lack of access to medical care or psychological services, vicarious trauma, distress, ...... seek to improve human services, the most affordable evidence-based ...... Schwartz, S. E. O., Rhodes, J. E., Liang, B., Sánchez, B., Spencer, R., Kremer, ...
PSYCHOSOCIAL WELLBEING: COMMUNITIES, FAMILIES, YOUTH & CHILDREN (0-18years) A literature review and qualitative analysis of psychosocial postdisaster adaptation considerations following the Canterbury sequence of earthquakes and aftershocks (July 2015) Prepared by Amba J. Sepie (University of Canterbury) and The Collaborative Trust for Research and Training in Youth Health and Development
EXECUTIVE SUMMARY This literature review and analysis was commissioned to focus upon postdisaster and posttraumatic-event literature, targeting children 0-18 years and their families, with a broader mandate to look at the wider psychosocial implications of living within a postdisaster environment. The objective was to capture the current status of research, in the fields of concern, in a manner that could be readily applied to children, youth, families, and the communities in which they live, following the Canterbury sequence of earthquakes and aftershocks beginning September 2010. Where possible, findings were applied to the local context. Research was conducted using a psychosocial research philosophy, which prioritised psychosocial concepts and literature that were multi-disciplinary in orientation. The subsequent literature review was generated from an extensive search of predominantly academic sources, which culminated in the creation of a database containing 2,558 international multidisciplinary sources. Search methodology, literature analysis, literature substantiation, and writing methodology were inductive and iterative, allowing in-depth consideration and cognitive processing of the key elements which were required to fulfil the mandate of this review. The research identified that a major obstacle to the success of psychosocial programmes was a poor understanding of what psychosocial actually means. Many attempts to initiate psychosocial intervention programmes around the world have failed due to poor understandings of central concepts, disorganised execution, or attempts to deliver psychosocial interventions from within, or in alliance with, agencies operating with different goals, structures, and paradigmatic assumptions. Therefore, this review, at every stage: i) clarifies the key terms of analysis regarding the psychosocial approach to postdisaster recovery or adaptation, and ii) provides clear explanation and substantiation of the theoretical and methodological differences between psychosocial and evidence-based approaches to the study and mitigation of disaster effects. Psychosocial perspectives are cross-domain and systems-based, flexible, reflexive, values-based, context-based, worldview-sensitive, person-centred (though not necessarily individualised), pedagogically and emotionally oriented, and transparent. Key concepts of psychosocial analysis were delineated and linked to postdisaster contexts. Disaster was defined as a collective locus of symbolic representations and a collective stress situation. The review found that as the disaster literature often overestimates costs to survivors in terms of effects, such as posttraumatic stress disorder (PTSD), and underestimates costs in less obvious socio-cultural and experiential domains. Researchers are increasingly moving away from traditional research models to non-experimental methods which can take account of complex social interactions and the meanings attached to disaster experiences. The most recent resiliency and psychosocial intervention literature for children, youth, their families, and their communities was evaluated, and nuanced explanations of resilience, risk, vulnerability, coping, competence, adaptation, developmental cascades, and interventions were included alongside the findings of international postdisaster resilience research. The studies reviewed were clear in evidencing a range of potentially serious postdisaster effects in a minority of susceptible individuals, however extensive analysis revealed that most postdisaster effects findings have no predictive value and are strictly context-dependent. All that can be reasonably inferred is
that any adverse event will impact upon an individual within any social group in a range of ways that are directly relative to, and may act to reinforce, a highly individualised degree of pre-existing vulnerabilities within specialised social and cultural contexts. The contextual factors regarding the social impact signature for the greater Christchurch area are elaborated, with an emphasis on individual, cultural, and social contexts as critical aspects of assessment. Linear, temporal models of disaster that are commonly used in postdisaster contexts were also evaluated and found to be insufficient as representations or predictive models, especially when there are pre-existing vulnerabilities within a community. A more salient model was that of secondary stressors, ripple effects, and the cascading consequences of ongoing postdisaster uncertainties. Examples given in this review emphasise that how people feel in the aftermath of disasters is a key to comprehending the nuanced perspective as to how breaches between models, expected outcomes, and real experiences can be difficult to negotiate. The literature also pointed to ripple effects being of far greater concern than the direct effects of disasters themselves. International findings regarding postdisaster ripple effects that are directly relevant to, and substantiated by, ongoing research within the greater Christchurch area include: •
•
•
Economic stressors – extended insurance compensatory issues, high rental, fuel, food and service costs, loss of income, loss of employment, changes in job markets, perceptions of inequalities between residents and the incoming workforce, resentment of the incoming workforce, loss of savings, lack of financial assistance, embarrassment and shame regarding economic status and ability to provide for dependents, difficulty in asking for financial assistance or knowing where and how to procure it. Displacement and housing stressors – recovery of and rebuilding of homes, stresses of ongoing maintenance, maintenance related physical injuries, aches and pains, rotating tradespeople in the home and workplace, poor perceptions regarding the attitudes, conduct, manners and service delivery of tradespeople, concerns about perceived neighbourhood and citywide inequalities, concerns for safety, relocation from familiar neighbourhoods and schools, changes in children’s accessible peer groups, fluctuating house stocks, loss of familiarity and place-attachment, grief regarding place-attachment, loss of social capital and support networks. Family stressors – changes to the functioning of families, parental concerns about children’s mental health and wellbeing, higher levels of parental responsibility, concerns regarding the family spending less time together, the adoption of different parenting strategies (sometimes stricter), increased alcohol use, navigating family members with ongoing or emergent mental health issues, new and upsetting circumstances, loss of security and normalcy for children, breakdowns in relationships, reduced social support from partners, inter-parental conflict, intimate partner abuse, changes to relationship status, negative impacts on family relationships, reduced intimacy, changes to the composition of households, change in household functioning, and physical separations.
•
•
•
•
Health-related stressors – sleeping problems, back problems, repetitive strain injuries, depression, anxiety, excess fatigue, exacerbation of pre-existing complaints, lack of access to medical care or psychological services, vicarious trauma, distress, frustration and inconsiderate attitudes from others, and having to get on with life whilst dealing with recovery associated problems. Loss of leisure and recreation – lack of time for sleep or free time to spend with others, loss of access to familiar leisure destinations, lack of energy for leisure activities, and insufficient money for leisure activities. Loss of predictability and frustrations in daily life – infrastructural issues, regime uncertainty, dissatisfaction with bureaucratic support, dissatisfaction with rebuilding progression, perceptions of a lack of transparency and limited personal agency in terms of rebuild and infrastructural impacts, difficulty in accessing workplaces and shopping districts, problems getting children to school on time in disorderly or unpredictable traffic, loss of access or disrupted access to familiar businesses or services, issues with excessive construction noise, issues with excessive construction near the home and workplace, car trouble due to suspension problems as a result of to poor roading, and loss of routines. Stresses relating to an individual’s changing views of themselves and the world – worldview disruptions, concerns with obvious structural inequalities, reduced levels of independence, negative cognitive appraisals of self, loss of meaning, trust issues, experiences of power inequalities, difficulty articulating issues which are personally concerning, difficulty asking for help or knowing how and where to access help, persistent uncertainty, lack of control and predictability, lack of orientation, loss of aspirations, and persistent impacts from feeling isolated.
As a psychosocial perspective holds that infants, children, young people, adults, families, members of communities, citizens, migrants, and visitors encountering or living within a postdisaster community, within a particular infrastructural organisation, are all part of a system of exchange that is primarily based upon relationships, the society which is emergent can be considered a collective representation of the quality of those relationships. Based on local research findings, as substantiated by international research literature, this review considers secondary stressors and their roles in affecting long-term mental health and wellbeing for individuals and communities to be cumulative, and argues that assessments and active responses to self-reportage of how communities are faring in terms of expected and realistic adaptations in the postdisaster contexts are necessary. The recommendations made in this review have been based upon a psychosocial research philosophy that is clearly oriented towards the successful design of context-specific, informed, psychosocial initiatives for children and youth, inclusive of the families and communities in which they are embedded, and initial directions for how to achieve this have been included. The findings of this review are that further context-specific research is needed to provide the means to innovate from the existing models for psychosocial interventions, in order to properly co-ordinate a plan to improve wellbeing for children and youth in the greater Christchurch area. In-depth recommendations of this specific nature were beyond the scope of this review.
CONTENTS ACKNOWLEDGEMENTS ..................................................................................... 1 1.0
INTRODUCTION ....................................................................................... 1
2.0
METHODS ............................................................................................... 3
3.0
KEY CONCEPTS OF ANALYSIS ................................................................... 4
4.0
3.10
How can disaster be defined? ......................................................................... 4
3.20
The Life Cycle of Disasters – The Zunin and Myers Model .............................. 7
3.30
Critiques and Considerations regarding the Zunin and Myers Model ............ 8
3.40
Ripple Effects, Waves, and Cascading Consequences after Disasters ........... 13
3.50
What do Disaster Models have to do with Children and Youth? .................. 17
A PSYCHOSOCIAL FOCUS ON CHILDREN AND YOUTH 0-18 YEARS ......... 20 4.10
Resilience of Children and Youth in Postdisaster Contexts ........................... 20
4.20
Coping and Competence of Children and Youth in Postdisaster Contexts.... 29
4.30
Establishing a Vulnerability Baseline for Assessing the Ongoing Ripple Effects
for Children and Youth in the Greater Christchurch Area ........................................... 30
5.0 NEXT-GENERATION PSYCHOSOCIAL INTERVENTION STRATEGIES FOR COMMUNITIES, FAMILIES, CHILDREN AND YOUTH IN THE GREATER CHRISTCHURCH AREA ..................................................................................... 36 5.10
Theory and Context for Successful Psychosocial Interventions .................... 36
5.20
Transformative Paradigms for Successful Psychosocial Interventions .......... 38
5.30
The Potential of Psychosocial Interventions for Communities, Families,
Children and Youth in the Greater Christchurch Area ................................................ 42
6.0
CONCLUSION......................................................................................... 46
7.0
REFERENCES .......................................................................................... 48
PSYCHOSOCIAL WELLBEING: COMMUNITIES, FAMILIES, YOUTH & CHILDREN
ACKNOWLEDGEMENTS This literature review was initially supported by a separate research project that was focused on conducting preliminary searches of disaster-related literature on children and youth, as funded by a University of Canterbury Research Grant and initiated by Dr. Anne Scott, with work undertaken by Amba J. Sepie and Candace Bobier. Further thanks are extended to Dr. Ria Schroder for her assistance, editorial advice, and guidance throughout this project, and Dr. Sue Bagshaw, Lucy D’Aeth, Kelly Mackintosh and Andrew J. Sepie for their contributions, feedback, and support.
1.0
INTRODUCTION
This review was commissioned to focus upon postdisaster and post-traumatic-event literature targeting children 0-18 years and their families, with a broader mandate to look at the wider psychosocial implications of living in a postdisaster environment and the ways in which the target group may be affected. The objective was to capture the current status of research in the fields of concern, in a manner that could be readily applied to children, youth, families, and the communities in which they live, following the Canterbury sequence of earthquakes and aftershocks. This research was conducted using a psychosocial research philosophy and prioritised psychosocial concepts and literature which were multidisciplinary in orientation. As psychosocial research approaches are often conceived of as potential components within health or service delivery models, rather than fundamentally different in paradigm orientation, philosophy, design, and implementation, some explanation of what the psychosocial research approach consists of is provided. The term psychosocial has historically been used within the context of practical applications within health care (for instance, in approaches which deal with the ‘whole person’, rather than as an atomised individual presenting a symptom with an associated anatomical part); although it has been extended gradually to capture a range of methods for attaining a broader understanding of the complexity of psychological and social processes which go into making sense of personal experiences (Woodward, 2015, p. 7). Psychosocial studies began to emerge in the 1960s, with notable applications in disaster studies (often in connection with resilience) during the late 1970s and 1980s (Drabek, 1986, 1989; Gist and Lubin, 1989; Green et al., 1981; Perry and Lindell, 1978; Raphael, 1984; Rutter, 1987; Shore, 1986; Werner and Smith, 1982). Psychosocial approaches take into account an individual’s personal experiences in the context of their social world: they are holistic in orientation. Such approaches provide a set of concepts and tools for investigating and trying to make sense of what is happening for people, and how they deal with their emotional responses to the ever-changing circumstances of daily life. Psychosocial perspectives are inter-subjective and relational in their orientation, iterative, and take an approach to health which extends beyond the medical models available in the study of disasters, adverse events, resilience, and so forth,
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PSYCHOSOCIAL WELLBEING: COMMUNITIES, FAMILIES, YOUTH & CHILDREN to include the social world as a critical element in the support of subjective wellbeing. Wellbeing is a term which connotes quality of life, happiness, life satisfaction, competence, positive coping, positive outlook, and so forth, but is generally left as a ‘fuzzy’ definition in the literature to reflect the idea that is contextually shaped by the experiencing individual. As such, wellbeing cannot be determined using scales, indicators, by assessing factors, risks, or by any external process. Psychosocial models should not be confused with social models of health, as they are not limited to philosophies of health promotion and health service domains. Whilst psychosocial models aim to create conditions to help people achieve improvements in their lives, which may include health improvements, the holistic focus conceives of health as a multi-dimensional index of relationships within the body, and between the body and the environment. This includes complex relationships between people in families, communities, neighbourhoods and societies. Psychosocial perspectives are cross-domain and systemsbased, flexible, reflexive, values-based, context-based, worldview-sensitive, person-centred (though not necessarily individualised), pedagogically and emotionally oriented, and transparent. They are also inherently mobile in terms of how philosophical ideas and practices are transferred, in that the prevailing goal is to reach out to people ‘where they are’ (not necessarily a location) and bring them into a community of shared experience, wisdom, and validity. These approaches are inclusive of not only the individual social circumstances within which people mediate their lives, but a range of interactions, strengths, or difficulties which emerge from personal biography and socio-economic factors which may have an influence upon ill health, unequal dependencies, underperformance in work and education, and antisocial or sub-optimal social and conduct behaviours (Woodward, 2015). Psychosocial studies use scholarship from traditional medical, psychological, social, educational, economic, and other disciplinary specialties with the aim of synthesising research to provide a rich view of socio-personal experience that can conceptualise an individual as embedded within social relationships that fluctuate, and are reactive to spatial-temporal conditions. The range of research that has been completed in order to provide this review was approached inclusively, however, as the research progressed, it became evident that psychosocial approaches and next-generation initiatives to improve personal and community wellbeing through psychosocial interventions have largely overtaken evidencebased approaches within postdisaster contexts worldwide, with the exception of firstresponse health and mental health care. The research also identified that a major obstacle to the success of psychosocial programmes was a poor understanding of what psychosocial actually means. Therefore, this review has attempted, at every stage, to: i) explain the terms of analysis regarding the psychosocial approach to postdisaster recovery (or adaptation), and ii) provide clear explanation and substantiation of the theoretical and methodological differences between psychosocial and evidence-based approaches to the study, and mitigation, of disaster effects. Any recommendations made in this review have been based upon a psychosocial research philosophy that is clearly oriented towards the successful design of context-specific, informed, psychosocial initiatives for children and youth, inclusive of the families and communities in which they are embedded, and initial directions
2
PSYCHOSOCIAL WELLBEING: COMMUNITIES, FAMILIES, YOUTH & CHILDREN for how to achieve this have been included. The findings of this review are that further context-specific research is needed to provide the means to innovate from the existing models for psychosocial interventions, in order to properly co-ordinate a plan to improve wellbeing for children and youth in the greater Christchurch area. In-depth recommendations of this specific nature were beyond the scope of this review.
2.0
METHODS
The subsequent literature review has been generated from an extensive search of sources which culminated in the creation of a database of 2,558 international multidisciplinary sources. Included were academic peer-reviewed articles (empirical, literature reviews, and meta-analyses), open-access scholarly journals, government papers, aid institution papers, and grey literature. Web of Science, Scopus, and Google Scholar were used to identify initial sources, with full-searches performed using Academic Search Direct, Blackwell Reference Online, Cambridge Journals, Directory of Open Access Journals, EBSCO, ERIC, Factiva, HeinOnline, IEEE Xplore, Informit, JSTOR, MasterFILE Premier, MEDLINE, OECD iLibrary, Oxford Journals, PILOTS, Project MUSE, ProQuest, PsycARTICLES, PsycINFO, PubMed, SAGE, ScienceDirect, SociINDEX, SpringerLink, Taylor & Francis, and Wiley Online. Books were sourced through EBL Ebook Library, Ebray, Te Puna, WorldCat, and Library of Congress search engines. Government papers, aid institution papers, and grey literature (all public domain documents) were generally sourced using Google search. Given the vast quantity of research available on this (and related) subjects, structured database searches focused on keywords such as disaster, resilience, trauma, vulnerability, intervention, psychosocial wellbeing, displacement, stress, and stressors. Particular collections by notable authors in the field of recovery were reviewed for up-to-date definitions of terms and exposition of key concepts. Noted longitudinal studies were considered, as were critiques of what are widely disseminated approaches to psychosocial recovery. Search methodology, literature analysis, literature substantiation, and writing methodology were inductive and iterative, allowing in-depth consideration and cognitive processing of the key elements which were required to fulfil the mandate of this review. Of the 1400 sources initially retrieved, a range of findings, as published between January 1995 and June 2015, were evaluated more closely, with a focus on the most recent research in the fields of disaster and resiliency studies, and historical sources where relevant to the scope of this review. In order to qualify the terms and concepts that would be relevant to the current report, the sources were moved into an Endnote database using keyword searches to create general groups (based on keywords, for example: displacement, coping, resilience, anxiety, interventions, family wellbeing, culture and disaster), author sets, longitudinal research sets (such as: Dutch Famine, Ice Storm), and specific disaster sets (for example: earthquake, Kobe earthquake, Kobe earthquake children, resilience children – school age). A total of 121 groups were developed and some of the categories used were formulated by identifying distinct bodies of research which appeared to be grouped together whilst undertaking searches.
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PSYCHOSOCIAL WELLBEING: COMMUNITIES, FAMILIES, YOUTH & CHILDREN This research database was then used to create a Qiqqa database, a programme which performs text recognition on the attached documents to make them fully searchable. The information was then grouped more specifically using tags for subject range, title, author, publisher, year, and theme. Groups of literature and reviews of literature in each subject range were then read either in whole or in part according to the designated parts of the intended review, and this database was updated constantly to eventually contain a further 1158 sources, as would be expected with inductive research methods. This was primarily because critiques and alternative perspectives on the core body of literature were sourced as needed to ensure academic rigour in the process of compiling the research and ensuring the information was as accurate as possible, within the context of a psychosocial analysis. A large number of supporting citations are given in this report to ensure that key elements of the analysis are evidenced as salient in the context of contemporary research findings in this area, and to ensure the findings are replicable. As a result of this process, the literature was subsequently divided into three key areas which provide the structure of the current report: i) key definitions of terms and concepts and specific psychosocial terms of analysis, ii) psychosocial implications for 0-18 year olds, their families and communities, within postdisaster and adverse contexts, and iii) successful intervention strategies that may mitigate the range of cross-domain postdisaster effects as experienced by this cohort.
3.0
KEY CONCEPTS OF ANALYSIS
3.10
How can disaster be defined?
A classic formulation of how to define a disaster is as: “an event, concentrated in time and space, in which a society, or a relatively self-sufficient subdivision of a society undergoes severe danger and incurs such losses to its members and physical appurtenances that the social structure is disrupted and the fulfilment of all or some of the essential functions of the society is prevented” (Fritz, 1961, p. 655). Disasters, therefore, become the immediate central focus of a community afflicted by the event in question, absorbing people’s attention and the focus of emotional reaction and release, becoming a collective locus of symbolic representations by which past, present, and future events become re-organised (Ibid, p. 691). Definitions that frame disasters as social are implicitly broad, and emphasise the dislocating, disrupting effects on human cognition and culture, which allows general comparisons between disasters as diverse as earthquakes, hurricanes, chemical oil spills, bombings, health epidemics, riots, and single event crises such as sniper attacks or hostage scenarios (Oliver-Smith, 1999). This has limitations and benefits, as every ‘disaster’ situation is notoriously unique in some aspects whilst being comparable in others. Drabek writes that disaster, “like disease, is a concept that requires more precise specification and clear linkage to the functioning of social systems on a daily basis. We could not understand human system response to illness without significant increases in our knowledge of more fundamental physiological processes. So too our understanding of disasters must be stretched so that it is routed within basic principles of human organization” (1989, p. 262). Of course, all social definitions must relate to the actual
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PSYCHOSOCIAL WELLBEING: COMMUNITIES, FAMILIES, YOUTH & CHILDREN physical events in question, but these quickly become a reference point that is larger than their physical reality and effects, and contested in terms of their complexity and reasonable boundaries (Kreps and Drabek, 1996). This complexity can be illustrated with a comparison from Bonanno et al.: “in a terrorist attack the danger of immediate physical injury is acute but generally transient and limited to a relatively focused geographic location. By contrast, the danger period for a natural disaster such as an earthquake may encompass hours or even days, may spread over a broader geographic area, and may induce both short- and long-term health consequences” (Bonanno et al., 2010, p. 20). Whilst the event itself may by characterised by what is called direct, or proximal exposure, what occurs in the aftermath of the event is called distal exposure; for instance, losing one’s home may occur during the event itself, but the full consequences are felt for weeks, months, or years after the event (Ibid, pp. 20-21). A literature analysis by Bonanno et al. was a general, yet substantial review, which came to five broad conclusions: disasters cause serious harm in a minority of exposed individuals; disasters produce multiple patterns of outcome, including psychological resilience; disaster outcome depends on a combination of risk and resilience factors; disasters put families, neighbourhoods and communities at risk; and the remote effects of a disaster in unexposed populations are generally limited and transient (Ibid, pp. 1-2). As some of these terms have attracted contested definitions, the approach taken herein has used the Bonanno research as a baseline study for how disaster is generally conceptualised, and augmented this with research studies that take a more nuanced approach. Despite the appearance of relatively simplistic conclusions, Bonanno et al, actually identify widely disparate findings regarding the relationship between resilience and coping to disaster, and disaster effects to proximate and distal exposure, as is supported by numerous studies in this topic (Berger, 2015; Joseph and Linley, 2008; Kilmer, 2010; Nüchterlein et al., 1993; Pynoos et al., 1999; Rudenstine and Galea, 2011; Zakour and Gillespie, 2013). Disasters have also been described as an example of collective stress situations, which occurs when members of a social system fail to receive expected conditions of life from the system, including (but not restricted to) physical safety and protection in their environment, provision of food, shelter, income, and basic services, and the guidance and information that is needed to resume collective activities (Barton, 1969, p. 38). It is in the area of guidance and information that communities often struggle, especially when the capacity of emergency and social organisations to respond are focused on immediate safety and provisional concerns as directly relative to the novelty of the event. Further consideration must also be made for the subjective experiences of disaster effects which are framed, both in rational and non-rational terms, by the experiencing population; often widely diverse in terms of representation, and personal management of the event. For instance, an individual’s hierarchy of needs may be assumed as prioritising food and shelter, but what may be most beneficial in emotional terms (or to counter feelings of vulnerability) may be social support, immediate childcare, or emergency financial assistance. Psychosocial studies of disasters, risks, vulnerabilities, resilience, coping, and so forth, focus on attaining more nuanced understandings of the interstitial areas between the psychological and the social which traditional disciplinary perspectives may not be able to
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PSYCHOSOCIAL WELLBEING: COMMUNITIES, FAMILIES, YOUTH & CHILDREN assess due to the prescribed limits of any disciplinary field. Issues which concern psychosocial researchers are multivariable, and can extend into areas such as the assessment of feelings of loss and general personal insecurity, responses to disruptions to livelihood, marginalisation within the recovery environment, and other socio-personal impacts, whilst also retaining an emphasis on innovative and supportive measures that focus upon enhancing specific coping mechanisms, increasing competence, supporting resilience, and the overall protection and support of wellbeing. Successful mitigation of issues which may present in a postdisaster context require the conceptualisation of the social environment as a whole, wherein the social dynamics of affected communities provide the context for psychological recovery (R. Gordon, 2004a). When conceptualising disaster, both individuals and social systems (which are dynamic, and infer relationships between the cellular, neural, familial, communal and wider social systems) can be described as expressing resilience in accordance with their capacity for adaptation (Alesch and Arendt, 2015; Masten and Tellegen, 2012). Resilience has been defined in various ways, and a full discussion of these definitions will be presented later in this review, however two broad types of resiliency definitions can be identified in the literature: hard definitions, which emerge from the history of resilience research and tend to treat structures and individuals in terms of strength properties and strengthening measures; and soft definitions, which emphasise fluidity, flexibility, adaptation, and change, yet refer to concepts of core strength, and strengths-based research (Proag, 2014). 1 Resilience has also been strongly linked to the concepts of risk and vulnerability as adverse states of being or experience, which culminates in a definition of resilience as ‘health despite adversity’ (Masten, 2001). Oliver-Smith describes disasters in the context of complex internal differentiation, which combines ecological systems thinking with an “analytical strategy which can encompass the interaction of environmental features, processes and resources with the nature, forms, and effects of the patterns of production, allocation, and internal social differentiation of society. The fact that complex societies, as adaptive systems, are controlled by contesting interests within a society, privileging some sectors with enhanced security while subjecting others to systemic risks and hazards, must also be apprehended by any effective research strategy” (1999, p. 29). A systems view can be augmented with a constructionist approach to disaster that emphasises the relationships between individuals and their environments as mutually constructed (Ungar, 2004). This relational perspective in which disaster capacities and vulnerabilities are emergent, rather than fixed, is integral to psychosocial perspectives on disaster, and are an expansion upon models which are domain-limited.
1
Hard definitions, which are still popular in economic, geographical, infrastructural analyses of disaster and some fields of psychology and medicine, arise less frequently in the targeted literature than soft definitions. To differentiate clearly between the hard and soft approaches, the use of the terms strength, strengthening, and strengths-based in this paper should be assumed to be in connection with a ‘soft’ definition of resilience and related concepts, unless clearly stated otherwise. This reflects the trend observed within current resilience research away from the harder definitions.
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PSYCHOSOCIAL WELLBEING: COMMUNITIES, FAMILIES, YOUTH & CHILDREN Disaster outcomes are varied, and depend upon a combination of risk and resilience factors. These types of assessments cannot be determined entirely pragmatically as they are intimately tied to personal biography, prior experience, and pre-established coping strategies. If immediate disaster intervention fails to meet these individual needs, there is an increased risk of on-going psychosocial and health vulnerabilities in the postdisaster context (Bonanno et al., 2010). Despite a mixed pattern of findings, the bulk of the evidence reviewed by Bonanno et al. suggests that “the stress of disasters can erode both interpersonal relationships and sense of community. Regardless of how they are affected, postdisaster social relations are important predictors of coping success and resilience” (2010, pp. 1-2). The literature also overestimates costs to survivors in terms of effects such as posttraumatic stress disorder (PTSD), and underestimates costs in other, less obvious, domains, primarily due to the post-war contexts in which much of the initial disaster research was undertaken. In response to this, researchers are increasingly moving away from traditional research models to non-experimental methods which can take account of complex social interactions (Fulbright-Anderson et al., 1998). The focus of contemporary research is more situational and engaged with mapping social representations and reactions in particular contexts in which meaning is attached to disaster experiences (R. Gordon, 2004b). 3.20
The Life Cycle of Disasters – The Zunin and Myers Model
A number of factors have to be taken into consideration when examining research with the disaster as a central organisational tool, or ‘event’. No disaster is a singular event; rather, disasters have a life cycle in which the event(s) themselves are in constant relationship with the natural, human, and non-human elements that are connected in numerous ways with where they occur (Shaw et al., 2012). Several models of disaster cycles are used in the literature; however, the most commonly cited is the Zunin and Myers model, summarised by Gordon (2004a), as an initial state of disorganisation or period of ‘shock’, followed by a rebound stage of somewhat integrated collective behaviour, a period of high morale, and then a period of conflict, discord, and isolation, in which secondary stressors and risk of psychological discontinuity increases, before a ‘new beginning’ and reconstruction phase (Drabek, 1986; Gist and Lubin, 1999; R. Gordon, 2004a; Van der Kolk et al., 1996; Zunin and Myers, 2000). “The community psychosocial response to disaster is interwoven with the disaster life cycle [...] a trajectory of community psychosocial response to a major disaster that has been found to broadly apply across a range of disaster types. Zunin and Myers (2000) described the community’s progression through the stages of disaster impact, heroism, community solidarity, disillusionment, and reconstruction” (Shaw et al., 2012, p. 26).
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PSYCHOSOCIAL WELLBEING: COMMUNITIES, FAMILIES, YOUTH & CHILDREN Figure A:
Model reproduced from Zunin, L. M., and Myers, D. (2000). Training manual for human service workers in major disasters (2nd ed.). Washington D.C.: Center for Mental Health Services; US Department of Health and Human Services Administration.
3.30 Critiques and Considerations regarding the Zunin and Myers Model Note that the designated 1-3 year period of disillusionment, as pictured in the Zunin and Myers model, does not always feature in other interpretations: this is an ideal model with a temporal, linear orientation that may have been originally generated out of observations of particular community recovery patterns, but is now used as a model that informs communities newly afflicted by adverse events. In practice, these stages are neither static nor linear, but fluid and largely reliant on the ability of a community (and the infrastructural, bureaucratic, organisational structures it is dependent upon) to respond to fluctuations in the needs of the community in question (Quitangon and Evces, 2015). Zack (2009) calls for more systematic study and greater innovation in cooperative efforts to properly assess the ways in which individuals and their communities recover financially, socially, and materially. Simplistic approaches suggest that recovery will be a success if a community has strong social capital, including high levels of civic participation and social cohesion, if there is a healthy regional economy with large numbers of skilled and educated workers, sufficient investment in rebuilding, facilitation of policy reform and enhanced resilience capacity (Liu, 2011). Where there are pre-existing vulnerabilities within a community, such as atomised neighbourhood structures, inadequate or expensive housing opportunities, high levels of economic and employment instability, substantial power inequalities, crime, disorder, and physical or mental health issues, such models often fail to meet expectations when such a community is afflicted with an adverse event (Leadbeater et al., 2004).
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PSYCHOSOCIAL WELLBEING: COMMUNITIES, FAMILIES, YOUTH & CHILDREN Vulnerability results most directly from a range of ‘unsafe’ conditions, which encompass structural inequalities, such as housing and financial strains, and psychosocial elements such as interpersonal and emotional concerns (Zakour and Gillespie, 2013, pp. 19-20). Vulnerability is sometimes thought to be synonymous with risk (Norris et al., 2008); elsewhere it is construed as a social model of vulnerability, which is concerned with the unequal power structures, political, and economic ideologies which act to increase vulnerabilities in a manner that is not simply connected to the disaster itself (McEntire, 2005; Wisner et al., 2004). McEntire (2005, p. 213) writes “Ideologies and the beliefs and daily activities of all citizens and organizations in the public, private and non-profit sectors have a bearing – positively or negatively – on our degree of vulnerability... Physical location, type of construction, use of technology, environmental degradation, public policy, people’s attitudes and values, economic circumstances, insurance coverage, prior planning and training, strength of emergency management institutions, the presence of special populations, enforcement of regulations, and community education each influence the degree of vulnerability in homes, businesses, communities and nations ” (see also Afedzie and McEntire, 2010; Alexander, 2000; Mileti, 1999; Weichselgartner and Kelman, 2015; Wisner et al., 2004). Various economic and political orderings, system capability (and strain), and the exercise of power all relate to vulnerability as emergent within a social system (Kreps and Drabek, 1996, p. 132; Rossi, 1993). In a multidisciplinary summary analysis of the vulnerability literature, McEntire (2005) found wide agreement among researchers, concluding that the assessment of vulnerability is generally a balance between liability and capability, with the majority of findings pointing to vulnerability as a) created by and within social systems which b) require mediation by an holistic, multi-dimensional, integrated, and aggressive set of postdisaster management initiatives. 2 The Zunin and Myers model has attracted at least one strong question regarding the last phase predicted in the process; that is, what can be expected to stand in for recovery? Hoffman (1999b), who summarises anthropological studies of the Oakland firestorm (California) and Cyclone Tracy (Australia), writes that despite the prediction of an ‘end’ to the process, there is rarely an end, as such. Four years following the Oakland disaster (which impacted upon a relatively affluent population), most, although not all, residents had resettled in rebuilt or purchased houses, or were still awaiting the completion of houses; six years later, some homes still existed in a state of permanent incompletion, and occupied houses had no steps, unfinished yards and unfinished exteriors. Many residents have 2
Contributing factors listed include: using of hazard-prone areas (Geography); structure and infrastructure weakness (Engineering); constraining values, attitudes and practices (Anthropology); inability to prevent, prepare, or recover as predicated by poverty (Economics); inaccurate assumptions about disaster behaviour as related to race, gender, age, disability, etc. (Sociology); overlooking or minimalising risk, and poor emotional coping skills relating to stress and loss (Psychology); susceptibility to disease and injury as relating to malnutrition and health issues (Epidemiology); proneness to environmental degradation (Environmental Science); political structure and incorrect decision making (Political Science); misguided laws, the failure to effectively implement policies and enforce regulations (Public Administration); negligence, described as a failure to act as reason or law dictates (Law); insufficient public awareness about disasters and how to respond (Journalism); lack of capacity to perform important functions before and after disaster strikes (Emergency Management); cultural misunderstandings, permeable borders, fragile infrastructure, and weak disaster management institutions (Homeland Security) (McEntire, 2005, p. 216).
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PSYCHOSOCIAL WELLBEING: COMMUNITIES, FAMILIES, YOUTH & CHILDREN returned to jobs and secured insurance payouts, but the suspicion and pent-up resentment toward the insurance companies still drives active lobbying by survivors of the firestorm. Hoffman notes that the changes brought about in the aftermath can take decades to be fully realised. Following Cyclone Tracy, many residents never returned, marriages dissolved, they suffered a ‘loss of hope’, and (as in Oakland) resentment lingers towards authorities and the decisions made in the wake of the disaster. Hoffman writes “for many disaster survivors the recovery turns ravelled, strife-ridden, debilitating, and sometimes stalemated” (1999b, p. 148). Personal and working relationships may also suffer as there is no obvious touchstone for defining what constitutes ‘common experience’ in the postdisaster context, how long reactions should go on for, or what is a ‘reasonable’ reaction, in comparative terms. It is common for people to use assertions of strength, rather than on-going vulnerability, such as the claim that they are ‘not really affected’ when comparing their situations with others who have been ‘suffering’ to a greater extent (R. Gordon, 2004b). In describing effects upon workers in the months following September 11, Kleinberg described workers as unenthusiastic, tired, experiencing hopelessness, and not especially focused on how they, or others, were feeling, which created vulnerability to decreasing morale, performance, and declining psychological health and wellbeing in the absence of what he calls a ‘salient life structure’ (2011, p. 259). He writes, “Of utmost significance is the ongoing nature of the crisis. ‘We’re waiting for the next shoe to drop,’ became the watchword. For some, an ambulance siren, a car backfiring, or a low-flying plane triggered a near-panic attack... Since the potential for further trauma never passes, ongoing threats produce peritraumatic stress... the focus is on one day at a time... home is more important than the office, and family members are more important than colleagues or clients” (p. 260). Further examples of how people feel in the aftermath of disasters might convey a more nuanced and critical perspective as to how the breaches between models, expected outcomes, and real experiences can be difficult to negotiate. In the example of Cyclone Tracy, the forced evacuation from the disaster site and the failure of the Navy and Police to let residents back into the disaster zone created a permanent dissociation between residents and their homes. Extended insurance issues, and difficulties dealing with what Hoffman calls ‘rotating adjustors’ in the aftermath of displacement, may also erode sympathy towards the agencies who are involved in the process of recovery and reconstruction. Survivors can feel like they are shifting from the status of victims, to prey. In the Oakland recovery period Hoffman notes hearing comments such as: “I wish my house would burn down so I could have a new one” (1999b, p. 145). Bunbury (1994) writes that, following Tracy, for every aircraft leaving with evacuees, another one full of consultants, building system designers, and ‘opportunists’ was arriving. Hoffman notes the same phenomenon after the Yungay avalanche, Hurricane Andrew in Florida, and in Oakland after the firestorm. “Architects and builders from far-flung communities arrived to take advantage of the destruction, many of them deserting unfinished houses when they took on yet other houses to build or their estimates were incorrect. Architects from across the country flew in to find prospective clients. Arriving by the hundreds, carpenters, bulldozer drivers, tree removers all worked both for survivors and against them with the insurance companies” (1999b, p. 145).
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PSYCHOSOCIAL WELLBEING: COMMUNITIES, FAMILIES, YOUTH & CHILDREN After the 1994 Northridge earthquake in California, “a local carpet dealer lost most of his inventory because the earthquake set off the sprinkler system in his warehouse, and then heavy rains poured more water into the building through the broken roof and missing back wall. While he was trying to get the landlord to repair the building... large manufacturers from Georgia and distributors from elsewhere... cut deals with the big contractors, offering truckload prices and immediate delivery. Like other small retailers, the beleaguered merchant finally acquired suitable space and an inventory just in time to learn that there was no longer a need for his product or services” (Alesch and Arendt, 2015, pp. 90-91). The business was no longer viable two years later. The conclusion to be drawn from these examples is that broad-scale assessments and models are only useful to a point, as in any assessment of a postdisaster scenario, there needs to be specific attention to not only the details of the event itself and visible impacts, but how the community is really faring in the gap between expected and realistic recovery outcomes. Disasters are what Drabek (1989) has called non-routine social problems, which is defined as the consequence of an ‘agreement’ between humans and their environment failing, wherein the demands for action and knowledge temporarily exceed the capacity of social institutions to respond (Kreps and Drabek, 1996). Drabek (1989) argues that the traditional concept, definition and response to disaster has become overly routinised, and thus, is often ill-equipped to attend to the novelty which presents in each disaster situation. Of course, this concept hinges upon the tacit assumption that there is such a thing as an unexamined ‘normality’ to be disrupted (Hewitt, 1995, p. 322). This is a critical consideration, because any psychosocial response to disaster that establishes social references to either a baseline, or future normality (as relative to concepts such as ‘bouncing forward’ or recovery), may be unintentionally setting up conditions for maladjustment to, or disappointment in, what is essentially a new, postdisaster situation (Aldunce et al., 2014). The adoption of fixed disaster phase models does not appear to be a particularly successful strategy in guiding postdisaster efforts; rather, recovery and wellbeing can be bolstered, or diminished, depending upon the understanding of, and response to, what is called the social time of disasters, which is the emphasis on doing what is needed now, rather than a strict adherence to scheduled events such as reconstruction efforts (Cope et al., 2013; Hopkins et al., 2012; Long and Wong, 2012; Neal, 2013). There are also concerns when aid agencies pull out too soon, short term gains in disaster response may create a drain in local capacity over the long term (Amin and Goldstein, 2008; Newburn, 1993). As external response agencies tend to be temporary, their dismantling leads to a loss of valuable information, experience, capacity, continuity, and responsibility, raising concern as to who should take over (Amin and Goldstein, 2008, pp. 242-244). The sympathy and support from those external to the situation may also be withdrawn sooner than expected. When Hoffman talks about the Oakland firestorm she is constantly fielding a particular trio of questions: It was what? It was when? Aren’t you over it yet? (1999a, p. 318). Concerns have been raised in the literature regarding a lack of consideration for politics, governmental power, and capitalistic drivers of social relations, specifically when equality is presumed across the individuals, cultures, communities and nations who are expected to
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PSYCHOSOCIAL WELLBEING: COMMUNITIES, FAMILIES, YOUTH & CHILDREN cope with postdisaster challenges (Hornborg, 2013; Leach, 2008, pp. 11-15; MacKinnon and Derickson, 2013). The political and economic ideologies involved in shaping postdisaster public (or popular) discourses have also come into question in the recent disaster recovery and resilience literature, generating critiques of the grey literature produced by governmental agencies, think tanks, consultancies, and other interest groups (Bene et al., 2012; Cote and Nightingale, 2012; Cretney, 2014, p. 631; Hornborg, 2013; Leach, 2008; MacKinnon and Derickson, 2013; O'Malley, 2010; Walker and Cooper, 2011). The central criticism is that immediate responses to crisis, recovery, and resilience scenarios tend to be reactionary, unreflexive, and under-researched or ‘borrowed’ from other agencies, without sufficient consideration for the specific nuances of the social context in which the crisis has arisen, nor engagement with the community which has to deal with its consequences (Cooper-Cabell, 2013; Rabiei et al., 2014; Reifels et al., 2013). In addition, critiques address the superficiality of presumed participatory democracy, and note that consultation on recovery processes rarely fulfil the expectations of the communities who have been consulted (Barrios, 2011). Plans for what the community wants, when translated by ‘experts’, create different results; as Wisner (2004) notes, populations experiencing marginalisation (which is a priori inclusive of every postdisaster community) can develop a profound mistrust of expert planners. To be truly participatory, the cultural, historical, political and social assumptions, implicit in the community’s conceptualisation of their wellbeing, recovery, and use of urban space, above that of the experts, is the central concern and objective of consultation and realisation, although this is rarely achieved (Barrios, 2011). Gordon stresses that interest groups must feel validated and integrated when it comes to legitimate needs and differences (2004a, p. 28). A further criticism which may impact upon the ongoing use of the Zunin and Myers model is the observation that in any long-term recovery project, the kind of ‘normalcy’ people might hope to return to may neither resemble, nor amount to an improvement upon, how life was prior to the event (Brenner et al., 2010; Cutter et al., 2008; Leitch and Bohensky, 2014; Lopez-Ibor et al., 2005; Norris et al., 2008; Zack, 2009). Although initially, Oakland, Yungay, Florida (following Hurricane Andrew), flood victims in the Mississippi and Grand Forks (US), and the community which came together after the Exxon-Valdez oil spill adopted motto’s such as ‘We will rebuild. We can. We must. We will grow stronger’, evoking strong desires to return to ‘what was’ and restore the past, there may, in fact, be no new beginning as such (Hoffman, 1999b). Generally, it is adaptation that occurs, rather than recovery framed as a kind of restoration (Alesch and Arendt, 2015; Companion, 2015; Kilmer, 2010; J.P. Wilson et al., 1988). The ‘new normal’ can grow old, quickly; or, simply not occur at all. This was the case in the aftermath of Hurricane Katrina for those who could not leave or chose not to (Lambert, 2014c; Manchester and O'Connor, 2012; Silver and Grek-Martin, 2015; Zack, 2009). These observations emphasise the importance of careful selection when policy and recovery planners choose collective terms of reference regarding the events in question, including the choice and promotion of recovery catchwords, discourses, and their attached expectations. This might include the renewal or abandonment of such discursive symbolic references (such as rebuild, recovery, bouncing back, and strength metaphors) when they are no longer salient to the public (see Cretney, 2014; O'Malley, 2010).
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3.40 Ripple Effects, Waves, and Cascading Consequences after Disasters There is the possibility of augmenting the Zunin and Myers model with other, more nuanced encapsulations of the postdisaster cycle and potential effects that may be unaccounted for in conventional analyses. Disaster cycle analyses also describe ripple effects and cascading consequences (Alesch and Arendt, 2015; Eyre, 2004) which do not conform to linear process models: “Postdisaster consequences are less like a chain of events than they are a cascade of interrelated events, the outcomes of which are largely a function of chance influenced by some degree of environmental chaos” (Alesch and Arendt, 2015, p. 75). A further concept that may be useful is used by Lowe et al. (2012), whereby sets of data known as waves, from both predisaster and postdisaster contexts, are compared to reduce assumptions in the competent analysis of psychological distress trajectories. They note that whilst studies with predisaster (or baseline) information tend to be robust in prediction of postdisaster mental health, very few studies actually use predisaster data and thus, likely overestimate the impact of predictor variables when determining ratios for effects such as PTSD (Lowe et al., 2011; Lowe et al., 2012; Lowe et al., 2015b; Lowe et al., 2013d). Figure B:
Model reproduced from Alesch, D. J., and Arendt, L. A. (2015). Long-Term Community Recovery from Natural Disasters. Boca Raton: CRC Press Inc., p. 78.
Ripple effects, framed in psychosocial terms, occur when a sufficient number of overall elements fail to prevent disruption to the overall system, or do not contain the disruption efficiently enough to prevent a ripple of consequences. Cascading consequences, even in mathematical modelling of postdisaster geological scenarios, prove to be complex, uncertain, and unpredictable (Qiu et al., 2014). Ripple effects (as experienced in a community) can be closely connected with cumulative stress effects (on an individual), as multiple stressors reduce the ability of an individual to manage their circumstances or
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PSYCHOSOCIAL WELLBEING: COMMUNITIES, FAMILIES, YOUTH & CHILDREN maintain interpersonal coping strategies (Berger, 2015, pp. 5-6). Typically, the term secondary stressor is used to describe situations which persist for longer than the event in question, and are defined as circumstances, events or policies that are indirectly related to the indexed event (Lock et al., 2012). Cascading secondary stressors can deepen the effects of a disaster, and may prolong the duration of the effects, thus making it difficult to delineate between proximal and distal effects as the temporal model and organisation of ‘the disaster’ collapses into what may be experienced as a reoccurrence (or perpetuation and exacerbation) of disaster-related emotions (Bonanno et al., 2010; Parker, 2015). The literature details the distress which primary stressors cause and their association with mental disorders; however, secondary stressors such as a lack of financial assistance, the gruelling process of submitting an insurance claim, parents’ worries about their children, and continued lack of infrastructure can manifest their effects shortly after a disaster and persist for extended periods of time (Gibbs et al., 2015; Kull and Coley, 2014; Leinonen et al., 2002; Lock et al., 2012). The difference between primary stressors, secondary stressors, life stressors, everyday stressors, cumulative daily hassles, and concurrent life events are very difficult to determine and poorly defined in the literature; however, a systematic review of secondary stressor literature from 2010-2011 found reasonable evidence for consistency within secondary stressor ripple effects in postdisaster situations. 3 This review concluded that secondary stressors, and their roles in affecting people’s longer-term mental health (especially the negative effects of depression on both adults, and adults parenting children) should not be overlooked (Lock et al., 2012; see also Turney, 2011; S. Wilson and Durbin, 2010). These findings are corroborated by research on the greater Christchurch area,4 which noted families were strongly affected by ongoing housing, accommodation and insurance issues, 3
This review lists economic stressors (such as problems with compensation, recovery of and rebuilding of homes, loss of income, loss of employment, loss of savings, lack of financial assistance); loss of physical possessions and resources (includes issues with replacement of items, and repair and services to homes); health-related stressors (exacerbation of pre-existing complaints, lack of access to medical care or psychological services, concerns for health of others, distress, frustration and inconsiderate attitudes from others, having to get on with life whilst dealing with recovery and associated problems); stress related to education and schooling (displacement and discontinuity); stress arising from media reportage (may increase risk of depression and need for counselling); family and social stressors (changes to the functioning of families, erosion of buffers or protective effects, new and upsetting circumstances, breakdowns in relationships, reduced social support from partners, inter-parental conflict, intimate partner abuse, changes to marital status, negative impacts on family relationships, reduced intimacy, loss of time spent with loved ones, changes to the composition of households, change in household functioning, breakdown of social networks, loss of social capital, physical separations); loss of leisure and recreation (lack of time for sleep or free time to spend with others); and stress relating to an individual’s changing views of themselves or the world (reduced levels of independence, lack of control and predictability, and loss of aspirations) (Lock et al., 2012). 4 Research in the greater Christchurch area is ongoing, but findings are increasingly consistent with international studies highlighting secondary stressors and ripple effects as more significant in 2015 than the initial sequence of earthquake events. Published findings include those by the Canterbury Earthquake Recovery Authority (CERA) (available at http://cera.govt.nz/recoverystrategy/social/social-monitoring); Families Commission research (available at http://www.superu.govt.nz/); and the Canterbury District Health Board (CDHB) All Right Research (available at http://allright.org.nz/is-canterbury-all-right/). There is also current academic research in this area that is Greater Christchurch area specific: (Clay and Bobier, 2012; Dorahy
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PSYCHOSOCIAL WELLBEING: COMMUNITIES, FAMILIES, YOUTH & CHILDREN including relocation issues, nearly four years after the first earthquake in September 2010. “Overcrowding of whānau homes, although not uncommon pre-quakes, had become a necessity rather than a choice. The lack of control around these issues caused frustration and emotional stress” (Families Commission, 2014) This research also showed the existence of a second and additional layer of stressors unrelated to housing were adversely affecting families. These included: parental concerns about children’s mental health and wellbeing; higher levels of parental responsibility; concerns regarding the family spending less time together; the adoption of different parenting strategies (sometimes stricter); increased alcohol use; and navigating family members with ongoing or emergent mental health issues (Families Commission, 2014; also suppported by Mirabile, 2014; Turney, 2011, 2012; Whiteford et al., 2013; S. Wilson and Durbin, 2010). 5 Communities are complex systems and failure to achieve coherence in one sphere of life (such as sleep disturbance, excess noise from construction, ease in accessing a workplace, or getting children to school in disorderly or unpredictable traffic), may create dysfunction or stress in other spheres of life.6 Changes in job markets, fluctuating housing stock, dependence on particular retail business (such as grocery providers) or services, and other elements familiar to the postdisaster context may also damage or alter pre-existing social relationships that are reliant on location and economic stability, which has long-term effects of the stability of the community in question (Alesch and Arendt, 2015, pp. 55-84). Ripple effects have also been discussed in general terms to qualify the nature of traumatic effects, and have been observed in conflict situations, famine, following the Aberfan disaster, September 11, Hurricane Katrina, the Kobe earthquake, the AIDS crisis, flood recovery, and other complex emergencies that were followed by an extended recovery period (Eyre, 2004; Kleinberg, 2011; Rodríguez et al., 2006; J.P. Wilson, 2013; Wisner et al., 2004). The ripple model describes the concept of ripple reverberations (sometimes called ‘downstream’ effects), which are the second-order effects upon the afflicted community, especially in the economic and employment sectors. These result from the adaptations made by organisations in other cities to ‘work around’ the lack of social and economic cohesion (and thus, reliability) present in the community which suffered the initial disaster. This amounts to a second, or third, round of adjustment for the community in question, and impacts strongly on families (Alesch and Arendt, 2015, p. 84; see also Kull and Coley, 2014; and Kannis-Dymand, 2011; Epston, 2014; Fergusson and Boden, 2014; Fergusson et al., 2014; Gawith, 2011, 2013; Gluckman, 2011; L. Gordon, 2013; L. Gordon et al., 2014; Havell, 2012; Hogg et al., 2014; Hooper, 2013; Ivory et al., 2011; Lambert, 2014c; McClure et al., 2015; Pearson et al., 2014; Rae, 2014; Renouf, 2012; S. Richardson, 2013; Rowlands, 2012; Shirlaw, 2014; S. Williams and Stanley, 1995; Yanicki, 2013). 5 These findings are also substantiated by international literature: (Alesch and Arendt, 2015; Calvo et al., 2014; Cerdá et al., 2013; Gill, 2007; Gow and Celinksi, 2011; La Greca et al., 2010; Luthar, 2003; Macarie et al., 2013; Masten and Cicchetti, 2010; Miller and Rasmussen, 2010; Mirabile, 2014; Overstreet et al., 2010; Overstreet et al., 2014; Somasundaram, 2014; Tehrani, 2007; J.A. Thomas and Mora, 2014; Thordardottir et al., 2015; Ursano et al., 2008; Ursano et al., 1994). 6 See the following studies indicating stress effects and on-going sleep disturbances from excess noise, traffic, and aggression: (DeLongis et al., 1988; Dzhambov and Dimitrova, 2014; Evans et al., 2001; Hennessy et al., 2000; Öhrström, 1989; Pulles et al., 1990; Sharp, 2010; Tempesta et al., 2013; Tompkins, 2009; Urban and Maca, 2013; F. van den Berg et al., 2014)
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PSYCHOSOCIAL WELLBEING: COMMUNITIES, FAMILIES, YOUTH & CHILDREN Leinonen et al., 2002; Sengupta et al., 2012). What this model suggests most strongly is the need for other stressors (including what might appear ‘lesser’ stressors, or daily hassles) to be taken into account when determining the overall social impact signature of an adverse event on a community. 7 Postdisaster scenarios, despite being routinely fixed to temporal, linear models, are the very definition of uncertainty, which results from a lack of information and, in turn, prevents both the definition and qualification of probabilities (Possekel, 2012). Uncertainty has been identified by a range of notable disaster scholars as a ‘major player’ at the ‘core of disaster theories’ (Becker et al., 2012; Gilbert, 1995; Quarantelli, 1989, 1995, 1998; Quarantelli and Perry, 2005; Rosenthal et al., 1989). In short, uncertainty has been linked to disruptions in the systems of meaning (alternately called the sense-making systems) which are conceptualised as being central to the organisation of daily life. “People generally believe that the world is a reasonably safe, predictable, benevolent, and meaningful place... [trauma] may have a devastating impact on this balance and cause our fundamental assumptions to be ‘shattered’” (Janoff-Bulman in Biruski et al., 2014, p. 1). Some of the things which may lead to feelings of uncertainty or disruptions to worldview include communications between people becoming confused, or chaotic, and a lack of predictability in general when it comes to navigating daily life. As Ungar notes, coherence is constructed through interpretative practices: “Individual’s are not passively exposed to external risk experiences – they interpret and process the information, bringing order and meaning to a changing world, and produce a set of expectations about how experiences fit together” (2012, p. 152). Wildavsky (1988) suggests two possible responses to uncertainty: anticipation and avoidance of risk (which requires the condition that risks can be predicated or foreseen); and elasticity or flexibility to uncertain conditions with the conscious acceptance of attached risks, which is the ability to accept the unexpected and to respond flexibly to changing conditions. In contrast to a situation of risk, which may have predictable parameters, or ambiguity, uncertainty requires people to construct (and reconstruct) forever changing mental models to counter the lack of prediction (Martin, 2010; Morell, 2010). Despite the best of intentions, governmental and aid agency actions in the postdisaster context can often exacerbate, as opposed to mediate, this uncertainty with the profusion of information (or, noise) that is generated when reframing and reorganising representations, plans, and reassurances regarding disasters and recovery (Chamlee-Wright and Storr, 2010; Gilbert, 1995; Hoffman, 1999b; Picou et al., 2004). Chamlee-Wright and Storr (2010) call this regime uncertainty, as linked with trust (or the lack thereof). 8 Becker et al. notes that trust issues arise when there is uncertainty regarding whether the mitigation measures advocated, or managed by organisations, will equate to reduced risk (2012, pp. 7
See in particular the following studies which discuss interactions of general life stressors and ‘daily hassles’ with other types: (Cerdá et al., 2013; DeLongis et al., 1988; Forsythe and Compas, 1987; Grzywacz et al., 2004; Hennessy et al., 2000; Lu, 1991; Miller and Rasmussen, 2010; Serido et al., 2004; Stawski et al., 2008; Suarez-Morales and Lopez, 2009). 8 Their descriptions of this are supported by the ethnographic fieldwork of Hoffman, Kilmer, and others from a range of disciplines: (Caia et al., 2010; Hartman and Squires, 2006; Hoffman, 1999a, 1999b; Kilmer, 2010; M. Levine et al., 2015; Levitt and Whitaker, 2009; Meskinazarian and Pelling, 2012; Pelling, 2003; G. Smith and Birkland, 2012).
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PSYCHOSOCIAL WELLBEING: COMMUNITIES, FAMILIES, YOUTH & CHILDREN 125-126; see also Perera-Mubarak, 2012 for perceptions of corruption in a postdisaster context). Institutional capabilities and limitations are an outcome of complex social interactions, power relationships, and economic circumstances (Hilhorst, 2003); to borrow from Putnam, “the performance of social institutions are indeed powerfully influenced by norms and networks of civic engagement” (cited in Meskinazarian and Pelling, 2012, p. 77). Uncertainty as a permanent postdisaster ‘state of being’ can lead to anticipatory anxiety, hypervigilance, hyperarousal, difficulty concentrating, trouble sleeping, increased irritability, inappropriate reactions, and a spectrum of related issues which indicate an increase in emotional and psychological vulnerability (Carll, 2007; Coates and Gaensbauer, 2009; Jones and Schmidt, 2013; Joseph et al., 1997; Kendall-Tackett, 2005; Nader, 2008; Norris, 1993; Shaw et al., 2012; Siegel, 2012; Stanley and Williams, 2000; Ursano and Norwood, 2003). “Uncertainty as an experience manifests itself as a state of feeling and consciousness. A state of fear, helplessness or lost orientation can be enforced by permanent changes in the living conditions. However, humans do not like to live with uncertainty. They try to either ignore it or – like complexity – reduce it” (Possekel, 2012, p. 25). Grasping how people in a postdisaster environment mitigate uncertainty is critical to understanding the process; residents trying to reconstitute their lives desire some ‘sense of what the future holds’ and processes that capture local conceptions of relevant conditions will generally prove better at mitigating it (Martin, 2010).
3.50 What do Disaster Models have to do with Children and Youth? Within the context of psychosocial analysis, the models that are being employed to manage and inform the postdisaster context for a community generate the actual and symbolic terms of discourse and reference regarding perceived progress, recovery (or adaptation), coping abilities, needs, and problems. In other words, these are the terms and concepts with which individuals within the community are communicating with a) the agencies charged with the mandate to assist, and b) with each other. The boundaries, limits, and terminology of this communication are set by these models, and children and young people are embedded in this network of relationships in a variety of ways. Threats to basic needs and depletion of resources emanate from multiple psychosocial domains, and increase the risk of negative emotional outcomes for this group (Weems and Overstreet, 2009). Franks (2011) refers to children in the contexts of postdisaster as ‘moving targets’, with different ways of understanding the world to adults. Disasters alter the contexts within which children are developing, and can alter their course of development, which brings into question the long-term usefulness of quantitative models that are focused on emergencybased coping (or dose-response), rather than on-going effects and impairment in other realms of children’s lives (Ibid, pp. 58-59). Whilst events models and biochemical models tend to conceptualise mental illness and wellbeing as emanating from psychological (internal) processes, psychosocial and stress models recognise social and cultural sources which may be beyond individual control (Aldwin, 2007). A transactionist (or systems) viewpoint acknowledges the contribution of both individual and environment, and looks for contexts rather than causal absolutes (Ibid).
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PSYCHOSOCIAL WELLBEING: COMMUNITIES, FAMILIES, YOUTH & CHILDREN Table 1: a Disaster
Ecologies and Salient Needs that may influence Youth Adaptation following
Table reproduced from Weems, C. F., and Overstreet, S. (2009). An Ecological-Needs-Based Perspective of Adolescent and Youth Emotional Development in the Context of Disaster: Lessons from Hurricane Katrina. In K. E. Cherry (Ed.), Lifespan Perspectives on natural disasters: coping with Katrina, Rita, and other storms. New York, NY: Springer US, p. 29.
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PSYCHOSOCIAL WELLBEING: COMMUNITIES, FAMILIES, YOUTH & CHILDREN This socio-ecological perspective (Bronfenbrenner, 1979), captured here within an analysis of children and adolescents exposed to Hurricane Katrina, posits that individuals function within multiple contexts that “vary in their proximity to the individual (e.g., a child) and include the macrosystem, which is the most distal ecology, and includes the government, culture, cultural values, and beliefs; the exosystem, which consists of processes taking place between two or more contexts, one of which does not directly involve the child, but has implications for the individual child (e.g., parent’s workplace); the mesosystem, which represents the linkages between proximal ecologies (e.g., school and home, parental participation in the child’s school); and the microsystem, which represents the proximal ecologies within which the child develops, including the family and school environments and peer relationships. The ontogenic level is the ecology of the individual and represents factors within the individual that influence developmental adaptation” (Weems and Overstreet, 2009, p. 28). In a summary of a range of research studies on children and youth (both school-aged and adolescent) Overstreet et al. show that postdisaster stressors in the months and years after a disaster can become more important than initial exposure factors in predicting long-term psychological outcomes; they are important risk factors for mental health as they serve as reminders of the initial event, tax coping skills, and create distress in their own right (La Greca et al., 1996; McFarlane et al., 1987; Norris et al., 1999; Overstreet et al., 2014). For some children, initial disaster related stressors may set in motion a cascading set of stressful life experiences (that is, consequences), such as parental divorce, separation, or illness, loss of routines and changes in ‘normal’ conditions, thus complicating their ability to cope (La Greca et al., 2010; Overstreet et al., 2014). “Extreme stress often depletes an individual’s independent coping abilities and resources; therefore, having others model healthy coping strategies is vital because it provides support during the struggle with ongoing loss and disruption” (Green, 1991; and Prinstein et al., 1996 cited in Overstreet et al., 2014, p. 58). Overstreet et al. highlight a body of research which supports the relationship between secondary stressors (such as parental unemployment, damaged homes, disrupted relationships with friends, and negative changes in lifestyle) and predictors of mental health issues in young people; depression, anxiety, and PTSD in particular (2014, p. 57). As the family is a primary support unit for children and youth, disruptions to the family’s ability to cope with everyday life commitments may result in loss spirals, where the additive loss of resources causes further distress, and as Hobfoll notes: “Employing resources for coping is stressful in itself” (1989, p. 518). Supporting people within a community as they learn to adapt to new circumstances following a disaster will, in turn, help support parents, which, by proxy, supports children. Determining the type of support required for parents is complex, as those who may perceive of themselves as unsupported may be receiving the most social support in an objective sense, but self-identify as not managing (Ghate and Hazel, 2002). There is a synergy, or interplay, between an individual’s self-perception, subjective, and objective measures that has to be carefully navigated in assessing need (Cherry, 2009). Gordon’s observation (2004b) that reasonable reactions or statements of need are qualified comparatively, and may deliberately mask vulnerabilities behind a veneer of ‘coping’ or ‘making do’ must also be considered in this context. The research on children coping with secondary stressors in family contexts summarises the issue as follows: “Lack of
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PSYCHOSOCIAL WELLBEING: COMMUNITIES, FAMILIES, YOUTH & CHILDREN family support networks can contribute to parental psychopathology. In turn, this can affect adults’ parenting, which then contributes to their children’s distress. Thus, the impact of events on adults may cause secondary effects, or burden, to fall on their children at a time when their usual needs have been intensified by their experiences of the same disaster. Viewed from the children’s perspectives, the impact of events on them can increase the burden of care that falls on their parents at a time when they may be struggling to cope with their own experiences... interaction between primary and secondary stressors within families and communities can also lead to mental disorders” (Lock et al., 2012).
4.0
A PSYCHOSOCIAL FOCUS ON CHILDREN AND YOUTH 0-18 YEARS
4.10 Resilience of Children and Youth in Postdisaster Contexts Recovery, or adaptation, in the postdisaster context, is generally connected to resilience, but moreso, it is connected with a commitment to resilience-enhancing initiatives and projects, over a long-term period, in order to cultivate a degree of permanent effectiveness (Ungar, 2012). Whilst initially, the central objective of research on postdisaster resilience (which emerged from the study of risk) has historically been concerned with the identification of ‘risk modifiers’ (that is, protective mechanisms and vulnerability factors) 9 which may be operative as predictors or explicans within potentially at-risk populations (Garmezy and Masten, 1986), resilience research has trended towards a processual, social, and ecologically oriented conceptualisation, given the heterogeneity of individual responses to stressors or otherwise destabilising events (Rutter, 2012a; Ungar, 2011). Resilience research is conceived of in terms of waves, with the fourth and fifth (most recent) waves of resilience research being very interdisciplinary and psychosocial in orientation.10 The fourth wave is described as a systems perspective that is focused upon multilevel adaptation and the dynamics of adaptation and change (Masten, 2007; O'Dougherty Wright et al., 2012); whilst the fifth wave brings together resilience practice and research with a social justice approach. 11 The fifth wave builds upon the first four (which were pioneered by Masten) to encourage a more politicised and community9
A protective mechanism can be defined as something that modifies the effect of risk in a helpful or beneficial way, whereas a vulnerability factor is not simply the inverse or a bipolar variable, but tends to coalesce negatively with other life stressors (Fergus and Zimmerman, 2005; Luthar, 1991, 2003; Luthar et al., 2000; Luthar et al., 2006). 10 In brief, the first wave is described as the creation of a ‘short list’ of observable correlates of resilience; the second wave is characterized by a concern with the processes that might account for these observed correlates; the third wave is psychologically-oriented with empirical investigations into prevention and intervention (Masten, 2007). The fourth wave includes gene research and epigenetic processes, neurobiological adaptation, brain development, behavior and multiple levels of interaction between these and other domains (O'Dougherty Wright et al., 2012). The fourth and fifth waves include a number of next generation psychosocial concepts, especially in the area of intervention. The wave metaphor used here ought not be confused with the multiwave analysis of disasters as mentioned earlier and used in Lowe et al. (Lowe et al., 2011; Lowe et al., 2015a; Lowe et al., 2013a; Lowe et al., 2012; Lowe et al., 2015b; Lowe et al., 2013b; Lowe et al., 2013c; Lowe et al., 2013d). 11 Fifth wave approaches are being pioneered by Angie Hart et al. at the University of Brighton. For research summaries and list of publications see https://www.brighton.ac.uk/healthresearch/research-areas/resilience/index.aspx
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PSYCHOSOCIAL WELLBEING: COMMUNITIES, FAMILIES, YOUTH & CHILDREN oriented notion of resilience which rejects the notion of ‘mass panic’ in disasters. The fifth wave is primarily intervention-based and emancipatory in orientation. Bonanno and Burton (2013, pp. 782-783) summarise three relatively common versions of a resilience definition: 1) recovery, which is an elastic process culminating in a return to the state prior to a trauma; 2) resistance, which is similar to immunological resistance and refers to individual characteristics that act as protective mechanisms; and 3) as a process culminating in adaptation leading to permanent reconfiguration, generally construed in terms of growth.12 Conversely, contemporary psychosocial scholarship adopts the following definition of resiliency, as a “dynamic process encompassing positive adaptation within the context of significant adversity” (Luthar et al., 2000, pp. 543, emphasis in original). This can be extended to incorporate the definition of Masten and Coatesworth (1998), which remains widely supported: “resilience is an inferential and contextual construct necessitating two key kinds of judgments. First, there must be a significant threat to an individual’s development. Secondly, there must be current or past dangers judged to have the potential to disrupt normal development. In other words, risk must be discernible” (in Zolkoski and Bullock, 2012, p. 2296). The claim that resilience can be retrospectively assessed in a community (or individual) also recurs in the literature, where it is defined as the collective ability to respond to the initial shock of an adverse event, and performance after the event has occurred, generally as linked to a measure of social capital (Birkmann, 2006; Liu, 2011; Meskinazarian and Pelling, 2012; National Research Council, 2006, 2011; Pelling, 2003; Zakour and Gillespie, 2013). Community disaster resilience (CDR) has become a key goal for communities afflicted by major adverse events worldwide. This is informed by the United Nation International Strategy for Disaster Reduction (UNISDR) definition of resilience as: “the ability of a system, community or society exposed to hazards to resist, absorb, accommodate to and recover from the effects of a hazard in a timely and effective manner, including through the preservation and restoration of its essential basic structures and functions” (Ostadtaghizadeh et al., 2015 np. emphasis in original). This type of resilience definition has proved to be difficult to employ, as resilience strengthening measures can be applied only subjectively in reference to the assessed vulnerability of a system. The implicit assumption, which can act to retard operational effectiveness, is that communities are too often perceived as relatively identical social units, and disasters or adverse events are conceptualised as if they were roughly commensurable with one another (Ungar, 2006, 2010b, 2011, 2013; Ungar et al., 2007). The terms by which a ‘successful’ response, good performance, or a good ‘outcome’ should be assessed also remain unclear (Masten, 2001; Masten and Coatsworth, 1998; Masten et al., 1999). 12
Bonanno, in this and other work, adopts the perspective that resilience is a ‘trait’; however the bulk of psychosocial scholarship tends toward rejecting the trait definition, whilst retaining the notion of personality characteristics as contributing important protective mechanisms. Bonanno and Burton provide a list of possible trait advantages, such as hardiness, resistances to the changes which may follow adversity, a commitment to stable emotional responses, positive selfconcepts and self-esteem, deliberate avoidance of memories and unpleasant emotions relative to the adverse event, optimism, self-improvement, coping, and a sense of coherence. This type of trait-based assessment of resilience is employed in the Connor-Davidson Resilience Scale (Bonanno and Burton, 2013, p. 783).
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PSYCHOSOCIAL WELLBEING: COMMUNITIES, FAMILIES, YOUTH & CHILDREN Contested definitions in resilience research raises concerns regarding a) what constitutes resilient behaviour and competence, b) how to best measure successful adaptation to hardship, c) how interpretation ought to proceed, and d) following interpretation, how then to operationalise interventions based upon both the scholarship and findings in the field (from a variety of disciplinary perspectives) and the on-going dynamic observation of, and interaction with, pre-identified vulnerable social groups. However, substantial longitudinal research on children and youth in adverse circumstances has demonstrated remarkable consistency in findings, in particular, that individual capacities (such as high intelligence, high sociality and ‘easy’ disposition), positive personality characteristics, achievements, and so forth can create highly adaptive individuals who are capable of compensatory behaviours when faced with adverse circumstances (Garmezy, 1991; Garmezy and Rutter, 1983; Rutter, 1987, 1989; Werner, 1989, 1993, 2012; Werner and Smith, 1982). This is based upon the evidence that ‘some’ individuals appear to have a better outcome than others, despite experiencing a similar level of adversity. There are still many questions regarding predictability of reaction, which has led to this goal being largely abandoned by researchers. For example, the experience of an adverse event can confer both sensitising effects and/or steeling effects relative to the experience of further adverse circumstances within the course of a person’s lifetime, sometimes together, and rather inconsistently across different domains (Rutter, 2012a). A steeling effect is similar to the notion of strength via adversity, or the colloquial notion of adversity building character, whilst a sensitising effect denotes the ‘wearing down’ or undermining of an individual’s ability to cope with stress; although, neither effect can be predicted in terms of pathways. Conversely, adverse experiences may confer what Unger (2006) refers to as hidden resilience some years following an event, which may become latterly conceptualised as, or transformed into, what is called posttraumatic growth (PTG). 13 Children process stress very differently as opposed to adults. For instance, research by Sprung et al. found that a child’s understanding of their own mind and its operation affects their ability to articulate their own intrusive thoughts (a common reaction to disasters) (Sprung, 2008; Sprung and Harris, 2010). Pynoos and Goenjian et al. suggest that a child’s developmental level can both positively and negatively influence the child’s own understanding of danger (lower age can denote less understanding, resulting in a positive effect) and that postdisaster effects can occur across multiple domains, from the development of adolescent depression and PTSD, to impacts upon the development of morality and conscience (Goenjian et al., 2009; Goenjian et al., 1995; Goenjian et al., 2011; Goenjian et al., 1999; Goenjian et al., 2005; Pynoos et al., 1999).
13
Recent research which supports this claim includes the following:(Betancourt, 2011, 2012; Betancourt et al., 2013; Cryder et al., 2006; de Jong, 2010; de Jong et al., 2015; Glad et al., 2013; Haroz et al., 2013; Hobfoll and De Vries, 1995; Hobfoll et al., 2009; Joseph, 2009; Joseph and Linley, 2008; Joseph et al., 1997; Kilmer et al., 2001; Kilmer and Gil-Rivas, 2008; Kilmer et al., 2014; Linley et al., 2011; Linley and Joseph, 2006; Meyerson et al., 2011; Seery et al., 2010; Shakespeare-Finch and Lurie-Beck, 2014; Sprague, 2014; Tedeschi, 1999; Tedeschi and Kilmer, 2005; Ungar, 2012).
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PSYCHOSOCIAL WELLBEING: COMMUNITIES, FAMILIES, YOUTH & CHILDREN Figure C:
Table of effects reproduced from Dogan-Ates, A. (2010). Developmental Differences in Children's and Adolescents' Post-Disaster Reactions. Issues in mental health nursing, 31(7), 470-476.
Such comprehensive lists of effects are widely found in the postdisaster literature, a range of effects such as those shown above (and others) are not only possible, but probable. It can also be argued that the overall ratio of children and youth experiencing some of the listed effects is going to be higher in populations with identifiable, shared, adverse events. Much of this kind of research began with Pynoos and Nader’s studies of a school sniper attack and related persistent PTSD (Nader et al., 1990; Pynoos et al., 1987). From this point onward, researchers began looking more comprehensively at shared adverse events and listing observed effects. What has emerged over time, however, is the realisation that such lists are so lengthy, they become almost redundant in terms of accurately ascertaining precisely how the unique constellation of social, emotional, psychological, cultural, cumulative experiences of postdisaster life, for any single individual, is likely to be experienced (Pfefferbaum et al., 2014a; Pfefferbaum et al., 2014b; Pfefferbaum et al., 2014c;
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PSYCHOSOCIAL WELLBEING: COMMUNITIES, FAMILIES, YOUTH & CHILDREN Pfefferbaum et al., 2014d; Pfefferbaum et al., 2013). The single consideration of having collectively experienced a ‘disaster’ is insufficient for such a task. What has become evident is that if children do not adequately process their mental and emotional responses to the adverse events in general, there remains the potential for effects to unfold over time. These are usually called sleeper effects, which means they appear unrelated, arrive late, and may worsen over time; however, these are difficult to attach to the disaster itself and difficult to measure below the age of eight.14 Rutter (2007) argues that the study of resilience demonstrates marked individual differences which are neither a reflection of measurement error, nor multifactorial causation, as has been evidenced by naturalistic and experimental, longitudinal and situational, animal, and human studies. His research presents resilience not as an observable ‘trait’, but an inference based upon findings concerning individual differences, wherein people may be resilient when presented with some situations, but not others (see also Masten and Tellegen, 2012; Rutter, 2007, 2012a). 15 He also notes that resilience cannot be reduced to the chemical processes that are a response to the moment of ‘exposure’, but has critical social context; furthermore, mediating (or coping) strategies as responses, which include both physical activities and mental operations, are central to the reconceptualisation of resilience as dynamic, interactive, and processual, rather than temporally fixed, or able to be scientifically established at a level which attracts losses or gains. A degree of continuity is expected in the assessment of any one individual; however, disruptions in the social context or life situation may create an impact that cannot be empirically correlated with the magnitude of the change (or event), or the inverse may be true. Negative psychopathological sequelae are not clearly indicated for any particular individuals, nor are they clearly correlated with certain types of stressors or traumatic events; furthermore, without a more nuanced appreciation of possible gene-environment interactions, more concrete understandings of potential biological pathways to resilience may remain elusive for some time (Cicchetti and Rogosch, 2012; Rutter, 2007, 2012a, 2012b). This is not to suggest that the studies do not show effects. Conclusions from multiple research projects emphasise the serious psychological harm that exposure to disasters may cause in a minority of susceptible individuals (Bonanno et al., 2010; Norris, 1992; Norris et al., 2002a, 2002b). Meta–analyses (of published reviews) have shown that only 5-10% of a population exposed to adverse events recognised as potentially traumatic may develop PTSD, and that the prevalence of such appears to be specifically linked to having 14
For supporting research on sleeper effects, see: (Catherall, 2005; Drumm and Stretch, 2004; Juffer et al., 2008; Rutter et al., 2008; Shaw et al., 2012) 15 Rutter, like Garmezy, Masten, Tellegen and others cited herein reject the trait model, as it cannot be ascertained whether the same features remain protective across a spectrum of risks, and, as Rutter argues, resilience cannot be measured directly as if it were a character trait. Ungar (2011) offers clarification on this. With the exception of very large longitudinal studies, resilience studies have been limited to a narrow set of traits or processes such as intelligence, attachment, educational performance, or civic engagement. He also supports the shift from trait-based measures, to an individual’s social and physical ecology as integral to enhancing wellbeing through an appreciation of self-environment interaction. Attempts at ‘measuring’ resilience tend to be so varied in terms of results that the usefulness of such studies becomes negligible, which has led to the technically ‘soft’, strengths-based approach to resilience that now dominates the field.
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PSYCHOSOCIAL WELLBEING: COMMUNITIES, FAMILIES, YOUTH & CHILDREN experienced an increased emotional reaction at the time of the event itself (Ozer et al., 2003). Research also shows that although the majority of children may experience severe distress after traumatic events, only a minority will develop full-blown PTSD (T.L. Taylor and Chemtob, 2004). 16 Although numerous longitudinal studies appear to have definitively ascribed specific and well-documented effects such as PTSD, suicide risk, and other issues to the aftermath of disaster, these results are in no way predictive. Researchers apply mixed methods, use a variety of scales, target particular demographics for applied study, work within diverse social, cultural, and temporal contexts, and employ different disciplinary lenses. The result is a vast base literature that is generally referred to as ‘conclusive’ or ‘extensive’ disaster research that can be used to both support, and debunk, the persistence of any number of effects in a target population.17 Although these studies (and others) provide absolutely clear evidence that the disasters or events in question did have an effect that was sometimes quite devastating on some portion of a particular population studied, the suggestion that these observations or results can be used as a conclusionary or predictive body of research is in error. All that can be reasonably inferred is that any adverse event will impact upon an individual either positively (as growth), or negatively, within any social group, in a range of ways that are directly relative to, and may act to reinforce a highly individualised degree of pre-existing vulnerabilities within very specialised social and cultural contexts. 18 Where predictability is desired, especially for studies that have an emergency response or medical focus, there is ample selective ‘evidence’ cited and claimed to suggest that it can be achieved; however, when the literature is considered as a whole, this claim proves to be unsupported and the resultant theories untenable. As Masten’s work in this area (over many years) demonstrates, the research data is certainly remarkably consistent in terms of
16
The symptoms of PTSD which culminate in clinical diagnoses may include: re-experiencing of traumatic events as flashbacks, repetitive thoughts, avoidance of trauma-related memories, psychic numbing, concentration problems, sleeping disturbances, nightmares, excessive fear, externalizing and internalizing symptomology (Peltonen and Punamäki, 2010). 17 Studies which have been used by scholars variously to both support, and deny, these claims include the following longitudinal bodies of research: The Isle of Wight studies (Collishaw et al., 2007; Pickles et al., 2010; Rutter, 1980, 1989, 1994, 1998; Rutter et al., 1976); the Dutch Famine birth cohort (Alisic et al., 2011; de Rooij et al., 2007; Lumey, 1998; Lumey et al., 2004; Lumey and Stein, 1997; Lumey et al., 2007; Lumey et al., 1995; Painter et al., 2008; Painter et al., 2005; Painter et al., 2012; Phillips et al., 2012; Räikkönen et al., 2012; Roseboom, 2012; Roseboom et al., 2006; Roseboom and de Rooij, 2013; Roseboom et al., 2012; Roseboom and Lambalk, 2001; Roseboom et al., 2011; Roseboom et al., 2001; Susser et al., 1998; B. van den Berg et al., 2012; Van der Velden et al., 2014; Veenendaal et al., 2013; Zucchi et al., 2013); the Kauai birth cohort (Hamada et al., 2003; Werner, 1989, 1993, 2004, 2012; Werner and Smith, 1982);the Buffalo Creek Disaster (Erikson, 1976a, 1976b, 1979, 1998; Ewen and Lewis, 1999; Green et al., 1981; Green et al., 1994; Green et al., 1990; Lifton and Olson, 1976); and Project Ice Storm (Auger et al., 2011; Brunet et al., 2003; Cao-Lei et al., 2014; Cao et al., 2014; Dancause et al., 2012; Dancause et al., 2011; Dancause et al., 2013; Harville et al., 2010; S. King et al., 2014; S. King and Laplante, 2005; S. King et al., 2003; Laplante et al., 2004; Laplante et al., 2008; Morin, 2005; Turcotte-Tremblay et al., 2014; Walder et al., 2014) 18 Support for this point can be substantiated by a considerable number of authors, of which a subset are: (Ardino, 2011; Bankoff, 2003a, 2003b, 2004; Bankoff et al., 2004; Marsella, 2010; Marsella et al., 2007; McDermott et al., 2010; McEntire, 2001, 2005, 2015; McEntire and Fuller, 2002; McEntire et al., 2002; Van der Kolk et al., 1996).
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PSYCHOSOCIAL WELLBEING: COMMUNITIES, FAMILIES, YOUTH & CHILDREN findings, but these findings show differential susceptibility and trajectories in terms of outcomes, developmental and otherwise: in other words, contexts matter. 19 Figure D:
Reproduced from Masten, A. S. (2013). Learning from disaster: perspectives from research in resilience on children and youth. Paper presented at the IOM Workshop on Disaster Preparedness, Response and Recovery: Considerations for Children and Families, June 10-11, 2013.
Life history not only matters in this assessment, but is crucial for consideration; consequently, the particular ways in which children and youth are embedded within specific social and cultural histories, communities, families, systems of meaning and experiences, must be fully taken into account. Scaer (2001) emphasises the potential somatic manifestations of emotional states which may have a delayed onset and diverse symptomology. Although natural disaster, exposure to warfare, assault, kidnapping, rape, physical injury through accident, and so forth, may be very different types of experience, the reaction of a particular individual to one or many of these has been shown to be 19
Research by Masten, with co-authors, as consulted for this review includes: (Burt et al., 2008; Garmezy and Masten, 1986; Herbers et al., 2014; Masten, 2001, 2006, 2007, 2011, 2013, 2014a, 2014b, 2015a, 2015b; Masten and Cicchetti, 2010; Masten and Coatsworth, 1998; Masten et al., 2008a, 2009; Masten and Garmezy, 1985; Masten et al., 2008b; Masten et al., 1999; Masten et al., 1993; Masten and Monn, 2015; Masten and Narayan, 2012; Masten and Obradovic, 2008; Masten and Osofsky, 2010; Masten et al., 2005; Masten and Tellegen, 2012; Nüchterlein et al., 1993; O'Dougherty Wright et al., 2012; Southwick et al., 2014). Strong support for the Masten findings on contexts as critical can be found in: (Pfefferbaum et al., 2014a; Pfefferbaum and North, 2013; Pfefferbaum et al., 2014b; Pfefferbaum et al., 2014c; Pfefferbaum et al., 2014d; Pfefferbaum et al., 2013; Rodriguez-Llanes et al., 2013).
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PSYCHOSOCIAL WELLBEING: COMMUNITIES, FAMILIES, YOUTH & CHILDREN relative to the cumulative load of experiences which have been personally identified or experienced as ‘traumatic’ (Ibid; see also Vermetten, 2015). In other words, the ‘effect’ of such an event is directly connected to other experiences which have occurred in the life of an individual, prior to the most recent experience; thus, resiliency is conferred more strongly in the absence of pre-existing vulnerabilities (Bomyea et al., 2012; Nordanger et al., 2014; Vijayakumar et al., 2006). Structured and intensive interventions are required where there is evidence of a preexisting cumulative load which has been either identified by the individual concerned, or evidenced by mental and/or physical presentation of symptoms, as traumatic. Health services need to be well-equipped to diagnose and treat severe symptoms, with sufficient resources to be operative long-term (R. Williams et al., 2008). As international studies of postdisaster communities make very clear, long-term serious problems for a minority of the population can be expected, and findings are extremely consistent. 20 If there is clear presentation of substantial anxiety or other psychopathological features that become obvious, in addition to the general set of postdisaster anxieties evident within a population, the general response is to apply more specialised therapeutic interventions, generally in the form of cognitive-behavioural therapies.21 Making a therapeutic intervention available is useful only if it is possible to identify the individuals who are not coping, coping moderately, or are misidentifying their ability (or inability) to cope. 22 Symptoms which follow such events are generally attributed to PTSD; however, purely psychiatric diagnoses cannot account for mental and physical symptoms which are the expression of a body that is in crisis. To complicate this further, “there remain surprisingly few longitudinal studies that control for preexisting and ongoing concurrent associations so that models of bidirectional influences and progressive effects from one domain of adaptation to another can be evaluated in a developmental perspective” (Masten et al., 2005). Conrad (2007) critiques overt medicalisation, defining it as the translation of human 20
Consistency in research findings is demonstrated by the work of the following authors:(Burt et al., 2008; Garmezy, 1991; Garmezy and Masten, 1986; Garmezy and Rutter, 1983; Goenjian et al., 2005; Herbers et al., 2014; Kinney et al., 2008; Kõlves et al., 2013; La Greca et al., 2010; La Greca et al., 1996; Lai et al., 2013; Masten, 2006, 2011, 2015b; Masten and Coatsworth, 1998; Masten et al., 2008a, 2009; Masten et al., 1999; Masten and Narayan, 2012; Masten and Osofsky, 2010; Masten and Tellegen, 2012; Moore and Varela, 2010; Norris, 1992; Norris et al., 2002a, 2002b; Norris et al., 1993; North et al., 2012; Nüchterlein et al., 1993; O'Dougherty Wright et al., 2012; Pfefferbaum et al., 2013; Pynoos et al., 1995; Pynoos and Nader, 1989; Pynoos et al., 1987; Rutter, 1987, 1989; Self-Brown et al., 2013; Southwick et al., 2014; Weems et al., 2013; Werner, 1989, 1993, 2012; Werner and Smith, 1982). 21 For more information on CBT, see the following papers: (Dattilio and Freeman, 2007; DeRosa et al., 2013; Ehlers et al., 2010; EPC Project, 2012; Jaycox et al., 2010; Kowalik et al., 2011; Pfefferbaum et al., 2014b; Pfefferbaum et al., 2014c; Shooshtary et al., 2008; Silverman et al., 2008; L.K. Taylor and Weems, 2011; Wethington et al., 2008). 22 Identification processes are beyond the scope of this review, however, key vulnerability factors and potential screens are discussed in the following sources: (Ardino, 2011; Asarnow et al., 1999; Bomyea et al., 2012; Delahanty, 2008; DiGangi et al., 2013; Jaycox et al., 2010; D.N. King, 2005; Lai et al., 2014; Lai et al., 2015; Lai et al., 2013; Leen-Feldner et al., 2013; McDonald et al., 2014; Nordanger et al., 2014; Purgato et al., 2014; Silverman and La Greca, 2002; Stanley and Williams, 2000; Steinbaum et al., 2008; Trickey et al., 2012; Verlinden et al., 2013; Vijayakumar et al., 2006; J.P. Wilson and Raphael, 1993).
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PSYCHOSOCIAL WELLBEING: COMMUNITIES, FAMILIES, YOUTH & CHILDREN conditions into treatable disorders. Psychosocial approaches, on the other hand, aim to achieve the opposite, by linking identified disorders to the conditions of human life, and applying methods which try to capture and resolve conflicts which arise from the space in between. The methods are holistic in both theory, and practice. As Scaer argues, the reduction of any diagnosis to PTSD neglects the somatic and emotional consequences of trauma which might affect all aspects of a person’s being. What is “produced by threat, shock, or injury that occurs in a state of helplessness, and the neurophysiological changes triggered by these experiences are somehow stored in a person’s unconscious memory in a cumulative manner along with other such life experience. Accumulation of traumatic life experiences then leads to a condition of increasing vulnerability and decreased resiliency to further trauma” (Scaer, 2001, p. xxi). It is in this area, wherein an individual is embedded within a set of relationships, that temporal-spatial models finally appear useful in the study of postdisaster effects. The theory of a cumulative load, as derived from life context and experiences, can be instructively connected with the concept of developmental cascades, which refers “to the idea that functioning in one domain or at one level of adaptation can spread to influence other domains or levels of adaptive function” (Masten and Tellegen, 2012, p. 349). The basic concept is that proficiency begets proficiency, and the reverse is also true: problems can span social domains just as readily as successes. What is being advocated here is a relational idea of transfer or transactional exchange between different social domains, over time, between systems, and across generations. The individual, in this context, is literally the site of exchange between self, past, future, and the world within which they are in relationship. Evidence from the Masten and Tellegen’s research, which took the form of a 20-year longitudinal study, 23 also supports the idea that families and communities acquire cumulative cultural wisdoms that facilitate future success in any particular context, and may also signal what tools need to be acquired by the group for ongoing adaptive success (Ibid). Furthermore, with these concepts in mind, it is possible to conceive of ripple effects as generated to flow in the opposite direction, with positive ripples resulting from community engagement and enhancement strategies (Hess et al., 2003; Medoff and Sklar, 1994; Sanders et al., 2009). 23
The Project Competence Longitudinal Study (PCLS), initiated by Norman Garmezy, “contributed models, measures, and methods, as well as working definitions of concepts like competence, developmental tasks, protective factors, and resilience. Findings from the study corroborated the feasibility of studying adaptation in a normative group of school children, identifying patterns of resilience, competence without major adversity, and maladaptive paths through life. Competence was multidimensional, showing continuity and change over time. Cascading effects across domains indicated that competence and problems spread over time. Thus, adult achievements in developmental tasks were rooted in childhood and adolescence. Young people who showed resilience had much in common with similarly successful peers who experienced less adversity over time, including high-quality relationships with parents and other adults, and good cognitive, as well as social–emotional, skills. Maladaptive youth in the study often faced high adversity with little adaptive capacity (internal or external) and tended to generate stressful experiences. Resilience often emerged in childhood and endured, but there also were late bloomers whose lives turned around in the transition to adulthood” (cited directly from abstract, Masten and Tellegen, 2012). PCLS also found that a self-described degree of wellbeing in work performance, educational pursuit, romantic relationships, parenting, and measures of financial success fit the definition of ‘doing well’ for young Americans.
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PSYCHOSOCIAL WELLBEING: COMMUNITIES, FAMILIES, YOUTH & CHILDREN
4.20 Coping and Competence of Children and Youth in Postdisaster Contexts A combination of the exponential growth within resilience research, fourth and fifth wave modifications, and the ever-increasing uncertainty regarding the predictability of models and effects, has led to the adoption of a strengths-based focus in the most recent generation of resilience research. This, in turn, has put the emphasis on broad interventional strategies which enhance coping skills and competence within any population that can be assumed to be experiencing a variety of posttraumatic, postdisaster, or adverse effects, not all of which can be presumed with absolute certainty within the target population. Monitoring progress in a population of children and youth in postdisaster contexts is notoriously unpredictable and, often, families with the greatest need ‘make the least noise’ and thus, receive the least support. Consequently, it may be necessary to maintain a degree of community-support infrastructure for an extended duration in order to address these situations effectively. Hence, as Ungar notes, implementation of long-term intervention strategies tends to garner the most success (2012). Atwool (2013) cautions that targeted services, as determined by eligibility criteria, may not reach all those who need them, and furthermore, families who need support may become reluctant to come forward if the status of a service as ‘monitored’ is perceived as a risk. Coping is defined as a relatively stable, individualistic, quality which implies overt action, but on its own does not include the social context necessary in a comprehensive definition of resilience (Rutter, 2007, p. 207; 2012b, p. 34). There are polar distinctions in coping styles and skills, depending upon the event and the regulatory strategies selected, for instance, a preference for introspective and avoidant versus external expressive (or social) mediation devices (Bonanno and Burton, 2013; Braun-Lewensohn, 2012, 2015; Braun-Lewensohn et al., 2009; Braun-Lewensohn et al., 2014; Braun-Lewensohn et al., 2011; Kagan, 1994). Coping skills are diverse and people respond to stressful events in different ways. Poor environments or poor parenting do not necessarily culminate in poor coping, although there is a degree of correlation in terms of vulnerability within certain (termed at-risk) populations (Ghate and Hazel, 2002). The concepts of being at-risk, and the related idea of the possession of limited social capital, have differential definitions, and that this situation is often linked to poverty as high-risk, is tenuous in different cultural contexts (Ibid). To offer an example, poorer communities with active, organised, stable, cohesive communities can be positively buffered against adverse events in a manner that isolated citizens and fragmented communities cannot (Leadbeater et al., 2004, p. 23). When an adverse event occurs, a group which already has a strong community and identity focus does not need to recover to the same degree as a group which lacks this social cohesion, which may account for a number of the widely divergent postdisaster findings (see also Lambert, 2014c). Resilience can therefore be said to be strengthened by social and cultural bonds which afford coherence to the everyday and extraordinary experiences in life. Schoon defines coherence as comprising of three dimensions: “comprehensibility (the extent to which an individual perceives a situation as meaningful and predictable); manageability (the degree to which an individual perceives his or her own resources to be sufficient to meet demands); and meaningfulness (the degree to which an individual feels that life is
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PSYCHOSOCIAL WELLBEING: COMMUNITIES, FAMILIES, YOUTH & CHILDREN meaningful and that problems are perceived as challenges rather than hindrances)” (2012, p. 152). Masten and Coatesworth include competence, which is key to adaptation, in their definition of resilience, specifically framing resilience as “manifested competence in the context of significant challenges to adaptation or development” (1998, p. 206). Competence can be defined as the criteria for adaptive success under difficult circumstances (Masten and Tellegen, 2012, p. 347). The ‘measure’ of individual competence (which results from complex interaction between an individual and their environment) is difficult to capture, as the development of competence in one domain may not confer to competence in others (Burt et al., 2008; Lau and Wu, 2012; Luthar et al., 2000; Masten and Coatsworth, 1998; Masten et al., 2008b; Masten et al., 1999; Masten and Tellegen, 2012; Rutter, 2007; Schoon and Parsons, 2002). In addition, an individual may be competent during one time in life, but not in another, which means that not only situational changes need be considered, but developmental and environmental changes must be included in a lifespan perspective. Cultural considerations are also important within the competence literature, especially when a child lives in a cultural context that differs from the majority population, and competent behaviours, within that context, are considered otherwise inappropriate, or exhibit different axiological orientations (Masten and Coatsworth, 1998). Competence is not achievement, but is a reflection of good adaptation to a situation, which may be performance in developmental tasks, but may also be the application of emotional intelligence, successful conduct (in accordance with prescribed social norms) within a peer situation, or even a self-description of experiencing wellbeing. This leads to the conclusion that good adaptation by children, youth, their families, and their communities, specifically through the application of broad-scale, long-term intervention programmes focused primarily upon enhancing coping skills and competence, are, in summary, the findings of the body of research as analysed in psychosocial terms.
4.30 Establishing a Vulnerability Baseline for Assessing the Ongoing Ripple Effects for Children and Youth in the Greater Christchurch Area Research has found that the inability of members of any community to perform ‘normal’ or ‘usual’ functions may lead to a secondary community disaster in which the ability of the community to adapt or recover is delayed (Alesch and Arendt, 2015; Zakour and Gillespie, 2013). Disasters can elicit what Biruski et al. (2014) call damage to worldview, or disruptions to ontological security, which is in colloquial terms, the rules for what is and is not permitted to happen in an individual’s life. Norris et al. write: “Communities share damages and disruptions to the various environments of which they are composed” (Norris et al., 2008, p. 131). A lack of co-ordinated services and initiatives, which may supply ballast to the emerging social infrastructure, can stimulate on-going tensions and create additional problems for the postdisaster community (R. Gordon, 2009; Nakagawa and Shaw, 2004). A psychosocial perspective holds that infants, children, young people, adults, families, members of communities, citizens, migrants, and visitors, encountering or living within a postdisaster community, with a particular infrastructural organisation, are all part of a
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PSYCHOSOCIAL WELLBEING: COMMUNITIES, FAMILIES, YOUTH & CHILDREN system of exchange that is primarily based upon relationships. The society which is emergent is a collective representation of the quality of those relationships. Much of the research on children, youth, and vulnerability in the Aotearoa New Zealand context, is summarised comprehensively in Atwool (2013), however, this research can be usefully augmented and is well supported by the international findings of Masten and Unger. Understanding the factors which are deterministic of increased vulnerability for children and youth requires an internalisation of the founding concept of modern resilience research, which is that not all children born into adverse circumstances fare badly; some appear to thrive or ‘defy the odds’ in spite of what are widely recognised as cumulative risk factors (Atwool, 2013; Howard et al., 1999; Resnick, 2000). 24 These risk factors are, with few exceptions, all environmental: “At the societal level they include poverty, poor housing, violent neighbourhoods, and marginalisation. At the family level they include isolation, family violence, abuse and neglect, compromised parenting due to mental health issues, alcohol and substance abuse and gambling; second-hand smoke exposure; parent(s) with a criminal record; low level of parental educational attainment; early parenthood; high mobility; and changing family structures” (cited in Atwool, 2013, p. 45). 25 In Aotearoa New Zealand, Māori and Pasifika families are overrepresented in the risk statistics (Atwool, 2013), which overlook the cumulative nature of risk and the diverse response trajectories identified by Masten and cited extensively in this review. Children exposed to a single risk factor tend to fare better than those who are exposed to multiple risk factors (Turner et al., 2010); however, development can be compromised by a single factor, especially if endured over time (Atwool, 2013; Masten, 2015b; Masten and Cicchetti, 2010; Masten and Coatsworth, 1998). The facilitatation of wellbeing can be said to be concretely linked to social experiences (Norris and Kaniasty, 1996); and the three key factors in the cultivation of positive coping in vulnerable or adverse circumstances are family support (internal), supportive relationships with persons within the extended community (external), and positive cultural belonging (Atwool, 2013, p. 46; Ungar, 2010b, 2011, 2013). 26 Of all the possible risk factors, children and youth who are experiencing isolation, and have limited social and cultural capital to draw upon, can be considered as exposed to the most risk regarding the full spectrum of psychological, emotional, and physical effects (McDermott et al., 2012; Moscardino et al., 2010; Panagioti et al., 2014). The pre-existent 24
Note that the use of the term increased vulnerability is used herein to point to the fact that all children and youth should be considered a priori as vulnerable, by proxy of having lesser agency in regard to control of their circumstances than adults (Atwool, 2013). 25 For research on alcohol abuse as a significant problem for parents and adolescents coping with adverse events, which has become an increasingly relevant concern within Aotearoa New Zealand context, see: (Boscarino et al., 2006; Cerdá et al., 2011a; Cerdá et al., 2011b; Chen et al., 2009; Freisthler et al., 2009; Huerta and Borgonovi, 2010; Marie, 2014; Masten et al., 2009; Pasch et al., 2009; Swahn and Bossarte, 2007; Theall et al., 2009; Visser et al., 2014). 26 Just as cascading risk does not necessarily lead to poor coping and competence, resilience research also shows that favourable genes and conditions do not always culminate in positive development trajectories and outcomes (Masten, 2007). In response to findings such as these, fourth wave resilience research has begun investigation into reprogramming stress networks to operate more capably when there is positive caregiving environment (Bradley et al., 2013; Calkins et al., 2013; Cicchetti, 2010; Cicchetti and Rogosch, 2012; Grigorenko et al., 2012; Luthar et al., 2000; Masten and Cicchetti, 2010; Nüchterlein et al., 1993; Toth and Cicchetti, 2011).
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PSYCHOSOCIAL WELLBEING: COMMUNITIES, FAMILIES, YOUTH & CHILDREN absence, or emergent deterioration, of family and social support (including how relationships are experienced, an ongoing sense of displacement, and positive feelings of community and belonging), impacts upon positive cognitive appraisals of adverse events, and may increase anxiety, depression, and more serious emergent psychological discontinuities (Bonanno et al., 2010; Campbell, 2014; Canfield, 2015; Havell, 2012; Norris and Kaniasty, 1996; Ozer et al., 2003). Displacement is a particularly strong factor for evoking feelings of safety, certainty, and connection, as evidenced by research on homelessness, home disruption postdisaster, place-attachment, and high family mobility. 27 Disaster experiences elicit feelings of uncertainty regarding beliefs about the world as a predictable and safe place (Biruski et al., 2014); displacement experiences are a particularly traumatic ripple effect which flows on from this uncertainty and can intensify it. In agreement with international literature, the Child Poverty Action Group research on children in the postdisaster Greater Christchurch area also emphasise: “(in)security of housing plays an important role in a child’s experiences both immediately after an earthquake and in the recovery period. Long-term problems, be they emotional, behavioural, physical or psychological, are more likely to be seen amongst children who have lost their house and/or possessions as a result of the disaster. Being able to restore a child’s ‘home’, even if this is just a different home, helps re-establish a child’s sense of security and normalcy... recovery of housing is [also] considered crucial to the recovery of a community as a whole” (Shirlaw, 2014, p. 7). 28 This report also cites a child’s own report (age 12) of her postdisaster displacement experiences: Me and my family have been struggling to find a permanent house to live in. First we started in Addington, where we had to move out of so we went to a friend's house and stayed in their garage. So we decided to go and stay in a sleep out. It was all good but then it went wrong. So me and my mum and my sisters stayed at another friend's house while our dad 27
A selection of considerations regarding displacement issues can be found in: (Abramson et al., 2010; Caia et al., 2010; Campbell, 2014; Canfield, 2015; Dickinson, 2013; Kılıç et al., 2006; Koch, 2015; Lê et al., 2013; J.N. Levine et al., 2007; Merdjanoff, 2013; Pfefferbaum et al., 2008; Samuels, 2009; Scannell and Gifford, 2010; Swick et al., 2014; Tapsell and Tunstall, 2008). 28 Also noted in this report: loss of housing stock “plus the entry of new renters needing housing after the permanent or temporary loss of their home, has led to a sharp increase in the demand for rental housing and significant increases in rents. A Housing Report completed by the Ministry of Business, Innovation and Employment in March this year found that average weekly rents in Christchurch increased 31% between August 2010 (just before the first earthquake) and February 2013. As a comparison, average weekly rents in Auckland increased by 13% in the same period. (More recently, figures released by Trade Me Property found that advertised rents for Canterbury rental properties were on average 25% higher than the previous year, and that for the first time ever, advertised rents for Christchurch properties were highest in New Zealand.)” (“Housing Pressures in Christchurch: A summary of the evidence” (2013) Ministry of Business Innovation and Employment, in Shirlaw, 2014, p. 7). This report also states that the majority of renters in Christchurch are low-income earners; a recent survey by the Christchurch Tenant’s Protection Association found that 52.7% of the tenants they surveyed had an annual income of less than $35,000, more than half of those tenants were (at time of publication) paying more than 40% of their income in rent, and more than 60% living in rental accommodation were yet to have damages repaired. The cascade effects upon children and youth from displacement and family financial pressure at the levels summarised here need to be considered seriously.
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PSYCHOSOCIAL WELLBEING: COMMUNITIES, FAMILIES, YOUTH & CHILDREN hired a caravan in Spencer Park. It was fine for him, but when we arrived we got really cramped so Mum hired another caravan in Spencer Park. Perfection was here! Except when we needed to have a shower or watch TV, because we had to run across the field even when it was raining. And we had to run across the camp site to go to the toilet. Mum suggested we go round the back of the caravan but there were insects so no-one wanted to do that. In the end we got a real house to live in but there's still one wish. I wish we get to live in the house forever because I'm sick of having to move house to house all the time (Shirlaw, 2014, p. 8). Shirlaw also attempts to capture the situation of children who are experiencing disruptions in their schooling environments, where such settings can be thought of, in psychosocial terms, as facilitating a network of relationships between children and youth, parents, teachers, school administrators, principals, and the school neighbourhood: all of whom are people living within a postdisaster context and, thus, experiencing the ripple effects and cascading consequences in the personal, family, working, and community spheres of their everyday lives (Parker, 2015; Sells et al., 2009). As Shirlaw states: “In a secular society schools frequently represent the heart or centre of a community; in the absence of a shared religion they become an important place of gathering. And, even under normal circumstances, children form significant emotional attachments to their school... A child’s recovery from a traumatic event is assisted if their school is able to provide a stable and familiar environment” (2014, p. 10). Lambert, who has written numerous papers on the experiences of Māori in the context of the Canterbury sequence of earthquake events, has demonstrated that Māori communities were significantly advantaged by the pre-existent cultural and community bonds, which he linked to increased resilience, coping, and endurance by Māori, within the postdisaster context (Lambert, 2014a, 2014b, 2014c, 2014d; Lambert and Mark-Shadbolt, 2012; Lambert et al., 2012). Within Māori traditions of tuakana/teina, where older whānau members support the young, a sense of collective identity and traditions of mentorship in the context of what are often shared, socially adverse, conditions are widely conceived of as increasing competence (Farruggia et al., 2011; Kenney and Phibbs, 2014, 2015; see also Lauer, 2012 for ethnographic examples regarding similar indigenous responses in the wake of disaster in the Solomon Islands; Norenzayan and Lee, 2010 for cultural variation in fate attributions; and Picou, 2000 for talking circle practices after the Exxon Valdez Oil Spill in an Alaskan context). On the other hand, the ongoing nature and impact of social adversity or limitations to those who are not experiencing coherence and a sense of belonging, despite cultural identification as Māori, has to also be considered in a similar manner to others who feel isolated from, or within, their communities (for research on serious impacts, such as suicide, see Beautrais, 2001; and Fergusson and Beautrais, 2006; for race and ethnicity identification as conferring critical identity support, see Webber et al., 2013). In the Pasifika context, although specific traditions vary, the strong identification with the notion of home is of central cultural importance: for instance, Samoan communities may link identity to belonging and connection to aiga (family and extended kin), ancestral land, and knowledge of the Samoan language (Farruggia et al., 2011). As a migrant community, however, Pasifika youth experience two kinds of isolation: from both the community at
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PSYCHOSOCIAL WELLBEING: COMMUNITIES, FAMILIES, YOUTH & CHILDREN home, in the Pacific Islands, and from the values which are a part of Aotearoa New Zealand society, often radically different from the traditionalist views maintained by their parents (Anae, 2000; see also Vakalahi, 2009). Acculturation perspectives, which aim for greater assimilation of migrant populations within the community in question, may increase competence in some areas but decrease it in other domains (Dimitrova et al., 2013; Marsella et al., 2007; Ungar, 2010b). There is no single pattern which confers resilience, but cross-cultural studies in Euro-American (Western) and distinctly non-Western contexts identified seven tensions which appear to be implicated in positive and negative resilience outcomes: access to resources, relationships, identity, cohesion, power and control, social justice, and cultural adherence (Ungar et al., 2007). Universalistic ideas about ethnic difference as problematic, or attracting potentially negative outcomes, may also lead to the underestimation of risk in both the dominant and the underrepresented (often statistically invisible) migrant populations (Atwool, 2013). The postdisaster experiences of new migrants, who were already settled into the greater Christchurch area prior to 2010, are underrepresented in the literature (Brown et al., 2015; Carlton and Vallance, 2013; L. Gordon et al., 2014; Seville et al., 2012). Many studies do not consider ethnicity, belonging, cultural norms, values, and institutions, as a part of the research at all. For example, a recent study on reactions to the already mentioned earthquakes, conducted in two Christchurch City suburbs to assess acute stress reactions did not mention cultural contexts, despite comparing two suburbs (Avonside and Hornby North) with quite significant demographic differences (Dorahy and Kannis-Dymand, 2011). Gawith has also conducted local research which states that ‘different groups of people may experience disaster in a range of ways’, but she fails to situate the participants contextually; they appear as disembodied voices (2013, p. 396). Although the possible reasons for this are beyond the scope of this review, it is important to note that cultural situatedness (or lack thereof) is absolutely integral for all assessments of vulnerability, independently of whatever scales or measures are used (Deeny and McFetridge, 2005). Furthermore, cultural situatedness does not equate with ethnicity, but with an experience of socio-cultural cohesion, wherein the norms and values of a community of others translate to positive interpretive and adaptative resources for demonstrating competence in the wake of extraordinary experiences. In her summary of the Ministry of Social Development Green Paper findings, 29 Atwool notes the figure of 15%, given for children living in circumstances that increase vulnerability, is possibly an underestimate, especially considering the children impacted by the effects of the greater Christchurch area sequence of earthquake events (2013, p. 49). The Green Paper, which prioritises child-centred policy changes and child-centred practices, does not give a definition of vulnerability, nor does it offer an integrated approach which can comprehensively manage the coordination of services and initiatives across multiple agencies and community groups. Scott, (2009, cited in Atwool, 2013, p. 50) is attributed 29
The Green Paper, White Paper, and an extensive list of submissions can be found at http://www.msd.govt.nz/about-msd-and-our-work/whats-happening/2011/green-paper-forvulnerable-children.html; http://www.msd.govt.nz/about-msd-and-our-work/workprogrammes/policy-development/green-paper-vulnerable-children/submissions/0000000499a.html and http://www.childrensactionplan.govt.nz/.
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PSYCHOSOCIAL WELLBEING: COMMUNITIES, FAMILIES, YOUTH & CHILDREN with the observation that: “Traditionally, services have operated in silos and professionals within those silos define their roles in ways that may limit their responsiveness to children who are vulnerable.” What is required to engage with vulnerability, as viewed from a psychosocial perspective, is a co-ordination of efforts which take into account multiple voices: from children, youth, their families, and the communities they live in, with the focus on listen and response initiatives, using participatory, relational strategies, rather than applied interventions structured as top-down ‘delivered’ initiatives (R. Rose et al., 2005; A.B. Smith, 2013; Underdown, 2006). Atwool considers the Whānau Ora initiative to be a significant step in going beyond what she calls the ‘rhetoric of coordinated service delivery’, but notes that it is yet to be determined whether mainstream services will be willing to work differently with the alternative kinds of demands embedded within such an approach (2013, p. 51). It can be broadly assumed from the data collected by the CDHB All Right Research Findings (February 2015)30 that greater Christchurch area residents, especially those who are still struggling with insurance claims and displacement issues, are experiencing a range of ripple effects, including wide-scale dissatisfaction with infrastructural and bureaucratic support efforts in a range of areas, which impact upon their overall wellbeing. As children and young people are embedded in family and community relationships within which they can be said to have limited agency regarding a) their personal contribution to enhancing family wellbeing, and b) their vulnerability to the effects of a lack of family wellbeing, the dissatisfaction of residents, as noted by the All Right research, should be seriously considered as contributing to ongoing cascading consequences that may impact upon children and youth within the postdisaster context (see Prilleltensky et al., 2001 for research on children's agency, power and control). According to the Families Commission research conducted in the greater Christchurch area, need for support varies. Families living in the postdisaster context are at risk of excess fatigue and may need intensive support interventions, but yet they do not always seek help or do not know where or how to procure it (Families Commission, 2014). This finding is consistent with the research by Ghate and Hazel, which indicated that “Data on parents’ attitudes to support… suggested that, even when support was available, there may be strong barriers to uptake connected with negative attitudes to asking for, or receiving support. This applied both to support within the immediate family and external to it. Indeed, problems with perceptions of informal support as potentially threatening or undermining, and discomfort with the expectations of reciprocity embedded in informal support relationships were widely evident in this normative sample, and not by any means confined to those with more severe levels of personal problems or parenting difficulties” (2002, p. 162). Gordon’s points regarding the concealment of vulnerabilities are also relevant in this context: “Tensions begin to develop because people increasingly feel the need for recognition of their unique problems, but feel unable to communicate them” (R. Gordon, 2004a, 2004b; 2009, p. 12).
30
Findings are available online at http://allright.org.nz/is-canterbury-all-right/.
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PSYCHOSOCIAL WELLBEING: COMMUNITIES, FAMILIES, YOUTH & CHILDREN
5.0 NEXT-GENERATION PSYCHOSOCIAL INTERVENTION STRATEGIES FOR COMMUNITIES, FAMILIES, CHILDREN AND YOUTH IN THE GREATER CHRISTCHURCH AREA 5.10 Theory and Context for Successful Psychosocial Interventions Next-generation psychosocial intervention strategies are vastly different in scope, but relatively consistent regarding philosophy and theoretical foundations.31 Such strategies also incorporate a number of key elements, which are distinctive from top-down service delivery strategies, in that vulnerability, risk, coping, and competence are addressed using cross-domain, interdisciplinary, and emotionally-sensitive pedagogically-oriented thinking. 32 As an example, the study of trauma, bereavement, and resilience, in Barnard et al. (1999), emphasises the importance (for both adults and children) of strong interactive listen and response techniques to improve the articulation, critique, expression, and integration of thoughts and feelings, and reinforce skills that can enhance coping and competence in the wake of adverse experience. Learning about and engaging with one’s own responses and feelings, and the sense of how an individual understands their own knowledge to be progressing, can be of profound benefit when dealing with adverse events (Barnard et al., 1999). Celinski also advocates this philosophy of intervention: “successful achievement of certain goals raises our awareness of available resources, enables exploration of various levels of functioning and increases confidence in self-efficacy which all together create opportunities for personal growth. From such a perspective, the goal of education, psychological interventions and spontaneous and deliberately guided growth at various stages of life can be formulated as the gradual strengthening of resilience and broadening of resourcefulness that would allow for their flexible and optimal utilization. In such a manner, an individual is able to better fulfill his or her human potential and follow on one’s life mission through the awareness of one’s agency and self-efficacy” (2011, p. 23). Barnard et al. (1999) operate from within the psychosocial paradigm, therefore their work is oriented by the recognition that there is no explicitly medical approach that can be applied across domains to attend to the recognised ‘processes of grieving’ which are, in themselves, completely unpredictable; ironically, the notion that such processes are individualised, nuanced, and complex is readily accepted and accommodated in social and cultural contexts. Similarly, effects on postdisaster populations are equally nuanced, complex, and unpredictable. This review has not identified any explicitly medical approach that could comprehensively attend to the full variety of predisaster, postdisaster, ripple effect and secondary stress contexts which may confer additional vulnerability for the population in 31
As a caveat, of the 472 interventions-related documents sourced for this review, only a handful of initiatives can possibly be discussed herein; the personalisation of such interventions for the greater Christchurch communities, which is recommended, would require further in-depth analysis to accurately target the application of psychosocial principles across agencies, within communities, schools and families, and in coordination with public and private health services. 32 In addition to the pioneering work of Masten in this area, the theoretical and practical literature which form the basis for the preceding caveat, and which has been analysed in order to identify foundational psychosocial concepts for this section of the review, has been included in the reference list.
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PSYCHOSOCIAL WELLBEING: COMMUNITIES, FAMILIES, YOUTH & CHILDREN question. This holistic and culturally sensitive view of human needs is supported by transcultural nursing theories, international codes and standards that guide disaster management, and is the ‘essence of humanitarianism’ as described by The International Federation of Red Cross and Red Crescent Societies (Deeny and McFetridge, 2005). Atwool writes: “The Green Paper (2011) has made reference to the workforce for children including those in health, education and the social services. It will be important that professionals in these fields recognise that they are part of this workforce, if they are to be proactive and engage in the additional training and development that is needed to improve children’s access to timely intervention” (2013, p. 53). 33 A caveat regarding the concept of timely intervention is possibly needed here, as psychosocial perspectives generally reject temporal models for change. As Celinski notes: “The need for resources will change depending on how the situation unfolds over time or as recovery requires, and on appraisal about how specific objectives have been already achieved” (2011, p. 23). Public health services, whilst important, do not, cannot, and should not be expected, to address the entire spectrum of considerations which impact upon vulnerability (Atwool, 2013); rather, psychosocial approaches, which include a modicum of medical support and expertise but are driven by holistic and transcultural principles of health and wellbeing in the context of community and educational initiatives (public, private, adult, and children), are likely to be more stable (Celinski and Gow, 2011; Kimbrough-Melton and Melton, 2015; McDonell et al., 2015; Melton, 2013). As Melton (2013) argues that when administrators seek to improve human services, the most affordable evidence-based programmes, which can be purchased, audited, delivered, and monitored as billed are the preferred option; however, this approach almost never confers effectiveness to the target issue or community. The economic language and the paradigm assumptions of such programmes are closely linked to factors and determinants, rather than contexts, which makes it difficult to deliver a context-based intervention within the boundaries of this paradigm. Whilst an ethic supporting collaborative efforts might appear to be an unfair burden upon communities which appear beleaguered, the use of local resources “avoids the perception of noblesse oblige and thus contributes to the acceptability of help” (Ibid, p. 3). Furthermore, because situations of concern are rarely linked to singular adverse events or discrete conditions, initiatives such as the Strong Communities for Children (US) (the counter-paradigmatic example given in Melton) are “designed to promote normative change in perceptions, beliefs, and behavior across whole communities – in effect, to change the local culture in order to ensure children’s safety and well-being” (2013, p. 4). The central philosophical aim of programmes such as Strong Communities is to build a sense of community and efficacy, or competence, through formal and informal support, and 33
If this workforce is based in the greater Christchurch area, pedagogical support for the implementation of next-generation intervention training initiatives, allowances for stressors emerging from the embeddedness of the worker’s themselves, and in turn, an awareness of the co-factorial possibilities for compassion fatigue and vicarious traumatic effects would confer an additional level of support needed (Baird and Kracen, 2006; Garside et al., 2013; Gelkopf et al., 2008; Kuntz et al., 2013; Quitangon and Evces, 2015; Schwartzhoffer, 2011; Steele, 2015; Tehrani, 2007).
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PSYCHOSOCIAL WELLBEING: COMMUNITIES, FAMILIES, YOUTH & CHILDREN capitalisation of existent networks. Where no such networks exist, deliberately inclusive, educational, and culturally sensitive efforts to overcome issues of social isolation and to mitigate uncertainty becomes the goal. As affirmed by the Commission on the Social Determinants of Health (CSDH) “the conditions in which people grow, live work and age have a powerful influence on health... [a] holistic view of these determinants calls for sustained action, globally, nationally and locally to overcome the unequal distribution of power, income, goods and services which often lead to unfair access to health care, schools and education and an individual’s chance of leading a flourishing life” (CDSH 2008, cited in Kawachi, 2010, p. ix). Similar sentiments are expressed in the Green Paper, but as noted in Atwool (2013) and Melton (2013), the provision of effective multi-level interventions, as opposed to ‘the delivery of services’, may require a paradigm shift in terms of how intervention is conceived of, and the level of commitment required to follow-through on reinvention of current paradigms to become transformative, in order to properly integrate psychosocial perspectives (Resnick, 2005; Roehrich et al., 2014). Many attempts to initiate psychosocial intervention programmes around the world have failed, due to poor understanding of the central concepts, disorganised execution, or attempts to deliver psychosocial interventions from within, or in alliance with, agencies operating with different goals, structures, and paradigmatic assumptions (Rabiei et al., 2014; Reifels et al., 2013). 34 To illustrate with an example, an edited book on the subject of resilience, which ironically includes work by Masten, Werner, and other pioneers in the field, heads up one section with: Expanding resilience programs to include neighbourhoods and communities (Peters et al., 2005). Conceding that this volume is now ten years old, and resilience research has moved on, this title nonetheless demonstrates the paradigm issue well. Resilience strategies and psychosocial interventions cannot be expanded to include communities or delivered to communities; they are fundamentally emergent from within the context of communities, defined as socio-ecological systems of interrelationship between individuals, physical features of the environment (including institutions), and worldviews (including culture), through which individuals are embedded in systems of meaning and structures of belonging.
5.20 Transformative Paradigms for Successful Psychosocial Interventions The most recent research in the field of psychosocial intervention and resilience literature incorporates a social justice perspective, consistent with the fifth wave. It also incorporates the cumulative wisdom of indigenous and critical theoretical perspectives on health and wellbeing in the form of transformative research strategies to innovate local solutions for what are considered to be complex global, post-colonial, post-industrial, often, corporateinterested, power-relative, racially and socio-economically situated, social problems. Emergent from this nexus of considerations is collaborative intervention with a long-term interest in community improvement, as innovated from the people up, rather than as managed from above. 34
For a strong critique of this in the local context, see Cooper-Cabell’s commentary on the Stronger Canterbury Strategic Planning Framework (2013).
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PSYCHOSOCIAL WELLBEING: COMMUNITIES, FAMILIES, YOUTH & CHILDREN Mertons, who is a fifth wave researcher, defines a transformative paradigm as a “metaphysical umbrella that brings together many philosophical strands where social justice operates as a first principle. It is applicable to people who experience discrimination and oppression on whatever basis, including (but not limited to) indigeneity, race/ethnicity, disability, immigrant status, political conflicts, sexual orientation, disability, deafness, poverty, gender, age, or the multitude of other characteristics that are associated with less access to social justice. In addition, the transformative paradigm is applicable to the study of power structures that perpetuate social inequities” (2009, p. 4; 2015). Culture is particularly important: Deeny and McFetridge argue that “any change in social structure that results in disturbance in beliefs, ritual practices, art forms, and ceremonies will result in mitigation of the methods available for cultural expression and eventually the identity of individuals. This places culture at the center of the identity processes in coping with disasters” (2005, p. 434; see also Panter-Brick, 2015). Achieving cultural nuance, within intervention in the first instance, requires the anthropological understanding that culture does not equate with ethnicity, or racial difference, or place-attachment, but broadly refers to social held commonalities which span multiple domains (Hoffman, 2015; Oliver-Smith, 1996). In the second instance, it is important to appreciate that lived experience within different socio-cultural contexts (local and global) can be radically different, or incredibly familiar, which is why anthropologists typically engage in years of fieldwork in an attempt to grasp this context, albeit within their own neighbourhoods, or in other countries (for an example, see cross-cultural attachment and parental bonding contexts in Otto and Keller, 2014). However difference is constructed (as culture, as ethnic, as gendered, as societal, etc.), the commonalities within communities of difference, and within communities we call societies, requires consideration in the sense Merton intends in her comments regarding social justice (2015). Mertens (2015) adds to this the requirement to ‘delve deeply into understanding factors that lead us to accept one version of reality over another’ and question the power-relations implicit in the definitions of the nature of problems that exist, vis-à-vis the characteristics of the peoples for whom interventions are designed. As an illustration, the example she gives is the Trenton Obesity Prevention Study, which adopted a five-step model: identify the worldview of evaluators and partners; identify community members to involve; develop a process to work together; redesign proposal to reflect mixed-method transformative approach; provide new model of design and programme (Ibid). When designing interventions which emerge from a transformative paradigm, Wenger’s work on cultivating communities of practice becomes extremely useful to organise thinking and innovate solutions. The guiding concept is that interventions occur within communities of practice, which cultivate ‘modes of belonging’ and conceive of learning as primarily a practice embedded within social (but not necessarily institutional) learning systems (Wenger, 1996, 2000; Wenger et al., 2002). Communities of practice approaches incorporate two components: “the competence that our communities have established over time (i.e. what it takes to act and be recognised as a competent member), and our ongoing experience of the world as a member (in the context of a given community and beyond)” (Wenger, 2000, p. 227). In addition “Communities of practice are the basic building blocks of a social learning system because they are the social ‘containers’ of the competences that
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PSYCHOSOCIAL WELLBEING: COMMUNITIES, FAMILIES, YOUTH & CHILDREN make up such a system” (Ibid, p. 229). All psychosocial interventions, as primarily pedagogical in their orientation, can benefit from communities of practice perspectives in terms of how knowledge and competence are linked. Foundational assumptions that can be incorporated into any intervention include the assertions that knowledge lives in the human act of knowing; knowledge is tacit as well as explicit; knowledge is social as well as individual; and knowledge is dynamic (Wenger et al., 2002). Furthermore, the ‘communities of practice perspective’ provides tools for transference of psychosocial concepts across organisational paradigm domains. Wenger et al. outline the different models in the following table: Table 2:
Reproduced from Wenger, E., McDermott, R. A., & Snyder, W. (2002). Cultivating Communities of Practice: A Guide to Managing Knowledge. Boston: Harvard Business Press, p. 42.
Wenger et al. (2002) also give practical directions for how to begin innovating cross-domain models for developing a community of practice model; especially useful for organisations charged with establishing psychosocial intervention programmes. They note that trying to design a knowledge base without a clear domain or coherence can easily produce a useless tool, and communities that do not focus on building shared practice objectives may be socially satisfying, but ineffective (Ibid, p. 46). Key considerations, which are considered optimal when developed in parallel, include: •
Domain – The work of negotiating a shared domain is critical to community of practice development. A community must ask itself: What topics and issues do we really care about (values)? What is in it for us (benefits)? What are the open questions and the leading edge of our domain (interests)? Are we ready to take some leadership in promoting and developing our domain (responsibilities)? What
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PSYCHOSOCIAL WELLBEING: COMMUNITIES, FAMILIES, YOUTH & CHILDREN
•
•
kind of influence do we want to have (goals)? Addressing these types of questions will help a community develop a shared understanding of its domain, find its legitimacy, and engage the passion of its members. Community – The community element needs attention, organization, and nurturing: What roles are people going to play? How often will the community meet, and how will members connect on an ongoing basis? What kinds of activities will generate energy and develop trust? How can the community balance the needs of various segments of members? How will members deal with conflict? Addressing these types of questions will enable the community to find its specific ways to operate, to build relationships, and to grow. Practice – Any community with sustained interactions in a domain will develop some kind of practice over time. Nevertheless, a community can become proactive in taking charge of the development of its practice. What knowledge to share, develop, document? What kinds of learning activities to organise? How should the knowledge repository be organised to reflect the practice of members and be easily accessible? When should processes be standardised and when are differences appropriate? What development project should the community undertake? Where are sources of knowledge and benchmarks outside the community? These are the kinds of questions that will help a community intentionally become an effective knowledge resource to its members and to other constituencies that may benefit from its expertise (abridged from Wenger et al., 2002, pp. 45-46).
In addition to the communities of practice model, the resilience framework for action which Masten (2015a, 2015b) employs has five key elements: define the mission (framing positive goals); find the models (include positive influences); set the measures (assess the assets of the models and defined positive goals); establish the methods (focused on prevention, promotion and protection) ; and engage multiple levels, which includes the full component of socio-ecological systems thinking insights, across disciplines, levels, and domains of conception, thinking, innovating or creating, and practice. Manley and Titchen’s (2006) observations and experiences of changing systems and practice in UK nursing practices, despite paradigm clashes, seems relevant and reassuring here in the context of what may appear overly idealistic or theoretical in the pursuit of real benefits and support for postdisaster communities in the local context. They write that seemingly unchangeable constraints and obstacles can be overcome when people work together, intentionally and democratically, to understand what they need to change and how to change it (Manley and Titchen, 2006). Furthermore, Masten, whose ideas underpin most psychosocial intervention strategies, has spent thirty years developing, testing, and improving upon resilience theory and strategic implementations which achieve results. Resilient frameworks for action are oriented around enhancing what Masten (2015b) calls executive function, which includes parents, children, teachers, and their communities, in coordinating a curriculum for change (although curriculum in this sense is not limited to educational facilities). This type of curriculum might include such elements as the encouragement (and training for) positive and emotionally responsive parenting, parent coping and problem solving skills, positive peer support networks, critical and reflexive thinking skills, and emotionally intelligent problem solving methods, with the aim of
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PSYCHOSOCIAL WELLBEING: COMMUNITIES, FAMILIES, YOUTH & CHILDREN creating a kind of reserve capacity (elsewhere called scaffolding, see Rojas-Drummond and Mercer, 2003) to mitigate adverse responses and enhance coping skills and competence (Vygotsky 1978, cited in Masten and Coatsworth, 1998, p. 206; Ungar, 2012). Interventions should also aim to incorporate critical thinking, questioning (reflective practices), mindfulness, and creativity in the framework for action, regardless of which domain (sporting, arts, schooling, parenting, etc.) the intervention is primarily operative within (Albergaria-Almeida, 2011; Burke and Williams, 2008; Caldwell, 2001) (Clouder, 2000).
5.30 The Potential of Psychosocial Interventions for Communities, Families, Children and Youth in the Greater Christchurch Area Successful psychosocial interventions can be briefly summarised as cross-domain, or systems-based, flexible, reflexive, values-based, context-based, worldview-sensitive, person-centred (though not necessarily individualised), pedagogically-oriented, emotionally intelligent, transparent, therapeutic programmes that are designed in an attempt to reach out to people ‘where they are’ (not necessarily a location) and bring them into a community of shared experience, wisdom, and validity. Masten (2015b) recommends that psychosocial intervention plans aim for what is called translational synergy, which needs to be theory-informed, but practical; collaborative from inception; incorporating domains and levels of function, systems and generations; designed by partners representing science, practice and service expertise; and in consultation with families, cultures of belonging, education systems, and communities throughout. As the systems in a child’s life are embedded, interacting, and interdependent, the resilience of children and youth depend upon the resilience of families, communities and societies, which is inclusive of schooling and cultural contexts (Ibid). Supporting people within a community as they learn to adapt to new circumstances following a disaster will, in turn, help support parents, which, by proxy, supports children. Neighbourhood, or place-based relationship, is also a key component in overcoming feelings of isolation and encouraging feelings of wellbeing and social connectedness (Atkinson et al., 2012; Chan et al., 2015; Pitt, 2014; Putrik et al., 2015; Scannell and Gifford, 2010; Silver and Grek-Martin, 2015). The neighbourhood element to strengths-based intervention is very important, as psychosocial interventions within a social context based on what are generally shorthanded as ‘Western’ cultural and social norms and axiological trajectories (such as is found within Aotearoa New Zealand) have as their most significant obstacle the increased social fragmentation inherent to modern, ‘Western’, societies (Bassett and Moore, 2013; Ivory et al., 2011; Jupp, 2008; Nogueira, 2009; Phibbs et al., 2014; Sengupta et al., 2013). Getting what could be colloquially termed as the ‘buy-in’ from people is difficult when the sense of isolation and lack of trust which can characterise such societies is entrenched in the collective worldview. With the exception of strong cultural models from Māori and some well-established migrant communities (Kenney and Phibbs, 2014, 2015; Lambert, 2014a, 2014c, 2014d; Lambert and Mark-Shadbolt, 2012; Lambert et al., 2012), there is a paucity of strong examples of community and neighbourhood bonding in ‘middle’ Aotearoa New Zealand.
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PSYCHOSOCIAL WELLBEING: COMMUNITIES, FAMILIES, YOUTH & CHILDREN Some examples of models that have been established overseas and show a degree of promise in terms of outcomes may assist in conceptualising the parameters of psychosocial interventions and how they might be structured. A well-established initiative from the UK is Resilient Therapy (RT) for children and youth, which aims to strategically “harness essential therapeutic principles and evidence-based mechanisms to find the best ways of helping children and young people ‘bounce up’ when life is particularly tough. The authors refer to ‘bounce up’, rather than ‘bounce back’ quite deliberately: many children have rarely, if ever, been anywhere worth bouncing back to” (Hart et al., 2008, p. 132). Figure E:
Reproduced from Hart, A., Blincow, D., & Thomas, H. (2008). Resilient Therapy: Strategic Therapeutic Engagement with Children. Child Care in Practice, 14(2), 131-145.
Resilient Therapy employs Masten’s translational synergistic approach in that, not only children, but those who work with them, are co-authors in their own resilience. Resilient Therapy is intersubjective and oriented around the explicit aspirations, experiences and actions which happen between people (Hart et al., 2008). There are five main conceptual tools in the ‘Magic Box’, which are adapted to children, parents, and other adults with relative consistency regarding the approach.
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Table 3:
Resilient Therapy (RS) Framework for Adults (www.boingboing.org.uk)
As family is the primary support for children and youth, a positive family environment with positive parent-child attachment, parental warmth, encouragement, assistance, cohesion, validation, and care are important in maintaining and supporting child wellbeing (Fergus and Zimmerman, 2005; Olsson et al., 2003). When children talk about their emotions in the context of a positive and supportive environment, they may be less reactive and more capable of coping (Overstreet et al., 2014, p. 58). Ungar (2010a) notes that family processes are critical to individual and collective wellbeing, and parents are often the navigators and negotiators when it comes to securing culturally and contextually appropriate kinds of support. Families do better when there is a co-ordinated and organised pattern to the accomplishment of daily tasks, good communication strategies, caring and nurturing practices, integrated family belief systems (be they cultural, religious, ethical, or spiritual), a positive outlook (hope), and good problem solving practices (Walsh, 2007). Parents and family provide critical coping assistance when familiar roles, routines, and security-promoting behaviours are enacted in the months and years following adverse events (Luthar, 2003, p. 15; Prinstein et al., 1996, p. 464); however, adults (mothers in particular) who are dealing with their own ‘exposure’, disruptions, and emotional distress, may not be equipped to provide adequate social support to children (Adams, 2010; Holloway and Machida, 1992; Overstreet et al., 2014). Holloway and Machida indicate that “maternal coping, child-rearing practices, and symptoms of distress (as perceived by children) mediate the relationship between a child’s adjustment and the family’s financial,
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PSYCHOSOCIAL WELLBEING: COMMUNITIES, FAMILIES, YOUTH & CHILDREN social, and personal resources” (1992, p. 254). If families with external stressors are strengthened from within to increase coping, competence, and confidence in their parenting and life skills, this can mitigate the effects of financial and other strain which may impact upon their children (Kull and Coley, 2014; Leinonen et al., 2002). Family resilience interventions involve co-opting the potential for relational growth experiences, as forged out of adversity, and families can emerge stronger and more resourceful when it comes to meeting further challenges (Walsh, 2003). Parenting interventions, such as the Tuning in to Kids programme in Australia, teaches emotion coaching skills to parents of preschool children, with the dual aim of improving child behaviour whilst simultaneously capitalising upon the interactive nature of parent training to improve parent’s awareness of their own emotions (Havighurst et al., 2009; Havighurst et al., 2010). This programme enhances the parent’s supportive practices towards their children, fostering an improvement in the regulation and expression of their own emotions, reactions to children’s emotions, and the parent’s ability to coach children about their emotions, which requires parents to become more sensitive to their own emotional landscapes. The literature on psychosocial interventions in school environments is especially voluminous, indicating that it is not only possible, but achievable, to innovate personalised interventions for unique local circumstances in the postdisaster context. A range of community and school-based interventions that encourage emotional expression and reflexivity, may aid in not only fostering resilience within the group as a whole, but assist in the successful identification of those who are particularly vulnerable. To offer an example, interventions such as Teaching Recovery Techniques (TRT), which focus on creating safety and feelings of mastery (or competence) through psycho-educational and CBT techniques, coping skills training, and creative expression, can lead to deeper levels of communication with children and young people, conferring benefits to low-risk individuals, whilst leading to a better chance of identifying those at increased risk (Diab et al., 2015; Peltonen and Punamäki, 2010; Qouta et al., 2012). The successful delivery of any such interventions requires reflexive qualities conferred by the intervention facilitator to account for a person’s unique circumstances, needs, and preferences, to apply, and transmit, critical thinking skills, whilst simultaneously encouraging on-going emotional expression and articulation of needs within an environment of constructed vulnerability (Consortium, 2010; DeRosa et al., 2013; Linley et al., 2011; Peltonen and Punamäki, 2010). It is in this regard that initiatives such as Resilient Therapy, which co-opt the practitioners as an integral part of the system of relations, can be effective. Further initiatives, which have been shown to be successful in the context they were intended are evidenced within the Compassionate Schools pilot models in the US (in alliance with the Trauma-Sensitive Schools Program), which have been studied by Wilson (2013) and Mireles (2010). The foundational concept of the Compassionate Schools programme is to stop the cycle of violence and intervene with positive coping strategies for children who had been exposed to violence. The definitions for what constitutes violence in the philosophy of this programme is very broad, and includes structural violence, such as racism, poverty, hate crimes, and unequal access to health, education, housing, safety, etc.,
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PSYCHOSOCIAL WELLBEING: COMMUNITIES, FAMILIES, YOUTH & CHILDREN and shared traumatic experiences, such as school shootings. Benefits of the model include the emphasis on mindfulness, self-awareness, empathy, compassionate and caring behaviours, alongside more body awareness and understandings of health and wellbeing. Current statistics for this curriculum state that has been applied in 25 schools (involving 20,000 children) over the projects 6 year run.35 Other school-based programmes include aspects of meditation and mindfulness practice, mentoring programmes, acceptance and commitment therapies, music and art programmes, psychosocial sports initiatives and structured recreation, critical thinking and emotional intelligence (EI) training and emotional literacy skills, community and school gardening projects, and creative thinking and play initiatives.36 School-based programmes are remarkably varied in content, but the general assertion within the supportive literature is that most efforts to engage children and youth productively in activities which ‘change their state’ in some capacity, or encourage them to alter their perspectives and worldview assumptions, tend to achieve the best results. Furthermore, many of the psychosocial aspects of programmes that have been pioneered by schools can be adapted to work within broader community projects and contexts. Next generation psychosocial intervention strategies such as these are not limited by paradigmatic assumptions and can be evaluated further in order to innovate and co-ordinate interventions which may improve postdisaster wellbeing for communities, families, children and youth in the greater Christchurch area.
6.0
CONCLUSION
This review has shown that postdisaster impacts upon physical and mental health outcomes, family relationships, parents’ (physical, mental and emotional) wellbeing, education and schooling, housing, safety, community structure, and urban infrastructure, are significant. When considered with the range of pre-existent and secondary stressors detailed herein, the nature of these impacts reinforce the unpredictability theory regarding effects of the Canterbury sequence of earthquakes and aftershocks which impacted upon children, youth, their families and communities in the greater Canterbury region from September 2010. It may be impossible to definitively ‘locate’, within the psyche of Canterbury’s residents, the precise effects of this sequence of events regardless of the rigour with which studies are undertaken. Having stated this, however, the events in question remain a salient focus of powerful symbolic representations, whether linked to extreme reactions such as grief, and loss, or ‘daily hassles’ such as ever-changing traffic conditions. Adaptation, rather than recovery, requires an increase in overall coping skills, competence, and in addition (to recall an earlier finding), trust, transparency and a feeling of progress when dealing with any aspect of ‘the earthquake’ that may bring provoke or add to feelings of uncertainty. The ‘earthquake’ cannot be reckoned as a singular event, but 35
See the Compassionate Schools website: http://www.compassionschools.org/program/. Additional material regarding the Compassionate Schools model can be found at: http://www.k12.wa.us/compassionateschools/pubdocs/TheHeartofLearningandTeaching.pdf 36 As the list of supporting scholarship for school-based, community, family, and parenting interventions is far too large to appear in citations or a footnote, these resources have been included in the reference list. An excellent starter text on this subject is Thompson, R. A. (2006). Nurturing Future Generations: Promoting Resilience in Children and Adolescents through Social, Emotional and Cognitive Skills (2nd ed.). New York; London: Routledge.
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PSYCHOSOCIAL WELLBEING: COMMUNITIES, FAMILIES, YOUTH & CHILDREN should be conceptualised as an ongoing set of events and circumstances that are potently manifested and reflected within the multiple interrelated spheres of social life, which provoke persistent and ongoing reminders within the daily lives of Cantabrians. This literature review and analysis was commissioned in order to focus upon postdisaster and post-traumatic-event literature, targeting children and youth 0-18 years and their families, with a broader mandate to look at the wider psychosocial implications of living in a postdisaster environment, and to consider the ways in which the target group might be affected. This review comprises the collection and analysis of a sufficient body of evidence, detailing the impacts of this sequence of events upon children, youth, their families, and the communities within which they navigate and negotiate their identities, to conclude that the impacts have been profound and are ongoing. The research indicates that there are no simple, quick, inexpensive, or short-term interventionist solutions that can capture and attend to the full range of ripple effects and cascading stressors that are downstream from the sequence of disaster events that set in motion many of the issues being experienced by people in the greater Christchurch area. However, there are a range of potential first step considerations, which have been mentioned within this review, that are within the domain of governmental agencies, providers, and policy makers to consider. The social impact assessment for the greater Christchurch area indicates that there are particular kinds of persistent socio-infrastructural problems for which psychosocial interventions will not be useful: psychosocial interventions will certainly help people cope with the ongoing uncertainty and improve their competence, but the weight of cascading stressors and the experiences of structural inequality that are accumulating over time would need to be alleviated for such interventions to be successful in the long-term. Individuals of whatever age within communities that are characterised by the progressive deterioration of trust relationships, as is the case in the greater Christchurch area, need to experience consistency, predictability, transparency, feelings of hope, a sense of progress, and bear witness to good intentions (with satisfactory follow-through or confirmation), in order to feel like they are valued and listened to, supported, validated, included, and connected in meaningful ways with other people. These are the basic foundations of wellbeing at any age, and they need to occur across multiple domains to create feelings of trust and security. These types of recommendations are inherent within the social justice (or fifth wave) resilience perspectives on adaptative strategies postdisaster, which require responsible, sensitive, transparent, yet direct engagement with the issues that can be obstacles to successful postdisaster adaptation. The goal of psychosocial resilience interventions in such contexts is to transform or create, rather than repair, community cohesiveness, and support the maintenance and expression of shared meanings, experience, and collective wisdoms, for the benefit of all members of those communities.
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7.0
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