This document provides an overview of a presentation on promoting resilience in youth using trauma-informed technology. It discusses key concepts in trauma and resilience frameworks and provides recommendations for developing apps to support youth well-being. The presentation includes a case study of "Mya" and discusses her experiences with childhood trauma and current symptoms. It also describes the Maltreatment and Adolescent Pathways (MAP) research study examining youth involved with child welfare services in Ontario.

1. TRAUMA-INFORMED TECHNOLOGY:
PROMOTING RESILIENCE IN YOUTH
Dr. Christine Wekerle
Pediatrics, McMaster University
wekerc@mcmaster.ca
Kent Monkman, 2016, Death of a Vir
John Otilano, P.T.S.D. Series #16
Frieda Kahlo, 1946, The Wounded
Deer

2. DISCLOSURE
• Research presented supported by Canadian Institutes of Health Research
and other federal or provincial peer-reviewed funding bodies
• No organizations with financial arrangement for consultancies
• No corporation or not-for-profit ownership

3. LEARNING OBJECTIVES
• (1) Identify key aspects of trauma-informed and resilience frameworks
• (2) Recommend evidence-based strategies from youth resilience research
• (3) Formulate an approach to app utilization for youth well-being

4. CASE EXAMPLE: MYA
• Mya is currently in training to become a social worker and is a passionate advocate for
trauma-informed practice. Adolescents related to her easily, finding that they relate well to
her sense of humour.
• Mya’s mother was depressed during pregnancy, and was not able to maintain adequate
nutrition. Mya was born with a low birthweight. Growing up, she experienced harsh
punishment and neglect, leaving home at 15 years of age.
• Becoming street-involved, Mya experience sexual violence repeatedly, and had been chased
and threatened with weapons. She attended a youth clinic and transitioned to housed living,
crediting her social worker for being “like a mom.” She was able to reconnect with her cultural
roots to become an active community member. She began getting involved in Big
Brother/Big Sister as a volunteer and went back to school. She began to lose her keen sense
of guilt and self-blame.
• Mya experiences chronic symptoms of hyper-arousal, with extreme difficulty falling asleep, she
thinks because she only has nightmares. Mya feels like she has to look “over her shoulder,”
even when in school. She feels under-deserving of positive feelings. Often she finds she is
unaware of what she is feeling, especially when asked to give a self-assessment about her
schoolwork or practice interview performance. In childhood, Mya completed trauma-focused
CBT. She is currently seeking therapy.

5. TRAUMA DEFINITION
Direct personal experience of
trauma
Witnessing a trauma
Learning about loved one’s
trauma
Repeated extreme exposure to
trauma details
Where traumatic event: Actual or
Threatened Death, Serious Injury,
Sexual Violence

6. TRAUMA FRAMEWORK – EMOTION/COGNITIVE PROCESSING
Chronic toxic stress experienced - Disruption in processing Liberzon & Abelson (201

7. Emotion
Dysregulation:
Being an Emotion or No
Emotion
Having Emotions
Sad Anger
Fear
Shame
Self

8. CHILD MALTREATMENT EXPERIENCES CAN LEAD TO ….
• Responding with goal-oriented action,
rather than cognitive disorganization
and emotional reactivity (Hughes, 2013)
• Practicing Positivity - Positive
relationships and nurturing
environments foster healthy
development of executive functions
• “Sensitivity to non-distress” as the
quality of caregiver responses that are
emotionally neutral or positive, which
includes warmth and synchrony during
non-distress (King et al., 2019)

9. RESILIENCE DEFINITION
Resilience is…the maintenance of high levels of
positive affect and well-being in the face of adversity,
...negative affect is experienced but negative affect
does not persist
Davidson, Richard J., (2000). Affective style, psychopathology, and resilience: Brain
mechanisms and plasticity. American Psychologist, 1192-1214.
Resilience is both the capacity of individuals
to negotiate obtaining and navigating their way to
the psychological, social, cultural, and physical
resources that sustain their well-being…
Ungar, M. (2008). Resilience across cultures. British Journal of Social Work, 38, 218–
235.
-Adaptive
response to
adversity or toxic
stress that
supports
functioning.
-Dynamic (short-
term vs. long-
term)
• May be
domain-specific
- Can include
positive rights

10. INTEGRATING TRAUMA & RESILIENCE
FRAMEWORKS
Low
Birthweight
Child Maltreatment
Sexual Violence
Cultural practices/value
system/community
resources
“Striving” (hopeful; grit;
goal-oriented)
Drawson et al., 2016;
Masten & Tellegen, 2012

11. THE MALTREATMENT AND ADOLESCENT
PATHWAYS (MAP) RESEARCH TEAM
• Multidisciplinary Team of Co-Investigators:
• Dr. Christine Wekerle (McMaster University; Clinical Psychology)
• Dr. Michael Boyle (McMaster University’ Epidemiology/Methodology)
• Dr. Deborah Goodman (Research Director; University of Toronto and the Child Welfare
Institute, Children’s Aid Society of Toronto; Social Work; Program Evaluation) Agency Lead
• Mr. Bruce Leslie (Quality Assurance; Catholic Children’s Aid Society of Toronto) Agency Lead
• Dr. Eman Leung (City University of Hong Kong; Psychology; Knowledge Mobilization)
• Dr. Harriet MacMillan (McMaster University; Pediatrics & Psychiatry)
• Dr. Nico Trocmé (McGill University; Social Work)
• Dr. Randall Waechter (St. George’s University; Psychology)
• Dr. Brendy Moody (Quality Assurance: Peel Region Children’s Aid Society) Agency Lead
• MAP Advisory Board: Child welfare agency representatives and researchers
• Partner Supports: Child Welfare Research Portal, Child Welfare League of Canada, First
Nations Child and Family Caring Society of Canada, and Ontario Association of Children’s Aid
Societies
• Many Collaborators (Sherry Stewart, Delphine Collin-Vézina, Elisa Romano, Lise Milne, Stephen
Ellenbogen, Jonathan Weiss, Abby Goldstein, Masako Tanaka, Lil Tonmyr, Amanda Hudson

12. THE MAP STUDY
• LONGSCAN, not meant to be representative, N=554, with CPS report
between 0 and 8 years of age, with assessments at age 4, 6, 8, 12, 16, 20
(administrative + testing youth)
http://cwrp.ca/sites/default/files/publications/en/KotchPDFE.pdf
• The MAP was first Canadian multi-year, multi-method assessment study of
youth receiving child welfare services (actually testing youth) who were
randomly sampled of from active CPS caseloads in Ontario
• N=561; 14-17 year-old youth Mean age: 15.83 years (SD=1.2) 54% Female;
Mean age of CPS involvement = 5.7 Years (SD=4.2); 62% Crown Wards
• Ethnicity: 38% Caucasian, 33% Black, 2% Aboriginal, and 27% Other or
Multiracial
• Living Arrangements: 33% in foster care, 30% in group home, 24% with
biological parent, 13% other

13. MALTREATMENT AND ADOLESCENT PATHWAYS STUDY
The Maltreatment and Adolescent Pathways (MAP ) Video:
https://www.youtube.com/watch?v=OftzALSA5yQ

14. 5 Pillars of Well-Being PERMA
- Flow: task absorption in challenge
(discovery; neither
bored/overwhelmed)
- Mindfulness (intention +
awareness)
- “Learned optimism” (effort for joy)
- Post-traumatic growth (reframing;
higher level of purpose, meaning)

15. HOW DOES TRAUMA FIT IN WITH
TRAUMA-INFORMED CARE
Trauma
Individual trauma
Simple trauma
Complex trauma
Developmental trauma
Type 1 Trauma vs. Type 2 trauma
Complex trauma history
Potentially traumatic event
Positive stress
Tolerable stress
Traumatic stress
Toxic stress
Extreme form of stress
Acute stress disorder
Post-traumatic stress symptoms
Psychological wound
Post-traumatic stress disorder
Vicarious trauma
Interpersonal trauma
Social trauma
External trauma
Historical/ intergenerational trauma
Traumatic grief
Various definitions conceptualizing trauma
*Created by Maria Bargeman and Sultana Al Sabahi
Responding across social
ecology
• Patient Safety
• Trauma Symptom Assessment
• Continuum of trauma-
informed practice
• Re-traumatization Avoidance
(trigger awareness)
• Address front-line staff
trauma and resilience
• Cultural Safety Training
• Branson et al. (2017)
http://dx.doi.org/10.1037/tra0000255

16. TRAUMA-INFORMED
PRACTICE (TIP)Trauma-InformedFramework
Organization
Emotion
Regulation
Relationships
Safety; Stability
RESILIENCE FRAMEWORKS
(POSITIVE PSYCHOLOGY)
Attention/Flow
Meaning
Empowerment
Support;
Mutuality
Positive Emotion
Accomplishment
Positive Trusting
Engagement

17. FORMULATING AN APPROACH TO APP UTILIZATION FOR YOUTH
RESILIENCE
• Bakker, Kazantzis, Rickwood, and Rickard (2016) provide evidence-based
recommendations for mental health apps
• Trauma-Informed Practice
• Monitor thoughts, emotions, or
behaviour
• Allow for real-time user
engagement
• Provide access to crisis services
• Meditation negative
consequences management*
Resilience-Promoting Features
• Provide activities specifically
designed to elevate mood
• Use games/intrinsic
motivation to engage user
• Provide positive activity
suggestions

18. MENTAL HEALTH APPS CURRENTLY AVAILABLE
Logo Function Main Features Issues
Mindshift Dealing with Anxiety - Symptom Monitoring
- Symptom
Management
-Rating negative emotion only
-Breathing exercises no guiding
visuals
Headspace Stress Management - Panic Management
- Mindfulness
-Negative language used
e.g.,“winding down” and
“powering down” during
relaxation exercises
SAM Dealing with Anxiety
Stress Management
- Symptom Monitoring
- Stress Management
-Rating negative emotion only
What’s Up Depression, Anxiety,
Anger Management
- Symptom
Monitoring
- Journaling
-Negative language used
e.g., Catastrophe Rating, “How
bad is the problem”

19. MINDFULNESS MEDITATION – TIP?
(ZHU, WEKERLE, LANIUS, & FREWEN, UNDER REVIEW)
• Mindfulness Meditation may be useful for the treatment of PTSD features: over- and under-modulation of emotion
• However, 1 in 4 treatment-seeking adults reported distress and intrusive trauma memories during MM (Carswell & Frewen, 2017)
• Pilot Study: N= 151 Collegiates, aged 18-22; 24% male
• Meditation Breath Attention Scores (MBAS) to assess focused attention during a brief mindfulness meditation: at sound of bell,
mark on paper if attention was focused on breathing (3x)
• Sitting Brief Mindfulness Meditation: 5-minute eyes-closed, breath-focused meditation
• Higher MBAS was positively associated with: feeling relaxed and calm, experiencing positive affect, interest in the process of
breathing, and use of a mantra during MM
• Resource: Mindfulness and Metta-based Trauma Therapy website (www.mmtt.ca)
ACE .018 -.062 -.002 -.023 .236**
Symptom Symptom MDES MEQ MEQ – Difficulty
Checklist Checklist Negative Upsetting Attending to
10R Re-experiencing Affectivity Thoughts Breathing
PCL-5 .478** .423** .304** .294** .071
Note: SCL, Symptom Checklist, 10R (Nguyen et al. 1983); MEDS, Modified Differential Emotions
Scale – Negative Affectivity (Fredrickson, Tugade, Waugh & Larkin, 2003); MEQ, Meditation
Experiences Questionnaire (Frewen et al. 2011)

20. THE JOYPOP APP
• (1) Enhance positive
emotionality and activity
• (2) Promote safe social
connectedness
• (3) Creating a daily resilience
routine
https://futurumcareers.com/dr-christine-wekerle-finding-joy-in-

21. MOOD RATINGS
• Happiness by sliding colour up or down
• 50% + Happy = Motivational Message
• If rating is under 50% happy, user is
asked to rate how sad, angry, or ‘meh’
they feel
• Consistent mood imbalance and
emotional suppression can lead to poor
mental health, negative mindset (Desmet,
Vastenburg, & Romero, 2016)
• Differentiating emotions supports
creating positive strategies to improve

22. CIRCLE OF TRUST
• Supportive others help to shape “resilient identity” of at-risk
youth (Ungar, 2004)
• Allows user to input up to six contacts to call when they are in
need of support
• Colour-coded for family, peers, professionals
• Establishing positive relationships has been shown to decrease
stress symptoms and increase relational learning (Wekerle,
Waechter, & Chung, 2012)
Youth need to know that they are trusted to make decisions,
but help is always available when they need it

23. THANK YOU FOR YOUR ATTENTION!
• Twitter: @DrWekerle; @ResilienceInYou
https://twitter.com/drwekerle
https://twitter.com/ResilienceInYou
• Instagram: @resilienceinyouth
https://www.intstagram.com/resilienceinyouth
• YouTube: resilienceinyouth
https://www.youtube.com/channel/UCwb2FU5KNOmazMX175ALKFQ/featured
• Slideshare: Christine Wekerle
https://www.slideshare.net/ChristineWekerle
• LinkedIn: Christine Wekerle
https://www.linkedin.com/in/christine-wekerle-27603013/

24. MAP STUDY PUBLICATIONS
(FROM MOST RECENT TO OLDEST)
Many MAP Publications are available on Dr. Wekerle’s Researchgate:
https://www.researchgate.net/profile/Christine_Wekerle
Park, T., Thompson, K., Wekerle, C., Al-Hamdani, M., Smith, S., Hudson, A., Goldstein, A., & Stewart, S. H.
(2018). Investigating the path from childhood maltreatment to alcohol misuse in a sample of child welfare-
involved youth. Journal of Traumatic Stress. Manuscript submitted for publication. [Resubmitted]
Waechter, R., Kumanayaka, D., Angus-Yamada, C., Wekerle, C., Smith, S., & The MAP Research Team. (in
press). Assessing research reactivity among adolescents in Child Protective Services: Child maltreatment
history, trauma symptoms, and participation ratings. Child and Adolescent Psychiatry and Mental Health.
Wekerle, C., Goldstein, A., Tanaka, M. & Tonmyr, L. (2017). Childhood sexual abuse, sexual motives, and
sexual risk-taking among male and female youth receiving child welfare services. Child Abuse & Neglect, 66,
101-111. doi:10.1016/j.chiabu.2017.01.013
Galitto, E., Lyons, J., Weegar, K., Romano, E., & The MAP Research Team (2017). Trauma-symptom profiles of
adolescents in child welfare. Child Abuse & Neglect, 68, 25-35. doi:10.1016/j.chiabu.2017.03.011
Hudson, A., Wekerle, C., Goldstein, A. L., Ellenbogen, S., Waechter, R., Thompson, K., Stewart, S. H. (2017).
Gender Differences in Emotion-Mediated Pathways from Childhood Sexual Abuse to Problem Drinking in
Adolescents in the Child Welfare System. Journal of Child and Adolescent Trauma, 10(1), 19-28.
doi:10.1007/s40653-016-0125-9
Hudson, A., Wekerle, C., & Stewart, S. H. (2015). Associations between personality and drinking motives in
adolescents involved in the child welfare system. Personality and Individual Differences, 81, 84-89.
doi:10.1016/j.paid.2014.12.008

25. Ellenbogen, S., Trocmé, N., Wekerle, C., & McLeod, K. (2015). An exploratory study of physical abuse-related
shame, guilt and blame in a sample of youth receiving child protective services: Links to maltreatment,
anger, and aggression. Journal of Aggression, Maltreatment & Trauma, 24(5), 532-551.
doi:10.1080/10926771.2015.102983
Faulkner, B., Goldstein, A. L., & Wekerle, C. (2014). Pathways from childhood maltreatment to emerging
adulthood: Investigating trauma-mediated substance use and dating violence outcomes among child-
protective services-involved youth. Child Maltreatment, 19 (3-4),219-232. doi:10.1177/1077559514551944
McPhie, M., Weiss, J., & Wekerle, C. (2014). Psychological distress as a mediator of the relationship between
childhood maltreatment and sleep quality in adolescence: Results from the Maltreatment and Adolescent
Pathways (MAP) Longitudinal Study. Child Abuse and Neglect, 38(12), 2044-2052.
doi:10.1016/j.chiabu.2014.07.009
Tanaka, M. & Wekerle, C. (2014). Dating violence among child welfare-involved youth: Results from the
Maltreatment and Adolescent Pathway (MAP) Longitudinal Study. International Journal of Child and
Adolescent Resilience, 2, 29-31. Retrieved from: https://in-car.ca/ijcar/issues/vol2/spring2014/R-
IJCAR_May2014_Tanaka_Wekerel_29-36.pdf
Ellenbogen, S., Trocmé, N., & Wekerle, C. (2013). The relationship between dimensions of physical abuse and
aggressive behavior in a Child Protective Services involved sample of adolescents. Journal of Child &
Adolescent Trauma, 6(2), 91-105. doi:10.1080/19361521.2013.781562
Goldstein, A.L., Vilhena-Churchill, N., Stewart, S.H., & Wekerle, C. (2012). Coping motives as moderators of
the relationship between emotional distress and alcohol problems in a sample of adolescents involved with
child welfare. Advances in Mental Health, 11(1), 67-75. doi:10.5172/jamh.2012.11.1.67
Fernandez, L., Wekerle, C. & Goldstein, A. (2012). Measuring adolescent dating violence: Development of
Conflict in Adolescent Dating Relationships Inventory (CADRI) Short Form. Advances in Mental Health,
11(1), 35-54. doi:10.5172/jamh.2012.11.1.35
Ellenbogen, S., Trocmé, N., & Wekerle, C. (2012). Self-generated outcome expectancies of violence in

26. Tanaka, M., Wekerle, C., Leung, E., Waechter, R., Gonzalez, A., Jamieson, E., & MacMillan, H. (2012).
Preliminary Evaluation of the Childhood Experiences of Violence Questionnaire Short Form. Journal of
Interpersonal Violence, 27, 396-407. doi:10.1177/0886260511416462.
Leung, E., Wekerle, C., Waechter, R., Engelstaff, J., & Bennett, M. (2011). Child protective services workers’
utilization of the Maltreatment and Adolescent Pathways Knowledge translation (MAP-KT) Portal: A report
on the usability statistics and usability gaps of Aboriginal best practice materials. First Peoples Child and
Family Services Review, 6(2), 7-13. doi:
Waechter, R., Leung, E., Bennett, M., Wekerle, C. & The MAP Research Team (2011). Cannabis use among
Aboriginal youth in the non-Aboriginal child protection services system. First Peoples Child & Family
Review, 6(1), 114-125.
Tanaka, M., Wekerle, C., Schmuck, ML., Paglia-Boak, A. & The MAP Research Team (2011). The linkages
among child maltreatment, adolescent mental health, and self-compassion in child welfare adolescents.
Child Abuse & Neglect, 35, 887-898. doi:10.1016/j.chiabu.2011.07.003
Weiss, J.A., MacMullin, J., Waechter, R., Wekerle, C., & The MAP Research Team (2011). Child maltreatment,
adolescent attachment style, and dating violence: Considerations in youths with borderline-to-mild
intellectual disability. International Journal of Mental Health and Addiction, 9(5), 555-576.
doi:10.1007/s11469-011-9321-x10.1007/s11469-011-
Goldstein, A.L., Wekerle, C., Tonmyr, L., Thornton, T., Waechter, R., Pereira, J., Chung, R., & The MAP Research
Team (2011). The Relationship Between Post-Traumatic Stress Symptoms and Substance Use Among
Adolescents Involved with Child Welfare: Implications for Emerging Adulthood. International Journal of
Mental Health and Addiction, 9(5), 505-524. doi:10.1007/s11469-011-9331-8
Waechter, R., Leung, E., Wekerle, C., Bennett, M., & The MAP Research Team (2011). Cannabis Use Among
Aboriginal Youth in the Non-Aboriginal Child Protection Services System. First Peoples Child & Family
Review, 6(1), 114-125.
Stewart, S., McGonnell, M., Wekerle, C., Adlaf, E., & The MAP Longitudinal Study Research Team (2011).
Associations with personality with alcohol use behaviors and alcohol problems in adolescents receiving
child welfare services. International Journal of Mental Health and Addiction, 9(5), 492-506.

27. Waechter, R., Wekerle, C., Leslie, B., Goodman, D. & The MAP Research Team (2009). Research with
Child Protective Services: A Participatory Action-Based Model for Successful Partnership and
Knowledge Translation. First Peoples Child & Family Review, 5, 118-128.
Wekerle, C., Leung, E., MacMillan, H.L., Boyle, M., Trocmé, N., & Waechter, R. (2009). The impact of
childhood emotional maltreatment on teen dating violence. Child Abuse & Neglect, 33(1), 45-58.
doi:10.1016/j.chiabu.2008.12.006
Wekerle, C., Leung, E., Wall, A-M., MacMillan, H., Trocmé, N., & Boyle, M. (2007). The Maltreatment and
Adolescent Pathways (MAP) Project: Using Adolescent Child Protective Services Population-Based
Research to Identify Research Questions. First Peoples Child and Family Review, 3, 8-16.