House-Tree-Person (HTP) Test drawings by children (N ϭ 131; age range 6 -15) in Haiti were studied statistically to assess for resilience and vulnerability post-2010 Haiti earthquake. Consistent with ecological theory, item contents indicated that resilience was derived from systems of home life and familial relationships, reflections on self-other interactions, interpersonal relationships, and connectedness with the environment, and that vulnerability was derived from living without external systemic support, placing a child at risk for an intrapersonal life of negative representation of self, self-in-relation to others, and personal-social attitudes. A pilot qualitative study developed item criteria with themes of resilience and vulnerability. While exploratory analyses of the scoring system led to the formation of resilience (RES) and Vulnerability (VUL) items (31 items) that were scored as present or not present (1 or 0) in the sample's drawings. For the study, several raters scored the same participant's 3 drawings, which showed fair interrater reliability through ICCs, moderate Cronbach's alphas, and a strong negative correlation between RES and VUL. A multivariate regression analysis for RES and VUL showed differences by age and sex, as well as trends in RES and VUL across time for participant locations that were impacted differently by postearthquake conditions. Over 50% of participants had significantly different RES and VUL scores that were not due to measurement error, suggesting differential individual profiles. The majority had higher RES scores and a few had significantly higher VUL scores, showing that resilience was the cultural norm for Haitian children. It is recommended that vulnerable Haitian children would benefit from strength-based resilience counseling for trauma. An innovative study applied the controversial HTP tool in a way that has not been done before to assess Haitian children who are exposed to continuous trauma. The study is important by virtue of examining over time the applicability and scope of the nonverbal HTP test to assess for adaptation and maladaptation in a non-English speaking and socioculturally different community in the Caribbean.

The House-Tree-Person (HTP) drawing test has been culturally adapted for Haitian children and objectively scored for resilience and vulnerability (Roysircar, Colvin, Afolayan, Thompson, & Robertson, 2017). The HTP was used to assess 88 Haitian children’s adjustment to the 2010 earthquake and the continuous trauma of societal inequalities. The study examined the validity of the adapted HTP test and its dimensionality. The study included participant interviews with child self-report measures of self-esteem, as perceived by self, peers, and family; posttraumatic symptoms; and self-concept. All measures were translated and administered in Créole. Analyses included standardized sample scores; descriptive statistics; internal consistency reliability; interscale correlations; a generalizability study showing that there were no differences in HTP scores due to novice or expert raters; and an exploratory factor analysis of HTP scores indicating three factors and accounting for just under 50% of the variance. The three dimensions, HTP Resilience-Vulnerability Integrated, House Feeling Safe, and Person Feeling Unloved, are discussed within the international literature on child disaster trauma assessed pictorially, and within Haitians’ spiritual worldview of suffering and endurance.

A qualitative interview is sensitive to social complexities and personal subjectivities, whereas quantitative assessment relies on preexisting frameworks to place responses in hierarchical frequencies and counts individual experiences as an additive aggregate. Using both enquiries, a mixed methods sequential exploratory design studied mothers' focus groups and their children's trauma assessment in 3 poor communities in the outskirts of Port-au-Prince, Haiti. The authors partnered with a free primary care clinic where they serve as U.S. behavioral health psychologists. The study enquired how Haitian children are socialized by their mothers'/caregivers' religious and nonreligious coping in the context of continuous trauma. Focus group questions for mothers (n ϭ 27), the House-Tree-Person (HTP) drawing test for their children (n ϭ 42), and their directions were translated, back-translated, and administered in Haitian Créole by trained Haitian staff members. Religious, African humanism, and shame stigma themes emerged from the focus groups. Correlations and multiple regressions examined relationships of the frequencies of the mothers' coping themes and with their children's scores on 2 factorial dimensions, Resilience-Vulnerability Integrated and Person Feeling Unloved. These conceptual factors were derived from culturally adapted ratings of children's HTP drawings in previous studies in the same communities (Roysircar, Colvin, Afolayan, Thompson, & Robertson, 2017;Roysircar, Geisinger, & Thompson, 2019). Significant negative relationships of religious and African humanism coping with shame stigma coping and their respective significant negative and positive relationships with children's trauma adjustment scores are integrated in a mixed methods design, related to the African diaspora literature, and approached with transnational feminist theory. Public Significance StatementOn the basis of the present transnational study in a primary care setting in Haiti, it is understood that mothers' religiousness and African cultural values can help to alleviate their children's despair and provide hope in traumatic circumstances of poverty compounded by disasters. Children of mothers who spoke more about the ways that religion and cultural values helped their children during adversity expressed less vulnerability than children of mothers who spoke less about the benefits of religion and cultural values. The findings were nuanced with children's expression of ineffectiveness.

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