Assessing the wellbeing of youth in care is crucial for providing effective support and interventions. Traditional assessment methods often focus on deficits and problems. However, a growing recognition of the importance of strengths-based approaches has led to the development and utilization of tools that highlight the positive attributes and capabilities of young people. This shift is particularly vital for youth in care, including Indigenous youth, who may have experienced trauma and adversity. Understanding their strengths can foster resilience, guide tailored support, and promote positive outcomes.
For Indigenous youth, culturally appropriate assessment tools are paramount. These tools must consider the unique cultural perspectives on wellbeing, which often encompass mental, physical, emotional, and spiritual dimensions. Several studies have explored the use of various measurement instruments for assessing the wellbeing of Indigenous children and youth in primary healthcare settings across Australia, Canada, Aotearoa New Zealand, and the United States. These studies reveal a landscape of assessment tools ranging from Indigenous-specific measures to adapted Western instruments, each with varying degrees of cultural relevance and strengths-based focus.
One notable example of an Indigenous-specific tool is the Aboriginal Children’s Health and Well-Being Measure (ACHWM), developed in Canada. This self-report survey, designed with and for Indigenous youth, focuses on positive wellbeing measures, reflecting the community’s understanding of health. The ACHWM assesses wellbeing across mental, physical, emotional, and spiritual quadrants, offering a holistic view of a young person’s strengths. Its collaborative design ensures cultural relevance and enhances accessibility through methods like tablet-based administration with voice-to-text software. Research indicates that the ACHWM is consistently and accurately interpreted by Indigenous children, demonstrating its reliability and validity in capturing their perspectives. Its successful application in evaluating youth wellbeing improvements after interventions, such as outdoor leadership programs, underscores its practical utility.
Alt text: The four quadrants of the Aboriginal Children’s Health and Well-Being Measure (ACHWM): mental, physical, emotional, and spiritual, representing a holistic approach to youth wellbeing assessment.
Another Indigenous-developed tool, Strong Souls, originates from the Northern Territory of Australia. This 25-item survey specifically includes questions about both strengths and challenges to wellbeing. Developed and piloted with Indigenous youth, Strong Souls aims to provide a balanced view by acknowledging both difficulties and positive attributes. While initial development is promising, further research has suggested the need for modifications to enhance its reliability across diverse Indigenous youth populations in Australia. The Westerman Aboriginal Symptoms Checklist—Youth (WASC-Y), also developed in Australia, serves as another example, although its wider accessibility is limited.
YouthCHAT, an electronic self-report tool from New Zealand, offers a different approach by incorporating strengths-based elements within a broader assessment framework. Designed for vulnerable youth, including Maori youth for whom a Te Reo version is available, YouthCHAT assesses wellbeing across 13 domains. Importantly, it identifies areas where youth would like help, enabling immediate provision of this information to healthcare providers. This feature streamlines assistance and empowers youth to actively participate in their care plans. While accepted and utilized within Maori communities, independent validation of YouthCHAT’s reliability and validity with Maori youth is still needed.
Beyond Indigenous-specific tools, some Western assessment instruments incorporate relational and strengths-based constructs that align with Indigenous understandings of wellbeing. The Session Rating Scale (SRS) and Outcome Rating Scale (ORS) are examples of such tools. Used in an Australian mental health service evaluation for Indigenous youth, these scales offer brief, youth-administered measures focusing on the therapeutic relationship and client progress. The SRS includes strengths-based questions about relationships, goals, topics, and overall session rating. The ORS captures client perspectives on personal, relational, social, and global wellbeing. While cross-cultural validation is ongoing, initial use suggests their appropriateness for Indigenous youth, providing valuable insights into client experiences and treatment outcomes. Positive pre-post improvements in ORS scores among Indigenous youth receiving mental health services indicate the potential of these tools in tracking progress and fostering positive change.
Alt text: Example questions from the Session Rating Scale (SRS) highlighting the strengths-based approach and focus on the therapeutic relationship in youth mental health assessment.
The Strengths and Difficulties Questionnaire (SDQ) is another Western tool frequently used with youth. While not explicitly strengths-based in its original design, the SDQ measures both strengths (prosocial behavior) and difficulties (emotional symptoms, peer problems, hyperactivity, conduct problems). Adaptations and considerations are necessary for cultural appropriateness when using the SDQ with Indigenous youth. Research in Australia indicates that while acceptable to Indigenous youth, parents, and healthcare staff, modifications to wording and response scales can improve clarity and cultural relevance. Focusing on the SDQ total difficulties score, rather than subscales like peer relationships, may enhance its validity in this context. Studies using SDQ with Indigenous youth have identified factors associated with good mental health, such as caregiver wellbeing and healthy lifestyle factors, alongside risk factors like foster care and housing instability. However, challenges related to length, literacy demands, and conceptual understanding have also been reported, highlighting the importance of careful administration and potential adaptations.
Other Western tools, such as the Children’s Global Assessment Scale (C-GAS), Patient Health Questionnaire 9 (PHQ-9), Kessler Distress Scale (K-6), Substance Abuse Choices Scale (SACS), Generalised Anxiety Disorder 7 (GAD-7), and Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), have been used to assess specific aspects of youth wellbeing, including mental health symptoms and substance use. While these tools may be reliable and valid in general youth populations or have been adapted for Indigenous adults, they often lack a strengths-based approach and may require careful consideration for cultural appropriateness when used with Indigenous youth. For instance, the adapted PHQ-9 showed cultural acceptability with Australian Indigenous adults, but raised concerns about potentially sensitive questions like suicidal ideation. The K-6, while validated with Native American youth, primarily focuses on distress rather than strengths. SACS, GAD-7, and ASSIST, used as secondary screening tools, target specific risk behaviors but do not inherently incorporate a strengths-based perspective. Even measures like emergency department presentations and hospital admissions for mental health, while indicative of severe distress, are deficit-focused.
In conclusion, the assessment of youth wellbeing, particularly for youth in care and Indigenous youth, benefits significantly from the adoption of strengths-based approaches. Tools like ACHWM, Strong Souls, and YouthCHAT exemplify culturally relevant, Indigenous-developed measures that prioritize strengths and holistic wellbeing. Western tools like SRS and ORS offer valuable relational and strengths-focused perspectives when adapted and used thoughtfully. While other Western instruments may serve specific screening purposes, a balanced approach that integrates strengths-based tools and cultural considerations is essential for empowering youth, fostering resilience, and guiding effective support systems. Continued development, validation, and culturally informed application of strengths-based assessment tools are crucial steps towards promoting positive wellbeing outcomes for all youth in care.
