The Strengths of Youth in a Public Behavioral Health System: Prevalence and Group Differences

Background and Purpose:  Public behavioral health systems serving youth require efficient, clinically-useful assessment tools to promote evidence-informed decision making. Policy documents (e.g. CHMI, 2011) and practice standards (e.g., Building Bridges Initiative, 2015) suggest that assessments should include a focus on strengths in addition to needs or pathology. However, strengths-based assessments have been understudied and underutilized (Snyder & Lopez, 2009), and the prevalence of strengths is reported less frequently than the prevalence of problems (e.g. Griffin et al., 2009). This study explores the prevalence and group differences in strengths among youth entering an urban, public behavioral health system (BHS), using the Child and Adolescent Needs and Strengths Assessment (CANS; Lyons, 2009).

Methods: Within 45 days of a youth’s first contact with the BHS, clinicians filled out an initial CANS. The sample includes 2,059 youth (median age = 13 years; 66% male; 33% Black/African-American, 28% Hispanic/Latino(a), 22% Asian/Asian-American, 8% White/European-American, 4% Multi-Ethnic, 3% Other race/ethnicity, 2% as Pacific Islander/Native Hawaiian). Six strength items were assessed (scored on a 0-3 scale): 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. T-tests, ANOVAs, and Bonferroni’s post-hoc pairwise comparison tests were used to examine group differences in strengths.

Results:

The average score for youth on each individual item (0-3) was nearly 2 points, with the scores ranging from an average of 1.77 points (SD: .90) for the Education Plan to 2.01 points (SD: .91) for Relationship Permanence. Gender differences had negligible effect sizes (d < .20); males and females scored similar levels of strengths. Younger youth scored significantly more strengths than older youth on some strength items, though the magnitude of any age group differences were negligible to small (all d ⪯ .24). There were some racial/ethnic group differences in strengths, but the magnitude of these differences were small, with the exception of Spiritual/Religious Involvement and Relationship Permanence, which were in the medium range. On Spiritual/Religious Involvement, Asian youth scored higher than African-American  ( p  <.001; d  = .31) and Pacific Islander/Native Hawaiian youth (p  <.001 ; d  = .60), while White youth scored higher than Latino youth ( p = .03 ; d  = .30). On Relationship Permanence, African-American youth scored higher than Asian youth (p  < .001; d  = .40), while Asian youth scored lower than Latino youth (p < .001; d  = .40).

Conclusions and Implications: The prevalence of strengths was high across items, suggesting that youth entered this BHS with many strengths that could be used as a focus of a strengths-based treatment plan. There appear to be more similarities than differences in strengths by gender and age, but important group differences by race/ethnicity appear in the assessment of strengths that  deserve attention in future research.  Implications for evidence-based decision making in public systems will be discussed.