How we can help children overcome adversity

Many children have the misfortune to be faced with extreme adversity: poverty, neighborhood violence, crime.

Many become depressed, anxious or lonely, or suffer other effects.

But somehow, others do not. They thrive in spite of the adversity.

Why?

Yanping Jiang, a researcher at the Rutgers Institute for Health, looked for an answer among children in rural China whose parents either lived with HIV or had died as a result of infection. In the 1990s, unhygienic blood and plasma collection processes had led to an outbreak of the disease. Many children were stigmatized. Those whose parents died often grew up in orphanages.

Jiang, also an instructor in the Department of Family Medicine and Community Health at the Rutgers Robert Wood Johnson Medical School, wanted to see what kind of interventions might help. Was intervention for the child alone enough? Or was it better to include the parents? What about the community at large?

Jiang and her co-researchers, Xiaoming Li and Sayward Harrison, both of the University of South Carolina, studied the mental health effects of the Child-Caregiver-Advocacy Resilience (ChildCARE) intervention on 790 children in Henan, China, to investigate these questions.

Their research has been published in the Journal of Child and Family Studies and Pediatric Clinics of North America.

What prompted you to look at how to best help children struggling with extreme adversity?

I was interested in resilience. Resilience, by definition, is the positive adaptation in the face of what we call challenges, or adversity. These challenges can include poverty, trauma, abuse.

Often, that leads us to talk about poor health outcomes. But this overlooks the fact that some children thrive in the context of adversity. This made me curious. What could lead to such adaptation? Can this be taught, or enhanced, to help more children thrive? Resilience is not a simple case of this child thrives, and this one does not. It’s more of a continuum. Some children perform well. Some children may experience maladjustment issues or behavior problems. Some may experience depression.

My work is trying to understand the factors contributing to resilience.

What did you learn from the families you worked with in China?

We had four groups of children: A control group that got no intervention, one where just the children received intervention, one where children and their caregivers received intervention, and another that added community intervention.

For the children, instead of focusing on fixing their mental health outcomes, we focused on enhancing protective factors that can lead to better mental health outcomes. So we didn’t focus on mental health counseling. Instead, for example, we taught them coping skills, emotional regulation skills.

We also worked with the children’s caregivers to reduce parenting stress and reduce the caregivers’ depression. At the same time, we also organized community events to promote community cohesion and community support, such as sports events.

We then evaluated the effectiveness of the interventions every six months, up to 36 months.

What surprised you most?

What surprised me the most is that we found our intervention only produced a short-term improvement in children’s mental health. We did not find it had a long-term impact. After 12 months, we did not see meaningful changes in the children in our study.

This may have been because the interventions were brief — about 20 hours for each child, and, for those that got the additional intervention, another 10 hours for the caregivers.

It also may have been that the challenges the children faced were ongoing. So to produce long-term effects for children who experience ongoing adversity, the sustainability of the intervention is key.

Another goal of this intervention was to test the difference among the control group and the three that received the different intervention components. Would they have different mental health outcomes?

We found that children in the second group, which included parenting interventions, had better mental health outcomes — less depression and loneliness — than those in the first. But we did not find that community intervention produced additional benefits. It was very surprising.

The lesson I learned from this is that for children experiencing extreme adversity, it’s not enough to focus on children themselves. We need to provide intervention targeting both children and their caregivers.

Could the lessons you’ve learned apply to Philadelphia, where many children experience extreme poverty, neighborhood violence and other urban pressures?

This is not a one-size-fits-all solution for children who face adversity. But a few things we learned can be applied here.

The first is that it’s critical to acknowledge the resilience among children, and it’s important to understand what factors can promote resilience — an understanding of the existing protective factors and existing resources. It’s important to have sustainable and effective interventions for better mental health outcomes.

In our study, we focused in part on orphanages. But these children were experiencing things similar to children in Philadelphia: extreme poverty and neighborhood violence. Some of the components of our interventions — emotional regulation and coping skills, as well as parenting practices — could be applied here.

What are some specific examples of things that worked for children, families and communities?

For the children, there are a few common things that have been found that work, such as promoting high self-esteem. This could include interventions to change how the children perceive themselves. We can design courses or role-play activities to help children see themselves in a more positive way.

We can also teach them more effective coping skills, such as positive emotional regulation strategies. For example, when children face challenges, they might cry and be upset. This is normal. But what next? How can they regulate these frustrations? We could teach them to secure support from adults or peers they trust. They could talk to their parents. They could talk to friends that they trust.

When we’re talking about interventions involving families, our research showed that focusing on parent-child relationships and reducing parenting stress could be an effective way to help children.

As for communities, there are many ways we can promote community cohesion and support. It can be very challenging, particularly when communities have differing cultures or languages or religious practices. Also, what are the resources in the community? That can limit what kinds of activities can be designed. We learned that community picnics or festivals can be a way to promote community support.

Overall, our study holds the promise that resilience-based intervention can be effective in improving mental health of children in the face of extreme adversity. As researchers, we can help by trying to understand which factors contribute to resilience. And by focusing on enhancing these factors, we can promote better mental health outcomes.