Growing Resilience:
Creating Opportunities for Resilience to Thrive

David Osher, Kimberly T. Kendziora, John VanDenBerg, and Karl Dennis

Nine effective, risk-reducing, and resilience-building programs provide powerful insights into what works for troubled children and how to build places where resilience thrives.

We are all inspired by stories about people who have persevered to achieve fulfillment in life. But who are the people who made it possible for these stars to shine? We must recognize the family members, friends, teachers, counselors, members of the faith community, and others who help make resilient outcomes happen. As we begin to pay more attention to the places where resilience thrives, and not just to the individuals who overcome obstacles to succeed, we can continue to make resilience a possibility for a new generation of children at risk.

It is tempting to simply give up when faced with the familiar litany of problems facing youth today (too much violence, sexual activity too early, too many drugs, not enough morality or responsibility). We sometimes hear that "nothing works" to help those who are at risk and in need. But in reality, there are many exemplary, evidence-based, family-focused programs offering both help and hope that reach beyond individuals to foster resilience. The following short list of such programs, though incomplete, can provide some powerful insights into what works for troubled children and how to build places where resilience thrives.

Seven of the nine programs described here were visited by researchers connected with the Center for Effective Collaboration and Practice after the programs (or models) were nominated as exemplary by panels of researchers, practitioners, and family members. The other two programs described here—Nurse Home Visitation and Big Brothers/Big Sisters of America—are both nationally recognized and have been the subject of rigorous evaluation.

Key Elements of Resilience-Building Programs

What we know from the field about what works is being reflected in research on effective, risk-reducing, and resilience-building programs. Effective services provide contexts that both reduce the impact of risk factors and foster the development of new or existing protective factors. These programs build on inherent strengths within families, schools, and communities, and enable these institutions to help children succeed. And more than just helping children, the best programs also support those who care for and provide services to these children, thereby enhancing their capacity to care. These programs address child development at a variety of stages, from prenatal care through postsecondary employment—stages that some would even say are too early or too late for appropriate intervention. These programs repeatedly demonstrate that resilience, rather than being solely dependent on individual characteristics, can be socially constructed.

We begin our examination of resilience beyond the individual by looking at programs that work with families during the prenatal period—before a child is even born. We follow with programs that address preschoolers and then schoolchildren, incorporating progressively broader ecological systems (schools, community institutions) into their considerations of what it takes to develop resilient children. Finally, we describe programs that move toward the ultimate goal of creating resilient communities that enable children and families to expect and achieve successful lives.

Key Elements of Resilience-Building Programs

Surveys of and information about other exemplary preventative and resilience-enhancing interventions may be obtained through these World Wide Web sites:

Blueprints for Violence Prevention:
http://www.Colorado.EDU/cspv/blueprints/       

Preventing Drug Use Among Children and Adolescents: A Research-Based Guide:
http://www.nida.nih.gov/prevention/prevopen.html

Prevention and Early Intervention: Collaboration and Practice:
http://cecp.air.org/prev-ei/

Strengthening America’s Families: Effective Family Programs for Prevention of Delinquency:
http://www.strengtheningfamilies.org/

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What happens when a woman is poor, single, and pregnant? An ordinary helper might point the mother-to-be in the direction of social services so that she could receive the public assistance to which she may be entitled. However, in some parts of the country, there are helpers who do much more. The Nurse Home Visitation Program, developed by David Olds and his colleagues (Olds, Henderson, Kitzman, et al., 1998) in Elmira, New York, offers more than a TANF paycheck to high-risk mothers. This program hires nurses who visit families in their homes 9 times during pregnancy and 23 times during the child’s first 2 years of life. These visits focus on three areas:

1. Improving the women’s prenatal health and pregnancy outcomes.
2. Improving the quality of child care provided to the infants once they are born in order to promote better child health and development.
3. Improving the women’s personal development in such areas as educational achievement, career development, and future family planning.

This kind of very early, positive, uplifting intervention can produce significant results, especially for those families at highest risk (both low income and unmarried). When compared to high-risk women who had not received visits, program participants in Elmira had 79% fewer verified reports of child abuse or neglect, spent less time on public assistance, had 44% fewer maternal alcohol and drug abuse problems, and had 69% fewer arrests. A 15-year follow-up of these women’s children showed that, compared to the children of high-risk women who had not received visits, there were 60% fewer instances of running away, 56% fewer arrests, and 56% fewer days of alcohol consumption (Olds, Henderson, Cole, et al., 1998). The program has been successfully replicated in Memphis, Tennessee, and is currently underway in Denver, Colorado. The costs of the program are recovered by the first child’s fourth birthday (Karoly et al., 1998).

Among currently active nurse home visitation programs, the one developed by David Olds and his colleagues has the strongest research support. Other programs have often not demonstrated the duration of effects on children seen here. For example, the Infant Health and Development Program had dramatic effects at age 3 but almost none at age 8 (McCarton, Brooks-Gunn, Wallace, & Bauer, 1997). Examples of inactive programs include the Child Parent Enrichment Project (Barth, Hacking, & Ash, 1988) and the multiagency, interdisciplinary program studied by Huxley and Warner (1993).

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Risks for adverse child outcomes still exist beyond the prenatal and infancy period. Toddlers who display high rates of emotionally intense, difficult behavior are at risk not only for future mental health problems, but also for child abuse and neglect. Promising interventions to build resilient families faced with such challenges exist and offer real help to families struggling with hard-to-manage preschoolers.

The resilience-building preschool-age programs with the most extensive research support are the Perry Preschool program, which pioneered the High/Scope curriculum, and the Houston Parent Child Development Center. The Perry program supports resilient outcomes by promoting school readiness in poor, underserved children and by reaching out to their families through weekly home visits by teachers.

Data from a follow-up of children served by the Perry Preschool program, conducted when participants were age 27, showed fewer chronic offenders (7% vs. 35% had been arrested five or more times), fewer welfare recipients (59% vs. 80%), and more high school graduates/GED recipients (71% vs. 54%), compared with a randomly assigned nonparticipating group of children (Schweinhart, Barnes, & Weikart, 1993). Training in the High/Scope curriculum is commercially available.

The Houston program included extensive supports for mothers as well as children and produced impressive outcomes (e.g., success in improving the quality of interaction between mothers and their children, reducing the incidence of behavior problems, and enhancing school performance 5 to 8 years after completion of the program [Johnson, 1989]). However, this program is not currently active. Head Start is by far the largest preschool program serving children and families who are poor, but Head Start lacks adequate research to support its impact (General Accounting Office, 1997).

Another impressive preschool program is offered through Early Intervention Centers (EICs) run by the Positive Education Program, a Cleveland-area agency serving children with serious emotional and behavioral problems and their families. The Early Intervention Centers provide intensive, family-driven training and support to children and their families from birth to 6 years of age. The goal of the EICs is to provide young, high-risk children with the skills and behaviors necessary for integration into an educational setting appropriate to their ages and ability levels.

The work of the EICs begins with a family-driven assessment. Because parents actually implement the interventions with their children, the program empowers families and helps them invest in finding solutions for themselves. Experienced professionals and a parent paraprofessional staff provide guidance and expertise. Although there is no financial cost to the family, participants "give back" to the program by teaching their new skills to new families. Program outcomes show that the sessions do work to develop skills in children that help them succeed in school.

During the 1997 fiscal year, 74 parents requested assistance from the EICs in finding their children placements in or helping their children make the transition to kindergartens, preschools, or daycare centers in the community. Of these, 55% were successfully placed in special education community programs, and 45% were successfully placed in non-special education community programs.

Routine follow-up contact with parents is primarily made through telephone calls, which help determine whether EIC program graduates are not only maintaining their progress but are also adequately being served within their current placements. All 412 parents who received follow-up calls and 42 more who initiated calls reported that they had received the assistance they requested and had successfully maintained their children in the home and in the community programs where they were placed.

The EICs support resilient families in large part because they do not just treat clients. Many of the staff are program graduates, and can share with other families their firsthand knowledge, skills, and resources for working with children who are behaviorally challenging and helping these children develop the behavioral skills that will help them succeed in school.

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Once children make the transition to school, behavior that may have been tolerable or even manageable at home can sometimes create problems in the classroom. Children who are aggressive at school risk rejection by peers and teachers, personal adjustment problems, and poor educational achievement. A proactive intervention during kindergarten may help divert children from this pathway and build resilient schools in the process.

The First Step to Success program was developed by Hill Walker and his colleagues at the University of Oregon. This program involves collaboration between the home and the school in teaching aggressive children the specific skills they need in order to succeed at school and build positive relationships. Like the Early Intervention Centers, it provides adults (in this case, teachers and parents) with the skills to support the development of children who are at risk of antisocial behavior. This intervention has three components:

1. Screening of all children to identify those needing help.
2. School-based intervention that includes teachers, peers, and parents.
3. A parent-based intervention to support parents in training their children in prosocial behavior and building self-esteem.

An evaluation of the initial trial of this program showed that it produced increases in adaptive behavior and time on task, and reductions in aggressive and inappropriate behavior. Improvements are still evident up to 4 years after services are provided (Sopris West, undated document). The program has been replicated at four sites in Oregon, three in Washington, and one in Kentucky.

Other early school-age programs that include an individual or family focus and have evidence of their effectiveness include Promoting Alternative Thinking Strategies (PATHS) (Greenberg, Kusche, Cook, & Quamma, 1995), the Seattle Social Development Project (Hawkins, von Cleve, & Catalano, 1991), and the Strengthening Families Program (Aktan, Kumpfer, & Turner, 1996).

Some families that are poor and socially isolated may not reach out when they are having problems because they do not know where to turn or because they find services to be aversive. Now they can turn to the Families and Schools Together (FAST) program in 27 U.S. states, Australia, Canada, and soon in Germany.

Families and Schools Together is a collaborative prevention and parent involvement program designed to address alcohol and drug abuse, violence and delinquency, and school dropout. Founded by Lynn McDonald of the University of Wisconsin– Madison, the program capitalizes on the fact that elementary school teachers are often among the first "outsiders" to notice signs of a child’s or a family’s stress. In this program, a teacher’s recommendation leads to an outreach home visit by a FAST parent graduate. During the visit, the entire family of an "at-risk" child is invited to a meeting with 10 to 12 other families from that school. The core of the program involves eight weekly meetings, usually held in the school, during which positive, fun interactions for families are structured and facilitated by a collaborative leadership team. Every meeting includes a family meal.

The ultimate goal of the process is to increase the likelihood of the child’s success in the home, school, and community. To achieve improved child outcomes in these arenas, FAST builds the central protective factor of family cohesion through five intermediate goals in three areas: strengthening the parents, increasing parental involvement on multiple levels, and reducing the risk factors of chronic daily stress, substance abuse, and chronic family conflict. To ensure that families use all the social supports available, rather than becoming dependent on the FAST trainers, the process also stresses community-building and family social networking strategies.

Of families who attend one meeting, over 80% complete the 8-week course and participate in a formal graduation ceremony. A majority of these parents remain more involved in school activities even after the initial course is over. Families then participate in monthly follow-up meetings, which they run for 2 years. An evaluation of FAST by McDonald and Sayger (1998) showed that after program completion, there were significant improvements in the child’s classroom behavior, home behavior, and self-esteem; in family closeness; in parent involvement in school; and reduction in the family’s social isolation. Two-year follow-up data on FAST program family graduates suggest continued improvements among children.

Other successful programs that focus on school-age children include Bry’s Behavioral Monitoring and Reinforcement Program (Bry, Conboy, & Bisgay, 1986), and the Midwestern Prevention Project (Pentz, 1993).

Some schools have been described as hopeless and overrun with "out-of-control" students, helpless teachers, and too many disciplinary referrals. While many schools simply remove such children from their programs, Project ACHIEVE offers one alternative answer to such school-wide problems. Developed by Howie Knoff and George Batsche in the School Psychology Program at the University of South Florida, Project ACHIEVE was originally implemented in schools in the Polk and Hillsborough County school districts. Now, there are over 20 Project ACHIEVE sites across the country.

Project ACHIEVE helps individual schools strategically plan for and address both immediate and long-term student needs. It particularly emphasizes improving and increasing students’ academic progress and success, social behavior, social skills and aggression control, and reducing occasions of school-based violence through organizational and resource development, comprehensive teacher inservice training and follow-up, and parent and community involvement.

The major accomplishments of the longest-running Project ACHIEVE school have included

• 28% fewer disciplinary referrals to the principal’s office
• reduction of students receiving out-of-school suspensions from 9% to 3%
• improvement in teachers’ perceptions of school climate
• 67% fewer students being placed in special education
• decline in student grade retentions from 6% of student body to only less than 1%
• increase in the number of students scoring above the 50th percentile on year-end achievement tests, especially for those involved at the youngest ages
• academic improvements for those students whose parents were trained at the Parent Drop-In Center

Project ACHIEVE demonstrates that there is hope for even the riskiest, most troubled schools. Because parents and communities are involved in the effort, reform spreads beyond the individual school and brings promise to formerly blighted areas.

Other effective programs targeting the behavior of school-age students include the Adolescent Transitions Program (Dishion & Andrews, 1995), Positive Adolescent Choices Training (PACT) (Hammond & Yung, 1991), and Second Step (Grossman et al., 1997).

Many people say that nothing works with troubled kids, especially with teens. A nationwide impact study of Big Brothers/Big Sisters of America (BB/BS) (Tierney, Grossman, & Resch, 1995) has proven otherwise. This program provides youth with the desperately needed positive experience of a nurturing relationship and positive things to do outside of school hours. Youth who do not have relatives and teachers to play the role of caring adult can still be positively influenced and become more resilient and successful when they are paired with carefully selected and matched mentors.

BB/BS has served over a million children since it was established in 1904. Over 500 local offices currently screen volunteers and match them to youth in the community. BB/BS typically serves youth, ages 6 to 18, from single-parent homes. A volunteer mentor will interact on a one-to-one basis with a young person in a variety of settings. The pair meet regularly (about three times a month). BB/BS distinguishes itself from other mentoring programs by its rigorous procedures that match participating youth to a volunteer through youth assessments as well as volunteer screening and orientation. All involved parties are supervised and supported during the full duration of the program.

The evaluation by Tierney, Grossman, and Resch (1995) that tracked youth involved with Big Brothers/Big Sisters of America reported that after 18 months in the program, youth who were poor and raised in single homes where there was a high proportion of violence:

• were 46% less likely than unmentored youth to initiate drug and alcohol use
• were 33% less likely than unmentored youth to engage in violent behavior
• had reduced their school absenteeism by 52%
• were more likely than unmentored youth to have higher quality relationships with their parents/guardians and peers

In addition to these positive outcomes, BB/BS shows that using community volunteers not only helps the youth become more resilient but also builds links across generations.

Some research supports the effectiveness of a number of other mentoring programs, including Across Ages (LoSciuto, Rajala, Townsend, & Taylor, 1996), Denver’s Gang Rescue and Support Project (GRASP) (Hritz & Gabow, 1997), and Project Support (Hurley & Lustbader, 1997).

Some children require more intensive services than schoolwide approaches or even such targeted interventions as mentoring or First Steps (Dwyer, Osher, & Warger, 1998). Many of these children and youth can benefit from supports that are individualized, strengths-based, culturally competent, and driven by their and their family’s needs. These interventions must be multisystemic, community-based, and unconditional (Burns & Goldman, 1999). Examples of these supports include respite care for children and families, assistance in getting youth up and out of the house so that they attend school, intensive tutoring, and therapy. Programs that use these approaches include Treatment Foster Care (Chamberlain & Reid, 1998) and Multisystemic Treatment (MST) (Henggeler, Schoenwald, Borduin, Rowland, & Cunningham, 1998).

Chicago’s Kaleidoscope program has also used such approaches for almost 30 years in its work with youth who are experiencing multiple stressors and who have multiple risk factors. Kaleidoscope maintains a "no reject, no eject" policy. Once a child is referred, the staff will do "whatever it takes" to work toward successful outcomes not only for the child, but also for the entire family (Clark, Unger, & Stewart, 1993). Alaska’s "Youth Initiative" similarly employed such wraparound approaches in the 1980s to successfully return all of its youth to their home communities (Burchard, Burchard, Sewell, & VanDenBerg, 1993). Since 1991, the La Grange (Illinois) Area Department of Special Education has employed teacher—as well as child—and family-driven wraparound planning and supports to include students with emotional disturbance in regular classes (Eber & Osuch, 1995). And since 1994, Wraparound Milwaukee has employed similar approaches as a Medicaid managed-care behavioral health carve-out for 600 children and adolescents who have serious emotional disturbances and are under court order in the child welfare or juvenile justice system. Both Treatment Foster Care and MST have produced impressive outcomes with youth who have juvenile justice, child welfare, substance abuse, or mental heath needs.

Many children with behavioral, emotional, or mental health problems need services and supports in a number of different areas, such as school, mental health, and social services. In the past, care from these different kinds of agencies has been conditional, disjointed, poorly coordinated, and agency-driven. Often youth received services in restrictive settings, and frequently these services were provided outside of the community. However, coordinating and thereby strengthening the disparate services that a community already has in place has proven a powerful way to build resilient communities.

During the last decade, federal agencies have initiated efforts to coordinate their fragmented service systems (Osher & Hanley, 1996). For example, since 1992, the Center for Mental Health Services has supported the development of local "Systems of Care." Effective Systems of Care are designed to allow different organizations and families to collaborate in planning, implementing, and evaluating approaches to providing individualized services for each child. Every child team has a family advocate, and the emphasis is on identifying and building upon child and family strengths. Teams may include representatives from mental health, education, child welfare, juvenile justice, vocational counseling, recreation, substance abuse, or other organizations. Evaluation of grantees in this program suggests that when these systems are developed effectively and when children and youth receive appropriate services, there are fewer hospital and out-of-home residential treatment placements; children’s behavior and emotional functioning improves; school performance improves; there is less law-breaking; and more children and families who receive services can be helped (Center for Effective Collaboration and Practice, 1999).

The ultimate goal in growing resilience is the creation of communities that can themselves buffer the various risks faced by all of its members and foster protective factors through building skills, providing outlets for constructive activity, and providing opportunities for meaningful relationships. One may think that this kind of community-building is not possible in this alienated, disconnected age. However, several communities have shown not only that they could come together to serve their endangered members, but also that it could be done efficiently and done well. These communities have developed new structures to develop resilient neighborhoods built on community strengths and have added community resources in creative ways.

One very exciting demonstration of this process of "back-loading" social resilience is currently being implemented in Barrie, Ontario (Simpson, 1998). In this effort—a mix of community organizing and the wraparound process—the community was divided into nine separate areas. Any citizen of any age within these areas who has needs that cannot be met with traditionally funded services or their own informal supports can request a wraparound plan. Each area has individuals trained in wraparound process and planning. A central community team manages the process and provides flexible funding to meet needs that cannot be funded any other way. The effort is co-funded by United Way, local and regional service agencies, and private individuals, and also involves churches and the business community.

Another innovative community development process is exemplified by King County, Washington, in the Bothell area. This effort, called the Family Support Network (Honey, 1997), has been developed by a group to provide a safety net and network for families who have complex needs. One of the principal beliefs of the effort is that "the more resourceful we are amongst ourselves, the more valuable a resource we become to our families, our communities, and our world." The Family Support Network recruits and trains community members as volunteers into the network to provide support to each other. The effort maintains a village directory and databank that contains member skills, hobbies, experiences, and resources to be shared. Organized as a nonprofit organization, the effort helps community members who feel isolated, confused, or alone.

Finally, other efforts being piloted by the grantees of the Center for Mental Health Services’ Division of Knowledge Development and Systems Change in over 40 sites often have included a strong focus on developing linkages to community resources and to neighborhoods. An example of this type of effort has been the Sacred Child Project in North Dakota, which uses cultural and spiritual linkages to help keep youth on the reservation instead of placing them in residential or institutional care (see page 69). Another example of a successful grant is the KanFocus effort in 13 counties in southeast Kansas (James Rast, personal communication, Spring 1999). In this effort, local community teams comprised of both formal, funded services and schools and informal networks of supports like churches and service clubs have linked together to build large resource pools that are available to families with complex needs.

If community-building efforts such as these are to succeed, they must address three daunting challenges. First, they must overcome what John McKnight (1995) described as the disabling function of the expert model of professionalized services. Some Center for Mental Health Services’ Systems of Care grantees are starting to accomplish this goal by supporting, for example, the development of new roles for families (Osher, deFur, Nava, Spencer, & Toth-Dennis, 1999). Second, these efforts must address the subtle and complex ways in which "isms"—racism, ethnocentrism, sexism, heterosexism, ableism, ageism—inhibit the development of community. Effective approaches to cultural competence suggest what can be done to create organizations that value and address diversity (Osher & Mejia, 1999). Finally, successful community building must address how poverty and the maldistribution of wealth and power contributes to "rotten social outcomes" (Schor, 1995; Schorr, 1988). Although these approaches are not easy, they can help develop the qualities that children and youth need to become healthy, caring, and responsible.

David Osher is an editorial board member of Reaching Today’s Youth and a senior fellow at American Institutes for Research, where he directs the Center for Effective Collaboration and Practice. He can be reached at the Center for Effective Collaboration and Practice, 1000 Thomas Jefferson N.W., Suite 400, Washington, DC 20007, telephone (888) 457-1551 or (202) 944-5400, fax (202) 944-5408, email center@air.org.

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