Graduate School of Applied and Professional Psychology

Center of Alcohol and Substance Use Studies

Discussant – Denise Hien, Ph.D., ABPP

Trauma and Resilience in Youth: The Clinicians Role

Lorraine Y. Howard, LCSW, LCADCDirector of Addiction Education

Center of Alcohol & Substance Use StudiesGraduate School of Applied & Professional Psychology

We often hear how resilient youth are; but what does this concept of “resilience” mean to the clinician who may be seeing the youth?

What is resilience?

Mainly, broadly defined as “the process of, capacity for, or outcome of successful adaptation despite challenging and threatening circumstances” (Masten, Best,& Garmezy, 1990, pg. 426

“an innate trait of a person” 

Currently, there are multiple concepts of resilience. 

What is resilience? 

Studies suggest that the definition of resilience is more complex 

Multiple conceptualizations of resilienceTrait Immediate outcome Process

Definition: stable innate trait

• Specialized ability • Moderates therapy• Cultural and 

environmental factors not considered

Definition: absence of symptoms and/orpresence of adaptive functioning  following trauma beforeintervention or treatment

• Protective factor• Select youth have 

“immunity” against adversity

Definition: dynamic process

• Potential for change• Resilience can be 

acquired• Recover from  

maladaptive  responses to trauma

Why Important for Clinicians?

• Have an effect on how clinicians’ see their role in assessing and treating youth with trauma.

• Less is known about how resilience influences and is influenced by mental health treatment. 

• Evidence that treatment can develop resilience; which results in better outcomes. 

• Resilience increase with treatment • Decline in trauma related symptoms

• Important goal for clinicians to know how to                                       best help youth with trauma

Multi‐system Model of Resilience (MSMR)

“Aims to capture the complexity of resilience as construct rests on the belief that resilience should not exist withina vacuum; rather, it is an interactive process between trauma and intra‐individual, inter‐individual, and socio‐ecological factors.”

MSMR

Core (Intra) ResilienceTrait‐like (elements are also 

dynamic throughout one's life). 

Internal ResilienceNot trait like (factors that can be fostered, developed, or acquired over time from inter‐personal 

sources, such as family, friends, and personal experiences and 

encounters). 

External ResilienceSocio‐ecological factors that 

facilitate resilience throughout one’s lifetime. Elements within this system can include access to health 

care, social services ad other resources that interact with an 

individual. 

Important!

“It is difficult to disentangle the aversive events that promote resilience from circumstances that facilitate adversity, such as low socio‐

economic status, or identification with a marginalized racial ethnic group.” (Liu, Reed, & Girard, 2017)

Clinical implications

• Clinicians have an opportunity to promote symptom reduction youth with trauma through fostering resilience 

• Understanding that resilience is multifaceted and modifiable is an essential concept for clinicians. (Happer, Brown, & Sharma‐Patel, 2017 & Liu, Reed, & Girard, 2017).

• Assessment: include measures of resiliency (don’t rely solely on symptoms)• Intra, internal & external resilience

• Re‐assess resilience and symptoms at various stages of the therapeutic process• monitor increase of resilience and symptom reduction. This would allow for identification of components that are particularly effective for a given client.

• Assesses effectiveness via direct measurement of resilience. • No gold standard assessment (Use what makes most sense for your youth/family)

Example: Julia (Liu, Reed, & Girard, 2017)

Evidence‐based Intervention (DuMont, Spatz‐Widom, & Czaja, 2007; Peltonen, Qouta, 

Diab, & Punamaki, 2014 

• Cognitive‐behavioral therapy (CBT) approach can activate and build resilience. Coping skills, which are central in CBT, may be an important mechanism through which treatment affects resilience 

• CBT also addresses social skills and support, which have been associated with higher levels of resilience 

Trauma Focused (TF‐CBT) (Cohen, Mannarino, & Deblinger, 2012)

• Empirically supported treatment for youth with trauma. • Studies have demonstrated that resilience can increase during TF‐CBT• Components associated with resilience (targets of TF‐CBT)

• including coping skills,• problem‐solving • meaning‐making • social support, 

• Resiliency increases significantly• Examining the relation between trauma‐ specific CBT and resilience is a necessary next step to advance the field. 

How They See Me: Fostering Resilience in Youth through Cultural Humility

Natalie Moore‐Bembry, Ed.D, MSW, LSWRutgers, The State University of New Jersey

Adverse Childhood Experiences (Child Trends, 2019)• Economic Hardship

• Divorce/separation of a parent

• Death of a parent

• A parent served time in jail

• Witness to adult domestic violence

• Victim of or witness to neighborhood violence

• Living with someone who was mentally ill or suicidal

• Living with someone who had an alcohol or drug problem

• Being treated or judge unfairly due to race/ethnicity

This Photo by Unknown author is licensed under CC BY‐NC.

ACEs in the US

• (Child Trends, 2019)

Stages of Change (Prochaska and DiClemente, 1983)

Relapse

Contemplation

Determination

Action

Maintenance

Precontemplation

Cultural Humility (Foronda, Baptiste, Reinholdt & Ousman, 2015; Hook, 2014; Hook & Watkins, 2015; 

Isaacson, 2014; Ortega & Faller, 2011; Yeager & Bauer‐Wu, 2013)

• Individual and institutional accountability 

• Self‐awareness 

• Openness 

• Transcendence 

This Photo by Unknown author is licensed under CC BY.

This Photo by Unknown author is licensed under CC BY‐NC‐ND.

Contact Information

Natalie Moore‐Bembrynmbembry@ssw.rutgers.edu

848‐932‐7520 x. 3@DrNatalieBembry

Neveah Counseling and Consulting, LLC

References

Child Trends. (2019). Adverse experiences. Retrieved from: https://www.childtrends.org/?indicators=adverse‐experiences.

Child Trends. (2019). Percentage of children with 2 or more ACEs. Retrieved from https://www.childtrends.org/publications/prevalence‐adverse‐childhood‐experiences‐nationally‐state‐race‐ethnicity.

Foronda, C., Baptiste, D. L., Reinholdt, M. M., & Ousman, K. (2016). Cultural humility: A concept analysis. Journal of Transcultural Nursing, 27(3), 210‐217. 

Hook, J. N. (2014). Engaging clients with cultural humility. Journal of Psychology and Christianity, 33(3), 277‐280. 

Hook, J. N., & Watkins, C. (2015). Cultural humility: The cornerstone of positive contact with culturally different individuals and group. American Psychologist, 70(7), 661‐662. 

References cont..

Isaacson, M. (2014). Clarifying concepts: Cultural humility or competency. Journal of Professional Nursing, 30(3), 251‐258.  

Ortega, R. M., & Coulborn Faller, K. (2011). Training child welfare workers from an intersectional cultural humility perspective: A paradigm shift. Child Welfare, 90(5), 27‐49.  

Prochaska, J., & DiClemente, C. (1983). Stages and processes of self‐change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51(3), 390‐395.

Yeager, K.A., & Bauer‐Wu, S. (2013). Cultural humility: Essential foundation for clinical researchers. Applied Nursing Research, 26(4), 251‐256.

Exercise: Promoting Resilience in YouthMark Louie

Relevance

YOUTH FACE TRAUMA AND ARE AT RISK

WIDE VARIETY OF RISK OUTCOMES

EXERCISE CAN HELP AS ADJUNCT THERAPY

Resilience

PREVENT REDUCE

Exercise Fosters

Protective Factors Attributes that help prevent and reduce the

negative emotional effects of a traumatic experience

Positive AdaptationEncourages flexibility to adapt to changing

demands both metal and physical

Protective Factors

Social Support Self-esteem Mastery

Cognitive Flexibility Health Mood

Literature

TRAINING EXERCISE PARTICIPATION CAN INCREASE

RESILIENCE

3 OBSERVATIONAL STUDIES REPORTED A POSITIVE

ASSOCIATION

Mechanisms

Effective at increasing mood and self-esteem

Improvements in cognition and confidence

Positive effects on physical strength, endurance, and make-up

Increased feelings of control and autonomy

Two Pathways

Mastery: Affect is improved after completing an effortful task; promotes changes in self-efficacyGives a sense of greater self-worth and personal control

Self-Concept: Self-evaluations of personal attributes.Engagement in physical activity promotes engagementChange in brain chemistry and exposure therapy theory.

Clinical Considerations

Consider Physical Activity as an adjunct therapy that can further promote resilience

Use of Sports, exercise gyms, zumba, yoga, and dance

promote movement

Exercising is associated with improved health behavior

such as sleep and diet

Finding and improving resilience in sports can

translate to increases in global resilience

Future Research

Association between exercise and resilience in youth

Continued clarity on mechanisms

Future longitudinal work needed

Resources • "Building Resilience in Children and Youth Dealing with Trauma," Substance Abuse and Mental Health Services Administration, U.S.

Department of Health and Human Services (http://www.samhsa.gov/children/trauma_resilience.asp)• Bell, C.C. & Jenkins E.J. (1993). "Community Violence and Children on Chicago's Southside." Psychiatry, 56 (1): 46-54.• Centers for Disease Control and Prevention (2016). Web-based injury statistics query and reporting system (WISQARS) National Center

for Injury Prevention and Control. • Finkelhor D., Turner H. A., Shattuk, A., & Hamby, S. L. (2015). Prevalence of childhood exposure to violence, crime, and abuse: Results

from the National Survey of Children’s Exposure to Violence. JAMA Pediatrics, 169, 746–754. • Finkelhor, David; Turner, Heather; Ormrod, Richard; Hamby, Sherry; Kracke, Kristen (October 2009). "Children's Exposure to Violence, a

Comprehensive National Survey." Office of Justice Programs Juvenile Justice Bulletin. (https://www.ncjrs.gov/pdffiles1/ojjdp/227744.pdf)• Hills, S. D., Anda, R. F., Dube, S., Felitti, V. J., Marchbanks, P. A., & Marks, J. S. (2004). The association between adverse childhood

experiences and adolescent pregnancy, long-term psychosocial consequences, and fetal death. Pediatrics, 113, 320-327. • JAMA Pediatrics, May 2013 (http://www.unh.edu/ccrc/pdf/05-13%20PED%20childhood%20exposure%20to%20violence.pdf)• Kilpatrick DG, Saunders BE. (1997). "Prevalence and Consequences of Child Victimization: Results from the National Survey of

Adolescents." National Crime Victims Research and Treatment Center, Medical University of South Carolina• Miller, A. B., Esposito-Smythers, C., Weismoore, J. T., & Renshaw, K. D. (2013). The relation between child maltreatment and adolescent

suicidal behavior: A systematic review and critical examination of the literature. Clinical Child and Family Psychology Review, 16(2), 146-172.

• National Center for Mental Health Promotion and Youth Violence Prevention, "Childhood Trauma and Its Effect on Healthy Development," July 2012

• Sacks, V., & Murphey, D. (2018). The prevalence of adverse childhood experiences nationally, by state, and by race/ethnicity. Child Trends Publication #2018-03. From https://www.childtrends.org/publications/prevalence-adverse- childhood-experiences-nationally-state-race-ethnicity/

• Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services (http://www.samhsa.gov/children/social_media_apr2011.asp)

• Substance Abuse and Mental Health Services Administration. (2014). SAMHSA’s concept of trauma and guidance for a trauma-informed approach (p. 9). HHS Publication No. (SMA) 14-4884. Rockville,

Thank You