Developing Resilience Professor Angie Hart

a.hart@brighton.ac.uk www.boingboing.org.uk http://twitter.com/bb_resilience

- Using resilience ideas in the context of Future in Mind

- Both about your (systemic) practice in your ‘clinic’ and local area - And your role in the wider system, the

world….. - Tools to use/ ‘prescribe’/choreograph the

use of…. - Not about practitioner resilience

Report of the Taskforce on Children and Young People’s Mental Health and

Wellbeing

• Ecological • Towards ‘nothing

about us without us’

Themes of the report Five key themes

1. Promoting resilience, prevention and early intervention

2. Improving access to effective support - a system without tiers

3. Care for the most vulnerable 4. Accountability and transparency 5. Developing the workforce

The report contains 49 proposals to transform the design and delivery of a local offer of services for children and young people with mental health needs

What is Resilience? And why bother?

The personal qualities that enables one to thrive in the

face of adversity. Connor et al, 2003

Reduced vulnerability to environmental risk

experiences…... Rutter, 2012

the capacity of individuals to navigate their way to …..

resources….., and …. individually and collectively to

negotiate them …. Ungar 2008

an emergent property of a hierarchically organized set of protective systems that cumulatively buffer the effects of adversity and can therefore rarely, if ever, be regarded as an intrinsic property of individuals.’ Roisman, Padrón et al. 2002

Hart, Blincow and Thomas (2007, p10) “…resilience is evident where people with persistently few assets and resources, and major vulnerabilities…have better outcomes than we might expect given their circumstances, and in comparison to what we know happens with other children in their contexts”.

Masten’s Four Waves of Resilience Research (2007)

1st Wave: Definitions centre on attributes specific to the individual such as personal qualities, capacities, skills and abilities

2nd Wave: Protective and risk factors incorporating meso level. Definitions characterised by abstractions such as processes, patterns, vulnerability, risk and protection

3rd Wave: More systemic understanding of resilience. Definitions refer to dynamic processes, systems and negotiation

Masten’s Four Waves of Resilience Research (2007)

4th Wave: An ecological understanding of resilience places individual and adversity within micro, meso, macro and exo context

INDIVIDUAL MICROSYST

EM

MESOSYSTEM

EXOSYSTEM

MACROSYSTEM

A Revised Model of Social Ecology: Small things can make a big difference

Micro-systemic level

Meso-systemic level

Macro-systemic level

Exo-systemic level

A Hierarchical Social Ecology A Complex Social Ecology

The Fourth Wave

.Disadvantage reduced to contextual ‘constant’, ‘factor’ or ‘variable’

The Fifth Wave

.We need to “redefine resilience as the ability to not only cope with conditions related to adversity and injustice but also to challenge their very existence” Prilleltensky and Prilleltensky, 2005

Otherwise building resilience is nothing more than: “putting a sticking plaster over the wound caused by macro-structural inequalities in power and resources”

Taylor, Mathers, Atfield and Parry, 2011

Critique of resilience…

Brings resilience research and practice development together with activism to explicitly unite resilience work with social justice values.

This is an overarching critical approach which explicitly takes into account political and

economic influences co-produced by researchers, practitioners and communities.

The Fifth Wave

Our Conceptualisation…..

“overcoming adversity, whilst also potentially subtly changing, or even dramatically transforming, (aspects of) that adversity”

“Beating the odds whilst changing the odds” Hart, Gagnon, Aumann, & Heaver, 2013

Ways of thinking about resilience…

• Through a technical lens • Diagnosis • ‘Treatment’ • Forms of social prescribing – individual, micro,

meso, exo, macro? • Including to the multidisciplinary team

working with parents and the child/young person as part of the team?

Social ecological approach • Research with the most vulnerable children

shows very clearly that they heal best when we shape their environments to meet their needs (Jaffee, Caspi, Moffitt, Polo-Tomas, & Taylor, 2007; Prilleltensky, 2012)

• Developing the protective factors associated with child development in adverse contexts

• Requires an ‘inequalities imagination’ • Multi-faceted strategies

‘Tools for developing resilience’

‘‘diagnosing’ resilience is a playful way of turning the focus on positive developmental processes. At lower levels of risk, the protective factors are more individual…but at higher levels of risk we need both individual and social ecological factors to help facilitate resilience.’ Michael Ungar, Personal communication

‘Diagnosing’ resilience

• Domain 1: Assess adversity – Severity – Chronicity – Ecological level – Attributions of causality – Cultural and contextual relevance

‘Diagnosing’ resilience

• Domain 2: Assess resilience – In low and medium risk contexts, assess individual

qualities—temperament, personality, cognitions – In high risk contexts, assess

• Availability of resources • Accessibility of resources • Strategic use of resources • Positive reinforcement of coping strategies • Adaptive capacity of the environment

Diagnosing resilience

• Domain 3: Multidimensional considerations – Temporal

• Sociohistorical • Developmental

– Cultural

RT strategically harnesses selected ‘therapeutic’ principles and techniques Developed for use across contexts and by different practitioners, including parents and young people themselves Designed to work with people as co-collaborators in the development of the methodology rather than as recipients Is user-friendly and readily accessible – you don’t need a lengthy specialised training Non-pathologising – ‘upbuilding’ Focuses on complex children and young people living in challenging circumstances

• Ordinary magic (Masten) …. sometimes the smallest move can make the most surprising difference

• Making resilient moves

Strategic way of building resilience

• Basics: getting the necessities sorted • Belonging: good relationships • Learning: interests, talents, life skills • Coping: skills to get by in everyday ways • Core Self: inner thoughts and beliefs

NOBLE TRUTHS

• Accepting where we start from and keep returning to, analysis and understanding, ‘unconditional positive

regard’ • Conserving containing but also preserving, no deconstruction without appreciation

• Commitment the family’s terms and ours, dependency addressed, the longer term

• Enlisting we may not be enough, we may be too much

RT glossary Potion bottles, potions, remedies, interventions Positive chain reactions Noble truths Upbuilding - downbuilding Bouncing up Working resiliently Embedded therapy Managing effective detail Deficit talk Collaborative inertia Organisational promiscuity Defensive practice Gloss Continual redisorganisation

Nowadays we both are, and we work with:

• Children and YP with mental health issues • Disabled C&YP • Children who are adopted or in foster care • C&YP who use drugs or alcohol • C&YP whose parents use drugs or alcohol • Mainstream C&YP • Parents, carers, practitioners, policy makers,

students, charities, government

• Work across NHS, Social Services, Education, the Voluntary Sector and Citizens themselves

• Anyone can join in, including young people themselves

• Community services/community development

Academic Resilience - an approach for schools devised by Lisa Williams and Professor Angie Hart and adopted by YoungMinds. Based on Angie’s collaborative resilience work at the University of Brighton and boingboing. YoungMinds continues to work in partnership with them to develop the approach and support for schools.

Overview of the website resources • Resources to increase staff understanding of

resilience and what they can do about it • Ways to help schools identify vulnerable pupils

earlier using pupil data and risk factors • Tools to audit the whole school against the

evidence of ‘what works’ • Help to gain insight and ideas for improvement

from pupils, staff and parents • Examples from schools – films promoting

practice

Resilient leadership moves that psychiatrists make

- Helping others to understand the biopsychosocial - Being brave - Holding risk - Flexibility in thinking and acting - Using authority to speed up resilient moves for

individual children and across local, national and international systems

Further reading: • Royal College of Psychiatry, user-friendly fact sheets and advice

http://www.rcpsych.ac.uk/expertadvice/youthinfo/mhgpfactsheetsindex.aspx

• Hart, A. and Blincow, D. with Thomas, H. (2007) Resilient Therapy: Working with children and families. London: Routledge

• Aumann, K. and Hart, A. (2009) Helping children with complex needs bounce back: Resilient Therapy for parents and professionals. London: Jessica Kingsley

• Publications by parents and young people at www.boingboing.org.uk • Email: a.hart@brighton.ac.uk

Professor Angie Hart

Contacts and websites • Website: www.boingboing.org.uk • Short film on resilience

Tedex:http://www.youtube.com/watch?v=XPUzjyAoOK4

• Various films on resilience including one from Peter Hindley http://www.youngminds.org.uk/training_services/head_start/resources

Resources and information available on; http://www.youngminds.org.uk/training_services/academic_resilience

Our Resilience Community