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

7 Conclusions

7.1 The Report of Time To Be Heard: A Pilot Forum recommended that research should be done to identify factors which affect the resilience of survivors of abuse. This review has identified a variety of indicators of resilience from a range of literature across academic disciplines, and has also highlighted how diverse these are: resilience is affected by personal characteristics, life circumstances, social interactions, and structural frames. It is further influenced by situational factors, including the unique aspects of individual abuse experiences. Furthermore, consequent responses to adversity are shaped by prior life experiences.

7.2 A single, comprehensive, universally accepted definition of resilience does not exist. Nevertheless, the evidence in this review suggests that despite this, we can recognise and describe resilience as highly individualised, positive personal reactions in response to adverse external events. The original recommendation for this review was to explore the factors which affect resilience. Given that we have a more descriptive understanding of resilience rather than a universal definition, 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. Much research has investigated the various personal, social and structural facets that intertwine to create these patterns of responses. Given its interactivity and fluidity, resilience is most helpfully seen as an ongoing, long term process rather than an inherent personality trait or definitive outcome: a journey, rather than a destination. This review has highlighted the enduring complexity of that journey.

7.3 Although harmful and distressing events and experiences are an unavoidable if regrettable part of life, the concept of resilience draws our attention to the fact that negative outcomes are not always inevitable in their aftermath, and that appropriate interventions can and will help those who experience them to recover and to live stable, happy lives. The development of resilience is dependent on a balance between a range of internal and external risk and protective factors; conditional on exposure to particular forms of harm; and invigorated or thwarted by wider social processes and structural frameworks. There is therefore reason to be hopeful: for a proportion of individuals, recovery from trauma will be robust, and for others it is possible that policy and practice interventions might encourage and support healthy survival.

7.4 This review has also highlighted reasons for caution. The first is in the definition of resilience itself: its fluidity leaves substantial scope for research, policy and practitioner interpretation. There is a danger that resilience goes unrecognised in some individuals if attention and resources remain problem-focussed; or that their efforts are dismissed as researchers and practitioners project their own definitions, and consequently analyses of needs, onto survivors. Resilience does not mean lives are trouble- or trauma-free: healthy recovery might mean "struggling successfully" (Roman et al, 2008). Individuals who describe themselves as resilient might be receiving ongoing treatment for depression, or adopt short term coping strategies which can be externally perceived as dysfunctional, but which are nevertheless felt to provide effective and temporary relief. There is a need, particularly in light of the importance for survivors to maintain control and exercise agency, to adopt person-centred, reflexive approaches which seek to understand and empower the individual, in research, in policy making, and in professional responses to survivors.

7.5 A further reason for caution is that there is a variation in the evidence relating to different categories of factors. There is considerable data focussing on internal/personal and external/social factors, but there appears to be less attention paid to structural aspects which may equally shape experiences of abuse and affect recovery trajectories (see, for example, Ungar, 2011). One widely acknowledged key absence is research which explores men's experiences of many forms of child abuse, and any future studies which have a broader remit might identify additional groups whose experiences are, at present, under-represented: this currently includes survivors of ICA. In this review, gender was the most apparent structural factor which affected responses to abuse, but there was also evidence of other elements which could be relevant: poverty, despite its well documented negative impacts in the broader academic literature and across policy domains, was only referred to briefly and tangentially in a very small number of papers. Furthermore, all the papers which explicitly identified religion and spirituality as a significant positive facet of resilience for survivors were American, for example, which may indicate the potential for cultural differences in resilience processes. This presents challenges for this type of literature review in terms of the generalisability of data located across academic disciplines, conducted in a variety of countries and consequently cultures, and which is methodologically diverse, as well as varying in scale and scope. Nevertheless in light of the well-documented difficulties experienced by specific equalities groups, attention might be paid in future to wider structural factors absent in the existing literature, since these may compromise access to the very resources and support services that might play a role in developing longer term resilience.

7.6 Much of the literature reviewed relating to experiences in institutional care focussed on young people. However, this review has demonstrated the importance of perceiving resilience as a longitudinal, conditional process, and experiences beyond care and into independent adulthood are critically important. While many reap positive benefits from residential care, a significant minority will be subjected to harm, and the process of recovery from many forms of child abuse, including ICA, may involve a prolonged process of acceptance prior to disclosure, as the full implications and impacts from those experiences emerge over unpredictable periods of time. There is a distinctive public dimension to disclosure of ICA: privacy may be unsustainable should allegations emerge from fellow residents, leading to what might be perceived as forced disclosure; claims of abuse are more likely to be evaluated by public bodies and institutions; and resultant investigations and court cases given prominent media coverage. Consequently, the impacts and implications of disclosure processes for ICA merit ongoing consideration, particularly as the literature suggested there is potential for it to contribute to the retraumatisation of survivors.

7.7 Nevertheless, there is convergence with some existing policy approaches, namely the assets-based focus in health, where pre-existing community strengths and resources are identified, fostered and cultivated. Contemporary childcare practice may already be contributing much to the development of resilience in looked-after children. However for adult survivors of abuse in residential care, this review has suggested several points which merit attention: the dearth of evidence relating to this particular population; the lack of research into survivors of all types of abuse who go onto live stable, secure lives and who describe themselves as resilient; and the need for continuing attention to and investment in developing disclosure and support processes in future public investigations into institutional child abuse.

Suggested future development

7.8 Institutional child abuse is thought to be under-reported and under-researched. Despite recent developments in child protection strategies and the introduction of frameworks such as Getting It Right For Every Child which seek to improve the safety of all children, it is reasonable to assume that survivors of ICA will continue to emerge. It could be argued that there are two reasons why resilience is 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 residential institutions, and for whom much can be done to nurture and develop longer term resilience as they grow into adulthood; and it offers a meaningful frame for understanding the diverse reactions of adult survivors who have already disclosed or who are likely to emerge in the future. However, future studies might refine existing definitions of resilience, developing the concept in operational and academic contexts, thus providing a platform for coherent policy development in the future.

7.9 This review found evidence that participation in public investigations and inquiries can be potentially disruptive and destructive for some individuals, while for others it may be revelatory and healing. Given the critical importance of disclosure of ICA for the ongoing recovery processes of survivors, further work is needed in order to design and establish effective, reflexive mechanisms and support systems for disclosure which should underpin future inquiries and forums. In light of potential trust issues, and the importance of empowerment of a population whose past experiences are marked by significant disempowerment, this should actively involve existing and emerging survivors in order that their needs and the needs of future survivors are effectively and sensitively met. In addition, examination of specialised services and initiatives for survivors of other forms of abuse, as well as the current specialised services provided by ICSSS, may offer starting points for the development of specific support models for survivors of ICA, and could potentially enrich current good practice in broader public services.

7.10 There is a need for further exploration of resilience as a journey: longitudinal empirical research, which embeds experiences in a wider context beyond individual life stages, and which might further augment and refine the current definitions of resilience. A significant minority of survivors in empirical studies relating to different forms of abuse are identified as 'resilient', and there is a need for research which focuses specifically on this population. There appears to be some convergence between existing assets-based approaches and resilience theory. This is one avenue of future enquiry which might prove fruitful, particularly in light of existing strengths-based resilience work among young people in care, such as the work undertaken as part of NRCCI.

7.11 Finally, there is a significant gap in our knowledge relating to men's recovery experiences from child abuse, including ICA. Given the substantial numbers of male survivors of this form of abuse and some evidence presented in this review that there may be gendered differences in the resilience processes of men and women, there is a pressing need for specifically gendered work in order to investigate men and women's differential experiences. This might contribute to a better understanding and more effective responses to the potentially varying needs of male and female survivors in the future.