The Maltreatment and Adolescent Pathways (MAP) Research Study

• Canadian Institutes of Health Research• Institute of Human Development and

Child and Youth Health• “Video Talks” competition (Research-2-

Action)• 2015 Awardeehttps://www.youtube.com/watch?v=3Zes-PJi2OY

The Maltreatment and Adolescent Pathways (MAP)

Research StudyChristine Wekerle, Ph.D. Pediatrics, McMaster

University Email: wekerc@mcmaster.ca

Twitter: @DrWekerle

ResilienceInYouth InitiativeWebsite: www.in-car.caInternational Journal of ChildandAdolescent ResilienceYouTube: ResilienceInYouthTwitter: ResilienceInYouth @ResilienceInYouInstagram: ResilienceInYouth

MAP Study Research Team & FundersMulti-disciplinary Co-Investigator Team (alphabetical order): Dr. Michael Boyle, McMaster UniversityDr. Deborah Goodman, University of Toronto; Child Welfare Institute, Children’s Aid Society of TorontoMr. Bruce Leslie, Catholic Children’s Aid Society of Toronto (retired)Dr. Eman Leung, City University of Hong KongDr. Harriet MacMillan, McMaster UniversityDr. Nico Trocmé, McGill UniversityDr. Randall Waechter, St. George’s University

MAP Advisory Board – child welfare agency representatives and researchersPartner Supporters: Child Welfare Research Portal (cwrp.ca), Child Welfare League of Canada, First Nations Child and Family Caring Society of Canada, Ontario Association of Children’s Aid Societies

Collaborating MAP Scientists

CIHR Team grant – male CSA – secondary analyses

What’s interesting about the MAP Research Study

• First longitudinal multi-method assessment study of youth receiving services from child welfare – every 6 months over a 2 to 3 year period

• Random sampling of child welfare caseloads• Inclusion: all youth excepting adoption

caseloads (youth served in- and out- of home)• Exclusion: youth in detention, in hospital,

suicidality, crisis at time of study entry• The value of youth perspective – use of self-

report on maltreatment history and other trauma events

• Large sample for child welfare (N=561 @ initial)

Why is understanding trauma important for the healthcare workforce?

• Trauma Events – Trauma Responses (“kids are do-ers” – often evidenced as behavioural issues)

• Adolescent trauma responses as “avoidance” “resistance” “protest” “testing” behaviours

• Behaviours: Conflict w/ authority; sexual acting-out (CSA); eating problems

• Practically for services? Trauma-informed approach:Physical, emotional, behavioural safety – health advocateCreate opportunities for resilienceExperience of choice and control – youth preferences and engagement…

Trauma Experiences are high-impact events that are emotionally difficult to deal with and cause stress

1TRAUMATIC EXPERIENCES 2TRAUMATIC

REACTIONS 3RESILIENCE

Crafting A Daily Resilience PracticeGoals: (1) Reducing everyday experience/perception of overwhelming stress;(2) Increasing/solidifying everyday resilience

•Sleep Quality•Social Connectedness•Self-compassion•Exercise/Fitness

From the MAP: Role of traumatic stress symptomsAs measured by self-report, trauma symptoms (distress/depression/anxiety/dissociation/anger/hyper-arousal) mediates in the prediction of:• Adolescent sleep quality (McPhie et al., 2014)• Alcohol use and problems (Goldstein et al., 2011)• Alcohol problems in Indigenous youth (Zahradnik et al., 2011)• Adolescent dating violence (Wekerle et al., 2009)• Males report symptoms of preoccupation with sexual thoughts more so than females: females are

otherwise higher than males on all other types of trauma-related symptoms • Child welfare youth report higher distress, see doctors more often and more often on medication for

anxiety and depression than non-child welfare youth (Hamilton et al., 2011)• When parental maltreatment considered, parenting stress is the mediator of parental sensitivity to

infant (Periera et al., 2012)• Core issues: High reactivity to stressors destabilize behaviours; need to target stressors, end on-going

violence/traumatic events; support emotion regulation; work up replacement for behaviourally-acting out to behaviourally acting resilience (cultural engagement; connectedness; competence; communication)

• Resilience protective against trauma re-experiencing in Indigenous youth (Zahradnik et al., 2010)

Some simple actions

Do We Know What Youth are Coping With?5As: ask, advise, assess, assist, and

arrange

• What is going on for you? (rather than thinking what is wrong with you?)• Give specific behaviourally-based positives

(cannot have enough +ves in the day! ;)

Thank you for your attention!

Questions or Comments?