Picturing Wellness

Christine Wekerle, Ph.D., Pediatricswekerc@mcmaster.ca

Editor-in-Chief, Child Abuse & NeglectCo-Curator, Picturing Wellness Art Exhibit

@McMaster Museum of Art

Picturing Wellness: From Adversity to Resilience

• March 3, 4, 5 2016 Conference via McMaster Continuing Health Sciences Education (CHSE)• Providing #art=#resilience activities:

o Picturing Wellness Exhibit @ McMaster Museum of Art

o Talk by Sheldon Kennedy: Swift Current Documentary

o Presentation from Toronto PoliceVictim Services’ Youth Advocates Teens Ending Abusive Relationships (TEAR) TwitterChat #TEARtalk

o One-man play on mental health and resilience journey

o Yoga & Mindfulness Practice

How do you picture wellness?

• Picturing Wellness by Craig Kung, McMaster Medical Student entered in Art with Impact 2015

How do you picture wellness?

Child Abuse & Neglect – Trauma, Resilience

• “…in the lexicon of strengths, it is as wrong to deny the possible as it is to deny the problem” (Saleeby, p.297)

• Child abuse/neglect deaths > male children > male offenders

• Cases w/ child abuse/neglect-related deaths differ in the use of all types of child welfare services

(case management, mental healthservices, education/training, court representatives)• Identified triggers: Crying child, toile training/feeding

issues, intimate partner violence• 1 in 6 children had prior disability/chronic illness (1 in 3 prior abuse/neglect, from autopsy evidence)• US National Child Death Review Case Reporting System

1TRAUMATIC EXPERIENCES 2TRAUMATIC

REACTIONS 3RESILIENCE

,,

The Resilience Journey

Navigating & Negotiating Resources

Transitioning from Adversity

to Resilience ① Acknowledging Adversity ② Crafting Daily Resilience Practice

③ Shifting Perspectives & Mindsets④ Reaching Out For Help ⑤ Transforming Burden Into Beauty

⑥ Managing Stress Storms⑦ Emerging & Extending Your Grace

TEDxHamilton 2015 Talk – C. Wekerle

Interpersonal Resilience • Review (Domhardt et al., 2015)(1) optimism/hope; (2) self-efficacy(3) solutions-focused coping style

• Flett, Flett, & Wekerle (in press; www.in-car.ca)(4) self-reinforcing (acknowledge achievements)(5) self-compassionate (capacity and motivation to perceive self accurately and empathically) (6) direct coaching (anticipatory social guidance; “mattering”)

• “…unique signature is the transformation of adversity into personal, relational, and collective growth through strengthening existing social engagements, and developing new relationships, with creative collective actions”

(Cacioppo et al., 2011, p. 44).

Childhood Traumatic Events: Abuse & Neglect

Abuse by a family member or someone connected with the family is in itself a barrier to victims accessing help (UK Child Commissioner’s Report, 2015,)

• Earlier disclosure predictive of better health outcomes

• Having 3+ persons to talk with buffers childhood adverse events

• 7.6% of adults reporting child abuse were child welfare system-involved

• 3 types of abuse (physical, sexual, and witnessing IPV increase likelihood of child welfare 16-fold

• What does it take for abused/neglected children to obtain protection?

Ontario Incidence Study of Reported Child Abuse & Neglect

CIS study – www.cwrp.ca

48% child previously investigated58% multiple substantiated incidents within maltreatment type (pattern)18% multiple substantiated types of maltreatment10% reported by health care professionals – under-reporting?

You & Art-based Learning

• Visual Literacy & Critical Thinking

CanMEDS Roles: Context for Child Abuse/Neglect Learning

Health Advocate- Child injuryprevention; child well-beingand resilience Collaborator – Team,Child welfare, police,Public health etc.Communicator: How-toof reporting

The Child Abuse/Neglect Challenge

“Child protection is a difficult area of practice that can involve making decisions that are emotionally challenging, complicated by uncertaintyand sometimes go against the wishes of parents.”-General Medical Council, 2012

Child Abuse/Neglect Assessment Considerationso Nature of the injuryo Developmental capabilities of the child o Social history (risk factors) and history of injuryo Research [e.g., 51% closed cases (substantiated)

and 38% (suspected) re-referred within 5 years to child welfare, Dakil et al., 2011]

o Most suspected cases in hospital go home with parents (75.6%, Friedman et al., 2012) – Follow-up assessment important

• Common to see risk to siblings, re-victimizations, and multiple forms of maltreatment

Describe: What do you see?

Child Abuse/Neglect Screening in ER (Netherlands; Louwers et al.,

2012• (1) Is the history consistent?• (2) Was there unnecessary delay in help-seeking?• (3) Does the onset of injury fit with the developmental

level of the child? (<1% babies who are not mobile present with bruising, Gilbert et al., 2009)

• (4) Is caregiver behaviour and caregiver-child interaction appropriate?

• (5) Are findings of the top-to-toe exam consistent with history?

• (6)Are there any signals for concern that the child or other family members are safe?

The Art-based System of Looking

How to Look:• Colour: hue, intensity, temperature• Texture: how surface looks or feels• Shape/Form: outline of object• Line: length, direction• Space: area around, within, or between objects• Emphasis: importance given to one part in the art• Movement/Rhythm: how the artist uses elements to

direct the eye around the art work• Pattern/Repetition: repeated use of similar elements

(such as colour or line)

Visual LiteracySupport for improvement in:

o Descriptive abilityo Observational accuracyo Manage complex patterns o Awareness of multiple perspectiveso Appreciation of subtle cueso Skepticism about initial impressions

Other proposed benefits (yet unsupported by quality data)o Improved teamwork and collaboration

Basic Questions to Guide Perceptual Awareness

• What’s going on in this picture?• What do you see that makes you say that?

(evidence)• What more can we find?

• START with:• 1. Where does your eye first go to?• 2. Describe details of what you see?• 3. Go around the picture? What else do you see?

Analyzing Visuals – 11-mo. Case – Shape?

Moharir, Niec & Wekerle (2012). Burn injury in an 11 month old infant. Pediatrics & Child Health,

17(9), 495-497.

Case Details • Child with father for 2 weeks• To return, there was a 5 hour car ride in 35°C weather• Infant in car seat, exposed to sun through windows • Mother noticed burn upon arrival• Went to emergency room following day• Infant appeared healthy and engaging• Burn pattern on infant exactly matched exposed plastic part of

car-seat • Verified by placing infant into car-seat

Conclusions: • Appropriate call to CAS – no story for injury• In-Depth CAAP Evaluation: Accidental burn injury due to skin

exposed to heated plastic of car-seat

Museums contribute to...pursuit of health [via] relaxation,

an immediate intervention of beneficial change in physiology, emotions or both.

They also encourage introspection, a process of understanding one’s feelings and

thoughts that is essential to mental health.

Museums foster health education that equips individuals…[to] address social conditions…

by public health advocacy and by enhancing healthcare environments.

Silverman, L. (2010). The Social Work of Museums. NY: Routledge.

The art & science of seeing

CAN Clinical Pearl: Understanding may reside in what is missing, what is not there but which is expected to be there, or distortions in what is there.

Further Resources• International Journal of Child and Adolescent

Resilience www.in-car.ca• TEDxHamilton Talk (C. Wekerle, September, 2015)• TED Ed Lessons: 1) Risk and Resilience in Youth

Suicidality:http://ed.ted.com/on/6nReRcN0 (2) Adverse Childhood Events (ACEs) & Childhood Maltreatment :http://ed.ted.com/on/iOyQVfhd

• Prezi Presentations: Child Sexual Abuse: A Hidden Problem https://prezi.com/-gl1ebv6ksra/child-sexual-abuse-a-hidden-probem/

• Follow on Twitter @DrWekerle #picturingwellness

Thank you for your attention!

…F