting
• Benson et al. 2006

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Resiliency A Shared Responsibility

• We all share the responsibility to ensure the
  success of our children, regardless of ability or
  disability.

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Components of Resiliency

• Validation and valuing
• Basic needs, safety, and services
• Sanctuary
• Supportive connections
• Hope
• Contribution participation
• Self wisdom
• Competencies
• Justice
• Expectations and accommodations that maximize
  success
• Courage
• Sense of meaning and joy

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Validation and Valuing

• A resilience-based mental health system is
  affirming of youth and family with unconditional
  acceptance.
• Supportive, emotionally safe environments are
  created, where youth and families can share their
  vulnerabilities and weaknesses safely and without
  judgment.
• The youth and family are validated for their
  efforts and persistence, knowing that progress is
  sometimes very difficult, and that hanging in
  there is sometimes all that is possible at any
  given point in a familys life.
• Youth with mental health disabilities and their
  families are doing the best they can, not only
  maintaining, but surviving well.

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Family InsightValidation and Valuing

• Recognizing my expertise on my child family
• Honoring my tenacity love for my child
• Acknowledging my accomplishment (and grit) for
  surviving the past 18 years.
• To maintain (some semblance of life) and to be
  able to stand is quite a feat, given the
  stressors in my family
• Verbalize to me my skills and commitment are
  keeping my kid (and family) afloat
  
  
• 
  

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Family InsightBasic Needs, Safety, Services

• Having children with special needs costs more all
  aroundmoney, time, and energyforcing our own
  resources to be fewer.
• Nobody realizes that some people expend
  tremendous energy merely to be normal. Camus

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Basic Needs, Safety, Services

• Children thrive in emotionally and physically
  safe families, communities and neighborhoods.
• Families and communities take an active role in
  the protection, monitoring, and comfort of every
  youth.
• Families are supported in their efforts to secure
  safe housing, and appropriate education for their
  children - through graduation.

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Basic Needs, Safety, Services

• Services and supports address the complete mental
  health needs across developmental ages and stages
  and are delivered in the least restrictive, most
  dignified environment.
• Mental health care is affordable, available, and
  accessible, where no family has to give up
  custody, or experience extreme financial hardship
  to receive any level of mental health care.

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Family InsightBasic Needs, Safety, Services

• Lost homes/housing
• Change (or risk loss) jobs because my childrens
  needs required so much time and energy away from
  work
• Economic hardships came from limited working
  hours
• Safety is a constant concern

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Sanctuary

• Youth and families need safe and calming people
  and places for refuge, respite, recovery, and
  rejuvenation.
• Both youth and parents need their own protected
  space where they can feel and be calm.
• Youth need multiple safe options for sanctuary in
  different contexts, including home, school, and
  the community.
• Designated and predictable breaks are important
  for coping with the ongoing challenges of mental
  illness.

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Family InsightSanctuary

• My ability to maintain this 24/7 job depends on
  being able to find respite and recharge my
  batteries. Having a weekend here and there keeps
  us healthy.
• Having a mentor for a few hours helps enormously.
  

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Supportive Connections

• Resiliency is nurtured by family, facilitated
  through helping relationships (formal and
  informal), and supported and embraced by the
  community.
• Children, youth, and families thrive when they
  feel understood and connected to positive and
  supportive family members, adults, peers,
  institutions, and culture.
• Youth and families benefit from social support
  systems that are responsive to their needs and
  that offer tangible, emotional, educational, and
  advocacy supports.
• The community actively reaches out to develop
  positive relationships with every youth and
  family.

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Youth InsightSupportive Connections

• When my teachers encourage me when I am
  challenged by our class work
• My case manager comes and makes sure I am doing
  OK when things have not been going well
• When our providers support our efforts and listen
  to me
• 
  

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Family InsightSupportive Connections

• School is working with us to get Michael to
  complete his high school education by making
  modifications for his mental health challenges

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Hope and Optimism

• In the depth of winter, I finally learned that
  within me there lay an invincible summer
• Albert Camus

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Hope and Optimism

• Resiliency is an ordinary process that is
  available and expected for all youth.
• All children have the right to hope and success
  starting at birth and lasting a lifetime.
• Communities, providers, and families foster
  opportunities and possibilities so that youth
  with emotional challenges have hope for a
  positive future with a self-determined and
  fulfilled life.
• We believe that even the smallest victories are
  significant, sustaining our hope, and giving us
  the courage to persevere.

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Family InsightHope Optimism

• Every success, every victory gives more energy
  and hope to move us into the future
• Celebrating where weve been and how far weve
  come
• At this very moment, we are still standing (many
  predicted our demise long before now- but weve
  made it this far)
• My son will have a good life, and meaningful
  work. Not IF but WHEN.

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Contribution Participation

• Youth with emotional and behavioral challenges
  thrive when given opportunities for contribution,
  participation, and positive involvement.
• Active involvement and meaningful belonging in
  community activities and schools are fostered and
  supported.
• Youths viewpoints and opinions are valued and
  meaningful leadership roles are created for them.
  

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Contribution Participation

• Community service and helping opportunities are
  made available for all youth.
• Communities actively seek out youth as community
  partners.
• Communities believe that youth CAN and DO make
  significant contributions.

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Contribution Participation

• When any ones gifts and contributions are
  rejected or not accepted, we are all poorer

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Policy Implication

• Make youth engagement and leadership normative
  (Benson et al, 2006)

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Youth Insight Self Wisdom

• Resiliency is knowing when you are falling, and
  knowing how to catch yourself
• Mary Beth Haubert

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Self Wisdom

• Youth and families are experts in their own
  experiences and develop practical knowledge about
  coping with, and managing, behavioral and
  emotional challenges.
• Youth and families know what works best for them,
  under what circumstances, and by whom.
• They know the situations when they can handle a
  problem by themselves and the conditions when
  they need help.
• They also recognize that not knowing the answer
  or solution to a problem is OK.
• Youth may have setbacks, but learn from each
  experience, always growing emotionally stronger
  and wiser.

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Youth Insight Self Wisdom

• I recognize when I need to ask for help
• I understand my disease well enough to know when
  I need additional medications.
• I can self determine my need for medication at
  school, and by following the steps on my
  emergency plan, the school gives me the
  medication when I need it.
• I know that I may not know what to do and that is
  OK, because I can get help

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Family InsightCompetencies

• What we couldnt do last month, we can do today.
  We build on what we are good at and practice what
  we arent.

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Competencies

• All children, youth, and families have unique
  strengths, abilities, and talents that when
  nurtured can grow, develop, and flourish.
• With the right supports, encouragement, and
  active facilitation, youth with emotional or
  behavioral challenges can achieve their full
  potential.
• Each community commits to creating positive
  learning environments that enhance abilities,
  teach skills, and offer sufficient opportunities
  for expression of each youths unique talents.

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Family InsightCompetencies

• Look for my childs strong points of ability and
  interest and then nurture those things. This is
  what happens with typical children and it should
  also apply to my child.
• See his many good qualities and embrace them.

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• We may encounter many defeats but we must not be
  defeated.
• Maya Angelou

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Justice

• All child serving systems make a commitment to
  provide safe and non-traumatizing care with all
  children and families, and to, above all else, DO
  NO HARM.
• A resiliency-oriented mental health system is
  sensitive to the culture, values, and situation
  of every person, treating each with dignity and
  respect regardless of the persons life
  circumstances.

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Justice

• Providers advocate for the rights of all youth
  and families and are proactive in facilitating
  and developing meaningful accommodations so that
  the youth can achieve success in all
  environments.
• Youth and families, of all cultures and life
  situations, have a legitimate voice at all levels
  of policy, services, and supports.
• This voice is supported and elevated through
  community champions and resiliency ambassadors.

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Youth Family InsightJustice

• Treat people the way you want to be treated
• Dont use my disability against me.
• Knowing my childs rights- and exercising them-
  is a protective factor- it can help protect
  him (or at least insulate) from stigma,
  exclusion, and invisibility (ignoring or not
  seeing him as if he isnt here)

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Expectations that Maximize Potential

• A resiliency-oriented mental health system
  promotes the expectation that resiliency is
  available to all youth.
• Reasonable and achievable expectations that
  maximize the functioning and potential of each
  youth are promoted.
• Youth with special needs succeed when they have
  flexible and accommodating environments with
  personal champions that support them in reaching
  their potential.

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Family Insight Expectations that Maximize
Potential

• Who we are today is not who we will become.
• Our children are still growing and learning they
  are not stuck as who they are today. It is our
  duty to encourage them to become the very best
  person that they can become.
• Children are only be limited by what we limit
  them to.

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Youth Insight Expectations that Maximize
Potential

• Set goals so that I can reach them, and once I
  reach them, then you can raise them.

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Courage

• Maintaining mental health involves great personal
  courage and bravery to deal with life stressors
  and obstacles, especially for individuals with
  emotional/behavior challenges.
• The daily act of coping with mental illness is
  itself a heroic act.
• Youth and families have the courage to stand
  their ground and say I can regardless of what
  others tell them is possible, and to face
  situations that appear insurmountable.
• A resiliency-orientated mental health system
  stands with youth and families and fights stigma
  and stereotypes through comprehensive mental
  health education that transforms the community.

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Family InsightCourage

• I am a warrior on a journey to ensure my childs
  future.

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Sense of Meaning and Joy

• All children, youth, and families seek to find
  their own personal happiness, meaning, and joy
  that brings them satisfaction and quality into
  their lives.
• Having a sense of purpose and fun promotes
  wellness and resiliency, and gives us something
  to look forward to each day
• Environments that foster creativity, playfulness,
  and humor, allow youth and families to experience
  lightheartedness and joy.
• In resiliency-oriented systems youth are
  supported in finding meaning and joy in their
  lives.

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HELPING HANDS
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Resiliency-Oriented Mental Health Systems

• Build positive relationships with both youth and
  families
• Facilitate opportunities for positive
  contributions and involvement
• Foster hope
• Understand that youth have different resiliency
  needs and trajectories

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Resiliency-Oriented Mental Health Systems

• Build functional competencies
• Build compensatory strengths (strengths in one
  area may compensate for challenges in another,
  Benson et al, 2006)
• Develop expectations standards that maximize
  potential and success
• Engage formal and informal services supports to
  promote multiple resiliencies

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Service Adaptations

• Service adaptations may be necessary to achieve
  resilience for youth with unique challenges
• Assertive outreach
• Increased intensity and availability of services
• Multiple resources and supports may be needed
• Supported connections (mentors)
• Advocacy that builds positive system
  relationships
• Creating supportive functional environments

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Extreme Persistence

• Resiliency-oriented mental health systems
  recognize that needs can be complex, that change
  is sometimes very difficult to achieve and
  promotes extreme persistence and creative
  adaptations in the delivery of services,
  changing the plan instead of rejecting the child
  and family from services and supports.
• (VanDenBerg,
  2002)

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Resilience A Complementary Construct

• Resilience is a complementary construct to
  current evidenced-based practices
• Resilience can be integrated into and inform
  other best practice models, serving to enhance
  them

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Examples of best practice models complimentary
to resilience

• Multisystemic Therapy
• Wraparound
• The DECA program
• The Incredible Years

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Elements of resilience common to these models

• Strength based
• Skill development and competency-enhancement
• Focus on parenting skills that are high in
  nurturance, supervision and monitoring
• Linkage to prosocial activities, peers, and
  mentors
• Development of positive connections in schools
  and in the community

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Common Elements of Effective Practice (Hubble,
Duncan, Miller, 1999)

• Client Factors (40) The largest single
  contributor to change is the client and family.
  Strengths Abilities Talents Social Supports
  Beliefs Resources Motivation for Change.
• Relationship (30) Use of empathic, supportive,
  motivation-enhancing techniques to improve
  alliance, engagement, and retention.
• Expectancy and Hope (15) The extent that the
  family believes that your prevention or treatment
  programming will be beneficial to them.
• Techniques (15)

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Resiliency and Culture

• Recognition of variability within cultures and
  the need to understand how strengths emerge and
  are nurtured within specific groups
• Balance the general with the specific no single
  strategy will work for each young person, even
  though all kids need more strengths/assets
  (Benson et al. 2006, P. 11)
• Sesman, A., Roehlkepartain, E. C. (2003).
  Unique strengths, shared strengths Developmental
  assets among youth of color. Insights and
  Evidence, 1 (2), 1-13.

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Policy Implications

• Recognize the need to support and align
  strategies that actively address individual and
  cultural differences (Sesman Roehlkepartain,2003
  ).
• Policy is informed and developed by culturally
  diverse representation of youth experiencing
  mental health challenges and their families and
  significant others

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Example Vision Statement

• Local mental health system that fosters
  resilience at all levels of mental health care
  and education, including mental health promotion,
  prevention, and intervention, with the ultimate
  outcome of resilient individuals, families, and
  communities

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Challenges

• Applying resiliency across the age span (birth to
  early adulthood)
• Linking with other statewide and ODMH initiatives
• Statewide implementation
• Evaluation

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Summary

• Resiliency is a natural platform for creating an
  overarching, strength-based framework for both
  prevention and intervention with youth with
  significant emotional and/or behavioral
  challenges and their families
• Resiliency is equally available to youth with
  significant emotional and/or behavioral
  challenges
• Resiliency is an expectation and not an exception
  for youth with significant emotional and/or
  behavioral challenges
• Efforts to implement a resiliency-oriented mental
  health system need to be imbedded in a community
  structure that supports them and sustains their
  effects

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Quote from Dr. Ann Masten

• The great danger I see in the idea of
  resilience is in expecting children to overcome
  deprivation and danger on their ownThere is no
  magic here resilient children have been
  protected by the actions of adults, by good
  nurturing, by their assets, and by opportunities
  to succeed. We cannot stand by as the
  infrastructure for child development collapses in
  this nation, expecting miracles.

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Bibliography/Resources

• Benard, B. (2004). Resiliency What We Have
  Learned. West Ed, San Francisco, California.
• Benson,P.L., Scales, P., Hamilton, S, Sesman, A.,
  Hong, K., Roehlkepartain (November, 2006).
  Positive Youth Development So Far Core
  Hypotheses and Their Implication for Policy and
  Practice, Insights and Evidence pp. 1-13, 3, 1.
• Masten, A. (2003) Resilience in Development. In
  Snyder and Lopez ed. The handbook of Positive
  Psychology. Oxford University Press
• Sesman, A., Roehlkepartain, E. C. (2003).
  Unique strengths, shared strengths Developmental
  assets among youth of color. Insights and
  Evidence, 1 (2), 1-13.
• The Presidents New Freedom Commission on Mental
  Health
• The Search Institute (1997) Search Institutes
  Framework of Developmental Assets (Ages 12 to
  18). Search-institute.org

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The Resiliency Workgroup

• Tova Black, Tracee Black, Ella Clayborn, Terre
  Garner, Robin Gilbert, Pam Gulley, Carrol
  Hernandez, Karen Hocker, Randall Hocker, Michael
  Jamison, Rachel Lewis, André Martin, Pam Mattson,
  Peter Mattson, Connie Truman, Susan Thompson,
  Sandy Regula, Rick Shepler, Bill Stidham-Garner,
  and Kathy Tenney, Charlotte Williams. The group
  would also like to acknowledge contributions from
  past workgroup members including Marci Dvorak,
  Mary Beth Haubert, Mike Lemon, Bernie Schell and
  Ed Schell.

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Contact Information

• Terre Garner
• Ohio Federation for Childrens Mental Health
• 513-948-3077
• Rick Shepler
• Center for Innovative Practices
• 330-455-3811
• ricks_at_cipohio.org
• Pam Gulley
• Ohio Department of Mental Health