The Impact of Building Resources On the Mental Health Needs of Youth in a Public Mental Health System

Purpose:  Mental health treatment outcomes for youth (children and adolescents) in public mental health systems are notoriously poor, particularly when youth  receiving “treatment-as-usual” are compared to youth receiving evidence-based practices (EBPs); however, evidence-based practices are underutilized in most public systems and even children receiving EBPs typically show effect sizes only in the small to mid-size range. Resilience and positive youth development research suggest that building resources, strengths, and protective factors in addition to reducing pathology are crucial to improving youth mental health outcomes, however, resources have rarely received the same efforts at conceptualization and quantification that pathologies and risks have received, particularly in a public system. The relationship between building resources and mental health needs for youth in a public mental health system is unclear. This study begins to address this by examining the following research questions: Is total child resources change over six months of treatment associated with child mental health need change over six months, controlling for initial mental health needs, gender, ethnicity, and age? This study predicted that building resources would be associated with reducing mental health needs.

Methods:  This study uses hierarchical linear modeling techniques to perform advanced statistical analyses in a secondary dataset of children aged 5-19 receiving mental health services in a large, urban, diverse Children’s System of Care (CSOC) between November 2009 and October 2011.  For every child, clinicians must enter into an online database a CANS (Child and Adolescent Needs and Strengths) assessment (system inter-rater reliability is alpha=.78) at initial assessment and every six months thereafter.  Child resources change was measured by building a composite score of nine child resources items captured on the CANS, and child mental health need change was measured using a composite score of 27 psychiatric symptoms, risk behaviors, and functioning items; for both, the initial assessment score was then subtracted from the six months assessment score for a final composite change score.

Results:  The dataset contained 41 programs (level two) serving a total of 658 children (level one), including 38% African American, 22% Latino/a, 16% Asian/Pacific Islander, 16% white or Caucasian, and 8% Other ethnicities, with a mean age of 12.44 (SD=3.8), of whom two-thirds were male. Hierarchical linear modeling found that building resources over six months was associated with a reduction in mental health needs over six months (beta=-.5, pvalue<.001). The between-program variation (psi=.75) was not statistically significant and was much smaller than the within-program variation (theta= 6.52).

Conclusions and Implications: This study provides evidence that building resources may be an important component of improving outcomes for youth in a public mental health system. Interestingly, the small between-program variation suggests variables within a program may have more impact on youth needs than the agency at which a youth receives services. Linear regression may be acceptable for this dataset since agency clustering effects are not significant and quite small. Implications for social workers and policy makers interested in strengths-based practice and empowering this vulnerable child stakeholder population will be discussed.