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Resilient Adaptation Among At-Risk Children: Harnessing Science Toward Maximizing Salutary Environments

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Abstract

Compiled in this Special Section are recommendations from multiple experts on how to maximize resilience among children at risk for maladjustment. Contributors delineated processes with relatively strong effects and modifiable by behavioral interventions. Commonly highlighted was fostering the well-being of caregivers via regular support, reduction of maltreatment while promoting positive parenting, and strengthening emotional self-regulation of caregivers and children. In future work, there must be more attention to developing and testing interventions within real-world settings (not just in laboratories) and to ensuring feasibility in procedures, costs, and assessments involved. Such movement will require shifts in funding priorities—currently focused largely on biological processes—toward maximizing the benefits from large-scale, empirically supported intervention programs for today's at-risk youth and families.
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Maximizing Resilience
Resilient adaptation among at-risk children:
Harnessing science toward maximizing salutary environments
Suniya S. Luthar & Nancy Eisenberg
Arizona State University
In press, Child Development: Introduction to Special Section on
Developmental Research and Translational Science:
Evidence-based Interventions for At-risk Youth and Families
Pre-Publication version;
for published article, please email Suniya.Luthar@ASU.edu
Luthar gratefully acknowledges Susan Budinger and the Rodel Foundation for support of
her ongoing work with at-risk mothers, and Eisenberg's work was supported by a grant from
NICHD (101 HD068522).
Section Editors’ Note: We had 81 Letters of Intent submitted in response to the Call
for Papers. Considering specific criteria in the call, independent rankings by Luthar and
Eisenberg led to invitation of 18 articles. Although often raising important issues, proposals that
were not selected did not focus sufficiently on the specific criteria for the Special Section, e.g.,
they were either general (more on theory than on tested interventions), or too narrow
(describing one particular program). All submitted manuscripts were reviewed by at least two if
not three external reviewers and then (with one exception) also by both Section editors; due to a
conflict of interest with both editors, one manuscript was handled by Associate Editor Carlo
Scheungel
Correspondence concerning this article should be addressed to Suniya S. Luthar,
Department of Psychology, Arizona State University, 950 S. McAllister Dr, Tempe, AZ 85287-
1104. Electronic mail may be sent to suniya.luthar@asu.edu.
Maximizing Resilience
Resilient adaptation among at-risk children:
Harnessing science toward maximizing salutary environments
ABSTRACT
Compiled in this Special Section are recommendations from multiple experts on how to
maximize resilience among children at risk for maladjustment. Contributors delineated
processes with relatively strong effects and modifiable by behavioral interventions. Commonly
highlighted was fostering the well-being of caregivers via regular support; reduction of
maltreatment while promoting positive parenting; and strengthening emotional self-regulation of
caregivers and children. In future work, there must be more attention to developing and testing
interventions within real-world settings (not just in laboratories), and to ensuring feasibility in
procedures, costs, and assessments involved. Such movement will require shifts in funding
priorities -- currently focused largely on biological processes – toward maximizing the benefits
from large-scale, empirically supported intervention programs for today's at-risk youth and
families.
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In this Special Section, our goal was to distill what we have learned from science about
maximizing the well-being of children and families at risk for psychological maladjustment. With
over six decades of research on childhood risk and resilience (Cicchetti & Curtis, 2006; Luthar,
Crossman, & Small, 2015; Masten & Narayan, 2012), applied scientists are at a juncture where
we can, and indeed should, distill robust findings to derive top priorities for interventions.
Considering the rich extant evidence on various “protective processes,” we need to pinpoint
those that can be changed via psychological or behavioral interventions, are likely to have
relatively strong effects, and can be feasibly implemented in real-world settings (Luthar et al.,
2015). Toward this end, we sought to bring together the take-home messages identified by
eleven sets of experts regarding empirical evidence on different “at-risk” groups, to ascertain
commonalities in central priorities, and to discuss pressing needs and future directions for the
field.
Before summarizing these recommendations, it is worth clarifying the particulars of what
we sought from contributors: Most importantly, the call was specificity and depth rather than
breadth. As developmental scientists, we are generally trained to think in terms of multi-level
influences (from the publication of Bronfenbrenner’s seminal model onwards). In this collection
of papers, by contrast, we asked authors to stay away from broad-strokes, comprehensive
models (e.g., involving society, community, family, and the child) and instead -- with an eye
toward informing policies -- to hone in on the one, two, or three well-defined processes that they
would target to implement change. This type of specificity resonates with Sunstein’s (2015, p.
765) recommendations on how psychological research can be best used to interest
policymakers; optimal suggestions “..are simple, and clear and suitable for actual
implementation, preferably in the short term,” and besides being specific and feasible, should
pass cost-benefit analyses. Furthermore, Sunstein (2015) cautioned that although
psychologists often provide valuable insights into important larger societal problems such as
poverty, discrimination, and terrorism, discussions of these issues tend not to provide action
steps that are clearly outlined, cost-effective, and imminently implementable.
Thus, in our own request to authors submitting articles for this Special Section, we
sought actionable directions for intervention approaches benefiting at-risk children and families,
with details of “who,” "what," "why," and "how." Authors were asked to elucidate the
characteristics of the group targeted, the nature of the processes to be altered, the scientific
evidence to support their prioritization, the procedures for bringing about change, and the
methods to document intervention gains. Explicit attention to pragmatics was essential with
consideration of costs, durability of effects, feasibility of implementation, and approaches to
dissemination. Importantly, authors were asked not to describe a particular program (e.g.,
developed by their own group), but rather an overall strategy studied by multiple laboratories,
with exemplars of well-tested interventions.
Central Recommendations
Table 1 includes a summary of the authors’ recommendations. Within this table, we have
noted the top risk-modifiers identified by each set of authors, and indicated alongside how they
suggested that each should be targeted.
Caregiver Well-being: Supportive Relationships
As can be seen in Table 1, the two processes most consistently noted were the well-
being of the primary caregiver – typically the mother – and attention to specific dysfunctional
parenting behaviors. The focus on psychological, emotional support for mothers was explicitly
noted in at least five instances, in the articles on single mothers, depressed mothers, those at
risk for maltreatment, and both articles on early childhood interventions for children in poverty
(Goodman & Garber; Morris, Robinson, Hays-Grudo, Claussen, & Hartwig, this issue; Reynolds,
Mondi, Ou & Hayakawa, this issue; Taylor & Conger, this issue; Valentino, this issue).
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Contributors highlighted the need to ensure ongoing nurturance and support for mothers
through relational, interpersonal therapeutic approaches and by fostering close networks with
people in their everyday life settings. This recommendation is entirely synchronous with current
conceptual perspectives on resilience (Luthar et al., 2015). Importantly, it is also supported by
research showing multiple benefits of relational interventions for diverse groups of at-risk
mothers, ranging from low-income women with mental illnesses such as substance abuse and
depression (Luthar, 2015; Swartz et al., 2016; Toth Gravener-Davis, Guild, & Cicchetti, 2013) to
professional mothers negotiating high everyday work stress (Luthar, Curlee, Tye, Engelman, &
Stonnington, 2017).
Of the remaining six articles, in three, the well-being of caregivers was emphasized not
necessarily through external supports but rather via improved quality of adult relationships in the
proximal settings of the family and school. Minimizing co-parents’ conflict and enhancing
cooperation in the couple’s relationship was the primary focus for both Pruett, Pruett, Cowan, &
Cowan (this issue), and Harold, Leve, & Sellers (this issue). This emphasis makes good sense
for all families where both parents are involved in raising the child, even when parents are not
co-residing. In the setting of K-12 schools, Domitrovich, Durlak, Staley, & Weissberg (this issue)
explicitly noted supports for teachers (who, second to parents, are major caregivers and
socializers; see Sabol & Pianta, 2012): K-12 teachers are among professionals with the highest
levels of stress and burnout, and social and emotional support from colleagues are among the
most salient factors that have buffering effects (Chang, 2009). In all these instances, the
emphasis on mutual supports resonates with the broad tenet, in prevention science, that
successful evidence-based prevention programs encourage people to recognize, praise, and
reinforce others around them in their everyday lives (Biglan & Embry, 2013).
Finally, across the recommendations in this Special Section, warmth and caring from the
intervention personnel was a clear mandate; in efficacious interventions, therapists or teachers
generally are accepting of their clients while “gently guiding them to behave more effectively”
(Biglan & Embry, 2013). Empathy, compassion, and supportiveness of program staff are
cardinal components within programs ranging from those targeting new mothers (Olds et al.,
2014) and foster parents (Dozier et al., 2006; Fisher et al., 2006), to parents struggling with
family management (Dishion et al., 2008) and those contending with divorce (Wolchick et al.,
2002). When asked about why the Family Check-Up “works,” Dishion said, “If I had to pick one
thing, it would be kindness – to a group of chronically disenfranchised, highly stressed, low-
resource parents.” (T. J. Dishion, personal communication, June 30, 2016.)
Specific Parenting Behaviors
In terms of specific parenting behaviors, contributors highlighted the need to avert harsh,
insensitive parenting behaviors, and concomitantly, to foster nurturing, loving interactions
(Goodman & Garber, this issue; Modecki, Zimmer-Gembeck, & Guerra, this issue; Morris et al. ,
this issue; Pruett et al. , this issue; Reynolds et al. , this issue; Valentino, this issue). Again, this
resonates with the conclusion from resilience research that prolonged maltreatment is the single
biggest environmental vulnerability factor for children’s maladjustment (Luthar et al., 2015). It is
also synchronous with prevention scientists’ exhortations to prioritize the minimizing of harsh
behavior patterns and fostering of nurturing ones (Biglan & Embry, 2013).
Contributors to this Special Section described several strategies shown to help highly
stressed parents to respond to children’s demands and needs not with harshness and
impatience, but with sensitivity and support. Frequently, this involves feedback based on dyadic
parent behaviors actually observed by program staff (as in toddler-parent interactions, see
Morris et al., this issue; Valentino, this issue). In other instances, parents are helped to
understand and avoid specific behavior patterns that can inadvertently reinforce negative child
behaviors and, conversely, to develop positive strategies that reinforce adaptive child behaviors
(see Crnic, Neece, McIntyre, Blacher, & Baker, this issue). For example, Smith, St. George, &
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Prado (this issue) recommended encouraging parents’ provision of healthy foods at home on an
everyday basis to foster good eating habits and prevent obesity, whereas Reynolds et al. (this
issue) discussed the importance for young children’s scholastic readiness of enhancing parents’
expectations of them, and involvement in children’s education-related activities.
Self-regulation/Coping
Across all articles, the third theme that came up recurrently was fostering self-regulation
and coping skills among parents as well as children themselves (Crnic et al., this issue; Morris
et al., this issue; Goodman & Garber, this issue; Modecki et al., this issue). This again makes
good sense because capacities for self-regulation are at the basis of, or shape, multiple aspects
of responding related to maladjustment and adjustment, including expressing anger and
negative emotion and depressive rumination at one end, to social competence, personality
resiliency, good quality of relationships with caregivers, and success in and comfort at
schooling, at the other (for reviews, see Eisenberg, Eggum, Vaughan, & Edwards, 2010;
Eisenberg, Hofer, et al., 2014; Eisenberg, Taylor, Widaman, & Spinrad, 2015; Nolen-Hoeksema,
1991). The development of self-regulation and effective coping strategies in childhood also
predicts externalizing and internalizing symptoms across time, as well as important aspects of
competence and well-being in adolescence and adulthood (see Belsky Fearon, & Bell, 2007;
Bridgett Burt, Edwards, & Deater-Deckard, 2015; Caspi, 1998; Eisenberg, Spinrad, & Eggum,
2010).
Importantly, well-regulated parents are relatively likely to use supportive, nonpunitive
parenting techniques (e.g., Cumberland-Li, Eisenberg, Champion, Gershoff, & Fabes, 2004;
Cuevas et al., 2014) that, as already mentioned, have been associated with a range of positive
outcomes in interventions with children. Moreover, the types of supportive parenting practices
encouraged in interventions discussed in this Special Section have been found to predict the
development of children’s self-regulatory skills at a subsequent point in time (see Eisenberg,
Smith, & Spinrad, 2016, for a review), sometimes even when controlling for prior levels of
children’s self-regulation. Therefore, interventions that foster self-regulation in parents as well as
children probably have additive and mutually reinforcing positive effects on children’s
adjustment.
It is also important to promote both children’s and parents’ self-regulation skills because
parents are likely to adjust their parenting behavior in some contexts based on how regulated
their children behave (e.g., Bridgett et al., 2009), and the relation between parenting and
children’s self-regulation is likely bi-directional (e.g., Belsky et al., 2007; Eisenberg, Taylor, et al.,
2015). Regulation and emotionality between children and parents do seem to be related to the
degree of conflictual interactions (see Eisenberg et al., 2008), as are aspects of executive
functioning in both (Cuevas et al., 2014; Valiente, Lemery-Chalfant, & Reiser, 2007).
In terms of fostering effective emotional self-regulation, the most often cited approach in
the Special Section articles was the use of cognitive behavioral therapy (CBT) to modify faulty
cognitions and attributions, and to develop more effective strategies to regulate affect. CBT was
recommended for vulnerable parents – single mothers and those contending with depression or
ongoing poverty (Goodman & Garber, this issue; Morris et al., this issue; Taylor & Conger, this
issue), as was the use of mindfulness-based approaches, especially for parents of children with
disabilities (Crnic et al., this issue; also Goodman & Garber, this issue). Among school-age
children and adolescents, primary emphasis was on developing skills to regulate negative
emotions (anger in particular), which tend to contribute to better decision-making in everyday life
and improved social relationships (Domitrovich et al., this issue; Modecki et al., this issue).
What is the Role of Biological Indices in the Intervention Efforts?
Authors were asked to explicitly delineate measures that would be central in assessing
their endorsed interventions in real-world settings, and none recommended including biological
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measures (e.g., genotypes or patterns of stress-related hormones). This likely reflects (a)
pragmatic concerns given the inevitable lack of funds to be able to profile hundreds of at-risk
children and then personalize community-based interventions based on their individual profiles,
as well as (b) ethical concerns regarding any suggestions of excluding some children from
prevention trials based on their biomarkers (Luthar & Brown, 2007).
On the issue of feasibility, authors were not equivocal. Contemporary researchers often
cite Gene X Environment (G X E ) studies (wherein particular genes interact with environmental
adversities to affect maladjustment) as having the potential to inform interventions. For
community-based programs, however, Harold et al. (this issue) underscore that “Having access
to genetic data is not commonplace among mental health service providers, particularly those
serving high-risk populations in community health settings” and further, “Recognizing the
challenges for practitioners in collecting, analyzing, and using DNA samples to gain this
information, we suggest instead that practitioners obtain detailed family histories of their clients
to assess heritable influences”. Resonant is Valentino’s (this issue) assertion that “Given the
associated costs and the nascent state of our knowledge regarding how this information may
inform … treatment recommendations, inclusion of biomarkers should not be brought to scale
as interventions are implemented outside the lab at this time.” Regarding the state of
knowledge on G x E processes specifically, Belsky and colleagues’ (2015, p. 19) concluded
plainly that “for now, the developmental biology linking genetic variation to complex
psychological phenotypes is far more conjecture than it is science”.
On the ethical front, an important issue explicated by Valentino (this issue), and echoed
by Harold and colleagues (this issue), is that biological data cannot dictate exclusion from
preventive interventions for known potent adversities, such as maltreatment or chronic
interparental conflict. It is plausible that biomarker data including genotyping could become
useful for identifying who will be more/less responsive to interventions, but this would not mean
that with a given sample of maltreated children, some would be deliberately excluded because
of their genetic profiles. (Again, conclusions from the Belsky et al. (2015) review were that
effects of insensitive mothering are in fact robust across many potential genetic moderators).
Acknowledging that children may have differential biological susceptibility to major stressors, the
Frameworks Institute’s Research Report (Kendall-Taylor, 2011) provided a simple, compelling
imperative, advocating a lowest common denominator approach to interventions. In general,
programs that help children who are highly sensitive to the quality of their environments also
benefit those who are less acutely sensitive. “This type of ’a rising tide lifts all boats’ explanation
is a direct policy implication of this science story.” Kendall-Taylor, 2011, p. 63). We agree:
Addressing the rising tide makes imminent sense for all children who face chronic maltreatment,
or prolonged chaos or violence in the home.
Although biological measures are not likely to be useful in large-scale community
interventions (the explicit focus in this Special Section), this in no way means that they are
unimportant for applied developmental research (Eisenberg, 2014; Luthar & Brown 2007). In
basic science, there is clear value to studying biological processes to understand multi-level
processes in development. In laboratory-based intervention studies as well, there are instances
when biological indices, supplementing self-report and behavioral outcome data, can be
invaluable when the goal is to demonstrate that novel interventions work well. When new
interventions are shown to improve not just subjective distress but also critical biological indices,
this can be compelling for future advocacy efforts. To illustrate, arguments for early childhood
interventions have received much ammunition from Cicchetti and colleagues’ seminal work
showing that early maltreatment has significant ill-effects on biology and the developing brain,
and as importantly, that sensitive, responsive caregiving can substantially reduce the negative
effects of toxic stress (Cicchetti, 1996; Cicchetti & Curtis, 2006; Cicchetti & Gunnar, 2008; see
also Shonkoff & Fisher, 2013).
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Areas Needing Further Attention in Prevention Research
In the remainder of our commentary, we discuss future directions for translational
intervention science, beginning with a review of specific at-risk samples and constructs that
warrant further attention. We then discuss broader issues in future work in the field of
prevention, including approaches to intervention development, national funding priorities, and
advocacy efforts.
Discrete Subgroups and Dimensions
We need much more attention to interventions for fathers and father-figures; by far the
bulk of existing work on parenting including interventions has been based on work with mothers.
We simply cannot assume that what works well with mothers works the same way with fathers
(Cabrera, Fitzgerald, Bradley, & Roggman, 2014). To illustrate, programs based in supportive,
close relationships among women (service providers and community-based “mentor mothers”)
can be attractive in recruiting mothers (Valentino, this issue; Luthar, 2015), but they are unlikely
to attract men quite as strongly. For fathers, Pruett et al. (this issue) recommend concentrating
recruitment efforts in community settings where they are commonly found, including soccer
games, employment centers, and shopping malls; they also spell out specific strategies to foster
fathers’ engagement in treatment, once they have been recruited.
Noted by more than one set of authors in this Special Section is the need for more
attention to adolescence. In prevention science, there is much and appropriate attention to early
childhood. But the transition to adolescence poses a host of new developmental tasks and
challenges for children, and concomitantly, for their parents (Luthar & Ciciolla, 2016).
Domitrovich et al. (this issue) underscored that we need more school-based programs
developed and tested at the high school level. Goodman and Garber (this issue) discussed the
need for more interventions for depressed mothers with older children, as Valentino (this issue)
noted that among mother at risk for maltreatment, programs must consider parenting challenges
in the later childhood years as well.
None of the 11 sets of authors described processes specific to ethnic minorities, and the
reason for this is likely linked to our requirement to elucidate the most potent two or three
protective processes. Thus, all articles were focused on children’s proximal environments of
families and schools, where it is plausible that more than the issues specific to particular ethnic
minority groups (i.e., culture-specific mores and challenges), the powerful processes just
discussed -- minimizing abuse, neglect, harshness in relationships with major caregivers —
must be first priorities across diverse at-risk populations. At the same time, we must underscore
two caveats. First, promising interventions highlighted in this Special Section cannot be
assumed to be equally beneficial across different cultural groups: Generalizability of particular
strategies across contexts is often an empirical question. Second, there are highly inimical
macro-systemic processes, at the levels of communities and society, that also require urgent
attention in fostering resilience among children and families. These include processes that
threaten physical survival (chronic poverty, community violence or war), to those entailing
interpersonal hostilities such as implicit biases, homophobia, and discrimination (Luthar &
Brown, 2007; Masten & Narayan, 2012). Important directions on forces such as these are
effectively summarized by Yoshikawa, Whipps,and Rojas in their commentary on articles in this
Special Section.
In terms of outcomes that we seek to promote among at-risk children, we need attention
not just to averting psychopathology and improving everyday competence (e.g., good grades),
but also to fostering indicators reflecting doing for the greater good, such as altruistic behaviors
and compassion (see Biglan & Embry, 2013; Eisenberg, Spinrad, & Knafo-Noam, 2015; Luthar,
Lyman, & Crossman, 2015). Children who are prosocial and sympathetic toward others tend to
be socially competent, well regulated, low in externalizing problems, and express more positive
emotion and less negative emotion (Eisenberg, Spinrad, et al., 2015). Further, children who
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give to others exhibit more happiness than when they receive the same resources for
themselves (Aknin, Hamlin, & Dunn, 2012), and socially anxious individuals who engage in acts
of kindness toward others reported increases in positive affect over time (Alden & Trew, 2013).
Programs designed to foster prosocial behaviors have resulted in significant gains among
intervention children, relative to controls, not just in prosocial behaviors but also in academic
grades, self-efficacy, and agreeableness by the end of middle school (Caprara et al., 2015; also
see Eisenberg, Spinrad, & Eggum, 2010; Eisenberg, Spinrad, & Knafo-Noam, 2015, for
reviews).
Broad Paradigm Shifts: Focus on Contexts in Intervention Development
Beyond the specific research needs previously listed, there is a substantive, major shift
in direction that is needed in prevention science, and that is for more efforts focused on
developing programs in community settings. A recurrent theme in the Special Section is that we
have strong evidence regarding what is destructive and what is beneficial for at-risk children,
and even on how to address these processes in sophisticated, effective evidence-based
interventions, but far too little has been done to translate this knowledge into real-world
programs readily accessed by those most in need. This view resonates with what leaders in
clinical and prevention science have argued. Pointing to the low relevance of most laboratory-
based clinical research to actual practice, Weisz and his colleagues (Weisz, Ng, & Bearman,
2014; Weisz et al., 2015) called for using a “deployment-focused model” wherein interventions
are developed and tested, as soon as feasible, in the kinds of settings, and with the types of
clients and clinicians, for whom they are ultimately intended. In this model, efficacy testing of
treatment gains in laboratory-based studies would constitute just a brief initial phase in the
development of an intervention, whereas effectiveness testing, conducted under clinically
representative conditions (and thus establishing external validity), would be the dominant
research approach (for descriptions of innovative community-based strategies, see Chorpita &
Weisz, 2009; Weisz et al., 2015). Similar recommendations were provided by Biglan and Levin
(2016), who also caution that in contemporary approaches to translational research, there has
been too much focus on demonstrating the efficacy of interventions under highly controlled
circumstances as a precursor to testing them in everyday settings (see also Leslie et al., 2016).
We should note here that the need to consider context in interventions is by no means a
novel idea in applied developmental science; what is new is the still greater emphasis on
children’s proximal environments. For many years, there has been explicit recognition of the
limits of “pull out interventions” that try to foster particular skills in children without attention also
to their contexts. As noted by Modecki et al. (this issue), “Simply injecting youth with a set of
skills, only to introduce them back to an environment with inadequate supports is less likely to
lead to long-term gains.” Similarly, Domitrovitch et al. (this issue) argued that successful
school-based interventions are those that work not just with children but with teachers and staff
as well.
In recent commentaries in prevention and resilience science, recommendations are to
move the central focus further toward environmental contexts, affording in-depth attention to
processes that affect multiple outcomes. To illustrate, Biglan and Embry (2013) argued that in
future research on at-risk children, socializing forces that have traditionally been treated as
independent variables must themselves be considered as central dependent variables. In
parallel, Luthar et al. (2015) underscored that the well-being of caregivers should be considered
not only in terms of how they affect children’s functioning but as important dependent variables
in themselves, with research illuminating how best to help at-risk parents or parent-figures, as
well as teachers, to manifest resilient adaptation (Luthar & Ciciolla, 2015).
In addressing environmental contexts, a logical first step is to work with institutions to
minimize systemic deleterious influences within them and maximize nurturing ones (see
discussions of Domitrovitch et al. (this issue) and Reynolds et al. (this issue) on schools; also
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Luthar et al., 2016, on workplace interventions). And in order to convince organizations to adopt
and maintain evidence-based interventions, research is needed that starts with an individual
organization, identifies plausible influences on that organizations practices, and manipulates
contextual influences to test effects on these practices (Biglan & Levin, 2016). As Weisz and
colleagues (2015) indicated, the successful implementation of interventions in community
settings necessitates research on the systemic supports needed to foster success of the
program, the best methods to train clinicians and to ensure fidelity in implementation, and on
modifications needed to the interventions to fit well with the organization’s practices and culture.
Moving beyond particular organizations or institutions to communities more broadly,
arguably, the single most viable target to incorporate promising prevention-based programs is
primary care facilities, wherein behavioral programs and medical pediatric care are provided in
one location. A group of pioneering prevention scientists (Leslie et al., 2016) has described how
effective family-focused prevention programs--including many of those described in this Special
Section such as Triple P, New Beginnings, Family Check-Up, and Incredible Years--can be
effectively integrated into primary care settings. They acknowledged barriers to implementation
including issues of stigma and limited funding streams, and provided concrete suggestions for
how to address these in the future (e.g., concerted advocacy including the use of the media,
and possible insurance reimbursements for family-based service programs likely to be
beneficial). The authors also cite evidence to show that a range of healthcare staff, including
community health workers, nurses, psychologists, and social workers, can be trained to
implement these programs successfully with little additional workload for primary health care
providers.
A related important area of emphasis in prevention involves entire communities. In this
Special Section, Morris et al. (this issue) underscored the importance of increasing the
availability of programs that strengthen parents’ social support and increase positive parent-
child interactions through the varied settings that low-income parents already access (e.g., not
just healthcare settings but also community and faith-based organizations, and schools). This
view is consistent with recommendations offered by other authors across disciplinary foci, with
emphases on using existing resources to keep costs low. Antonucci, Arouch, and Birditt (2013),
for example, urged efforts to systematically enhance mutually supportive relationships in
community settings such as residential communities. Several examples of therapeutic and
preventive strategies based in communities, accessible to many yet at relatively low cost, are
described by Kazdin and Rabbitt (2013) and Rotheram-Borus, Swendeman, and Chorpita
(2012).
A blueprint example for effective multi-pronged community-based programs, working
upwards from a grassroots level, is seen in the state of Washington wherein multiple
organizations were actively involved with a shared, research-based understanding on how best
to reduce environmental toxins. To illustrate, one campaign increased awareness of concepts
of adversity and trauma among local families. Alongside, in a high school for students with
behavioral challenges, there was a shift from relying on punishment to deter misbehaviors to a
trauma-informed approach, with a resulting 85% reduction in suspension rates (for details, see
Mathematica, 2016). Such synergistic coming together of multiple organizations is critical in
being able to effectively advocate for programs and policies that make community
environments less toxic and more nurturing to families and children (Biglan & Embry, 2013).
From a research perspective, another way to think about these goals is in terms of
focusing on “multi-level” pathways --not in terms of the typical connotations of the phrase
(aspects of biology and the environment) but rather, in terms of malleable, discrete, salutary
relationship contexts that should themselves be examined as foci for change. We need
separate and deliberate attention to processes in different socializing contexts, understanding
how best to maximize well-being of mothers and fathers, teachers and early childhood
educators, day care and after school providers – and relationships with peers in elementary,
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middle and high school, as well as with mentors as positive socializing influences (e.g.,
DuBois, Portillo, Rhodes, Silverthorn, & Valentine, 2011; Rhodes & Rhodes, 2009).
Concluding Remarks
In recent years, there have been several collections of articles addressing the core
question of how behavioral scientists can make a difference to humanity (e.g., Settersten &
McClelland, 2015; Teachman, Norton, & Spellman, 2015), reflecting a sense of urgency to use
science most effectively to help humankind. In our Special Section, we brought together
conclusions from 11 sets of experts and integrated them with major priorities currently outlined
in resilience research, prevention science, and child clinical science. There is a great deal of
congruence in what is emphasized.
Above all, the consensus is that we must minimize toxins and maximize nurturance in
children’s socializing contexts, targeting the most important, malleable processes in their
everyday environments. Because families constitute the most proximal and long-standing of
children’s environments, there must be concerted attention to ensuring the well-being of primary
caregivers. In addition, we need focused efforts to fostering the nurturance of adults in schools,
organizations, and communities. This “upstream” intervention on socializing environments rather
than on individual children’s problems is consistent with recommendations to focus on pathways
that are “broadly deterministic” (Luthar et al., 2015), that is, those that affect multiple risk and
protective mediators as well as diverse adjustment outcomes, with substantial effect sizes, and
relatively enduring rather than transient effects.
Paradigmatically, we must accelerate the move to a deployment-focused approach in
prevention science, such that programs are developed keeping in mind, at the outset,
pragmatic, real-world considerations. Our progress will be limited if we focus too narrowly on the
development and dissemination of evidence-based intervention programs that address
individual problems in laboratories, failing to consider what is needed to ensure effective
implementation in real-world settings of communities and organizations.
To implement the kinds of programs that are needed, we will need rigorous efforts to
understand what is required at the level of organizations and communities, in order to foster
their adoption of promising programs. We will also need concerted advocacy, convincing
society of the value of the evidence-based programs recommended and of the need to fund
these (because of cost effectiveness in the long run), with special attention to children and
families in poverty.
Funding issues are of much concern at this point in time. In the last decade or so, there
has been an enormous move toward including biological indicators across intervention trials --
examined as outcomes, mediators, or moderators – and this shift has rested, in large part, on
national funding trends (see Eisenberg, 2014; Luthar & Brown, 2007; Miller, 2010; Sameroff,
2010). The heavy prioritizing of biology in mental health obviously comes at the cost of other
research initiatives, as reflected in a letter from multiple scientific groups to the search
committee for a new Director of the National Institute of Mental Health, expressing concerns
regarding the disproportionate focus on biology (Developmental Psychologist, 2016; see also
Lewis-Fernández, 2016; Markowitz, 2016). At the National Institute on Drug Abuse, similarly,
the explosive growth in biological research is undoubtedly useful for developing pharmacologic
treatments, but there are concerns about adoption of an overly narrow biological approach,
minimizing environmental influences that are known well to contribute to addiction and are
themselves modifiable (Biglan & Levin, 2016). In addition to exhorting funding agencies to
adopt balanced approaches toward biological and environmental influences, we would urge our
colleagues in science also to be circumspect on this front, especially with regard to
recommendations that expensive biomarkers be included as moderators in intervention trials
(see Lerner, 2015). Such recommendations must come with documentation of how biological
indices might actually be incorporated in real-world interventions toward affecting, in meaningful
11
Maximizing Resilience
ways, the prodigious unmet mental health needs of today’s children and families. To bring about
beneficial changes through preventive interventions, developmental and clinical scientists, as
well as other concerned professionals, must find ways to intervene at the societal level to
change priorities regarding critical problems in our society, and to implement promising
interventions in ways that are scientifically sound, wide in reach, and practically feasible.
12
Maximizing Resilience
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17
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Table 1.
Summary of Authors’ Recommendations: Interventions by At–Risk Group, Processes to be Targeted Along With Methods and Measures, and Salient Challenges for the Future.
Population Process 1 How to target –
1Process 2 How to target- 2 Measures Process 3
Taylor and
Conger Single mothers
Perceived social
support: Faith in
network that
values, nurtures
them
Group-based
programs,
especially peer-
led
Internal
resources:
optimism, self-
efficacy, and self-
esteem
Cognitive-
behavioral -
coping, reframing;
Individual therapy
Depression,
stress, optimism,
gratitude
Valentino
Maltreating
mothers and their
children
Maternal
sensitivity
Tier 1:
Brief (8-10
sessions)
relational
programs;
support for
mother
Overall
attachment
security
Tier 2: Longer
term therapy,
case
management,
treatment for
depression
Attachment,
sensitivity, child
abuse potential,
child post
traumatic stress
symptoms
Goodman and
Garber
Depressed
mothers of young
children
Symptoms of
depression
Cognitive or
interpersonal
approaches;
medication
Dysfunctional
parenting
behavior
Home Visiting,,
Positive
Parenting
Programs
enhanced to
address maternal
depression;
support for
mothers
Maternal
depression,
parenting, marital
distress, child
adjustment
Reynolds, Ou,
Mondi, and
Hayakawa
Families in
poverty: Early
childhood
Cognitive
advantage
Activity-based
educational
experiences
Family support
Parent
involvement in
school,
expectations,
avoidance of
maltreatment
Child’s
educational
attainment,
externalizing and
internalizing
School support
Morris, Robinson,
Hays-Grudo,
Claussen,
Hartwig, and
Treat
Families in
poverty: Early
childhood (most
with mothers)
Nurturance for
caregivers
Group
interventions;
supportive
program
interventionists
Nurturing
relationships
between
caregivers and
children
Attachment,
positive
parenting, child
adjustment
Parent mental
health, coping,
responsive
parent-child
interactions
Pruett, Pruett
Cowan, and
Cowan
Families in
poverty: Fathers
Couple
relationship
quality
Fathers’
involvement and
parenting, couple
relationship
Co-parenting
relationship
Parents’
wellbeing;
negative
intergenerational
cycles; external
stresses, external
supports
Couple
satisfaction,
parent and child
symptoms
Table 1
Continued
Population Process 1 How to target – 1 Process 2 How to target- 2 Measures Process 3
Domitrovich
Durlak
Staley, and
Weissberg
Universal
populations
of K-12
students
Social and
emotional
intrapersonal
competencies
Explicit instruction
and learning
environments that
foster positive
mindsets, self-
awareness, and
self-management,
“resistance skills
Social and
emotional
interpersonal
competencies
Explicit instruction
and learning
environments that
foster
communication,
social awareness,
and social
problem solving.
Child symptoms,
academic
achievement /
engagement,
prosocial behaviors
-
18
Maximizing Resilience
Modecki,
Zimmer-
Gembeck,
and Guerra
Adolescents
at risk for
externalizing
behaviors
Emotional
regulation, coping,
decision making
Social cognitive
processing; warmth
and support from
significant adults
Parents
setting
behavioral
goals and
reinforce skill
integration
Parents modelling
and foster
effective coping
Externalizing
behaviors and
associated
problems
Coping, life
skills in the
school
Smith, St.
George and
Prado
Children at
risk for
obesity: Low
income,
minority
Parents facilitation
of healthy lifestyle
choices
Parent Positive
Behavior Support
interventions
Parents
reinforcement
of desired
behaviors
General and
health behavior
specific positive
behavior support
strategies
Child weight, body
composition, diet,
physical activity
Child
inhibitory
control (e g.,
mediator)
Crnic,
Neece,
McIntyre,
Blacher and
Baker
Families of
children with
Intellectual
disabilities
Parents’ behavior
management
Behavioral parent
training, with
adapted sections
relevant to children
with intellectual
disabilities
Parent stress
Mindfulness-
based stress
reduction
Child behavior
problems, parent-
child interactions,
parents’ stress and
emotional
dysregulation.
-
Harold,
Leve and
Sellers
Children at
risk for
internalizing,
externalizing
problems
Genetic
predisposition, as
moderator of
response to
interventions for
Processes 2 and 3
Biological family
history (where DNA
samples/molecular
genetics are not
feasible)
Couple/
interparental
relations
Couple/
interparental
relationship
interventions
Child symptoms,
parent-child
interactions,
interparental
relations
Parenting
behaviors
19
Maximizing Resilience
... There are growing calls for researchers to focus on the well-being of primary caregiverstypically mothersand what helps parents maintain good parenting when they are struggling with persistently high stress (Luthar and Eisenberg, 2017). Single-parent families are becoming increasingly common around the world (Chiu et al., 2018), and the United States. ...
... Although more research is needed to replicate these findings from our study, several implications for mental health practice can be proffered when considering these results. First, interventions and preventions with highly stressed families have often focused on altering parenting skills or child behaviors but do not explicitly or directly target parental well-being (Luthar and Eisenberg, 2017;Zhou et al., 2021). Focusing on improving single mothers' well-being, such as bolstering their social support, is expected to contribute positively to their parenting behaviors, parent-child relations, and their children's adjustment (Taylor and Conger, 2017). ...
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... The parent-child relationship is regarded as the predominant relationship in which children frequently seek parents' guidance, reassurance and direction (Furman & Buhrmester, 1985). Good parent-child relationship typically tops the list of protective factors identified in studies of resilience (Luthar & Eisenberg, 2017;Masten, 2014Masten, , 2021. Children's resilience can be cultivated and developed by parents' positive action (Pedro-Carroll, 2005;Chen & George, 2005). ...
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... The more general research tradition focused on resilience cuts across numerous types of stresses and adversities the child may face, ranging from poverty to natural Family-and School-Based Sources of Resilience Among Children of Incarcerated Parents disasters to chronic illness. In a recent overview of resilience research, Luthar and Eisenberg (2017) focused heavily on the presence of family strengths that included "nurturing, loving" interactions with parents and the development of positive coping strategies on the part of both the parent and child. This central focus on positive parenting dynamics clearly is warranted and is recognized as a key healthy child development. ...
... long-term impairments. This phenomenon of adaptive development and functioning despite exposure to risk factors is captured in the concept of resilience (Luthar, Cicchetti, & Becker, 2000;Luthar & Eisenberg, 2017;Masten & Gewirtz, 2006). Resilience models suggest that intra-and interpersonal protective factors may mitigate risk factors by buffering their impact on negative outcomes (Luthar et al., 2000;Masten & Obradović, 2006). ...
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... Additionally, general youth resilience research has highlighted the importance of a particular external factor to buffering risk and sustaining or bolstering resilience-caregivers, specifically caregivers' well-being and relationship to their children (Luthar, 2015;Luthar & Eisenberg, 2017;Masten & Motti-Stefanidi, 2020;Ungar, 2004;Williams & Nelson-Gardell, 2012); however, none of the studies in this review included caregivers (albeit, only two studies had a M age <18 years). Caregivers of individuals with PLEs may gradually experience increasing stress (Wong et al., 2008), and a healthy caregiver-child relationship can be protective for youth with PLEs (Bentley et al., 2016;Izon et al., 2018;McMahon et al., 2021). ...
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