Proceedings of a Workshop—in Brief

Building Resilience in the Face of Emerging Threats to Child and Youth Well-Being

Proceedings of a Workshop—in Brief

In the face of growing threats to child and youth well-being—whether it be the COVID-19 pandemic, climate change, systemic racism, or new crises that have yet to arise—it is imperative that youth well-being be promoted through the development of strong resilience skills. To explore strategies for building youth resilience, the National Academies of Sciences, Engineering, and Medicine Forum for Children’s Well-Being (the Forum) held a 3-day workshop in October 2022. The workshop included presentations from experts, as well as moderated conversations between the presenters and youth discussants. This Proceedings of a Workshop—in Brief provides a high-level summary of the topics addressed in the workshop. Additional details, including a workshop recording, can be found online.¹

DEFINING THE YOUTH POPULATION

The first step in understanding how to build youth resilience is to understand who the current youth population is. Lynn Olson, American Academy of Pediatrics, helped to orient the workshop participants with a description of the current child and youth population living in the United States. She noted that while the overall population of children in the United States is declining, the decline is not consistent across states; the northeast child population is shrinking, while the child population in the south has seen notable growth. Similarly, Olson said, children in the United States are largely diverse—but that diversity looks different across states. For example, Olson shared data which showed that while 14 percent of U.S. children report their race as Black, the percentage of Black children in individual states ranges from 1 percent in Idaho to 42 percent in Mississippi.

Furthermore, Olson also noted that the growth in immigrant children is at historic levels. In 2009, she said, immigrant children made up 23 percent of the overall child population in the United States; that is projected to increase to 34 percent by 2050. Carmen Valdez, University of Texas at Austin, noted that while immigrant and nonimmigrant youth alike experience poverty, discrimination, stress and trauma, immigrant families have unique stressors due to their immigration experiences.

Building on the discussion of the youth population, Victor Dzau, National Academy of Medicine, discussed new and

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¹https://www.nationalacademies.org/event/10-18-2022/building-resilience-in-the-face-of-emerging-threats-to-child-and-youth-well-being-a-workshop-day-one

rising challenges that this generation is experiencing. Dzau noted that “society faces a grave, existential, and unprecedented triple threat,” which he defined as the COVID-19 pandemic, systemic racism, and climate change. Regarding the COVID-19 pandemic, Dzau commented that although children may have been spared the most direct health impacts, they are still at risk of being victims of the pandemic. He listed three specific areas where children are likely to feel the burden of the pandemic: (1) a shift in their families’ socioeconomic status, which may contribute to food and housing insecurity; (2) a change in their access to education due to staff shortages, school closures, or quarantines; and (3) worsened mental health associated with a lack of access to appropriate care, removal from social support networks, and loss of a caregiver. Dzau also emphasized the disparate impacts of the pandemic on already vulnerable children, including children living in poverty, children of color, and children with disabilities. Ann Masten, University of Minnesota, called COVID-19 a wake-up call for the systems that care for children, emphasizing the fragmented and inadequate support that is currently available for children and families.

The second challenge in Dzau’s triple threat to society was structural racism. He noted that racism is a root cause of health inequities and has a profound impact on the health of children, adolescents, emerging adults, and their families. Dzau shared research that showed direct racial discrimination is associated with twice the risk of developing a mental health disorder, and that children exposed to persistent indirect discrimination are at greater odds of poor mental health. Dzau also commented on the role of systemic racism in contributing to the achievement gap in educational outcomes. Tamar Mendelson, Johns Hopkins Bloomberg School of Public Health, added that structural racism removes opportunities for youth of color and is associated with negative social, emotional, behavioral, and financial outcomes, as well as physical health problems, including early death. Shawn Jones, Virginia Commonwealth University, expanded on these ideas further, calling racism a “virus” that can incorporate itself into the social DNA and fabric of society. Jones commented that racism is a threat to overall well-being, noting that racial stress and trauma has been found to show effects similar to post-traumatic stress disorder.

The last component of the triple threat outlined by Dzau was climate change. He noted that approximately 1 billion children are at “extremely high risk” of negative impacts due to climate change events, including heatwaves, cyclones, flooding, water scarcity, vector-borne diseases, air pollution, and lead pollution. Almost all children across the globe, he said, are exposed to at least one climate or environmental hazard. Furthermore, Dzau explained that children are particularly vulnerable after a climate event; their family and social structures are often eroded, they experience more severe physical effects, half report symptoms of PTSD, and trauma associated with climate events can inhibit learning. In discussions about the climate change vulnerabilities of children, Joe Waters, Capita, said “climate change is an era not an issue.” Waters noted that over 70 percent of youth under age 25 already report having experienced a mental health event because of climate change.

Dzau concluded his presentation by commenting that setting children up for success begins early. Building resilience in children can help them cope with the challenges of the triple threat, as well as other challenges that may arise in their futures.

DEFINING RESILIENCE

Masten defined resilience as the “capacity of a system to adapt successfully to challenges that threaten system function, survival or development.” She explained that resilience is dynamic and always changing. Masten also commented that resilience can cascade across levels, domains, and generations, but individual resilience is dependent on the resilience of systems.

Jones expanded on this definition from two different perspectives. First, from a psychological perspective, he defined resilience as a “dynamic process encompassing positive adaptation within the context of significant adversity.” Second, from an ecological perspective, he defined resilience as “the ability and rate of an ecosystem to recover from a disturbance and return to its pre-disturbed state.”

Masten explained that youth may have a range of resilience factors which can be supported by multiple systems, including attachment bonds and close relationships, a sense of belonging, self-regulation and executive function, problem-solving skills, motivation to adapt, self-efficacy, hope and optimism for the future, a sense of purpose or meaning, a positive view of self and the community, and positive habits or traditions. Jones and Valdez added other protective factors to this list including, ethnic-racial identity, ethnic-racial socialization, cultural orientation, academic engagement, and psychological adjustment and well-being. Prameela Boorada, Impact Playground, noted that as a youth leader, the importance of positive views of self resonated with her, adding that this can often contribute to youth feeling more hopeful and optimistic.

PROMOTING RESILIENCE AT INDIVIDUAL AND SYSTEMS LEVELS

Workshop presenters discussed the difference between individual resilience and resilience of systems as well as strategies to promote resilience. Valdez explained several individual-level factors that can promote resilience. First, she said it is important for youth to have positive views of both their present and future self. Second, she said that ethnic, racial, or immigrant identity can help build cultural pride, and promote resistance to bias. Third, she said a help-seeking stance can encourage youth to seek emotional and material support when it is needed. Resilience can also occur at the family level, Valdez said. She noted that family connectedness and stability can help build a support system for youth.

While individual resilience is important, Bryan Samuels, Chapin Hall at the University of Chicago, commented that these individual factors are not something youth can choose—they either have them, or they don’t. Thus, Boorada noted that there needs to be a pathway to build community- and systems-level resilience in addition to individual-level resilience. In relation to this, Waters called for a new strategy to build social and physical infrastructure that protects youth and promotes their well-being. Samuels noted, “Major changes are needed at all systems levels in order to provide support and nurturance for young children growing up in poverty with chronic risk factors…” In his own work in child welfare, Samuels said, he has focused on creating policies that promote maintenance of relationships for children in out-of-home care.

Building on the idea of systems-level resilience, Jones discussed the notion of collective resilience, particularly as it relates to racism. He said that familial processes, school processes, neighborhood processes, and community processes can help build resilience in the face of systemic racism. Jocelyn Lee, University of North Carolina Greensboro, also commented that current societal structures require adaptive coping and hypervigilance from Black men, which places an undue burden on them. Instead, she said, there should be an emphasis on addressing the root causes of the problems.

In thinking about resilience from a systems perspectives, Mendelson noted that we can think about the social determinants of health² as systemic conditions that shape our health, well-being, and resilience. Mendelson discussed the importance of addressing determinants, such as economic stability and social and community support. In doing so, she said, there is an opportunity to create a society in which youth are not required to develop resilience to cope with extraordinary adversity. She mentioned several government programs that take initial steps toward targeting family economic stability, a social determinant of health—the Earned Income Tax Credit, the Child Tax Credit, and the Supplemental Nutrition Assistance Program—which evidence has showed has lifted families out of poverty and help families afford adequate food. Samuels added that increased access to economic support is associated with decreased child welfare involvement. Specifically, he noted the importance of macro-economic supports (e.g., paid family leave and unemployment benefits), concrete supports (e.g., health insurance, child care, housing), and public benefits (e.g., TANF, SNAP, WIC). Mendelson also mentioned several community-, family-, and school-based interventions that have been shown to promote resilience and youth well-being (e.g., Communities that Care, Positive Parenting Program, Positive Behavior Interventions and Supports).

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² For more details see here: https://health.gov/healthypeople/priority-areas/social-determinants-health

Dzau commented that early multisector attention and investment are required to understand and address the challenges that youth face, so that youth will no longer need to be resilient. Valdez added that broad, cross-sector approaches can serve as structural interventions that intervene on social determinants of health. She argued that for sustained improvements, there is a need to address these broader social issues, noting that individual and family solutions will not be enough.

Resilience, however, can only go so far in promoting youth well-being, Jones said. He suggested that it might be crucial to take the next step to resistance, which he defined as “the ability for an ecosystem to remain unchanged when being subjected to a disturbance or disturbances.” He explained that resistance can be a form of “pushing back” against the factors that cause youth to need to be resilient. Masten echoed this, saying youth cannot be expected to continually overcome all of the challenges they face. Joshua Calarino, Youth Move National, added that youth need support so they no longer have to be resilient, and Maya Nittoor, Mental Health America, commented that resistance can be a form of self-affirmation for youth.

THE FUTURE OF RESILIENCE IN RESEARCH AND PRACTICE

The workshop presenters pointed to several areas where additional research may be beneficial. Carley Riley, Cincinnati Children’s Hospital Medical Center, discussed the importance of measurement in promoting youth resilience and well-being. She emphasized, first, that measurement should be conducted in partnership with youth. This means that researchers should select specific measures that matter to youth, and advance a strengths-based, inclusive approach. Next, she explained the importance of measuring for outcomes. As part of this, she suggested that both person-reported measures and observed measures should be included. Riley also noted that researchers should measure for equity, which requires choosing measures that are meaningful not only to youth in general, but specifically to youth who are adversely affected by inequities. Additionally, she said equity should be considered as a primary outcome in measurement, and suggested researchers consider measuring the structural and policy factors that create and sustain inequities in outcomes. Riley added that researchers should also measure for improvement to drive action and enable learning for decisionmakers. Lastly, she said, researchers should measure for systems transformation. She explained this as a holistic measurement strategy that supports “whole person, whole system, whole community” action and improvement. Ultimately, Riley, commented, the goal should be to improve outcomes in a way that means youth do not have to be resilient, but instead are supported by the systems around them.

Workshop presenters also called for greater youth involvement in research, policy, and practice. Emily Ozer, University of California Berkeley, commented that engaging youth experts can help researchers understand the nuances of youth’s experiences, both positive and negative. Ozer added that it is important to support community efforts targeted at strengthening resilience, with a particular emphasis on efforts that support the agency of youth. As an example of how youth can be engaged in research, Ozer described community-based participatory research (CBPR), which implements shared decision making between researchers and community partners. She explained that CBPR creates a cyclical integration of research and action, where the community drives the research questions. Dashia Nicole Wright, University of California Irvine, commented that many youth are already engaged in this type of work, and researchers just need to lift them up. In light of this community participation in research, Ozer challenged the workshop audience to consider what “counts” as knowledge, noting that often data and research generated by youth are overlooked in data collection and research. Furthermore, Calarino added that engaging youth in research can teach them how to use their power to make informed decisions. Doing so, he said, can cultivate the next generation of leaders.

In considering youth voice, Nittoor said, researchers should keep in mind that youth leaders who are able to participate in programmatic work are not representative of all youth. Oftentimes, Nittoor noted, youth who are struggling are left out of the narrative. Jones added that for some youth, resilience is just making it to

the next day. Nittoor commented that building youth autonomy on a population level and providing accessible mental health supports can help youth feel empowered to advocate for themselves. Calarino explained the importance of meeting youth at their level, noting that he discovered his capacity for advocacy through participation in a community salsa group.

Furthermore, Waters called for increased attention to investment, insurance, and innovation.³ Investment, he said, should be focused on preparing for global shocks that are likely to come as a result of climate change and other threats to youth well-being. For example, communities can invest in public shading structures to protect children from heat exposure. Second, he said government social programs can provide insurance to protect families from climate change shocks. And third, he called for governments to be innovative in their solutions.

Additionally, Samuels added that most policies are targeted at fixing a specific problem. He called for future policies to be targeted at positive outcomes, instead. He noted policymaking should be less of a safety net, and more of a springboard toward greater success for youth and their families.

Overall, workshop presenters expressed a desire to move away from societal factors that cause youth to have to be resilient, instead hoping for a future where all youth see their well-being supported by the systems and communities around them. Mendelson advocated for embedding prevention and promotion strategies in all settings that serve youth and their families. To conclude the workshop, Boorada commented that resilience can be an intermediate step towards hope for a society that is supportive of all youth and their families.

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³ See UN report on human development for more discussion on investment, insurance, and innovation framework: https://hdr.undp.org/system/files/documents/global-report-document/hdr2021-22pdf_1.pdf

DISCLAIMER This Proceedings of Workshop—in Brief was prepared by Erin Fox as a factual summary of what occurred at the workshop. The statements made are those of the rapporteur or individual workshop participants and do not necessarily represent the views of all workshop participants; the planning committee; or the National Academies of Sciences, Engineering, and Medicine.

WORKSHOP PLANNING COMMITTEE TINA L. CHENG, University of Cincinnati College of Medicine; MARY ANN MCCABE, Society for Child and Family Policy and Practice; CHERYL POLK (Co-chair), Safe & Sound; and DEBRA B. WALDRON, American Academy of Pediatrics; and DAVID W. WILLIS (Co-chair), Center for the Study of Social Policy.

STAFF AMANDA GRIGG, Program Officer; BRIANA SMITH, Senior Program Assistant; PRIYANKA NALAMADA, Associate Program Officer.

REVIEWERS To ensure that it meets institutional standards for quality and objectivity, this Proceedings of a Workshop—in Brief was reviewed by MARY ANN MCCABE, Society for Child and Family Policy and Practice. We also thank staff member LESLIE SIM for reading and providing helpful comments on this manuscript. KIRSTEN SAMPSON SNYDER served as the review coordinator.

SPONSORS This workshop was supported by contracts between the National Academy of Sciences and the American Board of Pediatrics (unnumbered award); the Centers for Disease Control and Prevention (200-2011-38807, TO #69); and the Health Resources and Services Administration of the U.S. Department of Health and Human Services (HHSH250201500001I/5R60219F34017). Additional support came from the American Academy of Pediatrics, Chan Zuckerberg Initiative, Children’s Hospital Association, Family Voices, Global Alliance for Behavioral Health and Social Justice, Society for Child and Family Policy and Practice, Society of Clinical Child and Adolescent Psychology, Well Being Trust, and ZERO TO THREE.

For additional information regarding the workshop, visit: https://www.nationalacademies.org/event/10-18-2022/building-resilience-in-the-face-of-emerging-threats-to-child-and-youth-well-being-a-workshop-day-one

Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2023. Building Resilience in the Face of Emerging Threats to Child and Youth Well-Being: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press. https://doi.org/10.17226/26904.

Division of Behavioral and Social Sciences and Education Copyright 2023 by the National Academy of Sciences. All rights reserved.