Nurturing resilience in young people: Practical strategies

CHERI Conference, 3rd

September

Clin Prof David BennettDepartment of Adolescent Medicine & NSW Centre for the Advancement of Adolescent Health

• A new youth health policy• Understanding adolescence

& health risk• Being healthy and happy• Pathways to resilience and

wellbeing – family, school & community

‘And, just to make it interesting’

Conceptual framework

NSW CAAH - Key Focus Areas

• Developing information & resources

• Capacity building & training

• Supporting applied research

• Advocacy & policy development

NSW Youth Health Policy - healthy bodies, healthy minds, vibrant futures

• Youth participation• Consultation forum• Reference group team• Literature review ----->• Ongoing inter-sectoral

consultation

Youth participation in the Policy

• Input to overall direction• Specific suggestions to

inform the policy• Quotes to represent the

voices of young people• A name for the policy

Youth health policy consultation forum

We live in a web-based world

“Kids are great. You can teach them to hate the things you hate and they practically raise themselves nowadays, you know, with the Internet and all.”

Homer Simpson

Generation Y: born 1980 - 1995

“…towering self-esteem and unabashed assertiveness” Hugh Mackayinfo@thenexgengroup.com

“Adolescence is a time when longings awaken with an intensity that many have misunderstood and dismissed as “hormones”. The larger questions about meaning, identity, responsibility and purpose begin to press with an urgency and loneliness we can all remember.”Rachael Kessler, “The Soul of Education”, 2000

The health of young people

• Current indices of youth health are poor for 20 -30% of young people

• Health problems mainly psychosocial

• Risk burden often hidden or undetected

• Lifestyles adopted influence later life disease and are preventable!

Risk taking behaviour

• “Adolescents experiment with new activities, testing their limits, exploring new skills, and enjoying the often exhilarating sense of freedom involved.” Bennett & Rowe, 2003

• Biology of the brain relevant

Neurodevelopment – new findings

• The pre-frontal cortex continues to develop into early adulthood

• Changes move forward –‘from awkwardness to awareness’

• Brain development influences risk behaviours & medical care

Psychosocial concerns – increasing

“…the prevalence of social and psychological problems has increased in young people, with a fifth to a third now experiencing significant distress at any one time – and it is often higher than in older age groups.”

Weighing the risks

• Well adjusted

• Vulnerable

• Experimenter

• Troubled

• Out-of-controlOntario Medical Association, 1992

Adolescent mental health problems

• One in four young people has a mental health problem

• 75% of mental health problems begin in adolescence – peak age of onset 15 – 25 years

• 50% of depressed adolescents are undiagnosed

Being healthy and happy (NSW Youth Health Policy)

“It’s about all aspects of life, including physical, mental, emotional, spiritual, psychological aspects, and also having a work/life balance. Being healthy isn’t always easy; it is something that needs to be worked at and maintained.”

“Happy and healthy go hand in hand.”

The concept of mental health

A state of wellbeing in which the individual realises his or her own abilities, can cope with the normal stresses of everyday life, can work productively and fruitfully, and is able to make a contribution to his or her community.

WHO. Mental Health: New Understanding, New Hope. Geneva 2001.

What is happiness?

“Happiness comes of the capacity to feel deeply, to enjoy simply, to think freely…and to be needed.”

Margaret Storm Jameson

“If you want others to be happy, practise compassion. If you want to be happy, practise compassion.” Dalai Lama

‘Authentic happiness’

• The evidence so far indicates that meaningful and engaged lives are more important than pleasurable experiences in determining wellbeing.

• Healthy individuals – and a healthy society –strike a balance between commitment to the self and commitment to the common good.

Seligman et al, 2005www.authentichappiness.org

Wellbeing – a continuum

a social process <----> a personal experience

“While wellbeing is experienced subjectively by individuals, it is produced by social processes.”

“Wellbeing is enhanced by democratic processes that enable young people to have a say, to feel valued and to influence decisions.”

Joanna Wyn 2009

Adolescents’ multilevel view of their health

IndividualProductivity

Health & wellbeing (physical & emotional)

Protective & risk behaviours

RelationshipsFamily

Community

Peers

Supportive adults

Context

InformationPhysical Environment

FinancialStressors

School

Concepts of resilience

“Resilience is the happy knack of being able to bungy jump through the pitfalls of life. Even when the hardships of adversity arise, it is as if the person has an elasticised rope around them that helps them to rebound when things get low, and maintain their sense of who they are as a person.”

Andrew Fuller, 1998

Concepts of resilience“What seems important is to approach life’s challenges with a positive frame of mind, a confidence that one can deal with the situation, and a repertoire of approaches that are well-adapted to one’s own personal style of doing things.”

Michael Rutter, 1993

Concepts of resilience

• Resilient people always see a way of coping, and if the first way they try doesn’t work, they try a bunch of other things… Elisabeth Wynhausen On Resilience (2009)

• Resilient individuals in the face of overwhelming adversity are able to adapt and restore equilibrium.

Wagnild and Young (1993)

• A resolute acceptance of reality, a sense that life ismeaningful, and an exceptional ability to improviseDiane Coutu Harvard Business Review (2002)

Concepts of resilience

“Building resilience is a never-ending upward spiral of coping with and taking charge of problems, solving them one at a time, and transforming failures into strategies that can be used to cope with and take charge of the next problem.”

Michael Blum, 2006

Broader concepts of resilience

• “…the capacity of individuals, schools, families and communities to cope successfully with everyday challenges, including life transitions, times of cumulative stress and significant adversity or risk…”

Michael Rutter, 1990

• “Resilience is not only an individual’s capacity to overcome adversity, but the capacity of the individual’s environment to provide access to health enhancing resources in culturally relevant ways..” Ungar et al, Family process, 2007; 43(1):23-41

Protective factors

• Personality characteristicssuch as autonomy, self esteem and a positive social orientation

• Family cohesion, warmth and an absence of discord --->

• External support systemsthat encourage and reinforce a child’s coping efforts

Masten & Garmezy, 1985

Protective factors for mental health & social problems

0

10

20

30

40

50

0-1 2-3 4-6 7-10

Protective factors

%

depressivesymptomatologydeliberate self harm

homelessness

early sexual activity

Centre for Adolescent Health

It helps to feel connected

“Feeling connected is important for a million reasons; not feeling alone or outside, feeling connected is like a baseline of normality, a perspective thing. If you are not connected then you might feel alien, you may feel unhealthy and you might be in strife without connectedness.”

Adolescents with serious illness & disability

• Have lower levels of emotional wellbeing than their healthy peers

• Experience isolation, disconnection, lack of autonomy

• Report a sense of alienation from their peers

• Are absent from school on a regular basis

• Present a higher risk of poor social adjustment

‘Tear of thought’

“There is a need for expression that comes from being trapped inside a world of inescapable sickness and continuous hospitalisation.”

Kane, 1993

Health is always present...Health is always present...

“Health is always present regardless of the presence of disease, as the skies are present in spite of clouds on the horizon.”

Sartorius, 1990

Resilience – key concepts

• Competence

• Connection

• Confidence

• Character

• Contribution

The parent factor

The skill factor

EducationFactor

FamilyIdentity +

connectedness

The community factor

The peer factor

The money factor

www.theresiliencedoughnut.com.au

Family and resilience

“… the central importance of caring relationships between children and adults for the development of resilient adolescents and young adults …”

Michael Resnick et al, 1993

Challenging stages for parents

• The years 0 – 3

• The years 11 - 18

Tucci, Goddard & Mitchell, 2004

The family at adolescent transition

• Like a living organism, families seek to adjust to natural changes that occur across the family life cycle.

• 40% of parents report an increase in distress (especially mothers) in the early adolescent years -->

Parenting style (Diana Baumrind)

HIGH Control

LOW Control

HIGH warmth

AUTHORITARIAN AUTHORITATIVE

CHAOTIC(neglectful)

LAISSEZ-FAIRE (permissive)

LOW warmth

Authoritative parenting

• Warm, involved and responsive

• Firm & strict and demanding of maturity

• Fosters and encourages psychological autonomy

Diana Baumrind, 1971, 1991

Participation and responsibility

“The lessons we instil by insisting that our children do mundane tasks may very well be the ones that stay with them longest, helping them to become self-reliant adults, responsible community members, and loving parents.”

Wendy Mogel, The Blessing of a Skinned Knee, 2001

Family meals

• Eating meals as a family benefits young people above and beyond their general sense of connectedness to family members

• Frequency of family meals is inversely associated with tobacco, alcohol & marijuana use, depressive symptoms & suicide involvement, particularly among adolescent girls.

Eisenberg et al, 2004

Adolescents from authoritative homes

• Achieve more in school

• Better self-reliance & self-esteem; less depression and anxiety

• More positive social behaviour, self-control, cheerfulness & confidence

• Less likely to engage in anti-social behaviour

Lawrence Steinberg, 2001

Parenting style

HIGH Control

LOW Control

HIGH warmth

AUTHORITARIAN AUTHORITATIVE

CHAOTIC(neglectful)

LAISSEZ-FAIRE (permissive)

LOW warmth

The three Ps

• Keep it in perspective

• Don’t take it all personally

• It won’t persist – keep your eye on the longer term goal

Parenting programs

Universal parenting programs:

• When delivered during transition to secondary school, can prevent initiation of alcohol and smoking (monitoring and supervision)

• Brief or self-directed programs (materials at

home) can enhance family functioning and reduce adolescent risk behaviours

Lucy Tully, DOCS, 2007

Parenting programs

Targeted parenting programs:

• Improve parent and child outcomes (for families with multiple risks, parental depression, divorced parents, step-families…)

• Aggregation of high-risk young people can lead to an increase in substance use and behavioural problems

Lucy Tully, DOCS, 2007

School – relevance to what?

“When they ask me what I like doing at school, I say pissing people off.”

School and resilience

• Development and enhancement of academic and social competence

• A positive school ethos and warm classroom environment

• ‘Effective schooling –supportive, stimulating, caring teachers with high expectations’

Joy Dryfoos, 1995

A good school feels positive & safe

• Having good friends

• Having good teachers

• Believing you fit in

• Feeling respected

• Having an adult take an interest in you

Perceived school connectedness

“The most important things in life can never be measured.”

“I am enough of an artist to draw fully upon my imagination. Imagination is more important than knowledge. Knowledge is limited. Imagination encircles the world.”

Programs that work in schools:

• Increase social competence of adolescents

• Aim at general populations at transition to high school

• Promote changes to the school environment & school ethos

• Provide long term programs & employ interactive techniques

Stewart-Brown, WHO Europe, 2006

And - parental involvement

• The most effective interventions are those where parents and educators work together

• Exchange of information is effective in managing behaviour and school-related problems

A structured, values-based framework for group interaction

• Inclusion – everyone gets a turn, everyone else listens

• Respect – no put downs, personal positives only

• Safety – no pressure to say anything, may pass

www.wellbeingaustralia.com

Service-Learning

…defined as a teaching and learning strategy that integrates meaningful community service with instruction and reflection to enrich the learning experience, teach civic responsibility, and strengthen communities. www.servicelearning.org

Service-learning = values education Service-learning = enterprise education.

Peers and resilience

• Involvement in outside activities that create multiple friendship networks

Resnick et al, 1997; Resnick, 2000

What is positive youth development?

…includes the provision of opportunities, experiences and support to build personal strengths and assets necessary for positive development.

Positive youth development

• Feelings of motivation and competence• Connectedness to others and to society• A belief in control over one’s fate in life• Pride in one’s cultural heritage and

identityYouth participation epitomises the concept of ‘interactive roles for a healthy society’

International Youth Foundation, 1999

‘Helping disconnected young people to discover greatness within, by engaging, supporting and providing opportunities to encourage and facilitate positive life choices’

A final word from a young person

“Young people are like a butterfly in the cocoon process. We need to give them the support, courage and strength to bring them out safely, to face the world, spread their wings and reach their full potential. Every young person should have this opportunity – to realise their talents, goals, dreams, and have at least one person who never loses faith in them.”

Young person, aged 22 years

www.caah.chw.edu.au