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Wekerle CIHR Team - CAPHC Picturing Wellness


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CAPHC Picturing Wellness

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Wekerle CIHR Team - CAPHC Picturing Wellness

  1. 1. Picturing Wellness Christine Wekerle, Ph.D., Pediatrics Editor-in-Chief, Child Abuse & Neglect Co-Curator, Picturing Wellness Art Exhibit @McMaster Museum of Art
  2. 2. Picturing Wellness: From Adversity to Resilience • March 3, 4, 5 2016 Conference via McMaster Continuing Health Sciences Education (CHSE) • Providing #art=#resilience activities: o Picturing Wellness Exhibit @ McMaster Museum of Art o Talk by Sheldon Kennedy: Swift Current Documentary o Presentation from Toronto Police Victim Services’ Youth Advocates Teens Ending Abusive Relationships (TEAR) TwitterChat #TEARtalk o One-man play on mental health and resilience journey o Yoga & Mindfulness Practice
  3. 3. How do you picture wellness? • Picturing Wellness by Craig Kung, McMaster Medical Student entered in Art with Impact 2015
  4. 4. How do you picture wellness?
  5. 5. Child Abuse & Neglect – Trauma, Resilience • “…in the lexicon of strengths, it is as wrong to deny the possible as it is to deny the problem” (Saleeby, p.297) • Child abuse/neglect deaths > male children > male offenders • Cases w/ child abuse/neglect-related deaths differ in the use of all types of child welfare services (case management, mental health services, education/training, court representatives) • Identified triggers: Crying child, toile training/feeding issues, intimate partner violence • 1 in 6 children had prior disability/chronic illness (1 in 3 prior abuse/neglect, from autopsy evidence) • US National Child Death Review Case Reporting System
  7. 7. The Resilience Journey Navigating & Negotiating
  8. 8. Transitioning from Adversity to Resilience ① Acknowledging Adversity ② Crafting Daily Resilience Practice ③ Shifting Perspectives & Mindsets ④ Reaching Out For Help ⑤ Transforming Burden Into Beauty ⑥ Managing Stress Storms ⑦ Emerging & Extending Your Grace TEDxHamilton 2015 Talk – C. Wekerle
  9. 9. Interpersonal Resilience • Review (Domhardt et al., 2015) (1) optimism/hope; (2) self-efficacy (3) solutions-focused coping style • Flett, Flett, & Wekerle (in press; (4) self-reinforcing (acknowledge achievements) (5) self-compassionate (capacity and motivation to perceive self accurately and empathically) (6) direct coaching (anticipatory social guidance; “mattering”) • “…unique signature is the transformation of adversity into personal, relational, and collective growth through strengthening existing social engagements, and developing new relationships, with creative collective actions” (Cacioppo et al., 2011, p. 44).
  10. 10. Childhood Traumatic Events: Abuse & Neglect Abuse by a family member or someone connected with the family is in itself a barrier to victims accessing help (UK Child Commissioner’s Report, 2015,) • Earlier disclosure predictive of better health outcomes • Having 3+ persons to talk with buffers childhood adverse events • 7.6% of adults reporting child abuse were child welfare system-involved • 3 types of abuse (physical, sexual, and witnessing IPV increase likelihood of child welfare 16-fold • What does it take for abused/neglected children to obtain protection? Ontario Incidence Study of Reported Child Abuse & Neglect
  11. 11. CIS study – 48% child previously investigated 58% multiple substantiated incidents within maltreatment type (pattern) 18% multiple substantiated types of maltreatment 10% reported by health care professionals – under-reporting?
  12. 12. You & Art-based Learning • Visual Literacy & Critical Thinking
  13. 13. CanMEDS Roles: Context for Child Abuse/Neglect Learning Health Advocate- Child injury prevention; child well-being and resilience Collaborator – Team, Child welfare, police, Public health etc. Communicator: How-to of reporting
  14. 14. The Child Abuse/Neglect Challenge “Child protection is a difficult area of practice that can involve making decisions that are emotionally challenging, complicated by uncertainty and sometimes go against the wishes of parents.” -General Medical Council, 2012
  15. 15. Child Abuse/Neglect Assessment Considerations o Nature of the injury o Developmental capabilities of the child o Social history (risk factors) and history of injury o Research [e.g., 51% closed cases (substantiated) and 38% (suspected) re-referred within 5 years to child welfare, Dakil et al., 2011] o Most suspected cases in hospital go home with parents (75.6%, Friedman et al., 2012) – Follow-up assessment important • Common to see risk to siblings, re-victimizations, and multiple forms of maltreatment
  16. 16. Describe: What do you see?
  17. 17. Child Abuse/Neglect Screening in ER (Netherlands; Louwers et al., 2012 • (1) Is the history consistent? • (2) Was there unnecessary delay in help-seeking? • (3) Does the onset of injury fit with the developmental level of the child? (<1% babies who are not mobile present with bruising, Gilbert et al., 2009) • (4) Is caregiver behaviour and caregiver-child interaction appropriate? • (5) Are findings of the top-to-toe exam consistent with history? • (6)Are there any signals for concern that the child or other family members are safe?
  18. 18. The Art-based System of Looking How to Look: • Colour: hue, intensity, temperature • Texture: how surface looks or feels • Shape/Form: outline of object • Line: length, direction • Space: area around, within, or between objects • Emphasis: importance given to one part in the art • Movement/Rhythm: how the artist uses elements to direct the eye around the art work • Pattern/Repetition: repeated use of similar elements (such as colour or line)
  19. 19. Visual Literacy Support for improvement in: o Descriptive ability o Observational accuracy o Manage complex patterns o Awareness of multiple perspectives o Appreciation of subtle cues o Skepticism about initial impressions Other proposed benefits (yet unsupported by quality data) o Improved teamwork and collaboration
  20. 20. Basic Questions to Guide Perceptual Awareness • What’s going on in this picture? • What do you see that makes you say that? (evidence) • What more can we find? • START with: • 1. Where does your eye first go to? • 2. Describe details of what you see? • 3. Go around the picture? What else do you see?
  21. 21. Analyzing Visuals – 11-mo. Case – Shape? Moharir, Niec & Wekerle (2012). Burn injury in an 11 month old infant. Pediatrics & Child Health, 17(9), 495-497.
  22. 22. Case Details • Child with father for 2 weeks • To return, there was a 5 hour car ride in 35°C weather • Infant in car seat, exposed to sun through windows • Mother noticed burn upon arrival • Went to emergency room following day • Infant appeared healthy and engaging • Burn pattern on infant exactly matched exposed plastic part of car- seat • Verified by placing infant into car-seat Conclusions: • Appropriate call to CAS – no story for injury • In-Depth CAAP Evaluation: Accidental burn injury due to skin exposed to heated plastic of car-seat
  23. 23. Museums contribute to... pursuit of health [via] relaxation, an immediate intervention of beneficial change in physiology, emotions or both. They also encourage introspection, a process of understanding one’s feelings and thoughts that is essential to mental health. Museums foster health education that equips individuals…[to] address social conditions… by public health advocacy and by enhancing healthcare environments. Silverman, L. (2010). The Social Work of Museums. NY: Routledge.
  24. 24. The art & science of seeing CAN Clinical Pearl: Understanding may reside in what is missing, what is not there but which is expected to be there, or distortions in what is there.
  25. 25. Further Resources • International Journal of Child and Adolescent Resilience • TEDxHamilton Talk (C. Wekerle, September, 2015) • TED Ed Lessons: 1) Risk and Resilience in Youth Suicidality: (2) Adverse Childhood Events (ACEs) & Childhood Maltreatment : • Prezi Presentations: Child Sexual Abuse: A Hidden Problem probem/ • Follow on Twitter @DrWekerle #picturingwellness
  26. 26. Thank you for your attention! … F