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Family involvement in the planning and execution of mental health treatment has been shown to positively influence child outcomes; however, there is wide variability in the levels of involvement by families. The current study investigated the influence of child, family caregiver, service system, and community factors on the level of family involvement in the mental health treatment of children with severe emotional disturbances (SED). Although prior work in this area has primarily focused on family and child characteristics, the current study adds to the knowledge base by also exploring factors associated with the quality of service delivery that may influence levels of family involvement. The current study is a secondary analysis of existing data from the Impact Study of Medicaid in Mississippi and Tennessee that used in-depth interviews with parents and case review ratings. A total of 136 children and adolescents who received Medicaid coverage for mental health treatment in Mississippi and Tennessee were the focus of this study that assessed child and caregiver characteristics at the beginning of the study and rated service system factors 6 months after the study began. Results of the multiple regression analysis revealed the quality of the service delivery system had the most influence on the level of family involvement. Results suggest that levels of family involvement may have less to do with caregiver health, or other family characteristics, and more to do with the quality of the service delivery system. (Contains 1 figure, 3 tables, and 2 notes.)

The combined effect of race and place of residence on caregivers' perceptions of children's mental health services is underresearched. Differences in caregiver strain, barriers-to-care endorsement, and provider satisfaction are examined among 175 rural and urban African American caregivers from one Southern state whose children received Medicaid sponsored mental health services. Children exhibited clinical levels of externalizing and internalizing mental health symptoms and high levels of co-occurring physical health problems. Almost one quarter were cared for by someone other than biological parents. Almost all caregivers reported strain associated with children's mental health problems, compromised personal health status, and high levels of depression. Family perception barriers (such as concern about potential negative reactions of significant others) were most endorsed. Most caregivers were satisfied with their children's mental health services, with lowest levels on the provider sensitivity subscale. Initial rural-urban differences in caregiver strain did not remain significant in multiple regression analyses after other covariates were included. (Contains 4 tables.)

Parents and relative caregivers of children with severe emotional and behavioral disorders (EBD) often report high levels of strain associated with the care of that child. This study compares how parents and other relative caregivers, and different family caregiver groups, experience strain. Overall, we found that Medicaid care-givers (n = 648) reported high levels of objective strain, whereas military caregivers (n = 978) had high scores on the subjective internalized and externalized subscales of the Caregiver Strain Questionnaire (CGSQ). An exploratory common factor analysis showed that overall, the CGSQ performed similarly for the Medicaid and the military caregivers and was generally consistent with previous research showing three factors. However, among Medicaid caregivers, other relatives (n = 109) reported two rather than one type of objective strain, and emotionally based items had lower correlations with the latent factor among other relatives as compared with parents (n = 539). These findings suggest the need to tailor approaches to assisting different groups of caregivers in coping with their strain.

A study involving 574 children (ages 5-17) who received mental health services examined whether caregiver variables predicted child mental health service utilization patterns, particularly caregiver strain. Results found caregiver strain to be associated with the combination of services used, sequencing of services, gaps in care, and cost of services. (Contains references.) (Author/CR)

A study compared Medicaid children with and without serious mental health problems (n=965) using parent reports of global health status, physical functioning, and general health perceptions. Children with more serious mental health problems were significantly more likely to have chronic health conditions. The number of conditions also predicted parents' reports. (Contains references.) (CR)

A study of 984 families of children with emotional and behavioral disturbance used the Caregiver Strain Questionnaire to assess the effects of the shift of primary caregiving to the family due to deinstitutionalization. Results indicate the reliability and validity of the questionnaire, which also identified three related but unique dimensions of strain experienced by parents of this population. (CR/LC)

A study tested the efficacy of a multicomponent parent training curriculum with caregivers of children receiving mental health services (n=250). The parent group intervention was found to affect significantly two factors critical to increasing caregiver empowerment, knowledge of the mental health services system, and mental health services efficacy. (Author/CR)