Targeting Strengths and Associated Treatment Outcomes for Youth Receiving Public Mental Health Services

Abstract

Constructional approaches to clinical practice argue treatment should emphasize the enhancement of positive repertoires rather than primarily focus on the elimination of problematic behaviors. The movement away from a deficit-oriented model of mental health services to one that emphasizes strengths can have significant implications for treatment, particularly with youth. The literature on positive-oriented interventions suggests focusing on strengths (a) improves well-being, (b) reduces symptomology, and (c) is linked to positive outcomes. However, there is limited research on the use of strengths in youth clinical populations. The aim of the present study was to examine the extent of association, if any, between the targeting of strengths (including those of the client, the client’s family, and the client’s environment) and outcomes for 1,841 youth ages 3-19 receiving services through Hawai‘i’s public mental health system from 2006-2017. The study used archival data from a population of youth who received Intensive In-Home (IIH) treatment through Hawai‘i State Child and Adolescent Mental Health Division (CAMHD). Therapist-reported treatment characteristics, therapist and client variables, and other outcome data were examined using multi-level modeling approaches. As hypothesized, greater use of strength-focused treatment targets (i.e., a greater proportion of strength-focused treatment targets endorsed) was associated with increased likelihood of successful treatment discharge. Specifically, as the percentage of strengths targeted increased from 46% to 64% of total targets endorsed, the odds of successful discharge increased by 21%. This finding persisted despite other significant predictors of successful discharge. Clinical practice, dissemination, implementation, and future research implications are discussed.