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The aim of this study was to examine differences in responses to the Caregiver Strain Questionnaire (CGSQ) between African American and White caregivers of children with emotional and behavioral challenges. Significant item- and scale-level differences were detected across groups with African Americans consistently reporting less strain. We examined whether these differences were more likely due to nonequivalent measurement than to real differences in the experience of caregiver strain. Confirmatory factor analysis showed that the model fit the data well for both racial groups, but there were some differences in structural components. Internal consistency was equivalent across the groups. In an examination of criterion validity, regression analyses showed that African American caregivers experienced a slower rate of increase in objective caregiver strain at a given increase in child internalizing problems. No other race differences were found in the regression analyses. In general, we conclude that the CGSQ can be useful for detecting caregiver strain and identifying family support needs for both White and African American caregivers. Differences across groups in reports of caregiver strain, however, call for more research on racial differences in the impact on the family of caring for a child with emotional and behavioral disorders. [ABSTRACT FROM AUTHOR]

Many concerns have been raised about mental health services for children and adolescents. These concerns have included not treating those in need and providing inappropriate services to those who are treated. The continuum of care philosophy purports to remedy these problems by offering a comprehensive and coordinated range of services emphasizing community-based treatment. Services in the continuum include alternatives to traditional restrictive forms of care such as hospitalization. The provision of more appropriate care is hypothesized to improve the clinical outcomes of children treated in a continuum of care. The Fort Bragg Evaluation compared quality, use, outcome, and cost of the continuum of care model to a more traditional, fragmented system of care. This paper presents the effects of a service delivery system on short term psychopathology outcomes. [ABSTRACT FROM AUTHOR]

The article addresses several queries regarding the Fort Bragg Evaluation by Leonard Bickman et al. The continuum of care philosophy highlights the importance of delivering both the least restrictive and most appropriate services. Appropriateness entails matching needs with services delivered. The Fort Bragg Evaluation included youth of varying severity in a case mix that would be typical for a community mental health agency. Burchard also raised questions concerning whether the impact of the Demonstration on psychopathology would be greater if Bickman et al. examined only the children who received the intermediate services. Evan and Banks are perceptive in pointing out that the continuum of care field is still in its infancy. The Fort Bragg Evaluation recognized that providers lacked the experience to integrate and deliver the full array of services that were available in the Demonstration because of the novelty of these services. Most practitioners have no opportunities to use the treatment options that were available at the Demonstration. The authors claimed to be sensitive to the problem of testing a program that was not fully implemented. More than 97% of the outcome data in the Demonstration were collected 15 months after the Demonstration was funded and it took more than 30 months to collect all baseline data.