Build your resilience. Resilience is like a muscle you can build. It’s just a matter of knowing how. Explore Resilience.
Larry K. Brendtro, PH. D., Director, Resilience Resources.
Professional Highlights. Current: Director, Resilience Resources and Licensed Psychologist, Lennox, SDAugustana University.
Professor Emeritus, Augustana University, Sioux Falls, SD, Faculty of Special Education. University of Victoria, BCAdjunct Professor, University of Victoria, BC, School of Child and Youth Care. Reclaiming Youth International. Co- founder of the Circle of Courage Resilience Model and Reclaiming Youth International. Starr Commonwealth.
Former President of Starr Commonwealth, with campuses in Michigan and Ohio. University of Illinois, Urbana. Assistant Professor, Institute for Exceptional Children, University of Illinois, Urbana.
University of Michigan. Clinical Faculty, University of Michigan Fresh Air Camp, Ann Arbor, MIHawthorn Center. Psychology Intern & Residential Counselor, Hawthorn Center, Michigan Mental Health Dept., Livonia, MIChildren's Care Hospital. Principal, teacher, social worker, child care worker, Children’s Care Hospital and School, Sioux Falls, SDResearch and Publications. Author or co‑author of over 2. Book titles include: The Drive to Thrive, Deep Brain Learning, The Resilience Revolution, Reclaiming Youth at Risk, Reclaiming Our Prodigal Sons and Daughters, Positive Peer Culture, and The Other 2.
Karri Byrne, Independent Consultant. Emily Sloane, IRC. Sarah Ward, Independent Consultant. William Martin, CRS : Track: Resilience through Market Systems. Trauma and Resilience: Mind, Body, and Spirit - Transcript. Dr. Donald Lindberg: Welcome. I'm Don Lindberg. I am Director of National Library of Medicine. UN News Centre – Official site for daily UN news, press releases, statements, briefings and calendar of events. Includes UN radio, video, webcasts, magazines.
Hours. Training and Consultation. Has trained professionals in 2. With colleagues developed a full range of practical, research- grounded courses extending the Circle of Courage model of positive youth development. These include Connecting with Kids in Conflict, Building Resilient Families, Positive Staff and Peer Cultures, and Transforming Trauma into Resilience. Served as a practitioner expert member of the Coordinating Council on Juvenile Justice and Delinquency Prevention in the administrations of Presidents Clinton, Bush, and Obama. Was ceremonially adopted into the Rosebud Lakota Sioux tribe and has worked with indigenous nations worldwide.
Arranging Presentations. Dr. Brendtro can provide keynote addresses to professional conferences as well as workshops, consultation, and learning opportunities.
Topics tailored to needs of the particular audience include practical strategies and evidence- based principles delivered in inspirational presentations. For information, contact him at Resilience Resources: Phone: 6. Email: larry. brendtro@gmail.
Personal. Larry Brendtro and his wife Janna Brendtro established the research, publication, and training organization Resilience Resources. Janna has been research editor of all reclaiming youth publications over the past forty years. They reside near Sioux Falls, South Dakota, and have three adult children and seven grandchildren. The Reclaiming Youth Movement. The Roots of Reclaiming. For thousands of years, indigenous peoples worldwide have revered children as sacred beings.
During that same period, most Western cultures viewed children as chattel and reared them with harsh punishment. While reformers long attempted to challenge these practices, the modern reclaiming movement dates to August Aichhorn who described relational- based strategies in his 1.
Wayward Youth. As defined by Yochanan Wozner of Israel, reclaiming environments meet the needs of children and youth. In psychological terminology, this includes universal growth needs for attachment, achievement, autonomy, and altruism. August Aichhorn and Anna Freud trained a generation of leaders including Fritz Redl who emigrated to the U. S. prior to World War II. There, Fritz Redl and David Wineman authored the classic book, Children Who Hate. They worked with William Morse to establish the University of Michigan Fresh Air Camp as a laboratory for applied research on reclaiming challenging children and youth.
Larry Brendtro was trained in this tradition and completed a doctorate at the University of Michigan. He then joined the faculty of the University of Illinois where he established graduate programs for professionals serving students with emotional and behavior disorders. Dr. Brendtro left the university to put these principles into practice at Starr Commonwealth which operated treatment programs and alternative schools at campuses in Michigan and Ohio. During fourteen years at Starr, he and colleagues co- authored three books. The Other 2. 3 Hours focused on the transformational power of therapeutic living and learning environments and was translated into several languages.
This was followed by Re- Educating Troubled Youth and Positive Peer Culture which presented strategies for enlisting young people and staff in creating climates of respect. Positive Peer Culture is now listed on the California Evidence Based Clearing House, and these three early books are still in print, now being published by Routledge. The Circle of Courage. After leaving Starr, Brendtro returned to his native South Dakota as professor at Augustana University. He and Augustana colleagues Martin Brokenleg and Steve Van Bockern co- authored Reclaiming Youth at Risk which introduced the Circle of Courage model, a consilience of traditional Native American child- rearing values and the science of positive youth development.
That small book became a best seller for its publisher, National Education Services (now Solution Tree) and introduced reclaiming principles to professionals worldwide. Larry Brendtro and Nicholas Long established the journal Reclaiming Children and Youth to publish research and practice wisdom related to the Circle of Courage. Fred Tully, founder of the Black Hills Children’s Home, invited Augustana to offer graduate degrees there and hosted the first Black Hills Seminars on Reclaiming Youth in 1. This became an annual event, drawing professionals from throughout North America and beyond. The year 2. 01. 8 marks the 2.
Black Hills Seminars. A key leader in the reclaiming youth network has been Mark Freado who brought the strength- based principles of the Re- ED model for troubled children developed by Nicholas Hobbs and has been at the forefront of Life Space Crisis Intervention. Through the reclaiming book, journal, and seminars, a world- wide synergy developed. Lesley du Toit brought this model to South Africa and piloted the Response Ability Pathways [RAP] training curriculum.
European satellites were developed in Germany, Ireland, Belgium, Hungary, and Switzerland. In Australia, this reclaiming model was promoted by Youth Off the Streets of Sydney, Circle Seminars and Edith Cowan University in Perth, and Allambi Care in Newcastle. New Zealand colleagues formed a professional development trust and extended training throughout the Pacific Islands. And because of its Native roots, the Circle of Courage attracted the interest of indigenous peoples from many cultures.
Over a period of two decades, many schools and treatment programs have embraced the Circle of Courage model. It was applied to faith- based programs in juvenile justice by Scott Larson and generated books on resilience. The Circle of Courage was the early prototype for positive youth development as documented by Wayne State University researcher William Jackson. Under the leadership of Cathann Kress, the Circle of Courage was adopted as the “4- H Essentials of Youth Development” by this, the world’s largest youth organization. Subsequently, researchers from Tufts University received major funding to document the effectiveness of these principles, but, in the process, took the liberty to rename Circle of Courage concepts with synonyms called the 5 C’s. In spite of this alliterative relabeling, the Circle of Courage presaged other models as noted by Maurice Elias and colleagues in the Handbook of Social and Emotional Learning. In 2. 01. 2, Dr. Brendtro returned to Starr Commonwealth as Dean of the Starr Global Learning Network and chief psychologist in Starr’s doctoral internship program.
For a time, Starr also operated the South Dakota- based Reclaiming Youth International directed by Mark Freado. However, in 2. 01. Starr Commonwealth was no longer able to continue its support for the South Dakota initiatives. While Starr continues to provide Circle of Courage and RAP training, key leaders in the reclaiming movement are developing new collaborations to insure the future of this strength- based model. The Legacy Continues. Returning to their native South Dakota, Larry and Janna Brendtro established Resilience Resources to continue their legacy of research, publications, and professional development activities.
Building physician resilience. The concept of physician resilience is emerging in response to increasing evidence of physician stress.
The Canadian Medical Association reported that 5. The journal Hippocrates reported that, among their readers, fewer than half (4. Physician stress is attributed to changes in organizational structures. Although the data are not conclusive, work stress is theorized as manifesting as a triad of doubt, guilt, and exaggerated sense of responsibility resulting in emotional exhaustion, depersonalization, a low sense of personal accomplishment,1. While rates of depression. Physician suicide rates are substantially higher compared with the general population,1. Mc. Cue and Sachs argue that the “conspiracy of silence” about the nature and level of stress inherent in the physician role has inhibited the sharing of problems and solutions.
Our advisory team of 8 researchers with 5 family physicians met on 5 occasions to explore research direction and design. After an extensive literature review on physician stress and emergent research on resilience, we decided to take the more positive approach and focus on physician resilience. Four recent works guided us. The qualitative study of physician self- protective practices by Weiner et al. Huby et al. 26 define 3 predictors of physician morale: workload, personal style, and practice arrangements. Polk. 27 identifies 4 factors of resilience: dispositional, relational, situational, and philosophical.
Barankin et al describe resilience as “a dynamic process of actively managing life events and rebalancing work and family life.”2. METHODSOpen inquiry.
We began by posing nonpersonal questions to establish the domain of inquiry and to build rapport in the interview before moving to more personal inquiries. Ethics approval was granted by the Mc. Master University Research Ethics Board. Interview questions. Physician participants were asked the following questions: Suppose a young person is considering medicine as a career and asks for your advice.
What would you say? If a resident asks you about physician resilience—how to avoid stress and burnout—what kind of advice would you offer? Making clinical errors is often a source of stress. How do you deal with this? Keeping up in medicine can be a difficult task.
How do you manage this? Probes are follow- up questions, used when needed to deepen the level of response and to increase the richness of the data without directing the response. Probe question topics drawn from the literature on physician roles included competing time demands, clinical work issues, range of professional activities, and leadership roles. Sample. Our 8- member advisory committee identified a purposive sample of 2. Hamilton, Ont. When half had been selected systematically and interviewed, saturation was reached on core elements. It became apparent the sample needed to be expanded to reflect the changing demographics of family medicine and to include physicians of all ages, stages, and practice types.
Of a total of 2. 0 potential subjects contacted, 2 did not respond to 3 phone messages, 1 interview was excluded owing to audiotape technical difficulties, and none declined. The resulting 1. 7 interviews were found to be sufficient for saturation. Data collection. The potential sample was divided between 2 peer interviewers (K. T. K., H. W.) who selected those they did not know or know well. Physician subjects were asked to participate in audiotaped interviews of 3. Interviews were numbered with only the interviewers knowing identities of subjects. H. W.’s interview numbers are 2.
K. T. K.’s interview numbers are 3. Transcribed tapes have numbered lines and were kept in a locked file before being erased. Quotations are referred to by interview number and line of text (eg, 2.
Interview transcriptions were examined at 3 stages: early (after 5 done), halfway (1. Data analysis. Each interview, when completed, was read independently at least twice by 3 researchers (P. M. J., K. T. K., H. W.) for themes identified in the literature, new findings, and possible saturation. Constant comparison of themes guided the search for meaning and relative importance of concepts. These were organized into an axial coding scheme for text processing in NVivo.
Face validity was assured through an internal review by 2 members of the Mc. Master University Department of Family Medicine. DISCUSSIONOne could argue attitudes contributing to building resilience are inherent personality traits.
But our study physicians reported learning to set limits, resulting in improvements in sense of well- being and productivity. Hamilton family physicians’ recommendations for building resilience shift the focus from pathological stress to successful adaptation emphasizing 4 dynamic elements, each of which has research support. Attitudes and perspectives. Attitudes and perspectives reflect 2 factors identified by Polk in a systematic review of the literature on resilience: dispositional (sense of self and personal competence) and philosophical aspects (personal beliefs).
They also correlate with 5 resilience factors identified in a recent workshop by the Toronto Health Project: 1) being self- aware, reflective, and attuned, 2) having core values and an optimistic philosophy of life and being altruistic, 3) having a healthy temperament and a sense of humour, 4) acceptance of self and others and being able to forgive self and others, and 5) feeling that one is making a difference in one’s profession. Balance and prioritization. Balance and prioritization are supported by Polk’s situational factor of resilience and studies on workload. While early studies describe “physician work addiction” as a way of life,3. Australia,3. 4 Canada,6,3.
United Kingdom,3. United States,2 identify heavy workload and time pressures inherent to the role itself and not the person. Time pressures affect perceptions of having adequate time for patient care and do influence job satisfaction. Time for personal life includes family,3. Some studies show men and women perceive work stress differently,3.
Options some women choose when their children are young are salaried positions and part- time work. Practice management. Study physicians advised careful decision making about personal capacity for work,4.
Studies of work organization and physician job satisfaction from the United Kingdom. Hamilton family physicians stressed the importance of well structured work routines and practice arrangements that foster supportive networks of colleagues, consultants, and allied staff. Good communications with colleagues and patients is key to dealing with medical errors, and an essential element of enjoying practice. Supportive relations. Regular and strong peer interaction allows physicians to find practical answers to difficult clinical questions, and to address pervasive occupational stresses. Methods in Australia include voluntary educational programs,4.
Balint groups, which are also popular in the United States. United Kingdom. 3 Support services in Wales. New Zealand. 54 permit exploration of issues in confidential settings. The most popular option for the Hamilton physicians in this study was PBSGs, which provide CPD, mentoring, and peer support. The Ontario Physician Health Program offers resources for those at risk and workshop training to build resilience. Balance between personal and professional life is deemed essential. Hamilton physicians in this study stressed the importance of personal relations, exercise, relaxation, spirituality,5.
Personal support networks are necessary,4. Hamilton physicians strongly recommended having a family doctor as an important part of self- care. Conclusion. Hamilton family physicians identified 4 dynamic elements for building resilience: attitudes and perspectives; balance and prioritization; practice management; and supportive relations. Attitudes and perspectives include valuing the physician role, maintaining interest in one’s career, accepting career demands, developing self- awareness, and accepting personal limitations.
Balance and prioritization of work and personal life include setting limits to work, scheduling time off, and maintaining healthy relationships. Despite varied practice management styles, common contributors to resilience are identifiable: efficient organization, trusted and experienced office staff, supportive group practices with good on- call systems, and effective communication with colleagues and patients.