Understanding children’s behavioral health outcomes: A story of overcoming trauma and building strengths

Abstract

Background: Among children enrolled in behavioral health treatment, those with multiple trauma experiences (known as Adverse Childhood Experiences, or ACEs) typically see worse outcomes. In this study, we examine whether having or building strengths can help such children become more resilient and experience better outcomes. Objective: We examined the relationship between children's traumatic experiences, strengths, and clinical improvement, testing whether building strengths can help reduce the negative impact of ACEs on children's response to treatment. Participants and Setting: We used data from an evidence-based assessment to understand the clinical and functional needs and strengths of 5,423 children (ages 6-20) receiving treatment between 2019 and 2022 within a large community agency located in California. Methods: To classify children by both level and rate of improvement, we relied on machine learning and principal components analysis. To determine the relationships between ACEs, strengths, and improvement, we used a variety of predictive models and descriptive analyses. Results: After classifying children as being either "Faster", "Slower", or "Minimal" improvers, our analyses revealed that while higher total ACEs increases the likelihood of being a Slower improver, this effect can be mitigated by building strengths. Conclusions: These results suggest that children with more ACEs are likely to require a longer duration of treatment before improvement is seen. They also suggest that promoting resilience--specifically focusing on building strengths--may lead to more efficient and effective care, particularly for children with significant trauma histories.