Building blocks of resiliency: a transactional framework to guide research, service design, and practice in pediatric rehabilitation

Abstract

Purpose: Children’s resiliency is seen as important in pediatric rehabilitation, but is seldom the focus of research or intervention. This article presents a resiliency framework to inform pediatric rehabilitation research, service design, and practice.

Methods: The development of the framework was guided by a transactional, life course perspective, and a review of self-constructs in the resiliency literature.

Results: The framework comprises health-related adversities, self-capacities, self-regulatory processes, and adaptive benefits. Four adaptive self-capacities are highlighted (activity self-efficacy, capacity to marshal resources and supports to achieve goals, capacity to adapt to changing life situations, and capacity to envision a positive future). These self-capacities are linked to common adversities experienced by children with disabilities, namely activity limitations, functioning and participation restrictions, transition issues, and anticipated future life challenges. The self-capacities are also associated with empowered, optimistic, adaptive, and hopeful mindsets, which influence accommodative and assimilative self-regulatory strategies affecting children’s adaptive benefits.

Conclusions: The framework can inform resiliency-related research exploring self-capacities and resiliency processes. The framework points to what is modifiable through intervention targeting the person-in-context, namely self-capacities, mindsets, and situated experiences. Implications for service design and delivery include providing opportunities and interacting with clients in ways that support the development of these self-capacities.

Implications for rehabilitation

• Fostering resiliency means preparing children with disabilities to negotiate and navigate the adversities and challenges they will encounter over their lives.

• Important resiliency-related self-capacities include activity self-efficacy, capacity to marshal resources and supports to achieve goals, capacity to adapt to changing life situations, and capacity to envision a positive future.

• The resiliency framework suggests the importance of enhancing children’s views of themselves as empowered, optimistic, adaptive, and hopeful.

• Practice will be enriched by acknowledging that a range of health concerns are relevant to practice, including issues of impairment, functioning, participation, and adaptation.

Keywords:

• Adaptation
• adaptive benefits
• adversity
• expectancy
• hope
• mindset
• resilience
• self-capacity
• self-efficacy
• self-regulatory processes
• transaction

Acknowledgements

The authors thank Holland Bloorview’s transition strategy team for providing the impetus for the development of this article.

Disclosure statement

The authors alone are responsible for the content and writing of this article.

Additional information

Funding

The authors acknowledge the support of the Holland Bloorview Kids Rehabilitation Hospital Foundation for preparation of this work. The preparation of the article was also supported by the Canada Research Chair in Optimal Care for Children with Disabilities, funded by the Canadian Institutes of Health Research, held by Gillian King. This chair is supported by matching funds from the Kimel Family Opportunities Fund through the Holland Bloorview Kids Rehabilitation Hospital Foundation.