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

3 Methods

3.1 The study was conducted over a period of 13 weeks, and during this time the literature was sampled and purposively selected, and the data extracted, analysed and written up. The time limitations of this study therefore ruled out the possibility of a systematic review of the literature. Instead, the intention was to conduct a small scale evidence review, purposively and strategically sampling the literature in order to identify relevant data which might inform our understanding of adult survivors of childhood abuse in care. The aim therefore was to devise a research strategy which would generate reliable findings as far as was practicable within the available timescale. The final report was then subject to external peer review before publication.

3.2 The original recommendation in the Report on Time to Be Heard did not prescribe the manner of research that should be carried out. This allowed flexibility for the supervisory team and the researcher to design an achievable project within the timescale which would produce robust data from which meaningful and informative conclusions could be drawn. A search strategy was refined in consultation with academic and professional members of the supervisory panel, which consisted of members of the SurvivorScotland team, a senior researcher from the Scottish Government's Health and Analytical Services Division, and an academic from Edinburgh Napier University (see Appendix 1). It was decided that the focus should remain firmly on the factors relating to resilience, in keeping with the original recommendation. Consequently, keywords such as 'resilience', 'factors', and 'adult', 'institutional and/or residential' were used to search academic databases across a broad range of medical and social science disciplines (see Table 1) for material published between 1990 and 2011.

3.3 Initial searches revealed a very large literature addressing concepts of resilience in general, and relating these to various vulnerable groups including abused children who are admitted to the care system, and who are subsequently looked after in a variety of institutional settings, such as residential and foster care. There is an equally large body of evidence addressing survival processes of individuals who have been subjected to different forms of abuse experienced across the lifespan. However, there is a distinct lack of evidence examining the concept of resilience in relation to children who experience abuse while in residential care.

3.4 The search was narrowed by excluding papers which did not address interpersonal abuse (for example, those discussing political persecution); abuse in a non-care setting (the creation of pornographic images, for instance); and for abuse experienced as an adult - for example, the substantial literature relating to domestic abuse. It is of course acknowledged that children suffer abuse in these circumstances and that such literature might well contribute to our understanding of children's recovery processes as they grow into adulthood. However, due to the timescale of the review, it was agreed that selected papers should address a combination of aspects of resilience, explore the experiences of adult survivors who were subject to various categories of abuse in childhood, and, where possible, focus on residential care.

3.5 This search strategy produced a final bibliography of 61 papers and book chapters: Table 1 indicates the databases accessed and the volume of papers identified at each point in the searches. Papers removed from the initial search included those which addressed resilience among those exposed to, for example, political persecution or natural disasters. The 61 finalised titles were circulated among members of the team for feedback and comments.

Table 1: Volume of papers identified from database searches

3.6 The abstract from each paper was reviewed in more depth by the researcher in order to evaluate their relevance for the study, and duplicate papers which had appeared in more than one database were removed, as well as multiple papers drawing on a single study unless they contributed additional relevant information within the research parameters of this project. This reduced the number of papers to 35. A further 3 were unobtainable via available sources: this further reduced the number of papers to 32. The database searches found no papers which spoke of resilience in direct relation to ICA, and therefore these were augmented with hand searches of bibliographies and citation searches, and 6 additional papers were selected using this method. Therefore a total of 38 papers were identified as directly relevant to resilience and institutional abuse, and from which the data discussed in the findings chapters were drawn. Appendix 2 is a more detailed supplement to the full bibliography which lists all the literature used to inform this Report, and contains a table with detailed information on each of these 38 key papers, with those identified in addition to the database searches indicated in italics.

3.7 The aim of the study was to identify literature which addressed resilience in the adult survivors of institutional child abuse (ICA). The database searches failed to identify any papers or studies which distinctly addressed resilience in relation to ICA. However, the majority of papers selected discussed resilience either directly or indirectly - for example, referring to related concepts of thriving or coping - in the context of childhood abuse more generally, or children in the care system whose vulnerability was heightened because of pre-admission experiences. Table 2 offers a breakdown of the subject matter of the 38 papers:

Table 2: Subject of papers included in the final review

3.8 Despite the absence of data directly addressing resilience and ICA, it was possible to use findings in the sampled literature which discussed resilience more generally to draw constructive conclusions about the possible impact of this specific type of abuse on survivors' longer term recoveries. The final bibliography of 38 papers included 21 papers which reflected findings from primary research, and the remaining 17 papers comprised theoretical, discussion, and practice papers. Of the 21 original studies, one focussed on children, adolescents and young adults affected by a range of adversities in early life; 8 related to children or adolescents in institutional care; a further 8 examined the experiences of adult survivors of various forms of childhood abuse; and 4 specifically addressed ICA. The majority of data in these 21 primary studies was drawn from qualitative research (14 papers); the remaining 7 employed mixed or quantitative methods. While it was not feasible in the timeframe to individually evaluate the literature selected, all journal articles were published in peer reviewed academic journals. Papers were however assessed prior to inclusion for their relevance and usefulness in the context of this review, and on the quality of research methods used in the individual studies. The nature, scale and scope of those papers which employed data from primary research are indicated in the table in Appendix 2.

3.9 A literature template was used to organise the data extracted from the finalised body of literature reviewed. This assisted in identifying and organising key themes from the data, the analysis of which is presented in the following chapters, appearing under three main headings: Defining Resilience; Factors Affecting Resilience; and Abuse in Institutional Care.