Journal of Evidence-Based Social Work

Journal of Evidence-Based Social Work

A Review of Measures across the Life Course

Alexa Smith-Osborne and Kristin Whitehill Bolton

School of Social Work, University of Texas at Arlington, Arlington, Texas, USA

Through this systematic review the authors analyze scales used to measure resilience in individuals

across the life course. The scales were obtained according to a priori inclusion criteria through searches

using electronic databases, cited references, and requests to human services researchers currently

engaged in research utilizing a resiliency theory framework. Eleven measurement tools meeting study

inclusion criteria were located within the existing literature. Currently validated instruments measure

specific populations and vary in length and format. The need for an analytical approach to measuring

resilience is long overdue. This assessment is intended to aid social work practitioners working with

populations that have faced adversity.

Keywords: Resilience, measurement, life course, vulnerable populations, social work practice, inter-

vention research

Two divergent streams of research have operationalized the construct of resilience as either a

personality trait (or cluster of traits) or as a process of personal, interpersonal, and contextual

protective mechanisms, resulting in an anomalous, positive outcome in the face of adversity

(Egeland, Carlson, & Sroufe, 1993; Greene, 2008, 2010; Werner, 1982; Werner & Smith, 1992). Attention to the former appears to predominate; for example, a search of the keyword “resilience”

in the electronic database collection EBSCO showed that the database embedded this search term

within the larger category of “personality trait.” In contrast, use of the construct as a contextualized

process resulting in a positive outcome, rather than as an internal characteristic has been applied in many fields. One example from another discipline, information management, is in application

to key confirmation protocols used in cryptographic computer security. In these applications,

resilience is defined as the maintenance of the pre-existing system state or equilibrium after an

attack—in other words, the system’s function has not been disrupted by the attack (Mohammed, Chen, Hsu, & Lo, 2010). As an illustrative comparison, this application highlights the construct

as both a dynamic protective process and a desirable outcome under adverse circumstances.

Operationalization of the construct as a dynamic process is particularly consistent with the

biopsychosocial, person-in-environment focus of the social work discipline, and the contexts of adversity often experienced by social work clients, such as childhood abuse and neglect, domestic

violence, chronic illness, discrimination, and poverty (Fraser & Galinsky, 1997; Greene, 2007,

2010; Smith-Osborne, 2007). Furthermore, a shift from problem-focused and diagnostically driven theories and practice

models to the strengths perspective and resilience theoretical framework has been noted not

only in social work practice (Greene, 2010; Richardson, 2002; Smith-Osborne, 2007), but also

Address correspondence to Alexa Smith-Osborne, School of Social Work, University of Texas at Arlington, 211 S.

Cooper St., Box 19129, Arlington, TX 76019-0129. E-mail: alexaso@uta.edu

111

112 A. SMITH-OSBORNE AND K. WHITEHILL BOLTON

in such diverse fields as military medicine (Bowles & Bates, 2010), nursing (Tusaie & Dyer, 2004), and international youth development (Unger & Liebenberg, 2007). Application of the

theory in a variety of disciplines has supported growing recognition and evidence that risk and

protective factors for resilience may operate differently at different points and trajectories across

the life course (Garmezy, 1991; Garmezy, Masten, & Tellegen, 1984), and for different types of desired outcomes and adverse contexts (Bynner, 2000; Rudolph & Troop-Gordon, 2010; Rutter,

1979, 1985, 1990, 1995; Smith-Osborne, 2009a, 2009b). The need for an analytical approach

to measuring resilience is long overdue to support intervention research and practice (Luthar &

Cicchetti, 2000; Luthar, Cicchetti, & Becker, 2000; Luthar & Cushing, 1999; Luthar & Zigler, 1991). Although reviews of resilience measures have been done over the last decade in the fields

of nursing (Ahern, Kiehl, Sole, & Byers, 2006) and education (O’Neal, 1999; Rak & Patterson,

1996), to our knowledge none have examined contrasting operationalizations of the construct in

these measures and none have been done to date in social work. This systematic assessment of resilience measures of individuals across the life course is intended as a guide for social work

practitioners working with individuals having faced adversity.

METHOD

Systematic reviews of measures should account for variations in design, implementation, construct

operationalization, sample characteristics, settings, and psychometric analyses to produce better

results for application in real life practice (Alderson, Green, & Higgins, 2003; Boruch, Petrosino, & Chalmers, 1999; Chalmers, Hedges, & Cooper, 2002). Thus, operationalization of resilience

constructs are specified in Tables 1 and 2, sample, setting, and psychometrics in Table 3, and

study quality summarized in Table 4.

Operational Definitions

For inclusion criteria, resiliency was defined as a process of personal, interpersonal, and contextual protective mechanisms, resulting in an anomalous, positive outcome in the face of adversity,

TABLE 1

Resilience Construct Operationalization of Child and Adolescent Instruments

Instrument (Authors) Factors Theoretical Basis

Number

of Items Scaling

RSAS (Jew, Green, &

Kroger, 1999)

1. Active skill acquisition

2. Future orientation

3. Independence/risk taking

Past research by Mrazek

and Mrazek

35 items 5-point Likert

scale

ARS (Oshio et al.,

2003)

1. Novelty seeking

2. Emotional regulation

3. Positive future orientation

Drawn from past resilience

research

21 items 5-point rating

scale

READ (Hjemdal et al.,

2006)

1. Personal competence

2. Social competence

3. Structured style

4. Family cohesion

5. Social resources

Drawn from past research

on resilience

28 items 5-point Likert

scale

RSCA (Prince-Embury,

2008)

1. Emotional reactivity

2. Sense of mastery

3. Sense of relatedness

Developmental theory and

past research on resilience

64 items 5-point Likert

scale

T A

B L E

2

R e s ili

e n c e

C o n s tr

u c t

O p e ra

ti o n a liz

a ti o

n o f

A d u lt

In s tr

u m

e n ts

In st

ru m

e n

t (A

u th

o rs

) F

a c to

rs T

h e o

re ti

c a

l B

a si

s N

u m

b e r

o f

It e m

s S

c a

li n

g

R S

(W ag

n il

d &

Y o

u n

g ,

1 9

9 3

) 1

. P

er so

n al

co m

p et

en ce

2 .

A cc

ep ta

n ce

o f

se lf

an d

li fe

D ra

w n

fr o

m p

as t

re si

li en

ce re

se ar

ch 2

5 it

em s

7 -p

o in

t L

ik er

t sc

al e

B P

F I

(B ar

u th

& C

ar ro

ll ,

2 0

0 2

) 1

. A

d ap

ta b

le p

er so

n al

it y

2 .

S u

p p

o rt

iv e

en v

ir o

n m

en t

3 .

F ew

er st

re ss

o rs

4 .

C o

m p

en sa

ti n

g ex

p er

ie n

ce s

D ra

w n

fr o

m p

as t

re si

li en

ce re

se ar

ch 1

6 it

em s

5 -p

o in

t L

ik er

t sc

al e

R S

A (F

ri b

o rg

et al

., 2

0 0

3 ;

F ri

b o

rg

et al

., 2

0 0

9 )

1 .

P o

si ti

v e

p er

ce p

ti o

n o

f se

lf

2 .

P o

si ti

v e

p er

ce p

ti o

n o

f fu

tu re

3 .

S o

ci al

co m

p et

en ce

4 .

S tr

u ct

u re

d st

y le

5 .

F am

il y

co h

es io

n

6 .

S o

ci al

re so

u rc

es

D ra

w n

fr o

m p

as t

re si

li en

ce re

se ar

ch 3

3 it

em s

S em

an ti

c d

if fe

re n

ti al

re sp

o n

se fo

rm at

C D

-R IS

C (C

o n

n o

r &

D av

id so

n ,

2 0

0 3

)

1 .

P er

so n

al co

m p

et en

ce , h

ig h

st an

d ar

d s,

an d

te n

ac it

y

2 .

T ru

st in

o n

e’ s

in st

in ct

, to

le ra

n ce

o f

n eg

at iv

e ef

fe ct

s, an

d st

re n

g th

en in

g ef

fe ct

s

3 .

P o

si ti

v e

ac ce

p ta

n ce

o f

ch an

g e

an d

se cu

re

re la

ti o

n sh

ip s

4 .

C o

n tr

o l

5 .

S p

ir it

u al

in fl

u en

ce s

C o

p in

g ,

ad ap

ti o

n ,

an d

st re

ss

re se

ar ch

2 5

it em

s 5

-p o

in t

L ik

er t

sc al

e

B R

C S

(S in

cl ai

r &

W al

ls to

n ,

2 0

0 4

) A

d ap

ti v

e co

p in

g (P

o lk

’s si

tu at

io n

al p

at te

rn s)

P o

lk ’s

th eo

ry o

f re

si li

en ce

4 it

em s

5 -p

o in

t ra

ti n

g sc

al e

R IM

(R y

an &

C al

ta b

ia n

o ,

2 0

0 9

) 1

. S

el f-

ef fi

ca cy

2 .

F am

il y

/s o

ci al

n et

w o

rk s

3 .

P er

se v

er an

ce

4 .

In te

rn al

lo cu

s o

f co

n tr

o l

5 .

C o

p in

g an

d ad

ap ta

ti o

n

D ra

w n

fr o

m p

as t

re si

li en

ce an

d

m id

li fe

re se

ar ch

2 5

it em

s 5

-p o

in t

L ik

er t

sc al

e

113

T A

B L E

3

V a lid

a ti o

n S

a m

p le

C h a ra

c te

ri s ti c s

I n

s tr

u m

e n

t

R I M

R S

R S

A C

D – R

I S

C B

P F

I A

R S

B R

C S

R E

A D

R S

C A

R S

A S

A u

th o

r( s)

R y

an &

C al

ta b

ia n

o ,

2 0

0 9

W ag

n il

d &

Y o

u n

g ,

1 9

9 3

F ri

b o

rg et

al .,

2 0

0 3

C o

n n

er &

D av

id so

n ,

2 0

0 3

B ar

u th

&

C ar

ro ll

,

2 0

0 2

O sh

io

et al

.,

2 0

0 3

S in

cl ai

r &

W al

ls to

n ,

2 0

0 4

H je

m d

al

et al

.,

2 0

0 6

P ri

n ce

-E m

b u

ry ,

2 0

0 8

Je w

, G

re en

, &

K ro

g er

,

1 9

9 9

L o

ca ti

o n

o f

v al

id at

io n

A u

st ra

li a

U n

it ed

S ta

te s

S ca

n d

in av

ia U

n it

ed S

ta te

s U

n it

ed S

ta te

s Ja

p an

U n

it ed

S ta

te s

S ca

n d

in av

ia U

n it

ed S

ta te

s U

n it

ed S

ta te

s

S am

p le

si ze

N D

1 3

0 N

D 8

1 0

S am

p le

O n

e D

5 9

N D

8 0

6 N

D 9

8 N

D 2

0 7

S am

p le

O n

e D

9 0

S am

p le

T w

o D

1 4

0

N D

4 2

5 N

D 8

1 9

N D

4 0

8

A g

e (y

ea rs

) 3

5 –

6 0

5 3

– 9

5 1

8 –

7 5

M ea

n D

4 3

.8 1

9 –

5 4

1 9

– 2

3 M

ea n

(S 1

) D

4 6

M ea

n (S

2 )

D 5

7 .8

1 3

– 1

5 9

– 1

8 1

4 –

1 5

S ex

M D

4 0

F D

9 0

M D

4 7

.7 %

F D

6 2

.3 %

M D

1 4

F D

4 5

F D

5 1

0

M D

2 7

4

M D

1 9

F D

7 9

M D

1 0

4

F D

1 0

3

F (S

1 )

D 1

0 0

%

F (S

2 )

D 7

3 %

M D

1 8

4

F D

2 3

5

M D

3 2

5

F D

3 2

5

M D

4 9

%

F D

5 1

%

E th

n ic

it y

N o

t re

p o

rt ed

N o

t re

p o

rt ed

N o

rw eg

ia n

M aj

o ri

ty

C au

ca si

an

p ar

ti ci

p an

ts

M u

lt ie

th n

ic Ja

p an

es e

N o

t re

p o

rt ed

N o

rw eg

ia n

M u

lt ie

th n

ic M

u lt

ie th

n ic

T ar

g et

p o

p u

la ti

o n

M u

lt i-

st u

d y

sa m

p le

C o

m m

u n

it y

d w

el li

n g

o ld

er ad

u lt

s

P at

ie n

ts fr

o m

an

ad u

lt

o u

tp at

ie n

t

cl in

ic

M u

lt i-

st u

d y

sa m

p le

U n

d er

g ra

d

p sy

ch o

lo g

y

st u

d en

ts

U n

d er

g ra

d

st u

d en

ts

A d

u lt

s w

it h

rh eu

m at

o id

ar th

ri ti

s

A d

o le

sc en

ts

in ju

n io

r

h ig

h

A ca

d em

ic /o

ffi ce

se tt

in g

s

(n o

rm at

iv e

sa m

p le

);

cl in

ic al

tr ea

tm en

t

fa ci

li ti

es

(c li

n ic

al

sa m

p le

)

H ig

h sc

h o

o l

st u

d en

ts

P sy

ch o

m et

ri c

p ro

p er

ti es

(C ro

n b

ac h

’s

A lp

h a/

te st

re te

st )

.8 7

/n o

t

av ai

la b

le

.9 1

/n o

t

av ai

la b

le

C o

m p

o si

te :

.8 3

/. 7

7

.8 9

/. 8

7 .8

3 /n

o t

av ai

la b

le

.8 5

/n o

t

av ai

la b

le

.6 9

/. 7

1 .9

4 /n

o t

av ai

la b

le

C o

m p

o si

te :

.9 5

/. 8

7

C o

m p

o si

te :

.7 1

/. 5

3

* D

en o

te s

ad o

le sc

en t

an d

ch il

d in

st ru

m en

ts .

114

RESILIENCE MEASURES 115

TABLE 4

Methodological Quality Summary following QUADAS Standards

Study First Author, Publication Year, and Life Stage

Jew, 1999,

Adolescents

Oshio, 2003, Older

Adolescents and

Young Adults

Hjemdal,

2006,

Adolescents

Prince-Embury,

2008,

Adolescents

Representative sample spectrum C C C C

Reference standard C C C C

Time for adversity change during

testing limited

� C C C

Partial verification C C C C

Differential verification C C C C

Incorporation C C C C

Test review n.a. n.a. n.a. n.a.

Diagnostic review n.a. n.a n.a. n.a.

Clinical review C C C C

Uninterpretable results ? ? ? ?

Withdrawals C C C ?

Sponsoring precluded C C C C

Study First Author, Publication Year, and Life Stage

Wagnild,

1993,

Adults

Baruth,

2002,

Adults

Connor,

2003,

Adults

Friborg,

2003,

Adults

Sinclair,

2004

Ryan,

2009

Representative sample spectrum C C C C � C

Reference standard C C C C C C

Time for adversity change during

testing limited

C C C C C C

Partial verification C C C C C C

Differential verification C C C C C C

Incorporation C C C C C C

Test review n.a. n.a. n.a. n.a. n.a. n.a.

Diagnostic review n.a. n.a n.a n.a n.a n.a

Clinical review C C C C C C

Uninterpretable results ? ? ? ? ? ?

Withdrawals C C C C C C

Sponsoring precluded C C C C C C

including a range of outcomes, such as health status, educational attainment, and vocational

success. Anomalous, positive outcomes were defined as those which were better than expected

from the empirical literature, given the adversity experienced.

Literature Search and Data Sources

Studies used in this review were obtained following the guidelines of the Cochrane Collabora-

tion (Reitsma et al., 2009) from electronic searches of the following databases through 2009:

Academic Search Complete, Alt HealthWatch, CINAHL Plus with Full Text, EBSCO Animals, E-Journals, ERIC, Health Source: Nursing/Academic Edition, MasterFILE Premier, MEDLINE,

Professional Development Collection, PsycARTICLES, Psychology and Behavioral Sciences Col-

116 A. SMITH-OSBORNE AND K. WHITEHILL BOLTON

lection, PsycINFO, PubMed, Social Work Abstracts, JSTOR, and Google Scholar. Keywords entered were: resilience instruments, resilience/resiliency, resilience measures, protective mecha-

nisms, and scale validation.

The articles were scanned for references. Abstracts for additional references were obtained and

reviewed. Finally, requests for relevant articles and reviews were made to professionals involved in resiliency intervention and research across disciplines, and results were evaluated for inclusion

criteria and to ensure that appropriate instruments had not been omitted.

Inclusion Criteria and Study Selection

Inclusion criteria specified peer-reviewed journal articles published in English up to 2009 reporting

high quality (see below) validation of resiliency instruments for children, adolescents, adults, or older adults. Statistical conclusion validity was assessed initially to exclude studies which

reported insufficient statistical data or used inappropriate statistical methods or validation criteria

to determine psychometric properties, including specification of procedures used to determine

statistical properties of some dimensions of both validity and reliability. The two researchers, working independently, reviewed the retrieved abstracts and compared

their results (Moher, Liberati, Tetzlaff, & Altman, 2009). Differences were discussed and recorded

until consensus was reached. Full text articles were retrieved for those remaining abstracts, and the same independent review process followed (see Figure 1).

FIGURE 1 Flow chart of resilience instrument validation studies retrieval process following Preferred Reporting

Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines.

RESILIENCE MEASURES 117

Data Extraction

Studies that met inclusion criteria had data extracted by one author, followed by review by

the other. Population, Intervention, Comparison, and Outcome (PICO) criteria, as recommended

by Gambrill (2006), were applied to all studies. The answers to PICO questions define the

population under study, the specified measure and its use of extrinsic, contextual, as well as intrinsic, intrapsychic, protective mechanisms, the comparison instrument if any, and specified

outcomes, all with an element of time (e.g., how old are the participants, when is the outcome

measured). Finally, quality of evidence was considered during the data synthesis phase as well,

as recommended by Boruch et al. (1999) and Gambrill (2006).

Quality Assessment

We used the validity framework approach (Cook & Campbell, 1979; Wortman, 1994; Reitsma

et al., 2009) for this study both as inclusion criteria and to evaluate the quality of included studies. With reference to construct validity, studies were evaluated to determine degree of

match with the operationalization of resilience defined above. External validity was assessed for

sample characteristics and sampling method, life course applicability, and relevance to social work

practice. Then internal validity was assessed, excluding studies with fewer than two validity and reliability analyses and insufficient sample size to meet measure validation criteria of 2 participants

per item for sample size (Nunnally, 1978) and 5–30:1 for participant to variable ratio when factor

analytic methods were used (Osborne & Costello, 2004), since both issues may introduce excessive

threats to internal validity. Statistical conclusion validity was assessed to verify use of appropriate statistical methods and validation criteria.

For further assessment of quality of evidence, a summary score approach, using scales such as

the Downs and Black tool (Downs & Black, 1998), has been used recently for systematic reviews of self-report diagnostic/screening measures such as this one (e.g., Gorber, Tremblay, Moher, &

Gorber, 2007). However, in 2009, Reitsma and collegues for the Cochrane Collaboration (Reitsma

et al., 2009) recommended against this approach, supporting in its place the qualitative approach of

a modified 11-item QUADAS (Quality Assessment of Diagnostic Test Accuracy Studies) checklist tool (Whiting et al., 2006); therefore this approach has been used here. Items which pertain to

diagnostic measures rather than the type of measures of functioning examined here are indicated

as “not applicable.”

RESULTS

Ten scales met a priori inclusion criteria for this review. Eight scales were validated on American samples, while two—the Resilience Scale for Adolescents and Adolescent Resilience Scale—were

originally validated on non-American samples and have been included due to their adherence to

inclusion criteria, availability in English, and good convergent and discriminant validity with scales

validated on American samples. Refer to Tables 1 and 2 for construct operationalization, Table 3 for psychometric properties, and Table 4 for study quality summary.

Child and Adolescent Scales

Resilience Scale for Adolescents. The Resilience Scale for Adolescents (READ) is a 28 item scale, rated on a 5-point Likert scale. Five factors are discerned: Personal Competence, Social Competence, Structured Style, Family Cohesion, and Social Resources (Hjemdal, Friborg,

Stiles, Martinussen, & Rosenvinge, 2006). The READ was validated on 425 adolescents between

118 A. SMITH-OSBORNE AND K. WHITEHILL BOLTON

the ages of 13 and 15 in Norway (Hjemdal et al., 2006). Currently, validation of the READ is occurring on American and other non-Scandinavian populations (O. Hjemdal, personal commu-

nication, June 7, 2010). The scale is available at no cost by request to the first author.

Resilience Scale for Children and Adolescents. The Resilience Scale for Children and Adolescents (RSCA) was developed for use in preventive screening for psychological vulnerability

(Prince-Embury, 2008). The RSCA consists of three scales that assess for resilience in children and adolescents: Sense of Mastery, Sense of Relatedness, and Emotional Reactivity (Prince-

Embury & Courville, 2008a). Sense of Mastery is a 20 item scale rated on a 5-point Likert

scale and consists of three content areas: optimism, self-efficacy, and adaptability. The Sense

of Relatedness consists of 24 items rated on a 5-point Likert scale and encompasses comfort and trust in others, perceived access to support by others, and capacity to tolerate differences

in others. The Emotional Reactivity scale consists of 20 items rated on a 5-point Likert scale

and consists of sensitivity/threshold for and intensity of reaction, length of recovery time, and

impairment while upset. The RSCA validation consisted of normative samples of 226 chil- dren aged 9 to 11 years, 224 adolescents aged 12 to 14 years, 200 adolescents between 15

and 18 years (Prince-Embury & Courville, 2008b), and a clinical sample of 169 adolescents

between ages of 15 and 18 years (Prince-Embury, 2008). This scale’s 3rd grade reading level

may be conducive to use with children and adolescents with special needs, although it has not been validated with this population. The scale may be purchased online from the PsychCorp

Division of Pearson Assessments at http://psychcorp.pearsonassessments.com/HAIWEB/Cultures/

en-us/Productdetail.htm?PidD015-8006-186&ModeDsummary.

Adolescent Resilience Scale. The Adolescent Resilience Scale (ARS) for college-age youth consists of a 5-point Likert 21 item scale, consisting of three factors: novelty seeking, emotional regulation, positive future orientation. The construct validation on a Japanese population of 207

young adults between the ages of 19 and 23 (Oshio, Kaneko, Nagamine, & Nakaya, 2003)

differentiated among groups who were vulnerable (high stressors and psychopathology), resilient (high stressors, low psychopathology), and well adjusted (low stressors, low psychopathology).

The scale is available at no cost from the first author’s website at http://psy.isc.chubu.ac.jp/�oshio

lab/index_e.html

Resilience Skills and Abilities Scale. The Resilience Skills and Abilities Scale (RSAS), originally developed as the Adolescent Resiliency Belief System Scale (Jew, 1997), consists of 35 items rated on a 5-point Likert scale (Jew, Green, & Kroger, 1999). Validation of this measure

took place through four studies of high school students. Initially, the RSAS was comprised of four

sub-scales. During the fourth validation study, two of the subscales were merged, reducing the

number of subscales to three: Active Skill Acquisition, Future Orientation, and Independence/Risk Taking. Thus, this scale operationalizes resilience in a psychological context, of characteristics

that individuals use in stressful contexts, drawing heavily on the cognitive appraisal theory of

Mrazek and Mrazek (1987). This scale is available at no cost from the first author.

Validity and reliability issues. Quality indicators of sufficient sample size and type, appro- priate validation criteria, and appropriate statistical methods were required for study inclusion. Sample sizes used for validation of instruments were adequate for the instruments reviewed.

Sample sizes exceeded 100, with the largest samples used for the RSCA (n D 819) for the child

and adolescent instruments (see Table 3).

Studies reporting psychometric properties of the instruments did not cover all aspects of validity and reliability, but did report internal reliability, test–retest/stability reliability and construct,

factorial, convergent, divergent, and/or predictive validity, albeit with the resilience construct was

RESILIENCE MEASURES 119

limited to intrapsychic, individual traits in all instruments except the READ, limiting their utility for social workers. Studies generally reported a level of internal reliability that was acceptable

at Cronbach’s alpha D .70 or above (Nunnally, 1978). An intraclass correlation coefficient of

.50 for test–retest reliability from pre-test to post-test may be considered an acceptable level of

stability reliability (Fleiss, 1981), and the RSCA and RSAS reported at least that level. However, the statistic used to calculate test–retest reliability was not always specified, making it difficult

to assess the meaning of the stability reliability coefficients reported. Simple correlations, in

particular, may be more affected by temporal instability and measurement error (Heise, 1969).

Length of time between test–retest was 6 months for RSAS and not specified for the RSCA. Results for the RSCA indicate that all three measures exhibit strong internal consistency

and construct validity. Prince-Embury identifies the need for additional research to accompany

preliminary findings to increase sample size and enhance understanding of RSCA scores associated

with psychological symptoms (Prince-Embury, 2008). The initial validation study of the ARS (Oshio, Nakaya, Kaneko, & Nagamine, 2002) found

acceptable internal reliability. The scale has shown good convergent and discriminant validity with

the American-validated scale of the Big Five Personality Inventory (Nakaya, Oshio, & Kaneko,

2006). However, test–retest reliability was not reported in published studies. The RSAS appears both reliable and valid, showing acceptable intraclass correlations indicating

test–retest reliability (.36–.70) and internal consistency (.68–.95). The authors call for further

research to refine the instrument and increase the instrument’s relevance to resilience as a construct

(Jew et al., 1999). However, later use of the instrument has been confined to a dissertation (Bass, 2006).

The only identified child/adolescent measure utilizing the full construct was the READ. The

READ scale shows good discriminant validity with the Short Mood and Feeling Questionnaire and Social Phobia Anxiety Index for Children, both American-validated scales (Hjemdal, 2007) and

good predictive validity relevant to prevention efforts (Hjemdal, Aune, Reinfjell, Stiles, & Friborg,

2007). The READ appears both reliable and valid. Further studies should replicate the validation of

this scale, since the initial age group only spanned two years. A Norwegian validation of a shorter, 23-item version of the scale was recently reported as yielding acceptable psychometric properties

(von Soest, Mossige, Stefansen, & Hjemdal, 2010). This scale not only has the advantage of

measuring the full resilience construct, but also has been co-developed with an adult version,

the Resilience Scale for Adults, making them particularly useful for longitudinal research and treatment monitoring (RSA; see below).

Predictive validity was established for the READ, the RSCA, and the RSAS. For a method-

ological quality summary, see Table 4.

Adult Scales

Resilience Scale. The Resilience Scale (RS) is a 25-item scale rated on a 7-point Likert scale measuring two factors: personal competence, and acceptance of self and life; it was originally developed on a sample of older women (Wagnild, & Young, 1990). The RS was validated on

810 adults between 53 and 95 years (Wagnild & Young, 1993). Following the validation of the

RS, numerous studies have used this instrument on individuals of all ages and ethnic backgrounds,

and a 14 item version was developed and validated (Wagnild, 2009). The scale is written at a 6th grade reading level. The Resilience Scale is available at no cost, and the User’s Guide for

purchase, from http://www.resiliencescale.com.

Connor-Davidson Resilience Scale. The Connor-Davidson Resilience Scale (CD-RISC) consists of 25 items rated on a 5-point Likert scale that address 5 factors: personal competence,

120 A. SMITH-OSBORNE AND K. WHITEHILL BOLTON

high standards, and tenacity; trust in one’s instinct, tolerance of negative effects, and strengthening effects; positive acceptance of change and secure relationships; control; and spiritual influences.

The validation sample of the CD-RISC consisted of 6 groups (general population, primary care,

psychiatric outpatients, generalized anxiety disorder, and PTSD) with a total of 827 participants

(Connor & Davidson, 2003). The validation of CD-RISC suggested that health influences resilience and resilience can improve through treatment when psychiatric disorders constitute the ongoing

context of adversity (Connor & Davidson, 2003; Davidson et al., 2005; Vaishnavi, Connor, &

Davidson, 2007). This scale is available at no cost from the first author.

Baruth Protective Factors Inventory. The Baruth Protective Factors Inventory (BPFI) con- sists of 16 items rated on a 5-point Likert scale, addressing four factors: adaptable personality, supportive environment, fewer stressors, and compensating experiences. The BPFI was validated

on 98 undergraduate students in a Human Development course between the ages of 19 and 74

(Baruth & Carroll, 2002). The BPFI should be validated on a larger sample prior to use in

assessing for the protective factors that contribute to the presence of resilience. Furthermore, the initial researchers had predominantly female Hispanic and Anglo-American participants in the

initial validation and suggest that further research is needed to validate the instrument for other

populations. The scale was modified to generate a family scale (Gardner, Huber, Steiner, Vazquez,

& Savage, 2008), but has had no further validation studies to date. The scale may be found in the appendix to the validation article.

Resilience in Midlife. The Resilience in Midlife Scale (RIM) consists of 25-items, rated on a 5-point Likert scale and contains four factors: self-efficacy, family/social networks, persever-

ance, internal locus of control, coping and adaptation. The RIM was validated on an Australian population of 130 adults between the ages of 35 and 60 (Ryan & Caltabiano, 2009). The RIM

is the only peer reviewed instrument focusing on midlife present in the literature to date. Further

research should be done to demonstrate the effectiveness of the RIM in assessing for resilience

in individuals during midlife. The scale is available at no cost by request to the first author.

Resilience Scale for Adults. The Resilience Scale for Adults (RSA) was originally validated on 183 adults between the ages of 18 and 75 living in Scandinavia (Hjemdal, Friborg, Martinussen,

& Rosenvinge, 2001; Friborg, Hjemdal, Rosenvinge, & Martinussen, 2003). After the initial

validation, the original researchers continued to modify and validate the RSA and publishing the

updates in the academic literature (Friborg, Hjemdal, Martinussen, & Rosenvinge, 2009; Friborg et al., 2005). Currently, the RSA consists of 33-items that address six factors: positive perception

of self, positive perception of future, social competence, structured style, family cohesion, and

social resources. Thus, this scale operationalizes resilience in both psychological and ecological/

contextual terms. Currently, in the United States, the RSA is in the process of validation on an American population (O. Hjemdal, personal communication, June 7, 2010). The scale is available

at no cost by request to the first author.

Brief Resilient Coping Scale. The Brief Resilient Coping Scale (BRCS) is a brief assess- ment aimed at identifying one’s ability to cope with stress. There are four items; the response

format is a 5-point Likert scale and measures one factor, Adaptive Coping (Sinclair & Wallston, 2004). The scale is available at no cost by request to the first author.

Validity and reliability issues. Quality indicators of sufficient sample size and type, appropri- ate validation criteria, and appropriate statistical methods were required for study inclusion. Sample

RESILIENCE MEASURES 121

sizes used for validation of adult instruments were adequate for the instruments reviewed. Sample sizes generally exceeded 100, with the exception of the BPFI (n D 89), with the largest samples

used for the RS (n D 810) for the adult instruments. All adult instruments but the BCRS addressed

the full operationalization of the construct. As in the case of the child instruments, studies reporting

psychometric properties of the adult instruments did not cover all aspects of validity, but did report internal reliability, test–retest/stability reliability and construct, factorial, convergent, divergent,

and/or predictive validity. Discriminant and convergent validity were established for all instruments

but the BPFI and RS. Predictive validity was established for the RSA, CD-RISC, and BRCS.

In summary, results of the BPFI and RIM validations revealed sound psychometric properties, including good split-half reliability and internal consistency. The BRCS meets the minimal stan-

dard for reliability and validity of a resilience instrument; however, it operationalizes resilience

primarily in terms of intrapsychic traits. Further research needs to be conducted in order to solidify

the reliability and validity of these three measures. However, lack of subsequent replication of the BPFI, BRCS, and RIM to date limits support for their use by social workers.

Stronger results supported by repeated validation studies characterized the RS, the CD-RISC,

and the RSA. The RS presented strong internal consistency reliability, concurrent validity, and

construct validity (Wagnild & Young, 1993). The RS is adequate in measuring different ages and races (Wagnild, 2009). For the CD-RISC, subsequent validation study with young adults

(Campbell-Sills & Stein, 2007) and cross-cultural validation studies (Yu & Zhang, 2008; Bitsika,

Sharpely, & Peters, 2010; Singh & Yu, 2010) found acceptable psychometric properties for use in

intervention. The RSA continues to demonstrate sound psychometric properties, and good internal consistency and reliability with general and clinical Scandinavian samples (Friborg, Barlang,

Martinussen, Rosenvinge, & Hjemdal, 2005; Friborg et al., 2009; Hjemdal, 2007) and in cross-

cultural validation and intervention studies (Jowkar, Friborg, & Hjemdal, 2010; Lever & Gomez, 2010; Mikolajczak, Roy, Luminet, & de Timary, 2008), showing good convergent, discriminant,

and predictive validity.

Test–retest reliability was only reported for the RSA (4 months) and the CD-RISC (unreported

length) among the adult instruments. These differences become important to consider when selecting the most reliable instruments to use in longitudinal research and to evaluate outcomes in

longer-term therapy/intervention, since a reduced time interval between tests is known to reduce

variance in the scores and may introduce recall threats to reliability (Fleiss, 1981; Heise, 1969).

However, with the exception of the BPFI, reliability estimates of the included test scores have been studied in several different investigations, contributing to support for the robustness of these

measures’ test score reliability.

Methodological quality of instruments included in this review was assessed as high during

interpretation of study results (see Table 4), as expected, since QUADAS quality standards were adopted as part of inclusion criteria. Use of these criteria both in inclusion criteria and as a standard

for interpretation of review results is recommended by the Cochrane Collaboration (Reitsma et al.,

2009).

DISCUSSION

Validated resilience instruments now exist for children, adolescents, and adults, normed on a variety of populations. These populations include adults over age 65, healthy adults, adults with

chronic health conditions, college students, teens, and children ages 9 to 12. Only one instrument

for children under age 13, the trait-focused RSCA, was included in this review, although some

instruments are being used for Head Start and middle school populations (including grade 5) without formal, published validation studies (e.g., the Devereaux Early Childhood Initiative,

n.d., and see LeBuffe & Naglieri, 1999; the Resilience and Youth Development Module of the

122 A. SMITH-OSBORNE AND K. WHITEHILL BOLTON

California Healthy Kids Survey, n.d.; and see Benard, 2004). Psychometric properties for these child resilience measures have not yet been published in peer reviewed journals and so did not

meet the inclusion criteria for this review.

The published measures have primarily been used for research to date, although many were

developed with intervention applications in mind. For example, the developers of the BPFI suggest specific application of their instrument in individual and family therapy, via assessment of past

protective factors and goal-setting to target specific factors, re-administration of the instrument

to monitor practice outcomes, and assessment of family members’ individual score congruence

(Baruth & Carroll, 2002). Notably, the full construct measures which have been used to monitor practice outcomes are the READ for adolescents, and the CD-RISC, the RSA, and RS for adults

(e.g., Smith-Osborne, 2012; Connor, Davidson, & Lee, 2003; Neill & Dias, 2001; Wagnild, 2003).

The purpose of the authors in this review is to support more extended use of these instruments

in practice, for assessment as well as in monitoring treatment interventions. Since the social work profession historically works with vulnerable and disadvantaged populations, the construct of

resilience has particular salience in assessing social work clients and measuring the outcomes of so-

cial work prevention and treatment interventions. Inclusion of resilience in social work assessment

is consistent with the strengths-based perspective by permitting identification of strengths for sup- port and enhancement in the intervention plan. Empirical evidence suggests that analysis of protec-

tive and risk factors within resiliency domains can be useful in setting measurable goals in the inter-

vention plan, since levels of resiliency have been found to affect treatment response across several

different types of adversity, such as divorce (Masten, 2001), poverty (Masten, Best, & Garmezy, 1990; Wagnild, 2003), school bullying (Martin & Marsh, 2009), and chronic illness, including

psychiatric disorders (Connor & Davidson, 2003; Connor et al., 2003; Davidson et al., 2005).

When should practitioners consider including a measure of resilience in initial assessment? Since these results identified measures of high quality for adolescents and adults, the reviewers

recommend that clients of these life stages be assessed using full construct resilience measures

(e.g., RS, RSA, CD-RISC, READ) when an ongoing condition of adversity, rather than a single

stressor/event (consistent with the bulk of baseline theory and construct development to date), can be clearly identified and when the goal of the assessment is not limited to diagnosis only,

but to development of a comprehensive prevention or intervention plan. Rather than measuring

levels of psychopathology, the resilience instruments reviewed in this study measure levels of

both intrapsychic and contextual protective factors. They therefore offer more to the social work practitioner in determining specific protective domains for selective focus for enhancement

strategies as part of the intervention plan.

Use of resilience instruments in planning and monitoring intervention in cases of both ongoing

adversity and single stressors/events can direct the practitioner to targeted protective mechanisms not only with reference to the individual client’s strengths, but also with reference to the strengths

of the client’s environment in directing salient resources to the client targeted to specific resilient

outcomes appropriate to life stage or trajectory. For example, in addressing the resilient outcome

of increased educational attainment for an at-risk population which is not identified for special education services, informational social support may be more protective than emotional social

support, so the practitioner may use a resilience instrument to assess the levels of these different

types of protective factors and target intervention strategies accordingly (e.g., Dubow, Tisak, Causey, Hryshko, & Reid, 1991; Martin & Marsh, 2009; Smith-Osborne, 2009a, 2009b).

In considering selection of instruments for practice, social workers may wish to consider

not only the age of the clients in question but also temporal issues and level of focus in the

operationalization of each instrument as it pertains to their client population. Temporally, some instruments (e.g., RSCA, ARS) operationalize resilience in relation only or primarily to specific

time-specific stressors or traumatic events, usually outside the range of typical developmental stage

demands for adaptation or expected losses. Others (e.g., RSA, READ) operationalize resilience

RESILIENCE MEASURES 123

primarily in relation to ongoing or long term conditions of adversity. Practitioners, then, should select the instrument which has good fit with the temporal nature of the adversity experienced

by the client. Another major issue being raised in resilience research now, which has affected the

development of measures, is the alternate focus either on primarily intrapsychic, personal traits

and states characteristic of resilient individuals, or on dynamic processes which include adverse context and the provision of interpersonal and concrete resources by the family, community, and

society to the individual or group in adversity. Those instruments which include contextual items

and scales will provide a better fit with the profession’s focus on the person-in-environment and

transactional, ecological nature of issues which trigger help-seeking. Future research must address the utility of such instruments in supporting intervention outcomes.

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