Uncertain Legacies: Resilience and Institutional Child Abuse - A Literature Review

1 Executive Summary

Background

1.1 This report summarises the findings from a literature review on resilience and institutional abuse, specifically the abuse of children in residential care. The study was conducted in response to a recommendation in the Report on Time To Be Heard: A Pilot Forum (2011), which heard evidence from adults who had been looked after in Quarriers children's homes at various times between the 1930s and the 1980s. The Forum recorded the testimonies of ninety eight individuals, some of whom had experienced abuse while resident in the homes, and provided a means publicly to acknowledge the distress and suffering they had endured. The Report noted that while many survivors had struggled to cope with the after-effects of abuse well into adulthood, others reported fewer lingering impacts. It was therefore recommended that research should be carried out to identify factors which seemed to increase resilience in some survivors.

1.2 Professional practice has changed significantly in the last few decades, and is now underpinned by a public ethos which seeks to safeguard the wellbeing of children in all care settings - evidenced by, for example, efforts to promote safer recruitment practices, registration of care workers, closer monitoring and inspection of residential homes and the introduction of the Scottish Government's Getting It Right For Every Child strategy (GIRFEC). However it is acknowledged that abuse of children while in institutional care has occurred and requires appropriate state responses. Initiatives like In Care Survivors Service Scotland (ICSSS), which offers counselling and support to survivors and their families, are in recognition of the specific needs of those who took part in the Pilot Forum and those who might come forward in the future.

1.3 The aim of the study was to review the existing academic literature in order to identity definitions of resilience, the factors that are associated with resilience, and how this knowledge might contribute to our understanding of adult survivors of childhood abuse while in residential care. The objectives were: to examine key definitions of resilience; to identify and discuss the factors which affect resilience; to establish the extent to which these have been explored in relation to survivors of abuse; and to examine resilience factors from the perspective of adult survivors of childhood abuse in institutional care.

1.4 The review focussed on academic literature published between 1990 and 2011 relating to resilience, surviving abuse, and residential care, and included articles based on primary research, as well as discussion and practice papers. Database searches indicated a very large literature on resilience, and this was purposively sampled by focussing on literature relating to resilience and adult survivors of various types of childhood abuse, and residential care.

1.5 In light of a dearth of primary data addressing this particular group of survivors, the review attempted to draw together literature from a broad range of disciplines, focussing primarily on 21 papers which reflected findings from original research. The review assessed the potential relevance of these studies to adults who have experienced abuse in residential care settings as children. The conclusions drawn are therefore preliminary, and, it is hoped, will provide the stimulus for subsequent constructive deliberation and discussion, as well as the foundations for future development.

Note of Caution

1.6 There is a dearth of primary data addressing this group of survivors, and this review focussed on a small, methodically identified selection of academic papers. The conclusions drawn are therefore preliminary, with a view to stimulating subsequent constructive deliberation and discussion for future development.

1.7 The issue of definition is a complex one, and a standardised definition of resilience is absent in the literature. So too is a universal acknowledgement of what constitutes 'successful' survival; given the complexity of highly individualised responses to personal experiences, this will inevitably vary from individual to individual. Some care must be taken, therefore, to distinguish between academic definitions of 'resilience', and how resilience might be perceived by individuals themselves.

Findings

Defining Resilience

1.8 Survivors of childhood maltreatment frequently suffer long term negative impacts which result in physical, psychological and social impairments. However researchers have also noted that a proportion of survivors report few or no persisting problems as a consequence of their abuse experiences: in the studies reviewed, figures varied from 13 percent to almost one third. The concept of resilience is seen as helpful in explaining why survival experiences might vary from individual to individual.

1.9 Despite extensive research and developmental work, it has proved impossible to establish a single, comprehensive, universally accepted definition of resilience. Nevertheless the literature reviewed overwhelmingly identified resilience as a process, rather than an individual character trait, or a particular outcome. Two elements were apparent in all the proposed definitions: they described positive personal responses in the face of adverse external events.

1.10 Although there is no single definition, it is possible to identify a range of interlinking characteristics that might be associated with resilience: it is dynamic; it is contingent; it is longitudinal; it is multidimensional; and it is highly individualised yet dependent on interactions with other people. It is, therefore, a fluid, lifelong process that is context specific, yet fluctuates both within and between individuals across multiple aspects of their lives, and is shaped by personal circumstances and social interactions.

Factors affecting resilience

1.11 The literature reviewed discussed an extensive list of factors relating to resilience. These were generally classified as being either 'risk' or 'protective'. Risk factors were those associated with heightened chances of suffering negative outcomes as a result of adverse events or experiences, while protective factors acted as a buffer, offsetting the depth of harm caused. What is important is the balance of these different factors at any one time, and in any given situation, which leads to particular responses from individuals.

1.12 The review found that resilience was dependent on interactions between intrinsic personality characteristics and individual circumstances (internal/personal factors), and interpersonal relationships and exchanges (external/social factors), which take place within broader social, economic and political frameworks (structural factors). These aspects fluctuate over time, and the literature consistently reiterates their interactive nature.

1.13 Internal/personal factors included: self image; control; meaningfulness; and hope. They relate to how we see ourselves, the world around us, and also how we perceive the past, the present and the future. External/social factors were concerned with relationships with family, friends, and the wider community. For abuse survivors, it was found that safe, caring, supportive relationships could accelerate recovery and enhance resilience. Finally, structural factors influence experiences and responses to them. Gender was the most explicitly discussed structural factor, and the literature reviewed demonstrated potential differences in how men and women respond to and recover from abuse experiences.

Institutional Child Abuse

1.14 The Scottish Government describes five categories of harm which constitute child abuse: physical injury; physical neglect; emotional abuse; sexual abuse; and non organic failure to thrive. When any of these harms are inflicted on a child in any of a range of care settings provided by the public, voluntary or private sector, they are defined as institutional abuse. This review focussed on institutional abuse in a very specific circumstance: that which occurs in residential care. The rates of all forms of child abuse, including institutional child abuse, are unknown, and there is a distinct lack of research relating to institutional child abuse in particular.

1.15 Residential care can bring many benefits into children's lives, including stability and the opportunity to build good, caring relationships with adults, particularly as many who do come into care have been subjected to abuse and neglect within the family. However, it is wrong to assume that residential settings are inevitably safe, secure and nurturing, and revelations from high profile national investigations into abuse have clearly demonstrated the risk associated with being in residential care.

1.16 Many papers reviewed addressed resilience and looked after children, but on the assumption that any abuse experienced happened prior to admission. Although it is difficult to unravel abuse experiences of children who may have been previously abused and then further victimised in residential care, the literature suggests that there are circumstantial aspects of institutional child abuse which might complicate recovery trajectories and subsequently the development of resilience in adult survivors. Institutionalisation itself, for example, might compound the harm caused by abuse (Wolters, 2010), affecting self esteem and confidence, and diminishing a sense of control. While all abuse in childhood has the potential to impact on adult relationships, institutional child abuse, the literature suggests, might instil a universal distrust of institutions and those in authority - including caring professionals - exacerbated by feelings of impotence and powerlessness (Wolfe, 2006). Stigmatisation on grounds of class, race and disability, and gendered perspectives on both survivors and perpetrators might shape public responses to claims of abuse in care (Colton et al, 2002; Perry et al, 2005). Despite an absence of literature directly relating to resilience and survivors of institutional child abuse in residential care, therefore, specific characteristics of residential care might hamper the development of resilience, and there are particular difficulties associated with disclosure, a process which may be prolonged over a period of many years and which, if met with disbelief or rebuff, has the potential to cause further traumatisation to the adult survivor.

Conclusions

1.17 Resilience is most helpfully seen as an ongoing, long term process rather than an inherent personality trait or definitive outcome: a complex journey, rather than a destination. This concept draws our attention to the fact that negative outcomes are not always an inevitable consequence of encountering adverse events and experiences. There is no single overarching definition of resilience, and although this review set out to investigate the factors which affect its development, it might be more useful to view 'factors' as supple facets, which configure differently between individuals, varying across time and according to circumstance, to create fluctuating, personalised, patterns of resilience.

1.18 However the absence of a single overarching definition means that the concept is open to interpretation by researchers, policy makers and practitioners, and these interpretations may conflict with how individuals perceive themselves. Particular attention should be paid to how it is to be defined and measured among adult survivors of abuse in residential settings.

1.19 Much of the literature reviewed related to young people's experiences in institutional care, but institutional child abuse is under-researched and there are distinct gaps in our knowledge, including men's experiences of recovery and resilience processes. There may be particular aspects of this form of maltreatment which merit further consideration, including the distinctive public dimension to disclosure which is absent in other forms of abuse and structural facets which shape both experiences of abuse and public responses to them. This has implications for developing existing avenues of support beyond those already offered to survivors who take part in public inquiries and investigations.

1.20 There is some convergence between contemporary policy strategies and resilience, namely assets-based approaches in health which focus on reinforcing and developing existing community strengths and resources, as well as the Scottish Government's Getting It Right For Every Child framework. There are two reasons which make resilience a useful concept when focussing on children who experience abuse in residential child care settings: it raises awareness of the needs of children who are currently in care, and for whom much can be done to nurture and develop longer term resilience as they grow into adulthood; and it offers a meaningful framework for understanding the diverse reactions of adult survivors who have already disclosed or are likely to disclose in the future.