Development of population‐based resilience measures in the primary school setting

Well-being package for foster carers and teachers of looked-after children aged 8 to 11 years: the STrAWB feasibility RCT

Background

Children in care are at elevated risk of mental health issues and poorer well-being, and social care and health services are under pressure to meet their needs. The Shared Training and Assessment for Well-Being programme is a recent approach to training and assessment designed to bring together foster carers and designated teachers to identify and meet the well-being needs of primary school-aged children in care, across the home and school contexts.

Objectives

This feasibility randomised controlled trial addressed key questions concerning the acceptability of the Shared Training and Assessment for Well-Being intervention (including training, assessments, clinical review and feedback) and the feasibility of the research design for a larger randomised controlled trial (including recruitment, randomisation and outcome measures).

Design

This was a two-arm randomised controlled trial (Shared Training and Assessment for Well-Being intervention vs. control group), with two points of data collection (baseline and 12-month follow-up) for our primary and secondary outcomes.

Setting

The study focused on looked-after children from four local authorities in southern England. In the context of the COVID-19 pandemic, both the research and intervention activities were undertaken online with participants.

Participants

Looked-after children aged 8-11 years were recruited from the participating local authorities, along with their foster/kinship carers and designated teachers. Carers for all children in the authorities meeting inclusion criteria were initially invited to participate. The original target sample size was 70 children, with 35 receiving the Shared Training and Assessment for Well-Being intervention and 35 in the control group. However, only 21 looked-after children were successfully recruited and randomised.

Interventions

Shared Training and Assessment for Well-Being is an integrated approach that combines training on mental health, well-being and resilience for foster carers and designated teachers; a multi-informant assessment package; review of assessments by mental health experts; and feedback to enable key adults to respond to identified needs and strengths. COVID-19 adaptations enabled all key elements to be delivered remotely.

Main outcome measures

Two multi-informant primary outcome measures were included as possible candidates for a larger randomised controlled trial: the Strengths and Difficulties Questionnaire and the Paediatric Quality of Life Scale. A further multi-informant secondary outcome measure was also included: the Behavioural and Emotional Rating Scale.

Results

Feasibility was not demonstrated, as recruitment was heavily impacted by the COVID-19 pandemic and further attrition occurred over the extended project duration. For the small number who completed the Shared Training and Assessment for Well-Being package, key elements of the intervention were acceptable to participants. In addition, beyond issues with recruitment and retention, key aspects of the randomised controlled trial design, including randomisation, were acceptable.

Limitations

It is impossible to distinguish precisely between impacts of COVID-19 and broader challenges with securing the capacity and stability needed to deliver and evaluate the Shared Training and Assessment for Well-Being intervention.

Conclusions

Key elements of the Shared Training and Assessment for Well-Being intervention and randomised controlled trial process were acceptable, but the overall randomised controlled trial research design was not feasible in this study. The project was heavily compromised by the impact of the COVID-19 pandemic on foster carers, schools, local services and children.

Future work

Potential strategies are suggested to address challenges with evaluating integrated training and assessment approaches aimed at key adults supporting looked-after children.

Funding

This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR127799.

Longitudinal relationships across emotional distress, perceived emotion regulation, and social connections during early adolescence: A developmental cascades investigation

Early adolescence is a vulnerable period for emotional distress. Both emotion regulation and social connection to peers and family adults are understood to be associated with distress. However, existing longitudinal work has not explored these constructs jointly in a way that estimates their reciprocal relationships over adolescence. We present a three-wave random-intercepts cross-lagged panel model of reciprocal relationships between emotional distress, perceived emotion regulation, and social connections during early adolescence, among 15,864 participants from education settings in disadvantaged areas of England, over three annual waves (at ages 11/12, 12/13, and 13/14 years). Findings showed that emotional distress and perceived emotion regulation share a negative relationship over time, and that higher perceived emotion regulation predicts greater family connection in the initial stages of early adolescence (from age 11-12 to 12-13 years). Findings also indicated that connection to peers is positively associated with family connection, but also positively predicts slightly greater distress in the later stages of early adolescence (from age 12-13 to 13-14 years). Findings indicate a risk of negative spiral between emotional distress and perceived emotion regulation in early adolescence, and that social connection may not necessarily play the role we might expect in reducing distress.

Visiting the studies of resilience in language learning: From concepts to themes

Resilience, as a positive personal trait, has been a topic of hot debate in the field of general education with the booming perspective of positive psychology. The exploration of learner resilience is conducive to understanding how learners grapple with setbacks, positively adapt, and function well in the presence of challenging situations. To date, some attention is paid to the structure of learner resilience, its relationships with other psychological variables, and its impacts on academic achievement. However, research on the overall profile of resilience in the field of foreign language (FL) or second language (L2) from a holistic and systematic perspective is still lacking. Against this backdrop, the current study reviewed and synthesized research evidence on resilience in the FL/L2 learning context. Specifically, 27 high-quality empirical studies published between 2017 and 2023 were selected, and then they were analyzed in terms of substantive characteristics of the literature and research participants, models of resilience, methodological features, and research foci. The results revealed a steady increase in language learner resilience research and displayed the detailed distribution of reviewed articles in publication year and sources as well as participants' educational backgrounds. Moreover, the conceptualization of resilience displayed complex and diverse features, the quantitative approach took a dominant position in the reviewed literature, and resilience models from psychology were widely utilized in language learner resilience research directly or indirectly. Finally, the implications of these findings were discussed for the further development of language learner resilience research.

Protective factors for resilience in adolescence: analysis of a longitudinal dataset using the residuals approach

INTRODUCTION

The residuals approach, in which residual scores from regression models are used as a proxy for resilient functioning, offers great potential to increase understanding of resilience processes. However, its application in child and adolescent wellbeing research is limited to date. We use this approach to examine how adversity exposure impacts later wellbeing (life satisfaction, and internalising mental health difficulties) in the early-to-middle adolescence transition; whether gender and ethnic differences in resilience exist; which internal and external factors confer protective effects for resilience; and, whether the protective effect of these factors differs by gender and level of adversity exposure.

METHOD

Secondary analysis of the #BeeWell longitudinal data set (N = 12,130 adolescents, aged 12/13 at T1 and 13/14 at T2, representative of Greater Manchester, England) was undertaken, using a series of linear regressions to establish adversity indices for later wellbeing, before assessing the protective effects of internal and external factors on resilience.

RESULTS

Multiple adversity factors (e.g., home material deprivation, sexuality discrimination, bullying) were found to impact later wellbeing. Girls and white adolescents presented lower levels of resilience than their peers. Internal psychological factors (self-esteem, emotional regulation, optimism) consistently conferred the strongest protective effects, but behavioural/activity factors (physical activity, sleep) also contributed to resilience. Among external factors, friendships and peer support were the most salient. Physical activity yielded stronger protective effects among boys (compared to girls). Effects of protective factors were stronger among those at lower (compared to higher) levels of adversity exposure.

CONCLUSION

The residuals approach can make a considerable contribution to our understanding of the interplay between adversity exposure and access to protective factors in determining adolescent wellbeing outcomes. Moreover, its application provides clear implications for policy and practice in terms of prevention (of adversity exposure) and intervention (to facilitate resilience).

Gender difference in the change of adolescents' mental health and subjective wellbeing trajectories

Gender differences in adolescents' mental health problems have been extensively reported. Yet, there is limited research in exploring longitudinal trends in mental health and wellbeing between boys and girls. This study investigated any emerging developmental trends of gender differences in mental health problems and subjective wellbeing for young people from early to mid-adolescence in England. A longitudinal group of 8612 young people's mental health and subjective wellbeing trajectories were investigated between the period of ages 11/12 and 13/14. Mental health difficulties and subjective wellbeing were measured using the child self-report Strengths and Difficulties Questionnaire (SDQ) and Short Warwick and Edinburgh Wellbeing Scale (SWEMWBS), respectively. Any gender difference in the change of adolescents' mental health and subjective wellbeing over 3 year period were estimated using multi-level regression while accounting for various socio-demographic and resilience factors. Young people are at increased risk of mental health problems between the ages of 11 and 14, particularly girls. The overall difficulty levels reported by girls were significantly higher than boys across a range of mental health problems and subjective wellbeing. These developmental trends persisted after controlling for a broad range of potential confounders. Young people has shown clear signs of mental distress as they get older. This escalation was particularly evident among girls. Distress can come at the time of significant physical, emotional, and social changes in an adolescents' life, and can be heightened during secondary school transition. This evidence highlights the importance of early intervention to reduce risk of distress.

Analysis of Protective Factors in Schoolchildren in England Using the Dual-factor Model of Mental Health

The dual-factor approach to mental health was employed to explore levels and interrelations of protective factors associated with resilience in a dataset of 30,841 schoolchildren aged 11-14 in England. ANOVA was used to contrast levels of protective factors between groups (combinations of higher/lower psychopathology and higher/lower wellbeing) and network analysis to explore protective factor interrelations. Levels of protective factors tended to be highest for those who had higher wellbeing and lower psychopathology (termed 'complete mental health'). Those with lower levels of protective factors were split between two subpopulations: having lower wellbeing and higher psychopathology (termed 'troubled'), and having lower wellbeing and lower psychopathology (termed 'vulnerable'). Analysis of the protective factor networks revealed that the four subpopulations of the model were distinguished by both their overall structure and individual node connectivity (the 'complete mental health' subpopulation demonstrated the greatest connectivity), though two were similar: those with higher wellbeing and higher psychopathology (termed 'symptomatic but content') and lower wellbeing and higher psychopathology ('troubled'). The results indicate that while 'vulnerable' and 'symptomatic but content' may be hard to discriminate conceptually, the former may reflect a lower capacity to cope during periods of adversity (i.e., show resilience). Overall, the results encourage a holistic approach to mental health screening, particularly as children with lower wellbeing had lower levels of the protective factors, regardless of their level of psychopathology. Moreover, interventions to improve protective factors associated with positive development in stressed environments may therefore have a greater impact on improving wellbeing than decreasing symptoms of psychopathology.

Wellbeing while waiting evaluating social prescribing in CAMHS: study protocol for a hybrid type II implementation-effectiveness study

BACKGROUND

Social prescribing is a mechanism of connecting patients with non-medical forms of support within the community and has been shown to improve mental health and wellbeing in adult populations. In the last few years, it has been used in child and youth settings with promising results. Currently, pathways are being developed for social prescribing in Child and Adolescent Mental Health Services (CAMHS) to support children and young people on treatment waiting lists. The Wellbeing While Waiting study will evaluate whether social prescribing benefits the mental health and wellbeing of children and young people.

METHODS

This study utilises an observational, hybrid type II implementation-effectiveness design. Up to ten CAMHS who are developing social prescribing pathways as part of a programme run across England with support from the Social Prescribing Youth Network will participate. Outcomes for children and young people receiving social prescribing whilst on CAMHS waiting lists will be compared to a control group recruited prior to the pathway roll-out. Questionnaire data will be collected at baseline, 3 months and 6 months. Primary outcomes for children and young people are mental health symptoms (including anxiety, depression, stress, emotional and behavioural difficulties). Secondary outcomes include: loneliness, resilience, happiness, whether life is worthwhile, life satisfaction, and service use. An implementation strand using questionnaires and interviews will explore the acceptability, feasibility, and suitability of the pathway, potential mechanisms of action and their moderating effects on the outcomes of interest, as well as the perceived impact of social prescribing. Questionnaire data will be analysed mainly using difference-in-differences or controlled interrupted time series analysis. Interview data will be analysed using reflexive thematic analysis.

DISCUSSION

The Wellbeing While Waiting study will provide the first rigorous evidence of the impact of social prescribing for children and young people on waiting lists for mental health treatment. Findings will help inform the prioritisation, commissioning, and running of social prescribing in other CAMHS. To maximise impact, findings will be available on the study website ( https://sbbresearch.org ) and disseminated via national and international networks.

TRIAL REGISTRATION

N/A.

"What's going on?" Racism, COVID-19, and centering the voices of Black youth

This study examined the impact of COVID-19 stress and experiences of racism on COVID-19 adaptability and activism among Black youth. The protective role of perceived peer and adult social support were examined. Data were analyzed from 123 Black youth (M_age  = 15.44, 63% girls) from a school district in the Midwest. The findings revealed that more social support from adults increased Black youth adaptability (e.g., "ability to think through possible options to assist in the COVID-19 pandemic"). Perceived lower social support from adults predicted higher engagement in high-risk activism, and higher levels of peer social support were associated with higher levels of high-risk activism. Further, Black youth reporting higher levels of racism and adult social support were more likely to report higher levels of COVID-19 adaptability. Black youth reporting higher racism and peer social support engaged in high-risk activism. Black youth who reported high levels of racism and low perceived adult social support reported higher engagement in high-risk activism. Research and practice implications that support Black youth during the COVID-19 pandemic and the impact of racism and COVID-19 stress on well-being and activism are discussed.

Development and Validation of Age-Specific Resilience Instruments for Early Childhood Assessment: A Taiwan Birth Cohort Study

BACKGROUND

We sought to develop and validate age-specific instruments for measuring early childhood resilience at ages 3, 5 and 8 in the Taiwan Birth Cohort Study, a national longitudinal study.

METHODS

Using data from 18,553 mother-infant pairs, we conducted exploratory factor analysis (EFA) on a simple random half of our sample. We then used the remaining half of these data for confirmatory factor analysis (CFA) to further assess the fit of 3 CFA models (ie, first-order, second-order, and bifactor). Psychometric properties, distributions, and inter-item and inter-factor correlations of each instrument were also evaluated.

RESULTS

EFA and CFA showed that the bifactor model of resilience (which included a general resilience factor and 5 specific factors) had the best fit for all 3 resilience scales, with 19 items at year 3, 18 items at year 5, and 19 items at year 8. All 3 resilience scales showed good psychometric properties, including construct validity, internal consistency, and normal distributions. For predictive validity, we found that in the face of adversity (measured by the High Risk Family Score), individuals with high resilience scores at age 3 had better general health scores at ages 3, 5, and 8 compared to those with low resilience scores.

CONCLUSIONS

We describe the development and validation of age-appropriate survey instruments to assess resilience in young children at the population level. These instruments can be used to better understand how resilience can impact child health over time, and to identify key factors that can foster resilience.

Academic stress and suicidal ideation: moderating roles of coping style and resilience

BACKGROUND

As a global phenomenon, suicide has generated a lot of concern. Scholars from various fields have conducted extensive research on the prevalence, causes, factors, and/or management or possible solutions to suicidal ideation. Despite the research efforts, suicidal cases worldwide still yell for more empirical attention. No doubt that some of the extant literature have specifically evidenced the causal links and factors in suicidal ideation. Yet, none had focused on the moderating roles of coping and resilience in an academic population. We therefore, examined the moderating roles of coping and resilience in the relationship between academic stress and suicidal ideation.

METHOD

We used a cross-sectional design to sample 505 participants (329 males and 176 females) from three southern Nigerian universities. Participants who willingly indicated their participatory consent were administered a paper self-report questionnaire containing the Lakaev Academic Stress Response Scale (LASRS), Scale for Suicidal Ideation (SSI), Brief COPE (B-COPE), and Resilience Scale (RS-14). Hierarchical regression analysis was used to test the hypotheses of the study. Academic stress (r = 0.17; p.001) was found to be positively associated with suicidal ideation, whereas resilience (r = -.22; p.001) was found to be negatively associated with suicidal ideation. Suicidal ideation had no significant correlation with adaptive coping style, but it did have a significant correlation with maladaptive coping (r = .15; p.001). The regression-based PROCESS macro showed that academic stress was a significant predictor of coping [ΔR² = .03, F (1, 502) = 16.18, p = .01]. Academic stress was positively associated with suicidal ideation at low or moderate levels of adaptive coping styles. At high levels of adaptive coping styles, the association between academic stress and suicidal ideation was not significant. However, resilience negatively predicted suicidal ideation [R = .29, (R² = .08), F(1, 499) = 19.94, p = .00] with academic stress showing a positive association with suicidal ideation at low and moderate levels of resilience, but for those with high resilience, academic stress was not associated with suicidal ideation. In sum, suicidal ideation is heightened by increased academic stress, with greater resilience ameliorating the tendency of academic stress resulting in suicidal ideation. Also, adopting maladaptive ways of coping promotes suicidal ideation among students, with resilience and adaptive coping strategies moderating the relationship between academic stress and suicidal ideation. It is therefore recommended that educational administrators, policy makers, lecturers, teachers, and tutors incorporate courses, teachings, and sessions that foster as well as inculcate resilience and efficient coping skills in pupils and students.

Correlates of suicidal ideation in rural Chinese junior high school left-behind children: A socioecological resilience framework

INTRODUCTION

Suicide is one of the top five causes of adolescent mortality around the world. The socioecological resilience framework in explaining the risk factors and protective factors for suicidal ideation in left-behind children (LBC) has not been well explored. The current study aims to compare the prevalence of suicidal ideation in LBC and non-LBC, and explore its correlations with resilience factors among LBC.

METHODOLOGY

This study was part of an epidemiological survey conducted by UNICEF exploring mental health outcomes in left-behind children. We implemented a cross-sectional study collecting data from 11 provinces and 1 municipal, with 5,026 participants (3,359 LBC, 1,667 controls) in year one junior high school living in impoverished areas of rural China. Data on suicidal ideation, self-harm, resilience factors including health-risk behaviors, psychological wellbeing as it was measured by the Strengths and Difficulties Questionnaire, peer relationship within the school environment, and family support were collected.

RESULTS

Overall prevalence of suicidal ideation among LBC was 7.2% which is significantly different from 5.5% reported by NLBC (χ2 = 4.854, p = 0.028). LBC reported a higher prevalence of self-harm (16.4%) than NLBC (13.0%; χ2 = 10.232, p = 0.001), but there was no difference in the prevalence of suicide plan, suicide attempt or help-seeking. LBC had significantly poorer psychological feeling, and greater emotional and behavioral difficulties peer relationship in the school environment than controls. In the multiple logistic regression, history of self-harm was the greatest predictor for suicidal ideation among LBC (OR = 2.078, 95% CI: 1.394-3.100, p < 0.001). Health risk behavior including previous smoking attempt, poor psychological feeling, and emotional and behavior difficulties, and poor peer relationship within school environment, were also significant risk factors for suicidal ideation among LBC.

CONCLUSION

The prevalence of suicidal ideation and self-harm was greater among left-behind than non-left-behind children. Our results show resilience factors including previous self-harm, emotional and behavioral problems, smoking, and poor peer relationship are significantly associated with suicidal ideation in left-behind adolescents.

Bounce Back: randomised trial of a brief, school-based group intervention for children with emergent mental health difficulties

We report the findings of the first randomised trial of Bounce Back, a brief, school-based group intervention for children with emergent mental health difficulties, whose aim is to improve their understanding of resilience and well-being, support them to build their confidence and friendships, and provide practical skills to make positive behaviour changes. 24 primary schools (N = 326 children) were randomly allocated to deliver the intervention or continue practice as usual in a waitlist design. Children in the intervention arm of the trial worked in groups of up to 15, supported by a trained youth practitioner, over ten weekly sessions that were delivered during the school day for up to an hour. Measures of emotional symptoms, behavioural difficulties, problem-solving, and self-esteem were recorded at baseline and post-intervention follow-up. Routinely collected session attendance data were used as a proxy for intervention compliance. Intent to treat analyses revealed that Bounce Back produced significant reductions in emotional symptoms (d = - 0.21). Furthermore, complier average causal effect analyses established that intervention compliance modified this treatment effect, such that children who attended more sessions accrued greater reductions in symptoms (moderate compliance d = - 0.54; high compliance d = - 0.61). There were no intervention effects for any of the other outcomes. Collectively, these findings provide robust preliminary evidence of the efficacy of Bounce Back.Trial registration: ISRCTN11162672.

Children and young people's experiences of completing mental health and wellbeing measures for research: learning from two school-based pilot projects

BACKGROUND

In recent years there has been growing interest in child and adolescent mental health and wellbeing, alongside increasing emphasis on schools as a crucial site for research and intervention. This has coincided with an increased use of self-report mental health and wellbeing measures in research with this population, including in school-based research projects. We set out to explore the way that children and young people perceive and experience completing mental health and wellbeing measures, with a specific focus on completion in a school context, in order to inform future measure and research design.

METHODS

We conducted semi-structured interviews and focus groups with 133 participants aged 8-16 years following their completion of mental health and wellbeing measures as part of school-based research programmes, using thematic analysis to identify patterns of experience.

FINDINGS

We identified six themes: Reflecting on emotions during completion; the importance of anonymity; understanding what is going to happen; ease of responding to items; level of demand; and interacting with the measure format.

CONCLUSIONS

Our findings offer greater insight into children and young people's perceptions and experiences in reporting on their mental health and wellbeing. Such understanding can be used to support more ethical and robust data collection procedures in child and adolescent mental health research, both for data quality and ethical purposes. We offer several practical recommendations for researchers, including facilitating this in a school context.

The Child Outcome Rating Scale: validating a four-item measure of psychosocial functioning in community and clinic samples of children aged 10-15

Psychosocial functioning is considered an important and valued outcome in relation to young people's mental health as a construct distinct from psychiatric symptomology, especially in the light of an increasing focus on transdiagnostic approaches. Yet, the level of psychosocial functioning is rarely directly asked of young people themselves, despite the widespread recognition that the young person's perspective is valuable and is often at odds with those of other reporters, such as parents or professionals. One possible reason for this is that the field lacks a clear agreed tool to capture this information in a non-burdensome way. To begin to address this gap, this paper describes psychometric analysis of the Child Outcome Rating Scale (CORS), a brief and highly accessible self-report measure of young people's psychosocial functioning already used extensively by mental health professionals around the world but with only limited data on psychometric robustness. Using large community (n = 7822) and clinic (n = 2604) samples, we explore the factor structure, construct validity, internal consistency, differential item functioning, and sensitivity of the CORS. We found that the CORS stands up to psychometric scrutiny, having found satisfactory levels of reliability, validity, and sensitivity in this sample. We also found that the CORS is suitable for use with young people as old as 15 years old. That the CORS has been found to be psychometrically robust while being highly feasible (brief, simple, easy to administer) for use in busy clinical settings, combined with the fact that the CORS has already been widely adopted by clinicians and young people, suggests CORS may be an important tool for international use.

Assessing resiliency in paediatric rehabilitation: A critical review of assessment tools and applications

BACKGROUNDS

Resiliency has attracted a growing interest in paediatric rehabilitation as a key capacity for disabled children and their families to thrive. This study aimed to identify measures used to assess resiliency of disabled children/youth and their families and critically appraise the current use of resiliency measures to inform future research and practice.

METHODS

A two-stage search strategy was employed. First, systematic reviews of resiliency measures published since 2000 were searched. Second, full names of measures identified in at least two systematic reviews were searched across four electronic databases. Included studies assessed resiliency among children/youth (0-18 years old) with chronic health conditions and/or disabilities and their families. Identified articles were then analysed to discern the study's definition of resiliency, authors' rationales for measurement selection, and types of perceived adversities facing the study participants.

RESULTS

From an initial yield of 25 measures identified in five systematic reviews, 11 were analysed in two or more reviews. The second stage yielded 41 empirical studies published between 2012 and 2018, which used 8 of the 11 resiliency measures searched by name. Of 41, 17 studies measured resiliency of disabled children/youth, 23 assessed resiliency within family members, and 1 studied both children/youth and their families. Our critical appraisal identified inconsistencies between the studies' definition of resiliency and chosen measures' operationalization, implicit assumption of disabilities as a developmental risk that automatically results in life adversities, and the tendency among family studies to reduce resiliency down to stress coping skills. Research that encompasses contextual factors and developmental influences is lacking.

CONCLUSIONS

There is a need for a situated measurement approach that captures multiple interacting factors shaping resiliency over one's life course. Resiliency measures would benefit from a greater focus on a person-environment transaction and an alternative definition of resiliency that accounts for multiple capacities to navigate through disabling environments.

The resilience of parents who have children with autism spectrum disorder in China: a social culture perspective

BACKGROUND

Parenting children with autism spectrum disorder (ASD) continues to be challenging worldwide, especially in the Chinese context where there lacks support for parents.

METHOD

Five parents of children with ASD of high level of resilience in China were interviewed about their experiences of raising children with ASD and influencing factors of developing resilience.

RESULTS

Findings highlighted the process of developing resilience shaping from the interaction between different social system, including introspect and self-cultivation in micro system, acceptance of ASD, playing various roles for their children, and expanded social network in the interactions between micro and mezzo systems and accept the worst results in the interactions between micro and macro systems. The characteristics of resilience for Chinese parents of children with ASD were that parents built positive relationships with themselves and outsides though active interaction and changed their social environment as an outcome.

CONCLUSION

The results of this study may reveal the process and characteristics of resilience for Chinese parents having children with ASD, which can be a starting point for other parents to understand and learn from them. Besides, it provides insight for service providers into paying attention to the whole experience of parents and help them to expand the relative network to support them.

Bounce Forward: A School-Based Prevention Programme for Building Resilience in a Socioeconomically Disadvantaged Context

Socioeconomic status is a strong predictor of normative development and well-being in young people. It is well-known that growing up in a socioeconomically disadvantaged context may lead to negative outcomes, both in childhood and in adulthood. Early intervention and prevention programmes are crucial for building resilience and improving health, well-being and equity. Bounce Forward is a school-based prevention programme implemented in Blackpool, a town in the United Kingdom facing multiple challenges. It was part of a whole town resilience approach and nascent global social movement known as the "Resilience Revolution." Between 2017 and 2019, the programme was delivered in all Year 5 classes at every primary school in Blackpool (n _school = 36), reaching out to 3,134 students (ages 9-10; 50.4% male). The programme aimed to increase resilience in young people by building knowledge and skills about mental health and resilience through 10 sessions. In the current study, we longitudinally examined a range of protective factors, which are relevant to young people's resilience, as well as their mental health outcomes at three time points: before they participated in Bounce Forward, at the end of the programme, and 3-5 months later, when they started Year 6. The current sample included 441 Year 5 students (54.2% male) from 11 primary schools in Blackpool. Nineteen teaching staff also participated in the study and provided qualitative data regarding the impact of the programme on their students. Results showed improvement in some areas of young people's resilience after taking part in Bounce Forward. We also identified gender differences in several protective factors, indicating that boys may need further support. Teaching staff highlighted improvements in various areas; and also observed that their students have been using the strategies that they learnt from the programme. Altogether, findings suggested that young people benefitted from Bounce Forward. The programme is sustainable, offering a free to download teacher resource pack that allows schools to self-deliver it.

Promoting mental health and wellbeing in schools: examining Mindfulness, Relaxation and Strategies for Safety and Wellbeing in English primary and secondary schools: study protocol for a multi-school, cluster randomised controlled trial (INSPIRE)

BACKGROUND

There are increasing rates of internalising difficulties, particularly anxiety and depression, being reported in children and young people in England. School-based, universal prevention programmes are thought to be one way of helping tackle such difficulties. This protocol describes a four-arm cluster randomised controlled trial, investigating the effectiveness of three different interventions when compared to usual provision, in English primary and secondary pupils. The primary outcome for Mindfulness and Relaxation interventions is a measure of internalising difficulties, while Strategies for Safety and Wellbeing will be examined in relation to intended help-seeking. In addition to the effectiveness analysis, a process and implementation evaluation and a cost-effectiveness evaluation will be undertaken.

METHODS AND ANALYSIS

Overall, 160 primary schools and 64 secondary schools will be recruited across England. This corresponds to 17,600 participants. Measures will be collected online at baseline, 3-6 months later, and 9-12 months after the commencement of the intervention. An economic evaluation will assess the cost-effectiveness of the interventions. Moreover, a process and implementation evaluation (including a qualitative research component) will explore several aspects of implementation (fidelity, quality, dosage, reach, participant responsiveness, adaptations), social validity (acceptability, appropriateness and feasibility), and their moderating effects on the outcomes of interest, and perceived impact.

DISCUSSION

This trial aims to address important questions about whether schools' practices around the promotion of mental wellbeing and the prevention of mental health problems can: (1) be formalised into feasible and effective models of school-based support and (2) whether these practices and their effects can be sustained over time. Given the focus of these interventions on mirroring popular practice in schools and on prioritising approaches that present low-burden, high-acceptability to schools, if proved effective, and cost-effective, the findings will indicate models that are not only empirically tested but also offer high potential for widespread use and, therefore, potentially widespread benefits beyond the life of the trial.

TRIAL REGISTRATION

ISRCTN16386254. Registered on 30 August 2018.

School-based intervention study examining approaches for well-being and mental health literacy of pupils in Year 9 in England: study protocol for a multischool, parallel group cluster randomised controlled trial (AWARE)

INTRODUCTION

The prevalence of emotional difficulties in young people is increasing. This upward trend is largely accounted for by escalating symptoms of anxiety and depression. As part of a public health response, there is increasing emphasis on universal prevention programmes delivered in school settings. This protocol describes a three-arm, parallel group cluster randomised controlled trial, investigating the effectiveness and cost-effectiveness of two interventions, alongside a process and implementation evaluation, to improve mental health and well-being of Year 9 pupils in English secondary schools.

METHOD

A three-arm, parallel group cluster randomised controlled trial comparing two different interventions, the Youth Aware of Mental Health (YAM) or the Mental Health and High School Curriculum Guide (The Guide), to Usual Provision. Overall, 144 secondary schools in England will be recruited, involving 8600 Year 9 pupils. The primary outcome for YAM is depressive symptoms, and for The Guide it is intended help-seeking. These will be measured at baseline, 3-6 months and 9-12 months after the intervention commenced. Secondary outcomes measured concurrently include changes to: positive well-being, behavioural difficulties, support from school staff, stigma-related knowledge, attitudes and behaviours, and mental health first aid. An economic evaluation will assess the cost-effectiveness of the interventions, and a process and implementation evaluation (including a qualitative research component) will explore several aspects of implementation (fidelity, quality, dosage, reach, participant responsiveness, adaptations), social validity (acceptability, feasibility, utility), and their moderating effects on the outcomes of interest, and perceived impact.

ETHICS AND DISSEMINATION

This trial has been approved by the University College London Research Ethics Committee. Findings will be published in a report to the Department for Education, in peer-reviewed journals and at conferences.

TRIAL REGISTRATION NUMBER

ISRCTN17631228.

PROTOCOL

V1 3 January 2019. Substantial changes to the protocol will be communicated to the trials manager to relevant parties (eg, ISRCTN).

Resilience Factors Important in Health-Related Quality of Life of Subjects With COPD

BACKGROUND

Common among patients with COPD is declining health-related quality of life (HRQOL). Although results of research identified some factors associated with HRQOL, resilience factors are yet to be fully investigated.

METHODS

This study examined resilience and demographic factors associated with HRQOL. Participants >40 y old were recruited from community health programs and hospitals in South East Queensland. Self-administered questionnaires were used to query subjects' HRQOL and levels of resilience. A decision tree examined the factors important to HRQOL in 159 subjects with COPD.

RESULTS

Factors of importance in the HRQOL of subjects with COPD were found in 3 domains of the St George Respiratory Questionnaire. Of importance on the breathlessness domain was marital status, defensive coping, coping, number of comorbidities, relationships, decision-making, self-esteem, self-efficacy, and professional support of health and well-being. Of the symptoms domain, self-efficacy, recruitment location, anxiety/depression, decision-making, self-esteem, coping, relationships, professional support of health and well-being, and risks were important. The cough domain found recruitment location, anxiety/depression, professional support of health and well-being, coping, and defensive coping to be important for subjects' HRQOL.

CONCLUSIONS

Resilience and confounding factors were of importance in the HRQOL of subjects with COPD. Thus, consultation with a medical professional, especially at discharge, who identifies, encourages, and approves of the patient's disease management abilities will enhance both resilience and HRQOL.

Convergent and divergent validity of the Connor-Davidson Resilience Scale in children with concussion and orthopaedic injury

OBJECTIVE

Psychological resilience is an important predictor of outcome in concussion; however, there is no published evidence of psychometric support for use of a measure of psychological resilience in children with concussion. This study examined construct validity of the Connor-Davidson Resilience Scale (CD-RISC) in a paediatric concussion and orthopaedic injury sample.

METHODS

Seventy-five children with a history of concussion or orthopaedic injury were recruited from a children's hospital. Total sample and within-group correlations between the CD-RISC (25- and 10-item versions) and measures presumed to be related or unrelated to the construct of psychological resilience were analysed.

RESULTS

In the total sample, both versions of the CD-RISC were negatively correlated with self-reported depressive symptoms and general behaviour problems. The 10-item version was also negatively correlated with parent-reported general behaviour problems and self-reported anxiety, and was positively correlated with self-reported quality of life. The injury groups did not exhibit significantly different correlations.

CONCLUSIONS

The construct validity of the CD-RISC is satisfactory when used with children with concussion. The 10-item version may provide a more efficient measure of resiliency with better construct validity in this population.

Building resilience in virtual and physical networked operations

As society becomes increasingly networked, both physically and virtually, so do human operations. This change exposes a unique subset of challenges and risks associated with the intersection of systems and the potential for cascading failure. Yet existing risk and resilience dependency models fail to accommodate these complexities, potentially exposing the capabilities that infrastructure systems enable to catastrophic failure. This paper builds on operational resilience (OR) theory, to develop a theoretical framework for developing resilience in physical and virtual networks, the networked OR framework. The authors argue that risk tolerance and resilience is developed through the concept of a projected tableau which is well situated in the broader network context. An overview of resilience, networks and OR is provided, with an explanation of the networked OR concept, a revised framework for developing resilience in networks and application to an emergency services network.

The student resilience survey: psychometric validation and associations with mental health

BACKGROUND

Policies, designed to promote resilience, and research, to understand the determinants and correlates of resilience, require reliable and valid measures to ensure data quality. The student resilience survey (SRS) covers a range of external supports and internal characteristics which can potentially be viewed as protective factors and can be crucial in exploring the mechanisms between protective factors and risk factors, and to design intervention and prevention strategies. This study examines the validity of the SRS.

METHODS

7663 children (aged 11-15 years) from 12 local areas across England completed the SRS, and questionnaires regarding mental and physical health. Psychometric properties of 10 subscales of the SRS (family connection, school connection, community connection, participation in home and school life, participation in community life, peer support, self-esteem, empathy, problem solving, and goals and aspirations) were investigated by confirmatory factor analysis (CFA), differential item functioning (DIF), differential test functioning (DTF), Cronbach's α and McDonald's ω. The associations between the SRS scales, mental and physical health outcomes were examined.

RESULTS

The results supported the construct validity of the 10 factors of the scale and provided evidence for acceptable reliability of all the subscales. Our DIF analysis indicated differences between boys and girls, between primary and secondary school children, between children with or without special educational needs (SEN) and between children with or without English as an additional language (EAL) in terms of how they answered the peer support subscale of the SRS. Analyses did not indicate any DIF based on free school meals (FSM) eligibility. All subscales, except the peer support subscale, showed small DTF whereas the peer support subscale showed moderate DTF. Correlations showed that all the student resilience subscales were negatively associated with mental health difficulties, global subjective distress and impact on health. Random effects linear regression models showed that family connection, self-esteem, problem solving and peer support were negatively associated with all the mental health outcomes.

CONCLUSIONS

The findings suggest that the SRS is a valid measure assessing these relevant protective factors, thereby serving as a valuable tool in resilience and mental health research.

Development of a resilience scale for Thai substance-dependent women: A mixed methods approach

The purpose of this study was to develop a resilience scale based on the experiences of substance-dependent women in Thailand and evaluate its validity and reliability. A sequential exploratory mixed methods design was employed as the main methodology to develop the resilience scale according to the results from qualitative data by analyzing focus group discussions of 13 participants. Then, the scale was administered to 252 substance-dependent women from four substance-treatment centers. The psychometric properties were explored with an index of item objective congruence (IOC), Pearson correlation, second-order confirmatory factor analysis and Cronbach's alpha coefficient to estimate the quantitative data. The qualitative results showed that resilience is defined by three themes: individual, family and community factors, consisted of 13 different categories. The quantitative results also revealed that all 71 items in the resilience scale passed the IOC criteria, convergence and construct validity. The goodness-of-fit indices demonstrated that the resilience model was consistent with the empirical data. (Chi-square=74.28, df=59, p-value=0.08, RMSEA=0.03, SRMR=0.04, NNFI=0.99, CFI=0.99, GFI=0.96). The internal consistency, assessed by a Cronbach's alpha score of 0.92, can be interpreted as demonstrating high reliability. Furthermore, the structure of the resilience scale was confirmed by the available resilience literature. This study can help clinicians gain a more comprehensive understanding regarding the complex process of resilience among substance-dependent women and aid them in providing these women with the appropriate interventions.

Food practices and school connectedness: a whole-school approach

Purpose

– The health-promoting schools (HPSs) framework has emerged as a promising model for promoting school connectedness in the school setting. The purpose of this paper is to explore the potential for food practices to promote school connectedness within a HPSs framework.

Design/methodology/approach

– This study explores food practices within a New Zealand secondary school by using an ethnographic methodology, with interviews and observations, to explore in-depth the range of food practices that occurred within the school across a whole school year. Thematically the data were ready for school connectedness indicators across the recorded events, and categorically the practices were coded according to their level of occurrence within the HPS framework.

Findings

– The findings showed that food practices occurred across class- and school-level organisation, ethos, environment, and community partnerships, and indicated that they may be valuable assets for a HPS approach to school connectedness. By integrating the findings of the present study with previous literature the authors suggest a HPS framework for promoting school connectedness through food practices.

Originality/value

– This paper contributes to the emerging research on whole-school approaches to building school connectedness, and provides a first contribution on the value of food practices for school connectedness.

Resiliência e Justiça Organizacional como Antecedentes da Percepção de Desenvolvimento Profissional

RESUMO O mercado competitivo da atualidade tem exigido mais qualificação dos trabalhadores, o que aumenta a relevância do construto desenvolvimento profissional. O objetivo deste estudo foi testar um modelo de predição da percepção do desenvolvimento profissional. Participaram da pesquisa 320 trabalhadores de diferentes categorias profissionais de organizações públicas e privadas. O questionário continha três escalas, todas com bons indicadores psicométricos. Os resultados apontados a partir da regressão múltipla confirmaram que percepção de justiça organizacional e resiliência predizem positivamente a percepção de desenvolvimento profissional, sendo que esta demonstra maior poder preditivo. Os resultados foram discutidos de acordo com a teoria do desenvolvimento profissional.

An in-depth psychometric analysis of the Connor-Davidson Resilience Scale: calibration with Rasch-Andrich model

Background

The Connor-Davidson Resilience Scale (CD-RISC) is inarguably one of the best-known instruments in the field of resilience assessment. However, the criteria for the psychometric quality of the instrument were based only on classical test theory.

Method

The aim of this paper has focused on the calibration of the CD-RISC with a nonclinical sample of 444 adults using the Rasch-Andrich Rating Scale Model, in order to clarify its structure and analyze its psychometric properties at the level of item.

Results

Two items showed misfit to the model and were eliminated. The remaining 22 items form basically a unidimensional scale. The CD-RISC has good psychometric properties. The fit of both the items and the persons to the Rasch model was good, and the response categories were functioning properly. Two of the items showed differential item functioning.

Conclusions

The CD-RISC has an obvious ceiling effect, which suggests to include more difficult items in future versions of the scale.

Measuring resilience after spinal cord injury: Development, validation and psychometric characteristics of the SCI-QOL Resilience item bank and short form

OBJECTIVE

To describe the development and psychometric properties of the Spinal Cord Injury--Quality of Life (SCI-QOL) Resilience item bank and short form.

DESIGN

Using a mixed-methods design, we developed and tested a resilience item bank through the use of focus groups with individuals with SCI and clinicians with expertise in SCI, cognitive interviews, and item-response theory based analytic approaches, including tests of model fit and differential item functioning (DIF).

SETTING

We tested a 32-item pool at several medical institutions across the United States, including the University of Michigan, Kessler Foundation, the Rehabilitation Institute of Chicago, the University of Washington, Craig Hospital and the James J. Peters/Bronx Department of Veterans Affairs medical center.

PARTICIPANTS

A total of 717 individuals with SCI completed the Resilience items.

RESULTS

A unidimensional model was observed (CFI=0.968; RMSEA=0.074) and measurement precision was good (theta range between -3.1 and 0.9). Ten items were flagged for DIF, however, after examination of effect sizes we found this to be negligible with little practical impact on score estimates. The final calibrated item bank resulted in 21 retained items.

CONCLUSION

This study indicates that the SCI-QOL Resilience item bank represents a psychometrically robust measurement tool. Short form items are also suggested and computer adaptive tests are available.

Obsessive-compulsive symptoms and personal disposition, family coherence and school environment in Chinese adolescents: a resilience approach

BACKGROUND

Risk factors of adolescents with obsessive-compulsive symptoms (OC) have been extensively examined, but protective resilience factors have not been explored, particularly in Chinese adolescents.

AIM

This study aimed to investigate the association of resilience factors with the occurrence of OC and its symptoms in Chinese adolescents.

METHOD

This study consisted of two phases. The first phase used a cross-sectional design involving a stratified clustered non-clinical sample of 3185 secondary school students. A clinical interview procedure was then employed to diagnose OC in students who had a Leyton Obsessional Inventory 'yes' score of ≥15. The second phase used a case-control study design to analyse the relationship between resilience factors and OC in a matched sample of 288 adolescents with diagnosed OC relative to 246 healthy adolescents.

RESULTS

Low personal disposition scores in self-fulfilment, flexibility and self-esteem, and low peer relation scores in the school environment were associated with a higher probability of having OC. Canonical correlation analysis indicated that OC symptoms were significantly associated with personal dispositions, poor peer relationships and maladaptive social life, but not to family coherence.

LIMITATIONS

The study is not prospective in nature, so the causal relationship between OC occurrence and resilience factors cannot be confirmed. Second, the use of self-report instruments in personal disposition, family coherence, and school environment may be a source of error.

CONCLUSIONS

Resilience factors at both the personal disposition and school environment levels are important predictors of OC symptoms and caseness. Future studies using prospective designs are needed to confirm these relationships.

Does a socio-ecological school model promote resilience in primary schools?

BACKGROUND

This research investigates the extent to which the holistic, multistrategy "health-promoting school" (HPS) model using a resilience intervention can lead to improved resilience among students.

METHODS

A quasi-experimental design using a study cohort selected from 20 primary schools in Queensland, Australia was employed. Ten intervention schools using HPS protocols, with training support, were compared with 10 control schools in student resilience scores and protective factors. Baseline data explored the interactive effect of protective factors on overall resilience scores. Postintervention analysis compared changes in protective factors and resilience, after implementing the HPS project.

RESULTS

Baseline data analysis indicated no significant differences in the mean scores of protective factors and resilience scores between intervention and control groups (except for school connection). After 18 months of implementation, a resurvey showed that the intervention group had significantly higher scores than the control group on students' family connection, community connection, peer support, and their overall resilience.

CONCLUSIONS

Results showed that students in the HPS group had significantly higher scores on resilience than did students in the control group. A comprehensive, whole-school approach to building resilience that integrates students, staff, and community can strengthen important protective factors and build student resilience.

Reliability and validity of a scale for health-promoting schools

Despite a growing body of research regarding the health-promoting schools (HPS) concept from the World Health Organization (WHO), research on measuring of the HPS is limited. This study aims to develop a scale for assessing the status of the HPS based on the WHO guidelines and to evaluate the reliability and validity of the scale. After completing the translation and back-translation process, the content validity of the 50-item scale for HPS (SHPS) was assessed by an expert committee review and pretested with 17 teachers. A stratified, random sampling design was used. A total of 728 teachers from 94 schools completed a self-administered questionnaire. The total sample was randomly divided into three groups for exploratory factor analysis (EFA), confirmatory factor analysis (CFA) and cross-validation. The EFA suggested seven factors, including 37 items, and the CFA confirmed these factors. In a second-order factor analysis, the second-order seven-factor model had acceptable fit indices (root mean square error of approximation 0.07, comparative fit index 0.98) with stability over validation sample and whole sample. Thus, the first-order seven factors (school nutrition services [three-item, α = 0.87], healthy school policies [six-item, α = 0.87], school's physical environment [10-item, α = 0.91], school's social environment [four-item, α = 0.88], community links [six-item, α = 0.91], individual health skills and action competencies [three-item, α = 0.89], and health services [five-item, α = 0.86]) loaded significantly onto the second-order factor (HPS [37-item, α = 0.97]). In conclusion, the SHPS is a reliable and valid measurement tool for assessing the states of the HPS in the Korean school context. It will be useful for comprehensively assessing schools' needs and monitoring the progress of school health interventions.

Resilience after maltreatment: the importance of social services as facilitators of positive adaptation

This practice note will show that resilience among children who have been maltreated is the result of multiple protective factors, including the quality of the services provided to children exposed to chronic adversity. This social ecological perspective of resilience suggests that resilience is a process resulting from interactions between individuals and their environments, and depends upon individual characteristics (temperament and personality), the social determinants of health that affect children and children's families, formal interventions by multiple service providers (child welfare, special education, mental health, addictions, public health, and juvenile corrections), and the social policies that influence service provision to vulnerable populations. Clinicians and researchers concerned with the resilience of chronically abused and neglected children have tended to overlook the protective processes unique to children who have been abused that are different from the protective processes that promote positive development among children who have experienced no maltreatment. Most importantly, studies of resilience among maltreated children have rarely investigated the impact child welfare interventions have on the resilience of children who have been maltreated, mistakenly attributing children's abilities to cope to be the result of individual factors rather than the responsiveness of service providers and governments to tailor interventions to children's needs. To enhance the likelihood of resilience among maltreated children, those who design and implement interventions need to address three aspects of resilience-related programming: make social supports and formal services more available and accessibility; design programs flexibly so that they can respond to the differential impact specific types of interventions have on children who are exposed to different forms of maltreatment; and design interventions to be more focused on subpopulations of children who have experienced maltreatment rather than diffuse population-wide initiatives.

Resilience as a positive youth development construct: a conceptual review

The concept of resilience is reviewed from a range of disciplinary perspectives in this paper. Both broad and narrow definitions of resilience are highlighted and a working definition of resilience is proposed to inform research, policy and practice. Different psychological, social and ecological protective factors, particularly competence, optimism, and bonding to family and cultural beliefs are highlighted. Theoretical relationships between resilience and positive youth development are examined with an attempt to erase misunderstandings. Finally, how schools can promote resilience among students is discussed.

A school-based resilience intervention to decrease tobacco, alcohol and marijuana use in high school students

Background

Despite schools theoretically being an ideal setting for accessing adolescents and preventing initiation of substance use, there is limited evidence of effective interventions in this setting. Resilience theory provides one approach to achieving such an outcome through improving adolescent mental well-being and resilience. A study was undertaken to examine the potential effectiveness of such an intervention approach in improving adolescent resilience and protective factor scores; and reducing the prevalence of adolescent tobacco, alcohol and marijuana use in three high schools.

Methods

A non-controlled before and after study was undertaken. Data regarding student resilience and protective factors, and measures of tobacco, alcohol and marijuana use were collected from grade 7 to 10 students at baseline (n = 1449) and one year following a three year intervention (n = 1205).

Results

Significantly higher resilience and protective factors scores, and significantly lower prevalence of substance use were evident at follow up.

Conclusions

The results suggest that the intervention has the potential to increase resilience and protective factors, and to decrease the use of tobacco, alcohol and marijuana by adolescents. Further more rigorous research is required to confirm this potential.

The salutogenic approach to the making of HiAP/healthy public policy: illustrated by a case study

Twenty years have passed since the central document of health promotion, the Ottawa Charter, was constituted. Health was seen as the process enabling individuals and communities to increase control over their determinants of health, thereby improving their health and enabling an active and productive life, that is, a good quality of life. One main strategy was the making of a healthy public policy. At the same time Aaron Antonovsky developed the salutogenic theory and its core concepts the sense of coherence and the generalized resistance resources. This paper integrates Antonovsky's salutogenic theory and a salutogenic model of quality of life into the core principles of the Ottawa Charter and exemplifies how to make healthy public policy the salutogenic way. A process-oriented coherent health promotion research model integrating an ecological, a salutogenic and a resilient approach is shown. The objective of this theoretical model is to bring together the whole spectrum of risk factors, protective factors and promotion factors in one model. Further, individual, group and society level are considered. The model suggested aims to contribute to the creation of sense of coherence. This is exemplified in practice in a case study of a Nation, that is, on a national level. The case study of the “Nation” is partly masked. The principles behind these processes are explained in detail while the case study of the “Nation” only includes parts of the process explaining some core issues. The overall aim of this paper is to stimulate health promotion activities along the lines presented and invite the readers to comment and continue the discussion. (Global Health Promotion, 2009; 16 (1): pp. 17—28)