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

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. ### Competing Interest Statement All of the authors are employed either by the Center for Innovation in Population Health (which produces the CANS assessment) or Pacific Clinics (the service provider from which the data was collected). ### Funding Statement This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study used already existing, de-identified data which was collected through the regular course of treatment and was therefore considered Exempt by Pacific Clinic's Institutional Review Board I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Given the sensitive nature of the data, it is not able to be released to the public.