Educational Programs to Build Resilience in Children, Adolescent or Youth with Disease or Disability: A Systematic Review

: Resilience is understood as interactive processes that strengthen the individual and the family in the face of the demands of adversity or vulnerable situation. Resilience is fostered from a psychopedagogical approach when practices are developed that assist in facing challenges positively, having life projects and developing academic potentialities. Thus, the objective of this systematic review of the literature is cartography programs that promote resilience in children, adolescents, or youths who are facing a challenging condition, such as a disease or disability. The PRISMA declaration was used to guide this systematic search. The databases consulted were Web of Science, Scopus, EBSCOhost, ERIC and Dialnet Plus. Open access articles were selected between 2016 and 2021. The selection resulted in 15 educational programs. The results indicate that there are several models for building resilience, such as ecosystem, family, community, and academic models. In conclusion, interdisciplinarity is a cross-cutting axis for enhancing resilience in vulnerable settings. Different visualization technologies have been applied for science mapping and bibliometric analysis in recent times. The main objectives of these visualizations are to highlight the dynamic and complex relationships between ﬁelds, authors, journals, organizations, countries, and key knowledge ideas. This study made use of VOSviewer, a widely used application with an easy-to-use graphic interface for creating bibliometric networks of authors, publications, journals, organizations, and countries. Figure 1 depicts the study performed in VOSviewer using a Scopus database search. The Scopus results were used to analyze the cross-sectional nature of the keywords of the articles selected in the evaluation phase. It indicates how the descriptor psychological resilience is the most frequently used term in the results.


Introduction
How to build a resilient character through interdisciplinary programs? The solution is not straightforward, but it is achievable. Thus, we must interpret resilience and its relationship from an interdisciplinary perspective. In respect of interpreting what is resilience, authors from a variety of disciplines have sought to clarify resilience by using several notions as a reference framework for their studies. This means that there is no single way to interpret resilience, even within the same field. According to Manciaux [1], these definitions often have only a weak consensus. The added nuances are substantial, and many of the terms used to define them in other disciplines of study are identical or quite similar. These different approximations and nuances within the same scientific discipline led to inconsistencies in concepts linked to resilience itself [2].
However, regardless of the discipline in which resilience is investigated, the definition utilized, or the approach taken by the researcher, the phenomenon resilience refers to the same idea. Thus, resilience is a reference framework for describing the positive aspects and mechanisms in an individual, group, material, or system that, when faced with a destabilizing and disruptive situation that threatens their integrity and stability, allows them to hold up, cope, recover, and emerge strengthened.
It is also agreed that the phenomenon can be looked at from an ecological point of view, meaning it can be used to refer to both individual characteristics and those of the context, as well as all the mechanisms used by the internal and external assets when facing adversity [3]. Furthermore, there are other factors that must be considered as influential in

The Concept of Resilience
The concept of resilience refers to the capacity composed of the set of personal characteristics and the contexts of development of an individual and the set of internal and external mechanisms when facing adversity [10,11]. Thus, resilience is interpreted as the ability to respond positively, despite living in challenging or threatening circumstances.
This means holding out, facing, and reacting better than expected in a situation of risk, a traumatic event or adversity affecting the psycho-social integrity of an individual [12,13]. Others add that it is possible to come out of such situations strengthened, avoiding situations of risk, thus producing a better state [14,15] From a purely individual level, resilience is considered as a characteristic of personality, the ability to adapt control depending on the circumstance [16].
Walsh [17,18] according to whom resilience interactive processes that strengthen the individual and the family over time. With this family-centered approach, interdisciplinarity is vital to promote resilience, not only from an educational field, but also from a health and social perspective.
Masten [19] considered that resilience might depend on dynamic psychological processes such as the use of coping strategies (CS), and/or on personality factors configuring what she called resiliency. In relation to these two possibilities, on one side, some authors [11,20,21] have shown the important role that the personality factors configuring resiliency play as potential determinants of resilience in adolescence. On the other side, resilience in adolescents depends in great degree on coping styles and strategies [6]. However, it is possible that the coping styles and the personality factors underlying resilience are related. If this were the case, it would be important to know the relative weight of each of these variables on resilience, as depending on the answer to this question, the implications for assessment and intervention would be different.
In sum, resilience is understood as a dynamic process, not as an absolute static or definitive quality [1]. It arises from a process of interaction which implies a positive personal and social adaptation of the individual despite exposure to risk [14]. It is evident in continuous interaction with the environment in which people develop and socialize [22].
It can vary according to the relationship with the context, requiring a reaction to a series of circumstances specific to each moment and everyone. It is applied when facing an adverse situation which could put personal and social stability at risk [6,22,23]. Greater resilience is shown on occasions when a person must put it into practice. However, the development of resilience is subject to the specific adjustment a person makes in an adverse situation [14].
This systematic review has the objective cartography and analyze programs which develop strategies to build resilience in children, adolescents, or youth with some vulnerability, such as disease or disability. Thus, this systematic review was carried out focused on educational, psychological and health programs, under an interdisciplinary perspective.

Search Strategy
Systematized review is a methodology that promotes transparency and rigor [24] and allows to identify trends and opportunities in future lines of research [25]. The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines [26] and the Framework ReSiste-CSH [27] were followed to conduct this systematic review. Moreover, this systematized review includes creating the database and the Visualizing Scientific Landscape (VOSviewer) analysis.
Between February and May of 2021, this systematic review was carried out. Databases used included: Scopus, Web of Science (WoS), ERIC, EBSCOhost (Psychology and Behavioral Sciences Collection, Academic Search Complete, APA PsycInfo, APA PsycArticles, E-Journals, eBook Collection, Social Work Abstracts, SocINDEX with Full Text) and Dialnet Plus. Descriptors and keywords were selected from DeCS (Health Sciences Descriptors) and ERIC thesaurus (Table 1). Search strategies were adapted to the different academic databases, the final search equations presented in Table 2. In the search equations, used boolean operators (AND, OR) and truncations (*) for terms resilience, program, plan, and strategy. In addition, search was limited to the topic section (Title, Keyword and Abstracts). Inclusion criteria for the review were records from 2016 to 2021, records in Open Access from an account at the Library Service of the University of the Balearic Islands, article type, and English and Spanish language.
In total, 2451 articles were included for the evaluation phase [27]. All documents were uploaded to Mendeley's bibliographic manager. Furthermore, references were checked through the Endnote web manager.

Analysis Using VOSviewers
Different visualization technologies have been applied for science mapping and bibliometric analysis in recent times. The main objectives of these visualizations are to highlight the dynamic and complex relationships between fields, authors, journals, organizations, countries, and key knowledge ideas.
This study made use of VOSviewer, a widely used application with an easy-to-use graphic interface for creating bibliometric networks of authors, publications, journals, organizations, and countries. Figure 1 depicts the study performed in VOSviewer using a Scopus database search. The Scopus results were used to analyze the cross-sectional nature of the keywords of the articles selected in the evaluation phase. It indicates how the descriptor psychological resilience is the most frequently used term in the results.
In total, 2451 articles were included for the evaluation phase [27]. All documents wer uploaded to Mendeley's bibliographic manager. Furthermore, references were checked through the Endnote web manager.

Analysis Using VOSviewers
Different visualization technologies have been applied for science mapping and bib liometric analysis in recent times. The main objectives of these visualizations are to high light the dynamic and complex relationships between fields, authors, journals, organiza tions, countries, and key knowledge ideas.
This study made use of VOSviewer, a widely used application with an easy-to-us graphic interface for creating bibliometric networks of authors, publications, journals, or ganizations, and countries. Figure 1 depicts the study performed in VOSviewer using Scopus database search. The Scopus results were used to analyze the cross-sectional na ture of the keywords of the articles selected in the evaluation phase. It indicates how th descriptor psychological resilience is the most frequently used term in the results.

Analytical Produce
A peer review was conducted for the data extraction and confirmation procedure; al authors read the publications and selected the results to be included in the analysis phase PRISMA Flowchart depicts the results of the articles' identification, screening, eligibility evaluation, and inclusion ( Figure 2). This is still an essential component of report of com pleted systematic reviews [28]. Following the analysis phase, 15 papers were chosen fo the synthesis phase. As a result, the analytical process was systematized through the cre ation of tables including the main bibliometric variables of the programs (Table 3).

Analytical Produce
A peer review was conducted for the data extraction and confirmation procedure; all authors read the publications and selected the results to be included in the analysis phase. PRISMA Flowchart depicts the results of the articles' identification, screening, eligibility evaluation, and inclusion ( Figure 2). This is still an essential component of report of completed systematic reviews [28]. Following the analysis phase, 15 papers were chosen for the synthesis phase. As a result, the analytical process was systematized through the creation of tables including the main bibliometric variables of the programs (Table 3).
In the database variable, 7 articles from WoS, 5 from Scopus, 1 from Eric, 1 form EBSCOhost and 1 from Dialnet Plus. Regarding publication by country, Spain has 5 records, followed by the USA (4), and the other countries with 1 record. Regarding language, 33% are articles in Spanish and 67% in English. Finally, Figure 3 shows how 2016 was the year with the highest number of articles and how in 2020 there was a rebound with 3 articles.      In the database variable, 7 articles from WoS, 5 from Scopus, 1 from Eric, 1 form EB-SCOhost and 1 from Dialnet Plus. Regarding publication by country, Spain has 5 records, followed by the USA (4), and the other countries with 1 record. Regarding language, 33% are articles in Spanish and 67% in English. Finally, Figure 3 shows how 2016 was the year with the highest number of articles and how in 2020 there was a rebound with 3 articles.

Results
The results are presented below in relation to the goal of the investigation: cartography and analyze interdisciplinary programs which develop strategies to build resilience in children, adolescents, or youth with some vulnerability, such as disease or disability. In total, 15 programs matched the goal of this systematic review.
The programs were systematized by drawing up summarized tables with details of the main descriptive data (Table 4): Reference, Program, Objective, Participants, Design, Intervention, Measures, and Results.

Discussion
This review offers a comprehensive summary of the 15 educational programs to promote resilience in the field of care for children, adolescents, or young people, including their families, with a situation of vulnerability due to a disease or disability. By summarizing the information in the articles, an up-to-date overview of current knowledge in this field is obtained, focusing on the results provided by different resilience-building interventions with educational and interdisciplinary programs. However, these results must be treated with caution.
Furthermore, this systematized review makes it possible to map various educational programs focused on resilience with different intervention and design models. On the one hand, the family-centered model is present in 46% of the programs [29,31,32,36,37,40,41]. This approach considers that families are a fundamental pillar in making informed decisions, thus being the center from which the promotion of the quality of life of children and adolescents begins. Thus, family resilience is understood as the interactive processes that strengthen the individual and the family in the face of the demands of the disease [17,45]. For example, "Supérate. ¡No tires la toalla!" Program used group techniques such as the case study method, guided discussion, role play, activities, and commitments according to the experimental methodology to assist parents learn or improve their coping skills for stress and self-regulation of their emotions, thereby increasing their resilience. This program consisted of 10 group sessions of 90 min per week divided into two parts: first, family conflict resolution strategies (sessions 1-6); second, coping strategies and improving levels of resilience (sessions 7-10).
Another program, FOCUS [41] provided family psychoeducation and developmental guidance through shared family narratives using the timeline technique. In this program, interventions were carried out in eight sessions: the first two with the parents, the second two with the children, a fifth session with the parents to prepare for the family sessions, and then a series of three family sessions. Hence, having a family approach allows integral care, which not only meets the needs of the child, adolescent or youth, but also the needs of the family that, in addition to contributing to the physical and emotional health of its members, the family can be potential victim of the effects of the disease [46].
With this family-based approach to integral care, interdisciplinarity is vital to promote resilience. Therefore, interdisciplinarity of several fields, such as educational, psychological, social and health, will allow an ecosystem approach to resilience. This review makes it possible to detect various programs that stand out for an ecosystem and interdisciplinary approach. Aggarwal and Salamon [29] described an intervention in the hospital setting from an interdisciplinary approach. In this program, each adolescent who entered the program was evaluated by a medical provider, a psychologist, and a physical or occupational therapist. Her families also were given treatment recommendations, including individual, family, and group psychotherapy.
In Li et al. [35], a community vision of resilience is promoted in children of parents affected by HIV in a rural context. The intervention consisted of three levels: child, caregiver, and community. The child intervention included 20 h of facilitator-guided programming given in 10 peer-group sessions to increase resilience by developing skills (positive thinking, emotional regulation, coping, and problem solving). At the caregiver level, five sessions were organized with the goal of improving positive parenting skills and participating in personal care and seeking support. At the community level, a series of community activities were organized to promote cohesion. Rosen et al. [40] conducted a similar project (ZAMFAM) in which they promoted community resilience of adolescents with HIV and their families in the context of Zambia ZAMFAM's multilevel interventions supplement an integral package of health and social support services across five domains: HIV care and treatment, Parenting, Food security, Household economic strengthening, and Psychosocial support. In Muñoz Garrido [37], the need and importance of interdisciplinary work in hospital classrooms is evident. In this program of Hospital Pedagogy, educational interventions were supported by a coordinated multiprofessional intervention adapting interventions at level of curricular competence of the students, their diagnosis, the entrance phase, and their response capacity. Thus, integral and ecosystem care for children, adolescents and youth with diseases and or disabilities is based on interdisciplinarity [47].
Regarding the educational context, resilience is understood as the achievement of good educational results despite the adversity of the students [48]. Thus, a school based on resilience is one that develops educational practices that help students to face difficulties in a positive way, to have life projects and to develop their potentialities. This review shows that various programs focus on the academic model of resilience. The following programs with educational interventions are described.
DREAM Program [30] makes it possible to improve the academic agency of students following the psychological model called R.E.A.L. (Rational Emotive Attachment Logotherapy). DREAM is a SEL program that consisted of 10 brief units with administration times ranging from 5 to 30 min. Each of the units included an original song and a hands-on activity as a teaching tool. In Barrera et al. [31] resilience was promoted in children between 6 and 7 years old with some oral and writing language difficulties. This program worked with the group of six children during 40 sessions twice a week. In addition, three sessions were dedicated to parents to promote the correct practice of the elements of the language. Additionally, three meetings were held with the teachers to share information about the performance and development of the participating children.
Dray et al. [33] postulated a strategy based on universal school to promote resilience and mental health for adolescents. This program designed 16 strategies to address internal factors (cooperation, communication, empathy, self-efficacy) or external resilience protective factor (school support, school meaningful participation, peer caring relationships). Schools were required to implement 9 h of resilience-focused content in a minimum of three of the following key learning areas (KLAs): English; Math; Science; History and Geography, or Personal Development, Health and Physical Education (PDHPE). Furthermore, schools received support from an interdisciplinary school intervention team.
UPRIGHT program [36] was implemented to improve and promote adolescent mental health. In this program, teachers were asked to implement 18 sessions (each session at least 40 min) with adolescents. Sessions included (a) 1 session to present the program; (b) 14 sessions dedicated to each skill of the Coping, Efficacy and Socio-Emotional Learning components; and (c) 3 sessions dedicated to the skills, concerns, or preferred activities suggested because of the co-creation process in their countries.
Angel project [38] was aimed at students with ADHD to build their resilient personality. This project created intervention strategies in five categories: emotional identification, identify, self-esteem, communication skills, and teamwork. This program consisted of 15 sessions: five were assigned to the category of feelings and emotions, three to the category of identity, three to the category of self-esteem, three to the category of communication skills and two to the category of teamwork.
Multimedia perspectives project [39] proposed a socio-educational interventions through an edu-communicative approach in favor of the resilience of children and youth in vulnerable situation. This initiative brought together instructors and students of education, communications, and psychology, together with social entities and a social educator to cooperatively create a series of multimedia videos and a documentary short film, to disseminate and reflect on the processes of social exclusion and childhood resilience.
Penn Resiliency Program [42] aimed to prevent depression in elementary school students. In this program, twelve sessions of two hours each were used to deliver the cognitive-behavioral intervention in a group setting. According to the handbook, the group leader conducted two sessions per week, and students were given an activity book to use during those sessions. Session models consisted of four elements: (a) Adversity-Beliefs-Consequences (ABC model); (b) Changes to the explanatory style; (c) Questioning and de-catastrophizing; (d) Resolution of interpersonal problems. For organizational team development and stress management, the program included a blend of didactic presentations, hands-on interactive exercises, and case studies.
The Summer Institute [43] fostered an ecosystem immersion of community resilience in the field of public mental health. This program was a two models' immersion: a multisystemic, strength-based viewpoint was used in Module I to introduce participants to clinical and community approaches to mental health and psychosocial well-being promotion. Module 2 focused on psychosocial and clinical approaches targeting populations at risk for common mental health conditions.
Finally, SONAR study [34] promoted community resilience through youth co-researchers (YCRs). In the rural community of SONAR study, youth were not exposed to opportunities or engaged in discussion about possibilities for their future. Interventions consisted of several group meeting led by the YCRs. During meetings, the youth identified that they wanted to create a web-app (called SONAR) that would be simple and easy to use. The web-app was viewed as a platform for sparking dialogue about the needs of youth in this community and initiating further opportunities for positive engagement.
The limitations of this systematized review were, on the one hand, the search for equations of generic terms to find studies or programs related to our research objective; on the other hand, the term resilience is used in different areas and fields, this resulted in the selection of the articles being more careful, trying to ensure that the programs were appropriate to the research question.

Conclusions
This systematic review provides evidence to support the design and implementation of educational programs to enhance or strengthen resilience in vulnerable groups. Vulnerable groups need integral care; therefore, first, it is suggested that educational programs should strengthen interdisciplinary interventions. Furthermore, secondly, it is suggested that these educational interventions integrate the family and social context from an ecological and holistic model of resilience. Thus, this review can act as a guide to generate more inclusive and resilience-building educational programs. Hence, programs to promote resilience in children, adolescents, or young people with a situation of vulnerability due to a disease or disability must have a transversal axis based on interdisciplinarity.
On the other hand, it is essential to emphasize future research on two critical aspects: (a) how to build or create interprofessional commitments that generate good teaching practices to promote resilience, and (b) how to evaluate and transfer these interprofessional commitments to offer cohesion to a resilient character in children, adolescents, youths, and their families with some situation of disease or disability.