CAPHC Picturing Wellness

1. Picturing Wellness
Christine Wekerle, Ph.D., Pediatrics
wekerc@mcmaster.ca
Editor-in-Chief, Child Abuse & Neglect
Co-Curator, Picturing Wellness Art Exhibit @McMaster
Museum of Art

2. 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 Police
Victim Services’ Youth Advocates
Teens Ending Abusive Relationships
(TEAR) TwitterChat #TEARtalk
o One-man play on mental health
and resilience journey
o Yoga & Mindfulness Practice

3. How do you picture
wellness?
• Picturing Wellness by Craig Kung, McMaster Medical
Student entered in Art with Impact 2015

4. How do you picture
wellness?

5. 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 health
services, 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

6. TRAUMATIC
EXPERIENCES
TRAUMATIC
REACTIONS RESILIENCE
,,

7. The Resilience Journey
Navigating & Negotiating

8. Transitioning from Adversity
to Resilience
① Acknowledging Adversity
② Crafting Daily Resilience Practice
③ Shifting Perspectives & Mindsets
④ Reaching Out For Help
⑤ Transforming Burden Into Beauty
⑥ Managing Stress Storms
⑦ Emerging & Extending Your Grace
TEDxHamilton 2015 Talk – C. Wekerle

9. 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).

10. 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

11. CIS study – www.cwrp.ca
48% child previously investigated
58% multiple substantiated incidents within maltreatment type
(pattern)
18% multiple substantiated types of maltreatment
10% reported by health care professionals – under-reporting?

12. You & Art-based Learning
• Visual Literacy & Critical Thinking

13. CanMEDS Roles: Context for
Child Abuse/Neglect Learning
Health Advocate- Child injury
prevention; child well-being
and resilience
Collaborator – Team,
Child welfare, police,
Public health etc.
Communicator: How-to
of reporting

14. The Child Abuse/Neglect
Challenge
“Child protection is a difficult area of
practice that can involve making
decisions that are emotionally
challenging, complicated by
uncertainty
and sometimes go against the wishes
of parents.”
-General Medical Council, 2012

15. Child Abuse/Neglect
Assessment Considerations
o Nature of the injury
o Developmental capabilities of the child
o Social history (risk factors) and history of injury
o 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

16. Describe: What do you see?

17. 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?

18. 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)

19. Visual Literacy
Support for improvement in:
o Descriptive ability
o Observational accuracy
o Manage complex patterns
o Awareness of multiple perspectives
o Appreciation of subtle cues
o Skepticism about initial impressions
Other proposed benefits (yet unsupported by quality data)
o Improved teamwork and collaboration

20. 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?

21. 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.

22. 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

23. 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.

24. 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.

25. 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

26. Thank you for your attention!
…
F