Changes in resilience in children in the welfare system
Today, I am presenting summary information from a longer article than usual because I think the topic is extremely important. Yoon et al. (2023) published “Can Resilience Change Over Time? Patterns and transitions in resilience among young children involved with the child welfare system” in Child Development. This is a highly edited summary:
This study examined transitions in resilience profiles and the role of caregiver risk and protective factors in resilience transition probabilities over 18 months among children involved with the child welfare system, using latent profile analysis and latent transition analysis. The sample included 486 children (48% female, baseline Mage = 3.49). There were three resilience profiles at Time 1 (19.9% low emotional behavioral, 26.1% low cognitive, 54.0% multidomain) and two profiles at Time 2 (18.9% low emotional behavioral, 81.1% multidomain).
Breaking the common narrative that children who experience maltreatment during childhood are predetermined to have negative outcomes, resilience scientists have provided empirical evidence of resilience among children with maltreatment histories (Dubowitz et al., 2016; Wekerle, 2013). Although there is no universal definition of resilience, resilience is commonly understood as the dynamic process and mechanisms associated with positive adaptation following exposure to adversity (Luthar et al., 2000). Each year, approximately 4 million referrals are made to U.S. child protective services agencies for alleged child abuse and neglect, and more than 600,000 children are found to be victims of maltreatment after investigation. Children and families involved with the child welfare system often have a constellation of risk factors and challenges, such as caregiver mental health problems, substance use, and poverty (Austin et al., 2020), and entry into the child welfare system can add another layer of burden and trauma (e.g., removal from home and placement in out-of-home care) to already vulnerable children. Young children are at the highest risk of experiencing child maltreatment. The rate of maltreatment victimization generally declines with a child's age, making young children more vulnerable to maltreatment than older children.
In the current study, we conceptualized resilience as the outcome or process of positive adaptation in the domains of emotional, behavioral, social, and cognitive functioning despite exposure to early adversity (e.g., child maltreatment and involvement with the child welfare system). The resilience theoretical framework adopts a strengths-based lens to understand the protective factors, processes, and pathways through which individuals achieve adaptive functioning in the face of adversity. The resilience portfolio model (RPM) is one such strengths-based framework. The RPM posits that resilience is a process rather than a fixed feature and that resilience is shaped by multi-level socio-ecological systems (e.g., individual, family, community) and strengths (e.g., self-regulation, interpersonal strengths, meaning-making) that support individuals' positive development (Grych et al., 2015). Building on this theoretical approach, children who have experienced child maltreatment may obtain positive adaptation and resilience, which may manifest in different forms and patterns at different time periods, depending on the protective factors and strengths in which children are embedded.
The resilience literature has generally supported the tenets of attachment theory by highlighting the importance of positive parenting and close caregiver-child relationships in the development of resilience among children exposed to early adversity (Masten & Palmer, 2019). Although families involved with the child welfare system due to child abuse and neglect may experience various co-occurring challenges, such as parental mental health and substance use problems, in many cases they also possess unique strengths that contribute to the development of resilience in children (Davidson et al., 2019). Caregivers' warm and responsive care may foster positive caregiver-child relationships upon which children build resilience. In the maltreatment literature, caregiver warmth has been positively associated with resilience following child maltreatment.
Caregiver cognitive stimulation refers to caregivers' efforts to provide their children with opportunities, activities, or experiences that promote learning and perceptual, cognitive, and language development. Prior studies have suggested that the female gender is associated with greater resilience following child maltreatment.
In terms of stability, we found that the overall structure of the profile stayed relatively similar over the 18-month study period, given that the low emotional behavioral resilience profile and the multidomain resilience profile were observed at both time points. One notable difference in resilience profiles at the two time points was that the low cognitive resilience profile, which contained a little over one-quarter of the children (26.1%) at Time 1, disappeared at Time 2. It should be noted that we primarily used measures of language development as indicators of cognitive resilience. Thus, the finding may suggest that children who show lower levels of language functioning in the preschool period (ages 3–4) generally overcome difficulties in language functioning and develop language competence by the time they enter kindergarten. Additionally, there were differences in the size and composition of profiles across the time points. A little over half of the children (54%) had the multidomain resilience profile at Time 1, but more than 80% of the children had this profile at Time 2, showing a sharp increase in the number of children displaying the optimal resilience pattern.
Specifically, approximately 64.8% of the children (the stayers) maintained the same resilience profiles over time, while the remaining 35.2% (the movers) moved into a new resilience profile group across the time points in the study.
The study results revealed that the majority of the children maintained their membership in the optimal resilience group or transitioned from a poorer resilience profile to a better resilience profile over time. About 82.9% of the children in the low cognitive resilience group at Time 1 moved into the multidomain resilience group at Time 2, with less than 20% of the children moving into the low emotional behavioral resilience group. Another promising and exciting finding was that almost 96% of the children in the multidomain resilience group at Time 1 maintained their membership in that group at Time 2, with only a handful of children (under 5%) moving into the low emotional behavioral resilience group. These findings are consistent with prior studies that found that children's resilience increases over time as they age.
Children in the low emotional behavioral resilience group at Time 1 showed a somewhat different transition trend. In contrast to about 83% of the children in the low cognitive resilience group at Time 1 who transitioned into the multidomain resilience group, only about 34% of the children in the low emotional behavioral resilience group at Time 1 moved into this desirable profile group at Time 2. That is, two-thirds (66.1%) remained in the low emotional behavioral resilience group at Time 2. These findings corroborate prior research that indicates chronic emotional and behavioral challenges, including internalizing, externalizing, and posttraumatic stress symptoms, experienced by some children who have experienced maltreatment (Godinet et al., 2014; Kim & Cicchetti, 2003). Once a child experiences emotional and behavioral difficulties, these might be particularly difficult to resolve in a relatively short period of time.
Regarding the relations between caregiver factors and resilience profiles, we found that caregiver mental health problems were associated with membership in the low emotional and behavioral resilience group and the low cognitive resilience group, compared to the multidomain resilience group at Time 1.
Another important finding was that children with higher levels of caregiver cognitive stimulation were more likely to be in the multidomain resilience group initially (at Time 1) and remain in the group over time. Essentially, having caregivers who provide a language-rich home environment and engage children in cognitively stimulating activities such as reading, storytelling, singing nursery rhymes, or playing letter and number games were found to be important in ensuring continued optimal resilient functioning for young children with a history of maltreatment. Our findings support and extend the past work that suggested the positive link between caregiver cognitive stimulation and better child outcomes. The link between caregiver cognitive stimulation and persistent multidomain resilience observed in this study is noteworthy as it suggests that the positive impact of early cognitive stimulation may go beyond enhanced cognitive abilities and extend to competence across broad and diverse aspects of resilience.
Lastly, we found that caregiver warmth may be differently associated with resilience for boys and girls. Study results suggested that caregiver warmth serves as a key protective factor for resilience for girls, although such protective effects did not seem to last or help girls transition into a more optimal resilience profile over time. Our findings are in line with prior studies that found that the positive effects of caregiver warmth were stronger for girls versus boys. It might be that girls are more likely than boys to benefit from emotional support obtained through their close relationships with warm and caring caregivers, because girls generally use social support and emotional support as their main coping strategies while boys tend to use other copings strategies, such as avoidant coping. Building on this study's preliminary evidence of gender moderation of the link between caregiver warmth and resilience, further investigation is warranted to unravel the complex associations among child gender, caregiver factors, and early childhood resilience in the context of maltreatment.
Different transition patterns of resilience profiles observed in the study provide insightful information for practice. More than half of the children in our study initially belonged to the multidomain resilience group, with many of them maintaining their membership in this group over 18 months. The findings suggest that practitioners working with children with a history of maltreatment should strive to identify and capitalize on the strengths, assets, and resources children already possess and help them maintain resilience. At the same time, about two-thirds of the children who were initially in the low emotional behavioral resilience profile remained in the same profile group over time. These findings point to the importance of identifying behavioral health service needs among young children in the child welfare system and delivering targeted, early intervention programs for those with emotional and behavioral challenges.
Finally, our findings point to the critical need for the promotion of caregiver mental health and cognitive stimulation to effectively foster resilience building among young children involved with the child welfare system. At the macro level, more funding and resources should be allocated to ensure that all children, including those who come to the attention of the child welfare system, have equitable access to quality early learning environments and opportunities. At the practice level, efforts to promote resilience in children with a history of maltreatment should not only focus on children's needs but also recognize and address the mental health needs of caregivers involved with the child welfare system. Additionally, it might be important for parenting programs targeting this population to incorporate modules that teach parents how to engage their children in cognitively stimulating activities at home, to facilitate their children's resilient development. For example, home visiting programs for high-risk families with young children could focus on helping parents create more stimulating home environments for their children. Early childhood education and care, including schools, could also play a vital role and help supplement low stimulation at home.
I love this study for several reasons. First, its strengths-based approach encourages optimism about children who may encounter the welfare system. It also provides helpful tips for examining the child’s resilience when first in care and for developing appropriate intervention strategies, especially when exhibit low emotional and behavioral resilience at the outset. Finally, it recommends specific issues to focus on in caregivers (cognitive stimulation, warmth, and absence of their own mental health problems).