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Wekerle CIHR Team - Resilience Team Presentation 2016 - Supporting Adolescent & Young Adult Health
- 1. 1 Sexual violence prevention and resilience promotion Building international collaborations Presentations to: University of Worcester, University of West England October, 2016 Editor-in-Chief, Child Abuse & Neglect Supporting Adolescent & Young Adult Health: Christine Wekerle, Ph.D. Pediatrics, McMaster University Hamilton, ON, Canada wekerc@mcmaster.ca @DrWekerle
- 2. Presenter Conflicts of Interest Disclosure • Presently: Dr. Christine Wekerle • Relationships with commercial interests: NONE
- 5. Definition of child maltreatment (CM) • “Child maltreatment, sometimes referred to as child abuse and neglect, includes all forms of physical and emotional ill-treatment, sexual abuse, neglect, and exploitation that results in actual or potential harm to the child's health, development or dignity” • WHO | Child maltreatment www.who.int/topics/child_abuse/en/ – Public Health – Prevention of premature mortality, directly and indirectly – Humanitarian – Use of children during conflict (sex, labor, shielding) – Human Rights – Basic rights to non-violence and well-being; Disability prevention (14% >likely to be unemployed in adulthood; Currie & Widom, 2010; open access article: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3571659/) – Legal – Mandatory Reporting – for US States reporting numbers and information https://www.childwelfare.gov/organizations/?CWIGFunctionsaction=rols:mai n.dspROL&rolType=custom&rs_id=5
- 6. Child Maltreatment Harm and Resilience Potential Artwork in the 2016 McMaster Museum of Art: “Picturing Wellness” Exhibit https://museum.mcmaster.ca/exhibitions/past-archive/ #art=#resilience
- 7. Outline: #SGDs #GlobalGoals #ENDviolence #malehealthmatters #violenceprevention #resilienceinyouth #picturingwellness 7 I. Child Maltreatment Connecting to Global Partnership to End Violence Against Children Keeping adolescents and emerging adults in mind Connecting to developmentally-timed task II. Canadian Institutes of Health Research (Institute of Gender & Health, Public Health Agency of Canada) Team Grant in Boys’ and Men’s Health Range of studies from epidemiology to social media-based Kmb Targets for Prevention in Vulnerable Populations (hand-out) III. Discussion
- 8. Global Partnership to End Violence Against Children (http://www.end-violence.org/) • SAFE, STABLE, NURTURING CARE – (1) Teach positive parenting skills; – (2) Help children develop life skills and stay in school; – (3) Raise access to treatment and support services; – (4) Implement and enforce laws to protect children; – (5) Value social norms that protect children; – (6) Empower families economically; – (7) Sustain safe environments for children
- 9. Global Partnership to End Violence • https://sustainabledevelopment.un.org/partnership/?p=9061 • 2017 Deliverable: Build political will to end violence against children - make violence prevention a global policy priority • Goal 4: Build and upgrade education facilities that are child, disability and gender sensitive and provide safe, non-violent, inclusive and effective learning environments for all • Target 16.2 End all forms of violence against children • What about adolescents? 9
- 10. Trauma Experiences are high-impact events that are emotionally difficult to deal with and cause stress TRAUMATIC EXPERIENCES TRAUMATIC REACTIONS RESILIENCE COMMUNITY DIVERSITY VITALITY UNICEF 2016 plan 12% of budget in youth protection http://www.unicef.org/publications/files/HAC_2016_Overview_ ENG.pdf
- 11. Terms used in Elsevier’s Child Abuse & Neglect articles published 2010-2014 Citation impact: Note: Elsevier analyses of common terms from Child Abuse & Neglect articles; Used with permission, 2016
- 12. Global research priorities for interpersonal violence prevention: a modified Delphi study (Mikton et al., 2016) 12 • Interpersonal violence= child maltreatment, intimate partner violence, sexual violence, youth violence, armed violence, elder abuse (lifespan) • Findings: • International expert research priority ratings on 1 (most)-6 (least)Likert scale: • Child Maltreatment (2.05); • Sexual Violence (4.07).
- 13. Reviews of the global literature, including population surveys… • 363/1000 children (emotional abuse); • 226/1000 children (physical abuse) • 163-184/1000 children (neglect) • 127/1000 children (sexual abuse) • Unique impact of sexual abuse (e.g., Dion et al., 2016) • An increasing recognition that male youth may feel greater stigmatization and may under-report • Issue of sexual violence exposure among vulnerable populations (child welfare, juvenile justice, military, street-involved, LBGT+, Indigenous etc.)
- 14. 4-D (dimensions) Model of Trauma: (time; thought; body; emotion) Frewen & Lanius (2014) https://www.researchgate.net/publication/260994367_Trauma- Related_Altered_States_of_Consciousness_TRASC_Exploring_the_4-D_Model14
- 15. 4-D Model of Trauma: Sense-of-Self I am in the past . . . I am outside my body, and my body does not belong to me . . . My thoughts and voices take control . . . I can’t feel, I don’t know what I’m feeling, I feel too much, I too little . . . SELF TRAUMATIZED I am in the present . . . I am in my body and it belongs to me . . . I own and am in control of my thoughts . . . I can feel, and know what I’m feeling . . . SELF RECOVERED
- 16. Traumatic Responses – Male victim • “Major isolation, major depression, major anger, sadness, shame, guilt, scared – I always felt I was to blame. I suffer from PTSD, serious sleep deprivation, struggled with a lot of depression, anxiety, suicidal ideations, difficult to relate to peers, socially isolated, withdrawn, introverted, extreme mistrust of people, extreme amount of guilt, disassociation – - no safe place. “ • From: http://www.justice.gc.ca/eng/rp-pr/cj- jp/victim/rr13_8/rr13_8.pdf
- 17. CSA &Gender Rates STUDY CSA Rape/Sodomy Sexual Harassment Internet Sex Talk Sexual Dating Violence US Juvenile Offenders and Victims 2014 National Report 5.1% 12.9% 3.4% 20.5% 5.6% 13.9% US NatSCEV (2011) 4.0% 17.0% 0.4% 3.6% US CDC Youth Risk Behavior Survey (YRBS) 2013 6.2% 14.4% US National Incidence - Based Reporting System Law Enforcement Modal Age Boys= 4 years old Modal Age Females= 14 years old 62.0% 55.0% (Fondling) 5.0%/30.0% 35.0%/ 5.0% Global Rates Stoltenborgh et al. (2011) Systematic Review 7.6% 18.0%
- 18. Maltreated youth tend to function day-to-day (adaptation) • Order of Canada, ex-NHL’er Sheldon Kennedy adolescent interview YouTube • Documentary: “Swift Current” • CLIP: https://www.youtube.com/watch?v=sP3z8KVttro (1.03 minutes) • “Graham asked me questions about my life that nobody ever asked me. He asked me how I got along with my father, how I liked playing on my team, how I felt about school. I opened up to him immediately, especially…I wasn’t used to being asked about my feelings and opinions about things, and I sure wasn’t used to being listened to with so much interest and attention.” (p.33, Why I didn’t Say Anything, 2011)
- 19. MAP Study Research Team & Funders Multi-disciplinary Co-Investigator Team (alphabetical order): Dr. Michael Boyle, McMaster University Dr. Deborah Goodman, University of Toronto; Child Welfare Institute, Children’s Aid Society of Toronto Mr. Bruce Leslie, Catholic Children’s Aid Society of Toronto (retired) Dr. Eman Leung, City University of Hong Kong Dr. Harriet MacMillan, McMaster University Dr. Nico Trocmé, McGill University Dr. Randall Waechter, St. George’s University MAP Advisory Board – child welfare agency representatives and researchers Partner 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
- 20. Maltreatment and Adolescent Pathways (MAP) Research Study • Random case selection of active caseload • Across types of status – 62% Crown Wards • Repeated assessments every 6 mo. – 2 years • Some findings overview: • https://www.youtube.com/watch?v=3Zes- PJi2OY 20
- 21. Maltreatment and Adolescent Pathways (MAP) Research Study - Child Sexual Abuse Experiences • From initial assessment (N=561) – Grouping into CSA experiences using youth self- report (CTQ/CEVQ) and Caseworker Report » Females (n=145; 49%) Males (n=70; 27%) Using CTQ Fondling 54% 45% Molested 47% 38% “I was sexually abused.” 55% 41% http://www.nspcc.org.uk/globalassets/documents/research-reports/social- workers-knowledge-confidence-child-sexual-abuse.pdf 2014 Brady et al. NSPCC report – challenges of workforce in specific trauma assessment areas like CSA
- 22. Motives for Sex &: Sexual Health Risks (n=297) CopingEnhancement Social Conformity Source Valence Positive/Approach Negative/ Avoid External/ Other-focus Internal/ Self-focus Cooper, 1994
- 23. • For child welfare-involved male youth, direct (c’) and indirect significant (PA, PM) • CSA+ males > CSA- males and CSA+ females to use alcohol before sex 23 Childhood Sexual Abuse Coping Motives Partner Approval Motives Peer Approval Motives Risky Sexual Behaviour a1 a3 a2 b1 b2 b3 c´ • Early age of intercourse; • 4+partners, lack of protection, sex w/ not well-known person past 6 mo. • Use alcohol/drugs before sex
- 24. Youth are more challenged in normative adolescent risk-taking: Drinking & Sex • Teaching consent helps w/ what not-to do, but not what to-do (strategies for peer pressure) • Adolescent and young adults, including collegiates, at risk of sexual violence • Audrie & Daisy 2016 documentary trailer • https://www.youtube.com/watch?v=29Dr4ChJUBc • Interview with male youth: • https://www.youtube.com/watch?v=S4eOS- TvVmA 24
- 25. College as a Resilience Hub • Colleges and universities are service providers across a spectrum: food security, learning, organization, career planning, physical health, mental health, sexual violence prevention, special needs • Recognized time of risk-taking within a structured environment - safe schools are required • Research study within The Caring Campus Project, funded by Movember Canada (http://caringcampus.ca) on sexual violence and drinking • Kehayes, I. L, Hudson, A., Thompson, K., Wekerle, C., & Stewart, S. H. (2017). Alcohol-Involved Sexual Victimization in College Men and Women: Anxiety and Depression Outcomes. Poster submitted to the Anxiety and Depression Association of America (ADAA) Annual Anxiety and Depression Conference, San Francisco, California, April. • Kehayes, I. L, Hudson, A., Thompson, K., Wekerle, C., & Stewart, S. H. (in preparation). The consequences of alcohol use and sexual victimization in men and women college students. 25
- 26. Collegiates as a Resilience Population • Collegiates experience adversity and local service access and resources may be a context of resilience • Young adulthood more developed executive function to support reaching for positives under challenge (school stress, connectedness, growth mindset) • Key adverse event: Collegiate sexual assault – 20% women experience assault – 1-14% men experience assault • Sexual victimization and alcohol use often co-occur – 50-70% of sexual assaults involve alcohol use1 • Heavy drinking may increase risk of sexual assault as victims may be targeted by perpetrators1 • Alcohol intoxication may interfere with a victim's ability to keep themselves safe – Women who drink regularly once a week, more likely to experience a sexual assault than women who don’t drink regularly2 – 1Abbey et al., 2004; 2Testa & Livingston, 2000 26
- 27. Alcohol and Sexual Assault • Alcohol first acts as an anxiolytic (inhibits anxiety) • Alcohol influences higher-order processing (planning, problem- solving and inhibition)1 – cues that would inhibit behaviour (empathy, concern) less salient than feelings of sexual arousal when drinking • Alcohol as synergistic – Predisposed to sexual perpetration more likely to act on desire when intoxicated • Beliefs about alcohol also important – College men who thought they were drinking more aroused by consensual and forced sex2 1Chermack & Giancola, 1997; 2George et al., 2000
- 28. • Longitudinal (5 waves) – 1,475 participants • Present study utilizes wave 3 only – 819 first-year students (512 who drink) – M age = 18.34 (1.88) – 69.1% female, 30.9% male • Victimized while drinking – How often have you experienced the following as a result of using alcohol this term? • Was taken advantage of sexually • Never, Once or twice, 3-5 times, 6-9 times, More than 10 times • Victimized by someone who was drinking – How many times this term has another student (i.e., friend, roommate, classmate, or other student) who had been drinking or using drugs… • Sexually harassed or sexually assaulted you • Never, One or twice, 3 or 4 times, 5 or more times • Anxiety and depression – Mood and Anxiety Symptom Questionnaire – (MASQ; Watson & Clark, 1991)
- 29. Model Victimized by Someone Drinking A) B) Anxiety Depression Victim of Sexual Assault When Drinking Anxiety Depression .14* (F = .08, M = .28**) .03 (F = .-.04, M = .17†) .21*** (F = .15*, M = .38**) .06 (F = .02, M = .01) ∆χ²(9) = 49.472, p < .001 ∆χ²(9) = 48..974, p < .001 † p = marginal, * p < .05, ** p < .01, *** p < .001
- 30. Affective Issues involved in trauma: Anhedonia (Frewen et al. work) HEDONIC DEFICIT (HD) NEGATIVE AFFECTIVE INTERFERENCE (NAI) POSITIVE AFFECT NEGATIVEAFFECT Trauma Theory: Child maltreatment challenges affect regulation, given the experience of competing emotions e.g., attachment feelings with fear of attachment figure; experiencing pain and positives from the same parent or attachment figure. Association of positives with negatives and visa versa.
- 31. Childhood Maltreatment & Anhedonia (Frewen et al. studies) EMOTIONAL ABUSE 0 1 2 3 4 5 6 HD NAI EA (n=20) No-EA (n=79) SEXUAL ABUSE 0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 HD NAI SA (n=14) No-SA (n=85) * *** * *
- 32. Mindfulness Mindset Mindfulness: • A resilience process to de- couple positives from negatives and reduce emotion over- or under- reactivity • Building the observational self (versus the victimized or victimizer self-concept) to provide self-scaffolding to emotional experiences (in maltreatment, parental lack of scaffolding child’s experiences
- 33. Frewen & Lanius, 2014 Mindfulness Intervention: In the PALM of your hand... Presence • I am in the Present, not the Past • Recognize influence of past on my responses in the present Awareness • Being Aware of my senses, body, and emotions • Labeling and under- standing my experience Letting-Go • Letting-go of distressing experience • Non- attach- ment to harmful impulses or desires Metta • Being Kind & Compass- ionate to Self & Trusted Others
- 34. Crafting A Daily Resilience Practice (1) Reducing everyday experience/perception of overwhelming stress (rumination); (2) Increasing positives and regulation actions •Sleep Quality •Social Connectedness •Self-compassion •Exercise/Fitness •Healthy Fun
- 35. Thank you for your time and attention! 35 Youtube = ResilienceInYouth Instagram = ResilienceinYouh Twitter = @ResilienceinYouth @Team_Resilience @DrWekerle Email: wekerc@mcmaster.ca for CIHR Team Twitter Chart Researchgate: Follow Project @ https://www.researchgate.net/project/Understanding-health-risks- and-promoting-resilience-in-male-youth-with-sexual-violence- experience-CIHR-Team-Grant-TE3-138302
Editor's Notes
- COMPLETION INSTRUCTIONS: All faculty must complete this slide; information should match Competing Interest Form; If NO relationship, add “Potential for conflict(s) of interest: Not Applicable” to this slide. This slide must be visually presented to the audience AND verbalized by the speaker.
- The following statements describe a Sense of Self according to the 4-D model From a Traumatized State (IN RED) through to Recovery following psychotherapy (IN BLUE). ** may end this talk here after reading statements… **
- Cooper’s 1994 model of drinking motives. Drinking motives can be classified along two dimensions: valence or type of reinforcement (positive or negative) and source of reinforcement (external or internal). Valence refers to the nature of the emotion that is being targeted by drinking…be it to achieve a positive emotional outcome or to avoid a negative emotional state. The other dimension is source. Source can be identified as internal or external, meaning that the individual drinks to change their internal experience or to fulfill external, social goals. By combining these dimensions, we end up with four separate motives for drinking: enhancement (internally motivated to increase a positive state), coping (internally motivated to reduce a negative state), social (externally motivated to increase a positive state), conformity (externally motivated to reduce a negative state). Give examples…… Enhancement –to get an emotional high, to have fun….might be thought of as taking place in a party context Coping – to deal with negative emotional states, to escape or forget about problems, to numb emotional pain/distress Social – for reasons such as social affiliation, to enjoy social gatherings Conformity – due to peer pressure, feel like you need it to fit in
- Alcohol affects high-order processing such as planning, problem-solving and inhibition (e.g., Chermack & Giancola, 1997). As a result, cues that would normally inhibit sexually aggressive behavior, such as concern for others and empathy, are likely to be less salient when drinking than feelings of sexual arousal. Thus, it is likely that alcohol acts in a synergistic manner whereby individuals who are predisposed to sexual assault are more likely to act on their desires when intoxicated. Beliefs around alcohol consumption and sexual arousal are also important predictors of sexual assault. In a study by George et al. (2000), college men who thought they were drinking alcohol were more aroused by depictions of both consensual and forced sex than were men who did not think they had consumed alcohol. In this study, it was the belief that the men had consumed alcohol rather than actual alcohol consumption that influenced their arousal.
- Anxious arousal and anhedonia depression
- These models all control for age and have been restricted to only drinkers These are all just-identified models because everything is estimated so there are no fit indices Bold numbers indicate significant paths Moderation was tested using gender on each model, so the first path coefficient is the overall model with males and females included together, and the numbers in brackets indicate the separate effects for males and females The chi-square indicates whether the male and female models are statistically different from each other Looking at our first model, overall individuals who were assaulted while they were drinking experienced increased anxiety but not depression Looking at males and females separately, this effect was driven by the men who experienced the increased anxiety but not women, and these models were statistically significant from each other. Men were also marginally more depressed when they were assaulted while drinking (p = .07) Looking at our second model, overall individuals who were assaulted by someone who was drinking experienced increased anxiety but not depression Looking at males and females separately, this effect was present for both males and females who both experienced increased anxiety, but this anxiety was much higher for the men as indicated by the significant chi-square
- BASICALLY THE CONCEPT IS THAT anhedonia may involve low (deficit) experience low positive affect, and/or high experience of negative affect that INTERFERES with their ability to experience positive affect.
- Here we showed in undergraduates that HDIS scores (Hedonic Deficit – HD, and Negative Affective Interference – NAI) were higher in people with Emotional Abuse (EA) and Sexual Abuse (SA) histories.
- A common feeling during and in the aftermath of traumatic life events and relationships is of being out of control. What we try to do in MMTT is put a sense of control back into a person’s own hands. We use the acronym PALM to stand for the first 4 of the MMTT principles: The P stands for Presence. This principle is about reminding yourself that you are in the present, to differentiate the present from the past, and to recognize the influence the past may be having on your way of responding to the present. In other words, it is important to recognize the influence past experiences, memories, and emotions may be having on your responses in the here and now; The A stands for Awareness. This principle is about being experientially aware, especially of sensory stimuli, your body, and of your emotions, primarily as a means of grounding yourself and improving your ability to label and understand your experiences and describe them to others; The L stands for Letting-Go. This principle is about trying to allow intruisve, distressing experiences to pass by, and becoming less attached to acting upon harmful impulses or desires. The M stands for Metta. This principle is about being more kind and compassionate toward yourself as well as trusted others.