Trauma Experiences, Youth Strengths, and Mental Health Needs of Youth Receiving Services in a Public Mental Health System

Background and Purpose: Exposure to traumatic events during childhood or adolescence is associated with increased risk of mental health needs. Child trauma theorists (e.g. Pynoos et al., 1999), community violence researchers (e.g. Ozer et al., 2004), and others have suggested a role for strengths, resources, and/or protective factors in mental health recovery for youth with trauma exposure. However, few studies have examined the relationship between trauma, strengths, and mental health needs among diverse youth receiving services in an urban, public mental health system. Previous work has been limited by its cross-sectional nature. This study seeks to determine: 1) the prevalence of lifetime trauma experiences, youth strengths, and mental health needs among youth entering services in a public mental health system, 2) the relationship between lifetime trauma, strengths, and mental health needs for youth entering treatment, and 3) whether strengths moderate the relationship between lifetime trauma and mental health needs for youth after six months of treatment.

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.