Patterns of Child and Adolescent Needs and Strengths Among Youth at Risk for Suicide Attempt

Background and Purpose: Understanding the relationship of strengths to mental health disorders is critical as the strength-based approach supports mental health recovery (Gable & Haidt, 2005; Xie, 2013). Although recovery occurs among many adolescents, mental health problems remain common and suicide rates continue to grow (Hedegaard, Curtin, & Warner, 2018). A few studies were conducted in identifying patterns of strengths, classifying similar groups, or tracking them using latent classes (Leon & Dickson, 2018). This study aimed to (1) identify subgroups of strengths and (2) determine how subgroups are predicted based on demographic characteristics (e.g., gender and race).

Methods: The sample of youth who participated in mental health and addiction services in one Midwestern state was selected. Of the youth who received mental health/addiction services and closed the episode of care during state fiscal year 2019 (N=8,877), those requiring intervention for suicide risk were selected (n=391). The Child and Adolescent Needs and Strengths (CANS; Lyons, 2009) include six domains: (1) youth strengths, (2) life functioning, (3) cultural factors, (4) caregiver needs and resources, (5) child behavioral or emotional needs, and (6) risk behaviors. This study focused on the strength domain with eleven items (i.e., family strengths, interpersonal, optimism, educational, vocational, talents/interests, spiritual/religious, community life, relationship permanence, youth involvement with care, natural supports). Each item is rated on a four-point scale, ranging from 0 (centerpiece strength) to 3 (no strength identified). Items with ratings of 0, 1, or 2 are considered Usable or Buildable strength items: a high strength group received the lowest scores for each item. We first analyzed youth strengths at baseline (Month/Year) and during the last assessment via latent profile analysis (LPA), respectively, and examined tenability and trajectories of different latent classes at the end of an episode via latent transition analysis (LTA).

Results: The LPA/LTA results indicated that two strength profiles emerged for both baseline and the last assessment: “Strength in place” class (39%) and “Buildable strengths” class (61%) at baseline and “Strength in place” class (47.8%) and “Buildable strengths” class (52.2%) at the last assessment. Covariates, like gender and race, were significant at the last assessment when “Buildable strengths” was a reference group. White and male youths are more likely to be in the “Strength in place,”. Among the high portion of youth, their strength class remains unchanged (90% in Strength in place group and 73% in Buildable strength group) between baseline and the last assessment. However, some subgroups showed significant movements: 27% moved in a positive direction, and 10% moved in a negative direction.

Conclusion and Implications: The findings suggested that subgroups of strengths could be a promising source to track youths’ progress in the strength domains and guide healthcare professionals to allocate community-based resources more efficiently in order to improve specific strength areas. Further research is needed to explore the relationship between subgroup changes, the area of needs, and their corresponding interventions. The relationship study will also highlight the need for efficient ways to overcome barriers and challenges in strength development and needs.