Promoting Child Flourishing amid Mental Health Crises: A Concept Mapping Study of Provider Perspectives

Backgrounds:

In high-acuity child mental health settings, outcomes are often defined by symptom reduction and risk stabilization, offering limited insight into how children engage, develop, and sustain well-being during crises. Children’s well-being is shaped by interrelated influences, including access to resources, supportive relationships, caregiving practices, and youth capacities. However, these domains are often examined in isolation, with limited attention to how they are prioritized and enacted in real-world contexts characterized by shifting needs and constraints. Existing approaches, largely based on general population samples, may not capture the dynamic and context-dependent nature of well-being among youth experiencing crisis, service transitions, or system involvement. Emerging literature conceptualizes human flourishing as a multidimensional, strengths-based state of well-being beyond the absence of illness, offering a framework for understanding holistic well-being. However, little is known about how providers define and operationalize flourishing in high-acuity settings. This study examines provider-identified factors that promote flourishing among youth ages 5–18 at risk of psychiatric hospitalization or placement disruption.

Methods:

We used a mixed-method, participatory concept mapping design. Participants were 18 community mental health providers recruited through the Kentucky Family Intervention Treatment Team, an in-home crisis stabilization program. In brainstorming sessions, participants responded to the focal prompt “One specific factor that promotes child or youth flourishing amid mental health crises is ____”, generating 237 statements that were synthesized into 108 unique items. Participants sorted statements into conceptually similar groups and rated each item on importance (priority for measurement) and feasibility (ease of implementation) using 5-point Likert scales. Multidimensional scaling generated a point map representing the spatial arrangement of statements, followed by hierarchical cluster analysis that produced cluster solutions. The final cluster map was selected through participatory processes involving participant interpretation and discussion. Pattern-match analyses examined the relationship between importance and feasibility ratings, and go-zone analyses identified statements above the mean on both dimensions as actionable priorities.

Results:

Multidimensional scaling and hierarchical cluster analysis produced an 11-cluster solution with acceptable model fit (Kruskal stress=0.30), representing multidimensional domains promoting child flourishing. Importance ratings were consistently high (range: 3.88-4.27), with the highest-rated clusters including 1) Access to Basic Needs and Coordinated Supports (M=4.27), 2) Emotional Safety and Acceptance within Families (M=4.27), and 3) Availability of Trusted and Invested Adults (M=4.25). Feasibility ratings were lower and more variable (range: 2.90-3.78). The most feasible clusters included Access to Psychoeducation and Peer Support (M=3.78) and Healthy Emotional Outlets and Expression (M=3.67), whereas Access to Basic Needs and Coordinated Supports was rated least feasible (M=2.90) despite its high importance. Pattern match analysis indicated a positive association (r=0.12) between importance and feasibility. Go-zone analyses further identified a subset of high-importance, high-feasibility statements as actionable targets.

Conclusion:

Findings suggest a gap between factors providers view as important for child flourishing and those feasible to address in practice, reflecting a two-tiered structure: domains within provider influence (e.g., emotional support) and those requiring system-level coordination (e.g., access to basic needs). These provider-informed insights may inform future research and practice aimed at supporting child flourishing in high-acuity practice settings.