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

2 Introduction and Background to the Review

2.1 This report summarises the findings from a literature review on resilience and institutional abuse in residential childcare which was conducted in response to a recommendation in the Report on Time To Be Heard: A Pilot Forum (Scottish Government, 2011a). Tom Shaw, who chaired the Pilot Forum, was appointed by the Minister for Public Health and had previously conducted an in depth, historic review of residential childcare in Scotland (Scottish Government, 2007). His independent Report recorded the experiences of those who took part in the Pilot Forum, which was set up by the Scottish Government in 2009, in order to listen and respond to former residents of Quarriers children's homes. This provided an opportunity to record their testimonies of in-care experiences, whether or not they were survivors of abuse while resident in the homes, as well as offering a means of publicly acknowledging the distress and suffering of those who had been abused.

2.2 Ninety eight individuals participated, recounting their childhood experiences of living in Quarriers residential homes at various times between the 1930s and the 1980s. Participants who experienced abuse during their time in residential care reported a range of different longer term impacts: while some continued to struggle to cope with the after-effects of the abuse well into adulthood, it was also found that: "many participants had managed to go on to lead very fruitful existences despite their very traumatic experiences in childhood." (Scottish Government, 2011a, p70).

2.3 This is consistent with the wider literature relating to surviving childhood abuse: for some the negative impacts of abuse are endured long beyond childhood into adult life; others seem more able to flourish despite suffering similarly traumatic experiences at a young age. One possible explanation for such disparate outcomes is the presence or otherwise of a combination of personal, community and social elements which "seem to contribute to an individual's extraordinary ability to "bounce back" from trauma experiences…" (Bogar and Hulse-Killacky, 2006, p319). These elements collectively affect an individual's ability to maintain "stability under significant adverse conditions" (Liepold and Greve, 2009, p40): that is, their resilience.

2.4 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 the institutional care system. In 2008, the Scottish Government introduced Getting It Right For Every Child, which promotes collaboration between public services in order to safeguard all children across Scotland, whatever their care context. Following the Shaw Report in the same year, the Scottish Government commissioned a strategic review of residential childcare - the National Residential Child Care Initiative (NRCCI) - which highlighted issues relating to professional training, advocacy on behalf of children in care, and the need for collaborative working, and this is being taken forward by the Looked After Children Strategic Implementation Group managed by the Centre for Excellence for Looked After Children in Scotland CELCIS), previously the Scottish Institute for Residential Child Care (SIRCC) (Celcis, 10/02/12). In addition, the Scottish Government established the In Care Survivors Service Scotland (ICSSS), which offers ongoing counselling, advocacy and befriending support to both survivors and their families who are living with the long term effects of abuse in care. As a consequence of recognising the potential for retraumatisation which revisiting and recalling such distressing life events might provoke (Karatzias, 2010), the services of ICSSS were made available to participants at all stages of the Time To Be Heard Pilot Forum.

2.5 Our knowledge and understanding of the nature and role of resilience in surviving different forms of abuse has grown in the last few decades, and the Time To Be Heard Pilot Forum recommended that: "The Scottish Government should fund research to identify which factors make some individuals more resilient to the effects of abuse" (Scottish Government, 2011a, p111). This project sought to respond to that recommendation. Following on from the Forum's note that a proportion of participants reported resilient survival stories, the rationale for the study was to review the existing literature on resilience in the context of child abuse in residential care, in order to identify potentially significant gaps in our knowledge. The aim of the study was:

• to review the existing academic literature to identify concepts of resilience; the factors that are associated with resilience; and how this might contribute to our knowledge and understanding of adult survivors of childhood abuse in residential care.

As a consequence, 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;
• to examine resilience factors from the perspective of adult survivors of childhood abuse in residential care.

Definitions

2.6 There is no single, universal concept of child abuse. However the Scottish Government lists five forms of harm: physical injury; physical neglect; emotional abuse; sexual abuse; and non-organic failure to thrive (Scottish Government, 2002). These individual strands commonly intertwine to create unique patterns of abuse for individual children (ibid). Children might be subjected to abuse at the hands of family members, professionals whom they encounter in their daily lives, other children or, more rarely, strangers (Hobbs et al, 1999). Recovery trajectories can be influenced by aspects of abuse such as the "timing, duration, frequency, severity, degree of threat and relationship to the perpetrator" (Collishaw et al, 2007, p214; Lev-Wiesel, 2008; Wolfe et al, 2003).

2.7 The family can be a dangerous arena for the many children who are exposed to cruelty, neglect and violence within their own homes, and child protection has become a central concern of policy makers and academics across a range of disciplines, initiating interventions in a variety of policy domains (Colton et al, 2002; Scottish Government, 2002). However, it has become apparent that children have also been at acute risk within State-created substitute families, whose primary purpose is to provide refuge and shelter for children who have experienced, or are at risk of experiencing, abuse from their primary carers (Hobbs et al, 1999).

2.8 In recent years, voices raised both in the UK and further afield have disclosed accounts of widespread and systematic abuse of children of all ages who have resided in public and third sector institutions principally designed to protect them (Australian Parliament, 2004; Commission to Inquire into Child Abuse, 2009; Scottish Government, 2011a). When child abuse, of any form, occurs in these particular settings it is described as institutional abuse, differentiated from familial and stranger abuse because it is perpetrated by those who: "may be employed in a paid or voluntary capacity; in the public, voluntary or private sector; in a residential or non-residential setting; and may work either directly with children or be in an ancillary role." (Gallagher, 2000).

2.9 This definition reflects the variety of institutional settings in which children are 'looked after' by the State; these include residential care facilities (those which accommodate larger groups of children and young people communally within a purpose built or adapted 'home'), and non residential arrangements, which include fostering, for example. In light of emerging revelations of abuse in residential settings of other population groups - for example, adults with learning difficulties and the elderly - this document will refer to institutional child abuse (ICA) to differentiate it from harm inflicted in other types of residential care. The number of children being placed in residential institutions has fallen in recent times, while the number of children in community settings, such as foster and adoptive families, has correspondingly risen (Scottish Government, 2011b). However in light of the context of the Time To Be Heard Pilot Forum, this review is specifically concerned with the survivors of abuse which has occurred in residential care settings, and how the particular circumstances of those experiences might affect them in the longer term.

Note of caution

2.10 Much of the literature sampled in this study cites a significant piece of empirical research on resilience conducted by Werner and her colleagues in the United States in the 1950s. This study was longitudinal in nature, following the lives of more than 600 participants from the general population over three decades. There has never been a subsequent study of this scale or scope, and while the concept of resilience has become honed and increasingly applied to specific research populations, this literature review found an absence of empirical evidence relating to resilience and adult survivors of ICA. In light of a dearth of primary data addressing this particular group of survivors, this review attempted to draw together literature from a broad range of disciplines, focussing primarily on 21 papers which reflected findings from original research, and to demonstrate their potential relevance in relation 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.

2.11 The issue of definition is a complex one, and this is reflected in the variety of attempts in the literature reviewed adequately to capture and describe resilience. Many of the definitions in the literature imply that resilience reflects more than just survival or coping, referring to an individual's 'successful' transition, adaptation or development in the aftermath of traumatic experiences (for example, Hauser, 1999; Roman et al, 2008; Simpson, 2010). A standardised definition of resilience is absent, and 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. Authors such as Ungar (2001) and Roman et al (2008) draw attention to the inevitability of subjectivity in defining and measuring resilience, and some of the papers in the review adopt a feminist approach, emphasising the need to allow participants the right to self-identify and evaluate. This is one strategy which overcomes the problem of imposing definitive categorisations on individuals as either 'resilient' or 'unresilient', and reduces the risk of misusing the concept to make subjective judgements about individuals' efforts to overcome adversities. Some care must be taken, therefore, to distinguish between academic definitions of 'resilience', and how resilience might be perceived by individuals themselves.

2.12 A further caveat relates to the complex life histories of many survivors of ICA. The literature highlighted that many of those who enter the care system have experienced abuse prior to their admission, and as a result are already suffering the negative impacts of that abuse (Daniel, 2008; Hobbs et al, 1999; Jackson and Martin, 1998; Lösel and Bliesener, 1990; Rutter, 2000). In addition, adult survivors of ICA may have encountered many additional trials and challenges following their childhood experiences in care. As a consequence, it is almost certainly impossible to unravel the longer term impacts of one set of traumatic experiences from another. While ICA is the focus of this study, it is acknowledged that this might capture only one source of trauma from a diverse range of adversities experienced by individuals.

2.13 With these caveats in mind, the rest of this report outlines the design of the study, its findings, and the conclusions that might reasonably be drawn from the available evidence. The next chapter describes the methods employed in the study in order to identify and select relevant literature for the review.