Abstract: Exploring Growth in Strengths for Youth in Contact with a Public Behavioral Health System (Society for Social Work and Research 21st Annual Conference - Ensure Healthy Development for all Youth)

Schedule:

Saturday, January 14, 2017: 2:00 PM

Balconies I (New Orleans Marriott)

* noted as presenting author

Sarah Accomazzo, PhD, Postdoctoral Scholar, University of California, Berkeley, Berkeley, CA

Valerie B. Shapiro, PhD, Assistant Professor, University of California, Berkeley, Berkeley, CA

Nathaniel Israel, PhD, Policy Fellow, University of Chicago, Chicago, IL

B. K. Elizabeth Kim, PhD, Assistant Professor, University of Southern California, Los Angeles, CA

Background and Purpose: Approximately 10% of youth in the United States will qualify as having “severe” emotional and behavioral problems during any given year (Kessler et al., 2012). Over the past thirty years, the federal government’s response to youth with emotional and behavioral problems has been to develop the System of Care (SOC) approach (CMHI, 2011). A focus on strengths has been identified as one way to improve service delivery for youth and families in SOC (McCammon, 2012). However, in studies using SOC samples, strengths are rarely reported (e.g. Snyder et al., 2012) and the growth in strengths is even less frequently addressed (e.g. Sieracki et al., 2009). Using data from a large, urban SOC, this study explored: 1) growth in strengths over twelve months, and 2) whether youth characteristics (gender, age, race, initial psychiatric symptoms at intake, and exposure to trauma) are related to growth in strengths.

Methods: Clinicians used the Children and Adolescent Needs and Strengths Assessment (CANS; Lyons, 2009) at three time points (at entry, 6 months, and 12 months). The sample includes 2,059 youth (61% male; median age=13; 33% Black/African-American, 28% Hispanic/Latino(a), 22% Asian/Asian-American, 8% White/European-American, 4% Multi-Ethnic, 3% Other, 2% Pacific Islander/Native Hawaiian). A total strengths score was created by summing the six individual items (e.g. Family/Caregiver Relationship, Peer and Non-Family/Caregiver Relationships, School System and Educational Plan, Extracurricular Activities and Talents, Spiritual/Religious Beliefs and/or Involvement, and Relationship Permanence) in the CANS Strengths Domain. Multilevel modeling estimated growth in strengths over time accounting for the nesting of youth within clinicians.

Findings: Strengths significantly increased across time, averaging an increase of .04 points per time interval (p = .03). Most of the growth occurred during the first six months of contact with the SOC (p < .001), and youth did not experience significant growth between 6 and 12 months (p = .19). There were no significant differences in growth in strengths by gender or age. Asian youth were assessed with significantly fewer strengths than white youth (B = -.52, p = .03) and experienced more growth in strengths over time than white youth (B = .10, p = .01). Youth with higher levels of psychiatric symptom severity and exposure to trauma at entry had significantly fewer strengths at entry (B = -.25, p < .001 and B = -.10, p < .001, respectively) but reported more growth in strengths over time (psychiatric symptom severity: B = .02, p = .01; exposure to trauma: B = .01, p = .05).

Conclusion and Implications: These analyses suggest that growth in strengths is common for youth in contact with an urban, public System of Care, regardless of gender or age. Youth with higher levels of psychiatric symptoms and exposure to trauma at entry experienced more growth in strengths over time. Differences in growth in protective factors for Asian and white youth deserve further inquiry. Limitations of this administrative dataset, and implications for the role of strengths in improving mental health policy and practice in Systems of Care, will be discussed.