Trauma Experiences, Youth Strengths, and Mental Health Needs of Youth Receiving Services in a Public Mental Health System
Methods: Youth aged 5-19 who received behavioral health services in a large, urban Children’s System of Care between August 2010 and April 2011 were sampled (n=303). Clinicians completed a Child and Adolescent Needs and Strengths (CANS) assessment (with a reported system-wide clinician inter-rater reliability of alpha=.78) at initial and six month assessment. Every assessment domain contained multiple items, scored on a 0-3 severity likert scale. The following continuous composite score variables were constructed by adding together the 0-3 score for each item in the domain: Lifetime Trauma (i.e. sexual abuse, physical abuse, emotional abuse, neglect, medical trauma, witness family violence, witness community violence, school violence, natural/man-made disaster, traumatic grief/separation, war affected, terrorism affected, and witness to/victim of a crime); Youth Strengths (i.e. family, interpersonal, educational, vocational, well-being, optimism, talents/interests, spiritual/religious, community life, and relationship permanence); Mental Health Needs (i.e. psychosis, impulse/hyper, depression, anxiety, oppositional, conduct, substance abuse, eating disturbances, behavioral regression, somatization, anger control). Bivariate and multivariate regression models were performed, adjusting for age, ethnicity, and gender.
Results: The sample included: 50% African American, 26% Latino/a, 10% Asian/Pacific Islander, 8% White, and 6% Other ethnicities, mean age of 12.44 (SD=3.8), and two-thirds male. Youth entered into treatment with an average of 4.2 trauma types (SD = 2.0) and 5.4 strengths (SD = 2.3). For youth entering treatment, higher mental health needs were associated with a higher lifetime trauma score (beta=.15, p<.001) and a lower strengths score (beta=-.25, p<.001). Youth strengths moderated the relationship between lifetime trauma types and mental health needs over six months of treatment (beta=-.02, pvalue<.05), adjusting also for initial mental health needs.
Conclusions and Implications: This study is one of the first to examine the relationships between lifetime trauma types, strengths, and mental health needs in a sample of diverse, urban youth in a public mental health system. The small but robust moderation effect suggests that youth strengths may be an under-studied point of intervention, on a policy and clinical level, for social workers and others working with this vulnerable population.