Factors Contributing to Employment Status over Time for Caregivers of Young People with Mental Health Disorders.

This study utilized the conservation of resources theory to guide the examination of employment outcomes for caregivers of children with emotional and/or behavioral disorders. The sample included 2455 caregivers whose children received services through federally funded systems of care. Of special interest was whether receiving services and supports predicted change in employment status. We examined change in employment between baseline data collection and the six-month follow-up including: (1) gaining employment, and (2) retaining employment. Findings indicated that the relationship between service/supports and caregiver employment differed depending on initial employment status, and type of service received. Accessing any service was associated with gaining employment. For families who accessed any services, receiving behavioral aide services was associated with gaining employment. Caregivers of children who used residential services were less likely to lose employment. Several child, caregiver, and demographic variables also predicted employment status over time. Taken together, the findings suggest that caregivers of children with emotional and behavioral challenges are at risk for downward cycles of resource loss, and that services and supports have the potential to mitigate that risk.

Patterns of Child Mental Health Service Delivery in a Public System: Rural Children and the Role of Rural Residence.

This study uses existing data from Hawaii's public mental health system for children and youth as an example of a state-level examination of service use patterns and health care disparities. The purpose of this study was to compare differences in mental health service utilization between rural and non-rural children, especially use of residential services. This study used a performance measure approach to conduct multi-level modeling on existing administrative data to examine the impact of community factors on service utilization. Rural children were found to have the most serious levels of mental health problems at intake, more likely to be placed in out-of-home care, more likely to receive only out-of-home care, more likely to in stay out-of-home longer, and less likely to receive follow-up care than their non-rural counterparts. Practice, policy, and research implications are discussed.

Measurement Quality of the Caregiver Strain Questionnaire-Short Form 7 (CGSQ-SF7).

This study examined the measurement quality of an abbreviated version of the Caregiver Strain Questionnaire. The CGSQ-Short Form 7 (CGSQ-SF7) is practical for routine assessment of objective and subjective internalized caregiver strain. The subjective externalized subscale is not included in the CGSQ-SF7. Findings indicate that the reliability and validity of the shortened objective and subjective internalized subscales are comparable to the original. Examination of construct validity suggested that caregiver, youth, and clinician ratings of child clinical severity were related to objective caregiver strain. However, youth and clinician ratings of child clinical severity were not related to subjective internalized caregiver strain.

Implementation and development of federally-funded systems of care over time.

This study describes development in federally funded systems of care. Data for this study were collected using the System of Care Assessment that rated grantees' enactment of system of care principles in the infrastructure and service delivery domains. Data were collected by trained raters who conducted several site visits over the funding period. This study described system development over time across 61 sites and tested whether gains were statistically significant. Latent profile analysis was used to explore whether sites could be meaningfully grouped based on their baseline service delivery domain scores. Differences across groups were tested in terms of community, system, and client characteristics. Differential growth across groups was also examined. Overall, systems of care developed over time in both the infrastructure and service delivery domains. Although infrastructure scores were generally lower than service delivery scores, greater gains were seen for the infrastructure domain. Three groups of sites were identified that could be distinguished in terms of degree of development overall, and for specific system of care principles. The groups of sites differed in terms of community factors, system features, and client characteristics. In addition, repeated measures analyses found differential growth in system development over time across groups.

Caregiver, child, family, and service system contributors to caregiver strain in two child mental health service systems.

Children's mental health researchers are increasingly recognizing the importance of caregiver strain (i.e., the impact on families of caring for children with emotional and behavioral disorders). This study examined the caregiver, child, family, and service variables associated with caregiver strain with special attention to the role of barriers to care. These relationships were compared across enrollees in a managed care Medicaid and a traditional fee-for-service system. Findings indicated that severity of child problems was the most consistent predictor of caregiver strain. Although there was considerable similarity in the variables associated with caregiver strain across the two systems, important differences were also evident. Caregivers in the managed care setting were significantly more likely to report provider/payer-related barriers to care. Provider/payer barriers predicted strain in the managed care sample. In the fee-for-service system, barriers related to family perceptions and inconvenient location and appointment times were significant predictors.

Use of the family resource scale in children's mental health: reliability and validity among economically diverse samples.

The adequacy of a family's resources has implications for child and family service processes and outcomes. The field needs tools to assess resources in a manner relevant to children's services research. The purpose of this study was to examine the reliability and validity of the FRS among families caring for children who are receiving mental health services and to compare its measurement quality across samples that differ on economic variables. Exploratory and confirmatory factor analyses supported similar factor structures across samples, and internal consistency was equivalent. Findings from the regression analyses provided evidence of construct validity for the FRS. Overall, findings indicated that the FRS holds promise as a reliable and valid tool for assessing perceived adequacy of concrete resources among economically diverse families of children with emotional and behavioral disorders. However, the FRS could benefit from some refinements; those recommendations are discussed.