April 20, 2017

Resilience Study poster sparks conversations at 2017 NARRTC conference

Two people discussing poster at conference

Dr. Jean Ann Summers presents the Resilience Poster to another researcher at the NARRTC annual meeting, April 2017

RTC:Rural researchers recently returned from the 2017 National Association of Rehabilitation Research and Training Centers (NARRTC) conference in Alexandria, Virginia, where the latest research findings on three RTC:Rural projects were presented. These included two presentations as well as a poster displaying the preliminary results of The Resilience Study, a collaboration between RTC:Rural and the University of Kansas Research and Training Center on Independent Living.

See the poster and a full text description below.

The poster session prompted conversations about how to develop interventions to foster various resilient characteristics, said the study’s lead author Dr. Jean Ann Summers, Director of Research at the Research and Training Center on Independent Living at the University of Kansas.

The poster, “How People with Disabilities Thrive in Rural Communities” presented results of Phase I of the Resilience Study. In collaboration with staff at Centers for Independent Living (CILs), researchers identified people with physical disabilities who were considered “resilient.” About 40 people attended focus groups and discussed what enabled them to live successfully as persons with disabilities in rural communities.

Instead of following the more traditional scientific poster format, the researchers decided to present their results using a schematic diagram of a tree.

“We wanted to represent our qualitative data in a way that encourages more public engagement than a traditional scientific poster might,” said Lauren Smith, Knowledge Translation Associate at RTC:Rural, one of the poster’s authors. “The tree provides a nice framework for the results, while also emphasizing their relationship to each other and to the overall definition of resilience.”

How People with Disabilities Thrive in Rural Communities This poster displays different skills, strategies, and supports that help people with disabilities thrive in their rural communities. In the center of the poster is an oak tree with the word “resilience” on the trunk. Two main branches come off the trunk: the first says “coping skills,” and the second says “coping strategies.” The “coping skills” branch has seven smaller branches. These say “problem solving,” “identifying role models,” “leadership,” advocacy,” “information-seeking,” “using support,” and “using technology.” Each of the seven smaller branches has an acorn that contains a quote illustrating the corresponding skill. These skills and their associated quotes are listed below. • Problem solving: “There is a little store I can’t get into, so I have my niece go in and get stuff for me.” • Identifying role models: “There was this one guy… I watched him jump out of his wheelchair and onto a counter, and I was just, ‘I want to be like that guy.’ ” • Leadership: “They asked me if I wanted to be on the board, and I said, ‘sure!’ They send me all over the state because I am on the Diversity Council.” • Advocacy: “I am one of those people that if it’s going to benefit me and also somebody else who is disabled, I won’t take ‘no’ for an answer.” • Information-seeking: “No one is volunteering any information. I had to get on the phone and resource it and call…” • Using support: “In a rural community it’s a family, so you have to get out and make yourself part of the family… You can’t be afraid to ask.” • Using technology: “I wouldn’t be able to do half of what I do without a phone. It tells me how to get home if I get lost… I wouldn’t go out walking if I didn’t have that.” The “coping strategies” branch has ten smaller branches. These say, “taking one day at a time,” “reciprocation,” “focus on others,” “taking charge,” “positive self-image,” “sense of purpose,” “positive comparisons,” “analyzing and acknowledging limits,” “sense of independence,” and “persistence.” Each of these ten smaller branches has an acorn that contains a quote illustrating the corresponding strategies. These strategies and their associated quotes are listed below. • Taking one day at a time: “Just stay in today and live one day at a time… Make the best of it for today.” • Reciprocation: “Whenever I go to someone and ask for help, I always try to tie it to something that benefits them. [If] I ask for a cooked meal, I usually say, ‘You can have the same food as me. I’ll pay for it all.’” • Focus on others: “I’ve got four young grandkids… They call me Poppy. And that was another reason to get on the positive side too: family.” • Taking charge: “Exercise improves mood. I feel a lot more able, like I have more control over my muscles… Not only am I more able, I FEEL more able.” • Positive self-image: “I seem to have a pretty successful time doing what I need to do. I see a lot of ways in which I’m more able than I was a few years ago.” • Sense of purpose: “I’ve got two grown sons and a baby… I was thinking, ‘You’re going to have to be a role model.’ So that’s what pushed me to do the best for them.” • Positive comparisons: “I accept my disability and just kind of slow down and say, ‘It’s okay, I’m not in that nursing home no more. You know how horrible that was.’ “ • Analyzing and acknowledging limits: “The hardest thing for me was to accept the fact that I was disabled, to [the point] where I could laugh again and find things I could still do, like grow a garden.” • Sense of independence: “I am a very independent person. I try not to push my boundaries too far to where I get stuck. I know my limits, which is good.” • Persistence: “The best advice I can give is don’t give up, don’t give in. Stay strong. Find out what you can still do.” Below the ground, the oak tree’s roots reach out to water droplets with quotes that illustrate two different types of supports that contribute to resilience. On one side are Formal Supports, which include Personal Care Assistants and Centers for Independent Living and other community programs. On the other side are Informal Supports, which include family, peers, neighbors and community, and spirituality. The quotes associated with each type of support are listed below. • Formal Support, Personal Care Assistants: “Because of the medications that I’m on, I spend a lot of time in la-la land. I rely on the support of my worker to help me look things up, to help me keep track of my weekly appointments.” • Formal Supports, Centers for Independent Living and other community programs: “I think that the CIL is a lot of our biggest lifelines because if it wasn’t for them advocating I don’t think any of us would know where we would be today.” • Informal Support, Family: “Between them [my parents], the rest of the family, and extended friends, there’s like a Plan B. Okay, what do I need to do today… who’s available that I can call to do that.” • Informal Support, Peers: “He checks on me and I check on him. We’ve got another friend who checks on us… We always try to stay motivated and it helps me stay motivated when I’m helping somebody else.” • Informal Support, Neighbors and Community: “That’s one thing I like about rural communities, it is like a little family and they have little get-togethers, and you do become part of a social network.” • Informal Support, Spirituality: “I really had to let go and believe that God’s going to take care of me and that things are going to be alright.” A text box in the bottom corner of the poster contains the question “Which skills, strategies, and supports do you identify in your life?” The contents of this poster come from: Summers, JA, Nary, D. (October 2016). The Resilience Study: Exploring Resilience in Adults with Physical Disabilities in Rural Communities. Missoula, MT: The University of Montana Rural Institute for Inclusive Communities. Retrieved from http://rtc.ruralinstitute.umt.edu/research-findings/resilience-study/. Poster authors are Jean Ann Summers, PhD, Dot E. Nary, PhD, Heather Lassman, MSW, and Lauren Smith, M.S. The contents of this poster were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90RT502501400). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this poster do not necessarily represent the policy of NIDILRR, ALCL, or HHS, and you should not assume endorsement by the Federal Government.

Resilience Poster – click on the image for a larger version

Resilience is the ability to function well both mentally and physically in the face of major challenges, such as coping with a disability. It is the product of both personal factors, such as age when disability occurs or having a positive attitude, and environmental factors, such as education level and available social support.

The roots of the tree represent supports identified by the focus group participants: friends, family, agencies, and services. The branches of the tree represent what those roots supported: coping skills, such as problem-solving and advocacy; and strategies, such as positive attitudes and sense of purpose.

“Specifically, I wanted to move away from the unconscious ranking sometimes associated with a list, that something at the top of the list is more significant than the last item,” said Smith. “With a tree, each branch and each root is equally important. The tree also emphasizes that while there are many components to resilience, a person doesn’t need to have all of these factors to be resilient. A tree is still a tree if it has one or ten branches or roots.”

The poster, one of five presented at the conference, prompted a number of conversations including ideas on how to use the poster as an interactive framework, using the poster as a guide to identify existing training programs that might build these coping skills and strategies, and brainstorming ways to increase opportunities to recruit supports.

“Our poster was provocative in terms of stimulating conversation about what it might take to translate the experiences of these resilient people into training for those who need it,” said Dr. Summers.

RTC:Rural and our partners value the opportunity to share ideas and spark conversations with our fellow NIDILRR grantees.