Well-Being Measurements with Children and Adolescents in the Behavioral Health System: Current Strategies and Challenges

Background & Purpose: Particularly among young people exposed to early life adversity, the ability to achieve a state of well-being represents normal development and adaptive functioning in the most optimistic light. Unfortunately, theoretical and empirical models attempting to conceptualize and measure well-being lag behind those designed to assess and measure risk. The current study brought the research on well-being assessment to practitioners in the field to explore the perspectives of clinicians working with children and adolescents on: 1) the concept of well-being measurement and 2) the utility and practicality of modifying existing child and adolescent assessment practices to reflect well-being.

Methods:  Using purposive sampling to recruit clinicians with relevant knowledge of child and adolescent assessment, we conducted focus groups at four behavioral health agencies. Focus groups consisted of 5-6  child/adolescent clinicians each (N=21). Clinician characteristics included: 76.2% female; 62% Non-Hispanic/White, 19% Latina; 81% masters degree or higher; and 71% current clinical license. Focus groups were conducted by two trained facilitators who employed a semi-structured interview guide to illicit information about the typical domains of well-being, types of instruments currently used, and the clinicians’ impressions of specific well-being items.  Clinicians were asked how they would use a brief well-being instrument in their practice and to discuss possible barriers.  The transcribed data was analyzed in Atlas-Ti 7.0 using constant comparative analysis (Lincoln & Guba, 1985).

Results:  Results suggest five distinct themes. Hierarchy of Needs described how the basic economic needs of clients impacted what could be done in the treatment setting, with well-being seen as a luxury more than a need. Cultural Relevance represented challenges in incorporating cultural strengths and protective factors into their work. Additionally, although clinicians were supportive of the idea of well-being, the clinicians often spoke from a Risk-Dominant Framework and were challenged to account for well-being in the real risk exposure and complexity of these youth’s lives. Many clinicians emphasized the role of family relationships (Primacy of Family Relationships). And yet, many of the children in service settings are missing this secure base and dealing with significant loss. Finally, clinicians described difficulty understanding how well-being assessment or measures might practically be linked to the treatment plan or other aspects of treatment/service delivery (Treatment Linkages).

Implications:  Results suggest a brief measure of well-being (easy to administer/low cost) is a promising way to bring aspects of well-being to the forefront of clinicians’ minds and treatment plans.  Well-being and strengths are currently not systematically measured; however, clinicians described a desire to include client strengths and well-being in their assessment and treatment practices. Future psychometric testing of a brief measure of well-being (separate measures for children and adolescents) and training (through case scenario examples) demonstrating how to link this information to treatment plans and service delivery may improve long-term positive outcomes for our most vulnerable youth.  From a practice perspective, the ability to assess well-being may be directly linked to efforts to support and encourage well-being, perhaps by sharpening the attention of practitioners, caregivers, and the child herself on this important outcome.