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Child strengths and the level of care for children with emotional and behavioral disorders

Donald Oswald et al

The assessment of children's strengths is increasingly becoming an accepted component of a comprehensive child evaluation. However, until recently, the trend was based largely on philosophical grounds, reflecting the perspective that an evaluation that documents only disability fails to respect the dignity of the individual and misses important personal qualities that may affect treatment. The availability of a strengths scale such as the BERS provides researchers with the means to address questions regarding the role of child strengths in a variety of intrapersonal and interpersonal processes. With such a scale, child strengths becomes another measurable construct that can be investigated in relation to individual disability, family strengths and weaknesses, educational success and failure, and other child characteristics. It further offers clinicians and educators a tool to systematically incorporate strengths assessment into their evaluations without relying solely on anecdotal data.

The present study demonstrates that child strengths are significantly associated with the variation in child placement decision making, even after demographic and clinical characteristics are accounted for. Individual child strengths may mitigate the impact of serious psychiatric symptoms and risk, allowing children to remain in homelike settings successfully, whereas children who lack comparable strengths may require a more restrictive placement. At the same time, there remains a wide range of ecological variables that were not included in the present model and that might be expected to also play important roles in placement decision making. Examples of such variables include community capacity to provide a full continuum of care and family capacity to meet the needs of children with substantial impairment.

This study builds on previous research that considered the role of strengths in the assessment and treatment of children with emotional and behavioral disorders. Greenbaum et al., (1996) reported that communications skills helped predict readmission rates to highly restrictive living environments; however, these researchers stressed the impact of communication deficits rather than focusing on relative communication strengths among their sample. Our study provided what is perhaps the first concrete, empirical evidence in the literature that individual child strengths may serve to mitigate the negative impact of psychiatric symptoms and functional impairment and should thus be considered in decisions regarding level of care.

One limitation of the present study was that the key dependent variable, actual placement, is determined by a wide variety of factors, some of which are independent of child and family characteristics. For example, a given service system may be more or less likely to place children in nonhomelike settings on philosophical or fiscal grounds. Furthermore, the study did not investigate how successful children were in their placement; the nature of their present actual placement is a relatively gross measure of child outcomes. Further investigation of the role of strengths in determining child outcomes will require more-sensitive dependent variables that are more closely tied to child behavior, mental status, and functioning.

The sample included only children from a single state, they were not randomly selected, and they were largely from urban settings. In addition, the BERS was completed only by the youths' case managers, so the impact of the informant was not examined. There is some evidence that strengths' ratings differ among informants (Friedman, Leone, & Friedman, 1999), and using youths' parents or primary caregivers as informants might yield different results. Finally, the study could not rule out the possibility that out-of-home placements may have confounded assessment of child strengths. This concern argues for a prospective study of individual child strengths in a sample of children who are subsequently placed in a variety of treatment settings.

Future research should investigate the relationship between children's strengths and restrictiveness of placement in a sample for which the results may be generalized with more confidence. In addition, because rural communities often have fewer treatment options and fewer homelike living options, a sample that includes a greater representation of rural children may allow for a determination of the extent to which urban and rural community status influences placement restrictiveness, independent of children's strengths. Finally, further research might contribute to understanding the importance of multiple informants in strengths assessment and treatment planning, and the extent to which separate norms may be needed for the various groups of potential informants.

Oswald, D.; Cohen, R.; Jenson, C. and Lyons, J. (2001). Child Strengths and the Level of Care for Children with Emotional and Behavioral Disorders.
Journal of Emotional and Behavioral Disorders. Fall, 2001

References
Friedman, K. A., Leone, P. E., & Friedman, P. (1999). Strengths-based assessment of children with SED: Consistency of reporting by teachers and parents. Journal of Child and Family Studies, 8, 169-180.
Greenbaum, P. E., Dedrick, R. F., Friedman, R. M., Kutash, K., Brown, E. C., Lardieri, S. P., & Pugh, A. M. (1996). National Adolescent and Child Treatment Study (NACTS): Outcomes for children with serious emotional and behavioral disturbance. Journal of Emotional and Behavioral Disorders, 4, 130-146.  

 

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