Methods: The study included young adults, aged 18-25, who received services in publicly funded mental health and substance use treatment in a Midwestern state during state fiscal year 2019 (n=9,148). The secondary administrative data originated from the state assessment registry which included ANSA ratings, demographic, diagnostic, and provider data. To conduct exploratory and confirmatory factor analysis, the data were randomly split into two groups. Using the first group (n=4,544), exploratory factor analysis (EFA) examined the relationship among 50 ANSA core items to identify and restructure underlying factors. Principal Factors Analysis with Promax rotation was used. The eigenvalue, scree plot, and interpretability of the factor solution were considered when determining the number of factors to be retained. Confirmatory factor analysis (CFA) was conducted to cross validate the factor structure from EFA, using the second group (n=4,604).
Results: Five factors with adequate internal consistency (α = 0.67 - 0.83) emerged from EFA: 1) Developmental and behavior factor included a combination of developmental tasks and challenges for young adults such as independent living skills, decision-making, interpersonal problems, and impulse control; 2) Personal recovery factor included social and community connections, optimism, and resiliency; 3) Trauma and stress related factor combined depression, adjustment to trauma, anxiety, sleep, danger to self, and eating disorders; 4) Substance use risks factor included legal, criminal behavior, and substance use; 5) Cultural-linguistic factor included cultural identity, stress, rituals, and language. The proposed five-factor EFA model was used for CFA and provided evidence of ill fit, χ2 (584) = 10511.98, p < .01; RMSEA = 0.06, CFI = 0.78. The five-factor model with a full list of items was compared to the five-factor model with more parsimonious items. Results indicate that the five-factor model with a reduced number of items fits the data better than the five-factor model with a full list of items (CFI=.948; RMSEA=.057).
Conclusions and implications. The study found some support for the use of the ANSA tool for young adults. Used for all adults, ages 18 to 80, the identified ANSA items are relevant for young, emerging adults with behavioral health needs who are concurrently working through developmental tasks. However, CFA findings warrant additional consideration for specialized assessment tools and practice for young adults. More research is needed to validate and refine the ANSA so that it can be used to better plan services and monitor outcomes.