Positive developmental cascades: Strength development reduces support needs in children

Background: Strength development in children across a range of psychiatric diagnoses may reduce needs for mental health, social, and functioning support over time. A strength-based adjunct to child and adolescent mental health may foster the developmental context most helpful for achieving desired outcomes with positive developmental cascading effects. Methods: We longitudinally examined changes across 5 years in the Child and Adolescent Needs and Strengths Assessment in 2- to 18-year-old children (N = 30,103) from a public mental health system. Results: First, children who began with a greater number of strengths consistently had fewer support needs, not only at entry but also at one, two, three, four, and five years later. Second, initial strengths appeared to have cumulative positive cascades with reduced support needs over time; each additional strength a child possessed at the beginning of service was associated with a progressively faster decrease in their support needs each subsequent year. Furthermore, developing more strengths during the service period also predicted lower support needs one, two, three, four, and five years later. Finally, the impact of developing strengths over time varied depending on the child's age. Developing more strengths was linked to an increasingly rapid reduction in support needs each year for 2- to 5-year-olds. In contrast, developing more strengths was linked to a progressively slower reduction in support needs each year for 11- to 15-year-olds. Conclusion: We provide empirical support suggesting both the clinical utility of strength-based behavioral health care and the value of strength development in relation to reduction in support needs as a transdiagnostic clinical dimension. In turn, positive developmental cascading effects during a sensitive period early in development suggest the importance of early intervention. Strength-based mental health classification and treatment systems can be balanced with a traditional mental health symptom focus to more broadly leverage individuals' abilities for adaptation.