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Title: Factors associated with resilience after paediatric injury : working towards a systemic model of resilience
Author: Washington, F.
ISNI:       0000 0004 7658 5447
Awarding Body: University of Liverpool
Current Institution: University of Liverpool
Date of Award: 2018
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The overall aim of the current thesis was to improve understanding of what factors can help to support children and adolescents who have experienced severe physical trauma. Non-fatal injuries affect up to 30 million young people worldwide each year (World Health Organisation [WHO], 2005). Significant proportions of young people who have to attend Accident and Emergency (A&E) departments as a result of major injury are left with ongoing disabilities (WHO, 2008), which impact on their own and their families' physical, psychological, and social functioning and well-being. Despite these experiences, a number of young people 'bounce back' from such adversity (Le Brocque, Hendrikz, & Kenardy, 2010a, 2010b; Quezada, González, & Mecott, 2016; Windle, 2011). In recent decades, research surrounding physical injury and disability has changed from a problem-focused emphasis to one of positive psychology and the 'bouncing back' from such trauma and adversity; a notion referred to as resilience (Masten, 2007; Windle, 2011; Rosenberg & Yi-Frazier, 2016). This shift in perspective has also been reflected in wider societal discourses, with mainstream and social media progressively reporting stories of resilience following injury. Government policies and agendas are also promoting resilience specifically as key to supporting the well-being of young people (Challen, Noden, West, & Machin 2011). To the author's best knowledge, the factors associated with resilience in physical health samples have only been reviewed in adult injury populations or for children and young people with chronic illnesses or conditions. To date, there has not been a review examining resilience following paediatric injury. In order to address this, Chapter 1 of the current thesis outlines a systematic review of studies investigating the factors associated with resilience in children and adolescents following physical trauma. The review revealed a general paucity of research exploring resilience in this population. The findings demonstrated a lack of consistent evidence for a relationship between a range of demographic and injury-related variables and young person resilience, but revealed a negative relationship between psychological difficulties and resilience. Notably, the review also highlighted the conceptual ambiguity that is apparent across the wider resilience literature (Zolkoski & Bullock, 2012), with a lack of consistency within which resilience was measured and conceptualised. Despite evidence implicating systemic variables (e.g., family, peers) in resilience in paediatric illness and adult injury samples, these factors were not consistently explored in the studies included in the review. In summary, the review revealed gaps in the literature which related to the use of validated, resilience-specific tools that assess resilience on a continuum (Cosco et al., 2017), the need for multivariate analyses to control for confounding variables, and the systematic investigation of systemic variables that are prominent in other paediatric resilience studies. The need to ensure clarity in the conceptualisation of resilience within research was also highlighted (Rosenberg & Yi-Frazier, 2016). In order to address some of the limitations documented within the review, Chapter 2 details an empirical study that examined demographic, injury-related, family, and social support variables in relation to resilience in young people who had experienced major physical trauma. The study utilised a validated, resilience-specific measure (ConnorDavidson Resilience Scale [CD-RISC]; Connor & Davidson, 2003) to assess self-reported resilience on a continuum in young people who had attended one of two Major Trauma Centres (MTCs) in the UK. It ran a multiple regression analysis to test the ability of social support factors (The Child and Adolescent Social Support Scale [CASSS]; Malecki, Demaray, & Elliott, 2000, 2014) to predict levels of resilience above and beyond the influence of family environment variables (The Family Relationship Index [FRI]; Holahan & Moos, 1982; Moos & Moos, 2002, 2009), whilst controlling for the effects of associated demographic and injury factors. The need for further prospective research and clarity when defining and studying resilience is discussed. Clinical implications regarding the focus of assessment, support and intervention to foster resilience are presented.
Supervisor: Van Vuuren, Julie ; Gray, Victoria ; Gillespie, Steven Sponsor: Not available
Qualification Name: Thesis (D.Clin.Psy.) Qualification Level: Doctoral